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Epidemiology of contact dermatitis. The information network of departments of dermatology (IVDK) in Germany.

In 1988, the multicenter project "Information Network of Departments of Dermatology (IVDK)", including eight university skin hospitals was founded. It now comprises 30 participating centers. At these centers, all patch test results are recorded, together with important anamnestic details and, twice a year, these are sent to the data center at the Göttingen University Skin Hospital. Regular, descriptive analyses of data collected by this epidemiological surveillance system serve the different purposes discussed in this paper: 1) observation of "sentinel events"; e.g. an increase in the proportion of patients tested who were sensitized to a certain allergen, or the identification of certain subgroups at particular risk as a starting point for further research or preventive action, and 2) advancement of good clinical practice in patch testing. In October 1996, a working group of the European Society of Contact Dermatitis (ESCD) called the "European Surveillance System on Contact Allergies (ESSCA)" was established with a similar aim of communal data collection and analysis.

Dermatitis, Contact↗

[Contact allergies in patients with eczema of the external ear canal. Results of the Information Network of Dermatological Clinics and the German Contact Allergy Group].

BACKGROUND AND OBJECTIVE: The Information Network of Departments of Dermatology (IVDK) centrally collects patch tests results in cooperation with the German Contact Dermatitis Research Group (DKG). Data of patients, who underwent patch testing to evaluate otitis externa were analyzed. PATIENTS/METHODS: Data of 145 patients that had been recorded between 1992 and 1997 were evaluated. The evaluation included data yielded by standardized patch testing as well as by patch testing of products that the patients had used. RESULTS: Allergic contact dermatitis was diagnosed in one third of patients suffering from otitis externa. Topical drugs were shown to be the most important allergens. In comparison to the entire IVDK collective, the population-adjusted frequency of sensitization (PAFS) of neomycin sulfate was higher in the study population whereas that of nickel sulfate was lower. That shows that in a very specific topographic area, different allergens may be of clinical significance. CONCLUSIONS: Whereas nickel sulfate represents an important allergen in the contact dermatitis of the external ear, topical therapeutical agents, especially neomycin sulfate and, as evaluation of the patch tests of the patient's own products revealed, probably polymyxin B are the dominating allergens in otitis externa.

Adult↗

The Open System Interconnection as a building block in a health sciences information network.

The interconnection of integrated health sciences library systems with other health sciences computer systems to achieve information networks will require either custom linkages among specific devices or the adoption of standards that all systems support. The most appropriate standards appear to be those being developed under the Open System Interconnection (OSI) reference model, which specifies a set of rules and functions that computers must follow to exchange information. The protocols have been modularized into seven different layers. The lowest three layers are generally available as off-the-shelf interfacing products. The higher layers require special development for particular applications. This paper describes the OSI, its application in health sciences networks, and specific tasks that remain to be undertaken.

Computers↗

A regional university hospital in the framework of a regional information network: the experience of Lille.

Information is essential for the taking care of the patients and is also a guarantee for the quality of cares. In this objective, the University Hospital of Lille has developed for 10 years a politic based on information and communication divided in 3 phases: 1. The University Hospital has developed a HIS based on the communication between hospitals and medical centers for a better sharing of data concerning the patient. 2. The second phase consisted in the integration of external platforms to the HIS with a middleware. 3. The actual phase consists in the opening of the HIS to the external environment of the hospital and especially to the GPs through a Regional Medical Information System.

Computer Communication Networks↗

[Current and future perspectives of medical information network systems for community health using personal computers and IC cards].

Recent developments in computer and communication technology were studied in relation to medical information network systems, using computers and IC cards, to solve problems in community health. Trial use of personal computer network systems among physicians and IC card systems for personal health data management are already in existence in some parts of Japan. These trials were studied and analyzed based on a questionnaire survey of physicians and patients. Results of the study produced some useful points that should be considered when introducing these systems. These included: 1) details on expectations and specifications for these systems by physicians and patients, 2) easy access to valuable information is a key point for active network systems among physicians, 3) plausibility of improvement of communication between physicians and patients by using these systems, 4) recognition that an important problem concerns patient information privacy and must be considered before introducing these systems. A study of practical merits of these systems and methodology for realization indicates that participation by active and attractive providers of information can be expected to stimulate frequent use of the network system. The cost of introducing these systems can be partially borne by eliminating the large investment now allocated for processing requests for reimbursement of medical services. Investigation into the introduction of medical information systems provides a good opportunity to elucidate problems in the present medical systems.

