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At least 433 records · Page 24Linked to original sources
PubMed2004

Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing.

OBJECTIVE: To examine whether a supplemental remote intensive care unit (ICU) care program, implemented by an integrated delivery network using a commercial telemedicine and information technology system, can improve clinical and economic performance across multiple ICUs. DESIGN: Before-and-after trial to assess the effect of adding the supplemental remote ICU telemedicine program. SETTING: Two adult ICUs of a large tertiary care hospital. PATIENTS: A total of 2,140 patients receiving ICU care between 1999 and 2001. INTERVENTIONS: The remote care program used intensivists and physician extenders to provide supplemental monitoring and management of ICU patients for 19 hrs/day (noon to 7 am) from a centralized, off-site facility (eICU). Supporting software, including electronic data display, physician note- and order-writing applications, and a computer-based decision-support tool, were available both in the ICU and at the remote site. Clinical and economic performance during 6 months of the remote intensivist program was compared with performance before the intervention. MEASUREMENTS AND MAIN RESULTS: Hospital mortality for ICU patients was lower during the period of remote ICU care (9.4% vs. 12.9%; relative risk, 0.73; 95% confidence interval [CI], 0.55-0.95), and ICU length of stay was shorter (3.63 days [95% CI, 3.21-4.04] vs. 4.35 days [95% CI, 3.93-4.78]). Lower variable costs per case and higher hospital revenues (from increased case volumes) generated financial benefits in excess of program costs. CONCLUSIONS: The addition of a supplemental, telemedicine-based, remote intensivist program was associated with improved clinical outcomes and hospital financial performance. The magnitude of the improvements was similar to those reported in studies examining the impact of implementing on-site dedicated intensivist staffing models; however, factors other than the introduction of off-site intensivist staffing may have contributed to the observed results, including the introduction of computer-based tools and the increased focus on ICU performance. Although further studies are needed, the apparent success of this on-going multiple-site program, implemented with commercially available equipment, suggests that telemedicine may provide a means for hospitals to achieve quality improvements associated with intensivist care using fewer intensivists.

Confidence Intervals↗
PubMed2003

Endogenous context for visual processing of human faces and other objects.

The human ability to quickly recognise faces and objects is an important skill. This skill may be facilitated by the prior existence of context-setting functional brain states. MEG was used to test the hypothesis that such states may be defined neurophysiologically. One type of state was identified by evaluating deterministic features in the dynamics of pre-stimulus brain activity in 10 individuals engaging in an object categorisation task. These states followed a statistical gamma-distribution similar to that seen in models of percept duration of competing stimuli. Both an early (42 ms) and a late (440 ms) response were only seen for face stimuli that were presented during states in which the MEG data displayed low determinism. A second type of state was identified by evaluating amplitudes of pre-stimulus brain activity. Between 140 and 150 ms, activity was highest for face as well as non-face stimuli presented during a low amplitude state. These findings suggest that detectable states may provide an endogenous context for object processing, independently of experimental parameters.

Adult↗
PubMedDate not supplied

TreePlus: interactive exploration of networks with enhanced tree layouts.

Despite extensive research, it is still difficult to produce effective interactive layouts for large graphs. Dense layout and occlusion make food webs, ontologies, and social networks difficult to understand and interact with. We propose a new interactive Visual Analytics component called TreePlus that is based on a tree-style layout. TreePlus reveals the missing graph structure with visualization and interaction while maintaining good readability. To support exploration of the local structure of the graph and gathering of information from the extensive reading of labels, we use a guiding metaphor of "Plant a seed and watch it grow." It allows users to start with a node and expand the graph as needed, which complements the classic overview techniques that can be effective at (but often limited to) revealing clusters. We describe our design goals, describe the interface, and report on a controlled user study with 28 participants comparing TreePlus with a traditional graph interface for six tasks. In general, the advantage of TreePlus over the traditional interface increased as the density of the displayed data increased. Participants also reported higher levels of confidence in their answers with TreePlus and most of them preferred TreePlus.

