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At least 1,279 records · Page 71Linked to original sources
PubMed1995

Haematological cytology image bank and teletransmission for microscopic diagnosis.

Video recording of microscopic preparations, digitalization and storage, transmission by a specialized telephone network are revolutionizing microscopic diagnosis procedures. Adjustment of standardization of medical diagnosis, based on internationally recognized classifications and their computerized coding are fundamental to this process (ADICAP coding system). We are evaluating telediagnosis procedure to test their relevance in practical hematology. Taking into account clinical and biological informations is necessary to deal with difficult cases, in using in addition to microscopic observations, a compromise of analytic data which must be rapidly available in a data bank by cross references research. In comparison with other pathological applications, the sampling problem is specially crucial in hematologic cases, for which it is necessary to observe at high resolution a fairly high number of microscopic fields, from the peripheral blood and bone marrow smears, in addition to samples of histopathologic sections from bone marrow and/or lymph-node. A previous teleconsultation of an extensive data bank appears as being one of the best way to reduce the procedure of telediagnosis to the only difficult cases, for which clear responses cannot be found in the data bank. A link between the access to the data bank and the telediagnosis procedures appears to be a fundamental approach. Our first experience shown us that a mean of 10 to 15 observed fields are necessary to conclude in ordinary cases (i.e. peripheral blood of lymphoproliferative disorders), while up to 30 fields or more are sometimes necessary for complex cases (acute leukemias, myelodysplastic and myeloproliferative syndromes), including cytologic and histopathologic data from the peripheral blood, bone marrow, lymph nodes.

Computer Communication Networks↗
PubMed1995

[Modern ethical problems in environmental epidemiology].

The author presents a summary account on the session of the International workshop on ethical and philosophical issues in environmental epidemiology convened by the Rome Division of ECEH WHO and the International Society for Environmental Epidemiology (North Carolina, USA, Sept. 16-18, 1994). Twenty-one epidemiologists and workers concerned with ethics and philosophy from Europe, North America and other regions were invided. The subject of discussion was a definition of the discipline of environmental epidemiology and concurrently ethical and philosophical problems of the discipline. It was stated that it is essential to adopt ethical guidelines in the sphere of environmental epidemiology. It was recommended that, where reliable safeguards of processed personal data exist, access to the pertinent databases could be granted without previous informed consent of probands. Informed consent must be obtained only in later stages of research if direct contact with the individual subject is essential. Recommendations were adopted for practitioners, universities and training centres, professional organizations and institutions as well as sponsors interested in environmental epidemiology. It was emphasized that efforts to improve ethical awareness and practice must become and integral part of training and practical activities of all concerned.

Environmental Health↗
PubMed1995

Enroute toward a computer based patient record: the ACIS project.

The clinical arm of the University of Utah operates a 400 bed general hospital and 30 specialty and subspecialty clinics and with the advent of managed care will soon be linked to a much wider network of health care facilities throughout the state. Each of these patient care facilities maintains its own patient record. To provide common access to data on any patient needed to provide continuity to the care process where ever it occurs, the institution has embarked on the development of a completely electronic patient record. In this paper we will describe the route we have taken to achieve this goal in hopes of providing some sign posts along the way for others seeking the same destination.

Computer Communication Networks↗
PubMed1995

A proposed architecture for ambulatory systems development.

We have developed an architecture and application framework known as the Ambulatory Services Architecture (ASA) for computerized management of patient records for ambulatory care. Our primary design goals included the development of an architecture that will be readily adaptable to advances in technology needed to enhance computerized patient record systems (e.g., multimedia, human-computer interfaces such as voice-to-text, and a fully distributed objects, etc.) and a data model and database implementation capable of providing the flexibility and extensibility needed to support a broad spectrum of specialty medical practices. This report describes the data model, access control, and the client/server components of the Ambulatory Services Architecture.

Ambulatory Care Information Systems↗
PubMed1995

Integrated clinical information system.

