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PubMed2002

Construction of a system for the access, storage and exploitation of data and medical images generated in radiology information systems (RIS).

We present the analysis, design and implementation of a system that allows specialists at a medical centre to recuperate and manage information produced by computers that generate medical diagnosis images. The main objective of the system is to define an architecture that provides doctors with an easy and centralized access to any information they may need, and to allow users to access this information from the computers at the hospital itself as well as from remote locations, which then require telemedicine sessions. The architecture is built according to a layered and modular methodology, which provides high scalability and interoperability with other information systems (HIS, RIS, etc). All the information is stored in a database: not only the various image studies of the patient, but also all data concerning the diagnosis and any comments the specialist may have made. We have also incorporated tools that are not usually found in conventional systems (image segmentation, advanced visualization, etc), but that help the specialist with the decision-making process.

Diagnostic Imaging↗

PubMed2000

The need for a shared database infrastructure: combining X-ray crystallography and electron microscopy.

Advances in structural biology are opening greater opportunities for understanding biological structures from the cellular to the atomic level. Particularly promising are the links that can be established between the information provided by electron microscopy and the atomic structures derived from X-ray crystallography and nuclear magnetic resonance spectroscopy. Combining such different kinds of structural data can result in novel biological information on the interaction of biomolecules in large supramolecular assemblies. As a consequence, the need to develop new databases in the field of structural biology that allow for an integrated access to data from all the experimental techniques is becoming critical. Pilot studies performed in recent years have already established a solid background as far as the basic information that an integrated macromolecular structure database should contain, as well as the basic principles for integration. These efforts started in the context of the BioImage project, and resulted in a first complete database prototype that provided a versatile platform for the linking of atomic models or X-ray diffraction data with electron microscopy information. Analysis of the requirements needed to combine data at different levels of resolution have resulted in sets of specifications that make possible the integration of all these different types in the context of a web environment. The case of a structural study linking electron microscopy and X-ray data, which is already contained within the BioImage data base and in the Protein Data Bank, is used here to illustrate the current approach, while a general discussion highlights the urgent need for integrated databases.

Crystallography, X-Ray↗

PubMed1997

Cloning of the phosphonoacetate hydrolase gene from Pseudomonas fluorescens 23F encoding a new type of carbon-phosphorus bond cleaving enzyme and its expression in Escherichia coli and Pseudomonas putida.

The phnA gene encoding a novel carbon-phosphorus bond cleavage enzyme, phosphonoacetate hydrolase, from Pseudomonas fluorescens 23F was cloned and expressed in Escherichia coli and Pseudomonas putida. It conferred on the latter host the ability to mineralize phosphonoacetate but on the former the ability to utilize it as sole phosphorus source only. The nucleotide and deduced amino acid sequences of the phnA gene showed no significant homology with any data bank accessions.

Alkaline Phosphatase↗

PubMed2004

An improved failure mode effects analysis for hospitals.

OBJECTIVE: To review the Failure Mode Effects Analysis (FMEA) process recommended by the Joint Commission on Accreditation of Health Organizations and to review alternatives. This reliability engineering tool may be unfamiliar to hospital personnel. DATA SOURCES: Joint Commission on Accreditation of Health Organizations recommendations, Mil-Std-1629A, and other articles about FMEA were used. STUDY SELECTION: The articles were selected by a literature search that included Web site-accessible material. DATA EXTRACTION: All articles found were used. DATA SYNTHESIS: The results are based on the articles cited and the author's experience in conducting FMEAs in the medical diagnostics industry. CONCLUSIONS: Fault trees and a list of quality system essentials are recommended additions to the FMEA process to help identify failure mode effects and causes. Neglecting mitigations for failure modes that have never occurred is a possible danger when too much emphasis is placed on improving risk priority numbers. A modified Pareto, not based on the risk priority number, is recommended when there are qualitatively different failure mode effects with different severities. Performing a FMEA that both meets accreditation requirements and reduces the risk of medical errors is an attainable goal, but it may require a different focus.

Clinical Laboratory Techniques↗

PubMedDate not supplied

Data withholding in academic genetics: evidence from a national survey.

