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PubMed1999

A health information network for managing innercity tuberculosis: bridging clinical care, public health, and home care.

The purpose of this study was to use a health information network and innovative technology to coordinate tuberculosis care. An innercity medical center, a local health department, and a home care nurse service in northern Manhattan were used. The organizations were linked with computer networks. An automated decision support system with a natural language processor was used to detect tuberculosis cases and report them to the health department, and to select patients for respiratory isolation. Educational materials were placed on the World Wide Web and a Web-based kiosk. Home care nurses were outfitted with wireless pen-based computers, and data were relayed to the medical center. Automated tuberculosis case reporting resulted in time savings but not improved accuracy. Automated rules resulted in significant improvements in respiratory isolation. Kiosk educational materials were well-used. Wireless computing led to better access to information for both nurses and physicians, but not to reduction of workload. The key success element was recognition of critical priorities. It is concluded that innovative technology can facilitate the coordination of clinical care, public health, and home care.

Academic Medical Centers↗
PubMed1995

Cost justification of a community health information network: the ComputerLink for AD caregivers.

Recent studies examined the perceived benefits of the ComputerLink, a specialized computer network for caregivers of persons with Alzheimer's Disease. The ComputerLink existed as a special service within a free, public access community health information network. The issue of "free", however, is debatable. Though usage costs were not incurred by the AD caregivers who used ComputerLink, there are direct and indirect costs associated with these and other community networks. This study will focus on costs incurred at the individual level, recognizing that organizations and society also bear community network costs. At this level, the primary cost savings occur with the caregiver. The biggest factor determining net economic benefits is the extent to which this technology intervention delays or prevents institutionalization. Results of this analysis suggest that community health networks do return economic and social benefits to their users.

Alzheimer Disease↗
PubMed1995

The crucial roles of standards and strategy in developing a regional health information network.

Contemporary medical practice increasingly involves the use of inter-professional teams and complex care protocols. Increasing emphasis on value for money, medical audit, quality assurance and optimal outcomes requires that the practitioner has ready access to large amounts of up-to-date information, and that various abstracts and summaries of cases are made available quickly to providers, purchaser/funders, statisticians and researchers, and others. Rapid movements of large quantities of information is vital for the future success of health care: development of health information networks are vital strategic goals. In 1991 New Zealand initiated a widespread process of health services reform, whose success depended upon better availability and faster movements of information. The first phase of a national network to support these needs was successfully implemented in mid 1993: this provided for a point of connection for all individuals and organisations involved in the health sector, using commercial networking services. Fundamental to this development has been the adoption adaptation and development of appropriate standards and specifications for interconnection profiles, communications protocols, message formats, privacy and security requirements classification and coding systems and data element definitions. These have been selected to provide the maximum utility whilst imposing the minimum of constraints on the diversity of end user systems.

Computer Communication Networks↗
PubMed1995

The trouble with CHINS (community health information networks).

If one had to choose a single acronym that captures both the vision and folly of today's health care industry, it would be "CHIN." The term--which stands for "community health information network"--combines the idealism of community-based health care with the promise of computer automation. Ironically, the acronym may come to be synonymous with "sticking your neck out"; these costly computer networks presuppose a quixotic collaboration among hospitals and health systems long at one another's competitive throats. For CHINs to succeed, they must overcome barriers that many industry insiders say are insurmountable.

Community Health Planning↗
PubMedDate not supplied

Smart technology, stunted policy: developing health information networks.

Ideally, computer networks should help raise the quality of health care, reduce its cost, and enable consumers and providers to make smarter decisions. But government and the private sector have failed to resolve such critical problems as the protection of medical privacy and production of reliable comparative data on plans and providers. While individual enterprises are building information networks, community networks serving public purposes have lagged. An information revolution in health care is the making, but the hope that it will allow consumers and providers to make smarter choices is still far from being realized.

Community Health Services↗
PubMedDate not supplied

Protecting patient privacy and data quality in a community health information network.

The healthcare industry is under mounting pressure to cut costs without reducing the quality and quantity of healthcare services. One method to streamline operations is to implement community health information networks (CHINs). This article describes ways in which CHINs can offer subscribers improved efficiency, decreased costs, and improved patient care. It also addresses the fact that membership in a CHIN, if not controlled, greatly increases legal risks. Details on how many of these risks can be minimized or avoided are provided.

