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At least 1,621 records · Page 90Linked to original sources
PubMed2006

A Web-based telemedicine system for diabetic retinopathy screening using digital fundus photography.

The purpose was to design and implement a Web-based telemedicine system for diabetic retinopathy screening using digital fundus cameras and to make the software publicly available through Open Source release. The process of retinal imaging and case reviewing was modeled to optimize workflow and implement use of computer system. The Web-based system was built on Java Servlet and Java Server Pages (JSP) technologies. Apache Tomcat was chosen as the JSP engine, while MySQL was used as the main database and Laboratory of Neuro Imaging (LONI) Image Storage Architecture, from the LONI-UCLA, as the platform for image storage. For security, all data transmissions were carried over encrypted Internet connections such as Secure Socket Layer (SSL) and HyperText Transfer Protocol over SSL (HTTPS). User logins were required and access to patient data was logged for auditing. The system was deployed at Hubert H. Humphrey Comprehensive Health Center and Martin Luther King/Drew Medical Center of Los Angeles County Department of Health Services. Within 4 months, 1500 images of more than 650 patients were taken at Humphrey's Eye Clinic and successfully transferred to King/Drew's Department of Ophthalmology. This study demonstrates an effective architecture for remote diabetic retinopathy screening.

Diabetic Retinopathy↗
PubMed2001

Oral bexarotene in the treatment of cutaneous T-cell lymphoma.

OBJECTIVE: To review the preclinical and clinical information related to oral bexarotene approved by the Food and Drug Administration for the treatment of cutaneous manifestations of cutaneous T-cell lymphoma (CTCL) in patients who are refractory to at least one prior systemic therapy. DATA SOURCES: Literature accessed through MEDLINE (from 1990 to July 2000) and provided by the manufacturer. Key search terms included bexarotene, Targretin, LGD1069, and cutaneous T-cell lymphoma. DATA SYNTHESIS: The management of CTCL remains controversial due to its rarity in the US and its heterogeneity. An evaluation focusing on the pharmacology of bexarotene and its role in the management of the different stages of CTCL was conducted. CONCLUSIONS: Bexarotene has demonstrated activity in the treatment of CTCL. The oral route of administration and the adverse effect profile of bexarotene appear to make this drug a favorable option for the treatment of CTCL. Compared with other systemic therapies. Phase III randomized studies are needed to determine the clinical benefits of bexarotene as monotherapy or combination therapy in the treatment of CTCL.

Administration, Oral↗
PubMed2004

UUMA. Regional eHealth services in the hospital district of Helsinki and Uusimaa (HUS).

The UUMA approach is based on a stepwise implementation of integrated regional healthcare services to create a virtually borderless healthcare organisation--a patient centred virtual workspace. In the virtual workspace multi-professional teams and patients collaborate and share information regardless of time and place. Presently the regional ehealth network is comprised of four different integrated services between primary, secondary and tertiary care within the county of Uusimaa. The strategic healthcare modules consist of an (1) ereferral and econsultation network, (2) a knowledge-based disease management platform, (3) PACS system and (4) a universal model for integrated regional services between professionals and patients by a link directory service. The ereferral between primary and secondary care not only speeds up the transfer, but also offers an option for communication in the form of econsultation between general practitioners and hospital specialists. By sharing information and knowledge remote econsultations create a new working environment for integrated delivery of eServices between the health care providers. Last year over 60,000 eReferrals were transferred between health care providers. When associated with viewing of patient data through the link directory, interactive econsultations enable supervised care leading to the reduction of outpatient visits and more timely appointments. The link directory service extends the dimensions of networking between organizations by combining legacy systems within regional primary and secondary care. The link directory is an interface to diverse patient information systems, like HUSpacs, containing links pointing to the actual patient data located in remote information systems. The original data including images can be viewed with a web browser, but data can be accessed only with the patient's informed consent. The chronic disease management system is disease specific: information is utilised in parallel to viewing other relevant medical data through the link directory. We aim to create a new working environment for professionals by incorporation of innovative information and communication technology, new organisation of work and re-engineering of workflows. The citizen has an active role in deciding on the use of his medical information, participating in decisions on his care, carrying out guided self-care and taking steps of pro-active prevention.

Computer Communication Networks↗
PubMedDate not supplied

A practical approach to public health surveillance of violent deaths related to intimate partner relationships.

