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IT in health care has evolved rapidly over the past 20 years. The rise of the computer is at the core of these changes. Most agree that although these technologies have revolutionized the practice of medicine, they have additionally fostered a data revolution that is simultaneously useful and disruptive. The effective use and implementation of the right IT tools are critical to the success of the imaging profession. This article serves as a guideline to radiologists on how to build an effective IT division within an imaging enterprise from the perspective of leadership, management, and human resources. We address the process for building an IT team from the ground up and also provide recommendations for modifying an existing IT group to make it more effective. Paramount to this discussion is the concept of the imaging informatics professional and the advantage this type of training brings to a radiology department. In addition, we focus on the critical role of the physician informaticist as a liaison to bridge gaps among the IT, medical, and administrative functions in an organization. [ABSTRACT FROM AUTHOR]

The corrosion rate of Mg alloys is currently too high for viable resorbable implant applications. One possible solution is to coat the alloy with a hydroxyapatite (HA) layer to slow the corrosion and promote bone growth. As such coatings can be under severe stresses during implant insertion, we present a nano-mechanical and nano-tribological investigation of RF-sputtered HA films on AZ31 Mg alloy substrates. EDX and XRD analysis indicate that as-deposited coatings are amorphous and Ca-deficient whereas rapid thermal annealing results in c-axis orientation and near-stoichiometric composition. Analysis of the nanoindentation data using a thin film model shows that annealing increases the coating's intrinsic hardness (H) and strain at break (H/E) values, from 2.7 GPa to 9.4 GPa and from 0.043 to 0.079, respectively. In addition, despite being rougher, the annealed samples display better wear resistance; a sign that the rapid thermal annealing does not compromise their interfacial strength and that these systems have potential for resorbable bone implant applications. [Display omitted] • We have successfully prepared RF-magnetron sputtered hydroxyapatite films on AZ31 Mg alloy substrate. • As-deposited coatings are amorphous and Ca-deficient whereas annealed ones are c-axis oriented and stoichiometric. • Annealing increases the coating's intrinsic hardness (H), strain at break (H/E) and wear resistance. • The critical load is similar for all coatings, a sign that the annealing has not compromised their interfacial strength. • Low temperature flash annealing of HA-coated Mg alloys enhances their potential as bone fracture fixation devices. [ABSTRACT FROM AUTHOR]

Abstract: Gaseous plasma discharges are one of the most common means to modify the surface of a polymer without affecting its bulk properties. However, this normally requires the materials to be processed in vacuo to create the active species required to permanently modify the surface chemistry. The ability to invoke such changes under normal ambient conditions in a cost-effective manner has much to offer to enhance the response of medical implants in vivo. It is therefore important to accurately determine the nature and scale of the effects derived from this technology. This paper reports on the modification of poly(styrene) (PS) and poly(methyl methacrylate) (PMMA) using atmospheric pressure plasma processing via exposure to a dielectric barrier discharge (DBD). The changes in surface chemistry and topography after DBD treatment were characterised using water contact angle, X-ray photoelectron spectroscopy (XPS) and atomic force microscopy. A marked increase in the surface oxygen concentration was observed for both PMMA and PS. An increase in surface roughness was observed for PMMA, but not for PS. These changes were found to result in an increase in surface wettability for both polymers. Adsorption of albumin (Alb) onto these substrates was studied using XPS and quartz crystal microbalance with dissipation (QCM-D). The rate of adsorption of Alb onto pristine PMMA and PS was faster than that on the DBD-treated polymers. XPS indicated that a similar concentration of Alb occurred on both of the treated surfaces. Deconvolution of the C1s XPS spectra showed that Alb is adsorbed differently on pristine (hydrophobic) compared to DBD-treated (hydrophilic) surfaces, with more polar functional groups oriented towards the upper surface in the latter case. The QCM-D data corroborates this finding, in that a more viscoelastic layer of Alb was formed on the DBD-treated surfaces relative to that on the pristine surfaces. It was also found that Alb was more easily replaced by larger proteins from foetal bovine serum on the DBD-treated surfaces. The viability of human lens epithelial cells on both of the DBD-treated polymer surface was significantly (P <0.05) greater than on the respective pristine surfaces. In addition, cells that adhered to the treated polymers exhibited a polygonal morphology with well spread actin stress fibres compared with the contracted shape displayed on the pristine surfaces. The results presented here clearly indicate that DBD surface modification has the capability to influence key protein and cell responses. [Copyright &y& Elsevier]