Antitrust Laws↗
PubMed1995

Evaluation of patch test results by use of the reaction index. An analysis of data recorded by the Information Network of Departments of Dermatology (IVDK).

Results of patch tests performed in 15,553 patients by 18 dermatological departments (members of the German Contact Dermatitis Research Group) and recorded by the Information Network of Departments of Dermatology (IVDK) were analysed by comparing recently defined reaction indices (RIs). The RIs studied were calculated from the numbers of allergic (a), questionable (q), and irritant (i) reactions (RI = (a-q-i/(a + q + i)), which were obtained using 13 European standard allergens. RIs were calculated for all patients and for separate subgroups defined by age, sex, history of atopic dermatitis, time of allergen exposure (1 versus 2 days), and time of patch test reading (2 or 3 days after allergen application). Higher RIs were consistently obtained when patch tests were applied for 1 day, as compared to 2 days. Readings at 3 days after allergen application resulted in higher RIs than readings after 2 days. In contrast, sex, age, and history of atopic dermatitis of patients were not found to have a consistent influence on the RIs. We suggest that reading after 3 days should be obligatory, and that allergen exposure for 1 day instead of 2 days might make patch test evaluation easier. These suggestions need to be substantiated by data on clinical relevance.

Adult↗
PubMed2004

Allergic and non-allergic periorbital dermatitis: patch test results of the Information Network of the Departments of Dermatology during a 5-year period.

Periorbital dermatitis is common and can be due to the external use of ophthalmic drugs. We evaluated patch test results of the Information Network of the Departments of Dermatology. During a 5-year period (1995-99), of a total 49,256 patch-tested patients, 1053 (2.1%) were eventually diagnosed as allergic periorbital contact dermatitis (APD) and 588 (1.2%) as non-allergic periorbital dermatitis (NAPD). Patient characteristics between APD, NAPD and other cases (OCs) differed with respect to sex (19.7% male in both periorbital groups versus 36.3% in OCs), atopic dermatitis (10.4% in APD versus 60.2% in NAPD versus 16.9% in OCs) and age, APD being substantially more often (68.2%) aged 40 and above than NAPD (52.6%). Several of the top allergens in OCs [such as fragrance mix, Myroxylon pereirae resin (balsam of Peru), lanolin alcohol and potassium dichromate] caused significantly fewer positive test reactions in both periorbital groups. In contrast, thimerosal, phenylmercuric acetate, sodium disulfite, gentamicin sulfate, phenylephrine hydrochloride and benzalkonium chloride tested positively significantly more often in APD but not in NAPD, verifying them as true ophthalmic allergens. Finally, in 42 cases (4%) of APD patients, additional allergens were identified by testing of the patients' own substances (mostly beta-blockers, oxybuprocaine and dexpanthenol), supporting the necessity of testing with ophthalmic drugs as is where individual substances are not readily available.

Adult↗
PubMed1997

Developing a secure healthcare information network on the Internet.

Healthcare professionals across the country are using the Internet for a variety of activities, including the transmission of medical record data via e-mail. The transmission of confidential information, however, is a serious concern of healthcare consumers, providers, and payers alike. At Indiana University School of Medicine, security on the Internet is no longer a concern. The Internet is, in fact, the heart of a healthcare information network currently in development for the Indianapolis area. A complex set of encryption/decryption algorithms and user identifier and private passwords currently in development should greatly reduce the risk of security breach on the network.

Community Networks↗
PubMed1993

[The development of an information network for new techniques in clinical microbiology].

In accordance with changes in our life styles and our social and biological environment, the techniques and methods of clinical microbiology must change and develop. New techniques, such as selected zone culture, direct drug susceptibility test, ATP bio-luminescence assay on membrane filter and expiratory gas analysis are among these developments. To ensure equal development among medical laboratories, an information network concerning these new microbiological methods in needed. An enormous quality of information can be contained and managed usefully by a two dimensional bar-code system. Clinical microbiology must not only contribute to clinical medicine but also respond to changes in the social and biological environment, and must include cost effectiveness, and preservation of natural resources. Using the new techniques effectively and introducing automatic systems will facilitate practical, useful and rapid clinical microbiological diagnoses.

Computer Communication Networks↗
PubMed1996

TRYPNET. New hemoparasite information network.

