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At least 1,171 records · Page 65Linked to original sources
PubMed2002

A networked electronic patient record system for diabetes.

This paper describes the development and clinical implementation of the SincroDiab--a synchronized diabetes register for the routine clinical practice in a LAN and for design of long-term trials and epidemiological studies based on the GEHR (Good European Health Record) architecture. The objectives of the SincroDiab system were to address the need to establish a more efficient and more effective information infrastructure to improve the ability to share patient record information among health care providers, to reduce the health care delivery costs, to meet the requirements of legal, regulatory or accreditation standards, to share comparable patients data among different sites within a multi-entity health care delivery system and to improve quality of care by network connecting the data repository to clinical workstations and departmental systems.

Diabetes Mellitus↗
PubMed2002

MedView: a declarative approach to evidence-based medicine.

MedView is a project that meets the challenges of evidence-based oral medicine by providing a formalisation of clinical examination data and clinical procedures. Tools are provided for knowledge acquisition, knowledge generation, visualisation and analysis of data, and knowledge sharing. The formal declarative model constitutes the main governing principle in MedView, not only in the formalisation of clinical terms and concepts, but in visualisation models and in the design and implementation of individual tools and the system as a whole as well.

Decision Support Systems, Clinical↗
PubMed2004

[Evaluation of a pilot study on needle and syringe exchange program among injecting drug users in a community in Guangdong, China].

OBJECTIVE: To evaluate the feasibility and effectiveness of needle and syringe exchange program among a community of injecting drug users (IDUs) on AIDS prevention. METHODS: A quasi-experiment design was used in a controlled community intervention study. Needle and syringe exchange program was implemented for 10 months in IDUs of an intervention community, including peer education and health education, provision of free needles and syringes, and collecting back of used needles and syringes by trained peer educators and local health workers, whereas no intervention measure in a control community was instituted. Interviews with IDUs were conducted before and after intervention with a snowballing strategy to evaluate its effectiveness. RESULTS: A total of 428 and 429 IDUs were interviewed with structured questionnaire before and after intervention in intervention and control communities, respectively. Results revealed that awareness of HIV-related knowledge increased from 29.4% to 58.7% in the intervention community. Multivariate logistic regression analysis showed that awareness of HIV-related knowledge was higher in those who had read health education materials (OR = 2.93, 95% CI 2.12 - 4.04). As compared with the baseline data, frequency of sharing needles and syringes in past 30 days in the intervention community decreased from 48.9% to 20.4% in before intervention community (chi(2) = 41.02, P = 0.001), whereas there was no significant change in the control community. The causes of sharing needles and syringes in the intervention community included 'disable to get needle and syringe during the night', 'lack of needle and syringe when injecting at friend's home', 'not daring to buy needle and syringe for fear of being arrested' and 'no money to buy needle and syringe', declined markedly. CONCLUSIONS: Needle and syringe exchange program was feasible and effective in reducing their risky drug injecting behavior among IDUs in communities. Such strategy should be adopted in the country to reduce rapid spread of HIV.

Adult↗
PubMed2004

Access control mechanisms for distributed healthcare environments.

Today's IT-infrastructure provides more and more possibilities to share electronic patient data across several healthcare organizations and hospital departments. A strong requirement is sufficient data protection and security measures complying with the medical confidentiality and the data protection laws of each state or country like the European directive on data protection or the U.S. HIPAA privacy rule. In essence, the access control mechanisms and authorization structures of information systems must be able to realize the Need-To-Access principle. This principle can be understood as a set of context-sensitive access rules, regarding the patient's path across the organizations. The access control mechanisms of today's health information systems do not sufficiently satisfy this requirement, because information about participation of persons or organizations is not available within each system in a distributed environment. This problem could be solved by appropriate security services. The CORBA healthcare domain standard contains such a service for obtaining authorization decisions and administrating access decision policies (RAD). At the university hospital of Mainz we have developed an access control system (MACS), which includes the main functionality of the RAD specification and the access control logic that is needed for such a service. The basic design principles of our approach are role-based authorization, user rights with static and dynamic authorization data, context rules and the separation of three cooperating servers that provide up-to-date knowledge about users, roles and responsibilities. This paper introduces the design principles and the system design and critically evaluates the concepts based on practical experience.

