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PubMed1998

Access control and system audit based on "patient-doctor relation and clinical situation" model.

Both confidentiality of privacy and the data sharing between healthcare practitioners are required in hospital information systems. A new access control method has been designed by the "patient-doctor relation and clinical situation at the point-of-care" model in addition to the traditional "account and password" mechanism. This method can; (I) allow flexible data access in need, (2) afford accurate access audit, (3) suppress inappropriate access.

Computer Security↗
PubMed2006

Lombardia Stroke Unit Network Project.

Stroke unit care represents the major advancement in stroke management and it is applicable to all stroke patients. The Lombardia Health-Care Program for the period 2000-2004 planned to implement new semi-intensive stroke units in order to guarantee access to such units to all stroke patients. As has happened in other countries, there is a need to coordinate and streamline the process of care in order to optimise resources and outcome. The aim of the Stroke Unit Network (SUN) project is the improvement of the quality of stroke care in the acute and post-acute phase, developing an efficient network between hospitals involved in stroke care in order to quickly identify patients' needs and to improve cultural exchange on clinical and therapeutic information between people involved in the process of care. A web-based network has been created connecting the Lombardia Stroke Units and the departments in which stroke units will be implemented; a website to facilitate the exchange of scientific data, the discussion of clinical problems, the sharing of research projects and results, and a web-based quality register in order to verify quality, efficacy and efficiency of stroke units participating in the project providing important, consistently available data to monitor progress in reducing the incidence of stroke and associated disability and mortality. The Lombardia Stroke Unit Network Project, promoting and facilitating the exchange of know-how and collecting data on the quality of the processes of care provided, can significantly improve stroke care in Lombardia.

Computer Communication Networks↗
PubMed2004

Studies in emergency department data collection: shared versus split responsibility for patient enrollment.

OBJECTIVES: To compare patient enrollment in six clinical studies using shared coverage (24 emergency department [ED] rooms-two students share enrollment responsibility) with enrollment using split coverage (12 rooms each per student). The academic associate (AA) program uses undergraduate students to collect data for clinical studies in the ED by providing double coverage 16 hours/day, seven days/week. Prior studies have shown that this system captures >85% of eligible patients. Methods to obtain closer to 100% enrollment are desired. METHODS: During consecutive 15-day periods with the same 24 AAs, the daily ED census, hours of AA coverage, and enrollment in each of six studies were evaluated prospectively in the ED. Data are presented as means with 95% confidence intervals (CIs). RESULTS: There was no difference between the shared and split enrollment periods with respect to hours of AA coverage (30.3 vs. 30.7 hours/day; p = 0.7) or average daily ED census (133.7 vs. 141.8; p = 0.15). Overall, the percentages of ED patients recruited for study participation were not different depending on whether the split versus shared recruitment strategy was used (907 patients recruited out of 2005 ED patients (45.2%; 95% CI = 43.0 to 47.4) vs. 937 of 2127 (44.0%; 95% CI = 41.9 to 46.1). The 95% CI for the 1.2% difference was -1.8% to 4.2%. Patient enrollments in six individual studies were similar regardless of recruitment strategy. Following the 30-day trial, AAs were surveyed: 17 of 24 (71%) found the split strategy to be "more helpful in enrolling subjects," and 20 of 24 (83%) found split strategy helped them "keep better track" of patients. CONCLUSIONS: Study subject enrollment was not affected by the use of either the shared or split responsibility strategy for recruitment. Students generally preferred the split strategy because it was more helpful and easier to monitor. Therefore, this may be the best option for similar student-oriented data collection programs.

Data Collection↗
PubMed1996

Knowledge-based temporal abstraction in clinical domains.

