SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In summary, the Luke article is a solid starting point for understanding the relationships between existing hospital systems, developing regional systems, and ultimate benefits to patients, their employers, and their communities. We clearly have a long way to go though, and the attention should turn to some of the key functional features of integrated systems.
UNLABELLED: The authors, security directors at Yale University Medical School and Yale-New Haven Hospital respectively, discuss their decision to coordinate their efforts to procure compatible new security systems that would integrate such components as alarms, CCTV, and access control within and between the two campuses. The goal: improve safety and make alarm monitoring easier and more efficient by centralizing operations. THE RESULTS: an increase in security, a decline in security incidents, and a reduction in costs.
The factors that should be considered in designing an integrated blood transfusion system are outlined. The system work performed by the Committee of Collaborative EDP Assistance in the Swedish Blood Transfusion Service is reviewed to illustrate these points. The system that has been developed is described.
For a hospital information system, object-oriented methodology plays an increasingly important role, especially for the management of digitized data, e.g., the electrocardiogram, electroencephalogram, electromyogram, spirogram, X-ray, CT and histopathological images, which are not yet computerized in most hospitals. As a first step in an object-oriented approach to hospital information management and storing medical data in an object-oriented database, we connected electrocardiographs to a hospital network and established the integration of ECG storage and retrieval systems with a hospital information system. In this paper, the object-oriented analysis and design of the ECG storage and retrieval systems is reported.
BACKGROUND AND PURPOSE: There is increasing emphasis on the use of integrated systems for timely, accurate, and efficient data collection for a range of service, audit, quality, and research applications. The present study evaluates the acceptability and the quality of data collected on a ward-based system over a 6-month period. METHODS: A multidisciplinary system specific for stroke rehabilitation was used. Members of each discipline were required to enter demographic, medical, nursing, therapy, and psychosocial data as appropriate to their specialty. A users' survey was undertaken at the beginning and at the end of the study. The quality and completeness of data entry were assessed by a "snapshot" of the database at the end of the study period. Primary users (n = 13) included physicians, nurses, and therapists. RESULTS: The user survey at the end of the evaluation showed a significant increase in confidence in using the system. Although the frequency of use had increased, the time spent in data entry had decreased significantly. The increase in work load, estimated at 15 to 60 minutes per week, was considered to be balanced by the benefits in patient care, audit, and research. There were 67 medical and 1046 other assessments on 67 patients entered into the system. Seven patients (11%) had incomplete medical records. Nursing and therapy assessments had been entered for all patients at admission and on discharge, with more than 95% of all possible assessments monitoring recovery being recorded accurately compared with conventional records. CONCLUSIONS: The study showed that it was possible to introduce a computerized multidisciplinary assessment system on rehabilitation wards as a part of day-to-day work without the need for significant extra resources.
Integrated library systems have not yet been created, although they have been emphasized for nearly two decades. Now and in the future, the task is even more complex because the principal issue is access to information itself, wherever it is located and in whatever form it may exist. The goal becomes more feasible because of changes in library practices achieved with technological innovation. Although individual elements of a campus-wide information system may already exist, the details for implementation are yet to be articulated.
This review examines a manifold of apparently loosely linked observations and mechanisms, from membrane to man, and assembles them to support the notion that mechanoelectric transduction is an integrative regulatory system in the heart. For this, the assemblage has to satisfy, at least to some extent, criteria that apply to other integrative regulatory systems such as the endocrine and nervous systems. The integrative effectors in the endocrine system are chemical linkages, circulating hormones: in the nervous system the linkage is a network of cables, nerve conduction and neurotransmitters. Mechanical integration is would be effected through mechanical machinery, cardiac contractile and hydraulic function with attendant stress and strain transmitted via "tensegrity". This can, through the cytoskeleton, begin with membrane integrins and transmit intracellularly for example via F actins to reach the rest of the membranous integrins. Further transmission to the organ is via cell-to-cell adhesion complexes and the extracellular matrix. This tensegrity facilitates integration of force and strain changes from area to area. In consequence, and analogous to the neurendocrine system, mechanoelectric transduction should, and does (1) operate at the molecular or membrane level--this would be via mechanotransducers affecting transmembrane ionic flow; (2) operate in the cell--to influence electrophysiology; (3) have a multicellular expression--e.g. mechanical distortion of one cell can raise intracellular calcium of an adjacent cell; (4) express in the intact organ--e.g. an increase in venous return hydraulically distends the sinoatrial node, steepening its pacemaker potential, thus increasing heart rate. It should also (5) demonstrate elements of a feedback system--"mechanoelectric feedback", and (6) interact with other systems--the cytoskeleton incorporates cell signalling complexes intersecting with other signal cascades. Finally, (7) it can malfunction to produce clinical abnormality--it contributes electrophysiologically to lethal cardiac arrhythmia. This anatomical and functional behaviour of mechanoelectric transduction could sanction the prospect of viewing it as analogous to the other integrative physiological systems.
