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PubMed1991

Understanding computers or some of the things you always wanted to know about computers ... but were afraid to ask.

Criteria for computer systems evaluation are changing. No longer can we rely on an evaluation based solely on what the combination of hardware and software does for the user (functional criteria). Significant improvements in software productivity have occurred in recent years as a result of the availability of tools such as relational database management systems and fourth-generation languages. Meanwhile new technologies such as image processing and graphical user interfaces, e.g. MS-Windows and X Window, are coming onstream. Most of these technologies and capabilities require substantially more computing resources than traditional character-based systems. Fortunately, the open systems revolution is creating a more competitive marketplace and computer price/performance ratios are soaring, making the additional computing resources readily available at reasonable prices. But the opportunities of the future will not be for everyone. They will exist only for those medical record practitioners who recognize that a shift away from purely functional evaluation is necessary. Those that make the shift successfully will not become computer technicians, but they will understand the few technical criteria that are truly essential in systems evaluation. They will, in short, apply the 80/20 principle successfully to make future system selections. Medical record professionals must take steps to upgrade their computer system knowledge in order to accommodate the needs of technical criteria evaluation. For the active practitioner this means taking the time to learn from the many sources available in print, educational programs, and knowledgeable persons. Students should seek out courses that will give them a balanced view of the computer sciences, without being overloaded with specifics. AMRA should look for ways to augment the computer sciences requirements in the student's curriculum. Development of study tracks that concentrate on combining standard curricula with computer science would both create a new breed of practitioner and expand the horizons of the profession. The medical record profession must actively work to keep pace with the ever-changing information management environment in order to maintain its position of healthcare information management leadership.

Computer User Training↗
PubMed2005

The Primary Care Electronic Library (PCEL) five years on: open source evaluation of usage.

BACKGROUND: The Primary Care Electronic Library (PCEL) is a collection of indexed and abstracted internet resources. PCEL contains a directory of quality-assured internet material with associated search facilities. PCEL has been indexed, using metadata and established taxonomies. Site development requires an understanding of usage; this paper reports the use of open source tools to evaluate usage. This evaluation was conducted during a six-month period of development of PCEL. OBJECTIVE: To use open source to evaluate changes in usage of an electronic library. METHOD: We defined data we needed for analysis; this included: page requests, visits, unique visitors, page requests per visit, geographical location of users, NHS users, chronological information about users and resources used. RESULTS: During the evaluation period, page requests increased from 3500 to 10,000; visits from 1250 to 2300; and unique visitors from 750 to 1500. Up to 83% of users come from the UK, 15% were NHS users. The page requests of NHS users are slowly increasing but not as fast as requests by other users in the UK. PCEL is primarily used Monday to Friday, 9 a.m. to 5 p.m. Monday is the busiest day with use lessening through the week. NHS users had a different list of top ten resources accessed than non-NHS users, with only four resources appearing in both. CONCLUSIONS: Open source tools provide useful data which can be used to evaluate online resources. Improving the functionality of PCEL has been associated with increased use.

Information Dissemination↗
PubMed1999

[Results of ambulatory major surgery in urology, within an integrated unit].

OBJECTIVE: To contribute our experience in the performance of ambulatory major surgery, through the creation of an integrated unit. Such units take advantage of existing resources both in terms of space and materials, as well as personnel, without the need to open separate ambulatory major surgery units that would involve greater resources expenditure. MATERIAL AND METHODS: 48 patients undergoing ambulatory major urology surgery were analyzed. The patients were admitted the same morning of the procedure and then, after leaving the operating theatre, they were moved to the reanimation room and later to the urology ward, where they were evaluated by the urologist on duty and discharged. A few days later the patients returned to the outpatient's clinic for re-evaluation. RESULTS: 48 patients underwent surgery, 44 male and 4 female. Mean age of patients was 34 (3-86) years. The procedures most frequently performed were: hydrocelectomy, vaginal peritoneum duct closure, orchiopexy, ureterorenoscopy due to ureteral lithiasis, internal urethrotomy, varicocelectomy, vesical tumor resection and circumcision in children. Only in two cases, hospital stay was longer than 12 hours and there was only one re-admission. CONCLUSIONS: Ambulatory major surgery integrated units may allow to perform this type of surgery in small units, with little resources and with a volume of patients not sufficient to create an independent unit.

Adolescent↗
PubMed1996

Gene co-ops and the biotrade: translating genetic resource rights into sustainable development.

