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PubMed1995

SNOMED-based knowledge representation.

A standardized vocabulary and a standardized representation for this vocabulary are necessary prerequisites for the development of a computer-based patient record. A standard conceptual scheme or data structure for this vocabulary must be in place to define clinical events and to share data. SNOMED International is a detailed, fine grained, semantically typed and comprehensive computer processable vocabulary encompassing both human and veterinary medicine. Each term is placed in a standardized data structure that shows the term relationship within its own and other related taxonomic hierarchies. SNOMED International is a standardized vocabulary and data structure suitable for use in the computer-based patient record.

Animals↗
PubMed1986

Etiological heterogeneity in Hodgkin's disease: HLA linked and unlinked determinants of susceptibility independent of histological concordance.

Forty-one multiplex families, from published sources and new data from the National Cancer Institute, segregating for Hodgkin's disease and HLA, have been studied. A reanalysis of these data strongly suggests a recessive mode of inheritance for susceptibility to Hodgkin's disease. The HLA haplotype sharing data between affected relatives demonstrate that approximately 60% of cases in multiplex families are due to an HLA-linked susceptibility gene, the remaining 40% being due to other familial factors. The data clearly support the hypothesis of etiological heterogeneity for Hodgkin's disease, with both HLA-linked and HLA-unlinked factors being responsible. Finally, there is an increased concordance of histological types between affected relatives, but this concordance seems independent of HLA sharing.

Female↗
PubMed2005

Analysis of spatial patterns at a geographical scale over north-western Europe from point-referenced aphid count data.

The spatial analysis by distance indices (SADIE) technique was developed to evaluate the spatial pattern of point-referenced count data as well as the spatial association between two sets of data sharing the same point locations. This paper presents an analysis of spatial patterns in aphid count data and the association of these data with climate across north-west Europe. The paper tests the applicability of the technique to large geographical areas. Aggregation and cluster indices were calculated for the total annual abundance of the peach-potato aphid Myzus persicae (Sulzer) and for the annual mean rainfall and temperature at aphid monitoring sites. Association indices demonstrated the stability in time of aphid spatial structures and the correlation between aphid density and climate patterns. Groups of relatively large numbers of aphids, termed patches, and groups of relatively small numbers of aphids, termed gaps, were located and their mean size estimated. The aphid patterns were quite stable in time and the spatial patterns of temperature and rainfall were weakly associated with M. persicae annual abundance. Similarities were observed between the results of SADIE and those from the more widely used technique of spatial autocorrelation (SAC). However, the SADIE association index has the advantage of quantifying the possible associations between aphid data and the factors that determine population distribution. Thus, high temperature and low rainfall were identified as environmental factors that were positively associated with aphid abundance across north-west Europe.

Animals↗
PubMed2000

Using benchmarking data to evaluate and support pharmacy programs in health systems.

The use of benchmarking data to evaluate and support pharmacy programs in health systems is discussed. Benchmarking is a method of comparing the outcomes of health care products, services, and practices at an institution against those of competitors in order to learn what might be improved. Benchmarking programs can provide valuable feedback about both positive and negative outcomes. However, it is imperative to avoid inappropriate comparisons and inappropriate assessments. Ideal services for benchmarking are those that have a good likelihood of improving patient care and other outcomes. Successful benchmarking requires sound and thorough data, which is why as many health systems as possible should participate in a benchmarking program. The National Committee for Quality Assurance has formulated guidelines that should enable health systems to develop an information framework that will improve their ability to collect and use data for benchmarking. Standardization in collecting and submitting information is important because it enables institutions to share data easily. Benchmarking can help health-system pharmacists understand the value and outcomes of efforts by their colleagues at other institutions. In addition, benchmarking can help convince health-system administrators of the value of pharmaceutical services in terms of patient care and the bottom line. Benchmarking provides a means of evaluating and supporting the development of pharmacy programs that improve care and save money.

