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Results for “clinical data sharing”

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At least 145 records · Page 8Linked to original sources
PubMed2005

A new experimental rat model of osteosarcoma established by intrafemoral tumor cell inoculation, useful for biology and therapy investigations.

Satisfactory experimental models for preclinical cancer studies must follow several criteria: (1) reproducibility of the method used to induce the tumor and (2) clinical, pathological and kinetic similarity with the corresponding human tumors. We developed a model of osteosarcoma locally induced by the intrafemoral injection of osteosarcoma (OSR) cells in Sprague-Dawley rats. This method yields nearly 80% of bone tumors at the injection site. These tumors double their volume fairly slowly (in approximately 20 days) and lung metastases occur in 96% of the animals. The OSR cell-induced tumor is characterized by a direct production of mineralized matrix by the tumor cells themselves, as revealed by histochemical analysis. The microarchitectural parameters which were quantified by a microscanner show an increased trabecular bone volume (+238%) when OSR cells were injected in the femur, as compared to controls injected with vehicle. Osteoblastic markers such as alkaline phosphatase, osteopontin, osteocalcin and bone sialoprotein were expressed by the tumor in vivo, whereas the initially injected OSR cells did not express some of these markers, suggesting that OSR cells reacquired an osteoblastic phenotype in a favorable environment. The clinical, radiological and histological data show that this model shares high similarities with the osteocondensing forms of osteosarcoma in humans.

Animals↗
PubMed2005

Clinical teaching of student nurses by unit managers of selected hospitals in Limpopo Province.

The comprehensive nature of nurse training needs the involvement of almost all health team personnel, including unit managers to gain practical experience and learn to correlate theory and practice. The overall aim of the study was to explore and describe the experiences of unit managers regarding teaching of student nurses in the clinical area and to develop recommendations that will enhance clinical teaching, for the production of competent future nurse practitioners who will render quality care to patients. A qualitative design, which is explorative, descriptive and contextual in nature, was employed, utilizing a phenomenological approach to capture the experiences of unit managers regarding teaching of student nurses at selected hospitals, where students are allocated for their clinical exposure. Ethical measures as well as measures to ensure trustworthiness were adhered to. In-depth phenomenological interviews were conducted with unit managers who shared their experiences regarding clinical teaching of student nurses. Data analysis was done according to Tesch's (1990) open coding method. One major theme emerged, namely that unit managers experienced problems when doing clinical teaching of student nurses. Based on the findings the following recommendations were made: Colleges should open a two-way communication with unit managers, involvement of unit managers in the activities that take place at the college like courses, seminars and workshops on clinical teaching, learning contracts should be developed for the students and issues of clinical learning should be addressed and unit managers should be included in both summative and formative evaluations.

Attitude↗
PubMed1999

[Limitations of the concept of idiopathic generalized epilepsy].

The 1989 International Classification of Epilepsies confirmed the existence of a category of Idiopathic Generalized Epilepsies (IGE), which includes a list of age-dependent syndromes that are supposed to share a common mechanism. Recent clinical, experimental and genetic data have shown that the group of IGEs is indeed heterogeneous, that various mechanisms are implied, and that the limits of this category remain comparatively unclear, especially versus cryptogenic or symptomatic generalized epilepsies. There is no such thing as a truly "generalized" epilepsy, and "idiopathic" means in fact that epileptic seizures are the only, or predominant symptom of the condition. The pharmacological sensitivity (some drugs control IGEs, other drugs usually aggravate them) seems to be common to a majority of the syndromes of IGE. The concept of IGE remains useful in clinical practice, and should be widened to include newly described syndromes.

Age Factors↗
PubMed1991

[Nephrotoxicity of anti-CD3 monoclonal antibodies].

The OKT3 monoclonal antibody entails a transient acute nephrotoxicity when used either to prevent or to treat renal allograft rejection. This nephrotoxicity was reproduced experimentally in mice injected with 145-2C11, an anti-CD3 monoclonal antibody which shares many properties with OKT3. Both clinical and experimental data suggest that the renal lesions are due to the systemic release of cytokines that occurs prior to the immunosuppression. Pre-treatment with corticosteroids before the injection of anti-CD3 monoclonal antibody mitigates both the release of cytokines and the nephrotoxicity, in a dose-dependent manner. Experimental data suggest that very high doses of methylprednisolone (50 mg/kg) administered 2 to 3 hours before the monoclonal antibody are necessary to obtain an optimal protection.

Animals↗
PubMed1998

Benefits of the worldwide government computer-based patient record framework.

