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PubMed2005

Anatomic pathology databases and patient safety.

CONTEXT: The utility of anatomic pathology discrepancies has not been rigorously studied. OBJECTIVE: To outline how databases may be used to study anatomic pathology patient safety. DESIGN: The Agency for Healthcare Research and Quality funded the creation of a national anatomic pathology errors database to establish benchmarks for error frequency. The database is used to track more frequent errors and errors that result in more serious harm, in order to design quality improvement interventions intended to reduce these types of errors. In the first year of funding, 4 institutions (University of Pittsburgh, Henry Ford Hospital, University of Iowa, and Western Pennsylvania Hospital) reported cytologic-histologic correlation error data after standardizing correlation methods. Root cause analysis was performed to determine sources of error, and error reduction plans were implemented. PARTICIPANTS: Four institutions self-reported anatomic pathology error data. MAIN OUTCOME MEASURES: Frequency of cytologic-histologic correlation error, case type, cause of error (sampling or interpretation), and effect of error on patient outcome (ie, no harm, near miss, and harm). RESULTS: The institutional gynecologic cytologic-histologic correlation error frequency ranged from 0.17% to 0.63%, using the denominator of all Papanicolaou tests. Based on the nongynecologic cytologic-histologic correlation data, the specimen sites with the highest discrepancy frequency (by project site) were lung (ranging from 16.5% to 62.3% of all errors) and urinary bladder (ranging from 4.4% to 25.0%). Most errors detected by the gynecologic cytologic-histologic correlation process were no-harm events (ranging from 10.7% to 43.2% by project site). Root cause analysis identified sources of error on both the clinical and pathology sides of the process, and error intervention programs are currently being implemented to improve patient safety. CONCLUSIONS: A multi-institutional anatomic pathology error database may be used to benchmark practices and target specific high-frequency errors or errors with high clinical impact. These error reduction programs have national import.

Benchmarking↗

PubMedDate not supplied

The Biological Macromolecule Crystallization Database and NASA Protein Crystal Growth Archive.

The NIST/NASA/CARB Biological Macromolecule Crystallization Database (BMCD), NIST Standard Reference Database 21, contains crystal data and crystallization conditions for biological macromolecules. The database entries include data abstracted from published crystallographic reports. Each entry consists of information describing the biological macromolecule crystallized and crystal data and the crystallization conditions for each crystal form. The BMCD serves as the NASA Protein Crystal Growth Archive in that it contains protocols and results of crystallization experiments undertaken in microgravity (space). These database entries report the results, whether successful or not, from NASA-sponsored protein crystal growth experiments in microgravity and from microgravity crystallization studies sponsored by other international organizations. The BMCD was designed as a tool to assist x-ray crystallographers in the development of protocols to crystallize biological macromolecules, those that have previously been crystallized, and those that have not been crystallized.

Crystallization↗

PubMed1997

Process-based measures of quality: the need for detailed clinical data in large health care databases.

The Institute of Medicine defines health care quality as increasing "the likelihood of desired health outcomes" using "services ... consistent with current professional knowledge." This definition implies that quality measures can be based on either achieving health care outcomes or completing processes that experts agree have been shown by scientific evidence to improve outcomes. Process-based measures are especially suitable when the user needs to know how to improve quality, when provider comparisons show equivalent outcomes but all providers should improve processes, when measures are needed to evaluate health care that is intended to improve long-term outcomes, or when the contribution of individual providers (especially providers who have a small number of cases) needs to be defined. However, many different process-based measures are needed to comprehensively assess quality, and many process-based measures require detailed clinical data currently found only in medical records. Therefore, the expense of abstracting records is a barrier to process-based measurement. Fortunately, large-scale process-based measures are becoming more feasible because the required clinical data are being included in large databases. The merging of existing inpatient and outpatient databases with pharmacy and laboratory databases is an important step toward obtaining data that link all patient admissions, appointments, diagnostic procedures, and prescriptions with diagnoses and test results. Other data that are valuable for process-based measures must still be obtained by abstracting data from records, including clinical findings, patient preferences, and medical and family history. In the future, such data may be added to large databases to create computerized medical records.