Benchmarking↗
PubMedDate not supplied

[Telematics equipment for poison control surveillance. Its applications in the health management of relevant chemical incidents].

Health management of major chemical incidents requires a close collaboration between rescuers (on the disaster site and in the emergency department) and the poison center. The study tested telematic technologies allowing telepresence and teleconsulting, a real time and continuous connection among health care personnel and toxicologists involved in the management of the emergency. The link between the poison center (PC) and the emergency department in the local hospital is provided by a ISDN operating video conferencing system, while the data transmission from the site of the accident to the PC is achieved with a personal computer and GSM cellular data transmission. Toxicological databases and risk assessment software are integrated in the system, to support information sharing. To test such instruments in operative nearly realistic conditions, the main phase of the study has implemented simulated chemical disasters in different locations in Italy. Instruments for telepresence and teleconsulting have been effectively utilized to evaluate from a remote location the scenario and the severity of the accident, by inspecting either specific details or the whole scene, to enable PC guiding the triage of the victims before and after hospitalization, to utilize and share data, such as intervention protocols or patient records, and to document all the activities. In summary, this experience shows that the telematic link allows the toxicologists of the poison center to rapidly understand the situation, and to correctly learn about the conditions of patients with the help of images. The results of this study indicate the valuable benefits of telematic instruments for the health care in case of major chemical disasters occurring in a remote geographical location or in an area which lacks local toxicological experts, where specialized expertise can be achieved by the use of telematic technologies.

Emergency Service, Hospital↗
PubMed2007

Emergency department access to a longitudinal medical record.

Our goal is to assess how clinical information from previous visits is used in the emergency department. We used detailed user audit logs to measure access to different data types. We found that clinician-authored notes and laboratory and radiology data were used most often (common data types were used up to 5% to 20% of the time). Data were accessed less than half the time (up to 20% to 50%) even when the user was alerted to the presence of data. Our access rate indicates that health information exchange projects should be conservative in estimating how often shared data will be used and the wide breadth of data accessed indicates that although a clinical summary is likely to be useful, an ideal solution will supply a broad variety of data.

Emergency Service, Hospital↗
PubMed2000

Integrating medical information and knowledge in the HL7 RIM.

Guidelines have a proven ability to improve quality of health care and reduce cost, yet, guidelines are not very well deployed at the point of care. This is largely due to the impedance mismatch between decision support modules and the Electronic Medical Record (EMR.) The Unified Service Action Model (USAM) as part of the HL7's Reference Information Model provides a conceptual integration between patient data and medical knowledge. The USAM defines one action-oriented information structure for patient data, concept definitions, action plans, conditionals, and goals. This suggests a new approach to the problem of sharing data and knowledge, effectively working around the problem of missing domain terminology.

Computer Communication Networks↗
PubMed2006

Leveraging the benefits of Health Information Technology to support healthcare delivery model redesign.

Uninsured and low income underinsured patients create substantial challenges for local healthcare systems, yet their providers are not always included in community-wide implementations of health information technology. To address this deficit, prototypes of the recently proposed National Health Information Network must include providers who care for underserved populations. In 2003, a consortium of providers founded the Waterbury Health Access Program (WHAP) to implement an electronic medical record (EMR) system that would first address the needs of the region's vulnerable underserved patients. It was anticipated that lessons learned would be applicable to other patient populations as well. The WHAP consortium of competing hospitals and outpatient clinics developed a broad-based community-wide initiative to include implementing a common EMR system to share clinical information across all locations. The design includes 11 outpatient clinic locations linked to a common data-sharing tool that is accessible by each clinic, emergency department and community practitioner participating in a local, coordinated charity care program. The collaboration required to support community-wide implementations of health information technology also can be leveraged to facilitate additional quality improvement initiatives.

Ambulatory Care↗
PubMed2002

A community-centric internet portal for stereotactic and functional neurosurgery with a probabilistic functional atlas.

