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SUMMARY: Medusa is a Java application for visualizing and manipulating graphs of interaction, such as data from the STRING database. It features an intuitive user interface developed with the help of biologists. Medusa is optimized for accessing protein interaction data from STRING, but can be used for any type of graph from any scientific field.
Using data from the 1996/1997 Community Tracking Study household survey, this study examines the effects of public programs on the decision to take up employer coverage when offered versus enrolling in public coverage or being uninsured. The results show that among those with access to employer-sponsored coverage, low-income persons living in states with more expansive eligibility for Medicaid were more likely to decline employer coverage in favor of public coverage, while low-income persons in areas with public hospitals were more likely to decline coverage in favor of being uninsured. While persons who decline employer coverage in favor of public coverage maintain the same level of access to medical care, those who decline coverage in favor of being uninsured give up a considerable degree of access. Implications concerning policies to improve access to care for the uninsured are discussed.
OBJECTIVE: To evaluate evidence supporting the use of spironolactone in managing congestive heart failure. DATA SOURCES: Literature accessed through MEDLINE (January 1966-December 1999) and cross-referencing of selected articles. Search terms included spironolactone and heart failure. DATA SYNTHESIS: Heart failure is a leading cause of morbidity and mortality. Through aldosterone antagonism, spironolactone may be an effective pharmacotherapeutic addition to patients not responding to standard drug therapy for heart failure. RESULTS: Clinical trials have demonstrated that, in patients with heart failure, spironolactone improves laboratory indices, quality of life, and morbidity. Recently, spironolactone has been demonstrated to improve the survival of patients with New York Heart Association (NYHA) III or IV heart failure. CONCLUSIONS: Spironolactone use should be considered in patients with NYHA Class III or IV heart failure.
The Genetics of Kidneys in Diabetes (GoKinD) study is an initiative that aims to identify genes that are involved in diabetic nephropathy. A large number of individuals with type 1 diabetes were screened to identify two subsets, one with clear-cut kidney disease and another with normal renal status despite long-term diabetes. Those who met additional entry criteria and consented to participate were enrolled. When possible, both parents also were enrolled to form family trios. As of November 2005, GoKinD included 3075 participants who comprise 671 case singletons, 623 control singletons, 272 case trios, and 323 control trios. Interested investigators may request the DNA collection and corresponding clinical data for GoKinD participants using the instructions and application form that are available at http://www.gokind.org/access. Participating scientists will have access to three data sets, each with distinct advantages. The set of 1294 singletons has adequate power to detect a wide range of genetic effects, even those of modest size. The set of case trios, which has adequate power to detect effects of moderate size, is not susceptible to false-positive results because of population substructure. The set of control trios is critical for excluding certain false-positive results that can occur in case trios and may be particularly useful for testing gene-environment interactions. Integration of the evidence from these three components into a single, unified analysis presents a challenge. This overview of the GoKinD study examines in detail the power of each study component and discusses analytic challenges that investigators will face in using this resource.
Rhesus monkeys implanted with intravenous catheters readily self-inject a wide variety of psychoactive drugs. Under conditions where access to drug is not limited, pharmacological variables are important determinants of the rate and pattern of drug-reinforced responding. Data for unlimited access phencyclidine self-administration are presented to illustrate the types of findings obtained from unlimited access studies. The results with phencyclidine indicate a pattern of drug intake that progressed from variable day-to-day response rates at a low dose to relatively stable daily response rate with greater drug intake at a higher dose. The pattern of responding, toxicity, and development of physical dependence seen in these subjects were similar in many respects to results found with several other drugs under conditions of unlimited access. These findings demonstrate that unlimited access studies are particularly useful for revealing toxic consequences of self-administered doses. Moreover, a review of the literature indicated that procedures allowing unlimited access by drug-naive monkeys were at least as likely to reveal reinforcing properties of drugs as limited access procedure using drug-experienced subjects.
INTRODUCTION: The distribution and types of Internet connectivity will determine the equity of access by patient populations to emerging health technologies. We sought to measure the rates, types, and predictors of access in a patient population targeted for Web-based medical services. METHODS: Design. Cross sectional in-person interview. Setting. Emergency department of a large urban pediatric teaching hospital. Subjects. Primary caretakers of patients or patients at least 16 years old. Procedure and measures. Subjects were asked about access to e-mail and the Internet as well as about willingness to use and concerns about Web-based services. Views of equity and access and sociodemographic data were also elicited. RESULTS: 132 subjects were enrolled in the study. Of respondents, 67.2% use a computer and 36.4% can access the Internet or e-mail from home. Including Internet connections and/or e-mail accounts at work, school and public libraries, 50.7% of the sample has access. Forty percent of families have e-mail accounts. The rate at which families have connectivity is primarily correlated with income (r = 0.6, p < 0.01). At all income levels, rates of access to the World Wide Web are higher than to e-mail. White patients are much more likely to have e-mail (OR 5.0, 95% CI 2.4-10.8) and Web access (OR 3.6, 95% CI 1.7-7.5). CONCLUSIONS: Connectivity is directly correlated with income and distributed unevenly across racial and ethnic groups. World Wide Web access is more prevalent than e-mail accounts, and both are often obtained outside the home. Design of health applications should account for these attributes of patient access.
