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A uniform database of rehabilitation as a basis for evaluating the outcome quality.

To make it possible to benefit from patient data recorded in rehabilitation clinics, with regard to outcome quality and scientific investigation, the Rehabilitation Research Centre at the University of Ulm has created a rehabilitation register, a database based on ORACLE, into which the relevant patient data is transferred, having been made anonymous via an SQL archiving program. The archived data includes the clinical parameters, the running text of the discharge report, and the doctor's and patient's assessment of the rehabilitation outcome. It can be automatically searched for structured data, according to every conceivable criterion and in every conceivable combination, also in combination with a text search in the running text of the admission and discharge reports and the rehabilitation outcome. With the aid of the rehabilitation register and thanks to the possibilities of EDP (Electronic Data Processing), in future it will be possible to make much more differentiated comments on the rehabilitation outcome than would be the case if the search were restricted to structured data alone. This is essential in order to be able constantly to improve outcome quality and to verify the economic benefit of rehabilitation medicine.

Databases as Topic↗

Third generation electronic pharmacy communications. Recommendations based on ten years' experience.

The number of electronic prescriptions in Denmark is increasing and almost 600,000 electronic prescriptions are now sent every month. There is therefore a strong interest in directly reusing the data entered in the medical practitioner systems in the pharmacy systems. It has therefore been decided to introduce a shared data foundation in all medical practitioner and pharmacy systems in Denmark in conjunction with the introduction of the new MEDPRE electronic prescription standard. Parallel to the standardisation work, concrete guidelines have been prepared for the individual EDP (Electronic Data Processing) systems to ensure rapid, problem-free prescription communication. The aim in the longer term is for 95% of all EDIFACT prescriptions to reach the receiving pharmacy no more than 20 minutes after being sent from a medical practice.

Computer Communication Networks↗

[The follow-up of the orthodontic treatment of facial cleft patients with the Göttingen computer-supported documentation system].

The care of patients with cleft lip, alveolus, and palate demands supervision of the development and progress over a long period of time. It also requires a standardized and systematic basic documentation. In our cleft center the documentation is summarized on one sheet of paper with DIN-A4 formation (297 x 210 mm). The use of electronic data processing improves the documentation. The storage of general and medical data has been supplemented by a personal computer system, PC-System. Five years after developing of this computer aided documentation system several patients are shown as examples for the application of this system for longterm control patients with cleft lip, alveolus, and palate.

Child↗

[4-year experiences with computer-assisted registration of postoperative wound infections and identification of risk factors].

A continuous record of postoperative surgical infections was carried out by electronic data processing of 9,181 orthopaedic and general operations. The overall infection rate was 5.7%, ranging from 2.0% (clean wounds) to 22.1% (dirty wounds). The corresponding deep infection rates were 1.7%, 0.4% and 5.4%, respectively. Employing a multiple logistic regression analysis, ten risk factors were evaluated. Factors found to be significant for both departments were: wound contamination, duration of operation and age. In addition, in the department of orthopaedic surgery: date of operation and surgeon, and in the department of general surgery: planning of operation, length of preoperative stay and anatomic groups. Sex had no influence on postoperative infection. Significant factors altered during the four years. Postoperative stay was, on an average, 13.9 days longer in infected patients.

Denmark↗

Computer-aided surveillance of surgical infections and identification of risk factors.

A continuous record of postoperative surgical infections was carried out by electronic data processing (EDP) of 4340 orthopaedic and general operations. The overall infection rate was 6.3%, ranging from 2.3% (clean wounds) to 27.1% (dirty wounds). The corresponding deep infection rates were 1.6%, 0.4% and 4.6%. Employing a multiple logistic regression analysis, 10 risk factors were evaluated. Factors found to be significant were: wound contamination, department, duration of operation, date of operation and age, and in addition for the department of general surgery: surgeon, planning of operation, length of preoperative stay and anatomic groups. A statistical model for identification of risk patients is described. Postoperative stay was on average 20.5 days longer in infected patients. We find that EDP-recording may result in an annual cost reduction of at least 175,000 pounds for our hospital.

Denmark↗

[Data protection--an obstacle for prospective studies? Solutions exemplified by a cohort study].

Prospective studies require the storage of the participants' personal data for follow-up. This demands special precautions for the protection of these data. Additional to the informed consent of the participant which enables the researchers to collect the prospective study data, the participant's right of informal self-determination should be protected. In the EPIC (European Prospective Investigation into Cancer and Nutrition) Potsdam study, therefore, an internal trustee was established that collects follow-up information from participants, physicians, clinics, health offices, tumour and population registries with the aim to obtain valid information on vital status and diseases of the participants. The internal trustee is a spatial and organizational separated working group. The isolated electronic data processing network, the alarm system which controls the rooms of the working group, the access control for employees are special security arrangements. During follow-up the individual identification number of the study data base is replaced by a specific identification number solely for the follow-up. Further, unique identification numbers are allocated to every single action and every single document such as inquiry forms which are sent to physicians, health offices, or population registries, that allow anonymous mailing and processing of the collected information. On copies of important documents, the name is erased and replaced by a specific record number. The inquiry forms for the physicians, for instance, contain the name of the participant at the head which has to be cut off before returning the form to the internal trustee. The identification number is also printed as bar code on each document facilitating its processing with technical aids such as scanners. If checkbacks are necessary, only certain work group members are able to reconnect the document number with the name. Depending on the task, the computer programmes confine automatically the details presented to the assistant. All arrangements to protect personal data do not interfere with research interests; on the contrary they lead to an efficient work routine and guarantee follow-up according to international rules.

Cohort Studies↗

How increased automation will improve the 1990 census of population and housing of the United States.

