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PubMed2002

Strengthening primary health care: building the capacity of rural communities to access health funding.

Present health funding models can place onerous pressures on rural health services. Staff may lack the time, resources, access to data, and the expertise needed to complete complex and lengthy funding submissions. This present study describes an innovative capacity-building approach to working with Victorian rural communities seeking to access health care funding through the Regional Health Services Program. This approach used several strategies: engaging stakeholders in targeted rural communities, developing an information kit and running a workshop on preparing submissions to the Regional Health Services Program, facilitating community consultations, and providing ongoing support with submissions. Six rural communities were supported in this way. Four have been funded to date, with a combined annual recurrent budget for new primary health care services of over $2.5 million. Each community has developed a service delivery model that meets the particular needs of their local area. This capacity-building approach is both effective and replicable to other health funding opportunities.

Budgets↗
PubMed2005

KORA-gen--resource for population genetics, controls and a broad spectrum of disease phenotypes.

KORA-gen is a resource for genetic epidemiological research, based on the KORA platform (Cooperative Health Research in the Region of Augsburg). Biosamples and phenotypic characteristics as well as environmental parameters of 18,000 adults from Augsburg and the surrounding counties are available. The age range of the participants was 25 to 74 years of recruitment and is 30 to 90 years in 2005. KORA-gen can be used by external partners. Interested parties can inform themselves interactively via internet about the available data and the rules of access. The genotypic data base is a common resource of all partners.

Adult↗
PubMed2001

Changing access to health services in urban China: implications for equity.

The ongoing reform of public institutions and state-owned enterprises in urban China has had a profound impact on the financing, organization and provision of health services. Access to health care by the urban population has become more inequitable. One of the most pressing concerns is that those who have lost jobs have increasing difficulties accessing health care. Using the data from the national household health surveys conducted in 1993 and 1998, this paper presents empirical results of changing utilization of health care among different income groups. Over 16 000 households and 54 000 individuals in the urban areas were randomly selected to collect information on perceived need of and demand for health care and expenditures on the services. The findings show that the income gap between the highest and lowest income groups increased in real terms from 1993 to 1998. There was a significant decline in the population covered by the government insurance scheme (GIS) and the labour insurance scheme (LIS), while the proportion of the population who had to pay for services out-of-pocket increased from 28% in 1993 to 44% in 1998. There was no statistically significant change in self-reported illness in the 2 weeks prior to survey among the study population over the period. While it was found that more people who reported illness from each income group received medical treatment of some kind, there was a decline in seeking care from a health provider. Among those in the lowest income group who reported illness but did not obtain treatment of any kind, nearly 70% (as compared with 38% in 1993) claimed financial difficulty as the major reason in 1998. The use of in-patient services dropped significantly from 4.5% in 1993 to 3.0% in 1998. The decreased use of in-patient services was more serious in the lowest and lower income groups than in higher and highest income groups. The percentage of patients referred for hospital admission but not being hospitalized had a negative relationship with income level. We can conclude from the data analysis that access of the urban population, particularly the poor, to formal health services has worsened and become more inequitable since the early 1990s. Among possible reasons for this trend are the rapid rise of per capita expenditure on health services and the decline in insurance coverage.

China↗
PubMed1995

Evaluation of an object-based data model implemented over a proprietary, legacy data model.

Most computerized medical information today is contained in legacy systems. As vendors slowly move to open systems, legacy systems remain in use and contain valuable information. This paper evaluates the use of an object model imposed on an existing database to improve the ease with which data can be accessed. This study demonstrates that data elements can be retrieved without specific programming knowledge of the underlying data structure. It also suggests that underlying data structures can be changed without updating application code. Programs written using the object model were easier to program but ran greater than one order of magnitude slower than traditionally coded programs. In this paper, the legacy information system is introduced, the methods used to implement and evaluate the object-based data model are explained, and the results and conclusions are presented.

Computer Systems↗
PubMed1993

Formalized decision support for cardiovascular intensive care.

