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At least 1,333 records · Page 74Linked to original sources
PubMed1997

Trauma outcome analysis and the development of regional norms.

Early attempts to assess patient outcomes in trauma hospitals included morality reviews and expert panel chart audits. More recently, a statistical methodology combining the Revised Trauma Score and Injury Severity Score has been developed (TRISS). A modification of this methodology--TRISS-like analysis--allows the inclusion of patients who have required endotracheal intubation prior to the time of arrival at the trauma hospital. This study was undertaken to further improve this TRISS-like methodology by developing statistical coefficients based on regional data. It was hypothesized that his would allow the analysis to better identify those hospitals with significantly better worse outcomes than their peers. The Comprehensive Data Set of the Ontario Trauma Registry was accessed, which contains data on severely injured patients from all 11 lead trauma hospitals in the province. Three years' data were obtained, and checked for accuracy and completeness. Analysis was performed using the previously published coefficients. New coefficients were then derived, using regression analysis on the Ontario patient data. 5,258 of 6,389 files were complete and eligible for analysis. TRISS-like analysis resulted in an expected mortality of 21.2% (1115.6/5258) with a z score for the entire province of -14.102. Individual hospital scores were all negative (fewer deaths than expected), and 9/11 hospital scores were < -1.96 (statistically significant). The new coefficients were markedly different from those previously published, and their application resulted in an overall z score of 0.000. Institutional scores ranged from -3.309 to +4.686, with two hospitals < -1.96 and one > +1.96. The old coefficients predicted many more deaths than occurred in all of the hospitals. The new coefficients proved quite accurate overall in predicting outcomes, and identified one institution with significantly more deaths than would have been predicted for other hospitals in the province. Subsequently, a fourth year's data files were obtained, and used as a validation data set. The new coefficients again proved more useful than the original ones.

Humans↗
PubMed2001

[Pharmaceutical traceability integrated with the patient file. Development of a computerized hospital application].

The Clinical Pharmacy Department (CPD) of the Gustave Roussy Institute, has developed a traceability software package that is integrated with the patient file. The Traceability & Medical Devices Functional Unit manages the Blood Derivative Medicinal Product traceability circuits, the circuits of over 400 Sterile Medical Devices and, generally speaking, those for all pharmaceutical goods for which traceability is imperative. The SIMBAD-TRACE software package has been developed in situ and was first open for access in March 1999. It enables pharmaceutical traceability data to be accessed from 500 networked workstations. The references tracked generated about 10,000 movements per year. In terms of performance, the system achieves three complementary objectives: 1) reporting traceability scores which reflect the ability of CPD and the establishment to pertinently respond to a complex regulatory requirement on a daily basis; 2) the contribution of the tool to cost containment with respect to allocating rare goods; the contribution of the software package to the implementation of medical device vigilance inquiries, particularly descending inquiries. Finally, SIMBAD-TRACE is one of the pillars of our Quality Assurance Program (QAP).

Equipment and Supplies↗
PubMed1995

Three-dimensional ultrasound.

The papers in this issue show that the feasibility of three-dimensional ultrasound methods in the clinical setting using commercially available equipment is nearby. Their results demonstrate some of the advantages compared to two-dimensional ultrasound and other diagnostic modalities, including reduced scanning times that will offer more cost-effective use of equipment and sonographer time. Other benefits of three-dimensional ultrasound include allowing the physician: to evaluate arbitrary planes not available with two-dimensional ultrasound due to patient body habitus; to measure organ dimensions and volumes; to obtain anatomic and blood flow information; to improve assessment of complex anatomic anomalies; to confirm normalcy; to standardized the ultrasound exam procedures; to enhance the understanding of physicians in primary care facilities and communicate volume data over networks for consultation at tertiary facilities. Standardization of the ultrasound examination protocols can lead to uniformly high-quality examinations and decreased health care costs. Ultimately, three-dimensional ultrasound imaging will make it easier for primary care physicians to understand complex patient anatomy. Tertiary care physicians specializing in ultrasound can further enhance the quality of patient care by using high-speed computer networks to review volume or dynamic data at specialization centers with primary care physicians. Access to volume data at specialization centers affords more sophisticated analysis and review, further augmenting patient diagnosis and treatment and reducing health care costs.

Congenital Abnormalities↗
PubMed2000

[IT safety in medical networks--current problems and approach to solutions].

