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Search Results: 1 - 10 of 168610 matches for " Don E Detmer "
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Building the national health information infrastructure for personal health, health care services, public health, and research
Don E Detmer
BMC Medical Informatics and Decision Making , 2003, DOI: 10.1186/1472-6947-3-1
Abstract: A national health information infrastructure for the United States should address the needs of personal health management, health care delivery, public health, and research. It should also address relevant global dimensions (e.g., standards for sharing data and knowledge across national boundaries). The public and private sectors will need to collaborate to build a robust national health information infrastructure, essentially a 'paperless' health care system, for the United States. The federal government should assume leadership for assuring a national health information infrastructure as recommended by the National Committee on Vital and Health Statistics and the President's Information Technology Advisory Committee. Progress is needed in the areas of funding, incentives, standards, and continued refinement of a privacy (i.e., confidentiality and security) framework to facilitate personal identification for health purposes. Particular attention should be paid to NHII leadership and change management challenges.A national health information infrastructure is a necessary step for improved health in the U.S. It will require a concerted, collaborative effort by both public and private sectors.If you cannot measure it, you cannot improve it. Lord KelvinBetter health in the 21st century – it is what we seek for our families, our patients, our neighbors, our communities, our nation, and indeed people all over the world. It is a matter of quality of life for individuals, stability and happiness within communities, productivity for industry, security for nations, and professional satisfaction for heath workers. Maintaining and improving health is not an abstract notion. We already know much about where and how we fall short in assuring health. We also know the potential to improve health grows daily as result of the steady flow of research advances.The health of individuals and the population depends on four major domains of our vast, complex, and disorganized health secto
Beyond Trial Registration: A Global Trial Bank for Clinical Trial Reporting
Ida Sim ,Don E Detmer
PLOS Medicine , 2005, DOI: 10.1371/journal.pmed.0020365
Beyond trial registration: a global trial bank for clinical trial reporting.
Sim Ida,Detmer Don E
PLOS Medicine , 2005,
How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings
Nancy M Lorenzi, Angelina Kouroubali, Don E Detmer, Meryl Bloomrosen
BMC Medical Informatics and Decision Making , 2009, DOI: 10.1186/1472-6947-9-15
Abstract: The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process.The EHR implementation experience depends on a variety of factors including the technology, training, leadership, the change management process, and the individual character of each ambulatory practice environment. Sound processes must support both technical and personnel-related organizational components. Additional research is needed to further refine recommendations for the small physician practice and the nuances of specific medical specialties.Physicians in ambulatory practices are under increasing pressure to use computer-based systems to support the clinical side
Non-invasive neurosensory testing used to diagnose and confirm successful surgical management of lower extremity deep distal posterior compartment syndrome
Eric H Williams, Don E Detmer, Gregory P Guyton, A Lee Dellon
Journal of Brachial Plexus and Peripheral Nerve Injury , 2009, DOI: 10.1186/1749-7221-4-4
Abstract: Non-painful neurosensory testing of the myelinated large sensory nerve fibers of the lower extremity were obtained with the Pressure Specified Sensory Device? in a 25 year old male with history and invasive compartment pressures consistent with CECS both before and after running on a tread mill. After the patient's first operation to release the deep distal posterior compartment, the patient failed to improve. Repeat sensory testing revealed continued change in his function with exercise. He was returned to the operating room where a repeat procedure revealed that the deep posterior compartment was not completely released due to an unusual anatomic variant, and therefore complete release was accomplished.The patient's symptoms numbness in the plantar foot and pain in the distal calf improved after this procedure and his repeat sensory testing performed before and after running on the treadmill documented this improvement.This case report illustrates the principal that non-invasive neurosensory testing can detect reversible changes in sensory nerve function after a provocative test and may be a helpful non-invasive technique to managing difficult cases of persistent lower extremity symptoms after failed decompressive fasciotomies for CECS. It can easily be performed before and after exercise and be repeated at multiple intervals without patient dissatisfaction. It is especially helpful when other traditional testing has failed.Chronic exertional compartment syndrome (CECS) is defined as a condition in which exercise or heavy exertion creates elevated pressures within the closed space of an extremity muscular compartment which subsequently causes consistently recurring symptoms and/or disability by progressive impairment of the neuromuscular function of the involved compartment [1-6]. The diagnosis of CECS is primarily made on careful history that demonstrates consistent appearance of symptoms in the same compartments in the lower extremities with exertion. Symptoms m
Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care
Don Detmer, Meryl Bloomrosen, Brian Raymond, Paul Tang
BMC Medical Informatics and Decision Making , 2008, DOI: 10.1186/1472-6947-8-45
Abstract: While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders.Integrated PHRs promote active, ongoing patient collaboration in care delivery and decision making. With some exceptions, however, the integrated PHR model is still a theoretical framework for consumer-centric health care. The authors pose questions that need to be answered so that the field can move forward to realize the potential of integrated PHRs. How can integrated PHRs be moved from concept to practical application? Would a coordinating body expedite this progress? How can existing initiatives and policy levers serve as catalysts to advance integrated PHRs?Personal health records (PHRs) are consumer-centric tools that can strengthen consumers' ability to activ
Response to: ‘Should Ecosystem Management Involve Active Control of Species Abundances?’
