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At least 1,423 records · Page 79Linked to original sources
PubMed2006

The crisis in sexual health and developing genitourinary medicine services: lessons from a primary care trust.

The House of Commons Health Select Committee recently described a national crisis in sexual health. Alarmed by dramatic increases in the rates of sexually transmitted infections (STIs) and appalled by over-stretched, under-resourced genitourinary (GU) medicine services, the committee has called for urgent action. The increasing rates of STIs locally, a significant cluster of syphilis cases, and an over-burdened GU medicine service prompted Walsall primary care trust to undertake an evaluation of local service provision. The results were used to inform the development of GU medicine services locally and Walsall's sexual health strategy. This paper reports the results of the evaluation and the implications for service development. The Walsall GU medicine service was evaluated using three approaches, based on standards for GU medicine service provision identified from the literature. Routine data were used to analyse trends in STIs and service activity, including access times. These data further informed the evaluation process. Local stakeholder views on GU medicine service provision were sought using semi-structured interviews. Most standards relating to the provision of core services, including those for the management of patients with HIV infection, were met. High levels of patient satisfaction were reported. However, under-staffing, inadequate clinic facilities, and limited joint working with other agencies were highlighted as key concerns. Tackling sexual health inequalities and improving the sexual health of the population requires investment in resources and manpower, improved partnership working, and configuring services around the needs of patients. In addition, and perhaps most importantly, it will require a shift in how both health professionals and the public perceive and utilize sexual health services.

Adolescent↗
PubMed1984

Medicaid drug-event data: an emerging tool for evaluation of drug risk.

Post-marketing surveillance (PMS) of drugs requires access to multiple data resources covering the spectrum of drug exposures and drug-associated events. In the U.S., the Federal/State third party payment system for medical care to welfare recipients, Medicaid, maintains drug-event data by date of service. The FDA has explored this data for drug utilization studies, generation of signals of drug risk, and strengthening of hypotheses of drug associated problems. Thus far, studies suggest the data from Michigan and Minnesota, covering 1.5 million patients for 18 months, can be a useful, multifunctional tool for PMS studies. Examples of use to date are presented.

Adolescent↗
PubMed2004

Remote monitoring of implantable cardioverter defibrillators: a prospective analysis.

A prospective study evaluating the functionality and ease of use of the Medtronic CareLink Network, "CareLink," was conducted at ten investigational sites. This internet-based remote monitoring service allows clinicians to remotely manage their patients' implantable cardioverter defibrillators (ICDs) and chronic diseases. The network is comprised of a patient monitor, a secure server, and clinician and patient websites. Under clinician direction, patients interrogated their ICDs at home, and transmitted data to secure servers via a standard telephone line. Comprehensive device data and a 10-second presenting rhythm electrogram were captured by the monitor and available for access and review on the clinician website. The information could also be printed using a standard desktop computer with internet access. During this study, patients were asked to transmit device data twice, at least 7 days apart, as scheduled by the clinic. Monitor functionality was assessed, and ease of using the system components was evaluated via questionnaires completed by patients and clinicians following each data transmission and review. Fifty-nine patients (64 +/- 14 years, range 22-85 years) completed 119 transmissions with only 14 calls to the study support center. Clinician review of data transmissions revealed several clinically significant findings, including silent AF discovery, assessment of antiarrhythmic drug efficacy in a previously diagnosed AF patient, previously unobserved atrial undersensing, and ventricular tachycardia. ICD patients found the monitor easy to use. Clinicians were pleased with the performance of the network and the quality of the web-accessed data, and found it comparable to an in-office device interrogation. CareLink is a practical tool for routine device management and may allow timely identification of clinically important issues.

Adult↗
PubMed1998

MHCWeb: converting a WWW database into a knowledge-based collaborative environment.

