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Foundations need to be set to promote connectivity among healthcare organizations, providers. | Promoting good regional and national electronic data sharing in healthcare will not be possible unless two goals are accomplished: An electronic health record is widely adopted by healthcare providers and an infrastructure for information sharing is developed; according to a new report from a public/private collaborative called Connecting for Health. | 15682567 | [
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Your diagnosis? Midfoot sprain: Lisfranc ligament disruption. | Suspected midfoot sprains can be a challenge to evaluate when the initial weight-bearing views are normal. In this case; MRI allowed prompt confirmation of the suspected unstable Lisfranc ligament injury and contributed to prompt management with rigid fixation. | 15682568 | [
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A new clinical test for avulsion of the insertion of the biceps tendon. | nan | 15682572 | [
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What's the scoop with grapefruit? | nan | 15682573 | [
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Total knee replacement in juvenile rheumatoid arthritis. | In general; longer operative times and in some cases increased blood requirements can be expected with TKA in patients with juvenile rheumatoid arthritis. Complications also are more frequent. Pain relief is usually good to excellent; and function and deformity are significantly improved. Range of motion after TKA for juvenile rheumatoid arthritis is usually less than that obtained in osteoarthritis; but still allows for dramatic improvements in performing activities of daily living (Figure 3). | 15682575 | [
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Histologic and mechanical evaluation of impaction grafting for femoral component revision in a goat model. | A goat model of revision hip arthroplasty was used to examine the histology and mechanical performance of impaction grafting using two femoral stems varying in stem surface finish. There were no significant mechanical or qualitative histologic differences between smooth; tapered; polished stems and step-cut; grit-blasted stems. Allograft distribution; bone incorporation; and cement mantle thickness were not uniform within the femoral canal. Efforts to improve the impaction grafting technique may be more imp | 15682576 | [
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Histologic and mechanical evaluation of impaction grafting for femoral component revision in a goat model. | ortant than stem design. | 15682576 | [
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A new approach to the treatment of osteoporosis. | Osteoporosis remains a significant clinical problem despite the availability of effective therapies. The main therapy still needed is an anabolic agent for the treatment of osteoporosis. This study examined the in vivo effect of the enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor simvastatin; which controls the first step in the biosynthesis of cholesterol; on bone formation in rats. Histologic specimens were collected 7; 14; and 21 days after administration of 1 mg of simvastatin | 15682577 | [
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A new approach to the treatment of osteoporosis. | for 5 days and compared with control specimens for changes in bone tissue. The observed effects on the bone in a healthy animal model included advancement of the blood supply; acceleration of the proliferation and differentiation of osteoprogenitor cells; and formation of osteoid tissue. | 15682577 | [
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The Ponseti method of treatment for congenital clubfoot: importance of maximal forefoot supination in initial casting. | The correction of cavus deformity requires further supination of the forefoot. In the Ponseti method; the initial cast is applied with the forefoot supinated such that the plane of the metatarsal heads is parallel to the long axis of the tibia. This study reviewed Pirani scores of 27 patients with 38 clubfeet treated over an 18-month period by the Ponseti method to evaluate changes in midfoot deformity after the initial cast. Initial average scores for severity of the lateral border deformity; medial crease | 15682578 | [
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The Ponseti method of treatment for congenital clubfoot: importance of maximal forefoot supination in initial casting. | ; and talonavicular joint reducibility decreased from 0.92; 0.75; and 0.75; respectively; to 0.73; 0.25; and 0.5; respectively; after the first cast. The improvement in Pirani scores provides support for the efficacy of the initial cast to reduce the cavus and also increase the reducibility of the midfoot. Failure to address the cavus deformity with the initial cast as described by Ponseti may lead to persistent rigidity and incomplete correction. | 15682578 | [
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Histoplasmosis of the tibia. | nan | 15682579 | [
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Volar perilunate trans-scaphoid fracture-dislocation in a skeletally immature patient. | nan | 15682580 | [
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Community-based student practice: a transformational model of nursing education. | Nursing and nursing faculty shortages demand innovation of nurse-educators and nursing leaders to prepare nursing students for the environment in which they will practice. This article outlines the process of curricular revision undertaken by a department of nursing in a small rural liberal arts college; in partnership with clinical affiliates; based on a structure-process-outcome framework. An expanding literature base promotes service learning in nursing education. Comparison of service-learning and commu | 15682583 | [
