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PubMed2005

Integrated treatment of first-episode psychosis: effect of treatment on family burden: OPUS trial.

BACKGROUND: The families of patients with first-episode psychosis often play a major role in care and often experience lack of support. AIMS: To determine the effect of integrated treatment v. standard treatment on subjective burden of illness, expressed emotion (EE), knowledge of illness and satisfaction with treatment in key relatives of patients with a first episode of schizophrenia-spectrum disorder. METHOD: Patients with ICD-10 schizophrenia-spectrum disorders (first episode) were randomly assigned to integrated treatment or to standard treatment. Integrated treatment consisted of assertive community treatment, psychoeducational multi-family groups and social skills training. Key relatives were assessed with the Social Behaviour Assessment Schedule (SBAS, burden of illness), the 5-min speech sample (EE), and a multiple choice questionnaire at entry and after 1 year. RESULTS: Relatives in integrated treatment felt less burdened and were significantly more satisfied with treatment than relatives in standard treatment. There were no significant effects of intervention groups on knowledge of illness and EE. CONCLUSIONS: The integrated treatment reduced family burden of illness and improved satisfaction with treatment.

Adaptation, Psychological↗
PubMed1994

Integration of community-based services for the severely mentally ill and the structure of public funding: a comparison of four systems.

Despite strong interest by health care services researchers in studying community-based service delivery to persons with severe mental illness, few understand the relationship between the structure of public funding and differences in how mental health care delivery systems are organized. In particular, the structure of public funding may have a substantial effect on the nature and extent of integration among the various service providers that comprise a community's delivery network. Such an understanding is critical if mental health policymakers are to use their influence on funding to guide the structure of service delivery. To investigate this issue, we compared community mental health care systems in four U.S. cities. We found that services will be integrated regardless of the structure of public funding but that the structure of integration among providers will be affected. Specifically strong fiscal control by the state is conducive to delivery systems that are integrated through the core mental health care agency in a community, whereas weak fiscal control is more likely to result in decentralized integration among system providers.

Arizona↗
PubMed2005

Using the balanced scorecard to characterize benefits of integration in the safety net.

The purpose of this study was to develop a comprehensive framework depicting the potential benefits of integration among health-care providers that serve vulnerable populations. Research teams interviewed participants in 12 integrated functions across seven community health-centre-led networks. Functions included clinical processes; managed care contracting; and administrative services such as human resources, finance, and information systems. Using a Balanced Scorecard framework, benefits were identified across financial, customer, internal business, and learning and growth perspectives. Financial benefits were more frequently cited relative to managed care and administrative functions than relative to clinical functions. Clinical functions were frequently characterized by perceived improvements in patient care quality, while managed-care functions appeared to yield most benefits in access. Administrative functions were most often associated with improvements in internal business operations. There were substantial findings in learning and growth across all three types of integration, in keeping with the early stages of the integrated functions in the study. Findings imply that integration among health-care providers yields a wide range of benefits, but not necessarily quickly or financial in nature.

Attitude of Health Personnel↗
PubMed1997

Service integration: something old and something new.

The authors trace the definition and challenges of "service integration," variously known over time as "collaboration," "coordination," "human services integration," and "one-stop shopping." While the common use of service integration terminology currently may seem to indicate a consensus in favor of a broad systemic reform, motivations and expectations for service integration differ significantly among different players in the service system. The authors conclude that service integration cannot be defined by a particular service model or outcome, but instead should be conceived of as an ongoing reform process. This process, when well-designed and implemented with long-term vision, can reduce duplication, strengthen communities, and improve client outcomes.

California↗
PubMed2005

Integrating child health information systems.

The Health Resources and Services Administration and All Kids Count (a national technical assistance center fostering development of integrated child health information systems) have been working together to foster development of integrated child health information systems. Activities have included: identification of key elements for successful integration of systems; development of principles and core functions for the systems; a survey of state and local integration efforts; and a conference to develop a common vision for child health information systems to meet medical care and public health needs. We provide 1 state (Utah) as an example that is well on the way to development of integrated child health information systems.