The massive volume of hemodynamic data routinely available within the Cardiovascular Intensive Care Unit (CVICU) can adversely affect the quality, relevance, and timing of hemodynamic management decisions on patients after cardiac surgery. Yet, at the same time, the lack of appropriate treatment-outcome data and access to prior CV case histories deprives the clinician of any opportunity to improve personal decision-making skill and assess the effectiveness of various treatment methods. This paper presents a formalized decision-support model for CVICU that incorporates expert and quantitative knowledge, as well as prior outcome and case experience to augment the clinician's decision-making capability. This includes the use of optimal hemodynamic patterns derived from outcome analysis as therapy goals, expert rules and trend analysis to interpret incoming data, standardized protocols based on predefined hemodynamic patterns from clinical cases, and access to the database for similar case comparison. Most importantly, the model suggests an integrated approach where the clinical database not only is a documentation source for the patient, but also can serve as an outcome research database where clinical experience can be formalized and combined with expert knowledge to influence future therapy decisions. At present, a prototype is being developed at the CVICU of the University of Alberta Hospitals on a Unix platform using ART-IM, C and Ingres. Once implemented, the prototype will be evaluated on a small group of CV patients for its effectiveness and acceptability to clinicians.

Artificial Intelligence↗
PubMed1992

Formalized decision-support for cardiovascular intensive care.

The massive volume of hemodynamic data routinely available within the Cardiovascular Intensive Care Unit (CVICU) can adversely affect the quality, relevance and timing of hemodynamic management decisions on patients after cardiac surgery. Yet, at the same time, the lack of appropriate treatment-outcome data and access to prior CV case histories deprives the clinician of any opportunity to improve personal decision-making skill and assess the effectiveness of various treatment methods. This paper presents a formalized decision-support model for CVICU that incorporates expert and quantitative knowledge, as well as prior outcome and case experience to augment the clinician's decision-making capability. This includes the proposed use of optimal hemodynamic patterns derived from outcome analysis as therapy goals, expert rules and trend analysis to interpret incoming data, standardized protocols based on predefined hemodynamic patterns from clinical cases, and access to the database for similar case comparison. Most importantly, the model suggests an integrated approach where the clinical database is not only a documentation source for the patient, but can also serve as an outcome research database where clinical experience can be formalized and combined with expert knowledge to influence future therapy decisions. At present, a prototype is being developed at the CVICU of the University of Alberta Hospitals on a Unix platform using ART-IM, C and Ingres. Once implemented, the prototype will be evaluated on a small group of CV patients for its effectiveness and acceptability to clinicians.

Cardiovascular Diseases↗
PubMed2005

Consensus proposals for a unified system of nomenclature of hepatitis C virus genotypes.

International standardization and coordination of the nomenclature of variants of hepatitis C virus (HCV) is increasingly needed as more is discovered about the scale of HCV-related liver disease and important biological and antigenic differences that exist between variants. A group of scientists expert in the field of HCV genetic variability, and those involved in development of HCV sequence databases, the Hepatitis Virus Database (Japan), euHCVdb (France), and Los Alamos (United States), met to re-examine the status of HCV genotype nomenclature, resolve conflicting genotype or subtype names among described variants of HCV, and draw up revised criteria for the assignment of new genotypes as they are discovered in the future. A comprehensive listing of all currently classified variants of HCV incorporates a number of agreed genotype and subtype name re-assignments to create consistency in nomenclature. The paper also contains consensus proposals for the classification of new variants into genotypes and subtypes, which recognizes and incorporates new knowledge of HCV genetic diversity and epidemiology. A proposal was made that HCV variants be classified into 6 genotypes (representing the 6 genetic groups defined by phylogenetic analysis). Subtype name assignment will be either confirmed or provisional, depending on the availability of complete or partial nucleotide sequence data, or remain unassigned where fewer than 3 examples of a new subtype have been described. In conclusion, these proposals provide the framework by which the HCV databases store and provide access to data on HCV, which will internationally coordinate the assignment of new genotypes and subtypes in the future.

Genotype↗
PubMed2003

Overview of the ISCE ECG "genome project".