This study compared couples receiving two marital therapy approaches and a control group over a 10-week treatment period. Integrated systemic therapy (IST) and an emotionally focused approach (EFT) were both found to be superior to the control and to be equally effective in alleviating marital distress, facilitating conflict resolution and goal attainment, and reducing target complaints at termination. IST couples, however, showed greater maintenance of gains from termination to 4-month follow-up on marital satisfaction and goal attainment. Clients' perceptions of how change occurred and issues related to the use of a team of observers in IST are discussed.
A case is presented that shows the usefulness of integrating systems theory and attachment theory in the formulation and treatment of a clinical problem. The 5 year old son of East Indian immigrants presented with persistent psychogenic vomiting associated with pathological family attachments. It was evident that the precarious family equilibrium was stabilized by the child's psychogenic vomiting. The therapeutic team suggested to the family that their problems might be more satisfactorily resolved if the mother and child maintained their link by two-way radio. Three weeks later the vomiting had ceased, the child no longer felt that he needed the radio and both parents had established new patterns of relating to their child, whose attendance and peer socialization at school showed marked improvement. To some extent the rapid resolution of the problems was facilitated by the cultural strengths of the family.
Malolactic fermentation conducted by Leuconostoc oenos is an essential step in winemaking. L. oenos bacteriophages are thought to be responsible for fermentation failures, yet they have received little attention. The integration system of bacteriophage phi 10MC in the LOF111 L. oenos strain chromosome was studied and a 1,456 bp phage DNA fragment was cloned and sequenced. An open reading frame (int) showing homology with several temperate bacteriophage integrases was located upstream of the phage attachment site (attP). This organisation is comparable to other phage site-specific recombination systems. The same bacterial attachment site (attB) located in at tRNA(leu) gene was found in all 15 L. oenos strains studied and was involved in phi 10MC integration in the bacterial chromosome.
In 9 mongrel dogs, venous return was completely drained from the caval veins to an oxygenator and returned to the femoral arteries with a roller pump. Perfusion rate of systemic circulation and blood pressures in both caval veins were kept constant. Changes in the oxygenator weight were recorded and reflected reciprocal changes in integrated systemic venous blood volume. The vagal nerves were dissected. The carotid sinuses were separately perfused with blood by means of a pump. In 25 experiments, increases in carotid sinus pressure of 15 to 74 mm Hg resulted in decreases in systemic arterial pressure of 10 to 57 mm Hg and increases in systemic venous blood volume of 1.1 to 4.7 ml/kg. On an average, systemic venous blood volume was changed by 1.25 +/- 0.08 ml/kg when the change in systemic arterial pressure was 10 mm Hg. It is concluded that the carotid sinus pressoreceptor reflex considerably alters the systemic venous capacity which in tern alters venous return and cardiac output. These changes in cardiac output are expected to be small, but sufficient to alter the arterial pressure considerably. Thus, they might contribute nearly as much as the reflex effect on total peripheral resistance to the reflex control of arterial pressure.
An in-house library system based on a dedicated mini-computer has been in operation in the Israel National Medical Library since the summer of 1979. The integrated system, called MAIMON, features on-line access to bibliographic and circulation records. It replaces manual procedures in cataloging, searching, lending, and reservations. The system provides previously unavailable statistics on items in heavy use and demand, items to be removed from the active collection, and who uses what in the library. It is designed to be user cordial and to save users' time. The system has been very favorably accepted by patrons, and frees professional librarians from time-consuming clerical routine tasks. The system is evaluated in terms of performance, convenience, and cost.
