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A European and global strategy for a nursing information network.

Information at every nurse researcher's fingertips. That is the goal of an information system for nursing services in Europe. Not only would it be able to provide fast information for analyzing and developing nursing but it also aspires to end the costly duplication of research work regionally and worldwide. Below, a report on how a European network can be developed to become a potential hub for a global nursing system.

Computer Communication Networks

Information networks in biomedicine.

The term information networks refers to systems of information retrieval and dissemination designed for the sharing of knowledge among individuals, groups and institutions. In the biomedical field, information networks may be categorized loosely according to their structure (direct, centralized, or cooperative) and their function (educational, service-oriented, or research-oriented). This article describes a number of current biomedical information networks, focusing on those with an educational function. Although most of the networks mentioned here are relatively successful, certain serious problems are encountered commonly in the planning, implementation, utilization, and evaluation of all kinds of biomedical information networks.

Education, Continuing

Structuring strain data for storage and retrieval of information on fungi and yeasts in MINE, the Microbial Information Network Europe.

A distributed Microbial Information Network Europe (MINE) is being constructed by a number of major microbial culture collections in countries of the European Community, with the support of the Biotechnology Action Programme (BAP) of the Commission of the European Community. The representatives of the collections participating in MINE have agreed to adopt a general format for the computer storage and retrieval of strain data. This uniform format will facilitate the electronic combination and exchange of data from different collections in order to produce integrated catalogues and the use of identical commands to search the different databases. It is recommended to other collections who may wish to contribute data to the MINE network or between themselves. Three kinds of records can be linked to the leading 'species records': strain records, synonym records, and alternative morphonym records. A minimum data set of 30 fields (similar to the fields used for producing catalogues) is defined that facilitates the exchange of data between the national nodes and serves as a directory to strains available at other nodes. It is suggested that the full strain record comprise 99 fields, grouped in 12 blocks: internal administration--name--strain administration--status--environment and history--biological interactions--sexuality--properties (cytology, biomolecular data)--genotype and genetics--growth conditions--chemistry and enzymes--practical applications. Several fields are divided into subfields of different ranks. Delimiters are used either to separate a range of entries that have to be indexed or to divide an entry from the reference to its source or remarks that should not be indexed. The contents and structure of the fields proposed for filamentous fungi and yeasts are described and in some cases illustrated by examples. Uniformity of input is essential for indexed fields and desirable for non-indexed fields. Seven thesaurus files are envisaged to ensure consistency.

Data Collection

Development of a statewide Maternal and Child Health Information Network.

The Maternal and Child Health Information Network (MATCH) was a national demonstration project funded in 1983 by a Special Projects of Regional and National Significance (SPRANS) grant. The network's major objectives have been to correlate collected clinical service data items into usable information, to expand the database through linkage with other systems within the Ohio Department of Health, and to analyze the conjugated data in an effort to expand current knowledge of maternal and child health. The network is interactive between local funded agencies and the state Health Department. Both data entry and data retrieval are distributed at the end-user information centers. Training and support, major components of the project, are provided to each participant and user of the network. One advantage of MATCH is that it allows linkage of clinical service records with vital records as an outcome of prenatal care and/or a history for child health clients. This aspect of the system permits an expanded look at the population being served by funds designated for maternal and child health programs and the ultimate outcome of such services, and permits comparison with those not receiving preventive health services.

Child Health Services

Use of a statewide Maternal and Child Health Information Network.

The Maternal and Child Health Information Network (MATCH) contains numerous data elements. The process of converting these data into information is an essential component of comprehensive management information system planning. This process must address not only the end-user mechanics of data retrieval, but also the framework for how data can be used in program administration. Although potential data use contributes to and may in fact drive system design, the reality of integrating computer and data usage into daily activities presents a different set of challenges in system implementation. For both state and local end-users, barriers to system use had to be addressed. In terms of directing system use, it was helpful to provide a format for categorizing data needs. The broad categories of data needs identified for program administration were planning, research, evaluation, management, and collaboration. Numerous initiatives have evolved for each of these categories.