Clinicians are always searching for efficient access to clinical data. The Regenstrief Medical Record System has a printed report that fills this niche: Pocket Rounds. Handheld computers may offer an alternative, but it is unclear how effectively a handheld computer can display such data. We surveyed residents and students on the general medicine services for their opinions regarding Pocket Rounds. Those with handheld computers were given access to an electronic version of Pocket Rounds-e-Rounds. We surveyed the subjects who used e-Rounds for their opinions on the electronic format and how it compared to paper. Users overall satisfaction with Pocket Rounds was 5.8 on a seven-point scale. User s overall satisfaction for e-Rounds was 5.6 on a seven-point scale. The most useful function was retrieval of lab data for both modalities. The results suggest that the electronic format is a viable alternative to paper. Further evaluation is needed, and we plan a prospective controlled trial to study this further.
A lot of nucleotide sequences of some genes, especially 16S rRNA gene, are registered in the public data-base. In order to identify clinical mycobacterial strains, 16S rRNA gene partial nucleotide sequences from 15 strains of Mycobacterium malmoense and 24 strains of Mycobacterium szulgai which are stored in the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association were determined. Then homology of the sequences to the data of type strains submitted to public database were determined. Relative analogy to type strains by delta DDH was also measured. In the area of nucleotide position 51-588 corresponding accession number X52930 which is Mycobacterium malmoense type strain 16S rRNA gene sequence data, the homology of some partial sequences with Mycobacterium malmoense strains to data of accession number X52930 were lower than that with Mycobacterium szulgai type strain data, accession number X52926. In the area of nucleotide position 31-568 or nucleotide position 31-588, the homology of all nucleotide sequence data to collect species data of type strains were higher than the homology to another species data. Nucleotide position 38, 40, 47 and 49 might be differential nucleotides conserved between Mycobacterium malmoense strains and Mycobacterium szulgai one. These results suggest that homology of about 500 bp's 16S rRNA gene nucleotide sequence data may not be enough for differential identification. Nevertheless, database of RIDOM, Ribosomal differentiation of Medical Microorganisms, identified partial nucleotide sequences between nucleotide position 51-588 corresponding accession number X52930 correctly, though some were lower than 97% homology (data not shown). Therefore quality-controlled 16S rRNA gene nucleotide sequence database could be used for differential identification.
It is important for a PACS to have access to the patient data, as well as to the images themselves, for the purpose of sophisticated image archiving, retrieving, viewing and interpretation. There are many kinds of patient data concerning image examinations (i.e., patient name, ID, age, examination date and time, examined regions, methods, findings on images, diagnoses or diagnostic impressions, etc.). Some of them are acquired from image examination apparatus, some are supplied by diagnostic radiologists, while some need be retrieved from the radiology and hospital information systems. To facilitate this data exchange, a PACS-RIS-HIS coupling is required. The author has constructed at Tokyo University Hospital a small PACS called TRACS, which adopts one of the possible PACS-RIS-HIS coupling configurations.
CONTEXT: Although an extensive literature exists comparing national access to health care for uninsured vs insured children, few data exist regarding differences in access across states. OBJECTIVE: To examine variation in access to physician services for uninsured children in 10 states, the safety net's role in explaining this variation, and the potential effects of the State Children's Health Insurance Program (CHIP) on insurance coverage and access. DESIGN AND SETTING: The population-based Robert Wood Johnson Foundation Family Health Insurance Survey, conducted between summer 1993 and spring 1994 in 10 states (Colorado, Florida, Minnesota, New Mexico, New York, North Dakota, Oklahoma, Oregon, Vermont, and Washington), with a response rate of families by state ranging from 61% to 83%. PARTICIPANTS: A total of 8565 children who were uninsured (1586), covered by Medicaid (2723), or covered by employer-sponsored private insurance (4256) for 1 full year prior to the survey. MAIN OUTCOME MEASURES: Percentage of low-income children who are uninsured and predicted annual physician visits by state if insurance was provided to uninsured children in families with incomes of less than 200% of poverty level. RESULTS: In the 10 study states, low-income children ranged from 61% to 86% of all uninsured children and the uninsured rate for low-income children varied from 9% to 31%. On average, providing public coverage would increase annual physician visits from 2.3 to 4.6 (a 105% increase), but the increase would range from 41% to 189% across states. The annual physician visit rate in the 3 states with the highest access for the uninsured was 160% of that in the 3 lowest-access states. Safety net capacity in the high-access states ranged from 120% to 220% of that in the low-access states. CONCLUSIONS: Our data suggest that the potential effects of CHIP vary substantially across states. Notably, improvements in access to health care by uninsured low-income children should be greater in states with the fewest safety net resources.
