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At least 307 records · Page 17Linked to original sources

Outpatient health care statistics data warehouse--implementation.

Data warehouse implementation is assumed to be a very knowledge-demanding, expensive and long-lasting process. As such it requires senior management sponsorship, involvement of experts, a big budget and probably years of development time. Presented Outpatient Health Care Statistics Data Warehouse implementation research provides ample evidence against the infallibility of the above statements. New, inexpensive, but powerful technology, which provides outstanding platform for On-Line Analytical Processing (OLAP), has emerged recently. Presumably, it will be the basis for the estimated future growth of data warehouse market, both in the medical and in other business fields. Methods and tools for building, maintaining and exploiting data warehouses are also briefly discussed in the paper.

Ambulatory Care↗

Secondary centers of ossification of the human toes: exceptional polymorphism and evolutionary perspectives.

As great morphological variability characterizes the phalanges of the human toes in adults, we hypothesized for a possible variability in the presence or absence of their secondary (= epiphyseal) centers of ossification linked to the unique morphology of the human foot within primates. The aim of this study was thus to provide original and detailed data on the occurrence of these centers. Classically, the big toe or hallux (I) presents two secondary centers and the lateral toes (II-V) three centers, and consequently the five toes present a total of 14 secondary centers. The material studied consisted of 261 foot radiographs from 261 young individuals of European origin (202 males and 59 females; 6-16 years). The presence (or absence) of the secondary centers of the phalanges of the toes was assessed for each foot. Feet presenting a biphalangeal variant in one or more lateral toes were studied separately. The theoretical possibilities of association of the three secondary centers in a given lateral toe (II-V) are eight in number; these eight patterns were studied and coded in the present study by types A-H. An exceptional variability in the occurrence of the secondary centers in lateral toes (II-V) was observed, and the classic pattern of phalangeal ossification was never observed. The absence of one or more secondary centers seems to be observed only in the human species, and we suggest that this could be a derived pattern specific to the human species, i.e., autapomorphic pattern. These results are of interest in the characterization and understanding of the reduction in size of the lateral toes which characterizes the specific evolution of the human foot.

Adolescent↗

Recent advances in the protocols of transgenic mouse mutation assays.

Transgenic mutation assays were developed to detect gene mutations in multiple organs of mice or rats. The assays permit (1) quantitative measurements of mutation frequencies in all tissues/organs including germ cells and (2) molecular analysis of induced and spontaneous mutations by DNA sequencing analysis. The protocols of recently developed selections in the lambda phage-based transgenic mutation assays, i.e. cII, Spi(-) and 6-thioguanine selections, are described, and a data set of transgenic mutation assays, including those using Big Blue and Muta Mouse, is presented.

Animals↗

Making the case for EDI.

The 1993 chair of the Health and Human Services' Workgroup for Electronic Data Interchange's Financial Implications Technical Advisory Group predicts big savings from EDI under the Clinton healthcare reform plan. A cost/benefit analysis by the TAG foresees net cumulative savings from EDI of $42 billion by the turn of the century.

Computer Communication Networks↗

Risk adjustment wrinkle.

Health plans and providers contracting under Medicare risk want greater equity and the right incentives. Clinical risk adjustment, already being tried in various forms on the private health insurance side, seems to offer a good solution. But the tremendous lack of outpatient data for risk adjustment is throwing up a very big obstacle to the evolution of the Medicare+Choice program, and could result in bad public policy, some industry observers warn. Is the federal government about to make a policy misstep at a critical moment in the Medicare program's development?

Ambulatory Care↗

Renal effects of big endothelin-1 in experimental congestive heart failure.

