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PubMed1998

Rationale and design considerations for a semantic mediator in health information systems.

Rapid development of community health information networks raises the issue of semantic interoperability between distributed and heterogeneous systems. Indeed, operational health information systems originate from heterogeneous teams of independent developers and have to cooperate in order to exchange data and services. A good cooperation is based on a good understanding of the messages exchanged between the systems. The main issue of semantic interoperability is to ensure that the exchange is not only possible but also meaningful. The main objective of this paper is to analyze semantic interoperability from a software engineering point of view. It describes the principles for the design of a semantic mediator (SM) in the framework of a distributed object manager (DOM). The mediator is itself a component that should allow the exchange of messages independently of languages and platforms. The functional architecture of such a SM is detailed. These principles have been partly applied in the context of the HELIOS object-oriented software engineering environment. The resulting service components are presented with their current state of achievement.

Computer Communication Networks↗
PubMed1994

Chemical hazard evaluation: the use of factual health and safety databanks.

The usefulness of factual health and safety databanks is discussed in this paper. Four databanks have been selected for this study: HSDB (Hazardous Substances Data Bank), ECDIN (Environmental Chemicals Data Information Network), RTECS (Registry of the Toxic Effects of Chemical Substances) and CCRIS (Chemical Carcinogenesis Research Information). The quality of the information available in the databanks considered was examined for five different chemical compounds and the completeness of the information available was carried out by an analysis of carcinogenic and mutagenic data.

Animals↗
PubMed2000

EU-project medCERTAIN: Certification and Rating of Trustworthy and Assessed Health Information on the Net.

Med-CERTAIN (MedPICS Certification and Rating of Trustworthy Health Information on the Net, http://www.medpics.org/medcertain/) is a recently launched project funded under the EU Action Plan for safer use of the Internet. It will provide the technical infrastructure for an international system of "quality seals" for Internet health information. Digital "quality seals" may be evaluative metainformation (using standards such as PICS = Platform for Internet Content Selection, now being replaced by RDF/XML) assigned by trusted third-party raters. The project will also enable and encourage self-labelling with descriptive metainformation by web authors. Together these measures will help consumers to identify high-quality information on the Internet. Med-CERTAIN will establish a fully functional demonstrator for a self- and third-party rating system enabling patients and consumers to filter harmful health information and to positively identify and select high quality information. We aim to provide a system allow European citizens to place greater trust in networked information, exemplified in the domain of health information, whilst also making a significant contribution for similar projects with different target domains. The project will demonstrate how PICS-based content rating and filtering technologies can automate and exploit value-adding resource description services. The proposed technology strategy combines a pragmatic use of simple existing technologies for data acquisition with a future-oriented standards policy intended to lead rather than follow the evolution of definitions for information-mediation services.

Europe↗
PubMed2000

Computer-based ambulatory information systems: recent developments.

This article updates the author's earlier review of some of the major computer-based ambulatory information systems and the literature evaluating their costs, benefits, effect on quality of care, and physician acceptance. The evidence suggests that computer-based information systems can increase access to clinical information, improve physician performance, enhance quality of care, and facilitate outcomes research review. In addition to presenting health information networks and clinical decision support systems such as reminder systems, drug ordering systems, and medical care management systems, the article describes applications of telemedicine and Web-based systems. It also discusses barriers to the widespread use of computer-based ambulatory information systems.

Ambulatory Care Information Systems↗
PubMed2002

Establishing a health outcomes and economics center in radiology: strategies and resources required.