SIDOCI (Système Informatisé de DOnnées Cliniques Intégrées) is a Canadian joint venture introducing newly-operating paradigms into hospitals. The main goal of SIDOCI is to maintain the quality of care in todayUs tightening economy. SIDOCI is a fully integrated paperless patient-care system which automates and links all information about a patient. Data is available on-line and instantaneously to doctors, nurses, and support staff in the format that best suits their specific requirements. SIDOCI provides a factual and chronological summary of the patient's progress by drawing together clinical information provided by all professionals working with the patient, regardless of their discipline, level of experience, or physical location. It also allows for direct entry of the patient's information at the bedside. Laboratory results, progress notes, patient history and graphs are available instantaneously on screen, eliminating the need for physical file transfers. The system, incorporating a sophisticated clinical information database, an intuitive graphical user interface, and customized screens for each medical discipline, guides the user through standard procedures. Unlike most information systems created for the health care industry, SIDOCI is longitudinal, covering all aspects of the health care process through its link to various vertical systems already in place. A multidisciplinary team has created a clinical dictionary that provides the user with most of the information she would normally use: symptoms, signs, diagnoses, allergies, medications, interventions, etc. This information is structured and displayed in such a manner that health care professionals can document the clinical situation at the touch of a finger. The data is then encoded into the patient's file. Once encoded, the structured data is accessible for research, statistics, education, and quality assurance. This dictionary complies with national and international nomenclatures. It also contains personalized profiles: questionnaires based on the predetermined choices of the information most relevant to the specific user. The SIDOCI clinical dictionary also includes the hospital's suggested or mandatory interventions, clinical guidelines, and protocols. These clinical guidelines are customized at the hospital, service, and professional levels. Common interventions have been regrouped so that health professionals may apply the appropriate diagnostic, therapeutic, educational, or other intervention plans. The clinical dictionary also serves as a teaching and continuing education tool. The patient profile is a permanent record containing information on allergies, blood type, primary and secondary diagnoses, ongoing treatments, and prior hospitalizations. The problem list dealing with the current hospitalization includes symptoms, signs, and diagnoses. This standard clinical record facilitates communication between the services and provides a quick overview of the patient's history should emergency treatment be required. This health information system integrates Requests and Results, Progress Notes, and Analysis of the results. In addition, functions inherent to a patient's clinical cycle such as Administrative Management of episodes, Adaptation to physical and professional structures of the hospital, Messages between health professionals, and Electronic signature constitute the basis of SIDOCI. The most exciting aspect of this research project is its social impact: a more efficient health care system will improve the lives of all citizens. Moreover this applied research project involves the information industry and directly calls for the input of users such as doctors, nurses and hospital support staff.

Hospital Information Systems↗
PubMed1996

Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis.

OBJECTIVE: To try and establish a consensus about the ideal secondary access for haemodialysis by assessing factors that affect the longevity of various access routes. DESIGN: Multicentre survey, by questionnaire. SETTING: General hospital, Athens. SUBJECTS: All 1516 patients in the Athens area receiving chronic haemodialysis. MAIN OUTCOME MEASURES: Longevity of present and any previous access routes (n = 2323). Data including type of access, age, sex and the existence of diabetes, hypertension, hyperlipidaemia, or other systematic diseases were recorded. RESULTS: Some 1220 (80%) of the patients were using autologous access, 1049 (69%) arteriovenous (AV) fistulas at wrist and 171 (11%) at elbow. Variables were analysed using Cox's proportional hazard model. Age and female sex were significantly associated with failure of autogenous access (p < 0.001) although not affecting synthetic grafts. Autogenous fistula at the elbow was the only secondary access that was less likely to fail than the initial (baseline) fistula at the wrist. Among the various grafts, straight arm grafts had the best prognosis and straight forearm grafts were the most likely to fail (p < 0.001). CONCLUSION: An AV fistula at the elbow should be considered the second best after the fistula at wrist, but is not always feasible. A synthetic graft is more likely to be needed in elderly patients and women, in whom an autogenous AV fistula is more likely to fail.

Age Factors↗
PubMedDate not supplied

[Integratable message: central problem of communication for therapeutic information].

The aim of therapeutic information is that people who need it have access to data of the highest level of evidence. In this context, a message is defined as the medium of information. The conditions for an ideal message to the prescriber are described: its content, the qualities it must meet, and the functional issues it will tackle. An example illustrates the importance of the form of a message. The difference between recommendation and message is highlighted.