OBJECTIVE: This paper describes an Internet portal for stereotactic and functional neurosurgery with a probabilistic functional atlas (PFA) calculated from electrophysiological and neuroimaging data. This portal enables (1) data sharing among neurosurgeons; (2) the calculation of probabilistic functional maps of stereotactic target structures from a neurosurgeon's own data, optionally combined with data from other neurosurgeons, and (3) the construction and development of a PFA of the human brain by the neurosurgical community via the Internet. METHOD: The overall approach is done in three steps: (1) development and validation of the algorithm for PFA generation; (2) design and development of the portal for stereotactic and functional neurosurgery with tools for the rapid calculation, presentation, and use of the PFA, and (3) portal testing with the initial data acquired for 274 Parkinson's disease patients, 487 hemispheres, and 500 best contacts. This paper covers step 2 and some results from step 3. RESULTS: The Internet portal has been developed in Java and tested with the available data. Functions have been developed for: (1) data input, transfer, and editing; (2) data selection for PFA generation; (3) PFA generation; (4) PFA display and interactive manipulation, and (5) target planning. The portal has been put on the Internet for public use and so far more than 100 users downloaded it. CONCLUSION: The Internet portal for stereotactic and functional neurosurgery with a PFA potentially increases both the accuracy of targeting and the neurosurgeon's confidence. The portal may be useful for both experienced functional neurosurgeons who have studied numerous cases and novices in the field. The use of the PFA through this portal, and sharing and expanding its content by neurosurgeons represents a paradigm shift from manufacturer centric to community centric.

Anatomy, Artistic↗
PubMed1991

Providing an integrated clinical data view in a hospital information system that manages multimedia data.

The VA's hospital information system, the Decentralized Hospital Computer Program (DHCP), is an integrated system based on a powerful set of software tools with shared data accessible from any of its application modules. It includes many functionally specific application subsystems such as laboratory, pharmacy, radiology, and dietetics. Physicians need applications that cross these application boundaries to provide useful and convenient patient data. One of these multi-specialty applications, the DHCP Imaging System, integrates multimedia data to provide clinicians with comprehensive patient-oriented information. User requirements for cross-disciplinary image access can be studied to define needs for similar text data access. Integration approaches must be evaluated both for their ability to deliver patient-oriented text data rapidly and their ability to integrate multimedia data objects. Several potential integration approaches are described as they relate to the DHCP Imaging System.

Computer Communication Networks↗
PubMed1999

Third generation electronic pharmacy communications. Recommendations based on ten years' experience.

The number of electronic prescriptions in Denmark is increasing and almost 600,000 electronic prescriptions are now sent every month. There is therefore a strong interest in directly reusing the data entered in the medical practitioner systems in the pharmacy systems. It has therefore been decided to introduce a shared data foundation in all medical practitioner and pharmacy systems in Denmark in conjunction with the introduction of the new MEDPRE electronic prescription standard. Parallel to the standardisation work, concrete guidelines have been prepared for the individual EDP (Electronic Data Processing) systems to ensure rapid, problem-free prescription communication. The aim in the longer term is for 95% of all EDIFACT prescriptions to reach the receiving pharmacy no more than 20 minutes after being sent from a medical practice.

Computer Communication Networks↗
PubMed2005

The Australian EEG database.

The Australian EEG Database is a web-based de-identified searchable database of 18,500 EEG records recorded at a regional public hospital over an 11-year period. Patients range in age from a premature infant born at 24 weeks gestation, through to people aged over 90 years. This paper will describe the history of the database, the range of patients represented in the database, and the nature of the text-based and digital data contained in the database. Preliminary results of the first two studies undertaken using the database are presented. Plans for sharing data from the Australian EEG database with researchers are discussed. We anticipate that such data will be useful in not only helping to answer clinical questions but also in the field of mathematical modeling of the EEG.

Adolescent↗
PubMedDate not supplied

Methods for assessing sperm motility, morphology, and counts in the rat, rabbit, and dog: a consensus report. ILSI Risk Science Institute Expert Working Group on Sperm Evaluation.

