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PubMedDate not supplied

Integrating quality management into clinical systems: tools for achieving clinical integration.

This article describes the use of quality systems as a tool for managers of health-care clinical services to establish a common framework across the different disciplines in the continuum of care. Quality systems used internationally in the manufacturing and service sectors are applicable to multidisciplinary clinical systems management because the essential elements of quality are universal. These elements have been redefined into health-care terminology and can be used by clinical systems managers as a basis for implementing a quality system. The structure for documents in a quality system also has been adapted to health care and allows for a common set of quality policies and processes to unify the different clinical services. By using a consistent quality management approach and documentation, managers can transcend technical operational differences and ensure effective clinical integration.

Clinical Laboratory Techniques↗

PubMed2000

Integrating specialized application systems into hospital information systems--obstacles and factors for success.

Hospital information systems are often huge and heterogeneous systems. To support physicians with their daily clinical work, application systems are developed which are dedicated to particular medical fields or tasks and which have to be integrated into the hospital information system. The integration process is quite complicated, because it makes the information system's infrastructure even more heterogeneous. We developed an application system for documentation and therapy planning in pediatric oncology (DOSPO) and we started to introduce it into the Department of Pediatric Oncology of Heidelberg University Hospital. The fact that DOSPO is developed as a universal system for nationwide use made the integration process more difficult. In any case, the introduction of specialized application systems has to be planned systematically in advance, regarding the prevailing information system's infrastructure, available resources and established processes. To simplify the integration process comprehensive electronic patient records for the future should be designed in a way that they can be enhanced easily by new clinical functions.

Child↗

PubMed2003

Integrated healthcare networks' performance: a growth curve modeling approach.

This study examines the effects of integration on the performance ratings of the top 100 integrated healthcare networks (IHNs) in the United States. A strategic-contingency theory is used to identify the relationship of IHNs' performance to their structural and operational characteristics and integration strategies. To create a database for the panel study, the top 100 IHNs selected by the SMG Marketing Group in 1998 were followed up in 1999 and 2000. The data were merged with the Dorenfest data on information system integration. A growth curve model was developed and validated by the Mplus statistical program. Factors influencing the top 100 IHNs' performance in 1998 and their subsequent rankings in the consecutive years were analyzed. IHNs' initial performance scores were positively influenced by network size, number of affiliated physicians and profit margin, and were negatively associated with average length of stay and technical efficiency. The continuing high performance, judged by maintaining higher performance scores, tended to be enhanced by the use of more managerial or executive decision-support systems. Future studies should include time-varying operational indicators to serve as predictors of network performance.

Case Management↗

PubMed1998

Simple sequence repeats in the Helicobacter pylori genome.

We describe an integrated system for the analysis of DNA sequence motifs within complete bacterial genome sequences. This system is based around ACeDB, a genome database with an integrated graphical user interface; we identify and display motifs in the context of genetic, sequence and bibliographic data. Tomb et aL (1997) previously reported the identification of contingency genes in Helicobacter pylori through their association with homopolymeric tracts and dinucleotide repeats. With this as a starting point, we validated the system by a search for this type of repeat and used the contextual information to assess the likelihood that they mediate phase variation in the associated open reading frames (ORFs). We found all of the repeats previously described, and identified 27 putative phase-variable genes (including 17 previously described). These could be divided into three groups: lipopolysaccharide (LPS) biosynthesis, cell-surface-associated proteins and DNA restriction/modification systems. Five of the putative genes did not have obvious homologues in any of the public domain sequence databases. The reading frame of some ORFs was disrupted by the presence of the repeats, including the alpha(1-2) fucosyltransferase gene, necessary for the synthesis of the Lewis Y epitope. An additional benefit of this approach is that the results of each search can be analysed further and compared with those from other genomes. This revealed that H. pylori has an unusually high frequency of homopurine:homopyrimidine repeats suggesting mechanistic biases that favour their presence and instability.

Base Sequence↗

PubMed1994

Building a legacy for the future: creating an integrated health care system.