OBJECTIVES: Articles describing the epidemiology of intimate partner homicide (IPH) have often been positioned as one-time research projects utilizing a single data source for case identification. However, researchers without access to centralized repositories for data pertinent to IPH can ascertain cases by using multiple extant data sources. The authors describe a surveillance system that can serve as a model for state health departments and others seeking to quantify and characterize violent deaths related to intimate partner relationships on an ongoing basis. METHODS: Retrospective surveillance was conducted to identify and characterize deaths related to intimate partnerships by linking the following data sources: death certificates, newspaper articles, law enforcement reports, and medical examiners' records. RESULTS: The authors identified at least 34% more IPHs using multiple data sources than would have been recognized solely using Supplementary Homicide Reports--the most frequently cited data source for IPH case ascertainment--and 22% more cases than newspaper data alone would have allowed for. CONCLUSIONS: While it was discovered that at least 181 IPHs--and at least 128 other deaths related to intimate partnerships--occurred in Michigan from 1999-2001, this frequency of occurrences is probably conservative. This limitation is due, in part, to the researchers not having access to information from all possible data source contributors. However, in the absence of statewide data systems, the authors demonstrate the utility of using multiple data sources for violent death surveillance to address incomplete case ascertainment.

Female↗
PubMed2003

3-D imaging with MDCT.

Without doubt, the greatest challenge of multidetector-row CT is dealing with 'data explosion'. For our carotid/intracranial CT angiograms, we routinely have 375 images to review (300 mm coverage reconstructed every 0.8 mm); for aortic studies we have 450-500 images ( approximately 600 mm coverage reconstructed every 1.3 mm); and for a study of the lower extremity inflow and run-off, we may generate 900-1000 transverse reconstructions. While we could reconstruct fewer images for these data, experience with single-detector row CT scanners indicates that longitudinal resolution and disease detection is improved when at least 50% overlap of cross-sections is generated [Radiology 200 (1996) 312]. If we are to optimize our clinical protocols and take full advantage of these CT scanners, we will need to change the way that we interpret, transfer, and store CT data. Film is no longer a viable option. Workstation based review of transverse reconstructions for interpretation is a necessity, but the workstations must improve to provide efficient access to these data, and we must have a way of providing our clinicians with images that can be transported to clinics and the operating room. Alternative visualization and analysis using volumetric tools, including 3-D visualization must evolve from luxury to necessity. We cannot rest on historical precedent to interpret these near isotropically sampled volumetric data using transverse reconstructions alone [Radiology 173 (1989) 527]. Although the tools for volumetric analysis on 3-D workstations have evolved over recent years, they have probably not yet evolved to a level that routine interpretation can be performed as efficiently and accurately as transverse section review. Both hardware and software developments must occur. While current computer workstations and visualization software are certainly adequate for assessing these MDCT data volumetrically, the process is very time consuming. What follows are a description of current workstation capabilities and a brief discussion of where development needs to go to facilitate the complete integration of volumetric analysis into the interpretive process of CT data.

Humans↗
PubMed2004

[A multidisciplinary mModule for oncological documentation within a hospital information system].

The follow-up documentation of oncological patients in Germany is inadequate in many cases: it is usually limited to a minimal dataset mandated by the epidemiological tumor registers; it is carried out in a paper-based fashion and rarely in a multi-disciplinary context. Parallel documentation efforts can result in redundant or erroneous data and excess work. The introduction of hospital information systems (HIS) allows the implementation of digital oncological documentation systems integrated in surrounding clinical workflows that can provide access to existing data sources as well as data entry and presentation across departmental boundaries. This concept enables the integration of tumor documentation, quality assurance and process optimization within HIS. Feasibility requirements include a high flexibility and adaptability of the underlying HIS to reach a seamless integration of oncological documentation forms within routine clinical workflows. This paper presents the conceptual design and implementation of a modular oncological documentation system at the Muenster University Hospital that is capable of integrating the documentation requirements of multiple departments within the hospital.

Computer Systems↗
PubMedDate not supplied

Quality of life in rheumatoid arthritis.

Assessment of health-related quality of life (HRQoL) is relevant for the patients and is important in both clinical research and daily clinical practice. Generic and disease-specific instruments for assessment of HRQoL are reviewed. Changes in HRQoL provide important information on randomized controlled clinical trials as well as on observational studies. The floor effect is a limitation of many of the scales, especially in patients with less severe disease. Feasibility and low test-retest reproducibility limit the use of many of the instruments in clinical practice, especially when they are used for individual treatment decisions. Electronic transferral of data from patients to the health professionals by, for example, internet or a personal digital assistant (PDA), opens up new opportunities for frequent patient reports and improved access to the data.