Designers and users of medical networks have to face strong requirements for data protection and security. Professional discretion and data protection laws allow the transfer of or access to patient data only in a therapeutic context. These data should also be protected from the network provider. Patients should be safe from any harm by faulty data or buggy procedures. On the other hand the security of the most used software products gets worse and worse. The use of the internet endangers more and more the integrity of the user's computer. The security requirements can be met only through strict care in planning, building, and configuring the infrastructure. Some concrete recommendations and guiding principles can immediately be realized. If these recommendations are followed, the internet can be of immense value for health care.

Computer Security↗
PubMed1996

Computerised data collection for a cancer centre: a Queensland perspective.

The Queensland Radium Institute has had a computerised database for 15 years but there was little uniformity in the data collected and there was considerable scope for improvement. In 1991 the institute decided to upgrade and standardise its data collection system. The improvements will allow easier access to the data for research and audit purposes. The process was effective and the implementation straightforward because of effective planning and training. This paper outlines the process used in the review and implementation of the new database system and describes the date sets in some detail.

Abstracting and Indexing↗
PubMed2004

Handheld-assisted field data collection for occupational risk assessment.

A computerized handheld procedure is presented in this paper. It is intended as a database complementary tool, to enhance prospective risk analysis in the field of occupational health. The Pendragon forms software (version 3.2) has been used to implement acquisition procedures on Personal Digital Assistants (PDAs) and to transfer data to a computer in an MS-Access format. The data acquisition strategy proposed relies on the risk assessment method practiced at the Institute of Occupational Health Sciences (IST). It involves the use of a systematic hazard list and semi-quantitative risk assessment scales. A set of 7 modular forms has been developed to cover the basic need of field audits. Despite the minor drawbacks observed, the results obtained so far show that handhelds are adequate to support field risk assessment and follow-up activities. Further improvements must still be made in order to increase the tool effectiveness and field adequacy.

Computers, Handheld↗
PubMed2005

ECG and XML: an instance of a possible XML schema for the ECG telemonitoring.

Management of many types of chronic diseases relies heavily on patients' self-monitoring of their disease conditions. In recent years, Internet-based home telemonitoring systems allowing transmission of patient data to a central database and offering immediate access to the data by the care providers have become available. The adoption of Extensible Mark-up Language (XML) as a W3C standard has generated considerable interest in the potential value of this language in health informatics. However, the telemonitoring systems often work with only one or a few types of medical devices. This is because different medical devices produce different types of data, and the existing telemonitoring systems are generally built around a proprietary data schema. In this paper, we describe a generic data schema for a telemonitoring system that is applicable to different types of medical devices and different diseases, and then we present an architecture for the exchange of clinical information as data, signals of telemonitoring and clinical reports in the XML standard, up-to-date information in each electronic patient record and integration in real time with the information collected during the telemonitoring activities in the XML schema, between all the structures involved in the healthcare process of the patient.

Electrocardiography↗
PubMed1998

Improving patient outcomes through CQI: vascular access planning.

This article reports the use of the continuous quality improvement (CQI) process to improve patient outcomes. The FADE method (focus, analyze, develop, and execute) was used to focus on vascular access planning, analyze data concerning intravenous (i.v.) therapy, develop a vascular access planning algorithm, and execute implementation of the algorithm. An evaluation study revealed that patients whose vascular access planning was consistent with the algorithm reported fewer i.v.s, less difficulty starting i.v.s, and less stress; waited significantly less time until central venous line (CVL) placement (for those who received CVLs); and had significantly shorter lengths of stay.

Algorithms↗
PubMed2004

A data management system for structural genomics.

BACKGROUND: Structural genomics (SG) projects aim to determine thousands of protein structures by the development of high-throughput techniques for all steps of the experimental structure determination pipeline. Crucial to the success of such endeavours is the careful tracking and archiving of experimental and external data on protein targets. RESULTS: We have developed a sophisticated data management system for structural genomics. Central to the system is an Oracle-based, SQL-interfaced database. The database schema deals with all facets of the structure determination process, from target selection to data deposition. Users access the database via any web browser. Experimental data is input by users with pre-defined web forms. Data can be displayed according to numerous criteria. A list of all current target proteins can be viewed, with links for each target to associated entries in external databases. To avoid unnecessary work on targets, our data management system matches protein sequences weekly using BLAST to entries in the Protein Data Bank and to targets of other SG centers worldwide. CONCLUSION: Our system is a working, effective and user-friendly data management tool for structural genomics projects. In this report we present a detailed summary of the various capabilities of the system, using real target data as examples, and indicate our plans for future enhancements.

