WorldWideScience

Sample records for legacy clinical information

  1. LEGACY MANAGEMENT REQUIRES INFORMATION

    International Nuclear Information System (INIS)

    CONNELL, C.W.; HILDEBRAND, R.D.

    2006-01-01

    ''Legacy Management Requires Information'' describes the goal(s) of the US Department of Energy's Office of Legacy Management (LM) relative to maintaining critical records and the way those goals are being addressed at Hanford. The paper discusses the current practices for document control, as well as the use of modern databases for both storing and accessing the data to support cleanup decisions. In addition to the information goals of LM, the Hanford Federal Facility Agreement and Consent Order, known as the ''Tri-Party Agreement'' (TPA) is one of the main drivers in documentation and data management. The TPA, which specifies discrete milestones for cleaning up the Hanford Site, is a legally binding agreement among the US Department of Energy (DOE), the Washington State Department of Ecology (Ecology), and the US Environmental Protection Agency (EPA). The TPA requires that DOE provide the lead regulatory agency with the results of analytical laboratory and non-laboratory tests/readings to help guide them in making decisions. The Agreement also calls for each signatory to preserve--for at least ten years after the Agreement has ended--all of the records in its or its contractors, possession related to sampling, analysis, investigations, and monitoring conducted. The tools used at Hanford to meet TPA requirements are also the tools that can satisfy the needs of LM

  2. LEGACY MANAGEMENT REQUIRES INFORMATION

    Energy Technology Data Exchange (ETDEWEB)

    CONNELL, C.W.; HILDEBRAND, R.D.

    2006-12-14

    ''Legacy Management Requires Information'' describes the goal(s) of the US Department of Energy's Office of Legacy Management (LM) relative to maintaining critical records and the way those goals are being addressed at Hanford. The paper discusses the current practices for document control, as well as the use of modern databases for both storing and accessing the data to support cleanup decisions. In addition to the information goals of LM, the Hanford Federal Facility Agreement and Consent Order, known as the ''Tri-Party Agreement'' (TPA) is one of the main drivers in documentation and data management. The TPA, which specifies discrete milestones for cleaning up the Hanford Site, is a legally binding agreement among the US Department of Energy (DOE), the Washington State Department of Ecology (Ecology), and the US Environmental Protection Agency (EPA). The TPA requires that DOE provide the lead regulatory agency with the results of analytical laboratory and non-laboratory tests/readings to help guide them in making decisions. The Agreement also calls for each signatory to preserve--for at least ten years after the Agreement has ended--all of the records in its or its contractors, possession related to sampling, analysis, investigations, and monitoring conducted. The tools used at Hanford to meet TPA requirements are also the tools that can satisfy the needs of LM.

  3. Legacy System Wrapping for Department of Defense Information System Modernization

    National Research Council Canada - National Science Library

    Jordan, Kathleen

    1995-01-01

    This document explains the activities, benefits, problems, and issues in using the object-oriented technique of software wrapping to support the migration from legacy information systems to modernized systems...

  4. Office of Legacy Management. Information and Records Management. Transition Guidance

    International Nuclear Information System (INIS)

    2004-01-01

    The Office of Legacy Management (LM) is an integral part of the U.S. Department of Energy's (DOE's) strategy to ensure that legacy liabilities of former nuclear weapons production sites are properly managed following the completion of environmental cleanup activities. LM will work with each site using an integrated team approach to ensure a successful transition. Part of this process will include transition of Government records and information. The Office of Legacy Management Information and Records Management Transition Guidance focuses on LM's goal to preserve and protect legacy records and information. This guidance document establishes a framework for the transfer of records management responsibilities for sites transferring to LM. It describes the requirements, responsibilities, and procedures for the efficient and cost-effective transfer of custody, ownership, and management of records and other information products from the transfer site to LM. Records management practices are critical to the functions of Federal agencies because records provide information about, or evidence of, the organization, functions, policies, decisions, procedures, operations, or other activities. Therefore, the information generated by an agency is created, maintained, and dispositioned through records management processes that ensure the appropriate preservation and retrieval of essential information. Because of their intrinsic value, best practices to preserve information and records should be utilized when records are transferred from one organization to another. As the transfer program completes cleanup activities at closure sites, a transitional process will facilitate the transparent shift in the management of site records activities to LM. The roles and responsibilities of the transfer site and/or program and LM described in this document are a necessary foundation for cooperation and coordination and are essential to the successful transition of records and information

  5. Office of Legacy Management. Information and Records Management. Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    None

    2004-03-01

    The Office of Legacy Management (LM) is an integral part of the U.S. Department of Energy’s (DOE’s) strategy to ensure that legacy liabilities of former nuclear weapons production sites are properly managed following the completion of environmental cleanup activities. LM will work with each site using an integrated team approach to ensure a successful transition. Part of this process will include transition of Government records and information. The Office of Legacy Management Information and Records Management Transition Guidance focuses on LM’s goal to preserve and protect legacy records and information. This guidance document establishes a framework for the transfer of records management responsibilities for sites transferring to LM. It describes the requirements, responsibilities, and procedures for the efficient and cost-effective transfer of custody, ownership, and management of records and other information products from the transfer site to LM. Records management practices are critical to the functions of Federal agencies because records provide information about, or evidence of, the organization, functions, policies, decisions, procedures, operations, or other activities. Therefore, the information generated by an agency is created, maintained, and dispositioned through records management processes that ensure the appropriate preservation and retrieval of essential information. Because of their intrinsic value, best practices to preserve information and records should be utilized when records are transferred from one organization to another. As the transfer program completes cleanup activities at closure sites, a transitional process will facilitate the transparent shift in the management of site records activities to LM. The roles and responsibilities of the transfer site and/or program and LM described in this document are a necessary foundation for cooperation and coordination and are essential to the successful transition of records and

  6. Historical Legacies, Information and Contemporary Water Science and Management

    Directory of Open Access Journals (Sweden)

    Charles J. Vörösmarty

    2011-05-01

    Full Text Available Hydrologic science has largely built its understanding of the hydrologic cycle using contemporary data sources (i.e., last 100 years. However, as we try to meet water demand over the next 100 years at scales from local to global, we need to expand our scope and embrace other data that address human activities and the alteration of hydrologic systems. For example, the accumulation of human impacts on water systems requires exploration of incompletely documented eras. When examining these historical periods, basic questions relevant to modern systems arise: (1 How is better information incorporated into water management strategies? (2 Does any point in the past (e.g., colonial/pre-European conditions in North America provide a suitable restoration target? and (3 How can understanding legacies improve our ability to plan for future conditions? Beginning to answer these questions indicates the vital need to incorporate disparate data and less accepted methods to meet looming water management challenges.

  7. Historical legacies, information and contemporary water science and management

    Science.gov (United States)

    Bain, Daniel J.; Arrigo, Jennifer A.S.; Green, Mark B.; Pellerin, Brian A.; Vörösmarty, Charles J.

    2011-01-01

    Hydrologic science has largely built its understanding of the hydrologic cycle using contemporary data sources (i.e., last 100 years). However, as we try to meet water demand over the next 100 years at scales from local to global, we need to expand our scope and embrace other data that address human activities and the alteration of hydrologic systems. For example, the accumulation of human impacts on water systems requires exploration of incompletely documented eras. When examining these historical periods, basic questions relevant to modern systems arise: (1) How is better information incorporated into water management strategies? (2) Does any point in the past (e.g., colonial/pre-European conditions in North America) provide a suitable restoration target? and (3) How can understanding legacies improve our ability to plan for future conditions? Beginning to answer these questions indicates the vital need to incorporate disparate data and less accepted methods to meet looming water management challenges.

  8. Born Broken: Fonts and Information Loss in Legacy Digital Documents

    Directory of Open Access Journals (Sweden)

    Geoffrey Brown

    2011-03-01

    Full Text Available For millions of legacy documents, correct rendering depends upon resources such as fonts that are not generally embedded within the document structure. Yet there is a significant risk of information loss due to missing or incorrectly substituted fonts. Large document collections depend on thousands of unique fonts not available on a common desktop workstation, which typically has between 100 and 200 fonts. Silent substitution of fonts, performed by applications such as Microsoft Office, can yield poorly rendered documents. In this paper we use a collection of 230,000 Word documents to assess the difficulty of matching font requirements with a database of fonts. We describe the identifying information contained in common font formats, font requirements stored in Word documents, the API provided by Windows to support font requests by applications, the documented substitution algorithms used by Windows when requested fonts are not available, and the ways in which support software might be used to control font substitution in a preservation environment.

  9. The Legacy of Tomas Bata to the Information Processing for the Development of Enterprise

    Directory of Open Access Journals (Sweden)

    Jakub Chvatal

    2014-04-01

    Full Text Available Businessman Tomas Bata was successful also because he was able to work with information efficiently. While it is difficult to compare the work with information twenties with today's information systems, but we can find elements that do not emphasize current systems because the information is accessible anytime, anywhere on-line. One such element is the regularity in information processing and its presentation. The article gives an overview of resources to draw from the legacy of Tomas Bata, the first comparison approach in creating and using of personnel and manufacturing information and how to deal with the legacy of Tomas Bata in information processing. This is done a methodology for upcoming research. Even it can be assumed that the corporation meets the characteristics of Tomas Bata „learning organisation" as we understand in the dimension of the information and knowledge society. Historical development is also confronted with the current state of the information system Bata Shoes Organisation.

  10. Creation and implementation of the international information system for radiation legacy of the USSR 'RADLEG'

    International Nuclear Information System (INIS)

    Iskra, A.A.

    2002-01-01

    The stating of radiological problem of the radiation legacy of the Soviet and Russian military and civil programs of the nuclear fuel cycle have became possible after 'cold war' termination. The objective of the 'RADLEG' project is 'Development of a sophisticated computer based data system for evaluation of the radiation legacy of the former USSR and setting priorities on remediation and prevention policy'. The goal of the 'RADLEG' Project Phase 1 was creation of a simple operational database to be linked to GIS, describing currently available information on radiation legacy of the former USSR. During the Project Phase 2 the public accessible database linked to GIS has been developed. This GIS data system containing comprehensive information on the radiation legacy of the former Soviet Union has been developed in order to aid policy makers in two principle areas: to identify and set priorities on radiation safety problems, and to provide guidance for the development of technically, economically and socially sound policies to reduce health and environmental impact of radioactively contaminated sites. (author)

  11. REDLetr: Workflow and tools to support the migration of legacy clinical data capture systems to REDCap.

    Science.gov (United States)

    Dunn, William D; Cobb, Jake; Levey, Allan I; Gutman, David A

    2016-09-01

    A memory clinic at an academic medical center has relied on several ad hoc data capture systems including Microsoft Access and Excel for cognitive assessments over the last several years. However these solutions are challenging to maintain and limit the potential of hypothesis-driven or longitudinal research. REDCap, a secure web application based on PHP and MySQL, is a practical solution for improving data capture and organization. Here, we present a workflow and toolset to facilitate legacy data migration and real-time clinical research data collection into REDCap as well as challenges encountered. Legacy data consisted of neuropsychological tests stored in over 4000 Excel workbooks. Functions for data extraction, norm scoring, converting to REDCap-compatible formats, accessing the REDCap API, and clinical report generation were developed and executed in Python. Over 400 unique data points for each workbook were migrated and integrated into our REDCap database. Moving forward, our REDCap-based system replaces the Excel-based data collection method as well as eases the integration into the standard clinical research workflow and Electronic Health Record. In the age of growing data, efficient organization and storage of clinical and research data is critical for advancing research and providing efficient patient care. We believe that the workflow and tools described in this work to promote legacy data integration as well as real time data collection into REDCap ultimately facilitate these goals. Published by Elsevier Ireland Ltd.

  12. Why Replacing Legacy Systems Is So Hard in Global Software Development: An Information Infrastructure Perspective

    DEFF Research Database (Denmark)

    Matthiesen, Stina; Bjørn, Pernille

    2015-01-01

    to be obvious explanations for why GSD tasks fail to reach completion; however, we account for the difficulties within the technical nature of software system task. We use the framework of information infrastructure to show how replacing a legacy system in governmental information infrastructures includes...... the work of tracing back to knowledge concerning law, technical specifications, as well as how information infrastructures have dynamically evolved over time. Not easily carried out in a GSD setup is the work around technical tasks that requires careful examination of mundane technical aspects, standards......, and bureaucratic forms, as well as the excavation work that keeps the information infrastructure afloat....

  13. From legacy and client/server systems to components in healthcare information systems in Finland.

    Science.gov (United States)

    Mykkänen, J; Korpela, M; Eerola, A; Porrasmaa, J; Ruonamaa, H; Sormunen, M

    2001-01-01

    A strategy and toolset (FixIT) for migrating a specific type of legacy systems--based on the FileMan DBMS of the U.S. Department of Veterans Affairs--to a two-tier client/server and web browser-based architecture was presented in MEDINFO'98. In the current paper we discuss the further migration to a multitier software component architecture. A literature survey and industry contacts were used to specify an open, component-based target architecture for healthcare information systems to be reached by the year 2005, as well as a phased migration strategy from the present FileMan/FixIT-based systems towards the target. The target architecture is based on large-grained business components and accommodates heterogeneous elements on the intra-component, intra-application, intra-organization and inter-organizational levels. Four logical tiers are identified within a business component. Three migration paths are specified for different cases: the tier-by-tier, piece-by-piece, and web-wrapping paths. It is argued that the architecture, supported by off-the-shelf toolsets, application frameworks and a new software development process, makes it possible to turn legacy systems into a valuable asset, split monolithic applications into reusable components, and ultimately replace the legacy parts at a feasible pace

  14. Veterans Affairs Information Technology: Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems

    Science.gov (United States)

    2017-02-07

    Veterans Affairs, Volume 1: Integrated Report (Washington, D.C.: Sept. 1, 2015). This assessment was conducted in response to a requirement in the Veterans...VETERANS AFFAIRS INFORMATION TECHNOLOGY Management Attention Needed to Improve Critical System Modernizations...Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems What GAO Found GAO

  15. Information Management System Supporting a Multiple Property Survey Program with Legacy Radioactive Contamination.

    Science.gov (United States)

    Stager, Ron; Chambers, Douglas; Wiatzka, Gerd; Dupre, Monica; Callough, Micah; Benson, John; Santiago, Erwin; van Veen, Walter

    2017-04-01

    The Port Hope Area Initiative is a project mandated and funded by the Government of Canada to remediate properties with legacy low-level radioactive waste contamination in the Town of Port Hope, Ontario. The management and use of large amounts of data from surveys of some 4800 properties is a significant task critical to the success of the project. A large amount of information is generated through the surveys, including scheduling individual field visits to the properties, capture of field data laboratory sample tracking, QA/QC, property report generation and project management reporting. Web-mapping tools were used to track and display temporal progress of various tasks and facilitated consideration of spatial associations of contamination levels. The IM system facilitated the management and integrity of the large amounts of information collected, evaluation of spatial associations, automated report reproduction and consistent application and traceable execution for this project.x. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. A Debate over the Teaching of a Legacy Programming Language in an Information Technology (IT) Program

    Science.gov (United States)

    Ali, Azad; Smith, David

    2014-01-01

    This paper presents a debate between two faculty members regarding the teaching of the legacy programming course (COBOL) in a Computer Science (CS) program. Among the two faculty members, one calls for the continuation of teaching this language and the other calls for replacing it with another modern language. Although CS programs are notorious…

  17. Informed Consent (Clinical Trials)

    Science.gov (United States)

    ... Health Professionals Questions to Ask about Your Treatment Research Informed Consent Credit: National Cancer Institute Informed consent is a ... of ensuring patient safety in research. During the informed consent process, the research team, which is made up of doctors and ...

  18. Colorism, a Legacy of Historical Trauma in Parent-Child Relationships: Clinical, Research, and Personal Perspectives

    Science.gov (United States)

    Lewis, Marva L.; Noroña, Carmen Rosa; McConnico, Neena; Thomas, Kandace

    2013-01-01

    Practitioners need to be aware of the intergenerational transmission of historical trauma in families with young children. One legacy of historical trauma, "colorism"--valuing light skin over dark skin--occurs among many oppressed indigenous, ethnic, racial, and cultural groups around the world. The unconscious hierarchy and privilege…

  19. Clinical research before informed consent.

    Science.gov (United States)

    Miller, Franklin G

    2014-06-01

    Clinical research with patient-subjects was routinely conducted without informed consent for research participation prior to 1966. The aim of this article is to illuminate the moral climate of clinical research at this time, with particular attention to placebo-controlled trials in which patient-subjects often were not informed that they were participating in research or that they might receive a placebo intervention rather than standard medical treatment or an experimental treatment for their condition. An especially valuable window into the thinking of clinical investigators about their relationship with patient-subjects in the era before informed consent is afforded by reflection on two articles published by psychiatric researchers in 1966 and 1967, at the point of transition between clinical research conducted under the guise of medical care and clinical research based on consent following an invitation to participate and disclosure of material information about the study. Historical inquiry relating to the practice of clinical research without informed consent helps to put into perspective the moral progress associated with soliciting consent following disclosure of pertinent information; it also helps to shed light on an important issue in contemporary research ethics: the conditions under which it is ethical to conduct clinical research without informed consent.

  20. Clinical Information Support System (CISS)

    Data.gov (United States)

    Department of Veterans Affairs — Clinical Information Support System (CISS) is a web-based portal application that provides a framework of services for the VA enterprise and supplies an integration...

  1. Legacy question

    International Nuclear Information System (INIS)

    Healy, J.W.

    1977-01-01

    The legacy question discussed refers to the definition of appropriate actions in this generation to provide a world that will allow future generations to use the earth without excessive limitations caused by our use and disposal of potentially hazardous materials

  2. The Southeastern Minnesota Beacon Project for Community-driven Health Information Technology: Origins, Achievements, and Legacy.

    Science.gov (United States)

    Chute, Christopher G; Hart, Lacey A; Alexander, Alex K; Jensen, Daniel W

    2014-01-01

    The Southeastern (SE) Minnesota Beacon organized all the health care providers, county public health organizations, and school districts in the deployment and integration of health information exchange (HIE) and targeted health communication around childhood asthma and diabetes. The community cooperated to establish a clinical data repository for all residents in the 11-county region. Through this community of practice approach that involved traditional and nontraditional providers, the SE Minnesota Beacon was able to realize unique applications of this technology. This manuscript overviews the associated organization and infrastructure of this community collaboration. The Office of the National Coordinator for Health Information Technology (ONC), as part of the American Recovery and Reinvestment Act of 2009 (ARRA) stimulus, established 17 projects throughout the United States targeting the introduction and meaningful use of health information technology (HIT). These 17 communities were intended to serve as an example of what could be accomplished. The SE Minnesota Beacon is one of these communities. The community ultimately opted for peer-to-peer HIE, using Nationwide Health Information Network (NwHIN) Connect software. The clinical data repository was established using the infrastructure developed by the Regenstrief Institute, which operated as a trusted third party. As an extension to HIE, the consortium of county public health departments created a patient data portal for use by school nurses and parents. Childhood asthma was addressed by creating, exchanging, and maintaining an "asthma action plan" for each affected child, shared throughout the community, including through the patient portal. Diabetes management introduced patient treatment decision tools and patient quality of life measures, facilitating care. Influenza vaccination was enhanced by large-scale community reporting in partnership with the state vaccination registry. The methodology and

  3. Analyzing Patterns of Community Interest at a Legacy Mining Waste Site to Assess and Inform Environmental Health Literacy Efforts

    Science.gov (United States)

    Ramirez-Andreotta, Monica D.; Lothrop, Nathan; Wilkinson, Sarah T.; Root, Robert A.; Artiola, Janick F.; Klimecki, Walter; Loh, Miranda

    2015-01-01

    Understanding a community’s concerns and informational needs is crucial to conducting and improving environmental health research and literacy initiatives. We hypothesized that analysis of community inquiries over time at a legacy mining site would be an effective method for assessing environmental health literacy efforts and determining whether community concerns were thoroughly addressed. Through a qualitative analysis, we determined community concerns at the time of being listed as a Superfund site. We analyzed how community concerns changed from this starting point over the subsequent years, and whether: 1) communication materials produced by the USEPA and other media were aligned with community concerns; and 2) these changes demonstrated a progression of the community’s understanding resulting from community involvement and engaged research efforts. We observed that when the Superfund site was first listed, community members were most concerned with USEPA management, remediation, site-specific issues, health effects, and environmental monitoring efforts related to air/dust and water. Over the next five years, community inquiries shifted significantly to include exposure assessment and reduction methods and issues unrelated to the site, particularly the local public water supply and home water treatment systems. Such documentation of community inquiries over time at contaminated sites is a novel method to assess environmental health literacy efforts and determine whether community concerns were thoroughly addressed. PMID:27595054

  4. Data mining : open systems drill through layers of legacy data to manage the flow of information

    International Nuclear Information System (INIS)

    Polczer, S.

    1999-01-01

    Information management challenges facing the petroleum and natural gas industry are discussed in conjunction with the increasing difficulty of accessing information because of the sheer volume of it, plus the fact that most data systems are proprietary 'closed' systems. In this context, reference is made to a newly developed software system named PetroDesk, developed by Merak Petroleum. PetroDesk is a geographical information browser used for integration and analysis of public, proprietary and personal data under a common interface. The software can be used to plot land position, chart productivity of wells, and produce graphs of decline rates, reserves and production. The software, which was originally designed for engineering data, also has been found useful in determining costs, revenue projections and other information needed to obtain a real-time net present worth of a company, and also in identifying business opportunities. 2 figs

  5. 77 FR 28401 - Information Collection Activities: Legacy Data Verification Process (LDVP); Submitted for Office...

    Science.gov (United States)

    2012-05-14

    ... geoscientists can use the information to evaluate resources for lease sales for fair market value. With respect..., based on: (1) 0.5 hours to locate and copy a summary of drilling operations (e.g., scout tickets) for...

  6. Advancing description and explanation in clinical linguistics: a legacy of Martin J. Ball.

    Science.gov (United States)

    Damico, Jack S; Damico, Holly L; Nelson, Ryan L

    2011-11-01

    This article asserts the importance of explication of order and disorder in language as a privileged objective of clinical linguistics and service delivery and reviews the contributions of Martin Ball in advancing this agenda.

  7. Organizational Approaches to Managing Tacit Knowledge Loss of Legacy System Information Technology Professionals

    Science.gov (United States)

    Bitner, Michael

    2012-01-01

    Information Technology (IT) employment shortages may be related to employee retirement or normal attrition. Within IT job shortages, tacit knowledge is lost when employees retire or leave organizations. Tacit knowledge is unwritten or unspoken knowledge that is not easily articulated, and exists only with the individuals who obtain the knowledge…

  8. From pioneering to implementing automated blood pressure measurement in clinical practice: Thomas Pickering's legacy

    DEFF Research Database (Denmark)

    Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Wizner, Barbara

    2010-01-01

    Thomas G. Pickering spent most of his scientific career in carrying out research on clinical hypertension and blood pressure (BP) measurement. In our review of Pickering's seminal work, we first focused on white-coat hypertension and masked hypertension, two terms that he had introduced. Next, we...

  9. Holistic information evaluation of divergence of soil's properties by using of legacy data of large scale monitoring surveys

    Science.gov (United States)

    Mikheeva, Irina

    2017-04-01

    Identification of tendencies of soil's transformations is very important for adequate ecological and economical assessment of degradation of soils. But monitoring of conditions of soils, and other natural objects, bring up a number of important methodological questions, including the probabilistic and statistical analysis of the accumulated legacy data and their use for verification of quantitative estimates of natural processes. Owing to considerable natural variability there is a problem of a reliable assessment of contemporary soil evolution under the influence of environmental management and climate changes. When studying dynamics of soil quality it is necessary to consider soil as open complex system with parameters which significantly vary in space. The analysis of probabilistic distributions of attributes of studied system is informative for the characteristic of holistic state and behavior of the system. Therefore earlier we had offered the method of evaluation of alterations of soils by analysis of changes of pdf of their properties and their statistical entropy. The executed analysis of dynamics of pdf showed that often opposite tendencies to decrease and to increase of property can be shown at the same time. However to give an adequate quantitative evaluation of changes of soil properties it is necessary to characterize them in general. We proposed that it is reasonable to name processes of modern changes in soil properties concerning their start meaning by the term "divergence" and investigate it quantitatively. For this purpose we suggested to use value of information divergence which is defined as a measure of distinctions of pdf in compared objects or in various time. As the measure of dissimilarity, divergence should satisfy come conditions, the most important is scale-invariance property. Information divergence was used by us for evaluation of distinctions of soils according heterogeneity of factors of soil formation and with course of natural and

  10. The information minefield: access to clinical information

    African Journals Online (AJOL)

    Adele

    2004-02-17

    Feb 17, 2004 ... unavoidable. The patient requests access to information about himself. / herself. In the past despite their curiosity patients would hardly ever have thought to ask their attending doctor for even a peek at his notes. But section 32 of the final Constitution of RSA states that “everyone has the right of access to.

  11. Altmetrics, Legacy Scholarship, and Scholarly Legacy

    Directory of Open Access Journals (Sweden)

    Lauren B. Collister

    2017-10-01

    Full Text Available When using alternative metrics (altmetrics to investigate the impact of a scholar’s work, researchers and librarians are typically cautioned that altmetrics will be less useful for older works of scholarship. This is because it is difficult to collect social media and other attention retroactively, and the numbers will be lower if the work was published before social media marketing and promotion were widely accepted in a field. In this article, we argue that altmetrics can provide useful information about older works in the form of documenting renewed attention to past scholarship as part of a scholar’s legacy. Using the altmetrics profile of the late Dr. Thomas E. Starzl, often referred to as “the father of modern transplantation”, we describe two cases where altmetrics provided information about renewed interest in his works: a controversy about race and genetics that shows the ongoing impact of a particular work, and posthumous remembrances by colleagues which reveal his scholarly legacy.

  12. Repurposing legacy data innovative case studies

    CERN Document Server

    Berman, Jules J

    2015-01-01

    Repurposing Legacy Data: Innovative Case Studies takes a look at how data scientists have re-purposed legacy data, whether their own, or legacy data that has been donated to the public domain. Most of the data stored worldwide is legacy data-data created some time in the past, for a particular purpose, and left in obsolete formats. As with keepsakes in an attic, we retain this information thinking it may have value in the future, though we have no current use for it. The case studies in this book, from such diverse fields as cosmology, quantum physics, high-energy physics, microbiology,

  13. The Java Legacy Interface

    DEFF Research Database (Denmark)

    Korsholm, Stephan

    2007-01-01

    The Java Legacy Interface is designed to use Java for encapsulating native legacy code on small embedded platforms. We discuss why existing technologies for encapsulating legacy code (JNI) is not sufficient for an important range of small embedded platforms, and we show how the Java Legacy...... Interface offers this previously missing functionality. We describe an implementation of the Java Legacy Interface for a particular virtual machine, and how we have used this virtual machine to integrate Java with an existing, commercial, soft real-time, C/C++ legacy platform....

  14. Putting User Stories First: Experiences Adapting the Legacy Data Models and Information Architecture at NASA JPL's PO.DAAC to Accommodate the New Information Lifecycle Required by SWOT

    Science.gov (United States)

    McGibbney, L. J.; Hausman, J.; Laurencelle, J. C.; Toaz, R., Jr.; McAuley, J.; Freeborn, D. J.; Stoner, C.

    2016-12-01

    The Surface Water & Ocean Topography (SWOT) mission brings together two communities focused on a better understanding of the world's oceans and its terrestrial surface waters. U.S. and French oceanographers and hydrologists and international partners have joined forces to develop this new space mission. At NASA JPL's PO.DAAC, the team is currently engaged in the gathering of SWOT User Stores (access patterns, metadata requirements, primary and value added product requirements, data access protocols, etc.) to better inform the adaptive planning of what will be known as the next generation PO.DAAC Information Architecture (IA). The IA effort acknowledges that missions such as SWOT (and NISAR) have few or no precedent in terms of data volume, hot and cold storage, archival, analysis, existing system engineering complexities, etc. and that the only way we can better understand the projected impacts of such requirements is to interface directly with the User Community. Additionally, it also acknowledges that collective learning has taken place to understand certain limitations in the existing data models (DM) underlying the existing PO.DAAC Data Management and Archival System. This work documents an evolutionary, use case based, standards driven approach to adapting the legacy DM and accompanying knowledge representation infrastructure at NASA JPL's PO.DAAC to address forthcoming DAAC mission requirements presented by missions such as SWOT. Some of the topics covered in this evolution include, but are not limited to: How we are leveraging lessons learned from the development of existing DM (such as that generated for SMAP) in an attempt to map them to SWOT. What is the governance model for the SWOT IA? What are the `governing' entities? What is the hierarchy of the `governed entities'? How are elements grouped? How is the design-working group formed? How is model independence maintained and what choices/requirements do we have for the implementation language? The use of

  15. Meeting the challenges of clinical information provision.

    Science.gov (United States)

    Spring, Hannah

    2017-12-01

    This virtual issue of the Health Information and Libraries Journal (HILJ) has been compiled to mark the 5th International Clinical Librarian Conference 2011. In considering the challenges of clinical information provision, the content selected for the virtual issue offers an international flavour of clinical information provision and covers a variety of different facets of clinical librarianship. The issue broadly covers the areas of information needs and preferences, clinical librarian roles and services, and education and training, and reflects the way in which a normal issue of the HILJ would be presented. This includes a review article, a collection of original articles, and the three regular features which comprise International Perspectives and Initiatives, Learning and Teaching in Action, and Using Evidence in Practice. All papers included in this virtual issue are available free online. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

  16. Clinical information success in a maternity hospital

    OpenAIRE

    Reid, Louise; O'Connor, Sandra; Richardson, Ita; Hogan, Jennifer; O'Donoghue, Theresa; Philip, Roy; Burke, Gerard

    2012-01-01

    non-peer-reviewed Clinical staff must have access to high quality information in order to provide safe care to patients. This cannot be provided by clinical information systems (CIS) that are not correctly managed and regularly used. Ensuring the success of CIS in the healthcare environment presents a particular set of difficulties. This paper describes an action research study aimed at improving information success in a maternity hospital. Following a literature review and ...

  17. Exploring legacy systems using types

    NARCIS (Netherlands)

    A. van Deursen (Arie); L.M.F. Moonen (Leon)

    2000-01-01

    textabstractWe show how hypertext-based program understanding tools can achieve new levels of abstraction by using inferred type information for cases where the subject software system is written in a weakly typed language. We propose TypeExplorer, a tool for browsing COBOL legacy systems based on

  18. Measure of clinical information technology adoption.

    Science.gov (United States)

    Lee, Jinhyung; Park, Young-Taek

    2013-03-01

    The objective of this study was to create a new measure for clinical information technology (IT) adoption as a proxy variable of clinical IT use. Healthcare Information and Management Systems Society (HIMSS) data for 2004 were used. The 18 clinical IT applications were analyzed across 3,637 acute care hospitals in the United States. After factor analysis was conducted, the clinical IT adoption score was created and evaluated. Basic clinical IT systems, such as laboratory, order communication/results, pharmacy, radiology, and surgery information systems had different adoption patterns from advanced IT systems, such as cardiology, radio picture archiving, and communication, as well as computerized practitioner order-entry. This clinical IT score varied across hospital characteristics. Different IT applications have different adoption patterns. In creating a measure of IT use among various IT components in hospitals, the characteristics of each type of system should be reflected. Aggregated IT adoption should be used to explain technology acquisition and utilization in hospitals.

  19. Annotating temporal information in clinical narratives.

    Science.gov (United States)

    Sun, Weiyi; Rumshisky, Anna; Uzuner, Ozlem

    2013-12-01

    Temporal information in clinical narratives plays an important role in patients' diagnosis, treatment and prognosis. In order to represent narrative information accurately, medical natural language processing (MLP) systems need to correctly identify and interpret temporal information. To promote research in this area, the Informatics for Integrating Biology and the Bedside (i2b2) project developed a temporally annotated corpus of clinical narratives. This corpus contains 310 de-identified discharge summaries, with annotations of clinical events, temporal expressions and temporal relations. This paper describes the process followed for the development of this corpus and discusses annotation guideline development, annotation methodology, and corpus quality. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Voluntary informed consent and good clinical practice for clinical ...

    African Journals Online (AJOL)

    Most differences, shortcomings and contradictions regarding voluntary informed consent for participation in clinical research relate to the South African-specific guidance documents, i.e. South African Guidelines for Good Practice in the Conduct of Clinical Trials with Human Participants in South Africa (2006) and Ethics in ...

  1. Summarization of clinical information: a conceptual model.

    Science.gov (United States)

    Feblowitz, Joshua C; Wright, Adam; Singh, Hardeep; Samal, Lipika; Sittig, Dean F

    2011-08-01

    To provide high-quality and safe care, clinicians must be able to optimally collect, distill, and interpret patient information. Despite advances in text summarization, only limited research exists on clinical summarization, the complex and heterogeneous process of gathering, organizing and presenting patient data in various forms. To develop a conceptual model for describing and understanding clinical summarization in both computer-independent and computer-supported clinical tasks. Based on extensive literature review and clinical input, we developed a conceptual model of clinical summarization to lay the foundation for future research on clinician workflow and automated summarization using electronic health records (EHRs). Our model identifies five distinct stages of clinical summarization: (1) Aggregation, (2) Organization, (3) Reduction and/or Transformation, (4) Interpretation and (5) Synthesis (AORTIS). The AORTIS model describes the creation of complex, task-specific clinical summaries and provides a framework for clinical workflow analysis and directed research on test results review, clinical documentation and medical decision-making. We describe a hypothetical case study to illustrate the application of this model in the primary care setting. Both practicing physicians and clinical informaticians need a structured method of developing, studying and evaluating clinical summaries in support of a wide range of clinical tasks. Our proposed model of clinical summarization provides a potential pathway to advance knowledge in this area and highlights directions for further research. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. Comparison of Overridden Medication-related Clinical Decision Support in the Intensive Care Unit between a Commercial System and a Legacy System.

    Science.gov (United States)

    Wong, Adrian; Wright, Adam; Seger, Diane L; Amato, Mary G; Fiskio, Julie M; Bates, David

    2017-08-23

    Electronic health records (EHRs) with clinical decision support (CDS) have shown to be effective at improving patient safety. Despite this, alerts delivered as part of CDS are overridden frequently, which is of concern in the critical care population as this group may have an increased risk of harm. Our organization recently transitioned from an internally-developed EHR to a commercial system. Data comparing various EHR systems, especially after transitions between EHRs, are needed to identify areas for improvement. To compare the two systems and identify areas for potential improvement with the new commercial system at a single institution. Overridden medication-related CDS alerts were included from October to December of the systems' respective years (legacy, 2011; commercial, 2015), restricted to three intensive care units. The two systems were compared with regards to CDS presentation and override rates for four types of CDS: drug-allergy, drug-drug interaction (DDI), geriatric and renal alerts. A post hoc analysis to evaluate for adverse drug events (ADEs) potentially resulting from overridden alerts was performed for 'contraindicated' DDIs via chart review. There was a significant increase in provider exposure to alerts and alert overrides in the commercial system (commercial: n=5,535; legacy: n=1,030). Rates of overrides were higher for the allergy and DDI alerts (pcommercial system. Geriatric and renal alerts were significantly different in incidence and presentation between the two systems. No ADEs were identified in an analysis of 43 overridden contraindicated DDI alerts. The vendor system had much higher rates of both alerts and overrides, although we did not find evidence of harm in a review of DDIs which were overridden. We propose recommendations for improving our current system which may be helpful to other similar institutions; improving both alert presentation and the underlying knowledge base appear important.

  3. Radiation information and informed consent for clinical trials

    Energy Technology Data Exchange (ETDEWEB)

    Caon, Martin [School of Nursing and Midwifery, Flinders University, Adelaide (Australia)], E-mail: martin.caon@flinders.edu.au

    2008-09-01

    Examples of the statements about the radiation from medical imaging in the information for participants provided to the Human Research Ethics Committee (HREC) for approval are presented and discussed. There is considerable scope for improvement in the information about radiation that is presented to potential participants in clinical trials. Many radiation statements seem only intended to allay fear and anxiety about radiation rather than providing accurate information. This situation cannot be said to be conducive to allowing the participant to give informed consent to their involvement in a clinical trial in which ionising radiation is used. As many clinical trials are international and conducted at many sites (sometimes over 100), we would expect the same statements to have been seen by members of HRECs in many countries. Few HRECs include a member who is an expert in radiation. Hence, to ensure that the information is sound, those sections of the participant information that refer to radiation should be written or reviewed by a specialist in radiation protection such as a medical physicist, a health physicist or a radiation safety officer. (opinion)

  4. Radiation information and informed consent for clinical trials

    International Nuclear Information System (INIS)

    Caon, Martin

    2008-01-01

    Examples of the statements about the radiation from medical imaging in the information for participants provided to the Human Research Ethics Committee (HREC) for approval are presented and discussed. There is considerable scope for improvement in the information about radiation that is presented to potential participants in clinical trials. Many radiation statements seem only intended to allay fear and anxiety about radiation rather than providing accurate information. This situation cannot be said to be conducive to allowing the participant to give informed consent to their involvement in a clinical trial in which ionising radiation is used. As many clinical trials are international and conducted at many sites (sometimes over 100), we would expect the same statements to have been seen by members of HRECs in many countries. Few HRECs include a member who is an expert in radiation. Hence, to ensure that the information is sound, those sections of the participant information that refer to radiation should be written or reviewed by a specialist in radiation protection such as a medical physicist, a health physicist or a radiation safety officer. (opinion)

  5. Public information about clinical trials and research.

    Science.gov (United States)

    Plétan, Yannick; Zannad, Faïez; Jaillon, Patrice

    2003-01-01

    Be it to restore the confused image of clinical research in relation to the lay public, or to develop new ways of accruing healthy volunteers or patients for clinical trials, there is a need to draft some guidance on how best to provide information on research. Although the French legal and regulatory armamentarium in this area is essentially liberal, there is currently little-justified reluctance among study sponsors to advertise publicly. A group of academic and pharmaceutical industry researchers, assembled for a workshop, together with regulators, journalists, representatives from ethics committees, social security, patient and health consumer groups and other French institutional bodies, has suggested the following series of recommendations: there is no need for additional legal or regulatory constraints; sponsors should be aware of and make use of direct public information on trials; a 'good practice charter' on public communication about clinical trials should be developed; all professionals should be involved in this communication platform; communication in the patient's immediate vicinity should be preferred (primary-care physician, local press); clinical databases and websites accessible to professionals, but also to patients and non-professionals, should be developed; genuine instruction on clinical trials for physicians and health professionals unfamiliar with such trials should be developed and disseminated; media groups should receive at least some training in the fundamentals of clinical research.

  6. Legacy sample disposition project. Volume 2: Final report

    International Nuclear Information System (INIS)

    Gurley, R.N.; Shifty, K.L.

    1998-02-01

    This report describes the legacy sample disposition project at the Idaho Engineering and Environmental Laboratory (INEEL), which assessed Site-wide facilities/areas to locate legacy samples and owner organizations and then characterized and dispositioned these samples. This project resulted from an Idaho Department of Environmental Quality inspection of selected areas of the INEEL in January 1996, which identified some samples at the Test Reactor Area and Idaho Chemical Processing Plant that had not been characterized and dispositioned according to Resource Conservation and Recovery Act (RCRA) requirements. The objective of the project was to manage legacy samples in accordance with all applicable environmental and safety requirements. A systems engineering approach was used throughout the project, which included collecting the legacy sample information and developing a system for amending and retrieving the information. All legacy samples were dispositioned by the end of 1997. Closure of the legacy sample issue was achieved through these actions

  7. Successful Implementation of Clinical Information Technology

    Science.gov (United States)

    Hill, V.; Bruner, K.; Maciaz, G.; Saucedo, L.; Catzoela, L.; Ramirez, R.; Jacobs, W.J.; Nguyen, P.; Patel, L.; Webster, S.L.

    2015-01-01

    Summary Objectives To identify and describe the most critical strategic and operational contributors to the successful implementation of clinical information technologies, as deployed within a moderate sized system of U.S. community hospitals. Background and Setting CHRISTUS Health is a multi-state system comprised of more than 350 services and 60 hospitals with over 9 000 physicians. The Santa Rosa region of CHRISTUS Health, located in greater San Antonio, Texas is comprised of three adult community hospital facilities and one Children’s hospital each with bed capacities of 142–180. Computerized Patient Order Entry (CPOE) was first implemented in 2012 within a complex market environment. The Santa Rosa region has 2 417 credentialed physicians and 263 mid-level allied health professionals. Methods This report focuses on the seven most valuable strategies deployed by the Health Informatics team in a large four hospital CHRISTUS region to achieve strong CPOE adoption and critical success lessons learned. The findings are placed within the context of the literature describing best practices in health information technology implementation. Results While the elements described involved discrete de novo process generation to support implementation and operations, collectively they represent the creation of a new customer-centric service culture in our Health Informatics team, which has served as a foundation for ensuring strong clinical information technology adoption beyond CPOE. Conclusion The seven success factors described are not limited in their value to and impact on CPOE adoption, but generalize to – and can advance success in – varied other clinical information technology implementations across diverse hospitals. A number of these factors are supported by reports in the literature of other institutions’ successful implementations of CPOE and other clinical information technologies, and while not prescriptive to other settings, may be adapted to yield

  8. Requirements for clinical information modelling tools.

    Science.gov (United States)

    Moreno-Conde, Alberto; Jódar-Sánchez, Francisco; Kalra, Dipak

    2015-07-01

    This study proposes consensus requirements for clinical information modelling tools that can support modelling tasks in medium/large scale institutions. Rather than identify which functionalities are currently available in existing tools, the study has focused on functionalities that should be covered in order to provide guidance about how to evolve the existing tools. After identifying a set of 56 requirements for clinical information modelling tools based on a literature review and interviews with experts, a classical Delphi study methodology was applied to conduct a two round survey in order to classify them as essential or recommended. Essential requirements are those that must be met by any tool that claims to be suitable for clinical information modelling, and if we one day have a certified tools list, any tool that does not meet essential criteria would be excluded. Recommended requirements are those more advanced requirements that may be met by tools offering a superior product or only needed in certain modelling situations. According to the answers provided by 57 experts from 14 different countries, we found a high level of agreement to enable the study to identify 20 essential and 21 recommended requirements for these tools. It is expected that this list of identified requirements will guide developers on the inclusion of new basic and advanced functionalities that have strong support by end users. This list could also guide regulators in order to identify requirements that could be demanded of tools adopted within their institutions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Understanding legacy liabilities

    Energy Technology Data Exchange (ETDEWEB)

    Ossi, G.J. [Venable, LLP (United States)

    2005-08-01

    Among the most immediate issues facing operations with a workforce represented by the United Mine Workers of America (UMWA) are the so-called 'legacy liabilities'. Legacy liabilities fall under two categories: retiree health care and pension. The retiree health benefit obligations fall into two categories; statutory - those created under the Coal Industry Retiree Health Benefit Act of 1992 and contractual - the 1993 Employer Benefit Plan and the Individual Employer Plans. The pension liabilities are more straightforward; there are three different retirement plans in the NBCWA; the UMWA 1950 Pension Plan, the UMWA 1974 Pension Plan and the UMWA Cash Deferred Savings Plan of 1988.

  10. Creating legacy through evaluation

    DEFF Research Database (Denmark)

    Degn, Hans-Peter; Lynghøj, Hanne; Hansen, Louise Ejgod

    is how to stimulate cultural legacy in certain directions through the emphasis of specific values in the strategic objectives and evaluation criteria. Another perspective is how, to whom and for what purpose evaluation results are reported and implemented, and thus how evaluation may affect design, aims...

  11. Evaluation of clinical information modeling tools.

    Science.gov (United States)

    Moreno-Conde, Alberto; Austin, Tony; Moreno-Conde, Jesús; Parra-Calderón, Carlos L; Kalra, Dipak

    2016-11-01

    Clinical information models are formal specifications for representing the structure and semantics of the clinical content within electronic health record systems. This research aims to define, test, and validate evaluation metrics for software tools designed to support the processes associated with the definition, management, and implementation of these models. The proposed framework builds on previous research that focused on obtaining agreement on the essential requirements in this area. A set of 50 conformance criteria were defined based on the 20 functional requirements agreed by that consensus and applied to evaluate the currently available tools. Of the 11 initiative developing tools for clinical information modeling identified, 9 were evaluated according to their performance on the evaluation metrics. Results show that functionalities related to management of data types, specifications, metadata, and terminology or ontology bindings have a good level of adoption. Improvements can be made in other areas focused on information modeling and associated processes. Other criteria related to displaying semantic relationships between concepts and communication with terminology servers had low levels of adoption. The proposed evaluation metrics were successfully tested and validated against a representative sample of existing tools. The results identify the need to improve tool support for information modeling and software development processes, especially in those areas related to governance, clinician involvement, and optimizing the technical validation of testing processes. This research confirmed the potential of these evaluation metrics to support decision makers in identifying the most appropriate tool for their organization. Los Modelos de Información Clínica son especificaciones para representar la estructura y características semánticas del contenido clínico en los sistemas de Historia Clínica Electrónica. Esta investigación define, prueba y valida

  12. Managing a project's legacy: implications for organizations and project management

    Science.gov (United States)

    Cooper, Lynne P.; Hecht, Michael H.; Majchrzak, Ann

    2003-01-01

    Organizations that rely on projects to implement their products must find effective mechanisms for propagating lessons learned on one project throughout the organization. A broad view of what constitutes a project's 'legacy' is presented that includes not just the design products and leftover parts, but new processes, relationships, technology, skills, planning data, and performance metrics. Based on research evaluating knowledge reuse in innovative contexts, this paper presents an approach to project legacy management that focuses on collecting and using legacy knowledge to promote organizational learning and effective reuse, while addressing factors of post-project responsibility, information obsolescence, and the importance of ancillary contextual information. .

  13. Informal interprofessional learning: Visualizing the clinical workplace

    NARCIS (Netherlands)

    Wagter, J.M.; van de Bunt, G.G.; Honing, M.; Eckenhausen, M.; Scherpbier, A.

    2012-01-01

    Daily collaboration of senior doctors, residents and nurses involves a major potential for sharing knowledge between professionals. Therefore, more attention needs to be paid to informal learning to create strategies and appropriate conditions for enhancing and effectuating informal learning in the

  14. Fundamental Considerations for Biobank Legacy Planning

    Science.gov (United States)

    Fombonne, Benjamin; Watson, Peter Hamilton; Moore, Helen Marie

    2016-01-01

    Biobanking in its various forms is an activity involving the collection of biospecimens and associated data and their storage for differing lengths of time before use. In some cases, biospecimens are immediately used, but in others, they are stored typically for the term of a specified project or in perpetuity until the materials are used up or declared to be of little scientific value. Legacy planning involves preparing for the phase that follows either biobank closure or a significant change at an operational level. In the case of a classical finite collection, this may be brought about by the completion of the initial scientific goals of a project, a loss of funding, or loss of or change in leadership. Ultimately, this may require making a decision about when and where to transfer materials or whether to destroy them. Because biobanking in its entirety is a complex endeavour, legacy planning touches on biobank operations as well as ethical, legal, financial, and governance parameters. Given the expense and time that goes into setting up and maintaining biobanks, coupled with the ethical imperative to appropriately utilize precious resources donated to research, legacy planning is an activity that every biobanking entity should think about. This article describes some of the fundamental considerations for preparing and executing a legacy plan, and we envisage that this article will facilitate dialogue to help inform best practices and policy development in the future. PMID:26890981

  15. Information on blinding in registered records of clinical trials

    Directory of Open Access Journals (Sweden)

    Viergever Roderik F

    2012-11-01

    Full Text Available Abstract Information on blinding is part of the data that should be provided upon registration of a trial at a clinical trials registry. Reporting of blinding is often absent or of low quality in published articles of clinical trials. This study researched the presence and quality of information on blinding in registered records of clinical trials and highlights the important role of data-recording formats at clinical trial registries in ensuring high-quality registration.

  16. Sediment Budgets and Sources Inform a Novel Valley Bottom Restoration Practice Impacted by Legacy Sediment: The Big Spring Run, PA, Restoration Experiment

    Science.gov (United States)

    Walter, R. C.; Merritts, D.; Rahnis, M. A.; Gellis, A.; Hartranft, J.; Mayer, P. M.; Langland, M.; Forshay, K.; Weitzman, J. N.; Schwarz, E.; Bai, Y.; Blair, A.; Carter, A.; Daniels, S. S.; Lewis, E.; Ohlson, E.; Peck, E. K.; Schulte, K.; Smith, D.; Stein, Z.; Verna, D.; Wilson, E.

    2017-12-01

    Big Spring Run (BSR), a small agricultural watershed in southeastern Pennsylvania, is located in the Piedmont Physiographic Province, which has the highest nutrient and sediment yields in the Chesapeake Bay watershed. To effectively reduce nutrient and sediment loading it is important to monitor the effect of management practices on pollutant reduction. Here we present results of an ongoing study, begun in 2008, to understand the impact of a new valley bottom restoration strategy for reducing surface water sediment and nutrient loads. We test the hypotheses that removing legacy sediments will reduce sediment and phosphorus loads, and that restoring eco-hydrological functions of a buried Holocene wetland (Walter & Merritts 2008) will improve surface and groundwater quality by creating accommodation space to trap sediment and process nutrients. Comparisons of pre- and post-restoration gage data show that restoration lowered the annual sediment load by at least 118 t yr-1, or >75%, from the 1000 m-long restoration reach, with the entire reduction accounted for by legacy sediment removal. Repeat RTK-GPS surveys of pre-restoration stream banks verified that >90 t yr-1 of suspended sediment was from bank erosion within the restoration reach. Mass balance calculations of 137Cs data indicate 85-100% of both the pre-restoration and post-restoration suspended sediment storm load was from stream bank sources. This is consistent with trace element data which show that 80-90 % of the pre-restoration outgoing suspended sediment load at BSR was from bank erosion. Meanwhile, an inventory of fallout 137Cs activity from two hill slope transects adjacent to BSR yields average modern upland erosion rates of 2.7 t ha-1 yr-1 and 5.1 t ha-1 yr-1, showing modest erosion on slopes and deposition at toe of slopes. We conclude that upland farm slopes contribute little soil to the suspended sediment supply within this study area, and removal of historic valley bottom sediment effectively

  17. Research-informed teaching: a clinical approach

    OpenAIRE

    Nicholson, Alex

    2017-01-01

    In a bid to attract students amidst increasing competition within the sector, many universities claim that their teaching is “research-informed”. However, there is some disagreement amongst academics about what actually counts as research-informed teaching and therefore how it should be developed and delivered. Furthermore, whilst academic reputation is a key factor for prospective university applicants, the primary\\ud objective of the majority is to enhance employability. Institutions must t...

  18. RESEARCH Voluntary informed consent and good clinical practice ...

    African Journals Online (AJOL)

    Voluntary informed consent for participation in clinical research is the cornerstone of health research ethics and a requirement for clinical research in South Africa. The South African-specific guidance documents concerning voluntary informed consent provisions differ and sometimes contradict international documents.

  19. Revisiting Legacy Software System Modernization

    NARCIS (Netherlands)

    Khadka, R.

    2016-01-01

    Legacy software systems are those that significantly resist modification and evolution while still being valuable to its stakeholders to the extent that their failure has a detrimental impact on business. Despite several drawbacks of legacy software systems, they are still being extensively used in

  20. Health Management Information System in Private Clinics in Ilorin ...

    African Journals Online (AJOL)

    This descriptive survey was conducted among private clinics located in Ilorin, Kwara State, Nigeria to determine the awareness and level of involvement of private clinic operators towards the National Health Management Information System. A total of 37 functional clinics responded to the survey. Structured questionnaire ...

  1. Design of an extensive information representation scheme for clinical narratives.

    Science.gov (United States)

    Deléger, Louise; Campillos, Leonardo; Ligozat, Anne-Laure; Névéol, Aurélie

    2017-09-11

    Knowledge representation frameworks are essential to the understanding of complex biomedical processes, and to the analysis of biomedical texts that describe them. Combined with natural language processing (NLP), they have the potential to contribute to retrospective studies by unlocking important phenotyping information contained in the narrative content of electronic health records (EHRs). This work aims to develop an extensive information representation scheme for clinical information contained in EHR narratives, and to support secondary use of EHR narrative data to answer clinical questions. We review recent work that proposed information representation schemes and applied them to the analysis of clinical narratives. We then propose a unifying scheme that supports the extraction of information to address a large variety of clinical questions. We devised a new information representation scheme for clinical narratives that comprises 13 entities, 11 attributes and 37 relations. The associated annotation guidelines can be used to consistently apply the scheme to clinical narratives and are https://cabernet.limsi.fr/annotation_guide_for_the_merlot_french_clinical_corpus-Sept2016.pdf . The information scheme includes many elements of the major schemes described in the clinical natural language processing literature, as well as a uniquely detailed set of relations.

  2. Patient representatives' views on patient information in clinical cancer trials

    DEFF Research Database (Denmark)

    Dellson, Pia; Nilbert, Mef; Carlsson, Christina

    2016-01-01

    responses. Subthemes related to the former included individual preferences and perceptions of effect, while subthemes related to the latter were comprehensibility and layout. Based on these observations the patient representatives provided suggestions for improvement, which largely included development......BACKGROUND: Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed...... consent is possible to provide. We explored patient representatives' views and perceptions on the written trial information used in clinical cancer trials. METHODS: Written patient information leaflets used in four clinical trials for colorectal cancer were used for the study. The trials included phase I...

  3. Informed Consent for Inclusion into Clinical Trials: A Serious Subject ...

    African Journals Online (AJOL)

    Informed Consent for Inclusion into Clinical Trials: A Serious Subject to Note in the Developing World Morteza. ... Review: The process of taking informed consent is wellunderstood in developed countries, with every effort taken to enhance and maintain the autonomy of patients and their right to make an informed choice of ...

  4. [Development and clinical evaluation of an anesthesia information management system].

    Science.gov (United States)

    Feng, Jing-yi; Chen, Hua; Zhu, Sheng-mei

    2010-09-21

    To study the design, implementation and clinical evaluation of an anesthesia information management system. To record, process and store peri-operative patient data automatically, all kinds of bedside monitoring equipments are connected into the system based on information integrating technology; after a statistical analysis of those patient data by data mining technology, patient status can be evaluated automatically based on risk prediction standard and decision support system, and then anesthetist could perform reasonable and safe clinical processes; with clinical processes electronically recorded, standard record tables could be generated, and clinical workflow is optimized, as well. With the system, kinds of patient data could be collected, stored, analyzed and archived, kinds of anesthesia documents could be generated, and patient status could be evaluated to support clinic decision. The anesthesia information management system is useful for improving anesthesia quality, decreasing risk of patient and clinician, and aiding to provide clinical proof.