Computerized patient charting and trended data acquisition are becoming important elements of respiratory and intensive care. Continuous, remote monitoring of a patient's respiratory functions is now accessible with automated data acquisition systems. The system described in this article features real-time data collection from up to eight ventilators, automated patient charting, graphic trending, and configurable modes for viewing graphic trends. These features provide practitioners with continuous graphic presentations of ventilator data, which allows for better recording and understanding of each patient's respiratory progress.
BACKGROUND: Clinical trial data provide an approach to the investigation of the effects of psychopharmacological agents, and psychiatric disorders themselves, on seizure threshold. METHODS: We accessed public domain data from Food and Drug Administration (FDA) Phase II and III clinical trials as Summary Basis of Approval (SBA) reports that noted seizure incidence in trials of psychotropic drugs approved in the United States between 1985 and 2004, involving a total of 75,873 patients. We compared seizure incidence among active drug and placebo groups in psychopharmacological clinical trials and the published rates of unprovoked seizures in the general population. RESULTS: Increased seizure incidence was observed with antipsychotics that was accounted for by clozapine and olanzapine, and with drugs indicated for the treatment of OCD that was accounted for by clomipramine. Alprazolam, bupropion immediate release (IR) form, and quetiapine were also associated with higher seizure incidence. The incidence of seizures was significantly lower among patients assigned to antidepressants compared to placebo (standardized incidence ratio = .48; 95% CI, .36- .61). In patients assigned to placebo, seizure incidence was greater than the published incidence of unprovoked seizures in community nonpatient samples. CONCLUSIONS: Proconvulsant effects are associated with a subgroup of psychotropic drugs. Second-generation antidepressants other than bupropion have an apparent anticonvulsant effect. Depression, psychotic disorders, and OCD are associated with reduced seizure threshold.
Individual health outcomes differ greatly between neighborhoods, and recent research has begun to examine how neighborhood environment affects individual health. A common hypothesis is that the inequitable distribution of healthcare resources limits access to health care for individuals in disadvantaged neighborhoods, causing poorer long-term health. Yet, research has not examined if neighborhood environment actually affects an individual's ability to access primary care. Data from the Los Angeles Family and Neighborhood Survey suggests there is significant variation between neighborhoods in an individual's ability to access primary care. This neighborhood-level effect is not explained by the composition of individuals living in the neighborhood. Four mechanisms through which neighborhood environment could affect an individual's ability to access primary care are examined: (1) neighborhood information networks, (2) neighborhood health behavior norms, (3) neighborhood social capital and (4) neighborhood healthcare resources. Social capital and healthcare resources significantly predict an individual's primary care access. Since differences in primary care access may explain individual-level health disparities between neighborhoods, policies designed to improve primary care access must account for both individual and neighborhood effects.
BACKGROUND: Nonoperative management of radiographically defined solid organ injuries has proven highly successful in children with blunt splenic and hepatic injuries. The role of nonoperative management protocols is less well defined for blunt renal injuries. The purpose of this study was to review the management and outcome of a consecutive series of children with blunt renal injury. METHODS: The trauma registry from a Level I pediatric trauma center was reviewed to identify all children (age < 19 years) who were treated for a blunt renal injury for the period January 1995 through December 2002. Demographic, anatomic, physiologic, management, and outcome data were analyzed. RESULTS: For the 8 years of review, 101 children with a blunt renal injury were identified, including 95 with accessible and complete data. The renal injury population had a mean age of 10.4 years (range, 0.5-18 years) and was 72.6% male. The renal injuries were distributed as follows: grade 1, n = 22; grade 2, n = 40; grade 3, n = 20; grade 4, n = 11; and grade 5, n = 2. Hematuria was present in 88.1% of children (in whom urinalysis results were available). Four children had underlying congenital renal anomalies. The mean hospital length of stay and intensive care unit stay were 6.0 and 2.6 days, respectively. Overall, 5 children (5.3%) required laparotomy, including 1 nephrectomy (isolated grade 4 injury) and 1 renorrhaphy, for an overall renal salvage rate of 98.9%. In children with isolated renal injuries (n = 48), one child (2.1%) required laparotomy. Seven children required adjunctive urologic procedures (ureteral stenting, n = 5; cystoscopy/cystogram, n = 2). There were seven deaths (7.4% overall; five because of head injury and two because of severe abdominal bleeding at presentation). CONCLUSION: A nonoperative management strategy was advantageous and successful in pediatric blunt renal injuries (94.7% successful nonoperative rate, 98.9% renal salvage rate). Adjunctive urologic procedures (e.g., ureteral stenting) were beneficial in selected cases.