Journal Article↗
PubMed1997

An open distributed medical image and signal data server network with World Wide Web front-end.

In modern patient care and medical research diagnostic imaging from multiple modalities plays an essential role. In general these digital image data are acquired at different locations. An efficient access to the data via network is often not provided due to technical, organisational and political reasons. This article presents an approach to solve the problem by means of an open distributed data server network with Web-based front-ends and describes the prototype DACHS that has been developed at the University Hospital of the Technical University of Munich.

Computer Communication Networks↗
PubMed2000

Generic data modeling for home telemonitoring of chronically ill patients.

Management of many types of chronic diseases such as diabetes and asthma relies heavily on patients' self-monitoring of their disease conditions. In recent years, internet-based home telemonitoring systems that allow transmission of patient data to a central database and offer immediate access to the data by the care providers have become available. However, these systems often work with only one or a few types of medical devices and thus are limited in the types of diseases they can monitor. For example, a system designed to collect spirometry data from asthmatic patients cannot be easily adapted to collect blood glucose data from diabetic patients. This is because different medical devices produce different types of data and the existing telemonitoring systems are generally built around a proprietary data schema specific for the device used. In this paper, we describe a generic data schema for a telemonitoring system that is applicable to different types of medical devices and different diseases, and show an implementation of the schema in a relational database suitable for a variety of telemonitoring activities.

Asthma↗
PubMed2002

Generic data modelling and use of XML standard for home telemonitoring of chronically ill patients.

In recent years, internet-based home telemonitoring systems that allow transmission of patient data to a central database and offer immediate access to the data by the care providers have become available. The adoption of Extensible Mark-up Language (XML) as a W3C standard has generated a lot of interest in the potential value of this language in health informatics. However the telemonitoring systems often work with only one or a few types of medical devices and thus are limited in the types of diseases they can monitor. This is because different medical devices produce different types of data and the existing telemonitoring systems are generally built around a proprietary data schema specific for the device used. In this paper, we describe a generic data schema for a telemonitoring system that is applicable to different types of medical devices and different diseases, and then we present an architecture for the exchange of clinical information as data, signals of telemonitoring and clinical reports in the XML standard, up-to-date information in each electronic patient record and integration in real time with the information collected during the telemonitoring activities in the XML schema, between all the structures involved in the health care process of the patient.

Chronic Disease↗
PubMed1991

Software support for Huntingtons disease research.

Huntingtons disease (HD) is a hereditary disorder involving the central nervous system. Its effects are devastating, to the affected person as well as his family. The Department of Medical and Molecular Genetics at Indiana University (IU) plays an integral part in Huntingtons research by providing computerized repositories of HD family information for researchers and families. The National Huntingtons Disease Research Roster, founded in 1979 at IU, and the Huntingtons Disease in Venezuela Project database contain information that has proven to be invaluable in the worldwide field of HD research. This paper addresses the types of information stored in each database, the pedigree database program (MEGADATS) used to manage the data, and significant findings that have resulted from access to the data.

Algorithms↗
PubMed1996

Tapping the television cable.

Immediate access to patient data is essential to support good clinical decision making and support. However, away from the surgery, the doctor is currently unable to have any access to the clinical database. Solutions exist to support remote access, such as modems or radio data networks, but these are slow, with typical speeds in the 2-10 kbaud region. We propose a novel solution, to use the TV cable already installed in many homes. Using this technology, a suitably equipped computer (RF modern) is capable of connecting at speeds in excess of 500 kbaud and will run applications in exactly the same way as if connected to a surgery network: the cable TV becomes a LAN, but on a metropolitan scale. Brunel University, in collaboration with the Cable Corporation, has been piloting such a network. Issues include not only levels of service, but also security on the network and access, since the data are being effectively received in every home. However, close scrutiny of channel use can create closed networks reserved for specific users. The technology involves use of an RF modem to transmit data on a reverse channel (based at 16 MHz) on each subnet to a router at the head end of the cable network. This frequency translates the packet and retransmits it to all the subnets on a forward channel (based at 178 MHz). Each channel occupies the bandwidth normally allocated to one TV channel. Access is based on a modified CSMA/CD protocol, so treating the cable network as single multiple access network. The modem comes as a standard card installed in a PC and appears much as an ethernet card, but at reduced speed. With an NDIS driver it is quite able to support almost any network software, and has successfully demonstrated Novell and TCP/IP. We describe the HomeWorker network and the results from a pilot study being undertaken to determine the performance of the system and its impact on working practice.

