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PubMed1980

A computerized chart management system for medical records.

A computerized system is described which improves turnaround time for completion of in-patient medical records and copes with the problem of delinquent records. Many patients seen at University Hospital are referred from throughout the State, thus the specialist must stay in contact with the referring physician for optimal patient care. The Medical Records Department assists in this effort through use of the system, which includes pertinent dates and other information concerning each patient. Several reports are generated from this information, e.g., outstanding records sorted by department/physician and outstanding records with charges pending. The total software system is comprised of 22 program, 2 sub-routines, and 4 data files; the total disk storage space required is 1413 kilobytes.

Computers↗

PubMed1996

Incorporating Monte Carlo simulation into physiologically based pharmacokinetic models using advanced continuous simulation language (ACSL): a computational method.

Biologically based models with physiological parameters are becoming more popular as a tool to estimate target tissue doses from chemical exposures. However, the majority of current physiologically based pharmacokinetic (PBPK) models do not take into account the uncertainty and/or variability within the various model parameters. Consideration of uncertainty is important to evaluate the predictive ability and complexity of a model as well as identification of parameters which contribute disproportionately to variability in model output. In order to estimate the uncertainty in PBPK model output, a versatile and simple computational method is presented which can be readily incorporated into the majority of PBPK models without extensive additions to model computer code. In this paper, a separate computer program for Monte Carlo simulation is furnished that randomly samples values for model parameters and writes them into a run-time language (command file) format which can then be utilized to execute individual PBPK models. Modifications to the PBPK model allow the desired output to be written to a data file for statistical analysis. The method presented in this paper is applied to a simple PBPK model for benzene disposition.

Algorithms↗

PubMed2002

A network system of medical and welfare information service for the patients, their families, hospitals, local governments, and commercial companies in a medical service area.

A service information system using the Internet, which connected the various people who are related to medical treatment and nursing welfare, was constructed. An intractable neurological disease patient who lives in the Onga district, Fukuoka, Japan, and the people who are related to the service were chosen as test users in an experimental model. The communicated service information was divided into open-use data (electronic bulletin board, welfare service, medical care service, and link to private company service home page) and closed-use data (the individual patient's hysterics). The open data server was installed in an Internet service provider The open data could be accessed not only by the patient, but also by the family, information center, companies, hospitals, and nursing commodity store related to patient's nursing and medical treatment. Closed data server was installed in an information center (public health center). Only patient and information center staff can access the closed data. Patients should search and collect the service information of various medical and welfare services by themselves. Therefore, services prepared for the patient are difficult to know, and they cannot be sufficiently utilized. With the use of this information system, all usable service information became accessible, and patients could easily use it. The electronic bulletin board system (BBS) was used by patients for knowing each other or each others' family, and was used as a device for exchange of wisdom. Also, the questions for the specialist, such as doctor, dentist, teacher, physical therapist, care manager, welfare office staff member, and public health nurse, and the answers were shown on the BBS. By arranging data file, a reference of various patients in question and answer, which appeared in this BBS, was made as "advisory hints" and was added to the open data. The advisory hints became the new service information for the patients and their family. This BBS discovered the possibility of becoming an important information source for companies, hospital and, administration to know the requirements of patients and their families and the kind of services to be served. Although suppliers provide medical and welfare services for the patient, there is a tendency that the service information is sent by the suppliers at their own convenience. The information system in which various people participated was constructed in order to collect information for the patient, taking a patient-oriented approach. The result of the model test showed that this information system using Internet technology is a good system for both the service supplier and its receiver.

Access to Information↗

PubMed2006

A bioinformatics pipeline for high-throughput microbial multilocus sequence typing (MLST) analyses.

Multilocus sequence typing (MLST) analysis for semi-routine applications is hindered by the downstream, manually intensive steps of processing the raw sequence data files. This report describes the development of an MLST pipeline that automates DNA sequence editing and analysis in order to significantly reduce the time required for processing data. Validation using a pneumococcal dataset revealed complete agreement between the results generated by manual and automated workflows. The MLST pipeline was developed for both double-strand and single-strand sequencing.