  5. Till Moritz Karbach, Scientific Legacy

    CERN Document Server

    Aaij, Roel; Adinolfi, Marco; Affolder, Anthony; Ajaltouni, Ziad; Akar, Simon; Albrecht, Johannes; Alessio, Federico; Alexander, Michael; Ali, Suvayu; Alkhazov, Georgy; Alvarez Cartelle, Paula; Alves Jr, Antonio Augusto; Amato, Sandra; Amerio, Silvia; Amhis, Yasmine; An, Liupan; Anderlini, Lucio; Anderson, Jonathan; Andreassi, Guido; Andreotti, Mirco; Andrews, Jason; Appleby, Robert; Aquines Gutierrez, Osvaldo; Archilli, Flavio; d'Argent, Philippe; Artamonov, Alexander; Artuso, Marina; Aslanides, Elie; Auriemma, Giulio; Baalouch, Marouen; Bachmann, Sebastian; Back, John; Badalov, Alexey; Baesso, Clarissa; Baldini, Wander; Barlow, Roger; Barschel, Colin; Barsuk, Sergey; Barter, William; Batozskaya, Varvara; Battista, Vincenzo; Bay, Aurelio; Beaucourt, Leo; Beddow, John; Bedeschi, Franco; Bediaga, Ignacio; Bel, Lennaert; Bellee, Violaine; Belyaev, Ivan; Ben-Haim, Eli; Bencivenni, Giovanni; Benson, Sean; Benton, Jack; Berezhnoy, Alexander; Bernet, Roland; Bertolin, Alessandro; Bettler, Marc-Olivier; van Beuzekom, Martinus; Bien, Alexander; Bifani, Simone; Bird, Thomas; Birnkraut, Alex; Bizzeti, Andrea; Blake, Thomas; Blanc, Frédéric; Blouw, Johan; Blusk, Steven; Bocci, Valerio; Bondar, Alexander; Bondar, Nikolay; Bonivento, Walter; Borghi, Silvia; Borsato, Martino; Bowcock, Themistocles; Bowen, Espen Eie; Bozzi, Concezio; Braun, Svende; Brett, David; Britsch, Markward; Britton, Thomas; Brodzicka, Jolanta; Brook, Nicholas; Bursche, Albert; Buytaert, Jan; Cadeddu, Sandro; Calabrese, Roberto; Calvi, Marta; Calvo Gomez, Miriam; Campana, Pierluigi; Campora Perez, Daniel; Capriotti, Lorenzo; Carbone, Angelo; Carboni, Giovanni; Cardinale, Roberta; Cardini, Alessandro; Carniti, Paolo; Carson, Laurence; Carvalho Akiba, Kazuyoshi; Casse, Gianluigi; Cassina, Lorenzo; Castillo Garcia, Lucia; Cattaneo, Marco; Cauet, Christophe; Cavallero, Giovanni; Cenci, Riccardo; Charles, Matthew; Charpentier, Philippe; Chefdeville, Maximilien; Chen, Shanzhen; Cheung, Shu-Faye; Chiapolini, Nicola; Chrzaszcz, Marcin; Cid Vidal, Xabier; Ciezarek, Gregory; Clarke, Peter; Clemencic, Marco; Cliff, Harry; Closier, Joel; Coco, Victor; Cogan, Julien; Cogneras, Eric; Cogoni, Violetta; Cojocariu, Lucian; Collazuol, Gianmaria; Collins, Paula; Comerma-Montells, Albert; Contu, Andrea; Cook, Andrew; Coombes, Matthew; Coquereau, Samuel; Corti, Gloria; Corvo, Marco; Couturier, Benjamin; Cowan, Greig; Craik, Daniel Charles; Crocombe, Andrew; Cruz Torres, Melissa Maria; Cunliffe, Samuel; Currie, Robert; D'Ambrosio, Carmelo; Dalseno, Jeremy; David, Pieter; Davis, Adam; De Bruyn, Kristof; De Capua, Stefano; De Cian, Michel; De Miranda, Jussara; De Paula, Leandro; De Silva, Weeraddana; De Simone, Patrizia; Dean, Cameron Thomas; Decamp, Daniel; Deckenhoff, Mirko; Del Buono, Luigi; Déléage, Nicolas; Demmer, Moritz; Derkach, Denis; Deschamps, Olivier; Dettori, Francesco; Dey, Biplab; Di Canto, Angelo; Di Ruscio, Francesco; Dijkstra, Hans; Donleavy, Stephanie; Dordei, Francesca; Dorigo, Mirco; Dosil Suárez, Alvaro; Dossett, David; Dovbnya, Anatoliy; Dreimanis, Karlis; Dufour, Laurent; Dujany, Giulio; Dupertuis, Frederic; Durante, Paolo; Dzhelyadin, Rustem; Dziurda, Agnieszka; Dzyuba, Alexey; Easo, Sajan; Egede, Ulrik; Egorychev, Victor; Eidelman, Semen; Eisenhardt, Stephan; Eitschberger, Ulrich; Ekelhof, Robert; Eklund, Lars; El Rifai, Ibrahim; Elsasser, Christian; Ely, Scott; Esen, Sevda; Evans, Hannah Mary; Evans, Timothy; Falabella, Antonio; Färber, Christian; Farinelli, Chiara; Farley, Nathanael; Farry, Stephen; Fay, Robert; Ferguson, Dianne; Fernandez Albor, Victor; Ferrari, Fabio; Ferreira Rodrigues, Fernando; Ferro-Luzzi, Massimiliano; Filippov, Sergey; Fiore, Marco; Fiorini, Massimiliano; Firlej, Miroslaw; Fitzpatrick, Conor; Fiutowski, Tomasz; Fohl, Klaus; Fol, Philip; Fontana, Marianna; Fontanelli, Flavio; Forty, Roger; Francisco, Oscar; Frank, Markus; Frei, Christoph; Frosini, Maddalena; Fu, Jinlin; Furfaro, Emiliano; Gallas Torreira, Abraham; Galli, Domenico; Gallorini, Stefano; Gambetta, Silvia; Gandelman, Miriam; Gandini, Paolo; Gao, Yuanning; García Pardiñas, Julián; Garra Tico, Jordi; Garrido, Lluis; Gascon, David; Gaspar, Clara; Gastaldi, Ugo; Gauld, Rhorry; Gavardi, Laura; Gazzoni, Giulio; Geraci, Angelo; Gerick, David; Gersabeck, Evelina; Gersabeck, Marco; Gershon, Timothy; Ghez, Philippe; Gianelle, Alessio; Gianì, Sebastiana; Gibson, Valerie; Girard, Olivier Göran; Giubega, Lavinia-Helena; Gligorov, Vladimir; Göbel, Carla; Golubkov, Dmitry; Golutvin, Andrey; Gomes, Alvaro; Gotti, Claudio; Grabalosa Gándara, Marc; Graciani Diaz, Ricardo; Granado Cardoso, Luis Alberto; Graugés, Eugeni; Graverini, Elena; Graziani, Giacomo; Grecu, Alexandru; Greening, Edward; Gregson, Sam; Griffith, Peter; Grillo, Lucia; Grünberg, Oliver; Gui, Bin; Gushchin, Evgeny; Guz, Yury; Gys, Thierry; Hadavizadeh, Thomas; Hadjivasiliou, Christos; Haefeli, Guido; Haen, Christophe; Haines, Susan; Hall, Samuel; Hamilton, Brian; Han, Xiaoxue; Hansmann-Menzemer, Stephanie; Harnew, Neville; Harnew, Samuel; Harrison, Jonathan; He, Jibo; Head, Timothy; Heijne, Veerle; Hennessy, Karol; Henrard, Pierre; Henry, Louis; Hernando Morata, Jose Angel; van Herwijnen, Eric; Heß, Miriam; Hicheur, Adlène; Hill, Donal; Hoballah, Mostafa; Hombach, Christoph; Hulsbergen, Wouter; Humair, Thibaud; Hussain, Nazim; Hutchcroft, David; Hynds, Daniel; Idzik, Marek; Ilten, Philip; Jacobsson, Richard; Jaeger, Andreas; Jalocha, Pawel; Jans, Eddy; Jawahery, Abolhassan; Jing, Fanfan; John, Malcolm; Johnson, Daniel; Jones, Christopher; Joram, Christian; Jost, Beat; Jurik, Nathan; Kandybei, Sergii; Kanso, Walaa; Karacson, Matthias; Karodia, Sarah; Kelsey, Matthew; Kenyon, Ian; Kenzie, Matthew; Ketel, Tjeerd; Khanji, Basem; Khurewathanakul, Chitsanu; Klaver, Suzanne; Klimaszewski, Konrad; Kochebina, Olga; Kolpin, Michael; Komarov, Ilya; Koopman, Rose; Koppenburg, Patrick; Korolev, Mikhail; Kozeiha, Mohamad; Kravchuk, Leonid; Kreplin, Katharina; Kreps, Michal; Krocker, Georg; Krokovny, Pavel; Kruse, Florian; Kucewicz, Wojciech; Kucharczyk, Marcin; Kudryavtsev, Vasily; Kuonen, Axel Kevin; Kurek, Krzysztof; Kvaratskheliya, Tengiz; Lacarrere, Daniel; Lafferty, George; Lai, Adriano; Lambert, Dean; Lambert, Robert W; Lanfranchi, Gaia; Langenbruch, Christoph; Langhans, Benedikt; Latham, Thomas; Lazzeroni, Cristina; Le Gac, Renaud; van Leerdam, Jeroen; Lees, Jean-Pierre; Lefèvre, Regis; Leflat, Alexander; Lefrançois, Jacques; Leroy, Olivier; Lesiak, Tadeusz; Leverington, Blake; Li, Yiming; Likhomanenko, Tatiana; Liles, Myfanwy; Lindner, Rolf; Linn, Christian; Lionetto, Federica; Liu, Bo; Liu, Xuesong; Loh, David; Lohn, Stefan; Longstaff, Iain; Lopes, Jose; Lowdon, Peter; Lucchesi, Donatella; Luo, Haofei; Lupato, Anna; Luppi, Eleonora; Lupton, Oliver; Machefert, Frederic; Maciuc, Florin; Maev, Oleg; Maguire, Kevin; Malde, Sneha; Malinin, Alexander; Manca, Giulia; Mancinelli, Giampiero; Manning, Peter Michael; Mapelli, Alessandro; Maratas, Jan; Marchand, Jean François; Marconi, Umberto; Marin Benito, Carla; Marino, Pietro; Märki, Raphael; Marks, Jörg; Martellotti, Giuseppe; Martin, Morgan; Martinelli, Maurizio; Martinez Santos, Diego; Martinez Vidal, Fernando; Martins Tostes, Danielle; Massafferri, André; Matev, Rosen; Mathad, Abhijit; Mathe, Zoltan; Matteuzzi, Clara; Mauri, Andrea; Maurin, Brice; Mazurov, Alexander; McCann, Michael; McCarthy, James; McNab, Andrew; McNulty, Ronan; Meadows, Brian; Meier, Frank; Meissner, Marco; Melnychuk, Dmytro; Merk, Marcel; Milanes, Diego Alejandro; Minard, Marie-Noelle; Mitzel, Dominik Stefan; Molina Rodriguez, Josue; Monteil, Stephane; Morandin, Mauro; Morawski, Piotr; Mordà, Alessandro; Morello, Michael Joseph; Moron, Jakub; Morris, Adam Benjamin; Mountain, Raymond; Muheim, Franz; Müller, Janine; Müller, Katharina; Müller, Vanessa; Mussini, Manuel; Muster, Bastien; Naik, Paras; Nakada, Tatsuya; Nandakumar, Raja; Nandi, Anita; Nasteva, Irina; Needham, Matthew; Neri, Nicola; Neubert, Sebastian; Neufeld, Niko; Neuner, Max; Nguyen, Anh Duc; Nguyen, Thi-Dung; Nguyen-Mau, Chung; Niess, Valentin; Niet, Ramon; Nikitin, Nikolay; Nikodem, Thomas; Ninci, Daniele; Novoselov, Alexey; O'Hanlon, Daniel Patrick; Oblakowska-Mucha, Agnieszka; Obraztsov, Vladimir; Ogilvy, Stephen; Okhrimenko, Oleksandr; Oldeman, Rudolf; Onderwater, Gerco; Osorio Rodrigues, Bruno; Otalora Goicochea, Juan Martin; Otto, Adam; Owen, Patrick; Oyanguren, Maria Aranzazu; Palano, Antimo; Palombo, Fernando; Palutan, Matteo; Panman, Jacob; Papanestis, Antonios; Pappagallo, Marco; Pappalardo, Luciano; Pappenheimer, Cheryl; Parkes, Christopher; Passaleva, Giovanni; Patel, Girish; Patel, Mitesh; Patrignani, Claudia; Pearce, Alex; Pellegrino, Antonio; Penso, Gianni; Pepe Altarelli, Monica; Perazzini, Stefano; Perret, Pascal; Pescatore, Luca; Petridis, Konstantinos; Petrolini, Alessandro; Petruzzo, Marco; Picatoste Olloqui, Eduardo; Pietrzyk, Boleslaw; Pilař, Tomas; Pinci, Davide; Pistone, Alessandro; Piucci, Alessio; Playfer, Stephen; Plo Casasus, Maximo; Poikela, Tuomas; Polci, Francesco; Poluektov, Anton; Polyakov, Ivan; Polycarpo, Erica; Popov, Alexander; Popov, Dmitry; Popovici, Bogdan; Potterat, Cédric; Price, Eugenia; Price, Joseph David; Prisciandaro, Jessica; Pritchard, Adrian; Prouve, Claire; Pugatch, Valery; Puig Navarro, Albert; Punzi, Giovanni; Qian, Wenbin; Quagliani, Renato; Rachwal, Bartolomiej; Rademacker, Jonas; Rama, Matteo; Rangel, Murilo; Raniuk, Iurii; Rauschmayr, Nathalie; Raven, Gerhard; Redi, Federico; Reichert, Stefanie; Reid, Matthew; dos Reis, Alberto; Ricciardi, Stefania; Richards, Sophie; Rihl, Mariana; Rinnert, Kurt; Rives Molina, Vincente; Robbe, Patrick; Rodrigues, Ana Barbara; Rodrigues, Eduardo; Rodriguez Lopez, Jairo Alexis; Rodriguez Perez, Pablo; Roiser, Stefan; Romanovsky, Vladimir; Romero Vidal, Antonio; Ronayne, John William; Rotondo, Marcello; Rouvinet, Julien; Ruf, Thomas; Ruiz, Hugo; Ruiz Valls, Pablo; Saborido Silva, Juan Jose; Sagidova, Naylya; Sail, Paul; Saitta, Biagio; Salustino Guimaraes, Valdir; Sanchez Mayordomo, Carlos; Sanmartin Sedes, Brais; Santacesaria, Roberta; Santamarina Rios, Cibran; Santimaria, Marco; Santovetti, Emanuele; Sarti, Alessio; Satriano, Celestina; Satta, Alessia; Saunders, Daniel Martin; Savrina, Darya; Schiller, Manuel; Schindler, Heinrich; Schlupp, Maximilian; Schmelling, Michael; Schmelzer, Timon; Schmidt, Burkhard; Schneider, Olivier; Schopper, Andreas; Schubiger, Maxime; Schune, Marie Helene; Schwemmer, Rainer; Sciascia, Barbara; Sciubba, Adalberto; Semennikov, Alexander; Serra, Nicola; Serrano, Justine; Sestini, Lorenzo; Seyfert, Paul; Shapkin, Mikhail; Shapoval, Illya; Shcheglov, Yury; Shears, Tara; Shekhtman, Lev; Shevchenko, Vladimir; Shires, Alexander; Silva Coutinho, Rafael; Simi, Gabriele; Sirendi, Marek; Skidmore, Nicola; Skillicorn, Ian; Skwarnicki, Tomasz; Smith, Edmund; Smith, Eluned; Smith, Iwan Thomas; Smith, Jackson; Smith, Mark; Snoek, Hella; Sokoloff, Michael; Soler, Paul; Soomro, Fatima; Souza, Daniel; Souza De Paula, Bruno; Spaan, Bernhard; Spradlin, Patrick; Sridharan, Srikanth; Stagni, Federico; Stahl, Marian; Stahl, Sascha; Steinkamp, Olaf; Stenyakin, Oleg; Sterpka, Christopher Francis; Stevenson, Scott; Stoica, Sabin; Stone, Sheldon; Storaci, Barbara; Stracka, Simone; Straticiuc, Mihai; Straumann, Ulrich; Sun, Liang; Sutcliffe, William; Swientek, Krzysztof; Swientek, Stefan; Syropoulos, Vasileios; Szczekowski, Marek; Szczypka, Paul; Szumlak, Tomasz; T'Jampens, Stephane; Tekampe, Tobias; Teklishyn, Maksym; Tellarini, Giulia; Teubert, Frederic; Thomas, Christopher; Thomas, Eric; van Tilburg, Jeroen; Tisserand, Vincent; Tobin, Mark; Todd, Jacob; Tolk, Siim; Tomassetti, Luca; Tonelli, Diego; Topp-Joergensen, Stig; Torr, Nicholas; Tournefier, Edwige; Tourneur, Stephane; Trabelsi, Karim; Tran, Minh Tâm; Tresch, Marco; Trisovic, Ana; Tsaregorodtsev, Andrei; Tsopelas, Panagiotis; Tuning, Niels; Ukleja, Artur; Ustyuzhanin, Andrey; Uwer, Ulrich; Vacca, Claudia; Vagnoni, Vincenzo; Valenti, Giovanni; Vallier, Alexis; Vazquez Gomez, Ricardo; Vazquez Regueiro, Pablo; Vázquez Sierra, Carlos; Vecchi, Stefania; Velthuis, Jaap; Veltri, Michele; Veneziano, Giovanni; Vesterinen, Mika; Viaud, Benoit; Vieira, Daniel; Vieites Diaz, Maria; Vilasis-Cardona, Xavier; Vollhardt, Achim; Volyanskyy, Dmytro; Voong, David; Vorobyev, Alexey; Vorobyev, Vitaly; Voß, Christian; de Vries, Jacco; Waldi, Roland; Wallace, Charlotte; Wallace, Ronan; Walsh, John; Wandernoth, Sebastian; Wang, Jianchun; Ward, David; Watson, Nigel; Websdale, David; Weiden, Andreas; Whitehead, Mark; Wiedner, Dirk; Wilkinson, Guy; Wilkinson, Michael; Williams, Mark Richard James; Williams, Matthew; Williams, Mike; Williams, Timothy; Wilson, Fergus; Wimberley, Jack; Wishahi, Julian; Wislicki, Wojciech; Witek, Mariusz; Wormser, Guy; Wotton, Stephen; Wright, Simon; Wyllie, Kenneth; Xie, Yuehong; Xu, Zhirui; Yang, Zhenwei; Yu, Jiesheng; Yuan, Xuhao; Yushchenko, Oleg; Zangoli, Maria; Zavertyaev, Mikhail; Zhang, Liming; Zhang, Yanxi; Zhelezov, Alexey; Zhokhov, Anatoly; Zhong, Liang

    2015-01-01

    We are deeply touched by the sudden loss of our dear friend and colleague Till Moritz Karbach. With this memorial book we wish to commemorate Moritz’ scientific legacy, and what Moritz meant to us as a friend.

  6. Informed Consent for Inclusion into Clinical Trials: A Serious Subject ...

    African Journals Online (AJOL)

    Informed Consent for Inclusion into Clinical Trials: A Serious Subject to Note in the Developing World Morteza. ... Arab Journal of Nephrology and Transplantation ... in developed countries, with every effort taken to enhance and maintain the autonomy of patients and their right to make an informed choice of whether to ...

  7. The regulation of informed consent to participation in clinical ...

    African Journals Online (AJOL)

    Informed consent is a primary precondition of legal and ethical clinical research and is regarded as the ... on the ethical principle of respect for personal autonomy, informed consent flows from the ..... Ethics. Chichester: John Wiley & Sons, 1994: 63-64, where he presents Kant's argument in favour of respecting autonomy.) 3.

  8. Clinical information in drug package inserts in India

    Directory of Open Access Journals (Sweden)

    Shivkar Y

    2009-01-01

    Full Text Available Background: It is widely recognized that accurate and reliable product information is essential for the safe and effective use of medications. Pharmaceutical companies are the primary source of most drug information, including package inserts. Package inserts are printed leaflets accompanying marketed drug products and contain information approved by the regulatory agencies. Studies on package inserts in India, in 1996, had shown that crucial information was often missing and they lacked uniformity. Aim: To assess the presentation and completeness of clinically important information provided in the currently available package inserts in India. Materials and Methods: Package inserts accompanying allopathic drug products marketed by pharmaceutical companies in India were collected. These package inserts were analyzed for the content of clinically important information in various sections. Statistical Analysis: The results were expressed as absolute numbers and percentages. Results: Preliminary analyses revealed that most package inserts did contain information under headings, such as, therapeutic indications, contraindications, undesirable effects, etc., listed in the Drugs and Cosmetics Rules 1945. The findings indicated considerable improvement in package inserts since 1996. However, on critical evaluation it was revealed that clinically important information was not well presented and was often incomplete. Information with regard to pediatric and geriatric use was present in only 44% and 13% of the package inserts, respectively. Only five of the inserts had information on the most frequent adverse drug reactions associated with the drug. Also, information on interactions and overdosage was often missing. Conclusion: Although the package inserts appear to have improved over the past decade there is still a definite need to further refine the clinical information contained, to minimize the risks to patients. This could be brought about by self

  9. The Role of Simulation in Clinical Information Systems Development

    DEFF Research Database (Denmark)

    Jensen, Sanne; Lyng, Karen Marie; Nøhr, Christian

    2012-01-01

    high fidelity environments. The paper discusses how simulation may be used during the lifecycle of clinical information systems, and the requirements on simulation fidelity in various situations. We recommend that simulation should get a more prominent role in the design and evaluation of clinical......This paper describes the role of simulation involving end-users in Health Informatics. Simulation has long been established as a widely accepted method in clinical skills training. During the last decade simulation has also gained a place in the development and evaluation of clinical information...... systems. Simulation is especially well suited for the evaluation of human factors and organizational aspects in relation to application of information systems. In full-scale simulation tests it is possible to evaluate socio-technical interaction. A near to real life experience can be achieved by creating...

  10. Assisted Emulation for Legacy Executables

    Directory of Open Access Journals (Sweden)

    Kam Woods

    2010-07-01

    Full Text Available Emulation is frequently discussed as a failsafe preservation strategy for born-digital documents that depend on contemporaneous software for access (Rothenberg, 2000. Yet little has been written about the contextual knowledge required to successfully use such software. The approach we advocate is to preserve necessary contextual information through scripts designed to control the legacy environment, and created during the preservation workflow. We describe software designed to minimize dependence on this knowledge by offering automated configuration and execution of emulated environments. We demonstrate that even simple scripts can reduce impediments to casual use of the digital objects being preserved. We describe tools to automate the remote use of preserved objects on local emulation environments.  This can help eliminate both a dependence on physical reference workstations at preservation institutions, and provide users accessing materials over the web with simplified, easy-to-use environments. Our implementation is applied to examples from an existing collection of over 4,000 virtual CD-ROM images containing thousands of custom binary executables.

  11. Creating a career legacy map to help assure meaningful work in nursing.

    Science.gov (United States)

    Hinds, Pamela S; Britton, Dorienda R; Coleman, Lael; Engh, Eileen; Humbel, Tina Kunze; Keller, Susan; Kelly, Katherine Patterson; Menard, Johanna; Lee, Marlene A; Roberts-Turner, Renee; Walczak, Dory

    2015-01-01

    When nurses declare a professional legacy (or what they intend to be better in health care because of their efforts), they are likely to maintain a focus on achieving their legacy and to experience meaning in the process. We depict the legacy and involved steps in creating a legacy map, which is a concrete guide forward to intended career outcomes. Informed by the "meaningful work" literature, we describe a legacy map, its function, the process to create one, and the application of a legacy map to guide careers. We also describe an administrative benefit of the legacy map-the map can be used by team leaders and members to secure needed resources and opportunities to support the desired legacy of team members. Legacy mapping can be a self-use career guidance tool for nurses and other health care professionals or a tool that links the career efforts of a team member with the career support efforts of a team leader. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. WORLD CUP LEGACY AND PERTAINING IMPACTS ON SÃO PAULO CITY´S FUTURE

    Directory of Open Access Journals (Sweden)

    Marcos Vinicius Cardoso

    2013-08-01

    Full Text Available Legacies – structures that are built for events and which remain after the same - are one of the major positive aspects paraded by mega sporting events organizers. This study´s purpose is to analyze the current situation of legacies promised by the many governmental instances for the city of São Paulo - host city of Fifa´s 2014 World Cup – and prospect which legacies will become effective in the city. Preliminary assessments may raise construction concerns, alert the public to keep an eye on undertaken obligations and encourage official actions (Mangan, 2008, p. 1,871. Data was obtained from National Audit Court (TCU reports, Ministry and United Nations documents, in addition to testimonials and information gathered from some of Brazil´s major press media. Data analysis was conducted by classifying legacies according to tangible and intangible legacy concepts (Kaplanidou and Karadakis, 2010 followed by an analysis of promised legacies versus current status during the period of analysis. Finally, discussions as to most probable to come about legacies were presented. Results indicate that a portion of promised legacies stand a fair chance of achievement. On the other hand, other projects lag behind schedule or have been cancelled. Preliminary surveys suggest full completion of promised legacies is not possible, there has been an overuse of public resources as opposed to that planned, and provide indicatives as to the investment´s high opportunity cost.

  13. CliniProteus: A flexible clinical trials information management system

    Science.gov (United States)

    Mathura, Venkatarajan S; Rangareddy, Mahendiranath; Gupta, Pankaj; Mullan, Michael

    2007-01-01

    Clinical trials involve multi-site heterogeneous data generation with complex data input-formats and forms. The data should be captured and queried in an integrated fashion to facilitate further analysis. Electronic case-report forms (eCRF) are gaining popularity since it allows capture of clinical information in a rapid manner. We have designed and developed an XML based flexible clinical trials data management framework in .NET environment that can be used for efficient design and deployment of eCRFs to efficiently collate data and analyze information from multi-site clinical trials. The main components of our system include an XML form designer, a Patient registration eForm, reusable eForms, multiple-visit data capture and consolidated reports. A unique id is used for tracking the trial, site of occurrence, the patient and the year of recruitment. Availability http://www.rfdn.org/bioinfo/CTMS/ctms.html. PMID:21670796

  14. Designing healthcare information technology to catalyse change in clinical care

    Directory of Open Access Journals (Sweden)

    William Lester

    2008-05-01

    Full Text Available The gap between best practice and actual patient care continues to be a pervasive problem in our healthcare system. Efforts to improve on this knowledge_performance gap have included computerised disease management programs designed to improve guideline adherence. However, current computerised reminder and decision support interventions directed at changing physician behaviour have had only a limited and variable effect on clinical outcomes. Further, immediate pay-for-performance financial pressures on institutions have created an environmentwhere disease management systems are often created under duress, appended to existing clinical systems and poorly integrated into the existing workflow, potentially limiting their realworld effectiveness. The authors present a review of disease management as well as a conceptual framework to guide the development of more effective health information technology (HIT tools for translating clinical information into clinical action.

  15. Hospital information management: the need for clinical leadership.

    Science.gov (United States)

    Wyatt, J. C.

    1995-01-01

    On 12 July the Audit Commission published For Your Information, a well researched report about information and its management in acute hospitals in Britain, how and why it is failing, and steps that clinicians, managers, and the NHS should take to correct this. This article discusses why information management matters to clinicians and considers the problems identified by the Audit Commission--most of which will strike chords with doctors--and possible remedies. Finally, it describes possible routes to administer these remedies and the proposal, recently supported by the BMA Council, for a national centre for health informatics with the goals of educating and enthusing clinicians about informatics, empowering them to participate in local and national information management decisions; exploring how information can be used to improve patient care and outcomes; and evaluating clinical information systems and helping to realise their benefits. PMID:7613433

  16. A study of clinical and information management processes in the surgical pre-assessment clinic.

    Science.gov (United States)

    Bouamrane, Matt-Mouley; Mair, Frances S

    2014-03-25

    Establishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients. As part of a study to elucidate clinical and information management processes within the patient surgical pathway in NHS Scotland, we conducted a total of 10 in-depth semi-structured interviews during 4 visits to the Dumfries & Galloway Royal Infirmary surgical pre-assessment clinic. We modelled clinical processes using process-mapping techniques and analysed interview data using qualitative methods. We used Normalisation Process Theory as a conceptual framework to interpret the factors which were identified as facilitating or hindering information elucidation tasks and communication within the multi-disciplinary team. The pre-assessment clinic of Dumfries & Galloway Royal Infirmary was opened in 2008 in response to clinical and workflow issues which had been identified with former patient management practices in the surgical pathway. The preoperative clinic now operates under well established processes and protocols. The use of a computerised system for managing preoperative documentation substantially transformed clinical practices and facilitates communication and information-sharing among the multi-disciplinary team. Successful deployment and normalisation of innovative clinical and information management processes was possible because both local and national strategic priorities were synergistic and the system was developed collaboratively by the POA staff and the health-board IT team, resulting in a highly contextualised operationalisation of clinical and information management processes. Further concerted efforts from a range of stakeholders are required to fully integrate preoperative assessment

  17. Clinical and Para Clinical Information Needs of Infertility Electronic Health Records in Iran: A Delphi Study.

    Science.gov (United States)

    Farzandipour, Mehrdad; Jeddi, Fateme Rangraz; Gilasi, Hamid Reza; Shirzadi, Diana

    2017-09-01

    infertility is referred to the person's inability to conceive pregnancy after one year of intercourse without using protection. This study paves the ground for creating a complete, united, and coherent source of patients' medical information. this is an applied research of descriptive-cross sectional type which has been carried out through qualitative - quantitative methods. The sample of the present study was 50 specialists in the field of infertility which has been chosen based on purposive sampling method. Designing the questionnaire was done based on library studies and Gathering experts' views was done based on Delphi technique. 261 items from clinical and Para clinical information of infertile patients' electronic health records were subjected to an opinion poll by experts. During this process 223 items were accepted and 38 items have been rejected after two sessions of surveys by infertility experts. Para clinical information section consisted of 57 items that all of them have been accepted by the experts. Also, clinical information section consisted of 242 items from which 204 items were accepted and 38 items were rejected by the experts. existence of a structured electronic record system of infertile patients' information leads to the integration of patients' information, improvement of health care services and a decrease in treatment costs: all working to increase information safety. Furthermore, only essential and relevant information would be provided for the specialists and it will facilitate and direct the future infertility related studies due to the coherence, unity and relevance of the information.

  18. Informed consent for clinical trials: a review | Lema | East African ...

    African Journals Online (AJOL)

    Data sources: Published original research findings and reviews in the English literature, together with anecdotal information from our current professional experiences with clinical trials. Design: Review of peer-reviewed articles. Data extraction: Online searches were done and requests for reprints from corresponding ...

  19. Change management and clinical engagement: critical elements for a successful clinical information system implementation.

    Science.gov (United States)

    Detwiller, Maureen; Petillion, Wendy

    2014-06-01

    Moving a large healthcare organization from an old, nonstandardized clinical information system to a new user-friendly, standards-based system was much more than an upgrade to technology. This project to standardize terminology, optimize key processes, and implement a new clinical information system was a large change initiative over 4 years that affected clinicians across the organization. Effective change management and engagement of clinical stakeholders were critical to the success of the initiative. The focus of this article was to outline the strategies and methodologies used and the lessons learned.

  20. U.S. Spacesuit Legacy: Maintaining it for the Future

    Science.gov (United States)

    Chullen, Cinda; McMann, Joe; Thomas, Ken; Kosmo, Joe; Lewis, Cathleen; Wright, Rebecca; Bitterly, Rose; Olivia, Vladenka Rose

    2013-01-01

    The history of U.S. spacesuit development and its use are rich with information on lessons learned, and constitutes a valuable legacy to those designing spacesuits for the future, as well as to educators, students, and the general public. The genesis of lessons learned is best understood by studying the evolution of past spacesuit programs - how the challenges and pressures of the times influenced the direction of the various spacesuit programs. This paper shows how the legacy of various spacesuit-related programs evolved in response to these forces. Important aspects of how this U.S. spacesuit legacy is being preserved today is described, including the archiving of spacesuit hardware, important documents, videos, oral history, and the rapidly expanding U.S. Spacesuit Knowledge Capture program.

  1. Information needs for the rapid response team electronic clinical tool.

    Science.gov (United States)

    Barwise, Amelia; Caples, Sean; Jensen, Jeffrey; Pickering, Brian; Herasevich, Vitaly

    2017-10-02

    Information overload in healthcare is dangerous. It can lead to critical errors and delays. During Rapid Response Team (RRT) activations providers must make decisions quickly to rescue patients from physiological deterioration. In order to understand the clinical data required and how best to present that information in electronic systems we aimed to better assess the data needs of providers on the RRT when they respond to an event. A web based survey to evaluate clinical data requirements was created and distributed to all RRT providers at our institution. Participants were asked to rate the importance of each data item in guiding clinical decisions during a RRT event response. There were 96 surveys completed (24.5% response rate) with fairly even distribution throughout all clinical roles on the RRT. Physiological data including heart rate, respiratory rate, and blood pressure were ranked by more than 80% of responders as being critical information. Resuscitation status was also considered critically useful by more than 85% of providers. There is a limited dataset that is considered important during an RRT. The data is widely available in EMR. The findings from this study could be used to improve user-centered EMR interfaces.

  2. Development of a clinical data warehouse from an intensive care clinical information system.

    Science.gov (United States)

    de Mul, Marleen; Alons, Peter; van der Velde, Peter; Konings, Ilse; Bakker, Jan; Hazelzet, Jan

    2012-01-01

    There are relatively few institutions that have developed clinical data warehouses, containing patient data from the point of care. Because of the various care practices, data types and definitions, and the perceived incompleteness of clinical information systems, the development of a clinical data warehouse is a challenge. In order to deal with managerial and clinical information needs, as well as educational and research aims that are important in the setting of a university hospital, Erasmus Medical Center Rotterdam, The Netherlands, developed a data warehouse incrementally. In this paper we report on the in-house development of an integral part of the data warehouse specifically for the intensive care units (ICU-DWH). It was modeled using Atos Origin Metadata Frame method. The paper describes the methodology, the development process and the content of the ICU-DWH, and discusses the need for (clinical) data warehouses in intensive care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  3. Forging Links between the Web and Legacy Systems.

    Science.gov (United States)

    Chapman, Noleen

    1998-01-01

    Discusses why information technology managers are exploring the economic and strategic advantages of Web technology and finding that legacy systems still have an important role. Presents benefits: centralized management, reduced cost of ownership, wide user access; models of Web-to-host access; the Citrix thin client model; and future of…

  4. Tools in a clinical information system supporting clinical trials at a Swiss University Hospital.

    Science.gov (United States)

    Weisskopf, Michael; Bucklar, Guido; Blaser, Jürg

    2014-12-01

    Issues concerning inadequate source data of clinical trials rank second in the most common findings by regulatory authorities. The increasing use of electronic clinical information systems by healthcare providers offers an opportunity to facilitate and improve the conduct of clinical trials and the source documentation. We report on a number of tools implemented into the clinical information system of a university hospital to support clinical research. In 2011/2012, a set of tools was developed in the clinical information system of the University Hospital Zurich to support clinical research, including (1) a trial registry for documenting metadata on the clinical trials conducted at the hospital, (2) a patient-trial-assignment-tool to tag patients in the electronic medical charts as participants of specific trials, (3) medical record templates for the documentation of study visits and trial-related procedures, (4) online queries on trials and trial participants, (5) access to the electronic medical records for clinical monitors, (6) an alerting tool to notify of hospital admissions of trial participants, (7) queries to identify potentially eligible patients in the planning phase as trial feasibility checks and during the trial as recruitment support, and (8) order sets to facilitate the complete and accurate performance of study visit procedures. The number of approximately 100 new registrations per year in the voluntary trial registry in the clinical information system now matches the numbers of the existing mandatory trial registry of the hospital. Likewise, the yearly numbers of patients tagged as trial participants as well as the use of the standardized trial record templates increased to 2408 documented trial enrolments and 190 reports generated/month in the year 2013. Accounts for 32 clinical monitors have been established in the first 2 years monitoring a total of 49 trials in 16 clinical departments. A total of 15 months after adding the optional feature of

  5. The Legacy of Nikola Tesla

    Indian Academy of Sciences (India)

    Srimath

    and problems of rural power situation in India. Writing books of science for children is his major preoccupation now. The Legacy of Nikola Tesla. 2. AC Power System and its Growth in India. D P Sen Gupta. Electrical power supply has grown enormously during this century. In 1950 the total capacity of generators producing.

  6. The Olympic legacy: feeding London

    NARCIS (Netherlands)

    Janssens, F.

    2012-01-01

    Over the last decades, the Olympic Games have increasingly claimed to deliver a social and economic ‘legacy’ to the host city. The 2012 Olympic Games in London have set out to deliver a legacy of better food for east London, an area perceived as ‘deprived’, with higher than average rates of obesity

  7. Einstein's Legacy, at the Globe

    CERN Multimedia

    2005-01-01

    One-hundred years on, Albert Einstein's theories continue to fuel the daily work of physicists. From research into gravity waves to the quest for grand unification in physics, today's researchers have not finished with the legacy of the most famous and iconic physicist of the 20th Century.

  8. The Legacy of Nikola Tesla

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 12; Issue 4. The Legacy of Nikola Tesla - AC Power System and its Growth in India. D P Sen Gupta. General Article Volume 12 Issue 4 April 2007 pp 69-79. Fulltext. Click here to view fulltext PDF. Permanent link:

  9. Understanding Legacy Features with Featureous

    DEFF Research Database (Denmark)

    Olszak, Andrzej; Jørgensen, Bo Nørregaard

    2011-01-01

    Feature-centric comprehension of source code is essential during software evolution. However, such comprehension is oftentimes difficult to achieve due the discrepancies between structural and functional units of object-oriented programs. We present a tool for feature-centric analysis of legacy...

  10. The Legacy of Nikola Tesla

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 12; Issue 3. The Legacy of Nikola Tesla - The AC System that he Helped to Usher in. D P Sen Gupta. General Article Volume 12 Issue 3 March 2007 pp 54-69. Fulltext. Click here to view fulltext PDF. Permanent link:

  11. The Legacy of S Chandrasekhar

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 2; Issue 4. The Legacy of S. Chandrasekhar Remembering a Giant of Our Times. Kameshwar C Wali. General Article Volume 2 Issue 4 April 1997 pp 19-24. Fulltext. Click here to view fulltext PDF. Permanent link:

  12. From Event Planning to Legacy Planning

    OpenAIRE

    Elo, Lauri

    2016-01-01

    The importance of legacy and legacy planning is increasing in the event industry. Mega-events are becoming so expensive to host that the opportunity costs decreases the amount of potential future hosts. The events aim to surpass the costs by creating positive legacies, impacts that last longer than the event itself. Small-events can also have legacies and the positive affects can be even more significant than with the mega-events. Event planning must change to legacy planning in the future, b...

  13. Missing Clinical Information in NHS hospital outpatient clinics: prevalence, causes and effects on patient care

    Directory of Open Access Journals (Sweden)

    Moorthy Krishna

    2011-05-01

    Full Text Available Abstract Background In Britain over 39,000 reports were received by the National Patient Safety Agency relating to failures in documentation in 2007 and the UK Health Services Journal estimated in 2008 that over a million hospital outpatient visits each year might take place without the full record available. Despite these high numbers, the impact of missing clinical information has not been investigated for hospital outpatients in the UK. Studies in primary care in the USA have found 13.6% of patient consultations have missing clinical information, with this adversely affecting care in about half of cases, and in Australia 1.8% of medical errors were found to be due to the unavailability of clinical information. Our objectives were to assess the frequency, nature and potential impact on patient care of missing clinical information in NHS hospital outpatients and to assess the principal causes. This is the first study to present such figures for the UK and the first to look at how clinicians respond, including the associated impact on patient care. Methods Prospective descriptive study of missing information reported by surgeons, supplemented by interviews on the causes. Data were collected by surgeons in general, gastrointestinal, colorectal and vascular surgical clinics in three teaching hospitals across the UK for over a thousand outpatient appointments. Fifteen interviews were conducted with those involved in collating clinical information for these clinics. The study had ethics approval (Hammersmith and Queen Charlotte's & Chelsea Research Ethics Committee, reference number (09/H0707/27. Participants involved in the interviews signed a consent form and were offered the opportunity to review and agree the transcript of their interview before analysis. No patients were involved in this research. Results In 15% of outpatient consultations key items of clinical information were missing. Of these patients, 32% experienced a delay or disruption

  14. Building a clinical leadership community to drive improvement: a multi-case educational study to inform 21st century clinical commissioning, professional capability and patient care.

    Science.gov (United States)

    Lynch, Marion; Verner, Elizabeth

    2013-01-01

    The new NHS requires transformational leadership; people with the knowledge and motivation to make effective change combined with an understanding of the system they work in. The aim of the Practice Leaders' Programme (PLP) is to generate the conditions needed to focus the energy and collaborative creativity required for innovation to enhance leadership skills across the health economy improving patient care. The PLP engaged 60 local leaders from central England in a new approach enabling them to influence others. It has informed educational policy and practice and helped change professional behaviours. Each participant implemented improvements in care and participated in six action learning sets (ALS) and up to six coaching sessions. Evidence of progress, learning and impact was identified in project reports, reflective diaries and evaluations. The ALS brought together key individuals from clinical and management disciplines across a diverse organisation to redesign a system by developing a shared vision for improving the quality of patient care. The links forged, the projects initiated, and the skills cultivated through the PLP produced ongoing benefits and outcomes beyond the course itself. Coaching sessions helped participants focus their efforts to achieve maximum impact and to become resilient in managing service change effectively. The programme has evolved over four years, building on recommendations from external evaluation which identified statistically significant increases in leadership competences. Further enhancement of this programme secured an International Health Improvement Award. Three key findings of positive impact have emerged; personal growth, service improvement, and legacy and sustainability.

  15. Automatically extracting information needs from complex clinical questions.

    Science.gov (United States)

    Cao, Yong-gang; Cimino, James J; Ely, John; Yu, Hong

    2010-12-01

    Clinicians pose complex clinical questions when seeing patients, and identifying the answers to those questions in a timely manner helps improve the quality of patient care. We report here on two natural language processing models, namely, automatic topic assignment and keyword identification, that together automatically and effectively extract information needs from ad hoc clinical questions. Our study is motivated in the context of developing the larger clinical question answering system AskHERMES (Help clinicians to Extract and aRrticulate Multimedia information for answering clinical quEstionS). We developed supervised machine-learning systems to automatically assign predefined general categories (e.g. etiology, procedure, and diagnosis) to a question. We also explored both supervised and unsupervised systems to automatically identify keywords that capture the main content of the question. We evaluated our systems on 4654 annotated clinical questions that were collected in practice. We achieved an F1 score of 76.0% for the task of general topic classification and 58.0% for keyword extraction. Our systems have been implemented into the larger question answering system AskHERMES. Our error analyses suggested that inconsistent annotation in our training data have hurt both question analysis tasks. Our systems, available at http://www.askhermes.org, can automatically extract information needs from both short (the number of word tokens 20), and from both well-structured and ill-formed questions. We speculate that the performance of general topic classification and keyword extraction can be further improved if consistently annotated data are made available. Copyright © 2010 Elsevier Inc. All rights reserved.

  16. Clinical information system based on the medical smart card.

    Science.gov (United States)

    Danon, Y L; Saiag, E

    2000-07-01

    Over the last 5 years Israel has implemented a nationwide health insurance plan covering the entire population of the country. We have developed a clinical information system based on electronic-chip health care medical smart cards. Health care cards are used in several European countries and chip smart cards have been successful in many sectors. Our project involves the community use of the MSC, thereby enabling health care professionals to skillfully employ card systems in the health care sector. This system can easily arrange electronic medical charts in clinics, facilitating the confidential sharing of personal health databases among health professionals. To develop an MSC applicable for daily use in the community and hospital system. The MSC project, currently underway in Israel and the USA, will aid in determining the costs, benefits and feasibility of the MSC. Successful implementation of the MSC in chosen clinics will promote a nationwide willingness to adopt this promising technology.

  17. Federally qualified health center dental clinics: financial information.

    Science.gov (United States)

    Bailit, Howard L; Devitto, Judy; Myne-Joslin, Ronnie; Beazoglou, Tryfon; McGowan, Taegan

    2013-01-01

    Federally Qualified Health Center (FQHC) dental clinics are a major component of the dental safety net system, providing care to 3.75 million patients annually. This study describes the financial and clinical operations of a sample of FQHCs. In cooperation with the National Network for Oral Health Access, FQHC dental clinics that could provide 12 months of electronic dental record information were asked to participate in the study. Based on data from 28 dental clinics (14 FQHCs), 50 percent of patients were under 21 years of age. The primary payers were Medicaid (72.4 percent) and sliding-scale/self-pay patients (17.5 percent). Sites averaged 3.1 operatories, 0.66 dental hygienists, and 1.9 other staff per dentist. Annually, each FTE dentist and hygienist provided 2,801 and 2,073 patient visits, respectively. Eighty percent of services were diagnostic, preventive, and restorative. Patient care accounted for 82 percent of revenues, and personnel (64.2 percent) and central administration (13.4 percent) accounted for most expenses. Based on a small convenience sample of FQHC dental clinics, this study presents descriptive data on their clinical and financial operations. Compared with data from the UDS (Uniform Data System) report, study FQHCs were larger in terms of space, staff, and patients served. However, there was substantial variation among clinics for almost all measures. As the number and size of FQHC dental clinics increase, the Health Resources and Services Administration needs to provide them access to comparative data that they can use to benchmark their operations. © 2013 American Association of Public Health Dentistry.

  18. The radiation legacy of Russia

    International Nuclear Information System (INIS)

    Lebedev, V.A.

    2002-01-01

    Nuclear weapons making and testing, operation of enterprises of the nuclear industry, of military and civilian nuclear fleet, as well as peaceful nuclear explosions -- all that led in the USSR to release of radioactive products into the environment. In some parts of the FSU radioactive contamination exceeded permissible levels. The necessity of remediation of such territories became evident. The most part of the contamination resulted from major radiation accidents in Kyshtym (19570 and Chernobyl (1986). Today those objects, as well as some sites of radwaste storage and disposal, written-off nuclear submarines with non-unloaded spent nuclear fuel, some floating and on-shore repositories of nuclear fleet's radwaste and spent nuclear fuel, pose a potential hazard to the biosphere. Appropriate measures aimed at decreasing their impact on the population and environment are needed. Such measures should include both restoration of contaminated lands and social support programs for the population affected by radiation. The main task of the rehabilitation is reduction of consequences of internal and external exposure of the people, creation of necessary conditions for efficient and safe economical activities. Concrete objectives should be determined, as well as principles and standards to ensure radiation safety when conducting remediation works, and also -- specifications for evaluation of the lands condition prior to their remediation, criteria of decision making, rehabilitation planning, techniques of the lands' restoration and recommendations for their future uses. The Russian Federal special program 'Radioactive Waste and Spent Nuclear Materials Management, Utilization and Disposal for 1996-2005' envisages studies on Russia's radiation legacy's assessment on the basis of up-to-date information technologies of computer-based systems for data collection, storage and processing for accounting and analysis of information on availability, origin, physical and chemical

  19. Remote Evaluation of the Coherence of Indirect Manipulation Interface Systems For Agent-Mediated Legacy Data

    National Research Council Canada - National Science Library

    Schafer, Joseph

    2000-01-01

    Many information systems depend heavily on distributed legacy data sources. These data sources introduce a number of significant problems, especially when the sources must be combined and displayed to remote users...

  20. Legacy application integration architecture

    OpenAIRE

    Grom, Jure

    2009-01-01

    Information needs of modern businesses are constantly growing. Own development of a business information system is time consuming and expensive but, as an alternative, using smaller partial solutions doesn’t cover all user needs. Decision to buy a universal solution, often results in only part of it being actively and efficiently used. By application integration we manage to achieve efficient use of applications, since by linking them, we enable sharing of business logics among applications a...

  1. The Effectiveness and Clinical Usability of a Handheld Information Appliance

    Directory of Open Access Journals (Sweden)

    Patricia A. Abbott

    2012-01-01

    Full Text Available Clinical environments are complex, stressful, and safety critical—heightening the demand for technological solutions that will help clinicians manage health information efficiently and safely. The industry has responded by creating numerous, increasingly compact and powerful health IT devices that fit in a pocket, hook to a belt, attach to eyeglasses, or wheel around on a cart. Untethering a provider from a physical “place” with compact, mobile technology while delivering the right information at the right time and at the right location are generally welcomed in clinical environments. These developments however, must be looked at ecumenically. The cognitive load of clinicians who are occupied with managing or operating several different devices during the process of a patient encounter is increased, and we know from decades of research that cognitive overload frequently leads to error. “Technology crowding,” enhanced by the plethora of mobile health IT, can actually become an additional millstone for busy clinicians. This study was designed to gain a deeper understanding of clinicians’ interactions with a mobile clinical computing appliance (Motion Computing C5 designed to consolidate numerous technological functions into an all-in-one device. Features of usability and comparisons to current methods of documentation and task performance were undertaken and results are described.

  2. Audio-visual presentation of information for informed consent for participation in clinical trials.

    Science.gov (United States)

    Synnot, Anneliese; Ryan, Rebecca; Prictor, Megan; Fetherstonhaugh, Deirdre; Parker, Barbara

    2014-05-09

    Informed consent is a critical component of clinical research. Different methods of presenting information to potential participants of clinical trials may improve the informed consent process. Audio-visual interventions (presented, for example, on the Internet or on DVD) are one such method. We updated a 2008 review of the effects of these interventions for informed consent for trial participation. To assess the effects of audio-visual information interventions regarding informed consent compared with standard information or placebo audio-visual interventions regarding informed consent for potential clinical trial participants, in terms of their understanding, satisfaction, willingness to participate, and anxiety or other psychological distress. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, issue 6, 2012; MEDLINE (OvidSP) (1946 to 13 June 2012); EMBASE (OvidSP) (1947 to 12 June 2012); PsycINFO (OvidSP) (1806 to June week 1 2012); CINAHL (EbscoHOST) (1981 to 27 June 2012); Current Contents (OvidSP) (1993 Week 27 to 2012 Week 26); and ERIC (Proquest) (searched 27 June 2012). We also searched reference lists of included studies and relevant review articles, and contacted study authors and experts. There were no language restrictions. We included randomised and quasi-randomised controlled trials comparing audio-visual information alone, or in conjunction with standard forms of information provision (such as written or verbal information), with standard forms of information provision or placebo audio-visual information, in the informed consent process for clinical trials. Trials involved individuals or their guardians asked to consider participating in a real or hypothetical clinical study. (In the earlier version of this review we only included studies evaluating informed consent interventions for real studies). Two authors independently assessed studies for inclusion and extracted data. We synthesised the findings

  3. Perspectives on Clinical Informatics: Integrating Large-Scale Clinical, Genomic, and Health Information for Clinical Care

    Directory of Open Access Journals (Sweden)

    In Young Choi

    2013-12-01

    Full Text Available The advances in electronic medical records (EMRs and bioinformatics (BI represent two significant trends in healthcare. The widespread adoption of EMR systems and the completion of the Human Genome Project developed the technologies for data acquisition, analysis, and visualization in two different domains. The massive amount of data from both clinical and biology domains is expected to provide personalized, preventive, and predictive healthcare services in the near future. The integrated use of EMR and BI data needs to consider four key informatics areas: data modeling, analytics, standardization, and privacy. Bioclinical data warehouses integrating heterogeneous patient-related clinical or omics data should be considered. The representative standardization effort by the Clinical Bioinformatics Ontology (CBO aims to provide uniquely identified concepts to include molecular pathology terminologies. Since individual genome data are easily used to predict current and future health status, different safeguards to ensure confidentiality should be considered. In this paper, we focused on the informatics aspects of integrating the EMR community and BI community by identifying opportunities, challenges, and approaches to provide the best possible care service for our patients and the population.

  4. Use of altered informed consent in pragmatic clinical research.

    Science.gov (United States)

    McKinney, Ross E; Beskow, Laura M; Ford, Daniel E; Lantos, John D; McCall, Jonathan; Patrick-Lake, Bray; Pletcher, Mark J; Rath, Brian; Schmidt, Hollie; Weinfurt, Kevin

    2015-10-01

    There are situations in which the requirement to obtain conventional written informed consent can impose significant or even insurmountable barriers to conducting pragmatic clinical research, including some comparative effectiveness studies and cluster-randomized trials. Although certain federal regulations governing research in the United States (45 CFR 46) define circumstances in which any of the required elements may be waived, the same standards apply regardless of whether any single element is to be waived or whether consent is to be waived in its entirety. Using the same threshold for a partial or complete waiver limits the options available to institutional review boards as they seek to optimize a consent process. In this article, we argue that new standards are necessary in order to enable important pragmatic clinical research while at the same time protecting patients' rights and interests. © The Author(s) 2015.

  5. Legacies of the Manhattan Project

    Science.gov (United States)

    Kevles, Daniel

    2017-01-01

    The Manhattan Project of World War II mobilized thousands of people, including many of the nation's leading physicists, and extensive material resources to design, develop, and manufacture the world's first nuclear weapons. It also established sprawling new facilities for the production of fissionable fuels - notably at Oak Ridge, Tennessee, and Hanford, Washington. It left a set of powerful legacies in the context of the Cold War - endowing scientists with conscience-taxing responsibilities in the nuclear arms race; promoting enormous patronage of academic research by defense and defense-related federal agencies, notably the Office of Naval Research and the Atomic Energy Commission; and turning its wartime facilities into major national laboratories that advanced the fields of high-energy and nuclear physics and stimulated local industrial economies but that in some cases, notably at Hanford, severely polluted the surrounding environment with radioactive waste and disrupted the livelihoods of native peoples. ``Legacies of the Manhattan Project''

  6. Grounded theory for radiotherapy practitioners: Informing clinical practice

    International Nuclear Information System (INIS)

    Walsh, N.A.

    2010-01-01

    Radiotherapy practitioners may be best placed to undertake qualitative research within the context of cancer, due to specialist knowledge of radiation treatment and sensitivity to radiotherapy patient's needs. The grounded theory approach to data collection and analysis is a unique method of identifying a theory directly based on data collected within a clinical context. Research for radiotherapy practitioners is integral to role expansion within the government's directive for evidence-based practice. Due to the paucity of information on qualitative research undertaken by radiotherapy radiographers, this article aims to assess the potential impact of qualitative research on radiotherapy patient and service outcomes.

  7. Participants with schizophrenia retain the information necessary for informed consent during clinical trials

    Science.gov (United States)

    Fischer, Bernard A.; McMahon, Robert P.; Meyer, Walter A.; Slack, Daniel J.; Appelbaum, Paul S.; Carpenter, William T.

    2015-01-01

    Objective Cognitive impairment is a characteristic of schizophrenia. This impairment may affect the retention of information required for ongoing knowledgeable participation in clinical trials. This study monitored retention of study-related knowledge--including assessment of therapeutic misconception--in people with stable, DSM-IV schizophrenia during participation in placebo-controlled clinical trials of adjunctive agents. Stability was defined as being on an antipsychotic with no change in medication or dose over the previous 4 weeks. Method Individuals enrolling in one of seven clinical trials were approached for participation. Participants came from research clinics and community mental health centers. At baseline, clinical trial consent forms were reviewed and study knowledge assessed. Participants were randomized to follow-up assessments at weeks 1, 4, and 8; weeks 4 and 8; or at week 8 only. Clinical trial consent forms were not re-reviewed at any follow-up visit. Results Fifty-nine participants were enrolled; analysis included 52 participants with at least one follow-up visit. Study knowledge did not decrease meaningfully in any group. Therapeutic misconception was not observed in participants during the study. The group assessed most frequently demonstrated significant improvement over baseline (t44= 3.43, p= 0.001). Retention of study knowledge was not related to symptoms, but had a weak correlation with cognitive capacity (R= 0.28, p= 0.07). Performance did not differ between participants from research clinics and those from community mental health centers. Conclusions Clinically-stable people with schizophrenia enrolling in a placebo-controlled adjunctive medication study, once determined to have capacity to consent to a clinical trial, retained appropriate study knowledge for at least 8 weeks. In the absence of a specific reason to suspect a loss of decisional capacity, there appears to be no need to routinely re-evaluate participants during this type

  8. Using information management to implement a clinical resource management program.

    Science.gov (United States)

    Rosenstein, A H

    1997-12-01

    This article provides a consultant's account of a 250-bed community hospital's experience in implementing the Clinical Resource Management (CRM) program, a four-stage process of using information to identify opportunities for improvement, developing an effective resource management team, implementing process improvement activities, and measuring the impact on outcomes of care. CASE STUDY EXAMPLE--CONGESTIVE HEART FAILURE: The chair of the departments of internal medicine and family practice selected congestive heart failure for in-depth study. A task force focused on treatment and patient disposition in the emergency room (ER), where most of the nonelective admissions originated. A set of standardized ER orders was developed that emphasized rapid and effective diuresis through the initiation of a progressive diuretic dosing schedule directly linked to patient response. Factors critical to the success of the CRM program included allocating adequate time to promote and sell the value and importance of the program, as well as securing the support of both information systems and physicians. The main barriers to success involved limitations in the information system infrastructure and delays attributable to committee review. Short-term results from the CRM program were encouraging, with average lengths of stay reduced by 0.5 days and average costs of care reduced by 12% for the ten diagnoses studied with no adverse results. Nonstudy diagnoses showed no notable improvement. Recognizing the growing importance of information management not only for clinical decision support but for accommodating all the necessary internal and external reporting requirements will require a significant commitment and investment in technology and personnel resources.

  9. Clinical genomics information management software linking cancer genome sequence and clinical decisions.

    Science.gov (United States)

    Watt, Stuart; Jiao, Wei; Brown, Andrew M K; Petrocelli, Teresa; Tran, Ben; Zhang, Tong; McPherson, John D; Kamel-Reid, Suzanne; Bedard, Philippe L; Onetto, Nicole; Hudson, Thomas J; Dancey, Janet; Siu, Lillian L; Stein, Lincoln; Ferretti, Vincent

    2013-09-01

    Using sequencing information to guide clinical decision-making requires coordination of a diverse set of people and activities. In clinical genomics, the process typically includes sample acquisition, template preparation, genome data generation, analysis to identify and confirm variant alleles, interpretation of clinical significance, and reporting to clinicians. We describe a software application developed within a clinical genomics study, to support this entire process. The software application tracks patients, samples, genomic results, decisions and reports across the cohort, monitors progress and sends reminders, and works alongside an electronic data capture system for the trial's clinical and genomic data. It incorporates systems to read, store, analyze and consolidate sequencing results from multiple technologies, and provides a curated knowledge base of tumor mutation frequency (from the COSMIC database) annotated with clinical significance and drug sensitivity to generate reports for clinicians. By supporting the entire process, the application provides deep support for clinical decision making, enabling the generation of relevant guidance in reports for verification by an expert panel prior to forwarding to the treating physician. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Automated Extraction of Family History Information from Clinical Notes

    Science.gov (United States)

    Bill, Robert; Pakhomov, Serguei; Chen, Elizabeth S.; Winden, Tamara J.; Carter, Elizabeth W.; Melton, Genevieve B.

    2014-01-01

    Despite increased functionality for obtaining family history in a structured format within electronic health record systems, clinical notes often still contain this information. We developed and evaluated an Unstructured Information Management Application (UIMA)-based natural language processing (NLP) module for automated extraction of family history information with functionality for identifying statements, observations (e.g., disease or procedure), relative or side of family with attributes (i.e., vital status, age of diagnosis, certainty, and negation), and predication (“indicator phrases”), the latter of which was used to establish relationships between observations and family member. The family history NLP system demonstrated F-scores of 66.9, 92.4, 82.9, 57.3, 97.7, and 61.9 for detection of family history statements, family member identification, observation identification, negation identification, vital status, and overall extraction of the predications between family members and observations, respectively. While the system performed well for detection of family history statements and predication constituents, further work is needed to improve extraction of certainty and temporal modifications. PMID:25954443

  11. Celebrating the Tevatron legacy

    CERN Multimedia

    2012-01-01

    Fermilab hosted an exceptional event on 11 June: the Tevatron Impact symposium. More than 800 people attended to hear how the Tevatron advanced our understanding of fundamental physics.   A version of this "Director's Corner" by Pier Oddone first appeared in Fermilab Today on 12 June.   The development of accelerator technology for the Tevatron has influenced every subsequent major hadron accelerator. We heard reviews on the detector technologies and trigger systems developed with the Tevatron that are essential today for high-luminosity machines like the LHC. There were also talks on the superconducting-wire industry that made MRI magnets ubiquitous, and we discussed the major computational systems that use large farms of Linux-based commodity processors. Researchers who worked on the Tevatron also established multivariate analysis techniques that now allow us to squeeze the maximum information from complex data sets. One focus of the symposium was the ...

  12. Information technology for clinical, translational and comparative effectiveness research. Findings from the section clinical research informatics.

    Science.gov (United States)

    Daniel, C; Choquet, R

    2013-01-01

    To summarize advances of excellent current research in the new emerging field of Clinical Research Informatics. Synopsis of four key articles selected for the IMIA Yearbook 2013. The selection was performed by querying PubMed and Web of Science with predefined keywords. From the original set of 590 papers, a first subset of 461 articles which was in the scope of Clinical Research Informatics was refined into a second subset of 79 relevant articles from which 15 articles were retained for peer-review. The four selected articles exemplify current research efforts conducted in the areas of data representation and management in clinical trials, secondary use of EHR data for clinical research, information technology platforms for translational and comparative effectiveness research and implementation of privacy control. The selected articles not only illustrate how innovative information technology supports classically organized randomized controlled trials but also demonstrate that the long promised benefits of electronic health care data for research are becoming a reality through concrete platforms and projects.

  13. Chernobyl's other legacy

    International Nuclear Information System (INIS)

    Hohenemser, C.; Renn, O.

    1988-01-01

    A number of accounts of the Chernobyl accident argue that governments and the public were overwhelmed by the transnational impact of the accident, and that their response was in some sense irrational or exaggerated. This article describes the essential features of what is now known about the radiation release at Chernobyl, its world-wide dispersion, the resulting exposures, and the expected health consequences. With this basis the fallout exposure is related to changes in public attitudes about nuclear power, to the extent of protective action achieved, and to the level commitment to nuclear power in several countries. This analysis allows a number of questions to be posed, as follows: 1. Were shifts in public opinion related to the level of exposure, and if so, what does this suggest? 2. Were protective actions, as measured by radiation exposure averted (dose savings), proportional to the danger posed? 3. Were protective actions related to the change in public attitudes toward nuclear power? 4. Was a country's degree of commitment to nuclear energy, as measured by the nuclear share of electricity generation, a factor in its response to the Chernobyl accident? Analysis of these questions, which is largely based on data for the Western democracies, suggests that, with some significant exceptions, both public and government responses were surprisingly rational in that they were proportional to the public's level of exposure. This finding speaks in turn to the central importance of public information in fashioning a response to risky technology. 41 notes, 6 figures, 4 tables

  14. Automated Extraction of Substance Use Information from Clinical Texts.

    Science.gov (United States)

    Wang, Yan; Chen, Elizabeth S; Pakhomov, Serguei; Arsoniadis, Elliot; Carter, Elizabeth W; Lindemann, Elizabeth; Sarkar, Indra Neil; Melton, Genevieve B

    2015-01-01

    Within clinical discourse, social history (SH) includes important information about substance use (alcohol, drug, and nicotine use) as key risk factors for disease, disability, and mortality. In this study, we developed and evaluated a natural language processing (NLP) system for automated detection of substance use statements and extraction of substance use attributes (e.g., temporal and status) based on Stanford Typed Dependencies. The developed NLP system leveraged linguistic resources and domain knowledge from a multi-site social history study, Propbank and the MiPACQ corpus. The system attained F-scores of 89.8, 84.6 and 89.4 respectively for alcohol, drug, and nicotine use statement detection, as well as average F-scores of 82.1, 90.3, 80.8, 88.7, 96.6, and 74.5 respectively for extraction of attributes. Our results suggest that NLP systems can achieve good performance when augmented with linguistic resources and domain knowledge when applied to a wide breadth of substance use free text clinical notes.

  15. An Approach to Peabody's Gifts and Legacies.

    Science.gov (United States)

    Parker, Franklin

    1994-01-01

    One in a collection of papers on self-made millionaire and educational philanthropist George Peabody offers a listing of his gifts and legacies, which fall into the categories of libraries, lyceums, athenaeum, art, music; science; model housing; education; exploration; patriotic causes; historical societies; hospitals; churches; legacies; and…

  16. Types and concept analysis for legacy systems

    NARCIS (Netherlands)

    T. Kuipers (Tobias); L.M.F. Moonen (Leon)

    2000-01-01

    textabstractWe combine type inference and concept analysis in order to gain insight into legacy software systems. Type inference for Cobol yields the types for variables and program parameters. These types are used to perform mathematical concept analysis on legacy systems. We have developed

  17. Northeastern Area Forest Legacy Program Yearbook 2008

    Science.gov (United States)

    US Forest Service, Northeastern Area, State and Private Forestry

    2009-01-01

    The purpose of the Forest Legacy Program (FLP) is to protect environmentally important forest areas that are threatened by conversion to nonforest uses. The Forest Legacy Program is a partnership between participating States and the Forest Service, U.S. Department of Agriculture. These two entities work together to identify important forest lands and...

  18. A validatable legacy database migration using ORM

    NARCIS (Netherlands)

    Moes, T.H.; Wijbenga, J.P.; Balsters, H.; Huitema, G.B.

    2012-01-01

    This paper describes a method used in a real-life case of a legacy database migration. The difficulty of the case lies in the fact that the legacy application to be replaced has to remain fully available during the migration process while at the same time data from the old system is to be integrated

  19. Clinical Simulation and Workflow by use of two Clinical Information Systems, the Electronic Health Record and Digital Dictation

    DEFF Research Database (Denmark)

    Schou Jensen, Iben; Koldby, Sven

    2013-01-01

    Clinical information systems do not always support clinician workflows. An increasing number of unintended clinical inci-dents might be related to implementation of clinical infor-mation systems and to a new registration praxis of unin-tended clinical incidents. Evidence of performing clinical...... simulations before implementation of new clinical information systems provides the basis for use of this method. The intention has been to evaluate patient safety issues, functionality, workflow, and usefulness of a new solution before implementation in the hospitals. Use of a solution which integrates...... digital dictation and the EHR (electronic health record) were simulated in realistic and controlled clinical environments. Useful information dealing with workflow and patient safety were obtained. The clinical simulation demonstrated that the EHR locks during use of the integration of digital dictation...

  20. The influence of marketing scholarship's legacy on nonprofit marketing

    OpenAIRE

    Wymer, Walter

    2013-01-01

    This inquiry contributes to the literature on the development of “nonprofit marketing thought” by describing how the field’s early period established a legacy effect on nonprofit marketing scholarship to the present day. This qualitative work uses a wide variety of sources from a protracted historical period in order to more fully inform a perspective on the relevant issues that have influenced the development of nonprofit marketing scholarship. The investigation suggests that, although the d...

  1. Verification and the safeguards legacy

    International Nuclear Information System (INIS)

    Perricos, Demetrius

    2001-01-01

    of Iraq was a case of late detection of undeclared activities, the case of DPRK was a case of prompt detection of discrepancies in the initial declaration through implementation of modem detection techniques, such as environmental sampling, and access to information. Access to the Security Council became important in view of the protracted process of non-compliance. The Model Additional Protocol (INFCIRC 540) agreed in 1997 incorporates the results of the efforts to strengthen the safeguards system and as such provides the possibility for more transparency by the States and more access to locations by the inspectors on the basis of information. It does not provide the broad and intrusive access rights as in the case of Iraq, since such rights are unprecedented and the result of a cease-fire arrangement involving the Security Council. But the expectations are that the broad implementation of the Additional Protocol will result in an effective and efficient safeguards verification system for the future. The on-site verification systems on a national, regional or multinational basis that have been put into operation in the past or are being discussed by States for the implementation of disarmament and non-proliferation conventions related to weapons of mass destruction whether nuclear, chemical or biological, have benefited and will benefit in the future from the guiding experience - both from the strengths and weaknesses -of the IAEA verification system. This is hopefully a legacy for the future of verification

  2. Technological Feasibility of a Nursing Clinical Information System.

    Science.gov (United States)

    Jeddi, Fatemeh Rangraz; Hajbaghery, Mohsen Adib; Akbari, Hossein; Esmaili, Soheila

    2016-09-01

    A successful implementation of an information system is impossible without sufficient knowledge of available technical resources of an institute. The aim of this study was to determine technical feasibility of a nursing clinical information system (NCIS) in Mazandaran province, Iran, 2015. This cross-sectional study was conducted in three steps. In the first step, a data gathering tool was developed through an unsystematic literature review. In the second step, a questionnaire was developed and validity of the tool was confirmed by receiving opinions of faculty members and calculating indices of Content Validity Index (CVI) and Content Validity Ratio (CVR). The questionnaire reliability was confirmed by calculating Cronbach's alpha coefficient (α= 0.72). In the third step, the feasibility of implementation of NCIS was evaluated by forming a panel of IT experts (n= 30), and through a questionnaire. Data were collected by 5-point Likert scale, very low to very high (scoring 1-5). Scores of each item were calculated and score percentage was determined. Chi-square and Fisher Exact tests were used. Maximum possibility of implementing NCIS were in the hardware area, additional equipment (92.6%), in the area of software, financial software (99.4%), in the area of network equipment, the possibility of integration with other internal systems, (92.6%) and in the area of network security, the possibility of backup version for security purposes (97.4%). Type of employment was statistically significant according to IT experts' opinions (p= 0.014). Hardware and software infrastructures for implementation of NCIS were desirable. The provision of more portable computers, advanced equipment such as barcode scanner, Radio-frequency identification (RFID), some approaches for increase accessibility of the system and essential databases from other resources and also increase of network lines' speed are necessary.

  3. Effect of clinical information in brain CT scan interpretation : a blinded double crossover study

    International Nuclear Information System (INIS)

    Zhianpour, M.; Janghorbani, M.

    2004-01-01

    Errors and variations in interpretation can happen in clinical imaging. Few studies have examined the biased effect of clinical information on reporting of brain CT scans. In a blinded double crossover design, we studied whether three radiologists were biased by clinical information when making CT scan diagnosis of the brain. Three consultant radiologists in three rounds with at least a one month interval assessed 100 consecutive cases of brain CT scan. In the first round, clinical information was not available and 100 films without clinical information were given to radiologists. In the second round, the same 100 films were given and true clinical information was available. In the third round, the same 100 films were given and false clinical information was allocated. In 180 cases (60%) the evaluation resulted in the same diagnosis on all three occasions (95% confidence interval (CI): 54.5, 65.5), whereas 120(40%; 95% CI:34.5, 45.5) sets were evaluated differently. 48 cases (16%; 95% CI:11.9,20.1) had discordant evaluation with true and 33 (11%; 95% CI:7.5, 14.5) with false clinical information. Discordance without and with true and false clinical information was 39 (13%; 95% CI:9.2, 16.8). Correct clinical information improves the brain CT report, while the report became less accurate false clinical information was allocated. These results indicate that radiologists are biased by clinical information when reporting brian CT scans

  4. How information systems should support the information needs of general dentists in clinical settings: suggestions from a qualitative study

    Directory of Open Access Journals (Sweden)

    Wali Teena

    2010-02-01

    Full Text Available Abstract Background A major challenge in designing useful clinical information systems in dentistry is to incorporate clinical evidence based on dentists' information needs and then integrate the system seamlessly into the complex clinical workflow. However, little is known about the actual information needs of dentists during treatment sessions. The purpose of this study is to identify general dentists' information needs and the information sources they use to meet those needs in clinical settings so as to inform the design of dental information systems. Methods A semi-structured interview was conducted with a convenience sample of 18 general dentists in the Pittsburgh area during clinical hours. One hundred and five patient cases were reported by these dentists. Interview transcripts were coded and analyzed using thematic analysis with a constant comparative method to identify categories and themes regarding information needs and information source use patterns. Results Two top-level categories of information needs were identified: foreground and background information needs. To meet these needs, dentists used four types of information sources: clinical information/tasks, administrative tasks, patient education and professional development. Major themes of dentists' unmet information needs include: (1 timely access to information on various subjects; (2 better visual representations of dental problems; (3 access to patient-specific evidence-based information; and (4 accurate, complete and consistent documentation of patient records. Resource use patterns include: (1 dentists' information needs matched information source use; (2 little use of electronic sources took place during treatment; (3 source use depended on the nature and complexity of the dental problems; and (4 dentists routinely practiced cross-referencing to verify patient information. Conclusions Dentists have various information needs at the point of care. Among them, the needs

  5. Readability and comprehensibility of informed consent forms for clinical trials

    Directory of Open Access Journals (Sweden)

    Anvita Pandiya

    2010-01-01

    A shortened Informed Consent Form, with information that a reasonable person would want to understand along with specific information that the person wants in particular would be a good option to improve understanding or comprehensibility. Additional informational meetings with a qualified person like a counselor could help in comprehension. Questionnaires designed to test comprehension of patient, peer review, patient writing the salient features could help evaluate the comprehensibility of the Informed Consent Form.

  6. Exploring the structure and organization of information within nursing clinical handovers.

    Science.gov (United States)

    Johnson, Maree; Jefferies, Diana; Nicholls, Daniel

    2012-10-01

    Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress. © 2012 Wiley Publishing Asia Pty Ltd.

  7. (Resurveying Mediterranean Rural Landscapes: GIS and Legacy Survey Data

    Directory of Open Access Journals (Sweden)

    Robert Witcher

    2008-07-01

    Full Text Available Legacy data have always been important for Mediterranean archaeologists. Over the past decade, one specific category of legacy data, that deriving from regional survey, has become particularly important. Not only has the scale of research questions become larger (requiring greater reliance on others' data, but the surface archaeological record is deteriorating (diminishing the ability to recover good data. The legacy data from many individual surveys have now been subject to digitisation and GIS analysis, successfully redeploying data collected for one purpose within new theoretical and interpretive frameworks. However, a key research focus is now comparative survey - using the results of many different Mediterranean surveys side-by-side to identify regional variability in settlement organisation, economy and demography. In order to overcome the significant methodological differences between these surveys, attention has focused on the documentation of metadata. Yet, many legacy data lack vital information about their creation and hence how they might be (reinterpreted and compared. GIS has been advanced as an environment in which to contain, order and analyse the data necessary for comparative survey. However, there is a danger that the technology will facilitate inappropriate use of these datasets in a way that fails to acknowledge and understand the very real differences between them. Here, emphasis is placed upon the use of GIS as a space for exploratory data analysis: a process that encompasses and emphasises the integral processes of digitisation, visualisation and simple analysis for the characterisation of datasets in order to derive an alternative form of metadata. Particular emphasis is placed upon the interaction of past human behaviour (e.g. in the Roman period and archaeological recovery (i.e. the behaviour of archaeologists in the present, or recent past; these two sets of 'social action' combine to create distinctive archaeological

  8. The Virtuous Circles of Clinical Information Systems: a Modern Utopia.

    Science.gov (United States)

    Degoulet, P

    2016-11-10

    Clinical information systems (CIS) are developed with the aim of improving both the efficiency and the quality of care. This position paper is based on the hypothesis that such vision is partly a utopian view of the emerging eSociety. Examples are drawn from 15 years of experience with the fully integrated Georges Pompidou University Hospital (HEGP) CIS and temporal data series extracted from the data warehouses of Assistance Publique - Hôpitaux de Paris (AP-HP) acute care hospitals which share the same administrative organization as HEGP. Three main virtuous circles are considered: user satisfaction vs. system use, system use vs. cost efficiency, and system use vs quality of care. In structural equation models (SEM), the positive bidirectional relationship between user satisfaction and use was only observed in the early HEGP CIS deployment phase (first four years) but disappeared in late post-adoption (≥8 years). From 2009 to 2013, financial efficiency of 20 AP-HP hospitals evaluated with stochastic frontier analysis (SFA) models diminished by 0.5% per year. The lower decrease of efficiency observed between the three hospitals equipped with a more mature CIS and the 17 other hospitals was of the same order of magnitude than the difference observed between pediatric and non-pediatric hospitals. Outcome quality benefits that would bring evidence to the system use vs. quality loop are unlikely to be obtained in a near future since they require integration with population-based outcome measures including mortality, morbidity, and quality of life that may not be easily available. Barriers to making the transformation of the utopian part of the CIS virtuous circles happen should be overcome to actually benefit the emerging eSociety.

  9. The legacy of fossil fuels.

    Science.gov (United States)

    Armaroli, Nicola; Balzani, Vincenzo

    2011-03-01

    Currently, over 80% of the energy used by mankind comes from fossil fuels. Harnessing coal, oil and gas, the energy resources contained in the store of our spaceship, Earth, has prompted a dramatic expansion in energy use and a substantial improvement in the quality of life of billions of individuals in some regions of the world. Powering our civilization with fossil fuels has been very convenient, but now we know that it entails severe consequences. We treat fossil fuels as a resource that anyone anywhere can extract and use in any fashion, and Earth's atmosphere, soil and oceans as a dump for their waste products, including more than 30 Gt/y of carbon dioxide. At present, environmental legacy rather than consistence of exploitable reserves, is the most dramatic problem posed by the relentless increase of fossil fuel global demand. Harmful effects on the environment and human health, usually not incorporated into the pricing of fossil fuels, include immediate and short-term impacts related to their discovery, extraction, transportation, distribution, and burning as well as climate change that are spread over time to future generations or over space to the entire planet. In this essay, several aspects of the fossil fuel legacy are discussed, such as alteration of the carbon cycle, carbon dioxide rise and its measurement, greenhouse effect, anthropogenic climate change, air pollution and human health, geoengineering proposals, land and water degradation, economic problems, indirect effects on the society, and the urgent need of regulatory efforts and related actions to promote a gradual transition out of the fossil fuel era. While manufacturing sustainable solar fuels appears to be a longer-time perspective, alternatives energy sources already exist that have the potential to replace fossil fuels as feedstocks for electricity production. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  10. Integration of Hospital Information and Clinical Decision Support Systems to Enable the Reuse of Electronic Health Record Data.

    Science.gov (United States)

    Kopanitsa, Georgy

    2017-05-18

    The efficiency and acceptance of clinical decision support systems (CDSS) can increase if they reuse medical data captured during health care delivery. High heterogeneity of the existing legacy data formats has become the main barrier for the reuse of data. Thus, we need to apply data modeling mechanisms that provide standardization, transformation, accumulation and querying medical data to allow its reuse. In this paper, we focus on the interoperability issues of the hospital information systems (HIS) and CDSS data integration. Our study is based on the approach proposed by Marcos et al. where archetypes are used as a standardized mechanism for the interaction of a CDSS with an electronic health record (EHR). We build an integration tool to enable CDSSs collect data from various institutions without a need for modifications in the implementation. The approach implies development of a conceptual level as a set of archetypes representing concepts required by a CDSS. Treatment case data from Regional Clinical Hospital in Tomsk, Russia was extracted, transformed and loaded to the archetype database of a clinical decision support system. Test records' normalization has been performed by defining transformation and aggregation rules between the EHR data and the archetypes. These mapping rules were used to automatically generate openEHR compliant data. After the transformation, archetype data instances were loaded into the CDSS archetype based data storage. The performance times showed acceptable performance for the extraction stage with a mean of 17.428 s per year (3436 case records). The transformation times were also acceptable with 136.954 s per year (0.039 s per one instance). The accuracy evaluation showed the correctness and applicability of the method for the wide range of HISes. These operations were performed without interrupting the HIS workflow to prevent the HISes from disturbing the service provision to the users. The project results have proven that

  11. Clinical Practice Informs Secure Messaging Benefits and Best Practices.

    Science.gov (United States)

    Haun, Jolie N; Hathaway, Wendy; Chavez, Margeaux; Antinori, Nicole; Vetter, Brian; Miller, Brian K; Martin, Tracey L; Kendziora, Lisa; Nazi, Kim M; Melillo, Christine

    2017-10-01

    Background Clinical care team members in Department of Veterans' Affairs (VA) facilities nationwide are working to integrate the use of Secure Messaging (SM) into care delivery and identify innovative uses. Identifying best practices for proactive use of SM is a key factor in its successful implementation and sustained use by VA clinical care team members and veterans. Objectives A collaborative project solicited input from VA clinical care teams about their local practices using SM to provide access to proactive patient-centered care for veterans and enhance workflow. Methods This project implemented a single-item cross-sectional qualitative electronic survey via internal e-mail to local coordinators in all 23 Veterans Integrated Service Networks (VISNs). Content analysis was used to manage descriptive data responses. Descriptive statistics described sample characteristics. Results VA clinical care team members across 15 of 23 VISNs responded to the questionnaire. Content analysis of 171 responses produced two global domains: (1) benefits of SM and (2) SM best practices. Benefits of SM use emphasize enhanced and efficient communication and increased access to care. Care team members incorporate SM into their daily clinical practices, using it to provide services before, during, and after clinical encounters as a best practice. SM users suggest improvements in veteran care, clinical team workflow, and efficient use of health resources. Clinical team members invested in the successful implementation of SM integrate SM into their daily practices to provide meaningful and useful veteran-centered care and improve workflow. Conclusion VA clinical care team members can use SM proactively to create an integrated SM culture. With adequate knowledge and motivation to proactively use this technology, all clinical team members within the VA system can replicate best practices shared by other clinical care teams to generate meaningful and useful interactions with SM

  12. Clinical trials information in drug development and regulation : existing systems and standards

    NARCIS (Netherlands)

    Valkenhoef, Gert van; Tervonen, Tommi; Brock, Bert de; Hillege, Hans

    2012-01-01

    Clinical trials provide pivotal evidence on drug efficacy and safety. The evidence, information from clinical trials, is currently used by regulatory decision makers in marketing authorization decisions, but only in an implicit manner. For clinical trials information to be used in a transparent and

  13. Automated Methods to Extract Patient New Information from Clinical Notes in Electronic Health Record Systems

    Science.gov (United States)

    Zhang, Rui

    2013-01-01

    The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…

  14. Clinical Information Systems as the Backbone of a Complex Information Logistics Process: Findings from the Clinical Information Systems Perspective for 2016.

    Science.gov (United States)

    Hackl, W O; Ganslandt, T

    2017-08-01

    Objective: To summarize recent research and to propose a selection of best papers published in 2016 in the field of Clinical Information Systems (CIS). Method: The query used to retrieve the articles for the CIS section of the 2016 edition of the IMIA Yearbook of Medical Informatics was reused. It again aimed at identifying relevant publications in the field of CIS from PubMed and Web of Science and comprised search terms from the Medical Subject Headings (MeSH) catalog as well as additional free text search terms. The retrieved articles were categorized in a multi-pass review carried out by the two section editors. The final selection of candidate papers was then peer-reviewed by Yearbook editors and external reviewers. Based on the review results, the best papers were then chosen at the selection meeting with the IMIA Yearbook editorial board. Text mining, term co-occurrence mapping, and topic modelling techniques were used to get an overview on the content of the retrieved articles. Results: The query was carried out in mid-January 2017, yielding a consolidated result set of 2,190 articles published in 921 different journals. Out of them, 14 papers were nominated as candidate best papers and three of them were finally selected as the best papers of the CIS field. The content analysis of the articles revealed the broad spectrum of topics covered by CIS research. Conclusions: The CIS field is multi-dimensional and complex. It is hard to draw a well-defined outline between CIS and other domains or other sections of the IMIA Yearbook. The trends observed in the previous years are progressing. Clinical information systems are more than just sociotechnical systems for data collection, processing, exchange, presentation, and archiving. They are the backbone of a complex, trans-institutional information logistics process. Georg Thieme Verlag KG Stuttgart.

  15. Clinical Trials: Information and Options for People with Mood Disorders

    Science.gov (United States)

    ... of Personal Stories Peers Celebrating Art Peers Celebrating Music Be Vocal Support Locator DBSA In-Person Support ... contribution made by a clinical trial is to science first and to the patient second. back to ...

  16. Clinical Trials: Information and Options for People with Mood Disorders

    Science.gov (United States)

    ... with Symptoms & Treatment Help with Relationships Support for Helpers Balanced Mind Parent Network Family Center I'm ... may benefit me? First, ask your mental health professional about clinical trials that might be appropriate for ...

  17. Information and communication in the context of a clinical trial

    DEFF Research Database (Denmark)

    Hietanen, P; Aro, A R; Holli, K

    2000-01-01

    for decision-making. Less educated patients and older patients had needed more time. Eighty-seven per cent (218/251) were happy with their decision to participate. While most patients are satisfied with the information received, there is a poor understanding of how treatment is allocated. Information should...

  18. Clinical simulation and workflow by use of two clinical information systems, the electronic health record and digital dictation.

    Science.gov (United States)

    Koldby, Sven; Schou Jensen, Iben

    2013-01-01

    Clinical information systems do not always support clinician workflows. An increasing number of unintended clinical incidents might be related to implementation of clinical information systems and to a new registration praxis of unintended clinical incidents. Evidence of performing clinical simulations before implementation of new clinical information systems provides the basis for use of this method. The intention has been to evaluate patient safety issues, functionality, workflow, and usefulness of a new solution before implementation in the hospitals. Use of a solution which integrates digital dictation and the EHR (electronic health record) were simulated in realistic and controlled clinical environments. Useful information dealing with workflow and patient safety were obtained. The clinical simulation demonstrated that the EHR locks during use of the integration of digital dictation, thus making it impossible to use the EHR or connected applications during digital dictation. The results of the simulations showed that the tested and evaluated solution does not support the clinical workflow. Conducting the simulations enabled us to improve the solution before implementation, but further development is necessary before implementation of the solution.

  19. Informed consent in clinical trials: Perceptions and experiences of a ...

    African Journals Online (AJOL)

    It is recommended that more recognition be given to the important role of trial counsellors in clinical trials, and that they be given more formal training, support and ... Daar word aanbeveel dat meer erkenning gegee word aan die rol van proefvoorligters in kliniese proewe, dat hulle meer formele opleiding ondergaan, dat ...

  20. Identification of clinically-informative biomarkers for risk stratification ...

    African Journals Online (AJOL)

    Background: Barrett's esophagus is the precursor of esophageal adenocarcinoma with a 5-year survival rate of 25-30%. Objective: To define clinically useful biomarkers for transcriptional profiling in South African patients with Barrett's esophagus in order to identify those patients with an increased cancer risk necessitating ...

  1. Informed Consent: Ethical Issues and Future Challenges in Clinical Education.

    Science.gov (United States)

    Angaran, David M.

    1989-01-01

    A look at pharmaceutical care needs in the future is the basis for discussion of the educational needs of clinical pharmacists. Issues discussed include the appropriate degree (bachelor's vs. doctoral), costs of instruction, faculty/student ratios, the pharmacy practice faculty as role models, and computer-assisted instruction. (MSE)

  2. Transparency and public accessibility of clinical trial information in Croatia: how it affects patient participation in clinical trials.

    Science.gov (United States)

    Šolić, Ivana; Stipčić, Ana; Pavličević, Ivančica; Marušić, Ana

    2017-06-15

    Despite increased visibility of clinical trials through international trial registries, patients often remain uninformed of their existence, especially if they do not have access to adequate information about clinical research, including the language of the information. The aim of this study was to describe the context for transparency of clinical trials in Croatia in relation to countries in Central and Eastern Europe, and to assess how informed Croatian patients are about clinical trials and their accessibility. We assessed the transparency of clinical trials from the data available in the public domain. We also conducted an anonymous survey on a convenience sample of 257 patients visiting two family medicine offices or an oncology department in south Croatia, and members of national patients' associations. Despite legal provisions for transparency of clinical trials in Croatia, they are still not sufficiently visible in the public domain. Among countries from Central and Eastern Europe, Croatia has the fewest number of registered trials in the EU Clinical Trials Registry. 66% of the patients in the survey were aware of the existence of clinical trials but only 15% were informed about possibilities of participating in a trial. Although 58% of the respondents were willing to try new treatments, only 6% actually participated in a clinical trial. Only 2% of the respondents were aware of publicly available trial registries. Our study demonstrates that there is low transparency of clinical trials in Croatia, and that Croatian patients are not fully aware of clinical trials and the possibilities of participating in them, despite reported availability of Internet resources and good communication with their physicians. There is a need for active policy measures to increase the awareness of and access to clinical trials to patients in Croatia, particularly in their own language.

  3. 77 FR 38634 - Request for Information: Collection and Use of Patient Work Information in the Clinical Setting...

    Science.gov (United States)

    2012-06-28

    ... the Clinical Setting: Electronic Health Records AGENCY: The National Institute for Occupational Safety... inclusion of work information in the electronic health record (EHR). NIOSH requests input on these issues... Information in Electronic Health Records'' written by the Institute of Medicine (IOM) Committee on Occupation...

  4. Impact and user satisfaction of a clinical information portal embedded in an electronic health record.

    Science.gov (United States)

    Tannery, Nancy H; Epstein, Barbara A; Wessel, Charles B; Yarger, Frances; LaDue, John; Klem, Mary Lou

    2011-01-01

    In 2008, a clinical information tool was developed and embedded in the electronic health record system of an academic medical center. In 2009, the initial information tool, Clinical-e, was superseded by a portal called Clinical Focus, with a single search box enabling a federated search of selected online information resources. To measure the usefulness and impact of Clinical Focus, a survey was used to gather feedback about users' experience with this clinical resource. The survey determined what type of clinicians were using this tool and assessed user satisfaction and perceived impact on patient care decision making. Initial survey results suggest the majority of respondents found Clinical Focus easy to navigate, the content easy to read, and the retrieved information relevant and complete. The majority would recommend Clinical Focus to their colleagues. Results indicate that this tool is a promising area for future development.

  5. A classification framework for clinical information system implementation in hospitals.

    NARCIS (Netherlands)

    Meulendijks, A.; Batenburg, R.; Wetering, R. van de

    2012-01-01

    In the last decade, many information system (IS) implementations took place in the healthcare organisations. Mainstream reasons for this evolvement are the increase of quality and safety of care, and reducing costs. As in many other sectors IS implementations in healthcare are complex, and

  6. [Low concordance between primary care and hospital clinical information].

    Science.gov (United States)

    Revilla-López, Concha; Calderón-Larrañaga, Amaia; Enríquez-Martín, Natalia; Prados-Torres, Alexandra

    2016-04-01

    To measure the diagnostic agreement between Primary Care (PC) and hospital information systems, in order to assess the usefulness of health care records for research purposes. Cross-sectional retrospective study integrating PC and hospital diagnostic information for the Aragon population admitted to hospital in 2010. 75.176 patients were analysed. Similarities, differences and the kappa index were calculated for each of the diagnoses recorded in both information systems. The studied diseases included COPD, diabetes, hypertension, cerebrovascular disease, ischaemic heart disease, asthma, epilepsy, and heart failure. Diagnostic concordance was higher in men and between 45 and 64 years. Diabetes was the condition showing the highest concordance (kappa index: 0.75), while asthma had the lowest values (kappa index: 0.34). The low concordance between the diagnostic information recorded in PC and in the hospital setting calls for urgent measures to ensure that healthcare professionals have a comprehensive picture of patient's health problems. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  7. [Ethics in clinical routine care: example of prognosis information].

    Science.gov (United States)

    Elger, Bernice S

    2002-09-15

    The article discusses from an ethical point of view the question whether a physician should tell the patient the whole truth about a poor prognosis. From a legal viewpoint, the therapeutic privilege gives physicians in most countries the right to limit information, if they are concerned that this information will severely harm the patient. An overview about empirical studies, especially surveys of physicians and patients, shows that most patients always wish to know their prognosis, while physicians would less often tell the whole truth. Physicians explain their attitudes by referring to the ethical principles of nonmaleficience and beneficience. These principles are apparently in conflict with the principles of veracity and respect of patient autonomy. However, it can be shown that this conflict does not persist when empirical data about consequences of truthful information are considered: telling the truth seems not to have negative, but rather positive consequences on the overall well-being of the patient. After having summarized the empirical studies that have examined the consequences of truthful information about severe and incurable diseases, the article argues for always telling patients the truth if they want to know it. Many conflicts in medical ethics are between prima facie principles. In cases where the principles of beneficience and nonmaleficience are used in the argumentation, some of the conflicts can be eliminated when the ethical judgment is made on a thorough empirical basis, as shown by the example of truth-telling about prognosis.

  8. Legacy material work-off project

    International Nuclear Information System (INIS)

    Sloan, T.J.; Baker, D.H. IV

    1999-01-01

    Los Alamos National Laboratory (LANL) and its subcontractors recently completed a nine-month legacy material clean-up effort. Legacy materials were defined as chemicals, hazardous, non-hazardous, and both hazardous and radioactive (mixed), that no longer served a programmatic use and had no identified individual owner within the Laboratory. Once personnel identified the legacy materials, the items were transferred to Solid Waste Operation's (EM-SWO) control. Upon completing this process, the responsible division-level manager was required to certify that all non-radioactive hazardous and non-hazardous materials and acceptable mixed legacy materials had been identified and transferred to EM-SWO for proper handling or disposal. The major expense in this project was the cost of actual chemical and radiological analysis. This expense was the result of items not having an identified individual owner. The major benefit of this project is that LANL is now in an excellent position to implement its Integrated Safety Management (ISM) Plan, which requires the implementation of safe work practices, including requirements for removing unused items when vacating workspaces. Effective implementation of ISM will go a long way toward ensuring that legacy materials are no longer an issue at the Laboratory

  9. Adoption of health information technologies by physicians for clinical practice

    DEFF Research Database (Denmark)

    Villalba-Mora, Elena; Casas, Isabel; Lupiañez-Villanueva, Francisco

    2015-01-01

    OBJECTIVES: We investigated the level of adoption of Health Information Technologies (HIT) services, and the factors that influence this, amongst specialised and primary care physicians; in Andalusia, Spain. METHODS: We analysed the physicians' responses to an online survey. First, we performed...... a statistical descriptive analysis of the data; thereafter, a principal component analysis; and finally an order logit model to explain the effect of the use in the adoption and to analyse which are the existing barriers. RESULTS: The principal component analysis revealed three main uses of Health Information...... Technologies: Electronic Health Records (EHR), ePrescription and patient management and telemedicine services. Results from an ordered logit model showed that the frequency of use of HIT is associated with the physicians' perceived usefulness. Lack of financing appeared as a common barrier to the adoption...

  10. Ethics in clinical research: need for assessing comprehension of informed consent form?

    Science.gov (United States)

    Shafiq, Nusrat; Malhotra, Samir

    2011-03-01

    Comprehension of informed consent form has not achieved the attention it deserves. We made a 24-item questionnaire to assess clinical research participants' comprehension of informed consent form (Contemp Clin Trials 2009;30:427-30). Due to repeated requests by clinical researchers in our country and abroad, we are publishing the questionnaire in this article. Copyright © 2010 Elsevier Inc. All rights reserved.

  11. Clinical relevance of informal coercion in psychiatric treatment – a systematic review

    Directory of Open Access Journals (Sweden)

    Florian Hotzy

    2016-12-01

    Full Text Available Introduction:Although informal coercion is frequently applied in psychiatry its use is discussed controversially. This systematic review aimed to summarize literature on attitudes towards informal coercion, its prevalence and clinical effects.Methods:A systematic search of Pubmed, Embase, PsycINF and Google Scholar was conducted. Publications were included if they reported original data describing patients’ and clinicians’ attitudes towards and prevalence rates or clinical effects of informal coercion.Results:21 publications out of a total of 162 articles met the inclusion criteria. Most publications focused on leverage and inducements rather than persuasion and threat. Prevalence rates of informal coercion were 29 to 59%, comparable on different study sites and in different settings. The majority of mental health professionals as well as one to two thirds of the psychiatric patients had positive attitudes, even if there was personal experience of informal coercion. We found no study evaluating the clinical effect of informal coercion in an experimental study design.Discussion:Cultural and ethical aspects are associated with the attitudes and prevalence rates. The clinical effect of informal coercion remains unclear and further studies are needed to evaluate these interventions and the effect on therapeutic relationship and clinical outcome. It can be hypothesized that informal coercion may lead to better adherence and clinical outcome but also to strains in the therapeutic relationship. It is recommendable to establish structured education about informal coercion and sensitize mental health professionals for its potential for adverse effects in clinical routine practice.

  12. Development of a clinical information tool for the electronic medical record: a case study.

    Science.gov (United States)

    Epstein, Barbara A; Tannery, Nancy H; Wessel, Charles B; Yarger, Frances; LaDue, John; Fiorillo, Anthony B

    2010-07-01

    What is the process of developing a clinical information tool to be embedded in the electronic health record of a very large and diverse academic medical center? The development took place at the University of Pittsburgh Health Sciences Library System. The clinical information tool developed is a search box with subject tabs to provide quick access to designated full-text information resources. Each subject tab offers a federated search of a different pool of resources. Search results are organized "on the fly" into meaningful categories using clustering technology and are directly accessible from the results page. After more than a year of discussion and planning, a clinical information tool was embedded in the academic medical center's electronic health record. The library successfully developed a clinical information tool, called Clinical-e, for use at the point of care. Future development will refine the tool and evaluate its impact and effectiveness.

  13. Age and leadership : The moderating role of legacy beliefs

    NARCIS (Netherlands)

    Zacher, Hannes; Rosing, Kathrin; Frese, Michael

    Age and age-related motivations have been neglected in leadership research. This study examined the moderating influence of legacy beliefs on the relationships between age and transformational, transactional, and passive-avoidant leadership behaviors. Legacy beliefs involve individuals' convictions

  14. Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction.

    Science.gov (United States)

    Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel

    2011-01-01

    Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

  15. The scientific legacy of Howard Vincent Malmstadt

    International Nuclear Information System (INIS)

    Horlick, Gary

    2006-01-01

    Howard Malmstadt was a true giant of Analytical Chemistry and clearly one of the most influential analytical chemists of the last 50 years. Howard, through his own work and that of his students (first generation) and their students (second generation) and their students' students (third generation) changed the course of Analytical Chemistry. His research interests were broad and ranged from analytical solution chemistry (titrimetry and reaction rates) and electrochemistry to atomic and molecular spectroscopy, chemical instrumentation, clinical chemistry and automation. Howard was also one of the most innovative and influential educators of our time. He changed forever the analytical curriculum through his many books on Electronics for Scientists, most written in conjunction with Chris Enke and Stan Crouch. Their texts and short courses went from pioneering the application of tube-based analog electronics (servo systems and operational amplifiers) in scientific measurements to the impact that integrated circuits and digital electronics would have on laboratory measurements. He strongly believed in the importance of 'hands-on' in education. To this end, he expended considerable personal effort and time to see not only the development and commercialization of an effective laboratory infrastructure to support education in analog and digital electronics, but also oversaw the development of modular instrumentation for spectroscopy. Over the years he received many awards from the Analytical Chemistry community for his outstanding efforts and contributions to teaching and research. Many of Howard's students went on into academia. They and their students now represent the ongoing legacy for analytical chemistry that evolved from Howard's laboratory at Illinois. A remarkable diversity of research programs are underway in their laboratories. Topics range from atomic, laser, mass, and Raman spectroscopy to detection technology, analytical education, micro

  16. Information structuring improves recall of emergency discharge information: a randomized clinical trial.

    Science.gov (United States)

    Ackermann, Selina; Ghanim, Leyla; Heierle, Anette; Hertwig, Ralph; Langewitz, Wolf; Mata, Rui; Bingisser, Roland

    2017-07-01

    This article examines the extent to which structuring Emergency Department discharge information improves the ability to recall that information, and whether such benefits interact with relevant prior knowledge. Using three samples of students with different levels of prior medical knowledge, we investigated the amount of information recalled after structured vs. non-structured presentation of information. Across all student samples, the structured discharge information led to a relative increase in recalled items of 17% compared to non-structured discharge information (M = 9.70, SD = 4.96 vs. M = 8.31, SD = 4.93). In the sample with least medical knowledge, however, the structured discharge information resulted in a relative increase in recall by 42% (M = 8.12 vs. M = 5.71). These results suggest that structuring discharge information can be a useful tool to improve recall of information and is likely to be most beneficial for patient populations with lower levels of medical knowledge.

  17. [Informed consent right of the appraised individuals in forensic clinical examination].

    Science.gov (United States)

    Li, Ju-Ping; Han, Wei; Gu, Shan-Zhi; Chen, Teng

    2015-02-01

    Informed consent right is not just for basic ethical consideration, but is important for protecting patient's right by law, which is expressed through informed consent contract. The appraised individuals of forensic clinical examination have the similar legal status as the patients in medical system. However, the law does not require informed consent right for the appraised individuals. I recommend giving certain informed consent right to the appraised individuals in the forensic clinical examination. Under the contracted relationship with the institution, the appraised individuals could participate in the examination process, know the necessary information, and make a selected consent on the examination results, which can assure the justice and fairness of judicial examination procedure.

  18. MedTime: a temporal information extraction system for clinical narratives.

    Science.gov (United States)

    Lin, Yu-Kai; Chen, Hsinchun; Brown, Randall A

    2013-12-01

    Temporal information extraction from clinical narratives is of critical importance to many clinical applications. We participated in the EVENT/TIMEX3 track of the 2012 i2b2 clinical temporal relations challenge, and presented our temporal information extraction system, MedTime. MedTime comprises a cascade of rule-based and machine-learning pattern recognition procedures. It achieved a micro-averaged f-measure of 0.88 in both the recognitions of clinical events and temporal expressions. We proposed and evaluated three time normalization strategies to normalize relative time expressions in clinical texts. The accuracy was 0.68 in normalizing temporal expressions of dates, times, durations, and frequencies. This study demonstrates and evaluates the integration of rule-based and machine-learning-based approaches for high performance temporal information extraction from clinical narratives. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Legacy data sharing to improve drug safety assessment: the eTOX project

    DEFF Research Database (Denmark)

    Sanz, Ferran; Pognan, François; Steger-Hartmann, Thomas

    2017-01-01

    The sharing of legacy preclinical safety data among pharmaceutical companies and its integration with other information sources offers unprecedented opportunities to improve the early assessment of drug safety. Here, we discuss the experience of the eTOX project, which was established through the...

  20. Legacy data sharing to improve drug safety assessment : the eTOX project

    NARCIS (Netherlands)

    Sanz, Ferran; Pognan, François; Steger-Hartmann, Thomas; Díaz, Carlos; Cases, Montserrat; Pastor, Manuel; Marc, Philippe; Wichard, Joerg; Briggs, Katharine; Watson, David K; Kleinöder, Thomas; Yang, Chihae; Amberg, Alexander; Beaumont, Maria; Brookes, Anthony J; Brunak, Søren; Cronin, Mark T D; Ecker, Gerhard F; Escher, Sylvia; Greene, Nigel; Guzmán, Antonio; Hersey, Anne; Jacques, Pascale; Lammens, Lieve; Mestres, Jordi; Muster, Wolfgang; Northeved, Helle; Pinches, Marc; Saiz, Javier; Sajot, Nicolas; Valencia, Alfonso; van der Lei, Johan; Vermeulen, Nico P E; Vock, Esther; Wolber, Gerhard; Zamora, Ismael

    2017-01-01

    The sharing of legacy preclinical safety data among pharmaceutical companies and its integration with other information sources offers unprecedented opportunities to improve the early assessment of drug safety. Here, we discuss the experience of the eTOX project, which was established through the

  1. An indicator framework to assess the legacy impacts of the 2010 ...

    African Journals Online (AJOL)

    Assessing legacy impacts entails monitoring and evaluating the long-terms effects of mega events which is a neglected area of research. Most researchers on mega events focus ... to sustainability imperatives. Furthermore, examining long-term outcomes are central to informing future bidding and planning of mega events.

  2. U.S. Department of Energy, Office of Legacy Management Program Update, April-June 2009

    Energy Technology Data Exchange (ETDEWEB)

    None

    2009-04-01

    Welcome to the April-June 2009 issue of the U.S. Department of Energy (DOE) Office of Legacy Management (LM) Program Update. This publication is designed to provide a status of activities within LM. The Legacy Management goals are: (1) Protect human health and the environment through effective and efficient long-term surveillance and maintenance - This goal highlights DOE's responsibility to ensure long-term protection of people, the environment, and the integrity of engineered remedies and monitoring systems. (2) Preserve, protect, and make accessible legacy records and information - This goal recognizes LM's commitment to successfully manage records, information, and archives of legacy sites under its authority. (3) Support an effective and efficient work force structured to accomplish Departmental missions and assure continuity of contractor worker pension and medical benefits - This goal recognizes DOE's commitment to its contracted work force and the consistent management of pension and health benefits. As sites continue to close, DOE faces the challenges of managing pension plan and health benefits liability. (4) Manage legacy land and assets, emphasizing protective real and personal property reuse and disposition - This goal recognizes a DOE need for local collaborative management of legacy assets, including coordinating land use planning, personal property disposition to community reuse organizations, and protecting heritage resources (natural, cultural, and historical). (5) Improve program effectiveness through sound management - This goal recognizes that LM's goals cannot be attained efficiently unless the federal and contractor work force is motivated to meet requirements and work toward continuous performance improvement.

  3. The Timeless Legacy of Robert Koch

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 11; Issue 9. The Timeless Legacy of Robert Koch - Founder of Medical Microbiology. Jaya S Tyagi. General Article Volume 11 Issue 9 September 2006 pp 20-28. Fulltext. Click here to view fulltext PDF. Permanent link:

  4. The Legacy of 1789: Part 2.

    Science.gov (United States)

    Kirkaldy, James

    1990-01-01

    Honoring the French Revolution's bicentennial, examines its legacy for modern France. Contends that 1789's imprint appears in France's centralized bureaucracy, strong political divisions (conservative-liberal-socialist), church-state separation, and tendency for government to argue ends justify means. Maintains the Revolution also spawned…

  5. George Peabody's (1795-1869) Educational Legacy.

    Science.gov (United States)

    Parker, Franklin; Parker, Betty J.

    During his career, George Peabody financially supported educational endeavors and went beyond the accumulation of money to leave for one's children. His support began in the mid-1800s and his educational legacy remains. He established: (1) a $2 million Peabody Education Fund to promote public schools and teacher training in 12 civil war devastated…

  6. Christian Social Justice Advocate: Contradiction or Legacy?

    Science.gov (United States)

    Edwards, Cher N.

    2012-01-01

    In this article, the relationship between Christian religiosity and the principles of social justice is explored, including the sociopolitical aspects of faith and advocacy. A particular emphasis is placed on the historical legacy and theological relationships between Christianity and social justice. The author concludes with a call for…

  7. Asutosh Mukhopadhyay and his Mathematical Legacy

    Indian Academy of Sciences (India)

    IAS Admin

    In this article, we describe the life and career of the versatile genius, Asutosh Mukhopadhyay. The article offers a few glimpses of his mathe- matical talent and contributions to mathemat- ics, and of his efforts to propagate and foster the study of and research in mathematics. 1. Introduction. The legacy of Asutosh ...

  8. Factors shaping effective utilization of health information technology in urban safety-net clinics.

    Science.gov (United States)

    George, Sheba; Garth, Belinda; Fish, Allison; Baker, Richard

    2013-09-01

    Urban safety-net clinics are considered prime targets for the adoption of health information technology innovations; however, little is known about their utilization in such safety-net settings. Current scholarship provides limited guidance on the implementation of health information technology into safety-net settings as it typically assumes that adopting institutions have sufficient basic resources. This study addresses this gap by exploring the unique challenges urban resource-poor safety-net clinics must consider when adopting and utilizing health information technology. In-depth interviews (N = 15) were used with key stakeholders (clinic chief executive officers, medical directors, nursing directors, chief financial officers, and information technology directors) from staff at four clinics to explore (a) nonhealth information technology-related clinic needs, (b) how health information technology may provide solutions, and (c) perceptions of and experiences with health information technology. Participants identified several challenges, some of which appear amenable to health information technology solutions. Also identified were requirements for effective utilization of health information technology including physical infrastructural improvements, funding for equipment/training, creation of user groups to share health information technology knowledge/experiences, and specially tailored electronic billing guidelines. We found that despite the potential benefit that can be derived from health information technologies, the unplanned and uninformed introduction of these tools into these settings might actually create more problems than are solved. From these data, we were able to identify a set of factors that should be considered when integrating health information technology into the existing workflows of low-resourced urban safety-net clinics in order to maximize their utilization and enhance the quality of health care in such settings.

  9. Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics

    Science.gov (United States)

    Hahn, Daniel; Wanjala, Pepela; Marx, Michael

    2013-01-01

    Background Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily) for patient care. Design A multiple case study was carried out between March and August 2012 at the antenatal care (ANC) clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC). Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Results Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. Conclusions We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers) and individual skills and motivation. PMID:23993022

  10. Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics

    Directory of Open Access Journals (Sweden)

    Daniel Hahn

    2013-08-01

    Full Text Available Background: Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily for patient care. Design: A multiple case study was carried out between March and August 2012 at the antenatal care (ANC clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC. Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Results: Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. Conclusions: We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers and individual skills and motivation.

  11. Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics.

    Science.gov (United States)

    Hahn, Daniel; Wanjala, Pepela; Marx, Michael

    2013-08-29

    Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily) for patient care. A multiple case study was carried out between March and August 2012 at the antenatal care (ANC) clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC). Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers) and individual skills and motivation.

  12. Impact of a prototype visualization tool for new information in EHR clinical documents.

    Science.gov (United States)

    Farri, O; Rahman, A; Monsen, K A; Zhang, R; Pakhomov, S V; Pieczkiewicz, D S; Speedie, S M; Melton, G B

    2012-01-01

    EHR clinical document synthesis by clinicians may be time-consuming and error-prone due to the complex organization of narratives, excessive redundancy within documents, and, at times, inadvertent proliferation of data inconsistencies. Development of EHR systems that are easily adaptable to the user's work processes requires research into visualization techniques that can optimize information synthesis at the point of care. To evaluate the effect of a prototype visualization tool for clinically relevant new information on clinicians' synthesis of EHR clinical documents and to understand how the tool may support future designs of clinical document user interfaces. A mixed methods approach to analyze the impact of the visualization tool was used with a sample of eight medical interns as they synthesized EHR clinical documents to accomplish a set of four pre-formed clinical scenarios using a think-aloud protocol. Differences in the missing (unretrieved) patient information (2.3±1.2 [with the visualization tool] vs. 6.8±1.2 [without the visualization tool], p = 0.08) and accurate inferences (1.3±0.3 vs 2.3±0.3, p = 0.09) were not statistically significant but suggest some improvement with the new information visualization tool. Despite the non-significant difference in total times to task completion (43±4 mins vs 36±4 mins, p = 0.35) we observed shorter times for two scenarios with the visualization tool, suggesting that the time-saving benefits may be more evident with certain clinical processes. Other observed effects of the tool include more intuitive navigation between patient details and increased efforts towards methodical synthesis of clinical documents. Our study provides some evidence that new information visualization in clinical notes may positively influence synthesis of patient information from EHR clinical documents. Our findings provide groundwork towards a more effective display of EHR clinical documents using advanced visualization applications.

  13. Spontaneously Reported Symptoms by Informants Are Associated with Clinical Severity in Dementia Help-Seekers.

    Science.gov (United States)

    Xu, Jia-Qi; Choy, Jacky C P; Tang, Jennifer Y M; Liu, Tian-Yin; Luo, Hao; Lou, Vivian W Q; Lum, Terry Y S; Wong, Gloria H Y

    2017-09-01

    To investigate the predictive value of symptoms of dementia that the person or an informant noticed spontaneously in determining the clinical severity of dementia. Cross-sectional. Community-based open-referral dementia assessment service in Hong Kong between 2005 and 2013. Help-seekers for dementia assessment service and their informants (N = 965 dyads). Participants underwent a clinical dementia interview based on the Clinical Dementia Rating. Spontaneous complaints that the person and the informant made that had prompted their help-seeking of groups with interview results suggestive of no impairment, mild cognitive impairment, and dementia were compared. Logistic regression was used to evaluate the predictive value of spontaneous complaints for clinical severity. Independent raters blinded to clinical results coded spontaneously reported symptoms into theoretical themes: memory, executive function, language, time and place orientation, neuropsychiatric, mood, and avolition. Memory problems were the most frequently reported complaints for participants (87.7%) and their informants (95.5%), followed by self-reported language (33.0%) and informant-reported orientation (33.0%) difficulties. Informant-reported but not self-reported symptoms predicted clinical severity. Compared with the persons themselves, informants reported more pervasive symptoms corresponding to clinical severity. Persons with dementia self-reported fewer types of symptoms than their healthy or mildly impaired counterparts. Spontaneously reported language and orientation symptoms by the informant distinguished persons with mild or worse dementia (P < .001, Nagelkerke coefficient of determination = 29.7%, percentage correct 85.6%). The type and pervasiveness of symptoms spontaneously that informants reported predicted clinical severity. This may provide a quick reference for triage. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  14. Sustainable legacies for the 2012 Olympic Games.

    Science.gov (United States)

    Shipway, Richard

    2007-05-01

    The London 2012 Olympic and Paralympic Games have the unique potential to deliver sustainable sporting, social, cultural, economic and environmental legacies, not just for London as the host city, but for the whole of Britain. This article focuses primarily on the first three of these potential Olympics legacies. The first area explored is the social legacy as it impacts on host communities; second, the potential educational and cultural legacy of the 2012 Games are examined; and finally, there follows an overview of the health benefits that could result from a sustained increase in mass participation in sport, physical activity and exercise. This appraisal is undertaken through a review of existing Olympic literature and examples are drawn from previous summer and winter Games. This preliminary exploration is followed by the identification of some key challenges to be overcome if the opportunities available to a wide and diverse range of stakeholders are to be fully optimized. The article suggests that the 2012 Games can act as a catalyst for sports development throughout Britain, while also assisting with government cross-cutting agendas such as tackling crime, antisocial behaviour, developing healthy and active communities, improving educational attainment, and combating barriers to participation. In doing so, this article argues that priority should be placed at supporting grassroots sport through greater access to sport in the community, and not solely elite level sports development. The article concludes by suggesting that the 2012 Games provide opportunities to deliver real and tangible changes and most importantly, to afford a higher priority to sport, along with the obvious associated health benefits for Britain as a whole. The underlying challenge as we move towards 2012 is to achieve a positive step change in the attitudes towards sport and physical activity in British society. Achieving this would possibly be the greatest legacy of the 2012 Olympic and

  15. [Development of an ophthalmological clinical information system for inpatient eye clinics].

    Science.gov (United States)

    Kortüm, K U; Müller, M; Babenko, A; Kampik, A; Kreutzer, T C

    2015-12-01

    In times of increased digitalization in healthcare, departments of ophthalmology are faced with the challenge of introducing electronic clinical health records (EHR); however, specialized software for ophthalmology is not available with most major EHR sytems. The aim of this project was to create specific ophthalmological user interfaces for large inpatient eye care providers within a hospitalwide EHR. Additionally the integration of ophthalmic imaging systems, scheduling and surgical documentation should be achieved. The existing EHR i.s.h.med (Siemens, Germany) was modified using advanced business application programming (ABAP) language to create specific ophthalmological user interfaces for reproduction and moreover optimization of the clinical workflow. A user interface for documentation of ambulatory patients with eight tabs was designed. From June 2013 to October 2014 a total of 61,551 patient contact details were documented. For surgical documentation a separate user interface was set up. Digital clinical orders for documentation of registration and scheduling of operations user interfaces were also set up. A direct integration of ophthalmic imaging modalities could be established. An ophthalmologist-orientated EHR for outpatient and surgical documentation for inpatient clinics was created and successfully implemented. By incorporation of imaging procedures the foundation of future smart/big data analyses was created.

  16. Information disclosure in clinical informed consent: "reasonable" patient's perception of norm in high-context communication culture.

    Science.gov (United States)

    Hammami, Muhammad M; Al-Jawarneh, Yussuf; Hammami, Muhammad B; Al Qadire, Mohammad

    2014-01-10

    The current doctrine of informed consent for clinical care has been developed in cultures characterized by low-context communication and monitoring-style coping. There are scarce empirical data on patients' norm perception of information disclosure in other cultures. We surveyed 470 adults who were planning to undergo or had recently undergone a written informed consent-requiring procedure in a tertiary healthcare hospital in Saudi Arabia. Perceptions of norm and current practice were explored using a 5-point Likert scale (1 = strongly agree with disclosure) and 30 information items in 7 domains: practitioners' details, benefits, risks, complications' management, available alternatives, procedure's description, and post-procedure's issues. Respondents' mean (SD) age was 38.4 (12.5); 50.2% were males, 57.2% had ≥ college education, and 37.9% had undergone a procedure. According to norm perception, strongly agree/agree responses ranged from 98.0% (major benefits) to 50.5% (assistant/trainee's name). Overall, items related to benefits and post-procedure's issues were ranked better (more agreeable) than items related to risks and available alternatives. Ranking scores were better in post-procedure respondents for 4 (13.3%) items (p culture, extensive and more information than is currently disclosed is perceived as norm, 2) the focus of the desired information is closer to benefits and post-procedure's issues than risks and available alternatives, 3) male, post-procedure, and older patients are in favor of more information disclosure, 4) male, older, and more educated patients may be particularly dissatisfied with current information disclosure. The focus and extent of information disclosure for clinical informed consent may need to be adjusted if a "reasonable" patient's standard is to be met.

  17. Are Clinical Trial Experiences Utilized?: A Differentiated Model of Medical Sites’ Information Transfer Ability

    DEFF Research Database (Denmark)

    Smed, Marie; Schultz, Carsten; Getz, Kenneth A.

    2015-01-01

    The collaboration with medical professionals in pharmaceutical clinical trials facilitates opportunities to gain valuable market information concerning product functionality issues, as well as issues related to market implementation and adoption. However, previous research on trial management lacks...

  18. Detailed clinical models: representing knowledge, data and semantics in healthcare information technology.

    Science.gov (United States)

    Goossen, William T F

    2014-07-01

    This paper will present an overview of the developmental effort in harmonizing clinical knowledge modeling using the Detailed Clinical Models (DCMs), and will explain how it can contribute to the preservation of Electronic Health Records (EHR) data. Clinical knowledge modeling is vital for the management and preservation of EHR and data. Such modeling provides common data elements and terminology binding with the intention of capturing and managing clinical information over time and location independent from technology. Any EHR data exchange without an agreed clinical knowledge modeling will potentially result in loss of information. Many attempts exist from the past to model clinical knowledge for the benefits of semantic interoperability using standardized data representation and common terminologies. The objective of each project is similar with respect to consistent representation of clinical data, using standardized terminologies, and an overall logical approach. However, the conceptual, logical, and the technical expressions are quite different in one clinical knowledge modeling approach versus another. There currently are synergies under the Clinical Information Modeling Initiative (CIMI) in order to create a harmonized reference model for clinical knowledge models. The goal for the CIMI is to create a reference model and formalisms based on for instance the DCM (ISO/TS 13972), among other work. A global repository of DCMs may potentially be established in the future.

  19. Implications of the concept of minimal risk in research on informed choice in clinical practice.

    Science.gov (United States)

    Wada, Kyoko; Nisker, Jeff

    2015-10-01

    The concept of a minimal risk threshold in research, beneath which exception to informed consent and ethics review processes may occur, has been codified for over 30 years in many national research regulations and by the Council for International Organizations of Medical Sciences. Although minimal risk in research constitutes one of the criteria for allowing waiver of informed consent or modification to the consent process and a large body of literature exists, discussion of a minimal risk threshold in clinical practice has not occurred. One reason for lack of discussion may be that implicit consent is accepted for a wide range of routine clinical practices. Extending the role of minimal risk in research to clinical practice might assist clinicians in identifying circumstances for which implicit consent is indeed sufficient and circumstances in which it is not. Further, concepts from minimal risk in research might assist clinicians regarding when information provision in health promotion is required. We begin by reviewing concepts in both minimal risk in research and informed choice in clinical practice. We then explore how a clinical minimal risk concept may clarify recommendations for information provision in clinical practice and support the patient's informed choice regarding therapeutic and diagnostic procedures and also health promotion. Given that clinical practice involves a broad scope of health information, professional practice guidelines on information provision based on the application of the minimal risk threshold in research could be developed to guide clinicians in what information must be provided to their patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Respiratory clinical guidelines inform ward-based nurses’ clinical skills and knowledge required for evidence-based care

    Directory of Open Access Journals (Sweden)

    Alisha M. Johnson

    2016-09-01

    Full Text Available Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. ­Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge ­identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients. 17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management. The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients.

  1. Respiratory clinical guidelines inform ward-based nurses' clinical skills and knowledge required for evidence-based care.

    Science.gov (United States)

    Johnson, Alisha M; Smith, Sheree M S

    2016-09-01

    Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients. 17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management. The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients.

  2. Patient-reported conformity of informed consent procedures and participation in clinical research.

    Science.gov (United States)

    Agoritsas, T; Perneger, T V

    2011-02-01

    There is growing evidence that the quality of informed consent in clinical research is often sub-optimal. To explore the conformity of patient recruitment with recommended informed consent procedures among patients who were invited to participate in a clinical study at a general teaching hospital, and to examine the association between consent procedures and the patients' decision to participate. All inpatients discharged during a 1-month period were invited to complete a mailed survey in which they reported whether they were invited to participate in a study and whether 13 recommended elements of informed consent actually occurred. Among 1303 respondents, 265 (20.3%) reported that they had been invited to participate in a study, and 191 (72.1%) accepted. While the majority of potential participants were fully informed about practical issues related to the study (e.g. what their participation would consist in), informed of possible risks or benefits, and only 20% about the origin of the study funds. Only 60% reported satisfactory answers to items assessing the overall information process (e.g. explanations were easy to understand). Older and sicker patients reported lower levels of conformity with informed consent procedures, as did patients who refused to participate in a study. Our results confirm that informed consent procedures fail to meet standards for many patients. In particular, consent information should be adapted to the needs of older and sicker patients. Improving the quality of informed consent may increase patients' participation in clinical research.

  3. The Henrietta Lacks legacy grows

    OpenAIRE

    Greely, Henry T; Cho, Mildred K

    2013-01-01

    Now that the NIH has reached an agreement with Henrietta Lacks's family concerning the use of the HeLa cell line, what lessons can we learn about informed consent and the unforeseen use of biological samples?

  4. 76 FR 63355 - Proposed Information Collection (Prevalence and Clinical course of Depression Among patients with...

    Science.gov (United States)

    2011-10-12

    ...: Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research... practical utility; (2) the accuracy of VHA's estimate of the burden of the proposed collection of information; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4...

  5. A CIS (Clinical Information System) Quality Evaluation Tool for Nursing Care Services

    Science.gov (United States)

    Lee, Seon Ah

    2010-01-01

    The purpose of this study was to develop a tool to evaluate the quality of a clinical information system (CIS) conceived by nurses and conduct a pilot test with the developed tool as an initial assessment. CIS quality is required for successful implementation in information technology (IT) environments. The study started with the realization that…

  6. Informed consent in clinical research: Consensus recommendations for reform identified by an expert interview panel.

    Science.gov (United States)

    Lorell, Beverly H; Mikita, J Stephen; Anderson, Annick; Hallinan, Zachary P; Forrest, Annemarie

    2015-12-01

    Informed consent is the cornerstone for protection of human subjects in clinical trials. However, a growing body of evidence suggests that reform of the informed consent process in the United States is needed. The Clinical Trials Transformation Initiative conducted interviews with 25 experienced observers of the informed consent process to identify limitations and actionable recommendations for change. There was broad consensus that current practices often fail to meet the ethical obligation to inform potential research participants during the informed consent process. The most frequent single recommendation, which would affect all participants in federally regulated clinical research, was reform of the informed consent document. The interviews also identified the need for reform of clinical research review by institutional review boards, including transitioning to a single institutional review board for multi-site trials. The consensus recommendations from the interviewees provide a framework for meaningful change in the informed consent process. Although some proposed changes are feasible for rapid implementation, others such as substantive reform of the informed consent document may require change in federal regulations. © The Author(s) 2015.

  7. Walter Bonime's legacy: principal contributions.

    Science.gov (United States)

    Eckardt, Marianne Horney

    2002-01-01

    Walter Bonime is best known for his influential book, The Clinical Use of Dreams, published in 1962. Though Bonime embraced a neo-Freudian orientation, The Clinical Use of Dreams is remarkable for an absence of theoretical discussions, emphasizing instead a detailed practical approach, aided by illustrative vignettes. His particular emphases are on collaboration in the discovery of meaning and the importance of recognizing feeling representations in dreams. Further writings focussed on character disorders with depressive and paranoid symptomatology, vividly describing the typical underlying neurotic character structures. An outstanding article, co-authored with his wife Florence Bonime, criticizes the usual obscurity of psychoanalytic writings and suggests that conceptual abstractions be well balanced by clinical illustrations. Bonime's style is an exemplary model for such balanced writings.

  8. Issues Associated with Tritium Legacy Materials

    International Nuclear Information System (INIS)

    Mills, Michael

    2008-01-01

    This paper highlights some of the issues associated with the treatment of legacy materials linked to research into tritium over many years and also of materials used to contain or store tritium. The aim of the work is to recover tritium where practicable, and to leave the residual materials passively safe, either for disposal or for continued storage. A number of materials are currently stored at AWE which either contain tritium or have been used in tritium processing. It is essential that these materials are characterised such that a strategy may be developed for their safe stewardship, and ultimately for their treatment and disposal. Treatment processes for such materials are determined by the application of best practicable means (BPM) studies in accordance with the requirements of the Environment Agency of England and Wales. Clearly, it is necessary to understand the objectives of legacy material treatment / processing and the technical options available before a definitive BPM study is implemented. The majority of tritium legacy materials with which we are concerned originate from the decommissioning of a facility that was operational from the late 1950's through to the late 1990's when, on post-operative clear-out (POCO), the entire removable and transportable tritium inventory was moved to new, purpose built facilities. One of the principle tasks to be undertaken in the new facilities is the treatment of the legacy materials to recover tritium wherever practicable, and render the residual materials passively safe for disposal or continued storage. Where tritium recovery was not reasonably or technically feasible, then a means to assure continued safe storage was to be devised and implemented. The legacy materials are in the following forms: - Uranium beds which may or may not contain adsorbed tritium gas; - Tritium gas stored in containers; - Tritide targets for neutron generation; - Tritides of a broad spectrum of metals manufactured for research / long

  9. Peer Review of Clinical Information Models: A Web 2.0 Crowdsourced Approach.

    Science.gov (United States)

    Leslie, Heather; Ljosland Bakke, Silje

    2017-01-01

    Over the past 8 years the openEHR Clinical Model program has been developing a Web 2.0 approach and tooling to support the development, review and governance of atomic clincial information models, known as archetypes. This paper describes the background and review process, and provides a practical example where cross standards organisation collaboration resulted in jointly agreed clinical content which was subsequently represented in different implementation formalisms that were effectively semantically aligned. The discussion and conclusions highlight some of the socio-technical benefits and challenges facing organisations who seek to govern automic clinical information models in a global and collaborative online community.

  10. Alcohol use disorder clinical course research: informing clinicians' treatment planning now and in the future.

    Science.gov (United States)

    Maisto, Stephen A; Kirouac, Megan; Witkiewitz, Katie

    2014-09-01

    The clinical course of alcohol use disorder (AUD) has been widely researched over the past half-century and has been used to advance our understanding of the treatment of AUD. Nevertheless, new directions in AUD clinical course research could enhance its value in informing clinical decision-making in patient-centered treatment of AUD. An overview, a critical analysis, and a discussion of AUD clinical course research are presented. This article discusses three research directions that promote the advancement of the knowledge regarding the clinical course of AUD to better inform clinical decision-making in patient-centered treatment of AUD. Specifically, we hypothesized that (a) real-time data collection of the clinical course of AUD via ecological momentary assessment would help elucidate near real-time associations between risk factors and alcohol use, (b) future research designs should use person-centered and dynamic analyses of alcohol use over time, and (c) adaptive treatment designs would provide personalized and optimized AUD treatment. Consequently, the field will advance the development of clinical decision-making support systems to better inform clinicians and clients in making informed AUD treatment decisions. In addition, such research would advance clinical practice with more attention to theory and expansion of the study of the clinical course of AUD to include areas of life functioning besides alcohol use. These research directions have the potential to build a scientific knowledge base that could improve our understanding of AUD among individuals with alcohol problems, would allow providers to predict patient outcomes during and after treatment, and would offer practical strategies regarding steps that could ultimately improve the clinical course of AUD.

  11. The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems

    Science.gov (United States)

    2014-01-01

    Health information systems (HISs) hold the promise to transform health care; however, their adoption is challenged. We have developed the Clinical Adoption Meta-Model (CAMM) to help describe processes and possible challenges with clinical adoption. The CAMM, developed through an action research study to evaluate a provincial HIS, is a temporal model with four dimensions: availability, use, behaviour changes, and outcome changes. Seven CAMM archetypes are described, illustrating classic trajectories of adoption of HISs over time. Each archetype includes an example from the literature. The CAMM and its archetypes can support HIS implementers, evaluators, learners, and researchers. PMID:24884588

  12. The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems.

    Science.gov (United States)

    Price, Morgan; Lau, Francis

    2014-05-29

    Health information systems (HISs) hold the promise to transform health care; however, their adoption is challenged. We have developed the Clinical Adoption Meta-Model (CAMM) to help describe processes and possible challenges with clinical adoption. The CAMM, developed through an action research study to evaluate a provincial HIS, is a temporal model with four dimensions: availability, use, behaviour changes, and outcome changes. Seven CAMM archetypes are described, illustrating classic trajectories of adoption of HISs over time. Each archetype includes an example from the literature. The CAMM and its archetypes can support HIS implementers, evaluators, learners, and researchers.

  13. Natural language processing systems for capturing and standardizing unstructured clinical information: A systematic review.

    Science.gov (United States)

    Kreimeyer, Kory; Foster, Matthew; Pandey, Abhishek; Arya, Nina; Halford, Gwendolyn; Jones, Sandra F; Forshee, Richard; Walderhaug, Mark; Botsis, Taxiarchis

    2017-09-01

    We followed a systematic approach based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify existing clinical natural language processing (NLP) systems that generate structured information from unstructured free text. Seven literature databases were searched with a query combining the concepts of natural language processing and structured data capture. Two reviewers screened all records for relevance during two screening phases, and information about clinical NLP systems was collected from the final set of papers. A total of 7149 records (after removing duplicates) were retrieved and screened, and 86 were determined to fit the review criteria. These papers contained information about 71 different clinical NLP systems, which were then analyzed. The NLP systems address a wide variety of important clinical and research tasks. Certain tasks are well addressed by the existing systems, while others remain as open challenges that only a small number of systems attempt, such as extraction of temporal information or normalization of concepts to standard terminologies. This review has identified many NLP systems capable of processing clinical free text and generating structured output, and the information collected and evaluated here will be important for prioritizing development of new approaches for clinical NLP. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. A Balance of Primary and Secondary Values: Exploring a Digital Legacy

    Directory of Open Access Journals (Sweden)

    Amber L. Cushing

    2014-06-01

    Full Text Available This exploratory research explores the concept of a digital legacy as a general concept and as a collection of digital possessions with unique characteristics. The results reported in this article are part of a larger study. In Cushing (2013, the author identified the characteristics of a digital possession. In this study, these characteristics of a digital possession were utilized to explore how the characteristics of several digital possessions could form a collection, or a digital legacy. In addition to being explored as a collection of digital possessions, data was collected about the general concept of a digital legacy. In part I of the study, 23 participants from three age groups were interviewed about their general concept of a digital legacy. Five general characteristics describing a digital legacy were identified. In part II of the study, interview data from Cushing (2013 was used to create statements describing digital possessions. The statements were classified utilizing the archival concept of primary and secondary values, as well as the consumer behavior concepts of self extension to possessions and possession attachment. Primary value refers to the purpose for which the item was created, while secondary value refers to an additional value that the participants can perceive the item to hold, such as a perception that an item can represent one's identity. Using standard Q method procedure, 48 participants were directed to rank their agreement with 60 statements (written on cards, along a distribution of -5 to +5, according to the characteristics of the digital possession they would most like to maintain for a digital legacy. The ranked statements were analyzed using Q factor analysis, in order to perceive the most common statements associated with maintaining digital possessions for a digital legacy. Q method results suggested that most individuals described the digital possessions they wanted to maintain for a digital legacy using

  15. Automatically extracting clinically useful sentences from UpToDate to support clinicians' information needs.

    Science.gov (United States)

    Mishra, Rashmi; Del Fiol, Guilherme; Kilicoglu, Halil; Jonnalagadda, Siddhartha; Fiszman, Marcelo

    2013-01-01

    Clinicians raise several information needs in the course of care. Most of these needs can be met by online health knowledge resources such as UpToDate. However, finding relevant information in these resources often requires significant time and cognitive effort. To design and assess algorithms for extracting from UpToDate the sentences that represent the most clinically useful information for patient care decision making. We developed algorithms based on semantic predications extracted with SemRep, a semantic natural language processing parser. Two algorithms were compared against a gold standard composed of UpToDate sentences rated in terms of clinical usefulness. Clinically useful sentences were strongly correlated with predication frequency (correlation= 0.95). The two algorithms did not differ in terms of top ten precision (53% vs. 49%; p=0.06). Semantic predications may serve as the basis for extracting clinically useful sentences. Future research is needed to improve the algorithms.

  16. The digital pen and paper technology: implementation and use in an existing clinical information system.

    Science.gov (United States)

    Despont-Gros, Christelle; Bœuf, Christophe; Geissbuhler, Antoine; Lovis, Christian

    2005-01-01

    Evaluation of the technical feasibility of tight integration of the digital pen and paper technology in an existing computerized patient record.Technology: The digital pen is a normal pen able to record all actions of the user and to analyze a micro pattern printed on the paper. The digital paper is a normal paper printed with an almost invisible micro pattern of small dots encoding information such as position and identifiers. We report our experience in the implementation and the use of this technology in an existing large clinical information system for acquiring clinical information. It is possible to print uniquely identified forms using the digital paper technology. These forms can be pre-filled with clinical readable information about the patient. When care providers complete these forms using the digital pen, it is possible to acquire the data in a structured computerized patient record. The technology is easy to integrate in a component-based architecture based on Web Services. The digital pen and paper is a cost-effective technology that can be integrated in an existing clinical information system and allows fast and easy bedside clinical information acquisition without the need for an expensive infrastructure based on traditional portable devices or wireless devices.

  17. Audit of the informed consent process as a part of a clinical research quality assurance program.

    Science.gov (United States)

    Lad, Pramod M; Dahl, Rebecca

    2014-06-01

    Audits of the informed consent process are a key element of a clinical research quality assurance program. A systematic approach to such audits has not been described in the literature. In this paper we describe two components of the audit. The first is the audit of the informed consent document to verify adherence with federal regulations. The second component is comprised of the audit of the informed consent conference, with emphasis on a real time review of the appropriate communication of the key elements of the informed consent. Quality measures may include preparation of an informed consent history log, notes to accompany the informed consent, the use of an informed consent feedback tool, and the use of institutional surveys to assess comprehension of the informed consent process.

  18. Nurse-led outpatient clinics in oncology care - Patient satisfaction, information and continuity of care.

    Science.gov (United States)

    Berglund, Catharina Bau; Gustafsson, Eva; Johansson, Hemming; Bergenmar, Mia

    2015-12-01

    The aims of the present study were to investigate patients' satisfaction with nurse-led clinics, patients' perception of received information and associations between continuity of care and satisfaction with information. Questionnaires on patient satisfaction were sent to consecutive samples of patients after they attended a nurse-led clinic at the Department of Oncology, Karolinska University Hospital in 2007, 2009, 2011 and 2013. Patients' perceptions of received information were evaluated in 2011 and 2013, by the EORTC QLQ-INFO25. Data on registered continuity of care were retrieved from the patients' medical record. A total of 962 patients responded (79%) to one of the four surveys. Patients' satisfaction with nurse-led clinics was stable over time. More than 90% rated nurses' interpersonal manners and the care at the clinic as "good", the waiting time as "acceptable", and the length of appointments as "sufficient". Over 90% responded that it was important to meet the same nurse and 62% reported they actually did so and 52% stated they were assigned a named nurse navigator. More than 75% rated the information at their latest visit at a nurse-led clinic as "completely" sufficient. However, 48% expressed wish for more information "during the current disease". No statistical significant associations were found between "satisfaction with information" and continuity of care. Patients' satisfaction with nurse-led clinics was stable over time with generally high figures with the exception for continuity of care and information, areas in which improvements are needed. The wide variety in information needs might require a person-centred approach. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. The ATLAS Trigger Simulation with Legacy Software

    CERN Document Server

    Bernius, Catrin; The ATLAS collaboration

    2017-01-01

    Physics analyses at the LHC require accurate simulations of the detector response and the event selection processes, generally done with the most recent software releases. The trigger response simulation is crucial for determination of overall selection efficiencies and signal sensitivities and should be done with the same software release with which data were recorded. This requires potentially running with software dating many years back, the so-called legacy software. Therefore having a strategy for running legacy software in a modern environment becomes essential when data simulated for past years start to present a sizeable fraction of the total. The requirements and possibilities for such a simulation scheme within the ATLAS software framework were examined and a proof-of-concept simulation chain has been successfully implemented. One of the greatest challenges was the choice of a data format which promises long term compatibility with old and new software releases. Over the time periods envisaged, data...

  20. The ATLAS Trigger Simulation with Legacy Software

    CERN Document Server

    Bernius, Catrin; The ATLAS collaboration

    2017-01-01

    Physics analyses at the LHC which search for rare physics processes or measure Standard Model parameters with high precision require accurate simulations of the detector response and the event selection processes. The accurate simulation of the trigger response is crucial for determination of overall selection efficiencies and signal sensitivities. For the generation and the reconstruction of simulated event data, generally the most recent software releases are used to ensure the best agreement between simulated data and real data. For the simulation of the trigger selection process, however, the same software release with which real data were taken should be ideally used. This requires potentially running with software dating many years back, the so-called legacy software. Therefore having a strategy for running legacy software in a modern environment becomes essential when data simulated for past years start to present a sizeable fraction of the total. The requirements and possibilities for such a simulatio...

  1. Olympics Legacy: the London Olympics 2012

    OpenAIRE

    Gulsen, Guler; Holden, Robert

    2010-01-01

    The reasons for proposing a London 2012 bid are outlined in the light of London city planning over the past sixty years. The processes influencing the bid for the London 2012 Olympics are investigated in respect of the lessons from Barcelona and Sydney. The role of environmental\\ud and landscape improvement is examined and the importance of legacy is described and analysed. The cost of Olympiads since Sydney 2000 are described and compared. Then progress of the London 2012 Olympics developmen...

  2. The mycological legacy of Elias Magnus Fries

    OpenAIRE

    Petersen, Ronald H.; Knudsen, Henning

    2015-01-01

    The taxonomic concepts which originated with or were accepted by Elias Magnus Fries were presented during his lifetime in the printed word, illustrative depiction, and in collections of dried specimens. This body of work was welcomed by the mycological and botanical communities of his time: students and associates aided Fries and after his passing carried forward his taxonomic ideas. His legacy spawned a line of Swedish and Danish mycologists intent on perpetuating the Fries tradition: Hampus...

  3. Requalification of Legacy Radioactive Waste in Germany

    International Nuclear Information System (INIS)

    Bandt, Gabriele; Hoffmann, Paulina; Spicher, Gottfried; Filss, Martin; Schauer, Claudia

    2016-01-01

    Conclusion: • Large stocks of legacy radioactive waste exist, which do not comply with the requirements of the Konrad repository. • Requalification campaigns with thousands of waste packages have successfully been carried out. • Quality assurance plans contain all necessary steps of specific (requalification) campaigns and optimize the procedures for each campaign in advance. • When sophisticated measurement equipment was needed an iterative procedure was adopted. Repeated evaluations of the nondestructive res. destructive measurements limited the measures to the necessary limit.

  4. Migration Performance for Legacy Data Access

    Directory of Open Access Journals (Sweden)

    Kam Woods

    2008-12-01

    Full Text Available We present performance data relating to the use of migration in a system we are creating to provide web access to heterogeneous document collections in legacy formats. Our goal is to enable sustained access to collections such as these when faced with increasing obsolescence of the necessary supporting applications and operating systems. Our system allows searching and browsing of the original files within their original contexts utilizing binary images of the original media. The system uses static and dynamic file migration to enhance collection browsing, and emulation to support both the use of legacy programs to access data and long-term preservation of the migration software. While we provide an overview of the architectural issues in building such a system, the focus of this paper is an in-depth analysis of file migration using data gathered from testing our software on 1,885 CD-ROMs and DVDs. These media are among the thousands of collections of social and scientific data distributed by the United States Government Printing Office (GPO on legacy media (CD-ROM, DVD, floppy disk under the Federal Depository Library Program (FDLP over the past 20 years.

  5. A legacy building model for holistic nursing.

    Science.gov (United States)

    Lange, Bernadette; Zahourek, Rothlyn P; Mariano, Carla

    2014-06-01

    This pilot project was an effort to record the historical roots, development, and legacy of holistic nursing through the visionary spirit of four older American Holistic Nurses Association (AHNA) members. The aim was twofold: (a) to capture the holistic nursing career experiences of elder AHNA members and (b) to begin to create a Legacy Building Model for Holistic Nursing. The narratives will help initiate an ongoing, systematic method for the collection of historical data and serve as a perpetual archive of knowledge and inspiration for present and future holistic nurses. An aesthetic inquiry approach was used to conduct in-depth interviews with four older AHNA members who have made significant contributions to holistic nursing. The narratives provide a rich description of their personal and professional evolution as holistic nurses. The narratives are presented in an aesthetic format of the art forms of snapshot, pastiche, and collage rather than traditional presentations of research findings. A synopsis of the narratives is a dialogue between the three authors and provides insight for how a Legacy Model can guide our future. Considerations for practice, education, and research are discussed based on the words of wisdom from the four older holistic nurses.

  6. The Political Legacy of School Accountability Systems

    Directory of Open Access Journals (Sweden)

    Sherman Dorn

    1998-01-01

    Full Text Available The recent battle reported from Washington about proposed national testing program does not tell the most important political story about high stakes tests. Politically popular school accountability systems in many states already revolve around statistical results of testing with high-stakes environments. The future of high stakes tests thus does not depend on what happens on Capitol Hill. Rather, the existence of tests depends largely on the political culture of published test results. Most critics of high-stakes testing do not talk about that culture, however. They typically focus on the practice legacy of testing, the ways in which testing creates perverse incentives against good teaching. More important may be the political legacy, or how testing defines legitimate discussion about school politics. The consequence of statistical accountability systems will be the narrowing of purpose for schools, impatience with reform, and the continuing erosion of political support for publicly funded schools. Dissent from the high-stakes accountability regime that has developed around standardized testing, including proposals for professionalism and performance assessment, commonly fails to consider these political legacies. Alternatives to standardized testing which do not also connect schooling with the public at large will not be politically viable.

  7. The development and evaluation of a nursing information system for caring clinical in-patient.

    Science.gov (United States)

    Fang, Yu-Wen; Li, Chih-Ping; Wang, Mei-Hua

    2015-01-01

    The research aimed to develop a nursing information system in order to simplify the admission procedure for caring clinical in-patient, enhance the efficiency of medical information documentation. Therefore, by correctly delivering patients’ health records, and providing continues care, patient safety and care quality would be effectively improved. The study method was to apply Spiral Model development system to compose a nursing information team. By using strategies of data collection, working environment observation, applying use-case modeling, and conferences of Joint Application Design (JAD) to complete the system requirement analysis and design. The Admission Care Management Information System (ACMIS) mainly included: (1) Admission nursing management information system. (2) Inter-shift meeting information management system. (3) The linkage of drug management system and physical examination record system. The framework contained qualitative and quantitative components that provided both formative and summative elements of the evaluation. System evaluation was to apply information success model, and developed questionnaire of consisting nurses’ acceptance and satisfaction. The results of questionnaires were users’ satisfaction, the perceived self-involvement, age and information quality were positively to personal and organizational effectiveness. According to the results of this study, the Admission Care Management Information System was practical to simplifying clinic working procedure and effective in communicating and documenting admission medical information.

  8. Quantitative metrics for evaluating the phased roll-out of clinical information systems.

    Science.gov (United States)

    Wong, David; Wu, Nicolas; Watkinson, Peter

    2017-09-01

    We introduce a novel quantitative approach for evaluating the order of roll-out during phased introduction of clinical information systems. Such roll-outs are associated with unavoidable risk due to patients transferring between clinical areas using both the old and new systems. We proposed a simple graphical model of patient flow through a hospital. Using a simple instance of the model, we showed how a roll-out order can be generated by minimising the flow of patients from the new system to the old system. The model was applied to admission and discharge data acquired from 37,080 patient journeys at the Churchill Hospital, Oxford between April 2013 and April 2014. The resulting order was evaluated empirically and produced acceptable orders. The development of data-driven approaches to clinical Information system roll-out provides insights that may not necessarily be ascertained through clinical judgment alone. Such methods could make a significant contribution to the smooth running of an organisation during the roll-out of a potentially disruptive technology. Unlike previous approaches, which are based on clinical opinion, the approach described here quantitatively assesses the appropriateness of competing roll-out strategies. The data-driven approach was shown to produce strategies that matched clinical intuition and provides a flexible framework that may be used to plan and monitor Clinical Information System roll-out. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  9. Clinical social networking--a new revolution in provider communication and delivery of clinical information across providers of care?

    Science.gov (United States)

    Kolowitz, Brian J; Lauro, Gonzalo Romero; Venturella, James; Georgiev, Veliyan; Barone, Michael; Deible, Christopher; Shrestha, Rasu

    2014-04-01

    The adoption of social media technologies appears to enhance clinical outcomes through improved communications as reported by Bacigalupe (Fam Syst Heal 29(1):1-14, 2011). The ability of providers to more effectively, directly, and rapidly communicate among themselves as well as with patients should strengthen collaboration and treatment as reported by Bacigalupe (Fam Syst Heal 29(1):1-14, 2011). This paper is a case study in one organization's development of an internally designed and developed social technology solution termed "Unite." The Unite system combines social technologies' features including push notifications, messaging, community groups, and user lists with clinical workflow and applications to construct dynamic provider networks, simplify communications, and facilitate clinical workflow optimization. Modeling Unite as a social technology may ease adoption barriers. Developing a social network that is integrated with healthcare information systems in the clinical space opens the doors to capturing and studying the way in which providers communicate. The Unite system appears to have the potential to breaking down existing communication paradigms. With Unite, a rich set of usage data tied to clinical events may unravel alternative networks that can be leveraged to advance patient care.

  10. Use of a clinical information system to support the cancer pathway

    DEFF Research Database (Denmark)

    Mukai, Thomas; Vedsted, Peter; Bro, Flemming

    satisfactorily. This may lead to diagnostic delay, delay in treatment, lack of continuity and seamless pathways and low patient satisfaction. Objective: Our aim is to clarify to which degree clinical information support systems can provide GPs and Our aim is to clarify to which degree clinical information...... support systems can provide GPs and patients with on-time and updated information about agreed care pathways and to examine the effect on delay, use of and adherence to guidelines and doctor and patient satisfaction. Subjects and Methods: We intend to conduct two randomized controlled trials to measure...... an electronic questionnaire compared to using a paper questionnaire to create an extended data and feedback system. Results: Different outcome measures will be analyzed: Use of health care services, clinical satisfaction, patient experienced continuity, use of further tests and adherence to guidelines....

  11. System architecture for temporal information extraction, representation and reasoning in clinical narrative reports.

    Science.gov (United States)

    Zhou, Li; Friedman, Carol; Parsons, Simon; Hripcsak, George

    2005-01-01

    Exploring temporal information in narrative Electronic Medical Records (EMRs) is essential and challenging. We propose an architecture for an integrated approach to process temporal information in clinical narrative reports. The goal is to initiate and build a foundation that supports applications which assist healthcare practice and research by including the ability to determine the time of clinical events (e.g., past vs. present). Key components include: (1) an annotation schema for temporal expressions and the development of an associated tagger; (2) a natural language processing (NLP) system for encoding and extracting medical events and associating them with formalized temporal data; (3) a post-processor, with a knowledge-based subsystem to help discover implicit information, that resolves temporal expressions and deals with issues such as granularity and vagueness; and (4) a reasoning mechanism which models clinical reports as Simple Temporal Problems (STPs).

  12. WebCIS: large scale deployment of a Web-based clinical information system.

    Science.gov (United States)

    Hripcsak, G; Cimino, J J; Sengupta, S

    1999-01-01

    WebCIS is a Web-based clinical information system. It sits atop the existing Columbia University clinical information system architecture, which includes a clinical repository, the Medical Entities Dictionary, an HL7 interface engine, and an Arden Syntax based clinical event monitor. WebCIS security features include authentication with secure tokens, authorization maintained in an LDAP server, SSL encryption, permanent audit logs, and application time outs. WebCIS is currently used by 810 physicians at the Columbia-Presbyterian center of New York Presbyterian Healthcare to review and enter data into the electronic medical record. Current deployment challenges include maintaining adequate database performance despite complex queries, replacing large numbers of computers that cannot run modern Web browsers, and training users that have never logged onto the Web. Although the raised expectations and higher goals have increased deployment costs, the end result is a far more functional, far more available system.

  13. High-end clinical domain information systems for effective healthcare delivery.

    Science.gov (United States)

    Mangalampalli, Ashish; Rama, Chakravarthy; Muthiyalian, Raja; Jain, Ajeet K

    2007-01-01

    The Electronic Health Record (EHR) provides doctors with a quick, reliable, secure, real-time and user-friendly source of all relevant patient data. The latest information system technologies, such as Clinical Data Warehouses (CDW), Clinical Decision-Support (CDS) systems and data-mining techniques (Online Analytical Processing (OLAP) and Online Transactional Processing (OLTP)), are used to maintain and utilise patient data intelligently, based on the users' requirements. Moreover, clinical trial reports for new drug approvals are now being submitted electronically for faster and easier processing. Also, information systems are used in educating patients about the latest developments in medical science through the internet and specially configured kiosks in hospitals and clinics.

  14. Hospital clinicians' information behaviour and attitudes towards the 'Clinical Informationist': an Irish survey.

    LENUS (Irish Health Repository)

    Flynn, Maura G

    2012-02-01

    BACKGROUND: Hospital clinicians are increasingly expected to practice evidence-based medicine (EBM) in order to minimize medical errors and ensure quality patient care, but experience obstacles to information-seeking. The introduction of a Clinical Informationist (CI) is explored as a possible solution. AIMS: This paper investigates the self-perceived information needs, behaviour and skill levels of clinicians in two Irish public hospitals. It also explores clinicians\\' perceptions and attitudes to the introduction of a CI into their clinical teams. METHODS: A questionnaire survey approach was utilised for this study, with 22 clinicians in two hospitals. Data analysis was conducted using descriptive statistics. RESULTS: Analysis showed that clinicians experience diverse information needs for patient care, and that barriers such as time constraints and insufficient access to resources hinder their information-seeking. Findings also showed that clinicians struggle to fit information-seeking into their working day, regularly seeking to answer patient-related queries outside of working hours. Attitudes towards the concept of a CI were predominantly positive. CONCLUSION: This paper highlights the factors that characterise and limit hospital clinicians\\' information-seeking, and suggests the CI as a potentially useful addition to the clinical team, to help them to resolve their information needs for patient care.

  15. [The added value of information summaries supporting clinical decisions at the point-of-care.

    Science.gov (United States)

    Banzi, Rita; González-Lorenzo, Marien; Kwag, Koren Hyogene; Bonovas, Stefanos; Moja, Lorenzo

    2016-11-01

    Evidence-based healthcare requires the integration of the best research evidence with clinical expertise and patients' values. International publishers are developing evidence-based information services and resources designed to overcome the difficulties in retrieving, assessing and updating medical information as well as to facilitate a rapid access to valid clinical knowledge. Point-of-care information summaries are defined as web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. Their validity must be assessed against marketing claims that they are evidence-based. We periodically evaluate the content development processes of several international point-of-care information summaries. The number of these products has increased along with their quality. The last analysis done in 2014 identified 26 products and found that three of them (Best Practice, Dynamed e Uptodate) scored the highest across all evaluated dimensions (volume, quality of the editorial process and evidence-based methodology). Point-of-care information summaries as stand-alone products or integrated with other systems, are gaining ground to support clinical decisions. The choice of one product over another depends both on the properties of the service and the preference of users. However, even the most innovative information system must rely on transparent and valid contents. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time.

  16. The NIAID Division of AIDS enterprise information system: integrated decision support for global clinical research programs.

    Science.gov (United States)

    Kagan, Jonathan M; Gupta, Nitin; Varghese, Suresh; Virkar, Hemant

    2011-12-01

    The National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) Enterprise Information System (DAIDS-ES) is a web-based system that supports NIAID in the scientific, strategic, and tactical management of its global clinical research programs for HIV/AIDS vaccines, prevention, and therapeutics. Different from most commercial clinical trials information systems, which are typically protocol-driven, the DAIDS-ES was built to exchange information with those types of systems and integrate it in ways that help scientific program directors lead the research effort and keep pace with the complex and ever-changing global HIV/AIDS pandemic. Whereas commercially available clinical trials support systems are not usually disease-focused, DAIDS-ES was specifically designed to capture and incorporate unique scientific, demographic, and logistical aspects of HIV/AIDS treatment, prevention, and vaccine research in order to provide a rich source of information to guide informed decision-making. Sharing data across its internal components and with external systems, using defined vocabularies, open standards and flexible interfaces, the DAIDS-ES enables NIAID, its global collaborators and stakeholders, access to timely, quality information about NIAID-supported clinical trials which is utilized to: (1) analyze the research portfolio, assess capacity, identify opportunities, and avoid redundancies; (2) help support study safety, quality, ethics, and regulatory compliance; (3) conduct evidence-based policy analysis and business process re-engineering for improved efficiency. This report summarizes how the DAIDS-ES was conceptualized, how it differs from typical clinical trial support systems, the rationale for key design choices, and examples of how it is being used to advance the efficiency and effectiveness of NIAID's HIV/AIDS clinical research programs.

  17. Quantitative evaluation of legacy phosphorus and its spatial distribution.

    Science.gov (United States)

    Lou, Hezhen; Zhao, Changsen; Yang, Shengtian; Shi, Liuhua; Wang, Yue; Ren, Xiaoyu; Bai, Juan

    2018-04-01

    A phosphorus resource crisis threatens the security of global crop production, especially in developing countries like China and Brazil. Legacy phosphorus (legacy-P), which is left behind in agricultural soil by over-fertilization, can help address this issue as a new resource in the soil phosphorus pool. However, issues involved with calculating and defining the spatial distribution of legacy-P hinder its future utilization. To resolve these issues, this study applied remote sensing and ecohydrological modeling to precisely quantify legacy-P and define its spatial distribution in China's Sanjiang Plain from 2000 to 2014. The total legacy-P in the study area was calculated as 579,090 t with an annual average of 38,600 t; this comprises 51.83% of the phosphorus fertilizer applied annually. From 2000 to 2014, the annual amount of legacy-P increased by more than 3.42-fold, equivalent to a 2460-ton increase each year. The spatial distribution of legacy-P showed heterogeneity and agglomeration in this area, with peaks in cultivated land experiencing long-term agricultural development. This study supplies a new approach to finding legacy-P in soil as a precondition for future utilization. Once its spatial distribution is known, legacy-P can be better utilized in agriculture to help alleviate the phosphorus resource crisis. Copyright © 2018 Elsevier Ltd. All rights reserved.

  18. Transforming Cobol Legacy Software to a Generic Imperative Model

    National Research Council Canada - National Science Library

    Moraes, DinaL

    1999-01-01

    .... This research develops a transformation system to convert COBOL code into a generic imperative model, recapturing the initial design and deciphering the requirements implemented by the legacy code...

  19. Information management to enable personalized medicine: stakeholder roles in building clinical decision support

    Directory of Open Access Journals (Sweden)

    Brinner Kristin M

    2009-10-01

    Full Text Available Abstract Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures, and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In

  20. Information management to enable personalized medicine: stakeholder roles in building clinical decision support.

    Science.gov (United States)

    Downing, Gregory J; Boyle, Scott N; Brinner, Kristin M; Osheroff, Jerome A

    2009-10-08

    Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized

  1. Clinical Information Systems Integration in New York City's First Mobile Stroke Unit.

    Science.gov (United States)

    Kummer, Benjamin R; Lerario, Michael P; Navi, Babak B; Ganzman, Adam C; Ribaudo, Daniel; Mir, Saad A; Pishanidar, Sammy; Lekic, Tim; Williams, Olajide; Kamel, Hooman; Marshall, Randolph S; Hripcsak, George; Elkind, Mitchell S V; Fink, Matthew E

    2018-01-01

     Mobile stroke units (MSUs) reduce time to thrombolytic therapy in acute ischemic stroke. These units are widely used, but the clinical information systems underlying MSU operations are understudied.  The first MSU on the East Coast of the United States was established at New York Presbyterian Hospital (NYP) in October 2016. We describe our program's 7-month pilot, focusing on the integration of our hospital's clinical information systems into our MSU to support patient care and research efforts.  NYP's MSU was staffed by two paramedics, one radiology technologist, and a vascular neurologist. The unit was equipped with four laptop computers and networking infrastructure enabling all staff to access the hospital intranet and clinical applications during operating hours. A telephone-based registration procedure registered patients from the field into our admit/discharge/transfer system, which interfaced with the institutional electronic health record (EHR). We developed and implemented a computerized physician order entry set in our EHR with prefilled values to permit quick ordering of medications, imaging, and laboratory testing. We also developed and implemented a structured clinician note to facilitate care documentation and clinical data extraction.  Our MSU began operating on October 3, 2016. As of April 27, 2017, the MSU transported 49 patients, of whom 16 received tissue plasminogen activator (t-PA). Zero technical problems impacting patient care were reported around registration, order entry, or intranet access. Two onboard network failures occurred, resulting in computed tomography scanner malfunctions, although no patients became ineligible for time-sensitive treatment as a result. Thirteen (26.5%) clinical notes contained at least one incomplete time field.  The main technical challenges encountered during the integration of our hospital's clinical information systems into our MSU were onboard network failures and incomplete clinical

  2. Impact of a nursing information system in clinical practice: a longitudinal study project.

    Science.gov (United States)

    D'Agostino, F; Zega, M; Rocco, G; Luzzi, L; Vellone, E; Alvaro, R

    2013-01-01

    The implementation of adequate clinical information systems helps to deal with the immense flow of health data to ensure the continuity of care and access to a safe and high-quality healthcare system. Currently there is an increasing awareness of the importance of evaluating and measuring the impact of such systems in clinical practice. Implementations often fail, due to inadequate interaction between technology and human elements. This article describes a research project aimed at evaluating the impact of a clinical nursing information system (CNIS), called Professional Assessment Instrument (PAI), in clinical practice. The study will evaluate PAI Quality, Nurses Satisfaction, PAI Use, Nurses and Environment Characteristics, Net Benefits and Nurses' Experiences related to the PAI use. A theoretical model developed for this research will guide the study. A quali-quantitative longitudinal design will be performed involving two hospitals over a 9-month period. To measure different dimensions that affect the success/failure of CNIS we will use different tools/ methods of data collection (questionnaires, psychometric tools, surveys and focus groups). This study will evaluate the impact of a CNIS in hospitals providing an overview of the factors which can help and hinder the implementation of an information system. The results of the study will support interventions to improve and implement clinical information systems designed to computerize nursing data, with positive effects on public health and research in general, providing further evidence for health policy.

  3. Computational Comparison and Visualization of Viruses in the Perspective of Clinical Information.

    Science.gov (United States)

    Lopes, António M; Machado, J A Tenreiro; Galhano, Alexandra M

    2017-04-08

    This paper addresses the visualization of complex information using multidimensional scaling (MDS). MDS is a technique adopted for processing data with multiple features scattered in high-dimensional spaces. For illustrating the proposed techniques, the case of viral diseases is considered. The study evaluates the characteristics of 21 viruses in the perspective of clinical information. Several new schemes are proposed for improving the visualization of the MDS charts. The results follow standard clinical practice, proving that the method represents a valuable tool to study a large number of viruses.

  4. Information systems for administration, clinical documentation and quality assurance in an Austrian disease management programme.

    Science.gov (United States)

    Beck, Peter; Truskaller, Thomas; Rakovac, Ivo; Bruner, Fritz; Zanettin, Dominik; Pieber, Thomas R

    2009-01-01

    5.9% of the Austrian population is affected by diabetes mellitus. Disease Management is a structured treatment approach that is suitable for application to the diabetes mellitus area and often is supported by information technology. This article describes the information systems developed and implemented in the Austrian disease management programme for type 2 diabetes. Several workflows for administration as well as for clinical documentation have been implemented utilizing the Austrian e-Health infrastructure. De-identified clinical data is available for creating feedback reports for providers and programme evaluation.

  5. Quality assurance program plan for cesium legacy project

    International Nuclear Information System (INIS)

    Tanke, J.M.

    1997-01-01

    This Quality Assurance Program Plan (QAPP) provides information on how the Quality Assurance Program is implemented for the Cesium Legacy Project. It applies to those items and tasks which affect the completion of activities identified in the work breakdown structure of the Project Management Plan (PMP). These activities include all aspects of cask transportation, project related operations within the 324 Building, and waste management as it relates to the specific activities of this project. General facility activities (i.e. 324 Building Operations, Central Waste Complex Operations, etc.) are covered in other appropriate QAPPs. The 324 Building is currently transitioning from being a Pacific Northwest National Laboratory (PNNL) managed facility to a B and W Hanford Company (BWHC) managed facility. During this transition process existing PNNL procedures and documents will be utilized until replaced by BWHC procedures and documents

  6. Designing a clinical dashboard to fill information gaps in the emergency department.

    Science.gov (United States)

    Swartz, Jordan L; Cimino, James J; Fred, Matthew R; Green, Robert A; Vawdrey, David K

    2014-01-01

    Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties.

  7. Reconciling disparate information in continuity of care documents: Piloting a system to consolidate structured clinical documents.

    Science.gov (United States)

    Hosseini, Masoud; Jones, Josette; Faiola, Anthony; Vreeman, Daniel J; Wu, Huanmei; Dixon, Brian E

    2017-10-01

    Due to the nature of information generation in health care, clinical documents contain duplicate and sometimes conflicting information. Recent implementation of Health Information Exchange (HIE) mechanisms in which clinical summary documents are exchanged among disparate health care organizations can proliferate duplicate and conflicting information. To reduce information overload, a system to automatically consolidate information across multiple clinical summary documents was developed for an HIE network. The system receives any number of Continuity of Care Documents (CCDs) and outputs a single, consolidated record. To test the system, a randomly sampled corpus of 522 CCDs representing 50 unique patients was extracted from a large HIE network. The automated methods were compared to manual consolidation of information for three key sections of the CCD: problems, allergies, and medications. Manual consolidation of 11,631 entries was completed in approximately 150h. The same data were automatically consolidated in 3.3min. The system successfully consolidated 99.1% of problems, 87.0% of allergies, and 91.7% of medications. Almost all of the inaccuracies were caused by issues involving the use of standardized terminologies within the documents to represent individual information entries. This study represents a novel, tested tool for de-duplication and consolidation of CDA documents, which is a major step toward improving information access and the interoperability among information systems. While more work is necessary, automated systems like the one evaluated in this study will be necessary to meet the informatics needs of providers and health systems in the future. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Health information technology: integration of clinical workflow into meaningful use of electronic health records.

    Science.gov (United States)

    Bowens, Felicia M; Frye, Patricia A; Jones, Warren A

    2010-10-01

    This article examines the role that clinical workflow plays in successful implementation and meaningful use of electronic health record (EHR) technology in ambulatory care. The benefits and barriers of implementing EHRs in ambulatory care settings are discussed. The researchers conclude that widespread adoption and meaningful use of EHR technology rely on the successful integration of health information technology (HIT) into clinical workflow. Without successful integration of HIT into clinical workflow, clinicians in today's ambulatory care settings will continue to resist adoption and implementation of EHR technology.

  9. Scientific Data as the Core Legacy of IPY

    Science.gov (United States)

    Parsons, M. A.

    2008-12-01

    The interdisciplinary breadth of the International Polar Year is unprecedented. The IPY has explicit objectives to link researchers across different fields to address questions and issues lying beyond the scope of individual disciplines and to strengthen international coordination of research and enhance international collaboration and cooperation. The IPY Data Policy and Management Subcommittee have developed a policy to help meet these objectives and an international collaboration of investigators and data managers, the IPY Data and Information Service, are working to make IPY data widely available. I will present an overview of the primary data management considerations for IPY and how diverse organizations are making IPY and related data available. Centralized discovery mechanisms for widely distributed data plus targeted access mechanisms for specific disciplines will be presented. These range from near real time access to satellite remote sensing data and GCM output to fair and appropriate access to traditional knowledge of the Arctic. These mechanisms reflect significant advancement in polar data management, but they belie the major challenges that remain. These challenges include fostering a culture change in science that puts greater value on data publication and open data access as well as developing sustained systems and business models for the long-term preservation of IPY data. This will be crucial to ensuring the legacy of IPY, a major objective of IPY sponsors, ICSU and WMO. New efforts to ensure this legacy include the development of the WMO Information System, the Sustained Arctic Observing Network, and the Global Earth Observing System of Systems; the reform of ICSU's World Data Center System; and the results of the Electronic Geophysical Year.

  10. Ethical aspect of the clinical research. Informed consent in the clinical research for heavy ion radiotherapy of cancer

    International Nuclear Information System (INIS)

    Murata, Hajime

    2003-01-01

    The research center for heavy ion therapy of cancer was decided to be built in 1984 as a part of the national 10-year anticancer campaign, and construction of Heavy Ion Medical Accelerator in Chiba (HIMAC) was completed at the National Institute of Radiological Sciences in 1993. The HIMAC is the first heavy ion accelerator for only medical use in the world, and the clinical research of cancer radiotherapy was begun in 1994 using carbon ion generated by HIMAC. The purposes of the clinical research are to evaluate the safety and usefulness of carbon ion for cancer treatment, and to establish carbon ion therapy as a new and valuable tool for cancer therapy. Therefore, to obtain exact data in ethical aspect as well as scientific aspect of the clinical research, many special committees have been organized like as the committees of protocol planning for each organ, clinical study groups for each organ, evaluating committee of clinical data, and the ethical committee. Each clinical research is performed according to the research protocol of each organ, in which study purpose, rationale, patient condition, end-point of the study, adverse reaction are described. The document of informed consent (IC) contains study purpose, patient condition, method, predicted effect and demerit, protection of privacy, etc.. IC to each patient is done precisely by the doctor, and the freely-given IC of the patient is obtained. After the IC was completed, judgement of propriety for carbon ion therapy is done by the ethical committee for IC of each patient. Since 1994 carbon ion therapy has been performed over 1300 patients with cancer in various organs, and its safety and usefulness for cancer treatment has been clarified gradually. The carbon ion therapy is thought to be a new and promising tool for cancer treatment near future. (authors)

  11. The legacy of Michael Balint.

    Science.gov (United States)

    Johnson, Alan H; Brock, Clive D; Zacarias, Ashleigh

    2014-01-01

    Michael Balint's lead article, "Repeat Prescription Patients: Are They An Identifiable Group?" inaugurated the first issue of Psychiatry in Medicine, Vol. 1, No. 1, 1970. A few years later, this Journal would be renamed International Journal of Psychiatry in Medicine (IJPM). Who is this author of over 165 papers, 10 books, practicing psychoanalyst from 1926 to 1970, director of the Budapest Psychoanalytic Institute from 1935 to 1939, consultant at the Tavistock Clinic from 1948 to 1961, President of the British Psycho-Analytical Society from 1968 to 1970, literary executor of Sandor Ferenczi, a foremost theorist of object relations, and international educator and statesman for general practitioners? We would like to review for you some of the formative experiences in Michael's life that wedded psychoanalysis and general practice, and how they contributed to his major educational commitment over 40 years to furthering the understanding and integration of psychosocial factors in the practice of primary healthcare as experienced by doctors all over the world. We would also like to highlight some of his major insights and see to what extent they are incorporated in contemporary medical education and practice. We believe that some of his major insights have been neglected and others have been further amplified and extended. Our intention is to speak not only to medical students who desire to pursue medicine related directly to patient care but as well to seasoned practitioners who continue on a daily basis to care for individual patients and their families.

  12. The information needs and behaviour of clinical researchers: a user-needs analysis.

    Science.gov (United States)

    Korjonen-Close, Helena

    2005-06-01

    As part of the strategy to set up a new information service, including a physical Resource Centre, the analysis of information needs of clinical research professionals involved with clinical research and development in the UK and Europe was required. It also aimed to identify differences in requirements between the various roles of professionals and establish what information resources are currently used. A user-needs survey online of the members of The Institute. Group discussions with specialist subcommittees of members. Two hundred and ninety members responded to the online survey of 20 questions. This makes it a response rate of 7.9%. Members expressed a lack of information in their particular professional area, and lack the skills to retrieve and appraise information. The results of the survey are discussed in more detail, giving indications of what the information service should collect, what types of materials should be provided to members and what services should be on offer. These were developed from the results of the needs analysis and submitted to management for approval. Issues of concern, such as financial constraint and staff constraints are also discussed. There is an opportunity to build a unique collection of clinical research material, which will promote The Institute not only to members, but also to the wider health sector. Members stated that the most physical medical libraries don't provide what they need, but the main finding through the survey and discussions is that it's pointless to set up 'yet another medical library'.

  13. A user-centered, object-oriented methodology for developing Health Information Systems: a Clinical Information System (CIS) example.

    Science.gov (United States)

    Konstantinidis, Georgios; Anastassopoulos, George C; Karakos, Alexandros S; Anagnostou, Emmanouil; Danielides, Vasileios

    2012-04-01

    The aim of this study is to present our perspectives on healthcare analysis and design and the lessons learned from our experience with the development of a distributed, object-oriented Clinical Information System (CIS). In order to overcome known issues regarding development, implementation and finally acceptance of a CIS by the physicians we decided to develop a novel object-oriented methodology by integrating usability principles and techniques in a simplified version of a well established software engineering process (SEP), the Unified Process (UP). A multilayer architecture has been defined and implemented with the use of a vendor application framework. Our first experiences from a pilot implementation of our CIS are positive. This approach allowed us to gain a socio-technical understanding of the domain and enabled us to identify all the important factors that define both the structure and the behavior of a Health Information System.

  14. Developing a Workflow Composite Score to Measure Clinical Information Logistics. A Top-down Approach.

    Science.gov (United States)

    Liebe, J D; Hübner, U; Straede, M C; Thye, J

    2015-01-01

    Availability and usage of individual IT applications have been studied intensively in the past years. Recently, IT support of clinical processes is attaining increasing attention. The underlying construct that describes the IT support of clinical workflows is clinical information logistics. This construct needs to be better understood, operationalised and measured. It is therefore the aim of this study to propose and develop a workflow composite score (WCS) for measuring clinical information logistics and to examine its quality based on reliability and validity analyses. We largely followed the procedural model of MacKenzie and colleagues (2011) for defining and conceptualising the construct domain, for developing the measurement instrument, assessing the content validity, pretesting the instrument, specifying the model, capturing the data and computing the WCS and testing the reliability and validity. Clinical information logistics was decomposed into the descriptors data and information, function, integration and distribution, which embraced the framework validated by an analysis of the international literature. This framework was refined selecting representative clinical processes. We chose ward rounds, pre- and post-surgery processes and discharge as sample processes that served as concrete instances for the measurements. They are sufficiently complex, represent core clinical processes and involve different professions, departments and settings. The score was computed on the basis of data from 183 hospitals of different size, ownership, location and teaching status. Testing the reliability and validity yielded encouraging results: the reliability was high with r(split-half) = 0.89, the WCS discriminated between groups; the WCS correlated significantly and moderately with two EHR models and the WCS received good evaluation results by a sample of chief information officers (n = 67). These findings suggest the further utilisation of the WCS. As the WCS does not

  15. Extracting genetic alteration information for personalized cancer therapy from ClinicalTrials.gov.

    Science.gov (United States)

    Xu, Jun; Lee, Hee-Jin; Zeng, Jia; Wu, Yonghui; Zhang, Yaoyun; Huang, Liang-Chin; Johnson, Amber; Holla, Vijaykumar; Bailey, Ann M; Cohen, Trevor; Meric-Bernstam, Funda; Bernstam, Elmer V; Xu, Hua

    2016-07-01

    Clinical trials investigating drugs that target specific genetic alterations in tumors are important for promoting personalized cancer therapy. The goal of this project is to create a knowledge base of cancer treatment trials with annotations about genetic alterations from ClinicalTrials.gov. We developed a semi-automatic framework that combines advanced text-processing techniques with manual review to curate genetic alteration information in cancer trials. The framework consists of a document classification system to identify cancer treatment trials from ClinicalTrials.gov and an information extraction system to extract gene and alteration pairs from the Title and Eligibility Criteria sections of clinical trials. By applying the framework to trials at ClinicalTrials.gov, we created a knowledge base of cancer treatment trials with genetic alteration annotations. We then evaluated each component of the framework against manually reviewed sets of clinical trials and generated descriptive statistics of the knowledge base. The automated cancer treatment trial identification system achieved a high precision of 0.9944. Together with the manual review process, it identified 20 193 cancer treatment trials from ClinicalTrials.gov. The automated gene-alteration extraction system achieved a precision of 0.8300 and a recall of 0.6803. After validation by manual review, we generated a knowledge base of 2024 cancer trials that are labeled with specific genetic alteration information. Analysis of the knowledge base revealed the trend of increased use of targeted therapy for cancer, as well as top frequent gene-alteration pairs of interest. We expect this knowledge base to be a valuable resource for physicians and patients who are seeking information about personalized cancer therapy. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Data Management Challenges and Development for Military Information Systems

    National Research Council Canada - National Science Library

    Ceruti, Marion G

    2003-01-01

    ..., interoperation, and application of C41 systems. Specific topics include issues in integration and interoperability, joint standards, data access, data aggregation, information system component reuse, and legacy systems...

  17. The Legacy of Utah's Country Schools, 1847-1896. Country School Legacy: Humanities on the Frontier.

    Science.gov (United States)

    Birkinshaw, Scott B.

    This section of the Country School Legacy: Humanities on the Frontier Project, funded by the National Endowment for the Humanities and sponsored by the Mountain Plains Library Association, traces the development of schools in Utah during the Territorial Period (1847-1896). Following a discussion of the influence of the Church of Jesus Christ of…

  18. The definition of placebo in the informed consent forms of clinical trials.

    Science.gov (United States)

    Hernández, Astrid; Baños, Josep-E; Llop, Cristina; Farré, Magí

    2014-01-01

    Lack of knowledge concerning the nature of placebo and why it is necessary may influence the participation of patients in clinical trials. The objective of the present study is to review how placebo is described in written information for participants in clinical trials to be evaluated by a Human Research Ethics Committee. All research protocols submitted for evaluation in a Spanish hospital during 2007-2013 were reviewed. The main characteristics of the studies using a placebo were collected. Three authors read each of them to determine how the term "placebo" was explained and if there was any comment on its efficacy and safety. Two thousand seven-hundred and forty research protocols were evaluated, of which three hundred and fifty-nine used a placebo. Pharmaceutical companies sponsored most placebo-controlled clinical trials (91.9%), and phase III studies were the commonest (59.9%). Oncology (15.0%), cardiology (14.2%), and neurology (13.1%) made the greatest contributions. A review of the informed consent forms showed that placebo was described in a similar manner in most studies: the explanation was limited to between four and eight words. Very few gave information about the risks of its use or adverse reactions from its administration. None of the studies provided details about the placebo effect. And 23 lacked any information about placebo at all. Explanations about placebo in informed consent forms is often scarce, and information about the placebo effect and associated risks are absent. This situation may influence a full understanding of placebo by participants in clinical trials and might reduce their informed decision to participate.

  19. Beyond information retrieval and electronic health record use: competencies in clinical informatics for medical education

    Directory of Open Access Journals (Sweden)

    Hersh WR

    2014-07-01

    Full Text Available William R Hersh,1 Paul N Gorman,1 Frances E Biagioli,2 Vishnu Mohan,1 Jeffrey A Gold,3 George C Mejicano4 1Department of Medical Informatics and Clinical Epidemiology, 2Department of Family Medicine, 3Department of Medicine, 4School of Medicine, Oregon Health & Science University, Portland, OR, USA Abstract: Physicians in the 21st century will increasingly interact in diverse ways with information systems, requiring competence in many aspects of clinical informatics. In recent years, many medical school curricula have added content in information retrieval (search and basic use of the electronic health record. However, this omits the growing number of other ways that physicians are interacting with information that includes activities such as clinical decision support, quality measurement and improvement, personal health records, telemedicine, and personalized medicine. We describe a process whereby six faculty members representing different perspectives came together to define competencies in clinical informatics for a curriculum transformation process occurring at Oregon Health & Science University. From the broad competencies, we also developed specific learning objectives and milestones, an implementation schedule, and mapping to general competency domains. We present our work to encourage debate and refinement as well as facilitate evaluation in this area. Keywords: curriculum transformation, clinical decision support, patient safety, health care quality, patient engagement

  20. Clinical information systems for the management of tuberculosis in primary health care.

    Science.gov (United States)

    Medeiros, Eliabe Rodrigues de; Silva, Sandy Yasmine Bezerra E; Ataide, Cáthia Alessandra Varela; Pinto, Erika Simone Galvão; Silva, Maria de Lourdes Costa da; Villa, Tereza Cristina Scatena

    2017-12-11

    to analyze the clinical information systems used in the management of tuberculosis in Primary Health Care. descriptive, quantitative cross-sectional study with 100 health professionals with data collected through a questionnaire to assess local institutional capacity for the model of attention to chronic conditions, as adapted for tuberculosis care. The analysis was performed through descriptive and inferential statistics. Nurses and the Community Health Agents were classified as having fair capacity with a mean of 6.4 and 6.3, respectively. The city was classified as having fair capacity, with a mean of 6.0 and standard deviation of 1.5. Family Health Units had higher capacity than Basic Health Units and Mixed Units, although not statistically relevant. Clinical records and data on tuberculosis patients, items of the clinical information systems, had a higher classification than the other items, classified as having fair capacity, with a mean of 7.3 and standard deviation of 1.6, and the registry of TB patients had a mean of 6.6 and standard deviation of 2.0. clinical information systems are present in the city, mainly in clinical records and patient data, and they have the contribution of professionals linked with tuberculosis patients.

  1. Combining Clinical Information and Patient Reported Outcome Measures in Orthopaedic Surgery and Sports Medicine

    NARCIS (Netherlands)

    Kampen, D.A. van

    2013-01-01

    In this thesis we investigated the use of clinical information and Patient Reported Outcome Measures (PROMs) for patient evaluation in orthopaedic surgery and sports medicine. In the first part, we showed that the Dutch version of the Simple Shoulder Test (SST) is a valid and reliable

  2. Use of Clinical Health Information Technology in Nursing Homes: Nursing Home Characteristics and Quality Measures

    Science.gov (United States)

    Spinelli-Moraski, Carla

    2014-01-01

    This study compares quality measures among nursing homes that have adopted different levels of clinical health information technology (HIT) and examines the perceived barriers and benefits of the adoption of electronic health records as reported by Nursing Home Administrators and Directors of Nursing. A cross-sectional survey distributed online to…

  3. Informed consent in clinical trials using stem cells: Sugges tions and ...

    African Journals Online (AJOL)

    2015-08-01

    Aug 1, 2015 ... research. The correlated results showed the need for continuous training and education of elucidators in order to make sure that they acquire and maintain ... in the recommendations show that improving IC related to stem cell research is a .... of this clinical trial. • Contact information and consultation service.

  4. Informing family members about a hereditary predisposition to cancer: attitudes and practices among clinical geneticists

    NARCIS (Netherlands)

    Stol, Y.; Menko, F.H.; Westerman, M.J.; Janssens, M.J.P.A.

    2010-01-01

    If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic

  5. Portuguese Cistercian Churches - An acoustic legacy

    Science.gov (United States)

    Rodrigues, Fabiel G.; Lanzinha, João C. G.; Martins, Ana M. T.

    2017-10-01

    The Cistercian Order (11th century) stands out as an apologist of the simplicity and austerity of the space. According to the Order of Cîteaux, only with an austere space, without any distractions, the true spiritual contemplation is achieved. This Order was an aggregator and consolidator pole during the Christian Reconquest. Thus, as it happens with other Religious Orders, Cîteaux has a vast heritage legacy. This heritage is witness, not only of the historical, but also social, political, and spiritual evolution. This legacy resumes the key principles to an austere liturgy, which requirements, in the beginning, are based on the simplicity of worship and of the connection between man and God. Later, these requirements allowed the development of the liturgy itself and its relation with the believers. Consequently, it can be concisely established an empirical approach between the Cistercian churches and the acoustics conditioning of these spaces. This outcome is fundamental in order to understand the connection between liturgy and the conception of the Cistercian churches as well as the constructed space and its history. So, an analysis of these principles is essential to establish the relation between acoustic and religious buildings design throughout history. It is also a mean of understanding the knowledge of acoustics principles that the Cistercian Order bequeathed to Portugal. This paper presents an empirical approach on Cistercian monastic churches acoustics. These spaces are the place where the greatest acoustic efforts are concentrated and it is also the space where the liturgy reaches greater importance. On the other hand, Portugal is a country which has an important Cistercian legacy over several periods of history. Consequently, the Portuguese Cistercian monastic churches are representative of the development of the liturgy, the design of spaces and of the acoustic requirements of their churches since the 12th century until the 21st century and it is of

  6. Legacy Risk Measure for Environmental Waste

    International Nuclear Information System (INIS)

    Eide, S. A.; Nitschke, R. L.

    2002-01-01

    The Idaho National Engineering and Environmental Laboratory (INEEL) is investigating the development of a comprehensive and quantitative risk model framework for environmental management activities at the site. Included are waste management programs (high-level waste, transuranic waste, low-level waste, mixed low-level waste, spent nuclear fuel, and special nuclear materials), major environmental restoration efforts, major decontamination and decommissioning projects, and planned long-term stewardship activities. Two basic types of risk estimates are included: risks from environmental management activities, and long-term legacy risks from wastes/materials. Both types of risks are estimated using the Environment, Safety, and Health Risk Assessment Program (ESHRAP) developed at the INEEL. Given these two types of risk calculations, the following evaluations can be performed: risk evaluation of an entire program (covering waste/material as it now exists through disposal or other e nd states); risk comparisons of alternative programs or activities; comparisons of risk benefit versus risk cost for activities or entire programs; ranking of programs or activities by risk; ranking of wastes/materials by risk; evaluation of site risk changes with time as activities progress; and integrated performance measurement using indicators such as injury/death and exposure rates. This paper discusses the definition and calculation of legacy risk measures and associated issues. The legacy risk measure is needed to support three of the seven types of evaluations listed above: comparisons of risk benefit versus risk cost, ranking of wastes/materials by risk, and evaluation of site risk changes with time

  7. Legacy Nitrate Impacts on Groundwater and Streams

    Science.gov (United States)

    Tesoriero, A. J.; Juckem, P. F.; Miller, M. P.

    2017-12-01

    Decades of recharge of high-nitrate groundwater have created a legacy—a mass of high-nitrate groundwater—that has implications for future nitrate concentrations in groundwater and in streams. In the United States, inorganic nitrogen fertilizer applications to the land surface have increased ten-fold since 1950, resulting in sharp increases in nitrate concentrations in recharging groundwater, which pose a risk to deeper groundwater and streams. This study assesses the factors that control time lags and eventual concentrations of legacy nitrate in groundwater and streams. Results from the USGS National Water-Quality Assessment Project are presented which elucidate nitrate trends in recharging groundwater, delineate redox zones and assess groundwater and stream vulnerability to legacy nitrate sources on a regional scale. This study evaluated trends and transformations of agricultural chemicals based on groundwater age and water chemistry data along flow paths from recharge areas to streams at 20 study sites across the United States. Median nitrate recharge concentrations in these agricultural areas have increased markedly over the last 50 years, from 4 to 7.5 mg N/L. The effect that nitrate accumulation in shallow aquifers will have on drinking water quality and stream ecosystems is dependent on the redox zones encountered along flow paths and on the age distribution of nitrate discharging to supply wells and streams. Delineating redox zones on a regional scale is complicated by the spatial variability of reaction rates. To overcome this limitation, we applied logistic regression and machine learning techniques to predict the probability of a specific redox condition in groundwater in the Chesapeake Bay watershed and the Fox-Wolf-Peshtigo study area in Wisconsin. By relating redox-active constituent concentrations in groundwater samples to indicators of residence time and/or electron donor availability, we were able to delineate redox zones on a regional scale

  8. Disaggregation of legacy soil data using area to point kriging for mapping soil organic carbon at the regional scale.

    Science.gov (United States)

    Kerry, Ruth; Goovaerts, Pierre; Rawlins, Barry G; Marchant, Ben P

    2012-01-15

    Legacy data in the form of soil maps, which often have typical property measurements associated with each polygon, can be an important source of information for digital soil mapping (DSM). Methods of disaggregating such information and using it for quantitative estimation of soil properties by methods such as regression kriging (RK) are needed. Several disaggregation processes have been investigated; preferred methods include those which include consideration of scorpan factors and those which are mass preserving (pycnophylactic) making transitions between different scales of investigation more theoretically sound. Area to point kriging (AtoP kriging) is pycnophylactic and here we investigate its merits for disaggregating legacy data from soil polygon maps. Area to point regression kriging (AtoP RK) which incorporates ancillary data into the disaggre-gation process was also applied. The AtoP kriging and AtoP RK approaches do not involve collection of new soil measurements and are compared with disaggregation by simple rasterization. Of the disaggregation methods investigated, AtoP RK gave the most accurate predictions of soil organic carbon (SOC) concentrations (smaller mean absolute errors (MAEs) of cross-validation) for disaggregation of soil polygon data across the whole of Northern Ireland. Legacy soil polygon data disaggregated by AtoP kriging and simple rasterization were used in a RK framework for estimating soil organic carbon (SOC) concentrations across the whole of Northern Ireland, using soil sample data from the Tellus survey of Northern Ireland and with other covariates (altitude and airborne radiometric potassium). This allowed direct comparison with previous analysis of the Tellus survey data. Incorporating the legacy data, whether from simple rasterization of the polygons or AtoP kriging, substantially reduced the MAEs of RK compared with previous analyses of the Tellus data. However, using legacy data disaggregated by AtoP kriging in RK resulted in

  9. Ontology content patterns as bridge for the semantic representation of clinical information.

    Science.gov (United States)

    Martínez-Costa, C; Schulz, S

    2014-01-01

    Semantic interoperability of the Electronic Health Record (EHR) requires a rigorous and precise modelling of clinical information. Our objective is to facilitate the representation of clinical facts based on formal principles. We here explore the potential of ontology content patterns, which are grounded on a formal and semantically rich ontology model and can be specialised and composed. We describe and apply two content patterns for the representation of data on tobacco use, rendered according to two heterogeneous models, represented in openEHR and in HL7 CDA. Finally, we provide some query exemplars that demonstrate a data interoperability use case. The use of ontology content patterns facilitate the semantic representation of clinical information and therefore improve their semantic interoperability. There are open issues such as the scalability and performance of the approach if a logic-based language is used. Implementation decisions might determine the final degree of semantic interoperability, influenced by the state of the art of the semantic technologies.

  10. Improving information availability in vascular surgical clinics. A service evaluation and improvement project.

    Science.gov (United States)

    Hurst, Katherine; Kreckler, Simon; Handa, Ashok; Handa, Ashok

    2016-01-01

    This prospective service evaluation was designed to assess the availability of critical information required in vascular surgical clinics. All the data was collected via a repeated questionnaire, and the outcomes from each cycle were used to highlight where intervention was required to improve the surgical clinic experience. The first audit identified outpatient clinic deficiencies and allowed for problem analysis. Two Plan-Do-Check-Act (PDCA) cycles then were undertaken. Interventions following each cycle included consultant access to online duplex scans and secretarial access to referral letters. Results from the first cycle showed that approximately 20% of clinic appointments were missing information and only 30% of these issues were resolved during the clinic using a work around. Following the first intervention; the numbers of missing patient notes reduced to 4.3% (10.5%), and referral letters to 3.6% (4.6%). Although the numbers of missing duplex scan results increased to 6.5% (3.3%), the new system of online scan results allowed for all scans to be accessed during the clinic. Following results of a second PDCA cycle, vascular surgical secretaries were given access to 'choose and book', a database of GP referral letters. Post intervention, all missing referral letters (2%) could be accessed immediately within the clinic setting. Data driven interventions and repeated PDCA cycles can improve hospital systems for minimal cost. With an annual clinic turnaround of 2500 patients, these interventions can reduce clinic delays and potential harm caused by unavailable records for up to 500 patients a year.

  11. Radioactive legacies from medicine and industry

    International Nuclear Information System (INIS)

    Linder, R.; Rodriguez, J.

    2005-01-01

    Due to the unintended disposal of radioactive legacies (waste from medicine, industry or private persons) radioactive material occasionally enters the disposal ways of conventional waste. The Swiss Federal Office of Public Health (SFOPH) and the Swiss accident Insurance Fund (Swiss) are the licensing authorities and regulatory agencies of the handling with radioactive materials for non-nuclear use. The aim is to avoid such incidents with concrete measures and so to preserve men and environment from the negative effect of not correctly disposed radioactive waste. (orig.)

  12. Eventscapes and the creation of event legacies

    OpenAIRE

    Brown, G.; Lee, I.S.; King, Katherine; Shipway, Richard

    2015-01-01

    Attention is directed to the difference in event legacies created by mega-events which often cause dramatic physical changes in urban environments and those which accompany events which leave very little imprint on the landscape where they are held. The Tour Down Under cycle race, which is held annually in South Australia, is examined as an example of the latter. The spatial pattern of the event and the range of settings which support it are presented as an eventscape by drawing on concepts s...

  13. Integrating commercial and legacy systems with EPICS

    International Nuclear Information System (INIS)

    Hill, J.O.; Kasemir, K.U.

    1997-01-01

    The Experimental Physics and Industrial Control System (EPICS) is a software toolkit, developed by a worldwide collaboration, which significantly reduces the level of effort required to implement a new control system. Recent developments now also significantly reduce the level of effort required to integrate commercial, legacy and/or site-authored control systems with EPICS. This paper will illustrate with an example both the level and type of effort required to use EPICS with other control system components as well as the benefits that may arise

  14. PD-atricians: Leveraging Physicians and Participatory Design to Develop Novel Clinical Information Tools.

    Science.gov (United States)

    Pollack, Ari H; Miller, Andrew; Mishra, Sonali R; Pratt, Wanda

    2016-01-01

    Participatory design, a method by which system users and stakeholders meaningfully contribute to the development of a new process or technology, has great potential to revolutionize healthcare technology, yet has seen limited adoption. We conducted a design session with eleven physicians working to create a novel clinical information tool utilizing participatory design methods. During the two-hour session, the physicians quickly engaged in the process and generated a large quantity of information, informing the design of a future tool. By utilizing facilitators experienced in design methodology, with detailed domain expertise, and well integrated into the healthcare organization, the participatory design session engaged a group of users who are often disenfranchised with existing processes as well as health information technology in general. We provide insight into why participatory design works with clinicians and provide guiding principles for how to implement these methods in healthcare organizations interested in advancing health information technology.

  15. The Electronic Healthcare Record for Clinical Research (EHR4CR) information model and terminology.

    Science.gov (United States)

    Ouagne, David; Hussain, Sajjad; Sadou, Eric; Jaulent, Marie-Christine; Daniel, Christel

    2012-01-01

    A major barrier to repurposing routinely collected data for clinical research is the heterogeneity of healthcare information systems. Electronic Healthcare Record for Clinical Research (EHR4CR) is a European platform designed to improve the efficiency of conducting clinical trials. In this paper, we propose an initial architecture of the EHR4CR Semantic Interoperability Framework. We used a model-driven engineering approach to build a reference HL7-based multidimensional model bound to a set of reference clinical terminologies acting as a global as view model. We then conducted an evaluation of its expressiveness for patient eligibility. The EHR4CR information model consists in one fact table dedicated to clinical statement and 4 dimensions. The EHR4CR terminology integrates reference terminologies used in patient care (e.g LOINC, ICD-10, SNOMED CT, etc). We used the Object Constraint Language (OCL) to represent patterns of eligibility criteria as constraints on the EHR4CR model to be further transformed in SQL statements executed on different clinical data warehouses.

  16. Comprehensibility of translated informed consent documents used in clinical research in psychiatry.

    Science.gov (United States)

    Jhanwar, Venu Gopal; Bishnoi, Ram Jeevan

    2010-01-01

    Informed consent forms are required in all clinical trials which are approved by an independent Ethics Committee before practical use in the trials. However, how much the average subject actually understands of the information contained in these informed consent forms is uncertain. In a cross sectional study, the translated informed consent forms used in psychiatric clinical trials were assessed with respect to their ease of readability. We analyzed 30 informed consent forms translated from English to Hindi used in multinational and multicentre psychiatric clinical trials sponsored by different sponsors. We examined consent forms for readability scores and factors that might relate to readability. The mean readability score for the informed consent forms, determined by the Flesch-Kincaid Grade Level Index (FKGL) was grade levels of 13.66. The ease of readability assessed by the Flesch Reading Ease Score (FRES) was 46.08 suggesting significant complexity of the texts. These values carry even more significance when the average years of schooling for India as a whole are 6.2 years. Our results show that the most informed consent forms were too complex to understand by an average adult subject. We suggest reducing this complexity and increasing the ease of readability so those average subjects receive the intended information as exactly as it could be. This can be achieved by few simple measures like improving the deficiencies in translation processes, encouraging the investigators to participate while preparing these forms, and enhanced understanding of the site specific requirements, namely culture, language (dialect), general literacy rate, etc.

  17. Understanding and retention of trial-related information among participants in a clinical trial after completing the informed consent process.

    Science.gov (United States)

    Mexas, Fernanda; Efron, Anne; Luiz, Ronir Raggio; Cailleaux-Cezar, Michelle; Chaisson, Richard E; Conde, Marcus B

    2014-02-01

    for assessing the level of understanding of trial-related information during the informed consent (IC) process in developing countries are lacking. To assess the understanding and retention of trial-related information presented in the IC process by administering an informed consent assessment instrument (ICAI) to participants in a clinical trial for a new tuberculosis (TB) regimen being conducted in Rio de Janeiro (Brazil). Methods The format of the ICAI was based on the language and structure of the United States National Cancer Institute's IC comprehension checklist. The ICAI was designed to assess points of the RioMAR study IC process that addressed the principles of research ethics requested by Brazilian Regulatory Authority: autonomy, beneficence, non-maleficence, and justice. Briefly, (1) Is the respondent participating in a clinical trial? (2) Are two different treatments being evaluated? (3) Is the treatment arm chosen by chance? (4) Is an HIV test required? (5) Are liver function tests required? (6) Can participants leave the study at any time? (7) Are the risks and benefits of taking part in the study clear? (8) May pregnant women participate in the study? (9) Can one of the study drugs reduce the effectiveness of contraceptives? (10) Are patients paid to participate in the study? The ICAI was applied at two time points: immediately after enrollment in the clinical trial and 2 months later. A total of 61 patients who enrolled in the RioMAR study participated in this study. The percentage of correct answers to all questions was 82% at the time of the first ICAI; 31 participants (51%) did not recall that an HIV test was required (question 4) and 43 (70%) did not know that they could leave the study (question 6). Other individual questions were answered correctly by at least 76% of participants. There was no association between incorrect answers and age, gender, monthly family income, neighborhood, or level of education (p > 0.07). When the responses to the

  18. What Clinical Information Is Valuable to Doctors Using Mobile Electronic Medical Records and When?

    Science.gov (United States)

    Kim, Junetae; Lee, Yura; Lim, Sanghee; Kim, Jeong Hoon; Lee, Byungtae; Lee, Jae-Ho

    2017-10-18

    There has been a lack of understanding on what types of specific clinical information are most valuable for doctors to access through mobile-based electronic medical records (m-EMRs) and when they access such information. Furthermore, it has not been clearly discussed why the value of such information is high. The goal of this study was to investigate the types of clinical information that are most valuable to doctors to access through an m-EMR and when such information is accessed. Since 2010, an m-EMR has been used in a tertiary hospital in Seoul, South Korea. The usage logs of the m-EMR by doctors were gathered from March to December 2015. Descriptive analyses were conducted to explore the overall usage patterns of the m-EMR. To assess the value of the clinical information provided, the usage patterns of both the m-EMR and a hospital information system (HIS) were compared on an hourly basis. The peak usage times of the m-EMR were defined as continuous intervals having normalized usage values that are greater than 0.5. The usage logs were processed as an indicator representing specific clinical information using factor analysis. Random intercept logistic regression was used to explore the type of clinical information that is frequently accessed during the peak usage times. A total of 524,929 usage logs from 653 doctors (229 professors, 161 fellows, and 263 residents; mean age: 37.55 years; males: 415 [63.6%]) were analyzed. The highest average number of m-EMR usage logs (897) was by medical residents, whereas the lowest (292) was by surgical residents. The usage amount for three menus, namely inpatient list (47,096), lab results (38,508), and investigation list (25,336), accounted for 60.1% of the peak time usage. The HIS was used most frequently during regular hours (9:00 AM to 5:00 PM). The peak usage time of the m-EMR was early in the morning (6:00 AM to 10:00 AM), and the use of the m-EMR from early evening (5:00 PM) to midnight was higher than during regular

  19. Truth telling and informed consent: is "primum docere" the new motto of clinical practice?

    Science.gov (United States)

    Byk, Christian

    2007-09-01

    Autonomy has become in many countries a key concept in the patient-physician relationship, leaving the old paternalistic medical attitude out of the realm of common good clinical practice. Consequently, the validity of the informed consent procedure which is related to any medical intervention, should imply that the information given is true. Raising the question as such obliges us to consider the truth not for itself but in regard to the validity of the consent to a medical intervention. Although a clinical approach reveals that loyalty should guide the patient-physician relationship, there are still some situations in which informed consent and truth telling may be controversial: in some circumstances, the physician should or may not tell the truth, in others he can simply forget to tell.

  20. Steps towards single source--collecting data about quality of life within clinical information systems.

    Science.gov (United States)

    Fritz, Fleur; Ständer, Sonja; Breil, Bernhard; Dugas, Martin

    2010-01-01

    Information about the quality of life from patients being treated in routine medical care is important for the attending physician. This data is also needed in research for example to evaluate the therapy and the course of the disease respectively. Especially skin diseases often negatively affect the quality of life. Therefore we aimed to design a concept to collect such data during treatment and use it for both medical care and research in the setting of dermatology. We performed a workflow analysis and implemented a designated form using the tools of the local clinical information system. Quality of life data is now collected within the clinical information system during treatment and is used for discharge letters, progress overviews as well as research about the treatment and course of disease. This concept which contributes to the single source approach was feasible within dermatology and is ready to be expanded into other domains.

  1. Biological field stations: research legacies and sites for serendipity

    Science.gov (United States)

    William K. Michener; Keith L. Bildstein; Arthur McKee; Robert R. Parmenter; William W. Hargrove; Deedra McClearn; Mark Stromberg

    2009-01-01

    Biological field stations are distributed throughout North America, capturing much of the ecological variability present at the continental scale and encompassing many unique habitats. In addition to their role in supporting research and education, field stations offer legacies of data, specimens, and accumulated knowledge. Such legacies often provide the only...

  2. Jack Wescott and Donald F. Smith. The Legacy Project

    Science.gov (United States)

    Moye, Johnny J.; Wescott, Jack W.; Smith, Donald F.

    2017-01-01

    This is the tenth in a series of articles entitled "The Legacy Project." The Legacy Project focuses on the lives and actions of leaders who have forged our profession into what it is today. Members of the profession owe a debt of gratitude to these leaders. One simple way to demonstrate that gratitude is to recognize these leaders and…

  3. Knowledge Author: facilitating user-driven, domain content development to support clinical information extraction.

    Science.gov (United States)

    Scuba, William; Tharp, Melissa; Mowery, Danielle; Tseytlin, Eugene; Liu, Yang; Drews, Frank A; Chapman, Wendy W

    2016-06-23

    Clinical Natural Language Processing (NLP) systems require a semantic schema comprised of domain-specific concepts, their lexical variants, and associated modifiers to accurately extract information from clinical texts. An NLP system leverages this schema to structure concepts and extract meaning from the free texts. In the clinical domain, creating a semantic schema typically requires input from both a domain expert, such as a clinician, and an NLP expert who will represent clinical concepts created from the clinician's domain expertise into a computable format usable by an NLP system. The goal of this work is to develop a web-based tool, Knowledge Author, that bridges the gap between the clinical domain expert and the NLP system development by facilitating the development of domain content represented in a semantic schema for extracting information from clinical free-text. Knowledge Author is a web-based, recommendation system that supports users in developing domain content necessary for clinical NLP applications. Knowledge Author's schematic model leverages a set of semantic types derived from the Secondary Use Clinical Element Models and the Common Type System to allow the user to quickly create and modify domain-related concepts. Features such as collaborative development and providing domain content suggestions through the mapping of concepts to the Unified Medical Language System Metathesaurus database further supports the domain content creation process. Two proof of concept studies were performed to evaluate the system's performance. The first study evaluated Knowledge Author's flexibility to create a broad range of concepts. A dataset of 115 concepts was created of which 87 (76 %) were able to be created using Knowledge Author. The second study evaluated the effectiveness of Knowledge Author's output in an NLP system by extracting concepts and associated modifiers representing a clinical element, carotid stenosis, from 34 clinical free-text radiology

  4. Care episode retrieval: distributional semantic models for information retrieval in the clinical domain.

    Science.gov (United States)

    Moen, Hans; Ginter, Filip; Marsi, Erwin; Peltonen, Laura-Maria; Salakoski, Tapio; Salanterä, Sanna

    2015-01-01

    Patients' health related information is stored in electronic health records (EHRs) by health service providers. These records include sequential documentation of care episodes in the form of clinical notes. EHRs are used throughout the health care sector by professionals, administrators and patients, primarily for clinical purposes, but also for secondary purposes such as decision support and research. The vast amounts of information in EHR systems complicate information management and increase the risk of information overload. Therefore, clinicians and researchers need new tools to manage the information stored in the EHRs. A common use case is, given a--possibly unfinished--care episode, to retrieve the most similar care episodes among the records. This paper presents several methods for information retrieval, focusing on care episode retrieval, based on textual similarity, where similarity is measured through domain-specific modelling of the distributional semantics of words. Models include variants of random indexing and the semantic neural network model word2vec. Two novel methods are introduced that utilize the ICD-10 codes attached to care episodes to better induce domain-specificity in the semantic model. We report on experimental evaluation of care episode retrieval that circumvents the lack of human judgements regarding episode relevance. Results suggest that several of the methods proposed outperform a state-of-the art search engine (Lucene) on the retrieval task.

  5. Development of patient centric virtual organizations (PCVOs) in clinical environment for patient information management.

    Science.gov (United States)

    Mohyuddin; Gray, W A; Bailey, Hazel; Jones, Wendy; Morrey, David

    2007-01-01

    A novel Virtual Organization framework which incorporates wireless technology support is presented in the research work. The Virtual Organization is designed for a clinical environment to provide better patient information management and enhanced collaborative working of multidisciplinary care teams. The analysis studies the current clinical practices and looks at the general patient information resource structure currently in use for patient care. Based on this problem analysis and current requirements of the multi-disciplinary care team members, we propose a generic and sustainable Patient Centric Virtual Organization (PCVO) framework to complement the functionality of the existing infrastructure by incorporating wireless technologies support for improved patient information provision at the point of care. The preliminary results of the study identify and classify the specific point of care tasks suited to appropriate information resources needed by the care team members. This paper concentrates on the patient information management aspects brought in by incorporating wireless technologies at the point of care using patient information resources in a decentralized and distributed computing environment. This applied research is carried out in the secondary and tertiary care sector in the cancer domain. For the analysis and results of the pilot project, we have used a case study of a local NHS Cancer Hospital.

  6. Legacy management: An old challenge with a new focus

    International Nuclear Information System (INIS)

    Gillogly, Mari; ); Sneve, Malgorzata; Smith, Graham

    2017-01-01

    The NEA Expert Group on Legacy Management (EGLM) aims to promote a practical and optimised approach for the regulatory supervision of nuclear legacy sites and installations. NEA member countries share their experiences and approaches on legacy management and have submitted case studies to the EGLM that illustrate the common challenges and approaches of many countries. The first report of the expert group will be based on these case studies and will be released in late 2017. A new, broader focus on decommissioning and legacy management issues within the NEA is expected to take shape in early 2018, carrying forward the mission to develop and promote a practical and optimised approach for the regulatory supervision of nuclear legacy sites and installations

  7. The effects of creating psychological ownership on physicians' acceptance of clinical information systems.

    Science.gov (United States)

    Paré, Guy; Sicotte, Claude; Jacques, Hélène

    2006-01-01

    Motivated by the need to push further our understanding of physicians' acceptance of clinical information systems, we propose a relatively new construct, namely, psychological ownership. We situated the construct within a nomological net using a prevailing and dominant information technology adoption behavior model as a logical starting point. A mail survey was sent to the population of users of a regional physician order entry (POE) system aimed at speeding up the transmission of clinical data, mainly laboratory tests and radiology examinations, within a community health network. All scales, but one, were measured using previously validated instruments. For its part, the psychological ownership scale was developed using a multistage iterative procedure. Ninety-one questionnaires were returned to the researchers, for a response rate of 72.8%. Our findings reveal that, in order to foster physicians' adoption of a clinical information system, it is important to encourage and cultivate a positive attitude toward using the new system. In this connection, positive perception of the technology's usefulness is crucial. Second, results demonstrate that psychological ownership of a POE system is positively associated with physicians' perceptions of system utility and system user friendliness. Last, through their active involvement and participation, physicians feel they have greater influence on the development process, thereby developing feelings of ownership toward the clinical system. Psychological ownership's highly significant associations with user participation and crucial beliefs driving technology acceptance behaviors among physicians affirm the value of this construct in extending our understanding of POE adoption.

  8. Combining corpus-derived sense profiles with estimated frequency information to disambiguate clinical abbreviations.

    Science.gov (United States)

    Xu, Hua; Stetson, Peter D; Friedman, Carol

    2012-01-01

    Abbreviations are widely used in clinical notes and are often ambiguous. Word sense disambiguation (WSD) for clinical abbreviations therefore is a critical task for many clinical natural language processing (NLP) systems. Supervised machine learning based WSD methods are known for their high performance. However, it is time consuming and costly to construct annotated samples for supervised WSD approaches and sense frequency information is often ignored by these methods. In this study, we proposed a profile-based method that used dictated discharge summaries as an external source to automatically build sense profiles and applied them to disambiguate abbreviations in hospital admission notes via the vector space model. Our evaluation using a test set containing 2,386 annotated instances from 13 ambiguous abbreviations in admission notes showed that the profile-based method performed better than two baseline methods and achieved a best average precision of 0.792. Furthermore, we developed a strategy to combine sense frequency information estimated from a clustering analysis with the profile-based method. Our results showed that the combined approach largely improved the performance and achieved a highest precision of 0.875 on the same test set, indicating that integrating sense frequency information with local context is effective for clinical abbreviation disambiguation.

  9. Automatically extracting clinically useful sentences from UpToDate to support clinicians’ information needs

    Science.gov (United States)

    Mishra, Rashmi; Fiol, Guilherme Del; Kilicoglu, Halil; Jonnalagadda, Siddhartha; Fiszman, Marcelo

    2013-01-01

    Clinicians raise several information needs in the course of care. Most of these needs can be met by online health knowledge resources such as UpToDate. However, finding relevant information in these resources often requires significant time and cognitive effort. Objective: To design and assess algorithms for extracting from UpToDate the sentences that represent the most clinically useful information for patient care decision making. Methods: We developed algorithms based on semantic predications extracted with SemRep, a semantic natural language processing parser. Two algorithms were compared against a gold standard composed of UpToDate sentences rated in terms of clinical usefulness. Results: Clinically useful sentences were strongly correlated with predication frequency (correlation= 0.95). The two algorithms did not differ in terms of top ten precision (53% vs. 49%; p=0.06). Conclusions: Semantic predications may serve as the basis for extracting clinically useful sentences. Future research is needed to improve the algorithms. PMID:24551389

  10. Vulnerability of streams to legacy nitrate sources

    Science.gov (United States)

    Tesoriero, Anthony J.; Duff, John H.; Saad, David A.; Spahr, Norman E.; Wolock, David M.

    2013-01-01

    The influence of hydrogeologic setting on the susceptibility of streams to legacy nitrate was examined at seven study sites having a wide range of base flow index (BFI) values. BFI is the ratio of base flow to total streamflow volume. The portion of annual stream nitrate loads from base flow was strongly correlated with BFI. Furthermore, dissolved oxygen concentrations in streambed pore water were significantly higher in high BFI watersheds than in low BFI watersheds suggesting that geochemical conditions favor nitrate transport through the bed when BFI is high. Results from a groundwater-surface water interaction study at a high BFI watershed indicate that decades old nitrate-laden water is discharging to this stream. These findings indicate that high nitrate levels in this stream may be sustained for decades to come regardless of current practices. It is hypothesized that a first approximation of stream vulnerability to legacy nutrients may be made by geospatial analysis of watersheds with high nitrogen inputs and a strong connection to groundwater (e.g., high BFI).

  11. Legacy and Emerging Perfluoroalkyl Substances Are ...

    Science.gov (United States)

    Long-chain per- and polyfluoroalkyl substances (PFASs) are being replaced by short-chain PFASs and fluorinated alternatives. For ten legacy PFASs and seven recently discovered perfluoroalkyl ether carboxylic acids (PFECAs), we report (1) their occurrence in the Cape Fear River (CFR) watershed, (2) their fate in water treatment processes, and (3) their adsorbability on powdered activated carbon (PAC). In the headwater region of the CFR basin, PFECAs were not detected in raw water of a drinking water treatment plant (DWTP), but concentrations of legacy PFASs were high. The U.S. Environmental Protection Agency’s lifetime health advisory level (70 ng/L) for perfluorooctanesulfonic acid and perfluorooctanoic acid (PFOA) was exceeded on 57 of 127 sampling days. In raw water of a DWTP downstream of a PFAS manufacturer, the mean concentration of perfluoro-2-propoxypropanoic acid (PFPrOPrA), a replacement for PFOA, was 631 ng/L (n = 37). Six other PFECAs were detected, with three exhibiting chromatographic peak areas up to 15 times that of PFPrOPrA. At this DWTP, PFECA removal by coagulation, ozonation, biofiltration, and disinfection was negligible. The adsorbability of PFASs on PAC increased with increasing chain length. Replacing one CF2 group with an ether oxygen decreased the affinity of PFASs for PAC, while replacing additional CF2 groups did not lead to further affinity changes. The USEPA’s recently completed Unregulated Contaminant Monitoring Rule 3 (UCMR3) p

  12. The mycological legacy of Elias Magnus Fries.

    Science.gov (United States)

    Petersen, Ronald H; Knudsen, Henning

    2015-06-01

    The taxonomic concepts which originated with or were accepted by Elias Magnus Fries were presented during his lifetime in the printed word, illustrative depiction, and in collections of dried specimens. This body of work was welcomed by the mycological and botanical communities of his time: students and associates aided Fries and after his passing carried forward his taxonomic ideas. His legacy spawned a line of Swedish and Danish mycologists intent on perpetuating the Fries tradition: Hampus von Post, Lars Romell, Seth Lundell and John Axel Nannfeldt in Sweden; Emil Rostrup, Severin Petersen and Jakob Lange in Denmark. Volumes of color paintings and several exsiccati, most notably one edited by Lundell and Nannfeldt attached fungal portraits and preserved specimens (and often photographs) to Fries names. The result is a massive resource from which to harvest the name-concept relationship with clarity. In the 20th century, nomenclatural commissions legislated Fries's Systema and Elenchus as the "starting point" for names of most fungi, giving these books special recognition. The present paper attempts to trace Fries's legacy from his lifetime to the recent past.

  13. iCONCUR: informed consent for clinical data and bio-sample use for research.

    Science.gov (United States)

    Kim, Hyeoneui; Bell, Elizabeth; Kim, Jihoon; Sitapati, Amy; Ramsdell, Joe; Farcas, Claudiu; Friedman, Dexter; Feupe, Stephanie Feudjio; Ohno-Machado, Lucila

    2017-03-01

    Implementation of patient preferences for use of electronic health records for research has been traditionally limited to identifiable data. Tiered e-consent for use of de-identified data has traditionally been deemed unnecessary or impractical for implementation in clinical settings. We developed a web-based tiered informed consent tool called informed consent for clinical data and bio-sample use for research (iCONCUR) that honors granular patient preferences for use of electronic health record data in research. We piloted this tool in 4 outpatient clinics of an academic medical center. Of patients offered access to iCONCUR, 394 agreed to participate in this study, among whom 126 patients accessed the website to modify their records according to data category and data recipient. The majority consented to share most of their data and specimens with researchers. Willingness to share was greater among participants from an Human Immunodeficiency Virus (HIV) clinic than those from internal medicine clinics. The number of items declined was higher for for-profit institution recipients. Overall, participants were most willing to share demographics and body measurements and least willing to share family history and financial data. Participants indicated that having granular choices for data sharing was appropriate, and that they liked being informed about who was using their data for what purposes, as well as about outcomes of the research. This study suggests that a tiered electronic informed consent system is a workable solution that respects patient preferences, increases satisfaction, and does not significantly affect participation in research. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  14. Informed consent for inclusion into clinical trials: a serious subject to note in the developing world.

    Science.gov (United States)

    Izadi, Morteza; Fazel, Mozhgan; Nasiri-Vanashi, Taha; Saadat, Seyed Hasan; Taheri, Saeed

    2012-05-01

    Informed consent is a critical issue especially in conducting clinical trials that expose human life to medical or surgical interventions. It necessitates a long and complex process through which the participant is presented with all potential favorable and non-favorable consequences upon getting enrolled in the study. The process of taking informed consent is well-understood in developed countries, with every effort taken to enhance and maintain the autonomy of patients and their right to make an informed choice of whether to participate or not. This may not be the case in the developing world.The information given to patients before the trial might not be properly developed and presented, an issue that can result in serious threat to the decision-making process. On the other hand, investigators should remember that enrolling people into a trial with no potential benefit for themselves cannot be considered ethical. In the current debate, we aim to address the issue of how respectfully and ethically clinical research trials can be done on human subjects and what we can do to enhance the practice in an ethical context. Development of a system through which we could warrant all rights of study participants in all cases around the world seems far from view. However, if we are in doubt about the ethics of a clinical trial, we can ask ourselves: "what would we do, if we were in the same position our patients are in now?"

  15. Informational resources utilized in clinical decision making: common practices in dentistry.

    Science.gov (United States)

    Straub-Morarend, Cheryl L; Marshall, Teresa A; Holmes, David C; Finkelstein, Michael W

    2011-04-01

    This study investigated current trends of Iowa dental practitioners with regard to acquisition and utilization of scientific information resources to support decision making in the clinical practice of dentistry. A survey questionnaire regarding the utilization of various sources of information to support clinical decisions was mailed in September 2009 to all dentists licensed and practicing in the state of Iowa. Dentists appointed full-time within the University of Iowa College of Dentistry were excluded from this study. Continuing education courses were the most frequently utilized and preferred information source by respondents, followed by print journals and consultation with other health care professionals. Practice patterns according to decade of dental school graduation as well as scope of practice were noted. The results of this study demonstrate that dental practitioners utilize a variety of evidence-based and non-evidence-based information resources to support decisions in clinical practice. The habits of newer graduates vary somewhat from those of earlier graduates; the habits of specialists vary from those of general practitioners.

  16. Successful Implementation of Clinical Information Technology: Seven Key Lessons from CPOE.

    Science.gov (United States)

    Gellert, G A; Hill, V; Bruner, K; Maciaz, G; Saucedo, L; Catzoela, L; Ramirez, R; Jacobs, W J; Nguyen, P; Patel, L; Webster, S L

    2015-01-01

    To identify and describe the most critical strategic and operational contributors to the successful implementation of clinical information technologies, as deployed within a moderate sized system of U.S. community hospitals. CHRISTUS Health is a multi-state system comprised of more than 350 services and 60 hospitals with over 9 000 physicians. The Santa Rosa region of CHRISTUS Health, located in greater San Antonio, Texas is comprised of three adult community hospital facilities and one Children's hospital each with bed capacities of 142-180. Computerized Patient Order Entry (CPOE) was first implemented in 2012 within a complex market environment. The Santa Rosa region has 2 417 credentialed physicians and 263 mid-level allied health professionals. This report focuses on the seven most valuable strategies deployed by the Health Informatics team in a large four hospital CHRISTUS region to achieve strong CPOE adoption and critical success lessons learned. The findings are placed within the context of the literature describing best practices in health information technology implementation. While the elements described involved discrete de novo process generation to support implementation and operations, collectively they represent the creation of a new customer-centric service culture in our Health Informatics team, which has served as a foundation for ensuring strong clinical information technology adoption beyond CPOE. The seven success factors described are not limited in their value to and impact on CPOE adoption, but generalize to - and can advance success in - varied other clinical information technology implementations across diverse hospitals. A number of these factors are supported by reports in the literature of other institutions' successful implementations of CPOE and other clinical information technologies, and while not prescriptive to other settings, may be adapted to yield value elsewhere.

  17. Adapting a program to inform African American and Hispanic American women about cancer clinical trials.

    Science.gov (United States)

    Sadler, Georgia Robins; Gonzalez, Jenny; Mumman, Manpreet; Cullen, Lisa; Lahousse, Sheila F; Malcarne, Vanessa; Conde, Viridiana; Riley, Natasha

    2010-06-01

    The dearth of evidence-based clinical trial education programs may contribute to the under-representation of African American and Hispanic American women in cancer research studies. This study used focus group-derived data from 80 women distributed among eight Spanish- and English-language focus groups. These data guided the researchers' adaptation and refinement of the National Cancer Institute's various clinical trials education programs into a program that was specifically focused on meeting the information needs of minority women and addressing the barriers to study participation that they perceived. A "sisterhood" theme was adopted and woven throughout the presentation.

  18. Assessing Resistance to Change during Shifting from Legacy to Open Web-Based Systems in the Air Transport Industry

    Science.gov (United States)

    Brewer, Denise

    2012-01-01

    The air transport industry (ATI) is a dynamic, communal, international, and intercultural environment in which the daily operations of airlines, airports, and service providers are dependent on information technology (IT). Many of the IT legacy systems are more than 30 years old, and current regulations and the globally distributed workplace have…

  19. Internet access and online cancer information seeking among Latino immigrants from safety net clinics.

    Science.gov (United States)

    Selsky, Claire; Luta, George; Noone, Anne-Michelle; Huerta, Elmer E; Mandelblatt, Jeanne S

    2013-01-01

    Internet use is widespread, but little is known about Internet use for cancer information among Latinos, especially those who rely on safety net clinics. The authors investigated access to and intended use of the Internet for cancer information among low income, immigrant Latinos predominately from Central and South America. A cross-sectional study of 1,273 Latinos 21 years and older attending safety net clinics or health fairs was conducted from June 2007 to November 2008. The authors used logistic regression models to evaluate associations of age, acculturation, psychosocial factors and other covariates with Internet access and intended use of the Internet for cancer information among those with access. Of the sample, 44% reported Internet access. Higher information self-efficacy and greater trust in the Internet were independently associated with Internet access (p = .05 and p Internet use for cancer information, considering covariates. In addition, those with high (vs. low) perceived risk of cancer (OR = 1.76; 95% CI [1.14, 2.73]; p = .01) and higher levels of trust in online health information (OR = 1.47 per one-point increase; 95% [CI 1.19, 1.82]; p = .0004) were more likely to intend to seek cancer information online. These findings that Internet access is fairly high in the immigrant Latino population and that the Internet is a trusted source of cancer information suggest that the Internet may be a channel for cancer control interventions.

  20. Evaluating the Quality of Website Information of Private-Practice Clinics Offering Cell Therapies in Japan.

    Science.gov (United States)

    Kashihara, Hidenori; Nakayama, Takeo; Hatta, Taichi; Takahashi, Naomi; Fujita, Misao

    2016-05-24

    Although the safety and effectiveness of stem cell therapies are yet to be proven, recent studies show that such therapies are being advertised with some questionable marketing techniques to effect positive portrayal of the therapies on the webpages of private-practice clinics to sell their therapies worldwide. In such context, those clinics communicate directly with consumers (patients and their family members) via the clinics' websites. Meanwhile, the Health Science Council at the Ministry of Health, Labour, and Welfare (MHLW) in Japan has pointed out noncompliance of some local clinics with the provisions concerning medical advertising in the Medical Care Act in the past. However, locally little is known about the current status of those clinics including the quality of their webpage information disseminated. To evaluate the quality of website information of private-practice clinics offering cell therapies in Japan. Twenty-four websites with 77 treatments from the Google search were identified for evaluation. The following three exploratory analyses were performed: first in order to ascertain web-based portrayal of private-practice clinics offering cell therapies, a descriptive analysis was conducted using a coding frame; second we evaluated the quality of the target website information from the viewpoint of the level of consideration taken for patients and their family members, using 10 quality criteria ("the Minimum Standard") from the e-Health Code of Ethics 2.0; third we counted and coded expressions that matched set categories for "name-dropping" and "personalized medicine" in the information posted on these websites. Analysis on the treatments (N=77) revealed 126 indications (multiple response): the top three indications were "cancer," "skin-rejuvenation/antiaging/anti-skin aging," and "breast augmentation/buttock augmentation." As for the portrayal of treatment risks and benefits, 78% (60/77) of treatments were mentioned with "benefits," whereas 77% (59

  1. Automating annotation of information-giving for analysis of clinical conversation.

    Science.gov (United States)

    Mayfield, Elijah; Laws, M Barton; Wilson, Ira B; Penstein Rosé, Carolyn

    2014-02-01

    Coding of clinical communication for fine-grained features such as speech acts has produced a substantial literature. However, annotation by humans is laborious and expensive, limiting application of these methods. We aimed to show that through machine learning, computers could code certain categories of speech acts with sufficient reliability to make useful distinctions among clinical encounters. The data were transcripts of 415 routine outpatient visits of HIV patients which had previously been coded for speech acts using the Generalized Medical Interaction Analysis System (GMIAS); 50 had also been coded for larger scale features using the Comprehensive Analysis of the Structure of Encounters System (CASES). We aggregated selected speech acts into information-giving and requesting, then trained the machine to automatically annotate using logistic regression classification. We evaluated reliability by per-speech act accuracy. We used multiple regression to predict patient reports of communication quality from post-visit surveys using the patient and provider information-giving to information-requesting ratio (briefly, information-giving ratio) and patient gender. Automated coding produces moderate reliability with human coding (accuracy 71.2%, κ=0.57), with high correlation between machine and human prediction of the information-giving ratio (r=0.96). The regression significantly predicted four of five patient-reported measures of communication quality (r=0.263-0.344). The information-giving ratio is a useful and intuitive measure for predicting patient perception of provider-patient communication quality. These predictions can be made with automated annotation, which is a practical option for studying large collections of clinical encounters with objectivity, consistency, and low cost, providing greater opportunity for training and reflection for care providers.

  2. The regulation of informed consent to participation in clinical research by mentally ill persons: An overview

    Directory of Open Access Journals (Sweden)

    A Nienaber

    2010-12-01

    Full Text Available The article examines the legal requirements relating to the informed consent of mentally ill persons to participation in clinical research in South Africa. First, the juridical basis of informed consent in South African law is outlined; and second, the requirements for lawful consent developed in South African common law and case law are presented. Finally, the article deliberates upon the requirements for the participation of mentally ill persons in research as laid down by the Mental Health Care Act and its regulations, the National Health Act and its (draft regulations, and the South African Constitution.

  3. Information visualisation in clinical Odontology: multidimensional analysis and interactive data exploration.

    Science.gov (United States)

    Falkman, G

    2001-05-01

    In 1995, the MedView project, based on a co-operation between computing science and clinical medicine was initiated. The overall goal of the project was to develop models, methods and tools to support clinicians in their daily diagnostic work. As part of MedView, two information visualisation tools were developed and tested as solutions to the problem of visualising clinical experience derived from large amounts of clinical data. The first tool (The Cube) was based on the idea of dynamic three-dimensional (3D) parallel diagrams, an idea similar to the notion of 3D parallel co-ordinates. The Cube was developed to enhance the clinician's ability to intelligibly analyse existing patient material and to allow for pattern recognition and statistical analysis. The second tool (SimVis) was based on a similarity assessment-based interaction model for exploring data, and was designed to help clinicians to classify and cluster clinical examination data. User interaction was supported by 3D visualisation of clusters and similarity measures. Both tools were tested on a knowledge base containing about 1500 examinations obtained from different clinics. Clinical practice indicated that the basic ideas are conceptually appealing to the involved clinicians as the tools can be used for generating and testing of hypotheses.

  4. Modeling information flows in clinical decision support: key insights for enhancing system effectiveness.

    Science.gov (United States)

    Medlock, Stephanie; Wyatt, Jeremy C; Patel, Vimla L; Shortliffe, Edward H; Abu-Hanna, Ameen

    2016-09-01

    A fundamental challenge in the field of clinical decision support is to determine what characteristics of systems make them effective in supporting particular types of clinical decisions. However, we lack such a theory of decision support itself and a model to describe clinical decisions and the systems to support them. This article outlines such a framework. We present a two-stream model of information flow within clinical decision-support systems (CDSSs): reasoning about the patient (the clinical stream), and reasoning about the user (the cognitive-behavioral stream). We propose that CDSS "effectiveness" be measured not only in terms of a system's impact on clinical care, but also in terms of how (and by whom) the system is used, its effect on work processes, and whether it facilitates appropriate decisions by clinicians and patients. Future research into which factors improve the effectiveness of decision support should not regard CDSSs as a single entity, but should instead differentiate systems based on their attributes, users, and the decision being supported. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Analyzing Statistical Mediation with Multiple Informants: A New Approach with an Application in Clinical Psychology.

    Science.gov (United States)

    Papa, Lesther A; Litson, Kaylee; Lockhart, Ginger; Chassin, Laurie; Geiser, Christian

    2015-01-01

    Testing mediation models is critical for identifying potential variables that need to be targeted to effectively change one or more outcome variables. In addition, it is now common practice for clinicians to use multiple informant (MI) data in studies of statistical mediation. By coupling the use of MI data with statistical mediation analysis, clinical researchers can combine the benefits of both techniques. Integrating the information from MIs into a statistical mediation model creates various methodological and practical challenges. The authors review prior methodological approaches to MI mediation analysis in clinical research and propose a new latent variable approach that overcomes some limitations of prior approaches. An application of the new approach to mother, father, and child reports of impulsivity, frustration tolerance, and externalizing problems (N = 454) is presented. The results showed that frustration tolerance mediated the relationship between impulsivity and externalizing problems. The new approach allows for a more comprehensive and effective use of MI data when testing mediation models.

  6. Effects of an integrated clinical information system on medication safety in a multi-hospital setting.

    Science.gov (United States)

    Mahoney, Charles D; Berard-Collins, Christine M; Coleman, Reid; Amaral, Joseph F; Cotter, Carole M

    2007-09-15

    The implementation of vendor-based integrated clinical information technology was studied, and its effect on medication errors throughout the medication-use process in a health care system was evaluated. The integrated systems selected for implementation included computerized physician order entry, pharmacy and laboratory information systems, clinical decision-support systems (CDSSs), electronic drug dispensing systems (EDDSs), and a bar-code point-of-care medication administration system. The primary endpoint was the reduction in related medication errors. Secondary endpoints included the reductions in medication order turnaround time and EDDS override transactions. Integrated clinical information system technology was implemented in a multihospital health care system with a phased-in approach. A positive effect of this integration on medication errors throughout the medication-use process was demonstrated. Most prescribing errors decreased significantly in the selected categories monitored, specifically drug allergy detection, excessive dosing, and incomplete or unclear orders. Pharmacists were also twice as likely to identify dosages requiring adjustment for renal insufficiency when the integrated technology was in place and more than six times as likely for drug levels outside of the therapeutic range. A positive effect on medication administration safety was also demonstrated: 73 administration-related errors were intercepted through electronic bar-code scanning for every 100,000 doses charted. Integration of clinical information system technology decreased selected types of medication errors throughout the medication-use process in a health care system and improved therapeutic drug monitoring in patients with renal insufficiency and in patients receiving drugs with narrow therapeutic ranges through the use of CDSS alerts.

  7. Creating ISO/EN 13606 archetypes based on clinical information needs.

    Science.gov (United States)

    Rinner, Christoph; Kohler, Michael; Hübner-Bloder, Gudrun; Saboor, Samrend; Ammenwerth, Elske; Duftschmid, Georg

    2011-01-01

    Archetypes model individual EHR contents and build the basis of the dual-model approach used in the ISO/EN 13606 EHR architecture. We present an approach to create archetypes using an iterative development process. It includes automated generation of electronic case report forms from archetypes. We evaluated our approach by developing 128 archetypes which represent 446 clinical information items from the diabetes domain.

  8. Implications of electronic health record meaningful use legislation for nursing clinical information system development and refinement.

    Science.gov (United States)

    Scherb, Cindy A; Maas, Meridean L; Head, Barbara J; Johnson, Marion R; Kozel, Marie; Reed, David; Swanson, Elizabeth; Moorhead, Sue

    2013-06-01

     To describe what electronic health record meaningful use requirements mean for nursing clinical information system (CIS) development.  The nursing CIS in many, if not most hospitals, has a number of critical design inadequacies that constrain the meaningful use of nursing data to ensure quality outcomes for patients and data-based maturing of the nursing profession.  It is the responsibility and obligation of nurses to ensure that CISs are designed for the meaningful use of nursing clinical data. To accomplish these ends, interoperable clinical nursing data must be documented in a properly integrated operational CIS, and must be retrievable and stored in data repositories for analysis and reports. © 2013, The Authors. International Journal of Nursing Knowledge © 2013, NANDA International.

  9. Do Patients Who Access Clinical Information on Patient Internet Portals Have More Primary Care Visits?

    Science.gov (United States)

    Leveille, Suzanne G; Mejilla, Roanne; Ngo, Long; Fossa, Alan; Elmore, Joann G; Darer, Jonathan; Ralston, James D; Delbanco, Tom; Walker, Jan

    2016-01-01

    As health care costs alarm the nation and the debate increases about the impact of health information technologies, patients are reviewing their medical records increasingly through secure Internet portals. Important questions remain about the impact of portal use on office visits. To evaluate whether use of patient Internet portals to access records is associated with increased primary care utilization. A prospective cohort study. Primary care patients registered on patient Internet portals, within an integrated health system serving rural Pennsylvania and an academic medical center in Boston. Frequency of "clinical portal use" (days/2 mo intervals over 2 y) included secure messaging about clinical issues and viewing laboratory and radiology findings. In year 2, a subset of patients also gained access to their primary care doctor's visit notes. The main outcome was number of primary care office visits. In the first 2 months of the 2-year period, 14% of 44,951 primary care patients engaged in clinical portal use 2 or more days per month, 31% did so 1 day per month, and the remainder had no clinical portal use. Overall, adjusted for age, sex, and chronic conditions, clinical portal use was not associated with subsequent office visits. Fewer than 0.1% of patients engaged in high levels of clinical portal use (31 or more login days in 2 mo) that were associated with 1 or more additional visits in the subsequent 2 months (months 3 and 4). However, the reverse was true: office visits led to subsequent clinical portal use. Similar trends were observed among patients with or without access to visit notes. Patients turn to their portals following visits, but clinical portal use does not contribute to an increase in primary care visits.

  10. Techniques to aid the implementation of novel clinical information systems: a systematic review.

    Science.gov (United States)

    Kelay, Tanika; Kesavan, Sujatha; Collins, Ruth E; Kyaw-Tun, Jimmy; Cox, Benita; Bello, Fernando; Kneebone, Roger L; Sevdalis, Nick

    2013-01-01

    This systematic review identifies and evaluates techniques that aid the implementation of novel clinical information systems (CIS) within healthcare. We searched electronic databases (MEDLINE, EMBASE, PsycINFO and HMIC Health Management Information Consortium). Desktop reviews for all potentially eligible studies were also conducted via reference lists and forward citation searches. 14,198 abstracts were identified through the initial electronic search. 63 articles were retained following title and abstract reviews, and submitted for full text evaluation. Of these, 18 papers met eligibility criteria. The 5 techniques that emerged from the review and that can assist CIS implementation were: system piloting, eliciting acceptance, use of simulation, training and education, and provision of incentives. These techniques were evaluated with a range of study endpoints (including system utilisation, clinical effectiveness, user satisfaction, attitudes towards system training, and attitudes towards implementation). Consideration of the clinical context in which the CIS was implemented was a consistent theme in the evidence-base. Although some evidence is available for the effectiveness of the 5 implementation techniques found in this review, the variable endpoints and the non-comparable study designs mean that the evidence-base needs further developing. We discuss the potential role of simulation and clinical leadership, particularly in relation to surgeons, in CIS implementation and we propose practical advice for CIS implementation and evaluation within hospital settings. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Iranian nurses' experience with applying information from continuing education programs in clinical practice.

    Science.gov (United States)

    Nayeri, Nahid Dehghan; Khosravi, Laleh

    2013-12-01

    One goal of continuing education is to improve nurses' performance and the quality of patient care. However, in most cases, nurses do not use the information gained through continuing education in the clinical environment. This study was conducted to explore nurses' experiences with applying new knowledge obtained from these programs in clinical settings. This study used qualitative content analysis. Data were gathered through interviews with participants. After the interviews were transcribed, a coding process was used and continued until categories and subcategories were developed. Five main categories emerged: (1) personal interest and self-confidence; (2) organizational structure and atmosphere; (3) professional nature; (4) opportunity to put education into practice; and (5) design of educational programs. Most of the nurses considered obligatory participation in these classes a way to gain annual educational upgrades. A considerable amount of the annual budget is allocated to continuing education. Therefore, the findings of this study, which described nurses' experience with applying what they learned through continuing education in clinical practice, can offer valuable information to help managers improve continuing education programs and the application of new knowledge in the clinical environment. Copyright 2013, SLACK Incorporated.

  12. MendeLIMS: a web-based laboratory information management system for clinical genome sequencing.

    Science.gov (United States)

    Grimes, Susan M; Ji, Hanlee P

    2014-08-27

    Large clinical genomics studies using next generation DNA sequencing require the ability to select and track samples from a large population of patients through many experimental steps. With the number of clinical genome sequencing studies increasing, it is critical to maintain adequate laboratory information management systems to manage the thousands of patient samples that are subject to this type of genetic analysis. To meet the needs of clinical population studies using genome sequencing, we developed a web-based laboratory information management system (LIMS) with a flexible configuration that is adaptable to continuously evolving experimental protocols of next generation DNA sequencing technologies. Our system is referred to as MendeLIMS, is easily implemented with open source tools and is also highly configurable and extensible. MendeLIMS has been invaluable in the management of our clinical genome sequencing studies. We maintain a publicly available demonstration version of the application for evaluation purposes at http://mendelims.stanford.edu. MendeLIMS is programmed in Ruby on Rails (RoR) and accesses data stored in SQL-compliant relational databases. Software is freely available for non-commercial use at http://dna-discovery.stanford.edu/software/mendelims/.

  13. The impact of clinical leadership on health information technology adoption: systematic review.

    Science.gov (United States)

    Ingebrigtsen, Tor; Georgiou, Andrew; Clay-Williams, Robyn; Magrabi, Farah; Hordern, Antonia; Prgomet, Mirela; Li, Julie; Westbrook, Johanna; Braithwaite, Jeffrey

    2014-06-01

    To conduct a systematic review to examine evidence of associations between clinical leadership and successful information technology (IT) adoption in healthcare organisations. We searched Medline, Embase, Cinahl, and Business Source Premier for articles published between January 2000 to May 2013 with keywords and subject terms related to: (1) the setting--healthcare provider organisations; (2) the technology--health information technology; (3) the process--adoption; and (4) the intervention--leadership. We identified 3121 unique citations, of which 32 met our criteria and were included in the review. Data extracted from the included studies were assessed in light of two frameworks: Bassellier et al.'s IT competence framework; and Avgar et al.'s health IT adoption framework. The results demonstrate important associations between the attributes of clinical leaders and IT adoption. Clinical leaders who have technical informatics skills and prior experience with IT project management are likely to develop a vision that comprises a long-term commitment to the use of IT. Leaders who possess such a vision believe in the value of IT, are motivated to adopt it, and can maintain confidence and stability through the adversities that IT adoptions often entail. This leads to proactive leadership behaviours and partnerships with IT professionals that are associated with successful organisational and clinical outcomes. This review provides evidence that clinical leaders can positively contribute to successful IT adoption in healthcare organisations. Clinical leaders who aim for improvements in the processes and quality of care should cultivate the necessary IT competencies, establish mutual partnerships with IT professionals, and execute proactive IT behaviours to achieve successful IT adoption. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Resolution improvement of brain PET images using prior information from MRI: clinical application on refractory epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Silva-Rodríguez, Jesus [Instituto de Investigaciones Sanitarias (IDIS), Santiago de Compostela (Spain); Tsoumpas, Charalampos [University of Leeds, Leeds (United Kingdom); Aguiar, Pablo; Cortes, Julia [Nuclear Medicine Department, University Hospital (CHUS), Santiago de Compostela (Spain); Urdaneta, Jesus Lopez [Instituto de Investigaciones Sanitarias (IDIS), Santiago de Compostela (Spain)

    2015-05-18

    An important counterpart of clinical Positron Emission Tomography (PET) for early diagnosis of neurological diseases is its low resolution. This is particularly important when evaluating diseases related to small hypometabolisms such as epilepsy. The last years, new hybrid systems combining PET with Magnetic Resonance (MR) has been increasingly used for several different clinical applications. One of the advantages of MR is the production of high spatial resolution images and a potential application of PET-MR imaging is the improvement of PET resolution using MR information. A potential advantage of resolution recovery of PET images is the enhancement of contrast delivering at the same time better detectability of small lesions or hypometabolic areas and more accurate quantification over these areas. Recently, Shidahara et al (2009) proposed a new method using wavelet transforms in order to produce PET images with higher resolution. We optimised Shidahara’s method (SFS-RR) to take into account possible shortcomings on the particular clinical datasets, and applied it to a group of patients diagnosed with refractory epilepsy. FDG-PET and MRI images were acquired sequentially and then co-registered using software tools. A complete evaluation of the PET/MR images was performed before and after the correction, including different parameters related with PET quantification, such as atlas-based metabolism asymmetry coefficients and Statistical Parametric Mapping results comparing to a database of 87 healthy subjects. Furthermore, an experienced physician analyzed the results of non-corrected and corrected images in order to evaluate improvements of detectability on a visual inspection. Clinical outcome was used as a gold standard. SFS-RR demonstrated to have a positive impact on clinical diagnosis of small hypometabolisms. New lesions were detected providing additional clinically relevant information on the visual inspection. SPM sensitivity for the detection of small

  15. SU-D-BRD-04: A Logical Organizational Approach to Clinical Information Management

    International Nuclear Information System (INIS)

    Shao, W; Kupelian, P; Wang, J; Low, D; Ruan, D

    2014-01-01

    Purpose: To develop a clinical information management system (CIMS) that collects, organizes physician inputs logically and supports analysis functionality. Methods: In a conventional electronic medical record system (EMR), the document manager component stores data in a pool of standalone .docx or .pdf files. The lack of a content-based logical organization makes cross-checking, reference or automatic inheritance of information challenging. We have developed an information-oriented clinical record system that addresses this shortcoming. In CIMS, a parent library predefines a set of available questions along with the data types of their expected answers. The creation of a questionnaire template is achieved by selecting questions from this parent library to form a virtual group. Instances of the same data field in different documents are linked by their question identifier. This design allows for flexible data sharing and inheritance among various forms using a longitudinal lineage of data indexed according to the modification time stamps of the documents. CIMS is designed with a web portal to facilitate querying, data entry and modification, aggregate report generation, and data adjudication. The current implementation addresses diagnostic data, medical history, vital signs, and various quantities in consult note and treatment summaries. Results: CIMS is currently storing treatment summary information of over 1,000 patients who have received treatment at UCLA Radiation Oncology between March 1, 2013 and January 31, 2014. We are in the process of incorporating a DICOM-RT dosimetry parser and patient reporting applications into CIMS, as well as continuing to define document templates to support additional forms. Conclusion: We are able to devise an alternative storage paradigm which results in an improvement in the accuracy and organizational structure of clinical information

  16. GCP compliance and readability of informed consent forms from an emerging hub for clinical trials

    Directory of Open Access Journals (Sweden)

    Satish Chandrasekhar Nair

    2015-01-01

    Full Text Available Background: The rapid expansion of trials in emerging regions has raised valid concerns about research subject protection, particularly related to informed consent. The purpose of this study is to assess informed consent form (ICF compliance with Good Clinical Practice (GCP guidelines and the readability easeof the ICFs in Abu Dhabi, a potential destination for clinical trials in the UAE. Materials and Methods: A multicenter retrospective cross-sectional analysis of 140 ICFs from industry sponsored and non-sponsored studies was conducted by comparing against a local standard ICF. Flesch-Kincaid Reading Scale was used to assess the readability ease of the forms. Results: Non-sponsored studies had signifi cantly lower overall GCP compliance of 55.8% when compared to 79.5% for industry sponsored studies. Only 33% of sponsored and 16% of non-sponsored studies included basic information on the participants′ rights and responsibilities. Flesch-Kincaid Reading ease score for the informed consent forms from industry sponsored studies was signifi cantly higher 48.9 ± 4.8 as compared to 38.5 ± 8.0 for non-sponsored studies, though both were more complex than recommended. Reading Grade Level score was also higher than expected, but scores for the ICFs from the industry sponsored studies were 9.7 ± 0.7, signifi cantly lower as compared to 12.2 ± 1.3 for non-sponsored studies. Conclusion: In spite of the undisputed benefits of conducting research in emerging markets readability, comprehension issues and the lack of basic essential information call for improvements in the ICFs to protect the rights of future research subjects enrolled in clinical trials in the UAE.

  17. SU-D-BRD-04: A Logical Organizational Approach to Clinical Information Management

    Energy Technology Data Exchange (ETDEWEB)

    Shao, W; Kupelian, P; Wang, J; Low, D; Ruan, D [UCLA School of Medicine, Los Angeles, CA (United States)

    2014-06-01

    Purpose: To develop a clinical information management system (CIMS) that collects, organizes physician inputs logically and supports analysis functionality. Methods: In a conventional electronic medical record system (EMR), the document manager component stores data in a pool of standalone .docx or .pdf files. The lack of a content-based logical organization makes cross-checking, reference or automatic inheritance of information challenging. We have developed an information-oriented clinical record system that addresses this shortcoming. In CIMS, a parent library predefines a set of available questions along with the data types of their expected answers. The creation of a questionnaire template is achieved by selecting questions from this parent library to form a virtual group. Instances of the same data field in different documents are linked by their question identifier. This design allows for flexible data sharing and inheritance among various forms using a longitudinal lineage of data indexed according to the modification time stamps of the documents. CIMS is designed with a web portal to facilitate querying, data entry and modification, aggregate report generation, and data adjudication. The current implementation addresses diagnostic data, medical history, vital signs, and various quantities in consult note and treatment summaries. Results: CIMS is currently storing treatment summary information of over 1,000 patients who have received treatment at UCLA Radiation Oncology between March 1, 2013 and January 31, 2014. We are in the process of incorporating a DICOM-RT dosimetry parser and patient reporting applications into CIMS, as well as continuing to define document templates to support additional forms. Conclusion: We are able to devise an alternative storage paradigm which results in an improvement in the accuracy and organizational structure of clinical information.

  18. Olympic Health Legacy; Essentials for Lasting Development of Host City.

    Science.gov (United States)

    Lee, Young-Hee; Kim, Jung Moon

    2013-03-01

    The purpose of the Olympic Games should be to contribute to the social development by leaving behind economic, cultural and environmental legacies to the hosting region. While tangible examples such as venues are often recognized as representative legacies of the Olympics, intangible aspects such as the environment, culture, policy and human resources have been gaining in importance. The Olympic Games, at its most fundamental level, is a sporting event. Sports not only is closely related to the physical health, but is also instrumental to fostering mental health through inspiration. One of the most important sports legacies was the general change in the population's perception on sports and physical activities; due to such change, people were able to enjoy sports as part of healthy and active everyday life and benefit physically. However, compared to tangible legacies such as the facilities, social legacies such as the general health and their planning, execution and achievements are hard to monitor. Therefore, for the Olympics to leave behind socio-cultural legacies that contribute to the development of the hosting region, there must be a thorough business plan that takes into account region-specific purpose, and is divided into stages such as before, during and after the Games. Should the 2018 Winter Olympic Games hope to create continuing contribution to its hosting region, it must leave behind 'Health Legacies' that will enhance the happiness of the hosting region's population. To this end, establishment of region-specific purpose and systematic promotion of business via detailed analysis of precedents are a must. This article aim to review the health legacy endeavors of past host cities and suggest the appropriate forms of health legacy of 2018 Pyeongchang Winter Olympic and Paralympic Games.

  19. Understanding managerial behaviour during initial steps of a clinical information system adoption

    Directory of Open Access Journals (Sweden)

    Pozzebon Marlei

    2011-06-01

    Full Text Available Abstract Background While the study of the information technology (IT implementation process and its outcomes has received considerable attention, the examination of pre-adoption and pre-implementation stages of configurable IT uptake appear largely under-investigated. This paper explores managerial behaviour during the periods prior the effective implementation of a clinical information system (CIS by two Canadian university multi-hospital centers. Methods Adopting a structurationist theoretical stance and a case study research design, the processes by which CIS managers' patterns of discourse contribute to the configuration of the new technology in their respective organizational contexts were longitudinally examined over 33 months. Results Although managers seemed to be aware of the risks and organizational impact of the adoption of a new clinical information system, their decisions and actions over the periods examined appeared rather to be driven by financial constraints and power struggles between different groups involved in the process. Furthermore, they largely emphasized technological aspects of the implementation, with organizational dimensions being put aside. In view of these results, the notion of 'rhetorical ambivalence' is proposed. Results are further discussed in relation to the significance of initial decisions and actions for the subsequent implementation phases of the technology being configured. Conclusions Theoretical and empirically grounded, the paper contributes to the underdeveloped body of literature on information system pre-implementation processes by revealing the crucial role played by managers during the initial phases of a CIS adoption.

  20. Understanding managerial behaviour during initial steps of a clinical information system adoption.

    Science.gov (United States)

    Rodríguez, Charo; Pozzebon, Marlei

    2011-06-17

    While the study of the information technology (IT) implementation process and its outcomes has received considerable attention, the examination of pre-adoption and pre-implementation stages of configurable IT uptake appear largely under-investigated. This paper explores managerial behaviour during the periods prior the effective implementation of a clinical information system (CIS) by two Canadian university multi-hospital centers. Adopting a structurationist theoretical stance and a case study research design, the processes by which CIS managers' patterns of discourse contribute to the configuration of the new technology in their respective organizational contexts were longitudinally examined over 33 months. Although managers seemed to be aware of the risks and organizational impact of the adoption of a new clinical information system, their decisions and actions over the periods examined appeared rather to be driven by financial constraints and power struggles between different groups involved in the process. Furthermore, they largely emphasized technological aspects of the implementation, with organizational dimensions being put aside. In view of these results, the notion of 'rhetorical ambivalence' is proposed. Results are further discussed in relation to the significance of initial decisions and actions for the subsequent implementation phases of the technology being configured. Theoretical and empirically grounded, the paper contributes to the underdeveloped body of literature on information system pre-implementation processes by revealing the crucial role played by managers during the initial phases of a CIS adoption.

  1. Supporting patients during their breast cancer journey: the informational role of clinical nurse specialists.

    Science.gov (United States)

    Droog, Elsa; Armstrong, Claire; MacCurtain, Sarah

    2014-01-01

    Research evidence suggests that a multidisciplinary team approach improves the outcomes of patients with breast cancer. However, limited attention has examined the extent to which the clinical nurse specialist's (CNS's) role can impact Irish patients' care, particularly given the novelty of this role in Ireland. The objective of this study was to examine the informational role of CNSs in supporting Irish patients during their breast cancer journey and the extent of its impact on their care. Three Irish breast cancer teams were investigated. A Picker questionnaire was administered to more than 100 patients per team who had completed treatment. Questions focused on the patients' journey from diagnosis through to treatment completion. Follow-up interviews with the teams' CNSs were conducted to achieve a deeper understanding of the care received. While patients reported an overall positive impression of their care, they were least satisfied with the amount of information and emotional support they received during their chemotherapy. Clinical nurse specialists commented that there is insufficient staffing in medical oncology to address this need in part because the ill-defined job description makes it difficult to quantify the impact of this role. The informational role of the CNS is inadequately recognized and is thus not currently able to fully address patients' care needs. Clarification of the CNS's role description in oncology care in Ireland is needed as is sufficient CNS staffing to maintain the vital informational role of CNSs throughout the patients' breast cancer journey.

  2. Pediatric Clinical Trials Conducted in South Korea from 2006 to 2015: An Analysis of the South Korean Clinical Research Information Service, US ClinicalTrials.gov and European Clinical Trials Registries.

    Science.gov (United States)

    Choi, Sheung-Nyoung; Lee, Ji-Hyun; Song, In-Kyung; Kim, Eun-Hee; Kim, Jin-Tae; Kim, Hee-Soo

    2017-12-01

    The status of pediatric clinical trials performed in South Korea in the last decade, including clinical trials of drugs with unapproved indications for children, has not been previously examined. The aim was to provide information regarding the current state of pediatric clinical trials and create a basis for future trials performed in South Korea by reviewing three databases of clinical trials registrations. We searched for pediatric clinical studies (participants South Korea between 2006 and 2015 registered on the Clinical Research Information Service (CRIS), ClinicalTrials.gov, and the European Clinical Trials Registry (EuCTR). Additionally, we reviewed whether unapproved indications were involved in each trial by comparing the trials with a list of authorized trials provided by the Ministry of Food and Drug Safety (MFDS). The primary and secondary outcomes were to determine the change in number of pediatric clinical trials with unapproved indications over time and to assess the status of unauthorized pediatric clinical trials from the MFDS and the publication of articles after these clinical trials, respectively. We identified 342 clinical studies registered in the CRIS (n = 81), ClinicalTrials.gov (n = 225), and EuCTR (n = 36), of which 306 were reviewed after excluding duplicate registrations. Among them, 181 studies were interventional trials dealing with drugs and biological agents, of which 129 (71.3%) involved unapproved drugs. Of these 129 trials, 107 (82.9%) were authorized by the MFDS. Pediatric clinical trials in South Korea aiming to establish the safety and efficacy of drugs in children are increasing; however, non-MFDS-authorized studies remain an issue.

  3. Public transparency Web sites for radiology practices: prevalence of price, clinical quality, and service quality information.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Doshi, Ankur M

    2016-01-01

    To assess information regarding radiology practices on public transparency Web sites. Eight Web sites comparing radiology centers' price and quality were identified. Web site content was assessed. Six of eight Web sites reported examination prices. Other reported information included hours of operation (4/8), patient satisfaction (2/8), American College of Radiology (ACR) accreditation (3/8), on-site radiologists (2/8), as well as parking, accessibility, waiting area amenities, same/next-day reports, mammography follow-up rates, examination appropriateness, radiation dose, fellowship-trained radiologists, and advanced technologies (1/8 each). Transparency Web sites had a preponderance of price (and to a lesser extent service quality) information, risking fostering price-based competition at the expense of clinical quality. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Clinical information on admission is insufficient to determine the appropriate isolation regimen for acute gastroenteritis

    DEFF Research Database (Denmark)

    Skyum, Florence; Abed, Osama Karim; Backer Mogensen, Christian

    2014-01-01

    admitted acutely within a one-year study period to a Danish hospital with a catchment population of 231,000 persons. The following items were analysed: information from the referring doctor, diarrhoea, nausea and vomiting and fever history, abdominal pain, prior antibiotics, co-morbidity, drugs, travel...... admitted patients and to analyse their clinical information focusing on risk indicators of contagious aetiology and on the chosen isolation regime to determine if the GE required a contact precaution isolation regime. MATERIAL AND METHODS: This study included patients above 16 years of age who were...... history, contagious contacts, general condition, vital values, isolation regime, final diagnosis and results of stool examination. RESULTS: Among 17,531 acute admissions, 1.6% had acute GE and 60% of these had stool examinations performed. Only 35% of the patients with GE had information about possible GE...

  5. Extracting and standardizing medication information in clinical text - the MedEx-UIMA system.

    Science.gov (United States)

    Jiang, Min; Wu, Yonghui; Shah, Anushi; Priyanka, Priyanka; Denny, Joshua C; Xu, Hua

    2014-01-01

    Extraction of medication information embedded in clinical text is important for research using electronic health records (EHRs). However, most of current medication information extraction systems identify drug and signature entities without mapping them to standard representation. In this study, we introduced the open source Java implementation of MedEx, an existing high-performance medication information extraction system, based on the Unstructured Information Management Architecture (UIMA) framework. In addition, we developed new encoding modules in the MedEx-UIMA system, which mapped an extracted drug name/dose/form to both generalized and specific RxNorm concepts and translated drug frequency information to ISO standard. We processed 826 documents by both systems and verified that MedEx-UIMA and MedEx (the Python version) performed similarly by comparing both results. Using two manually annotated test sets that contained 300 drug entries from medication list and 300 drug entries from narrative reports, the MedEx-UIMA system achieved F-measures of 98.5% and 97.5% respectively for encoding drug names to corresponding RxNorm generic drug ingredients, and F-measures of 85.4% and 88.1% respectively for mapping drug names/dose/form to the most specific RxNorm concepts. It also achieved an F-measure of 90.4% for normalizing frequency information to ISO standard. The open source MedEx-UIMA system is freely available online at http://code.google.com/p/medex-uima/.

  6. Subjective Evaluation of Mood and Cognitive Functions in a General Neurology Clinic: Patients versus Informants

    Science.gov (United States)

    Del Barrio, Antonio; Riva, Elena; Campo, Pablo; Toledano, Rafael; Franch, Oriol

    2017-01-01

    Background and Purpose We aimed to determine the correlation between subjective evaluations of mood and cognitive functions by patients and informants, and the findings of a battery of neuropsychological tests. Methods We analyzed 74 subjects recruited from a general neurology clinic, comprising 37 patients with cognitive complaints and 37 informants (either relatives or caregivers in close contact with the patients). Four ordinal scales concerning recent memory, verbal expression, initiative, and mood were correlated with the findings of a series of neuropsychological tests and questionnaires using the tau b coefficient. Results The scores for the patients on the scales were most strongly correlated with scores on the 15-item Geriatric Depression Scale (GDS-15), while the scores for the informants were most strongly correlated with scores on GDS-15, the Informant Questionnaire on Cognitive Decline, and the Functional Activities Questionnaire (FAQ). The most significant correlation was between the initiative scale from informants and FAQ (tau b=-0.591, p<0.001), and it was the only one that remained significant after correcting for multiple testing (p Holm=0.013). Conclusions Cognitive complaints from patients mainly reflect their mood, whilst informant reports mainly reflect both the functional ability and mood of the patients. PMID:28748677

  7. Cassini: The Journey and the Legacy

    KAUST Repository

    Porco, Carolyn

    2018-01-15

    An international mission to explore, in depth, the Saturnian system ヨthe planet Saturn and its magnetosphere, glorious rings, and many moons- begun over 27 years ago. After seven years of development, the Cassini spacecraft was launched in 1997, spent seven years trekking to Saturn, and finally entered Saturn orbit in the summer of 2004. In the course of its 13 years orbiting this ring world, Cassini returned over 450 thousand images, 635GB of data, and invaluable insights on the solar systemメs most splendid and scientifically rich planetary system. In this lecture, Carolyn Porco, the leader of the imaging science team on NASA\\'s Cassini mission, will delight her audience with a retrospective look at what has been learned from this profoundly successful mission and what its final legacy is likely to be.

  8. Peter Waterman and his scientific legacy

    Science.gov (United States)

    Mishchenko, Michael I.; Kahnert, Michael; Mackowski, Daniel W.; Wriedt, Thomas

    2013-01-01

    Peter C. Waterman, a giant figure in the theory of electromagnetic, acoustic, and elastic wave scattering, passed away on 3 June, 2012. In view of his fundamental contributions, which to a large degree have guided the progress of these disciplines over the past five decades and affected profoundly the multifaceted research published in the Journal of Quantitative Spectroscopy and Radiative Transfer (JQSRT), we felt that it would be appropriate to solicit papers for a special issue of JQSRT commemorating Peter Waterman's scientific legacy. This initiative was endorsed by the JQSRT management and has resulted in a representative collection of high-quality papers which have undergone the same peer scrutiny as any paper submitted to JQSRT.

  9. The Phenomenal Legacy of Rabindranath Tagore

    Directory of Open Access Journals (Sweden)

    Ketaki Kushari Dyson

    2010-12-01

    Full Text Available Belonging to a generation of Bengalis who received Tagore as an acknowledged classic of their tradition, I grew up reading his books, listening to his music, watching his dance-dramas, and writing poetry under the inspiration of his words. This youthful appreciation of Tagore eventually led to a deeper understanding of his stature as an artist and thinker, but it was only when I entered Tagore studies in a more formal manner that I realized how truly spectacular his achievements were from an international perspective. Tagore was fortunate in that his time, place, and circumstances allowed him to give a good run to the natural versatility and fecundity of his genius. He has thereby secured a rich and diverse legacy for us, which tends to mean different things to different groups of people.

  10. Could Freemium Models Work for Legacy Newspapers?

    DEFF Research Database (Denmark)

    Holm, Anna B.

    2016-01-01

    The newspaper industry has long been looking for sustainable business models for their digital editions. One of their popular choices is the freemium business model based on free and premium content with a paywall. However, freemium has not yet lived up to the expectation of the industry and has ...... not secured the revenues that industry players hoped for. This article discusses a number of the main principles of the freemium strategy and tactics, and highlights the critical points for legacy newspaper organisations.......The newspaper industry has long been looking for sustainable business models for their digital editions. One of their popular choices is the freemium business model based on free and premium content with a paywall. However, freemium has not yet lived up to the expectation of the industry and has...

  11. A methodology based on openEHR archetypes and software agents for developing e-health applications reusing legacy systems.

    Science.gov (United States)

    Cardoso de Moraes, João Luís; de Souza, Wanderley Lopes; Pires, Luís Ferreira; do Prado, Antonio Francisco

    2016-10-01

    In Pervasive Healthcare, novel information and communication technologies are applied to support the provision of health services anywhere, at anytime and to anyone. Since health systems may offer their health records in different electronic formats, the openEHR Foundation prescribes the use of archetypes for describing clinical knowledge in order to achieve semantic interoperability between these systems. Software agents have been applied to simulate human skills in some healthcare procedures. This paper presents a methodology, based on the use of openEHR archetypes and agent technology, which aims to overcome the weaknesses typically found in legacy healthcare systems, thereby adding value to the systems. This methodology was applied in the design of an agent-based system, which was used in a realistic healthcare scenario in which a medical staff meeting to prepare a cardiac surgery has been supported. We conducted experiments with this system in a distributed environment composed by three cardiology clinics and a center of cardiac surgery, all located in the city of Marília (São Paulo, Brazil). We evaluated this system according to the Technology Acceptance Model. The case study confirmed the acceptance of our agent-based system by healthcare professionals and patients, who reacted positively with respect to the usefulness of this system in particular, and with respect to task delegation to software agents in general. The case study also showed that a software agent-based interface and a tools-based alternative must be provided to the end users, which should allow them to perform the tasks themselves or to delegate these tasks to other people. A Pervasive Healthcare model requires efficient and secure information exchange between healthcare providers. The proposed methodology allows designers to build communication systems for the message exchange among heterogeneous healthcare systems, and to shift from systems that rely on informal communication of actors to

  12. Implementing Trauma-Informed Partner Violence Assessment in Family Planning Clinics.

    Science.gov (United States)

    Decker, Michele R; Flessa, Sarah; Pillai, Ruchita V; Dick, Rebecca N; Quam, Jamie; Cheng, Diana; McDonald-Mosley, Raegan; Alexander, Kamila A; Holliday, Charvonne N; Miller, Elizabeth

    2017-09-01

    Intimate partner violence (IPV) and reproductive coercion (RC) are associated with poor reproductive health. Little is known about how family planning clinics implement brief IPV/RC assessment interventions in practice. We describe the uptake and impact of a brief, trauma-informed, universal IPV/RC assessment and education intervention. Intervention implementation was evaluated via a mixed methods study among women ages 18 and up receiving care at one of two family planning clinics in greater Baltimore, MD. This mixed methods study entailed a quasi-experimental, single group pretest-posttest study with family planning clinic patients (baseline and exit survey n = 132; 3-month retention n = 68; retention rate = 52%), coupled with qualitative interviews with providers and patients (total n = 35). Two thirds (65%) of women reported receiving at least one element of the intervention on their exit survey immediately following the clinic-visit. Patients reported that clinic-based IPV assessment is helpful, irrespective of IPV history. Relative to those who reported neither, participants who received either intervention element reported greater perceived caring from providers, confidence in provider response to abusive relationships, and knowledge of IPV-related resources at follow-up. Providers and patients alike described the educational card as a valuable tool. Participants described trade-offs of paper versus in-person, electronic medical record-facilitated screening, and patient reluctance to disclose current situations of abuse. In real-world family planning clinic settings, a brief assessment and support intervention was successful in communicating provider caring and increasing knowledge of violence-related resources, endpoints previously deemed valuable by IPV survivors. Results emphasize the merit of universal education in IPV/RC clinical interventions over seeking IPV disclosure.

  13. Health information exchanges--Unfulfilled promise as a data source for clinical research.

    Science.gov (United States)

    Parker, Carol; Weiner, Michael; Reeves, Mathew

    2016-03-01

    To determine the use of health information exchange organizations (HIEs) to support and conduct clinical research. This scoping review included US-based studies published between January 2003 and March 2014 that used data from an HIE to address at least one of three categories of research: clinical or epidemiological research, financial evaluation, or utilization of health services. Eligibility was not restricted to research on HIEs. Studies with research questions outside of the evaluation of HIEs themselves were sought. Eighteen articles met final study inclusion criteria from an initial list of 847 hits. Fifteen studies addressed a clinical or epidemiological research question, 6 addressed a financial consideration, and 8 addressed a utilization issue. Considerable overlap was found among the research categories: 13 articles addressed more than one category. Of the eighteen included studies, only two used HIE data to answer a research objective that was NOT specific to HIE use. Research designs were varied and ranged from observational studies, such as cohort and cross-sectional studies, to randomized trials. The 18 articles represent the involvement of a small number of HIEs; 7 of the studies were from a single HIE. This review demonstrates that HIE-provided information is available and used to answer clinical or epidemiological, financial, or utilization-based research questions; however, the majority of the studies using HIE data are done with the primary goal of evaluating the use and impact of HIEs on health care delivery and outcomes. As HIEs mature and become integrated parts of the health care industry, the authors anticipate that fewer studies will be published that describe or validate the role of HIEs, and more will use HIEs as multi-institutional data sources for conducting clinical research and improving health services and clinical outcomes. Articles identified in this review indicate the limited extent that HIE data are being used for clinical

  14. Interface, information, interaction: a narrative review of design and functional requirements for clinical decision support.

    Science.gov (United States)

    Miller, Kristen; Mosby, Danielle; Capan, Muge; Kowalski, Rebecca; Ratwani, Raj; Noaiseh, Yaman; Kraft, Rachel; Schwartz, Sanford; Weintraub, William S; Arnold, Ryan

    2018-05-01

    Provider acceptance and associated patient outcomes are widely discussed in the evaluation of clinical decision support systems (CDSSs), but critical design criteria for tools have generally been overlooked. The objective of this work is to inform electronic health record alert optimization and clinical practice workflow by identifying, compiling, and reporting design recommendations for CDSS to support the efficient, effective, and timely delivery of high-quality care. A narrative review was conducted from 2000 to 2016 in PubMed and The Journal of Human Factors and Ergonomics Society to identify papers that discussed/recommended design features of CDSSs that are associated with the success of these systems. Fourteen papers were included as meeting the criteria and were found to have a total of 42 unique recommendations; 11 were classified as interface features, 10 as information features, and 21 as interaction features. Features are defined and described, providing actionable guidance that can be applied to CDSS development and policy. To our knowledge, no reviews have been completed that discuss/recommend design features of CDSS at this scale, and thus we found that this was important for the body of literature. The recommendations identified in this narrative review will help to optimize design, organization, management, presentation, and utilization of information through presentation, content, and function. The designation of 3 categories (interface, information, and interaction) should be further evaluated to determine the critical importance of the categories. Future work will determine how to prioritize them with limited resources for designers and developers in order to maximize the clinical utility of CDSS. This review will expand the field of knowledge and provide a novel organization structure to identify key recommendations for CDSS.

  15. The Quality of Clinical Information in Adverse Drug Reaction Reports by Patients and Healthcare Professionals : A Retrospective Comparative Analysis

    NARCIS (Netherlands)

    Rolfes, Leàn; van Hunsel, Florence; van der Linden, Laura; Taxis, Katja; van Puijenbroek, Eugène

    Introduction Clinical information is needed to assess the causal relationship between a drug and an adverse drug reaction (ADR) in a reliable way. Little is known about the level of relevant clinical information about the ADRs reported by patients. Objectives The aim was to determine to what extent

  16. Legacy Interventions With Patients with Co-Occurring Disorders: Legacy Definitions, Life Satisfaction, and Self-Efficacy.

    Science.gov (United States)

    Franklin, Felina C; Cheung, Monit

    2017-12-06

    Individuals with co-occurring disorders tend to avoid interaction with others. To instill hope, legacy intervention aims to highlight past experiences while managing life stressors for a positive outlook. Participants take part in legacy activities-crafting tangible projects and recording one's life events-in order to actualize a personal sense of legacy. This pre-posttest research tested whether legacy intervention in a partial hospital program (PHP) on reframing past experiences through creative activities could increase life satisfaction and self-efficacy among adults with co-occurring substance misuse and mental health symptoms. Eighty consented patients with co-occurring disorders were randomly assigned to two groups with 62 participants continuing: 37 in legacy intervention (LI) and 25 in partial hospital program only (PHP-only). LI participants were engaged in both PHP and legacy activities. Ten group sessions were held over the course of five weeks for cohorts of 10-15 adult patients in each intervention. Sense of legacy was measured to ensure that LI patients received the appropriate legacy dosage. With RANOVA analyses between and among three time points, life satisfaction was significantly higher in the LI group with group interaction effect over time. In terms of self-efficacy, both groups showed positive changes but no significant difference could be found between the two groups over time and the interaction (time X group) effect was not significant. The legacy definitions gathered from the LI group were consistent with existing literature and showed three additional themes: children's involvement, concreteness, and life continuation after death.

  17. LIFT: A Legacy InFormation retrieval Tool

    OpenAIRE

    BRITO, Kellyton dos Santos

    2007-01-01

    Atualmente, as empresas continuamente alteram suas práticas e seus processos a fim de permanecerem competitivas em seus negócios. Visto que os sistemas de informação não são mais tratados apenas como items adicionais, mas sim como parte do próprio negócio, eles devem acompanhar e dar suporte à dinâmica das empresas. Porém, a manutenção ou evolução dos sistemas ainda é um desafio, em especial quando se trata do entendimento dos sistemas legados, geralmente mal documentados. ...

  18. An information entropy model on clinical assessment of patients based on the holographic field of meridian

    Science.gov (United States)

    Wu, Jingjing; Wu, Xinming; Li, Pengfei; Li, Nan; Mao, Xiaomei; Chai, Lihe

    2017-04-01

    Meridian system is not only the basis of traditional Chinese medicine (TCM) method (e.g. acupuncture, massage), but also the core of TCM's basic theory. This paper has introduced a new informational perspective to understand the reality and the holographic field of meridian. Based on maximum information entropy principle (MIEP), a dynamic equation for the holographic field has been deduced, which reflects the evolutionary characteristics of meridian. By using self-organizing artificial neural network as algorithm, the evolutionary dynamic equation of the holographic field can be resolved to assess properties of meridians and clinically diagnose the health characteristics of patients. Finally, through some cases from clinical patients (e.g. a 30-year-old male patient, an apoplectic patient, an epilepsy patient), we use this model to assess the evolutionary properties of meridians. It is proved that this model not only has significant implications in revealing the essence of meridian in TCM, but also may play a guiding role in clinical assessment of patients based on the holographic field of meridians.

  19. Analyzing Statistical Mediation with Multiple Informants: A New Approach with an Application in Clinical Psychology

    Directory of Open Access Journals (Sweden)

    Lesther ePapa

    2015-11-01

    Full Text Available Testing mediation models is critical for identifying potential variables that need to be targeted to effectively change one or more outcome variables. In addition, it is now common practice for clinicians to use multiple informant (MI data in studies of statistical mediation. By coupling the use of MI data with statistical mediation analysis, clinical researchers can combine the benefits of both techniques. Integrating the information from MIs into a statistical mediation model creates various methodological and practical challenges. The authors review prior methodological approaches to MI mediation analysis in clinical research and propose a new latent variable approach that overcomes some limitations of prior approaches. An application of the new approach to mother, father, and child reports of impulsivity, frustration tolerance, and externalizing problems (N = 454 is presented. The results showed that frustration tolerance mediated the relationship between impulsivity and externalizing problems. Advantages and limitations of the new approach are discussed. The new approach can help clinical researchers overcome limitations of prior techniques. It allows for a more comprehensive and effective use of MI data when testing mediation models.

  20. Supporting Clinical Cognition: A Human-Centered Approach to a Novel ICU Information Visualization Dashboard.

    Science.gov (United States)

    Faiola, Anthony; Srinivas, Preethi; Duke, Jon

    2015-01-01

    Advances in intensive care unit bedside displays/interfaces and electronic medical record (EMR) technology have not adequately addressed the topic of visual clarity of patient data/information to further reduce cognitive load during clinical decision-making. We responded to these challenges with a human-centered approach to designing and testing a decision-support tool: MIVA 2.0 (Medical Information Visualization Assistant, v.2). Envisioned as an EMR visualization dashboard to support rapid analysis of real-time clinical data-trends, our primary goal originated from a clinical requirement to reduce cognitive overload. In the study, a convenience sample of 12 participants were recruited, in which quantitative and qualitative measures were used to compare MIVA 2.0 with ICU paper medical-charts, using time-on-task, post-test questionnaires, and interviews. Findings demonstrated a significant difference in speed and accuracy with the use of MIVA 2.0. Qualitative outcomes concurred, with participants acknowledging the potential impact of MIVA 2.0 for reducing cognitive load and enabling more accurate and quicker decision-making.

  1. Clinical utility of self-disclosure for adults who stutter: Apologetic versus informative statements.

    Science.gov (United States)

    Byrd, Courtney T; Croft, Robyn; Gkalitsiou, Zoi; Hampton, Elizabeth

    2017-12-01

    The purpose of the present study was to explore the clinical utility of self-disclosure, particularly, whether disclosing in an informative manner would result in more positive observer ratings of the speaker who stutters than either disclosing in an apologetic manner or choosing not to self-disclose at all. Observers (N=338) were randomly assigned to view one of six possible videos (i.e., adult male informative self-disclosure, adult male apologetic self-disclosure, adult male no self-disclosure, adult female informative self-disclosure, adult female apologetic self-disclosure, adult female no self-disclosure). Observers completed a survey assessing their perceptions of the speaker they viewed immediately after watching the video. Results suggest that self-disclosing in an informative manner leads to significantly more positive observer ratings than choosing not to self-disclose. In contrast, use of an apologetic statement, for the most part, does not yield significantly more positive ratings than choosing not to self-disclose. Clinicians should recommend their clients self-disclose in an informative manner to facilitate more positive observer perceptions. Copyright © 2017. Published by Elsevier Inc.

  2. [Development of a Web-based laboratory data browser integrated with heterogeneous clinical information].

    Science.gov (United States)

    Fujikawa, Jun

    2009-02-01

    To demonstrate the feasibility of a Web-based laboratory data browser integrated with heterogeneous clinical information in a hospital setting. A Java-based web application was developed in-house, using free open-source software. The server side manages queries to heterogeneous hospital databases containing patient data. Order entry information including laboratory test results, drug prescriptions, injection orders, physiological test orders and, imaging test orders, was retrieved from a replication database, and integrated with nursing data from a nursing system database. The result was visualized in a time-series table format, and accessed by web browsers on computers connected to the hospital intranet. The laboratory data browser system achieved practical response times over huge databases (> 90 million records). The medical personnel accepted the system well, and applied the system to various clinical situations. Integrating heterogeneous data from hospital databases in a Web-based laboratory data browser is a practical approach. Presenting relevant medical information simultaneously added value to the laboratory data, and may promote better medical management.

  3. The importance of clinical information in patients with gastroenteropancreatic neuroendocrine tumor.

    Science.gov (United States)

    Kudo, Atsushi; Akashi, Takumi; Kumagai, Jiro; Ban, Daisuke; Inokuchi, Mikito; Kojima, Kazuyuki; Kawano, Tatsuyuki; Tanaka, Shinji; Arii, Shigeki

    2012-01-01

    The WHO 2010 grading system for gastroenteropancreatic neuroendocrine tumors(GEP-NETs) is used to evaluate the malignant potential without clinicopathological information. This study was conducted to examine whether the new index is superior to the previous WHO 2004 classification, e.g.for well-differentiated endocrine carcinoma (WEC),involving clinical information. Between 2000 and 2011, 77 patients with sporadic GEP-NETs were treated at our institution and statistically estimated risk factors for overall survival (OS) were evaluated. Cox proportional hazards regression analyses were performed to estimate risk factors for OS. Overall 1-, 3- and 5-year survival rates were 92.8%, 78.4% and 76.0%, respectively. Median OS was 551 days in WEC-patients (odds ratio (OR)for OS=13.1, 95% confidence interval (CI)=2.90-59.5;p=0.001). The median OS was 813 days in G3-patients as compared with 1885 days in G1/G2-patients(OR for OS= 2.64, p=0.002). Multivariate analyses according to baseline characteristics revealed WEC as independent risk factor (OR=9.06, p=0.01). WEC was the only predictor of prognosis with an area under the receiver operating characteristic curves of 0.78(p=0.001). Clinical information was the best predictor for the prognosis of NETs.

  4. [Clinical outcomes research of Shuxuetong injection based on 59 287 cases in hospital information system].

    Science.gov (United States)

    Zhi, Ying-Jie; Zhang, Hui; Xie, Yan-Ming; Yang, Hu; Zhuang, Yan

    2012-09-01

    In order to find out the condition of patients who used the Shuxuetong injection and provide reference and guidance for clinical practice, we analyzed the data of related indicators in patients in the HIS based of the frequency analysis methods. In this study, we selected the hospitalized patient information in 20 hospital information systems (HIS). Reference to the integrated data warehouse build mode, including some information such as age, gender, cost categories of patients, route of administration etc. The average age of patients are 59-years-old , 56-years-old age and 71-years-old age are the two high peaks during the age distribution. Patients covered by health insurance accounted for 75.8%; Intravenous infusion in patients accounted for 95.76%; Patient are also diagnosed as cardiovascular and cerebrovascular diseases, such as hypertension, cerebral infarction, coronary heart diseas, combined with other medicines such as aspirin, insulin, heparin etc. Crowd using Shuxuetong injection mostly in the elderly population, most patients covered by health insurance, the route of administration conforms instructions basically, please attention the benefits and risks of the patients in the clinical practice.

  5. Features of assessment learners use to make informed self-assessments of clinical performance.

    Science.gov (United States)

    Sargeant, Joan; Eva, Kevin W; Armson, Heather; Chesluk, Ben; Dornan, Tim; Holmboe, Eric; Lockyer, Jocelyn M; Loney, Elaine; Mann, Karen V; van der Vleuten, Cees P M

    2011-06-01

    Conceptualisations of self-assessment are changing as its role in professional development comes to be viewed more broadly as needing to be both externally and internally informed through activities that enable access to and the interpretation and integration of data from external sources. Education programmes use various activities to promote learners' reflection and self-direction, yet we know little about how effective these activities are in 'informing' learners' self-assessments. This study aimed to increase understanding of the specific ways in which undergraduate and postgraduate learners used learning and assessment activities to inform self-assessments of their clinical performance. We conducted an international qualitative study using focus groups and drawing on principles of grounded theory. We recruited volunteer participants from three undergraduate and two postgraduate programmes using structured self-assessment activities (e.g. portfolios). We asked learners to describe their perceptions of and experiences with formal and informal activities intended to inform self-assessment. We conducted analysis as a team using a constant comparative process. Eighty-five learners (53 undergraduate, 32 postgraduate) participated in 10 focus groups. Two main findings emerged. Firstly, the perceived effectiveness of formal and informal assessment activities in informing self-assessment appeared to be both person- and context-specific. No curricular activities were considered to be generally effective or ineffective. However, the availability of high-quality performance data and standards was thought to increase the effectiveness of an activity in informing self-assessment. Secondly, the fostering and informing of self-assessment was believed to require credible and engaged supervisors. Several contextual and personal conditions consistently influenced learners' perceptions of the extent to which assessment activities were useful in informing self-assessments of

  6. Methods for Finding Legacy Wells in Residential and Commercial Areas

    Energy Technology Data Exchange (ETDEWEB)

    Hammack, Richard [National Energy Technology Lab. (NETL), Pittsburgh, PA, (United States); Veloski, Garret [National Energy Technology Lab. (NETL), Pittsburgh, PA, (United States)

    2016-06-06

    The objective of this study was to locate legacy wells in Versailles Borough so that the Pennsylvania Department of Environmental Protection could mitigate dangerous CH4 concentrations in the community by venting or plugging leaking wells.

  7. Sport and exercise medicine and the Olympic health legacy

    Directory of Open Access Journals (Sweden)

    Tew Garry A

    2012-07-01

    Full Text Available Abstract London 2012 is the first Olympic and Paralympic Games to explicitly try and develop socioeconomic legacies for which success indicators are specified - the highest profile of which was to deliver a health legacy by getting two million more people more active by 2012. This editorial highlights how specialists in Sport and Exercise Medicine can contribute towards increasing physical activity participation in the UK, as well as how the National Centre for Sport and Exercise Medicine might be a useful vehicle for delivering an Olympic health legacy. Key challenges are also discussed such as acquisition of funding to support new physical activity initiatives, appropriate allocation of resources, and how to assess the impact of legacy initiatives.

  8. An assessment of mine legacies and how to prevent them

    DEFF Research Database (Denmark)

    Pacheco Cueva, Vladimir

    of AMD is felt well beyond the mining district and the costs of prevention and remediation were found to be significant. Apart from environmental legacies, the mine also left a number of socio-economic legacies including: limited access to non-polluted water that results in San Sebastian residents...... devoting a high proportion of their income in obtaining water, lost opportunities due to the cessation of mining, uncertain land tenure situation and increasing growth of ASGM activities that exacerbate already existing environmental pollution due to use of mercury. The study also found that the state......The study seeks to enrich the growing literature on mine legacies by examining a case study of a small abandoned mine in Latin America. Using a combination of Rapid Rural Appraisal and secondary source analysis, this study assessed some of the most damaging legacies of the San Sebastian mine...

  9. Efficiency achievements from a user-developed real-time modifiable clinical information system.

    Science.gov (United States)

    Bishop, Roderick O; Patrick, Jon; Besiso, Ali

    2015-02-01

    This investigation was initiated after the introduction of a new information system into the Nepean Hospital Emergency Department. A retrospective study determined that the problems introduced by the new system led to reduced efficiency of the clinical staff, demonstrated by deterioration in the emergency department's (ED's) performance. This article is an investigation of methods to improve the design and implementation of clinical information systems for an ED by using a process of clinical team-led design and a technology built on a radically new philosophy denoted as emergent clinical information systems. The specific objectives were to construct a system, the Nepean Emergency Department Information Management System (NEDIMS), using a combination of new design methods; determine whether it provided any reduction in time and click burden on the user in comparison to an enterprise proprietary system, Cerner FirstNet; and design and evaluate a model of the effect that any reduction had on patient throughput in the department. The methodology for conducting a direct comparison between the 2 systems used the 6 activity centers in the ED of clerking, triage, nursing assessments, fast track, acute care, and nurse unit manager. A quantitative study involved the 2 systems being measured for their efficiency on 17 tasks taken from the activity centers. A total of 332 task instances were measured for duration and number of mouse clicks in live usage on Cerner FirstNet and in reproduction of the same Cerner FirstNet work on NEDIMS as an off-line system. The results showed that NEDIMS is at least 41% more efficient than Cerner FirstNet (95% confidence interval 21.6% to 59.8%). In some cases, the NEDIMS tasks were remodeled to demonstrate the value of feedback to create improvements and the speed and economy of design revision in the emergent clinical information systems approach. The cost of the effort in remodeling the designs showed that the time spent on remodeling is

  10. How Qualitative Research Informs Clinical and Policy Decision Making in Transplantation: A Review.

    Science.gov (United States)

    Tong, Allison; Morton, Rachael L; Webster, Angela C

    2016-09-01

    Patient-centered care is no longer just a buzzword. It is now widely touted as a cornerstone in delivering quality care across all fields of medicine. However, patient-centered strategies and interventions necessitate evidence about patients' decision-making processes, values, priorities, and needs. Qualitative research is particularly well suited to understanding the experience and perspective of patients, donors, clinicians, and policy makers on a wide range of transplantation-related topics including organ donation and allocation, adherence to prescribed therapy, pretransplant and posttransplant care, implementation of clinical guidelines, and doctor-patient communication. In transplantation, evidence derived from qualitative research has been integrated into strategies for shared decision-making, patient educational resources, process evaluations of trials, clinical guidelines, and policies. The aim of this article is to outline key concepts and methods used in qualitative research, guide the appraisal of qualitative studies, and assist clinicians to understand how qualitative research may inform their practice and policy.

  11. DEVELOPMENT OF CLINICAL SCENARIO’S INFORMATION MODEL IN THE MEDICAL SIMULATION CENTER

    Directory of Open Access Journals (Sweden)

    I. V. Tolmachyov

    2014-01-01

    Full Text Available There is the big issue in medical education which is students don’t have enough skills. Often even with theoretical knowledge graduate medical students need to improve their skills by working with patients. Obviously it can be a risk for patients and takes quite long time. This situation could be changed with applying simulation technologies in medical education. Medical education with virtual simulators allows reducing the time of skills development and improving the quality of training. The aims of this work are developing informational model and creating clinical scenarios of emergency states in the Medical Simulation Center.Objectives:– to analyze the process of scenario conducting;– to create clinical scenarios of emergency states (anaphylactic shock, hypovolemic shock, obstructive shock with specialist’s help.The scenarios consist of sections such as main aim, skills, required mannequins, preparation of the mannequins, preparation of medical equipment and instruments for the scenario, preparation of special materials, scenario description, guide for operator, information for trainees.By analyzing the process of scenario conducting the key participants were defined who are operator, assistant, trainer, trainees. Also the main scenario stages were defined. Based on the stages diagram of variants of scenario conducting was designed.As an example there are fragments of scenario “Obstructive shock – a pulmonary embolism” in this article. Learn skills are cognitive, technical, social ones.Results. This paper presents an analysis of the clinical scenario conducting. Information model was developed which based on object-oriented decomposition. The model is the diagram of variants of scenario conducting. Scenario’s structure for emergency states was formulated. The scenarios are anaphylactic shock, hypovolemic shock, obstructive shock (pulmonary embolism, tension pneumothorax, pulmonary edema, hypertensive crisis, respiratory

  12. Taking a Hike and Hucking the Stout: The Troublesome Legacy of the Sublime in Outdoor Recreation

    Directory of Open Access Journals (Sweden)

    Georg Drennig

    2013-12-01

    Full Text Available As Henry Thoreau noted in the 1850s, the simple act of walking can be loaded with political and spiritual meaning. Today, taking a hike as an act of engaging in outdoor recreation is equally non-trivial, and therefore subject of the following analysis. As this paper argues, outdoors recreation is still influenced by the legacy of the Sublime and its construction of wilderness. This troublesome legacy means that the cultural self-representation of outdoor sports – and the practice itself – lays claim to the environment in ways that are socially and sometimes even ethni-cally exclusive. This essay uses William Cronon’s critique of the cultural constructedness of wilderness as a point of departure to see how Western notions of sublime nature have an impact on spatial practice. The elevation of specific parts of the environ-ment into the category of wilderness prescribes certain uses and meanings as na-ture is made into an antidote against the ills of industrial civilization, and a place where the alienated individual can return to a more authentic self. This view then has become a troublesome legacy, informing the cultural self-representation of those uses of “wilderness” that are known as outdoor recreation. In its cultural production, outdoors recreation constructs “healthy” and “athlet-ic” bodies exercising in natural settings and finding refuge from the everyday al-ienation of postmodern society. Yet these bodies are conspicuously white, and the obligatory equipment and fashion expensive. Outdoor recreation is a privileged assertion of leisure, often denoting an urban, affluent, and white, background of the practitioner. These practitioners then lay exclusive claim on the landscapes they use. As trivial as taking a hike or any other form of outdoors recreation may thus seem, they put a cultural legacy into practice that is anything but trivial.

  13. Legacy Clinical Data from the Epo TBI Trial

    Science.gov (United States)

    2016-06-01

    FITBIR. 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF RESPONSIBLE PERSON USAMRMC a...investigators through the Federal Interagency Traumatic Brain Injury (FITBIR) Informatics System. This trial was funded by National Institute of Neurological

  14. Maternal pertussis immunisation: clinical gains and epidemiological legacy.

    Science.gov (United States)

    Bento, Ana I; King, Aaron A; Rohani, Pejman

    2017-04-13

    The increase in whooping cough (pertussis) incidence in many countries with high routine vaccination coverage is alarming, with incidence in the US reaching almost 50,000 reported cases per year, reflecting incidence levels not seen since the 1950s. While the potential explanations for this resurgence remain debated, we face an urgent need to protect newborns, especially during the time window between birth and the first routine vaccination dose. Maternal immunisation has been proposed as an effective strategy for protecting neonates, who are at higher risk of severe pertussis disease and mortality. However, if maternally derived antibodies adversely affect the immunogenicity of the routine schedule, through blunting effects, we may observe a gradual degradation of herd immunity. 'Wasted' vaccines would result in an accumulation of susceptible children in the population, specifically leading to an overall increase in incidence in older age groups. In this Perspective, we discuss potential long-term epidemiological effects of maternal immunisation, as determined by possible immune interference outcomes. This article is copyright of The Authors, 2017.

  15. Rett Syndrome and the Ongoing Legacy of Close Clinical Observation.

    Science.gov (United States)

    Zoghbi, Huda Y

    2016-10-06

    This year marks the 50 th anniversary of the publication of Andreas Rett's report on 22 girls who developed a peculiar and devastating neurological disorder that later came to bear his name. On this occasion, we reflect on the progress that has occurred in understanding Rett Syndrome, development of potential treatments, and the ramifications that Rett research has had on the fields of neurobiology and genetics. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Olympic Health Legacy; Essentials for Lasting Development of Host City

    Science.gov (United States)

    Lee, Young-Hee; Kim, Jung Moon

    2013-01-01

    The purpose of the Olympic Games should be to contribute to the social development by leaving behind economic, cultural and environmental legacies to the hosting region. While tangible examples such as venues are often recognized as representative legacies of the Olympics, intangible aspects such as the environment, culture, policy and human resources have been gaining in importance. The Olympic Games, at its most fundamental level, is a sporting event. Sports not only is closely related to the physical health, but is also instrumental to fostering mental health through inspiration. One of the most important sports legacies was the general change in the population’s perception on sports and physical activities; due to such change, people were able to enjoy sports as part of healthy and active everyday life and benefit physically. However, compared to tangible legacies such as the facilities, social legacies such as the general health and their planning, execution and achievements are hard to monitor. Therefore, for the Olympics to leave behind socio-cultural legacies that contribute to the development of the hosting region, there must be a thorough business plan that takes into account region-specific purpose, and is divided into stages such as before, during and after the Games. Should the 2018 Winter Olympic Games hope to create continuing contribution to its hosting region, it must leave behind ‘Health Legacies’ that will enhance the happiness of the hosting region’s population. To this end, establishment of region-specific purpose and systematic promotion of business via detailed analysis of precedents are a must. This article aim to review the health legacy endeavors of past host cities and suggest the appropriate forms of health legacy of 2018 Pyeongchang Winter Olympic and Paralympic Games. PMID:26064832

  17. California's digital divide: clinical information systems for the haves and have-nots.

    Science.gov (United States)

    Miller, Robert H; D'Amato, Katherine; Oliva, Nancy; West, Christopher E; Adelson, Joel W

    2009-01-01

    Strong barriers prevent the financing of clinical information systems (CIS) in health care delivery system organizations in market segments serving disadvantaged patients. These segments include community health centers, public hospitals, unaffiliated rural hospitals, and some Medicaid-oriented solo and small-group medical practices. Policy interventions such as loans, grants, pay-for-performance and other reimbursement changes, and support services assistance will help lower these barriers. Without intervention, progress will be slow and worsen health care disparities between the advantaged and disadvantaged populations.

  18. Discrepancy between information reported by the victims of sexual assaults and clinical forensic findings

    DEFF Research Database (Denmark)

    Scherer, Susanne; Hansen, Steen Holger; Lynnerup, Niels

    2014-01-01

    INTRODUCTION: From the clinical forensic examination reports made at the Department of Forensic Medicine, the University of Copenhagen, in 2007 concerning rape, attempted rape and sexual assault (RAS), information about the assault, including both violence and the perpetrator's line of sexual......, typically one. Anal penetration or attempted anal penetration is increasing. This will often cause genito-anal LE. This finding stresses the importance that these examinations take place where both forensic and health-care expertise are offered. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

  19. A Hierarchical Framework for Evaluation and Informed Decision Making Regarding Smartphone Apps for Clinical Care.

    Science.gov (United States)

    Torous, John Blake; Chan, Steven Richard; Gipson, Shih Yee-Marie Tan; Kim, Jung Won; Nguyen, Thuc-Quyen; Luo, John; Wang, Philip

    2018-02-15

    With thousands of smartphone apps targeting mental health, it is difficult to ignore the rapidly expanding use of apps in the treatment of psychiatric disorders. Patients with psychiatric conditions are interested in mental health apps and have begun to use them. That does not mean that clinicians must support, endorse, or even adopt the use of apps, but they should be prepared to answer patients' questions about apps and facilitate shared decision making around app use. This column describes an evaluation framework designed by the American Psychiatric Association to guide informed decision making around the use of smartphone apps in clinical care.

  20. Association of Informal Clinical Integration of Physicians With Cardiac Surgery Payments.

    Science.gov (United States)

    Funk, Russell J; Owen-Smith, Jason; Kaufman, Samuel A; Nallamothu, Brahmajee K; Hollingsworth, John M

    2017-12-27

    To reduce inefficiency and waste associated with care fragmentation, many current programs target greater clinical integration among physicians. However, these programs have led to only modest Medicare spending reductions. Most programs focus on formal integration, which often bears little resemblance to actual physician interaction patterns. To examine how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. National Medicare data from January 1, 2008, through December 31, 2011, identified 253 545 Medicare beneficiaries (aged ≥66 years) from 1186 health systems where Medicare beneficiaries underwent coronary artery bypass grafting (CABG) procedures. Interactions were mapped between all physicians who treated these patients-including primary care physicians and surgical and medical specialists-within a health system during their surgical episode. The level of informal integration was measured in these networks of interacting physicians. Multivariate regression models were fitted to evaluate associations between payments for each surgical episode made on a beneficiary's behalf and the level of informal integration in the health system where the patient was treated. The informal integration level of a health system. Price-standardized total surgical episode and component payments. The total 253 545 study participants included 175 520 men (69.2%; mean [SD] age, 74.51 [5.75] years) and 78 024 women (34.3%; 75.67 [5.91] years). One beneficiary of the 253 545 participants did not have sex information. The low level of informal clinical integration included 84 598 patients (33.4%; mean [SD] age, 75.00 [5.93] years); medium level, 84 442 (33.30%; 74.94 [5.87] years); and high level, 84 505 (33.34%; 74.66 [5.72] years) (P integration levels varied across health systems. After adjusting for patient, health-system, and community factors, higher levels

  1. Information Seeking Behaviour of Parents of Paediatric Patients for Clinical Decision Making: The Central Role of Information Literacy in a Participatory Setting

    Science.gov (United States)

    Kostagiolas, Petros; Martzoukou, Konstantina; Georgantzi, Georgia; Niakas, Dimitris

    2013-01-01

    Introduction: This study investigated the information seeking behaviour and needs of parents of paediatric patients and their motives for seeking Internet-based information. Method: A questionnaire survey of 121 parents was conducted in a paediatric clinic of a Greek university hospital. Analysis: The data were analysed using SPSS; descriptive…

  2. Type of evidence behind point-of-care clinical information products: a bibliometric analysis.

    Science.gov (United States)

    Ketchum, Andrea M; Saleh, Ahlam A; Jeong, Kwonho

    2011-02-18

    Point-of-care (POC) products are widely used as information reference tools in the clinical setting. Although usability, scope of coverage, ability to answer clinical questions, and impact on health outcomes have been studied, no comparative analysis of the characteristics of the references, the evidence for the content, in POC products is available. The objective of this study was to compare the type of evidence behind five POC clinical information products. This study is a comparative bibliometric analysis of references cited in monographs in POC products. Five commonly used products served as subjects for the study: ACP PIER, Clinical Evidence, DynaMed, FirstCONSULT, and UpToDate. The four clinical topics examined to identify content in the products were asthma, hypertension, hyperlipidemia, and carbon monoxide poisoning. Four indicators were measured: distribution of citations, type of evidence, product currency, and citation overlap. The type of evidence was determined based primarily on the publication type found in the MEDLINE bibliographic record, as well as the Medical Subject Headings (MeSH), both assigned by the US National Library of Medicine. MeSH is the controlled vocabulary used for indexing articles in MEDLINE/PubMed. FirstCONSULT had the greatest proportion of references with higher levels of evidence publication types such as systematic review and randomized controlled trial (137/153, 89.5%), although it contained the lowest total number of references (153/2330, 6.6%). DynaMed had the largest total number of references (1131/2330, 48.5%) and the largest proportion of current (2007-2009) references (170/1131, 15%). The distribution of references cited for each topic varied between products. For example, asthma had the most references listed in DynaMed, Clinical Evidence, and FirstCONSULT, while hypertension had the most references in UpToDate and ACP PIER. An unexpected finding was that the rate of citation overlap was less than 1% for each topic

  3. A standards-based clinical information system for HIV/AIDS.

    Science.gov (United States)

    Stitt, F W

    1995-01-01

    To create a clinical data repository to interface the Veteran's Administration (VA) Decentralized Hospital Computer Program (DHCP) and a departmental clinical information system for the management of HIV patients. This system supports record-keeping, decision-making, reporting, and analysis. The database development was designed to overcome two impediments to successful implementations of clinical databases: (i) lack of a standard reference data model, and; (ii) lack of a universal standard for medical concept representation. Health Level Seven (HL7) is a standard protocol that specifies the implementation of interfaces between two computer applications (sender and receiver) from different vendors or sources of electronic data exchange in the health care environment. This eliminates or substantially reduces the custom interface programming and program maintenance that would otherwise be required. HL7 defines the data to be exchanged, the timing of the interchange, and the communication of errors to the application. The formats are generic in nature and must be configured to meet the needs of the two applications involved. The standard conceptually operates at the seventh level of the ISO model for Open Systems Interconnection (OSI). The OSI simply defines the data elements that are exchanged as abstract messages, and does not prescribe the exact bit stream of the messages that flow over the network. Lower level network software developed according to the OSI model may be used to encode and decode the actual bit stream. The OSI protocols are not universally implemented and, therefore, a set of encoding rules for defining the exact representation of a message must be specified. The VA has created an HL7 module to assist DHCP applications in exchanging health care information with other applications using the HL7 protocol. The DHCP HL7 module consists of a set of utility routines and files that provide a generic interface to the HL7 protocol for all DHCP applications

  4. Who cares? The lost legacy of Archie Cochrane.

    Science.gov (United States)

    Askheim, Clemet; Sandset, Tony; Engebretsen, Eivind

    2017-03-01

    Over the last 20 years, the evidence-based medicine (EBM) movement has sought to develop standardised approaches to patient treatment by drawing on research results from randomised controlled trials (RCTs). The Cochrane Collaboration and its eponym, Archie Cochrane, have become symbols of this development, and Cochrane's book Effectiveness and Efficiency from 1972 is often referred to as the first sketch of what was to become EBM. In this article, we claim that this construction of EBM's historical roots is based on a selective reading of Cochrane's text. Through a close reading of this text, we show that the principal aim of modern EBM, namely to warrant clinical decisions based on evidence drawn from RCTs, is not part of Cochrane's original project. He had more modest ambitions for what RCTs can accomplish, and, more importantly, he was more concerned with care and equality than are his followers in the EBM movement. We try to reconstruct some of Cochrane's lost legacy and to articulate some of the important silences in Effectiveness and Efficiency From these clues it might be possible, we argue, to remodel EBM in a broader, more pluralistic, more democratic and less authoritarian manner. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. What can we learn about brain donors? Use of clinical information in human postmortem brain research.

    Science.gov (United States)

    Sullivan, Kathleen; Pantazopoulos, Harry; Liebson, Elizabeth; Woo, T-U W; Baldessarini, Ross J; Hedreen, John; Berretta, Sabina

    2018-01-01

    Postmortem studies on the human brain reside at the core of investigations on neurologic and psychiatric disorders. Ground-breaking advances continue to be made on the pathologic basis of many of these disorders, at molecular, cellular, and neural connectivity levels. In parallel, there is increasing emphasis on improving methods to extract relevant demographic and clinical information about brain donors and, importantly, translate it into measures that can reliably and effectively be incorporated in the design and data analysis of postmortem human investigations. Here, we review the main source of information typically available to brain banks and provide examples on how this information can be processed. In particular, we discuss approaches to establish primary and secondary diagnoses, estimate exposure to therapeutic treatment and substance abuse, assess agonal status, and use time of death as a proxy in investigations on circadian rhythms. Although far from exhaustive, these considerations are intended as a contribution to ongoing efforts from tissue banks and investigators aimed at establishing robust, well-validated methods for collecting and standardizing information about brain donors, further strengthening the scientific rigor of human postmortem studies. Copyright © 2018 Elsevier B.V. All rights reserved.

  6. [From library to clinical decision support systems: access of general practitioner to quality information].

    Science.gov (United States)

    Fauquert, B

    2012-09-01

    Since 2003, the following tools have been implemented in Belgium for improving the access of general practioners to the EBM literature: the Digital Library for Health and the evidence-linker of the CEBAM, the portal EBMPracticeNet.be and the multidimensional electronic clinical decision support EBMeDS. The aim of this article is to show the progress achieved in the information dissemination toward the belgian general practioners, particularly the access from the electronic health record. From the literature published these last years, the opportunities cited by the users are for using EBM and the strong willingness for using these literature access in the future; the limits are the medical data coding, the irrelevance of the search results, the alerts fatigue induced by EBMeDS. The achievements done and planned for the new EBMPracticeNet guidelines portal and the EBMeDS system are explained in the aim of informing belgian healthcare professionals. These projects are claiming for lauching a participatory process in the production and dissemination of EBM information. The discussion is focused on the belgian healthcare system advantages, the solutions for a reasonable implementation of these projects and for increasing the place of an evidence-based information in the healthcare decision process. Finally the input of these projects to the continuing medical education and to the healthcare quality are discussed, in a context of multifactorial interaction healthcare design (complexity design).

  7. ICT-Enabled Time-Critical Clinical Practices: Examining the Affordances of an Information Processing Solution

    Directory of Open Access Journals (Sweden)

    Leonard Hoon

    2015-11-01

    Full Text Available In this paper, we present a case study of a decision-support system deployment at The Alfred Hospital, in Melbourne, Australia. This work outlines Information and Communications Technology (ICT affordances and their actualisations in time-critical clinical practices to enable better information processing. From our study findings, we present a stage-wise model describing the role played by ICT in the context of the Trauma Centre practices. This addresses a knowledge gap surrounding the role and impact of ICT in the delivery of quality improvements to processes and culture in time-critical environments, amid increasing expenditure on ICT globally. Our model has implications for research and practice, such that we observe for the first time how information standards, synergy and renewal are developed between the system and its users in order to reduce error rates in the healthcare context. Through the study findings, we demonstrate that healthcare quality can be further refined as ICT allows for knowledge dissemination and informs existing practices.

  8. Pharmacists' journey to clinical pharmacy practice in Ethiopia: Key informants' perspective.

    Science.gov (United States)

    Mekonnen, Alemayehu B; Yesuf, Elias A; Odegard, Peggy S; Wega, Sultan S

    2013-01-01

    Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding and supplying drugs to roles more directly in caring for patients and providing medication consultation to staff. This area of practice is at the infant stage in Ethiopia. The aim of this study was to explore key informants' perspective in the implementation of clinical pharmacy practice in Jimma University Specialized Hospital, Ethiopia. A qualitative study was conducted through in-depth interviews with the heads of departments (internal medicine, paediatrics, surgery, nurse, pharmacy, medical director, administration) and pharmacy student representatives. Qualitative data analysis was done after audiotapes were transcribed verbatim and notes were compiled. All of the respondents interviewed express diverse and conflicting perspectives on pharmacists' role, varying from a health-care professional to a business man. Despite this, the current pace of change worldwide takes the professions' mission to that of a provider of clinical pharmacy services. The data ascertained the change in pharmacy practice, and integrating clinical pharmacy services within the health-care system should be seen as a must. Pharmacists should delineate from a business perspective and focus on widening the scope of the profession of pharmacy and should come close to the patient to serve directly. Although the perception of people on traditional roles of pharmacists was weak, there were promising steps in developing clinical pharmacy practice within the health-care system. Moreover, the results of this study revealed a high demand for this service among health-care providers.

  9. BRIDG: a domain information model for translational and clinical protocol-driven research.

    Science.gov (United States)

    Becnel, Lauren B; Hastak, Smita; Ver Hoef, Wendy; Milius, Robert P; Slack, MaryAnn; Wold, Diane; Glickman, Michael L; Brodsky, Boris; Jaffe, Charles; Kush, Rebecca; Helton, Edward

    2017-09-01

    It is critical to integrate and analyze data from biological, translational, and clinical studies with data from health systems; however, electronic artifacts are stored in thousands of disparate systems that are often unable to readily exchange data. To facilitate meaningful data exchange, a model that presents a common understanding of biomedical research concepts and their relationships with health care semantics is required. The Biomedical Research Integrated Domain Group (BRIDG) domain information model fulfills this need. Software systems created from BRIDG have shared meaning "baked in," enabling interoperability among disparate systems. For nearly 10 years, the Clinical Data Standards Interchange Consortium, the National Cancer Institute, the US Food and Drug Administration, and Health Level 7 International have been key stakeholders in developing BRIDG. BRIDG is an open-source Unified Modeling Language-class model developed through use cases and harmonization with other models. With its 4+ releases, BRIDG includes clinical and now translational research concepts in its Common, Protocol Representation, Study Conduct, Adverse Events, Regulatory, Statistical Analysis, Experiment, Biospecimen, and Molecular Biology subdomains. The model is a Clinical Data Standards Interchange Consortium, Health Level 7 International, and International Standards Organization standard that has been utilized in national and international standards-based software development projects. It will continue to mature and evolve in the areas of clinical imaging, pathology, ontology, and vocabulary support. BRIDG 4.1.1 and prior releases are freely available at https://bridgmodel.nci.nih.gov . © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  10. Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis.

    Science.gov (United States)

    Veinot, Tiffany C; Senteio, Charles R; Hanauer, David; Lowery, Julie C

    2017-09-02

    To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All

  11. Nutrient pressures and legacies in a small agricultural karst catchment

    Science.gov (United States)

    Fenton, Owen; Mellander, Per-Erik; Daly, Karen; Wall, David P.; Jahangir, Mohammad M.; Jordan, Phil; Hennessey, Deirdre; Huebsch, Manuela; Blum, Philipp; Vero, Sara; Richards, Karl G.

    2017-04-01

    Catchments with short subsurface hydrologic time lags are commonly at risk for leached losses of nitrogen (N) and phosphorus (P). Such catchments are suitable for testing the efficacy of mitigation measures as management changes. In some sites, however, N and P may be retained in the soil and subsoil layers, and then leached, mobilised or attenuated over time. This biogeochemical time lag may therefore have enduring effects on the water quality. The aim of this study was to improve the understanding of N and P retention, attenuation and distribution of subsurface pathway in an intensively managed agricultural karst catchment with an oxidised aquifer setting, and also to inform how similar sites can be managed in the future. Results showed that in the years pre-2000 slurry from an on-site integrated pig production unit had been applied at rates of 33 t/ha annually, which supplied approximately 136 kg/ha total N and approximately 26 kg/ha total P annually. This practice contributed to large quantities of N (total N and NH4-N) and elevated soil test P (Morgan extractable P), present to a depth of 1 m. This store was augmented by recent surpluses of 263 kg N/ha, with leached N to groundwater of 82.5 kg N/ha and only 2.5 kg N/ha denitrified in the aquifer thereafter. Sub hourly spring data showed the largest proportion of N loss from small (54-88%) and medium fissure pathways (7- 21%) with longer hydrologic time lags, with smallest loads from either large fissure (1-13%) or conduit (1-10%) pathways with short hydrologic time lags (reaction time at the spring from onset of a rainfall event is within hours). Although soils were saturated in P and in mobile forms to 0.5 m, dissolved reactive P concentrations in groundwater remained low due to Ca and Mg limestone chemistry. Under these conditions a depletion of the legacy store, with no further inputs, would take approximately 50 years and with NO3-N concentrations in the source area dropping to levels that could sustain

  12. Strategies to exclude subjects who conceal and fabricate information when enrolling in clinical trials

    Directory of Open Access Journals (Sweden)

    Eric G. Devine

    2017-03-01

    Full Text Available Clinical trials within the US face an increasing challenge with the recruitment of quality candidates. One readily available group of subjects that have high rates of participation in clinical research are subjects who enroll in multiple trials for the purpose of generating income through study payments. Aside from issues of safety and generalizability, evidence suggests that these subjects employ methods of deception to qualify for the strict entrance criteria of some studies, including concealing information and fabricating information. Including these subjects in research poses a significant risk to the integrity of data quality and study designs. Strategies to limit enrollment of subjects whose motivation is generating income have not been systematically addressed in the literature. The present paper is intended to provide investigators with a range of strategies for developing and implementing a study protocol with protections to minimize the enrollment of subjects whose primary motivation for enrolling is to generate income. This multifaceted approach includes recommendations for advertising strategies, payment strategies, telephone screening strategies, and baseline screening strategies. The approach also includes recommendations for attending to inconsistent study data and subject motivation. Implementing these strategies may be more or less important depending upon the vulnerability of the study design to subject deception. Although these strategies may help researchers exclude subjects with a higher rate of deceptive practices, widespread adoption of subject registries would go a long way to decrease the chances of subjects enrolling in multiple studies or more than once in the same study.

  13. Core Themes in Music Therapy Clinical Improvisation: An Arts-Informed Qualitative Research Synthesis.

    Science.gov (United States)

    Meadows, Anthony; Wimpenny, Katherine

    2017-07-01

    Although clinical improvisation continues to be an important focus of music therapy research and practice, less attention has been given to integrating qualitative research in this area. As a result, this knowledge base tends to be contained within specific areas of practice rather than integrated across practices and approaches. This qualitative research synthesis profiles, integrates, and re-presents qualitative research focused on the ways music therapists and clients engage in, and make meaning from, clinical improvisation. Further, as a conduit for broadening dialogues, opening up this landscape fully, and sharing our response to the analysis and interpretation process, we present an arts-informed re-presentation of this synthesis. Following an eight-step methodological sequence, 13 qualitative studies were synthesized. This included reciprocal and refutational processes associated with synthesizing the primary studies, and additional steps associated with an arts-informed representation. Three themes, professional artistry, performing self, and meaning-making, are presented. Each theme is explored and exemplified through the selected articles, and discussed within a larger theoretical framework. An artistic re-presentation of the data is also presented. Music therapists use complex frameworks through which to engage clients in, and make meaning from, improvisational experiences. Artistic representation of the findings offers an added dimension to the synthesis process, challenging our understanding of representation, and thereby advancing synthesis methodology. © the American Music Therapy Association 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  14. Assessment of commercial NLP engines for medication information extraction from dictated clinical notes.

    Science.gov (United States)

    Jagannathan, V; Mullett, Charles J; Arbogast, James G; Halbritter, Kevin A; Yellapragada, Deepthi; Regulapati, Sushmitha; Bandaru, Pavani

    2009-04-01

    We assessed the current state of commercial natural language processing (NLP) engines for their ability to extract medication information from textual clinical documents. Two thousand de-identified discharge summaries and family practice notes were submitted to four commercial NLP engines with the request to extract all medication information. The four sets of returned results were combined to create a comparison standard which was validated against a manual, physician-derived gold standard created from a subset of 100 reports. Once validated, the individual vendor results for medication names, strengths, route, and frequency were compared against this automated standard with precision, recall, and F measures calculated. Compared with the manual, physician-derived gold standard, the automated standard was successful at accurately capturing medication names (F measure=93.2%), but performed less well with strength (85.3%) and route (80.3%), and relatively poorly with dosing frequency (48.3%). Moderate variability was seen in the strengths of the four vendors. The vendors performed better with the structured discharge summaries than with the clinic notes in an analysis comparing the two document types. Although automated extraction may serve as the foundation for a manual review process, it is not ready to automate medication lists without human intervention.

  15. Quality of information about success rates provided on assisted reproductive technology clinic websites in Australia and New Zealand.

    Science.gov (United States)

    Hammarberg, Karin; Prentice, Tess; Purcell, Isabelle; Johnson, Louise

    2017-11-12

    Many factors influence the chance of having a baby with assisted reproductive technologies (ART). A 2016 Australian Competition and Consumer Commission (ACCC) investigation concluded that ART clinics needed to improve the quality of information they provide about chance of ART success. To evaluate changes in the quality of information about success rates provided on the websites of ART clinics in Australia and New Zealand before and after the ACCC investigation. Desktop audits of websites of ART clinics in Australia and New Zealand were conducted in 2016 and 2017 and available information about success rates was scored using a matrix with eight variables and a possible range of scores of 0-9. Of the 54 clinic websites identified in 2016, 32 had unique information and were eligible to be audited. Of these, 29 were also eligible to be audited in 2017. While there was a slight improvement in the mean score from 2016 to 2017 (4.93-5.28), this was not statistically significantly different. Of the 29 clinics, 14 had the same score on both occasions, 10 had a higher and five a lower information quality score in 2017. To allow people who consider ART to make informed decisions about treatment they need comprehensive and accurate information about what treatment entails and what the likely outcomes are. As measured by a scoring matrix, most ART clinics had not improved the quality of the information about success rates following the ACCC investigation. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  16. Seeking informed consent to Phase I cancer clinical trials: identifying oncologists' communication strategies.

    Science.gov (United States)

    Brown, Richard; Bylund, Carma L; Siminoff, Laura A; Slovin, Susan F

    2011-04-01

    Phase I clinical trials are the gateway to effective new cancer treatments. Many physicians have difficulty when discussing Phase I clinical trials. Research demonstrates evidence of suboptimal communication. Little is known about communication strategies used by oncologists when recruiting patients for Phase I trials. We analyzed audio recorded Phase I consultations to identify oncologists' communication strategies. Subjects were consecutive cancer patients from six medical oncologists attending one of three outpatient clinics at a major Cancer Center in the United States. Sixteen patients signed informed consent for audio recording of their consultations in which a Phase I study was discussed. These were transcribed in full and analyzed to identify communication strategies. Six communication themes emerged from the analysis: (1) orienting, (2) educating patients, (3) describing uncertainty and prognosis, (4) persuading, (5) decision making, and (6) making a treatment recommendation. As expected, although there was some common ground between communication in Phase I and the Phase II and III settings, there were distinct differences. Oncologists used persuasive communication, made explicit recommendations, or implicitly expressed a treatment preference and were choice limiting. This highlights the complexity of discussing Phase I trials and the need to develop strategies to aid oncologists and patients in these difficult conversations. Patient centered communication that values patient preferences while preserving the oncologist's agenda can be a helpful approach to these discussions. Copyright © 2010 John Wiley & Sons, Ltd.

  17. Medication safety: using incident data analysis and clinical focus groups to inform educational needs.

    Science.gov (United States)

    Hesselgreaves, Hannah; Watson, Anne; Crawford, Andy; Lough, Murray; Bowie, Paul

    2013-02-01

    Medication-related safety incidents are a source of concern to patients, policy makers and clinicians. The role of education in improving safety-critical practices in health care is poorly appreciated. This pilot study aimed to initiate collective discussion among professional groups of clinical staff about a range of medicine-related patient safety issues which were identified from a local incident reporting system. In engaging staff to collectively reflect on reported medication incidents we attempted to uncover a deeper understanding of local contextual issues and potential educational needs. A mixed method study was conducted involving categorical analysis of 1058 medication incident reports (Phase 1) and the use of three mixed focus groups of clinical staff (Phase 2) in three acute hospitals in one locality in NHS Scotland. Focus group transcript analysis produced four main themes (e.g. the medical role) and 12 related sub-themes (e.g. pharmacological education and skill mix for administration of medicines) concerning medication-related practices and possible educational interventions. While it is necessary to review reported incident data and disseminate the educational messages for the improvement of quality, this traditional risk management process is inadequate on its own. Reporting systems can be enhanced by collective examination of reported information about medicines by local clinical teams. We identified a strong message from the focus groups for learning about each other and from each other, and that the method piloted may be an important inter-professional mechanism for improvement. © 2011 Blackwell Publishing Ltd.

  18. [Concordance in the registry of dementia among the main sources of clinical information].

    Science.gov (United States)

    Marta-Moreno, Javier; Obón-Azuara, Blanca; Gimeno-Felíu, Luis; Achkar-Tuglaman, Nesib Nicolás; Poblador-Plou, Beatriz; Calderón-Larrañaga, Amaia; Prados-Torres, Alexandra

    2016-01-01

    The objective of this work was to analyse the concordance in the registry of dementia among the main sources of clinical information, with the aim of determining their usefulness for epidemiological and clinical research. Descriptive study of patients assigned to the Aragon Health Service in 2010 (n=1,344,891). (i)the pharmacy billing database (n=9,392); (ii)Primary Care electronic health records (EHR) (n=9,471), and (iii)the hospital minimum basic data set (n=3,289). When studying the concordance of the databases, the group of patients with a specific treatment for dementia (i.e., acetylcholinesterase inhibitors and/or memantine) was taken as the reference. The diagnosis in Primary Care was missing for 47.3% of patients taking anti-dementia drugs. The same occurred with 38.3% of dementia patients admitted to hospital during the study year. Among patients with a diagnosis of dementia in the EHR, only half (52.3%) was under treatment for this condition. This percentage decreased to 34.4% in patients with the diagnosis registered in the hospital database. The weak concordance in the registry of the dementia diagnosis between the main health information systems makes their use and analysis more complex, and supports the need to include all available health data sources in order to gain a global picture of the epidemiological and clinical reality of this health condition. Copyright © 2015 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Measuring the process and quality of informed consent for clinical research: development and testing.

    Science.gov (United States)

    Cohn, Elizabeth Gross; Jia, Haomiao; Smith, Winifred Chapman; Erwin, Katherine; Larson, Elaine L

    2011-07-01

    To develop and assess the reliability and validity of an observational instrument, the Process and Quality of Informed Consent (P-QIC). A pilot study of the psychometrics of a tool designed to measure the quality and process of the informed consent encounter in clinical research. The study used professionally filmed, simulated consent encounters designed to vary in process and quality. A major urban teaching hospital in the northeastern region of the United States. 63 students enrolled in health-related programs participated in psychometric testing, 16 students participated in test-retest reliability, and 5 investigator-participant dyads were observed for the actual consent encounters. For reliability and validity testing, students watched and rated videotaped simulations of four consent encounters intentionally varied in process and content and rated them with the proposed instrument. Test-retest reliability was established by raters watching the videotaped simulations twice. Inter-rater reliability was demonstrated by two simultaneous but independent raters observing an actual consent encounter. The essential elements of information and communication for informed consent. The initial testing of the P-QIC demonstrated reliable and valid psychometric properties in both the simulated standardized consent encounters and actual consent encounters in the hospital setting. The P-QIC is an easy-to-use observational tool that provides a quick assessment of the areas of strength and areas that need improvement in a consent encounter. It can be used in the initial trainings of new investigators or consent administrators and in ongoing programs of improvement for informed consent. The development of a validated observational instrument will allow investigators to assess the consent process more accurately and evaluate strategies designed to improve it.

  20. John Napier life, logarithms, and legacy

    CERN Document Server

    Havil, Julian

    2014-01-01

    John Napier (1550–1617) is celebrated today as the man who invented logarithms—an enormous intellectual achievement that would soon lead to the development of their mechanical equivalent in the slide rule: the two would serve humanity as the principal means of calculation until the mid-1970s. Yet, despite Napier’s pioneering efforts, his life and work have not attracted detailed modern scrutiny. John Napier is the first contemporary biography to take an in-depth look at the multiple facets of Napier’s story: his privileged position as the eighth Laird of Merchiston and the son of influential Scottish landowners; his reputation as a magician who dabbled in alchemy; his interest in agriculture; his involvement with a notorious outlaw; his staunch anti-Catholic beliefs; his interactions with such peers as Henry Briggs, Johannes Kepler, and Tycho Brahe; and, most notably, his estimable mathematical legacy. Julian Havil explores Napier’s original development of logarithms, the motivations for his approa...

  1. Latin America: Essays Interpretating Colonial Legacy

    Directory of Open Access Journals (Sweden)

    María Pia López

    2013-12-01

    Full Text Available A large part of the Latin–American literature of the 19th and 20th century tried to deal with the national question intertwining different dimensions: the weight of colonial legacy, the cultural peculiarity of the nation and the inner relations between social classes and ethnic groups. Thinking the nation implied, in any case, to think the difference and the conflict with others, as well as the inner conflict and the logic of local colonialism. Analyzing some of these essays that played a central role in such process of recasting the origin of the nation, the author moves around three main axes: the formulation of dualist writings (colonial/national; white /indigenous; civilization/wilderness, the issue of language (the language inherited from the colonial experience versus the multilingual nature of indigenous Latin American societies, and the hypothesis about the birth of the nation – appointed to different groups – and its normal functioning as legitimization of the order sprung from independences.

  2. Electrical distribution grids: from legacy to innovation

    International Nuclear Information System (INIS)

    Hadjsaid, N.; Sabonnadiere, J.C.; Angelier, J.P.

    2010-01-01

    The electrical distribution networks in general and distributed generation in particular are undergoing tremendous technological, economic and conceptual changes. Indeed, with the establishment of Distribution System Operators (DSOs), the environmental concerns of our modern societies, the needs of security and quality of supply and the emergence of new services related to the 'active energy customer' character have particularly highlighted the potential for innovation and development of distribution networks. Distribution networks are of particular importance because of their close link with the end user, their interface with distributed generation and their ability to facilitate and integrate new applications and services such as plug-in electric and hybrid vehicles or smart meters. On the other hand, they represent a large infrastructure that has become complex to manage with the emergence of this new energy paradigm. However, this strategic legacy is aging and the quality of supply, after years of improvement, begins to deteriorate again. It is therefore essential to increase investment in these assets at all levels whether in innovation, expansion or renovation to prepare the smarter grid of the future. (authors)

  3. Russian Planetary Exploration History, Development, Legacy, Prospects

    CERN Document Server

    Harvey, Brian

    2007-01-01

    Russia’s accomplishments in planetary space exploration were not achieved easily. Formerly, the USSR experienced frustration in trying to tame unreliable Molniya and Proton upper stages and in tracking spacecraft over long distances. This book will assess the scientific haul of data from the Venus and Mars missions and look at the engineering approaches. The USSR developed several generations of planetary probes: from MV and Zond to the Phobos type. The engineering techniques used and the science packages are examined, as well as the nature of the difficulties encountered which ruined several missions. The programme’s scientific and engineering legacy is also addressed, as well as its role within the Soviet space programme as a whole. Brian Harvey concludes by looking forward to future Russian planetary exploration (e.g Phobos Grunt sample return mission). Several plans have been considered and may, with a restoration of funding, come to fruition. Soviet studies of deep space and Mars missions (e.g. TMK, ...

  4. The History and Legacy of BATSE

    Science.gov (United States)

    Fishman, Gerald J.

    2012-01-01

    The BATSE experiment on the Compton Gamma-ray Observatory was the first large detector system specifically designed for the study of gamma-ray bursts. The eight large-area detectors allowed full-sky coverage and were optimized to operate in the energy region of the peak emission of most GRBs. BATSE provided detailed observations of the temporal and spectral characteristics of large samples of GRBs, and it was the first experiment to provide rapid notifications of the coarse location of many them. It also provided strong evidence for the cosmological distances to GRBs through the observation of the sky distribution and intensity distribution of numerous GRBs. The large number of GRBs observed with the high- sensitivity BATSE detectors continues to provide a database of GRB spectral and temporal properties in the primary energy range of GRB emission that will likely not be exceeded for at least another decade. The origin and development of the BATSE experiment, some highlights from the mission and its continuing legacy are described in this paper.

  5. The intangible legacy of the Indonesian Bajo

    Directory of Open Access Journals (Sweden)

    Chandra Nuraini

    2016-05-01

    Full Text Available The Sama-Bajau, or Bajo diaspora, extends from the southern Philippines and Sabah (Malaysian Borneo to the eastern part of Indonesia. The Indonesian Bajo, now scattered along the coasts of Sulawesi (Celebes and East Kalimantan, the Eastern Lesser Sunda Islands and Maluku, were once mostly nomadic fishermen of the sea or ocean freight carriers. Today, the Bajo are almost all fishermen and settled. Their former and present ways of life made them favour intangible forms of culture: it is impossible to transport bulky artefacts when moving frequently by boat, or when living in stilt houses, very close to the sea or on a reef. It is therefore an intangible legacy that is the essence of the Bajo’s culture. Sandro healers have a vast range of expertise that allows them to protect and heal people when they suffer from natural or supernatural diseases. On the other hand, music and especially oral literature are very rich. In addition to song and the pantun poetry contests, the most prestigious genre is the iko-iko, long epic songs that the Bajo consider to be historical rather than fictional narratives. The Bajo’s intangible heritage is fragile, since it is based on oral transmission. In this article, I give a description of this heritage, dividing it into two areas: the knowledge that allows them to “protect and heal” on the one hand, and to “distract and relax”, on the other.

  6. Hubble Legacy Archive And The Public

    Science.gov (United States)

    Harris, Jessica; Whitmore, B.; Eisenhamer, B.; Bishop, M.; Knisely, L.

    2012-01-01

    The Hubble Legacy Archive (HLA) at the Space Telescope Science Institute (STScI) hosts the Image of the Month (IOTM) Series. The HLA is a joint project of STScI, the Space Telescope European Coordinating Facility (ST-ECF), and the Canadian Astronomy Data Centre (CADC). The HLA is designed optimize science from the Hubble Space Telescope by providing online enhanced Hubble products and advanced browsing capabilities. The IOTM's are created for astronomers and the public to highlight various features within HLA, such as the "Interactive Display", "Footprint” and "Inventory” features to name a few. We have been working with the Office of Public Outreach (OPO) to create a standards based educational module for middle school to high school students of the IOTM: Rings and the Moons of Uranus. The set of Uranus activities are highlighted by a movie that displays the orbit of five of Uranus’ largest satellites. We made the movie based on eight visits of Uranus from 2000-06-16 to 2000-06-18, using the PC chip on the Wide Field Planetary Camera 2 (WFPC2) and filter F850LP (proposal ID: 8680). Students will be engaged in activities that will allow them to "discover” the rings and satellites around Uranus, calculate the orbit of the satellites, and introduces students to analyze real data from Hubble.

  7. Corruption in Mexico: A Historical Legacy

    Directory of Open Access Journals (Sweden)

    Nubia Nieto

    2014-06-01

    Full Text Available Among the many consequences of colonialism that are still present in postcolonial societies are corruption and the lack of strong institutions to fight against this phenomenon. What used to be unequal power relations between the colonizers and the colonies have been replaced by the dominance of the local elites over ordinary citizens, who have practically given the former a lot of leeway to commit acts of corruption with a sense of impunity and without regard for accountability. One case in point is Mexico which, in recent times, has made international news headlines because of incidences of drug trafficking, violence, and corruption in the country. This article delineates the historical relationship between corruption and colonialism, and how these forces have shaped Mexican culture. The discussion tackles the presence of corruption since the colonial times to the present. Specif ically, it starts with an analysis of the role of colonialism in the incidence of corruption. Secondly, it describes the discrepancy between the law and its application, from the arrival of the Spanish colonizers to the present. Finally, it examines the cultural, educational, and social challenges that should be addressed in order to surmount the colonial legacies that breed corruption.

  8. Identifying adverse drug event information in clinical notes with distributional semantic representations of context.

    Science.gov (United States)

    Henriksson, Aron; Kvist, Maria; Dalianis, Hercules; Duneld, Martin

    2015-10-01

    For the purpose of post-marketing drug safety surveillance, which has traditionally relied on the voluntary reporting of individual cases of adverse drug events (ADEs), other sources of information are now being explored, including electronic health records (EHRs), which give us access to enormous amounts of longitudinal observations of the treatment of patients and their drug use. Adverse drug events, which can be encoded in EHRs with certain diagnosis codes, are, however, heavily underreported. It is therefore important to develop capabilities to process, by means of computational methods, the more unstructured EHR data in the form of clinical notes, where clinicians may describe and reason around suspected ADEs. In this study, we report on the creation of an annotated corpus of Swedish health records for the purpose of learning to identify information pertaining to ADEs present in clinical notes. To this end, three key tasks are tackled: recognizing relevant named entities (disorders, symptoms, drugs), labeling attributes of the recognized entities (negation, speculation, temporality), and relationships between them (indication, adverse drug event). For each of the three tasks, leveraging models of distributional semantics - i.e., unsupervised methods that exploit co-occurrence information to model, typically in vector space, the meaning of words - and, in particular, combinations of such models, is shown to improve the predictive performance. The ability to make use of such unsupervised methods is critical when faced with large amounts of sparse and high-dimensional data, especially in domains where annotated resources are scarce. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Physician satisfaction with a critical care clinical information system using a multimethod evaluation of usability.

    Science.gov (United States)

    Hudson, Darren; Kushniruk, Andre; Borycki, Elizabeth; Zuege, Danny J

    2018-04-01

    Physician satisfaction with electronic medical records has often been poor. Usability has frequently been identified as a source for decreased satisfaction. While surveys can identify many issues, and are logistically easier to administer, they may miss issues identified using other methods This study sought to understand the level of physician satisfaction and usability issues associated with a critical care clinical information system (eCritical Alberta) implemented throughout the province of Alberta, Canada. All critical care attending physicians using the system were invited to participate in an online survey. Questions included components of the User Acceptance of Information Technology and Usability Questionnaire as well as free text feedback on system components. Physicians were also invited to participate in a think aloud test using simulated scenarios. The transcribed think aloud text and questionnaire were subjected to textual analysis. 82% of all eligible physicians completed the on-line survey (n = 61). Eight physicians were invited and seven completed the think aloud test. Overall satisfaction with the system was moderate. Usability was identified as a significant factor contributing to satisfaction. The major usability factors identified were system response time and layout. The think aloud component identified additional factors beyond those identified in the on-line survey. This study found a modestly high level of physician satisfaction with a province-wide clinical critical care information system. Usability continues to be a significant factor in physician satisfaction. Using multiple methods of evaluation can capture the benefits of a large sample size and deeper understanding of the issues. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. [Ethical dilemma in research: informed consent in clinical studies on persons with dementia].

    Science.gov (United States)

    Sinoff, Gary

    2012-09-01

    With the world's population aging, there is an increase in the number of demented elderly. It is vital to study this phenomenon in epidemiological and clinical studies, particularly the effects on the increasing numbers of demented elderly. Researchers need to understand the factors predicting the general decline in the demented elderly. However, before any research is undertaken, it is necessary to obtain approval from the Local Internal Review Board. This committee is responsible to maintain accepted national and international ethical standards. The basis for recruitment to a study is the signature on the informed consent form, where the patient is required to understand the study, internalize the study's aim, to consider all options and finally, to express an opinion. Potential elderly participants need to have their judgment evaluated before signing the form. In cases where the subject is incapable, some countries, including Israel, require that there be a legal guardianship. This is a long and complicated process that causes researchers not to recruit demented patients into a study which may actually be beneficial to all. Some countries allow a proxy to sign informed consent forms to permit the demented subject to participate in the study. Often the threshold may depend on the invasiveness of the intervention. The problem of proxies to sign informed consent form troubles researchers worldwide. This article addresses the history and development of ethics in research, and raises the issue to promote an official policy for proxy consent signing.

  11. Clinical information systems end user satisfaction: the expectations and needs congruencies effects.

    Science.gov (United States)

    Karimi, Faezeh; Poo, Danny C C; Tan, Yung Ming

    2015-02-01

    Prior research on information systems (IS) shows that users' attitudes and continuance intentions are associated with their satisfaction with information systems. As such, the increasing amount of investments in clinical information systems (CIS) signifies the importance of understanding CIS end users' (i.e., clinicians) satisfaction. In this study, we develop a conceptual framework to identify the cognitive determinants of clinicians' satisfaction formation. The disconfirmation paradigm serves as the core of the framework. The expectations and needs congruency models are the two models of this paradigm, and perceived performance is the basis of the comparisons in the models. The needs and expectations associated with the models are also specified. The survey methodology is adopted in this study to empirically validate the proposed research model. The survey is conducted at a public hospital and results in 112 and 203 valid responses (56% and 98% response rates) from doctors and nurses respectively. The partial least squares (PLS) method is used to analyze the data. The results of the study show that perceived CIS performance is the most influential factor on clinicians' (i.e., doctors and nurses) satisfaction. Doctors' expectations congruency is the next significant determinant of their satisfaction. Contrary to most previous findings, nurses' expectations and expectations congruency do not show a significant effect on their satisfaction. However, the needs congruency is found to significantly affect nurses' satisfaction. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Determinants of continuance intention in a post-adoption satisfaction evaluation of a clinical information system.

    Science.gov (United States)

    Hadji, Brahim; Dupuis, Isabelle; Leneveut, Laurence; Heudes, Didier; Wagner, Jean-François; Degoulet, Patrice

    2014-01-01

    The evaluation of end-user satisfaction is an essential part of any clinical information system (CIS) project. The purpose of this study is to evaluate the determinants of CIS continuance intention in a late post-adoption phase at the Georges Pompidou University Hospital (HEGP) in Paris. We designed an electronic survey instrument based on an IT post-adoption model (ITPAM) developed from three previous models, i.e., the Delone and McLean Information Success Model, the Davis TAM model and the Bhattacherjee information system continuance intention model. 419 questionnaires were collected from CIS users directly involved in patient care. The perceived CIS quality, usefulness and user satisfaction are significantly lower for medical professions than other professional groups. Continuance intention is very high within all professional subgroups. In a multiple regression analysis, the global satisfaction (R(2) = .780) was positively and significantly correlated with CIS quality, confirmation of expectations and perceived CIS usefulness. The continuance intention (R(2) = .392) was positively and significantly correlated with perceived CIS usefulness, confirmation of expectations and global satisfaction. In a late post-adoption CIS deployment phase, continuance intention does not significantly depend on individual end user characteristics but is significantly associated with the perceived CIS usefulness, confirmation of expectations and global satisfaction.

  13. Informative content of clinical symptoms of acute appendicitis in different terms of pregnancy

    Directory of Open Access Journals (Sweden)

    Kutovoy A.B.

    2015-09-01

    Full Text Available With the purpose to evaluate diagnostic efficacy of some clinical symptoms of acute appendicitis 75 women in different terms of pregnancy were examined. Informative content of such symptoms as Kocher- Volkovich, Rovsing, Bartomje - Michelson, Sitkovsky, Gabay, Brendo, Michelson, Ivanov was studied. Pain syndrome was fixed in all examined women. Pain localization was various and depended on the pregnancy term. During the I trimester of pregnancy the most often pain was manifestated in epigastrium and right lower quadrant, rarely in other abdomen regions. In the II trimester in majority of cases pain occurred in right lower quadrant. During III trimester pain prevailed in right upper quadrant of abdomen. Analyzing informative component of researching symptoms there was noted significant decrease (р<0,05; р<0,01; р<0,001 of their diagnostic value with growth of pregnancy term. Therefore Kocher – Volkovich and Rovsing symptoms were the most informative in the I trimester of pregnancy. Diagnostic efficacy of Brendo(67,3%, Michelson(55,7%, Ivanov(59,6% symptoms was higher than that of Kocher – Volkovich (36,5%, Rovsing (28,8%, Sitkovsky (51,9%, Bartomje – Michelson (55,7% symptoms, their value was diminishing together with increase of pregnancy terms.

  14. Respiratory clinical guidelines inform ward-based nurses’ clinical skills and knowledge required for evidence-based care

    OpenAIRE

    Alisha M. Johnson; Sheree M.S. Smith

    2016-01-01

    Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. ­Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge ­identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory pati...

  15. Innovating information-delivery for potential clinical trials participants. What do patients want from multi-media resources?

    Science.gov (United States)

    Shneerson, Catherine; Windle, Richard; Cox, Karen

    2013-01-01

    To discover whether the provision of clinical trials information via a multi-media platform could better meet the needs, preferences and practices of potential cancer trial participants. A mixed qualitative and quantitative questionnaire was delivered to 72 participants from cancer support groups to elicit views on the provision and design features of multimedia resources in delivering clinical trials information. Perceived lack of information is an expressed barrier to clinical trials participation. Multimedia resources were viewed positively as a way to address this barrier by most potential clinical trials participants; in particular by helping to align information to individual needs, promote active engagement with information, and by allowing more control of the learning experience. Whilst text remained the most valued attribute of any resource, other highly rated attributes included the resource being simple to use, easily accessible, having a clear focus, incorporating examples and visual aids, and being interactive. Provision of support for the learning resource was also rated highly. As in other areas, such as education, multimedia resources may enhance the delivery and acceptance of information regarding clinical trials. Better alignment of information may have a positive impact on recruitment and retention into clinical trials. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  16. Patients' Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines: A Narrative Inquiry.

    Science.gov (United States)

    Lindsay, Gail M; Mior, Silvano A; Côté, Pierre; Carroll, Linda J; Shearer, Heather M

    2016-01-01

    The purpose of this narrative inquiry was to explore the experiences of persons who were injured in traffic collisions and seek their recommendations for the development of clinical practice guideline (CPG) for the management of minor traffic injuries. Patients receiving care for traffic injuries were recruited from 4 clinics in Ontario, Canada resulting in 11 adult participants (5 men, 6 women). Eight were injured while driving cars, 1 was injured on a motorcycle, 2 were pedestrians, and none caused the collision. Using narrative inquiry methodology, initial interviews were audiotaped, and follow-up interviews were held within 2 weeks to extend the story of experience created from the first interview. Narrative plotlines across the 11 stories were identified, and a composite story inclusive of all recommendations was developed by the authors. The research findings and composite narrative were used to inform the CPG Expert Panel in the development of new CPGs. Four recommended directions were identified from the narrative inquiry process and applied. First, terminology that caused stigma was a concern. This resulted in modified language ("injured persons") being adopted by the Expert Panel, and a new nomenclature categorizing layers of injury was identified. Second, participants valued being engaged as partners with health care practitioners. This resulted in inclusion of shared decision-making as a foundational recommendation connecting CPGs and care planning. Third, emotional distress was recognized as a factor in recovery. Therefore, the importance of early detection and the ongoing evaluation of risk factors for delayed recovery were included in all CPGs. Fourth, participants shared that they were unfamiliar with the health care system and insurance industry before their accident. Thus, repeatedly orienting injured persons to the system was advised. A narrative inquiry of 11 patients' experiences with traffic collision and their recommendations for clinical

  17. To compare PubMed Clinical Queries and UpToDate in teaching information mastery to clinical residents: a crossover randomized controlled trial.

    Science.gov (United States)

    Sayyah Ensan, Ladan; Faghankhani, Masoomeh; Javanbakht, Anna; Ahmadi, Seyed-Foad; Baradaran, Hamid Reza

    2011-01-01

    To compare PubMed Clinical Queries and UpToDate regarding the amount and speed of information retrieval and users' satisfaction. A cross-over randomized trial was conducted in February 2009 in Tehran University of Medical Sciences that included 44 year-one or two residents who participated in an information mastery workshop. A one-hour lecture on the principles of information mastery was organized followed by self learning slide shows before using each database. Subsequently, participants were randomly assigned to answer 2 clinical scenarios using either UpToDate or PubMed Clinical Queries then crossed to use the other database to answer 2 different clinical scenarios. The proportion of relevantly answered clinical scenarios, time to answer retrieval, and users' satisfaction were measured in each database. Based on intention-to-treat analysis, participants retrieved the answer of 67 (76%) questions using UpToDate and 38 (43%) questions using PubMed Clinical Queries (PUpToDate compared to 29 min (95% CI: 26 to 32) using PubMed Clinical Queries (PUpToDate and also overall satisfaction were higher among UpToDate users compared to PubMed Clinical Queries users (PUpToDate compared to Pubmed Clinical Queries can lead to not only a higher proportion of relevant answer retrieval within a shorter time, but also a higher users' satisfaction. So, addition of tutoring pre-appraised sources such as UpToDate to the information mastery curricula seems to be highly efficient.

  18. To compare PubMed Clinical Queries and UpToDate in teaching information mastery to clinical residents: a crossover randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Ladan Sayyah Ensan

    Full Text Available PURPOSE: To compare PubMed Clinical Queries and UpToDate regarding the amount and speed of information retrieval and users' satisfaction. METHOD: A cross-over randomized trial was conducted in February 2009 in Tehran University of Medical Sciences that included 44 year-one or two residents who participated in an information mastery workshop. A one-hour lecture on the principles of information mastery was organized followed by self learning slide shows before using each database. Subsequently, participants were randomly assigned to answer 2 clinical scenarios using either UpToDate or PubMed Clinical Queries then crossed to use the other database to answer 2 different clinical scenarios. The proportion of relevantly answered clinical scenarios, time to answer retrieval, and users' satisfaction were measured in each database. RESULTS: Based on intention-to-treat analysis, participants retrieved the answer of 67 (76% questions using UpToDate and 38 (43% questions using PubMed Clinical Queries (P<0.001. The median time to answer retrieval was 17 min (95% CI: 16 to 18 using UpToDate compared to 29 min (95% CI: 26 to 32 using PubMed Clinical Queries (P<0.001. The satisfaction with the accuracy of retrieved answers, interaction with UpToDate and also overall satisfaction were higher among UpToDate users compared to PubMed Clinical Queries users (P<0.001. CONCLUSIONS: For first time users, using UpToDate compared to Pubmed Clinical Queries can lead to not only a higher proportion of relevant answer retrieval within a shorter time, but also a higher users' satisfaction. So, addition of tutoring pre-appraised sources such as UpToDate to the information mastery curricula seems to be highly efficient.

  19. Public preferences on written informed consent for low-risk pragmatic clinical trials in Spain.

    Science.gov (United States)

    Dal-Ré, Rafael; Carcas, Antonio J; Carné, Xavier; Wendler, David

    2017-09-01

    Pragmatic randomized clinical trials (pRCTs) collect data that have the potential to improve medical care significantly. However, these trials may be undermined by the requirement to obtain written informed consent, which can decrease accrual and increase selection bias. Recent data suggest that the majority of the US public endorses written consent for low-risk pRCTs. The present study was designed to assess whether this view is specific to the US. The study took the form of a cross-sectional, probability-based survey, with a 2 × 2 factorial design, assessing support for written informed consent vs. verbal consent or general notification for two low-risk pRCTs in hypertension, one comparing two drugs with similar risk/benefit profiles and the other comparing the same drug being taken in the morning or at night. The primary outcome measures were respondents' personal preference and hypothetical recommendation to a research ethics committee regarding the use of written informed consent vs. the alternatives. A total of 2008 adults sampled from a probability-based online panel responded to the web-based survey conducted in May 2016 (response rate: 61%). Overall, 77% of respondents endorsed written consent. In both scenarios, the alternative of general notification received significantly more support (28.7-37.1%) than the alternative of verbal consent (12.7-14.0%) (P = 0.001). Forty per cent of respondents preferred and/or recommended general notification rather than written consent. The results suggested that, rather than attempting to waive written consent, current pRCTs should focus on developing ways to implement written consent that provide sufficient information without undermining recruitment or increasing selection bias. The finding that around 40% of respondents endorsed general notification over written consent raises the possibility that, with educational efforts, the majority of Spaniards might accept general notification for low-risk pRCTs. © 2017 The

  20. Model driven development of clinical information sytems using openEHR.

    Science.gov (United States)

    Atalag, Koray; Yang, Hong Yul; Tempero, Ewan; Warren, Jim

    2011-01-01

    openEHR and the recent international standard (ISO 13606) defined a model driven software development methodology for health information systems. However there is little evidence in the literature describing implementation; especially for desktop clinical applications. This paper presents an implementation pathway using .Net/C# technology for Microsoft Windows desktop platforms. An endoscopy reporting application driven by openEHR Archetypes and Templates has been developed. A set of novel GUI directives has been defined and presented which guides the automatic graphical user interface generator to render widgets properly. We also reveal the development steps and important design decisions; from modelling to the final software product. This might provide guidance for other developers and form evidence required for the adoption of these standards for vendors and national programs alike.

  1. Assessing Hospital Physicians' Acceptance of Clinical Information Systems: A Review of the Relevant Literature

    Directory of Open Access Journals (Sweden)

    Bram Pynoo

    2013-06-01

    Full Text Available In view of the tremendous potential benefits of clinical information systems (CIS for the quality of patient care; it is hard to understand why not every CIS is embraced by its targeted users, the physicians. The aim of this study is to propose a framework for assessing hospital physicians' CIS-acceptance that can serve as a guidance for future research into this area. Hereto, a review of the relevant literature was performed in the ISI Web-of-Science database. Eleven studies were withheld from an initial dataset of 797 articles. Results show that just as in business settings, there are four core groups of variables that influence physicians' acceptance of a CIS: its usefulness and ease of use, social norms, and factors in the working environment that facilitate use of the CIS (such as providing computers/workstations, compatibility between the new and existing system.... We also identified some additional variables as predictors of CIS-acceptance.

  2. Pharmacogenetics Informed Decision Making in Adolescent Psychiatric Treatment: A Clinical Case Report

    Directory of Open Access Journals (Sweden)

    Teri Smith

    2015-02-01

    Full Text Available Advances made in genetic testing and tools applied to pharmacogenetics are increasingly being used to inform clinicians in fields such as oncology, hematology, diabetes (endocrinology, cardiology and expanding into psychiatry by examining the influences of genetics on drug efficacy and metabolism. We present a clinical case example of an adolescent male with anxiety, attention deficit hyperactivity disorder (ADHD and autism spectrum disorder who did not tolerate numerous medications and dosages over several years in attempts to manage his symptoms. Pharmacogenetics testing was performed and DNA results on this individual elucidated the potential pitfalls in medication use because of specific pharmacodynamic and pharmacokinetic differences specifically involving polymorphisms of genes in the cytochrome p450 enzyme system. Future studies and reports are needed to further illustrate and determine the type of individualized medicine approach required to treat individuals based on their specific gene patterns. Growing evidence supports this biological approach for standard of care in psychiatry.

  3. Addressing the future of clinical information systems--Web-based multilayer visualization.

    Science.gov (United States)

    Poh, Chueh-Loo; Kitney, Richard I; Shrestha, Rasu B K

    2007-03-01

    This paper addresses some key issues relating to the development of new technology for clinical information systems (CIS) in relation to imaging and visualizing data. With the increasing importance of molecular and cellular biology, a new type of medicine, molecular based medicine, is now developing. This will significantly alter the way in which medicine is practiced. The view is presented that CIS will need to operate seamlessly across the Biological Continuum, i.e., the hierarchy of the human organism comprising systems, viscera, tissue, cells, proteins, and genes. We propose a multilayered visualization interface, which operates across the Biological Continuum, based on Web-based technology. A visualization interface package for two-dimensional and three-dimensional image data at the visceral and cellular levels is described. Two application examples are presented: 1) MR knee images, at the visceral level and 2) endothelial nuclei images, acquired from confocal laser microscopy, at the cellular level.

  4. Towards optimised information about clinical trials; identification and validation of key issues in collaboration with cancer patient advocates

    DEFF Research Database (Denmark)

    Dellson, P; Nilbert, M; Bendahl, P-O

    2011-01-01

    Clinical trials are crucial to improve cancer treatment but recruitment is difficult. Optimised patient information has been recognised as a key issue. In line with the increasing focus on patients' perspectives in health care, we aimed to study patients' opinions about the written information used...... for improvements, 21 key issues were defined and validated through a questionnaire in an independent group of breast cancer patient advocates. Clear messages, emotionally neutral expressions, careful descriptions of side effects, clear comparisons between different treatment alternatives and information about...... the possibility to discontinue treatment were perceived as the most important issues. Patients' views of the information in clinical trials provide new insights and identify key issues to consider in optimising future written information and may improve recruitment to clinical cancer trials....

  5. "There are too many, but never enough": qualitative case study investigating routine coding of clinical information in depression.

    Science.gov (United States)

    Cresswell, Kathrin; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz

    2012-01-01

    We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined.

  6. “There Are Too Many, but Never Enough": Qualitative Case Study Investigating Routine Coding of Clinical Information in Depression

    Science.gov (United States)

    Cresswell, Kathrin; Morrison, Zoe; Sheikh, Aziz; Kalra, Dipak

    2012-01-01

    Background We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Materials and Methods Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Results Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. Conclusions There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined. PMID:22937106

  7. Healthcare information systems: data mining methods in the creation of a clinical recommender system

    Science.gov (United States)

    Duan, L.; Street, W. N.; Xu, E.

    2011-05-01

    Recommender systems have been extensively studied to present items, such as movies, music and books that are likely of interest to the user. Researchers have indicated that integrated medical information systems are becoming an essential part of the modern healthcare systems. Such systems have evolved to an integrated enterprise-wide system. In particular, such systems are considered as a type of enterprise information systems or ERP system addressing healthcare industry sector needs. As part of efforts, nursing care plan recommender systems can provide clinical decision support, nursing education, clinical quality control, and serve as a complement to existing practice guidelines. We propose to use correlations among nursing diagnoses, outcomes and interventions to create a recommender system for constructing nursing care plans. In the current study, we used nursing diagnosis data to develop the methodology. Our system utilises a prefix-tree structure common in itemset mining to construct a ranked list of suggested care plan items based on previously-entered items. Unlike common commercial systems, our system makes sequential recommendations based on user interaction, modifying a ranked list of suggested items at each step in care plan construction. We rank items based on traditional association-rule measures such as support and confidence, as well as a novel measure that anticipates which selections might improve the quality of future rankings. Since the multi-step nature of our recommendations presents problems for traditional evaluation measures, we also present a new evaluation method based on average ranking position and use it to test the effectiveness of different recommendation strategies.

  8. Clinical characteristics of mephedrone toxicity reported to the UK National Poisons Information Service

    Science.gov (United States)

    James, D; Adams, R D; Spears, R; Cooper, G; Lupton, D J; Thompson, J P

    2010-01-01

    Objective To describe the patterns and clinical features of toxicity related to recreational use of mephedrone and other cathinones in the UK using data collected by the National Poisons Information Service (NPIS). Methods The number of accesses to TOXBASE, the NPIS online poisons information database, details of consecutive cases uploaded onto TOXBASE and the number and details of telephone enquiries made to the NPIS by health professionals in the UK were collected for the period March 2009 to February 2010. Results Over the year of study there were 2901 TOXBASE accesses and 188 telephone enquiries relating to cathinones, the majority relating to mephedrone (TOXBASE 1664, telephone 157), with a month-on-month increase in numbers. In 131 telephone enquiries concerning mephedrone, alone or in combination with alcohol, common clinical features reported included agitation or aggression (n=32, 24%, 95% CI 18% to 33%), tachycardia (n=29, 22%, 95% CI 16% to 30%), confusion or psychosis (n=18, 14%, 95% CI 9% to 21%), chest pain (n=17, 13%, 95% CI 8% to 20%), nausea (n=15, 11%, 95% CI 7% to 18%), palpitations (n=14, 11%, 95% CI 6% to 18%), peripheral vasoconstriction (n=10, 8%, 95% CI 4% to 14%) and headache (n=7, 5%, 95% CI 2% to 11%). Convulsions were reported in four cases (3%, 95% CI 1% to 8%). One exposed person died following cardiac arrest (1%, 95% CI 0% to 4%), although subsequent investigation suggested that mephedrone was not responsible. Conclusions Toxicity associated with recreational mephedrone use is increasingly common in the UK. Sympathomimetic adverse effects are common and severe effects are also reported. Structured data collected by the NPIS may be of use in identifying trends in poisoning and in establishing toxidromes for new drugs of abuse. PMID:20798084

  9. Clinical medical students’ experiences of unprofessional behaviour and how these should inform approaches to teaching of professionalism

    LENUS (Irish Health Repository)

    Abu, Ozotu Rosemary

    2016-08-01

    This mixed method research explores unprofessional behaviour experienced by clinical Medical students, during clinical training in Ireland; with a view to obtaining learning points that inform future design of modules on Professionalism. It also looks at the impact of these on students and the relationship between gender\\/ethnicity and students’ experiences of these behaviours.

  10. A systematic review finds underreporting of ethics approval, informed consent, and incentives in clinical trials.

    Science.gov (United States)

    Trung, Ly Quoc; Morra, Mostafa Ebraheem; Truong, Nguyen Duc; Turk, Tarek; Elshafie, Ahmed; Foly, Amr; Hien Tam, Dao Ngoc; Iraqi, Ahmed; Hong Van, Trinh Thi; Elgebaly, Ahmed; Ngoc, Tran Nhu; Vu, Tran Le Huy; Chu, Ngan Thy; Hirayama, Kenji; Karbwang, Juntra; Huy, Nguyen Tien

    2017-11-01

    In this study, we aim to review researchers' reporting practices of the ethics statement, financial incentives, and local ethical committees' profile in their clinical trials. A systematic search was done through top-ranked 50 medical journals (Scimago Ranking) to retrieve 2,000 latest publications. Only primary clinical trials were included with no restriction to language or participants. Among the 927 included trials, 14 trials (1.5%) did not report an ethical statement and two-third (63%) did not completely report the investigated components (Institutional Review eBoard approval, Helsinki Declaration, and informed consent). Moreover, 21 trials (2.26%) reported motivational incentives with the method and amount of payment for participants. Of them, 15 trials offered monetary incentives to participants in different forms. In the remaining six trials, the incentives were mainly medical benefits. Only one trial reported the profile or quality of local Institutional Review Board. A potential gap in the reporting practices of ethics statement and financial incentives was addressed in this review. Authors are urged to fully report all ethical components related to their study, including incentives and compensations plan. Medical journals are also recommended to implement further publication requirements concerning ethics reporting. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. The Environmental Legacy of Modern Tropical Deforestation.

    Science.gov (United States)

    Rosa, Isabel M D; Smith, Matthew J; Wearn, Oliver R; Purves, Drew; Ewers, Robert M

    2016-08-22

    Tropical deforestation has caused a significant share of carbon emissions and species losses, but historical patterns have rarely been explicitly considered when estimating these impacts [1]. A deforestation event today leads to a time-delayed future release of carbon, from the eventual decay either of forest products or of slash left at the site [2]. Similarly, deforestation often does not result in the immediate loss of species, and communities may exhibit a process of "relaxation" to their new equilibrium over time [3]. We used a spatially explicit land cover change model [4] to reconstruct the annual rates and spatial patterns of tropical deforestation that occurred between 1950 and 2009 in the Amazon, in the Congo Basin, and across Southeast Asia. Using these patterns, we estimated the resulting gross vegetation carbon emissions [2, 5] and species losses over time [6]. Importantly, we accounted for the time lags inherent in both the release of carbon and the extinction of species. We show that even if deforestation had completely halted in 2010, time lags ensured there would still be a carbon emissions debt of at least 8.6 petagrams, equivalent to 5-10 years of global deforestation, and an extinction debt of more than 140 bird, mammal, and amphibian forest-specific species, which if paid, would increase the number of 20(th)-century extinctions in these groups by 120%. Given the magnitude of these debts, commitments to reduce emissions and biodiversity loss are unlikely to be realized without specific actions that directly address this damaging environmental legacy. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Astronomy Legacy Project - Pisgah Astronomical Research Institute

    Science.gov (United States)

    Barker, Thurburn; Castelaz, Michael W.; Rottler, Lee; Cline, J. Donald

    2016-01-01

    Pisgah Astronomical Research Institute (PARI) is a not-for-profit public foundation in North Carolina dedicated to providing hands-on educational and research opportunities for a broad cross-section of users in science, technology, engineering and math (STEM) disciplines. In November 2007 a Workshop on a National Plan for Preserving Astronomical Photographic Data (2009ASPC,410,33O, Osborn, W. & Robbins, L) was held at PARI. The result was the establishment of the Astronomical Photographic Data Archive (APDA) at PARI. In late 2013 PARI began ALP (Astronomy Legacy Project). ALP's purpose is to digitize an extensive set of twentieth century photographic astronomical data housed in APDA. Because of the wide range of types of plates, plate dimensions and emulsions found among the 40+ collections, plate digitization will require a versatile set of scanners and digitizing instruments. Internet crowdfunding was used to assist in the purchase of additional digitization equipment that were described at AstroPlate2014 Plate Preservation Workshop (www.astroplate.cz) held in Prague, CZ, March, 2014. Equipment purchased included an Epson Expression 11000XL scanner and two Nikon D800E cameras. These digital instruments will compliment a STScI GAMMA scanner now located in APDA. GAMMA will be adapted to use an electroluminescence light source and a digital camera with a telecentric lens to achieve high-speed high-resolution scanning. The 1μm precision XY stage of GAMMA will allow very precise positioning of the plate stage. Multiple overlapping CCD images of small sections of each plate, tiles, will be combined using a photo-mosaic process similar to one used in Harvard's DASCH project. Implementation of a software pipeline for the creation of a SQL database containing plate images and metadata will be based upon APPLAUSE as described by Tuvikene at AstroPlate2014 (www.astroplate.cz/programs/).

  13. Legacies of flood reduction on a dryland river

    Science.gov (United States)

    Stromberg, J.C.; Shafroth, P.B.; Hazelton, A.F.

    2012-01-01

    The Bill Williams (Arizona) is a regulated dryland river that is being managed, in part, for biodiversity via flow management. To inform management, we contrasted riparian plant communities between the Bill Williams and an upstream free-flowing tributary (Santa Maria). Goals of a first study (1996-1997) were to identify environmental controls on herbaceous species richness and compare richness among forest types. Analyses revealed that herbaceous species richness was negatively related to woody stem density, basal area and litter cover and positively related to light levels. Introduced Tamarix spp. was more frequent at the Bill Williams, but all three main forest types (Tamarix, Salix/Populus, Prosopis) had low understory richness, as well as high stem density and low light, on the Bill Williams as compared to the Santa Maria. The few edaphic differences between rivers (higher salinity at Bill Williams) had only weak connections with richness. A second study (2006-2007) focused on floristic richness at larger spatial scales. It revealed that during spring, and for the study cumulatively (spring and fall samplings combined), the riparian zone of the unregulated river had considerably more plant species. Annuals (vs. herbaceous perennials and woody species) showed the largest between-river difference. Relative richness of exotic (vs. native) species did not differ. We conclude that: (1) The legacy of reduced scouring frequency and extent at the Bill Williams has reduced the open space available for colonization by annuals; and (2) Change in forest biomass structure, more so than change in forest composition, is the major driver of changes in plant species richness along this flow-altered river. Our study informs dryland river management options by revealing trade-offs that exist between forest biomass structure and plant species richness. ?? 2010 John Wiley & Sons, Ltd.

  14. Implementing Provenance Collection in a Legacy Data Product Generation System

    Science.gov (United States)

    Conover, H.; Ramachandran, R.; Kulkarni, A.; Beaumont, B.; McEniry, M.; Graves, S. J.; Goodman, H.

    2012-12-01

    NASA has been collecting, storing, archiving and distributing vast amounts of Earth science data derived from satellite observations for several decades now. The raw data collected from the different sensors undergoes many different transformations before it is distributed to the science community as climate-research-quality data products. These data transformations include calibration, geolocation, and conversion of the instrument counts into meaningful geophysical parameters, and may include reprojection and/or spatial and temporal averaging as well. In the case of many Earth science data systems, the science algorithms and any ancillary data files used for these transformations are delivered as a "black box" to be integrated into the data system's processing framework. In contrast to an experimental workflow that may vary with each iteration, such systems use consistent, well-engineered processes to apply the same science algorithm to each well-defined set of inputs in order to create standard data products. Even so, variability is inevitably introduced. There may be changes made to the algorithms, different ancillary datasets may be used, underlying hardware and software may get upgraded, etc. Furthermore, late-arriving input data, operator error, or other processing anomalies may necessitate regeneration and replacement of a particular set of data files and any downstream products. These variations need to be captured, documented and made accessible to the scientific community so they can be properly accounted for in analyses. This presentation describes an approach to provenance capture, storage and dissemination implemented at the NASA Science Investigator-led Processing System (SIPS) for the AMSR-E (Advanced Microwave Scanning Radiometer - Earth Observing System) instrument. Key considerations in adding provenance capabilities to this legacy data system include: (1) granularity of provenance information captured, (2) additional context information needed

  15. THE CHANDRA COSMOS LEGACY SURVEY: OPTICAL/IR IDENTIFICATIONS

    Energy Technology Data Exchange (ETDEWEB)

    Marchesi, S.; Civano, F.; Urry, C. M. [Yale Center for Astronomy and Astrophysics, 260 Whitney Avenue, New Haven, CT 06520 (United States); Elvis, M. [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Salvato, M. [Max-Planck-Institut für extraterrestrische Physik, Giessenbachstrasse 1, D-85748 Garching bei München (Germany); Brusa, M.; Lanzuisi, G.; Vignali, C. [Dipartimento di Fisica e Astronomia, Università di Bologna, viale Berti Pichat 6/2, I-40127 Bologna (Italy); Comastri, A.; Gilli, R.; Zamorani, G.; Cappelluti, N. [INAF—Osservatorio Astronomico di Bologna, via Ranzani 1, I-40127 Bologna (Italy); Hasinger, G. [Institute for Astronomy, 2680 Woodlawn Drive, University of Hawaii, Honolulu, HI 96822 (United States); Miyaji, T. [Instituto de Astronomía sede Ensenada, Universidad Nacional Autónoma de México, Km. 103, Carret. Tijunana-Ensenada, Ensenada, BC (Mexico); Treister, E. [Universidad de Concepción, Departamento de Astronomía, Casilla 160-C, Concepción (Chile); Allevato, V.; Finoguenov, A. [Department of Physics, University of Helsinki, Gustaf Hällströmin katu 2a, FI-00014 Helsinki (Finland); Cardamone, C. [Department of Science, Wheelock College, Boston, MA 02215 (United States); Griffiths, R. E. [Physics and Astronomy Dept., Natural Sciences Division, University of Hawaii at Hilo, 200 W. Kawili Street, Hilo, HI 96720 (United States); Karim, A. [Argelander-Institut für Astronomie, Universität Bonn, Auf dem Hügel 71, D-53121 Bonn (Germany); and others

    2016-01-20

    We present the catalog of optical and infrared counterparts of the Chandra  COSMOS-Legacy  Survey, a 4.6 Ms Chandra  program on the 2.2 deg{sup 2} of the COSMOS field, combination of 56 new overlapping observations obtained in Cycle 14 with the previous C-COSMOS survey. In this Paper we report the i, K, and 3.6 μm identifications of the 2273 X-ray point sources detected in the new Cycle 14 observations. We use the likelihood ratio technique to derive the association of optical/infrared (IR) counterparts for 97% of the X-ray sources. We also update the information for the 1743 sources detected in C-COSMOS, using new K and 3.6 μm information not available when the C-COSMOS analysis was performed. The final catalog contains 4016 X-ray sources, 97% of which have an optical/IR counterpart and a photometric redshift, while ≃54% of the sources have a spectroscopic redshift. The full catalog, including spectroscopic and photometric redshifts and optical and X-ray properties described here in detail, is available online. We study several X-ray to optical (X/O) properties: with our large statistics we put better constraints on the X/O flux ratio locus, finding a shift toward faint optical magnitudes in both soft and hard X-ray band. We confirm the existence of a correlation between X/O and the the 2–10 keV luminosity for Type 2 sources. We extend to low luminosities the analysis of the correlation between the fraction of obscured AGNs and the hard band luminosity, finding a different behavior between the optically and X-ray classified obscured fraction.

  16. Age structure and disturbance legacy of North American forests

    Directory of Open Access Journals (Sweden)

    Y. Pan

    2011-03-01

    Full Text Available Most forests of the world are recovering from a past disturbance. It is well known that forest disturbances profoundly affect carbon stocks and fluxes in forest ecosystems, yet it has been a great challenge to assess disturbance impacts in estimates of forest carbon budgets. Net sequestration or loss of CO2 by forests after disturbance follows a predictable pattern with forest recovery. Forest age, which is related to time since disturbance, is a useful surrogate variable for analyses of the impact of disturbance on forest carbon. In this study, we compiled the first continental forest age map of North America by combining forest inventory data, historical fire data, optical satellite data and the dataset from NASA's Landsat Ecosystem Disturbance Adaptive Processing System (LEDAPS project. A companion map of the standard deviations for age estimates was developed for quantifying uncertainty. We discuss the significance of the disturbance legacy from the past, as represented by current forest age structure in different regions of the US and Canada, by analyzing the causes of disturbances from land management and nature over centuries and at various scales. We also show how such information can be used with inventory data for analyzing carbon management opportunities. By combining geographic information about forest age with estimated C dynamics by forest type, it is possible to conduct a simple but powerful analysis of the net CO2 uptake by forests, and the potential for increasing (or decreasing this rate as a result of direct human intervention in the disturbance/age status. Finally, we describe how the forest age data can be used in large-scale carbon modeling, both for land-based biogeochemistry models and atmosphere-based inversion models, in order to improve the spatial accuracy of carbon cycle simulations.

  17. Evaluating user interactions with clinical information systems: a model based on human-computer interaction models.

    Science.gov (United States)

    Despont-Gros, Christelle; Mueller, Henning; Lovis, Christian

    2005-06-01

    This article proposes a model for dimensions involved in user evaluation of clinical information systems (CIS). The model links the dimensions in traditional CIS evaluation and the dimensions from the human-computer interaction (HCI) perspective. In this article, variables are defined as the properties measured in an evaluation, and dimensions are defined as the factors contributing to the values of the measured variables. The proposed model is based on a two-step methodology with: (1) a general review of information systems (IS) evaluations to highlight studied variables, existing models and frameworks, and (2) a review of HCI literature to provide the theoretical basis to key dimensions of user evaluation. The review of literature led to the identification of eight key variables, among which satisfaction, acceptance, and success were found to be the most referenced. Among those variables, IS acceptance is a relevant candidate to reflect user evaluation of CIS. While their goals are similar, the fields of traditional CIS evaluation, and HCI are not closely connected. Combining those two fields allows for the development of an integrated model which provides a model for summative and comprehensive user evaluation of CIS. All dimensions identified in existing studies can be linked to this model and such an integrated model could provide a new perspective to compare investigations of different CIS systems.

  18. Tracking the workforce: the American Society of Clinical Oncology workforce information system.

    Science.gov (United States)

    Kirkwood, M Kelsey; Kosty, Michael P; Bajorin, Dean F; Bruinooge, Suanna S; Goldstein, Michael A

    2013-01-01

    In anticipation of oncologist workforce shortages projected as part of a 2007 study, the American Society of Clinical Oncology (ASCO) worked with a contractor to create a workforce information system (WIS) to assemble the latest available data on oncologist supply and cancer incidence and prevalence. ASCO plans to publish findings annually, reporting on new data and tracking trends over time. THE WIS REPORT IS COMPOSED OF THREE SECTIONS: supply, new entrants, and cancer incidence and prevalence. Tabulations of the number of oncologists in the United States are derived mainly from the American Medical Association Physician Masterfile. Information on fellows and residents in the oncology workforce pipeline come from published sources such as Journal of the American Medical Association. Incidence and prevalence estimates are published by the American Cancer Society and National Cancer Institute. The WIS reports a total of 13,084 oncologists working in the United States in 2011. Oncologists are defined as those physicians who designate hematology, hematology/oncology, or medical oncology as their specialty. The WIS compares the characteristics of these oncologists with those of all physicians and tracks emerging trends in the physician training pipeline. Observing characteristics of the oncologist workforce over time allows ASCO to identify, prioritize, and evaluate its workforce initiatives. Accessible figures and reports generated by the WIS can be used by ASCO and others in the oncology community to advocate for needed health care system and policy changes to help offset future workforce shortages.

  19. Tracking the Workforce: The American Society of Clinical Oncology Workforce Information System

    Science.gov (United States)

    Kirkwood, M. Kelsey; Kosty, Michael P.; Bajorin, Dean F.; Bruinooge, Suanna S.; Goldstein, Michael A.

    2013-01-01

    Purpose: In anticipation of oncologist workforce shortages projected as part of a 2007 study, the American Society of Clinical Oncology (ASCO) worked with a contractor to create a workforce information system (WIS) to assemble the latest available data on oncologist supply and cancer incidence and prevalence. ASCO plans to publish findings annually, reporting on new data and tracking trends over time. Methods: The WIS report is composed of three sections: supply, new entrants, and cancer incidence and prevalence. Tabulations of the number of oncologists in the United States are derived mainly from the American Medical Association Physician Masterfile. Information on fellows and residents in the oncology workforce pipeline come from published sources such as Journal of the American Medical Association. Incidence and prevalence estimates are published by the American Cancer Society and National Cancer Institute. Results: The WIS reports a total of 13,084 oncologists working in the United States in 2011. Oncologists are defined as those physicians who designate hematology, hematology/oncology, or medical oncology as their specialty. The WIS compares the characteristics of these oncologists with those of all physicians and tracks emerging trends in the physician training pipeline. Conclusion: Observing characteristics of the oncologist workforce over time allows ASCO to identify, prioritize, and evaluate its workforce initiatives. Accessible figures and reports generated by the WIS can be used by ASCO and others in the oncology community to advocate for needed health care system and policy changes to help offset future workforce shortages. PMID:23633965

  20. Financial incentives, quality improvement programs, and the adoption of clinical information technology.

    Science.gov (United States)

    Robinson, James C; Casalino, Lawrence P; Gillies, Robin R; Rittenhouse, Diane R; Shortell, Stephen S; Fernandes-Taylor, Sara

    2009-04-01

    Physician use of clinical information technology (CIT) is important for the management of chronic illness, but has lagged behind expectations. We studied the role of health insurers' financial incentives (including pay-for-performance) and quality improvement initiatives in accelerating adoption of CIT in large physician practices. National survey of all medical groups and independent practice association (IPA) physician organizations with 20 or more physicians in the United States in 2006 to 2007. The response rate was 60.3%. Use of 19 CIT capabilities was measured. Multivariate statistical analysis of financial and organizational factors associated with adoption and use of CIT. Use of information technology varied across physician organizations, including electronic access to laboratory test results (medical groups, 49.3%; IPAs, 19.6%), alerts for potential drug interactions (medical groups, 33.9%; IPAs, 9.5%), electronic drug prescribing (medical groups, 41.9%; IPAs, 25.1%), and physician use of e-mail with patients (medical groups, 34.2%; IPAs, 29.1%). Adoption of CIT was stronger for physician organizations evaluated by external entities for pay-for-performance and public reporting purposes (P = 0.042) and for those participating in quality improvement initiatives (P < 0.001). External incentives and participation in quality improvement initiatives are associated with greater use of CIT by large physician practices.

  1. Budget goal commitment, clinical managers' use of budget information and performance.

    Science.gov (United States)

    Macinati, Manuela S; Rizzo, Marco G

    2014-08-01

    Despite the importance placed on accounting as a means to influence performance in public healthcare, there is still a lot to be learned about the role of management accounting in clinical managers' work behavior and their link with organizational performance. The article aims at analyzing the motivational role of budgetary participation and the intervening role of individuals' mental states and behaviors in influencing the relationship between budgetary participation and performance. According to the goal-setting theory, SEM technique was used to test the relationships among variables. The data were collected by a survey conducted in an Italian hospital. The results show that: (i) budgetary participation does not directly influence the use of budget information, but the latter is encouraged by the level of budget goal commitment which, as a result, is influenced by the positive motivational consequences of participative budgeting; (ii) budget goal commitment does not directly influence performance, but the relationship is mediated by the use of budget information. This study contributes to health policy and management accounting literature and has significant policy implications. Mainly, the findings prove that the introduction of business-like techniques in the healthcare sector can improve performance if attitudinal and behavioral variables are adequately stimulated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Strategies for informed sample size reduction in adaptive controlled clinical trials

    Science.gov (United States)

    Arandjelović, Ognjen

    2017-12-01

    Clinical trial adaptation refers to any adjustment of the trial protocol after the onset of the trial. The main goal is to make the process of introducing new medical interventions to patients more efficient. The principal challenge, which is an outstanding research problem, is to be found in the question of how adaptation should be performed so as to minimize the chance of distorting the outcome of the trial. In this paper, we propose a novel method for achieving this. Unlike most of the previously published work, our approach focuses on trial adaptation by sample size adjustment, i.e. by reducing the number of trial participants in a statistically informed manner. Our key idea is to select the sample subset for removal in a manner which minimizes the associated loss of information. We formalize this notion and describe three algorithms which approach the problem in different ways, respectively, using (i) repeated random draws, (ii) a genetic algorithm, and (iii) what we term pair-wise sample compatibilities. Experiments on simulated data demonstrate the effectiveness of all three approaches, with a consistently superior performance exhibited by the pair-wise sample compatibilities-based method.