Drug Information Services↗
PubMed1996

Designing a low cost bedside workstation for intensive care units.

The paper describes the design and implementation of a software architecture for a low cost bedside workstation for intensive care units. The development is fully integrated into the information infrastructure of the existing hospital information system (HIS) at the University Hospital of Giessen. It provides cost efficient and reliable access for data entry and review from the HIS database from within patient rooms, even in very space limited environments. The architecture further supports automatical data input from medical devices. First results from three different intensive care units are reported.

Computer Systems↗
PubMed1977

Radioiron and erythropoiesis: methods, interpretation and clinical application.

Ferrokinetic studies have fallen somewhat out of fashion and this is probably because T 1/2, PIT and percentage utilization give a poor reflection of the state of erythropoiesis. Recent advances have, however, enabled total, effective and ineffective erythropoiesis to be measured. The technique is simple but time-consuming, and analysis of the data requires access to computing facilities. Nevertheless, when bone marrow erythroid activity must be assessed these radioiron methods offer a rational approach.

Anemia, Aplastic↗
PubMed1997

Renal transplantation in children; the Auckland experience 1980-96.

AIM: To review the experience and outcome of renal transplantation in children who received a renal allograft at the Auckland Children's Hospital between January 1980 and June 1996. METHODS: Retrospective review of patient records and access to data collected through the ANZDATA Registry. Forty one renal transplants were undertaken in 39 children. Prednisone and Azathioprine were the mainstay of the immunosuppressive regimen from 1980 to 1985, then cyclosporin A was introduced in 1986. Median age of first graft was 11 years (range 1.6-14 years). There were 34 living related and 7 cadaveric grafts and 17 males and 22 females. Thirteen children (33%) had a primary glomerular disorder as the cause of renal failure. Another 9 (28%) had reflux nephropathy and a further 8 (18%) had congenital renal dysplasia/hypoplasia either as primary cause or secondary to lower urinary obstruction. RESULTS: Survival analysis showed that 93% of grafts were functioning at 12 months and 73% were still functioning at 5 years. Longest surviving transplant is 16 years. Ten primary grafts were lost with the most common cause being chronic rejection, accounting for 50% of all transplants lost. Recurrence of primary disease was the second most common (4 of 13) cause of graft failure. There was one malignancy in this series with a child developing a Kaposi's sarcoma. CONCLUSIONS: Renal transplantation is a successful treatment of endstage renal failure in children. Chronic rejection remains a major cause of graft loss and better immunosuppressive strategies are required to deal with this problem.

Adolescent↗
PubMedDate not supplied

Information management in nursing.

The information technology environment is here to stay. Computers are the devices being used to manage the extension of care out of hospitals and into the community. Nurses are the focal point of clinical documentation because they access patient data most often. Nurses know what information is needed and seek ways to collect that information. Nurses can dictate the type of data collected and how that data is presented to allow the most appropriate, well-informed decisions possible. Nurses have the knowledge to make decisions, and with information management skills, we will have the means to communicate that knowledge to others.

Computer Communication Networks↗
PubMed1998

Detailed characterization of the binding site of the lipoprotein lipase-specific monoclonal antibody 5D2.

Monoclonal antibody (MAb) 5D2 recognizes lipoprotein lipases (LPL) from different species but not related lipases. This MAb is a unique reagent, used world-wide, because it differentiates between monomeric inactive and dimeric active LPL, inhibits human LPL enzyme activity, and binds to C-terminal LPL sequences involved in interactions with lipoproteins, lipoprotein receptors, and heparin. In this study we have analyzed the fine specificity of the MAb epitope recognition in order to better understand its functional properties and species-specific LPL immune reactivity. In peptide scan assays, MAb 5D2 reacted with all, except two, 13 amino acid-long peptides located between positions 380 and 410. Peptides from the amino terminal end of this region reacted more strongly than those from the carboxyl terminal end. Furthermore, only a peptide from the amino terminal end competed effectively with the binding of MAb 5D2 to native LPL bound to microtiter plates or nitrocellulose. A systematic peptide mutagenesis study indicated that 8 amino acids of the reactive region, mainly located in the amino terminal end, are critical for binding and probably directly interact with MAb 5D2. The experimentally determined antigenicities of species-specific LPL peptides and of the corresponding denatured full-length LPL proteins on immunoblots were consistent with these findings. According to a proposed 3D-model for LPL, only the amino terminal end of the antigenic region is easily surface-accessible. These data combined with 3D-modelling of monoclonal antibody (MAb)-lipoprotein lipase (LPL) protein interaction provide new insight into the known biological effects of MAb 5D2 on LPL and the antigenic determinants that are recognized.