Reproductive toxicity studies are increasingly including assessments of sperm parameters including motility, morphology, and counts. While these assessments can provide valuable information for the determination of potential reproductive toxicity, the methods for conducting the assessments have not been well developed in all laboratories and are continually evolving. The use of different methods in different laboratories makes comparison of data among laboratories difficult. To address the differences in methods, a working group was convened to discuss methods currently in use, share data, and try to reach consensus about optimal methods for assessing sperm parameters in rats, rabbits, and dogs. This article presents the consensus report, as well as future research needs, with the hope that optimized common methods will aid in the detection of reproductive effects and enhance interlaboratory comparisons.

Animals↗
PubMed2003

A tool for sharing annotated research data: the "Category 0" UMLS (Unified Medical Language System) vocabularies.

BACKGROUND: Large biomedical data sets have become increasingly important resources for medical researchers. Modern biomedical data sets are annotated with standard terms to describe the data and to support data linking between databases. The largest curated listing of biomedical terms is the the National Library of Medicine's Unified Medical Language System (UMLS). The UMLS contains more than 2 million biomedical terms collected from nearly 100 medical vocabularies. Many of the vocabularies contained in the UMLS carry restrictions on their use, making it impossible to share or distribute UMLS-annotated research data. However, a subset of the UMLS vocabularies, designated Category 0 by UMLS, can be used to annotate and share data sets without violating the UMLS License Agreement. METHODS: The UMLS Category 0 vocabularies can be extracted from the parent UMLS metathesaurus using a Perl script supplied with this article. There are 43 Category 0 vocabularies that can be used freely for research purposes without violating the UMLS License Agreement. Among the Category 0 vocabularies are: MESH (Medical Subject Headings), NCBI (National Center for Bioinformatics) Taxonomy and ICD-9-CM (International Classification of Diseases-9-Clinical Modifiers). RESULTS: The extraction file containing all Category 0 terms and concepts is 72,581,138 bytes in length and contains 1,029,161 terms. The UMLS Metathesaurus MRCON file (January, 2003) is 151,048,493 bytes in length and contains 2,146,899 terms. Therefore the Category 0 vocabularies, in aggregate, are about half the size of the UMLS metathesaurus.A large publicly available listing of 567,921 different medical phrases were automatically coded using the full UMLS metatathesaurus and the Category 0 vocabularies. There were 545,321 phrases with one or more matches against UMLS terms while 468,785 phrases had one or more matches against the Category 0 terms. This indicates that when the two vocabularies are evaluated by their fitness to find at least one term for a medical phrase, the Category 0 vocabularies performed 86% as well as the complete UMLS metathesaurus. CONCLUSION: The Category 0 vocabularies of UMLS constitute a large nomenclature that can be used by biomedical researchers to annotate biomedical data. These annotated data sets can be distributed for research purposes without violating the UMLS License Agreement. These vocabularies may be of particular importance for sharing heterogeneous data from diverse biomedical data sets. The software tools to extract the Category 0 vocabularies are freely available Perl scripts entered into the public domain and distributed with this article.

Algorithms↗
PubMedDate not supplied

Application of keyhole imaging to interventional MRI: a simulation study to predict sequence requirements.

A wide variety of techniques have been proposed recently to improve the temporal resolution of MRI. These include echo-planar imaging methods, wavelet encoding, singular value decomposition encoding, and k-space sharing methods known as "keyhole" imaging. In this work, we use a simulation study to investigate the phase-encoding ordering and data-sharing methods required for the application of keyhole imaging to interventional MRI (I-MRI). The advantages of keyhole imaging over other methods are its simplicity and the use of conventional phase encoding and Fourier transform reconstruction found on virtually all modern MR imagers. Our analysis has predicted that conventional keyhole methods that repeatedly acquire only the center portion of k space, and those that sequentially progress from the center of k space outward, will not meet the combination of temporal and spatial resolution required for tip localization during I-MRI needle insertion. Instead, acquisitions that acquire both high and low k-space data, in ranked order, should provide acceptable tip position and needle width accuracy in both temporal and spatial domains for use in I-MRI.

