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PubMedDate not supplied

Integration of concurrent trauma registry and performance improvement programs.

Health information management systems have had a tremendous impact on the delivery of healthcare. The implementation of an integrated, concurrent trauma registry and performance improvement system has had a remarkable impact on the University of Pennsylvania's trauma program. Having both the registry and performance improvement programs concurrent and integrated has allowed better utilization of staff and has produced more accurate, relevant and timely data.

Hospital Information Systems↗
PubMed2006

Nurses' opportunistic interventions with patients in relation to smoking.

AIM: This paper reports a study exploring nurses' provision of opportunistic health education on smoking for hospital patients. BACKGROUND: Smoking cessation guidelines recommend assessment of patients' smoking habits and provision of smoking cessation advice when possible, and highlight the importance of the role of nurses in health promotion and health education. In the past, nurses have been criticized for lack of knowledge, skills and confidence in relation to health education and the perception that it is additional to, rather than integrated with, nursing care. METHODS: A qualitative case study design was selected to explore the health education practice of 12 nurses working in acute wards in three general hospitals in Scotland. Data were collected in 2000 through non-participant observation, semi-structured interviews and the use of a radio-microphone to record nurse-patient interactions. The data analysis was guided by four key elements of health education practice: 'the teachable moment', 'readiness to learn', 'the provision of health information' and 'oral communication'. FINDINGS: Smoking was part of the nurses' agenda, as most recognized opportunities to introduce health education on smoking during nursing care, suggesting a tentative move towards the integration of health education with nursing care. Evidence from patients' interactions indicated ample opportunity for nurses to provide smoking-related health information. However, the content of nurses' interactions on smoking was variable, with some limited by poor communication skills and inadequate knowledge of smoking and smoking cessation. The context of the interactions was also important in understanding some of the restrictions on conversational progress. CONCLUSIONS: Nurses require the knowledge and skills to perform a health education role, and the inclusion of smoking cessation guidelines in nursing curricula would contribute to this. Where patients are in hospitals for short periods of time, opportunistic health education on smoking needs to be introduced as the basis for more specialist intervention.

Attitude of Health Personnel↗
PubMed1977

Privacy, confidentiality and automated health information systems.

Professor Vuori's paper, first presented at the fourth Medico-legal Conference in Prague in the spring of this year, deals with the problem of the maintenance of confidentiality in computerized health records. Although more and more information is required, the hardware of the computer systems is so sophisticated that it would be very expensive indeed to 'break in' and steal from a modern data bank. Those concerned with programming computers are becoming more aware of their responsibilities concerning confidentiality and privacy, to the extent that a legal code of ethics for programmers is being formulated. They are also aware that the most sensitive of all relationships--the doctor-patient relationship--could be in danger if they failed to maintain high standards of integrity. An area of danger is where administrative boundaries between systems must be crossed--say between those of health and employment. Protection of privacy must be ensured by releasing full information about the type of data being stored, and by maintaining democratic control over the establishment of information systems.

Computers↗
PubMedDate not supplied

Linking outcomes analysis to critical clinical pathways.

Expert decision-support soft-ware systems, when integrated with outcomes analyses, provide the opportunity to develop behavioral healthcare delivery systems in which providers are equipped to act decisively in a socially responsible manner. Key benefits of such systems include: enhancing the consistency and quality of clinical decision making across providers with varying professional backgrounds; providing a mechanism to ensure the rapid dissemination and implementation of new clinical research findings; performing severity-adjusted profiling of providers and programs based on the outcomes their services produce; and linking the prospective focus of clinical pathways with the retrospective rigor of outcomes analysis to accelerate advances in behavioral health. Integrating expert systems with outcomes analyses has the potential to rectify the historical failure by the behavioral healthcare professions to systematically link patient assessment data and their analysis to actual clinical decision making. Such systems will help make behavioral healthcare practice more accountable, thereby strengthening the argument for psychiatric patients to gain parity in healthcare benefits.

Expert Systems↗
PubMed1995

Integrated genetic map of human chromosome 2.

