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At least 919 records · Page 51Linked to original sources
PubMed2003

Improving the care of patients with regard to chemotherapy-induced nausea and emesis: the effect of feedback to clinicians on adherence to antiemetic prescribing guidelines.

PURPOSE: To evaluate the effect of performance and outcomes feedback on adherence to clinical practice guidelines regarding chemotherapy-induced nausea and emesis (CINE). METHODS: Institutional CINE clinical practice guidelines were developed based on American Society of Clinical Oncology guidelines. Consecutive administrations of moderately/highly emetogenic chemotherapy were assessed for errors. Baseline statistical process control (SPC) charts were created and mean errors per administration were calculated. Prospective SPC charts were used to measure the effect of guideline development and distribution, a visiting lecturer, and ongoing feedback regarding compliance with guidelines employing SPC charts. Patients were surveyed regarding the extent and severity of CINE for 5 days postadministration. These outcomes were then shared with physicians. RESULTS: Baseline compliance was poor (mean, 0.87 omissions per chemotherapy administration), largely because of inadequate adherence to recommendations for delayed CINE management. Most patients experienced delayed nausea, particularly on day 3 postchemotherapy. Physician prescribing performance did not undergo sustained improvement despite guideline development or distribution, a lecture by a visiting expert, or sharing of adherence data with clinicians. Once patient outcomes were shared, physicians accepted the need for compliance and instituted nurse practitioner antiemetic prescribing, with almost complete compliance and concurrent measurable reduction in day 3 nausea. SPC charts documented improvements in both outcomes. CONCLUSIONS: SPC charts effectively monitor ongoing compliance and patient symptoms and represent appropriate outcome measurement and change facilitation tools. However, physician participation in guideline development and evidence of poor compliance alone did not improve prescribing performance. Only evidence of patient CINE experience coupled with noncompliance improved results.

Adolescent↗
PubMed2004

Healthcare public key infrastructure (HPKI) and non-profit organization (NPO): essentials for healthcare data exchange.

To share healthcare information and to promote cooperation among healthcare providers and customers (patients) under computerized network environment, a non-profit organization (NPO), named as OCHIS, was established at Osaka, Japan in 2003. Since security and confidentiality issues on the Internet have been major concerns in the OCHIS, the system has been based on healthcare public key infrastructure (HPKI), and found that there remained problems to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority by contracting with the Ministry of Economics and Trading Industries in 2003. This paper describes the experimental design with NPO and the results of the study concerning message security and HPKI. The developed system has been operated practically in Osaka urban area.

Computer Security↗
PubMed2005

A shared response model for clustered binary data in developmental toxicity studies.

Existing distributions for modeling fetal response data in developmental toxicology such as the beta-binomial distribution have a tendency of inflating the probability of no malformed fetuses, and hence understating the risk of having at least one malformed fetus within a litter. As opposed to a shared probability extra-binomial model, we advocate a shared response model that allows a random number of fetuses within the same litter to share a common response. An explicit formula is given for the probability function and graphical plots suggest that it does not suffer from the problem of assigning too much probability to the event of no malformed fetuses. The EM algorithm can be used to estimate the model parameters. Results of a simulation study show that the EM estimates are nearly unbiased and the associated confidence intervals based on the usual standard error estimates have coverage close to the nominal level. Simulation results also suggest that the shared response model estimates of the marginal malformation probabilities are robust to misspecification of the distributional form, but not so for the estimates of intralitter correlation and the litter-level probability of having at least one malformed fetus. The proposed model is fitted to a set of data from the U.S. National Toxicology Program. For the same dose-response relationship, the fit based on the shared response distribution is superior to that based on the beta-binomial, and comparable to that based on the recently proposed q-power distribution (Kuk, 2004, Applied Statistics53, 369-386). An advantage of the shared response model over the q-power distribution is that it is more interpretable and can be extended more easily to the multivariate case. To illustrate this, a bivariate shared response model is fitted to fetal response data involving visceral and skeletal malformation.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMedDate not supplied

Data analysis in qualitative research: a plea for sharing the magic and the effort.

This discussion of data analysis in qualitative research addresses the question of how authors describe this aspect of their research. I suggest that the tradition of organization of research papers from quantitative research is not a good fit for writing qualitative research. I argue for less jargon and more detailed description, with the analytic process integrated into the findings and interpretation.

Humans↗
PubMed1994

The Medical Data Index (MDI) dependency module: a shared database to assist discharge planning and audit.

As part of the development of integrated, patient-based hospital information technology (IT) systems in the South-Western Region of England, a module has been developed which will hold core data pertaining to the functional status and current resources of elderly or disabled patients. Its purpose is to assist early identification of unmet needs and facilitate prompt transfer to community care. The module provides a shared database, which is completed or updated as necessary on admission and is then available to all appropriate users of the hospital system, avoiding duplication of data collection. In addition to details of home circumstances and support, it includes brief, standardized assessment scales for activities of daily living and mental state, which will identify the need for specialist referral. A summary is provided for easy communication with other care agencies.