The World Wide Web (WWW) is useful for distributing scientific data. Most existing web data resources organize their information either in structured flat files or relational databases with basic retrieval capabilities. For databases with one or a few simple relations, these approaches are successful, but they can be cumbersome when there is a data model involving multiple relations between complex data. We believe that knowledge-based resources offer a solution in these cases. Knowledge bases have explicit declarations of the concepts in the domain, along with the relations between them. They are usually organized hierarchically, and provide a global data model with a controlled vocabulary. We have created the OWEB architecture for building online scientific data resources using knowledge bases. OWEB provides a shell for structuring data, providing secure and shared access, and creating computational modules for processing and displaying data. In this paper, we describe the translation of the online immunological database MHCPEP into an OWEB system called MHCWeb. This effort involved building a conceptual model for the data, creating a controlled terminology for the legal values for different types of data, and then translating the original data into the new structure. The OWEB environment allows for flexible access to the data by both users and computer programs.

Artificial Intelligence↗
PubMed1997

Implementation of a filmless mini picture archiving and communication system in ultrasonography: experience after one year of use.

This article details our experience in developing and operating an ultrasound mini-picture archiving and communication system (PACS). Using software developed in-house, low-end Macintosh computers (Apple Computer Co. Cupertino, CA) equipped with framegrabbers coordinate the entry of patient demographic information, image acquisition, and viewing on each ultrasound scanner. After each exam, the data are transmitted to a central archive server where they can be accessed from anywhere on the network. The archive server also provides web-based access to the data and manages pre-fetch and other requests for data that may no longer be on-line. Archival is fully automatic and is performed on recordable compact disk (CD) without compression. The system has been filmless now for over 18 months. In the meantime, one film processor has been eliminated and the position of one film clerk has been reallocated. Previously, nine ultrasound machines produced approximately 150 sheets of laser film per day (at 14 images per sheet). The same quantity of data are now archived without compression onto a single CD. Start-up costs were recovered within six months, and the project has been extended to include computed tomography (CT) and magnetic resonance imaging (MRI).

Compact Disks↗
PubMed1994

The predictive utility of expressed emotion in schizophrenia: an aggregate analysis.

We analysed aggregate data from 25 studies linking Expressed Emotion (EE) and schizophrenia. We had access to original data sets from 17 studies, and used published data from the remainder. This provided us with 1346 cases from around the world. The association of EE with relapse was overwhelming, and was maintained whatever the geographical location. The predictive capacity of EE was virtually identical in men and women. While high contact with a high EE relative increased the risk of relapse, the opposite was true in low EE households. Medication and EE were independently related to relapse, and thus EE status has no bearing on the decision to prescribe. Our findings were confirmed using log-linear analysis.

Cross-Cultural Comparison↗
PubMedDate not supplied

Bringing chemical data onto the Semantic Web.

Present chemical data storage methodologies place many restrictions on the use of the stored data. The absence of sufficient high-quality metadata prevents intelligent computer access to the data without human intervention. This creates barriers to the automation of data mining in activities such as quantitative structure-activity relationship modelling. The application of Semantic Web technologies to chemical data is shown to reduce these limitations. The use of unique identifiers and relationships (represented as uniform resource identifiers, URIs, and resource description framework, RDF) held in a triplestore provides for greater detail and flexibility in the sharing and storage of molecular structures and properties.

Journal Article↗
PubMed2003

[Electronic distribution of patient records and images through PACS: implementation of data protection at the University Hospital in Freiburg].

In large installations of a Picture Archiving and Communication System (PACS), data protection becomes an issue. Above all, not every employee should have access to all data stored in the system. At the Freiburg University Hospital, we developed a concept of dynamic assignment of authorization, assuring that every physician is authorized to the data of all patients under his care. We describe the technical implementation of data protection developed for the integration of PACS and electronic patient records in Freiburg. The system was installed in January 2001 and the experience of its two years in operation is reported.

Computer Security↗
PubMed2002

Accessibility to the public environment as perceived by teenagers with functional limitations in a south Swedish town centre.