A framework genetic map of human chromosome 2 is described, integrating data from the Centre d'Etude du Polymorphisme Humain (CEPH) version 6 database, the CEPH chromosome 2 consortium database, the National Institute of Health (NIH)/CEPH Collaborative Mapping group and other laboratories. A comprehensive map is also presented, showing regional locations of a large number of additional loci. The framework map is used to identify an informative set of meiotic breakpoints within the CEPH families, and the utility of this information for mapping new markers is discussed. The degree of typing error within the data set is estimated, as are the sex-specific interference parameters. A location database for these genetic and additional cytogenetic data is constructed using algorithms which map genetic distances on to a physical scale, and the potential for this approach to aid the integration of genetic and physical data is examined.

Chromosome Mapping↗
PubMed2002

Self-management aspects of the improving chronic illness care breakthrough series: implementation with diabetes and heart failure teams.

Self-management is an essential but frequently neglected component of chronic illness management that is challenging to implement. Available effectiveness data regarding self-management interventions tend to be from stand-alone programs rather than from efforts to integrate self-management into routine medical care. This article describes efforts to integrate self-management support into broader health care systems change to improve the quality of patient care in the Chronic Illness Care Breakthrough Series. We describe the general approach to system change (the Chronic Care Model) and the more specific self-management training model used. The process used in training organizations in self-management is discussed, and data are presented on teams from 21 health care systems participating in a 13-month-long Breakthrough Series to address diabetes and heart failure care. Available system-level data suggest that teams from a variety of health care organizations made improvements in support provided for self-management. Improvements were found for both diabetes and heart failure teams, suggesting that this improvement process may be broadly applicable. Lessons learned, keys to success, and directions for future research and practice are discussed.

Chronic Disease↗
PubMed2002

An interdisciplinary course in women's health integrating basic and clinical sciences: clinical anatomy and women's health.

Traditionally, undergraduate medical education is divided into preclinical and clinical years, with basic sciences taught during the first years and clinical sciences taught during the latter years. In an effort to better integrate the basic and clinical sciences in undergraduate medical education, and focus on women's health, we have developed a new interdisciplinary fourth-year elective at the University of Michigan Medical School. The elective, titled "Clinical Anatomy and Women's Health," is a joint effort between the Division of Anatomical Sciences and the Department of Obstetrics and Gynecology at the University of Michigan Health System. During the course students participate in didactic, laboratory, cadaveric dissection, and clinical-correlate sessions that focus on gynecologic anatomy and clinical issues in women's health. Educational goals and learning objectives were used to assess the effectiveness of the curriculum; revisions, based on outcomes of the educational assessment, will be implemented in the next offering of the course. Preliminary data from the first offering of the course in February 2002 are provided. The goals of this course include integrating basic science and clinical concepts while reducing the division between preclinical and clinical medical education, addressing issues of women's health, and encouraging lifelong learning by using basic science concepts and techniques of discovery in clinical practice.

Anatomy↗
PubMed2003

New trends in the development of occupational exposure limits for airborne chemicals in China.

Occupational exposure limits (OELs) are well established in many countries, which serve occupational professionals as benchmarks of industrial hygiene practice at workplaces worldwide. Starting in the mid-1950s, the central government of China began promulgating OELs for hazardous substances at workplaces. This paper discusses the historical basis, philosophical principles and schematic protocols of developing and setting OELs in China. The underlying principles include: (1) protection of human health being the first and the most important criterion; (2) the use of quantitative epidemiological studies in humans being given top priority; (3) integration and full use of all information sources, including animal experimental data for new chemicals or chemicals with new toxicity concerns; (4) considerations of socioeconomic and technological feasibilities in the country; and (5) amending existing standards based on new evidence. The strategy of the World Health Organization's "Two-step Procedure" is applied to convert health-based recommendations to law-based operational OELs, with considerations for national technological and socioeconomic conditions and priorities. As a result of the recent passage of the new law Occupational Diseases Prevention and Control Act of the People's Republic of China (ODPCAct), an official document Occupational Exposure Limits for Hazardous Agents in the Workplace containing a comprehensive list of new and amended OELs has been issued, which has now become one of the most essential regulations affiliated with the ODPCAct. This paper provides a brief summary of the salient features of the new law ODPCAct and the principles and processes of developing or amending OELs. This paper also discusses the challenges that lie ahead in enforcing the new regulations in China.

