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PubMed2002

The leprosy elimination campaign in Jigawa, Nigeria: an opportunity for integration.

Integration of leprosy control into the general health services is regarded as an important condition for increasing the accessibility and sustainability of leprosy services. However, it is often difficult to embark on such an integration process. In Jigawa State in Northern Nigeria, the leprosy elimination campaign was used as the initiator and catalyst for the integration process. In this article, this challenging process is described and analysed. Available information is used to identify the constraints that emerged and to assess the consequences of integration for important aspects of leprosy control, such as case detection and case-holding and the accessibility and quality of the provided services. Some lessons from this experience are drawn that can be helpful for integration in other States or countries.

Delivery of Health Care, Integrated↗
PubMed2002

Lessons in integration--operations research in an Indian leprosy NGO.

Since the Alma Ata Declaration in 1978, health systems supporting the treatment and control of infectious diseases like leprosy and tuberculosis have been encouraged to 'integrate' into the primary health care structure within countries. Now, more than 20 years later, countries are still grappling with the concept of integration and looking for ways to achieve it. This study reports findings from a leprosy/Tuberculosis/AIDS awareness pilot project conducted by LEPRA India, a leprosy non-governmental organization (NGO), between 1996 and 2000 in Koraput district, Orissa. The project addressed the issue of integration on two levels. On the one hand LEPRA used the context of the project to explore ways in which to integrate TB services into their existing leprosy control structure. On the other hand, lessons from the pilot study were intended to help the organization find ways of linking with the government health care structure. Following a 'qualitative approach', this operations research project assessed the perceptions of communities and providers about leprosy and tuberculosis services. Providers across the spectrum of this plural healthcare system were asked to provide comment on developing stronger networks with each other, with NGOs and with government, while patients and communities were asked to describe the resources available to them and the constraints they face in accessing health care in general, and for leprosy and TB in particular. LEPRA staff from top management to the outreach workers were also approached for their views. Patients and communities noted that physical access to treatment was a major constraint, while the existence of local providers and family support structures facilitated health and health care. Providers expressed a willingness to collaborate (with LEPRA and the government), but lacked training, adequate staff support and the appropriate equipment/technical resources. Also lacking were adequate information campaigns to inform the public about these diseases and their treatment. This information has provided LEPRA with an understanding of how they might best fill gaps in the existing system and therefore assist in the process of integrating services in their own organization and through the primary health care structure. To achieve this aim, LEPRA will increasingly become involved in developing relationships and partnerships with government in the delivery of training and services and in infrastructure development.

Data Collection↗
PubMed2002

Processes and challenges: how the Sri Lankan health system managed the integration of leprosy services.

At the end of 1999, the Ministry of Health in Sri Lanka took the bold decision to integrate its Leprosy Services within the country's general health system. The integration was completed in February 2001 and is already starting to bear fruit, but implementing the necessary changes has been a challenging task. Many new procedures had to be established, logistics improved, attitudes changed and health workers trained. A broad bridge between curative and preventative health services needed to be built. Integration efforts were supported by an advertising campaign to inform people that leprosy, like any other illness, can be treated at all health facilities. Contrary to the expectation that quality of service would drop following integration, more cases are now detected and an extensive network of government doctors is able to diagnose, treat and manage leprosy patients more efficiently. Prevalence has increased by 36% and the new case load by 41%. A few areas still need more attention, such as integrating MDT supplies within existing systems and improving the flow of information, but nonetheless the ownership of leprosy is shifting rapidly to local health services.

Delivery of Health Care, Integrated↗
PubMed2002

Social stigma: a comparative qualitative study of integrated and vertical care approaches to leprosy.

Integration of leprosy into the general health system is very much emphasized by health care planners. One prime reason stated for this is to reduce stigma attached to this disease. This study was conducted in the state of Maharashtra, India, to compare the level of social stigma towards leprosy in communities with a vertical and an integrated programme. The data were collected in three areas of five villages each. The first two areas were in an integrated programme to test for internal consistency and the third in a vertical programme. All the leprosy patients with visible deformities in these villages were enrolled in the study, and an in-depth stigma measurement scale was administered. In addition, focus group discussions were conducted among the family members of leprosy patients and participative rural appraisal was done in the communities. The data were analysed using qualitative methods. A total of 24 leprosy patients with visible deformities participated in the in-depth stigma measurement exercise from 15 villages. Fifteen focus group discussions were conducted with families of leprosy patients and an equal number of participatory rural appraisals with communities were done. The results show that social stigma was virtually non-existent among the communities with the integrated approach and minimally experienced by leprosy patients in this model. However, a high level of self-stigmatization among leprosy patients was observed in the vertical approach and equally a high level of social stigma was found in their communities, which led to reduced interaction between the leprosy patients and their communities. The integrated approach to community-based primary health care is effective in reducing leprosy stigma in society.

