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Lowering the barrier to a decentralized NHIN using the open healthcare framework.

In this paper, we discuss two important elements to lowering the barrier to creation of a National Health Information Network. The first element is the adoption of standards that will enable interoperability while guarantee open interfaces (and preventing vendor lock-in). The second element is the role of open source. While adoption of open standards by large EMR vendors is critically important to enterprise healthcare providers and payors, the availability of inexpensive (or free) standardized Healthcare Information Technology for small physician practices is critical. By analogy to the emergence of the World Wide Web, a framework for creating inexpensive and open source applications for physicians will be as important to realizing a National Health Information Network as availability of free browser technology was to the growth of the internet.

Ambulatory Care Information Systems↗

The visual display of regulatory information and networks.

Cell regulation and signal transduction are becoming increasingly complex, with reports of new cross-signalling, feedback, and feedforward regulations between pathways and between the multiple isozymes discovered at each step of these pathways. However, this information, which requires pages of text for its description, can be summarized in very simple schemes, although there is no consensus on the drawing of such schemes. This article presents a simple set of rules that allows a lot of information to be inserted in easily understandable displays.

Audiovisual Aids↗

Informal control networks and adolescent orientations toward alcohol use.

Utilizing panel data obtained from 345 high school sophomores, juniors, and seniors in a medium-sized community in the Pacific Northwest, this study investigated the roles parental and peer informal control structures play in predicting adolescent alcohol use and abuse. The findings suggest that the "youth world" and "adult world" control structures are predictive of adolescents' orientations toward alcohol, though generally in different directions. While the adult-world predictors tended to constrain use and abuse, those of the youth world promoted use and discouraged abstinence. Further, changes occurred in the relative importance of the parental and peer predictors across time.

Adolescent↗

Evolution of document networks.

How does a network of documents grow without centralized control? This question is becoming crucial as we try to explain the emergent scale-free topology of the World Wide Web and use link analysis to identify important information resources. Existing models of growing information networks have focused on the structure of links but neglected the content of nodes. Here I show that the current models fail to reproduce a critical characteristic of information networks, namely the distribution of textual similarity among linked documents. I propose a more realistic model that generates links by using both popularity and content. This model yields remarkably accurate predictions of both degree and similarity distributions in networks of web pages and scientific literature.

Databases, Bibliographic↗

A practical object-oriented approach to a development of a next generation hospital information system.

KIND (stands for Kyushu university hospital Information Network Database) is a five years project, which aims to provide integrated services for patients, physicians, researchers and other hospital staffs. The final product of KIND is a next generation hospital information system. A physicians' clinical workstation, for example, integrated into a secured medical information network, can electronically develop a longitudinal medical record and interface with pharmacies, laboratories, medical specialists, and radiologists, as well as develop patient census and demographic profiles, in addition to doing electronic claims. Since clinical requirements on those medical records may vary for each case, we would like to have an essential data model under the hood. We decided to introduce domain analysis method to produce a relevant domain model. A domain analysis method captures the nature of business and helps us have an essential and extensible data model. Although there are several ways to describe a domain model, we chose an object-oriented description and consequently implementation using an object-oriented database system. Once we could have a decent domain model and implemented it as an object-oriented data model, application programs can utilize those data very easy without worrying extra efforts like finding complex queries including multiple joins. More over, if an application uses decent object-oriented technologies, it allows a user to access whole aspects of data transparently. This paper describes the architecture of KIND (the system) and outlines our domain model. In this paper, we also describe a practical application of several object-oriented technologies to develop a next generation hospital information system.

Database Management Systems↗

Potential predictors of information-seeking behavior by homosexual/bisexual (gay) men with a human immunodeficiency virus seropositive health status.

Seeking ways to improve their health, gay men with human immunodeficiency virus (HIV) infections living in San Francisco are developing information networks and patterns of self-care behavior. Drawing from a set of explanatory theories, this cross-sectional survey with retrospective elements examined patterns and potential predictors of information-seeking activity in a cohort or 162 HIV seropositive (HIV+) men, 60 of whom provided complete data sets. The study suggests that 1 year after becoming aware of an HIV+ health status, most patients have developed multifaceted information networks. The amount of tangible aid acquired from these networks and frequency of consultation is positively related to patterns of HIV self-care behaviors and "feeling calm" (p less than 0.01), suggesting that these variables may be important markers for the need of supportive-educative nursing care. Suggestions for nursing practice and research are also described.

Bisexuality↗

[Hospital infection control in the 21st century--importance of network for hospital infection control and role of clinical laboratory].