The International Society for Computerized Electrocardiography (ISCE) "genome" project was begun at the end of 2000 to explore mechanisms for development of a cross-platform electrocardiogram (ECG) database. Ultimate feasibility of this project is based on established interactive cooperation of clinical investigators, engineers, and industry within the ISCE framework. The US Food and Drug Administration (FDA) mandate for centralized access to digitized ECG waveforms used in clinical trials provides a complementary stimulus to technologies that facilitate ECG database development. The constituency of ISCE is interested in acquisition and analysis of data from both standard 12-lead (resting) ECG and ambulatory (monitoring) ECG. Support for project goals from industry, at the Trustee as well as at the engineering level, has led to initial focus on the resting ECG. A one-year pilot project has been proposed to establish and implement software methodology for transmission, storage, and integrated reanalysis of digitized ECG waveforms provided by several major manufacturers. Beyond data acquisition, storage, and analysis, a number of critical issues are associated with database development. These include definition of clinically relevant "gold" standards, acquisition and validation of non-ECG data, protection of patient privacy, control and ownership of data, and accessibility and use of the database. However, implementation of the pilot project is a necessary first step, since all issues become moot without technical cooperation for shared formatting and analysis.

Databases as Topic↗
PubMed1999

[The filmless hospital: 3-year experience at the Hammersmith Hospital, London].

A hospital-wide PACS (Picture Archiving and Communication System) is a computerised electronic system which entirely replaces conventional x-ray film by acquiring, archiving, transmitting and displaying digital images on a network of workstations throughout the hospital. Such a system has been operating without film for 3 years now at Hammersmith Hospital, London. PACS has a number of advantages over conventional films. These include time savings, reliability of the system, space savings, economies in consumables and personnel, reduced patient irradiation, efficiency of data management, accessibility of images and teaching benefits. The disadvantages of PACS are: its cost, the need for specialised personnel for its installation and maintenance, training of users, the possibility of breakdown, and data security issues. PACS has altered the work patterns of all its users, including non-radiologist clinicians, radiologists and radiographers. PACS is a step on the way to achieving the future objectives of teleradiology and the complete electronic patient record.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Computer monitoring- based algorithm for the discrimination between pathological and compensatory changes in acute disorders of blood circulation].

A differential diagnosis algorithm for pathological and compensatory changes was implemented on the basis of a general-access "Microsoft Access 2002" data bank (DB). The DB algorithm makes the soft more flexible; the interpretation of findings can be changed unassistedly in the real time mode with respect to specific needs encountered in the treatment of cardiologic patients. With DB a high-skilled practitioner can swiftly alter the algorithm while processing a complex gauging; it is also possible to make corrections in the reference data, to predetermine the stages and objects of analysis and to use applications in dealing with strategic tasks. Information is supplied from BD in the form of reports generated by Microsoft Access, it is integrated with other MS Office tools, which makes it accessible to layman users.

Algorithms↗
PubMed2000

The advantages of standardized evaluation of male infertility.

Healthcare can be improved by standardization and by evaluation of diagnostic methods and treatments. In the field of andrology, in which large patient numbers are required for the evaluation of diagnostic procedures and treatments, structured data collection and multicentre studies are especially warranted. Concomitant with routine clinical practice, a large amount of clinical data are collected that may be used to evaluate andrological care. Structuring and electronic storage of data holds promise in terms of clarity and accessibility of the data and its use for validation studies. The aim of the present work was to study the merits of routine collection of a common dataset in a computer-based patient record (CPR) for standardization, quality of data and clinical research. It was studied whether the data were of sufficient quality and accessibility for much needed studies on aetiology, interventions and diagnostics in andrology. Data collection in a structured CPR promoted complete and comprehensive data. We describe the advantages, pitfalls and solutions with this approach. Data on the uniform examination of 1549 infertile men became readily accessible. Population characteristics, basal associations and original studies were enabled and provided insight into the efficiency of clinical practice. In 66% of men, a cause for their infertility was identified, which provides a better rationale for treatment than semen parameters alone. For more than 30% of the patients, a rational andrological treatment was available, which could be deployed before assisted reproductive technologies were resorted to. However, most treatments have not been properly validated. The thorough diagnostic evaluation identifies subgroups that require an evidence base for treatment and further study on aetiology and diagnosis. Structured collection of uniform patient data through a CPR was feasible and facilitated the evaluation of diagnostic and therapeutic modalities. The reported advantages, pitfalls and solutions with this approach may help other centres to decide on how to implement a CPR. Conscientious collection of a standard data set in infertility centres facilitates pooling of data and evidence-based multicentre research.