"The U.S. Bureau of the Census will increase significantly the automation of operations for the 1990 Census of Population and Housing, thus eliminating or reducing many of the labor-intensive clerical operations of past censuses and contributing to the speedier release of data products. An automated address control file will permit the computer to monitor the enumeration status of an address. The automated address file will also make it possible to begin electronic data processing concurrently with data collection, and, thus, 5-7 months earlier than for the 1980 Census. An automated geographic support system will assure consistency between various census geographic products, and computer-generated maps will be possible. Other areas where automation will be introduced or increased are questionnaire editing, coding of written entries on questionnaires, and reporting of progress and cost by field offices."

Americas↗

[Criteria for the system selection in medicine (author's transl)].

The selection of an electronic data processing system for use in the medical field is in many cases complicated by the fact that the tasks have not yet been defined accurately in detail. Therefore, the technical system planning may only be carried out on the basis of an organization study which, among other things, is to provide bases for answering questions about the structure of this system, about the places where subsystems should operate in the hospital, and about the individual levels of implementation. When selecting the system, the criteria to be taken into consideration include the technical efficiency, organizational range of application, reliability, assistance by the manufacturer and, last but not least, the cost - bearing in mind that, in the medical field, the weights may be placed quite differently from the commercial field. With this planning consideration should also be given to the possibilities of utilization not basing on a system of one's own.

Computers↗

[Studies on the birth-weight and the size of the new-born child with reference to the parity of the mother (author's transl)].

The relation between the parity of the mother and the birth-weight as well as the size of the new-born child, taking into account the sex, were examined as follows: From the patients needing obstretical care during the period of 1966 to 1971 those 3441 women were chosen who had born twice or more times during this time. By means of an electronic data processing system the weight and size differences of the children were correlated with the parity of the mother taking again into account the order of male and female births. Births with uncertain gestational age, non-cephalic presentations, and premature births were excluded (WHO definition or gestational age less than or equal to 266 days counted from last menstruation). 1. The average birth-weight increases by 105 g from the first to the second child, by 39 g from the second to the third, and by 12 g from the third to the fourth child. Obviously, there is no linear link between the increase of the birth-weight and the increasing parity. The major weight-increase is to be observed from the first to the second child. 2. A corresponding statement concerning the size of the new-born children cannot be made which is partly due to the relative inaccuracy of the method applied. 3. On the average boys weigh between 130 g to 150 g more than girls according to the parity.

Birth Order↗

[(Partially) automated gel techniques for determining erythrocyte antigens and antibodies].

Today, in addition to the classical test tube technology to determine red blood cell antigens and antibodies, not only the microtitration plate is increasingly used, but also the gel card. Since this new technology is easy to practice and since it further provides a higher specificity and sensitivity, we investigated whether, and if so to what extent, the gel card can be automated. On the basis of our own experience spanning many years, we were able to show that antigen determinations and antibody screening can be automated. Once the samples to be tested and the tests to be performed have been recorded by electronic data processing and combined in a job list, any sampler can distribute liquids, such as reagents and serum and/or plasma as well as red blood cell suspensions, on the basis of these data. A positive sample identification is made feasible by bar coding sample tubes and gel cards; the pipetting action is organized via the bar codes. Incubation and centrifugation are of secondary importance for automation. At this time, an automatic evaluation of gel cards is not yet possible so that result interpretation must be visual and the input of results must be manual. For documentation, however, laboratory books and result interpretation reports can be printed out automatically.

Blood Grouping and Crossmatching↗

Proofreading performance by disabled adults.

The development of Optical Character Recognition and other data input technologies is providing disabled individuals access to occupations in electronic data processing. Many of these technologies require proofreading of previously captured data for prolonged periods of time. Research using other tasks requiring sustained attention has demonstrated steep performance decrements over time by many functionally impaired populations. Previous investigations have suggested that gains in proofreading performance may be achieved by increasing the error density in the material to be proofread. Thus, the present study was designed to assess the performance of a heterogeneous group of 12 disabled persons on a computerized proofreading tasks. Errors were embedded in alphanumeric code. The subjects included individuals with a broad range of physical or psychological impairments. After extensive training, all subjects participated in a 6-hr. proofreading task. The subjects corrected 96.6% of the errors embedded in 50,000 characters. Error detections were stable across six hours of proofreading. Implications for proofreading in applied settings are discussed.

Adolescent↗

Laboratory quality control issues related to screening newborns for cystic fibrosis using immunoreactive trypsin.

We have incorporated the IRT assay for CF to our newborn screening program, relying heavily on electronic data processing to optimize the test results in order to provide the most reliable data possible from the specimen at hand. We have established an internal cut-off of 100 ng/mL and an external referral of 180 ng/mL; this virtually eliminates the possibility that analytical imprecision will result in misidentifying a positive patient specimen. The relationship between IRT levels and various mutant forms of CF are not well established, and it is possible that various forms of CF may exhibit different levels of IRT in the first few days of life. We believe that IRT screening for CF could be a useful procedure for early identification of potential CF. However, by comparison with other newborn screening tests, its sensitivity, 90%, presents a concern. The expectation for PKU, hypothyroidism, MSUD, and galactosemia screening is 100% sensitivity. A false-negative usually results in litigation. The use of IRT in routine newborn screening will require considerable education of the general public and physicians receiving test results. Our program, along with many others, is anxiously watching the developments in the area of gene testing. We feel the relatively inexpensive IRT, used for mass screening can be successfully coupled with the more definitive (and expensive) gene test on a selected population to identify CF at the earliest possible age in a more effective manner. It is possible that in the near future gene probe tests will be applied in a cost effective manner to the initial filter paper specimen.

Cystic Fibrosis↗