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Community-based student practice: a transformational model of nursing education. | nity-based nursing education led the partners to view community-based nursing education experience as practice; and; as such; an emerging model that transcends service learning. Community-based student nursing experiences that meet student; program; and community outcomes are planned and implemented in collaboration with community partners. This model provides students with opportunities to develop a rich understanding of the professional nursing role; while promoting nursing workforce development at both t | 15682583 | [
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Community-based student practice: a transformational model of nursing education. | he individual and organizational levels. | 15682583 | [
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Leadership: The RN clinical leader: one hospital's experience. | Hartford Hospital in Hartford; Connecticut made some important changes in redesigning its patient care delivery system with the development of a new role: the RN clinical leader. This role provides for RN accountabilities; such as mentoring; data management; evidence-based practice; and shared governance. This article describes the RN clinical leader and the education provided to nurses who assume this role. An evaluation process is underway to capture the impact of this new nursing role. The RN clinical le | 15682584 | [
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Leadership: The RN clinical leader: one hospital's experience. | ader is not part of a career ladder in the typical sense. It does; however; recognize nurses who possess additional competencies and want to take on greater responsibility to provide leadership while retaining their role at the bedside. Those competencies are obtained through a formal educational program with immediate application in the hospital itself. | 15682584 | [
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Developing an accelerated BSN program: one college's experience. | During the past 10 years; there has been an explosion in the number of new accelerated Baccalaureate of Science in Nursing (BSN) programs. Declining enrollments in undergraduate nursing programs and the nursing workforce shortage created the impetus for this trend. In the past 2 years; baccalaureate nursing enrollments have begun to increase again and many nursing programs now struggle with a faculty shortage; however; starting an accelerated BSN program still presents an opportunity. That opportunity comes | 15682585 | [
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Developing an accelerated BSN program: one college's experience. | from the quality of students these programs attract. | 15682585 | [
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Thriving in chaos: Educating the nurse leaders of the future. | Nurse educators are challenged to prepare students to become effective leaders in a time of chaos. The last two decades have heralded many changes that have an impact on health care delivery; including changes in health care financing; the information explosion; the recognition of quality chasms; and the composition of the workforce. Nurses continue to be at the forefront of health care delivery and they must orchestrate care for their patients in an increasingly complex health care system. Our goal is to p | 15682586 | [
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Thriving in chaos: Educating the nurse leaders of the future. | rovide nurse educators with strategies to help students blend leadership and management techniques to lead the new generation of knowledge workers. Educators have the opportunity and the challenge to empower their students to master an eclectic set of management and leadership tools; including the best from historical management strategies and embracing the latest theories of leadership. This article presents thoughts and ideas to ponder as well as strategies to consider and implement as we create the curri | 15682586 | [
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Thriving in chaos: Educating the nurse leaders of the future. | culum and the learning environment for our students and the future leaders of our profession. | 15682586 | [
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Learning the organization: a model for health system analysis for new nurse administrators. | Health systems are large and complex organizations in which multiple components and processes influence system outcomes. In order to effectively position themselves in such organizations; nurse administrators new to a system must gain a rapid understanding of overall system operation. Such understanding is facilitated by use of a model for system analysis. The model presented here examines the dynamic interrelationships between and among internal and external elements as they affect system performance. Exte | 15682587 | [
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Learning the organization: a model for health system analysis for new nurse administrators. | rnal elements to be analyzed include environmental factors and characteristics of system clientele. Internal elements flow from the mission and goals of the system and include system culture; services; resources; and outcomes. | 15682587 | [
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Antifungal resistance: the clinical front. | The emergence of resistance and changes in the spectrum of Candida infections have led to an increased interest in susceptibility testing of antifungal drugs. Such testing may be particularly useful in patients with invasive candidiasis who have been previously treated with azole antifungals; those whose infections are not responding to treatment; and those with infections caused by non-albicans species of Candida. The choice of a specific antifungal depends on the clinical status of the patient; the relati | 15682590 | [