PURPOSE: To describe the resources and strategies required to establish a health outcomes and economics center in radiology. METHODS: Human and nonhuman resources required to perform sound outcomes and economics studies in radiology are reviewed. RESULTS: Human resources needed include skilled medical and nonmedical staff. Nonhuman resources required are: (1). communication and information network; (2). education tools and training programs; (3). budgetary strategies; and (4). sources of income. Effective utilization of these resources allows the performance of robust operational and clinical research projects in decision analysis, cost-effectiveness, diagnostic performance (sensitivity, specificity, and ROC curves), and clinical analytical and experimental studies. CONCLUSION: As new radiologic technology and techniques are introduced in medicine, society is increasingly demanding sound clinical studies that will determine the impact of radiologic studies on patient outcome. Health-care funding is scarce, and therefore third-party payers and hospitals are demanding more efficiency and productivity from radiologic service providers. To meet these challenges, radiology departments could establish health outcomes and economics centers to study the clinical effectiveness of imaging and its impact on patient outcome.

Budgets↗
PubMed1990

Perceived health problems, formal/informal support, and life satisfaction among older adults.

The purpose of this study was to assess whether support from formal sources buffers the effects of stress more effectively than assistance that is provided by informal network members. Findings from a longitudinal study of older adults suggests that formal support, but not informal assistance, reduces the deleterious effects of perceived health problems on changes in life satisfaction through time. In the process of evaluating these relationships, an effort was made to match the needs created by a particular type of stress (ongoing perceived health problems) with the benefits provided by a particular type of support (illness-related instrumental support).

Activities of Daily Living↗
PubMed2003

Translating clinical research into practice: practice-based research networks--a promising solution.

Greater effort is needed to translate research discoveries into clinical practice and to ensure that proven treatments are routinely implemented by physicians. Practice-based research networks are an undervalued resource in the endeavor to bring research results to bear in patient care. These networks are groups of practicing health care providers who have organized to address research questions of primary importance to their patients. Existing practice-based research networks have addressed a wide range of issues, including improvement of preventive service delivery, reliability of diagnostic measures, practice variation, disease prevention, and systems of care coordination. Several deficiencies in the current system prevent practice-based research networks from reaching their full potential as mechanisms of translating clinic research into practice. For practice-based research networks to flourish, they need increased funding for practice-based research networks; information systems to facilitate research by practicing physicians; training programs for health care providers; and communication networks between providers, clinical researchers, professional societies, and academic health centers.

Academic Medical Centers↗
PubMed2003

Social networks and use of social supports of minority elders in East Harlem.

Considerable empirical research substantiates the importance of social networks on health and well-being in later life. A study of ethnic minority elders living in two low income public housing buildings in East Harlem was undertaken to gain an understanding of the relationship between their health status and social networks. Findings demonstrate that elders with supportive housing had better psychological outcomes and used significantly more informal supports when in need. However, elders with serious health problems had poorer outcomes regardless of their level of social support. This study highlights the potential of supportive living environments to foster social integration and to optimise formal and informal networks.

Black or African American↗
PubMed1993

The development and practical use of information systems in the pharmaceutical industry.

To provide information on the efficacy, safety, and quality of medicine promptly and accurately, we have developed two databases: a literature database with numerical data, and a Drug Information database. By an easy-to-use, company-wide information network system, over 1,000 medical representatives in more than 80 offices throughout Japan can retrieve information. Information derived from the system is displayed on the terminal and the original documents are automatically output through a facsimile.

Databases, Bibliographic↗
PubMed1988

The IAIMS project of the American College of Obstetricians and Gynecologists: using information technology to improve the health care of women.

The mission of the ACOG IAIMS project is to identify the core of knowledge necessary for the practice of obstetrics and gynecology, structure it and put it in electronic form, integrate it into a national ob-gyn information network, prepare ACOG members to use it, and disseminate this core of knowledge to members in appropriate forms. This mission will be accomplished through four project objectives: educational programs on computers and information use; definition of a prototype ob-gyn knowledge base; automated access to ACOG and NAACOG membership services; and integration of ACOG IAIMS activities with other organizations. The ACOG IAIMS model phase project is a model for the role of a national specialty society in meeting the information needs of its members and for the integration of national specialty IAIMS programs with locally-developed programs.