BACKGROUND: Obstetric outcome data can be accessed by a variety of different methods in New South Wales, Australia, including Diagnosis-Related Group (DRG) summaries and the Midwives Data Collection (MDC). The accuracy of the reporting of the obstetric complications encompassed by the hypertensive disorders of pregnancy (HDP) has been doubted owing to the inconsistency and confusing coding categories available in both coding systems. AIM: To test that there would be no disagreement in coding between DRG coding, MDC coding and a disorder-specific database. METHODS: A prospective disorder-specific database, namely the Hypertensive Disorders of Pregnancy Database (HDPDB), was maintained for 6 months and diagnoses were compared with the DRG and MDC coding systems. Medical records of all women (n = 230) who received a HDP coding during this period were examined and recoded using the Australasian Society for the Study of Hypertension in Pregnancy diagnostic groupings. The HDPDB was the gold standard for the comparison of coding. RESULTS: Significant coding errors were found in both systems available. Sixty-four percent (P < 0.001) of medical records were incorrectly coded in the DRG coding system and 56% (P < 0.001) were incorrectly coded in the MDC. CONCLUSIONS: Current database systems are unreliable for recording maternal medical conditions, such as hypertension, and accuracy can only be assured with the use of a disorder-specific database, such as the HDPDB.
Despite the plethora of methods and tools available to support strategic management, the challenge for health executives in the next century will relate to their ability to access and interpret data from multiple and intricate communication networks. Integrated digital networks and satellite systems will expand the scope and ease of sharing information between business divisions, and networked systems will facilitate the use of virtual case discussions across universities. While the internet is frequently used to support clinical decisions in the healthcare industry, few executives rely upon the internetfor strategic analysis. Although electronic technologies can easily synthesize data from multiple information channels, research as well as technical issues may deter their application in strategic analysis. As digital models transform access to information, online models may become increasingly relevant in designing strategic solutions. While there are various pedagogical models available to support the strategic management process, this framework was designed to enhance strategic analysis through the application of technology and electronic research. A strategic analysis framework, which incorporated internet research and case analysis in a strategic managementcourse, is described alongwith design and application issues that emerged during the case analysis process.
In the sixties and seventies, the School of Medicine of the University of Chile was the first Chilean institution to incorporate computers into academic endeavors through its own Computer Center. Later, professors were marginated from policy making, which became oriented to administrative goals, but they compensated that situation with the easy access to personal computers brought about by present technology. In 1986, when School authorities were again elected by the faculty staff, professors were able to participate again in a committee designing projects in this area. Current development at the School of Medicine include a proliferation of personal computers, the implementation of a computer network with access to medical data bases, and a growing number of applications in the fields of research and teaching. In the near future, due to the accessibility of telecommunications and computers, these advancements should have an impact on the whole biomedical community, a situation that would restore, after many years, the traditional role of the University of Chile in the life of the country.
The concept of computerized expert systems is explained, the potential utility of these systems in pharmacy is explored, and strategies and imperatives for implementing them are described. Computerized expert systems attempt a higher level of analysis than traditional computer programs. They can be defined as systems that attempt to make or assist in a decision that is not yet completely and reliably definable in objective terms. Because of the information-intensive nature of pharmacy practice, this field is particularly suited to use of expert systems. Current applications include screening for drug interactions and therapeutic drug monitoring. Expert systems must offer a substantial advantage over human expertise (for example, by quickly analyzing enormous quantities of data); those that perform functions that humans could perform have failed to gain widespread use. An ideal hospital expert system would have access to any data available about a patient's care and would detect critical situations as they occur. Such a system would require pharmacists to shift from a prescription-based orientation to a case-management orientation. Factors to consider in implementing an expert system include linkage among multiple departments, usage options, development strategies, and maintenance requirements. Computerized expert systems hold great potential for application to pharmacy and may influence the pharmacist's role in patient care.