Algorithms↗
PubMedDate not supplied

Parallel sets: interactive exploration and visual analysis of categorical data.

Categorical data dimensions appear in many real-world data sets, but few visualization methods exist that properly deal with them. Parallel Sets are a new method for the visualization and interactive exploration of categorical data that shows data frequencies instead of the individual data points. The method is based on the axis layout of parallel coordinates, with boxes representing the categories and parallelograms between the axes showing the relations between categories. In addition to the visual representation, we designed a rich set of interactions. Parallel Sets allow the user to interactively remap the data to new categorizations and, thus, to consider more data dimensions during exploration and analysis than usually possible. At the same time, a metalevel, semantic representation of the data is built. Common procedures, like building the cross product of two or more dimensions, can be performed automatically, thus complementing the interactive visualization. We demonstrate Parallel Sets by analyzing a large CRM data set, as well as investigating housing data from two US states.

Computer Graphics↗
PubMed1994

An exploration of women's perceptions of the major factors that contributed to their alcohol abuse.

The purpose of this research was to explore the interviewees' perceptions of the major factors that contributed to their alcohol abuse. The research was carried out by interviewing seven women who were identified by community mental health professionals. The research was qualitative and exploratory. The semi-structured tape-recorded interview technique was used as an enquiry tool. The tapes were then transcribed and coded, and the findings were scrutinized and scanned for emerging themes and concepts using an interactive and cyclical process of data-reduction techniques, data display and verification of findings. The findings suggest that the majority of the interviewees could identify and isolate specific life events and past-life crises that contributed to an increase in their alcohol intake. Results also indicate that there is a need to consider the efficacy of the current models of primary, secondary and tertiary care as well as relapse-prevention programmes of care in order to facilitate women to have every opportunity to make informed and rational health choices about their drinking behaviours, and to maintain abstinence, for the promotion of positive mental health and for enhancing the quality of their lives.

Adult↗
PubMed2006

Nurses' perceptions of their documentation experiences in a computerized nursing care planning system.

AIM: To explore how the content design of a computerized nursing care plan affects nurses' perceptions of their documentation experience, specifically in making care plans. BACKGROUND: Nurses' attitudes towards and experiences of computer use in daily practice have been studied. However, no studies have examined how using a computerized nursing care planning system affects nurses' perceptions of the documentation process. METHODS: A descriptive, exploratory qualitative approach was used to conduct one-on-one, in-depth interviews with 20 nurses. The major interview question was, 'What do you think the content of the computerized care plan provided in making care plans?' Data analysis was based on Miles and Huberman's data reduction, data display, and a conclusion verification process. FINDINGS: Nurses generally viewed the content of the computerized nursing care planning system as a reference to aid memory, a learning tool for patient care, and a vehicle for applying judgement to modify care plan content. CONCLUSIONS: Although computer technology is designed to streamline nurses' work, using a computerized care plan system can also enhance their knowledge, experience and judgement of descriptions of patient problems and care strategies. Thus, the effects of using technology on documentation behaviours or patterns may deserve further exploration. RELEVANCE TO CLINICAL PRACTICE: While computerized documentation systems have been used widely in patient care, little attention has been given to how the design of care plan content affects the documentation process. Electronic documentation systems can introduce nurses to new skills and knowledge that may improve care quality.

Adult↗
PubMed2005

Reconstruct: a free editor for serial section microscopy.

Many microscopy studies require reconstruction from serial sections, a method of analysis that is sometimes difficult and time-consuming. When each section is cut, mounted and imaged separately, section images must be montaged and realigned to accurately analyse and visualize the three-dimensional (3D) structure. Reconstruct is a free editor designed to facilitate montaging, alignment, analysis and visualization of serial sections. The methods used by Reconstruct for organizing, transforming and displaying data enable the analysis of series with large numbers of sections and images over a large range of magnifications by making efficient use of computer memory. Alignments can correct for some types of non-linear deformations, including cracks and folds, as often encountered in serial electron microscopy. A large number of different structures can be easily traced and placed together in a single 3D scene that can be animated or saved. As a flexible editor, Reconstruct can reduce the time and resources expended for serial section studies and allows a larger tissue volume to be analysed more quickly.