PURPOSE: Owing to physical inaccessibility persons with mobility restrictions and other functional limitations often face problems in public environments, leading to restrictions in activity and participation. To investigate general accessibility and perceived problems of accessibility to the public environment in a town centre, as well as visiting preferences to public facilities, among teenagers with functional limitations. METHODS: An interview questionnaire specific to a south Swedish town was constructed and used with 33 Swedish teenagers with functional limitations. RESULTS: To a varying degree, all 33 teenagers commented on accessibility problems, e.g. concerning uneven surface material outdoors, steps at entrances, heavy doors and restricted space indoors. The results also indicated that teenagers with functional limitations to a high extent want to visit the same environments as other teenagers, but that it is often impossible owing to accessibility problems. Furthermore, because of accessibility problems, many of the teenagers were dependent on personal assistance. CONCLUSION: Inaccessibility results in dependence, which might affect personal development negatively, and much effort are required in order to ensure activity and societal participation. Efficient priorities in public environment accessibility matters and discussions with the actors involved require valid and reliable data on local accessibility problems.

Adolescent↗
PubMed2001

Progenetix.net: an online repository for molecular cytogenetic aberration data.

UNLABELLED: Through sequencing projects and, more recently, array-based expression analysis experiments, a wealth of genetic data has become accessible via online resources. In contrast, few of the (molecular-) cytogenetic aberration data collected in the last decades are available in a format suitable for data mining procedures. www.progenetix.net is a new online repository for previously published chromosomal aberration data, allowing the addition of band-specific information about chromosomal imbalances to oncologic data analysis efforts. AVAILABILITY: http://www.progenetix.net CONTACT: mbaudis@stanford.edu

Chromosome Aberrations↗
PubMed1984

Accuracy of spontaneous abortion recall.

Data regarding spontaneous abortion are more easily obtained retrospectively than prospectively. However, the comparable quality of data obtained by these two approaches is not known. Retrospective data are difficult to validate because spontaneous abortions are not routinely documented. In this study, the quality of retrospective data was evaluated by comparing them with prospective data collected incidentally in a long-term study of menstrual cycles. A total of 348 women recorded one or more spontaneous abortions while participating in the Menstrual and Reproductive Health Study and were resurveyed regarding their pregnancy histories. Seventy-five per cent of recorded abortions were recalled. Gestational age at time of abortion was the major determinant of recall, with early abortions less often remembered. Time since abortion also affected recall, but less so. Other factors such as parity or maternal age were not related to completeness of recall. Recall of three fourths of recorded abortions among this group of women sensitized to their reproductive functions probably represents an upper limit of recall for other populations. While retrospective abortion data often are more accessible than medical records or prospective data, there may be limits to the usefulness of recalled abortion data in certain settings.

Abortion, Spontaneous↗
PubMed2006

School performance indicators as proxy measures of school dental treatment needs: a feasibility study.

OBJECTIVE: This ecological study assessed the feasibility and predictive ability of readily available educational indicators as proxy measures of school dental treatment needs in York Region elementary school children, Canada. METHOD: Data sources included York Region Dental Health Unit dental screening data (2003-2004); area-based income data from Statistics Canada (2001) based on school address postcodes; grade three and grade six school performance results in reading, writing mathematics and English as a second language (ESL) data (2003-2004) obtained from publicly accessible educational websites. RESULTS: Data analyses included 219 schools. Pearson's correlations showed that schools with a higher percentage of children needing urgent dental treatment had significantly higher proportions of children scoring below provincial averages in all six school performance categories. Hierarchical stepwise multiple linear regression analysis showed that two school performance variables remained in the model after controlling for area-based median family income and ESL variables: the percentage of grade six pupils scoring below the provincial average in writing and the percentage of grade 3 pupils scoring below the provincial average in reading. CONCLUSIONS: The study established the feasibility of using school-level school performance indicators as proxy measures of school-level dental treatment needs. School performance results were good predictors of urgent dental treatment in York Region elementary school children. Further studies are needed using data from other jurisdictions to determine the utility of educational indicators in oral health programs.

Child↗
PubMed1998

Should vaccines require a prescription?