The 1992 Convention on Biological Diversity marks a basic change in the international status of genetic resources. Prior to the Convention, these resources were considered to be the "heritage of mankind.' Although the intent of this open access regime was to ensure the widespread availability of genetic resources for agriculture and industry, commercial use of the resources provided no additional economic incentive for conservation by source countries. The Biodiversity Convention corrects this policy failure by establishing that states have sovereign rights over their genetic resources, thereby enabling market incentives to complement various multilateral mechanisms that might directly fund biodiversity conservation. A number of obstacles face countries that are translating this broad right to regulate access into specific policies, laws, and regulations designed to meet conservation and development objectives. A review of these obstacles and of trends in technological development suggest that nations and developing country institutions should take a set of actions to develop access legislation and Material Transfer Agreements, establish biodiversity "cooperatives' and intermediary institutions to facilitate information exchange, develop minimum standards for access legislation, and require that prior informed consent of local communities be obtained by all biodiversity collectors.

Animal Population Groups↗
PubMed1995

Mobile access: opening health care doors.

By combining traditional services and resources, the HealthQuest mobile van travels through six counties in northeast Indiana to reach those who have no easy access to health care. Existing programs that focus on meeting the needs of infants, children and adults living in rural communities via the use of mobile primary care vans are reviewed as well as this recently developed program.

Health Services Accessibility↗
PubMed2002

The Schmidtea mediterranea database as a molecular resource for studying platyhelminthes, stem cells and regeneration.

Platyhelminthes are excellent models for the study of stem cell biology, regeneration and the regulation of scale and proportion. In addition, parasitic forms infect millions of people worldwide. Therefore, it is puzzling that they remain relatively unexplored at the molecular level. We present the characterization of approximately 3,000 non-redundant cDNAs from a clonal line of the planarian Schmidtea mediterranea. The obtained cDNA sequences, homology comparisons and high-throughput whole-mount in situ hybridization data form part of the S. mediterranea database (SmedDb; http://planaria.neuro.utah.edu). Sixty-nine percent of the cDNAs analyzed share similarities with sequences deposited in GenBank and dbEST. The remaining gene transcripts failed to match sequences in other organisms, even though a large number of these (approximately 80%) contained putative open reading frames. Taken together, the molecular resources presented in this study, along with the ability of abrogating gene expression in planarians using RNA interference technology, pave the way for a systematic study of the remarkable biological properties displayed by Platyhelminthes.

Animals↗
PubMed2004

Removing a barrier to computer-based outbreak and disease surveillance--the RODS Open Source Project.

INTRODUCTION: Computer-based outbreak and disease surveillance requires high-quality software that is well-supported and affordable. Developing software in an open-source framework, which entails free distribution and use of software and continuous, community-based software development, can produce software with such characteristics, and can do so rapidly. OBJECTIVES: The objective of the Real-Time Outbreak and Disease Surveillance (RODS) Open Source Project is to accelerate the deployment of computer-based outbreak and disease surveillance systems by writing software and catalyzing the formation of a community of users, developers, consultants, and scientists who support its use. METHODS: The University of Pittsburgh seeded the Open Source Project by releasing the RODS software under the GNU General Public License. An infrastructure was created, consisting of a website, mailing lists for developers and users, designated software developers, and shared code-development tools. These resources are intended to encourage growth of the Open Source Project community. Progress is measured by assessing website usage, number of software downloads, number of inquiries, number of system deployments, and number of new features or modules added to the code base. RESULTS: During September--November 2003, users generated 5,370 page views of the project website, 59 software downloads, 20 inquiries, one new deployment, and addition of four features. CONCLUSIONS: Thus far, health departments and companies have been more interested in using the software as is than in customizing or developing new features. The RODS laboratory anticipates that after initial installation has been completed, health departments and companies will begin to customize the software and contribute their enhancements to the public code base.

Disease Outbreaks↗
PubMed1984

Undergraduate social work programs as health resources in rural areas: needs assessment as an example.

Undergraduate social work programs in rural areas can meet their students' learning needs and function as integral parts of the community health system, at the same time. Based on open systems and exchange theories, the author advocates enhanced resource sharing between undergraduate programs and community social and health agencies. Within the context of the need for increased experiential learning opportunities for students and for planning activities appropriate for student participation, a successful deinstitutionalization needs assessment project is described. As a generic model, the project has applicability to other health problem areas and settings.

Community Health Services↗
PubMed1995

Values, participatory democracy, and healthcare resource allocation: an application to a campus community.

As healthcare reform is debated, it is important that decision makers consider the values of all citizens, that is, what people find desirable or useful about healthcare services. Several states have used town meetings in an effort to determine their citizens' views on the values in the realm of healthcare. In this article, the authors describe a process in which individuals actively participate in an open discussion about issues surrounding allocation of healthcare resources in a university setting. Three different groups from the university community participated in separate, structured meetings to discuss their values concerning the allocation of scarce healthcare resources. Such meetings give participants opportunities to learn about their values and those of other persons in the community.

