The hospital information system--integrated patient records.
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Communication↗
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The day after: effects of vocal interactions on territory defence in nightingales.
1. Models on territory acquisition and tenure predict that territorial animals benefit by adjusting territorial defence behaviour to previous challenges they had experienced within the socially complex environment of communication networks. 2. Here, we addressed such issues of social cognition by investigating persisting effects of vocal contests on territory defence behaviour in nightingales Luscinia megarhynchos (Brehm). 3. Using interactive playback during nocturnal song of subjects, a rival was simulated to countersing either aggressively (by song overlapping) or moderately (by song alternating) from outside the subjects' territory. Thereby, the time-specific singing strategy provided an experimentally controlled source of information on the motivation of an unfamiliar rival. 4. Expecting that nightingales integrate information with time, the same rival was simulated to return as a moderately singing intruder on the following morning. 5. The results show that the vigour with which male nightingales responded to the simulated intrusion of an opponent during the day depended on the nature of the nocturnal vocal interaction experienced several hours before. 6. Males that had received the song overlapping playback the preceding night approached the simulated intruder more quickly and closer and sang more songs near the loudspeaker than did males that had received a song alternating playback. 7. This adjustment of territory defence strategies depending on information from prior signalling experience suggests that integrating information with time plays an important part in territory defence by affecting a male's decision making in a communication network.
Aggression↗
Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system.
Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.
Artificial Intelligence↗
Digital imaging and electronic patient records in pathology using an integrated department information system with PACS.
Picture archiving and communication systems have been widely used in radiology thus far. Owing to the progress made in digital photo technology, their use in medicine opens up further opportunities. In the field of pathology, digital imaging offers new possiblities for the documentation of macroscopic and microscopic findings. Digital imaging has the advantage that the data is permanently and readily available, independent of conventional archives. In the past, PACS was a separate entity. Meanwhile, however, PACS has been integrated in DIS, the department information system, which was also run separately in former times. The combination of these two systems makes the administration of patient data, findings and images easier. Moreover, thanks to the introduction of special communication standards, a data exchange between different department information systems and hospital information systems (HIS) is possible. This provides the basis for a communication platform in medicine, constituting an electronic patient record (EPR) that permits an interdisciplinary treatment of patients by providing data of findings and images from clinics treating the same patient. As the pathologic diagnosis represents a central and often therapy-determining component, it is of utmost importance to add pathologic diagnoses to the EPR. Furthermore, the pathologist's work is considerably facilitated when he is able to retrieve additional data from the patient file. In this article, we describe our experience gained with the combined PACS and DIS systems recently installed at the Department of Pathology, University of Magdeburg. Moreover, we evaluate the current situation and future prospects for PACS in pathology.
Computer Communication Networks↗
Development of a web based electronic patient record extending accessibility to clinical information and integrating ancillary applications.
Web-technology offers a powerful mechanism for providing access to clinic information. Applications need no longer to be tied to a specific client operating system. The Johns Hopkins Hospital has designed a web based electronic patient record system which seamlessly incorporates multiple web sites. This paper will discuss the motivations for building the system, the architecture, and the challenges faced in designing the architecture.
Academic Medical Centers↗
The Indiana network for patient care: an integrated clinical information system informed by over thirty years of experience.
Presented in this article is the Indiana Network for Patient Care, an integrated citywide medical record system that promotes health quality by enabling efficient access to clinical information. It begins with a description of the system's infrastructure, which includes an explanation of how the system accomplishes data integration. This is followed by a series of descriptions and rationales behind the many clinical applications that interface these data. In doing so, some of the factors that we feel contribute to the success of the system are illustrated.
Databases, Factual↗
Integrating systemic information at the molecular level: cross-talk between steroid receptors and cytokine signaling on different target cells.