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Antifungal resistance: the clinical front. | ve toxicity and efficacy of the drug in the given patient population; the infecting species and antifungal susceptibility of the isolate; and the patient's prior exposure to antifungal agents. Infectious Diseases Society of America recommendations for the initial management of candidemia and acute disseminated candidiasis include an azole; caspofungin; amphotericin B (AmB); or a combination of fluconazole plus AmB. Caspofungin and voriconazole show good activity against most Candida species and may be good | 15682590 | [
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Antifungal resistance: the clinical front. | alternatives for patients with Candida glabrata and Candida krusei infections and for those with relapsing infections. | 15682590 | [
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Invasive Candida infections: the changing epidemiology. | Candida is recognized as the fourth most common cause of bloodstream infection in the United States; with a high attributable mortality rate. While Candida albicans remains the most common pathogen; non-albicans Candida species; including Candida glabrata and Candida krusei; with greater resistance to triazoles are being increasingly isolated. These epidemiologic changes are attributable to a combination of factors; such as the use of fluconazole prophylaxis; changes in patient demographics and underlying d | 15682589 | [
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Invasive Candida infections: the changing epidemiology. | iseases; and use of therapeutic strategies that may pose unique risks. Of particular concern is the increased prevalence of species that are resistant to the azole antifungals. Candida glabrata; for example; is often resistant to fluconazole; and its ability to become cross-resistant to newer azole antifungals is a recent concern. Increasing evidence underscores the need to carefully evaluate antifungal treatment options; according to both host and therapeutic risks for drug resistance. | 15682589 | [
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ACAHO rising...in conversation with Joe de Mora and Glenn Brimacombe. | nan | 15682592 | [
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Management competencies for Canadian health executives: views from the field. | In August 2003; a national survey of 485 (56% response rate) Canadian health service managers and executives ranked the importance and assessed their proficiency in 31 managerial competencies. While the survey respondents appear to agree with the importance of the 31 competencies; we have identified a gap between the perceived level of importance and self-assessed proficiency level that should be addressed by the Canadian College of Health Service Executives. | 15682593 | [
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Physician involvement in setting priorities for health regions. | Although many authors have emphasized the importance of including physicians in organizational activities; especially in integrated delivery systems; much of the literature has focused on physician involvement in governance or as managers. In this paper; program budgeting and marginal analysis (PBMA) is suggested as a mechanism to link physicians into organizational decision-making processes. This research included a wide range of examples that demonstrate the versatility of PBMA; and many ways to involve p | 15682594 | [
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Creating quality practice environments: not easy, but essential. | Quality practice environments for registered nurses correlate positively with job satisfaction; productivity; recruitment; retention and client outcomes. However; when registered nurses work in environments that do not enable them to consistently meet their nursing practice standards; patient safety is jeopardized. This article describes the development of Canada's first guidelines for a quality practice environment for registered nurses in all practice environments. It is a tool healthcare leaders can use | 15682595 | [
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Leadership's role in patient/client safety: are we doing enough? An accreditation perspective. | National and international literature; research; and experience have led to the identification of patient/client safety as a healthcare issue requiring immediate attention. Recent Canadian reports have suggested that the Canadian Council on Health Services Accreditation (CCHSA) has a responsibility in an integrated approach to improving patient/client safety. | 15682596 | [
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The benefits of an active corporate alum. | Corporate Alumni allow organizations to maintain contact with individuals post-termination. Beyond re-hiring former employees; Corporate Alumni help healthcare organizations stay in touch with the community. Strategies to start an alumni program are the subject of this column. | 15682597 | [
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Unilateral distalization of lower molars using the CD distalizer appliance: a case study. | The correction of malocclusions often requires space regaining. Clinicians have the choice of either extraction or non extraction treatment. In the non extraction approach; molar distalization is an option. Limited to headgear treatment for a long time; molar distalization can now be done with intra-oral devices. The CD distalizer is one of those options. This article will describe the application and techniques for the use of the CD distalizer in the lower arch. | 15682602 | [
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Retention: a clear way to do it! | nan | 15682606 | [
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Characterization of a differential fiber Bragg grating sensor for oil-water boundary detection. | We investigate the operating characteristics of an oil-water boundary detector utilizing differential interrogation of fiber Bragg grating sensors. The system resolution is shown to be stable with respect to the choice of strain actuator and long-term temperature changes and changes in the initial strain on the fiber string. Fluid flow; particularly turbulent flow; is found to reduce system resolution significantly for the current system design. Improvements in the system design are required to minimize the | 15682612 | [