CONTEXT: The free and open sharing of information, data, and materials regarding published research is vital to the replication of published results, the efficient advancement of science, and the education of students. Yet in daily practice, the ideal of free sharing is often breached. OBJECTIVE: To understand the nature, extent, and consequences of data withholding in academic genetics. DESIGN, SETTING, AND PARTICIPANTS: Mailed survey (March-July 2000) of geneticists and other life scientists in the 100 US universities that received the most funding from the National Institutes of Health in 1998. Of a potential 3000 respondents, 2893 were eligible and 1849 responded, yielding an overall response rate of 64%. We analyzed a subsample of 1240 self-identified geneticists and made a limited number of comparisons with 600 self-identified nongeneticists. MAIN OUTCOME MEASURES: Percentage of faculty who made requests for data that were denied; percentage of respondents who denied requests; influences on and consequences of withholding data; and changes over time in perceived willingness to share data. RESULTS: Forty-seven percent of geneticists who asked other faculty for additional information, data, or materials regarding published research reported that at least 1 of their requests had been denied in the preceding 3 years. Ten percent of all postpublication requests for additional information were denied. Because they were denied access to data, 28% of geneticists reported that they had been unable to confirm published research. Twelve percent said that in the previous 3 years, they had denied another academician's request for data concerning published results. Among geneticists who said they had intentionally withheld data regarding their published work, 80% reported that it required too much effort to produce the materials or information; 64%, that they were protecting the ability of a graduate student, postdoctoral fellow, or junior faculty member to publish; and 53%, that they were protecting their own ability to publish. Thirty-five percent of geneticists said that sharing had decreased during the last decade; 14%, that sharing had increased. Geneticists were as likely as other life scientists to deny others' requests (odds ratio [OR], 1.39; 95% confidence interval [CI], 0.81-2.40) and to have their own requests denied (OR, 0.97; 95% CI, 0.69-1.40). However, other life scientists were less likely to report that withholding had a negative impact on their own research as well as their field of research. CONCLUSIONS: Data withholding occurs in academic genetics and it affects essential scientific activities such as the ability to confirm published results. Lack of resources and issues of scientific priority may play an important role in scientists' decisions to withhold data, materials, and information from other academic geneticists.

Communication↗

PubMed1999

Current status of the Asthma and Allergy Database.

The database provides an online resource for access to data on the genetics of asthma and allergy. This report describes the present status of the site. Currently, a detailed description of 88 linkage studies (7164 linkage positions) and 72 mutation studies are available. The results can be accessed in table form or graphically. The database also contains mouse asthma studies and human homology relationships, gene expression studies and links to relevant patents. Technical details about the server architecture, database installation, database construction, database structure and the user interface are explained elsewhere [Wjst and Immervoll (1998) Bioinformatics, 14, 827-828]. The URL is http://cooke.gsf.de

Animals↗

PubMed1991

A computer-controlled ventilator weaning system.

Weaning of patients from mechanical ventilation is a time-consuming, labor-intensive process. Because most weaning decisions are based on objective data, we tested a computer-directed weaning system on postoperative patients. We developed an automatic, computer-controlled ventilator weaning system which interfaces a laptop computer to a ventilator and a pulse oximeter. The laptop computer program accesses patient data through the ventilator and pulse oximeter to make weaning decisions. The computer directly controls the ventilator through an interface developed for this system. We tested the system in nine postoperative patients who met the following criteria: negative inspiratory force less than or equal to -20 cm H2O, vital capacity greater than 10 ml/kg, inspired oxygen concentration less than or equal to 40 percent, and satisfactory arterial blood gas parameters (pH between 7.32 and 7.48, PCO2 between 32 and 48, and oxygen saturation greater than or equal to 90 percent). The computer decreased the SIMV rate by 2 breaths/min every 5 min until a rate of 2 breaths/min was reached, then decreased pressure support by 4 cm H2O every 5 min as long as the patient met the following criteria: respiratory rate between 8 and 25 breaths/min, minute ventilation between 6 and 14 L, and pulse oximeter oxygen saturation greater than or equal to 90 percent. If unsatisfactory weaning criteria were noted, the system automatically returned the patient to the previous weaning level. We successfully weaned nine patients using the system. Additional studies are underway to determine if this system can be used in medical patients. We believe this computer-controlled ventilator weaning system can be used successfully in patients requiring mechanical ventilation and may decrease the time and cost associated with the care of these patients.

Adult↗

PubMedDate not supplied

Approach to a hospital-based application of a medical expert system.

CADIAG-2 is a data-driven fuzzy medical expert system built for computer-based consultation in internal medicine. It has been integrated into the medical information system WAMIS of the Vienna General Hospital. Through the integration, CADIAG-2 is able to access patient data and laboratory test results already collected in the central patient database of WAMIS. CADIAG-2 operates in two subsequent phases: (1) as an automatic screening procedure for detecting pathological states in the patient, for generating diagnostic hypotheses, and for proposing further useful examinations; and (2) as an on-line consultation system for the clinician to assist him in clarifying patients' disorders completely and in great detail. At present, CADIAG-2 is subject to extended clinical trials. There are four application areas: rheumatic diseases, pancreatic diseases, gall bladder and bile duct diseases and colon diseases. First results on the performance of CADIAG-2 based on the evaluation of about 500 cases were obtained. In this paper, the principal goals, main components and concepts of CADIAG-2, and the experience gained until now are discussed.

