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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.

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At least 163 records · Page 9Linked to original sources
PubMed2026

Multi‑omics approaches to decipher the molecular mechanisms of exercise‑mediated bone protection: From mechanistic insights to personalized exercise prescription (Review).

The global burden of bone metabolic disorders necessitates a shift from generic exercise recommendations toward personalized prescription strategies. Exercise confers skeletal protection through mechanotransduction, yet the underlying molecular networks remain incompletely understood. Multi‑omics technologies, including transcriptomics, proteomics, metabolomics and single‑cell spatial approaches, have revolutionized the capacity to decode exercise‑mediated bone adaptation at the systems level. The present review synthesizes current single‑omics landscapes and integrative multi‑omics analyses that elucidate the core regulatory networks, mechanobiological coupling mechanisms and multiorgan crosstalk that are implicated in the bone response to mechanical loading. Translational applications across clinical scenarios such as osteoporosis, osteoarthritis and disuse bone loss are evaluated, and the technical, analytical and translational challenges limiting clinical implementation are addressed. Finally, the present review provides a framework for translating multi‑omics molecular signatures into personalized exercise prescriptions for optimized skeletal health.

Humans↗
PubMed1992

Challenges and opportunities for personal selling.

Health care organizations are beginning to use sales forces in much the same way as traditional for-profit organizations have used selling programs in the past. However, numerous challenges to the implementation of selling in the health care industry have yet to be overcome. The authors report viewpoints expressed by administrators in a national survey of health care organizations.

Commerce↗
PubMed1993

The SSD's (social services department) management challenge.

Health services managers are used to organisational change, but social services departments have been addressing, and are still facing, major challenges associated with implementing the changes to community care provision. Norma Raynes gives a perspective on local authorities' culture and bureaucracy, which need to change if the community care revolution is to be sustained.

Community Health Services↗
PubMed1995

A physical examination of health care's readiness for a total quality management program: a case study.

Initiating a total quality management (TQM) effort can be a time-consuming and costly effort for a hospital. Perceptions of management and employees are important in initiating TQM because people function as if perceptions are fact. Assessing these perceptions and determining the levels of readiness or resistance to change are important steps in reducing costs, thus increasing organizational ability to address proactively challenges to the implementation and ultimate success of a TQM effort. Key assessment criteria are discussed including a comparison of management and employee perceptions in one hospital.

Efficiency, Organizational↗
PubMed1997

From electronic medical record to personal health record.

In this paper we attempt to provide a definition and purpose for the electronic patient record, point out the benefits of its use and outline the major challenges in wider implementation that are encountered world-wide. Finally, some trends are highlighted that are believed to play an important role in the future development and use of the electronic patient record.

Computer Communication Networks↗
PubMed1985

Microinfusion: clinical and cost-containment concepts.

This article provides a detailed overview of the concept of intravenous drug delivery. Recognizing the limitations inherent in a gravity-controlled system and the new advantages achieved in the technology of microinfusion, defined here as the (controlled) delivery of small volumes of concentrated solutions of drugs, we have described the concepts and advantages associated with a microinfusion system. The clinical advantages to such a system are far reaching and include lower incidences of bacterial contamination, phlebitis, embolization, and fluid overload as well as more accurate delivery of drug. Since financial advantages are a prerequisite for any new system in this era of fiscal restraint, the financial considerations associated with the use of a microinfusion system are also delineated. These advantages, which range from decreases in supply costs to decreases in the overall cost of patient care, support the argument for increased utilization of microinfusion systems. Overall, it is our contention that microinfusion offers a more rational approach to the delivery of drugs in many patient populations, and expanded implementation of this challenging concept should be further explored.

Boston↗
PubMed1976

Effect of new technologies in the training and utilization of dental auxiliaries in the US Army.

The combat strength, readiness, and effectiveness of the US Army is dependent, in part, upon the health of the American soldier. The conservation of his oral health is the mission of the Army Dental Corps. Confronted with steadfast mission requirements, increasing demands for dental services, and a reduction of professional staff, the Corps has responded to challenge with the implementation of an alternative to the limitations of established and traditional concepts of practice. In 1972, the Army Dental Corps introduced a new system of care delivery, based upon the expanded utilization of its auxiliary personnel and the team mode of practice. In a six year period, approximately 900 expanded duty auxiliaries, known in the Army as Dental Therapy Assistants, or DTA's were to be trained to extend professional capability to the performance of a variety of reversible dental procedures. They were to operate as members of care delivery teams, and to perform their expanded functions only upon the direction and under the supervision of the responsible team dental officer. To date, more than 500 DTA's comprize this new para-professional force, with more than 300 trained and operationally employed. Interim assessments of this endeavor have confirmed the antecedent research, which identified the impressive potential of Team Dentistry. DTA's have been trained to perform previously professional dental functions to a professional standard of quality; their proper team utilization returns a marked increase in professional capability, enabling the delivery of a greater number of dental services to more of the patient community; and their expanded role in care delivery has been well received by both the patient and the professional. Team Dentistry and the expanded duty auxiliary have added a new dimension to dental care delivery, as well as a promising route to mission accomplishment by the Army Dental Corps.