The G-CPR organization composed of the DoD, VA, IHS, and the LSUMC presents an opportunity to facilitate the exchange of clinical data across existing healthcare information systems with new business practices. The organization's ability to reengineer existing healthcare delivery processes through the G-CPR framework will improve the sharing of information and will ultimately provide for better-quality healthcare, improved access to care, greater cost efficiencies, and enhanced medical readiness of the DoD healthcare beneficiaries. The projected benefits that are by-products of the organization sharing effort tend to be focused in two broad categories: improving access to clinical data and creating a mechanism to gather information across large clinical populations. Both of the two categories include various benefits that accrue to members of the organization relative to their ability to use the G-CPR framework as a business reengineering tool. As information management processes are refined through reengineering initiatives, benefits will be observed at multiple program levels--from the DoD enterprise level down to the operational level at individual treatment facilities. Using comprehensive data to quantify precise benefits and ROI strategies is difficult because the development of the G-CPR framework is still in its early stage. Formal performance-based outcome studies are envisioned to demonstrate these results once the G-CPR framework attains greater functional definition. Through the future development of benefits performance metrics, these benefits can be shown to have substantial impact on achieving the strategic goals of the MHS and the organization while helping to improve the cost and quality of healthcare, access to care, and the medical readiness posture within the DoD.

Computer Communication Networks↗
PubMed2006

Averting iatrogenic hypoglycemia through glucose prediction in clinical practice: progress towards a new procedure in diabetes.

BACKGROUND: Hypoglycemia is a risk factor common to all insulin therapy. The hypothesis is that efforts to reduce or prevent this adverse side effect may fail because providers generally lack the resources to predict not only future blood glucose levels but also future risks of hypoglycemia. This lack has been remedied. A controlled study was undertaken to test the hypothesis. METHODS: Twenty-two insulin dependent subjects suffering more than one (1) episode/week of hypoglycemia with similar insulin regimens, similar diabetes education and similar self-management training participated in this study. For all subjects, a remote monitoring resource (registry and database) was used to capture daily SMBG and afford a return path for provider interventions and decision support. Identical telemedical methods were used which differed only for the provider either by the presence (prediction group) or by the absence (control group) of an on-screen, visual display of predicted glycemia and predicted risks of hypoglycemia. The study lasted 2 months. RESULTS: Over an average of 41 days from baseline to follow up and while using the glycemic prediction resource, providers intervened more effectively in the prediction group reducing rates of hypoglycemia nine-fold (P<0.0001) and insulin therapy by just -9 U/day (P<0.01). Mean pre-meal glycemia was not compromised. Over 61 days from baseline to final follow up but without glycemic predictions in the control group, providers' interventions were less effective and resulted in no net changes in rates of hypoglycemia, daily insulin therapy, or mean pre-meal glycemia. CONCLUSIONS: Given knowledge of future glycemia and future risks of hypoglycemia, providers in clinical practice can now avert iatrogenic hypoglycemia in less than 2 months. A shared diabetes data center furnishing remote data capture and decision support is fundamental to the implementation of this as a new clinical procedure in diabetes.

Adolescent↗
PubMed2006

The effect of misclassification errors on case mix measurement.

Case mix systems have been implemented for hospital reimbursement and performance measurement across Europe and North America. Case mix categorizes patients into discrete groups based on clinical information obtained from patient charts in an attempt to identify clinical or cost difference amongst these groups. The diagnosis related group (DRG) case mix system is the most common methodology, with variants adopted in many countries. External validation studies of coding quality have confirmed that widespread variability exists between originally recorded diagnoses and re-abstracted clinical information. DRG assignment errors in hospitals that share patient level cost data for the purpose of establishing cost weights affects cost weight accuracy. The purpose of this study is to estimate bias in cost weights due to measurement error of reported clinical information. DRG assignment error rates are simulated based on recent clinical re-abstraction study results. Our simulation study estimates that 47% of cost weights representing the least severe cases are over weight by 10%, while 32% of cost weights representing the most severe cases are under weight by 10%. Applying the simulated weights to a cross-section of hospitals, we find that teaching hospitals tend to be under weight. Since inaccurate cost weights challenges the ability of case mix systems to accurately reflect patient mix and may lead to potential distortions in hospital funding, bias in hospital case mix measurement highlights the role clinical data quality plays in hospital funding in countries that use DRG-type case mix systems. Quality of clinical information should be carefully considered from hospitals that contribute financial data for establishing cost weights.

Diagnosis-Related Groups↗
PubMed2001

Childhood-onset schizophrenia: research update.

This review is a research update of recent literature related to childhood-onset schizophrenia (onset of psychotic symptoms by age 12 years). This subgroup of patients has attracted considerable research interest because patients with a childhood onset may represent a more homogeneous patient population in which to search for risk or etiologic factors. We examine data indicating that childhood-onset schizophrenia (COS) shares the same clinical and neurobiologic features as later-onset forms of the disorder. Compared with adults with schizophrenia, however, this subgroup of patients appears to have more severe premorbid neuro-developmental abnormalities, more cytogenetic anomalies, and potentially greater family histories of schizophrenia and associated spectrum disorders. While preliminary, these data indicate that a greater genetic vulnerability may be one of the underpinnings of COS. Future studies of this subgroup may provide important clues as to the genetic basis for schizophrenia and how gene products influence certain features of the disease, such as age of onset and mode of inheritance.