Air Pollutants, Occupational↗
PubMed1996

Using PC-based decision-support technology to improve efficiency.

Healthcare organizations do not need advanced information technology systems to take advantage of the information they gather regarding clinical and operational efficiency. PC-based decision support technology is available to analyze an integrated delivery system's (IDS) existing data and integrate it with competitive healthcare industry data from public and proprietary sources. Many system executives have purchased such technology for their IDSs, but few use the data they generated properly or successfully.

Decision Support Systems, Management↗
PubMed2006

Is verbatim transcription of interview data always necessary?

Verbatim transcription of interview data has become a common data management strategy in nursing research and is widely considered to be integral to the analysis and interpretation of verbal data. As the benefits of verbal data are becoming more widely embraced in health care research, interviews are being increasingly used to collect information for a wide range of purposes. In addition to purely qualitative investigations, there has been a significant increase in the conduct of mixed-method inquiries. This article examines the issues surrounding the conduct of interviews in mixed-method research, with particular emphasis on the transcription and data analysis phases of data management. It also debates on the necessity to transcribe all audiorecorded interview data verbatim, particularly in relation to mixed-method investigations. Finally, it provides an alternative method to verbatim transcription of managing audiorecorded interview data.

Humans↗
PubMed2006

Deoxynivalenol transport across human intestinal Caco-2 cells and its effects on cellular metabolism at realistic intestinal concentrations.

Deoxynivalenol (DON) is a mycotoxin of the trichothecenes family to which human exposure levels can be high. Epidemiological studies suggest a link between DON and gastrointestinal illness. We investigated the interaction of DON with Caco-2 cells, a widely used in vitro model of the human intestinal barrier. The apical to basolateral (absorption) and basolateral to apical (excretion) transports of DON were found strictly proportional to both the initial concentration and the duration of the incubation. The absorption and excretion mean rates were similar to those of mannitol and were increased in the presence of EGTA, a calcium chelator. These data suggest that DON crosses the intestinal mucosa by a paracellular pathway through the tight junctions although some passive transcellular diffusion may not be ruled out. The DON transport was not affected by P-glycoprotein (PgP) or multidrug resistance-associated proteins (MRPs) inhibitors. A prolonged exposure to DON provokes the phosphorylation of the mitogen-activated protein kinases (MAPKs) Erk1/2, p38 and SAPK/JNK, as well as a decrease of the transepithelial resistance, suggesting that DON could trigger intestinal inflammation. These data imply that a chronic exposure to DON contaminated foods may negatively affect human health by altering the intestinal mucosa integrity and by inducing the MAPKs implicated in inflammation.

Biological Transport↗
PubMed1998

Fatal firearm-related injury surveillance in Maryland.

CONTEXT: Maryland began a statewide firearm-related injury surveillance system in 1995. The system now focuses on firearm-related deaths; a system to monitor nonfatal injuries is being developed. The system is passive; it accesses, integrates, and analyzes data collected by Maryland's Office of the Chief Medical Examiner, Maryland State Police, and Division of Health Statistics. OBJECTIVE: To evaluate the surveillance system's ability to ascertain cases in the absence of a standard for the true number of cases. DESIGN: Link records of the same firearm-related death captured by the surveillance system's multiple data sources, comparing the rate of false positives and false negatives, and assessing errors in linkage variables. SETTING: Maryland, 1991-1994. PARTICIPANTS: All deaths occurring in the state of Maryland as a result of a firearm-related injury. MAIN OUTCOME MEASURES: Sensitivity and positive predictive value. RESULTS: The system is extremely sensitive, detecting 99.61% of cases, and it has a very high positive predictive value, with 99.87% of the cases identified from medical examiner's office data being confirmed as actual cases. CONCLUSIONS: Maryland's database of information from the medical examiner's office is highly accurate for ascertaining firearm-related deaths that occur in the state. A unique identifier common across data sources would ease record linkage efforts, and improve the system's ability to monitor firearm-related deaths.