Amino Acid Sequence↗
PubMed1997

Use of the World Wide Web for multisite data collection.

As access to the Internet becomes increasingly available, research applications in medicine will increase. This paper describes the use of the Internet, and, more specifically, the World Wide Web (WWW), as a channel of communication between EDs throughout the world and investigators who are interested in facilitating the collection of data from multiple sites. Data entered into user-friendly electronic surveys can be transmitted over the Internet to a database located at the site of the study, rendering geographic separation less of a barrier to the conduction of multisite studies. The electronic format of the data can enable real-time statistical processing while data are stored using existing database technologies. In theory, automated processing of variables within such a database enables early identification of data trends. Methods of ensuring validity, security, and compliance are discussed.

Computer Communication Networks↗
PubMed2002

Secure exchange of medical data: requirements and solutions.

It is now common to access and to exchange data through computer networks. The major applications used are Web access and, e-mail. But while there is no security concern when accessing classical or anonymous data, the exchange of sensitive data (e.g. patient-related information) is subject to legal constraints. This paper summarizes the current legal obligations in Switzerland and presents state of the art techniques for applying the legal rules. A commercial implementation in Switzerland is taken as illustration.

Computer Security↗
PubMed2003

Automated identification of shortcuts to patient data for a wireless handheld clinical information system.

Inadequate access to patient information at the point of care has been identified as an impediment to the health care process. To create clinical computing tools that are useful to and used by clinicians, developers of clinical information systems must have accurate models of the users for whom their systems are intended. To create these models, the information needs of clinicians must be understood. While the wireless handheld environment offers many advantages such as the ability to provide mobile access to information, there are a number of challenges. Developing for this environment differs from the laptop and desktop environments due to features such as processing power, screen size, input mechanism, and bandwidth. PalmCIS (Palm-based Clinical Information System) is a clinical application being developed at New York Presbyterian Hospital (NYPH) that provides clinicians with access to patient data via a wireless handheld device. We are using an automated technique to uncover patient-specific information needs of clinicians while using a patient record system. With the results, we can enhance PalmCIS.

Computers, Handheld↗
PubMed2004

A dynamic, web-accessible resource to process raw microarray scan data into consolidated gene expression values: importance of replication.

We propose a freely accessible web-based pipeline, which processes raw microarray scan data to obtain experimentally consolidated gene expression values. The tool MADSCAN, which stands for MicroArray Data Suites of Computed ANalysis, makes a practical choice among the numerous methods available for filtering, normalizing and scaling of raw microarray expression data in a dynamic and automatic way. Different statistical methods have been adapted to extract reliable information from replicate gene spots as well as from replicate microarrays for each biological situation under study. A carefully constructed experimental design thus allows to detect outlying expression values and to identify statistically significant expression values, together with a list of quality controls with proposed threshold values. The integrated processing procedure described here, based on multiple measurements per gene, is decisive for reliably monitoring subtle gene expression changes typical for most biological events.

Data Interpretation, Statistical↗
PubMed2005

The causes and effects of socio-demographic exclusions from clinical trials.