A food-grade vector system was developed that allows stable integration of multiple plasmid copies in the chromosome of Lactococcus lactis. The vector consists of the plus origin of replication (Ori+) of the lactococcal plasmid pWV01, the sucrose genes of the lactic acid bacterium Pediococcus pentosaceus PPE1.0 as selectable marker, a multiple-cloning site, and a lactococcal DNA fragment of a well-characterized chromosomal region. The system includes two L. lactis strains, LL108 and LL302, which produce the pWV01 RepA protein essential for replication of the Ori+ vectors. These helper strains allow the construction and isolation of the replicating form of the integration plasmids from a homologous background. Single-crossover integration of the plasmids in L. lactis MG1363 resulted in amplifications to a level of approximately 20 copies/chromosome after selection of the transformants on medium containing sucrose as the only fermentable sugar. The amplifications were stable under selective growth conditions. In glucose-containing medium a limited loss of integrated plasmid copies was detected at a rate of (7.5-15) x 10(-2) copies per generation. One strain, MG124, was isolated that had retained 11 integrated copies after a period of 120 generations of non-selective growth. These results show that the single-cross-over integration system described here represents a simple procedure for the engineering of stable food-grade strains carrying multiple copies of a gene of interest.
The results of one year's routine use of primary microfilm in a large diagnostic radiological institute is reviewed. Positive views were treated by electronic contrast enhancement in an integrated system of immediate filming and filing. The resulting changes and improvements in running the department are described. This involves a fundamental reorganisation of the department, as well as equipment which is not yet commercially available. The latter had therefore to be improvised and is described. Similar procedures introduced elsewhere are critically evaluated. The advantages of immediate filming are stressed and a comparison with conventional large film filing demonstrates its financial advantages. Logical application of the method results in saving in personnel and material, but implies that the radiologist must be prepared to change to positive films in routine diagnosis. By using microfilm positives with a resolution of 4.0 pairs of lines per mm., the results equal those from large film negatives.
It is surprising that integration has only recently re-emerged as a major issue in healthcare. It has taken the economic pressures of managed care and the demands from employers for accountability to place integration in the spotlight. Without these pressures, we would most likely continue to focus our attention in behavioral health on the preservation of traditional professional roles and boundaries, instead of focusing on prevention and developing processes that produce the best outcome for the patient at the lowest possible cost. Integration challenges traditional roles and processes, forcing institutions in our field to change. Role change, as sociologists know, can be profoundly disorienting to individuals and is often vehemently resisted by groups and institutions who have an investment in the status quo. That is where we are now in this field despite our current enthusiasm for this rather innocent-looking concept called integration. We should be confident that the innovators in healthcare will succeed. The economy and quality-of-care concerns demand it. I hope they receive something more than a lukewarm reception.
The effect of nitroglycerin, N-carboxy-3-morpholino-sydnonimine-ethylester (molsidomine, Corvaton), and its metabolite 3-morpholinosydnonimine upon the peripheral circulation was investigated in 38 dogs with cardio-pulmonary bypass. The three compounds increased the integrated systemic venous blood volume and decreased the mean arterial pressure. The time course of the action of nitroglycerin was different from that of molsidomine: The arterial and venous effects of nitroglycerin began immediately after the injection was started, reached a maximum, and had disappeared after 7 min. The effects of molsidomine started later and showed no tendency to decrease during the observation period of 30 min. When referred to the same decrease in arterial blood pressure, molsidomine acted more strongly upon the systemic venous bed than did nitroglycerin. The arterial and venous effects of the molsidomine metabolite could be antagonized by a dopamine infusion. It is concluded that the hypotensive effect of the three compounds observed in the intact circulation is due to the diminuation of peripheral resistance as well as to the dilatation of the systemic venous bed. The dilatation of the veins effects a decrease in the venous return and thereby in the cardiac output and the arterial pressure. It can be concluded that the antianginal effect of the three compounds is not only due to the diminution of the afterload of the heart; the diminution of the heart; the diminution of the preload also represents an important component of action.
