Encapsulation of 67Cu therapeutic radiometal in luminescent lanthanide phosphate core and core-shell nanoparticles.

Copper-67 (67Cu) has physical characteristics useful for both therapy and imaging. However, its applicability has been hindered by the complexity of obtaining large quantities of a product with high specific activity. With the advancement of 67Cu production methods, suitable radioisotope carriers are sought. Lanthanide phosphate nanoparticles have demonstrated their multifunctional characteristics for biomedical applications and, more recently, their potential in radiopharmaceuticals. Thus, we produced luminescent lanthanide phosphate nanoparticles with core and core-shell structures, incorporating 67Cu during their synthesis. The nanoparticles exhibited hexagonal crystalline structure and spherical morphology with sizes below 6 nm. The luminescent colloidal suspensions evidenced the characteristic 5D0-7FJ for Eu3+, providing the red color under UV light. A radiochemical yield of 67Cu >95% was obtained with both core and core-shell LaPO4:Eu. The core-shell nanoparticles reduced the release of 67Cu by a factor of ∼2 over that from the core, which continuously decreased with time. Multifunctional LnPO4 nanoparticles have the potential to be used as a carrier of single or multiple radioisotopes to enhance image-guided targeted nano-radiopharmaceutical therapy.

Standardized problem list generation, utilizing the Mayo canonical vocabulary embedded within the Unified Medical Language System.

UNLABELLED: VOCABULARY: The Mayo problem list vocabulary is a clinically derived lexicon created from the entries made to the Mayo Clinic's Master Sheet Index and the problem list entries made to the Impression/ Report/Plan section of the Clinical Notes System over the last three years. The vocabulary was reduced by eliminating repetition including lexical variants, spelling errors, and qualifiers (Administrative or Operational terms). Qualifiers are re-coordinated with other terms, at run-time, which greatly increased the number of input strings which our system is capable of recognizing. IMPLEMENTATION: The Problem Manager is implemented using standard windows tools in a Windows NT environment. The interface is designed using Object Pascal. HTTP calls are passed over the World Wide Web to a UNIX based vocabulary server. The server returns a document, which is read into Object Pascal structures, parsed, filtered and displayed. STUDY: This paper reports the results of a recent Usability Trial focused on assessing the viability of this mechanism for standardized problem entry. Eight clinicians engaged in eleven scenarios and responded as to their satisfaction with the systems performance. These responses were observed, videotaped and tabulated. Clinicians in this study were able to find acceptable diagnoses in 91.1% of the scenarios. The response time was acceptable in 92.5% of the scenarios. The presentation of related terms was stated to be useful in at least one scenario by seven of the eight participants. All clinicians wanted to make use of shortcuts which would minimize the amount of typing necessary to encode the concept they were searching for (e.g. Abbreviations, Word Completion). CONCLUSIONS: Clinicians are willing to choose a canonical term from a suggested list (as opposed to their own wording). Clinicians want an "intelligent" system, which would suggest terms within a category (e.g. Types of "Migraine"). They are able to make functional use of our system, in its current state of development. Finally, all clinicians appreciate the value of encoding their problems in a standardized vocabulary, toward improved research, education and practice.

A randomized controlled trial of a computer-based physician workstation in an outpatient setting: implementation barriers to outcome evaluation.

OBJECTIVE: A research prototype Physician Workstation (PWS) incorporating a graphical user interface and a drug ordering module was compared with the existing hospital information system in an academic Veterans Administration General Medical Clinic. Physicians in the intervention group received recommendations for drug substitutions to reduce costs and were alerted to potential drug interactions. The objective was to evaluate the effect of the PWS on user satisfaction, on health-related outcomes, and on costs. DESIGN: A one-year, two-period, randomized controlled trial with 37 subjects. MEASUREMENTS: Differences in the reliance on noncomputer sources of information, in user satisfaction, in the cost of prescribed medications, and in the rate of clinically relevant drug interactions were assessed. RESULTS: The study subjects logged onto the workstation an average of 6.53 times per provider and used it to generate 2.8% of prescriptions during the intervention period. On a five-point scale (5 = very satisfied, 1 = very dissatisfied), user satisfaction declined in the PWS group (3.44 to 2.98 p = 0.008), and increased in the control group (3.23 to 3.72, p < 0.0001). CONCLUSION: The intervention physicians did not use the PWS frequently enough to influence information-seeking behavior, health outcomes, or cost. The study design did not determine whether the poor usage resulted from satisfaction with the control system, problems using the PWS intervention, or the functions provided by the PWS intervention. Evaluative studies should include provisions to improve the chance of successful implementation as well as to yield maximum information if a negative study occurs.

Tutored videotape-instruction in clinical decision-making.

Tutored videotape-instruction (TVI) is a method for providing high quality instruction in topics for which the supply of expert teachers is limited. A small group of students and a tutor can watch a videotaped lecture that can be interrupted for discussion or questions. The tutor facilitates discussion and directs the students to outside reading. The authors in this report describe the use of tutored videotape-instruction in teaching clinical decision-making. Students were randomly assigned to a tutored videotape-instruction group or to a group that heard identical live lectures. The two groups had the same mean score on a final examination on the course material. The group that heard the live lectures rated the quality of instruction higher than the videotape group; however, the ratings were high for both groups. Tutored videotape-instruction provides expertise in a specialized topic and the advantages of instruction in small groups.