Bacteria↗

PubMed1986

Some applications for a personal computer data-base system in radiology.

Applications for a personal-computer-based relational data-base system in an academic radiologist's office are described. These include archival and flexible retrieval of desired cases from clinical-case and teaching-file data bases and data-base management of a transparency-slide collection and radiology journal articles. All applications were implemented by using commercially available software that was specially adapted for each purpose. These data-base systems have been effective organizing tools over the past 4 years.

Computers↗

PubMed2000

Inhaled nitric oxide for respiratory failure in preterm infants.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To determine whether, in preterm newborn infants who have hypoxic respiratory failure, treatment with inhaled nitric oxide improves oxygenation and reduces the rates of death, or adverse neurodevelopmental outcome. SEARCH STRATEGY: Electronic and hand searching of pediatric/neonatal literature and personal data files. SELECTION CRITERIA: Randomized and quasi randomized studies in preterm infants with hypoxic respiratory failure. Administration of inhaled nitric oxide. Clinically relevant outcomes, including death, oxygenation, intraventricular haemorrhage. DATA COLLECTION AND ANALYSIS: One randomized controlled trial of nitric oxide therapy was found in preterm infants with a high risk of developing bronchopulmonary dysplasia (Subhedar 1997). MAIN RESULTS: No significant effect of inhaled nitric oxide on any outcome variable was found. In particular there was no effect on the primary outcome variable of death or bronchopulmonary dysplasia. REVIEWER'S CONCLUSIONS: There is currently no published information to support the use of inhaled nitric oxide in preterm infants. Preterm infants should not be treated with inhaled nitric oxide except in the context of prospective, randomized controlled trials.

Administration, Inhalation↗

PubMed2002

The impact of financial incentives on physician productivity in medical groups.

OBJECTIVE: To estimate the effect of financial incentives in medical groups--both at the level of individual physician and collectively--on individual physician productivity. DATA SOURCES/STUDY SETTING: Secondary data from 1997 on individual physician and group characteristics from two surveys: Medical Group Management Association (MGMA) Physician Compensation and Production Survey and the Cost Survey Area Resource File data on market characteristics, and various sources of state regulatory data. STUDY DESIGN: Cross-sectional estimation of individual physician production function models, using ordinary least squares and two-stage least squares regression. DATA COLLECTION: Data from respondents completing all items required for the two stages of production function estimation on both MGMA surveys (with RBRVS units as production measure: 102 groups, 2,237 physicians; and with charges as the production measure: 383 groups, 6,129 physicians). The 102 groups with complete data represent 1.8 percent of the 5,725 MGMA member groups. PRINCIPAL FINDINGS: Individual production-based physician compensation leads to increased productivity, as expected (elasticity = .07, p < .05). The productivity effects of compensation methods based on equal shares of group net income and incentive bonuses are significantly positive (p < .05) and smaller in magnitude. The group-level financial incentive does not appear to be significantly related to physician productivity. CONCLUSIONS: Individual physician incentives based on own production do increase physician productivity.

Cross-Sectional Studies↗

PubMed1998

W2H: WWW interface to the GCG sequence analysis package.

MOTIVATION: The user-friendly, graphical X-windows interface (WPI) to the GCG sequence analysis package can often not be used due to the lack of an X-server on PC or Macintosh computers. Because Web browsers like Netscape are much more common on those platforms, we decided to develop W2H, a WWW interface to the GCG Sequence Analysis Software Package with nearly the same functionality as the X-windows interface WPI. RESULTS: The new WWW interface (W2H) to the GCG Sequence Analysis Software Package (Wisconsin Package) supports modern Web technologies, like client-pull method, or embedded scripting language, and provides a reasonable platform independence. The interface is quite comprehensive with advanced features like sequence selector, search set builder, enzyme chooser, access to sequence databases, uploading client files to the GCG server or displaying and manipulating graphical outputs in addition to GCG analysis programs. W2H also manages secure access to both GCG server and user data. For special environments, like workshops, conferences and company intranets, there is a special mode (Intranet mode) with less security constraints. The behaviour of W2H is mostly controlled by meta-data files describing the applications and giving a base for dynamic creation of HTML documents. This paper presents mainly the development approaches used, and architectural design aspects of W2H. AVAILABILITY: W2H is available by ftp://ftp.ebi.ac. uk/pub/software/unix/w2h or ftp://genome.dkfz-heidelberg.de/pub/w2h CONTACT: m.senger@ebi.ac.uk

Computational Biology↗

PubMedDate not supplied

Evolving practices of medical equipment. Management following FDA inspections.