Arthritis, Rheumatoid↗
PubMed1991

Computerization of a colposcopy clinic.

The first phase of a paperless computer record has been developed at Hammersmith Hospital. The system was designed around the work practices of the clinic staff. In this phase the data are collected on forms which replace the normal case notes. This information is entered onto an IBM compatible computer by the secretary using a quick, user-friendly program written in a dBASE dialect and compiled with Quicksilver. The program produces letters to patients and their doctors and a printed record of the clinic findings for the case sheet to replace the handwritten form. When funding for hardware becomes available the data will be entered directly into the system by the medical staff in the clinic. Clinic appointment lists are maintained and patients "lost to follow-up' can be identified. Ad hoc enquiries can be made using dBASE III Plus or any similar program. This approach has integrated the computerized recording of data in a colposcopy clinic with the normal work of the staff involved so that no extra effort is required from medical or secretarial staff. The immediate accessibility of patient data and the ability to audit the work of the clinic have been particularly useful.

Ambulatory Care Information Systems↗
PubMed1988

Office evaluation and management of the symptomatic knee.

In summary, data recorded during the office evaluation should include a chief complaint, a subjective history, a functional history, motion and strength analysis, and objective examination measurements. Storage and access of these data may be categorized on the basis of probable etiology. Finally, the historic and examination criteria for conservative or surgical care may be reviewed periodically to evaluate the results of a specific treatment and changes may be made as necessary to improve patient satisfaction and improve the physician's diagnostic and therapeutic capabilities.

Adolescent↗
PubMedDate not supplied

Using multiple imputation for analysis of incomplete data in clinical research.

BACKGROUND: Sample loss and missing data are inevitable in multivariate and longitudinal research. Ad hoc approaches such as analysis of incomplete data or substituting the group mean for missing data, while common, may unnecessarily reduce statistical power and threaten study validity. Multiple imputation for missing data is a newly accessible, methodologically rigorous approach to dealing with the problem of missing data. APPROACH: To (a) discuss the problem of missing data in clinical research, and (b) describe the technique of multiple imputation. A case of analysis of multivariate psychosocial data is presented to illustrate the practice of multiple imputation. RESULTS: The advantages of multiple imputation are it (a) results in unbiased estimates, providing more validity than ad hoc approaches to missing data; (b) uses all available data, preserving sample size and statistical power; (c) may be used with standard statistical software; and, (d) results are readily interpreted. DISCUSSION: Accessible, user-friendly computer programs are available to perform multiple imputation for missing data making ad hoc approaches to missing data obsolete.

Data Interpretation, Statistical↗
PubMed1998

Leprosy and disability control in the Guéra prefecture of Chad, Africa: do women have access to leprosy control services?

In a retrospective study, data from the Guéra Leprosy and Disability Control Project in Chad, covering the years from 1992 to 1996, were analysed in order to determine whether there was any indication that the quality of care provided to female leprosy sufferers is inferior to the care provided for male patients. Data from a total of 741 patient registered for MDT, of whom 351 were newly diagnosed cases, are presented and discussed. The data indicate that women have access to diagnosis and treatment and health education. They do not present for treatment later than men, disability rates are lower and they have slightly higher treatment completion rates. Both women and men benefit from footwear and loan programs. More women than men are involved in patient self-help groups. The study shows that in this part of central Chad, there is no evidence of disadvantage for women with leprosy in either diagnosis, treatment or follow-up, but more qualitative data is needed to confirm these findings.

Adolescent↗
PubMed1996

The need and demand for renal replacement therapy in ethnic minorities in England.

