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PubMed2000

Networking and expert-system analysis: next frontier in biomonitoring.

The extensive use of biomarkers in environment biomonitoring programmes has raised the problem of data management and intercomparison. A research project (Pollution Effect Network, PEN) is proposed here, consisting of the realisation of an on-line warehouse for biomarker data (http://www.muf.unipmn.it/pen). The web site will contain repository sections and expert system procedures able to integrate information from different biomarkers and provide ranking of the organism health status in terms of synthetic stress syndrome indexes. Researchers accessing the site will be able to submit and process their own data. This will allow common criteria in the evaluation of the biological effects of pollutants, and an intercomparison of biomonitoring data among different geographic areas and sentinel species.

Animals↗
PubMed2000

Congress 2000: a continuing medical education summit with implications for the future.

The expectations of attendees, the evaluations of themes, and the implications for continuing medical education (CME) identified by "Congress 2000: A Continuing Medical Education Summit on the Practices, Opportunities and Priorities for the New Millennium" are reviewed. A vision was identified with significant opportunities for CME to become a more valuable partner in and contributor to quality health care. The vision suggests that CME should be linked more closely to physician learning at the point of care and that technology might be used more successfully to address physician-learner needs by helping them to manage volumes of evidence for treating patients more effectively. At the same time, health care outcome data to analyze the need for and measure the effectiveness of educational interventions should become integrated into standards of practice for CME providers. Continuous improvement based on research about effective learning processes and outcomes should become an essential construct of the CME culture. Implications are summarized for the profession, organizational CME providers, individual CME professionals, and CME research from this new vision of CME crafted at Congress 2000.

Education, Medical, Continuing↗
PubMed2000

Generalising to theory: the use of a multiple case study design to investigate needs assessment and quality of care in community nursing.

This paper outlines the detail of the case study method used in a project commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment and quality of care in the context of the NHS and Community Care Act, 1990. It explains the methodological procedures and analytic processes which led to integration of data across the whole study, focusing on the role of a prior theoretical framework in case study design. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (N=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. They were interviewed after the observation period (N=33 practitioners), to determine the extent of formality they attached to each assessment, and elicit information about aspects which may be embedded in everyday practice as well as those recorded for explicit requirements.The preliminary analysis resulted in the modification of a model for assessing service quality, and identified various points where a 'policy-practice gap' might arise between policies and practice in both the health service and education. The practicalities of operationalising a multiple case study design into research are highlighted, and the mechanism for 'generalising to theory' illustrated.

Community Health Nursing↗
PubMed2005

Teaching research integrity and bioethics to science undergraduates.

Undergraduate students in the Department of Biomedical Sciences at the University of South Alabama, Mobile, are required to take a course entitled "Issues in Biomedical Sciences," designed to increase students' awareness about bioethical questions and issues concerning research integrity. This paper describes the main features of this course and summarizes the results of a survey designed to evaluate the students' perceptions about the course. A summary of this study was presented at the 2002 Conference on Research Integrity in Potomac, MD, sponsored by the Office of Research Integrity of the National Institutes of Health.

Bioethics↗
PubMed1994

The HELIOS Medical Connection Services.

This paper presents the design and implementation of the HELIOS software component that deals with integration of medical applications in health information networks. The problem of interoperability between health information systems based on different data exchange syntaxes is first discussed. A meta-model, relying on CEN TC251 recommendations, is then presented as a possible solution to this problem and a message description language including these recommendations is proposed. Using this meta-model, the Medical Connection Services that comprises a generic message processing automaton, a resource manager and a mapper is able either to interpret messages expressed in a given syntax (e.g., EDIFACT, ASTM) and map them to the application objects or to automate the translation of the messages in another syntax. Special focus is given on the position of the Medical Connection Services within the HELIOS integration strategy (i.e., through data, presentation and communication). The problem of semantic heterogeneity is then discussed.

Computer Communication Networks↗
PubMed1993

Automating the medical practice--promise and peril.

Pick up any newspaper or news magazine and chances are that an article on health care reform will be prominently featured. While we await the details of the plans for reform, we can divine some major implications. With certainty, one of these will be the need to access and integrate vast amounts of patient and provider data. These medical data, in electronic form, will fuel the interplay between provider, hospital, government organizations, and private health care management. These data will be used: to drive the outcome studies that will examine medical resource consumption; to track prescribing practices; to facilitate patient follow-up; and to monitor wellness programs. In short, data management will be an unseen, but very present, companion to all our practice decisions. The successful medical practitioners in the coming era will be those whose practices have an electronic infrastructure that allows comprehensive medical record keeping, inclusive of patient charting, billing, coding, scheduling, and data reporting to third parties.