Child↗
PubMed2006

Method for detection and identification of multiple chromosomal integration sites in transgenic animals created with lentivirus.

Transgene delivery systems, particularly those involving retroviruses, often result in the integration of multiple copies of the transgene throughout the host genome. Since site-specific silencing of trangenes can occur; it becomes important to identify the number and chromosomal location of the multiple copies of the transgenes in order to correlate inheritance of the transgene at a particular chromosomal site with a specific and robust phenotype. Using a technique that combines restriction endonuclease digest and several rounds of PCR amplification followed by nucleotide sequencing, it is possible to identify multiple chromosomal integration sites in transgenic founder animals. By designing genotyping assays to detect each individual integration site in the offspring of these founders, the inheritance of transgenes integrated at specific chromosomal locations can be followed efficiently as the transgenes randomly segregate in subsequent generations. Phenotypic characteristics can then be correlated with inheritance of a transgene integrated at a particular chromosomal location to allow rational selection of breeding animals in order to establish the transgenic line.

Animals↗
PubMedDate not supplied

An infrastructure for Integrated Electronic Health Record services: the role of XML (Extensible Markup Language).

BACKGROUND: The sharing of information resources is generally accepted as the key to substantial improvements in productivity and better quality of care. In addition, due to the greater mobility of the population, national and international healthcare networks are increasingly used to facilitate the sharing of healthcare-related information among the various actors of the field. In the context of HYGEIAnet, the regional health telematics network of Crete, an Integrated Electronic Health Record environment has been developed to provide integrated access to online clinical information, accessible throughout the island. OBJECTIVES: To make available comprehensive medical information about a patient by means of incorporating all the distributed and heterogeneous health record segments into an Integrated Electronic Health Record that can be viewed on-line through a unified user interface and visualization environment. METHODS: The technological approach for implementing this Integrated Electronic Health Record environment is based on the HYGEIAnet Reference Architecture, which provides the necessary framework for the reuse of services, components, and interfaces. Seamless presentation of information is achieved by means of the Extensible Markup Language (XML), while its underlying capabilities allow for dynamic navigation according to personalized end-user preferences and authorities. RESULTS: The Integrated Electronic Health Record environment developed in HYGEIAnet provides the basis for consistent and authenticated access to primary information over the Internet in order to support decision-making. Primary information is always kept at the place where it has been produced, and is maintained by the most appropriate clinical information system, contrasting traditional store and forward techniques, or centralized clinical data repositories. CONCLUSIONS: Since documents are much more easily accessible rather than data inside a database, Extensible Markup Language has the potential of becoming a very cheap technology provided, of course, that the underlying Healthcare Information Infrastructure exists. XML can be introduced incrementally and its implementation is completely transparent to the end user.

Databases as Topic↗
PubMedDate not supplied

Integrated data acquisition system for medical device testing and physiology research in compliance with good laboratory practices.

In seeking approval from the US Food and Drug Administration (FDA) for clinical trial evaluation of an experimental medical device, a sponsor is required to submit experimental findings and support documentation to demonstrate device safety and efficacy that are in compliance with Good Laboratory Practices (GLP). The objective of this project was to develop an integrated data acquisition (DAQ) system and documentation strategy for monitoring and recording physiological data when testing medical devices in accordance with GLP guidelines mandated by the FDA. Data aquisition systems were developed as stand-alone instrumentation racks containing transducer amplifiers and signal processors, analog-to-digital converters for data storage, visual display and graphical user-interfaces, power conditioners, and test measurement devices. Engineering standard operating procedures (SOP) were developed to provide a written step-by-step process for calibrating, validating, and certifying each individual instrumentation unit and the integrated DAQ system. Engineering staff received GLP and SOP training and then completed the calibration, validation, and certification process for the individual instrumentation components and integrated DAQ system. Eight integrated DAQ systems have been successfully developed that were inspected by regulatory affairs consultants and determined to meet GLP guidelines. Two of these DAQ systems were used to support 40 of the pre-clinical animal studies evaluating the AbiCor artificial heart (ABIOMED, Danvers, MA). Based in part on these pre-clinical animal data, the AbioCor clinical trials began in July 2001. The process of developing integrated DAQ systems, SOP, and the validation and certification methods used to ensure GLP compliance are presented in this article.