This paper outlines one hospital's response to the changing needs for: quality of care; risk management; cost control; and regulatory agency requirements. All recall, update, and product safety alerts are now routed to the office of The Director of Materials Management. The director notifies the appropriate department manager, who must reply in writing. The Clinical Engineering Department maintains a historical data file for medical equipment, which includes service costs information. New purchasing forms and terms have been developed for use in purchasing equipment and service. Maintenance of accurate historical data for medical devices begins at purchase, and continues to installation and through ongoing service. This requires the cooperation of the manufacturer, the service vendor, and the clinical department using the device. Because technology management can improve the quality of care and reduce risk, it is worth doing and can also reduce costs.

Capital Expenditures↗

PubMed2004

Accuracy of the Justy II Apex locator in determining working length in simulated horizontal and vertical fractures.

AIM: To study the effectiveness of an electronic apex locator (EAL; Justy II; Yoshida Dentcraft, Tokyo, Japan) in locating simulated horizontal and vertical fractures in single roots. METHODOLOGY: An EAL was used to measure the distance within the canal of horizontal (n = 31) and vertical (n = 31) fractures, created with a disk in single-rooted teeth. Accuracy of the EAL was evaluated by comparing the measurements with those made using a size 10 file. Data were analysed with the non-parametric Passing and Bablok method. RESULTS: For simulated horizontal fractures, the EAL measured exactly the same length as a size 10 file, without constant or proportional errors. In vertical simulated fractures, the EAL measured (on average) with a constant error of 7.5 mm shorter than the size 10 file; the difference had a wide confidence interval (-72.3 to 2.6 mm). CONCLUSIONS: In this laboratory study, the Justy II EAL was able to determine accurately the position of simulated horizontal fractures, but was unreliable when measuring simulated vertical fractures.

Dental Instruments↗

PubMed2002

Electronic data management for the Hemochron Jr. Signature coagulation analyzer.

Point-of-care testing (POC, POCT) laboratory devices are being introduced into operating suites and critical care units in ever increasing numbers. The small, portable devices have gained in popularity because of their ease of use and the rapid availability of test results. POCT is an integral part of extracorporeal technology (ECT). A challenge associated with the growth of POC technology is related to management of the data generated by these devices. In the field of ECT, storing, retrieving, analyzing, viewing and charting quality control (QC) and patient test data generated with POC coagulation instruments is essential. We evaluated a premarket version of data management software developed for the Hemochron Jr. Signature coagulation analyzer, a PC-based software capable of fulfilling our objective. A database comprised of greater than 50 plasma and electronic QC results and greater than 140 patient sample results for ACT, PT, and aPTT tests was transferred from a Hemochron Jr. Signature device to two different PCs, each equipped with Hemochron ReportMaker software supplied by the manufacturer. Data files were transferred directly from the coagulation test unit to the PCs via an RS-232 cable. A variety of charts, reports, and file listings were created from the datasets using the software menus. Transfer of the complete database required less than 5 min. The relative speed and simplicity of the data interface promotes frequent charting of QC data, permitting real-time monitoring and early identification of data trends or values requiring intervention. If a subset of QC data is found to be incomplete, altered, or unacceptable, all patient samples tested during that period can be promptly identified. The software also includes data query tools useful for sorting and selecting specific subsets of patient and QC data. Electronic data management can facilitate compliance with quality control requirements and assist clinicians and laboratory personnel in the collection, storage, and review of quality control and patient test data. In addition, the patient and QC data are readily accessible when necessary for use in risk management assessment, accreditation, or litigation proceedings.