Ambulatory Care Information Systems↗
PubMed2006

An enhanced benchmark for prosthetic joint replacement infection rates.

BACKGROUND: The National Nosocomial Infection Surveillance System (NNIS) has historically provided the infection control community with the most accurate benchmark for healthcare-associated infections. However, NNIS does not require postdischarge surveillance. For medical centers where comprehensive postdischarge surveillance is possible, the efficiency of surgical site infection (SSI) detection is enhanced and rates may be higher than those provided by NNIS. METHODS: From 1999 to 2004, a large integrated healthcare system (IHCS) used a standard surveillance methodology inclusive of the postdischarge period. This article compares IHCS and NNIS SSI data. RESULTS: IHCS infection rates, stratified and weighted average (hip, 1.7; knee, 2.1) for the study period are higher than the corresponding NNIS rates (hip, 1.4; knee, 1.2) (hip, P = .006; knee, P = .012) when infections detected by the IHCS during the postdischarge period are included. CONCLUSIONS: The data from the study period show that when comprehensive postdischarge surveillance is used by the IHCS, SSI rates are higher than those reflected in the NNIS database.

Arthroplasty, Replacement, Hip↗
PubMed2006

A data-gathering broker as a future-orientated approach to supporting EPR users.

With the continued expansion of electronic patient record systems ahead of comprehensive evidence, metrics, or future-proofing, health informatics in Europe and beyond is embarking on a faith-driven adventure that also risks data swamping of end-users. An alternative approach is an information broker system, drawing from departmental data sources. A 3-year study in health and social care has produced a first demonstrator which can search for specified information in heterogeneous distributed data stores, with source-specific permission can copy it, and then merge the search results into one integrated picture in a real-time process which is also captured in an audit system. The research project has addressed a number of issues during the study, including updating the concepts of role-based access, semantic interoperability, and harnessing web-based services bound at the time of need. A demonstrator now exists, and provides a platform for further application and development research. This paper summarises how this opens up a viable alternative approach for the next generation of health record systems, enabling record searching and integration as and when it is needed for specific patient-related purposes, whilst being independent of organisations, diagnostic approaches, or service delivery structures, and reducing the risks of data swamping.

Access to Information↗
PubMed1995

Improving the cost, quality, and access to healthcare in community hospitals through the use of reorganized integrated delivery systems and implementation of sophisticated clinical information systems: an organizational experience.

It is well recognized that health care is undergoing fundamental and necessary change. These changes rival, if not exceed, changes that have occurred in other industries. The factors underlying the changes are varied, but fundamentally, the economics of health care have altered. A new economic model is evolving that is disciplined by the marketplace and/or regulatory determination of "price" on a per capita basis. Success in this new model will require integrated delivery systems (IDS) serving local communities linked to purchasers through affiliations that span broader geographic areas. The demands of this model are placing unparalleled requirements for change on health care providers including the need to develop new forms of delivery systems and implement sophisticated new information systems that allow collection and detailed analysis of important clinical and financial data in an effort to achieve better value in health care. A case study of the Health and Hospital Services, Inc. (HHS) integrated delivery system and information system strategy will be discussed.

Community Health Planning↗
PubMed1998

Determining when integrated delivery systems should belong to GPOs.

Membership in national group purchasing organizations (GPOs) is a proven way for healthcare organizations to access supply price discounts through collectively negotiated contracts. Yet, for various reasons, both suppliers and healthcare materials managers have expressed dissatisfaction with GPOs. Integrated delivery systems (IDSs), in particular, may find that negotiating with suppliers independently is a more cost-effective alternative. Whether an IDS should participate in group purchasing or negotiate with suppliers on its own depends on the following factors: whether the IDS would find it relatively simple to get its clinicians to standardize on certain key supplies; whether the IDS has sufficient staff to devote to contracting; whether the benefits offered by the GPO do not outweight the costs of membership; and whether all of the supplier products and services the GPO makes available also are available through second-tier suppliers eager to negotiate directly with the IDS.

Consumer Behavior↗
PubMed2002

The Defense Medical Surveillance System and the Department of Defense serum repository: glimpses of the future of public health surveillance.

The Defense Medical Surveillance System (DMSS) is the central repository of medical surveillance data for the US armed forces. The DMSS integrates data from sources worldwide in a continuously expanding relational database that documents the military and medical experiences of service members throughout their careers. The Department of Defense Serum Repository (DoDSR) is a central archive of sera drawn from service members for medical surveillance purposes. Currently, the DMSS contains data relevant to more than 7 million individuals who have served in the armed forces since 1990, and the DoDSR contains more than 27 million specimens that are linkable to data in the DMSS. Recent applications of the DMSS and DoDSR provide glimpses of the capabilities and uses of comprehensive public health surveillance systems.

Confidentiality↗
PubMed2000

Psychiatric aspects of women's health.

A number of psychiatric disorders are present exclusively or more commonly in women. Furthermore, within a particular disorder there may be significant gender differences across demographic and clinical variables, and neurobiological fluctuations across women's menstrual and life cycles may affect the psychobiology of disorders and the pharmacokinetics of pharmacotherapies. Indeed, exploration of gender may serve as a useful heuristic for advancing the field as a whole and for integrating epidemiological and psychobiological data. In this supplement, we highlight three issues that fall under the rubric of 'women's mental health'; premenstrual dysphoric disorder, pharmacotherapy during pregnancy and lactation, and violent trauma and post-traumatic stress disorder in women. Although further work across the range of basic, clinical, and sociopolitical fronts is needed, advances in the pharmacotherapy of premenstrual dysphoric disorder, recent safety data on certain agents in pregnancy, and progress in the management of post-traumatic stress disorder provides cause for clinical

Adult↗
PubMedDate not supplied

Risk characterization: principles and practice.

In the field of risk assessment, characterizing the nature and magnitude of human health or environmental risks is arguably the most important step in the analytical process. In this step, data on the dose-response relationship of an agent are integrated with estimates of the degree of exposure in a population to characterize the likelihood and severity of risk. Although the purpose of risk characterizations is to make sense of the available data and describe what they mean to a broad audience, this step is often given insufficient attention in health risk evaluations. Too often, characterizations fail to interpret or summarize risk information in a meaningful way, or they present single numerical estimates of risk without an adequate discussion of the uncertainties inherent in key exposure parameters or the dose-response assessment, model assumptions, or analytical limitations. Consequently, many users of risk information have misinterpreted the findings of a risk assessment or have false impressions about the degree of accuracy (or the confidence of the scientist) in reported risk estimates. In this article we collected and integrated the published literature on conducting and reporting risk characterizations to provide a broad, yet comprehensive, analysis of the risk characterization process as practiced in the United States and some other countries. Specifically, the following eight topics are addressed: (1) objective of risk characterization, (2) guidance documents on risk characterization, (3) key components of risk characterizations, (4) toxicity criteria for evaluating health risks, (5) descriptors used to characterize health risks, (6) methods for quantifying human health risks, (7) key uncertainties in risk characterizations, and (8) the risk decision-making process. A brief discussion is also provided on international aspects of risk characterization. A number of examples are presented that illustrate key concepts, and citations are provided for approximately 100 of the most relevant papers.

Animals↗
PubMed2006

Perspectives on applied spatial analysis to animal health: a case of rodents in Thailand.

Geographic information systems (GIS) and remote sensing have been increasingly used in ecology and epidemiology, providing a spatial approach for animal health issues. Recent development of earth environmental satellites--i.e., their growing number, improving sensor resolutions and capabilities--has offered new opportunities to delineate possible habitats and understand animals and associated parasites in their environment, by identifying the nature and structure of land use, hydrological network, soil hydromorphy, and human settlements. Integrated into GIS, remotely sensed and other geo-referenced data allow both spatial and temporal analyses of animal ecology and health. However, a review of their applications has showed the poor quality of data sources and processing used, revealing limitations between theory and practical implementations. As an example, the assessment of the expected distribution of Bandicoot rats, main agricultural pest and vector of zoonoses in Phrae province (North Thailand), illustrates a rational use of spatial analysis, with the choice of relevant data, scales, and processing. Vegetation indices are computed on a TERRA ASTER image and further classified using elevation data. The biotopes of Bandicota indica and Bandicota savilei are delimited, providing a major source of knowledge for rodent and human health analyses.

Animals↗
PubMed2000

[Psychiatric care research--an instrument for planning health care needs].

The planning of health care is primarily an administrative task. Service research supports the health administration in this task by supplying empirical data to objectify the need for care and ways to cater for that need. In this, service research on the one hand draws on descriptive and analytical data of epidemiological studies. On the other hand, indices of social structure provide information about factors influencing the utilisation of health services. Apart from this, different types of service utilisation data are used for the analysis of needs. None of the methods mentioned is sufficient on its own. Only the integration of the different levels of analysis allows sufficiently competent statements on health care needs.

Epidemiologic Studies↗