Child

MATCH: a maternal and child health information network.

The Maternal and Child Health Information Network--MATCH--was begun in 1984 as a demonstration project with support from the Division of Maternal and Child Health of the Health Resources and Services Administration, Public Health Service. The primary purpose of the project was the development of a system to manage data related to prenatal, child health, family planning, and genetic services that are delivered with State support in clinics in the State of Ohio. The design of MATCH enables the same data base to be used at both the State and local levels. Because it allows all participants, central and district, to manipulate the raw data, it is called an end-user--as opposed to a batch retrieval--system. Data recorded on individual forms during each client's visit to local service clinics are collected and entered into a microcomputer whose software package is a commercial data base. The clinic can then use the data for its purposes: program planning, management, evaluation, client referrals, appointment followup, quality control, and billing. The same data are also uploaded by central office staff to the State's DEC mainframe from data-filled disks mailed in by the clinics. Personnel who staff local projects can access their own data on the mainframe computer to generate reports for local use and send and receive messages electronically. That is, the system is "interactive." The intent is to first link data generated by the primary care and preventive programs of maternal and child health (MCH) in an information system,then link that system to other health data arriving at the State health department (for example, birth and death certificates), and, finally, to use the system as the basis for a State level MCH primary care data system in Ohio for surveillance, planning,management, quality control, accountability,and research purposes.

Child Health Services

Information networks and their impact upon medicine.

There is an information explosion and geometric growth of knowledge in medicine. The individual physician finds himself having great difficulty coping with this ever increasing knowledge base. The recognition of a gap in such knowledge; while frustrating, may also have a direct impact upon patient care. Computer technology, information retrieval modalities, and teleprocessing between remote locations has been viewed as a partial solution to this issue. Microcomputers and their associated elements are able to be used as information retrieval devices tapping into vast reservoirs of data and information on all aspects of medicine. Physicians faced with this new technology generally have little or no training, experience or understanding of how best to harness the power of computers to meet their individual practice requirements. This article provides a basic overview of those computer concepts that relate specifically to information retrieval from large data bases to individual physician's offices, regardless of their location. The article explores the specific hardware and software components that are required for effective linkage into a computer based information network for medicine. The article concludes with an overview of the work done by the American Academy of Dermatology in this area to satisfy informational needs of its members in coping with the ever increasing knowledge base of medicine.

Computer Communication Networks

The Caribbean Animal and Plant Information Network.

The Inter-American Institute for Cooperation on Agriculture (IICA) is presently implementing a four-year project in the Caribbean region to establish a regional information network on animal and plant health--the Caribbean Animal and Plant Health Information Network (CARAPHIN). CARAPHIN's immediate goal is to give the participating countries the technical capability to process and analyze the phyto- and zoo-sanitary information that they generate, share this information within the region, and use it as an effective instrument for decision making for agricultural development and trade. Sharing of information is further facilitated through the periodic regional and hemispheric meetings organized by IICA, by the Inter-American Animal Health Commission, and by the Technical Advisory Committee on Plant Protection. The Veterinary and Plant Protection Services of the region have expressed interest in the continuation of CARAPHIN as a permanent mechanism for agricultural health information management in the Caribbean. This motivated IICA to seek financing for a second phase of CARAPHIN, which will be executed from 1992 through 1996. Phase II of the project will seek to ensure the continuing application of the techniques and methodologies acquired by the agricultural health services of the different countries, and the functioning of the disease/pest information systems at the regional level. This will be achieved through technical assistance, continuing education, publications, provision of useful databases, and transfer of the project to a regional institution.

Agriculture

The CHIPS project: a health information network to serve the consumer.

CHIPS (Consumer Health Information Program and Services/Salud y Bienestar) is a Library Services and Construction Act Title I-funded project that has as its major goal the formation of a health information network to serve the consumer, the public library client, and the hospital patient. Funded for two years, 1976-1978, this bilingual project coordinates efforts of the Los Angeles County Harbor General Hospital Regional Medical Library and the Los Angeles County Carson Regional Public Library to provide health information resources and services to the public. The target population is over two million people of diverse ethnic backgrounds. This paper discusses the project's objectives and encourages an active role for all libraries in the consumer health education movement.