Activities of Daily Living↗
PubMed2000

Radiology benchmarking data a hot commodity.

Here's some help on where to look. When a Healthcare Benchmarks reader called our offices to ask if we know of any resources for radiology benchmarks, there was little thought that there might be a story in the request. But the reader was having trouble locating any data, and a cursory search of some major organizations and consulting groups turned up little information. But HB has located some resources for those looking for data, which we share this month.

Benchmarking↗
PubMed1984

Shared hospital services: study report.

The study of shared hospital services reported in this article was conducted to determine the magnitude of shared administrative and clinical programs, what institutions participate, and most frequently shared services. To ensure that hospitals with different characteristics and in various areas were represented, the investigators mailed questionnaires to 1,731 of the nation's 5,987 short-term, acute care general hospitals in nine census regions. Responses indicated the following trends: Not-for-profit hospitals outrank other types of hospitals in using shared services. About 90 percent of hospitals with 200 to 499 beds shared services. For almost all categories of services, a percentage increase occurred in the number of hospitals participating in shared programs. The three most shared services were purchasing, data processing, and insurance programs. Hospitals shared more administrative than clinical services. According to administrators' responses, cost containment was the most common reason for sharing services. As the pressures to control health care costs increase, the investigators predict that hospitals will share more clinical services. Shared services decrease unit cost, however, only when providers have an excess capacity.

Data Collection↗
PubMed1988

Shared genes, shared experiences, and similarity of personality: data from 14,288 adult Finnish co-twins.

Similarities for Extraversion (E) and Neuroticism (N) scale scores from the Eysenck Personality Inventory were evaluated in 7,144 adult twin pairs, drawn from the population-based Finnish Twin Cohort, as a function of the co-twins' genetic resemblance, gender, age, and the frequency of their social interaction with each other. To separate effects of shared genes from those of shared experience, we performed hierarchical multiple regressions of double-entry data matrices. Results establish the predictive significance of both genetic and experiential influences: Genetic effects remained significant when tested after the effects of social contact were first removed; conversely, for N scores, the effects of social contact remained significant when assessed after genetic influences were first removed. These findings establish genetic variance in major dimensions of adult personality but assign a significant role to common experience as well. The first finding constructively replicates reports by others; the second challenges the widespread assumption that shared experiences have a negligible impact on sibling similarity in adult personality.

Adult↗
PubMed2004

Biodiversity informatics: managing and applying primary biodiversity data.

Recently, advances in information technology and an increased willingness to share primary biodiversity data are enabling unprecedented access to it. By combining presences of species data with electronic cartography via a number of algorithms, estimating niches of species and their areas of distribution becomes feasible at resolutions one to three orders of magnitude higher than it was possible a few years ago. Some examples of the power of that technique are presented. For the method to work, limitations such as lack of high-quality taxonomic determination, precise georeferencing of the data and availability of high-quality and updated taxonomic treatments of the groups must be overcome. These are discussed, together with comments on the potential of these biodiversity informatics techniques not only for fundamental studies but also as a way for developing countries to apply state of the art bioinformatic methods and large quantities of data, in practical ways, to tackle issues of biodiversity management.

Biodiversity↗
PubMed2005

Clinical terminology support for a national ambulatory practice outcomes research network.

The Medical Quality Improvement Consortium (MQIC) is a nationwide collaboration of 74 healthcare delivery systems, consisting of 3755 clinicians, who contribute de-identified clinical data from the same commercial electronic medical record (EMR) for quality reporting, outcomes research and clinical research in public health and practice benchmarking. Despite the existence of a common, centrally-managed, shared terminology for core concepts (medications, problem lists, observation names), a substantial "back-end" information management process is required to ensure terminology and data harmonization for creating multi-facility clinically-acceptable queries and comparable results. We describe the information architecture created to support terminology harmonization across this data-sharing consortium and discuss the implications for large scale data sharing envisioned by proponents for the national adoption of ambulatory EMR systems.

Ambulatory Care Information Systems↗
PubMed2001

Object-oriented modeling of patients in a medical federation.

This research explores the development of an object-oriented model to support inter-operation of simulations within a federation for the purpose of conducting medical analysis and training over a distributed infrastructure. The medical federation is referred to as the combat trauma patient simulation system and is composed using high level architecture. The infrastructure contains components that were separately developed and are heterogeneous in nature. This includes a general anatomical computer database capable of generating human injuries, referred to as operational requirements-based casualty assessment, an animated mannequin called the human patient simulator, and other components. The research develops an object model that enables bodily injury data to be shared across the simulation, conducts analysis on that data, and considers possible applications of the technique in expanded medical infrastructures.