The use of EUS in the assessment of rectal pathology is well established. The accurate staging of lower intestinal tumours predicts prognosis and guides the planning of individual patient treatment. Increased experience and the development of high resolution three-dimensional EUS has lead to the greater accuracy of rectal staging with EUS of rectal tumours now considered the gold standard showing T stage accuracy that ranges from 75% to 95%, with N stage accuracy ranging from 65% to 80%. The use of EUS in the staging of colonic pathology, however, is not so well established though advances in miniprobe EUS has improved the assessment of colonic tumours. EUS is also of benefit in the assessment of anal pathology though here, accurate correlation with histology has not been firmly established. [ABSTRACT FROM AUTHOR]

Abstract: The role of roughening and functionalization processes involved in modifying the wettability of poly(ε-caprolactone) (PCL) after treatment by an atmospheric pressure glow discharge plasma is discussed. The change in the ratio of C3;O bonds is a significant factor influencing the wettability of PCL. As the contact angle decreases, the level of Cends to rise. Surface roughness alterations are the driving force for lasting increases in wettability, while the surface functional species are shorter lived. We can approximate from ageing that the increase in wettability for PCL after plasma treatment is 55–60% due to roughening and 40–45% due to surface functionalization for the plasma device investigated. [Copyright &y& Elsevier]

Purpose: We used physician assigned diagnoses in an electronic medical record to assess comorbidities associated with interstitial cystitis. Materials and Methods: A computer search of the administrative database at Kaiser Permanente Northwest, Portland, Oregon was performed for May 1, 1998 to April 30, 2003. All women with a medical record diagnosis of interstitial cystitis (ICD-9 code 595.1) were identified. These cases were then matched with 3 controls each based on age and duration in the health plan. The medical diagnoses (using ICD-9 codes restricted to 3 digits) assigned to these 2 groups were compared using the OR. Results: A total of 239 cases and 717 matched controls were analyzed. There were 23 diagnoses that were significantly more common in cases than in controls (p ≤0.005). Seven of these 23 diagnoses were other urological or gynecological codes used to describe pelvic symptoms. Additional specific conditions associated with interstitial cystitis were gastritis (OR 12.2), child abuse (OR 9.3), fibromyalgia (OR 3.0), anxiety disorder (OR 2.8), headache (OR 2.5), esophageal reflux (OR 2.2), unspecified back disorder (OR 2.2) and depression (OR 2.0). Conclusions: A diagnosis of interstitial cystitis was associated with multiple other unexplained physical symptoms and certain psychiatric conditions. Studies to explore the possible biological explanations for these associations are needed. Interstitial cystitis was also associated with a history of child abuse, although 96% of patients with IC did not have this diagnosis. [Copyright &y& Elsevier]

CareOregon, an Oregon-based not-for-profit Medicaid health plan, successfully piloted a "CareSupport" model that identifies high-risk members and clinically stratifies them for intervention. Internal analyses indicate that CareSupport lowers utilization and cost; CareOregon, however, has lacked patient-reported outcome data on the health-related quality of life (HRQL) of Care-Support participants. Between September 2005 and November 2006, we conducted a pilot study in which the Health Utilities Index Mark 3 (HUI3), a generic preference-based measure of health status and HRQL, was integrated into CareOregon's existing screening algorithm for possible admission into Care-Support. We obtained baseline data on 616 CareSupport candidates and 4-month HUI3 follow-up data on 143 candidates (104 CareSupport, 39 non-CareSupport). On a 0.00 (dead)-to- 1.00 (perfect health) scale, the mean overall baseline HUI3 score for CareSupport patients was 0.18 (0.20 for non-CareSupport patients), comparable to baseline means reported elsewhere for much older patients immediately after suffering serious acute medical events, such as stroke or hip fracture. A 0.05 mean 4-month improvement in overall HRQL among CareSupport enrollees relative to non-CareSupport enrollees was clinically important but not statistically significant. A 0.10 improvement in HUI3 emotion was both statistically significant and clinically important. Study results provide good preliminary evidence of the value of patient-reported outcomes in clarifying individual illness burden and assessing intervention effectiveness. [ABSTRACT FROM AUTHOR]