Attitude to Health↗
PubMed1997

An integration programme of poverty alleviation and development with family planning.

The State Council (the central government) recently issued a Circular for Speeding Up the Integration of Poverty Alleviation and Development with the Family Planning Programme during the Ninth Five-year Plan (1996-2000). The Circular was jointly submitted by the State Family Planning Commission and the Leading Group for Poverty Alleviation and Development. The document sets the two major tasks as solving the basic needs for food and clothing of the rural destitute and the control of over-rapid growth of China's population. Practice indicates that a close Integration Programme is the best way for impoverished farmers to alleviate poverty and become better-off. Overpopulation and low educational attainments and poor health quality of population in backward areas are the major factors retarding socioeconomic development. Therefore, it is inevitable to integrate poverty alleviation with family planning. It is a path with Chinese characteristics for a balanced population and sustainable socioeconomic development. The targets of the Integration Programme are as follows: The first is that preferential policies should be worked out to guarantee family planning acceptors, especially households with an only daughter or two daughters, are the first to be helped to eradicate poverty and become well-off. They should become good examples for other rural poor in practicing fewer but healthier births, and generating family income. The second target is that the population plans for the poor counties identified by the central government and provincial governments must be fulfilled. This should contribute to breaking the vicious circle of poverty leading to more children, in turn generating more poverty. The circular demands that more efforts should focus on the training of cadres for the Integrated Programme and on services for poor family planning acceptors.

Asia↗
PubMed2003

Integrated care information technology.

Counties Manukau District Health Board (CMDHB) uses information technology (IT) to drive its Integrated Care strategy. IT enables the sharing of relevant health information between care providers. This information sharing is critical to closing the gaps between fragmented areas of the health system. The tragic case of James Whakaruru demonstrates how people have been falling through those gaps. The starting point of the Integrated Care strategic initiative was the transmission of electronic discharges and referral status messages from CMDHB's secondary provider, South Auckland Health (SAH), to GPs in the district. Successful pilots of a Well Child system and a diabetes disease management system embracing primary and secondary providers followed this. The improved information flowing from hospital to GPs now enables GPs to provide better management for their patients. The Well Child system pilot helped improve reported immunization rates in a high health need area from 40% to 90%. The diabetes system pilot helped reduce the proportion of patients with HbA1c rang:9 from 47% to 16%. IT has been implemented as an integral component of an overall Integrated Care strategic initiative. Within this context, Integrated Care IT has helped to achieve significant improvements in care outcomes, broken down barriers between health system silos, and contributed to the establishment of a system of care continuum that is better for patients.

Child↗
PubMed2003

Specification levels and collaborative definition for the integration of health information systems.

In this paper, we extend our previous work for defining interoperability for health information systems into proposed documentation levels for specifying integration, and a model for defining various interoperability aspects in collaboration between integrators, health service providers and system providers. We are using these models in defining solutions for a set of different integration needs in PlugIT project in Finland. We propose collaborative definition and clear levels of integration specifications to promote adequacy, consistency and efficiency of integration solutions and software component specifications in health information systems.

Delivery of Health Care↗
PubMedDate not supplied

HIS/RIS/PACS integration: getting to the gold standard.