Computer Communication Networks↗
PubMed2000

Providing managed care options for a large population: evaluating the CHAMPUS reform initiative. Civilian Health and Medical Program of the Uniformed Services.

OBJECTIVES: To evaluate a managed care demonstration project in CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), the insurance program covering physical and mental health care services for the dependents of active duty military personnel, military retirees, and the retirees' dependents. The demonstration project added a health maintenance organization (HMO) option and a preferred provider organization (PPO) option to the standard CHAMPUS coverage and allowed beneficiaries to select the coverage option they preferred. DATA SOURCES: Utilization, costs, access, and beneficiary satisfaction were measured using data from CHAMPUS claims records, the Defense Enrollment Eligibility Reporting System, the demonstration project contractor's HMO enrollment file, the contractor's list of network hospitals, and two surveys of CHAMPUS beneficiaries. STUDY DESIGN: Changes in utilization at 11 demonstration sites were compared with changes in utilization at 11 matched control sites. The effect of the demonstration project on costs was evaluated by estimating the costs for the demonstration sites both with and without the managed care options based on data from the control sites. Access to care and satisfaction were compared between the demonstration sites and control sites based on beneficiary surveys. DATA COLLECTION: All claims in both demonstration and control sites were used in estimating utilization changes. Two mailed surveys were sent to a randomly selected sample of active duty and retiree households with CHAMPUS beneficiaries; the sample was stratified by beneficiary type (active duty or retiree) and site. PRINCIPLE FINDINGS: Overall utilization in the CHAMPUS system decreased at the demonstration sites but stayed approximately the same at the control sites. Utilization among the enrollees in the HMO demonstration option, however, increased dramatically. Patient access to care and satisfaction generally remained at the same levels at both demonstration and control sites, but enrollees in the HMO option reported higher satisfaction. Costs to the government at the demonstration areas, based on regression estimates from the control sites, were about the same or slightly higher than what they would have been under the standard CHAMPUS system. CONCLUSIONS: Managed care plans for large government-sponsored insurance programs can reduce utilization and maintain patient access and satisfaction. Careful structuring of such plans is needed, however, if they are to reduce costs.

Health Benefit Plans, Employee↗
PubMed2004

Recommendations on the use of satellite remote-sensing data for urban air quality.

In the last 5 yr, the capabilities of earth-observing satellites and the technological tools to share and use satellite data have advanced sufficiently to consider using satellite imagery in conjunction with ground-based data for urban-scale air quality monitoring. Satellite data can add synoptic and geospatial information to ground-based air quality data and modeling. An assessment of the integrated use of ground-based and satellite data for air quality monitoring, including several short case studies, was conducted. Findings identified current U.S. satellites with potential for air quality applications, with others available internationally and several more to be launched within the next 5 yr; several of these sensors are described in this paper as illustrations. However, use of these data for air quality applications has been hindered by historical lack of collaboration between air quality and satellite scientists, difficulty accessing and understanding new data, limited resources and agency priorities to develop new techniques, ill-defined needs, and poor understanding of the potential and limitations of the data. Specialization in organizations and funding sources has limited the resources for cross-disciplinary projects. To successfully use these new data sets requires increased collaboration between organizations, streamlined access to data, and resources for project implementation.

Air Pollutants↗
PubMed2002

Security of medical multimedia.

The application of information technology to health care has generated growing concern about the privacy and security of medical information. Furthermore, data and communication security requirements in the field of multimedia are higher. In this paper we describe firstly the most important security requirements that must be fulfilled by multimedia medical data, and the security measures used to satisfy these requirements. These security measures are based mainly on modern cryptographic and watermarking mechanisms as well as on security infrastructures. The objective of our work is to complete this picture, exploiting the capabilities of multimedia medical data to define and implement an authorization model for regulating access to the data. In this paper we describe an extended role-based access control model by considering, within the specification of the role-permission relationship phase, the constraints that must be satisfied in order for the holders of the permission to use those permissions. The use of constraints allows role-based access control to be tailored to specifiy very fine-grained and flexible content-, context- and time-based access control policies. Other restrictions, such as role entry restriction also can be captured. Finally, the description of system architecture for a secure DBMS is presented.

Computer Security↗