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PubMedDate not supplied

Nurses' impact on the choice and longevity of vascular access.

A preponderance of data highlights significant improvements in outcomes when patients dialyze with arteriovenous fistulae compared with either catheters or grafts. "Fistula First" is a nationwide, evidence-based, quality improvement effort that is striving to improve vascular access outcomes by increasing the percentage of patients who dialyze with arteriovenous fistulae. Nephrology nurses will have a profound effect on achieving the goals outlined by Fistula First, including both the choice and longevity of vascular accesses.

Arteriovenous Shunt, Surgical↗
PubMed2002

[Telemedicine: chances and risks].

PROBLEM: Due to the rapid progress in the fields of information technology and data networks, telemedicine applications are growing in number. Besides curative telemedicine, the electronic exchange of medical data and the integration of health information systems between health care providers is gaining importance. Through the improved accessibility of electronic patient record information, considerable risks arise. METHODS: A project for the interconnection of medical picture archiving and communication systems (PACS) between several hospitals is presented and the possibilities for further developing such networking systems utilizing new software technologies for transparent data access between different locations (GRID) and for decision support (software agents) are considered. RESULTS: The availability of the electronic patient record via the data network and the perspective of semi intelligent software systems automatically preparing the data bears great potential for a boost in treatment quality and efficiency. Systems for unique electronic patient identification and for secure digital signature are a prerequisite, but per se not enough to ensure the protection of data against illegitimate access. CONCLUSION: Despite quality and efficiency benefits, challenges in the protection of sensible data and in the change of the physicians role result.

Artificial Intelligence↗
PubMed2004

Access to health care among Latinos of Mexican descent in colonias in two Texas counties.

CONTEXT: Critical to resolving the problem of health disparities among Latinos is examining the needs within ethnic subpopulations. This paper focused on the unique challenges encountered by one ethnic subpopulation-Latinos of Mexican descent living in colonias. Findings reaffirm the importance of looking within ethnic subpopulations to understand the complexities of health disparities. PURPOSE: This paper reports on data collected measuring access to health care among Latinos of Mexican descent living in several colonias in two southern Texas counties. METHOD: Observations are based on data gathered from a non-probability sample obtained through a face to face questionnaire focusing on health care access. Persons living in two Texas counties near the US border were included in this sample, and demographic data were compared to county, state and national statistics to examine the comparability of the sample to similar populations. FINDINGS: Findings from this snowball sample, N=271, suggested lower rates of health insurance coverage compared to the Latino population nationwide, decreased patterns of preventive screenings for blood pressure, diabetes, cholesterol, cancers (ie, breast, cervical, and prostate), and regular access to health care in Mexico by slightly more than half the sample. CONCLUSIONS: Seeking care in Mexico may be a viable solution for many indigent people of Mexican descent living in close geographic proximity to the border because it surmounts the political, cultural, linguistic, or economic barriers to health care services in the United States. Nonetheless, there are longer term questions regarding quality of care and health and wellness for this group of people.

Adolescent↗
PubMed2005

Grid-enabled biosensor networks for pervasive healthcare.

Current advances in biosensor technology allow multiple miniaturized or textile sensors to record continuously biosignals, such as blood pressure or heart rate, and transmit the information of interest to clinical sites. New applications are emerging, based on such systems, towards pervasive healthcare. This paper describes an architecture enabling biosensors, forming a Body Area Network (BAN), to be integrated in a Grid infrastructure. The Grid services proposed, such as access to recorded data, are offered via the BAN console, an enhanced wearable computer, where the recordings of multiple biosensors are integrated. Medical Grid-enabled Nodes can have access to biosensor measurements upon demand, or can agree to get notifications and alerts. Thus, in such a distributed environment, data and computational resources are independent, yet cooperating unobtrusively, contributing to the notion of pervasive healthcare.

Blood Pressure Monitoring, Ambulatory↗
PubMed1997

Electronic forms: benefits drawbacks of a World Wide Web-based approach to data entry.