Equipment and Supplies↗
PubMedDate not supplied

Using WWW and JAVA for image access and interactive viewing in an integrated PACS.

We start from the observations that (1) potential benefits from PACS can only be realized if PACS and HIS are integrated into a 'multimedia medical information system', and (2) that this also requires integration at the level of the user interface. The user interface should allow integrated interaction with information from different subsystems, of which PACS is one. However, in the real world, different information systems are constructed using different technologies. Moreover, radiological image viewing is a highly interactive task that puts a particular burden on the graphical user interface. We describe our experiences in applying technology emerging around the 'World Wide Web' (WWW) for interactive access to an integrated PACS/HIS. We illustrate the use of Web browsers to access new medical services, touch technologies for interactive access to HIS-PACS information, and emphasize the potential of JAVA applets. We argue that JAVA may become an important tool for providing highly interactive user interfaces to larger multimedia information systems. We discuss Web technology in the general context of HIS/PACS integration.

Archives↗
PubMed2026

Research progress and application prospects of multi-omics integration strategies in precision risk stratification of type 1 diabetes mellitus.

Type 1 diabetes (T1D) is a chronic metabolic disease mediated by autoimmunity. Its pathogenesis involves complex interactions between genetic susceptibility and environmental factors. Conventional T1D risk stratification primarily relies on genetic markers, islet autoantibodies, and glycemic indicators. Although these biomarkers remain indispensable in current clinical practice, they are often insufficient when used alone to accurately identify ultra-early high-risk individuals, predict disease progression rates, or support individualized preventive strategies. Consequently, more comprehensive molecular approaches are needed to improve precision risk stratification. In recent years, the rapid development of multi-omics technologies has provided new strategies for precise risk stratification of T1D. This narrative review critically evaluates how multi-omics integration strategies can improve precision risk stratification throughout the T1D disease continuum by integrating complementary molecular information from genomics, transcriptomics, proteomics, metabolomics, epigenomics, and the microbiome. Particular emphasis is placed on stage-specific biomarker discovery, multi-omics data integration frameworks, artificial intelligence-assisted prediction models, biomarker validation, and the opportunities and challenges associated with clinical translation. Current evidence suggests that integrated multi-omics approaches have the potential to improve risk prediction accuracy, distinguish heterogeneous disease trajectories, identify individuals at imminent risk of progression, and provide biologically informed targets for precision intervention. However, important challenges remain, including data harmonization, external validation, model interpretability, cost-effectiveness, and integration into routine clinical screening programs. Future research should prioritize prospective multicenter cohorts, standardized analytical pipelines, externally validated prediction models, and clinically interpretable multi-omics frameworks to facilitate the translation of precision risk stratification into routine T1D prevention and management.

Humans↗
PubMed1996

Lessons from the trenches in physician integration.

Beyond the theoretical basis for integration, three core considerations stand out as the primary reasons for pursuing integration from a physician's perspective. In the authors' experience, the ability to make a case for physician integration stands or falls based on the ability of the integrated delivery system to address these considerations: Gain greater access to capital; develop human resources with talents in managed care and the full spectrum of care services; and sustain an information infrastructure. This article explores the lessons learned in pursuing physician integration.

Community Networks↗
PubMed1997

Post-integration of a tumor documentation system into a HIS via middleware.