Adolescent↗
PubMed1998

[The costs of schizophrenia].

Schizophrenia is regarded as the most expensive mental illness because of its specific symptoms and characteristics (e.g. early onset, often chronic course, high rates of readmission to hospital treatment, high rate of disabilities and extensive rehabilitative interventions), which prove to be extremely costly. Despite this, studies on the financial aspects of schizophrenia or the provision of care for schizophrenic patients has become an issue of psychiatric research only since the beginning of the reform of mental healthcare. Early cost studies had been conducted in the United States (US) during the fifties. Since then, they have grown in number not only in the US and in Great Britain, but also on the Continent of Europe. On an international level, comprehensive literature concerning methodology has attempted to establish cost studies as an integral part of mental health services research. Germany, however, is far behind international developments. Although the fundamental lack of empirical data on costs both in psychiatry as a whole and in schizophrenia had already been ascertained in a large national survey called "Psychiatrie-Enquête" in the mid-seventies, little has changed since then. One reason for these possibly great methodological problems is associated with the assessment of cost data in fragmented community mental health care networks, which in Germany include the additional obstacle--unlike abroad--of non-availability of access to data from case registers. Psychiatric case registers are not permitted in Germany because of very strict data protection laws. Despite the problems in methodology, there is an urgent need in Germany to remedy the lack of cost data for schizophrenic-patient care. The pressure of curbing costs in health care will probably force the German mental health care services to provide detailed cost data with regular reports in the future.

Humans↗
PubMedDate not supplied

ICF Core Set for patients with cardiopulmonary conditions in early post-acute rehabilitation facilities.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with cardiopulmonary conditions in early post-acute rehabilitation facilities. METHODS: The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Seventeen experts selected a total of 84 second-level categories. The largest number of categories was selected from the ICF component Body Functions (33 categories or 39% of all ICF Core Set categories). Four (5%) of the categories were selected from the component Body Structures, 23 (27%) from the component Activities and Participation, and 24 (29%) from the component Environmental Factors. CONCLUSIONS: The Post-acute ICF Core Set for patients with cardiopulmonary conditions is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Set for geriatric patients in early post-acute rehabilitation facilities.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for geriatric patients in early post-acute rehabilitation facilities. METHODS: The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Fifteen experts selected a total of 123 second-level categories. The largest number of categories was selected from the ICF component Body Functions (51 categories or 41%). 14 (11%) of the categories were selected from the component Body Structures, 30 (29%) from the component Activities and Participation, and 28 (23%) from the component Environmental Factors. CONCLUSION: The Post-acute ICF Core Set for geriatric patients is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first version of the ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Set for patients with cardiopulmonary conditions in the acute hospital.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with cardiopulmonary conditions in the acute hospital. METHODS: The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Twenty-two experts selected a total of 48 second-level categories. The largest number of categories was selected from the ICF component Body Functions (21 categories or 44%). Four (8%) of the categories were selected from the component Body Structures, 10 (21%) from the component Activities and Participation, and 13 (27%) from the component Environmental Factors. CONCLUSION: The Acute ICF Core Set for patients with cardiopulmonary conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Set for patients with musculoskeletal conditions in the acute hospital.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with musculoskeletal conditions in the acute hospital. METHODS: The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Twenty-one experts selected a total of 47 second-level ICF categories. The largest number of categories was selected from the ICF component Body Functions (17 categories or 36%). Nine (19%) of the categories were selected from the component Body Structures, 11 (23%) from the component Activities and Participation, and 10 (21%) from the component Environmental Factors. CONCLUSION: The Acute ICF Core Set for patients with musculoskeletal conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Set for patients with musculoskeletal conditions in early post-acute rehabilitation facilities.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with musculoskeletal conditions in early post-acute rehabilitation facilities. METHODS: The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Fifteen experts selected a total of 70 second-level categories. The largest number of categories was selected from the ICF component Body Functions (23 categories or 33%). Seven (10%) of the categories were selected from the component Body Structures, 22 (31%) from the component Activities and Participation, and 18 (26%) from the component Environmental Factors. CONCLUSION: The Post-acute ICF Core Set for patients with musculoskeletal conditions is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