Adult↗
PubMed1990

Computerized determination of growth kinetic curves and doubling times from cells in microculture.

In this paper we describe the microcomputer-aided determination of cell proliferation kinetics and doubling times utilizing a crystal violet assay and a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay in microtitration plates. The analysis of spectrophotometric data provides the doubling times at any time of incubation. Plots of doubling time versus time of incubation give reproducible information on the exact duration of the logarithmic growth phase. This method is applicable to anchorage-dependent as well as anchorage-independent cells when colorimetric or fluorometric data are accessible.

Adenocarcinoma↗
PubMed2001

GBuilder--an application for the visualization and integration of EST cluster data.

This paper presents a network-centric DNA sequence visualization and analysis tool called GBuilder. The tool is an easy-to-use Java application that can be used to analyze DNA sequence clusters and assemblies. The emphasis is on the analysis of EST data, where these highly redundant collections of low-quality and often alternatively spliced or chimeric sequence data are difficult to explore. The tool has the capacity to visualize similarities or dissimilarities between sequences at the level of the nucleotide base or annotation in many ways. Sequences may also be edited manually. The novel feature of GBuilder is its ability to access different data sources and analysis applications available on the Internet and to integrate these results and functionality back into itself. External resources such as EST cluster databases and conventional command-line analysis applications are integrated and accessed using CORBA (Common Object Request Broker Architecture), which provides a standard implementation independent protocol for integration. New CORBA services can be integrated immediately if they use a known interface described using the Interface Definition Language.

Algorithms↗
PubMed1993

Enhancing the cost-effective practice of medicine: the physician's perspective.

Data-driven process improvement, such as that at Harper Hospital described earlier, requires several critical elements. First, data must be readily available, accurate, timely, and easy to analyze. Over 200 charts and graphs were produced at Harper Hospital to support the work of the five teams. Often, teams met weekly and data had to be accessed, analyzed, and turned around in five working days. Without the right systems, this is impossible. Second, accuracy of data and accessibility are issues. Sometimes, data are not accessible because of disparate systems or databases, or because they are not collected in a format to support analysis. An example of the latter occurred at Harper Hospital when it was discovered that surgical OR supplies were billed at one inclusive rate and that the detail data were not collected in an automated system. Manual analysis could not be done in the time frame required and momentum was lost. Next, timeliness is an issue when physicians are asked to make decisions using dated data. For most purposes, data should be no more than three months old. Ideally, two weeks should be the limit. Some hospitals are making new data available hourly. Trends change too rapidly, lengths of stay shorten, new antibiotics are introduced, new treatments are available, and reimbursement changes too often to use old data for decision making. Lastly, tools should be readily available to bring the story from the numbers. Graphs, charts, and statistics need to be used much more often and in more imaginative ways. As the health care information industry makes databases more user-friendly, physicians will understand and regain their potential to use medical science to improve the lives of their patients.

Coronary Artery Bypass↗
PubMedDate not supplied

Improved quality data systems through the use of standard electronic data deliverables (EDDs) and environmental data assessment software.

One of the challenges facing professionals in the environmental arena today is the collection and assessment of large amounts of environmental analytical data. The assessment of the quality of that data is essential as multi-million dollar decisions for environmental site cleanups and/or long term monitoring efforts are made based on the analytical results. Also critical to environmental programs is the sharing and access of data across multiple data users. The ability to share data allows for better use of the limited resources available to clean up and monitor contaminated environmental sites. Standardization of electronic deliverables allows for collection of data from multiple data collectors into a single database for use by numerous data users and stakeholders on a project. This paper discusses the benefits of using a standard EDD deliverable format and use of environmental data assessment software tools to do project planning and data assessment throughout the duration of the environmental project.