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Characterization of a differential fiber Bragg grating sensor for oil-water boundary detection. | effects of fluid flow and to accurately detect the presence of oil-water emulsions. | 15682612 | [
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A study of wavelet analysis based error compensation for the angular measuring system of high-precision test turntables. | An angular measuring system is the most important component of high-precision test turntables; its function and precision determine the turntable's function and precision. The angular measuring system's error was considered as a stationary signal in the past. An autocorrelation function and spectrum characteristics of the angular measuring system error are analyzed using the cyclostationary signal theory. The idea that the error in the angular measuring system is nonstationary is first put forward; theory i | 15682613 | [
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A study of wavelet analysis based error compensation for the angular measuring system of high-precision test turntables. | s provided to reconstruct the angular measuring system's error signal using wavelet analysis. The error signal is reconstructed using one-dimensional Mallat's algorithm. The standard deviation between the reconstructed and the original signal is much less than the angular measuring system's accuracy. The reconstruction signal is used to compensate the system error instead of the original error signal; the angular measuring system accuracy is improved. | 15682613 | [
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Linear mass balance equilibration: a new approach for an old problem. | Interval analyses are well known in the mathematics literature but have found few applications in control engineering. Based on the interval concept; we present here a methodology for data reconciliation and mass balance equilibration which is a very classical problem in mineral and chemical engineering. Indeed; this problem is solved with the view of inequality constraints which allows us to represent measurements by interval without particular knowledge and hypothesis about the density probability functio | 15682614 | [
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Linear mass balance equilibration: a new approach for an old problem. | n of the measurement errors. As a main result; the paper gives a set of solutions for the reconciled data under an interval form and not only one solution as is the case with classical approaches. | 15682614 | [
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Observer design and stabilization for linear neutral delay systems. | This paper focuses on the state observer design problem as well as the observer-based stabilization problem for linear neutral delay systems. The purpose of the former problem is to design an observer that guarantees the asymptotic stability of the estimation error dynamics. The existence condition for such an observer is established. The latter problem; which is the main problem studied in this paper; aims at designing an observer-based feedback controller; such that the closed-loop system is asymptoticall | 15682615 | [
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Observer design and stabilization for linear neutral delay systems. | y stabilized. It is shown that the desired controller can be easily designed if there are solutions to several linear matrix inequalities. Finally; two simulation examples are given to demonstrate the validity and effectiveness of the proposed approach. | 15682615 | [
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Geometrical error compensation of machines with significant random errors. | In this paper; we present a new statistical approach towards soft geometrical error compensation of machines with significant errors. The approach; based on an analysis of the probability of the random error recurring; can reduce the adverse influence of random errors on the compensation of systematic errors. The proposed methodology is made up of three steps. First; error classes are defined from the error bands obtained from calibration. Second; the probability of the magnitude of random error belonging t | 15682616 | [
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Geometrical error compensation of machines with significant random errors. | o each of these classes is computed based on the density of the data set within the class. Based on these probabilities; the most probable systematic part of the error measurement can be statistically deduced. Finally; the geometrical error compensation is carried out based on this value. Experimental results are provided for the linear error compensation of a single-axis piezo-ceramic motion system. | 15682616 | [
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Adaptive control of uncertain continuously stirred tank reactors with unknown actuator nonlinearities. | Adaptive nonlinear control is investigated for continuously stirred tank reactor (CSTR) systems using neural networks. The CSTR plant under study belongs to a class of nonaffine nonlinear systems; and contains an unknown parameter that enters the model nonlinearly. Using adaptive backstepping and neural network (NN) approximation techniques; an alternative adaptive NN controller is developed that achieves asymptotic output tracking control. A novel integral-type Lyapunov function; which includes both system | 15682617 | [
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Adaptive control of uncertain continuously stirred tank reactors with unknown actuator nonlinearities. | states and control input as its arguments; is constructed to solve the difficulty associated with the nonaffine control problem. Numerical simulation is performed to show the feasibility of the proposed approach for chemical process control. | 15682617 | [