Local and national market forces of decreasing inpatient utilization and increasing costs paved the way for a major merger involving five hospitals and one home health agency in Portland, Oregon. The result: a health care delivery system that merged corporate cultures, eliminated duplicity, integrated medical and administrative staffs, realized cost containment savings, and effectively responded to market trends toward reform.

Catchment Area, Health↗

PubMed2005

Integrated natural treatment systems for developing communities: low-tech N-removal through the fluctuating microbial pathways.

Integration of natural treatment systems (NTS) (WSP, wetlands etc.) with each other as well as with advanced unit processes (biofiltration) offers a second lease of life to NTS. Long-term full and pilot cale experience in South Africa and Thailand have shown that contrary to a common view, a low tech N-removal from municipal and light industrial wastewater is a reality for a developing community The high treatment efficiency is ascribed to interplay of N-related processes complementing each other. The present FISH-based (Fluorescence In Situ Hybridization) approach to microbial community structure is a pioneering effort in the field of NTS. It establishes interrelationships between major N-removing groups (aerobic and anaerobic ammonia oxidizers (ANAMMOX), denitrifiers) within integrated systems and links them to the high treatment performance. Seasonally fluctuating presence of the ANAMMOX bacteria (0-2.5% of total bacterial numbers) in the NTS (free surface flow wetland) is reported for the first time. Their numbers correlate with metabolically dependent ammonia-oxidizers (2.0-3.0%) but not with stable overall Planctomycetes population (4.5-5.1%). As a result of the flexible microbial structure the robust low cost removal down to TN < 10 mg/L is routinely feasible at the loading rates ranging from 0.005 to 0.08 TN kg/m3/day.

Ammonia↗

PubMed1988

Integrated Academic Information Management Systems (IAIMS). Part III. Implementation of integrated information services. Library/computer center partnership.

Information technologies are changing the traditional role of the library from that of a repository of information to that of an aggressive provider of information services utilizing electronic methods. In many cases, the library cannot realistically achieve this transformation independently but must work with the computer center to reach its objectives. Various models of the integration of libraries and computer centers are thus emerging. At the University of Maryland at Baltimore the Health Sciences Library and the Information Resources Management Division have developed a partnership based on functional relationships without changing the organizational structure. Strategic planning for an Integrated Academic Information Management System (IAIMS) acted as a catalyst in the process. The authors present the evolution of the partnership and discuss current projects being developed jointly by the two units.

Academic Medical Centers↗

PubMed1995

Image engine: an integrated multimedia clinical information system.

Image Engine is a microcomputer-based system for the integration, storage, retrieval, and sharing of digitized clinical images. The system seeks to address the problem of integrating a wide range of clinically important images with the text-based electronic patient record. Rather than create a single, integrated database system for all clinical data, we are developing a separate image database system that creates real-time, dynamic links to other network-based clinical databases. To the user, this system will present an integrated multimedia representation of the patient record, providing access to both the image and text-based data required for effective clinical decision making.

Abstracting and Indexing↗

PubMed2004

CalDAG-GEFI integrates signaling for platelet aggregation and thrombus formation.

Signaling through the second messengers calcium and diacylglycerol (DAG) is a critical element in many biological systems. Integration of calcium and DAG signals has been suggested to occur primarily through protein kinase C family members, which bind both calcium and DAG. However, an alternative pathway may involve members of the CalDAG-GEF/RasGRP protein family, which have structural features (calcium-binding EF hands and DAG-binding C1 domains) that suggest they can function in calcium and DAG signal integration. To gain insight into the signaling systems that may be regulated by CalDAG-GEF/RasGRP family members, we have focused on CalDAG-GEFI, which is expressed preferentially in the brain and blood. Through genetic ablation in the mouse, we have found that CalDAG-GEFI is crucial for signal integration in platelets. Mouse platelets that lack CalDAG-GEFI are severely compromised in integrin-dependent aggregation as a consequence of their inability to signal through CalDAG-GEFI to its target, the small GTPase Rap1. These results suggest that analogous signaling defects are likely to occur in the central nervous system when CalDAG-GEFI is absent or compromised in function.

Animals↗

PubMed1991

BEACHES: an observational system for assessing children's eating and physical activity behaviors and associated events.

