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PubMed2003

Deduction of principles on long-term conservation of electronically signed documents by multi professional analyses.

Due to actual equalization of qualified electronic signatures with handwritten signatures and the legal acknowledgment of the electronic form, the opportunity to use electronic patient records instead of classic paper-based ones is given. The archiving of medical records over a period of 10 to 30 years represents an important factor in medical documentation which has to be assured for electronically signed documents as well. The ArchiSig project deduces principles on long-term conservation of electronically signed documents and corresponding technical components to be realized by the means of multi professional analyses.

Archives↗
PubMed2004

Syndrome and outbreak detection using chief-complaint data--experience of the Real-Time Outbreak and Disease Surveillance project.

This paper summarizes the experience of the Real-Time Outbreak and Disease Surveillance (RODS) project in collecting and analyzing free-text emergency department (ED) chief complaints. The technical approach involves real-time transmission of chief-complaint data as Health Level 7 messages from hospitals to a regional data center, where a Bayesian text classifier assigns each chief complaint to one of eight syndrome categories. Time-series algorithms analyze the syndrome data and generate alerts. Authorized public health users review the syndrome data by using Internet interfaces with timelines and maps. Deployments in Pennsylvania, Utah, Atlantic City, and Ohio have demonstrated feasibility of real-time collection of chief complaints. Retrospective experiments that measured case-classification accuracy demonstrated that the Bayesian classifier can discriminate between different syndrome presentations. Retrospective experiments that measured outbreak-detection accuracy determined that the classifier's performance was adequate to support accurate and timely detection of seasonal disease outbreaks. Prospective evaluation revealed that a cluster of carbon monoxide exposures was detected by RODS within 4 hours of the presentation of the first case to an emergency department.

Algorithms↗
PubMed2005

Security and confidentiality approach for the Clinical E-Science Framework (CLEF).

OBJECTIVES: CLEF is an MRC sponsored project in the E-Science programme that aims to establish methodologies and a technical infrastructure for the next generation of integrated clinical and bioscience research. METHODS: The heart of the CLEF approach to this challenge is to design and develop a pseudonymised repository of histories of cancer patients that can be accessed by researchers. Robust mechanisms and policies have been developed to ensure that patient privacy and confidentiality are preserved while delivering a repository of such medically rich information for the purposes of scientific research. RESULTS: This paper summarises the overall approach adopted by CLEF to meet data protection requirements, including the data flows, pseudonymisation measures and additional monitoring policies that are currently being developed. CONCLUSION: Once evaluated, it is hoped that the CLEF approach can serve as a model for other distributed electronic health record repositories to be accessed for research.

Access to Information↗
PubMedDate not supplied

The neglected health care needs of street youth.

Juveniles who live on the street are often the victims of physical and sexual abuse and family chaos. They have a multitude of health problems such as malnutrition, respiratory infections, sexually transmitted diseases, including human immunodeficiency virus, mental illness, and substance abuse. Health care, if available, is generally fragmented and often not relevant to their needs. Their high-risk existence leads to individual morbidity and has a negative effect on the health of the community. Presently, there is limited research on the health status and health care needs of street youth who are difficult to track and quantify. The findings of a project undertaken by Region IX of the Public Health Service in 1989 to provide technical assistance to three primary care clinics serving street youth in San Francisco are reviewed. Data were collected on demographics, overall health status, sex-related medical problems, mental health, and substance abuse and compared with another group of adolescents in the general population. Street youth were found to have a greater number of problems--both physical and psychological--than the general adolescent population. High-risk behaviors, such as drug abuse and failure to use condoms during sex, make this population especially vulnerable to sexually transmitted diseases, including human immunodeficiency virus. The potential impact on public health is enormous. Adequate access to health services needs to be addressed legislatively.

Adolescent↗
PubMed1985

Application of lead-acrylic compensating filters in chiropractic full spine radiography: a technical report.

X-raying the entire spinal column in the standing position in a single exposure (mainly the AP projection) is an often-used chiropractic radiography procedure which has also found some application in medical scoliosis screening program. Aside from any controversy of clinical objectives or medical necessity, the primary agreed-upon requisite for such procedure is twofold; achieving the best possible film image quality with the least amount of radiation exposure to the patient. A popular method of accomplishing this objective is by the use of collimator-attached devices designed to selectively filter the primary x-ray beam in accordance with regional variations of body thickness and/or density. This study was conducted to evaluate the use of a new lead-acrylic filter system (a prior model of which had previously been evaluated for its use in medical radiography) under specialized chiropractic conditions. In comparison to other available systems, it was concluded that this new system; a) is generally equivalent in its radiation dose reduction capabilities; b) is capable of producing full spine radiographs with good to above average image quality; and c) is appreciably easier to use.