Although Guyana, Suriname, and French Guiana share borders and climatic and geographic similarities, the countries have maintained little contact, due to language, political, and administrative differences. In 1993, two international organizations involved in the improvement of animal health, the Inter-American Institute for Cooperation on Agriculture (IICA) and CIRAD-EMVT (Centre de Cooperation Internationale en Recherche Agronomique pour le Developpement-Elevage et Medecine Veterinaire des Pays Tropicaux), jointly developed a collaborative project between the veterinary services of the three countries entitled "Hemoparasite Network for the Guianas." This project seeks to pool livestock, laboratory, and technical resources between the three countries in order to generate and exchange information on hemoparasites of livestock. A Hemoparasite Reference Laboratory for the Guianas has been created at the CIRAD-EMVT laboratory in Cayenne, French Guiana. Besides processing ruminant serum samples from the three countries, specialists from this organization conduct training in hemoparasite diagnostic techniques for laboratory personnel from Guyana and Suriname. A large-scale epidemiologic study of hemoparasites of cattle in the three countries is under way, to determine the prevalence, distribution, and clinical and economic significance of hemoparasites in the three countries, particularly Trypanosoma vivax and T. evansi. Preliminary results are presented and discussed. A Hemoparasite Information Network (TRYPNET) has been initiated, including a quarterly hemoparasite newsletter (TRYPNEWS), published in English and Spanish and disseminated to researchers in the Americas, Europe, and Africa. In 1995/96, it is proposed to expand the network's scope to include Venezuela and Brazil.

Abattoirs↗
PubMed1997

Developing a health information network within an integrated delivery system: a case study.

Changes in the health care environment, such as the growth of integrated delivery systems and the proliferation of managed care, are having a profound impact on the way in which health care organizations manage both clinical and financial information. Health information networks (HINs) are emerging to support the goals and internal needs of integrated delivery systems. In this environment, health care managers must assume a leadership role in planning for the development of HINs. The article provides an overview of the principal issues that should be addressed in an organization's information systems plan when a HIN is being developed and includes a case study that illustrates the key points discussed.

Capital Financing↗
PubMed2004

Frequency of contact allergy in German children and adolescents patch tested between 1995 and 2002: results from the Information Network of Departments of Dermatology and the German Contact Dermatitis Research Group.

Allergic contact dermatitis (ACD) affects approximately 7% of the general population. To evaluate the frequency of ACD in children, we analysed patch test results collected by the Information Network of Departments of Dermatology between 1995 and 2002. Data of 285 children (6-12 year) and 2175 adolescent patients (13-18 year) were analysed to determine the frequency of sensitization to the 30 most common contact allergens, adjusting for age and sex. As control group, we defined adult patients (60-66 year, n = 7904). The top allergens in children were thimerosal, gentamicin sulphate, nickel-II-sulphate, ammoniated mercury, cobalt-II-chloride, fragrance mix, bufexamac, Compositae mix, propylene glycol and turpentine. The overall proportion of sensitized patients according to the patch test results was 52.6% in the children group compared to 49.7% in the adolescent group. These findings were similar in the adult group at 52.2%. The detailed analysis regarding sex, occupation, atopy, site of eczema and age showed distinct patterns in each group indicating age-specific exposures. Atopy-related diseases were more common in children compared to adults. On the basis of the data of this study, the relationship between atopy and the risk of development of ACD, at least in children, needs further investigation.

Adolescent↗
PubMed2000

Increase in sensitization to oil of turpentine: recent data from a multicenter study on 45,005 patients from the German-Austrian Information Network of Departments of Dermatology (IVDK).

Contact allergy to oil of turpentine was reported to have become rare. However, the evaluation of standardized data of 45,005 patients tested 1992-1997 in 30 Dermatological Centers associated with the German-Austrian Information Network of Departments of Dermatology (IVDK) showed an increase in positive patch test reactions to turpentine from 0.5% during the years 1992-1995, up to 1.7% in 1996 and 3.1% in 1997. In particular, 17,347 patients tested in 1996-1997 were evaluated in detail by comparing 431 individuals with positive patch test reactions with the rest of the group found negative to turpentine. Using the so-called MOAHLFA index, the following characteristics were shown. Turpentine allergy (a) was found to be significantly less frequent in men and in patients with occupational dermatitis, (b) showed no difference in its association with atopic dermatitis, (c) patients with turpentine allergy had significantly less symptoms of the hands, more symptoms of the legs or in the face and (d) were significantly more often aged over 60 years. Also, patients sensitized to turpentine had increased rates of additional sensitizations. The definite reason for the increase in turpentine sensitization in the population tested here is not clear. Therefore, a detailed exposure analysis is necessary; the new increase in turpentine allergies may be due to popular topical remedies or household chemicals.

