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PubMed2005

Representing the Patient's Therapeutic History in Medical Records and in Guideline Recommendations for Chronic Diseases Using a Unique Model.

Computer-interpretable guidelines (CIGs) are more likely to affect the clinician's behavior when they deliver patient-specific and just-in-time clinical advice. CIGs must take into account the data stored in the patient's electronic medical records (EMR). For chronic diseases, the outcome of past and ongoing treatments (therapeutic history) is used in the clinical guidelines. We propose a model for the conceptualization of therapeutic history, facilitating data sharing between EMRs and CIGs and the representation of therapeutic history and recommended treatments in clinical guidelines.Based on medical literature review and an existing treatment model, a core structure is first defined taking into account drug and non-drug treatment components and treatment type (e.g. bitherapy). These elements together with additional concepts obtained by analyzing a sample guideline relating to diabetes, are then organized into an object-oriented model, using UML formalism.We show how this model can be used to store the patient's therapeutic history in the EMR, together with other attributes such as treatment efficacy and tolerance. We also explain how this model can efficiently code guidelines therapeutic rules.We evaluated this model, using additional guidelines hypercholesterolemia and asthma. We found it capable for representing guideline recommendations in several domains of chronic diseases.

Chronic Disease↗
PubMed2005

The role of the forensic pathologist in quality assurance and safety of patient care.

During this past half century, there has been remarkable increase in the role of forensic pathologists and medical examiners in the determination of cause and manner of deaths in health care facilities and investigations of quality of patient care. Autopsy data are an essential part of this quality assurance (QA) program in patient care, especially in trauma centers' QA programs. Forensic pathologists participate in evaluating appropriateness of patient care where death occurs during or following therapeutic and diagnostic procedures. Continuous quality improvement programs now extend into data sharing in child and elder abuse, monitoring of defective medical devices and consumer products which contributed to deaths. In recent years, forensic pathologists are increasingly requested directly by family members to conduct private autopsies to provide independent opinions as to quality of patient care. Thus forensic pathologists are contributing expertise to an ever widening circle of influence in prevention of unnecessary deaths with quality assurance programs and peer review processes.

California↗
PubMed2006

The perfect storm for electronic health records.

EHRs and data sharing improve quality, reduce costs, and enhance workflow. They create a c ommunity of clinical collaboration, fostering the adoption of new knowledge and best practices. With government, provider, and payer support for the nationwide rollout of electronic records, 2006 will be the year in which the United States makes significant progress on the journey to deliver electronic systems to all clinicians.

Attitude of Health Personnel↗
PubMed2006

Computerize your infection surveillance for improved patient care--and savings.

Kadlec Medical Center, in Richland, Wash., was able to reduce its nosocomial infection rate by 13 percent and save nearly dollar 576,000 in 15 months by: Working with the infection control department. Developing the business case for infection control initiatives. Conducting a preliminary financial analysis. Sharing data throughout the hospital--not just with the infection control department. Making the adoption of a computerized infection-tracking system a priority.

Cost Savings↗
PubMed1991

Implementing the Medical Desktop: tools for the integration of independent information resources.

The increasing availability of medical information resources has moved the "Medical Desktop" from a theoretical construct to a practical necessity. Many micro-computers are becoming available in clinical and academic settings that can access several medical information applications. These computers are usually not powerful workstations that are part of a clinically oriented information support system, but are personal computers with varied capabilities. The applications on these computers come from different sources, are accessed through different user interfaces and do not share data well. The de facto "Medical Desktop" this situation presents will discourage most end-users because the combination of applications is complex, the applications are poorly integrated, and individual applications are inconsistent. At the State University of New York at Buffalo School of Medicine and Biomedical Sciences we have developed several Microsoft Windows-based tools that accept a systems level diversity of resources, but work toward the construction of a coherent "Medical Desktop." These tools include a lexical term linker, a resource database, and a context sensitive help system that is tailored to locally available resources.

Databases, Factual↗
PubMed1991

Hospitals with the best information systems. 1991 SDR awards of excellence.

For the second year, 12 hospitals with truly exceptional information systems are highlighted in Hospitals. The Shared Data Research Second Annual Award of Excellence is presented to those institutions showing leadership in information systems management. Recognition is based on cost and performance factors. As investment in these systems grows, so does executives' interest in measuring their cost and performance. Indeed, U.S. hospitals spent more than $6.5 billion on materials services in this area in 1989. "Hospitals with the Best Information Systems" leads off our 14-page Factbook--a guide to the 1991 HIMSS Annual Conference, to be held Feb. 11-14 in San Francisco.

Awards and Prizes↗
PubMed1991

1991 SDR Awards of Excellence. The most popular application software.

The 1991 SDR Awards of Excellence honor those vendors whose software applications are given the highest ratings by users. For the second year in a row, Shared Data Research, Hudson, OH, asked hospitals' software users to nominate the best products in 18 different application categories.

Awards and Prizes↗
PubMed1990

Hospital users rate software applications. 1990 SDR vendor awards of excellence.