OBJECTIVE: To review the rationale for requiring prescriptions to control vaccine access, in contrast to other medications. DATA SOURCES: Literature on immunization delivery and health-service barriers was reviewed via MEDLINE search and relevant textbooks. Additional literature was obtained from reference lists of pertinent articles. DATA SYNTHESIS: Society controls access to medications to protect consumers. Many medications have changed from prescription-only to over-the-counter (OTC) status. No parenteral drug has been switched, although insulin has long had OTC status. Limiting access to vaccines has advantages in record-keeping, storage, injection quality, and response to anaphylactic reactions. These advantages are outweighed by 600000 people who will die over the next decade for lack of pneumococcal and influenza immunizations. Physicians see most of those who die of these diseases, but many neglect to vaccinate them. Three options are offered to expand access to these vaccines. The most feasible one involves expanding prescribing authority for pneumococcal and influenza vaccines to all licensed healthcare professionals and paraprofessionals with physiologic and pharmacologic expertise to responsibly vaccinate. Community pharmacies offer advantages as immunization delivery sites, in terms of proximity, hours of operation, and knowledge of people at highest risk. Expanded professional training can ensure high levels of public safeguards while expanding immunization delivery. CONCLUSIONS: Society decides the controls needed to protect the health of the people. If society restricts vaccine access too severely, people die needlessly. Increasing prescribing authority for pneumococcal and influenza vaccines to more health professionals will save many lives.

Humans↗
PubMed2001

The effect of helicobacter pylori eradication on NSAID-induced gastrointestinal toxicity.

OBJECTIVE: To review the data to determine whether Helicobacter pylori eradication alters nonsteroidal antiinflammatory drug (NSAID)-induced gastrointestinal toxicity. DATA SOURCE: Literature accessed through MEDLINE from 1966 to May2000 and abstracts of recently presented data at scientific meetings. DATA SYNTHESIS: NSAID use and H. pylon infection are independent risk factors for the development of gastrointestinal ulcers. An evaluation of the relationship between these two risk factors and the impact of H. pylori eradication on NSAID-induced gastrointestinal toxicity was conducted. CONCLUSIONS: H. pylori colonization and NSAID use are independent risk factors for the development of gastrointestinal ulcers. The data regarding the interaction between these two risk factors in the development of gastrointestinal ulcers are conflicting. Eradication of H. pylori does not appear to decrease the risk of NSAID-induced gastrointestinal toxicity in the majority of patients. As there is little evidence to support a clear benefit of eradicating H. pylori in patients requiring NSAID therapy, routine screening for and eradication of H. pylori in these patients is not recommended.

Animals↗
PubMed1978

A problem orientated information system.

It has been suggested several times that care of patients with medical problems is not carried out in a consistent manner. Emergency medical care is most usually given by junior medical staff. It seems possible that their inexperience may further increase the inconsistency of care given. An information system HOISS (House Officer Information and Scheduling System) is described. It consists principally of a data-base of 80 clinical problems and a suite of programs to access the data-base. There is also a scheduling program which prints-out a worksheet of tests needed to be done that day. A review of the care of 86 patients is given. It is seen that there is considerable variation in the investigations done for a particular clinical problem. Also routine tests are not asked for and many investigations are done which cannot be justified from the patients condition. The results of five months experience with the system are presented. It is shown for the one problem considered that management was more consistent, the routine tests were done more regularly and there were less spurious tests performed.

Emergency Service, Hospital↗
PubMed1999

Evaluation of a data warehouse in an academic health sciences center.

A data warehouse can provide significant benefits to a health care organization if successfully designed and implemented. The Clinical Data Repository (CDR) at the University of Virginia Health Sciences Center improves access to needed data for clinical research and effective decision making at many levels of the organization. We conducted an evaluation of the CDR using a survey questionnaire and interviews of key executive leaders. Our results suggest factors that influence the initial decision to use an information resource, examine the impact of communication channels, and highlight key issues that determine the continued use and ultimate success of a healthcare data warehouse.

Academic Medical Centers↗