The technology for acquiring, storing, retrieving, displaying, and distributing images has advanced dramatically in recent years. The push is toward enterprise-wide image management solutions, where digital images from radiology, cardiology, and other "ologies" are seamlessly linked with information from clinical information systems and other databases, and they are accessed seamlessly from a single point of end-user interaction. The "gold standard" of system integration would provide the platform for improved workflow, patient throughput and patient safety, as well as decreased cost. Unfortunately, the gold standard remains elusive in most healthcare environments, even those with new systems. One of the earliest issues that plagued the progress of hospital information system/radiology information systems/picture archiving and communication systems (HIS/RIS/PACS) integration was a matter of language between Health Level-7 (HL7) and DICOM. This barrier was solved by the broker--a software and hardware device that accepts HL7 messages from the RIS then translates, or maps, the data to produce DICOM messages for transmission to the PACS. Technologist workflow requires patient and exam information from the RIS to flow to the modality. The broker provides support for this by taking advantage of the DICOM Modality Worklist (DMWL). Two primary problems are inherent in most brokered configurations. Workflow is driven by paper, and RIS information flows in 1 direction only, which leads to duplicative databases. Overcoming the limitations of HIS/RIS/PACS connectivity requires industry accepted communication protocols/rules. To facilitate this, the Integrating the Health Care Enterprise (IHE) initiative was developed. The goal of IHE is to provide end-users improved access to critical patient and clinical information across all systems within the healthcare delivery network. While the IHE initiative began to facilitate more efficient, predictable, and functional integration between disparate systems, vendors still had technology hurdles to overcome. System integration continues to be significantly hampered, not by technology limitations, but instead by business and political issues. In response to these challenges, several vendors have begun to offer consolidated RIS/PACS solutions and/or HIS/RIS/PACS solutions. Consequently, the prospect of the gold standard appears to be on the horizon. Single vendor consolidated systems are not, however, feasible for deployment in many healthcare organizations, and they are not necessarily the panacea.

Database Management Systems↗
PubMed1992

Friend murine leukaemia virus is integrated at a common site in most primary spleen tumours of erythroleukaemic animals.

A common proviral integration site was identified and characterized in erythroleukaemias induced by Friend murine leukaemia virus (F-MuLV). Using inverse polymerase chain reaction, we found a proviral integration site common to at least 90% of 20 primary tumours tested. This site was identical to Fli-1, a locus recently reported by others to be rearranged in 75% (9/12) of cell lines established from spleens of erythroleukaemic mice and to code for a member of the ets gene family. Our data suggest that about half of the F-MuLV-induced erythroleukaemias contained more than one cell clone with a proviral integration in Fli-1, with different individual integration sites within Fli-1 in each cell clone. All proviruses were found to be integrated in the same transcriptional orientation with respect to flanking cellular DNA. We discuss these findings in relation to multistage models of neoplasm.

Animals↗
PubMed2005

An OGSA-based integration of life-scientific resources for drug discovery.

OBJECTIVES: The rapid progress of life-scientific research has the potential to dramatically change the paradigm of drug discovery. Efficient utilization of life-scientific resources, i.e., databases and analytic software tools, poses a challenging issue with regard to the reduction of time and cost in the drug discovery process. In this paper, a variety of heterogeneous Web-based life-scientific resources are integrated toward the improvement of drug discovery performance. METHODS: For the integration of heterogeneous life-scientific resources, a database federation technique based on three-layer architecture has been utilized. With the federation technique, life-scientific resources are integrated step by step through database layers, database integration layers and analysis layers to encapsulate complexity and heterogeneity. In this study, we have taken advantage of the latest Grid technology based on OGSA (Open Grid Services Architecture) for the implementation of our approach. RESULTS: The actual case of life-scientific resources for drug discovery demonstrates that our prototype system developed with the proposed technique works well for the identification process of candidate compounds to a target protein. In other words, the prototype system allows a researcher to retrieve candidate compounds with less effort than before. CONCLUSIONS: The usefulness of the prototypic system represents the ability of our approach to integrate heterogeneous life-scientific resources, which have the potential to dramatically improve efficiency in drug discovery, resulting in the shortening of drug development. On the other hand, the system requires further consideration from the aspect of practical use. Dynamic aggregation of the resources is one example of such a consideration.

Biological Science Disciplines↗
PubMedDate not supplied

The financial performance of integrated health organizations.

This study examines the impact of integration strategies on the financial performance of hospitals, physicians, and health plans over time. Results from a study of 36 large integrated health organizations (IHOs) suggest that financial performance is adversely affected by the scale of investment in integration but not necessarily by the timing or sequencing of the investments made. The results also suggest that some integration strategies have more detrimental effects on financial performance than do others. Finally, the results show that centralized integrative structures appear more financially successful than are less centralized structures.

Delivery of Health Care, Integrated↗
PubMed2005

Integration of genomic data in Electronic Health Records--opportunities and dilemmas.