Computer Security↗
PubMed2005

Preparing the Electronic Patient Record for Collaborative Environments and eHealth.

In the era of eHealth the electronic patient record is increasingly regarded as part of a collaborative environment. To efficiently support the documentary tasks and analyses a cooperative documentation infrastructure which allows multiple use and shared entry of data is necessary. The objective of this paper is to introduce a method for systematically planning such a cooperative documentation environment. It consists of the steps: analyse the prevailing documentation infrastructure, provide terminology, provide documentation management, plan the logical architecture and provide all necessary tools. The steps can be formally specified so that parameters can be automatically controlled and the environment can be updated more easily.

Cooperative Behavior↗
PubMed2006

Chronic disease management systems registries in rural health care.

UNLABELLED: Health care quality is being addressed from a variety of policy perspectives. The 2001 Institute of Medicine report, Crossing the Quality Chasm, calls for sweeping action involving a five-part strategy for change in the U.S. health care system. This agenda for change includes use of evidence-based approaches to address common conditions, the majority of which are chronic. A Chronic Disease Management System (CDMS), or registry, is a tool that helps providers efficiently collect and analyze patient information to promote quality care for the rural population. CDMSs can provide a technological entry point for the impending use of Electronic Medical Records. A CDMS is a patient-centered electronic database tool that helps providers diagnose, treat, and manage chronic diseases. The purpose of this brief is to discuss the different types of CDMSs used by a sample of 14 state organizations and 19 local rural clinics in Maine, Nebraska, New Mexico, South Carolina, Washington, and Wisconsin. As part of a larger study examining the challenges and innovations in implementing disease management programs in rural areas, we conducted interviews with national, state, and local contacts. During interviews, respondents helped us understand the usefulness and functionalities of commonly used CDMSs in rural facilities. Our focus was on the use of CDMSs in the management of diabetes, a disease prevalent in rural populations. KEY FINDINGS: (1) CDMSs are readily available to rural clinics and are being implemented and maintained by clinic staff with minimal expenditures for technology. (2) Use of a standardized system in a collaborative helps provide data comparisons and share costs involved with technical assistance services across the group.

Chronic Disease↗
PubMed2006

Tobacco cessation interventions in dental networks: a practice-based evaluation of the impact of education on provider knowledge, referrals, and pharmacotherapy use.

Tobacco is a significant risk factor for oral diseases. Dental care providers have the opportunity to inform patients about the risks associated with tobacco use and refer them to tobacco cessation resources. Although dental teams usually ask their patients about their tobacco use, most do not provide tobacco cessation counseling. This project involved four staff-model dental clinics and four contracted network dental clinics. Project goals were to 1) describe current practice patterns of tobacco cessation intervention, 2) increase the use of steps for treatment, known as the 5 As, recommended by the U.S. Public Health Service, 3) increase referrals to a tobacco helpline, and 4) increase use of pharmacotherapy for tobacco dependence treatment. The project included training and program support (e.g., sharing of project data, weekly newsletters, discussion at clinic meetings). Results indicate that this approach to addressing tobacco dependence in a dental clinic setting can effectively change dental provider knowledge and action.

Bupropion↗
PubMed2006

[An introduction of the principle for the middleware based on HL7].

This article introduces the development of a middleware based on HL7, which solves the problem of data integration and sharing effectively and successfully, among the hospital internal subsystems and different hospitals' information systems.

Computer Communication Networks↗
PubMed1988

The substitution of carrier priming of helper function in the common American newt, Notophthalmus viridescens by lectins and human lymphokines.

There is no clear evidence that helper function is thymus dependent in the Common American newt, Notophthalmus viridescens. Here we test the capacity of concanavalin A, wheat germ agglutinin, human rIL-1 and rIL-2, reagents which stimulate T cell activities in other species, to substitute for carrier priming in the newt. Cytofluorimetric analyses have been used to demonstrate specific IL-2 receptor binding sites on newt splenocytes. Competitive pre-binding with rIL-2 tested whether anti-IL-2 receptor antibody binding sites would bind rIL-2. While Con A can substitute for carrier priming in the newt only when it is presented on Sepharose or agarose particles, wheat germ agglutinin cannot, even when it is injected in particulate form. Additionally, human rIL-1 can serve as an effective substitute for carrier priming, but rIL-2 cannot. The cytofluorimetric data are in agreement with the functional data in that they suggest that human rIL-2 may not bind newt splenocytes. Our data which show shared lectin specificities with T cell regulated helper function in another amphibian species are consistant with the possibility that T-like cells are responsible for helper function in this species.

