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PubMed2005

ASHP survey of ambulatory care pharmacy practice in health systems--2004.

PURPOSE: The characteristics of and trends in pharmacy practice in ambulatory care settings across the United States were studied. METHODS: A 2004 national survey of the ambulatory care responsibilities of pharmacists across a spectrum of organizational types (community hospitals, county facilities, Indian Health Services facilities, Veterans Affairs (VA) facilities, teaching institutions, integrated health networks, military facilities, and health maintenance organizations) was conducted and related to organizational features that could promote pharmacist participation. RESULTS: From 1672 deliverable Web-based surveys, 233 organizations reported at least some pharmacist involvement in ambulatory activities, while 475 reported none. Over half of the 228 organizations with some pharmacist involvement reported pharmacists tracking adverse drug reactions (67%), providing written (53%) or oral (52%) information with new prescriptions, and conducting medication management programs (51%). Some 85% reported having at least one clinic with pharmacist involvement. Clinics for anticoagulation services (36%) and oncology services (28%) were most prevalent, followed by primary care or family practice clinics (23%) and diabetes clinics (21%). New survey items found a high prevalence of pharmacist involvement in emergency preparedness programs (90%), medication management services in complex medication situations (63%), and using evidence-based practice guidelines (60%). Of nine enabling factors (factors potentially promoting pharmacist involvement) investigated, participation on multidisciplinary teams and having collaborative practice agreements were significantly associated with pharmacist participation in at least one ambulatory care activity. Having at last one ambulatory care staff pharmacist with advanced training, having at least one residency program, and having collaborative practice agreements were significantly associated with pharmacist participation in at least one clinic or program. Pharmacist participation in ambulatory care activities was not equally distributed across different types of organizations, and VA facilities were notable for the amount and extent of participation. CONCLUSION: Pharmacists' roles and responsibilities in ambulatory care appear to continue to evolve, with VA facilities leading the way.

Ambulatory Care↗
PubMed2001

Cambridge Healthtech Institute's Third Annual Conference on Lab-on-a-Chip and Microarrays. 22-24 January 2001, Zurich, Switzerland.

Cambridge Healthtech Institute's Third Annual Conference on Lab-on-a-Chip and Microarray technology covered the latest advances in this technology and applications in life sciences. Highlights of the meetings are reported briefly with emphasis on applications in genomics, drug discovery and molecular diagnostics. There was an emphasis on microfluidics because of the wide applications in laboratory and drug discovery. The lab-on-a-chip provides the facilities of a complete laboratory in a hand-held miniature device. Several microarray systems have been used for hybridisation and detection techniques. Oligonucleotide scanning arrays provide a versatile tool for the analysis of nucleic acid interactions and provide a platform for improving the array-based methods for investigation of antisense therapeutics. A method for analysing combinatorial DNA arrays using oligonucleotide-modified gold nanoparticle probes and a conventional scanner has considerable potential in molecular diagnostics. Various applications of microarray technology for high-throughput screening in drug discovery and single nucleotide polymorphisms (SNP) analysis were discussed. Protein chips have important applications in proteomics. With the considerable amount of data generated by the different technologies using microarrays, it is obvious that the reading of the information and its interpretation and management through the use of bioinformatics is essential. Various techniques for data analysis were presented. Biochip and microarray technology has an essential role to play in the evolving trends in healthcare, which integrate diagnosis with prevention/treatment and emphasise personalised medicines.

Computational Biology↗
PubMed2004

Medical informatics standards applicable to emergency department information systems: making sense of the jumble.

The adoption of medical informatics standards by emergency department information systems (EDISs) is not universal, despite obvious benefits. Clinicians and administrators looking to obtain an EDIS need to know exactly what the various standards can do for them and how the systems they depend on can be integrated and extended. In addition to the standard methods for systems to communicate (chiefly Health Level 7 [HL7]) and those required for submission of claims (Current Procedural Terminology [CPT]-4, International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], and X12N), there are several other available standards that are clinically useful and can greatly improve the ability to access and exchange patient information. Major advances in the Unified Medical Language System of the National Library of Medicine have made the patient medical record information standards (Systematized Nomenclature of Medicine [SNOMED], Logical Observation Identifiers, Names, and Codes [LOINC], RxNorm) easily accessible. Detailed knowledge of the arcana associated with the technical aspects of the standards is not needed (or desired) by clinicians to use standards-based systems. However, some knowledge about the commonly used standards is helpful in choosing an EDIS, interfacing the EDIS with the other hospital information systems, extending or upgrading systems, and adopting decision support technologies.