Animals↗
PubMed2004

Comparison of gastric volumes in response to isocaloric liquid and mixed meals in humans.

AIMS: To compare gastric volume responses to ingestion of isocaloric liquid or mixed (solid-liquid) meals and document the intra- and interindividual reproducibility of gastric volume measurement using single photon emission computed tomography (SPECT) imaging after i.v. 99mTc-pertechnetate. METHODS: Eight healthy volunteers performed two studies at least 9 months apart. Gastric volumes were measured after a 317 kcal liquid nutrient meal. Within 2 weeks of the second liquid meal study, participants performed a third study, ingesting an isocaloric mixed meal. The order of the mixed and second liquid meals was randomized; Bland-Altman plot displayed data on repeated studies with liquid meal and paired t-test compared gastric volumes after mixed or liquid isocaloric meals. RESULTS: Fasting and postprandial gastric volumes associated with the two liquid meals were not significantly different; inter- and intra-individual coefficients of variation were 13 and 13.8%. In response to the mixed meal, there was a lower absolute postprandial volume and lower change in gastric volume over fasting volume compared with the response to the liquid meal (P = 0.0001). CONCLUSION: The SPECT measurement of gastric volumes in response to a nutrient liquid meal is reproducible. The magnitude of the volume response is greater after the liquid meal compared with the isocaloric mixed meal.

Adult↗
PubMed2004

Facilitating scholarly writing in academic medicine.

Scholarly writing is a critical skill for faculty in academic medicine; however, few faculty receive instruction in the process. We describe the experience of 18 assistant professors who participated in a writing and faculty development program which consisted of 7 monthly 75-minute sessions embedded in a Collaborative Mentoring Program (CMP). Participants identified barriers to writing, developed personal writing strategies, had time to write, and completed monthly writing contracts. Participants provided written responses to open-ended questions about the learning experience, and at the end of the program, participants identified manuscripts submitted for publication, and completed an audiotaped interview. Analysis of qualitative data using data reduction, data display, and conclusion drawing/verification showed that this writing program facilitated the knowledge, skills, and support needed to foster writing productivity. All participants completed at least 1 scholarly manuscript by the end of the CMP. The impact on participants' future academic productivity requires long-term follow-up.

Attitude of Health Personnel↗
PubMed2005

Spatial resolution of pacemapping and activation mapping in patients with idiopathic right ventricular outflow tract tachycardia.

BACKGROUND: The purpose of this study was to compare the spatial resolution of activation mapping and pacemapping in patients undergoing ablation of idiopathic ventricular tachycardia (VT) arising from the right ventricular outflow tract (RVOT). A direct comparison of the two techniques has not been undertaken. METHODS AND RESULTS: Electroanatomical activation maps of the RVOT were obtained during VT in 15 patients. Pacemaps were obtained from multiple sites, tagged on the activation map, and scored according the degree of concordance between the paced QRS configuration and that of VT. The site of successful ablation was considered the VT site of origin. Initial endocardial activation away from the site of origin was rapid; the mean area of myocardium activated within the first 10 msec (early activation area, EAA) was 3.0 +/- 1.6 cm(2) (range: 1.3-6.4 cm(2)). Best pacemap scores were always obtained adjacent to the site of origin. Pacemap concordance, and the probability of an exact pacemap match significantly decreased with increasing distance of the pacing site from the site of origin (P < 0.01). All patients had more than one pacing site yielding a best pacemap score. The greatest distance between such sites in an individual patient ranged from 11 to 26 mm (mean: 18 +/- 5 mm), and was strongly correlated with the size of the EAA (r = 0.77, P < 0.001). CONCLUSIONS: Pacemapping and activation mapping provide similar localizing information. The spatial resolution of each technique is modest, varies between patients, and may be optimized by three-dimensional data display.