Adolescent↗
PubMed2002

An evaluation of the applicability of quantitative clinical standards for the management of genital chlamydial infection using an electronic database.

A prototype electronic database was designed for use as a retrospective audit tool to provide data that allowed comparison of genital chlamydial infection management performance with a series of quantitative operational consensus standards. However, some of the terms used by the standards require further definition for translation into database fields to improve accuracy and general application as an audit tool. Construction of the database involved differentiation between prior and clinic diagnostic points, as well as a forward contact trail of specific quantitative indicators of contact tracing. More definition is needed of the meaning of diagnosis and contact in the standards. For clinic-diagnosed patients, the time to treatment was mainly dependent on clinical factors, not on the availability of a chlamydial test result. For about one-third of patients (with prior management), several standards cannot be applied because data are not available, and this raises the issue of data sharing between various agencies involved in chlamydial testing. More data from other clinics may help both to test the appropriateness of, and inform, some of the operational standards. The database could be developed as a real-time audit tool for use with electronic patient records.

Ambulatory Care↗
PubMed2003

Liability to substance use disorders: 1. Common mechanisms and manifestations.

Variation in the risk for and severity of substance use disorders (SUD) in the population is caused by multiple organismic (genetic, biochemical, psychological) and environmental factors. Whereas drug- or drug-class-specific liability mechanisms exist, a substantial proportion of variance in the risk is shared between specific liabilities, reflecting mechanisms that determine common liability to SUD. Data from epidemiologic, clinical, psychological, physiological, biochemical, and family and genetic studies reviewed in this paper indicate the existence of mechanisms and characteristics shared in common by liabilities to SUD related to different drugs. These mechanisms can be conceptualized as common liability to SUD, a latent trait accounting for a substantial portion of variation in SUD risk and severity and determined by all factors influencing the probability of SUD development. An accompanying paper describes an approach to the quantitative estimation of this trait.

Brain Chemistry↗
PubMed2006

[The development of database system of electrocardiographic information].

An ECG information database system was established with 1297 ECG information records and clinical informations. The data and the analysis software in this database can be shared with the international physiological signal databases such as MIT-BIH Arrhythmia. The establishment of this database will facilitate the clinical interpretation, diagnosis and prediction of cardiovascular diseases, especially the cardiac sudden death (SCD).

Artificial Intelligence↗
PubMed2002

Lack of therapeutic interchangeability of HMG-CoA reductase inhibitors.

OBJECTIVE: To review relevant literature and provide an opinion on the class effect of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins). DATA SOURCES: Primary and review articles were identified by MEDLINE search (1990-July 2002). STUDY SELECTION AND DATA EXTRACTION: Editorials, studies, and review articles related to the class effect or therapeutic interchangeability of statins were reviewed. Also included was information that is relevant to this topic. DATA SYNTHESIS: Although statins share common main actions, they may have clinically important differences in terms of efficacy and safety. At fixed or allowable dosages, rosuvastatin, atorvastatin, and simvastatin produced greater low-density lipoprotein cholesterol-lowering effects compared with other statins. Some statins have shown reduction in either cardiovascular and/or total mortality. Statins also differ in their structure, pharmacokinetics, potency, and rate of metabolism, any or all of which may have clinical significance. Although inconclusive, subtle differences in nonlipid effects of some statins may have contributed to positive benefits observed in clinical studies. As a result of drug-related deaths, cerivastatin was withdrawn voluntarily from the market, which may raise the question whether there is therapeutic interchangeability (due to class effect) among statins. CONCLUSIONS: Despite the competition for market share and strategies attempting to identify differences in therapeutic value, few head-to-head comparisons between statins have been performed. The limited, available data suggest that statins are not therapeutically interchangeable.

Drug Interactions↗
PubMedDate not supplied

Recent advances in the management of biotherapy-related side effects: fatigue.

Limited information about fatigue patterns in patients with cancer exists in the biotherapy literature. When fatigue is mentioned, it is usually to state whether or not it was a dose-limiting side effect. No further data are provided on how fatigue was measured; which patterns were noted and when; and which relationships were found between fatigue and demographic characteristics, type of biologic response modifier, route of administration, or cumulative dose. Thus, there is little available in the biotherapy literature to guide nursing practice in managing this side effect. Theory that guides practice, however, often emanates from the personal experiences of the patients and from the clinical observations and intuitive hunches of the nurses and physicians participating in clinical trials. These individuals have been most generous in sharing their insights and unpublished data with the authors. This paper presents a comprehensive view of current knowledge on fatigue to guide present nursing practice with patients receiving biotherapy and to provide direction for future nursing and clinical trial research.