An essential event in immune activation is the increase of cytokines in both plasma and immune tissues. Steroid hormones influence several adaptive responses in both health and disease. Cytokines and steroids have an intimate cross-communication in many systems, making possible a satisfactory adaptive response to environmental changes. The ultimate level of integration of the cytokine-steroids cross-talk is the molecular level. We have demonstrated this in four types of cross-talk mechanisms on different cells in which steroids have major roles: (1) The tumor necrosis factor (TNF)-glucocorticoid receptor (GR) transcriptional interaction in cellular targets of TNF-induced cytotoxicity. TNF potentiates the transactivation activity of GR and the priming with TNF increases the protective action of GR on TNF-induced cytotoxicity. (2) The GR-T cell receptor (TCR) antagonism in GR-TCR-induced T cell apoptosis and its modulation by cAMP. cAMP inhibits the TCR-induced apoptosis through a PKA-CREB-dependent mechanism and potentiates glucocorticoid-induced apoptosis by means of a CREB-independent mechanism. (3) The GR influence on Th1-Th2 cytokine expression and differentiation. Glucocorticoids inhibit the induction of GATA-3 and T-bet transcription factors. (4) The influence of ER/Smad-4 signaling cross-communication on prolactinoma pathogenesis. Physical and functional interactions between Smad-4 and estrogen receptors take place in prolactinoma cells, providing a molecular explanation to link the tumorigenic action of these two important players of prolactinoma pathogenesis. The molecular cross-talk between steroids and transcription factors is the mechanism that provides the basis for the outcome of adaptive responses integrating the systemic information provided by hormones and cytokines.
Animals↗
How do the suprachiasmatic nuclei of the hypothalamus integrate photoperiodic information?
The suprachiasmatic nucleus of the hypothalamus (SCN) plays an essential role in the generation and maintenance of circadian rhythms in mammals. The SCN activity is also dependent upon the photoperiod. The duration of the SCN sensitive phase to light, in term of Fos induction, is variable and tied to the length of the night. The question is how and by which pathways can photoperiod influence SCN? It is possible following the theoretical model of evening and morning component of the clock that the SCN build itself the photoperiodic signal. That the SCN integrate the photoperiodic information through indirect neural or neuroendocrine pathways is also to consider. Data in favor of these different interpretations are presented.
Animals↗
A vision for child health information systems: developing child health information systems to meet medical care and public health needs.
In both the medical care and public health arenas, a variety of information systems have been developed to serve providers and program managers. In general, these systems have not been designed to share information with other information systems and provide comprehensive information about a child's health status to the information user. A number of initiatives are underway to develop integrated information systems. In December 2003, All Kids Count hosted an invitational conference "Developing Child Health Information Systems to Meet Medical Care and Public Health Needs." Through a series of plenary presentations and breakout discussion groups, participants developed a series of recommendations about governance, economic issues, information infrastructure, and uses of information from integrated child health information systems (CHIS). Common threads in the recommendations were: (1) development of a national coalition of stakeholders to promote integration of separate child health information systems within the context of ongoing national initiatives such as the National Health Information Infrastructure and the Public Health Information Network, (2) the need to develop the business and policy cases for integrated CHIS, (3) the need to develop agreement on standards for collecting and transferring information, and (4) the need to get the word out about the importance of integrating separate CHIS to improve health and health services.
Child↗
Using hub technology to facilitate information system integration in a health-care enterprise.
The deployment and maintenance of multiple point-to-point interfaces between a clinical information system, such as a laboratory information system, and other systems within a healthcare enterprise is expensive and time consuming. Moreover, the demand for such interfaces is increasing as hospitals consolidate and clinical laboratories participate in the development of regional laboratory networks and create host-to-host links with laboratory outreach clients. An interface engine, also called a hub, is an evolving technology that could replace multiple point-to-point interfaces from a laboratory information system with a single interface to the hub, preferably HL7 based. The hub then routes and translates laboratory information to other systems within the enterprise. Changes in application systems in an enterprise where a centralized interface engine has been implemented then amount to thorough analysis, an update of the enterprise's data dictionary, purchase of a single new vendor-supported interface, and table-based parameter changes on the hub. Two other features of an interface engine, support for structured query language and information store-and-forward, will facilitate the development of clinical data repositories and provide flexibility when interacting with other host systems. This article describes the advantages and disadvantages of an interface engine and lists some problems not solved by the technology. Finally, early developmental experience with an interface engine at the University of Michigan Medical Center and the benefits of the project on system integration efforts are described, not the least of which has been the enthusiastic adoption of the HL7 standard for all future interface projects.
Delivery of Health Care↗
[Anamnestic information by integration of documented data].
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Computers↗
Perceiving distance accurately by a directional process of integrating ground information.