Adult↗
PubMed2000

Downward trend of sensitization to glyceryl monothioglycolate in German hairdressers. IVDK study group. Information Network of Departments of Dermatology.

BACKGROUND: Due to a high incidence of cases of (occupational) sensitization to glyceryl monothioglycolate (GMT), products containing this compound were withdrawn from the German market some 8 years ago. METHODS: We analyzed the data of the Information Network of Departments of Dermatology in Germany which included 1, 336 hairdressers who had been tested with GMT (1% in petrolatum) between 1992 and 1998. RESULTS: The proportion of hairdressers reacting positively to GMT fell from initially 45% in 1992 to less than 20% in 1997 and 1998. CONCLUSION: This most likely reflects the above-mentioned preventive action.

Allergens↗
PubMed2001

Another look at seasonal variation in patch test results. A multifactorial analysis of surveillance data of the IVDK. Information Network of Departments of Dermatology.

There is conflicting evidence concerning seasonal variability of patch test results and no evidence concerning the influence of season on weak-positive, possibly false-positive, irritant reactions, which was analysed in the present study. Data collected in the German Information Network of Departments of Dermatology (IVDK) 1992 to 1997 were combined with external environmental data on temperature and absolute humidity in Germany, and bivariate as well as logistic regression analyses performed concerning the association between reactivity to selected allergens and air temperature and absolute humidity on the respective days of patch testing. Between 39,239 and 41,629 patients had been tested with the 4 allergens considered here. Only formaldehyde exhibited a distinct increase in questionable or irritant as well as weak-positive reactions associated with dry, cold weather. Methylchloroisothiazolinone/methylisothiazolinone and lanolin alcohol showed only a weak, and epoxy resin no, association with climatic conditions. The results indicate that weak-positive reactions, at least to formaldehyde as a prototype of an allergen which is at the same time a marginal irritant, may sometimes be irritant rather than allergic. Patients showing these should be re-tested to improve the poor reproducibilty observed with this allergen.

Climate↗
PubMed2026

Precision targeting of teacher burnout using network-informed ecological momentary interventions.

Teacher well-being affects classroom functioning and workforce stability, yet generic digital programs rarely use person-specific affect dynamics to select support. This cluster-randomised trial evaluated whether micro-interventions selected from high expected influence (EI) nodes in teachers' contemporaneous affect networks produced larger changes in burnout-related EI and everyday happiness than content-matched random allocation. The objectives were to estimate allocation effects on changes in estimated network summaries and happiness, evaluate network change as a statistical mediator, examine personality moderation, and benchmark simpler allocation rules. A two-arm cluster randomised platform trial was conducted in 84 public schools across four urban districts in H Province. After a 14 day baseline of ecological momentary assessment (EMA), person specific partial correlation networks were estimated for happiness, exhaustion, detachment, efficacy and rumination. An optimisation engine prioritised three brief micro-intervention types per teacher according to baseline EI, while the active control received the same library without network information. EMA continued for 8 weeks; Bayesian multilevel models, permutation-based mediation, and benchmarking analyses were applied. EI-based targeting produced larger reductions in the composite EI-change index than active control (mean difference 0.11, 95% credible interval 0.08 to 0.14) and higher week 7 EMA happiness (4.4 points on a 0 to 100 scale, 95% credible interval 2.7 to 6.0), with a positive arm by week slope difference of 0.62 points per week (95% credible interval 0.39 to 0.85). Model-based mediation estimates were consistent with approximately one half of the happiness difference being statistically associated with change in the composite EI-change index (average conditional mediation estimate 3.5 points, 95% credible interval 2.0 to 5.2). Benchmarking showed smaller gains under severity, threshold, or group-level centrality rules. Effects were stronger among teachers higher in conscientiousness. The findings indicate that integrating EMA, network modelling, and EI-driven optimisation yields measurable gains beyond content-matched exposure, providing a proof of concept for district-scale precision mental health that requires prospective implementation testing. Replication in additional regions, expanded node sets, and longer follow up are warranted to assess durability and generalisability.

Female↗