It has long been realized that, compared to paper-based records, electronic record systems provide many advantages in the healthcare environment, including increased availability, improved legibility, long-term accessibility, (potentially) greater completeness, data encoding, and automated decision support and analysis. In spite of these recognized benefits, collection of patient data at the point of service generally does not occur, in large part because each such effort usually requires application-specific software and hardware, and, most significantly, provider time. Given the presence of WWW browsers now available on nearly every desktop, the support and access concerns for data entry applications can be substantially lessened. Despite these advantages, there are also downsides to the use of the WWW for data entry, including user interface issues and security. At CPMC, we are currently using web-based forms to gather patient charge data from physical and occupational therapists. Benefits of this approach have included a 98.2% user compliance rate for at least weekly data entry, and the reduction of charge posting from an average of 24.3 days to 2.3 days following the date of service. Drawbacks to WWW-based applications have included increased security exposure and persistent human tendencies to enter data in batches rather than at the time of service. A final conclusion was that, in the absence of a strong central mandate, providers must perceive a clear benefit in order to be willing to learn and use a new technology.

Attitude to Computers↗
PubMed2004

Targacept active conformation search: a new method for predicting the conformation of a ligand bound to its protein target.

Targacept active conformation search (TACS) is a novel variation of well-established three-dimensional quantitative structure--activity relationship methodologies that seeks to determine probable conformation(s) of ligands bound to their protein targets. A combination of affinity or activity data and energetically accessible conformational ensembles, each conformer described by three-dimensional (3-D) sensitive descriptors, forms the basis of the TACS data model. Recursive pruning is used to reduce the size of both the conformational ensemble and the descriptor space until the TACS data model contains just enough information to determine probable conformation(s) of ligands bound to their protein targets. The TACS algorithm is comprised of five components: (1) conformational ensemble generation, (2) 3-D sensitive descriptor calculation, (3) ensemble descriptor preprocessing, (4) model generation, and (5) prediction of bound conformation(s). Significantly, this method precludes the need for subjective or objective molecular alignment. We report the application of this technique to five benchmark protein-ligand couples where the conformation of a bound ligand has been previously established using X-ray crystallography: 9-cis-retinoic (1) and 9-trans-retinoic acid (2), both agonists for the retinoic acid receptor gamma, compounds KH1060 (3) and MC1288 (4), which bind to the vitamin D3 receptor, and R04 (5), an inhibitor bound to human rhinovirus 14 thermolysin. The binding conformations predicted by TACS were compared to the crystallographic structures extracted from their respective binding sites using root-mean-squared deviation (rmsd) criteria. Three of the conformations found using TACS were within crystallographic error. 9-cis-Retinoic acid, 9-trans-retinoic acid, and MC1288, when superimposed on their crystallographic structures, gave rmsd values of 0.22, 0.17, and 0.34 A, respectively. The rmsd values for KH1060 (1.54 A) and R04 (1.01 A) were larger but still reasonable.

Binding Sites↗
PubMed1998

Tritium planigraphy: from the accessible surface to the spatial structure of a protein.

The method of tritium planigraphy, which provides comprehensive information on the accessible surface of macromolecules, allows an attempt at reconstructing the three-dimensional structure of a protein from the experimental data on residue accessibility for labeling. The semiempirical algorithm proposed for globular proteins involves (i) predicting theoretically the secondary structure elements (SSEs), (ii) experimentally determining the residue-accessibility profile by bombarding the whole protein with a beam of hot tritium atoms, (iii) generating the residue-accessibility profiles for isolated SSEs by computer simulation, (iv) locating the contacts between SSEs by collating the experimental and simulated accessibility profiles, and (v) assembling the SSEs into a compact model via these contact regions in accordance with certain rules. For sperm whale myoglobin, carp and pike parvalbumins, the lambda cro repressor, and hen egg lysozyme, this algorithm yields the most realistic models when SSEs are assembled sequentially from the amino to the carboxyl end of the protein chain.

Algorithms↗
PubMed2004

AthaMap: an online resource for in silico transcription factor binding sites in the Arabidopsis thaliana genome.

Gene expression is controlled mainly by the binding of transcription factors to regulatory sequences. To generate a genomic map for regulatory sequences, the Arabidopsis thaliana genome was screened for putative transcription factor binding sites. Using publicly available data from the TRANSFAC database and from publications, alignment matrices for 23 transcription factors of 13 different factor families were used with the pattern search program Patser to determine the genomic positions of more than 2.4 x 10(6) putative binding sites. Due to the dense clustering of genes and the observation that regulatory sequences are not restricted to upstream regions, the prediction of binding sites was performed for the whole genome. The genomic positions and the underlying data were imported into the newly developed AthaMap database. This data can be accessed by positional information or the Arabidopsis Genome Initiative identification number. Putative binding sites are displayed in the defined region. Data on the matrices used and on the thresholds applied in these screens are given in the database. Considering the high density of sites it will be a valuable resource for generating models on gene expression regulation. The data are available at http://www.athamap.de.