Blood Coagulation Tests↗

PubMed1995

Protection by endoscopy against death from colorectal cancer. A case-control study among veterans.

BACKGROUND: Although several clinical and epidemiologic studies suggest that timely diagnostic procedures of the large bowel may reduce mortality from colorectal cancer, the evidence for this relationship is primarily circumstantial. METHODS: A case-control study was conducted among hospitalized US military veterans to investigate whether diagnostic procedures of the large bowel were performed in the period preceding the diagnosis of colorectal cancer less frequently in patients dying of colorectal cancer than in control patients. Data files of a total of 4411 veterans dying of colorectal cancer between 1988 and 1992 were extracted from the records of the US Department of Veterans Affairs, Washington, DC. Data of four living control patients and four dead control patients without colorectal cancer were matched by age, sex, and race to each case patient. The case and the two control populations were compared by conditional logistic regression, calculating odds ratios, and their 95% confidence interval. RESULTS: Diagnostic procedures of the large bowel reduced mortality from colorectal cancer, the odds ratio being 0.41 (range, 0.33 to 0.50) for the comparison with living control patients. The protective effects of proctosigmoidoscopy, colonoscopy, and polypectomy lasted for 5 years. The procedures were protective against death from cancer of the colon, as well as cancer of the rectum. The most protective influence was associated with removal of tissue through biopsy, fulguration, and polypectomy. Similar influences were found comparing case patients with dead control patients. CONCLUSION: Removal of tissue represents the most effective means to reduce mortality from cancers of the large bowel. It retains its efficacy over a time period of 5 years.

Aged↗

PubMed1977

A computer analysis of cardiac electrograms.

Computer programs were constructed for the temporal analysis of 8 electrograms obtained from various regions of isolated dog hearts. The electrograms were recorded on photosensitive paper. A computer program written in the Fortran II language allowed an x-y digitizing table to be used to input the coordinates of each electrogram into a computer. Each electrode recording within a given cardiac cycle was digitized in this manner, and the temporal intervals between the 28 combinations of electrode pairs were calculated. The program also computed the heart rate and cardiac cycle length. Subroutine options permitted the grouping of data into experiment, record, and event numbers. All data were stored on a magnetic disk. A separate computer program written in the Fortran IV language performed basic statistical operations on each of the data files. The computer system described in the present report accurately and reliably processed over 10,000 cardiac cycles. Such a system can be used to analyze large amounts of data from sources other than electrograms. Temporal analysis of the standard electrocardiogram is offered as an example of the versatility of the programs.

Animals↗

PubMed1988

Older driver involvement in fatal and severe traffic crashes.

The question of the risks older drivers face, and impose on others, was addressed by examining as a function of age and sex: (a) driver involvement in crashes in the same high severity range; (b) the threat drivers pose to pedestrians; and (c) the contribution of motor vehicle fatalities to overall mortality. National data files provide source information on traffic fatalities, population, number of licensed drivers, distance of travel, and mortality from all causes. Involvement rates in severe crashes are inferred from fatality data using recently published relations linking occupant survivability to age and sex. In no case among 14 measures examined did the value at the oldest age for which data were available (varied from source to source) exceed that for young drivers. Although some risks that drivers face may increase at older ages to levels above their minimum values, the increases are small compared to the substantial reductions in distances driven with increasing age; thus, reductions in mobility may be a more dominant correlate of aging than reductions in driving safety.

Accidents, Traffic↗

PubMedDate not supplied

Comparison of polycarbonate and steel test surfaces for videokeratography.