STUDY OBJECTIVE: The study aimed to determine the relative risk of being accepted for renal replacement treatment of black and Asian populations compared with whites in relation to age, sex, and underlying cause. The implications for population need for renal replacement therapy in these populations and for the development of renal services were also considered. DESIGN/SETTING: This was a cross sectional retrospective survey of all patients accepted for renal replacement treatment in renal units in England in 1991 and 1992. PATIENTS: These comprised all 5901 patients resident in England with end-stage renal failure who had been accepted for renal replacement therapy in renal units in England and whose ethnic category was available from the units. Patients were categorised as white, Asian, black, or other. Population denominators for the ethnic populations were taken from the 1991 census. The census categories Indian, Pakistani, and Bangladeshi were aggregated to form the denominator for Asian patients, and black Caribbeans, black Africans, and black others were aggregated to form the denominator for black patients. MAIN RESULT: Altogether 7.7% of patients accepted were Asian and 4.7% were black; crude relative acceptance rates compared with whites were 3.5 and 3.2 respectively. Age sex specific relative acceptance ratios increased with age in both ethnic populations and were greater in females. Age standardised acceptance ratios were increased 4.2 and 3.7 times in Asian and black people respectively. The most common underlaying cause in both these populations was diabetes; relative rates of acceptance for diabetic end-stage renal failure were 5.8 and 6.5 respectively. The European Dialysis and Transplant Association coding system was inaccurate for disaggregating non-insulin and insulin dependent forms. "Unknown causes" were an important category in Asians with a relative acceptance of rate 5.7. The relative rates were reduced only slightly when the comparison was confined to the district health authorities with large ethnic minority populations, suggesting that geographical access was not a major factor in the high rates for ethnic minorities. CONCLUSION: Acceptance rates for renal replacement treatment are increased significantly in Asian and black populations. Although data inaccuracies and access factors may contribute to these findings, the main reason is probably the higher incidence of end-stage renal failure. This in turn is due to the greater prevalence of underlying diseases such as non-insulin dependent diabetes but possibly also increased susceptibility of developing nethropathy. The main implication is that these populations age demand for renal replacement treatment will increase. This will have an impact nationally but will be particularly apparent in areas with large ethnic minority populations. Future planning must take these factors into account and should include strategies for preventing chronic renal failure, especially that due to non-insulin dependent diabetes and hypertension. The data could not determine the extent to which population need was being met; further studies are required to estimate the incidence of end-stage renal failure in ethnic minority populations.

Adolescent↗
PubMed2003

Use of CAM in local African-American communities: community-partnered research.

Although previous national surveys have shown an increase in the use of complementary and alternative medicine (CAM) in the U.S. population, racial and ethnic minority populations were under-represented in these surveys. As a result, a profile of the CAM user as white, female, affluent, middle-aged and well educated has emerged. Representing the mainstream population, these previous studies did not take into account the racial and ethnic minority populations who may have their own healing traditions and who may hold different beliefs, use different terminology, and have unique patterns of CAM use. In partnership with community-based organizations and community residents, a culturally sensitive survey instrument and protocols were designed and tested to gather data on lower income, urban African-Americans' use of, attitudes toward, and understanding of CAM. The major findings of this pilot research are 1.) Community-partnered research can help researchers gain access to sensitive data and design culturally appropriate studies; 2.) CAM terminology varies by cultural group; 3.) Certain forms of CAM (folk or family practices) are commonly found in African-American populations; and 4.) Factors that affect CAM use--including age, lack of access to conventional medicine, cultural heritage, and dissatisfaction with conventional medicine.

Black or African American↗
PubMedDate not supplied

IVE (Image Visualization Environment): a software platform for all three-dimensional microscopy applications.

IVE (Image Visualization Environment) is a software platform designed from the outset to handle all aspects of modern computerized multidimensional microscopy. This platform provides users with an execution environment in which 5D data (XYZ, wavelength, and time) can be easily manipulated for the purpose of data collection, processing, display, and analysis. During the entire process, powerful data display functions are readily available for extracting complicated three-dimensional information through data visualization. By employing both the shared memory and multitasking features of the UNIX operation system, individual functions can be implemented as separate programs, and multiple programs can access the same data pool simultaneously. This enables users to combine the functionalities of different programs to facilitate each unique data analysis task. Furthermore, by defining an appropriate program execution model, commonly shared functional components such as data display, data I/O and user interface, etc. can be implemented using simple IVE library calls. This dramatically reduces the program development time and ensures consistency throughout the entire software system. As a result, users can quickly master the microscopy software system and new functions can be easily integrated, as different functional requirements arise for different research projects.

Chromosomes↗
PubMed2005

The impact of Life Science Identifier on informatics data.