The present study was designed to evaluate the effects of big endothelin (ET) on renal hemodynamics and excretory functions in rats with experimental congestive heart failure (CHF) produced by aortocaval fistula. Clearance studies were performed in control and in chronic (7 day) CHF rats. Administration of bit ET (1 and 3 nmol/kg, i.v.) to control rats caused an increase (29%) in mean arterial pressure (MAP) associated with a decrease (38%) in renal blood flow (RBF) and a marked increase (130%) in renal vascular resistance (RVR). These changes were accompanied by a decrease in glomerular filtration rate (GFR) and a significant increase in sodium excretion. In contrast, the effects of big ET on MAP and renal hemodynamics were blunted in CHF rats, and sodium excretion increased only minimally in response to big ET despite a significant increase in GFR. The data suggest that rats with CHF have reduced sensitivity to the vascular and renal action of ET.

Animals↗

Feasibility of AsthmaCritic, a decision-support system for asthma and COPD which generates patient-specific feedback on routinely recorded data in general practice.

BACKGROUND: Introducing decision-support systems as a tool to stimulate the dissemination of clinical guidelines in daily practice has been disappointing. Researchers have argued that integration of such systems with clinical practice is a prerequisite for acceptance. The big question concerns the feasibility of a true integration--if only routinely recorded data are used for such a system, can patient-specific feedback be produced? OBJECTIVE: The aim of this study was to assess the feasibility of generating patient-specific feedback based on routinely recorded data in general practice by AsthmaCritic, a decision-support system for asthma and chronic obstructive pulmonary disease (COPD). METHODS: We built the decision-support system AsthmaCritic and assessed its ability to detect asthma and COPD patient records and generate patient-specific feedback by retrospective analysis of routinely recorded data in 103 713 electronic patient records from primary care practices. We grouped feedback into categories of comments by age group (<12 years and > or =12 years). The main outcome measures were the number and percentage of "triggered" (selected) asthma and COPD patient records, and the number and percentage of records on which AsthmaCritic produced at least one feedback comment during the 1-year study period, by category of comments. RESULTS: AsthmaCritic detected 8784 (8.5%) asthma and COPD patient records. During the study period, AsthmaCritic generated 255 664 feedback comments (mean 3.4 per patient visit). The most frequently generated category of comments in the case of patients aged > or =12 years was "non-compliant prescription" (23.7%), whereas the most frequent category in the case of patients <12 years was "non-compliant route" (31.1%). CONCLUSIONS: This study shows that, using routinely recorded data only, AsthmaCritic is able to detect asthma and COPD patient records for further analysis and to produce patient-specific feedback.

Adolescent↗

Small signal, big noise: performance of the CIDI depression module.

OBJECTIVES: With the release of data from the Canadian Community Health Survey: Mental Health and Well-Being (Cycle 1.2), researchers have, for the first time, information on several psychiatric disorders from a nationally representative sample of Canadians residing in households. This survey used the Composite International Diagnostic Interview (CIDI) to identify persons with one or more psychiatric disorders. In this paper, our primary purpose was to evaluate the evidence supporting the validity of the CIDI--that is, the extent to which the depression diagnoses generated by the CIDI reflect true cases of depression. METHOD: We conducted a critical review of the CIDI, focusing on the depression module. RESULTS: Reliability studies indicate that the CIDI performs reliably, as measured by interrater reliability. However, the use of different versions of the CIDI and the occasional exclusion of the Depression module from studies suggest that the reliability of the CIDI Depression module remains unconfirmed. The most critical issue in regard to the CIDI's performance is that clinical samples are used to test validity. A clinical sample has a higher prevalence of depression than a community sample. CONCLUSION: The results generated by the CIDI in a community setting likely will have a high false-positive rate, resulting in a falsely elevated prevalence rate. Given the widespread application of the CIDI internationally, addressing the outstanding concerns about validity with proper validation studies should become an international priority.

Depression↗

[The law and "the bioethics of the beginning of life" on the Internet. A new electronic information resource promoted and developed by the Italian National Research Council].