Democracy↗
PubMed1996

An economic exploration of oral and intravenous ganciclovir in the induction and maintenance treatment of AIDS-related cytomegalovirus retinitis.

The objective of the study was to compare the impact of oral and i.v. ganciclovir on resource use and direct health care costs, from the perspective of the UK National Health Service (NHS). The analytical framework used was cost analysis. The sources of data were an open, randomized clinical trial, and additional research which collected resource use and cost data. From the perspective of the UK NHS, the expected cost of i.v. ganciclovir for initial induction and 140 days maintenance and reinduction therapy was pounds 730 higher than that of oral (pounds 8145 vs pounds 7415). Conservative estimates which did not favour oral ganciclovir were used wherever possible. Overall, the resource use and costs of maintenance therapy with oral ganciclovir calculated in the model used for this study were lower than those of i.v. ganciclovir, principally reflecting lower costs for the administration of therapy. In this model the drug cost of ganciclovir maintenance therapy was excluded.

AIDS-Related Opportunistic Infections↗
PubMed2000

PhysioNet: a research resource for studies of complex physiologic and biomedical signals.

PhysioNet (http://www.physionet.org/) is a web-based resource supplying well-characterized physiologic signals and related open-source software to the biomedical research community. Inaugurated in September 1999 under the auspices of the NIH's National Center for Research Resources (NCRR), PhysioNet provides an on-line forum for free dissemination and exchange of research data and software, with facilities for cooperative analysis of data and evaluation of new analytic methods. As of September 2000, PhysioBank, the data archive made available via PhysioNet, contained roughly 35 gigabytes of recorded signals and annotations. PhysioNet is a public service of the Research Resource for Complex Physiologic Signals, a cooperative project initiated by researchers at Boston's Beth Israel Deaconess Medical Center/Harvard Medical School, Boston University, McGill University, and MIT.

Cardiovascular Physiological Phenomena↗
PubMed2005

Squid - a simple bioinformatics grid.

BACKGROUND: BLAST is a widely used genetic research tool for analysis of similarity between nucleotide and protein sequences. This paper presents a software application entitled "Squid" that makes use of grid technology. The current version, as an example, is configured for BLAST applications, but adaptation for other computing intensive repetitive tasks can be easily accomplished in the open source version. This enables the allocation of remote resources to perform distributed computing, making large BLAST queries viable without the need of high-end computers. RESULTS: Most distributed computing / grid solutions have complex installation procedures requiring a computer specialist, or have limitations regarding operating systems. Squid is a multi-platform, open-source program designed to "keep things simple" while offering high-end computing power for large scale applications. Squid also has an efficient fault tolerance and crash recovery system against data loss, being able to re-route jobs upon node failure and recover even if the master machine fails. Our results show that a Squid application, working with N nodes and proper network resources, can process BLAST queries almost N times faster than if working with only one computer. CONCLUSION: Squid offers high-end computing, even for the non-specialist, and is freely available at the project web site. Its open-source and binary Windows distributions contain detailed instructions and a "plug-n-play" instalation containing a pre-configured example.

Base Sequence↗
PubMed2006

Integrating methods for the environmental sustainability: the SPIn-Eco Project in the Province of Siena (Italy).

This paper shows how different methods can be integrated in order to provide an organic evaluation of the environmental sustainability at the territorial level. A territory is a complex, dynamic and open system where a population develops, uses resources, produces goods and services, consumes, depletes and finally obtains economic results. All these elements characterise human behaviour, which can be monitored, measured and compared to the capacity of the environment to sustain it in the long run. The SPIn-Eco Project for the Province of Siena (Italy) is described as an example of an environmental sustainability assessment of an area, and its methods (Ecological Footprint, Greenhouse Gas Inventory, Extended Exergy Analysis, Emergy Evaluation, Life Cycle Assessment (LCA) and Remote Sensing) are briefly introduced. This Project has been proposed and funded by the most important provincial administrative and financial institutions in the territory (the Administration of the Province of Siena and the Monte dei Paschi Foundation, respectively), and was designed and realised in 4 years (2001-2004) by a research team coordinated by the University of Siena.

Conservation of Natural Resources↗
PubMed2004

DDBJ in the stream of various biological data.

In the past year we at DDBJ (http://www.ddbj.nig. ac.jp) have made a steady increase in the number of data submissions with a 50.6% increment in the number of bases or 46.5% increment in the number of entries. Among them the genome data of man, ascidian and rice hold the top three. Our activity has extended to providing a tool that enables sequence retrieval using regular expressions, and to launching our SOAP server and web services to facilitate the acquisition of proper data and tools from a huge number of biological data resources on websites worldwide. We have also opened our public gene expression database, CIBEX.