We have defined a knowledge-based framework for the creation of abstract, interval-based concepts from time-stamped clinical data, the knowledge-based temporal-abstraction (KBTA) method. The KBTA method decomposes its task into five subtasks; for each subtask we propose a formal solving mechanism. Our framework emphasizes explicit representation of knowledge required for abstraction of time-oriented clinical data, and facilitates its acquisition, maintenance, reuse and sharing. The RESUME system implements the KBTA method. We tested RESUME in several clinical-monitoring domains, including the domain of monitoring patients who have insulin-dependent diabetes. We acquired from a diabetes-therapy expert diabetes-therapy temporal-abstraction knowledge. Two diabetes-therapy experts (including the first one) created temporal abstractions from about 800 points of diabetic-patients' data. RESUME generated about 80% of the abstractions agreed by both experts; about 97% of the generated abstractions were valid. We discuss the advantages and limitations of the current architecture.

Artificial Intelligence↗
PubMed2002

A review of medical imaging informatics.

This review of medical imaging informatics is a survey of current developments in an exciting field. The focus is on informatics issues rather than traditional data processing and information systems, such as picture archiving and communications systems (PACS) and image processing and analysis systems. In this review, we address imaging informatics issues within the requirements of an informatics system defined by the American Medical Informatics Association. With these requirements as a framework, we review, in four sections: (1) Methods to present imaging and associated data without causing an overload, including image study summarization, content-based medical image retrieval, and natural language processing of text data. (2) Data modeling techniques to represent clinical data with focus on an image data model, including general-purpose time-based multimedia data models, health-care-specific data models, knowledge models, and problem-centric data models. (3) Methods to integrate medical data information from heterogeneous clinical data sources. Advances in centralized databases and mediated architectures are reviewed along with a discussion on our efforts at data integration based on peer-to-peer networking and shared file systems. (4) Visualization schemas to present imaging and clinical data: the large volume of medical data presents a daunting challenge for an efficient visualization paradigm. In this section we review current multimedia visualization methods including temporal modeling, problem-specific data organization, including our problem-centric, context and user-specific visualization interface.

Databases, Factual↗
PubMedDate not supplied

An Item Response analysis of the Hamilton Depression Rating Scale using shared data from two pharmaceutical companies.

Although the Hamilton Depression Rating Scale (HAMD) remains the most widely used outcome measure in clinical trials of Major Depressive Disorder, the psychometric properties of the individual HAMD items have not been extensively studied. In the present paper, data from four separate clinical trials conducted independently by two pharmaceutical companies were analyzed to determine the relationship between scores on the individual HAMD items and overall depressive severity in an outpatient population. Option characteristic curves (the probability of scoring a particular option in relation to overall HAMD scores) were generated in order to illustrate the relationship between scoring patterns for each item and the range of total HAMD scores. Results showed that Items 1 (Depressed Mood) and 7 (Work and Activities), and to a lesser degree, Items 2 (Guilt), 10 (Anxiety/Psychic), 11 (Anxiety/Somatic), and 13 (Somatic/General) demonstrated a good relationship between item responses and overall depressive severity. However, other items (e.g. Insight, Hypochondriasis) appeared to be more problematic with regard to their ability to discriminate over the full range of depression severity. The present results illustrate that co-operative data sharing between pharmaceutical companies can be a useful tool for improving clinical methods.

Clinical Trials as Topic↗
PubMed1995

Non-immunologic predictors of chronic renal allograft failure: data from the United Network of Organ Sharing.

Experimental evidence and clinical experience suggest that non-immunologic factors are important predictors of long-term renal allograft survival. It has been suggested that chronic allograft failure may in some cases by mediated by non-immunologic factors implicated in the pathobiology of other forms of progressive renal disease. Donor age, sex, and race may influence the "dose" of nephrons delivered in cadaveric renal transplantation. The United Network of Organ Sharing 1994 Public Use Data Tape was used to evaluate these and other risk factors in more than 31,000 recipients of cadaver allografts followed between 1987 and 1992. Female sex and African American race of the donor were important predictors of allograft failure. There was a markedly increased risk of allograft failure at both extremes of donor age. Recipients of large body size had accelerated graft loss. Stratified analyses suggested an interaction between donor and recipient race; nevertheless, all non-immunologic factors examined expressed independent associations with allograft survival. In sum, antigen-independent factors appear to be important determinants of allograft performance. Additional multivariable analyses are required to assess the relative importance of these factors compared with other known immunologic factors, such as HLA antigen mismatch. These findings may have important biomedical and health care policy implications.

