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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↗
PubMedDate not supplied

ICF Core Set for patients with neurological 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 neurological 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 85 second-level categories. The largest number of categories was selected from the ICF component Body Functions (41 categories or 48%). Five (6%) of the categories were selected from the component Body Structures, 18 (21%) from Activities and Participation and 21 (25%) from Environmental Factors. CONCLUSIONS: The Acute ICF Core Set for patients with neurological 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 neurological 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 neurological 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: Seventeen experts selected a total of 116 second-level categories. The largest number of categories was selected from the ICF component Body Functions (54 categories or 47%). Eleven (9%) of the categories were selected from the component Body Structures, 34 (29%) were of the categories from the component Activities and Participation, and 17 (15%) from the component Environmental Factors. CONCLUSION: The Post-acute ICF Core Set for neurological patients 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↗
PubMed2005

Bridging the gap: using triangulation methodology to estimate minimal clinically important differences (MCIDs).

This paper proposes the use of triangulation methodology to derive guidelines for interpreting change scores on health outcome measures. Triangulation integrates results from global ratings with clinical benchmarks of change, statistical estimates of magnitude, and qualitative data from patients and/or clinicians to derive guidelines that are not field-specific or method bound. A case study is presented to illustrate how this methodology can be applied. Secondary analyses were performed on blinded data from 2,971 patients enrolled in three phase IlIa clinical trials to develop guidelines for interpreting change scores on the Breathlessness Diary (BD), a relatively new approach for evaluating dyspnea outcomes in patients with chronic obstructive pulmonary disease. BD scores were examined by disease severity and rescue medication use. In addition, mean BD change scores by physician global ratings of efficacy were juxtaposed with changes in forced expiratory volume (FEV1) and St. George's Respiratory Questionnaire scores. Percent change, effect size, one-half standard deviation, and the standard error of measurement were used as statistical indicators of magnitude. Data from qualitative interviews provided insight into patient perspectives of change in dyspnea. Taking into consideration results across estimation methods, guidelines were developed for defining large, moderate, and small group-level mean changes on the BD. Areas of divergence and convergence across statistical indicators and clinical benchmarks in this case study highlight the importance of using triangulation methodology to derive guidelines that are both empirically sound and clinically relevant.

Adult↗
PubMed2025

Predicting host tropism in influenza a viruses: insights from multi-segment nucleotide signatures.

BACKGROUND: Influenza A virus (IAV) poses a significant public health threat due to its cross-species transmission and complex host adaptation mechanisms. This study integrated whole-genome data from avian, human, swine, and bovine IAV strains, using machine learning to predict viral host tropism based on nucleotide site features and to identify key sites driving host adaptation along with their synergistic effects. METHODS: A total of 64,000 IAV sequences from avian, human, swine, and bovine hosts were analyzed to build host-prediction models. A four-class classification framework (avian, human, swine, bovine) was constructed using nucleotide site features from all eight genomic segments (PB2, PB1, PA, HA, NP, NA, MP, NS). Eight machine learning algorithms (logistic regression, decision tree, random forest, SVM, KNN, gradient boosting, XGBoost, LightGBM) were benchmarked via 10-fold stratified cross-validation. Model performance was evaluated using accuracy, precision, recall, F1-score, AUPRC, and AUC. SHAP (SHapley Additive exPlanations) analysis prioritized critical nucleotide sites, while bivariate association tests identified synergistic/antagonistic interactions between sites. Nucleotide composition profiles were compared across host groups using hierarchical clustering and heatmap visualization. RESULTS: The XGBoost algorithm demonstrated the best and most stable performance, achieving an AUC value of over 0.95 in distinguishing human-derived sequences from non-human ones. SHAP analysis identified the top 20 critical nucleotide sites for each gene segment, such as sites 46 and 698 in the NS segment. Nucleotide composition analysis revealed high similarity between human and swine sequences in the HA and PB2 segments, and between avian and bovine sequences. The HA segment was particularly challenging in differentiating human from swine strains. Bivariate site association analysis uncovered significant synergistic or antagonistic effects between key sites within gene segments, forming complex networks. For instance, in the NS segment, a positive prediction contribution was observed when sites 371, 698, and 419 were all G. CONCLUSIONS: This study advances our mechanistic understanding of IAV host adaptation, identifies molecular determinants for zoonotic risk stratification, and establishes a scalable machine learning framework for predicting viral host tropism through nucleotide signature analysis, thereby enhancing surveillance strategies and informing preventive measures against emerging viral threats.