Computer Communication Networks↗
PubMed1995

Computer-based patient record with a cardiologic extension.

Shortcomings of Paper Medical Records have been well recognized: limited readability, completeness, consistency, availability, structure, etc. Although electronic storage solves the problems of availability and legibility, data analysis and decision support require more than free text in electronic form. Although many information systems contain diagnoses and lab data in coded form, findings have often been left to free text. Even though the shortcomings of paper records are more pronounced in specialized care than in primary care, Dutch general practitioners have proven far more receptive to the use of computerized records. Specialists are very diverse in their domains of expertise and usually work in a complex environment: no single record would satisfy them all. Our objective is to support the specialist with the acquisition of patient data in a structured format with emphasis on history and physical exam. Important considerations have been that it will benefit physician and patient if record data can be shared, and that every specialist can record both data within, as well as outside, his domain of expertise. The philosophy of our Computer-based Patient Record model is based on two main principles: 1) A 'mother' record that can be extended with specialized subrecords. 2) A structure that supports flexible retrieval, efficient data entry and data analysis. The mother record contains information that all records have in common, but also offers the option of entering information, which has not been modeled in a subrecord. The 'face' of the mother record is the patient profile which offers the physician an overview of the status of the patient on any specified date. The profile includes diagnoses, medication, test results, and dates of previous visits. From this overview, the physician can directly access the subrecords, zoom in on data, or call another view. To avoid abrupt change in the daily routine of the physician, the interface allows the user to keep records in a rather conventional way, i.e., as free text. Yet, the interface constantly brings to attention the benefits of structured data, which will stimulate the physician to enter the data in a structured way; when most fields in the patient profile are empty, such as medication and past history, he may regret to have only entered free text in a 'summary' field. The mother record and a specialized record for the out-patient clinic of cardiac failure have been developed with the Department of Internal Medicine and the Thorax Centre of the Academic Hospital Rotterdam. The demonstration will show the versatility of both records. The application runs on a Unix platform with the use of an Interbase DBMS, OSF-Motif windows, and the Hermes kernel.

Cardiology Service, Hospital↗
PubMed2005

A class of Bayesian shared gamma frailty models with multivariate failure time data.

For multivariate failure time data, we propose a new class of shared gamma frailty models by imposing the Box-Cox transformation on the hazard function, and the product of the baseline hazard and the frailty. This novel class of models allows for a very broad range of shapes and relationships between the hazard and baseline hazard functions. It includes the well-known Cox gamma frailty model and a new additive gamma frailty model as two special cases. Due to the nonnegative hazard constraint, this shared gamma frailty model is computationally challenging in the Bayesian paradigm. The joint priors are constructed through a conditional-marginal specification, in which the conditional distribution is univariate, and it absorbs the nonlinear parameter constraints. The marginal part of the prior specification is free of constraints. The prior distributions allow us to easily compute the full conditionals needed for Gibbs sampling, while incorporating the constraints. This class of shared gamma frailty models is illustrated with a real dataset.

Adolescent↗
PubMed2005

Data conferencing in health care.

Data conferencing is a computing technique that helps people to communicate in realtime and to share information with others simultaneously. The T.120 standard provides a base for: (1) multipoint data sharing; (2) interoperability; (3) reliable data transfer; (4) scalability, transparency and independence; (5) platform independence; (6) application independence. A review of the health-care data-conferencing literature identified 25 articles. Ten articles provided detailed information about data-conferencing applications. Of these, eight focused on application sharing, seven on whiteboards, two on chat and one on screen sharing. Articles published before the year 2000 typically focused on the use of NetMeeting and Intel ProShare with low-bandwidth network connections. After 2000, high-speed Internet connections became more popular and Web-based multimedia data conferencing became feasible. While there are undoubted benefits of data conferencing, more research and evaluation are required before the technique is widely implemented in health care.

Computer Communication Networks↗
PubMedDate not supplied

Wireless communication in health care: who will win the right to send data boldly where no data has gone before?

Increasingly, health care professionals will need to retrieve, store, share, and send data using several types of wireless devices. These devices include personal digital assistants, laptops, Web tablets, cell phones, and clothing that monitor heart rate and blood pressure. Regardless of the device, several standards will vie for the right to provide the wireless communications link between the health care professional and the wired data resources located within a health care organization. This article identifies the top three technologies in the wireless communications field: Wireless Fidelity (WiFi), Mobile Communications, and Bluetooth; breaks down each according to its strengths and weaknesses; and makes recommendations for their use by health care professionals located inside and outside a health care facility. Where appropriate the discussion includes an explication of how a specific technology can be made secure from hackers and other security breeches.

Cell Phone↗
PubMed2005

The tissue microarray data exchange specification: a document type definition to validate and enhance XML data.

