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Eighteen national and regional nursing informatics groups have established the Alliance for Nursing Informatics (ANI). The boards of directors for both the American Medical Informatics Association (AMIA) and the Healthcare Information and Management Systems Society (HIMSS) have agreed to provide ongoing support, coordination, and leadership for the Alliance.


The Alliance represents more than 2000 nurses and brings together 18 distinct nursing informatics groups in the United States that function separately at local, regional, national, and international levels and have established programs, publications, and organizational structures for their members. The ANI Steering Team will consist of representatives of organizational groups that have a nursing informatics focus and will guide the strategic goals and activities of the Alliance throughout the year.


The members of the Capital Area Roundtable on Informatics in Nursing (CARING) were instrumental in the formation of the ANI, providing support and leadership throughout the collaboration process. In addition, the American Nurses Association (ANA) assisted in developing the Alliance.


The Alliance intends to provide the structure and synergy needed to support the efforts of nursing informatics professionals toward the improved delivery of healthcare. Most of the groups participating in the Alliance do not have professional staff and depend on the volunteer efforts of their members to organize programs and activities.


The basic objectives of the Alliance are to


* provide a consolidated forum for the nursing informatics community,


* provide input to a nursing informatics research agenda to the Department of Health and Human Services and other government entities and funding sources,


* facilitate the dissemination of nursing informatics best practices, and


* present the collective voice of the nursing informatics specialty in national public policy initiatives and standards activities.



"The Alliance for Nursing Informatics represents an unprecedented commitment to the power of collaboration within the nursing informatics community," said Connie White Delaney, PhD, RN, FAAN, FACMI, and chair of AMIA's Nursing Informatics Working Group. "National health information technology strategic initiatives will benefit from the ability of the ANI to act as a whole, responding and participating in informatics- related issues and opportunities. The contribution that nursing plays in the consumer-centric, information-rich electronic health record initiative will benefit from the plethora of nursing education, research, and practice knowledge, given a voice through the Alliance."


Operational procedures and a governing infrastructure for the Alliance are now being developed by the ANI Steering Team, which includes a representative from each of the 18 participating organizations. AMIA and HIMSS will each appoint a nurse informatician to serve as a cochair of the Alliance.


ANI members include the following:


AMIA NIWG; ANA (Liaison); American Nursing Informatics Association (ANIA); Boston Area Nursing Informatics Consortium (BANIC); CARING; Central Savannah River Area Clinical Informatics Network (CSRA-CIN); Connecticut Healthcare Informatics Network (CHIN); Delaware Valley Nursing Computer Network (DVNCN); Health Informatics of New Jersey (HINJ); HIMSS; Nursing Informatics Community; Iowa HIMSS Nursing Informatics Committee; Informatics Nurses From Ohio (INFO); Michigan Nursing Informatics Network (MNIN); Minnesota Nursing Informatics Group (MINING); North Carolina State Nurses Association Council on NI (CONI); Nursing Information Systems Council of New England (NISCNE); Perinatal Information Systems User Group (PISUG); Puget Sound Nursing Informatics (PSNI); South Carolina Informatics Nursing Network (SCINN); and the Utah Nursing Informatics Network (UNIN).


For more information, visit the AMIA Web site ( or the HIMSS Web site (





Sabacare is proud to announce the release of a new version of Home Health Care Classification (HHCC) system. Renamed the Clinical Care Classification (CCC) system, this version updates the original HHCC Version 1.0 to CCC Version 2.0. The Web site that hosts the classification remains the same (


The new name, Clinical Care Classification (CCC), more accurately reflects the purpose of the classification. Recent research has demonstrated that the CCC could be used to document nursing and patient care in any healthcare environment where nurses practice, such as ambulatory care, outpatient clinics, and hospital settings from medical and surgical to critical care units. The CCC can also be used by multidisciplinary teams and by other healthcare providers.


The updated CCC Version 2.0 and the new name were approved by the HHCC Scientific Advisory Board, which meets annually to review the terminology and make suggested revisions. Version 2.0 follows the coding guidelines of the Unified Metathesaurus Literature System (UMLS) of the National Library of Medicine.


The updated CCC Version 2.0 contains a new care component labeled Life Cycle that addresses the Reproductive and Perinatal Systems, as well as Normal Growth and Development Diagnostic and Care Concepts. The updated CCC of Nursing Diagnoses contains 37 new terms, 10 of which were adapted from the NANDA list of Nursing Diagnoses 2001-2002. The CCC of Nursing Interventions contains 38 new interventions, which were added and renamed, and a few retired on recommendations by researchers and users of the HHCC.