Influenza A virus↗
PubMed2004

The impact of the electronic health record on patient safety: an Alberta perspective.

Alberta is at the leading edge in developing its electronic health record (EHR ), a provincial initiative to provide healthcare providers with immediate access to a patient's medication history and laboratory test results, regardless of where they are in the province, or where the patient's drugs or other treatments were ordered. The Alberta EHR was launched in October 2003. So far 6,000 healthcare providers have voluntarily signed on to use it, and benefits to patient safety have been reported. The EHR is an important part of healthcare renewal that is required to improve patient safety; however, it must not be viewed as a stand alone cure-all solution to Canada's patient safety challenge. The EHR will only reach its full potential if it is part of an integrated approach to health renewal that stresses consistency of healthcare, practice and information standards, and consistency and standardization of healthcare data. Without a sector-wide EHR like Alberta's, the proliferation of computerized electronic medical records (EMRs) in hospitals, clinics and pharmacies might create "islands of information" that are not widely compatible. A national EHR approach must acknowledge the importance of improving broadly accepted practice standards and data consistency in order to reduce the islands of information and protect patients from medical errors as they move between them.

Alberta↗
PubMed2003

Characteristics associated with alcohol consumption in Germany.

OBJECTIVE: Knowledge about predictors of alcohol intake in Germany is scarce. The purpose of this study was to analyze the association of sociodemographic and lifestyle characteristics and quality of life with alcohol consumption among German adults. METHOD: Analyses are based on cross-sectional data of the German adult population derived from the representative German National Health Interview and Examination Survey 1998 and the integrated German Nutrition Survey. In total, 1,925 women and 1,615 men, 18 to 79 years old, were included. Multiple linear regression analyses of alcohol intake were used to identify predictors of alcohol consumption. The analyses of drinkers were performed separately for women and men. RESULTS: Among women, alcohol consumption was associated with age, socioeconomic status, household size, smoking status, physical activity, use of soft drugs, body mass index, pregnancy and general health perception. The highest alcohol consumption was observed for women of middle age with high socioeconomic status. Among men, age, socioeconomic status, smoking status, physical activity, use of soft drugs, vegetarian diet, contentment with family or neighbors/friends, social functioning and physical functioning were associated with alcohol consumption, with age and smoking being the most important predictors. CONCLUSIONS: A variety of factors, including newly analyzed factors describing lifestyle and quality of life, are jointly associated with the higher alcohol consumption of German women and men. These findings may be valuable to focus health promotion projects on population groups with higher alcohol intake and, therefore, higher risk for harmful alcohol effects.

Adolescent↗
PubMed1975

Provision of on-site services in retirement housing.

The present paper addresses the question of on-site supportive services in retirement housing facilities for the well-elderly. Six hundred residents were interviewed, 100 at each of six widely varied sites in California: retirement hotel, urban highrise apartments, life-care home, and three retirement villages. Data were also collected on 600 matched controls in age-integrated housing. Questions were asked pertaining to caring for health needs, desire for counseling services, and expected support in crises. Results showed for the most part a good match between personal needs and environmental provisions. However, at one site considerable insecurity was expressed with regard to medical provisions and support in crises, and a desire was expressed for counseling services. There was no evidence of an erosion of independence at the sites where services are provided.

Aged↗
PubMed2000

Reconfiguring a curriculum for the new millennium: the process of change.

Over the past decade, changing demographics, new technology, an increased focus on health promotion, and radical shifts in health care reimbursement have significantly impacted the nursing role. The purpose of this article is to review the process of change at one university as its curriculum evolved from an integrated acute-care focus to a community-based, health promotion framework. A review of the literature and survey data from students, alumnae, faculty, other universities, and curriculum consultants laid the groundwork for this process. Curriculum generation followed guided by data analysis, template design and revision, values clarification, sacrificing "sacred cows," and consensus building. Implications for nursing and nursing education are explored.