Databases, Factual↗

PubMed1996

Integer-driven relational database for clinical outcomes research.

A working database program specifically designed to organize and analyze data for the purpose of generating clinical outcomes reports is presented. Following the author's hypothesis, the database accepts only integer input but can generate reports in textual format. The pilot model database presented here uses only five clinic data items, three outcomes items, and can generate 90 different outcomes reports in the form of charts, graphs, or grids. The program consists of a graphical user interface front end that drives a relational database.

Database Management Systems↗

PubMed1997

Implementing security on a prototype hospital database.

This paper describes the methodology used and the experience gained from the application of a new secure database design approach and database security policy in a real life hospital environment. The applicability of the proposed database security policy in a major Greek general hospital is demonstrated. Moreover, the security and quality assurance of the developed prototype secure database is examined, taking into consideration the results from the study of the user acceptance.

Computer Security↗

PubMed1997

ARMEDA: accessing remote medical databases over the World Wide Web.

We have created a computer system to access medical information located at remote databases over the World Wide Web, for epidemiological ad health services research. We made a preliminary prototype where a specific database model could be searched and information be retrieved. We are currently working on a new component-based architecture, where different databases scheme from various sites can be used to create a unified model, giving users a "virtual" vision of a single, local database. Different software engineering and artificial intelligence methods are used to access, integrate, filter and deliver information to users.

Computer Communication Networks↗

PubMed1997

From clinical data records to research: a database system for the study of clinical and functional indicators of chronic heart failure.

The identification of reliable clinical and functional indicators of Chronic Heart Failure (CHF) is currently a major research challenge for physicians dealing with this pathology. With the aim of providing an adequate infrastructure for this research, we have developed a Database System where all relevant information concerning CHF patients during follow-up can be efficiently recorded, monitored, extracted and easily transferred to commercial packages for data processing and statistical analysis. Patient clinical status is recorded every 6 months, whereas data from several laboratory investigations are recorded every 12 months. All complications or events between two successive controls are recorded too. Patients needing cardiac transplantation are entered in a transplantation waiting list. The Database is fully integrated into the Hospital Information System and meets the standards of the national database of CHF patients. It grows with the concurrent activity of several independent teams, all of which have access to complete and structured information for research purposes. A user-friendly procedure allows the export in a standard format (Microsoft Excel) of all patients' data pertaining to a selected set of controls and variables of interest. These data are used directly for analysis or sub-selections are performed by the investigator through a simple query language. Depending on the objectives and complexity of the research, different commercial statistical analysis packages are available, which are used by clinical investigators autonomously or with the aid of a statistician. This overall approach allows great autonomy of each user in extracting, manipulating and statistically analyzing data. The Database has been in use at the Heart Failure Unit of our Rehabilitation Center since October 1992 and 595 patients have been enrolled since then. Several studies based on these data have been performed and more than 120 scientific communications and 30 articles in national and international journals have been produced. Hence, this experience represents a successful example of how clinical data records can be efficiently and effectively linked to valuable clinical research.

Aged↗

PubMed1999

[The future of clinical laboratory database management system].

To assess the present status of the clinical laboratory database management system, the difference between the Clinical Laboratory Information System and Clinical Laboratory System was explained in this study. Although three kinds of database management systems (DBMS) were shown including the relational model, tree model and network model, the relational model was found to be the best DBMS for the clinical laboratory database based on our experience and developments of some clinical laboratory expert systems. As a future clinical laboratory database management system, the IC card system connected to an automatic chemical analyzer was proposed for personal health data management and a microscope/video system was proposed for dynamic data management of leukocytes or bacteria.

Clinical Laboratory Information Systems↗

PubMed1999

Peripheral database module for clinical management and research in sleep medicine.