The clinical laboratory is important as a department which provides diagnostic and advisory services to clinicians and support surveillance for hospital infection control. Though the link between clinical laboratory and other departments including infection control team is paramount for infection control, there are the communication delays by the documented reports. The use of the hospital information system can streamline the work of infection control, because laboratory(including microbiology) data can be obtained quickly. In order to implement efficient infection control, it is necessary to construct the information network by utilizing the local area network in the hospital. Since the community-acquired infections due to resistant micro-organisms are increasing in 1990s, we should expand the information network in community and nation-wide in the 21st century.

Cross Infection↗

[Systematization in the Central Clinical Laboratory of Kyoto University Hospital].

Recently, computer systems including several delivery systems have been installed in the Central Clinical Laboratory of Kyoto University Hospital. As for the physiological examination system, we have introduced PRINS (Physiological-examination Result Information Network System) using an NEC computer and LAN. Utilizing Windows, this PRINS is connected to individual systems and equipment, and the data are sent to the host computer system (KING: Kyoto University Hospital Information Network Galaxy, which utilizes IBM). This system enabled us to greatly improve (1) the efficacy of examinations, (2) management and data-stock of huge volumes, (3) rapid data analyses and simplicity in handling, and (4) facility of reception and reservation business. As for the sample analysis system, we formerly developed computer systems using MUMPS independently in the subdivisions. At the time of delivery system installation, we decided to unify them and newly establish a general managing system using MUMPS Sumitomo Electric Industries. The purpose of these installations are briefly as follows; (1) to reduce human power and to simplify delivery of samples and related business, (2) to report the assay results rapidly, (3) to improve and automate the quality controls, (4) to prevent from infections, and (5) to make handling and work easier. This system is comprised of biochemistry, immunology, hematology and emergency examination subdivisions, and connects each part in a network system using LAN. This is further connected to KING, the host. Actually, 4 sample delivery lines from 3 industries were introduced: Hitachi for biochemistry, Sysmex for hematology, and Toshiba-IDS for coagulation and immunology. Monitoring and data analyses including quality controls are performed by a host system or individual systems (biochemistry and hematology). At present, such heterogeneous installations were considered to be most suitable for our purpose and these made it possible to continue assays of other lines even when trouble occurred in one of the lines. In addition to the general systems, we have introduced various software programs for statistical analyses. These have been effectively utilized already for detailed setting of the clinical reference values for hematology data, and also for a computer diagnosis trial for anemia related diseases. When effective operations of these newly installed systems is achieved, we would like to extend our efforts to establish an ideal laboratory which is able to assist the intensive medi-care system in the university hospital.

Clinical Laboratory Information Systems↗

Networking groups provide refuge for CEOs.

The competitive spirit that dominated health care in the latter half of the 1980s isolated many CEOs from their peers. CEOs of competing hospitals felt that they couldn't talk openly with each other, problems were solved in isolation, and stress levels climbed. But CEOs have found a way to exchange ideas with other executives: informal networking groups. But one of the most important aspects of these meetings is that they're fun. They offer CEOs a chance to relax and talk frankly with others about mutual problems and how to solve them. These informal network groups also help younger executives, who are often invited to audit the meetings. Younger executives get a chance to see different management styles and new approaches to problem solving.

Economic Competition↗

Medical informatics in population health: building Wisconsin's strategic framework for health information technology.

Medicine is increasingly practiced through the application of information sciences. Medical informatics deals with optimal information use within bioinformatics, imaging, clinical, and population health domains. Population health informatics plays an important role in that it critically informs practice in each of the other domains. Proper functioning of health care systems requires an advanced health information network that supports clinical care, personal health management, population health, and research. But this infrastructure does not yet exist in the United States. A number of federal initiatives are underway to address this problem, including the development of a framework for a national health information network and funding for implementation. This network will be facilitated by federal leadership, but public and private partnerships, and state, regional, and local implementation and policy development will play a critical role. In this article, we describe several Wisconsin initiatives that are keys to developing a strategic framework and building the state's electronic health information infrastructure.

Biomedical Technology↗

Drug Information Center network: need, effectiveness, and cost justification.