BACKGROUND: Assessing video imaging systems for measuring corneal topography often requires test surfaces. Steel bearings have been employed, but manufacturers caution that high reflectance (> 90%) relative to the eye (< 10%) may compromise test findings. The differences between steel and polycarbonate test surfaces are quantified in this study. METHODS: Images of a steel and a polycarbonate sphere of known radius of curvature were obtained with the Tomey/Computed Anatomy Topographic Modeling System (TMS, Cambridge, Mass). Analysis was performed on the raw video data files and the resultant surface curvature estimates. RESULTS: The raw video images differed sufficiently to affect image processing. Polycarbonate yielded consistently better images. Many steel images (approximately 25%) contained data points that could not be processed; calculated surface contour was more variable for these. Differences were less obvious when these images were removed from the pool. CONCLUSIONS: Results support the manufacturer's caution against the use of steel surfaces for testing or calibration of the TMS instrument. Problems appear due to the fundamental differences in the intensity distributions of video images captured from high- and low-reflectance surfaces.

Calibration↗

PubMed1994

Customized dual data entry for computerized data analysis.

A major responsibility of any Quality Assurance Unit (QUA) is to ensure data integrity. Errors made during data entry can lead to many problems in the study review process and decrease the quality, accuracy, and overall efficiency of data management. One technique that can reduce the number of data entry errors in computer data sets is the use of a dual entry data system. Currently available software allows creation of customized data entry screens that either closely resemble or duplicate the data collection forms used during studies. Two data entry operators enter data into two independent data sets. The use of an on-screen display that resembles the data collection form reduces the potential for keypunch errors. The two data sets can then be electronically compared. The comparison reports differences between the two data sets. When differences exist, the correct values can be determined by reference to the original data sheets and the two data files can then be corrected. Theoretically, the only key punch errors that will exist after making these corrections are when the two independent entry operators make the same exact data entry error. Typically, the time required for two people to enter data is minimal compared to the time required to manually identify and correct data entry discrepancies. With error-free data entry, we have found that electronic data quality, accuracy, and audit efficiency are improved at every subsequent step of data management, analysis, quality assurance auditing, and report generation.

Information Systems↗

PubMed1994

Comparison of patients' compliance with prescribed oral and inhaled asthma medications.

BACKGROUND: Noncompliance with medications is one of the most serious problems facing health care today. However, methods to measure compliance have many limitations. METHODS: To measure specific drug compliance and dosing frequency of two asthma medications, we used medical records data and pharmacy claims data from 276 patients who had concurrent prescriptions for inhaled anti-inflammatory agents and oral theophylline. Patients were randomly selected from the pharmacy claims data files of a health maintenance organization. The patients' medical records were reviewed, and records that did not contain clear documentation of the medication, dose, and dosing frequency were excluded. Data from the remaining 119 medical records were compared with data from pharmacy claims to calculate compliance rates for each medication. RESULTS: Our calculations showed that patients were significantly more compliant with prescribed theophylline medication than with two inhaled anti-inflammatory medications (P = .0001). No significant differences in compliance were found relative to prescribed dosing frequency (twice daily or less compared with three times daily or more) for either medication (P = .6517). CONCLUSIONS: Comparison of medical record data with pharmacy claims data is an effective indirect measure of patients' compliance with prescribed oral theophylline and inhaled anti-inflammatory agents. Additional interventions must be pursued for patients with asthma regarding adherence to regimens for their prescribed inhaled anti-inflammatory agents.

Administration, Inhalation↗

PubMed2004

The effect of hospital bed reduction on the use of beds: a comparative study of 10 European countries.

In Europe, the reduction of acute care hospital beds has been one of the measures implemented to restrict hospital expenditure. The aim of this study is to gain insight into the effect bed reductions have on the use of the remaining beds within different healthcare systems. We concentrated on two healthcare system elements: hospital financing system (per diem and global budget systems) and physician remuneration system (fee-for-service and salary systems). We also controlled for technological development and demand for healthcare. We used data from the OECD health data files of 10 North-Western European countries on hospital bed supply and use. The hospital bed indicators used were occupancy rate, average length of stay and admission rate. The data were analysed with multilevel analysis. We found some indication that the different financial incentives of hospital financing systems do indeed influence hospital bed use in the case of reductions in acute care hospital bed supply in different ways. However, we found significant effects only for the hospital bed use indicators "occupancy rate" and "admission rate". For physician financing systems, no significant effects were found.

Bed Occupancy↗