Enhancing transfusion safety with an innovative bar-code-based tracking system.

In an effort to reduce transfusion errors, a novel, comprehensive, computerized wireless bar-code-based tracking system for matching patients, blood samples and blood products was created and deployed at a major academic medical centre. With a grant from the Agency for Healthcare Research and Quality, software was developed to track scans at the times of sample collection, sample arrival in the blood bank, blood product dispensation from the blood bank and blood product administration. The system was deployed in February 2005. The system was well accepted from the outset, and the sample rejection rate due to clerical errors fell from 1.82 to 0.17%; incident reports fell by 83%. At the final blood administration step, the accumulated data as of November 2008 indicated that identification errors were being detected and prevented every 42.4 days and that the scan completion rate was stable at about 99%. Process analysis suggested that these were independent events and, thus, would be expected to coincide (and potentially produce a mis-transfusion) every 4,240 days (11.6 years) on average. We estimate that the system is 10 times safer than the manual system previously employed at our institution and may be 15-20 times safer than most systems employed in the United States.

Genetic analysis of a novel Xylella fastidiosa subspecies found in the southwestern United States.

Xylella fastidiosa, the causal agent of several scorch diseases, is associated with leaf scorch symptoms in Chitalpa tashkentensis, a common ornamental landscape plant used throughout the southwestern United States. For a number of years, many chitalpa trees in southern New Mexico and Arizona exhibited leaf scorch symptoms, and the results from a regional survey show that chitalpa trees from New Mexico, Arizona, and California are frequently infected with X. fastidiosa. Phylogenetic analysis of multiple loci was used to compare the X. fastidiosa infecting chitalpa strains from New Mexico, Arizona, and trees imported into New Mexico nurseries with previously reported X. fastidiosa strains. Loci analyzed included the 16S ribosome, 16S-23S ribosomal intergenic spacer region, gyrase-B, simple sequence repeat sequences, X. fastidiosa-specific sequences, and the virulence-associated protein (VapD). This analysis indicates that the X. fastidiosa isolates associated with infected chitalpa trees in the Southwest are a highly related group that is distinct from the four previously defined taxons X. fastidiosa subsp. fastidiosa (piercei), X. fastidiosa subsp. multiplex, X. fastidiosa subsp. sandyi, and X. fastidiosa subsp. pauca. Therefore, the classification proposed for this new subspecies is X. fastidiosa subsp. tashke.

A Web-based database for pathology faculty effort reporting.

To ensure appropriate mission-based budgeting and equitable distribution of funds for faculty salaries, our compensation committee developed a pathology-specific effort reporting database. Principles included the following: (1) measurement should be done by web-based databases; (2) most entry should be done by departmental administration or be relational to other databases; (3) data entry categories should be aligned with funding streams; and (4) units of effort should be equal across categories of effort (service, teaching, research). MySQL was used for all data transactions (http://dev.mysql.com/downloads), and scripts were constructed using PERL (http://www.perl.org). Data are accessed with forms that correspond to fields in the database. The committee's work resulted in a novel database using pathology value units (PVUs) as a standard quantitative measure of effort for activities in an academic pathology department. The most common calculation was to estimate the number of hours required for a specific task, divide by 2080 hours (a Medicare year) and then multiply by 100. Other methods included assigning a baseline PVU for program, laboratory, or course directorship with an increment for each student or staff in that unit. With these methods, a faculty member should acquire approximately 100 PVUs. Some outcomes include (1) plotting PVUs versus salary to identify outliers for salary correction, (2) quantifying effort in activities outside the department, (3) documenting salary expenditure for unfunded research, (4) evaluating salary equity by plotting PVUs versus salary by sex, and (5) aggregating data by category of effort for mission-based budgeting and long-term planning.

A comparative labor productivity analysis of blood collection centers.

BACKGROUND: Blood center labor benchmarking data may be helpful to optimize staffing and to establish productivity targets. Data were gathered and labor productivity was analyzed among blood donor centers of different sizes collecting different product mixes. STUDY DESIGN AND METHODS: Blood collection volumes and blood center labor data were obtained from eight blood centers: six regional centers, one mobile collection operation, and our hospital-affiliated center. A total of 2004 annual whole-blood (WB) collections and apheresis platelet (PLT) collections were captured. Full-time equivalents (FTEs) associated with blood collection operations were captured. With these data total unit (WB + PLT) collection rates per FTE were calculated. To compare value associated with each center's total unit collections, an indexed monetary value was assigned to WB and PLT and the value was calculated. RESULTS: Despite a 12-fold range in the size of operations, there was a strong correlation between total annual products collected and number of FTEs (mean 460 +/- 39 units/FTE). As expected, centers that collected relatively more PLTs had higher value per total unit collected. Surprisingly, however, there was no relationship between proportion of PLTs collected and total units collected per FTE. Centers collecting proportionately more PLTs therefore had higher value per FTE. CONCLUSION: A benchmark scale of labor productivity among blood donor centers of different sizes and product mixes was established. Product mix is not a major determinant of total unit collections per FTE but is an important determinant of value per FTE. Correlating collection targets with benchmark data from this survey may help determine optimal blood center labor allocation strategies.