Adolescent↗
PubMed1980

Chronic renal insufficiency (CRI) in urolithiasis.

In 80 adult kidney stone formers (52 with reversible and 28 with irreversible renal impairment) laboratory and clinical data were evaluated to estimate the share of abnormalities in the metabolism of stone forming substances in the development of renal impairment, and to search for the causes of the irreversibility of renal impairment. The study confirmed the previous results from this laboratory suggesting a causal relationship between renal impairment and metabolic disorders. No significant differences in the incidence of metabolic disorders or in therapy have been found in patients with irreversible renal impairment as compared to those with progressive deterioration of renal function. Irreversible renal impairment developed in relationship with bilateral kidney stone formation and recurrent urinary infection.

Adolescent↗
PubMed2006

A secure web-based approach for accessing transitional health information for people with traumatic brain injury.

A web-based transitional health record was created to provide regional healthcare professionals with ubiquitous access to information on people with brain injuries as they move through the healthcare system. Participants included public, private, and community healthcare organizations/providers in Eastern Ontario (Canada). One hundred and nineteen service providers and 39 brain injury survivors registered over 6 months. Fifty-eight percent received English and 42% received bilingual services (English-French). Public health providers contacted the regional service coordinator more than private providers (52% urban centres, 26% rural service providers, and 22% both areas). Thirty-five percent of contacts were for technical difficulties, 32% registration inquiries, 21% forms and processes, 6% resources, and 6% education. Seventeen technical enquiries required action by technical support personnel: 41% digital certificates, 29% web forms, and 12% log-in. This web-based approach to clinical information sharing provided access to relevant data as clients moved through or re-entered the health system. Improvements include automated digital certificate management, institutional health records system integration, and more referral tracking tools. More sensitive test data could be accessed on-line with increasing consumer/clinician confidence. In addition to a strong technical infrastructure, human resource issues are a major information security component and require continuing attention to ensure a viable on-line information environment.

Brain Injuries↗
PubMed2000

Comparison of event rates and survival in patients with unexplained syncope without documented ventricular tachyarrhythmias versus patients with documented sustained ventricular tachyarrhythmias both treated with implantable cardioverter-defibrillators.

Patients with unexplained syncope and inducible ventricular tachyarrhythmias during electrophysiologic testing have an increased cardiac mortality rate. We compared event rates and survival of 178 patients with unexplained syncope and no documented ventricular arrhythmias (syncope group) versus 568 patients with documented sustained ventricular tachycardia (VT or fibrillation (VF) (VT/VF group) treated, as part of a lead (Ventritex TVL) investigation, with similar implantable cardioverter-defibrillators (ICDs) capable of extensive data storage. The 2 groups shared similar clinical characteristics. The mean follow-up was 11 months for the syncope group and 14 months for the VT/VF group. The mean time from device implantation to first appropriate therapy was similar in the 2 groups (109 +/- 140 vs 93 +/- 131 days, p = 0.40). Actuarial probability of appropriate ICD therapy was 49% and 55% at 1 and 2 years, respectively, in syncope group and 49% and 58% in VT/VF group (p = 0.57). Recurrent syncope was associated with ventricular tachyarrhythmias in 85% and 92% of the syncope group and VT/VF group, respectively (p = 0.54). At 2 years, actuarial survival was 91% in the syncope group and 93% in VT/VF group (p = 0.85). We conclude that patients treated with ICD with unexplained syncope and induced VT/VF have an equally high incidence of appropriate ICD therapy and low mortality compared with similar patients with documented VT/VF. These findings, plus the high association between recurrent syncope and ventricular arrhythmias, indicate that VT/VF are likely etiologies in selected patients with unexplained syncope and support ICD therapy in such cases.

Aged↗
PubMed2004

Immunophenotypic markers and antiretroviral therapy (IMART): T cell activation and maturation help predict treatment response.