Hospital-wide information systems may provide economical solutions for communication processes or for documentation by means of centralized digital medical records. Within a large university hospital, however, there may be too many diverse subspecialties and too many special medical procedures to be supported comprehensively by a single database information system. A peripheral modular system has been tailored to the specific needs of a sleep disorder clinic as an adjunct to the main clinical information system. The client server application allows for automatic data acquisition by on-line devices and by a graphical user interface. It supports administrative tasks for patient management, specific encounter interactions and data retrieval for research. Performance and acceptance of the system was assessed during clinical use, revealing positive response by the users, also with respect to significant time savings. Our experience suggests that the concept of peripheral database modules as "satellites" to a main clinical system provides flexibility in design and implementation of the specialized databases while providing access to data of more general relevance via the main database.

Database Management Systems↗

PubMed1999

Commentary: ethical issues in the use of computerized databases for epidemiologic and other health research.

Computerization of databases has increased apprehension about loss of privacy. The intent of this paper is to facilitate health research that gives proper respect to ethical principles, thereby increasing public comfort and reducing demands for restrictive legislation concerning access to databases. We review how computerization has increased the saliency of concerns and discuss examples of the application of ethical analysis in published database research. Extreme positions notwithstanding, there is general agreement among researchers that research curiosity and the convenience of database research cannot justify the suspension of moral concerns about privacy and confidentiality. Public and professional concerns may affect policy development; therefore, the methods of ensuring privacy and protecting confidentiality must be routinely described in research proposals and published reports along with the benefits of the research. An important issue requiring further attention is that the moral responsibility to respect privacy increases with the sensitivity of information.

Confidentiality↗

PubMed1999

Organization and dissemination of multimedia medical databases on the WWW.

In the paper, we focus on the problem of building and disseminating multimedia medical databases on the World Wide Web (WWW). The current results of the ongoing project of building a prototype dermatology images database and its WWW presentation are presented. The dermatology database is part of an ambitious plan concerning an organization of a network of medical institutions building distributed and federated multimedia databases of a much wider scale.

Computer-Assisted Instruction↗

PubMed1999

Integrated databases--the foundation for the information linking of the actors in the national health care and health insurance systems.

Among the characteristics of the present time, we meet the ranking of information among the key resources of effective management of business systems. Up to date, integral and accurate information have gained precedence over conventional economic resources. This applies particularly in the case of large and complex business systems, including the national health care and health insurance systems. High quality and unified databases form the foundation for rational and quality procedures ranging from the operative level to the national strategy level. The goal of this paper is to demonstrate, on the example of Slovene experience, the importance of keeping quality databases for the purposes of health care and health insurance system management. The paper reviews the achieved level and the plans of further development of unified databases in this sector in Slovenia. The key emphasis in the development of an integrated system has been laid upon establishing uniform primary databases and providing appropriate integration in the area of data interchange among the actors of the health care and health insurance systems and other national systems.

Data Collection↗

PubMed1999

Compulsory health insurance databases.

The compulsory health insurance databases represent fundamental infrastructure to the implementation of the Health Insurance Institute of Slovenia (HIIS) operations, i.e. for its effective performance in all the fields of its business. This paper presents the legal bases of the database management, the logocal database structure, the supply of data from various data sources, and the role of databases as the primary source of supply for the data collections kept by other institutions in Slovenia.

Data Collection↗

PubMed1999

Database search based on Bayesian alignment.

The size of protein sequence database is getting larger each day. One common challenge is to predict protein structures or functions of the sequences in databases. It is easy when a sequence shares direct similarity to a well-characterized protein. If there is no direct similarity, we have to rely on a third sequence or a model as intermediate to link two proteins together. We developed a new model based method, called Bayesian search, as a means to connect two distantly related proteins. We compared this Bayesian search model with pairwise and multiple sequence comparison methods on structural databases using structural similarity as the criteria for relationship. The results show that the Bayesian search can link more distantly related sequence pairs than other methods, collectively and consistently over large protein families. If each query made one error on average against SCOP database PDB40D-B, Bayesian search found 36.5% of related pairs, PSI-Blast found 32.6%, and Smith-Waterman method found 25%. Examples are presented to show that the alignments predicted by the Bayesian search agree well with structural alignments. Also false positives found by Bayesian search at low cutoff values are analyzed.