The Institute of Theory and Techniques of the Legal Information (ITTIG) of the Italian National Research Council (CNR) has produced various electronic information systems. Among these, the archive BIG (Bibliography on right to life and interruption of pregnancy, bioethics and genetic engineering). The article presents the archive BIG in its previous version in print and Internet versions, and it describes its main characteristics (original, analytical, objective, scientific). At last, it exposes the rules for data selection and the debate about the right to life in Italy. The archive BIG enables the expert as well as the layman, to exercise an effective control on the enormous material published on this matter.

Academies and Institutes↗

[Widened resection in locally advanced carcinomas of the right half of the colon].

We describe two cases of locally advanced carcinomas of the right half of colon. In spite of big tumour size and infiltration of adjacent organs we decided to perform widened "en block" resection. Microscopically no neoplastic cells were found in lymph nodes. During a year observation we did not ascertain any features of neoplasm relapse what is consistent with data published by other authors. They indicate that radical resection of big-sized tumours infiltrating adjacent organs in the case of absence of metastases into lymph nodes gives the patient a chance for long-term survival.

Adenocarcinoma↗

Adolescent personality factors in self-ratings and peer nominations and their prediction of peer acceptance and peer rejection.

In this study, the robustness of the Big Five personality factors in adolescents' self-ratings and peer nominations was investigated. Data were obtained on 2,001 adolescents attending secondary school (885 girls; 1,116 boys; M age = 14.5 years). Exploratory and confirmatory factor analyses on the self-ratings confirmed the Big Five personality factors. In contrast, exploratory analysis on the peer nominations revealed five different factors: Aggression-Inattentiveness, Achievement-Withdrawal, Self-Confidence, Sociability, and Emotionality-Nervousness. It is suggested that peers evaluate group members not in terms of their personality but in terms of their group reputation. Peer evaluations contributed substantially to the prediction of peer acceptance and rejection; the Big Five personality factors based on self-ratings did not.

Adolescent↗

Application of partial least-squares regression to near-infrared reflectance spectroscopic determination of shive content in flax.

Shive, the nonfiberous core portion of the stem, in flax fiber after retting is related to fiber quality. The objective of this study is to develop a standard calibration model for determining shive content in retted flax by using near-infrared reflectance spectroscopy. Calibration samples were prepared by manually mixing pure, ground shive and pure, ground fiber from flax retted by three different methods (water, dew, and enzyme retting) to provide a wide range of shive content from 0 to 100%. Partial least-squares (PLS) regression was used to generate a calibration model, and spectral data were processed using various pretreatments such as a multiplicative scatter correction (MSC), normalization, derivatives, and Martens' Uncertainty option to improve the calibration model. The calibration model developed with a single sample set resulted in a standard error of 1.8% with one factor. The best algorithm was produced from first-derivative processing of the spectral data. MSC was not effective processing for this model. However, a big bias was observed when independent sample sets were applied to this calibration model to predict shive content in flax fiber. The calibration model developed using a combination sample set showed a slightly higher standard error and number of factors compared to the model for a single sample set, but this model was sufficiently accurate to apply to each sample set. The best algorithm for the combination sample set was generated from second derivatives followed by MSC processing of spectral data and from Martens' Uncertainty option; it resulted in a standard error of 2.3% with 2 factors. The value of the digital second derivative centered at 1674 nm for these spectral data was highly correlated to shive content of flax and could form the basis for a simple, low-cost sensor for the shive or fiber content in retted flax.

Algorithms↗

Computer-aided information system to support direct patient care. The application of a hand-held data collector in a department of medicine.

In the pilot study, described herein, we have tried to develop a computerized system to assist and improve medical and nursing care. Our major goal was to bring the computer to the patient's bedside. This was achieved by a Hand-Held Data Collector, which is easy to carry and operate, and has a big enough memory. In this preliminary study, we have developed appropriate software specifically designed to reflect the daily activities and needs of a department of medicine. Using this software, we have demonstrated that all 'clinical events' and routine tasks of the department can be managed via the Hand-Held Data Collector.

Computer Systems↗