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Continuous analysis of move suppressed and shifted DMC. | "Shifted DMC" (shifted dynamic matrix control) has been empirically shown to have significant improved closed-loop control characteristics over "move-suppressed DMC" where; in the latter; diagonal terms of the dynamic matrix DMC prediction model are augmented to reduce numerical ill conditioning. An added benefit of shifted DMC was that the so-called "shifting parameter;" replacing the move suppression parameter; was easily found from the open-loop response. Therefore a novel analytical method; based on a c | 15682618 | [
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Continuous analysis of move suppressed and shifted DMC. | losed form; continuous approximation to closed-loop DMC control; is introduced here and used to quantify the previous empirical results. The dependence of slow and fast time scales of the closed-loop response on the parameters is examined for move-suppressed and shifted DMC methods. It is found that in move-suppressed DMC the slow control time scale is sharply dependent upon the sampling time and move-suppression parameter and that these difficulties are eliminated in shifted DMC. | 15682618 | [
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Design of controller using variable transformations for a nonlinear process with dead time. | In this work; a globally linearized controller (GLC) for a first-order nonlinear system with dead time is proposed. This is similar to the GLC proposed by Ogunnalke [Ind. Eng. Chem. Process. Des. Dev. 25; 241-248 (1986)] for nonlinear systems without dead time. Two methods are proposed. One is based on the Smith prediction from the model in the transformed domain and the other is based on Newton's extrapolation method. The simulation study is made on the conical tank level process and the results are compar | 15682619 | [
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Design of controller using variable transformations for a nonlinear process with dead time. | ed with those obtained using a conventional PI controller and the Smith PI controller based on the transfer function model about the operating point 39%. Finally; experimental results on the laboratory conical tank level process are also given. | 15682619 | [
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Digital redesign of observer-based weighting switch controller for cascaded analog systems with state saturation and external loads. | This paper presents an observer-based weighting switch controller for dealing with the problem of cascaded systems with state saturation and external loads. This method improves the generally poor transition response and output deviation caused by state saturation and external loads. In order to maintain the state-saturation limits; we adopt the evolutionary programming optimal search technique to find the optimal switching parameters for the weighted switch controller. Also; a digital redesign method is ut | 15682620 | [
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Digital redesign of observer-based weighting switch controller for cascaded analog systems with state saturation and external loads. | ilized to replace a designed high-gain analog controller with a low-gain digital controller. It is shown that the digitally redesigned outputs closely track the analogously controlled outputs. The digital redesign technique is then extended to find the digital version of the continuous-time observer. An illustrative example is demonstrated to show the effectiveness of the proposed procedure. | 15682620 | [
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Second-order sliding mode controllers for nonlinear singular perturbation systems. | Nonlinear systems are decomposed into slow and fast response subsystems using the singular perturbation theory and second-order sliding mode controllers are designed for each of the subsystems. The combined control action forms a suboptimal controller that can eliminate chattering in the continuous control output. Simulated examples are included to demonstrate the effectiveness of the proposed algorithm. | 15682621 | [
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Multi-model direct adaptive decoupling control with application to the wind tunnel system. | In this paper; a new multi-model direct adaptive decoupling controller is presented for multivariable processes; which includes multiple fixed optimal controllers; one free-running adaptive controller; and one re-initialized adaptive controller. The fixed controllers provide initial control to the process if its model lies in the corresponding region. For each controller selected; the re-initialized adaptive controller uses the values of this particular controller to improve the adaptation speed. This contr | 15682622 | [
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Multi-model direct adaptive decoupling control with application to the wind tunnel system. | oller may replace the fixed controller at a later stage according to the switching criterion which is to select the best one among all controllers. A free-running adaptive controller is also added to guarantee the overall system stability. Different from the multiple models adaptive control structure proposed in Narendra; Balakrishnan; and Ciliz [Adaptation and learning using multiple models; switching; and tuning. IEEE Control Syst. Mag. 15; 37-51 (1995)]; the method not only is applicable to the multi-inp | 15682622 | [
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Multi-model direct adaptive decoupling control with application to the wind tunnel system. | ut multi-output processes but also identifies the decoupling controller parameters directly; which reduces both the computational burden and the chances of a singular matrix during the process of determining controller parameters. Several examples for a wind tunnel process are given to demonstrate the effectiveness and practicality of the proposed method. | 15682622 | [