To determine whether markers of T cell activation and maturation are independently predictive of the response to potent antiretroviral therapy, the Immunophenotypic Markers and Antiretroviral Therapy study applied a novel data-sharing strategy across 5 Adult AIDS Clinical Trial Group trials that counted naive and activated CD4(+) and CD8(+) T cells in 324 subjects. Regression models--adjustment for baseline CD4 cell count, human immunodeficiency virus (HIV) RNA, and study--revealed that high pretreatment CD8(+) T cell activation predicted virologic failure (P=.046). Additional models showed the greatest increase in CD4(+) T cell counts in subjects with highest pretreatment naive CD4(+) T cell counts (P<.0001), which was enhanced by high CD4(+) and low CD8(+) T cell activation. Total lymphocyte count also predicted a subsequent CD4(+) T cell change. These results document the utility of T cell markers in predicting treatment outcome and their potential value for the study and management of HIV-1 infection.

Adult↗
PubMed2004

Quantifying headache symptoms and other headache features from chart notes.

OBJECTIVES: To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwise specified, ICD-9: 784) and to determine the share of NOS headache diagnoses with clinical data strongly suggestive of migraine or probable migraine headache. BACKGROUND: Headache is one of the most common pain symptoms that brings patients to a family physician. However, the majority of headache sufferers do not receive a specific headache diagnosis when they visit physicians. METHODS: We examined the chart notes of 454 patients exclusively diagnosed with one or more ICD-9 coded headache NOS diagnoses from July 1, 1995 through December 31, 1999 at a large suburban, university-affiliated practice. We developed a template containing 20 headache items combining International Headache Society diagnostic criteria and additional headache symptoms/features, and decision rules for coding symptoms/features and collected data from patient charts. We then developed decision rules and reclassified NOS headaches into categories strongly suggestive of migraine, probable migraine headache, or other diagnosis. Our main outcome measure is the consistency in the application of decision rules and diagnostic criteria. RESULTS: With this method we estimate 3 in 10 (29%) headache NOS patients may have had migraine (8%) or probable migraine headache (21%). Reclassified migraine visits averaged 6.5 migraine symptoms and reclassified probable migraine headache visits 4.7 migraine symptoms. Logistic regression analysis supports the consistency of diagnostic criteria for classifying headache based on coded symptoms/features--our model correctly predicted 96% of visits. Evidence of physical examination was recorded at 75% of visits suggesting that physician attention is focused on elimination of secondary headache. CONCLUSIONS: We think the use of our rigorous procedures reveals that a substantial amount of migraine and probable migraine headache may be missed in everyday practice. We hope our findings will provide a basis for the development of diagnostic methods more closely suited to the needs of nonspecialists, and contribute to a better standard of care for headache patients seen in primary care practice. Finally, we are hopeful that other researchers will consider using our template and guideline procedures in their efforts to identify diagnostic patterns and study headache and other health problems.

Adult↗
PubMed2006

Integrative assessment of brain function in PTSD: brain stability and working memory.

Posttraumatic Stress Disorder (PTSD) is characterized by symptoms of hyperarousal, avoidance and intrusive trauma-related memories and deficits in everyday memory and attention. Separate studies in PTSD have found abnormalities in electroencephalogram EEG, in event-related potential (ERP) and behavioral measures of working memory and attention. The present study seeks to determine whether these abnormalities are related and the extent to which they share this relationship with clinical symptoms. EEG data were collected during an eyes-open paradigm and a one-back working memory task. Behavioral and clinical data (CAPS) were also collected. The PTSD group showed signs of altered cortical arousal as indexed by reduced alpha power and an increased theta/alpha ratio, and clinical and physiological measures of arousal were found to be related. The normal relationship between theta power and ERP indices of working memory was not affected in PTSD, with both sets of measures reduced in the disordered group. Medication appeared to underpin a number of abnormal parameters, including P3 amplitude to targets and the accuracy, though not speed, of target detection. The present study helps to overcome a limitation of earlier studies that assess such parameters independently in different groups of patients that vary in factors such as comorbidity, medication status, gender and symptom profile. The present study begins to shed light on the relationship between these measures and suggests that abnormalities in brain working memory may be linked to underlying abnormalities in brain stability.

Adult↗
PubMed1999

Mission critical challenges: a data repository that addresses everyone's needs.