An integrated system for coding direct observations of children's dietary and physical activity behaviors was developed. Associated environmental events were also coded, including physical location, antecedents, and consequences. To assess the instrument's reliability and validity, 42 children, aged 4 to 8 years, were observed for 8 consecutive weeks at home and at school. Results indicated that four 60-min observations at home produced relatively stable estimates for most of the 10 dimensions. Interobserver reliabilities during live and videotaped observations were high, with the exception of "consequences" categories that occurred in less than 1% of observed intervals. Evidence of validity was provided by findings that antecedents were associated with respective dietary and physical activity behaviors. The five physical activity categories were validated by heartrate monitoring in a second study. The Behaviors of Eating and Activity for Children's Health Evaluation System is appropriate for studying influences on diet and physical activity in children in a variety of settings.

Behavior Therapy↗

PubMed2005

[Development of clinical performance indicators for establishing a connecting system between hospital performance management and quality improvement].

PURPOSE: This study aimed at developing integrated clinical performance indicators(CPIs) through the analysis of quality improvement(QI) activities of a hospital and literature review about performance measures. METHOD: The CPIs were developed through the following three stages; 1)Identifying preliminary CPIs 2)A staff validity test in preliminary CPIs 3)Developing final CPIs. RESULT: One hundred twenty-three preliminary CPIs were developed through QI activities of the target hospital for 8 years and literature review. The results of the validity test for the preliminary CPIs supported ninety-one items. Sixty-two CPIs were selected through integration, reclassification and renaming. Then, eighteen items were deleted on account of an imprecise calculation method. Finally, forty-four CPIs were confirmed. They consisted of twenty-six items at the hospital level and eighteen items at the department level. CONCLUSION: CPIs can be used as criteria to evaluate the performance of healthcare organizations, and to decide the quality of healthcare for customers. This study may contribute to establishing an integrated system between QI activities and performance measurement of healthcare organizations.

Adult↗

PubMedDate not supplied

[Pharmakologic analysis of the interrelationship between long-term and short-term memory in dogs with systems of conditioned reflexes].

It has been shown in experiments on dogs with elaborated integrated systems of conditioned reflexes (by Kupalov method) and choice reactions (by Hunter method); that the physiological mechanisms of short-term and long-term memory are not strictly isolated; they include some common biochemical structures and are interrelated. The action of amizyl or armin on the cholinoreceptors disturbs the short-term memory and some elements of the long-term conditioned memory: the duration of retention of traces from conditioned and unconditioned alimentary stimuli is reduced; regulation of the course of stabilized conditioned stereotypes is disturbed; differentiation and use of previous experience (extraction of data from long-term memory) are impeded.

Animals↗

PubMed2006

Measuring the user acceptance of a Web-based nursing documentation system.

OBJECTIVES: The development of an ICNP web-based nursing documentation system, and its evaluation for its usability, and its user acceptance. METHODS: A web-based nursing documentation system was designed and implemented by using the Greek translation of ICNP beta 2 version nursing terminology. The system integrates the steps of nursing process for providing and documenting nursing care, while ICNP terminology is used for the description of nursing concepts. The system was evaluated by nurses in a computer laboratory. We measured the user interaction satisfaction mainly by using questionnaires and scenarios. RESULTS: The nurses who evaluated the system possessed adequate basic computer skills; but low-to-moderate experience in clinical or hospital information systems; and insufficient experience with nursing vocabularies, and especially ICNP. Overall, they were satisfied enough with the system's usability and usefulness, while the acceptance level increased as the level of their training in computers, nursing process and ICNP was also increased. The integration and use in the system of predefined, or standardized, nursing concepts and care plans seems to increase the acceptance of the documentation system and also the ICNP. CONCLUSION: The subjective satisfaction and response of the users towards the system is specified. The described system was evaluated under "laboratory conditions" and revealed some of its strong and weak points and some of the factors that influenced its success and acceptance by its users.

Diffusion of Innovation↗

PubMed1991

A practical method to integrate some stiff systems.