Humans↗
PubMed1981

The integration of new therapies and radiation in the management of ovarian cancer.

New biologic information has led to a therapeutic program in Stage III ovarian cancer that considers the whole peritoneal cavity the tumor-bearing region and that uses intraperitoneal administration of ovarian cancer antiserum, intraperitoneal P-32, delayed split abdominal irradiation, and chemotherapy. The survival for those patients completing irradiation was 85%. Forty-nine patients with advanced (Stage III, IV, or recurrent) ovarian cancer have been treated with combinations of the present agents. Twenty-two patients have received intraperitoneal ovarian cancer antiserum without significant toxicity. Extensive staging has been a requirement for initial evaluation and includes maximal surgical resection, omentectomy, TAH and BSO, nodal biopsies, and peritoneal cytology. Nineteen patients had 5-mm nodules or less residual disease and were treated with colloidal P-32, abdominal irradiation, and chemotherapy; five of these patients received intraperitoneal antiserum before cytotoxic therapy. The four-year cumulative survival is 84%, and the disease-free survival 43%. A randomized prospective study is now examining the value of antiserum therapy. New experimental data from our laboratory indicate 1) the value of 2/3 biomarkers (alpha globulin and free secretory protein) in following patients for remission of disease and 2) the probability of the development of more effective antiserum with high specific titer. Studies of the radiosensitivity of ovarian cancer indicate the tumor was not different from other solid tumors. Our studies indicate the role of radiation therapy as a cytoreductive agent should be integrated in multimodality therapy and that the immune system offers new possibilities in amplifying therapeutic results.

Alpha-Globulins↗
PubMed2000

Applications of biochip and microarray systems in pharmacogenomics.

A DNA microarray system is usually comprised of DNA probes formatted on a microscale on a glass surface (chip), plus the instruments needed to handle samples (automated robotics), to read the reporter molecules (scanners) and analyse the data (bioinformatic tools). Biochips are formed by in situ (on chip) synthesis of oligonucleotides or peptide nucleic acids (PNAs) or spotting of DNA fragments. Hybridisation of RNA- or DNA-derived samples on chips allows the monitoring of expression of mRNAs or the occurrence of polymorphisms in genomic DNA. Basic types of DNA chips are the sequencing chip, the expression chip and chips for comparative genomic hybridisation. Advanced technologies used in automated microarray production are photolithography, mechanical microspotting and ink jets. Bioelectronic microchips contain numerous electronically active microelectrodes with specific DNA capture probes linked to the electrodes through molecular wires. Several biosensors have been used in combination with biochips. PNA biosensors commonly rely on the immobilisation of a single-stranded DNA sequence (the 'probe') onto a transducer surface for hybridisation with the complementary ('target') strand to give a suitable electrical signal. Other sensors are cell-based immunobiosensors with engineered molecular recognition, integrated biosensors based on phototransistor integrated circuits and sensors based on surface plasmon resonance. Microarray technologies offer enormous savings in time and labour as compared to standard gel-based microsatellite methods. Reading of the information and its management by bioinformatics is necessary because of the enormous amount of data generated by the various technologies using microarrays. Standardised procedures are essential for compatible data production, quality control and analysis. Expression monitoring is the most biologically informative application of this technology at present. Microarray technology has important applications in pharmacogenomics: drug discovery and development, drug safety and molecular diagnostics. DNA chips will facilitate the integration of diagnosis and therapeutics, as well as the introduction of personalised medicines.

Animals↗
PubMed2006

MaGe: a microbial genome annotation system supported by synteny results.