Not all software packages are made the same; some do their jobs better than others. Which software is most popular among hospitals? The 1990 SDR Vendor Awards of Excellence is an attempt to answer that question. For the awards, Shared Data Research (SDR), Hudson, OH, asked hospital software users to nominate companies that produce the best-performing software.

Attitude of Health Personnel↗
PubMed1990

Kaposi's sarcoma reporting in San Francisco: a comparison of AIDS and cancer surveillance systems.

A preliminary comparison of the reported incidence of Kaposi's sarcoma among males under 60 years of age residing in San Francisco was conducted using merged San Francisco AIDS Registry and California Tumor Registry (CTR) data. For the years 1980-1986, the number of cases reported by both registries was similar. However, only 961 (72.3%) of the 1,330 cases appearing in either registry appeared in both. Of the 160 Kaposi's sarcoma cases in the AIDS registry only, 11 (6.9%) were included in the CTR with another cancer diagnosis. Of the 209 Kaposi's sarcoma cases occurring only in the CTR, 109 (52.2%) were included in the AIDS registry with another diagnosis. The number of cases included in either or both registries was about 20% more than in either alone. Data sharing between the staff of these registries is precluded by confidentiality constraints.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Training analyst selection: the need for criteria.

Training analyses are not the same as other analyses. Simultaneously analyzing and educating complicates matters. Historical events in psychoanalysis confirm this; modest recommendations regarding non-reporting met significant resistance. Training needs and psychoanalysis needs overlap and merge rather than remain distinctly separate. Powerful professional identifications exist, evoking a sense of "parents' rights" and privilege within the training analyst and Education Committee, and abrogation of candidate privilege. Historical cultural factors in the training schools served or serve as social reinforcers, perpetuating pressures to share data. Democratization of training analyst appointment procedures denies manifest training complexities. After graduation, clearly defined steps toward training analyst status should be outlined. These should include criteria for selection, encouragement to apply step-wise procedures to aid further development and sophistication regarding issues described, and dilution of power among many well-qualified training analysts.

Confidentiality↗
PubMed1994

Human health and the environment in eastern and central Europe. Report of the conference Prague, Czech Republic, 12-15 April 1993.

A group of 46 leading environmental health scientists from 15 nations unanimously agreed to join forces in a new scientific effort to protect human health around the world from the potentially harmful effects of environmental chemicals and radioactive materials. The scientists agreed to establish a non-political European-based, not-for-profit organization whose objectives will be to promote, coordinate and fund environmental health research in order to provide a scientific basis for environmental remediation. The organization will be affiliated with the Conte Institute. The research priorities decided upon for Eastern and Central Europe were as follows: 1. Research into the effects of toxic metals, such as lead, cadmium, arsenic, and beryllium. 2. Research in the populations of the region on cancer, birth defects, and other diseases, with emphasis on data sharing across national boundaries, on quality control, and on use of biomarkers of reproductive and other effects. 3. Studies on the molecular, biochemical, and chromosomal bases for varying genetic susceptibilities to environmentally-induced diseases. 4. Coordination of research on radiation effects, especially on radiation-exposures resulting from nuclear power and weapons plants. 5. Research on approaches to bioremediation. 6. Education and training of professionals and nonprofessionals in environmental health issues, on an international basis. These and other issues will be taken up over time by this new, cooperative scientific research organization, as decided at the Prague Conference.

Commonwealth of Independent States↗
PubMed1995

Options in dairy data management.

A great deal of progress has been made in the development of dairy herd management software in the last few years. At the same time, the speed, capacity, and portability of computer hardware have increased, while costs have decreased, thus encouraging use by veterinarians,dairy herd managers, and other industry support groups. A review of the literature indicates that an increasing number of producers, veterinarians, and other dairy industry service personnel are using computers and dairy herd management software in the delivery of their services (1-3,5,9-11,26-30,38,39). Wider adoption will occur if information generated through the use of these systems is directed towards the improvement of the profitability of dairy production. The quality of a decision is only as good as the information used to make it. In the past, the limited availability of reliable herd data has restricted our understanding of factors that influence herd performance. In essence, we must define what is normal before we can determine what is abnormal. More importantly, we must define what management practices are profitable and to what extent they increase revenue (3 1,32). Improved record keeping will benefit the dairy industry by allowing producers and dairy consultants to make profitable decisions based on more accurate and complete information. The ability to merge biological, management,and economic data may prove valuable in the evaluation of intervention at the herd and individual animal level. The impact of interventions is often as much a function of the unique combination of management factors on a dairy, as the biological effect that can be evaluated in a clinical trial. For example, the use of gonadotrophin-releasing hormone therapy at the time of service has been shown to be more successful in herds with better than average conception rates than in herds with poor conception rates. This difference in efficacy may be due to nutritional and other herd level management factors. Sophisticated dairy information management systems provide valuable herd specific management information, which allows more comprehensive understanding of the complex interaction of pharmaceutical,biological, and management factors that ultimately determine the profitability of veterinary intervention strategies. The use of electronic transfer of data will become essential in order to increase efficiency of use of information through data sharing. This will decrease transfer time and cost of information exchange between dairy herd managers and support industries.