Computer Communication Networks↗

Co-operative health information networks in Europe: experiences from Greece and Scotland.

BACKGROUND: Internet technology is transforming the general approach to communication and dissemination of information in the field of healthcare. However, it is also creating problems in terms of finding information, and knowing what credibility to place on the information found. The chaotic nature of the World Wide Web (WWW) and the simplistic approach adopted by search engines can make the task of finding relevant information difficult, and the user can waste considerable amounts of time on the process. Even when information is found, there is no general quality assurance process that can guarantee the credibility of the resulting information. OBJECTIVE: The aim of this research was to develop an approach for establishing co-operative health information networks (CHINs) with different focuses, which can be used in different parts of Europe. The resulting CHINs would provide organised healthcare information and support comprehensive and integrated sets of healthcare telematic services for a broad range of users. Such developments would reduce the difficulties of finding information and knowing what credibility to ascribe to it. METHODS: A common approach has been developed based on drawing together contributions from the major healthcare service providers in the region. Standard structures are recommended so that information is presented in a uniform way. Appropriate mechanisms ensure adequate security and a level of quality assurance for the end user. RESULTS: Since 1996, CHINs have been developed in six European countries as part of a European Union (EU) project. This paper presents the overall approach adopted, and the achievements in two different regions of Europe (Greece and Scotland). Although the circumstances in these two regions are very different, in both cases the resulting CHIN has proved successful. CONCLUSIONS: CHINs offer a solution to the difficulty of finding relevant health information on the Internet and guaranteeing its credibility. They can be used in different ways in different regions, and have major benefits for both information providers and end users.

Community Networks↗

Nursing student information network: fostering collegial communications using a computer conference.

This article describes the development and implementation of a student-based computer information network in a university setting. A computer conference was established as a pilot project on two campuses in a large multipurpose, multicampus university school of nursing, and it was used to communicate information and facilitate collegial interaction among students, faculty, academic counselors, and administrators. The project demonstrates that computer conferences can be used to disseminate information effectively to diverse and geographically distant student populations. Such networks have the potential to enhance opportunities for collaborative learning experiences and student-faculty communication.

Communication↗

A medical information networking system between practitioners and academia.

This paper reports on a one-year experience with an information networking system (MIS) between 47 rural practitioners and an academic center. Physicians were invited to phone in non-emergency clinical questions specific to daily practice needs to a telephone answering service located in the medical school library. Two-hundred-forty questions triggered by patient visits, colleagues, local rounds, allied health or local professionals, and on-site administrative meetings were forwarded to the MIS. All inquiries were classified according to the International Classification of Disease-9th Revision-Clinical Modification, and categorized into three areas of practice: diagnostic/investigative, general treatment, and pharmacology (therapeutics). The paper outlines how specific practice questions are being screened and adopted for decisions relating to four current activities which assist the ongoing maintenance of competence: 1) CME program planning, 2) residency/undergraduate curriculum development, 3) individualized CME for specific practitioners and sites, and 4) future CME research. The physician inquiries represent true needs in rural medical practice and as such should be given high priority in programs and assessments addressing the maintenance of competence.

Academic Medical Centers↗

Florida Poison Information Network. Saving lives and money.

A highly sophisticated network of poison information centers exists in Florida, one each in the northern, central and southern regions of the state. These 24-hour-a-day centers are staffed by nurses and pharmacists who provide assessment, triage and management advice about a wide range of exposures. Toxicologists are available when in-depth consultation is needed. As most cases can be safely managed at home, costly visits to the emergency room are averted, resulting in significant overall health-care savings. These centers also provide educational programs for the public and health professionals and compile epidemiologic statistics.

Cost Savings↗

[Analysis of an information network].

This study, performed in the Loire-Atlantique region, gives a full list of the positions responsible for the transfer of information and the methods of implementation. It demonstrates that mobile blood collection units and numerous blood donor associations, although in close contact with donors, represent the weak link in the information network. This weakness has its origins in a lack of communication with the central sources of information, and in the absence of participation in various projects. The study emphasizes the importance of communication in addition to the responsibilities of the members of the organization.

Blood Banks↗

A general UNIX interface for biocomputing and network information retrieval software.