A compact, absolutely stable numerical method is presented to integrate stiff systems of pseudo-linear, ordinary, first-order differential equations, commonly found in the simulation of biological models. Solutions are stepwise approximated by a complete set of first order rational polynomials. Mass balance is preserved by the approximations. No matrix inversions are required. Besides being stable, the method is also convergent and can be used with deferred approximation to the limit h = 0. Comparisons between this method and the Stoer-Bullirsch algorithm and fourth-order Runge-Kutta method are presented.

Algorithms↗

PubMed2003

Alternative coupled integrable optical soliton system with higher-order effects.

The system of coupled Hirota equations, which explains the simultaneous propagation of two fields in a nonlinear optical fiber with the inclusion of higher-order linear and self-steepening effects, is considered. By making use of a Painlevé singularity structure analysis, the system is found to be an exactly integrable soliton system for three choices of physical parameters. Two of the soliton conditions are already well studied. For the third system, the soliton solutions are obtained using bilinear forms.

Journal Article↗

PubMed2005

Automated high-throughput nanoliter-scale protein crystallization screening.

A highly efficient method is developed for automated high-throughput screening of nanoliter-scale protein crystallization. The system integrates liquid dispensing, crystallization and detection. The automated liquid dispensing system handles nanoliters of protein and various combinations of precipitants in parallel to access diverse regions of the phase diagram. A new detection scheme, native fluorescence, with complementary visible-light detection is employed for monitoring the progress of crystallization. This detection mode can distinguish protein crystals from inorganic crystals in a nondestructive manner. A gas-permeable membrane covering the microwells simplifies evaporation rate control and probes extended conditions in the phase diagram. The system was successfully demonstrated for the screening of lysozyme crystallization under 81 different conditions.

Automation↗

PubMed1994

Bladder cancer: advances in biology and treatment.

Integrating systemic chemotherapy in the treatment of patients with invasive bladder cancer is essential to improve survival because the majority of deaths are from systemic relapse. However, as experience with invasive tumors evolves, it is clear that treatment recommendations need to be tailored to an individual patient based on metastatic risk and, ideally, sensitivity to treatment. For those with tumors that do not extend through the bladder wall, standard therapy remains radical surgery. Nevertheless, encouraging results are being reported with increasing frequency using strategies designed to preserve bladder function through a variety of means. Crucial to the recommendation of a specific approach for an individual is improving our ability to define prognosis prior to initiating treatment. Patients with a high risk of systemic recurrence generally require chemotherapy, although the optimal route of integration, pre vs. post-operatively, remains controversial. In those patients who require it, chemotherapy can be administered more safely with the concomitant administration of hematopoietic growth factors. These factors alone, however, are unlikely to improve overall survival. Crucial to the latter effort will be the identification of more active agents, improving our understanding of intrinsic and acquired resistance to chemotherapy, and better delivery of the chemotherapeutic agents currently available. Of equal importance, is the enrollment of patients in clinical trials. These can include large scale randomized comparisons with using a survival end-point, as well as new therapies in high risk populations. The latter would include patients with advanced T3b, T4 and N+ disease, with a high risk of metastatic failure, and low complete response proportions to presently available regimens.

Antineoplastic Agents↗

PubMed1995

Aphysiologic performance on dynamic posturography.

The remarkable ability of the body to maintain balance is the result of central nervous system integration of sophisticated inputs from the vestibular, visual, and somatosensory systems. Strategies by patients with balance dysfunction are aphysiologic when their performance is relatively better on more difficult conditions of sensory conflict than on easier ones. Twenty-two aphysiologic patterns on computerized dynamic posturography were compared with age-matched normal and vestibular patterns. The aphysiologic group performed significantly better than the patients in the vestibular dysfunction group on the most difficult subtests of computerized dynamic posturography, conditions 5 and 6, yet significantly poorer on the easier subtests, conditions 1 through 4. In addition, patients in the aphysiologic group tended to show greater intertrial variability compared with patients in both normal and vestibular system dysfunction groups. A stepwise linear discriminant analysis was used to determine a set of conditions that had significant value in discriminating between the three patient groups. Case studies are presented to further illustrate the clinical usefulness of computerized dynamic posturography testing in the evaluation of patients suspected of having a functional component to their on-feet balance problems.

Adult↗