During the past 15 years, the pharmacy profession has experienced much change. Certain pharmacy roles are being challenged and others are coming into existence. Today, health-care practitioners and health-care providers are seeking services not sought before from pharmacists in the area of rational therapeutics. This need for information extends to all pharmacy practice settings: institutional, independent pharmacies, chain stores, governmental agencies, and the pharmaceutical industry. In order to meet this demand for drug and toxicology information, however, the pharmacist must use resources outside the immediate area of his practice. The Drug Information Center (DIC) can be used as such a resource by pharmacists in their daily practice to provide the best possible care with regard to the rational use of drugs for their patients/clients. Specifically, our data indicate that in Tennessee, there is a need for providing drug and toxicology information; pharmacists perceive their role to be providers of drug information as well as drugs; the DIC plays an integral and necessary role as a back-up information resource and in teaching, service, research, and continuing education programs; and the programs provided by the DIC are cost effective and cost justifiable.

Cost-Benefit Analysis↗

Information retrieval in digital libraries: bringing search to the net.

A digital library enables users to interact effectively with information distributed across a network. These network information systems support search and display of items from organized collections. In the historical evolution of digital libraries, the mechanisms for retrieval of scientific literature have been particularly important. Grand visions in 1960 led first to the development of text search, from bibliographic databases to full-text retrieval. Next, research prototypes catalyzed the rise of document search, from multimedia browsing across local-area networks to distributed search on the Internet. By 2010, the visions will be realized, with concept search enabling semantic retrieval across large collections.

Abstracting and Indexing↗

Physician and practice characteristics associated with judgments about breast cancer treatment.

Since most cancer is treated in the local community, the judgments of primary care physicians about treatment of breast cancer are important. This study examined physician and practice characteristics associated with physician judgments about the treatment of Stage I and Stage II breast cancer. Data are combined from samples of 3,436 physicians: physicians affiliated with hospitals participating in the Community Clinical Oncology Program (CCOP) and a national sample of non-CCOP physicians. This study focused on 1,460 physicians who had seen breast cancer patients and participated in treatment decision-making. Judgments were elicited using brief vignettes. Judgments were more variable for Stage I than for Stage II treatments. Judgments consistent with the NIH Consensus Conferences on breast cancer were more likely from surgeons, physicians who participated in information networks focused on cancer, and those with more breast cancer patients. Concurrence with the consensus conference positions was less likely in older physicians and those in solo practice. These findings point to structures that reinforce quality of care, particularly those that enhance communication, such as group practice or the activities of hospital staffs, information networks, and organized continuing education.

Breast Neoplasms↗

Neural networks of information processing in posttraumatic stress disorder: a functional magnetic resonance imaging study.

BACKGROUND: Neuroimaging studies report reduced medial prefrontal cortical (particularly anterior cingulate) but enhanced amygdala response to fear signals in posttraumatic Stress Disorder (PTSD). We investigated whether anterior cingulate-amygdala dysregulation in PTSD would generalize to salient, but nonthreat related signals. METHODS: Individuals with PTSD (n = 14) and age and sex-matched nontraumatized controls (n = 14) completed an auditory oddball paradigm adapted to functional magnetic resonance imaging at a 1.5-T field strength. RESULTS: Controls displayed bilateral activation in ventral anterior cingulate and amygdala networks, and PTSD subjects showed bilateral dorsal anterior cingulate and amygdala activation to targets relative to nontargets. Compared to controls, PTSD subjects showed enhanced responses to targets in the dorsal and rostral anterior cingulate, and left amygdala. Whole-brain analyses confirmed the expected pattern of distributed prefrontal-parietal responses to targets in the oddball task. Greater activity in posterior parietal somatosensory regions was observed in PTSD. CONCLUSIONS: Our findings of enhanced anterior cingulate responses in PTSD contrast with reports of reduced activity for threat stimuli, suggesting that the latter may be specific to processing of threat-related content. Activation in rostral and dorsal anterior cingulate, left amygdala and posterior parietal networks in response to salient, nonthreatening stimuli may reflect generalized hypervigilance.

Amygdala↗

Epidemiology of contact allergy: an estimation of morbidity employing the clinical epidemiology and drug-utilization research (CE-DUR) approach.