California

The Iowa Medical Information Network: a concept.

Iowa Methodist Medical Center (IMMC) was one of the nation's early developers of a "hospital/physician" system, entering the arena during October 1985, under the direction of Ginny Wagner. Their "MOLI-Link" system now serves over 150 physicians in 50 locations, and is currently undergoing significant enhancement. MOLI-Link was originally developed using Annson Systems (IBAX) products, and has recently migrated to Wallace Computer Services (Wal-Link) software. Over the past 4 years, IMMC has investigated wide-area medical information networking, and is now actively investigating development of the Iowa Medical Information Network. It is envisioned that IMIN would provide clinical, administrative, and educational information services throughout the IMMC 37 county referral area.

Hospital Information Systems

Tufts academic health information network: concept and scenario.

Tufts University School of Medicine's new health sciences education building, the Arthur M. Sackler Center for Health Communications, will house a modern medical library and computer center, classrooms, auditoria, and media facilities. The building will also serve as the center for an information and communication network linking the medical school and adjacent New England Medical Center, Tufts' primary teaching hospital, with Tufts Associated Teaching Hospitals throughout New England. Ultimately, the Tufts network will join other gateway networks, information resource facilities, health care institutions, and medical schools throughout the world. The center and the network are intended to facilitate and improve the education of health professionals, the delivery of health care to patients, the conduct of research, and the implementation of administrative management approaches that should provide more efficient utilization of resources and save dollars. A model and scenario show how health care delivery and health care education are integrated through better use of information transfer technologies by health information specialists, practitioners, and educators.

Academic Medical Centers

The Open System Interconnection as a building block in a health sciences information network.

The interconnection of integrated health sciences library systems with other health sciences computer systems to achieve information networks will require either custom linkages among specific devices or the adoption of standards that all systems support. The most appropriate standards appear to be those being developed under the Open System Interconnection (OSI) reference model, which specifies a set of rules and functions that computers must follow to exchange information. The protocols have been modularized into seven different layers. The lowest three layers are generally available as off-the-shelf interfacing products. The higher layers require special development for particular applications. This paper describes the OSI, its application in health sciences networks, and specific tasks that remain to be undertaken.

Computers

Precision targeting of teacher burnout using network-informed ecological momentary interventions.

Teacher well-being affects classroom functioning and workforce stability, yet generic digital programs rarely use person-specific affect dynamics to select support. This cluster-randomised trial evaluated whether micro-interventions selected from high expected influence (EI) nodes in teachers' contemporaneous affect networks produced larger changes in burnout-related EI and everyday happiness than content-matched random allocation. The objectives were to estimate allocation effects on changes in estimated network summaries and happiness, evaluate network change as a statistical mediator, examine personality moderation, and benchmark simpler allocation rules. A two-arm cluster randomised platform trial was conducted in 84 public schools across four urban districts in H Province. After a 14 day baseline of ecological momentary assessment (EMA), person specific partial correlation networks were estimated for happiness, exhaustion, detachment, efficacy and rumination. An optimisation engine prioritised three brief micro-intervention types per teacher according to baseline EI, while the active control received the same library without network information. EMA continued for 8 weeks; Bayesian multilevel models, permutation-based mediation, and benchmarking analyses were applied. EI-based targeting produced larger reductions in the composite EI-change index than active control (mean difference 0.11, 95% credible interval 0.08 to 0.14) and higher week 7 EMA happiness (4.4 points on a 0 to 100 scale, 95% credible interval 2.7 to 6.0), with a positive arm by week slope difference of 0.62 points per week (95% credible interval 0.39 to 0.85). Model-based mediation estimates were consistent with approximately one half of the happiness difference being statistically associated with change in the composite EI-change index (average conditional mediation estimate 3.5 points, 95% credible interval 2.0 to 5.2). Benchmarking showed smaller gains under severity, threshold, or group-level centrality rules. Effects were stronger among teachers higher in conscientiousness. The findings indicate that integrating EMA, network modelling, and EI-driven optimisation yields measurable gains beyond content-matched exposure, providing a proof of concept for district-scale precision mental health that requires prospective implementation testing. Replication in additional regions, expanded node sets, and longer follow up are warranted to assess durability and generalisability.