Computer Communication Networks↗
PubMed2002

Kater-Karlsruhe Telemetry Test in Rescue Services.

The Karlsruhe Telemetry Test in Rescue Services (KATER) investigates the central role of the regional emergency dispatch center as the midpoint of the emergency medicine information network using ECG telemetry, in order to be able to draw conclusions for future development. Rescue centers today form the logistic center of the flow of information. Expanding this legally formulated role to data flows within a network is just beginning, however, since the introduction of EDP in pre-clinical emergency medicine is still in the pilot project stage. Legislators are tending toward big solutions due to economic reasons. The increasing complexity of this problem can only be handled by a networked infrastructure.

Computer Communication Networks↗
PubMed1991

[Survey of attitudes among general practitioners regarding the introduction of a personal computer medical network system in community health care].

General practitioners (GPs) play an important part in community health care. Their opinion regarding introduction of a medical information network system using a personal computer and factors influencing the decision to introduce such a system were surveyed among 977 randomly sampled GPs. A response from 727 GPs was obtained. Based on a two stage selection method, 20 factors were selected as effective factors among the 73 factors surveyed, with the following results: (1) Responses to the question concerning the approval of system introduction were classified into three groups: "not necessary + too early to make a decision (DA)" (DA group), "approve (A)" (A group) and "undecided (UD)" (UD group). Each group had nearly equal numbers of respondees. (2) Significant effective factors were "experience with personal computers", "a desire to use a personal computer", "a desire to use a computer-diagnosis-system", "cost", and "a volition to operate a computer by himself". (3) The "A group" had high experience and affirmative opinions, while the "DA group" had low experience and negative opinions. The "UD group" also tended to respond with "do not know" regarding the factors. (4) Approval of system introduction requires providing basic knowledge on computers, opportunities for positive experience with computers, and practical examples of problem solutions in a general practitioner's work.

Adult↗
PubMed2003

Roles of dynamic linkage of stable attractors across cortical networks in recalling long-term memory.

We propose a neural network model for a category-association task. By simulating the model, neuronal relevance of cortical interactions to recalling long-term memory was investigated. The model consists of the left and right hemispheres, each of which has IT (inferotemporal cortex) and PC (prefrontal cortex) networks. Information about visual features and their categories were encoded into point attractors of the IT and PC networks, respectively. In the task, the IT network of the right hemisphere was stimulated with a cue feature. After a delay period, the IT network of the left hemisphere was simultaneously stimulated with the choice feature and an irrelevant feature. The cue and choice features belong to the same category, while the irrelevant feature belongs to another category. To complete the task, the IT network must select the point attractor corresponding to the choice feature. We demonstrate that the top-down pathway (PC-to-IT) triggers the retrieval of long-term memory of the choice feature from the IT, and the bottom-up pathway (IT-to-PC) contributes to the maintenance of the retrieved memory during the delay period. The key mechanism for the retrieval and maintenance of that memory is the dynamic linkage of attractors across separate cortical networks. We show that a single hemisphere is sufficient for the memory retrieval, but it is advantageous to use the two hemispheres because the retrieved memory is thereby retained with greater reliability until the brain chooses the choice feature.

Action Potentials↗
PubMedDate not supplied

Applications of evidence-based medicine: cranial cruciate ligament injury repair in the dog.