Database Management Systems↗
PubMed2001

Wireless vital sign telemetry to hand held computers.

Most physicians and other health care providers share/access patient information via hard copy chart records, telephone conversations, or through hospital computer networks. These modalities are cumbersome when physicians are away from the hospital and ground wiring infrastructure is not readily available. In a prior study, we used wireless in-flight telephony and the Internet to transmit vital signs from an airborne Boeing 757 to three remote locations on the ground. However, because all recipient stations relied on an institutional network to receive the information, it was not possible to transfer data to a given location beyond the hospital campus. We now propose an innovative system capable of transmitting telemetry information from any location in the globe to a single portable computer using Wireless Application Protocol (WAP) technology for the Internet. Medical data including blood pressure, pulse, respiratory rate, end tidal CO2, oxygen saturation and EKG tracings were transferred from a G2 (digital cellular) phone linked to a hand held computer to a remote hand held device and were viewed in real time using customized software. Cellular Digital Packet Protocols (CDPD) enabled data transfer speeds up to 19,200 bps. Advances including the Internet and wireless computer technology may revolutionize the way medical information is shared, making it possible for physicians and health allies to directly access patient data from anywhere at any time.

Humans↗
PubMedDate not supplied

[Model of genes expression regulation in bacteria by means of formation of secondary RNA structures].

In this article a model, first, classical attenuation RNA regulation of gene expression by means of transcription termination is offered. The model bases on representation about a macrostate of secondary structure in RNA regulatory region between a ribosome and a RNA polymerase, on the formulas of a resonant type defining the value of deceleration of a RNA polymerase by a set of hairpins in the same region. The special attention is given to selection of parameters of model. To check of model the computer simulation is carried out and the dependences of transcription termination probability from the value of concentration charged tRNA are obtained, in particular, and from concentration of amino acid for many regulatory regions in genomes of bacteria (here data are presented for trpE genes in Streptomyces spp., Bradyrhizobium japonicum and Escherichia coli) and at various values of three parameters, which authors consider as the main. The obtained dependences are compounded with the accessible experimental data; including, under the form of the graphs concerning to activity of an enzyme depending on concentration of amino acid (for example, anthranilate synthase from tryptophan in S. venezuela). One possible usage: now attenuation is predicted usually by means of multiple alignment, it needs some sequences; the obtaining with the help of model on an individual sequence characteristic for attenuation or its absence of a curve at approaching parameters could be considered as argument for the benefit of presence or absence of attenuation.

Bacteria↗
PubMed2000

Genomic organization and chromosome localization of the newly identified human heparanase gene.

Heparanase (HPSE), which we have recently isolated, is an endo-beta-D-glucuronidase capable of cleaving heparan sulfate and has been implicated in inflammation and tumor angiogenesis and metastasis. In this report, the genomic organization and chromosome localization of the human heparanase gene is described. Polymerase chain reaction, subcloning and DNA sequencing analysis of a bacterial artificial chromosome (BAC) clone revealed that the 3.7 kb human heparanase cDNA is spread over about 50 kb and contains 14 exons and 13 introns. The heparanase gene is expressed as two mRNA species containing the same open reading frame, HPSE 1a (5 kb) (GenBank Data Library under accession number: AF155510); and HPSE 1b (1.7 kb) (GenBank Data Library under accession number: AF144325), generated by alternative splicing. The HPSE 1a-form contains all 14 exons, whereas in the HPSE 1b-form the first and fourteenth exons (5'- and 3'-untranslated region) have been spliced out. All splice sites conform to the GT-AG rule, except for the splice donor site of intron 13 (which is GA instead of GT), and the splice acceptor of intron 13 (which is GG instead of AG). Fluorescence in situ hybridization and radiation hybrid mapping suggest that the heparanase gene is located on human chromosome 4q22. This report regarding the structure of the human heparanase gene will aid in understanding the genetic contribution of this gene to normal physiology as well as to disease states. A possible involvement of heparanase in neuronal degeneration is discussed.

Alternative Splicing↗