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Certainly there are pitfalls and limitations in using information technol- ogy for KM—trying to force fluid knowledge into rigid data structures discount procardia 30mg overnight delivery, for example, or focusing too much on the tools and not enough on the content. But networks and computers, with their ability to connect people and store and retrieve virtually unlimited amounts of information, can dramatically improve departmental efficiencies. Some examples of knowledge management applications are listed below: • Data Mining tools enable decision makers to search and analyze large sets of data by using specific querying methods and tools (Standard Query Language, Rough Data set, On Line Analytical Processing). For example, intelligent agents could be used to forward completed test results to the corresponding physicians of a patient. As such, Web browsers are increasingly becoming the most common graphical user interface, even for specific software products such as financial accounting and patient order entry systems. Such systems are ideal for performance management and executive reporting and serve as the technological base for supporting the idea of a digital dashboard of indicators. A computerised patient order entry system is a classic example of a process-based operation in healthcare that requires the constant monitoring of the workflow status. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Key Performance Indicators and Information Flow 121 • E-learning and collaboration toolsare part of the knowledge distribution process, which is extremely important in healthcare, since continuous education is a key factor in effective practice of care. The essence of effective knowledge management does not rely on the use of one or more existing or forthcoming information technology tools. It is mostly about people, about processes and about capturing the results of people following processes, about trans- forming information into knowledge (explicit or tacit) and reusing it within a healthcare framework. Performance Management: Monitor and Manage Healthcare In order to persuade healthcare decision makers to assess the added value of KM tools, the latter should initially be used to propose new performance measurement and performance management techniques at all levels of a healthcare system (Hurst & Jee- Hughes, 2001). In that sense, performance management has long been considered as a tool for controlling spending and for increasing the efficiency of healthcare systems (Oxley & MacFarlan, 1994).

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Cytosine methylation on CpG dinucleotides of genomic DNA is one of many forms of DNA modifications that help maintain stability of numerous regions of genomic DNA cheap procardia 30mg without prescription. The areas of methylation that change during embryogenesis are at transposable element inser- tion sites in the genome that underlie epigenetic-induced phenotypic variability. It is hypothesized that such a mechanism may underlie the corrected NTD phenotype in folate supplementation. Another compound that prevented folate resistance NTD in the curly tail mouse and recently in humans is inositol. All these therapeutic measures are meant to prevent or correct defects early enough in devel- opment to prevent NTDs. Most forms of what we can designate as “magic repairs” are applied during intrauterine development or after birth. Both paradigms are designed to minimize further risk, prevent progressive functional loss, and possibly reverse neurological deterioration. Clearly, in the case of an open NTD, reversal of paralysis or sacral dysfunction is not expected or attained. For example, fetal ultrasonography revealed that human fetuses with myelomeningoceles retained lower extremity movements early in gestation and that the movements were lost by term. Parameters undergoing study include optimal timing, neurological recovery, and effects of repairs on associated hydrocephalus and Chiari II malformations. The study is comparing two approaches to the treatment of babies with spina bifida: surgery before birth (prenatal surgery) and the standard closure surgery after birth (postnatal surgery). Furthermore, when it appeared that spinal cord function was present to a degree, it was less than predicted based on data from the animal models. If the placode retains normal patterning and is simply un-neurulated, a repair may be effective in preventing secondary injury. Conversely, George and Cummings characterized the placode as having abnor- mal patterning along the dorsoventral and rostrocaudal axes indicative of a change © 2005 by CRC Press LLC in pattern determination and a paucity of maturing neurons with evidence of signif- icant inflammatory infiltrate, gliosis, and fibrosis consistent with secondary injury. All mammals except mice had spina bifida lesions in which the skin, muscle, lamina, and dura were opened, but the spinal cord itself was not dis- turbed. These surgical models represent a reopening mechanism of a closed neural tube that has not been shown to appear in humans, but was reported in curtailed mouse mutants.

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Significant differences still exist between the two professions in both diagnosis and the manipulative techniques that are employed discount procardia 30 mg free shipping, yet, as the evidence base increases, internationally and across all professions, these aspects are independently evolving in similar directions. Today, by virtue of education and license, the greatest difference between the chiropractic and osteopathic practitioners can be found in the training and the unlimited range of therapeutic options that are available to osteopathic physicians. Osteopathic considerations in neurology 65 On the other hand, OMT is often reported to be the most outward and visible sign of the difference between MDs and DOs. Nonetheless, the modality of OMT alone does not differentiate the two professions. It should be pointed out that many DOs choose not to integrate OMT into their practices and many MDs learn manual techniques in postgraduate coursework and integrate these into their practices. The importance of the integration of osteopathic philosophy and the OMM perspective cannot be overestimated in understanding the distinctiveness of the osteopathic profession. Just as the philosophical underpinnings of the acupuncturist differentiate needling from acupuncture, so the osteopathic perspective of philosophy, science and art modifies the choice and site of the application of a given manual technique and differentiates OMT from a chiropractic adjustment or an MD-applied manual medicine maneuver. Thus, for those critically evaluating clinical outcomes, for those referring patients for osteopathic care and also for the patient, the difference in the semantics is important. In summary, OMT played a central role in the history of the osteopathic profession and was a central component in discussions sponsored by the Macy Foundation. Leaders noted the specific need for expanding the evidence base and in demonstrating the mechanisms of action and clinical outcomes associated with OMT. Today, however, the curriculum of osteopathic colleges includes several hundred hours reserved for specifically teaching the art of palpatory diagnosis and manipulative technique and for testing the cognitive, psychomotor and affective aspects of OMT and OMM. There are over 50 different types of technique taught for treatment of somatic dysfunction in every region of the body and for its effect on homeostatic functions in 38 patients with diverse medical, surgical and other health problems. Most of these techniques have a long and respected tradition with clinically significant outcomes in the literature supported by practitioners of various types. Other techniques have little research support beyond the inherent logic of improving structure-function relationships or homeostatic mechanisms. Most have long histories of empirical evidence and postulated mechanisms that have scientific support ranging from preliminary to conclusive.


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