We describe a UNIX program, HYBROW, which can integrate without modification a wide range of UNIX biocomputing and network information retrieval software. HYBROW works in conjunction with a separate set of ASCII files containing embedded hypertext-like links. The program operates like a hypertext browser featuring five basic links: file link, execute-only link, execute-display link, directory-browse link and field-filling link. Useful features of the interface may be developed using combinations of these links with simple shell scripts and examples of these are briefly described. The system manager who supports biocomputing users should find the program easy to maintain, and useful in assisting new and infrequent users; it is also simple to incorporate new programs. Moreover, the individual user can customize the interface, create dynamic menus, hypertext a document, invoke shell scripts and new programs simply with a basic understanding of the UNIX operating system and any text editor. This program was written in C language and uses the UNIX curses and termcap libraries. It is freely available as a tar compressed file (by anonymous FTP from nuscc.nus.sg).

Biometry↗

The renal epidemiology and information network (REIN): a new registry for end-stage renal disease in France.

The French Renal Epidemiology and Information Network (REIN) registry began in 2002 to provide a tool for public health decision support, evaluation and research related to renal replacement therapies (RRT) for end-stage renal disease (ESRD). It relies on a network of nephrologists, epidemiologists, patients and public health representatives, coordinated regionally and nationally. Continuous registration covers all dialysis and transplanted patients. In 2003, 2070 patients started RRT, 7854 were on dialysis and 7294 lived with a functioning graft in seven regions (with a population of 16.5 million people). The overall crude annual incidence rate of RRT for ESRD was 123 per million population (p.m.p.) with significant differences in age-adjusted rates across regions, from 84 [95% confidence interval (CI): 74-94] to 155 [138-172] p.m.p. The principal causes of ESRD were hypertension (21%) and diabetic (20%) nephropathies. Initial treatment for ESRD was peritoneal dialysis for 15% of patients and a pre-emptive graft for 3%. The one-year survival rate was 81% [79-83] in the cohort of 2002-2003 incident patients. As of December 31, 2003, the overall crude prevalence was 898 [884-913] p.m.p, with 5% of patients receiving peritoneal dialysis, 47% on haemodialysis and 48% with a functioning graft. The experience in these seven regions over these two years clearly shows the feasibility of the REIN registry, which is progressively expanding to cover the entire country.

Adolescent↗

Issues influencing development of the Canadian Cardiovascular Information Network.

The 1995 Consensus Conference of the Canadian Cardiovascular Society on "Indications for and Access to Revascularization" recommended that Canadian centres with invasive cardiovascular facilities should participate in a national observational database that monitors the selection of patients, as well as evaluate outcomes. The Canadian Cardiovascular Society, the Heart and Stroke Foundation of Canada, and Health Canada with IBM as a partner, initiated a process to identify factors influencing the development of the Canadian Cardiovascular Information Network. IBM's "Business Discovery Methodology" was adapted for health care. Structured interviews with representatives of health organizations, cardiovascular databases and research institutes were conducted across Canada, followed by a workshop to identify goals, issues and challenges. Participants identified goals for a cardiovascular database (eg, evidence-based decision-making), project related issues (eg, respecting the integrity of existing databases) and health care related issues (eg, cardiac waiting lists). Challenges included initial mistrust between representatives of provincial cardiovascular databases and national agencies, and a lack of sustained funding. A Project Team was formed to address 'cardiac waiting lists'. Analysis of Alberta and Ontario data identified differences in definitions, such as when the waiting time for bypass surgery began, that impeded detailed comparisons. Development of a centralized national database was not feasible at this time for political, technical and financial reasons. However, provincial cardiovascular database representatives agreed to work together and to share aggregate data and analyses. A first step toward developing a national surveillance system for cardiovascular services will be achieving consensus about standardizing data definitions. This process will require sustained funding.

Canada↗

Protecting patients' privacy. Health information networks raise new questions.

Privacy is established as both a value and a right in our society, and as healthcare moves to improve quality and efficiency through the development of health information networks, which allow the electronic exchange of financial and clinical information, there will be a growing awareness of the necessity to protect patient privacy and confidentiality in these environments. Dealing with these concerns will require that healthcare providers take steps to ensure the security of patient information through technological and physical measures, programs of orientation and education, and the careful development and implementation of clear policies and procedures.

Computer Security↗

Connected information networks take the paper burden off your shoulders.

Electronic transfer of data within health systems and between offsite facilities, including payers, is becoming a cost-effective strategy for members of the Brookfield-based Wisconsin Health Information Network. The intranet technology is particularly well-suited for managed care because it generates even greater efficiencies and allows electronic communication between newly integrated health system partners.

Community Networks↗