Community Health Nursing↗
PubMedDate not supplied

Integrated delivery systems/networks in the uncertain future. Strategic stakeholder management, Round One continued.

This article presents an analysis of Round One data with a focus on integrated delivery systems/networks (IDS/Ns). These complex, multifaceted organizations are growing in importance in the turbulent health care industry. The emergence of these multi-organizational forms requires that all health care industry organizations--medical groups, hospitals, payer organizations, suppliers--adapt to the ever-increasing demands placed on them as the industry experiences revolutionary changes. The findings presented in this article were compiled from the responses of 580 health care industry experts about the uncertain future facing health care executives. These respondents represented virtually every health care organizational form, including medical groups, physicians, hospitals, payer organizations, academic researchers, pharmaceutical firms and other health care industry suppliers. Each of these health care respondent panels answered hundreds of questions pertaining to both the present (1994) and the future (1999). These analyses seek to describe the different relationships between medical groups, their stakeholders and IDS/Ns, and how they will change over the years of 1994 to 1999. We also present experts' perceptions and predictions about five other key stakeholders of medical groups--managed care organizations, governments, employers, system hospitals and patients.

Costs and Cost Analysis↗
PubMed2005

Round table of November 20th, 2004: recommendations for improving the management of envenomations.

The round table underlines the necessity to follow the epidemiological and clinical surveys in order to precise the incidence and severity of snakebites and inform the health authorities that could thus arrange to take in charge envenomation accidents. Simple therapeutic protocols adapted to epidemiological and clinical data will be elaborated according to each level of health pyramid. They will be included in the health staff training and integrate traditional practitioners whose role must be clearly defined. An experimental and clinical validation must confirm its appropriateness with countries and victims needs. Some microeconomic surveys are necessary to identify adapted funding and thus improve their accessibility

Africa↗
PubMed2006

Medical Data GRIDs as approach towards secure cross enterprise document sharing (based on IHE XDS).

Quality and efficiency of health care services is expected to be improved by the electronic processing and trans-institutional availability of medical data. A prototype architecture based on the IHE-XDS profile is currently being developed. Due to legal and organizational requirements specific adaptations to the IHE-XDS profile have been made. In this work the services of the health@net reference architecture are described in details, which have been developed with focus on compliance to both, the IHE-XDS profile and the legal situation in Austria. We expect to gain knowledge about the development of a shared electronic health record using Medical Data Grids as an Open Source reference implementation and how proprietary Hospital Information systems can be integrated in this environment.

Austria↗
PubMed2004

A culturally sensitive health care practice model--theory construction and its testing.

The major purpose of this paper was to develop a model for the use of complementary and alternative health care options. Chinese-American families were selected due to their large proportion among all ethnic populations in the United States. Andersen's (1973 and 1995) perception of predisposing and enabling was adopted to test study variables singly and interactively on their health care use. The dependent variable was defined as health behavior preference towards Chinese treatment (also known as complementary and alternative medicine treatment) or Western treatment, and a combination of Chinese and Western treatment (also known as integrative medicine treatment). Data were randomly collected from 240 adult Chinese-American respondents out of 1080 members of the Chinese American Association in the greater Cleveland area. Findings both in the full and partial research models reveal that the factors contributing the most to their medical preferences were their acculturation level and health beliefs. Inter-generational differences in health care use were also discussed.

Acculturation↗
PubMedDate not supplied

State agency policy and program coordination in response to the co-occurrence of HIV, chemical dependency, and mental illness.

UNLABELLED: The co-occurrence of HIV infection, chemical dependency, and mental illness challenges federal and state governments to develop flexible and coordinated health policy and financing for public health services. State agencies play a critical role in the organization and support of these services at the local level. With emerging stress upon state government budgets and concomitant increasing need for publicly funded services, state agency coordination may be an important policy safety net to assure services for populations at the margins of health systems. Despite this important potential role, nothing is known about the degree to which state HIV, substance abuse, and mental health agencies coordinate policies and/or programs in response to these co-morbid conditions. OBJECTIVE: This study sought to establish a conservative and initial understanding of state HIV, substance abuse, and mental health agency coordination of policy and program in response to the co-occurrence of HIV, chemical dependency, and mental illness. METHOD: Estimation of coordination was accomplished through the comparison of three surveys conducted among state substance abuse directors (1998), state AIDS directors (1999), and state mental health directors (2000). Data from 38 states were reviewed. RESULTS: The most frequently reported state agency activities included coordinating funding, engaging in integrative planning activities, and conducting staff cross-training. When compared for association with state characteristics, coordination among state agencies was found to be associated with Early Intervention Services (EIS) designation, higher rates of AIDS generally, higher rates of AIDS among African Americans, and higher rates of AIDS among Hispanic populations. Given the limitations of comparing three disparate surveys, we determined the estimate of interagency coordination to be conservative and preliminary. CONCLUSION: While this study was useful as an initial step toward identifying state interagency policy and program coordination in response to the co-occurrence of HIV, chemical dependency, and mental illness, there were methodological challenges that should be addressed in future studies of state agency coordination. Several recommendations were advanced.