Artifacts↗
PubMed1996

A collaborative project in Connecticut to improve the care of patients with acute myocardial infarction.

BACKGROUND: State-based peer review organizations (PROs) and individual hospitals are challenged to achieve their quality improvement (QI) goals with shrinking resources. In 1993-1994 the Connecticut PRO and 15 local hospitals generated a comparative QI database on acute myocardial infarction (AMI) care for 1,202 Medicare and non-Medicare patients discharged in 1992 and 1993. METHODS: A steering committee composed of hospital and PRO representatives was assembled to provide oversight. PRO staff developed a chart abstraction tool and trained hospital abstractors who collected and submitted data to the PRO for comparative analyses. Written feedback was provided to all hospitals and supplemented with onsite presentations when requested. Each hospital prepared a written QI plan based on its unique data profile. RESULTS: Opportunities for improvement were identified at all hospitals. The most commonly targeted areas for improvement included the use of thrombolytics at presentation, aspirin at presentation and at discharge, and beta blockers at discharge. Improvement interventions included staff education sessions, development of AMI critical paths and standing orders, and storage of appropriate medications in emergency departments. Self-report data from the hospitals indicate improvements in care. DISCUSSION: PROs and hospitals can augment their individual QI activities by working together to share data, resources, and lessons learned. Twenty-three hospitals are now collaborating with the Connecticut PRO on a similarly designed QI project aimed at improving the care of patients hospitalized with atrial fibrillation. This project includes a more formal means of communicating QI interventions.

Aged↗
PubMed2004

Monitoring eukaryotic gene expression using oligonucleotide microarrays.

An increasing number of biological and medical research questions depend on obtaining global views of gene expression. In this chapter, we will describe how oligonucleotide microarrays have been used to accomplish this goal. In particular, we will focus on the use of GeneChip arrays, which provide high levels of reproducibility, sensitivity, and specificity. Target preparation, hybridization, washing, signal detection, and data analysis will be described in detail. Additionally, we will discuss options for facilitating data sharing, including the creation of databases, and the use of internet tools that help users place their results in the context of data from public and proprietary databases. There is so much interest and innovation in the field of genomics that protocols are constantly evolving. This chapter should be used as a genomic profiling guide only. We urge readers to consult www.affymetrix.com for the most current products and protocols.

Animals↗
PubMed1997

A collaborative project in Connecticut to improve the care of patients with acute myocardial infarction.

BACKGROUND: State-based peer review organizations (PROs) and individual hospitals are challenged to achieve their quality improvement (QI) goals with shrinking resources. In 1993-1994 the Connecticut PRO and 15 local hospitals generated a comparative QI database on acute myocardial infarction (AMI) care for 1,202 Medicare and non-Medicare patients discharged in 1992 and 1993. METHODS: A steering committee composed of hospital and PRO representatives was assembled to provide oversight. PRO staff developed a chart abstraction tool and trained hospital abstracters who collected and submitted data to the PRO for comparative analyses. Written feedback was provided to all hospitals and supplemented with onsite presentations when requested. Each hospital prepared a written QI plan based on its unique data profile. RESULTS: Opportunities for improvement were identified at all hospitals. The most commonly targeted areas for improvement included the use of thrombolytics at presentation, aspirin at presentation and at discharge, and beta blockers at discharge. Improvement interventions included staff education sessions, development of AMI critical paths and standing orders, and storage of appropriate medications in emergency departments. Self-report data from the hospitals indicate improvements in care. DISCUSSION: PROs and hospitals can augment their individual QI activities by working together to share data, resources, and lessons learned. Twenty-three hospitals are now collaborating with the Connecticut PRO on a similarly designed QI project aimed at improving the care of patients hospitalized with atrial fibrillation. This project includes a more formal means of communicating QI interventions.

Aged↗