OBJECTIVES: To investigate the exclusion from trials of women, older people and minority ethnic groups, focusing on two drug exemplars, statins and non-steroidal anti-inflammatory drugs (NSAIDs). DATA SOURCES: Medical and ethical databases. Workshops with stakeholders. REVIEW METHODS: Literature was reviewed on exclusions in healthcare research and three workshops were held with stakeholders. Twenty-seven randomised controlled trials (RCTs) of statins use for secondary prevention of coronary heart disease (CHD) and 25 NSAIDs trials for pain in osteoarthritis (OA) were analysed. Using a Scottish cohort with record-linkage, profiling was carried out for 3188 people needing secondary prevention for CHD (1993-1996), ascertaining the independent effects of statins, and 131,410 people dispensed NSAIDs (1989-1996), examining adverse effects. Routine data sources were accessed to profile the need for secondary prevention of CHD in England and usage was estimated by consulting published surveys. The Somerset and Avon Survey of Health (SASH) 1996-97 and published data were accessed for information on potential need and usage of NSAIDs in OA. For both drugs, the socio-demographic profiles of trial samples, the population in potential need and those on treatment were compared. An evidence synthesis was produced to clarify the effects of statins on women and older people and the relationship of absolute effectiveness outcomes with underlying risk levels of disease events was modelled, examining the likely effects of trial exclusions. RESULTS: The average age of statins trial participants was 58.5 years; only 16.3% were women. Statins reduced cardiovascular disease (CVD) incidence by about 25% in both men and women. Older people up to 75 years of age also benefited. Meta-analysis and two landmark trials confirmed these results. The average age of NSAIDs trial participants was 61.9 years and women were well represented (68.5%). Gastrointestinal (GI) adverse events were commonly reported, but renal side-effects were not. Outcomes were seldom reported according to socio-demographic group. For both drugs, USA trials were more inclusive than UK/European trials. Ethnicity was not well reported for either drug. Some 23% of the cohort were treated with statins. Users were younger than non-statins users (but no more likely to be male) and had superior outcomes. High current exposure to NSAIDs elevated the risk of GI side-effects by about 50% versus no current exposure and renal impairment risk by nearly 140%. Side-effect risk increased with age; being female diminished risk. Approximately 537,000 incident cases of CVD would qualify for statins use in England each year. Women constitute 45% of this population with need, two-thirds of whom are aged 65 years or over. Need varies by ethnic group. No sex bias in prescribing statins was detected, but use was commoner in younger people. For NSAIDs, 6.3% of adults aged 35+ years reported hip and/or knee pain associated with OA; 3.9% of adults used prescribed analgesics for this and they were more likely to be women and to be >65 years old. For statins, women formed almost half of the 'with need' and 'on treatment' populations, but were markedly under-represented in trials. Those aged 65+ years formed nearly two-thirds of the 'with need' population, but only one-fifth of trial samples, and were less likely to be treated than younger subjects. For NSAIDs, women formed similar proportions. Associations of side-effects with socio-demographic factors was revealed in cohort data but not in trials. CONCLUSIONS: The issue of exclusion from trials of women, older people and ethnic minorities has been relatively neglected in the UK research community, and there is confusion about diversity issues. Under-representation occurs, but in drug trials at least this may not always affect the external validity of relative effect estimates. However, measures of absolute effectiveness, absolute harm and cost-effectiveness are associated with underlying risk levels in different socio-demographic groups. Under-representation will therefore bias absolute effect estimates. The following areas are suggested for future research: multi-disciplinary assessment of realistic options for trialists to address the issue of exclusions; clarification of the use of ethnic categories in health research and of the implications of the different dimensions of ageing and sex/gender; identification of barriers and facilitators to the involvement of different population groups in research, further investigation of the susceptibility of older men to NSAID adverse events, and the development of a 'register of registries and databases' and exploration of how linked health information systems in the UK could be improved.

Adult↗
PubMed1997

The Erlangen Hospital Communication Hub: migration from proprietary to standardised communication.

The Erlangen communication hub allows medical subsystems to exchange data by two completely different methods. Since 1995 a communication data base, which is implemented using the relational data base system ADABAS D, contains data from the most important hospital systems. This data can be accessed by other medical systems. Thus, the communication data base allows subsystems which do not have a standardised interface to implement proprietary system interconnections via access based on SQL. The capabilities of this interconnection are dependent on both the implementation and the data which is made available by the communication data base. This contains mainly basic patient data and the results of tests performed by various laboratory systems. In addition to this proprietary communication system we have since the end of 1996 a communication server which can also handle standardised message formats such as HL7, EDIFACT, DICOM3. Future subsystems which possess standard interfaces will be connected via this server. The connection of the patient management system IS-H and the central laboratory system to the database has been proceeding since the beginning of 1997.

Computer Communication Networks↗