BACKGROUND: The Association for Pathology Informatics (API) Extensible Mark-up Language (XML) TMA Data Exchange Specification (TMA DES) proposed in April 2003 provides a community-based, open source tool for sharing tissue microarray (TMA) data in a common format. Each tissue core within an array has separate data including digital images; therefore an organized, common approach to produce, navigate and publish such data facilitates viewing, sharing and merging TMA data from different laboratories. The AIDS and Cancer Specimen Resource (ACSR) is a HIV/AIDS tissue bank consortium sponsored by the National Cancer Institute (NCI) Division of Cancer Treatment and Diagnosis (DCTD). The ACSR offers HIV-related malignancies and uninfected control tissues in microarrays (TMA) accompanied by de-identified clinical data to approved researchers. Exporting our TMA data into the proposed API specified format offers an opportunity to evaluate the API specification in an applied setting and to explore its usefulness. RESULTS: A document type definition (DTD) that governs the allowed common data elements (CDE) in TMA DES export XML files was written, tested and evolved and is in routine use by the ACSR. This DTD defines TMA DES CDEs which are implemented in an external file that can be supplemented by internal DTD extensions for locally defined TMA data elements (LDE). CONCLUSION: ACSR implementation of the TMA DES demonstrated the utility of the specification and allowed application of a DTD to validate the language of the API specified XML elements and to identify possible enhancements within our TMA data management application. Improvements to the specification have additionally been suggested by our experience in importing other institution's exported TMA data. Enhancements to TMA DES to remove ambiguous situations and clarify the data should be considered. Better specified identifiers and hierarchical relationships will make automatic use of the data possible. Our tool can be used to reorder data and add identifiers; upgrading data for changes in the specification can be automatically accomplished. Using a DTD (optionally reflecting our proposed enhancements) can provide stronger validation of exported TMA data.

AIDS-Related Complex↗
PubMedDate not supplied

Comparing two-dimensional electrophoretic gel images across the Internet.

Scientists around the world often work on similar data so the need to share results and compare data arises periodically. We describe a method of comparing two two-dimensional (2-D) protein gels of similar samples created in different laboratories to help identify or suggest protein spot identification. Now that 2-D gels and associated databases frequently appear on the Internet, this opens up the possibility of visually comparing one's own experimental 2-D gel image data with data from another gel in a remote Internet database. In general, there are a few ways to compare images: (i) slide one gel (autoradiograph or stained gel) over the other while back-illuminated, or (ii) build a 2-D gel computer database from both gels after scanning and analyzing these gels. These are impractical since in the first case the gel from the Internet database is not locally available. In the second, the costs of building a multi-gel database solely to answer the question of whether a spot is the same spot may be excessive if only a single visual comparison is needed. We describe a distributed gel comparison program (URL: http://www-lmmb.ncifcrf.gov/flicker) which runs on any World Wide Web (WWW) connected computer and is invoked from a Java-capable web browser. One gel image is read from any Internet 2-D gel database (e.g. SWISS-2DPAGE) and the other may reside on the investigator's computer. Images may be more easily compared by first applying spatial warping or other transforms interactively on the user's computer. First, regions of interest are "landmarked" with several corresponding points in each gel image, then one gel image is warped to the geometry of the other. As the two gels are rapidly alternated, or flickered, in the same window, the user can slide one gel past the other to visually align corresponding spots by matching local morphology. This flicker-comparison technique may be applied to analyzing other types of one-dimensional and 2-D biomedical images.

Computer Communication Networks↗
PubMed1995

Sex-specific effects for body mass index in the new Norwegian twin panel.

Sex-specific effects for body mass index (BMI) were explored in a newly established, population-based Norwegian twin panel. The sample includes 5,864 individuals, aged 18-25 years, who responded to a questionnaire containing items for zygosity classification, height, weight, health, health-related behaviors, well-being, and demographic information. Among the 2,570 intact pairs who returned the questionnaire there were 416 identical (MZ) male pairs, 387 fraternal (DZ) male pairs, 528 MZ female pairs, 443 DZ female pairs, and 796 unlike-sexed pairs. Alternate sets of models testing for either sex-specific genetic or environmental parameters were evaluated using structural equation analysis. Results from the most parsimonious model indicated that the genes contributing to variation in BMI are not identical for men and women; rather, some genetic effects were shared by the sexes and some were unique to each sex. Total variation in BMI could be explained by sex-specific additive genetic effects, as well as genetic and non-shared environmental effects common to men and women. Estimates of heritability were .708 for men and .789 for women, and the male-female genetic correlation was 0.622. The series of models specifying sex-specific shared environment also fit the data and suggests that shared environmental factors may be important for males but not for females. The findings raise questions concerning the relationship between sex-specific effects for BMI and sex differences in health outcomes.

Adolescent↗