Magnifying Genomes (MaGe) is a microbial genome annotation system based on a relational database containing information on bacterial genomes, as well as a web interface to achieve genome annotation projects. Our system allows one to initiate the annotation of a genome at the early stage of the finishing phase. MaGe's main features are (i) integration of annotation data from bacterial genomes enhanced by a gene coding re-annotation process using accurate gene models, (ii) integration of results obtained with a wide range of bioinformatics methods, among which exploration of gene context by searching for conserved synteny and reconstruction of metabolic pathways, (iii) an advanced web interface allowing multiple users to refine the automatic assignment of gene product functions. MaGe is also linked to numerous well-known biological databases and systems. Our system has been thoroughly tested during the annotation of complete bacterial genomes (Acinetobacter baylyi ADP1, Pseudoalteromonas haloplanktis, Frankia alni) and is currently used in the context of several new microbial genome annotation projects. In addition, MaGe allows for annotation curation and exploration of already published genomes from various genera (e.g. Yersinia, Bacillus and Neisseria). MaGe can be accessed at http://www.genoscope.cns.fr/agc/mage.

Computational Biology↗
PubMed2004

QIS: A framework for biomedical database federation.

Query Integrator System (QIS) is a database mediator framework intended to address robust data integration from continuously changing heterogeneous data sources in the biosciences. Currently in the advanced prototype stage, it is being used on a production basis to integrate data from neuroscience databases developed for the SenseLab project at Yale University with external neuroscience and genomics databases. The QIS framework uses standard technologies and is intended to be deployable by administrators with a moderate level of technological expertise: It comes with various tools, such as interfaces for the design of distributed queries. The QIS architecture is based on a set of distributed network-based servers, data source servers, integration servers, and ontology servers, that exchange metadata as well as mappings of both metadata and data elements to elements in an ontology. Metadata version difference determination coupled with decomposition of stored queries is used as the basis for partial query recovery when the schema of data sources alters.

Computer Communication Networks↗
PubMed2005

Mars habitat modules: launch, scaling and functional design considerations.

The Sasakawa International Center for Space Architecture (SICSA) is undertaking a multi-year research, planning and design study that is exploring near- and long-term commercial space development opportunities. The central goal of this activity is to conceptualize a scenario of sequential, integrated private enterprise initiatives that can carry humankind forward to Mars. Each development stage is planned as a building block to provide the economic foundation, technology advancements and operational infrastructure to support others that follow. This report presents fundamental issues and requirements associated with planning human Mars initiatives that can transfer crews, habitats and equipment from Earth to Mars orbit, deliver them to the planet's surface, and return people and samples safely back to Earth. The study builds in part upon previous studies which are summarized in SICSA's: Commercial Space Development Plan and the Artificial Gravity Science and Excursion Vehicle reports. Information and conclusions produced in this study provide assumptions and a conceptual foundation for a subsequent report titled The First Mars Outpost: Planning and Concepts.

Air Conditioning↗
PubMed2000

The use of digital imaging and communications in medicine (DICOM) in the integration of imaging into the electronic patient record at the Department of Veterans Affairs.

The US Department of Veterans Affairs (VA) is using the Digital Imaging and Communications in Medicine (DICOM) standard to integrate image data objects from multiple systems for use across the health care enterprise. DICOM uses a structured representation of image data and a communication mechanism that allows the VA to easily acquire images from multiple sources and store them directly into the online patient record. The VA can obtain both radiology and nonradiology images using DICOM, and can display them on low-cost clinician's color workstations throughout the medical center. High-resolution gray-scale diagnostic-quality multimonitor workstations with specialized viewing software can be used for reading radiology images. The VA's DICOM capabilities can interface six different commercial picture archiving and communication systems (PACS) and more than 20 different image acquisition modalities. The VA is advancing its use of DICOM beyond radiology. New color imaging applications for gastrointestinal endoscopy and ophthalmology using DICOM are under development. These are the first DICOM offerings for the vendors, who are planning to support the recently passed DICOM Visible Light and Structured Reporting service classes. Implementing these in VistA is a challenge because of the different workflow and software support for these disciplines within the VA hospital information system (HIS) environment.