Rehabilitation Medicine Summit: Building Research Capacity--executive summary.

The advancement of medical science depends on the production, availability, and utilization of new information generated by research. A successful research enterprise depends not only on a carefully designed agenda that responds to clinical and societal needs but also on the research capacity necessary to perform the work. Research that is likely to enhance clinical practice presupposes the existence of a critical mass of investigators working as teams in supportive environments. Unfortunately, far too little research capacity of that kind exists in rehabilitation medicine to ensure a robust future for the field. The "Rehabilitation Medicine Summit: Building Research Capacity" was conceptualized as a way of fashioning a long-term plan to foster the required developments.

Rehabilitation Medicine Summit: Building Research Capacity: executive summary.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.

Rehabilitation Medicine Summit: building research capacity.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.

Rehabilitation medicine summit: building research capacity (executive summary).

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were (a) researchers; (b) research culture, environment, and infrastructure; (c) funding; (d) partnerships; and (e) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A postsummit, multiorganizational initiative is called for to pursue the agendas outlined in this report.

Rehabilitation Medicine Summit: Building Research Capacity--executive summary.

The general objective of the Rehabilitation Medicine Summit: Building Research Capacity was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were: (1) researchers, (2) research environment, infrastructure, and culture, (3) funding, (4) partnerships, and (5) metrics. The [approximately] 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small-group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.

Rehabilitation medicine summit: building research capacity.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multiorganizational initiative is called to pursue the agendas outlined in this article.

Rehabilitation medicine summit: building research capacity. Executive summary.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were researchers; research culture, environment, and infrastructure; funding; partnerships; and metrics. Participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. Small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multiorganizational initiative is called for to pursue the agendas outlined in this report.

Rehabilitation medicine summit: building research capacity executive summary.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: 1) researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and 5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report (see Additional File 1).

Rehabilitation Medicine Summit: building research capacity.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: 1) researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and 5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called for to pursue the agendas outlined in this report.

A simple, focused, computerized query to detect overutilization of laboratory tests.

CONTEXT: Although there is nearly universal agreement that laboratory tests are overutilized, the degree of overutilization in a given institution is difficult to quantify and monitor across time. OBJECTIVE: To detect and clearly document repetitive daily ordering of a commonly ordered laboratory test (serum sodium) by employing a simple, focused, computerized query of a test result database followed by chart review and validation. DESIGN: A retrospective computerized query of our clinical data repository was performed to find inpatients who displayed normal serum sodium test results on 4 or more consecutive days, without any abnormal values during the same admission. The search was limited to a 1-month period. A subset of these patients was selected for chart review. RESULTS: One hundred sixteen patients met our criteria, and the tests ordered for those patients comprised 5.1% of the monthly volume of serum sodium tests ordered in our institution. Chart review revealed a consistent lack of documentation of medical necessity for repeat testing as well as persistence of repeat serum sodium orders until the end of the patients' hospital course. CONCLUSIONS: We conclude that a focused query of data derived from a clinical data repository can detect and document overutilization of a common laboratory test in a convincing fashion within a given institution.

BiP and zein binding domains within the delta zein protein.

Zeins are alcohol soluble seed storage proteins synthesized within the endosperm of maize and subsequently deposited into endoplasmic reticulum (ER) derived protein bodies. The genes encoding the beta and delta zeins were previously introduced into tobacco with the expectation of improving the nutritional quality of plants (Bagga et al. in Plant Physiol 107:13, 1997). Novel protein bodies are produced in the leaves of transgenic plants accumulating the beta or delta zein proteins. The mechanism of protein body formation within leaves is unknown. It is also unknown how zeins are retained in the ER since they do not contain known ER retention motifs. Retention may be due to an interaction of zeins with an ER chaperone such as binding luminal protein (BiP). We have demonstrated protein-protein interactions with the delta zeins, beta zeins, and BiP proteins using an E. coli two-hybrid system. In this study, four putative BiP binding motifs were identified within the delta zein protein using a BiP scoring program (Blond-Elguindi et al. in Cell 75:717, 1993). These putative binding motifs were mutated and their effects on protein interactions were analyzed in both a prokaryotic two-hybrid system and in plants. These mutations resulted in reduced BiP-zein protein interaction and also altered zein-zein interactions. Our results indicate that specific motifs are necessary for BiP-delta zein protein interactions and that there are specific motifs which are necessary for zein-zein interactions. Furthermore, our data demonstrates that zein proteins must be able to interact with BiP and zeins for their stability and ability to form protein bodies.

Rehabilitation Medicine Summit: Building Research Capacity-Executive Summary.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multiorganizational initiative is called to pursue the agendas outlined in this report.