Specific elements of the Clinical Care Classification (CCC) Version 2.0 include the following:


* Care Components: contains 21 care components used to classify and code the taxonomies.


* CCC of Nursing Diagnoses contains 182 nursing diagnoses (59 major and 123 subcategories) used to label and code diagnoses.


* CCC of Nursing Outcomes, derived from CCC of Nursing Diagnoses, contains 546 nursing diagnoses outcomes using three modifiers (Improved, Stabilized, or Deteriorated) to label and code Expected and/or Actual Outcomes.


* CCC of Nursing Interventions contains 198 interventions (72 major and 126 subcategories) using four Type Action modifiers (Assess, Care, Teach, or Manage) to label and code 792 unique interventions.



All of the changes (Additions, Retired, and Renamed Terms and/or Codes) from Version 1.0 to 2.0 can be found at in Appendices A1, A2, and A3.


The Clinical Care Classification System emerged from the federally funded Home Care Project conducted by Saba and colleagues (1991) at Georgetown University School of Nursing in Washington, DC. The project was funded to develop a method to assess and classify patients to determine the resources required to provide home health services to the Medicare population including measuring their outcomes of care.


For additional information, visit





Judith Effken, PhD, RN, received the 2004 Harriet H. Werley Award at MedInfo 2004 in San Francisco. The American Medical Informatics Association gives the annual award in recognition of the publication contributing the most to the advance of the field of nursing informatics. The article "Using Computational Modeling to Improve Patient Care Unit Safety and Quality Outcomes" reported findings of an Impact Study funded by the Agency for Healthcare Research and Quality.


Effken, who is an Associate Professor at the University of Arizona College of Nursing, has also published work in and is a reviewer for CIN.





A new general medical journal launched with a nontraditional publishing model is the latest venue for publishing peer-reviewed biomedical research. Unlike most medical journals, which are available only through a subscription, PLoS Medicine is available free of charge and is accessible to everyone through the Internet, at PLoS Medicine is published by the Public Library of Science (PLoS), a coalition of researchers and physicians cofounded in 2000 by Nobel Prize winner and former National Institutes of Health Director Harold Varmus, MD.


PLoS Medicine's introduction is being hailed by people who support open access to medical publications, many of whom helped begin an international movement for free access to medical research.


PLoS Medicine's peer-review process is designed to be as rigorous as the best-known medical journals, and uniquely collaborative, with nearly 100 experts from 28 countries on all five continents involved in the decision-making process. Editors say they are consciously creating a journal with global medical relevance. In addition to the research papers, PLoS Medicine contains a section for essays, commentaries, and debates.


PLoS Medicine's introduction comes at a time when many experts say that medical journal publishers must recognize that taxpayers fund much of the research they are publishing and acknowledge that consumers should have access to it at no charge. Last July, the US Congress publicly encouraged increased access to peer-reviewed medical journals, particularly if the research was conducted with government funds.


PLoS Medicine's expenses are recovered by imposing a charge of $1,500 to be recovered from the research funding. These one-time charges allow PLoS to make all research freely available for viewing and downloading from the moment of publication. Independent economic evaluations support open access as a viable publishing model. PLoS expects to achieve sustainability within 5 years through a comprehensive publishing plan.


The Public Library of Science (PLoS) is a nonprofit organization of scientists and physicians committed to making the world's scientific and medical research a public resource. PLoS publishes open-access journals of original peer-reviewed research, including PLoS Biology and PLoS Medicine, which are available at no cost to anyone in the world with a connection to the Internet. More information can be found at and



The United States was the 800-pound spam-spewing gorilla throughout 2004, a spot it held from wire to wire throughout the year, an anti-virus firm announced in late December 2004.


According to researchers at UK-headquartered Sophos, the US accounted for 42.1% of the world's spam, more than three times the next-guiltiest nation, South Korea, which launched 13.4% of the globe's junk mail. China, Canada, and Brazil rounded out the top five.


"When we first reported on the top spamming countries back in February 2004, the US had the excuse that the CAN-SPAM Act had been in existence for a couple of months," said Graham Cluley, a senior technology consultant for Sophos, in a statement. "Almost a year and millions of spam messages later, it's quite evident that that the CAN-SPAM legislation has made very little headway in damming the flood of spam."