By itself, the absolute distance of an object cannot be accurately judged beyond 2-3 m (refs 1-3). Yet, when it is viewed with reference to a flat terrain, humans accurately judge the absolute distance of the object up to 20 m, an ability that is important for various actions. Here we provide evidence that this is accomplished by integrating local patches of ground information into a global surface reference frame. We first show that restricting an observer's visual field of view to the local ground area around the target leads to distance underestimation, indicating that a relatively wide expanse of the ground surface is required for accurate distance judgement. Second, as proof of surface integration, we show that even with the restricted view, the observer can accurately judge absolute distance by scanning local patches of the ground surface, bit by bit, from near to far, but not in the reverse direction. This finding also reveals that the surface integration process uses the near-ground-surface information as a foundation for surface representation, and extrapolation to the far ground surface around the target for accurate absolute distance computation.
Darkness↗
A conceptual model integrating spatial information to assess target volume coverage for IMRT treatment planning.
PURPOSE: We propose a model that integrates the spatial location of each voxel within a clinical target volume (CTV) to differentiate the merit of intensity-modulated radiation therapy (IMRT) plans with similar dose-volume histogram (DVH). This conceptual model is based on the hypothesis that various subregions within a given CTV that may carry different degree of risk in containing microscopic disease. METHODS AND MATERIALS: We hypothesize that a correlation between the probability of microscopic tumor extension and the risk of lymph node metastasis of a particular voxel point within CTV can be inferred based on its distance from the surface of radiographically evident gross disease. A preliminary observation was gathered from existing clinicopathologic data, and, based on these observations, a conceptual model for exponential-decay microscopic-extension probability function around primary tumor and linear function parameters relating the likelihood of lymph node metastasis to the distance from primary tumor was proposed. This model was generated to provide scoring functions to examine the merit of IMRT plans. To test the feasibility of this model, we generated two IMRT plans with similar and clinically acceptable DVH-based CTV coverage. Planning data were transferred to a data analysis software package (Matlab, The Mathworks Inc.). A 3D scoring function was calculated for each voxel inside the CTV. The adequacy of target coverage was evaluated by several novel approaches: 2D dose-volume scoring-function histograms (DVSH), the integral probability of relative residual tumor burden (RRTB), and tumor control probabilities (TCP) employing the scoring function as a pseudo-clonogen density distribution. RESULTS: Incorporating parameters for the risk of containing microscopic disease in each voxel into the scoring function algorithm, 2D DVSHs, RRTBs, integral RRTBs, and TCPs were computed. On each axial image, an RRTB map could locate the regions at greatest risk. These scoring functions were able to differentiate the merit of CTV coverage of clinically different IMRT plans but having very similar DVHs; one with cold spots centrally located over the gross tumor, and the other with more acceptable cold spots on the periphery of the CTV further away from the gross tumor volume. CONCLUSIONS: We demonstrated the feasibility and potential utility of an IMRT scoring method derived from this conceptual modeling approach. These methods are capable of ranking treatment plans with similar DVH profiles but different underdosed regions within the target. We will examine the accuracy of model parameters by performing tumor-specific image-pathologic correlation studies. Upon validation of these parameters, incorporating this scoring function model into plan optimization may have the potential to avoid underdosing subvolumes within CTV that harbor a higher likelihood of microscopic disease.
Humans↗
Great expectations: benefits realization from an integrated hospital information system.
Defining the expected benefits from an intended change, development and/or investment has been recognized for some time as being an integral part of a decision making process. A dictionary definition of Benefit is: "A favorable or helpful factor or circumstance, advantage, profit." A definition of Realization is: "Convert into actuality; acquire; convert into money; achieve."
Hospital Information Systems↗
Mitochondria as integrators of information in an early-evolving animal: insights from a triterpenoid metabolite.
Mitochondria have the capacity to integrate environmental signals and, in animals with active stem cell populations, trigger responses in terms of growth and growth form. Colonial hydroids, which consists of feeding polyps connected by tube-like stolons, were treated with avicis, triterpenoid electrophiles whose anti-cancer properties in human cells are mediated in part by mitochondria. In treated hydroids, both oxygen uptake and mitochondrial reactive oxygen species were diminished relative to controls, similar to that observed in human cells exposed to avicins. While untreated colonies exhibit more stolon branches and connections in the centre of the colony than at the periphery, treated colonies exhibit the opposite: fewer stolon branches in the centre of the colony than at the periphery. The resulting growth form suggest an inversion of the normal pattern of colony development mediated by mitochondrial and redox-related perturbations. An as-yet-uncharacterized gradient within the colony may determine the ultimate phenotypic effects of avicin perturbation.