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Design and analysis of controllers for a double inverted pendulum. | A physical control problem is studied with the Hinfinity; and the micro methodology. The issues of modeling; uncertainty modeling; performance specification; controller design; and laboratory implementation are discussed. The laboratory experiment is a double inverted pendulum placed on a cart. The limitations in the system with respect to performance are the limitation in the control signal and the limitation of the movement of the cart. It is shown how these performance limitations will effect the design | 15682623 | [
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Design and analysis of controllers for a double inverted pendulum. | of Hinfinity and micro controllers for the system. | 15682623 | [
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Why are broad contraceptive choices important? | nan | 15682625 | [
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Contraceptive coverage grows, but significant challenges remain. | Coverage for women's health care in general; and contraception in particular; is included in most health insurance plans. Twenty-one states mandate equal coverage between men and women; but not all Food and Drug Administration-approved approaches are reimbursed. In addition; some employers opt out; despite landmark rulings. | 15682626 | [
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A conversation with Ruth Shaber, MD. | A fundamental aspect of preventive health care for women includes the provision of contraceptive benefits. However; birth control coverage in managed care plans is often limited. Ruth Shaber; MD; Director; Women's Health Services at Kaiser Permanente; Northern California; San Francisco; discusses the plan's philosophy regarding the fundamental nature of contraceptive benefits for women; and the various ways in which Kaiser Permanente is a leader in offerering women a more complete health program. | 15682627 | [
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Employee knowledge of a managed pharmacy benefit in a large corporation. | Knowledge about prescription drug benefits is necessary for consumers to choose appropriate health benefits plans in a consumer-directed health plan market. The objective of this study was to describe employees' knowledge of their prescription drug benefits. A one-group; cross-sectional survey of full-time university employees with a tiered pharmacy benefit was performed. Correct responses to knowledge questions were described individually and as an aggregate index score. Respondent understanding of pharmac | 15682630 | [
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Employee knowledge of a managed pharmacy benefit in a large corporation. | y benefits was low to moderate. Specifically; knowledge of pharmacy benefits was most limited with respect to formulary management; cost sharing; and financial implications of out-of-network use and the selection of a branded or generic medication. Future research should refine methods for assessing knowledge of pharmacy benefits; explore knowledge of pharmacy benefits in diverse samples; and assess the consequences associated with variations in knowledge of prescription drug benefits. | 15682630 | [
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Health savings accounts are a new source of patients for disease management. | nan | 15682631 | [
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How to implement a disease management program: ten steps to success . | nan | 15682632 | [
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Pharmacoeconomic analysis of sequential treatment pathways in the treatment of onychomycosis. | This study examines the budgetary effect of using ciclopirox; itraconazole (pulse treatment); terbinafine; or itraconazole (continuous treatment) as first-; second-; or third-line therapy in the treatment of toenail onychomycosis by determining which therapeutic sequence is most cost effective. Using a disease treatment pathway model; alternative agents were compared based on cost per clinical response. The results from this sequential treatment analysis demonstrated that ciclopirox followed by itraconazole | 15682633 | [
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Pharmacoeconomic analysis of sequential treatment pathways in the treatment of onychomycosis. | pulse and then terbinafine provides the lowest-cost approach to the treatment of onychomycosis (dollar 757.89 per clinical response); followed by the sequence of ciclopirox; terbinafine; and itraconazole pulse (dollar 796.13 per clinical response). This study provides a framework for formulary decision makers to evaluate a sequential treatment pathway that resembles actual practice. | 15682633 | [
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Do employers voluntarily include patient protections in self-insured managed care plans? | Managed care patient protection laws passed by states do not apply to health plans sponsored by self-insured employers; although 54% of workers who receive health insurance coverage through their employer are in self-insured plans. In-depth interviews conducted in five states with employers offering self-insured health benefits and with other knowledgeable market informants provide evidence that self-insured managed care plans nonetheless include important features that strengthen subscribers' access to med | 15682634 | [
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Are the breast cancer screening recommendations clear or confusing? | The American public is convinced that cancer screening tests are valuable. Breast cancer screening recommendations have recently received a great deal of attention. Careful review of the available data reveals that combined annual mammography and clinical breast examination is the appropriate breast cancer screening program for most women over the age of 40. However; a small group of women with a genetic susceptibility for breast cancer may benefit from additional imaging. In this article; the criteria for | 15682635 | [
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Are the breast cancer screening recommendations clear or confusing? | a good screening program are identified. | 15682635 | [
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Subsets and Splits