Sophos, which used its global network of spam honeypots to attract messages to analyze, also noted that countries with high numbers of broadband Internet users are attractive targets to spammers, who often hijack vulnerable PCs, then turn them into spam "zombies" to disguise the real origin of the junk mail.


South Korea, which boasts the world's highest percentage of Internet users that connect via always-on, fast broadband links, is in second place on Sophos' list for that very reason.


"Spammers are motivated by one thing: fast and easy money," said Cluley. "Many home users' computers are sending out spam because they have had their broadband Internet connections exploited by remote hackers. Zombies are sending out over 40% of the world's spam, usually to the complete ignorance of the PC's owner."





A 26-year-old college student faces 15 years in prison as the first person convicted of software piracy stemming from April's international raids dubbed "Operation Fastlink."


According to court documents made public in December and reported by the Iowa City Press-Citizen, Jathan Desir, 26, who is registered at the University of Iowa, pleaded guilty December 22 in US District Court in Des Moines.


Court records say that Desir and others set up an online library for a private group to share movies, games, software, and music in January 2003. By April 2004, the collection had mushroomed to about 13,000 titles.


In April, FBI agents seized six computers at Desir's residence as part of Operation Fastlink, a crackdown that targeted so-called warez groups, which act as the source for most pirated software or movies. The raids were conducted by the FBI in 27 states, and by local law enforcement agencies in 10 other countries.


Desir is responsible for up to $200,000 in losses to the software industry by purloining copyrighted software, the federal records showed. He faces a possible 15-year jail sentence for copyright infringement and conspiracy, with sentencing set for March 18, 2005.





The National Science Foundation has awarded a grant of more than $491,000 for the continued development of a robotic surgical-instrument server at NewYork-Presbyterian Hospital/The Allen Pavilion. The system, known as Penelope, would be the world's first vision-guided, autonomous surgical robot and could save hospitals money and improve efficiency of care in the operating room. The system uses digital imaging technology to identify surgical instruments and hand them to a surgeon at voice command. When the surgeon has used the instrument, Penelope returns it to its position on the surgical tray. Penelope could be configured to handle additional instruments for more complex surgeries, keep an accurate count of instruments, and free operating room personnel for more direct patient care. The National Science Foundation made the grant to Robotic Surgical Tech, Inc, under the Small Business Innovation Research program. The development of Penelope is led by Dr. Michael R. Treat, an attending surgeon at NewYork-Presbyterian Hospital/ The Allen Pavilion and an associate professor of clinical surgery at Columbia University Medical Center's College of Physicians and Surgeons.


Penelope comprises a robotic arm, the instrument platform, the system stand, and the system control software. The arm's electromagnetic gripper can pick up surgical instruments weighing up to 8 oz. The digital cameras standing above the instrument tray allow the system to identify instruments by shape. Using speech recognition, it processes instructions and speaks back to the surgeon. Penelope uses an artificial intelligence "brain" to integrate its capabilities. The artificial intelligence software incorporates a unique innovation-the prediction engine. The prediction engine anticipates the surgeon's instrument requests, as an experienced operating room scrub nurse or technician would do. The prediction engine and the other aspects of the software "brain" of the robot were developed with the support of the National Science Foundation.


"Penelope is a creative response to major problems facing US hospitals, including litigation costs and the chronic shortage of nursing staff and technicians," said Dr Treat. "By performing mechanical tasks like instrument handling and maintaining accurate instrument counts, Penelope frees the operating room staff to concentrate on the human side of patient care."


Other major supporters of the project are New York-Presbyterian Hospital, National Institute of Nursing Research of the National Institutes of Health (NIH), the US Army's Telemedicine and Advanced Technology Research Center (TATRC), Defense Advanced Research Projects Agency (DARPA), New York State Office of Science, Technology and Academic Research (NYSTAR).


The National Science Foundation (NSF) is an independent federal agency that supports fundamental research and education across all fields of science and engineering, with an annual budget of nearly $5.58 billion. NSF funds reach all 50 states through grants to nearly 2000 universities and institutions. Each year, NSF receives about 40,000 competitive requests for funding, and makes about 11,000 new funding awards. The NSF also awards over $200 million in professional and service contracts yearly.


The robot may be previewed at the NSF Web site at: