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PubMed2003

The US Agency for Healthcare Research and Quality's activities in patient safety research.

PURPOSE: To update the international community on the US Agency for Healthcare Research and Quality's (AHRQ) recent and current activities in improving patient safety. DATA SOURCES: Review of the literature concerning the importance of patient safety as a health care quality issue, international perspectives on patient safety, a review of research solicitations, and early results of funded studies. STUDY SELECTION: A representative sample of patient safety studies from those currently being funded by AHRQ. RESULTS: In response to a growing interest in patient safety in general and a recent US Institute of Medicine report on patient safety in particular, the US Agency for Healthcare Research and Quality has refocused its quality research mission. In the fiscal year 2002, AHRQ spent US$55 million on patient safety research. This investment was spread across six complementary research areas: (1) health systems error reporting, analysis, and safety improvement research demonstrations; (2) Clinical Informatics to Promote Patient Safety (CLIPS); (3) Centers of Excellence for patient safety research and practice (COE); (4) Developmental Centers for Evaluation and Research in Patient Safety (DCERPS); (5) The Effect of Health Care Working Conditions on Quality of Care; and (6) Partnerships for Quality: Patient Safety Research Dissemination and Education. Internal teams of researchers at AHRQ have published studies on patient safety, such as documenting the impact of medication errors. In addition to funding research on patient safety, AHRQ is an integral partner in several national and international collaborations to form strategic synergies that build upon each member organization's strengths, reduce redundant efforts, and benefit from each other's successes. As evidence on patient safety is generated, AHRQ also serves the important mission of disseminating information to the public. CONCLUSION: The patient safety research field has undergone a period of rapid evolution. It is now incumbent upon the international health care quality improvement community to translate the future results of this research investment into improved safety for patients.

Community-Institutional Relations↗

PubMed1995

Understanding the biology of aging: the key to prevention and therapy.

OBJECTIVE: To review recent progress and consider future approaches for basic research on aging with clinical applicability. DATA SOURCES: Peer-reviewed publications on experimental gerontology and geriatrics. STUDY SELECTION AND DATA EXTRACTION: Studies were selected that described experimental approaches in gerontology and geriatrics, starting with the evolutionary basis of aging, through theories trying to explain its major causes, to novel experimental approaches, e.g., computer informatics, protein chemistry and genetics. DATA SYNTHESIS: Our increased understanding of the evolutionary basis of aging has made it possible to consider a number of experimental strategies more rationally. Most theories on the causes of aging involve some kind of somatic damage that accumulates with age, the rate of which is determined by environmental, genetic, and behavioral factors. The recent emergence of more powerful methodology offers new possibilities for identifying basic mechanisms of aging, which would increase our understanding of biologically based susceptibility to age-related health problems. CONCLUSIONS: There is a growing awareness that age-related deterioration will affect an ever growing number of people, in both absolute and relative terms. It can be expected that this will further increase the resources that will be made available for research on aging. Although ultimately unavoidable, aging is a process that appears to be experimentally accessible. Therefore, the mechanisms of senescence and death may eventually be more completely understood, with the promise of preventing and/or delaying many of the adverse effects associated with aging, including most of the common diseases, and possibly also of extending lifespan.

Aged↗

PubMed1998

Renewing information infrastructure at Hospital das Clínicas.

In this paper we describe the process of renewing the Informatics infrastructure of Sao Paulo University Medical School Hospital, a very complex environment. Our proposal consists of a change in the paradigm of Informatics and the use of Information Technology in the hospital. That change aims at making information available to the hospital, its managers, health care workers and patients. The paradigm change is reflected in every aspect of the new infrastructure: human resources, methods, and organizational structure, as we intend to demonstrate in this paper. This process is expected to be concluded by the end of this year, yielding benefits regarding costs, efficiency, and better patient care.

Brazil↗

PubMed2000

Medical research in Israel and the Israel biomedical database.

The data collected for the second edition of the Directory of Medical Research in Israel and the Israel Biomedical Database have yielded very relevant information concerning the distribution of investigators, publication activities and funding sources. The aggregate data confirm the findings of the first edition published in 1996 [2]. Those facts endorse the highly concentrated and extensive nature of medical research in the Jerusalem area, which is conducted at the Hebrew University and its affiliated hospitals. In contrast, Tel Aviv University, whose basic research staff is about two-thirds the size of the Hebrew University staff, has a more diffuse relationship with its clinical staff who are located at more than half a dozen hospitals. Ben-Gurion University in Beer Sheva and the Technion in Haifa are smaller in size, but have closer geographic contact between their clinical and basic research staff. Nonetheless, all the medical schools and affiliated hospitals have good publication and funding records. It is important to note that while some aspects of the performance at basic research institutions seem to be somewhat better than at hospitals, the records are actually quite similar despite the greater burden of clinical services at the hospitals as compared to teaching responsibilities in the basic sciences. The survey also indicates the substantial number of young investigators in the latest survey who did not appear in the first survey. While this is certainly encouraging, it is also disturbing that the funding sources are apparently decreasing at a time when young investigators are attempting to become established and the increasing burden of health care costs precludes financial assistance from hospital sources. The intensity and undoubtedly the quality of medical research in Israel remains at a level consistent with many of the more advanced western countries. This conclusion is somewhat mitigated by the fact that there is a decrease in available funding and a measurable decrease in scholarly activity at a time when a new, younger generation of investigators is just beginning to become productive. In closing, we wish to stress that the collection of data for the Biomedical Database is a continuing project and we encourage all medical researches who may not have contributed relevant information to write to the Office of the Chief Scientist or contact the office by email.

Database Management Systems↗

PubMed2005

Evidenced-based nursing resources.

Evidence-based medicine and, more generally, evidence-based practice (EBP), is the integration of the best available patient care evidence and clinical expertise-guided by and sensitized to patient values-into a patient-oriented decision-making process. It is increasingly clear that all health professions neither equally value nor draw upon the same pool of evidence. Although there are areas of overlap between evidence-based nursing and medicine, for example, there are important differences as well. Accordingly, this selective list of Web-based evidence-based nursing (EBN) resources attempts to capture the broader scope and practice of nursing in terms of its focus, subject matter, and research methods.

Evidence-Based Medicine↗

PubMedDate not supplied

The future of the IAIMS in a managed care environment: a call for private action and public investment.

A national public and private "grand challenge" initiative should be undertaken to assure the American public that the telecommunications and computing revolutions improve health care, health education, and biomedical and health services research, and secure accountability for cost, quality, and access. The initiative should focus on meeting the needs of the patient and society at large. It needs to be a national vision, but it also ought to have regional focus. A plan for action would include a health-infrastructure strategy, a service strategy, an education strategy, a research and development strategy, and an international-linkages strategy. Without this type of initiative, health care will lack the basic building blocks it needs to more effectively deal with the transformational forces that have already been unleashed. These forces will strengthen or weaken health care in the next century depending on whether and how the nation--including the leadership in health care and the informatics community--responds to this challenge.

Academic Medical Centers↗

PubMed2003

Initiating informatics and GIS support for a field investigation of Bioterrorism: The New Jersey anthrax experience.

BACKGROUND: The investigation of potential exposure to anthrax spores in a Trenton, New Jersey, mail-processing facility required rapid assessment of informatics needs and adaptation of existing informatics tools to new physical and information-processing environments. Because the affected building and its computers were closed down, data to list potentially exposed persons and map building floor plans were unavailable from the primary source. RESULTS: Controlling the effects of anthrax contamination required identification and follow-up of potentially exposed persons. Risk of exposure had to be estimated from the geographic relationship between work history and environmental sample sites within the contaminated facility. To assist in establishing geographic relationships, floor plan maps of the postal facility were constructed in ArcView Geographic Information System (GIS) software and linked to a database of personnel and visitors using Epi Info and Epi Map 2000. A repository for maintaining the latest versions of various documents was set up using Web page hyperlinks. CONCLUSIONS: During public health emergencies, such as bioterrorist attacks and disease epidemics, computerized information systems for data management, analysis, and communication may be needed within hours of beginning the investigation. Available sources of data and output requirements of the system may be changed frequently during the course of the investigation. Integrating data from a variety of sources may require entering or importing data from a variety of digital and paper formats. Spatial representation of data is particularly valuable for assessing environmental exposure. Written documents, guidelines, and memos important to the epidemic were frequently revised. In this investigation, a database was operational on the second day and the GIS component during the second week of the investigation.