Arabidopsis↗
PubMed1998

Acute bereavement services and routine referral as a mechanism to increase donation.

Efforts to develop a mechanism that improves donation rates and provides better service to patients and staff are presented in this article. The University of Nebraska Medical Center has incorporated a routine referral process into its acute bereavement services requiring representatives to respond to each in-house death to provide consistent support and management for the decedent's family and the hospital staff. Every family was offered bereavement support and the opportunity to consent to autopsy as well as to organ and tissue donation if medically appropriate. Key data related to death and consent discussions were documented, routinely reviewed, and reported to a central location. Appropriate and timely access of these data helped to modify the program and assess its need for additional education or intervention.

Academic Medical Centers↗
PubMed2006

[Constraints on publication rights in industry-initiated clinical trials--secondary publication].

In 22 of 44 industry-initiated clinical trial protocols from 1994-95, it was noted that the sponsor either owned the data or needed to approve the manuscript; another 18 protocols had other constraints. Furthermore, in 16 trials, the sponsor had access to accumulating data, and in an additional 16 trials the sponsor could stop the trial at any time, for any reason. These facts were not noted in any of the trial reports. We found similar constraints on publication rights in 44 protocols from 2004. This tight sponsor control over industry-initiated trials should be changed.

Clinical Trials Data Monitoring Committees↗
PubMed1996

Structural features and light-dependent changes in the cytoplasmic interhelical E-F loop region of rhodopsin: a site-directed spin-labeling study.

Thirty consecutive single cysteine substitution mutants in the amino acids Q225-I256 of bovine rhodopsin have been prepared and modified with a sulfhydryl specific nitroxide reagent. This sequence includes the E-F interhelical loop, a transducin interaction site. The accessibilities of the attached nitroxides to collisions with hydrophilic and hydrophobic paramagnetic probes in solution were determined, and the electron paramagnetic resonance spectra analyzed in terms of side chain mobility, both in the dark and after photoactivation. Accessibility cata shows that the rhodopsin polypeptide chain crosses an aqueous/ hydrophobic boundary in the range V227-K231 and again in the range V250-V254. In the hydrophobic segments, both the accessibility and mobility data are consistent with helical structures. In the regions of the sequence located within the aqueous phase, periodic variation in both accessibility and mobility of the spin-labeled side chains indicates that the E-F interhelical loop is largely alpha-helical, being formed by regular extensions of the E and F helices by about 1.5 and 3 turns, respectively. Judging from nitroxide mobilities, the putative extension of helix E in the aqueous phase is more dynamic than that of helix F. Changes in the electron paramagnetic resonance characteristics of the spin-labeled rhodopsin upon photoactivation indicate that chromophore isomerization results in patterns of structural changes that can be interpreted in terms of movements of helices that extend into the aqueous loop regions.

Amino Acid Sequence↗
PubMed1995

A relational database in neurosurgery.