Adult↗
PubMedDate not supplied

Creating and utilizing a multimedia dermatology medical record for a PocketPC personal digital assistant.

Personal digital assistants are lightweight computers that capture and display data via tapping on their screens with a stylus and are easily linked to desktop and network computers. They have been used in medicine for a variety of purposes, and many believe personal digital assistant use can improve the provision of medical care. The author created a multimedia dermatology electronic medical record for a PocketPC (Microsoft Corp., Redmond, WA) personal digital assistant that contains patient images, tables of phototherapy, laboratory and systemic medication data, and typed chart notes. Such a record can be created and utilized but requires more time to assemble than a handwritten note, mostly due to capturing and organizing images. Future challenges involve streamlining record assembly, integrating multimedia records with hospital and office medical records, and assessing how having multimedia data available might affect care.

Computers, Handheld↗
PubMed2005

Analysis of integration in nursing science and practice.

PURPOSE: To clarify the definition of integration and to identify universal aspects of the experience of integration related to healing, health, and nursing care. DESIGN: An integrative review concept analysis method was used. Relevant reports were identified by a computer-assisted search using the keyword integration in CINAHL from 1966 to 2004 and by reviewing the reference lists of retrieved reports. The final sample included 56 reports; 36 were empirical and 20 were theoretical. METHODS: Data were extracted from primary sources on the definition of integration, aspects of the process, antecedents, consequences, and facilitators. Data display matrices were used and were iteratively compared to derive a process model of integration related to health. FINDINGS: A wide range of primary sources indicated that integration is an important aspect of healing or recovery from illness. Integration is defined as a complex person-environment interaction whereby new life experiences (i.e., illness) are assimilated into the self and activities of daily living, thereby contributing to overall life balance. CONCLUSIONS: Results of this analysis indicate the importance of the concept of integration to the science and practice of nursing. The process of integration appears to be a significant phase that occurs between a diagnosis of illness and subsequent physical and emotional healing.

Activities of Daily Living↗
PubMedDate not supplied

Positive communication and management techniques: essential components of effective QA programs.

Communication is a process that is complex but of great importance in successful development of quality assurance programs. Good communication is never fully achieved by an individual, but is constantly being developed. The quality assurance program is for everyone in the organization, not just the quality assurance staff. In summary, the following techniques will help you in your role as quality assurance coordinator or in any management role. 1. Use positive feedback. 2. Prepare for meetings by using an agenda and displaying data graphically or visually. 3. Be available to talk to staff and physicians by letting people know when they can find you. Return phone calls and answer correspondence. 4. Learn to listen. People often have excellent ideas for problem resolution. Let others help you!

Communication↗
PubMedDate not supplied

CAN'T MISS--conquer any number task by making important statistics simple. Part 3. Standard error, estimation, and confidence intervals.

Healthcare quality improvement professionals need to understand and use inferential statistics to interpret sample data from their organizations. In quality improvement and healthcare research studies all the data from a population often are not available, so investigators take samples and make inferences about the population by using inferential statistics. This three-part series will give readers an understanding of the concepts of inferential statistics as well as the specific tools for calculating confidence intervals for samples of data. This article, Part 3, describes standard error and margin of error for a continuous variable and how they are calculated from the sample size and standard deviation of a sample. The article then demonstrates how the standard error and margin of error are used to calculate the confidence interval for estimating a population mean based on a sample mean.

Analysis of Variance↗
PubMedDate not supplied

Noise reduction methods for hybrid subtraction.