Journal Article↗

PubMed2002

A first class knowledge service: developing the National electronic Library for Health.

With the introduction of clinical governance and the move towards evidence-based practice, there is a growing need to provide health professionals and patients, and the public, with high quality information. Developments in the health service have added weight and urgency to this need. The National electronic Library for Health (NeLH) has a key role to play in providing health professionals with a core knowledge base of accredited and evaluated information. The Pilot NeLH was launched in November and this article outlines the progress and achievements made during this time. The NeLH is based around a central website featuring core resources and links to commissioned specialist collections. Over 70 information resources, including bibliographic databases and full text publications, are accessible via the NeLH, which aims to act as a one-stop shop to support evidence-based decision-making. Much work has been undertaken on national procurement and licensing, particularly in partnership with National Health Service (NHS) libraries. Partnerships as a whole are crucial to ensure true seamless access for health professionals. Key partners include NHS libraries, NHS Direct Online and the electronic Library for Social Care. A short glossary is included for those readers less familiar with current health service developments in the UK.

Cooperative Behavior↗

PubMed2006

Cancer knowledge and disparities in the information age.

Increasing information flow often leads to widening gaps in knowledge between different socioeconomic status (SES) groups as higher SES groups are more likely to acquire this new information at a faster rate than lower SES groups. These gaps in knowledge may offer a partial but robust explanation for differential risk behaviors and health disparities between different social groups. Drawing on the Health Information National Trends Survey (HINTS 2003), a national survey of communication behaviors conducted by the National Cancer Institute (NCI), we examine the relationship between publicity and knowledge gaps on two cancer topics that received different levels of publicity: knowledge about tobacco and sun exposure and their respective links to cancer. Analyses of the HINTS 2003 data suggest that differential knowledge levels of causes of cancer between SES groups are one potential explanation of cancer disparities that have been extensively reported in the literature. It is evident that high income and high education are associated with awareness about causes of major cancers such as lung and skin, and may allow people to protect themselves and minimize their risks. The data also show that heavier media attention could attenuate the knowledge gaps though moderate publicity or lack of news coverage may actually widen them. Last, the findings in this article suggest that it is necessary to take into account the SES variation within different racial and ethnic groups rather than mask them by treating the groups as one.

Adult↗

PubMed1998

A proposal for incorporating health level seven (HL7) vocabulary in the UMLS Metathesaurus.

The HL7 Vocabulary Technical Committee (TC) was organized to select and maintain the vocabulary used in HL7 messages. The goal is to make implementations of the Version 3 HL7 Standard more plug-and-play compatible. In order to make the vocabulary readily accessible to the public, HL7 is collaborating with the U.S. National Library of Medicine (NLM) to include HL7 vocabulary in the Unified Medical Language System (UMLS) Metathesaurus. This article describes a proposal for how HL7 data elements and coded values can be represented accurately in the relational tables of the UMLS Metathesaurus.

Computer Communication Networks↗

PubMed1997

[Codes and names of clinical laboratory tests and shared interlaboratory databases].

Physicians need to combine and compare laboratory data for one patient results from many laboratories and hospital officers and policy makers also need to merge them form the view point of public health. As there are many different codes used by different sources for the same test, it is impossible to transmit results using electronic massage standards. This problem would not exist if all laboratories used the same universal set of test identifiers. Public use sets of codes and names of clinical laboratory tests are available. We have to select and use them properly. We proposed a project to have a systematizing guideline for laboratory systems not for rationalization of laboratory works but for sharing database to assess appropriate laboratory use.

Clinical Laboratory Information Systems↗

PubMed1987

Public access computing in health science libraries.