Fatigue↗
PubMed1993

Clinical quality improvement in a multihospital system: the voluntary hospitals of America/Pennsylvania experience.

Sharing of patient outcome data among hospitals hastened the evolution of continuous quality improvement at Voluntary Hospitals of American/Pennsylvania (VHA/PA) to a focus on learning from the best: clinical benchmarking. Analysis of VHA/PA MedisGroups comparative outcome data showed significant variation. In the first study, variations from 3 to 25% normal appendectomy rates were noted. A second study on primary and secondary cesarean section rates again showed variation in outcomes. A study of the benchmark hospitals showed characteristics, specific to those institutions, that resulted in excellent outcomes. To quantify best processes, VHA/PA has embarked on a clinical benchmarking project with the assistance of MediQual Systems, Inc.

Adolescent↗
PubMed1997

A foundational model of time for heterogeneous clinical databases.

Differences among the database representations of clinical data are a major barrier to the integration of databases and to the sharing of decision-support applications across databases. Prior research on resolving data heterogeneity has not addressed specifically the types of mismatches found in various timestamping approaches for clinical data. Such temporal mismatches, which include time-unit differences among timestamps, must be overcome before many applications can use these data to reason about diagnosis, therapy, or prognosis. In this paper, we present an analysis of the types of temporal mismatches that exist in databases. To formalize these various approaches to timestamping, we provide a foundational model of time. This model gives us the semantics necessary to encode the temporal dimensions of clinical data in legacy databases and to transform such heterogeneous data into a uniform temporal representation suitable for decision support. We have implemented this foundational model as an extension to our Chronus system, which provides clinical decision-support applications the ability to match temporal patterns in clinical databases. We discuss the uniqueness of our approach in comparison with other research on representing and querying clinical data with varying timestamp representations.

Databases as Topic↗
PubMed1995

The registration function as a critical dependency in a lifetime clinical record (LCR).

Over the past two years, we have successfully migrated the Regenstrief Clinical Information System into our hospital. Integral to this process was the need to develop interfaces and processes supporting movements of patient identification data between the existing clinical management system (Unity, SMS) and Carebase (RCIS). Critical to the implementation of Carebase was the development of an interface between Carebase and the registration system based upon a unique medical record number. Even more critical was the development of stable processes that supported the accurate patient identification and assignment of medical record numbers. The medical record number at our institution is assigned or verified at the time of registration. Major problems occurred when patients presented during system down-times and existing medical record numbers could not be accessed, resulting in multiple registrations and medical record numbers for the same patient. This resulted in data fragmentation and required merging at a later date. Other more serious problems resulted from the assignment of the same medical record number to separate patients and with the mixing of data from multiple patients into one patient record. This was largely due to the failure of clerical personnel to appropriately identify patients at the time of registration, or multiple patients sharing identification documents, a common problem in our geographic area. Given that clinical data was to be maintained and added to the repository for several decades, errors such as these in registration would prove catastrophic. The interfaces between the various clinical systems that pass data to Carebase are all HL-standard and largely prevent data passage if registration data is inaccurate. During the early stages of implementation, approximately 300 exceptions per day were generated from clinical systems attempting to pass data to the repository. Following re¿engineering of the registration process, education of clerical personnel, and analysis of exception type, the number of exceptions due to faulty registration data fell to less than one per week. To achieve improvement in exception volume, several innovative measures were undertaken. Firstly, down-time procedures were changed to require query of the LCR for existing registration data. The LCR was maintained on a separate platform that experienced essentially no down-time and was available for this purpose. This largely eliminated the need for the use of "down-time numbers" or medical record numbers that could be temporarily assigned to patients registered when the registration system was unavailable (data would subsequently be merged into existing patient records if the patient was found to be currently in the system). If the patient was not in the LCR, then a permanent number was assigned in sequence. A registration dataset was developed and encoded onto a magnetic card (Carecard, Eltrax) and carried by patients. This enabled the rapid verification of registration data on subsequent visits to the parent institution or affiliated clinical sites. The issue of fraudulent use of the card and encoded registration dataset, however, remained problematic. Currently, a new imaging system is being installed that will soon enable the inclusion of a photograph of the patient as a component of the registration dataset. Perhaps the most significant change in the registration process involved the education of central registration and admitting personnel. An educational program was developed that reinforced the need for accuracy in collecting registration data, identifying patients, and assigning medical record numbers; more importantly, it stressed the linkage of the registration function and patient care. Lastly, an aggressive approach to monitoring exceptions resulting from errors in registration was developed. A near real-time process for identifying errors in registrations allowed for rapid intervention and feedback to involved de

Medical Records Systems, Computerized↗