Computer Communication Networks↗
PubMed2003

Genetic approaches in the clinical investigation of complex disorders: malnutrition, inflammation, and atherosclerosis (MIA) as a prototype.

Despite major research efforts and improvements in dialysis technology, patients with end-stage renal disease (ESRD) experience an extremely high mortality, which seems to be increasingly related to cardiovascular disease. Cardiovascular disease has been linked to the presence of systemic inflammation and malnutrition (MIA syndrome), in addition to the high prevalence of traditional risk factors observed in ESRD patients. Since the mechanisms underlying the development of these complications of ESRD are largely unknown, new strategies for identification of risk factors, pathophysiologic pathways, and targets for intervention are warranted. Although the combined impact of MIA complications seems to determine the extremely poor clinical outcome in the ESRD patients, there are significant unexplained individual differences in the development of the MIA syndrome, implying that genetic differences might play a role. The vast information generated by the advances in molecular genetics offers a great opportunity to analyze the causes of differences not only in our susceptibility to (or protection from) various diseases, but also in the age of onset, severity of illness, and in the way our bodies respond to treatment. In this review, we summarize an integrated approach in the investigation of complex disorders, requiring the interactive collaboration between laboratory, clinical, and epidemiologic resources using the MIA syndrome as a prototype. We focus on the application of common genetic variations (single nucleotide polymorphisms [SNPs]) in association with studies to generate potential risk profiling using data from multiple vulnerability genes. The appropriate application of this approach may be essential in the early identification of high-risk individuals and groups of patients for whom specific therapeutic interventions are indicated, thus creating a tailor-made clinical management for the future.

Arteriosclerosis↗
PubMed1997

[Exchange of medical imaging and data information in radiotherapy: needs, methods and current limits].

Extension of the image network within radiotherapy departments provides the technical infrastructure which is made necessary by the rapid evolution of techniques in the field of diagnosis and treatment in radiotherapy. The system is aimed at managing the whole set of data (textual data and images) that are needed for planning and control of treatments. The radiotherapy network addresses two objectives: managing both the information necessary for treatment planning (target volumes definition, planning dosimetry) and the control of all parameters involved during the patient's treatment under the treatment unit. The major challenge is to improve the quality of treatment. Multimodal imaging is a major advance as it allows the use of new dosimetry and simulation techniques. The need for standards to exchange medical imaging information is now recognized by all the institutions and a majority of users and manufacturers. It is widely accepted that the lack of standard has been one of the fundamental obstacles in the deployment of operational "Picture Archiving Communication Systems". The International Standard Organisation Open System Interconnection model is the standard reference mode used to describe network protocols. The network is based on the Ethernet and TCP/IP protocol that provides the means to interconnect imaging devices and workstations dedicated to specific image processing or machines used in radiotherapy. The network uses Ethernet cabled on twisted-pair (10 BaseT) or optical fibres in a star-shaped physical layout. Dicom V3.0 supports fundamental network interactions: transfer of images (computerized tomography magnetic resonance imaging query and retrieve of images), printing on network attached cameras, support of HIS/RIS related interfacing and image management. The supplement to the Dicom standard, Dicom RT, specifies five data objects known in Dicom as Information Object Definition for relevant radiotherapy. Dicom RT objects can provide a mean for standardized transfer of most of the information wich circulates in a radiotherapy department. A wide range of device types are represented, (treatment planning systems, portal imaging devices, linear accelerators, recording and verifying systems, conventional and virtual simulators). There will be additions and perhaps new developments in dataflow management, more complete integration with HIS/RIS system and printing, but the lion's share of the work has now been done. A project to integrate some security features into the Dicom protocol has begun.

Computer Communication Networks↗
PubMed1997

What do patients want and not want to see about themselves on the computer screen: a qualitative study.