Artificial Intelligence↗

PubMed1991

Data protection in networks.

Health Data are sensitive to loss, manipulation and breach of confidentiality. Systems handling health data must be especially secure. Anyone accessing health data-be they stored in data banks or in personalized chip-cards-must be specifically authorized to do so and must be strongly authenticated before access is granted.

Computer Communication Networks↗

PubMed2002

An XML Gateway to Patient Data for Medical Research Applications.

As the medical environment becomes increasingly electronic, clinical databases are continually growing, accruing masses of patient information. This wealth of data is an invaluable source of information to researchers, serving as a testbed for the development of new information technologies and as a repository of real-world data for data mining and population-based studies. However, the true utility of this information is not fulfilled, in part because of issues pertaining to security and patient confidentiality, but also due to the lack of an effective infrastructure to access the data. This paper describes a system, DataServer, that permits researchers to query and retrieve data from multiple clinical data sources, automatically deidentifying patient data so that it can be used for research purposes. DataServer functions as an application framework, enabling extensible markup language (XML)-based querying of existing medical databases. Key aspects of DataServer include ready inclusion of new information resources, minimal processing impact on existing clinical systems via a distributed cache, and flexible output representation via XSL (eXtensible Style Language) transforms.

Databases, Factual↗

PubMed2003

Health plan quality-of-care information is undermined by voluntary reporting.

BACKGROUND: Most health services in the United States are delivered by managed care organizations (MCOs). Publicly available, plan-specific performance information is required to adequately assess healthcare quality provided. Using women's health indicators, we compared performance results for MCOs and evaluated whether those MCOs that publicly report quality-of-care (QOC) results demonstrate better QOC than those plans that restrict public access to data. METHODS: Data from the Health Plan Employer Data and Information Set (HEDIS) for commercial MCOs in 1998 were analyzed for women's QOC indicators. Plan-specific, regional, and national performances were analyzed and results compared to established benchmarks. Public-reporting plans were compared to plans that restrict access to QOC information. Linear regression was used to identify determinants of health plan performance including public release of information. RESULTS: Commercial MCOs had wide variations in QOC indicators and, on average, failed to attain national health goals for most women's health indicators analyzed. Plans that restricted public access to QOC information had poorer performance than those that did not (p<0.05). Results suggest that whether a plan publicly releases its performance information is highly associated with health plan performance even after taking into account other factors. CONCLUSIONS: The voluntary aspect of reporting and the ability of health plans to restrict public access is allowing poorer performing health plans to escape public scrutiny. Variations in QOC have clinical significance and, if publicly available, would enable individuals to select high-quality healthcare products. The ability of health plans to restrict public information is not consistent with the 1973 Health Maintenance Organization Act requiring public information on health plan quality. A national strategy to ensure that QOC information is available on all healthcare systems is past due.

Adult↗

PubMed2002

The Celera Discovery System.

The Celera Discovery System (CDS) is a web-accessible research workbench for mining genomic and related biological information. Users have access to the human and mouse genome sequences with annotation presented in summary form in BioMolecule Reports for genes, transcripts and proteins. Over 40 additional databases are available, including sequence, mapping, mutation, genetic variation, mRNA expression, protein structure, motif and classification data. Data are accessible by browsing reports, through a variety of interactive graphical viewers, and by advanced query capability provided by the LION SRS search engine. A growing number of sequence analysis tools are available, including sequence similarity, pattern searching, multiple sequence alignment and Hidden Markov Model search. A user workspace keeps track of queries and analyses. CDS is widely used by the academic research community and requires a subscription for access. The system and academic pricing information are available at http://cds.celera.com.

Animals↗

PubMed1988

Amendment of the Ordinance on Civil Status, 28 November 1988.

This Amendment inserts into the Swiss Ordinance on Civil Status of 1 June 1953 provisions relating to the electronic management of data. It provides that the authorization of such systems of management is left to cantonal authorities and that the cantonal authorities are to furnish information about such systems to the Federal Office of Civil Status. It also provides rules on limited access to data, reports based on data, and forms, among other things. In addition, the Amendment makes a number of small changes in the Ordinance relating to names, security of data, publication, foreign domicile, and the application of national law, among other things.

Communication↗

PubMed2003

ASAP, a systematic annotation package for community analysis of genomes.