Delivery of Health Care↗
PubMed1989

Health maintenance.

"Health maintenance" includes screening procedures, risk assessment, early intervention, and prevention--primary, secondary, and anticipatory. Guidelines for health maintenance in some age groups are quite well established, especially for children. Although recommendations for older adults may lack complete consensus, there are many activities that are widely accepted and can be employed in every primary care physician's practice. In the words of Anne Somers: "Postponement of dependency and promotion of vitality may be the most important public health challenges of the next two decades." Primary care physicians have the greatest opportunity to meet this challenge through the implementation of specific strategies for health maintenance with patients at every stage of life.

Aged↗
PubMedDate not supplied

Use of a statewide Maternal and Child Health Information Network.

The Maternal and Child Health Information Network (MATCH) contains numerous data elements. The process of converting these data into information is an essential component of comprehensive management information system planning. This process must address not only the end-user mechanics of data retrieval, but also the framework for how data can be used in program administration. Although potential data use contributes to and may in fact drive system design, the reality of integrating computer and data usage into daily activities presents a different set of challenges in system implementation. For both state and local end-users, barriers to system use had to be addressed. In terms of directing system use, it was helpful to provide a format for categorizing data needs. The broad categories of data needs identified for program administration were planning, research, evaluation, management, and collaboration. Numerous initiatives have evolved for each of these categories.

Child↗
PubMedDate not supplied

Collaborative care: a professional model that influences job satisfaction.

At Overland Park Regional Medical Center/Columbia/HCA, Inc., the challenge was to implement a new patient care delivery model and measure the effect of this model on job satisfaction. In reviewing the literature, experts on case management/managed care noted a relationship between this form of practice model and high levels of job satisfaction. However, this relationship was not well illustrated through research studies. Analysis of this implementation plan demonstrated that managed care had a positive impact on job satisfaction.

Humans↗
PubMedDate not supplied

Making policy and procedure systems work effectively.

Policy and procedure manuals can be cumbersome to keep current and updated. One approach to meet this challenge is by implementing a decentralized system to develop, review, revise and approve policies and procedures. Mechanisms to operationalize such a system involve sharing of responsibility and accountability of specified policies and procedures by various existing committees and development of coordinating systems and support mechanisms. Other key attributes of a decentralized system included collaboration and extensive communication strategies.

Humans↗
PubMed1997

Collaborative care: improving patient outcomes in cardiovascular surgery.

Collaborative care, a multidisciplinary process to standardize and streamline care for selected case types, has gained momentum as a care delivery system in health care settings. The major goals of these programs are to improve the quality and continuity of care, while decreasing length of stay and cost. This article will describe key components, issues and challenges of developing, implementing and evaluating a collaborative care program for cardiovascular patients. The initial clinical path focused on bypass surgery, incorporating many of the aggressive bypass surgery recovery guidelines, such as short-acting anesthesia, same-day extubation and decreased laboratory blood analyses and test utilization. Issues that arose focused on patient selection, documentation, determining appropriateness for discontinuing paths and patient/family education. In regard to clinical outcomes, no significant differences were found in mortality or complication rates, such as postoperative bleeding, dysrhythmias and infection rates, between the clinical path group and a comparable group of non-path patients. Both intensive care unit (ICU) and overall hospital length of stay were concomitantly reduced. Other examples of program evaluation are also described, such as variation and patient follow-up data, to highlight quality improvement initiatives that further improve quality of care and reduce length of stay for this patient population.

Coronary Artery Bypass↗
PubMedDate not supplied

Effects of the purchaser/provider split on research implementation.

The issues surrounding the use of research to inform practice and the potential problems involved in this process have been the subject of debate within nursing for many years. The purchaser/provider relationship has led to an increase in the number of challenges nursing encounters regarding the implementation of research. These challenges and relationships, which will either promote or prevent the implementation of research in nursing practice, are explored using Nolan and Grant's (1993) framework. The analysis concludes that implementation of nursing research needs to be part of the contracting process involving shared dialogue between purchasers and providers. Discussions on clinical effectiveness need to include nursing evidence as part of the health-care contracting process. Professionals involved in contracting require equal knowledge about research and joint professional values in order to support its implementation within contracting appropriately.