OBJECTIVES: In this paper we give an overview about the challenge the postgenomic era poses on biomedical informaticists. The occurrence of new (genomic) data types necessitates new data models, new viewing metaphors and methods to deal with the disclosure of genomic data. We discuss integration issues when inferring phenotype and genotype data. Another challenge is to find the right phenotype to genotype data in order to get appropriate case numbers for sound clinical genotype-phenotype inference studies. METHODS: Genomic data could be integrated in an Electronic Health Record (EHR) in several ways. We describe patient-centered and pointer-based integration strategies and the corresponding data types and data models. The inference mechanisms for the interpretation of row data contain different agents. We describe vertical, horizontal and temporal agents. RESULTS: We have to deal with several new data types, not being standardized for EHR integration. Genomic data tends to be more structured than phenotype data. Beyond the development of new data models, vertical, horizontal and temporal agents have to be developed in order to link genotype and phenotype. As the genomic EHR will contain very sensitive data, confidentiality and privacy concerns have to be addressed. CONCLUSIONS: Given the necessity to capture both environment and genomic state of a patient and their interaction, clinical information systems have to be redesigned. While genotyping seems to be automatable easily, this is not the case for clinical information. More integration work on terminologies and ontologies has to be done.

Computational Biology↗
PubMedDate not supplied

[Integrated health care organizations: guideline for analysis].

There has been a tendency recently to abandon competition and to introduce policies that promote collaboration between health providers as a means of improving the efficiency of the system and the continuity of care. A number of countries, most notably the United States, have experienced the integration of health care providers to cover the continuum of care of a defined population. Catalonia has witnessed the steady emergence of increasing numbers of integrated health organisations (IHO) but, unlike the United States, studies on health providers' integration are scarce. As part of a research project currently underway, a guide was developed to study Catalan IHOs, based on a classical literature review and the development of a theoretical framework. The guide proposes analysing the IHO's performance in relation to their final objectives of improving the efficiency and continuity of health care by an analysis of the integration type (based on key characteristics); external elements (existence of other suppliers, type of services' payment mechanisms); and internal elements (model of government, organization and management) that influence integration. Evaluation of the IHO's performance focuses on global strategies and results on coordination of care and efficiency. Two types of coordination are evaluated: information coordination and coordination of care management. Evaluation of the efficiency of the IHO refers to technical and allocative efficiency. This guide may have to be modified for use in the Catalan context.

Continuity of Patient Care↗
PubMed2006

Tissue characterization of solitary pulmonary nodule: comparative study between helical dynamic CT and integrated PET/CT.

UNLABELLED: Recent advances in the technology of helical multidetector CT allow precise evaluations of nodule hemodynamics. In addition, the efficacy of tissue characterization has improved, and now sensitivity and specificity of >90% are achieved. Moreover, the efficacy of PET for the tissue characterization of solitary pulmonary nodules (SPNs) has also become of importance. The purpose of this study was to compare the diagnostic accuracy of helical dynamic (HD) CT (HDCT) and integrated PET/CT for pulmonary nodule characterization. METHODS: One hundred nineteen patients with an SPN underwent both HDCT (unenhanced scans, followed by series of images at 30, 60, 90, 120 s and at 5 and 15 min after intravenous injection of contrast medium) and integrated PET/CT. On HDCT, a nodule was regarded as malignant with a net enhancement of > or =25 Hounsfield units (HU) and a washout of 5-31 HU. On integrated PET/CT, nodules were considered malignant with a > or =3.5 maximum standardized uptake value and an 18F-FDG uptake greater than that of mediastinal structures. The sensitivity, specificity, and accuracy of the 2 modalities for malignancy were compared using the McNemar test. RESULTS: There were 79 malignant and 40 benign nodules. The sensitivity, specificity, and accuracy for malignancy on HDCT were 81% (64/79 nodules), 93% (37/40), and 85% (101/119), respectively, whereas those on integrated PET/CT were 96% (76/79), 88% (35/40), and 93% (111/119), respectively (P = 0.008, 0.727, and 0.011, respectively). All malignant nodules were interpreted correctly on either HDCT or PET/CT. CONCLUSION: Integrated PET/CT is more sensitive and accurate than HDCT for the malignant nodule characterization; therefore, PET/CT may be performed as the first-line evaluation tool for SPN characterization. Because HDCT has high specificity and acceptable sensitivity and accuracy, it may be a reasonable alternative for nodule characterization when PET/CT is unavailable.

Adult↗
PubMed1994

Stable integration of retrovirally transduced genes into human umbilical cord blood high-proliferative potential colony-forming cells (HPP-CFC) as assessed after multiple HPP-CFC colony replatings in vitro.