UNLABELLED: This paper describes teh automatic procedure for a clinical record management in a Neurosurgery ward. The automated record allows the storage, querying and effective management of clinical data. This is useful during the patient stay and also for data processing and analysis aiming at clinical research and statistical studies. The clinical record is problem-oriented. It contains a minimum data set regarding every patient and a data set which is defined by a classification nomenclature (using an inner protocol). The main parts of the clinical record are the following tables: PERSONAL DATA: contains the fields relating to personal and admission data of the patient. The compilation of some fields is compulsory because they serve as input for the automated discharge letter. This table is used as an identifier for patient retrieval. ANAMNESIS: composed of five different tables according to the kind of data. They are: familiar anamnesis, physiological anamnesis, past and next pathology anamnesis, and trauma anamnesis. GENERAL OBJECTIVITY: contains the general physical information of a patient. The field hold default values, which quickens the compilation and assures the recording of normal values. NEUROLOGICAL EXAMINATION: contains information about the neurological status of the patient. Also in this table, ther are default values in the fields. COMA: contains standardized ata and classifications. The multiple choices are automated and driven and belong to homogeneous classes. SURGICAL OPERATIONS: the information recording is made defining the general kind of operation and then defining the peculiar kind of operation. INSTRUMENTAL EXAMINATIONS: some examination results are recorded in a free structure, while other ones (TAC, etc.) follow codified structure. In order to identify a pathology by means of TAC, it is enough to record three values corresponding to three variables. THis classification fully describes a lot of neurosurgical pathologies. DISCHARGE: contains conclusions, therapies, result, and hospital course. Medical language is closer to the natural one and presents some abiguities. In order to solve this problem, a classification nomenclature was used for diagnosis definition. DISCHARGE LETTER: the document given to the patient when he is discharged. It extracts data from the previously described modules and contains standard headings. The information stored int he database is structured (e.g., diagnosis, name, surname, etc.) and access to this data takes place when the user wants to search the database, using particular queries where the identifying data of a patient is put as conditions for the research (SELECT age, name WHERE diagnosis="TRAUMA"). Logical operators and relational algebra of the relational DBMS allows more complex queries ((diagnosis="TRAUMA" AND age="19") OR sex="M"). The queries are deterministic, because data management uses a classification nomenclature. Data retrieval takes place through a matching, and the DBMS answers directly to the queries. The information retrieval speed depends upon the kind of system that is used; in our case retrieval time is low because the accesses to disk are few even for big databases. In medicine, clinical records can have a hierarchical structure and/or a relational one. Nevertheless, the hierarchical model presents a disadvantage: it is not very flexible because it is linked to a pre-defined structure; as a matter of fact, the definition of path is established in the beginning and not during the execution. Thus, a better representation of the system at a logical level requries a relational DBMS which exploits the relationships between entities in a vertical and horizontal way. That is why the developers adopted a mixed strategy which exploits the advantages of both models and which is provided by M Technology with SQL language (M/SQL). For the future, it is important to have at one's disposal multimedia technologies, which integrate different kinds of information (alp

Databases, Factual↗
PubMed2002

Large-scale open bioinformatics data resources.

The data explosion in bioinformatics is relentless. More and more genomes are being sequenced and many new types of datasets are being generated in large-scale projects. Integration and true open access to the data are still difficult issues, although they are gradually being addressed. Notably, certain fields have good standardization and interoperability, while others lag behind. This review summarizes the latest developments in genome and sequences databases, transcriptomics data (ESTs, ORESTES, full-length cDNAs), proteomics data (protein databases, protein structures, family and domain classification) as well as loosely integrated fields, such as microarray experiments, mutation databases and databases of regulatory regions and elements. The review attempts to resist simply summarizing what data are available, and aims to provide a critical look at some of the integration and access issues associated with several of these resources.

Computational Biology↗
PubMed2001

Methods of the National Check Bus Project.

OBJECTIVES: Prevention at the worksite is considered increasingly important. This paper describes the methods used in a nationwide prevention campaign performed at a large Swiss bank and a Swiss industrial company. The aim of this project was to encourage general health awareness among company employees. We also aimed to provide the companies with general health analyses of their staff as a basis for future health promotion. Furthermore, new screening methods were evaluated in the field of research. METHODS: Participation in the programme was voluntary and free of charge. The programme targeted all 25,243 employees of the two companies in all regions of Switzerland. A mobile unit was available on site. The programme included a written health questionnaire and medical examinations (e.g., blood pressure, blood tests, ultrasound of the common carotid artery, osteodensitometry, examinations of the eye, etc). Analysis of individual test results, information brochures, and a telephone information service were also provided. Based on the data of the individuals, the "health status" of the employees of the two companies was analysed. The companies did not have access to the data of the individuals. The programme ran from August 1996 to August 1998. RESULTS: With a total of 10,321 persons taking part in the project, the participation rate was 41%. For the different examinations offered, patterns of participation were identifiable that varied with age, hierarchical status within the concern, body mass index, and number of physical complaints of the employee. Some of the variables showed the same trend for different tests, while others showed opposite trends. CONCLUSIONS: Participation in worksite health promotion programmes is dependent on a complex system of individual and structural variables that need to be considered when planning worksite health promotion programmes. Consideration of specific target population characteristics, including motivations and incentives as well as structural constraints is likely to improve participation rates in worksite health promotion programmes among employees.

Adolescent↗
PubMed1991

A model for critiquing based on automated medical records.