Female

Ecosystem health. IV. The National Animal Poison Information Network database as a tool for ecological risk assessment.

Toxicology is a unique discipline in human and veterinary medicine because there are orders of magnitude more toxicants available to man and animals than all known pathogenic microorganisms and parasites. The study of toxicologic responses of ecosystems to contaminants, ecoepidemiology, and the specific study of animal populations in this context, epizootiologic ecotoxicology, are concerned with identifying chemically induced causes and determining effects on and links among populations, communities, and ecosystems. Necessary activities implied by the term "epizootiologic ecotoxicology" are the systematic compilation and analysis of "health" data for ecosystem components. This concept paper describes the value and limitations of adapting methods used by the National Animal Poison Information Network (NAPINet) for epizootiologic ecotoxicology studies. It is concluded that NAPINet methodology, as part of an innovative use of population statistics and clinical measurements, could eventually be adapted into a valuable component of a standardized approach to epizootiologic ecotoxicology.

Animals

Network information security in a phase III Integrated Academic Information Management System (IAIMS).

The developing Integrated Academic Information System (IAIMS) at Columbia-Presbyterian Medical Center provides data sharing links between two separate corporate entities, namely Columbia University Medical School and The Presbyterian Hospital, using a network-based architecture. Multiple database servers with heterogeneous user authentication protocols are linked to this network. "One-stop information shopping" implies one log-on procedure per session, not separate log-on and log-off procedures for each server or application used during a session. These circumstances provide challenges at the policy and technical levels to data security at the network level and insuring smooth information access for end users of these network-based services. Five activities being conducted as part of our security project are described: (1) policy development; (2) an authentication server for the network; (3) Kerberos as a tool for providing mutual authentication, encryption, and time stamping of authentication messages; (4) a prototype interface using Kerberos services to authenticate users accessing a network database server; and (5) a Kerberized electronic signature.

Computer Communication Networks

Medical information networking and standardization.

There are few environments that generate and manage as much information as the hospital. Although computers are used extensively to manage this information, their application has been opportunistic rather than strategic. This has led to a multi-vendor information processing environment in many hospitals. Hospitals today have financial systems, order-entry communication systems, ADT systems, and clinical systems such as laboratory, pharmacy, etc. Communication between these islands of automation however are still, for the most part, primitive. Exceptions are in the large teaching hospitals where internal staff have been utilized to link systems together. The effort has traditionally been huge and fraught with difficulties related to the heterogeneous environment that is involved. In order to overcome these problems and enable us to truly bring the power of modern computing to bear on hospital-wide problems, as well as to make feasible, for example, the computerized medical record, we must develop an appropriate strategy. It seems unlikely that a single-vendor solution will entirely answer hospital information processing needs. Therefore, a perpetuation of the heterogeneous environment is inevitable. With this in mind, an alternative approach is proposed: to develop networking standards for the hospital, as has been done for the manufacturing and technical office environment, such that vendors can build systems that can be easily integrated.

Hospital Information Systems

The use of key informant networks in assessment of community health.

Program planning requires the acquisition of current, reliable information to accurately define the need for the program and to aid in developing its basic structure. In a time of financial restraint, a cost- and time-efficient method for collecting information for program development is important. This paper presents a strategy, borrowed from anthropology, that develops a network of key individuals in the community as a source of information and as a potential resource in program development. The effectiveness of this approach as a method for data collection is illustrated through application to a health and medical needs assessment of a geriatric population. A community diagnosis of this population was obtained.

Anthropology