In digital subtraction angiography, hybrid subtraction provides selective vessel images free of soft-tissue motion artifacts but with a lower signal-to-noise ratio (SNR) than temporal subtraction images. An image processing method called measurement-dependent filtering has been developed to enhance the SNR of hybrid images without losing resolution or selectivity. Linear combinations of four images consisting of a pre- and postcontrast dual-energy measurement pair form both the hybrid image and a lower noise but less selective vessel image. The noise-reduced image is derived by combining the low-frequency components of the hybrid image with the high-frequency components of the lower noise image in a variety of ways. The results of the filtering method, when tested on both phantom and clinical data, display images with about the same degree of conspicuity as the hybrid image and a SNR approaching that of the temporal image.

Angiography↗
PubMed1997

Association of multiple-antibiotic-resistance profiles with point and nonpoint sources of Escherichia coli in Apalachicola Bay.

A total of 765 Escherichia coli isolates from point and nonpoint sources were collected from the Apalachicola National Estuarine Research Reserve, and their multiple-antibiotic-resistance (MAR) profiles were determined with 10 antibiotics. E. coli isolates from point sources showed significantly greater resistance (P < 0.05) to antibiotics and higher MAR indices than isolates from nonpoint sources. Specifically, 65 different resistance patterns were observed among point source isolates, compared to 32 among nonpoint source isolates. Examples of this contrast in MAR profiles included percentages of isolates with resistance to chlortetracycline-sulfathiazole of 33.7% and to chlortetracycline-penicillin G-sulfathiazole of 14.5% for point source isolates versus 15.4 and 1.7%, respectively, for nonpoint source isolates. MAR profile homology, based on coefficient similarity, showed that isolates from point sources were markedly more diverse than isolates from nonpoint sources. Seven clusters were observed among point source isolates, with a coefficient value of approximately 1.8. In contrast, only four clusters were observed among nonpoint source isolates. Covariance matrices of data displayed six very distinct foci representing nonpoint source E. coli isolates. Importantly, E. coli isolates obtained directly from human and animal feces also clustered among point and nonpoint sources, respectively. We conclude that E. coli MAR profiles were associated with point and nonpoint sources of pollution within Apalachicola Bay and that this method may be useful in facilitating management of other estuaries.

Animals↗
PubMed2005

Reproducibility of computer based neuropsychological testing among Norwegian elite football players.

BACKGROUND: Head injuries account for 4-22% of all football injuries. The rate of brain injuries is difficult to assess, due to the problem of defining and grading concussion. Thus computerised testing programs for cognitive function have been developed. OBJECTIVE: To assess the reliability of a computerised neuropsychological test battery (CogSport) among Norwegian professional football players. METHODS: Norwegian professional football league players (90.3% participation) performed two consecutive baseline Cogsport tests before the 2004 season. CogSport consists of seven different subtasks: simple reaction time (SRT), choice reaction time (ChRT), congruent reaction time (CgRT), monitoring (MON), one-back (OBK), matching (Match) and learning (Learn). RESULTS: There was a small but significant improvement from repeated testing for the reaction time measurements of all seven subtasks (SRT: 0.7%, ChRT: 0.4%, CgRT: 1.2%, MON: 1.3%, OBK: 2.7%, Match: 2.0%, Learn: 1.1%). The coefficient of variation (CV) ranged from 1.0% to 2.7%; corresponding intraclass correlation coefficients ranged from 0.45 (0.34 to 0.55) to 0.79 (0.74 to 0.84). The standard deviation data showed higher CVs, ranging from 3.7% (Learn) to 14.2% (SRT). Thus, the variance decreased with increasing complexity of the task. The accuracy data displayed uniformly high CV (10.4-12.2) and corresponding low intraclass correlation coefficient (0.14 (0.01 to 0.26) to 0.31 (0.19 to 0.42)). CONCLUSION: The reproducibility for the mean reaction time measures was excellent, but less good for measures of accuracy and consistency. Consecutive testing revealed a slight learning effect from test 1 to test 2, and double baseline testing is recommended to minimise this effect.

Adolescent↗