Utilization of medical imaging informatics and biometrics technologies in healthcare delivery

Purpose

With the large amount of image data accumulated daily from medical imaging modalities and picture archiving and communication systems (PACS) in hospitals and from healthcare biometrics related databases, we can take advantage of these data resources to investigate innovative clinical service, research and education using the concept of imaging informatics. In this paper we present five independent concepts and technologies in their own right and their intertwined relationship in achieving some goal-oriented healthcare applications.

Methods

The five independent concepts and technologies with goal-oriented healthcare applications include medical imaging informatics infrastructure; Data Grid for image fault tolerant backup and disaster recovery; integration of computer-assisted detection and diagnosis (CAD) in daily clinical practice; biometrics technology for patient location and identification in an enterprise Hospital/Radiology information system (HIS/RIS/PACS) integrated environment; and the concept of in vivo image-guided diagnosis and real-time surgical treatment.

Conclusion

The success of implementing these novel technologies and concepts would have tremendous impact to better present and future healthcare delivery as illustrated by examples in the paper.     

Diversity issues in the delivery of healthcare

What does it mean to be culturally competent and proficient? What criteria are used to describe a culturally competent healthcare delivery system and how can an individual or an organization grow in competency? What is the delivery of competent care related to me personally?This article addresses these questions with the assumption that knowing one's viewpoints on how culture change offers a sample of the glasses through which we view others. Culture and culture change are defined, and four models that explain the process of culture change are discussed in detail. These models represent different world views held to explain the phenomena of acculturation. The article concludes with a summary of the recommended National Standards for cultural and linguistic appropriate healthcare services developed by the Office of Minority Health. The concepts described can serve as universal tools for individuals and/or organizations interested in cultural competency.     

Improving healthcare accessibility through point-of-care technologies

BACKGROUND: The NIH is committed to improving healthcare quality in the US and has set up initiatives to address problems such as the fragmented nature of healthcare provision. A hypothesis has been developed that testing closer to the point at which care is delivered may reduce fragmentation of care and improve outcomes. METHODS: The National Institute of Biomedical Imaging and Bioengineering (NIBIB), the NIH's National Heart, Lung, and Blood Institute, and the National Science Foundation sponsored a workshop, "Improving Health Care Accessibility through Point-of-Care Technologies," in April 2006. The workshop assessed the clinical needs and opportunities for point-of-care (POC) technologies in primary care, the home, and emergency medical services and reviewed minimally invasive and noninvasive testing, including imaging, and conventional testing based on sensor and lab-on-a-chip technologies. Emerging needs of informatics and telehealth and healthcare systems engineering were considered in the POC testing context. Additionally, implications of evidence-based decision-making were reviewed, particularly as it related to the challenges in producing reliable evidence, undertaking regulation, implementing evidence responsibly, and integrating evidence into health policy. RESULTS: Many testing procedures were considered to be valuable in the clinical settings discussed. Technological solutions were proposed to meet these needs, as well as the practical requirements around clinical process change and regulation. From these considerations, a series of recommendations was formulated for development of POC technologies based on input from the symposium attendees. CONCLUSION: NIBIB has developed a funding initiative to establish a Point-of-Care Technologies Research Network that will work to bridge the technology/clinical gap and provide the partnerships necessary for the application of technologies to pressing clinical needs in POC testing.     

Complexity science and leadership in healthcare.

The emerging field of complexity science offers an alternative leadership strategy for the chaotic, complex healthcare environment. A survey revealed that healthcare leaders intuitively support principles of complexity science. Leadership that uses complexity principles offers opportunities in the chaotic healthcare environment to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve to produce creative outcomes.     

Emerging technologies in the delivery of erythropoietin for therapeutics

Deciphering the function of proteins and their roles in signaling pathways is one of the main goals of biomedical research, especially from the perspective of uncovering pathways that may ultimately be exploited for therapeutic benefit. Over the last half century, a greatly expanded understanding of the biology of the glycoprotein hormone erythropoietin (Epo) has emerged from regulator of the circulating erythrocyte mass to a widely used therapeutic agent. Originally viewed as the renal hormone responsible for erythropoiesis, recent in vivo studies in animal models and clinical trials demonstrate that many other tissues locally produce Epo independent of its effects on red blood cell mass. Thus, not only its hematopoietic activity but also the recently discovered nonerythropoietic actions in addition to new drug delivery systems are being thoroughly investigated in order to fulfill the specific Epo release requirements for each therapeutic approach. The present review focuses on updating the information previously provided by similar reviews and recent experimental approaches are presented to describe the advances in Epo drug delivery achieved in the last few years and future perspectives. © 2009 Wiley Periodicals, Inc. Med Res Rev, 31, No. 2, 284–309, 2011     