Don E. Harron
Ecology and Society , 2006,
Branchiogenic Basaloid Squamous Cell Carcinoma with Adenosquamous Features. Branchiogenic Carcinoma in the Setting of Another Head and Neck Primary: Literature Review and Report of a Case  [PDF]
Riley E. Alexander, Don-John Summerlin, Muhammad T. Idrees
Open Journal of Pathology (OJPathology) , 2012, DOI: 10.4236/ojpathology.2012.23013
Abstract: The diagnosis of branchiogenic carcinoma is one of significant controversies in the field of head and neck oncology. Those who support its existence adhere to rigid criteria to validate its existence. Those that deny it, purport that the entity is simply metastatic disease masquerading as a branchial cleft primary. One aspect of agreement between the two opposing views is that a separate head and neck primary disqualifies the diagnosis of branchiogenic carcinoma. We report a case in which branchiogenic carcinoma was diagnosed in the presence of an additional base of tongue primary squamous cell carcinoma based on morphologic dissimilarity and evidence of origination from the basal layer of the branchial cleft epithelium. In doing so, we attempt to make the case that unequivocal histologic evidence of branchial cleft origin is the defining feature of branchiogenic carcinoma and, as with many other carcinomas, should be the diagnostic criterion of choice in issuing the diagnosis. A brief pertinent literature review is presented.
Live bacterial vaccines – a review and identification of potential hazards
Ann Detmer, Jacob Glenting
Microbial Cell Factories , 2006, DOI: 10.1186/1475-2859-5-23
Abstract: Live vaccines have played a critical role from the beginning of vaccinology. Indeed, the very first vaccination experiment in the Western world was Jenner's inoculation of a boy with the milder cowpox virus to protect against the deadly smallpox. Although effective the technology has safety problems associated with the risk of reversion to a virulent organism and the possibility of causing disease in immune compromised individuals. Within the last 20 years the concept of live vaccines gains renewed interest due to our increased immunological understanding and the availability of molecular techniques making the construction of safer live vaccines possible. This opens for the development of new live bacterial vaccines that can avoid the downsides of parenterally administered vaccine because it (i) mimics the route of entry of many pathogens and stimulate the mucosal immune response (ii) can be administered orally or nasally avoiding the risk associated with contaminated needles and need for a professional healthcare infra structure (iii) has a simple down stream processing. Broadly, live bacterial vaccines can be classified as a self-limiting asymptomatic organism stimulating an immune response to one or more expressed antigens.Furthermore, live bacterial vaccines can be designed to induce an immune response to itself or to a carried heterologous antigen. A non-virulent or attenuated derivative of the pathogen is used to induce a response to the bacterium itself. When used as a vaccine vehicle the bacterium expresses an antigen from another species. Most commonly, these vaccine vehicles are based on either attenuated pathogens or bacteria used in the food industry. Both classes of bacteria deliver the vaccine component to the immune system whereby immunization may benefit from the bacterium's intrinsic adjuvant. The vaccine component to be delivered can be either protein or DNA. In addition, the vaccine component may be a classical antigen but may also be allergens or
The identity of Myotis punensis (Chiroptera: Vespertilionidae)
Moratelli, Ricardo;Wilson, Don E;
Zoologia (Curitiba) , 2011, DOI: 10.1590/S1984-46702011000100016
Abstract: currently twelve species of myotis kaup, 1829 (vespertilionidae: myotinae) are recognized from south america, with several other named taxa regarded as synonyms, among them myotis punensis j.a. allen, 1914. this name was first regarded as a junior synonym of myotis albescens (é. geoffroy, 1806) and subsequently of myotis nigricans (schinz, 1821). to address the taxonomic status of the holotype of m. punensis, we compared it to all south american species in the genus. the fringe of hairs on the trailing edge of the uropatagium, the fur color, and external and skull dimensions all suggest m. punensis should be treated as a junior synonym of m. albescens
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