Public access computing in health science libraries began with online computer-assisted instruction. Library-based collections and services have expanded with advances in microcomputing hardware and software. This growth presents problems: copyright, quality, instability in the publishing industry, and uncertainty about collection scope; librarians managing the new services require new skills to support their collections. Many find the cooperative efforts of several organizational units are required. Current trends in technology for the purpose of information management indicate that these services will continue to be a significant focus for libraries.

Computer-Assisted Instruction↗

PubMed2005

Central IT-Structures for Integrated Medical Research and Health Care of Viral Hepatitis--Hep-Net.

Hep-Net is a German medical research and health care network dedicated to viral hepatitis. Its many activities include basic and clinical research, training and public awareness, and rely on modern information technology and the Internet. One major component is a central registry for medical data, serum and tissue samples. In order to build this registry, important legal and technological issues needed to be addressed. Specifically, commercially available electronic data capture systems for clinical trials are generally ill suited for this purpose. The framework of the solution described here may be the basis for similar networks dedicated to specific disease entities or other phenomena.

Biomedical Research↗

PubMed2006

The impact of the 'Clinical Trials' directive on the cost and conduct of non-commercial cancer trials in the UK.

BACKGROUND: The UK Medicines for Human Use (Clinical Trials) Regulations 2004 implemented the European 'Clinical Trials' Directive (2001/20/EC) (EUCTD) into UK law and came into effect on 1(st) May 2004. In the period leading up to the implementation of the EUCTD in the UK there were serious concerns that it would have major cost implications for academic units running non-commercial clinical trials. METHODS: Directors and senior staff in 8 Clinical Trials Units (CTUs) were contacted and invited to participate in the study; arrangements were made for face-to-face interviews and the units were sent a questionnaire in advance of the meeting. The questionnaire was divided into six sections covering their involvement in non-commercial cancer clinical trials, and their perceptions of the EUCTD and its impact on all stages of trial development and conduct. Detailed cost data were also collected. FINDINGS: The findings from the questionnaire and interviews indicate that the EUCTD has resulted in a doubling of the cost of running non-commercial cancer clinical trials in the UK and a delay to the start of trials. The lack of central guidance, lack of clarity regarding the interpretation of the guidance notes, and increase in essential documentation and paperwork were causes of major concern for experienced staff who were anxious about whether they were interpreting the Directive correctly. Moreover, the CTUs were unable or unwilling to open trials in non-UK centres because of the different interpretation of the EUCTD by member states. INTERPRETATION: The EUCTD has both increased the cost and caused delay to non-commercial cancer clinical trials run by major public sector Clinical Trials Units in the UK. Staff have felt that they were working beyond capacity and were feeling demoralised in many CTUs. Finally, rather than harmonising and simplifying the regulatory environment, the Clinical Trials Directive has stopped many units from running trials in international centres. The UK has taken action to address some of the problems identified by this and other research, but problems remain.

Attitude of Health Personnel↗

PubMedDate not supplied

[Mortality in schizophrenic patients. 3 years follow-up of a cohort].