Since the Life Science Identifier (LSID) data identification and access standard made its official debut in late 2004, several organizations have begun to use LSIDs to simplify the methods used to uniquely name, reference and retrieve distributed data objects and concepts. In this review, the authors build on introductory work that describes the LSID standard by documenting how five early adopters have incorporated the standard into their technology infrastructure and by outlining several common misconceptions and difficulties related to LSID use, including the impact of the byte identity requirement for LSID-identified objects and the opacity recommendation for use of the LSID syntax. The review describes several shortcomings of the LSID standard, such as the lack of a specific metadata standard, along with solutions that could be addressed in future revisions of the specification.

Computational Biology↗
PubMed2001

The Functional Magnetic Resonance Imaging Data Center (fMRIDC): the challenges and rewards of large-scale databasing of neuroimaging studies.

The Functional Magnetic Resonance Imaging Data Center (fMRIDC) (http://www.fmridc.org) was established in the Autumn of 1999 with the objective of creating a mechanism by which members of the neuroscientific community may more easily share functional neuroimaging data. Examples in other sciences offer proof of the usefulness and benefit that sharing data provides through encouraging growth and development in those fields. By building a publicly accessible repository of raw data from peer-reviewed studies, the Data Center hopes to create a similarly successful environment for the neurosciences. In this article, we discuss the continuum of data-sharing efforts and provide an overview of the scientific and practical difficulties inherent in managing various fMRI data-sharing approaches. Next, we detail the organization, design and foundation of the fMRIDC, ranging from its current capabilities to the issues involved in the submitting and requesting of data. We discuss how a publicly accessible database enables other fields to develop relevant tools that can aid in the growth of understanding of cognitive processes. Information retrieval and meta-analytic techniques can be used to search, sort and categorize study information with a view towards subjecting study data to secondary 'meta-' and 'mega-analyses'. In addition, we detail the technical and policy challenges that have had to be addressed in the formation of the Data Center. Among others, these include: human subject confidentiality issues; ensuring investigator's rights; heterogeneous data description and organization; development of search tools; and data transfer issues. We conclude with comments concerning the future of the fMRIDC effort, its role in promoting the sharing of neuroscientific data, and how this may alter the manner in which studies are published.

Brain↗
PubMed2007

Mental health and substance abuse services to parents of children involved with child welfare: a study of racial and ethnic differences for American Indian parents.

American Indian (AI) parents of children involved with child welfare were compared to White, Black and Hispanic parents on mental health and substance abuse problems and access to treatment. Data came from the National Study of Child and Adolescent Well-Being, a longitudinal study of a nationally representative sample of children aged 0-14 years involved with child welfare. Weighted statistics provided population estimates, and multivariate logistic regression was used to predict the likelihood of caregivers receiving mental health or substance abuse services. There were significant disparities in the likelihood of receiving mental health, but not substance abuse, services. Unmet need for mental health and substance abuse treatment characterized all parents in this study. AI parents fared the worst in obtaining mental health treatment. Parents of children at home and of older children were less likely to access mental health or substance abuse treatment.

Adolescent↗
PubMed2000

An expressed sequence tag database of T-cell-enriched activated chicken splenocytes: sequence analysis of 5251 clones.

The cDNA and gene sequences of many mammalian cytokines and their receptors are known. However, corresponding information on avian cytokines is limited due to the lack of cross-species activity at the functional level or strong homology at the molecular level. To improve the efficiency of identifying cytokines and novel chicken genes, a directionally cloned cDNA library from T-cell-enriched activated chicken splenocytes was constructed, and the partial sequence of 5251 clones was obtained. Sequence clustering indicates that 2357 (42%) of the clones are present as a single copy, and 2961 are distinct clones, demonstrating the high level of complexity of this library. Comparisons of the sequence data with known DNA sequences in GenBank indicate that approximately 25% of the clones match known chicken genes, 39% have similarity to known genes in other species, and 11% had no match to any sequence in the database. Several previously uncharacterized chicken cytokines and their receptors were present in our library. This collection provides a useful database for cataloging genes expressed in T cells and a valuable resource for future investigations of gene expression in avian immunology. A chicken EST Web site (http://udgenome. ags.udel. edu/chickest/chick.htm) has been created to provide access to the data, and a set of unique sequences has been deposited with GenBank (Accession Nos. AI979741-AI982511). Our new Web site (http://www. chickest.udel.edu) will be active as of March 3, 2000, and will also provide keyword-searching capabilities for BLASTX and BLASTN hits of all our clones.

Animals↗