Administrative Personnel↗
PubMed2004

Knowledge sharing and information integration in healthcare using ontologies and deductive databases.

This paper describes a method for using Semantic Web technologies for sharing knowledge in healthcare. It combines deductive databases and ontologies, so that it is possible to extract knowledge that has not been explicitly declared within the database. A representation of the UMLS (Unified Medical Language System) Semantic Network and Metathesaurus was created using the RDF standard, in order to represent the basic medical ontology. The inference over the knowledge base is done by the TRI-DEDALO System, a deductive data-base created to query and update RDF based knowledge sources as well as conventional relational databases. Finally, an ontology was created for the Brazilian National Health Card data interchange format, a standard to capture and transmit health encounter information throughout the country. This paper demonstrates how this approach can be used to integrate heterogeneous information and to answer complex queries in a real world environment.

Brazil↗
PubMed2006

Evaluation of the Outreach School Garden Project: building the capacity of two Indigenous remote school communities to integrate nutrition into the core school curriculum.

ISSUE ADDRESSED: This paper describes the Outreach School Garden Project, which was conducted in two remote Indigenous school communities in north-west Queensland. This project integrated nutrition into the key learning areas of the core school curriculum by using a school-based garden as a nutritional education tool. METHODS: Evaluation was by a descriptive qualitative approach supplemented by some quantitative data consistent with Indigenous research methods. The objectives were linked to the Health Promoting Schools Framework, using concepts of community capacity building, action research, social capital and experiential learning. RESULTS: Nutrition was extensively integrated into the core school curriculum by the teaching staff, who required no specific nutrition knowledge or gardening skills prior to the implementation. Students' knowledge and skills in nutrition and gardening were increased over the six-month period and positive improvements in the physical and social environment at the school were observed. CONCLUSION: A school-based nutrition garden enables the teaching and learning of basic nutrition through the core school curriculum. This concept was an innovative, practical nutritional education tool to engage and build the capacity of Indigenous students, school staff and the broader community in nutrition.

Community-Institutional Relations↗
PubMed2003

Regional repositories, reintermediation and the new GMS contract: cardiovascular disease in Tayside.

BACKGROUND: The new contract for general medical practitioners will make increasing demands on the primary care informatics community. There are a number of potential ways to provide reports which meet the requirements for data on the quality of care being provided by practices. In Scotland there are four components of the national information technology strategy which make meaningful comparisons of data possible. OBJECTIVE: Using cardiovascular data as an example, to describe how the community health index number, managed clinical networks (MCNs), increasing consistency of Read codes, and regional repositories of data make the acquisition, processing and use of data more straightforward. METHOD: The cardiovascular MCN collects the majority of its data electronically and four properties are crucial to its success: automatic collection of electronic data from many sources, prioritisation of data derived from multiple sources, record linkage processes, and manual validation of electronic data. RESULTS: Clinicians in primary and secondary care enter data during consultations and see the results of consultations recorded elsewhere. Because all data from the region are able to be Read coded according to prespecified templates, we are able to indicate to practices where they are in relation to the new contract targets and indicate which patients need to be seen, or excluded from, calculations. CONCLUSION: Effectively integrated management is facilitated by provision of regular prompted recall and review of people with chronic disease by multidisciplinary teams collaborating across the health service and into the community. In Scotland, use of newer informatics tools are proving to be useful contributions from primary care computing to equitable, evidence-based care.

Cardiovascular Diseases↗