OBJECTIVE: To evaluate the literature reporting surgical interventions pertaining to canine cranial cruciate ligament (CCL) injury using an evidence-based medicine paradigm. STUDY DESIGN: Systematic literature review. METHODS: An on-line bibliographic search through Medline, PubMed, Veterinary Information Network, and Commonwealth Agricultural Bureau Abstracts was performed during August 2004. Two hundred and forty resources of information were identified. Studies were compared and evaluated with regard to study design (retrospective, prospective, randomization), surgical technique, short- and long-term follow-up, and evidence classification. RESULTS: Twenty-eight resources qualified to assist with evidence classification. No class I or class II studies were present, 5 studies were categorized as a class III and 23 studies were categorized as a class IV. Seventeen studies were retrospectively designed and 11 studies were prospectively designed. Proposed results ranged from a wide variety of subjective findings including clinical impression, radiographic analysis, synovial fluid analysis, gross pathology, and histopathology. Objective results, although infrequent, included force plate analysis and cadaveric biomechanical testing. CONCLUSIONS: At this time, the application of evidence-based medicine in analyzing the current available evidence suggests that there is not a single surgical procedure that has enough data to recommend that it can consistently return dogs to normal function after CCL injury. The requirement for assessing and categorizing the available evidence becomes increasingly important as more data becomes available and the quality of research improves. CLINICAL RELEVANCE: An evidence-based medicine paradigm did not provide sufficient evidence favoring 1 surgical technique for management of canine CCL injury.

Animals↗
PubMed1995

CHINs: making the important decisions.

Community health information networks (CHINs) are an evolving concept. In their most basic form, CHINs provide a structure for sharing financial and clinical information among a defined group of entities. However, several key decisions affect how a CHIN will function. Among those decisions are what "community" will be included, what technical infrastructure to use, what organization or group of organizations will lead the CHIN development effort, what types of information will be shared, and how to safe-guard confidentiality.

Clinical Medicine↗
PubMed1997

Practical lessons in remote connectivity.

Community Health Information Networks (CHINs) require the ability to provide computer network connections to many remote sites. During the implementation of the Washington Heights and Inwood Community Health Management Information System (WHICHIS) at the Columbia-Presbyterian Medical Center (CPMC), a number of remote connectivity issues have been encountered. Both technical and non-technical issues were significant during the installation. We developed a work-flow model for this process which may be helpful to any health care institution attempting to provide seamless remote connectivity. This model is presented and implementation lessons are discussed.

Academic Medical Centers↗
PubMedDate not supplied

Protecting and securing networked medical devices.

Designing, building, and maintaining a secure environment for medical devices is a critical component in health care technology management. This article will address several avenues to harden a health care information network to provide a secure enclave for medical devices.

Computer Communication Networks↗
PubMed2026

Beyond one-to-one mappings: Modelling distributed lesion-symptom relationships with multilayer networks.

Lesion-symptom mapping is widely used to identify causal relationships between brain structures and behaviour, and has played a central role in neuropsychologically informed network models of cognition. However, even recent approaches remain constrained by a one-to-one mapping framework, which oversimplifies the complex relationships between network-level damage and cognitive deficits. In addition, the non-orthogonality of cortical and white matter damage makes it difficult to disentangle their distinct contributions. Here, we used graph-based multilayer network analysis to address these limitations and evaluate clinical relevance. Using neuroanatomical and longitudinal neuropsychological data from 252 patients who underwent awake neurosurgery for low-grade glioma, we constructed interactive, three-layer networks for each hemisphere. Layer 1 comprised neuropsychological tasks (NT), layer 2 structural disconnections (SD), and layer 3 cortical damage (CD). Nodes represented tasks, white matter tracts, and cortical parcels, respectively, whereas within-layer edges captured correlations in performance or co-occurring damage patterns. Multilayer community detection identified domain- and hemisphere-specific brain-behaviour motifs linking executive, language, and spatial functions to distinct combinations of cortical and white matter disruption, a pattern confirmed by two spatial embedding approaches. Centrality analyses revealed a continuum of mapping relationships, ranging from one-to-one to one-to-many associations, indicating that tasks such as verbal fluency are better explained by multiple disconnection mechanisms. Additional analyses uncovered many-to-one and many-to-many relationships and highlighted tracts and cortical regions with domain-general relevance. Together, these findings support a neurobiologically grounded, network-oriented account of how structural brain damage gives rise to cognitive deficits, with implications for clinical care.

Humans↗