Dairying↗
PubMed1994

The role of an electronic mail system in the educational strategies of a residency in obstetrics and gynecology.

Computerized electronic mail (E-mail) systems provide a rapid means of data sharing and are used in a variety of commercial and industrial settings for the widespread distribution of memoranda. We adapted an E-mail system to our program to determine the feasibility of incorporating such a system into didactic resident education in obstetrics and gynecology and to assess resident response to this form of computer-based learning. The system was programmed to distribute one review question per day to 24 resident physicians for 60 days. Residents were given 24 hours to respond and comment. Each question was discussed and appropriate references distributed within 48 hours of presentation. All questions and responses were then stored in an electronic file folder for later review. An examination was given at completion of the project (post-test), and these scores were compared to performance during the project (pre-test). An anonymous questionnaire was distributed upon completion of the project to assess the residents' overall satisfaction with the program. The system was well received by the residents. On a scale of 1 to 6 (1 = lowest; 6 = highest), resident satisfaction was high, with an overall average rating of 5.0. Using this scale, residents assessed their frustration level as 1.5. Average daily participation was 85%. An average of 9 minutes was required to complete each question and review prior responses and discussion; this interval was not significantly different among the postgraduate years. Scores on the examination at project completion were significantly higher than performance during the project.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗
PubMed1994

Endoscopic imaging technology.

Upper gastrointestinal endoscopy has evolved from semiflexible instruments of large diameter to a generation of high-resolution electronic and fiberoptic instruments of narrow diameter with many diagnostic and therapeutic capabilities. Resolution and color fidelity are important considerations in endoscopy, and advances in technology have resulted in substantial improvements in both over the last decade. Enhancements in electronic imaging techniques and developments in networking will make image transfer and shared data easier in the coming years, and image processing may help refine diagnostic endoscopy.

Computer Systems↗
PubMed1993

[Synovial sarcoma of the abdominal wall. Apropos of a case].

On the basis of one case of malignant synovioma exceptionally located in the abdominal wall and of a review of the literature, the authors give the highlights on the current clinicopathological, evolutive and prognostic data shared by all malignant synoviomas, whatever their location. Finally, they discuss the specific diagnostic and therapeutic issues of the abdominal site.

Abdominal Muscles↗
PubMed1993

Safety considerations in a surgical robot.

This paper describes the safety features of the ROBODOC Surgical Assistant System, an image-driven robotic system which has been used to perform Total Hip Replacement surgery. These features include a dedicated processor for continuous monitoring of system status, shared data areas (dual-ported RAM), and external sensors (force-torque sensor, redundant positional encoders, and bone motion monitor).

Equipment Safety↗
PubMed1993

Planning and implementing a microcomputer local-area network.

Factors to be considered in planning and implementing a microcomputer local-area network (LAN) in a pharmacy department are discussed. Reasons for implementing a LAN include the ability to share data, programs, and peripheral devices among multiple users. The network operating system may be full featured or a peer-to-peer system. Full-featured networks require a dedicated file server but are more powerful and versatile. The file server, if used, is the most important piece of equipment. Factors that affect the choice of a file server are the processor, the bus, memory and speed, the supplier, and the power supply. It is necessary to select network adapters and wiring and to decide whether any of the department's current computer equipment will be used in the network. Decisions must also be made about software. The equipment should be set up by the computer services department or a vendor. Two or more pharmacists must be appointed and trained as supervisors to manage the network, diagnose and correct problems, perform network backup, and guard against computer viruses. Security is a major concern because of the need for confidentiality, the licensure of software for only a limited number of users, and the risk of inadvertent alteration or erasure of data. Network users must be trained to use the system properly. Department managers should consider the need to access the LAN from computers outside the department and the possible incorporation of the LAN into a wide-area network. A microcomputer LAN can provide valuable information services, but careful planning is necessary to avoid pitfalls and to ensure that the network meets current and future needs.

Clinical Pharmacy Information Systems↗
PubMed1996

Genome scanning for linkage: an overview.

Several different methods for linkage analysis are shown to arise from a single likelihood function L for the observed allele-sharing data at multiple markers in a chromosomal region. These include classical parametric lod score methods, nonparametric or "model-free" affected pedigree-member (APM) methods, and the Gaussian process method. Setting the methods in the context of the likelihood function L clarifies their underlying assumptions. A test statistic derived from L, the efficient score statistic, is introduced. It is asymptotically equivalent to the lod score, but it can be easier to compute when the penetrances and frequencies of alleles of the trait gene are not known. APM test statistics and the Gaussian lod score are shown to be special cases of efficient score statistics. This unified framework facilitates exploration of a range of models for the effects of a putative trait-predisposing gene, and it facilitates sensitivity analyses to examine the consequences of model misspecification.

Female↗