Purpose: We quantified the degree of symptomatic overlap in individuals who reported urological symptoms and compared these patterns between men and women. Materials and Methods: A questionnaire was mailed to a random sample of the Kaiser Permanente Northwest membership with no medical record evidence of pelvic malignancy or neurological disease. The questionnaire included the International Prostate Symptom Scale, Interstitial Cystitis Symptom Index and Problem Index, and National Institutes of Health Chronic Prostatitis Symptom Index. The 701 men and 745 women who reported urological symptoms were selected for analysis. The degree of overlap of storage symptoms, voiding symptoms and pain symptoms was assessed. Multiple logistic regression was used to determine symptom predictors. Results: There was a high degree of overlap among the 3 symptom categories with few observed differences between men and women. Of individuals with storage or voiding symptoms 34% of men and 43% of women also had pain symptoms. Of those with pain 90% of men and 94% of women also had voiding or storage symptoms. Logistic regression results indicated that frequency, urgency and any storage symptoms were statistically more common in women than in men, while a slow stream was more common in men than in women. Conclusions: As previously reported, there are limited differences in the degree and distribution of lower urinary tract symptoms in men and women. To our knowledge the novel finding of this study is that pain symptoms commonly coincide with voiding and storage symptoms in the 2 genders. This suggests that categorizing patients into disease categories, such as lower urinary tract symptoms or bladder conditions, may ignore the pain components of symptoms. A symptom based classification symptom may more accurately identify and address all patient complaints. [Copyright &y& Elsevier]

Purpose: Previous studies to assess risk factors for prostatitis used patient self-reported data and, therefore, they were subject to recall bias. We 1) used coded physician diagnoses to calculate the prevalence of prostatitis and 2) compared these patients with matched controls to identify medical conditions that are associated with prostatitis. Subjects were male enrollees in the Kaiser Permanente Northwest, Portland, Oregon health maintenance organization. Materials and Methods: A computer search of the Kaiser Permanente Northwest administrative database was performed for May 1, 1998 to April 30, 2004 to identify men with a coded diagnosis of prostatitis. Prostatitis cases were each age matched with 3 controls and the medical diagnoses (using 3-digit International Classification of Diseases, 9th Revision codes) assigned to these 2 groups were compared. Results: A prostatitis diagnosis was present in 4.5% of the male population. There were 37 diagnoses that were significantly more common in cases than in controls (p <0.0001). Most of them were other urological codes to describe prostatitis symptoms, unexplained physical symptoms in other organ systems and psychiatric diagnoses. The strongest observed associations were with benign prostatic hyperplasia (OR 2.7), functional digestive disorders (OR 2.6), dyspepsia (OR 2.1), anxiety disorders (OR 2.0), other soft tissue disorders (OR 2.0), esophageal reflux (OR 1.8) and mood disorders (OR 1.8). Conclusions: Prostatitis is a commonly diagnosed condition in the community setting, affecting approximately 1/22 men. The diagnosis is associated with multiple other unexplained physical symptoms and certain psychiatric conditions. Studies to explore possible biological explanations for these associations are needed. [Copyright &y& Elsevier]