ASAP (a systematic annotation package for community analysis of genomes) is a relational database and web interface developed to store, update and distribute genome sequence data and functional characterization (https://asap.ahabs.wisc.edu/annotation/php/ASAP1.htm). ASAP facilitates ongoing community annotation of genomes and tracking of information as genome projects move from preliminary data collection through post-sequencing functional analysis. The ASAP database includes multiple genome sequences at various stages of analysis, corresponding experimental data and access to collections of related genome resources. ASAP supports three levels of users: public viewers, annotators and curators. Public viewers can currently browse updated annotation information for Escherichia coli K-12 strain MG1655, genome-wide transcript profiles from more than 50 microarray experiments and an extensive collection of mutant strains and associated phenotypic data. Annotators worldwide are currently using ASAP to participate in a community annotation project for the Erwinia chrysanthemi strain 3937 genome. Curation of the E. chrysanthemi genome annotation as well as those of additional published enterobacterial genomes is underway and will be publicly accessible in the near future.

Databases, Genetic↗

PubMed1999

Computing data about patients with cleft lip and palate.

For clinical research and quality control in the treatment of patients with cleft lip and palate (CLP) we created a register based on commercially available computer components. In this report we present the logical organisation of the system and give some representative examples of its applicability. There is great potential for easy access to data, and presentation.

Adult↗

PubMed1997

Education and income differentials in breast and cervical cancer screening. Policy implications for rural women.

OBJECTIVES: Despite substantial evidence of socioeconomic differences in the use of breast and cervical cancer screening, the mechanisms explaining these differences, and therefore their policy implications are not well understood. We investigated the way that education and income influence rural women's use of mammograms and Pap tests, including financial barriers to medical care, knowledge and attitudinal barriers, and nonfinancial factors related to health-care access. METHODS: Data were from a population-based telephone survey of 2,346 rural Wisconsin women aged 40 years and older. Logistic regression analyses and simulation exercises were conducted. RESULTS: The strongest barriers to screening in this rural population were nonfinancial impediments to access. Removing economic barriers did not lead to significant increases in screening when other types of barriers were present. CONCLUSIONS: Policies and interventions that focus on the most visible differences that exist between rural women of differing socioeconomic levels (ie, differences in the ability to afford health services) and do not simultaneously address knowledge, attitudinal, and health-care access barriers will fall short of their goal to increase breast and cervical cancer screening.

Adult↗

PubMed2001

Handheld computers in critical care.

BACKGROUND: Computing technology has the potential to improve health care management but is often underutilized. Handheld computers are versatile and relatively inexpensive, bringing the benefits of computers to the bedside. We evaluated the role of this technology for managing patient data and accessing medical reference information, in an academic intensive-care unit (ICU). METHODS: Palm III series handheld devices were given to the ICU team, each installed with medical reference information, schedules, and contact numbers. Users underwent a 1-hour training session introducing the hardware and software. Various patient data management applications were assessed during the study period. Qualitative assessment of the benefits, drawbacks, and suggestions was performed by an independent company, using focus groups. An objective comparison between a paper and electronic handheld textbook was achieved using clinical scenario tests. RESULTS: During the 6-month study period, the 20 physicians and 6 paramedical staff who used the handheld devices found them convenient and functional but suggested more comprehensive training and improved search facilities. Comparison of the handheld computer with the conventional paper text revealed equivalence. Access to computerized patient information improved communication, particularly with regard to long-stay patients, but changes to the software and the process were suggested. CONCLUSIONS: The introduction of this technology was well received despite differences in users' familiarity with the devices. Handheld computers have potential in the ICU, but systems need to be developed specifically for the critical-care environment.

Artificial Intelligence↗

PubMed1999

The Asian Pacific Economic Cooperation Emerging Infections Network.

ISSUE: The Asia Pacific Economic Cooperation (APEC) has undertaken an initiative in emerging infections. PROJECT: The APEC Emerging Infections Network project uses collaborative telecommunications tools such as e-mail and a World Wide Web site to bridge the broad geographic expanse and diversity of APEC. Scientists and policymakers share information to effectively combat emerging infectious disease (EID) through surveillance, prevention, research, and control measures. RESULTS: In the project's first year, site visits compiled information on Internet access in selected economies. Information sharing via electronic lists has been successful; feedback suggests that these strategies will become increasingly useful. The Emerging Infections Network (EINet) Web site includes project information, library access, surveillance data, prevention guidelines, and distance learning resources. A pilot effort to promote the secure electronic exchange of surveillance data demonstrated that informal communications may be both preferable and more feasible during the early stages of this project. LESSONS LEARNED: Human networking is as important as technology-based networking in addressing emerging infections. Internet technology in some APEC economies is barely adequate, but is becoming more reliable and accessible. Numerous member economies are eager to be included in project activities.

Asia↗