UNLABELLED: Ochsner Health Plan, New Orleans. PROBLEM: The health plan's information systems were inflexible and ineffective in meeting the needs of healthcare administrators, clinicians and others within the organization. SOLUTION: Ochsner officials reorganized the information systems by restructuring the computing architecture and building an enterprisewide relational database. RESULTS: Separate departments within the health plan now can share the same base of clinical and financial data online. KEYS TO SUCCESS: "The new server gave us the benefits of a centralized system combined with powerful back-end processing capabilities that enabled online analytical processing."

Chronology as Topic↗
PubMed2000

The direct and indirect effects of cost-sharing on the use of preventive services.

OBJECTIVE: To test empirically a model for estimating the direct and indirect effects of different forms of cost-sharing on the utilization of recommended clinical preventive services. DATA SOURCES/SETTINGS: Stratified random sample of 10,872 employees, 18-64 years, who had belonged to their plan for at least one year, from seven large companies that were members of the Pacific Business Group on Health (PBGH) in 1994. DATA COLLECTION: The 1994 PBGH Health Plan Value Check Survey. 1994 PBGH data on requirements for employee out-of-pocket patient cost-sharing for 52 different health plans. DESIGN: Five equations were derived to estimate the direct and indirect effects of two forms of cost-sharing (copayments and coinsurance/deductibles) in two forms of managed care (HMOs and PPO/indemnity plans) on four clinical preventive services: mammography screening, cervical cancer screening, blood pressure screening, and preventive counseling. Probit models were used to estimate elasticities for the indirect and direct effects. PRINCIPAL FINDINGS: Both forms of cost-sharing in both plan types had negative and significant indirect effects on preventive counseling (from -1 percent to -7 percent). The direct effect of cost-sharing was negative for preventive counseling (-5 percent to -9 percent) and Pap smears (from -3 percent to -9 percent) in both HMOs and PPOs, and for mammography only in PPOs (-3 percent to -9 percent). The results of the effects on blood pressure screening are inconclusive. CONCLUSIONS: Both the direct and indirect effects of cost-sharing negatively affected the receipt of preventive counseling in HMOs and PPOs. As predicted, the direct negative effect of cost-sharing was greater than the indirect effect for Pap smears and mammography. Eliminating cost-sharing for these services may be important to increasing their utilization to recommended levels.

Adolescent↗
PubMed2006

Tobacco cessation interventions in dental networks: a practice-based evaluation of the impact of education on provider knowledge, referrals, and pharmacotherapy use.

Tobacco is a significant risk factor for oral diseases. Dental care providers have the opportunity to inform patients about the risks associated with tobacco use and refer them to tobacco cessation resources. Although dental teams usually ask their patients about their tobacco use, most do not provide tobacco cessation counseling. This project involved four staff-model dental clinics and four contracted network dental clinics. Project goals were to 1) describe current practice patterns of tobacco cessation intervention, 2) increase the use of steps for treatment, known as the 5 As, recommended by the U.S. Public Health Service, 3) increase referrals to a tobacco helpline, and 4) increase use of pharmacotherapy for tobacco dependence treatment. The project included training and program support (e.g., sharing of project data, weekly newsletters, discussion at clinic meetings). Results indicate that this approach to addressing tobacco dependence in a dental clinic setting can effectively change dental provider knowledge and action.

Bupropion↗
PubMed1995

Knowledge-based temporal abstraction in diabetes therapy.

We suggest a general framework for solving the task of creating abstract, interval-based concepts from time-stamped clinical data. We refer to this problem-solving framework as the knowledge-based temporal-abstraction (KBTA) method. The KBTA method emphasizes explicit representation, acquisition, maintenance, reuse, and the sharing of knowledge required for abstraction of time-oriented clinical data. We describe the subtasks into which the KBTA method decomposes its task, the problem-solving mechanisms that solve these subtasks, and the knowledge necessary for instantiating these mechanisms in a particular clinical domain. We have implemented the KBTA method in the RESUME system and have applied it to the task of monitoring the care of insulin-dependent diabetics.

Artificial Intelligence↗