Purpose: We calculated the prevalence of symptoms typically associated with chronic prostatitis/chronic pelvic pain syndrome in men in a managed care population in the Pacific Northwest. Materials and Methods: A questionnaire mailing to 5,000 male enrollees 25 to 80 years old in the Kaiser Permanente Northwest (Portland, Oregon) health plan was performed. The questionnaires included screening questions about the presence, duration and severity of pelvic pain, and the National Institutes of Health Chronic Prostatitis Symptom Index. Chronic prostatitis/chronic pelvic pain syndrome symptoms were defined in 2 ways: 1) presence of any of the following for a duration of 3 or more months: pain in the perineum, testicles, tip of penis, pubic or bladder area, dysuria, ejaculatory pain; and 2) perineal and/or ejaculatory pain, and a National Institutes of Health Chronic Prostatitis Symptom Index total pain score of 4 or more. Prevalence estimates were age adjusted to the total Kaiser Permanente Northwest male population. Results: A total of 1,550 questionnaires were returned. The prevalence of chronic prostatitis/chronic pelvic pain syndrome symptoms was 7.5% for definition 1 and 5.9% for definition 2. Mean National Institutes of Health Chronic Prostatitis Symptom Index scores were 17 for definitions 1 and 2. Of those with prostatitis-like symptoms, 30% met criteria for having both definitions present. The prevalence of prostatitis-like symptoms using either of the 2 diagnoses was 11.2%. Conclusions: This population based study indicates that approximately 1 in 9 men have prostatitis-like symptoms. Application of 2 different definitions for prostatitis-like symptoms identified unique groups of men, with limited overlap in the groups. [Copyright &y& Elsevier]

BACKGROUND: Although the ASGE recommends that high-risk endoscopic procedures can safely be performed on patients taking aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) in standard doses, there is a paucity of data on EUS-FNA per se in this setting. OBJECTIVE: We studied the safety and cellular yield of EUS-FNA and/or Trucut biopsy (TCB) in patients taking aspirin, NSAIDS, or prophylactic low molecular weight heparins (LMWH). DESIGN: Prospective control study. PATIENTS: Consecutive patients undergoing EUS-FNA and/or TCB were recruited over an 18-month period. The usage of aspirin, NSAIDS, or LMWH were recorded and patients who were not taking these medications served as controls. MAIN OUTCOME MEASUREMENTS: The bleeding events (endosonographic findings of extraluminal bleeding, intraluminal bleeding requiring hemostatic procedures, hematemesis, or melena) and cellular yield were compared between patients and controls. RESULTS: Two hundred fourteen patients (8 had repeat procedures) underwent EUS-FNA and/or TCB on 241 lesions. Bleeding events occurred in none (0 of 26), 33.3% (2 of 6), and 3.7% (7 of 190) of the patients in the aspirin/NSAIDS, LMWH, and control groups, respectively (p = 0.023). The mean numbers of FNA passes, applications of suction, bloody specimens, and cellular yield were not significantly different between patients who were or were not receiving medications. No significant difference in bleeding events was noted between the FNA and TCB groups. CONCLUSION: EUS-FNA or TCB is safe in patients taking aspirin or NSAIDS. Consideration should be given to stopping LMWH before the procedure. The cellular yield and blood contamination of the specimen from FNA are similar to those in controls. [ABSTRACT FROM AUTHOR]

Background: Although the ASGE recommends that high-risk endoscopic procedures can safely be performed on patients taking aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) in standard doses, there is a paucity of data on EUS-FNA per se in this setting. Objective: We studied the safety and cellular yield of EUS-FNA and/or Trucut biopsy (TCB) in patients taking aspirin, NSAIDS, or prophylactic low molecular weight heparins (LMWH). Design: Prospective control study. Patients: Consecutive patients undergoing EUS-FNA and/or TCB were recruited over an 18-month period. The usage of aspirin, NSAIDS, or LMWH were recorded and patients who were not taking these medications served as controls. Main Outcome Measurements: The bleeding events (endosonographic findings of extraluminal bleeding, intraluminal bleeding requiring hemostatic procedures, hematemesis, or melena) and cellular yield were compared between patients and controls. Results: Two hundred fourteen patients (8 had repeat procedures) underwent EUS-FNA and/or TCB on 241 lesions. Bleeding events occurred in none (0 of 26), 33.3% (2 of 6), and 3.7% (7 of 190) of the patients in the aspirin/NSAIDS, LMWH, and control groups, respectively (p = 0.023). The mean numbers of FNA passes, applications of suction, bloody specimens, and cellular yield were not significantly different between patients who were or were not receiving medications. No significant difference in bleeding events was noted between the FNA and TCB groups. Conclusion: EUS-FNA or TCB is safe in patients taking aspirin or NSAIDS. Consideration should be given to stopping LMWH before the procedure. The cellular yield and blood contamination of the specimen from FNA are similar to those in controls. [Copyright &y& Elsevier]