Children, even at the one-word stage of language development, spontaneously produce gestures along with their speech, just as adults do. Although there appears to be a brief period prior to the onset of two-word speech during which gesture and speech do not form a well-integrated system, the ability to coordinate gesture and speech to convey a single message--and to "read" others' gestures with their speech to comprehend a message--develops early and is maintained throughout life. Gesture-speech combinations deliver a coherent message to the listener despite the fact that they consist of two different modalities of expression. According to McNeill (1992; Chapter One), this coherence is possible because gesture and speech share a common cognitive representation; that is, before the communication unfolds, gesture and speech are part of a single idea. As expression proceeds the message is parsed, with most information channeled into speech but some information channeled into gesture. Speech conveys information in a segmented, combinatorial format, whereas gesture conveys information in a global, mimetic format (see Goldin-Meadow, McNeill, and Singleton, 1996). Thus gesture and speech need not, and in fact often do not, convey the same information within a single utterance. Because gesture and speech form a unified system, mismatches between them can be a source of insight into the cognitive state of the speaker. And, indeed, it turns out that in both the young, one-word speaker and the older child (and possibly adults as well; Perry and Elder, 1996), a difference--or mismatch--between the information conveyed in gesture and the information conveyed in speech can signal readiness for cognitive growth. Whether the actual production of gesture-speech mismatches contributes to cognitive growth is an open question. That is, does the act of expressing two different pieces of information across modalities but within a single communicative act improve a child's ability to transpose that knowledge to a new level and thus express those pieces of information within a single modality? More work is needed to investigate whether the act of producing gesture-speech mismatches itself facilitates transition. Even if it turns out that the production of gesture-speech mismatches has little role to play in facilitating cognitive change, mismatch remains a reliable marker of the speaker's potential for cognitive growth. As such, an understanding of the relationship between gesture and speech may prove useful in clinical settings. For example, there is some evidence that children with delayed onset of two-word speech fall naturally into two groups: children who eventually achieve two-word speech, albeit later than the norm (that is, late bloomers), and children who continue to have serious difficulties with spoken language and may never be able to combine words into a single string (Feldman, Holland, Kemp, and Janosky, 1992; Thal, Tobias, and Morrison, 1991). Observation of combinations in which gesture and speech convey different information may prove a useful clinical tool for distinguishing, at a relatively young age, children who will be late bloomers from those who will have great difficulty mastering spoken language without intervention (see Stare, 1996, for preliminary evidence that the relationship between gesture and speech in children with unilateral brain damage correlates with early versus late onset of two-word combinations. In sum, for both speakers and listeners, gesture and speech are two aspects of a single process, with each modality contributing its own unique level of representation. Gesture conveys information in the global, imagistic form for which it is well suited, and speech conveys information in the segmented, combinatorial fashion that characterizes linguistic structures. The total representation of any message is therefore a synthesis of the analog gestural mode and the discrete speech mode. (ABSTRACT TRUNCATED)
UNLABELLED: The aim of this study is the analysis of electrical failures in transvenous cardioverter/defibrillator (ICD) lead systems with regard to the importance of device implemented diagnostic and measurement functions and the potential role of an automated device-control in the detection of lead failures. METHODS: All consecutive ICD patients at our institution were enrolled in this retrospective investigation. The routine follow-up controls consisted in a complete evaluation of all diagnostic and measurement ICD features and additional controls in case of spontaneous arrhythmia episodes. RESULTS: Two hundred thirty patients, 193 male and 37 female, were enrolled in this study (mean age: 61.5 +/- 10.2 years; mean LVEF 32 +/- 9%). During a mean follow-up period of 29.5 +/- 18.4 (6-76) months, lead failure occurred in 19 patients (8%), 16 patients were implanted with an ICD, capable of diagnostic and measurement functions. All nonadequate device discharges could be classified as sensing-failure by stored electrograms. Device implemented measurement features revealed clinical important information in 13/16 patients (81%). In 14/16 patients, the lead defect could not be detected during routine follow-up. At the time of documented lead failure the safety of the implanted devices was already lost in 6/16 patients (38%). CONCLUSIONS: Device implemented diagnostic and measurement options are of great importance in the early detection of ICD lead failures. The implementation of automated measurements of lead related parameters in connection with a patient alert function may contribute to a further increase in the safety of ICD therapy.