OBJECTIVE: To explore patients' views about what they would or would not like to read on the computer screen, and how this might be managed. DESIGN: A qualitative study using semi-structured interviews with patients who had recently consulted, and who were representative of the age-sex structure of our practice population. SETTING: Primary health care, patients' homes. PATIENTS: 30 patients aged 18-89 years. MAIN OUTCOME MEASURES: Patients were likely to state that information about lifestyle (e.g. smoking and drinking) might be helpful to read on condition that it had been provided by the patients themselves, and not by a third party. Most patients would not want to read personal comments. Nearly half of the patients expressed concern about seeing a serious illness on the screen, especially if it had not been fully discussed in advance. Over a third were concerned about seeing a mental illness listed. They suggested that these labels were subjective, confusing, and likely to be rejected by patients. CONCLUSIONS: Doctors need to develop and evaluate ways by which patients gain access to reading about their problems on desk-top computers, and devise strategies whereby this can be integrated constructively with information exchange in the consultation.

Adult↗
PubMed2005

Clinical cognition and biomedical informatics: issues of patient safety.

Recent developments in biomedical informatics research have afforded possibilities for great advances in health care delivery. These exciting opportunities also present a number of challenges to the implementation and integration of technologies in the workplace. As in most domains, there is a gulf between technologic artifacts and end users, which compromises the culture of safety in the workplace. Because clinical practice is a human endeavor, there is a need for bridging disciplines to enable clinicians to benefit from rapid technologic advances. This, in turn, necessitates a broadening of disciplinary boundaries to consider cognitive and social factors related to the design and use of technology. The authors argue for a place of prominence for cognitive science in understanding nursing factors associated with patient safety. Cognitive science provides a framework for the analysis and modeling of complex human performance. Studies of clinical cognition can meaningfully inform and shape design, development and assessment of information systems. Furthermore, they have a decisive impact on whether information technology has a positive influence on human performance and are especially important in understanding and promoting safe practices. These issues are discussed in the context of clinical informatics with a focus on nursing practice.

Biomedical Engineering↗
PubMed1991

Medical informatics--an Australian perspective.

Computers, like the X-ray and stethoscope can be seen as clinical tools, that provide physicians with improved expertise in solving patient management problems. As tools they enable us to extend our clinical information base, and they also provide facilities that improve the delivery of the health care we provide. Automation (computerisation) in the health domain will cause the computer to become a more integral part of health care management and delivery before the start of the next century. To understand how the computer assists those who deliver and manage health care, it is important to be aware of its functional capabilities and how we can use them in medical practice. The rapid technological advances in computers over the last two decades has had both beneficial and counterproductive effects on the implementation of effective computer applications in the delivery of health care. For example, in the 1990s the computer hobbyist is able to make an investment of less than $10,000 on computer hardware that will match or exceed the technological capacities of machines of the 1960s. These rapid technological advances, which have produced a quantum leap in our ability to store and process information, have tended to make us overlook the need for effective computer programmes which will meet the needs of patient care. As the 1990s begin, those delivering health care (eg, physicians, nurses, pharmacists, administrators ...) need to become more involved in directing the effective implementation of computer applications that will provide the tools for improved information management, knowledge processing, and ultimately better patient care.

Australia↗
PubMedDate not supplied

Information and communication systems for the assistance of carers based on ACTION.

Recent advances in telecommunication technologies allow the design of information and communication systems for people who are caring for others in the home as family members or as professionals in the health or community centres. The present paper analyses and classifies the information flow and maps it to an information life cycle, which governs the design of the deployed hardware, software and the data-structure. This is based on the initial findings of ACTION (assisting carers using telematics interventions to meet older persons' needs) a European Union funded project. The proposed information architecture discusses different designs such as centralized or decentralized Web and Client server solutions. A user interface is developed reflecting the special requirements of the targeted user group, which influences the functionality and design of the software, data architecture and the integrated communication system using video-conferencing. ACTION has engineered a system using plain Web technology based on HTML, extended with JavaScript and ActiveX and a software switch enabling the integration of different types of videoconferencing and other applications providing manufacturer independence.

Adult↗
PubMed2004

Critical issues in management of congenital vascular malformation.