Analysis of Variance↗
Computerized tracking of mammography patients: value of a radiology information system integrated with a personal-computer data base.
OBJECTIVE. We investigated the advantages of using a radiology information system as the primary data source for a mammographic patient-tracking system that is based on a personal-computer local-area network and that requires almost no data entry. HARDWARE AND SOFTWARE. Our mammographic data base is maintained on a file server that provides cross-platform access to both Macintosh and IBM-compatible personal computers. Locally developed software automatically transfers mammographic data from our radiology information system to the file server's mammographic data base. The data transferred include patients' demographics (e.g., hospital identification number, address, referring physician) and the complete mammographic report. With the use of specific terminology, the need for follow-up can be automatically gleaned from the mammographic report and coded within the data base. Graphically oriented, commercially available software provides easy access to this information from any personal computer on our department's network. The software provides considerable flexibility for searching and manipulating the data without the need for customized data-base programming. Redundant data entry and associated errors are drastically reduced, as are personnel requirements for maintaining the system. Relative to most commercial radiology information systems, a personal computer facilitates the steps involved in tracking patients and obtaining highly customized analyses of the mammographic data base. The data in the mammographic data base exactly match those in the hospital's registration data and are easily transferred to other personal-computer programs for ancillary processing. CONCLUSION. This technique is ideal for departments that use a general-purpose radiology information system for mammographic reporting, yet need a more powerful but user-friendly and low-cost method for tracking their mammography patients.
Female↗
Bridging the gap between medical and bioinformatics: an ontological case study in colon carcinoma.
Ontological principles are needed in order to bridge the gap between medical and biological information in a robust and computable fashion. This is essential in order to draw inferences across the levels of granularity which span medicine and biology, an example of which include the understanding of the roles of tumor markers in the development and progress of carcinoma. Such information integration is also important for the integration of genomics information with the information contained in the electronic patient records in such a way that real time conclusions can be drawn. In this paper, we describe a large multi-granular datasource built by using ontological principles and focusing on the case of colon carcinoma.
Colonic Neoplasms↗
Striatal dopamine denervation and sensory integration for balance in middle-aged and older adults.
UNLABELLED: The dopaminergic system of the basal ganglia has been implicated in the integration of sensory information important for balance based on studies in patients with Parkinson's disease. Striatal dopaminergic activity decreases with normal aging. OBJECTIVE: To investigate the relationship between regional striatal dopaminergic denervation and sensory information integration important for balance in middle-aged and older adults. METHODS: Community-dwelling subjects (N=35; age 41-83) with no clinical diagnoses of conditions affecting balance underwent dynamic posturography testing (Sensory Organization Test/SOT) and C-11-beta-CFT dopamine transporter positron emission tomography. RESULTS: Reduced ventral striatal dopamine was significantly correlated with increased anterior-posterior sway in three SOT conditions. Specifically, during quiet standing (SOT Conditions #1, 2) and when repeatedly to sway-referenced visual environments (SOT Condition #3, Trial #3), pre-synaptic dopaminergic denervation in the anteroventral striatum explained over 20-25% of the variability in sway magnitude above and beyond that explained by age (p<or=0.01). Striatal dopaminergic denervation did not impact balance in sway-referenced floor conditions. CONCLUSIONS: The SOT Condition #3 findings suggest that, in normal aging, the central ability to inhibit balance destabilizing vision-related postural control processes depends at least partially on striatal dopaminergic pathways. In contrast, striatal dopaminergic denervation does not appear to impair the ability to disengage destabilizing proprioceptive inputs and to trigger the vestibular control system during challenging sensory perturbations (SOT Conditions #4-6). Finally, quiet standing results (SOT Conditions #1, 2) justify the need to further investigate the impact of striatal dopaminergic denervation on the ability to tune muscle tone in healthy adults.
Accidental Falls↗