Contract Services↗
PubMed2022

A Multitrait Locus Regulates Sarbecovirus Pathogenesis.

Infectious diseases have shaped the human population genetic structure, and genetic variation influences the susceptibility to many viral diseases. However, a variety of challenges have made the implementation of traditional human Genome-wide Association Studies (GWAS) approaches to study these infectious outcomes challenging. In contrast, mouse models of infectious diseases provide an experimental control and precision, which facilitates analyses and mechanistic studies of the role of genetic variation on infection. Here we use a genetic mapping cross between two distinct Collaborative Cross mouse strains with respect to severe acute respiratory syndrome coronavirus (SARS-CoV) disease outcomes. We find several loci control differential disease outcome for a variety of traits in the context of SARS-CoV infection. Importantly, we identify a locus on mouse chromosome 9 that shows conserved synteny with a human GWAS locus for SARS-CoV-2 severe disease. We follow-up and confirm a role for this locus, and identify two candidate genes, CCR9 and CXCR6, that both play a key role in regulating the severity of SARS-CoV, SARS-CoV-2, and a distantly related bat sarbecovirus disease outcomes. As such we provide a template for using experimental mouse crosses to identify and characterize multitrait loci that regulate pathogenic infectious outcomes across species. IMPORTANCE Host genetic variation is an important determinant that predicts disease outcomes following infection. In the setting of highly pathogenic coronavirus infections genetic determinants underlying host susceptibility and mortality remain unclear. To elucidate the role of host genetic variation on sarbecovirus pathogenesis and disease outcomes, we utilized the Collaborative Cross (CC) mouse genetic reference population as a model to identify susceptibility alleles to SARS-CoV and SARS-CoV-2 infections. Our findings reveal that a multitrait loci found in chromosome 9 is an important regulator of sarbecovirus pathogenesis in mice. Within this locus, we identified and validated CCR9 and CXCR6 as important regulators of host disease outcomes. Specifically, both CCR9 and CXCR6 are protective against severe SARS-CoV, SARS-CoV-2, and SARS-related HKU3 virus disease in mice. This chromosome 9 multitrait locus may be important to help identify genes that regulate coronavirus disease outcomes in humans.

Animals↗
PubMed1995

The effects of hospital-physician integration strategies on hospital financial performance.

STUDY QUESTION: This study investigated the longitudinal relations between hospital financial performance outcomes and three hospital-physician integration strategies: physician involvement in hospital governance, hospital ownership by physicians, and the integration of hospital-physician financial relationships. DATA SOURCES AND STUDY SETTING: Using secondary data from the State of California, integration strategies in approximately 300 California short-term acute care hospitals were tracked over a ten-year period (1981-1990). STUDY DESIGN: The study used an archival design. Hospital performance was measured on three dimensions: operational profitability, occupancy, and costs. Thirteen control variables were used in the analyses: market competition, affluence, and rurality; hospital ownership; teaching costs and intensity; multihospital system membership; hospital size; outpatient service mix; patient volume case mix; Medicare and Medicaid intensity; and managed care intensity. DATA COLLECTION/EXTRACTION: Financial and utilization data were obtained from the State of California, which requires annual hospital reports. A series of longitudinal regressions tested the hypotheses. PRINCIPAL FINDINGS: Considerable variation was found in the popularity of the three strategies and their ability to predict hospital performance outcomes. Physician involvement in hospital governance increased modestly from 1981-1990, while ownership and financial integration declined significantly. Physician governance was associated with greater occupancy and higher operating margins, while financial integration was related to lower hospital operating costs. Direct physician ownership, particularly in small hospitals, was associated with lower operating margins and higher costs. Subsample analyses indicate that implementation of the Medicare prospective payment system in 1983 had a major impact on these relationships, especially on the benefits of financial integration. CONCLUSIONS: The findings support the validity of hospital-physician financial integration efforts, and to a lesser extent the involvement of physicians in hospital governance. The results lend considerably less support for strategies built around direct physician ownership in hospitals, particularly since PPS implementation. RELEVANCE/IMPACT: These findings challenge prior studies that found few financial benefits to hospital-physician integration prior to PPS implementation in 1983. The results imply that financial benefits of integration may take several years after implementation to emerge, are most salient in a managed care or managed competition environment, and vary by hospital size and multihospital system membership.

Analysis of Variance↗