UNLABELLED: Although schizophrenia is not in itself a lethal illness, an overmortality in psychiatric patients in comparison to the reference population has been attested to for a long time. Until the use of antibiotics, this overmortality was mainly due to infectious diseases caused by the close quarters in mental institutions. At the present time this overmortality is mainly due to suicide but also with a noteworthy mortality by certain natural causes such as respiratory diseases and cardio-vascular and cerebro-vascular diseases. Some questions still persist as far as cancer is concerned because it represents the cause of death for which the results are the most contradictory and the most surprising. In France psychiatric case registers do not exist. At this moment, there is no systematic registration which allows us to study the mortality of psychiatric patients. If we want to know about the mortality of the mentally ill, we have to conduct special research. Consequently, a special research project concerning the mortality of schizophrenic patients taken into care in public psychiatric sectors was undertaken in 1993. We chose schizophrenic patients because of the greater reliability of the diagnosis and because they are a population affected by over-mortality, particularly by suicide. The importance of mortality studies remains twofold:--They are a good indicator of the quality of health care policy as is for instance the infant mortality rate which remains one of the best indicators of the quality of maternal and infant health care.--They enable the formulation of research hypotheses to be made if you point out specific causes of death in a sub-group like schizophrenics compared to the general population. METHOLOGY: The setting of the research was the public psychiatric sector. Public psychiatric sector is a geographical catchment area of about 70,000 adult inhabitants. The national territory is divided into 800 psychiatric sectors. Sectors volunteered to participate. A selection at random would have led to too many refusal to be pertinent. The sectors were contacted through associations like the French Epidemiologic Psychiatric Group, professional reviews, and telephone contacts. Sectors volunteered to participate but patients had to be included at random. All the patients seen within three months and who met the following inclusion criteria: schizophrenic (ICD10) seen as in-or-out patients, aged 18-64, residing in France and under care in public psychiatric sectors were eligible. Various observations concerning social and demographic characteristics, behavioural risks, physical health, access to private somatic care and psychotropic medication were been made by means of a questionnaire at the time of inclusion. Because we wanted to compare the access to private somatic care, one of the themes studied, consequently we excluded chronic patients, that is to say patients hospitalized for more than one year without interruption and whose access to private somatic care couldn't be comparable in a pertinent way to the general population access. FOLLOW-UP: every year at the anniversary of the inclusion of the patient we ask the sector if the patient is alive, dead or lost sight of. In the last two cases we send a letter to the City hall of their place of birth (procedure approved by National Commission for Informatics and Freedom) in order to know if they are alive or not and if they are dead to know the date of their death. For patients deceased we check then their causes of death in the French National Register of Deaths. For deceased patients we check also their causes of death near the sector. So we have a twofold means of checking up. RESULTS: 3,470 patients were included. These patients came from 122 sectors (15% of all the sectors) spread out over 73% of the territory. The sample did not present statistical differences in its sex and age distribution compared to a national sample. A longitudinal observation has been going on for thre

Adolescent↗

PubMed2003

Open Source software in medical informatics--why, how and what.

'Open Source' is a 20-40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market--probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model.

Database Management Systems↗

PubMed2006

Biomedical informatics research and education at the EuroMISE Center.

OBJECTIVES: In the paper we described the partial achievements reached by the EuroMISE Center in research and higher education, supporting better healthcare in future information society. METHODS: Through the research cooperation, the EuroMISE Centre suggests publicly available tools and methods that allow the application of new technologies for various healthcare organizations and citizens, with a special focus on the national environment of the Czech Republic. It provides a platform for a greater level of research cooperation with the usage of the most up-to-date information and communication technologies and a wide spectrum of clinical and genetic data and knowledge. RESULTS: Results of research and higher education of the EuroMISE Centre in the field of Biomedical Informatics are described in outputs of national and European projects. Further results have been published and/or presented at national and international meetings and incorporated in education and healthcare practice. CONCLUSIONS: The long-term effect of postgraduate doctoral education in the field of biomedical informatics consists in the rapid increase of scientists that are needed in the Czech Republic to reach the goals of information society in health care. The multidisciplinary research at the EuroMISE Center moves towards direct usage in the informational support of diagnostics and therapy, mining of the medical databases, and in the customization of healthcare based on the clinical and genetic profile of a patient.

Biomedical Research↗

PubMed2001

Academic and commercial development of open source applications in international health informatics. Opposite sides of the same coin?

Whilst covertly in the past many ideas developed in academic environments have made their way into commercial applications, there is growing acknowledgment that this model may be necessary for both funding academics and for project enrichment in private ventures. This paper seeks to explore and expound on the various pressures related to protocol development and the creation of a MAP (Multiphasic Algorithimic Protocol) Engine as a commercial venture based on an evolution from an academic environment, into a service oriented commercial product. It has been determined in a series of symposia that an Object Oriented; Open Source (OS) environment may best meet the needs for this endeavor. Numerous barriers and agreements remain, and explorations of these will, we believe, bring out the best of both sides of the coin - reflecting the strengths of both cultures.

Algorithms↗