Clinical epidemiology (CE) is considered unable to estimate morbidity concerning either contact sensitization (CS) or allergic contact dermatitis (ACD) at the population level. Drug-utilization research (DUR) methods estimate the morbidity of suitable diseases based on prescription data for disease-specific drugs. Our objective was to estimate population figures for incidence and prevalence of ACD and CS based on sales data for patch test material in Germany and on patient data from the Information Network of Departments of Dermatology (IVDK). Approximately 600000 standard series are sold per year in Germany, according to the 2 main manufacturers. This raw sales figure was corrected for certain effects (discarded preparations, proportion of formerly patch-tested patients, proportion of patients with ACD seeking medical advice) to obtain an estimate of the denominator of patients eligible for patch testing annually, and combined with patch test results from the Information Network of Departments of Dermatology (IVDK). In 17.8% (of 9266 IVDK patients) ACD was established. Extrapolated to the general population, an incidence of ACD of between 1.7 and 7 per 1000 per year was estimated, depending on whether conservative or more liberal assumptions concerning the above effects were made. Of 78067 IVDK patients tested between 1992 and 2000, 46.8% had at least 1 positive reaction (+ to + + +), and 22.7% had at least 1 stronger positive reaction (+ + or + + +). The 9-year prevalence of CS was estimated to lie between 4.0% and 16.6% for the first outcome, and between 2.0% and 8.1% for the second. Concerning single allergens, 1.9-4.5 million individuals are probably sensitized to nickel, and 1.4-3.4 million to fragrance mix among the German population of 82 million inhabitants. The morbidity data found in this study are in good accordance with data from population-based epidemiological studies. In comparison to these, the CE-DUR approach seems to be an economically feasible method to estimate continuously the population impact of ACD and CS.

Allergens↗

The effects of pre-entry career maturity and support networks in workplace on newcomers' mental health.

The present study examined the effects of pre-entry experiences (i.e. career maturity), as well as support networks (i.e. informational and friendship), on newcomers' mental health (i.e. depression, self-esteem, psychosomatic symptoms, and work motivation). We performed a longitudinal study of 890 men and women who first entered the workplace in 2003. Surveys were distributed at two time points: just prior to entering the workplace, and two months after entering. Results indicated that career maturity related positively to newcomers' mental health, and newcomers with high career maturity were more successful in establishing positive relationships with superiors and co-workers. Although, informational support networks positively related to work motivation, friendship networks did not show any direct effects on mental health. These results underscore the crucial roles of career maturity and informational networks in facilitating the transition to the workplace. The results also provide empirical support for an expanded view of the importance of pre-entry experiences to workplace newcomers' mental health.

Adult↗

Information technology can enhance quality in regional health delivery.

OBJECTIVES: a) The use of information technology (IT) based solutions for quality health delivery in regional health information networks and the study of the enabling factors for their use in a regional health care network from key classes of users such as the medical personnel and the citizens. b) Identification of potential technologies for usage from all citizens and health providers in a regional environment, in all aspects of everyday life. c) Presentation of a generic user model for reference when developing and assessing IT based health delivery solutions. METHODS: After defining the major questions to be addressed, an overview of tele-health and tele-medicine technologies and solutions currently available shall be presented. Further, a generic user model applied to the use of IT based regional health delivery solutions both for the daily life and home care, and for research and clinical routine purposes are presented. Enabling technologies for integration of different IT modules, medical data processing and management procedures and the wireless application protocol (WAP) technology is discussed. RESULTS: Different levels of user applications are presented such as mobile telephony driven health information monitoring and systems integrating electronic health care records with multimedia medical information management and processing modules. CONCLUSIONS: Although IT solutions are advanced and continue to evolve, still the user acceptance and user friendliness issues are unresolved. Mobile telecommunication solutions however may hold the key for wide scale implementation of IT solutions in regional health information networks and increased quality of health services.

Decision Support Systems, Clinical↗

The Nordic Study on schizophrenic patients living in the community. Subjective needs and perceived help.

In a community sample of 418 persons diagnosed with schizophrenia, subjective needs and perceived help was measured by the Camberwell Assessment of Need (CAN). The mean number of reported needs was 6.2 and the mean number of unmet needs 2.6. The prevalence of needs varied substantially between the need areas from 3.6% ('telephone') to 84.0% ('psychotic symptoms'). The rate of satisfaction estimated as the percentage of persons satisfied with the help provided within an area varied between 20.0% ('telephone') and 80.6% ('food'). The need areas concerning social and interpersonal functioning demonstrated the highest proportion of unmet to total needs. In a majority of need areas the patients received more help from services than from relatives, but in the areas of social relations the informal network provided substantial help. In general the patients reported a need for help from services clearly exceeding the actual amount of help received. In a linear regression model symptom load (BPRS) and impaired functioning (GAF) were significant predictors of the need status, explaining 30% of the variance in total needs and 20% of the variance in unmet needs. It is concluded that the mental health system fails to detect and alleviate needs in several areas of major importance to schizophrenic patients. Enhanced collaboration between the care system and the informal network to systematically map the need profile of the patients seems necessary to minimise the gap between perceived needs and received help.

Activities of Daily Living↗