We describe the design of a critiquing system, HyperCritic, that relies on automated medical records for its data input. The purpose of the system is to advise general practitioners who are treating patients who have hypertension. HyperCritic has access to the data stored in a primary-care information system that supports a fully automated medical record. Hyper-Critic relies on data in the automated medical record to critique the management of hypertensive patients, avoiding a consultation-style interaction with the user. The first step in the critiquing process involves the interpretation of the medical record in an attempt to discover the physician's actions and decisions. After detecting the relevant events in the medical record, HyperCritic views the task of critiquing as the assignment of critiquing statements to these patient-specific events. Critiquing statements are defined as recommendations involving one or more suggestions for possible modifications in the actions of the physician. The core of the model underlying HyperCritic is that the process of generating the critiquing statements is viewed as the application of a limited set of abstract critiquing tasks. We distinguish four categories of critiquing tasks: preparation tasks, selection tasks, monitoring tasks, and responding tasks. The execution of these critiquing tasks requires specific medical factual knowledge. This factual knowledge is separated from the critiquing tasks and is stored in a medical fact base. The principal advantage demonstrated by HyperCritic is the adaption of a domain-independent critiquing structure. We show how this domain-independent critiquing structure can be used to facilitate knowledge acquisition and maintenance of the system.

Artificial Intelligence↗
PubMedDate not supplied

A workstation for multi-dimensional display and analysis of biomedical images.

The capability to extract objective and quantitatively accurate information from 3-D radiographic biomedical images has not kept pace with the capabilities to produce the images themselves. This is rather an ironic paradox, since on the one hand the new 3-D and 4-D imaging capabilities promise significant potential for providing greater specificity and sensitivity (i.e. precise objective discrimination and accurate quantitative measurement of body tissue characteristics and function) in clinical diagnostic and basic investigative imaging procedures than ever possible before, but on the other hand, the momentous advances in computer and associated electronic imaging technology which have made these 3-D imaging capabilities possible have not been concomitantly developed for full exploitation of these capabilities. Therefore, we have developed a powerful new microcomputer-based system which permits detailed investigations and evaluation of 3-D and 4-D (dynamic 3-D) biomedical images. The system comprises a special workstation to which all the information in a large 3-D image data base is accessible for rapid display, manipulation, and measurement. The system provides important capabilities for simultaneously representing and analyzing both structural and functional data and their relationships in various organs of the body. This paper provides a detailed description of this system, as well as some of the rationale, background, theoretical concepts, and practical considerations related to system implementation.

Computer Systems↗
PubMed1997

Mapping malaria risk in Africa: What can satellite data contribute?

Recent developments in the access of remotely sensed vegetation and weather data, and their analysis along with other data sources within a geographical information system (GIS), have opened up new possibilities for African health services and research institutes in malaria stratification, monitoring and early warning. Madeleine Thomson, Stephen Connor, Paul Milligan and Stephane Flasse review the current situation and outline the way ahead.

Journal Article↗
PubMed2002

The syndromic approach to treatment of sexually transmitted diseases in low-income countries: issues, challenges, and future directions.

BACKGROUND: Sexually transmitted diseases (STDs) are a major cause of adult morbidity worldwide. In 1991, the World Health Organization (WHO) introduced the concept of the "syndromic approach" to managing sexually transmitted diseases in low-income countries, however, there has been some controversy regarding the ongoing use of this approach. OBJECTIVES: (1) To understand the use of the syndromic approach to managing sexually transmitted diseases in low-income countries, and to determine if evidence supports its continued use. (2) To help Canadian doctors understand the past STD management of immigrant patients from low-income countries, and evaluate the direct effect (if any) of such medical practices to the patient's health and perception of health in Canada. METHODS: Medline was searched under the key words "sexually transmitted diseases," "developing nations," and "syndrome," as well as "algorithms," "prevention and control," and "WHO." Research articles and data were also accessed from the Web sites of WHO, UNAIDS, Reproductive Health Online (JHSPH), and the Centers for Disease Control and Prevention (USA). Data were selected based on the relevance to the topic, and research articles assessed from a methodological perspective. Most research articles were of Level II-2 evidence or lower as described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. RESULTS: In resource-poor countries, the use of the syndromic approach is appropriate for high-risk groups and for symptomatic individuals. However, it is still a poor screening approach when applied to asymptomatic cases, particularly in women. Risk scoring and simple laboratory tests help to increase the algorithmic sensitivity of the syndromic approach. CONCLUSION: Syndromic management involves making clinical decisions based on a patient's symptoms and signs. Until inexpensive, simple, and accurate STD diagnostics are developed and made available for use in low-income countries, a modified syndromic approach is the most feasible method of STD management in these countries. It is useful for Canadian physicians to be aware of this approach especially when caring for women from these countries.

Algorithms↗