Background: Diagnosing primary sclerosing cholangitis (PSC) is problematic and requires meeting a burden of proof through clinical, biochemical, radiologic, and histological features. Endoscopic ultrasound yields detailed images of the extrahepatic biliary tree, but its value in contributing to the diagnosis of this condition is unknown. Objectives: To determine the potential for transduodenal EUS to detect common bile duct wall thickening in PSC. Design: A prospective, controlled study with retrospective, blinded data analysis. Setting: Single tertiary referral center for inflammatory bowel disease and EUS. Patients: Four groups of patients were assessed with radial endosonography: PSC (n = 9); inflammatory bowel disease (IBD) with abnormal liver blood tests (n = 21); choledocholithiasis (n = 15); and normal controls (n = 50). Measurements were made of the common bile duct diameter and wall thickness. Interventions: Transduodenal radial EUS of the biliary tree. Main Outcome Measurements: Common bile duct diameter and wall thickness. Results: The mean diameter (SD) of the common bile duct for the PSC, IBD, choledocholithiasis, and normal control groups measured 8.9 mm (2.8), 5.4 mm (1.7), 7.2 mm (2.2), and 5.0 mm (1.9), respectively (PSC and choledocholithiasis groups compared to the IBD group, P < .05 for a single test of hypothesis, but correction for the multiple testing of data removed this significance; normal control group P < .005). Mean ductal wall thickness (SD) was 2.5 mm (0.8) for the PSC group, 0.7 mm (0.4) for the IBD group, 0.8 mm (0.4) for the choledocholithiasis group, and 0.8 mm (0.4) for the normal control group, respectively (PSC group compared to the other 3 groups, P < .005). Limitations: Assessment of intrahepatic PSC is problematic. Conclusion: Thickening (>1.5 mm) of the common bile duct wall is seen in patients with PSC but not in those with apparently uncomplicated IBD or choledocholithiasis. The results of this study suggest that standard endosonography contributes to the imaging and potentially to the diagnosis of PSC. [Copyright &y& Elsevier]

ABSTRACT: Purpose: We calculated the prevalence and incidence of physician diagnosed interstitial cystitis (IC) in men and women in a managed care population in the Pacific Northwest. Materials and Methods: A computer search of the Kaiser Permanente Northwest (Portland, Oregon) database was performed for January 1998 to May 2002. The prevalence of IC in patients 25 to 80 years old was calculated using the 4 definitions of 1) patients assigned a diagnosis of IC, 2) patients assigned a diagnosis of IC without any of the consensus IC exclusion criteria, 3) patients who had also had undergone cystoscopy and 4) patients who had specifically undergone cystoscopy with hydrodistention for IC. A second database search was performed 1 year later (May 2003) to identify incident cases of IC. Results: The prevalence of IC was 197 per 100,000 women and 41 per 100,000 men for definition 1, 158 per 100,000 women and 28 per 100,000 men for definition 2, 99 per 100,000 women and 19 per 100,000 men for definition 3, and 45 per 100,000 women and 8 per 100,000 men for definition 4. Using definition 2 the 1-year incidence of IC was 21 per 100,000 women and 4 per 100,000 men. The female-to-male ratio for each estimate was 5:1. Conclusions: The prevalence and incidence of interstitial cystitis is significantly higher for women and men than previously published estimates. Men account for a higher proportion of patients with IC than has previously been recognized. [Copyright &y& Elsevier]

The integration of complementary and alternative medicine (CAM) with conventional medicine continues across practice settings and modalities. Managed care is of particular interest to practitioners, policy makers, and researchers concerned with the evolution of CAM integration. Within health maintenance organizations (HMOs), availability, coverage, and support of CAM are variable. We present an organizational model within which we identify factors that influence the degree of CAM integration within HMOs. We describe avenues through which CAM is currently available within the Northwest Region of Kaiser Permanente (KPNW). We also describe research methods applicable to the study of CAM integration within HMOs. [ABSTRACT FROM AUTHOR]