We previously demonstrated stable integration of a transduced thymidine kinase (TK)-neo gene into immature and replatable stem and progenitor cells, as assessed by the presence of the gene in second-generation colonies. To evaluate whether this integration was still present in third- and fourth-generation colonies, nonadherent low-density T-lymphocyte-depleted (NALT-) cells from human umbilical cord blood were prestimulated with recombinant human (rhu) erythropoietin (Epo), steel factor (SLF), interleukin-3 (IL-3), granulocyte-macrophage (GM) colony-stimulating factor (CSF), and granulocyte (G)-CSF. Prestimulated NALT- cells were incubated with retroviral-containing supernatant obtained from TK-neo vector-producing cells, washed, and assayed for colony formation in the presence of Epo, SLF, IL-3, GM-CSF, and G-CSF -/+ G418. The results confirmed that the TK-neo gene could be efficiently introduced into hematopoietic progenitor cells without stromal cells as a source of virus. As previously reported, proviral integration was detected in primary G418R-colonies, and in second-generation replated colonies derived from G418R granulocyte erythroid macrophage megakaryocyte colony-forming units and high-proliferative potential colony-forming cells (HPP-CFCs). Moreover, we now document that proviral integration was apparent in cells from colonies derived from third- and fourth-generation replated HPP-CFC, suggesting a high degree of stable integration of the transduced gene.

Cells, Cultured↗
PubMed1994

Implementing organized delivery systems: an integration scorecard.

Organized vertically integrated health systems are in a key position to play a major role in present health care reform efforts. To demonstrate a competitive advantage in the new health care environment, however, integration efforts must be successful. Based on a national study of nine organized delivery systems, this article develops measures of three types of integration that occur in vertically integrated health systems--functional, physician-system, and clinical. These measures can be used as a "scorecard" to assess progress toward achieving integration objectives.

Comprehensive Health Care↗
PubMed1994

Integrated hepatitis B virus X and 3' truncated preS/S sequences derived from human hepatomas encode functionally active transactivators.

The hepatitis B virus (HBV) frequently integrates into hepatocellular genomic DNA during viral infection. Transcriptional transactivators encoded by integrated HBV X and 3' truncated preS/S sequences are known to stimulate gene expression from homologous and heterologous promoters. Here we demonstrate that 21 of 26 (81%) hepatocellular carcinoma tissues/cell lines contain coding sequences for at least one of the two known transactivators. Four integrated X and three preS/S transactivator sequences contained in five isolates from three hepatoma primary tissues or cell lines were used as examples to prove functionality of the encoded transactivators. In one case, where both X and preS/S sequences were present, dissection of X and preS/S transactivator sequences showed independent functionality. The investigation of X- and preS/S-specific RNA and protein expression revealed the existence of carboxyterminally truncated viral-cellular fusion proteins that were able to stimulate gene expression from the c-fos proto-oncogene promoter five- to ten-fold. These results demonstrate that structurally intact HBV transactivator sequences are integrated in the majority of HBV-associated HCCs/hepatoma cell lines. In all tested examples integrated DNAs had retained functionality as transactivators. This data thereby support indirectly the hypothesis of a possible involvement of HBV transactivators in liver cell proliferation and hepatocarcinogenesis.

Base Sequence↗
PubMed1994

Integration of human papillomavirus type 6a DNA in a tonsillar carcinoma: chromosomal localization and nucleotide sequence of the genomic target region.

Human papillomavirus type 6a (HPV 6a) DNA was detected in a tonsillar carcinoma both as integrated and episomal molecules, and one viral-cellular junction was molecularly cloned (Bercovich et al., J. Gen Virol., 72: 2569-2572, 1991). The cellular sequence was used as a probe for the isolation of a cosmid from a normal human genomic DNA library. A 2.7-kilobase subclone including the integration site was sequenced. It was shown to contain sequences with similarities to the E2 and L2 regions of human papillomaviruses, a 5' truncated long interspersed repeated DNA element type 1 retrotransposon, and a fragment of an O-repeat element. The chromosomal localization of the integration site was determined to be at region 24 of the long arm of chromosome 10 (10q24). This is the region where the fragile site is located in which HPV 18 DNA is integrated in the cell line FEP18-5. In addition it contains the site of breakpoints affecting protooncogenes Hox11 and Lyt10. Other genes related to cell division and DNA repair have also been mapped to this chromosomal band. Analysis of genomic DNA of cell lines and patients using 10q24-derived probes is presented. The integration of human papillomavirus type 6 DNA into chromosome 10q24 may have disrupted a cellular gene critical for normal cell growth, which further analysis should help to identify.

Base Sequence↗