Algorithms↗

PubMed2000

[Interest of a computerized ALS database in the diagnosis and follow-up of patients with ALS].

The aim of the study is to present a computerized database of the Neurology department of Limoges University Hospital and the main results obtained from data of 340 patients suffering from amyotrophic lateral sclerosis (ALS), diagnosed between 1984 and 1997. It is a user friendly and can be accessed by all neurologists at any level of computer knowledge. This database is modular (6 modules) and flexible according to need. The software used, Access 7, is an open relation database, which allows export of data to statistical or other compatible software. One of the reasons, which led to the elaboration of this database was to develop a means of collecting data in an analyzable manner for therapeutic trials. During these trials, a great number of data can be collected during each clinic visit for the evaluation of the degree of impairment, disability, and handicap. We present part of the data from the patients followed, some of whom were treated with riluzole, the current reference molecule for ALS.

Aged↗

PubMed2000

[Computer databases on cancer-related genes].

A database of mutations in various cancer-related genes has been constructed and named as KMcancerDB (Keio Mutation DataBase for cancer-related genes). This KMcancerDB utilizes a database software called MutationView which we designed to compile various mutation data and to provide graphical presentation of data analysis through the network using ordinary internet browser softwares such as Netscape. Currently, the KMcancerDB accommodates 1261 mutation data of different genes for cancers in 9 different organs/tissues (breast, stomach, uterus, liver, prostate, colon, ovary, thymus and retinoblastoma). KMcancerDB is accessible through http:¿mutview.dmb.med.keio.ac.jp. OMIM is an important document database for human Mendelian traits and hereditary diseases. The information from OMIM is also used in MutationView/KMcancerDB. Some display windows of OMIM and KMcancerDB are presented.

Computer Communication Networks↗

PubMed2000

ABCdb: an ABC transporter database.

We present the first release of a database devoted to the ATP-binding cassette (ABC) protein domains (ABCdb). The ABC proteins are involved in a wide variety of physiological processes in Archea, Bacteria and Eucaryota where they are encoded by large families of paralogous genes. The majority of ABC domains energize the transport of compounds across the membranes. In bacteria, ABC transporters are involved in the uptake of a wide range of molecules and in mechanisms of virulence and antibiotic resistance. In eukaryotes, most of them are involved in drug resistance and in human cells, many are associated with diseases. Sequence analysis reveals that members of the ABC superfamily can be organized into sub-families and suggests that they have diverged from common ancestral forms. In this release, ABCdb includes the inventory and assembly of the ABC transporter systems of completely sequenced genomes. In addition to the protein entries, the database comprises information on functional domains, sequence motifs, predicted trans-membrane segments, and signal peptides. It also includes a classification in sub-families of the ABC systems as well as a classification of the different partners of the systems. Evolutionary trees and specific sequence patterns are provided for each sub-family. The database is endowed with a powerful query system and it was interfaced with blastP2 program for similarity searches. ABCdb has been developed in the ACeDB format, a database system developed by Jean Thierry-Mieg and Richard Durbin. ABCdb can be accessed via the World Wide Web (http://ir2lcb.cnrs-mrs.fr/ABCdb/).

ATP-Binding Cassette Transporters↗

PubMed2000

The evolution of a clinical database: from local to standardized clinical languages.

For more than twenty years, the University of Iowa Hospitals and Clinics Nursing Informatics (UIHC NI) has been developing a clinical database to support patient care planning and documentation in the INFORMM NIS (Information Network for Online Retrieval & Medical Management Nursing Information System). Beginning in 1992, the database content was revised to standardize orders and to incorporate the Standardized Nursing Languages (SNLs) of the North American Nursing Diagnosis Association (NANDA), Nursing Diagnosis Extension Classification (NDEC), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). This paper reports the results of the database revision as well as recent usage data, new user selection methods for clinical content, and the advantages of a database utilizing SNLs.

Databases as Topic↗