Animals↗
PubMed2000

The effects of open access on member satisfaction and intentions to remain in an HMO.

This study is the first empirical test of the strategic importance of member autonomy and open access in a managed care environment. The model utilized in this study assesses the relative importance of autonomy in selecting specialists (open access), service convenience, value/pricing, and HMO resources on member satisfaction with care and intentions to remain with the HMO.

Fees and Charges↗
PubMed2006

Antiviral activity of nucleoside analogues during short-course monotherapy or dual therapy: its role in preventing HIV infection in infants.

BACKGROUND: This is the first report on the preliminary efficacy of 4 different short-course nucleoside analogue regimens (stavudine [d4T], didanosine [ddI], d4T+ddI, and zidovudine [ZDV]) for the prevention of mother-to-child transmission of HIV-1 (MTCT) in a resource-limited setting. DESIGN: This prospective open-label, randomized 4-arm study (May 1999 to May 2000) conducted in South Africa enrolled 373 women from 34 weeks of gestation; medication was continued through delivery and for 6 weeks to infants. MTCT rates were ascertained at birth, 6, 12, and 24 weeks of age. RESULTS: Mean maternal HIV-1 RNA levels decreased rapidly on treatment in all groups. At week 4, the mean decrease was 1.91 log10 copies/mL (c/mL) in the d4T+ddI group, 1.33 log10 c/mL in the ddI group, 1.12 log10 c/mL in the d4T group, and 0.76 log10 c/mL in the ZDV group. Among the 362 evaluable mother-infant pairs, 11 infants in the d4T group, 10 in the ddI group, 5 in the ZDV group, and 4 in the d4T+ddI group were infected by 24 weeks of age. Eleven infections occurred in utero. Treatment with d4T and ddI was not associated with lactic acidosis or hepatic steatosis. CONCLUSIONS: The abbreviated use of nucleoside analogues for the prevention of MTCT appears safe and effective.

Acidosis, Lactic↗
PubMed2006

The influence of Israel Health Insurance Law on the Negev Bedouin population--a survey study.

The extension of universal health service insurance to national populations is a relatively new phenomenon. Since 1995, the Israeli National Health Insurance Law (NHIL) has provided universal health services to every resident, but the effect of this law on health and health services among minorities has not been examined sufficiently. The goals of this study were to track some of the first changes engendered by the NHIL among the Negev Bedouin Arabs to examine the effects of universal health care services. Methods included analysis of historical and health policy documents, three field appraisals of health care services (1994, 1995, 1999), a region-wide interview survey of Negev Bedouins (1997), and key informant interviews. For the interview survey, a sample of 515 households was chosen from different Bedouin localities representing major sedentarization stages. Results showed that prior to the NHIL, a substantial proportion of the Negev Bedouins were uninsured with limited, locally available health service. Since 1995, health services, particularly primary care clinics and health manpower, have dramatically expanded. The initial expansion appears to have been a marketing ploy, but real improvements have occurred. There was a high level of health service utilization among the Bedouins in the Negev, especially private medical services, hospitals, and night ambulatory medical services. The NHIL brought change to the structure of health services in Israel, namely the institution of a national health system based on proportional allocation of resources (based on size and age) and open competition in the provision of quality health care. The expansion of the pool of potential members engendered by the new universal coverage had profound effects on the Health Funds' attitudes towards Negev Bedouins. In addition, real consumer choice was introduced for the first time. Although all the health care needs of this rapidly growing population have yet to be met fully, the assurances under the Law and the new level of competition promise a higher level of service in the future.

Adolescent↗
PubMed2005

[The development of obstetric ultrasound in Switzerland].

Ultrasound has conquered obstetrics during the last 40 years. Today it is an integral part of antenatal care. Its broad use as a screening method has pushed critics who found open doors at health authorities facing short resources. In Switzerland in early 1996, routine ultrasound as a health technology was temporarily excluded from reimbursement by the health insurances. Under the pressure of the public, the health authorities had to reintroduce reimbursement within a few months. However, reimbursement was linked with several conditions: the ultrasound examination has to be performed by physicians with adequate training and experience; routine ultrasound needs a strict informed consent, and its benefit has to be evidenced. This decision has had a positive impact on quality. After 7 years, Switzerland has a good training program; guidelines for prenatal ultrasound already exist in their second edition, and spot checks of performance showed that quality in Switzerland meets international standards. Ultrasound mainly has a positive cost-effectiveness ratio due to the detection of fetal malformations with consecutive termination of pregnancy. Since termination of pregnancy is ethically questionable, the discussion with respect to reimbursement will most probably go on. In this light, a comprehensive informed consent of the pregnant women is essential.

Female↗