Integrating autonomous applications is a difficult task since they usually represent similar informations in different data schemes. Any communication requires an agreement of sender and receiver on a common data representation. The number of interfaces to convert one data representation into another is minimized if all participants of an information system agree on one data representation such as Health Level Seven (HL7) or Edifact. Even more convenient is the use of a middleware solution like the Distributed Healthcare Environment (DHE) that keeps message transfer completely transparent to the integration process. This paper discusses a project that aims at the integration of a cancer registry system into a DHE based Hospital Information System (HIS). The project is a cooperation between the universities of Giessen and Magdeburg within the framework of the European Communities Telematics Research Project HC 1019 HANSA (Healthcare Advanced Networked System Architecture). The concept of a so called 'DHE-Adapter' to integrate existing legacy systems is explained. This adapter converts a data or message format of a legacy system into calls of the DHE programming interface. To develop a DHE-Adapter for our cancer registry system we intend to design a DHE-Adapter-Generator which would be able to produce DHE-Adapters for different systems and export formats, e.g. HL7 or Edifact. That would allow a variety of software vendors to integrate their products into the DHE without entering deeply into the DHE's programming interface.

Computer Communication Networks↗
PubMedDate not supplied

Beyond incompatibility: integrating process for optimal performance.

Organizations are bringing disparate groups together to cut costs and integrate services. Ironically, they are finding the very people they look to for success are those who were used to working independently. At a breakout session of the Congress of Integrated Delivery Systems held in Dallas in March, 1997, participants were asked to share some of their real-world experiences as they worked toward integration. Mission statements tend to be at the head of the list for most organizations as they strive to integrate. Not all the participants agreed on their value, however. The success of reengineering depends on many factors. Is the facility fully behind the initiative? Is the team cohesive and focused? One participant pointed out that leadership was a problem: the staff was not empowered and in the end, the organization was leaderless--someone has to take control, this manager stated. Some groups have found that starting with a clean slate is helpful, particularly if the whole operation is flawed. Another manager felt that wiping the slate clean is not always the answer. Some industries have always looked at business along product lines and now healthcare is attempting to do the same. Will it work? One participant answered that this view has helped her organization see who their patients are. Another insists it has facilitated teamwork between disciplines. All would agree that communication is critical. Most agree that e-mail is a good tool and to some, it is invaluable. Slowly but surely, each organization will have to learn how to integrate its own processes and services.

Communication↗
PubMed1998

Integrated primary mental health care.

Mental health is increasingly being recognized as contributing significantly to the burden of disease, particularly now that the indicators have shifted from measures of mortality to measures of morbidity. Psychiatric morbidity in the community, based on community surveys, is estimated at 20 to 30% of the population. Increasingly, patients needing mental health services prefer to be in a general health care setting than in specialized centres. Internationally and regionally, the general policy has been to move toward the development of comprehensive mental health programmes integrated within primary health care. This integration may be structural (use of shared facilities), administrative (shared administrative resources) or functional (complete integration of clinical services, with staff jointly responsible for patient welfare). This paper examines how this integration can be achieved, and the potential role of the Department of Community Health and Psychiatry, University of the West Indies in advancing this integrative process through research and training.

Community Medicine↗
PubMed2001

Detection of integrated papillomavirus sequences by ligation-mediated PCR (DIPS-PCR) and molecular characterization in cervical cancer cells.