Animals↗
PubMed1985

Spontaneous antiidiotypic antibodies to the NZB Coombs autoantibody.

We have further investigated the phenomenon of spontaneous anti-(Coombs) antiidiotypic antibodies in the F1 hybrids of New Zealand black (NZB) and CBA mice. These mice show an age-related increase in incidence of such antiidiotype during the first year of life. There is no difference between males and females in the occurrence of antiidiotype. Reciprocal hybrids are both affected, so that maternal influence from the NZB strain is not critical. The antiidiotype also occurs in spite of the xid gene. We have so far detected such spontaneous antiidiotype only in (CBA X NZB)F1 hybrids and not in hybrids of NZB with two other strains or in a variety of recombinant inbred strains between NZB and C58. Our results to data suggest extensive shared idiotypy among NZB mice and a limited number of total idiotypes.

Aging↗
PubMed1980

[The follow up of patients with bronchial carcinoma (author's transl)].

The aims of follow up of patients with bronchial carcinoma are: 1. Complete use of all therapeutical possibilities. 2. Avoidance of preventable complications of therapeutical prescriptions. 3. Prevention of sicknesses beside the basic complaint. 4. The rehabilitation of the patient. The medical structure for realizing these aims, we suppose in the cooperation of the doctor of the family or the factory, who will see the patient in intervals of four weeks, and the ambulant working pulmologist, who will see the patient in intervals of 3 months, and the thorax-centre, what the patient will consult once or twice the year, and the centre for rehabilitation, where patients with limited cardiorespiratoric function will get an appropriated training of condition. Two cure-places with this special direction will satisfy the require in the GDR. The oncologist of the district where the patient lives will be the coordinator of all parts of this system and the controller to keep its function. The effectivity of follow up will be realised by clear and proofed recommendations by the therapeutical centres and the continued consultations on actual problem cases with the shared doctors. The data processing can do an useful help in this cooperation.

Aftercare↗
PubMed1980

[Genetics of insulin-dependent juvenile diabetes].

Since the works of Singal and al. and Nerup and al., an increase in B 8, B 15 and B 18 antigens has been found in Insulin Dependent Diabetes. Thomson and al., Rubinstein and al. and the authors of this paper have shown an stronger association with DRw 3 and DRw 4 antigens. We investigated the genetic predisposition to juvenile diabetes in 22 families of 48 cases and 96 members. The study of one affected child in each family showed that DRw 3 was found in 63,63% and DRw 4 in 59,59% (healthy 16,22%)--RR = 9,0 and 7,49. The hypothesis of overdominance proposed by Nerup can be confirmed by our data, when I.D.D.M. share two different alleles (DRw 3 and DRw 4). 3 particular haplotypes with linkage imbalance are therefore observed in our series: B 8-Bf S-DRw 3, B 15-Bf F-DRw 4 and B 8-Bf F 1-DRw 3. Our date show a excessive transmission of the diabetic haplotype by parents who are either diabetics or carriers of the gene.

Antigens↗
PubMed1995

A unique dialysis quality management experience: an interview with novelist James A. Michener. Interview by Alex Rosenblum.

As a renal quality management nurse, I am always looking for new and interesting ways to share information and comparative data to educate and motivate fellow renal professionals. The intent of the sharing of the information is to stimulate quality activity. As a quality improvement project this interview with novelist James Michener, a patient with end stage renal disease, provides ANNA Journal readers with an increased understanding of the importance of providing quality care to the lives of people we care for. Recently, Michener provided an excellent opportunity to share his own experience in dealing with renal failure and dialysis therapy. His celebrity status and openness in discussing many issues related to his renal failure furnished a unique quality improvement opportunity.