Acrylates↗
PubMed1993

[2D-time-of-flight MR angiography in the diagnosis of abdominal aorta aneurysms].

In abdominal aortic aneurysm ultrasonography, contrast-enhanced CT, and digital subtraction angiography (DSA) are the preoperative diagnostic methods of choice accepted today. It was the goal of this study to evaluate time-of-flight magnetic resonance angiography (MRA) in comparison with other radiographic procedures in different types of aneurysms. In 24 patients with proven aortic aneurysm, projection angiograms (MIP algorithm) of the abdominal aorta and pelvic arteries were performed using two-dimensional gradient echo multi slice sequence (FLASH, TE/TR = 10/51 ms; three slices; breathhold technique; flip angle = 30 degrees) in coronal orientation. In addition, renal arteries were imaged in axial slices. The information provided by MRA was comparable to that of DSA (perfused vascular lumen) and contrast-enhanced CT (alteration of vascular wall). Thus dilatation, thrombus, dissection, or inflammation could be analysed safely. Extension of the aneurysm to pelvic arteries could be evaluated in most cases by rotation of the projection angiograms; ostial renal artery disease could be visualized on axial slices. If further technical improvement of MRA is presupposed, this noninvasive method may completely replace the invasive procedures of contrast-enhanced CT and DSA in the future.

Aged↗
PubMed1996

[The legal status of telemedicine in Austria].

The rapid development of modern communication technologies offers new opportunities for medical diagnosis and treatment. In spite of the obvious theoretical benefits of telemedicine, which have been proven by many projects in practice, telemedicine has not become generally established in Europe. Besides lack of technical standardisation and high purchase costs, one of the reasons might be the as yet unclarified legal situation. Taking the present legal situation in Austria we tried to explore questions of liability concerning telemedicine. The outstanding point seems to lie in the contract between the participating physicians on the one hand and between the physicians and the patient on the other hand. If the consulting physician is self-employed he has to take responsibility for any error on the part of the consulted physician. However, if he is working in a hospital, then he is legally considered an "Erfüllungsgehilfe" (person employed by the debtor in the performance of his obligation) an any further doctor consulted is automatically also an "Erfüllungsgehilfe" of the hospital and therefore the hospital takes responsibility for any mistakes made by the consulted physician. Although there has not been any specific jurisdiction concerning telemedicine in Austria, the present legal provisions are adequate for reaching decisions on questions of liability, so that there are no objections from the legal point of view to the general implementation of telemedicine.

Austria↗
PubMed2005

Current status of biodiesel development in Brazil.

In recent years, the concept of producing biodiesel from renewable lipid sources has regained international attention. In Brazil, a national program was launched in 2002 to evaluate the technical, economic, and environmental competitiveness of biodiesel in relation to the commercially available diesel oil. Several research projects were initiated nationwide to investigate and/or optimize biodiesel production from renewable lipid sources and ethanol derived from sugarcane (ethyl esters). Once implemented, this program will not only decrease our dependence on petroleum derivatives but also create new market opportunities for agribusiness, opening new jobs in the countryside, improving the sustainability of our energy matrix, and helping the Brazilian government to support important actions against poverty. This article discusses the efforts to develop the Brazilian biodiesel program in the context of technical specifications as well as potential oilseed sources.

Biotechnology↗
PubMed1992

Stochastic population forecasts and their uses.

"The properties and uses of stochastic forecasts are discussed here. For linear stochastic projections, we show how the computation of forecast moments and the statistical distribution of forecasts depend on the multiplicative and autoregressive structure of the dynamics. Both scalar and vector projection methods are discussed, and their similarities are explored. Next we discuss the uses of stochastic forecasts, arguing that it is important to relate forecasts to the specific decision-making criteria of particular forecast users. The example of [the U.S. system of] Social Security is used to show how a dynamic programming approach may be used to explore alternative decisions in a probabilistic context."

Americas↗