SUMMARY: BACKGROUND We examine the ability of various publicly available risk models to identify high-cost individuals and enrollee groups using multi-HMO administrative data.METHODS Five risk-adjustment models (the Global Risk-Adjustment Model [GRAM], Diagnostic Cost Groups [DCGs], Adjusted Clinical Groups [ACGs], RxRisk, and Prior-expense) were estimated on a multi-HMO administrative data set of 1.5 million individual-level observations for 1995-1996. Models produced distributions of individual-level annual expense forecasts for comparison to actual values. Prespecified “high-cost” thresholds were set within each distribution. The area under the receiver operating characteristic curve (AUC) for “high-cost” prevalences of 1% and 0.5% was calculated, as was the proportion of “high-cost” dollars correctly identified. Results are based on a separate 106,000-observation validation dataset.MAIN RESULTS For “high-cost” prevalence targets of 1% and 0.5%, ACGs, DCGs, GRAM, and Prior-expense are very comparable in overall discrimination (AUCs, 0.83-0.86). Given a 0.5% prevalence target and a 0.5% prediction threshold, DCGs, GRAM, and Prior-expense captured $963,000 (approximately 3%) more “high-cost” sample dollars than other models. DCGs captured the most “high-cost” dollars among enrollees with asthma, diabetes, and depression; predictive performance among demographic groups (Medicaid members, members over 64, and children under 13) varied across models.CONCLUSIONS Risk models can efficiently identify enrollees who are likely to generate future high costs and who could benefit from case management. The dollar value of improved prediction performance of the most accurate risk models should be meaningful to decision-makers and encourage their broader use for identifying high costs. [ABSTRACT FROM AUTHOR]

Objectives: Develop and estimate the RxRisk model, a risk assessment instrument that uses automated ambulatory pharmacy data to identify chronic conditions and predict future health care cost. The RxRisk model's performance in predicting cost is compared with a demographic-only model, the Ambulatory Clinical Groups (ACG), and Hierarchical Coexisting Conditions (HCC) ICD-9-CM diagnosis-based risk assessment instruments. Each model's power to forecast health care resource use is assessed.Data Sources: Health services utilization and cost data for approximately 1.5 million individuals enrolled in five mixed-model Health Maintenance Organizations (HMOs) from different regions in the United States.Study Design: Retrospective cohort study using automated managed care data. SUBJECTS All persons enrolled during 1995 and 1996 in Group Health Cooperative of Puget Sound, HealthPartners of Minnesota and the Colorado, Ohio and Northeast Regions of Kaiser-Permanente. MEASURES RxRisk, an algorithm that classifies prescription drug fills into chronic disease classes for adults and children.Results: HCCs produce the most accurate forecasts of total costs than either RxRisk or ACGs but RxRisk performs similarly to ACGs. Using the R(2) criteria HCCs explain 15.4% of the prospective variance in cost, whereas RxRisk explains 8.7% and ACGs explain 10.2%. However, for key segments of the cost distribution the differences in forecasting power among HCCs, RxRisk, and ACGs are less obvious, with all three models generating similar predictions for the middle 60% of the cost distribution.Conclusions: HCCs produce more accurate forecasts of total cost, but the pharmacy-based RxRisk is an alternative risk assessment instrument to several diagnostic based models and depending on the nature of the application may be a more appropriate option for medical risk analysis. [ABSTRACT FROM AUTHOR]

Is there a sound model for the United Kingdom (UK) to adopt should it decide to legislate against age discrimination in employment? In this article the writer attempts to answer this question first, by outlining existing UK sex and race discrimination laws and then progressing to an examination of long-standing American legislation and caselaw in this area. Finally, it explores the irish Employment Equality Act, 1998. a composite and comprehensive act which prohibits discrimination in employment based on `age' and eight other grounds. The strengths and weaknesses of each of these laws are examined in turn and measured against each other. The final analysis would suggest that each of these models can usefully inform any future law-making process to a greater or lesser degree and that good practice and legislation can co-exist in harmony. Moreover, the present lack of legislation in the UK against age discrimination in any area but especially employment, is remarkable when compared with British laws on sex and race discrimination and is ultimately unwise in the face of the real need for remedies and, the pre- sent and growing expansion in numbers of that portion of the population and the working population which British and European society call 'old.' [ABSTRACT FROM AUTHOR]