Human papillomavirus (HPV) genomes usually persist as episomal molecules in HPV associated preneoplastic lesions whereas they are frequently integrated into the host cell genome in HPV-related cancers cells. This suggests that malignant conversion of HPV-infected epithelia is linked to recombination of cellular and viral sequences. Due to technical limitations, precise sequence information on viral-cellular junctions were obtained only for few cell lines and primary lesions. In order to facilitate the molecular analysis of genomic HPV integration, we established a ligation-mediated PCR assay for the detection of integrated papillomavirus sequences (DIPS-PCR). DIPS-PCR was initially used to amplify genomic viral-cellular junctions from HPV-associated cervical cancer cell lines (C4-I, C4-II, SW756, and HeLa) and HPV-immortalized keratinocyte lines (HPKIA, HPKII). In addition to junctions already reported in public data bases, various new fusion fragments were identified. Subsequently, 22 different viral-cellular junctions were amplified from 17 cervical carcinomas and 1 vulval intraepithelial neoplasia (VIN III). Sequence analysis of each junction revealed that the viral E1 open reading frame (ORF) was fused to cellular sequences in 20 of 22 (91%) cases. Chromosomal integration loci mapped to chromosomes 1 (2n), 2 (3n), 7 (2n), 8 (3n), 10 (1n), 14 (5n), 16 (1n), 17 (2n), and mitochondrial DNA (1n), suggesting random distribution of chromosomal integration sites. Precise sequence information obtained by DIPS-PCR was further used to monitor the monoclonal origin of 4 cervical cancers, 1 case of recurrent premalignant lesions and 1 lymph node metastasis. Therefore, DIPS-PCR might allow efficient therapy control and prediction of relapse in patients with HPV-associated anogenital cancers.

Base Sequence↗
PubMedDate not supplied

[Integration activities of a central municipal hospital].

Scientifically-based integration of therapeutic and prophylactic institutions is needed for better meeting the population requirement of medical care, and it is desirable to unite the financial resources and personnel; such is the objective reality for municipal therapeutic and prophylactic institutions of local public health systems. In order to make medical care available for the population and to ensure its high quality, structural changes in the public health of a region are needed. These changes include integration of medical services of these territories; creation of a network of therapeutic and prophylactic institutions corresponding to medical demographic structure of population, so that the scope of medical care be increased and specialized care made easier available for the population; and creation of the optimal managing system. Comparative studies of population health and its time course, public health organization at neighboring territories, where therapeutic and prophylactic institutions, such as Central Municipal Hospital and Central Regional Hospital have autonomous managing and financing, confirmed the need in integration of public health units functioning at a certain territory into a universal system, and in development of approaches to overcome the present-day miscellaneous network by integrating the activities of treatment-and-prophylaxis institutions. Identical economic, geographic, and macroeconomic living conditions of the population, similarity of medical demographic structure and similar changes in it, as well as similar morbidity structure, are sufficient grounds for integration of public health services.

Adolescent↗
PubMed2000

Integrating maternal and child health with primary health care in Saudi Arabia.

Integration is an important tool for successful implementation of components of a comprehensive health programme. We describe strategies adopted to integrate the Saudi maternal and child health (MCH) activities with other primary health care (PHC) components in order to achieve optimal quality care. Achieving such integration was one of the specific objectives of the MCH programme. Besides training MCH workers, other important tools of MCH/PHC integration included: organization, supervision, continuing education, data management and health systems research. The strengths and weaknesses of integration are discussed while the opportunities, limitations and implications are reviewed.

Child Health Services↗
PubMed2002

Integrating measurements of disability in federal surveys: seminar proceedings. Documents and Committee Reports.

In November 2000, the Federal Committee on Statistical Methodology (FCSM) convened the seminar "Integrating Federal Statistical Information and Practices" to foster a great awareness of the importance of integrating statistical information issued by different Federal agencies. Disability statistics was one of a dozon cross-cutting subject matter areas that were discussed at the FCSM seminar. This publication contains the proceedings of the session on "Integrating Comparable Measures of Disability in Federal Surveys." The first part of this publication describes programs that count people with disabilities in surveys of four Federal statistical agencies: the Bureau of Labor Statistics, the Social Security Administraion, the National Center for Health Statistics, and the Bureau of Justice Statistics. The second part of this publication contains the remarks of the sessions' two discussants. The recognize thesignificant progress made by th four Federal agencies in developing survey disability measures responsive to their own agency needs but conclude that by mandate or purpose of the data collection, the disability measures differ significantly between agencies and interagency integration of disability statistics will be difficult. The discussants propose research and funding strategies to improve disability measurement integration among Federal statistical agencies.

Activities of Daily Living↗