Attitude to Health↗
PubMed1994

Differential assembly of coexpressed glutamate receptor subunits in neurons of rat cerebral cortex.

In the rat, subunits of the glutamate receptor family fall into three pharmacologically distinct groups: alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid preferring receptors (Glu R1-4), kainate preferring receptors (Glu R5-7, KA 1, KA 2), and N-methyl-D-aspartate preferring receptors (NMDA R1, NMDA R2A-2D). In the present study, we demonstrate immunocytochemically that the majority of neurons in rat cerebral cortex coexpress members of all three groups of glutamate receptor subunits, Glu R2/3, Glu R5/6/7, and NMDA R1. Using immunoaffinity purified or immunoprecipitated alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid, kainate and N-methyl-D-aspartate receptors, we show that alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors containing Glu R1-4, kainate receptors containing Glu R6, Glu R7, and KA 2 and N-methyl-D-aspartate receptors containing NMDA R1 each form distinct protein complexes that do not share subunits. Our data indicate that a mechanism exists which allows for the specific assembly of selected glutamate receptor subunits into functionally and structurally distinct heteromeric receptors.

Animals↗
PubMed1996

Controversies about amyotrophic lateral sclerosis.

Controversy regarding amyotrophic lateral sclerosis (ALS) concerns aspects of relatively little consequence (such as the role of lead intoxication or trauma in the pathogenesis of the disease) and others of greater relevance, particularly the two following questions regarding treatment options: 1) Are we in a new era of therapy for ALS? Prior to the 1990's no controlled study showed consistent benefit from any of the treatments tried. We have now had announcements of benefit for four entirely different agents: riluzole, insulin-like growth hormone, brain derived neurotrophic hormone and gabapentin. The benefit, at most, is marginal or questionable. The effect is of statistical significance but of little clinical relevance, and 2) what is the role of peripheral nerves in ALS? The syndrome of multifocal motor neuropathy and conduction block (MMNCB) shares some clinical data (active tendon jerks in weak, wasted and fasciculating muscles) and pathological features (anterior horn cell loss and glions) with "typical" ALS. This is relevant because MMNCB is reversible with immunoglobulin therapy. The rigid separation between ALS (a disease of the motor neuron perikaryon) and MMNCB (a disease of the motor neuron axon) is no longer tenable.

Amyotrophic Lateral Sclerosis↗
PubMed1999

Nature, nurture and first sexual intercourse in the USA: fitting behavioural genetic models to NLSY kinship data.

Fisher (1930) presented both theoretical and empirical results concerning genetic influences on fertility. Since then, only sparse research has been done on the genetics of fertility, although more sophisticated methodogy and data now exist than were available to Fisher. This paper presents a behavioural genetic analysis of age at first intercourse, accounting for genetic, shared environmental, and selected non-shared environmental influences. The data came from the nationally representative National Longitudinal Survey of Youth (NLSY). A newly developed kinship linking procedure was used that identifies links for cousins, half-siblings, full-siblings and twins in the NLSY. The results suggest a genetic influence in the overall dataset, and also among whites and in male-male and opposite-sex pairs. Genetic influences were extremely small or non-existent for blacks and for female-female pairs. Shared environmental influences were small for most subsets of the data, but moderate for female-female pairs. Two specific non-shared environmental influences--self-esteem and locus of control--were ruled out as accounting for any meaningful variance, although other general sources of non-shared environmental influence appear potentially important. Analysis of selected samples from upper and lower tails suggested that genetic influences are important in accounting for both early and late non-virginity. These findings are consistent with work reported by Miller et al. (1999), who used molecular genetic methods. Generally, these findings support the existence of genetic influences and implicate non-shared environmental influences as being important determinants of the timing of loss of virginity among US adolescents and young adults.

Adolescent↗
PubMed2004

Using overall allele-sharing to detect the presence of large-scale data errors and parameter misspecification in sib-pair linkage studies.

Data errors and marker allele frequency misspecification can lead to incorrect inference in linkage analysis. Here we demonstrate the effect of each on an allele-sharing statistic in a sample of sib pairs. In the context of relationship testing, we propose a new test that compares the sample genome-wide sib-pair allele sharing to its expectation and show that this test can detect the presence of large-scale data and model errors.

Alleles↗