Gene delivery technologies for cardiac applications

Ischemic heart disease (IHD) and heart failure (HF) are major causes of morbidity and mortality in the Western society. Advances in understanding the molecular pathology of these diseases, the evolution of vector technology, as well as defining the targets for therapeutic interventions has placed these conditions within the reach of gene-based therapy. One of the cornerstones of limiting the effectiveness of gene therapy is the establishment of clinically relevant methods of genetic transfer. Recently there have been advances in direct and transvascular gene delivery methods with the use of new technologies. Current research efforts in IHD are focused primarily on the stimulation of angiogenesis, modify the coronary vascular environment and improve endothelial function with localized gene-eluting catheters and stents. In contrast to standard IHD treatments, gene therapy in HF primarily targets inhibition of apoptosis, reduction in adverse remodeling and increase in contractility through global cardiomyocyte transduction for maximal efficacy. This article will review a variety of gene-transfer strategies in models of coronary artery disease and HF and discuss the relative success of these strategies in improving the efficiency of vector-mediated cardiac gene delivery.     

Quantifying income-related inequality in healthcare delivery in the United States

BACKGROUND: Numerous studies have found that high-income Americans use more medical care than their low-income counterparts, irrespective of medical "need." The methods employed in these studies, however, make it difficult to evaluate differences in the degree of income-related inequality in utilization across population subgroups. In this study, we derive a summary index to quantify income-related inequality in need-adjusted medical care expenditures and report values of the index for adults and children in the United States. METHODS: We used the summary index of income-related inequality in expenditures developed by Wagstaff et al. 1 The source of data for the study was the Household Component of the 1996-1998 Medical Expenditure Panel Survey, which contains person-level data on medical care expenditures, demographic characteristics, household income, and a wide array of health status measures. We used multivariate regression analysis to predict need-adjusted annual medical care expenditures per person by income level and used the predictions to calculate the indices of inequality. Separate indices were calculated for all adults, working-age adults, seniors, and children ages 5 to 17. RESULTS: For all age groups, predicted expenditures per person, adjusted for medical need, generally increased as income rose. The index of inequality for all adults was +0.087 (95% confidence interval, +0.035, +0.139); for working-age adults, +0.099 (+0.046, +0.152); for seniors, +0.147 (+0.059, +0.235); and for children, +0.067 (+0.006, +0.128). CONCLUSIONS: There exists income-related inequality in medical care expenditures in the United States, and it favors the wealthy. The inequality is highest among seniors despite Medicare, intermediate among working-age adults, and lowest among children.     

Improving healthcare delivery with the transformational whole person care model

A Whole Person Care model was developed by The New England School of Whole Health Education following a 2-year pilot study that demonstrated the transformational effects of whole health education. This holistic model of health education and behavioral interaction provides a tool for nurses, physicians, and staff to redirect the momentum of care toward in-the-moment, relationship-centered whole person care, improving healthcare worker and patient satisfaction and outcomes.     

Migration of women from the Philippines: implications for healthcare delivery

Filipinos have been an important part of the global workforce since the first half of the twentieth century. The initial migration of primarily men has shifted to an increasing numbers of women in recent decades. These changes are primarily attributed to a high demand for domestic workers, nurses and occupations that are female dominated. In 2005, about 70% of the international Labour migrants are women from the Philippines. Living in a foreign land, these women face challenges that affect their physical, emotional and social well being. Especially on their first year living abroad, these women experience significant stress which affects their health as they adjust to a new work environment, culture, social norms, diet, and weather. The emotional strain can be greater for those who have left their families behind in the Philippines and aggravated by the financial need to send money to them. Striking examples, such as the homicide rate of Filipino women married to Australian men being 5.6 times higher than that of Australian-born women, underscores the importance of supportive health care environments and appreciating socio-cultural factors. In the delivery of healthcare services to migrant women, it is critical to consider the unique socio-cultural background of women as well as health beliefs and practices.