Congenital vascular malformation (CVM) has long been a challenging problem. Recently, a new classification of CVMs was launched, opening up a new era. This improved definition provides critical information on CVM etioanatomopathophysiology. Advanced diagnostic technology has also provided more accurate and safer diagnosis. Finally a new, improved method of managing CVMs based on a new, multidisciplinary approach has emerged. In this study, various noninvasive diagnostic tests were adopted for contemporary diagnosis, and invasive studies were reserved for use as a road map for treatment. A new treatment strategy evolved, following proper identification of absolute and relative indications for treatment, which integrates surgical therapy and embolosclerotherapy. Three hundred and sixty-two patients selected for treatment, among a total of 1007 patients with various indications, were retrospectively reviewed. Various embolosclerotherapy techniques were performed on 333 patients, including 640 sessions of ethanol-based therapy. The immediate success rate was excellent (96.2%) but was accompanied by various complications mostly of a minor nature during 212 sessions (22%). The interim results were also excellent, with no evidence of recurrence. A total of 102 patients underwent 128 surgical procedures, consisting of a variety of different therapies, either independently (29/102) or in conjunction with preoperative embolosclerotherapy (73/102). Most of the interim results were excellent (111/128). The use of a complex therapy regimen through a multidisciplinary approach leads to a more manageable and satisfactory outcome.

Central Nervous System Vascular Malformations↗
PubMed1995

An overview of the CERC ARTEMIS project.

The basic premise of this effort is that health care can be made more effective and affordable by applying modern computer technology to improve collaboration among diverse and distributed health care providers. Information sharing, communication, and coordination are basic elements of any collaborative endeavor. In the health care domain, collaboration is characterized by cooperative activities by health care providers to deliver total and real-time care for their patients. Communication between providers and managed access to distributed patient records should enable health care providers to make informed decisions about their patients in a timely manner. With an effective medical information infrastructure in place, a patient will be able to visit any health care provider with access to the network, and the provider will be able to use relevant information from even the last episode of care in the patient record. Such a patient-centered perspective is in keeping with the real mission of health care providers. Today, an easy-to-use, integrated health care network is not in place in any community, even though current technology makes such a network possible. Large health care systems have deployed partial and disparate systems that address different elements of collaboration. But these islands of automation have not been integrated to facilitate cooperation among health care providers in large communities or nationally. CERC and its team members at Valley Health Systems, Inc., St. Marys Hospital and Cabell Huntington Hospital form a consortium committed to improving collaboration among the diverse and distributed providers in the health care arena. As the first contract recipient of the multi-agency High Performance Computing and Communications (HPCC) Initiative, this team of computer system developers, practicing rural physicians, community care groups, health care researchers, and tertiary care providers are using research prototypes and commercial off-the-shelf technologies to develop an open collaboration environment for the health care domain. This environment is called ARTEMIS--Advanced Research TEstbed for Medical InformaticS.

Computer Communication Networks↗
PubMed2004

An architecture for biological information extraction and representation.

MOTIVATIONS: Technological advances in biomedical research are generating a plethora of heterogeneous data at a high rate. There is a critical need for extraction, integration and management tools for information discovery and synthesis from these heterogeneous data. RESULTS: In this paper, we present a general architecture, called ALFA, for information extraction and representation from diverse biological data. The ALFA architecture consists of: (i) a networked, hierarchical, hyper-graph object model for representing information from heterogeneous data sources in a standardized, structured format; and (ii) a suite of integrated, interactive software tools for information extraction and representation from diverse biological data sources. As part of our research efforts to explore this space, we have currently prototyped the ALFA object model and a set of interactive software tools for searching, filtering, and extracting information from scientific text. In particular, we describe BioFerret, a meta-search tool for searching and filtering relevant information from the web, and ALFA Text Viewer, an interactive tool for user-guided extraction, disambiguation, and representation of information from scientific text. We further demonstrate the potential of our tools in integrating the extracted information with experimental data and diagrammatic biological models via the common underlying ALFA representation. CONTACT: aditya_vailaya@agilent.com.

Abstracting and Indexing↗