  3. Enhancement of CLAIM (clinical accounting information) for a localized Chinese version.

    Science.gov (United States)

    Guo, Jinqiu; Takada, Akira; Niu, Tie; He, Miao; Tanaka, Koji; Sato, Junzo; Suzuki, Muneou; Takahashi, Kiwamu; Daimon, Hiroyuki; Suzuki, Toshiaki; Nakashima, Yusei; Araki, Kenji; Yoshihara, Hiroyuki

    2005-10-01

    CLinical Accounting InforMation (CLAIM) is a standard for the exchange of data between patient accounting systems and electronic medical record (EMR) systems. It uses eXtensible Markup Language (XML) as a meta-language and was developed in Japan. CLAIM is subordinate to the Medical Markup Language (MML) standard, which allows the exchange of medical data between different medical institutions. It has inherited the basic structure of MML 2.x and the current version, version 2.1, contains two modules and nine data definition tables. In China, no data exchange standard yet exists that links EMR systems to accounting systems. Taking advantage of CLAIM's flexibility, we created a localized Chinese version based on CLAIM 2.1. Since Chinese receipt systems differ from those of Japan, some information such as prescription formats, etc. are also different from those in Japan. Two CLAIM modules were re-engineered and six data definition tables were either added or redefined. The Chinese version of CLAIM takes local needs into account, and consequently it is now possible to transfer data between the patient accounting systems and EMR systems of Chinese medical institutions effectively.

  4. Racial Disparities in Clinically Significant Prostate Cancer Treatment: The Potential Health Information Technology Offers.

    Science.gov (United States)

    Bickell, Nina A; Lin, Jenny J; Abramson, Sarah R; Hoke, Gerald P; Oh, William; Hall, Simon J; Stock, Richard; Fei, Kezhen; McAlearney, Ann Scheck

    2018-01-01

    Black men are more likely to die as a result of prostate cancer than white men, despite effective treatments that improve survival for clinically significant prostate cancer. We undertook this study to identify gaps in prostate cancer care quality, racial disparities in care, and underlying reasons for poorer quality care. We identified all black men and random age-matched white men with Gleason scores ≥ 7 diagnosed between 2006 and 2013 at two urban hospitals to determine rates of treatment underuse. Underuse was defined as not receiving primary surgery, cryotherapy, or radiotherapy. We then interviewed treating physicians about the reasons for underuse. Of 359 black and 282 white men, only 25 (4%) experienced treatment underuse, and 23 (92%) of these were black. Most (78%) cases of underuse were due to system failures, where treatment was recommended but not received; 38% of these men continued receiving care at the hospitals. All men with treatment underuse due to system failures were black. Treatment rates of prostate cancer are high. Yet, racial disparities in rates and causes of underuse remain. Only black men experienced system failures, a type of underuse amenable to health information technology-based solutions. Institutions are missing opportunities to use their health information technology capabilities to reduce disparities in cancer care.

  5. Linguistic Strategies for Improving Informed Consent in Clinical Trials Among Low Health Literacy Patients.

    Science.gov (United States)

    Krieger, Janice L; Neil, Jordan M; Strekalova, Yulia A; Sarge, Melanie A

    2017-03-01

    Improving informed consent to participate in randomized clinical trials (RCTs) is a key challenge in cancer communication. The current study examines strategies for enhancing randomization comprehension among patients with diverse levels of health literacy and identifies cognitive and affective predictors of intentions to participate in cancer RCTs. Using a post-test-only experimental design, cancer patients (n = 500) were randomly assigned to receive one of three message conditions for explaining randomization (ie, plain language condition, gambling metaphor, benign metaphor) or a control message. All statistical tests were two-sided. Health literacy was a statistically significant moderator of randomization comprehension (P = .03). Among participants with the lowest levels of health literacy, the benign metaphor resulted in greater comprehension of randomization as compared with plain language (P = .04) and control (P = .004) messages. Among participants with the highest levels of health literacy, the gambling metaphor resulted in greater randomization comprehension as compared with the benign metaphor (P = .04). A serial mediation model showed a statistically significant negative indirect effect of comprehension on behavioral intention through personal relevance of RCTs and anxiety associated with participation in RCTs (P literacy, with a benign metaphor being particularly effective for patients at the lower end of the health literacy spectrum. The theoretical model demonstrates the cognitive and affective predictors of behavioral intention to participate in cancer RCTs and offers guidance on how future research should employ communication strategies to improve the informed consent processes. © The Author 2016. Published by Oxford University Press.

  6. A need to simplify informed consent documents in cancer clinical trials. A position paper of the ARCAD Group.

    Science.gov (United States)

    Bleiberg, H; Decoster, G; de Gramont, A; Rougier, P; Sobrero, A; Benson, A; Chibaudel, B; Douillard, J Y; Eng, C; Fuchs, C; Fujii, M; Labianca, R; Larsen, A K; Mitchell, E; Schmoll, H J; Sprumont, D; Zalcberg, J

    2017-05-01

    In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants. The purpose of this work is to focus on the written information in the informed consent documentation for drug development clinical trials and suggests (i) to distinguish between necessary and not essential information, (ii) to define the optimal format allowing the best legibility of those documents. The Aide et Recherche en Cancérologie Digestive (ARCAD) Group, an international scientific committee involving oncologists from all over the world, addressed these issues and developed and uniformly accepted a simplified informed consent documentation for future clinical research. A simplified form of informed consent with the leading part of 1200-1800 words containing all of the key information necessary to meet ethical and regulatory requirements and 'relevant supportive information appendix' of 2000-3000 words is provided. This position paper, on the basis of the ARCAD Group experts discussions, proposes our informed consent model and the rationale for its content. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology.

  7. Distilling clinically interpretable information from data collected on next-generation wearable sensors.

    Science.gov (United States)

    Haslam, Bryan; Gordhandas, Ankit; Ricciardi, Catherine; Verghese, George; Heldt, Thomas

    2011-01-01

    Medical electronic systems are generating ever larger data sets from a variety of sensors and devices. Such systems are also being packaged in wearable designs for easy and broad use. The large volume of data and the constraints of low-power, extended-duration, and wireless monitoring impose the need for on-chip processing to distill clinically relevant information from the raw data. The higher-level information, rather than the raw data, is what needs to be transmitted. We present one example of information processing for continuous, high-sampling-rate data collected from wearable and portable devices. A wearable cardiac and motion monitor designed by colleagues at MIT simultaneously records electrocardiogram (ECG) and 3-axis acceleration to onboard memory, in an ambulatory setting. The acceleration data is used to generate a continuous estimate of physical activity. Additionally, we use a Portapres continuous blood pressure monitor to concurrently record the arterial blood pressure (ABP) waveform. To help reduce noise, which is an increased challenge in ambulatory monitoring, we use both the ECG and ABP waveforms to generate a robust measure of heart rate from noisy data. We also generate an overall signal abnormality index to aid in the interpretation of the results. Two important cardiovascular quantities, namely cardiac output (CO) and total peripheral resistance (TPR), are then derived from this data over a sequence of physical activities. CO and TPR can be estimated (to within a scale factor) from heart rate, pulse pressure and mean arterial blood pressure, which in turn are directly obtained from the ECG and ABP signals. Data was collected on 10 healthy subjects. The derived quantities vary in a manner that is consistent with known physiology. Further work remains to correlate these values with the cardiac health state.

  8. Treatment of African children with severe malaria - towards evidence-informed clinical practice using GRADE

    Directory of Open Access Journals (Sweden)

    English Mike

    2011-07-01

    Full Text Available Abstract Background Severe malaria is a major contributor of deaths in African children up to five years of age. One valuable tool to support health workers in the management of diseases is clinical practice guidelines (CPGs developed using robust methods. A critical assessment of the World Health Organization (WHO and Kenyan paediatric malaria treatment guidelines with quinine was undertaken, with a focus on the quality of the evidence and transparency of the shift from evidence to recommendations. Methods Systematic reviews of the literature were conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE tool to appraise included studies. The findings were used to evaluate the WHO and Kenyan recommendations for the management of severe childhood malaria. Results The WHO 2010 malaria guidance on severe malaria in children, which informed the Kenyan guidelines, only evaluated the evidence on one topic on paediatric care using the GRADE tool. Using the GRADE tool, this work explicitly demonstrated that despite the established use of quinine in the management of paediatric cases of severe malaria for decades, low or very low quality evidence of important outcomes, but not critical outcomes such as mortality, have informed national and international guidance on the paediatric quinine dosing, route of administration and adverse effects. Conclusions Despite the foreseeable shift to artesunate as the primary drug for treatment of severe childhood malaria, the findings reported here reflect that the particulars of quinine therapeutics for the management of severe malaria in African children have historically been a neglected research priority. This work supports the application of the GRADE tool to make transparent recommendations and to inform advocacy efforts for a greater research focus in priority areas in paediatric care in Africa and other low-income settings.

  9. Climate legacies drive global soil carbon stocks in terrestrial ecosystems.

    Science.gov (United States)

    Delgado-Baquerizo, Manuel; Eldridge, David J; Maestre, Fernando T; Karunaratne, Senani B; Trivedi, Pankaj; Reich, Peter B; Singh, Brajesh K

    2017-04-01

    Climatic conditions shift gradually over millennia, altering the rates at which carbon (C) is fixed from the atmosphere and stored in the soil. However, legacy impacts of past climates on current soil C stocks are poorly understood. We used data from more than 5000 terrestrial sites from three global and regional data sets to identify the relative importance of current and past (Last Glacial Maximum and mid-Holocene) climatic conditions in regulating soil C stocks in natural and agricultural areas. Paleoclimate always explained a greater amount of the variance in soil C stocks than current climate at regional and global scales. Our results indicate that climatic legacies help determine global soil C stocks in terrestrial ecosystems where agriculture is highly dependent on current climatic conditions. Our findings emphasize the importance of considering how climate legacies influence soil C content, allowing us to improve quantitative predictions of global C stocks under different climatic scenarios.

  10. Developing a TTCN-3 Test Harness for Legacy Software

    DEFF Research Database (Denmark)

    Okika, Joseph C.; Ravn, Anders Peter; Siddalingaiah, Lokesh

    2006-01-01

    challenge in developing the test harness is to interface a generic test driver to the legacy software and provide a suitable interface for test engineers. The main contribution of this paper is a demonstration of a suitable design for such a test harness. It includes: a TTCN-3 test driver in C++, the legacy...... control software in C, a Graphical User Interface (GUI) and the connectors in Java. Our experience shows that it is feasible to use TTCN-3 in developing a test harness for a legacy software for an embedded system, even when it involves different heterogeneous components.......We describe a prototype test harness for an embedded system which is the control software for a modern marine diesel engine. The operations of such control software requires complete certification. We adopt Testing and Test Control Notation (TTCN-3) to define test cases for this purpose. The main...

  11. Developing a TTCN-3 Test Harness for Legacy Software

    DEFF Research Database (Denmark)

    Okika, Joseph C.; Ravn, Anders Peter; Siddalingaiah, Lokesh

    2006-01-01

    We describe a prototype test harness for an embedded system which is the control software for a modern marine diesel engine. The operations of such control software requires complete certification. We adopt Testing and Test Control Notation (TTCN-3) to define test cases for this purpose. The main...... challenge in developing the test harness is to interface a generic test driver to the legacy software and provide a suitable interface for test engineers. The main contribution of this paper is a demonstration of a suitable design for such a test harness. It includes: a TTCN-3 test driver in C++, the legacy...... control software in C, a Graphical User Interface (GUI) and the connectors in Java. Our experience shows that it is feasible to use TTCN-3 in developing a test harness for a legacy software for an embedded system, even when it involves different heterogeneous components....

  12. Legacy to Industry 4.0: A Profibus Sniffer

    Science.gov (United States)

    Tsegaye Mamo, Fesseha; Sikora, Axel; Rathfelder, Christoph

    2017-07-01

    Legacy industrial communication protocols are proved robust and functional. During the last decades, the industry has invented completely new or advanced versions of the legacy communication solutions. However, even with the high adoption rate of these new solutions, still the majority industry applications run on legacy, mostly fieldbus related technologies. Profibus is one of those technologies that still keep on growing in the market, albeit a slow in market growth in recent years. A retrofit technology that would enable these technologies to connect to the Internet of Things, utilize the ever growing potential of data analysis, predictive maintenance or cloud-based application, while at the same time not changing a running system is fundamental.

  13. The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey.

    Science.gov (United States)

    Jones, Teresa H; Hanney, Steve; Buxton, Martin J

    2007-01-15

    Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. We inquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. The same three information sources--professional meetings & conferences, peer-reviewed journals and medical colleagues--were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be

  14. 'Trial Exegesis': Methods for Synthesizing Clinical and Patient Reported Outcome (PRO Data in Trials to Inform Clinical Practice. A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Angus G K McNair

    Full Text Available The CONSORT extension for patient reported outcomes (PROs aims to improve reporting, but guidance on the optimal integration with clinical data is lacking. This study examines in detail the reporting of PROs and clinical data from randomized controlled trials (RCTs in gastro-intestinal cancer to inform design and reporting of combined PRO and clinical data from trials to improve the 'take home' message for clinicians to use in practice.The case study was undertaken in gastro-intestinal cancer trials. Well-conducted RCTs reporting PROs with validated instruments were identified and categorized into those combining PRO and clinical data in a single paper, or those separating data into linked primary and supplemental papers. Qualitative methods were developed to examine reporting of the critical interpretation of the trial results (trial exegesis in the papers in relation of the PRO and clinical outcomes and applied to each publication category. Results were used to inform recommendations for practice.From 1917 screened abstracts, 49 high quality RCTs were identified reported in 36 combined and 15 linked primary and supplemental papers. In-depth analysis of manuscript text identified three categories for understanding trial exegesis: where authors reported a "detailed", "general", or absent PRO rationale and integrated interpretation of clinical and PRO results. A total of 11 (30% and 6 (16% combined papers reported "detailed" PRO rationale and integrated interpretation of results although only 2 (14% and 1 (7% primary papers achieved the same standard respectively. Supplemental papers provide better information with 11 (73% and 3 (20% achieving "detailed" rationale and integrated interpretation of results. Supplemental papers, however, were published a median of 20 months after the primary RCT data in lower impact factor journals (median 16.8 versus 5.2.It is recommended that single papers, with detailed PRO rationale and integrated PRO and

  15. 'Trial Exegesis': Methods for Synthesizing Clinical and Patient Reported Outcome (PRO) Data in Trials to Inform Clinical Practice. A Systematic Review.

    Science.gov (United States)

    McNair, Angus G K; Macefield, Rhiannon C; Blencowe, Natalie S; Brookes, Sara T; Blazeby, Jane M

    2016-01-01

    The CONSORT extension for patient reported outcomes (PROs) aims to improve reporting, but guidance on the optimal integration with clinical data is lacking. This study examines in detail the reporting of PROs and clinical data from randomized controlled trials (RCTs) in gastro-intestinal cancer to inform design and reporting of combined PRO and clinical data from trials to improve the 'take home' message for clinicians to use in practice. The case study was undertaken in gastro-intestinal cancer trials. Well-conducted RCTs reporting PROs with validated instruments were identified and categorized into those combining PRO and clinical data in a single paper, or those separating data into linked primary and supplemental papers. Qualitative methods were developed to examine reporting of the critical interpretation of the trial results (trial exegesis) in the papers in relation of the PRO and clinical outcomes and applied to each publication category. Results were used to inform recommendations for practice. From 1917 screened abstracts, 49 high quality RCTs were identified reported in 36 combined and 15 linked primary and supplemental papers. In-depth analysis of manuscript text identified three categories for understanding trial exegesis: where authors reported a "detailed", "general", or absent PRO rationale and integrated interpretation of clinical and PRO results. A total of 11 (30%) and 6 (16%) combined papers reported "detailed" PRO rationale and integrated interpretation of results although only 2 (14%) and 1 (7%) primary papers achieved the same standard respectively. Supplemental papers provide better information with 11 (73%) and 3 (20%) achieving "detailed" rationale and integrated interpretation of results. Supplemental papers, however, were published a median of 20 months after the primary RCT data in lower impact factor journals (median 16.8 versus 5.2). It is recommended that single papers, with detailed PRO rationale and integrated PRO and clinical data

  16. Risk-Based Ranking Experiences for Cold War Legacy Facilities in the United States

    International Nuclear Information System (INIS)

    Droppo, James G.

    2003-01-01

    Over the past two decades, a number of government agencies in the United States have faced increasing public scrutiny for their efforts to address the wide range of potential environmental issues related to Cold War legacies. Risk-based ranking was selected as a means of defining the relative importance of issues. Ambitious facility-wide risk-based ranking applications were undertaken. However, although facility-wide risk-based ranking efforts can build invaluable understanding of the potential issues related to Cold War legacies, conducting such efforts is difficult because of the potentially enormous scope and the potentially strong institutional barriers. The U.S. experience is that such efforts are worth undertaking to start building a knowledge base and infrastructure that are based on a thorough understanding of risk. In both the East and the West, the legacy of the Cold War includes a wide range of potential environmental issues associated with large industrial complexes of weapon production facilities. The responsible agencies or ministries are required to make decisions that could benefit greatly from information on the relative importance of these potential issues. Facility-wide risk-based ranking of potential health and environmental issues is one means to help these decision makers. The initial U.S. risk-based ranking applications described in this chapter were ''ground-breaking'' in that they defined new methodologies and approaches to meet the challenges. Many of these approaches fit the designation of a population-centered risk assessment. These U.S. activities parallel efforts that are just beginning for similar facilities in the countries of the former Soviet Union. As described below, conducting a facility-wide risk-based ranking has special challenges and potential pitfalls. Little guidance exists to conduct major risk-based rankings. For those considering undertaking such efforts, the material contained in this chapter should be useful

  17. Groundwater Discharge of Legacy Nitrogen to River Networks: Linking Regional Groundwater Models to Streambed Groundwater-Surface Water Exchange and Nitrogen Processing

    Science.gov (United States)

    Barclay, J. R.; Helton, A. M.; Briggs, M. A.; Starn, J. J.; Hunt, A.

    2017-12-01

    Despite years of management, excess nitrogen (N) is a pervasive problem in many aquatic ecosystems. More than half of surface water in the United States is derived from groundwater, and widespread N contamination in aquifers from decades of watershed N inputs suggest legacy N discharging from groundwater may contribute to contemporary N pollution problems in surface waters. Legacy N loads to streams and rivers are controlled by both regional scale flow paths and fine-scale processes that drive N transformations, such as groundwater-surface water exchange across steep redox gradients that occur at stream bed interfaces. Adequately incorporating these disparate scales is a challenge, but it is essential to understanding legacy N transport and making informed management decisions. We developed a regional groundwater flow model for the Farmington River, a HUC-8 basin that drains to the Long Island Sound, a coastal estuary that suffers from elevated N loads despite decades of management, to understand broad patterns of regional transport. To evaluate and refine the regional model, we used thermal infrared imagery paired with vertical temperature profiling to estimate groundwater discharge at the streambed interface. We also analyzed discharging groundwater for multiple N species to quantify fine scale patterns of N loading and transformation via denitrification at the streambed interface. Integrating regional and local estimates of groundwater discharge of legacy N to river networks should improve our ability to predict spatiotemporal patterns of legacy N loading to and transformation within surface waters.

  18. 'You can't just hit a button': an ethnographic study of strategies to repurpose data from advanced clinical information systems for clinical process improvement.

    Science.gov (United States)

    Morrison, Cecily; Jones, Matthew; Jones, Rachel; Vuylsteke, Alain

    2013-04-10

    Current policies encourage healthcare institutions to acquire clinical information systems (CIS) so that captured data can be used for secondary purposes, including clinical process improvement. Such policies do not account for the extra work required to repurpose data for uses other than direct clinical care, making their implementation problematic. This paper aims to analyze the strategies employed by clinical units to use data effectively for both direct clinical care and clinical process improvement. Ethnographic methods were employed. A total of 54 contextual interviews with health professionals spanning various disciplines and 18 hours of observation were carried out in 5 intensive care units in England using an advanced CIS. Case studies of how the extra work was achieved in each unit were derived from the data and then compared. We found that extra work is required to repurpose CIS data for clinical process improvement. Health professionals must enter data not required for clinical care and manipulation of this data into a machine-readable form is often necessary. Ambiguity over who should be responsible for this extra work hindered CIS data usage for clinical process improvement. We describe 11 strategies employed by units to accommodate this extra work, distributing it across roles. Seven of these motivated data entry by health professionals and four addressed the machine readability of data. Many of the strategies relied heavily on the skill and leadership of local clinical customizers. To realize the expected clinical process improvements by the use of CIS data, clinical leaders and policy makers need to recognize and support the redistribution of the extra work that is involved in data repurposing. Adequate time, funding, and appropriate motivation are needed to enable units to acquire and deliver the necessary skills in CIS customization.

  19. From Usability Testing to Clinical Simulations: Bringing Context into the Design and Evaluation of Usable and Safe Health Information Technologies

    DEFF Research Database (Denmark)

    Kushniruk, Andre; Nøhr, Christian; Jensen, Sanne

    2013-01-01

    Objectives: The objective of this paper is to explore human factors approaches to understanding the use of health information technology (HIT) by extending usability engineering approaches to include analysis of the impact of clinical context through use of clinical simulations. Methods: Methods...... of clinical context into stronger focus. This involves testing of systems with representative users doing representative tasks, in representative settings/environments. Results: Application of methods where realistic clinical scenarios are used to drive the study of users interacting with systems under...

  20. El grupo de trabajo sobre consultas en bases de datos del CAICYT: un antecedente argentino en la pre-historia de las búsquedas de información científica y tecnológica en Internet. Parte 2: Desarrollo, actividades y legado = The Work Team on Databases Queries of CAICYT: An Argentine Precedent in the Pre-History of the Scientific and Technological Information Search on the Internet. Part 2: Development, Activities and Legacy

    Directory of Open Access Journals (Sweden)

    Pedro Falcato

    2014-06-01

    Full Text Available El presente artículo se dedica al desarrollo, actividades y legado del grupo de trabajo para el proyecto Recuperación de información en bases de datos distantes a través de terminal, que funcionó en el CAICYT (Centro Argentino de Información Científica y Tecnológica entre 1981 y 1987. Se aborda aspectos tales como la evolución profesional de sus miembros, las variaciones en la composición del grupo, las actividades de formación de usuarios, los modos de realización de las búsquedas, la problemática económica, las fortalezas y limitaciones del servicio y, finalmente, se repasan algunas facetas de lo expuesto que pueden ser útiles en la actualidad = This article deals with the development, activities and legacy of the workgroup for the Information Retrieval in Remote Databases by means of Terminal project, which met in CAICYT (Centro Argentino de Información Científica y Tecnológica between 1981 and 1987. It addresses issues such as the professional development of its members, changes in the membership, user training activities, ways of conducting searches, economic problems, strengths and limitations of the service. Finally, some aspects of the foregoing that may be useful at present are reviewed.

  1. New Media, Legacy Media and Misperceptions Regarding Sourcing

    Directory of Open Access Journals (Sweden)

    Stan Diel

    2017-07-01

    Full Text Available Resource dependence theory and related theories of management suggest online-only news media may displace legacy news media, but until that happens the two systems are likely to be dependent on the same resource: news. This quantitative content analysis finds that the systems exist as parallel but distinctly separate entities. Websites associated with legacy news media such as newspapers publish mostly hard news or news analysis in the form of original work. New, online-only news media publish mostly unoriginal features, but the origins of much of the content published by onlineonly media are unclear.

  2. Traceability of Software Safety Requirements in Legacy Safety Critical Systems

    Science.gov (United States)

    Hill, Janice L.

    2007-01-01

    How can traceability of software safety requirements be created for legacy safety critical systems? Requirements in safety standards are imposed most times during contract negotiations. On the other hand, there are instances where safety standards are levied on legacy safety critical systems, some of which may be considered for reuse for new applications. Safety standards often specify that software development documentation include process-oriented and technical safety requirements, and also require that system and software safety analyses are performed supporting technical safety requirements implementation. So what can be done if the requisite documents for establishing and maintaining safety requirements traceability are not available?

  3. The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

    Directory of Open Access Journals (Sweden)

    Frank E. DiLiberto

    Full Text Available ABSTRACT Background Implementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload. Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus. There is limited evidence targeting the prevention of first-time ulceration, and there is a need to consider additional factors of plantar stress to supplement current guidelines. Objectives The first purpose of this article is to discuss the biomechanical theory underpinning diabetic foot ulcerations and illustrate how plantar tissue underloading may precede overloading and breakdown. The second purpose of this commentary is to discuss how advances in biomechanical foot modeling can inform clinical practice in the prevention of first-time ulceration. Discussion Research demonstrates that progressive weight-bearing activity programs to address the frequency of plantar stress and avoid underloading do not increase ulceration risk. Multi-segment foot modeling studies indicate that dynamic foot function of the midfoot and forefoot is compromised in people with diabetes. Emerging research demonstrates that implementation of foot-specific exercises may positively influence dynamic foot function and improve plantar stress in people with diabetes. Conclusion Continued work is needed to determine how to best design and integrate activity recommendations and foot-specific exercise programs into the current interprofessional paradigm for the prevention of first-time ulceration in people with Diabetes Mellitus.

  4. Towards a clinically informed, data-driven definition of elderly onset epilepsy.

    Science.gov (United States)

    Josephson, Colin B; Engbers, Jordan D T; Sajobi, Tolulope T; Jette, Nathalie; Agha-Khani, Yahya; Federico, Paolo; Murphy, William; Pillay, Neelan; Wiebe, Samuel

    2016-02-01

    Elderly onset epilepsy represents a distinct subpopulation that has received considerable attention due to the unique features of the disease in this age group. Research into this particular patient group has been limited by a lack of a standardized definition and understanding of the attributes associated with elderly onset epilepsy. We used a prospective cohort database to examine differences in patients stratified according to age of onset. Linear support vector machine learning incorporating all significant variables was used to predict age of onset according to prespecified thresholds. Sensitivity and specificity were calculated and plotted in receiver-operating characteristic (ROC) space. Feature coefficients achieving an absolute value of 0.25 or greater were graphed by age of onset to define how they vary with time. We identified 2,449 patients, of whom 149 (6%) had an age of seizure onset of 65 or older. Fourteen clinical variables had an absolute predictive value of at least 0.25 at some point over the age of epilepsy-onset spectrum. Area under the curve in ROC space was maximized between ages of onset of 65 and 70. Features identified through machine learning were frequently threshold specific and were similar, but not identical, to those revealed through simple univariable and multivariable comparisons. This study provides an empirical, clinically informed definition of "elderly onset epilepsy." If validated, an age threshold of 65-70 years can be used for future studies of elderly onset epilepsy and permits targeted interventions according to the patient's age of onset. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  5. After the Fall: The RHESSI Legacy Archive

    Science.gov (United States)

    Schwartz, Richard A.; Zarro, Dominic M.; Tolbert, Anne K.

    2017-08-01

    Launched in 2002 the Ramaty High Energy Solar Spectroscopic Imager (RHESSI) continues to observe the Sun with a nearly 50% duty cycle. During that time the instrument has recorded ~100,000 solar flares in energies from 4 keV to over 10 MeV.with durations of 10s to 1000s of seconds. However, for the reasons of the decline of the solar cycle, possible failure of the instrument, or the absence of funding, our operational phase will end someday. We describe here our plans to continue to serve this dataset in raw, processed, and analyzed forms to the worldwide solar community to continue our legacy of a stream of rich scientific results.We have and are providing a stream of quicklook lightcurves, spectra, and images that we mainly serve through a web interface as well as the data in raw form to be fully analyzed within our own branch of Solar Software written in IDL. We are in the process of creating higher quality images for flares in multiple energy bands on relevant timescales for those whose needs can be met without further processing. For users with IDL licenses we expect this software to be available far into the unknowable future. Together with a database of AIA cutouts during all SDO-era flares, along with software to recover saturated images by using the AIA diffraction fringes, these will be a highly used resource.We also are developing additional tools and databases that will increase the utility of RHESSI data to members of the community with and without either IDL licenses or full access to the RHESSI database. We will provide a database of RHESSI x-ray visibilities obtained during flares at a >4 second cadence over a broad range of detectable energies. With our IDL software those can be rendered as images for times and energies of nearly the analysts's choosing. And going beyond that we are converting our imaging procedures to the Python language to eliminate the need for an IDL license. We are also developing methods to allow the customization of these

  6. Nuclear legacy: Students of two atomic cities

    International Nuclear Information System (INIS)

    Petersen, Gary

    2002-01-01

    Full text: Battelle Memorial Institute operates the Pacific Northwest National Laboratory (PNNL) for the U.S. Department of Energy. Within PNNL is the International Nuclear Safety Program (INSP) assigned to work on improving the safe operations of 67 Soviet-designed nuclear reactors in nine countries. One major mission of this program has been Chernobyl NPP activities, both for the operating plant, and for the Chernobyl Shelter. In conjunction with the activities at Chernobyl, several Battelle staff members have been living in Slavutych (the city closest to Chernobyl) for periods of up to two years. Through these personal relationships, Battelle began to take personal interest in students in Slavutych. In 1999 Battelle used private funding to support 20 students from Slavutych, Ukraine; and 20 students from Richland, Washington, U.S.A., in authoring a book called Nuclear Legacy: Students of Two Atomic Cities. This hard-bound book was researched, and written, entirely by these 40 13-to-15-year-old students. It is an amazing book, which describes the past, the present, and the future of two nuclear cities - Slavutych near Chernobyl, and Richland, near Hanford. It was written in two languages, with every article translated into both English and Ukrainian. It was published in June, 2000, and has now sold more than 2,600 copies in 14 countries. The book is primarily an educational publication designed to teach students how to write and publish a book on a sensitive subject - nuclear. It is not a political statement. However, the student researched and written articles do discuss politically sensitive nuclear topics in straightforward detail. The moving first hand accounts through the eyes of these young people of the 1986 Chernobyl nuclear accident, and interviews with scientists and engineers who worked on the 1940's Manhattan Project in the United States, make the book a unique collaboration on two nuclear cultures. What started as a one-semester project took a full

  7. Local meanings of a sport mega-event's legacies : Stories from a South African urban neighbourhood

    NARCIS (Netherlands)

    Waardenburg, Maikel; van den Bergh, Marjolein; van Eekeren, Frank

    2015-01-01

    Studies on sport mega-events and their legacies often seem only loosely connected to local experiences. Stories on sport mega-event legacy appear as a setting-the-scene or function as a reference to illustrate specific types of legacy. However, stories themselves are never the primary focus in these

  8. 31 CFR 357.20 - Securities account in Legacy Treasury Direct ®.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Securities account in Legacy Treasury Direct ®. 357.20 Section 357.20 Money and Finance: Treasury Regulations Relating to Money and Finance... Securities System (Legacy Treasury Direct) § 357.20 Securities account in Legacy Treasury Direct ®. (a...

  9. A transdisciplinary model to inform randomized clinical trial methods for electronic cigarette evaluation

    Directory of Open Access Journals (Sweden)

    Alexa A. Lopez

    2016-03-01

    Full Text Available Abstract Background This study is a systematic evaluation of a novel tobacco product, electronic cigarettes (ECIGs using a two-site, four-arm, 6-month, parallel-group randomized controlled trial (RCT with a follow-up to 9 months. Virginia Commonwealth University is the primary site and Penn State University is the secondary site. This RCT design is important because it is informed by analytical work, clinical laboratory results, and qualitative/quantitative findings regarding the specific ECIG products used. Methods Participants (N = 520 will be randomized across sites and must be healthy smokers of >9 cigarettes for at least one year, who have not had a quit attempt in the prior month, are not planning to quit in the next 6 months, and are interested in reducing cigarette intake. Participants will be randomized into one of four 24-week conditions: a cigarette substitute that does not produce an inhalable aerosol; or one of three ECIG conditions that differ by nicotine concentration 0, 8, or 36 mg/ml. Blocked randomization will be accomplished with a 1:1:1:1 ratio of condition assignments at each site. Specific aims are to: characterize ECIG influence on toxicants, biomarkers, health indicators, and disease risk; determine tobacco abstinence symptom and adverse event profile associated with real-world ECIG use; and examine the influence of ECIG use on conventional tobacco product use. Liquid nicotine concentration-related differences on these study outcomes are predicted. Participants and research staff in contact with participants will be blinded to the nicotine concentration in the ECIG conditions. Discussion Results from this study will inform knowledge concerning ECIG use as well as demonstrate a model that may be applied to other novel tobacco products. The model of using prior empirical testing of ECIG devices should be considered in other RCT evaluations. Trial registration TRN: NCT02342795 , registered December 16, 2014.

  10. Hospital Discharge Information After Elective Total hip or knee Joint Replacement Surgery: A clinical Audit of preferences among general practitioners

    Directory of Open Access Journals (Sweden)

    Andrew M Briggs

    2012-05-01

    Full Text Available AbstractThe demand for elective joint replacement (EJR surgery for degenerative joint disease continues to rise in Australia, and relative to earlier practices, patients are discharged back to the care of their general practitioner (GP and other community-based providers after a shorter hospital stay and potentially greater post-operative acuity. In order to coordinate safe and effective post-operative care, GPs rely on accurate, timely and clinically-informative information from hospitals when their patients are discharged. The aim of this project was to undertake an audit with GPs regarding their preferences about the components of information provided in discharge summaries for patients undergoing EJR surgery for the hip or knee. GPs in a defined catchment area were invited to respond to an online audit instrument, developed by an interdisciplinary group of clinicians with knowledge of orthopaedic surgery practices. The 15-item instrument required respondents to rank the importance of components of discharge information developed by the clinician working group, using a three-point rating scale. Fifty-three GPs and nine GP registrars responded to the audit invitation (11.0% response rate. All discharge information options were ranked as ‘essential’ by a proportion of respondents, ranging from 14.8–88.5%. Essential information requested by the respondents included early post-operative actions required by the GP, medications prescribed, post-operative complications encountered and noting of any allergies. Non-essential information related to the prosthesis used. The provision of clinical guidelines was largely rated as ‘useful’ information (47.5–56.7%. GPs require a range of clinical information to safely and effectively care for their patients after discharge from hospital for EJR surgery. Implementation of changes to processes used to create discharge summaries will require engagement and collaboration between clinical staff

  11. From Usability Testing to Clinical Simulations: Bringing Context into the Design and Evaluation of Usable and Safe Health Information Technologies

    DEFF Research Database (Denmark)

    Kushniruk, Andre; Nøhr, Christian; Jensen, Sanne

    2013-01-01

    Objectives: The objective of this paper is to explore human factors approaches to understanding the use of health information technology (HIT) by extending usability engineering approaches to include analysis of the impact of clinical context through use of clinical simulations. Methods: Methods...... discussed are considered on a continuum from traditional laboratory-based usability testing to clinical simulations. Clinical simulations can be conducted in a simulation laboratory and they can also be conducted in real-world settings. The clinical simulation approach attempts to bring the dimension...... such evaluation can be used to improve both the usability and safety of HIT. In addition, recent work has shown that clinical simulations, in particular those conducted in-situ, can lead to considerable benefits when compared to the costs of running such studies. Conclusion: In order to bring context of use...

  12. Data collection and information presentation for optimal decision making by clinical managers--the Autocontrol Project.

    Science.gov (United States)

    Grant, A M; Richard, Y; Deland, E; Després, N; de Lorenzi, F; Dagenais, A; Buteau, M

    1997-01-01

    The Autocontrol methodology has been developed in order to support the optimisation of decision-making and the use of resources in the context of a clinical unit. The theoretical basis relates to quality assurance and information systems and is influenced by management and cognitive research in the health domain. The methodology uses population rather than individual decision making and because of its dynamic feedback design promises to have rapid and profound effect on practice. Most importantly the health care professional is the principle user of the Autocontrol system. In this methodology we distinguish three types of evidence necessary for practice change: practice based or internal evidence, best evidence derived from the literature or external evidence concerning the practice in question, and process based evidence on how to optimise the process of practice change. The software used by the system is of the executive decision support type which facilitates interrogation of large databases. The Autocontrol system is designed to interrogate the data of the patient medical record however the latter often lacks data on concomitant resource use and this must be supplemented. This paper reviews the Autocontrol methodology and gives examples from current studies.

  13. Seizure reporting technologies for epilepsy treatment: A review of clinical information needs and supporting technologies.

    Science.gov (United States)

    Bidwell, Jonathan; Khuwatsamrit, Thanin; Askew, Brittain; Ehrenberg, Joshua Andrew; Helmers, Sandra

    2015-11-01

    This review surveys current seizure detection and classification technologies as they relate to aiding clinical decision-making during epilepsy treatment. Interviews and data collected from neurologists and a literature review highlighted a strong need for better distinguishing between patients exhibiting generalized and partial seizure types as well as achieving more accurate seizure counts. This information is critical for enabling neurologists to select the correct class of antiepileptic drugs (AED) for their patients and evaluating AED efficiency during long-term treatment. In our questionnaire, 100% of neurologists reported they would like to have video from patients prior to selecting an AED during an initial consultation. Presently, only 30% have access to video. In our technology review we identified that only a subset of available technologies surpassed patient self-reporting performance due to high false positive rates. Inertial seizure detection devices coupled with video capture for recording seizures at night could stand to address collecting seizure counts that are more accurate than current patient self-reporting during day and night time use. Copyright © 2015. Published by Elsevier Ltd.

  14. The Shared Health Research Information Network (SHRINE): a prototype federated query tool for clinical data repositories.

    Science.gov (United States)

    Weber, Griffin M; Murphy, Shawn N; McMurry, Andrew J; Macfadden, Douglas; Nigrin, Daniel J; Churchill, Susanne; Kohane, Isaac S

    2009-01-01

    The authors developed a prototype Shared Health Research Information Network (SHRINE) to identify the technical, regulatory, and political challenges of creating a federated query tool for clinical data repositories. Separate Institutional Review Boards (IRBs) at Harvard's three largest affiliated health centers approved use of their data, and the Harvard Medical School IRB approved building a Query Aggregator Interface that can simultaneously send queries to each hospital and display aggregate counts of the number of matching patients. Our experience creating three local repositories using the open source Informatics for Integrating Biology and the Bedside (i2b2) platform can be used as a road map for other institutions. The authors are actively working with the IRBs and regulatory groups to develop procedures that will ultimately allow investigators to obtain identified patient data and biomaterials through SHRINE. This will guide us in creating a future technical architecture that is scalable to a national level, compliant with ethical guidelines, and protective of the interests of the participating hospitals.

  15. Lexical analysis in schizophrenia: how emotion and social word use informs our understanding of clinical presentation.

    Science.gov (United States)

    Minor, Kyle S; Bonfils, Kelsey A; Luther, Lauren; Firmin, Ruth L; Kukla, Marina; MacLain, Victoria R; Buck, Benjamin; Lysaker, Paul H; Salyers, Michelle P

    2015-05-01

    The words people use convey important information about internal states, feelings, and views of the world around them. Lexical analysis is a fast, reliable method of assessing word use that has shown promise for linking speech content, particularly in emotion and social categories, with psychopathological symptoms. However, few studies have utilized lexical analysis instruments to assess speech in schizophrenia. In this exploratory study, we investigated whether positive emotion, negative emotion, and social word use was associated with schizophrenia symptoms, metacognition, and general functioning in a schizophrenia cohort. Forty-six participants generated speech during a semi-structured interview, and word use categories were assessed using a validated lexical analysis measure. Trained research staff completed symptom, metacognition, and functioning ratings using semi-structured interviews. Word use categories significantly predicted all variables of interest, accounting for 28% of the variance in symptoms and 16% of the variance in metacognition and general functioning. Anger words, a subcategory of negative emotion, significantly predicted greater symptoms and lower functioning. Social words significantly predicted greater metacognition. These findings indicate that lexical analysis instruments have the potential to play a vital role in psychosocial assessments of schizophrenia. Future research should replicate these findings and examine the relationship between word use and additional clinical variables across the schizophrenia-spectrum. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Brain Stroke Detection by Microwaves Using Prior Information from Clinical Databases

    Directory of Open Access Journals (Sweden)

    Natalia Irishina

    2013-01-01

    Full Text Available Microwave tomographic imaging is an inexpensive, noninvasive modality of media dielectric properties reconstruction which can be utilized as a screening method in clinical applications such as breast cancer and brain stroke detection. For breast cancer detection, the iterative algorithm of structural inversion with level sets provides well-defined boundaries and incorporates an intrinsic regularization, which permits to discover small lesions. However, in case of brain lesion, the inverse problem is much more difficult due to the skull, which causes low microwave penetration and highly noisy data. In addition, cerebral liquid has dielectric properties similar to those of blood, which makes the inversion more complicated. Nevertheless, the contrast in the conductivity and permittivity values in this situation is significant due to blood high dielectric values compared to those of surrounding grey and white matter tissues. We show that using brain MRI images as prior information about brain's configuration, along with known brain dielectric properties, and the intrinsic regularization by structural inversion, allows successful and rapid stroke detection even in difficult cases. The method has been applied to 2D slices created from a database of 3D real MRI phantom images to effectively detect lesions larger than 2.5 × 10−2 m diameter.

  17. Towards optimised information about clinical trials; identification and validation of key issues in collaboration with cancer patient advocates

    DEFF Research Database (Denmark)

    Dellson, P; Nilbert, M; Bendahl, P-O

    2011-01-01

    for improvements, 21 key issues were defined and validated through a questionnaire in an independent group of breast cancer patient advocates. Clear messages, emotionally neutral expressions, careful descriptions of side effects, clear comparisons between different treatment alternatives and information about...... in three clinical trials for breast cancer. Primary data collection was done in focus group interviews with breast cancer patient advocates. Content analysis identified three major themes: comprehensibility, emotions and associations, and decision making. Based on the advocates' suggestions...... the possibility to discontinue treatment were perceived as the most important issues. Patients' views of the information in clinical trials provide new insights and identify key issues to consider in optimising future written information and may improve recruitment to clinical cancer trials....

  18. Correction of technical bias in clinical microarray data improves concordance with known biological information

    DEFF Research Database (Denmark)

    Eklund, Aron Charles; Szallasi, Zoltan Imre

    2008-01-01

    The performance of gene expression microarrays has been well characterized using controlled reference samples, but the performance on clinical samples remains less clear. We identified sources of technical bias affecting many genes in concert, thus causing spurious correlations in clinical data...... sets and false associations between genes and clinical variables. We developed a method to correct for technical bias in clinical microarray data, which increased concordance with known biological relationships in multiple data sets....

  19. Celebrating the Life and Legacy of Rosa Parks

    Science.gov (United States)

    Stewart, Loraine

    2006-01-01

    In this article, the author presents the life and legacy of Rosa Parks. The author highlights four children's books that accurately portray Parks as an activist and acknowledge the broader context of her life's story--and the years of struggle of the black community against Jim Crow laws. The four children's books share Rosa Park's story in ways…

  20. Soil and Groundwater Characteristics of a Legacy Spill Site | Adoki ...

    African Journals Online (AJOL)

    The soil and groundwater of a legacy spill site in Eleme Local Government Authority Area of Rivers Stae were investigated. The general land use of the area within 1500m radius of the spill site is devoted to farming, fishing and hunting. The main crops grown include yams, cassava, maize, sugarcane, plantain, banana, ...

  1. Soil and Groundwater Characteristics of a Legacy Spill Site AKURO ...

    African Journals Online (AJOL)

    MICHAEL HORSFALL

    ABSTACT: The soil and groundwater of a legacy spill site in Eleme Local Government Authority Area of. Rivers Stae were investigated. The general land use of the area within 1500m radius of the spill site is devoted to farming, fishing and hunting. The main crops grown include yams, cassava, maize, sugarcane, plantain,.

  2. Legacy, resource mobilisation and the olympic movement | Girginov ...

    African Journals Online (AJOL)

    There has been a growing interest in legacies of the Olympic Games focusing on external tangible outcomes, such as the number of sport competitions, participants and jobs created. Little is still known about the equally valuable internal benefits to individuals and organisational capacities of national sport systems.

  3. Leaving a Legacy: Passing Montessori to the Next Generation

    Science.gov (United States)

    Loveless, Sylvia

    2012-01-01

    For each of the past 19 years, the American Montessori Society has chosen to recognize one Montessorian as an AMS Living Legacy. Recipients are honored at the AMS annual conference for their salient work or volunteerism in the Montessori field and their dedication and leadership that has made an impact on the AMS community. It seems fitting that…

  4. The impact of colonial legacies and globalization processes on ...

    African Journals Online (AJOL)

    In this paper, I postulate that forced migration in modern Africa is largely explained by factors deeply rooted in colonial legacies and the globalization process. For example, among the colonial historical factors someone may identify land alienation that still fuels conflicts in Zimbabwe, the colonial military doctrine based on ...

  5. The Troublesome Legacy of "Brown v. Board of Education"

    Science.gov (United States)

    López, Gerardo R.; Burciaga, Rebeca

    2014-01-01

    Purpose: This article reflects on the 60th anniversary of the "Brown v. Board of Education" Supreme Court decision while discussing the significant lessons learned from this and subsequent court decisions. Argument: In this article, we posit that a fundamentally different conversation surrounding the legacy of Brown is needed if we are…

  6. Bridging the gap between legacy services and Web Services

    DEFF Research Database (Denmark)

    Bissyandé, Tegawendé; Réveillère, Laurent; Bromberg, Yérom-David

    2010-01-01

    itself. In this paper, we introduce a generative language based approach for constructing wrappers to facilitate the migration of legacy service functionalities to Web Services. To this end, we have designed the Janus domain-specific language, which provides developers with a high-level way to describe...

  7. BOKO HARAM IN NORTHERN NIGERIA: A MAUDUDIAN LEGACY ...

    African Journals Online (AJOL)

    Dean SPGS NAU

    colonialism and slavery” (2010, 168). Without question, colonial legacy contributed to the ... is the nature and mode of Shari'a implementation that is the issue. (2003, 144). This alludes to the influence of .... Syria, Iraq, Indonesia, Malaysia, Sri Lanka, Bangladesh, Nigeria,. South Africa, Kenya as well as elsewhere (2003, 533 ...

  8. Securing South Africa during the 2010 FIFA World Cup: Legacy ...

    African Journals Online (AJOL)

    Securing South Africa during the 2010 FIFA World Cup: Legacy implications for post-event safety and security. EC Perry, A Chunderduth, C Potgieter. Abstract. The trepidation over crime and safety concerns emerged as one of the main issues in relation to South Africa's hosting of the 2010 FIFA World Cup, prominent in the ...

  9. Paralympics 2012 Legacy: Accessible Housing and Disability Equality or Inequality?

    Science.gov (United States)

    Ahmed, Nadia

    2013-01-01

    The golden summer of sport is now over, but what is the legacy of London 2012 for disabled people? Nadia Ahmed, a disabled student, discusses the difficulties she has faced in finding accessible accommodation in London. She argues that while the Games are over, the United Kingdom still has lots of hurdles to leap when it comes to disability. The…

  10. Albert Schweitzer's Legacy for Education: Reverence for Life

    Science.gov (United States)

    Rud, A. G.

    2010-01-01

    "Albert Schweitzer's Legacy for Education" is the first book devoted to the study of the thought and deeds of Albert Schweitzer in relation to education. Schweitzer's life and work offer both inspiration and timely insights for educational thought and practice in the twenty-first century. Focusing on Schweitzer's central thought,…

  11. The Kemper History Project: From Historical Narrative to Institutional Legacy

    Science.gov (United States)

    Hunzicker, Jana

    2017-01-01

    An "institutional legacy" can be understood as knowledge, values, and shared experiences transmitted by or received from a college or university for the benefit of all who have taught, served, researched, and/or learned there. This article describes a year-long, collaborative writing project carried out by one university to chronicle two…

  12. An object-oriented framework for managing cooperating legacy databases

    NARCIS (Netherlands)

    Balsters, H; de Brock, EO

    2003-01-01

    We describe a general semantic framework for precise specification of so-called database federations. A database federation provides for tight coupling of a collection of heterogeneous legacy databases into a global integrated system. Our approach to database federation is based on the UML/OCL data

  13. Celebrating the Life and Legacy of Dr. John Hope Franklin

    Science.gov (United States)

    Harris, Robert L., Jr.; Levering-Lewis, David; French, John D.; Wharton, Clifton R., Jr.

    2009-01-01

    Dr. John Hope Franklin chronicled the experiences of African-Americans like no one before him, forcing America to recognize Black history as American history. His contributions were innumerable and his impact was abiding. In celebration of his life and legacy, the authors profile the celebrated scholar and activist, Dr. John Hope Franklin.

  14. Information Technology for Clinical, Translational and Comparative Effectiveness Research. Findings from the Yearbook 2015 Section on Clinical Research Informatics.

    Science.gov (United States)

    Daniel, C; Choquet, R

    2015-08-13

    To summarize excellent current research in the field of Bioinformatics and Translational Informatics with application in the health domain and clinical care. We provide a synopsis of the articles selected for the IMIA Yearbook 2015, from which we attempt to derive a synthetic overview of current and future activities in the field. As last year, a first step of selection was performed by querying MEDLINE with a list of MeSH descriptors completed by a list of terms adapted to the section. Each section editor has evaluated separately the set of 1,594 articles and the evaluation results were merged for retaining 15 articles for peer-review. The selection and evaluation process of this Yearbook's section on Bioinformatics and Translational Informatics yielded four excellent articles regarding data management and genome medicine that are mainly tool-based papers. In the first article, the authors present PPISURV a tool for uncovering the role of specific genes in cancer survival outcome. The second article describes the classifier PredictSNP which combines six performing tools for predicting disease-related mutations. In the third article, by presenting a high-coverage map of the human proteome using high resolution mass spectrometry, the authors highlight the need for using mass spectrometry to complement genome annotation. The fourth article is also related to patient survival and decision support. The authors present datamining methods of large-scale datasets of past transplants. The objective is to identify chances of survival. The current research activities still attest the continuous convergence of Bioinformatics and Medical Informatics, with a focus this year on dedicated tools and methods to advance clinical care. Indeed, there is a need for powerful tools for managing and interpreting complex, large-scale genomic and biological datasets, but also a need for user-friendly tools developed for the clinicians in their daily practice. All the recent research and

  15. Modeling information flows in clinical decision support: key insights for enhancing system effectiveness

    NARCIS (Netherlands)

    Medlock, Stephanie; Wyatt, Jeremy C.; Patel, Vimla L.; Shortliffe, Edward H.; Abu-Hanna, Ameen

    2016-01-01

    A fundamental challenge in the field of clinical decision support is to determine what characteristics of systems make them effective in supporting particular types of clinical decisions. However, we lack such a theory of decision support itself and a model to describe clinical decisions and the

  16. Understanding Clinician Information Demands and Synthesis of Clinical Documents in Electronic Health Record Systems

    Science.gov (United States)

    Farri, Oladimeji Feyisetan

    2012-01-01

    Large quantities of redundant clinical data are usually transferred from one clinical document to another, making the review of such documents cognitively burdensome and potentially error-prone. Inadequate designs of electronic health record (EHR) clinical document user interfaces probably contribute to the difficulties clinicians experience while…

  17. 77 FR 22578 - Submission for OMB Review; Comment Request; Information Program on Clinical Trials: Maintaining a...

    Science.gov (United States)

    2012-04-16

    ..., physicians, and medical researchers; in particular those involved in clinical research. While many clinical... Program on Clinical Trials: Maintaining a Registry and Results Databank SUMMARY: Under the provisions of Section 3507(a)(1)(D) of the Paperwork Reduction Act of 1995, the National Library of Medicine (NLM), the...

  18. Clinical trial considerations on male contraception and collection of pregnancy information from female partners

    Directory of Open Access Journals (Sweden)

    Banholzer Maria

    2012-06-01

    principle, provide a consistent approach for minimizing the risk of embryo-fetal exposure to potentially harmful drugs during pregnancy of female partners of males in clinical trials. Proactive targeted collection of pregnancy information from female partners should help determine the teratogenic potential of a drug and minimize background noise and ethical/logistical issues.

  19. Nosocomial infections: knowledge and source of information among clinical health care students in Ghana

    Directory of Open Access Journals (Sweden)

    Bello AI

    2011-08-01

    Full Text Available Ajediran I Bello1, Eunice N Asiedu1, Babatunde OA Adegoke2, Jonathan NA Quartey1, Kwadwo O Appiah-Kubi1, Bertha Owusu-Ansah11Department of Physiotherapy, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana; 2Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, NigeriaBackground: This study determined and compared the knowledge of nosocomial infections among clinical health care students at the College of Health Sciences, University of Ghana.Methods: Two hundred undergraduate health care students from four academic programs participated in the study. The study sample was drawn from each academic program by a simple random sampling technique using the class directory from each course. The Infection Control Standardized Questionnaire (ICSQ was used to assess the knowledge of students about three main domains, ie, hand hygiene, nosocomial infections, and standard precautions. A maximum score of 50 was obtainable, and respondents with scores ≥70% were classified as having a satisfactory knowledge. The response on each item was coded numerically to generate data for statistical analysis. Comparison of knowledge on the domains among categories of students was assessed using the Kruskal–Wallis test, while associations between courses of study and knowledge about nosocomial infections were determined using the Chi-square test. All statistical tests had a significant level of 5% (P < 0.05Results: Overall mean percentage score of the participants on ICSQ was 65.4 ± 2.58, with medical, physiotherapy, radiography, and nursing students recording mean percentage scores of 70.58 ± 0.62, 65.02 ± 2.00, 64.74 ± 1.19, and 61.31 ± 2.35, respectively. The main source of information about the prevention of nosocomial infections as cited by participants was their routine formal training in class. There was no significant association (P > 0.05 between course of study and knowledge of

  20. Informed consent and placebo effects: a content analysis of information leaflets to identify what clinical trial participants are told about placebos.

    Science.gov (United States)

    Bishop, Felicity L; Adams, Alison E M; Kaptchuk, Ted J; Lewith, George T

    2012-01-01

    Placebo groups are used in randomised clinical trials (RCTs) to control for placebo effects, which can be large. Participants in trials can misunderstand written information particularly regarding technical aspects of trial design such as randomisation; the adequacy of written information about placebos has not been explored. We aimed to identify what participants in major RCTs in the UK are told about placebos and their effects. We conducted a content analysis of 45 Participant Information Leaflets (PILs) using quantitative and qualitative methodologies. PILs were obtained from trials on a major registry of current UK clinical trials (the UKCRN database). Eligible leaflets were received from 44 non-commercial trials but only 1 commercial trial. The main limitation is the low response rate (13.5%), but characteristics of included trials were broadly representative of all non-commercial trials on the database. 84% of PILs were for trials with 50:50 randomisation ratios yet in almost every comparison the target treatments were prioritized over the placebos. Placebos were referred to significantly less frequently than target treatments (7 vs. 27 mentions, peffects (1 vs. 45, peffects (4 vs. 39, pplacebo treatment was either undesirable or ineffective. PILs from recent high quality clinical trials emphasise the benefits and adverse effects of the target treatment, while largely ignoring the possible effects of the placebo. Thus they provide incomplete and at times inaccurate information about placebos. Trial participants should be more fully informed about the health changes that they might experience from a placebo. To do otherwise jeopardises informed consent and is inconsistent with not only the science of placebos but also the fundamental rationale underpinning placebo controlled trials.

  1. Independent technical evaluation and recommendations for contaminated groundwater at the department of energy office of legacy management Riverton processing site

    Energy Technology Data Exchange (ETDEWEB)

    Looney, Brain B. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Denham, Miles E. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Eddy-Dilek, Carol A. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2014-04-01

    The U.S. Department of Energy Office of Legacy Management (DOE-LM) manages the legacy contamination at the Riverton, WY, Processing Site – a former uranium milling site that operated from 1958 to 1963. The tailings and associated materials were removed in 1988-1989 and contaminants are currently flushing from the groundwater. DOE-LM commissioned an independent technical team to assess the status of the contaminant flushing, identify any issues or opportunities for DOE-LM, and provide key recommendations. The team applied a range of technical frameworks – spatial, temporal, hydrological and geochemical – in performing the evaluation. In each topic area, an in depth evaluation was performed using DOE-LM site data (e.g., chemical measurements in groundwater, surface water and soil, water levels, and historical records) along with information collected during the December 2013 site visit (e.g., plant type survey, geomorphology, and minerals that were observed, collected and evaluated).

  2. From legacy systems via client/server to web browser technology in hospital informatics in Finland.

    Science.gov (United States)

    Korpela, M

    1998-01-01

    The majority of hospital information system installations in Finland are based on a legacy technology from the U.S. Department of Veterans Affairs (VA). This paper presents an architecture and a tool set which provide a migration path from terminal-based to client/server technology, conserving much of the investments in existing applications. It is argued, though, that a new technological revolution is required in the form of extending the web browser/server technology to operational information systems in hospitals. A blueprint is presented for a further migration path from client/server to browser/server technology. The browser technology is regarded as a major challenge to hospital information systems in the next few years.

  3. Evidence-based information-seeking skills of junior doctors entering the workforce: an evaluation of the impact of information literacy training during pre-clinical years.

    Science.gov (United States)

    Cullen, Rowena; Clark, Megan; Esson, Rachel

    2011-06-01

    To investigate the extent to which junior doctors in their first clinical positions retained information literacy skills taught as part of their undergraduate education. Participants drawn from different training cohorts were interviewed about their recall of the instruction they had received, and their confidence in retrieving and evaluating information for clinical decision making. They completed a search based on a scenario related to their specialty. Their self-assessment of their competency in conducting and evaluating a search was compared with an evaluation of their skills by an experienced observer. Most participants recalled the training they received but had not retained high-level search skills, and lacked skills in identifying and applying best evidence. There was no apparent link between the type of training given and subsequent skill level. Those whose postgraduate education required these skills were more successful in retrieving and appraising information. Commitment to evidence-based medicine from clinicians at all levels in the profession is needed to increase the information seeking skills of clinicians entering the work force. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

  4. Towards optimised information about clinical trials; identification and validation of key issues in collaboration with cancer patient advocates.

    Science.gov (United States)

    Dellson, P; Nilbert, M; Bendahl, P-O; Malmström, P; Carlsson, C

    2011-07-01

    Clinical trials are crucial to improve cancer treatment but recruitment is difficult. Optimised patient information has been recognised as a key issue. In line with the increasing focus on patients' perspectives in health care, we aimed to study patients' opinions about the written information used in three clinical trials for breast cancer. Primary data collection was done in focus group interviews with breast cancer patient advocates. Content analysis identified three major themes: comprehensibility, emotions and associations, and decision making. Based on the advocates' suggestions for improvements, 21 key issues were defined and validated through a questionnaire in an independent group of breast cancer patient advocates. Clear messages, emotionally neutral expressions, careful descriptions of side effects, clear comparisons between different treatment alternatives and information about the possibility to discontinue treatment were perceived as the most important issues. Patients' views of the information in clinical trials provide new insights and identify key issues to consider in optimising future written information and may improve recruitment to clinical cancer trials. © 2010 Blackwell Publishing Ltd.

  5. Scale and legacy controls on catchment nutrient export regimes

    Science.gov (United States)

    Howden, N. J. K.; Burt, T.; Worrall, F.

    2017-12-01

    Nutrient dynamics in river catchments are complex: water and chemical fluxes are highly variable in low-order streams, but this variability declines as fluxes move through higher-order reaches. This poses a major challenge for process understanding as much effort is focussed on long-term monitoring of the main river channel (a high-order reach), and therefore the data available to support process understanding are predominantly derived from sites where much of the transient response of nutrient export is masked by the effect of averaging over both space and time. This may be further exacerbated at all scales by the accumulation of legacy nutrient sources in soils, aquifers and pore waters, where historical activities have led to nutrient accumulation where the catchment system is transport limited. Therefore it is of particular interest to investigate how the variability of nutrient export changes both with catchment scale (from low to high-order catchment streams) and with the presence of legacy sources, such that the context of infrequent monitoring on high-order streams can be better understood. This is not only a question of characterising nutrient export regimes per se, but also developing a more thorough understanding of how the concepts of scale and legacy may modify the statistical characteristics of observed responses across scales in both space and time. In this paper, we use synthetic data series and develop a model approach to consider how space and timescales combine with impacts of legacy sources to influence observed variability in catchment export. We find that: increasing space and timescales tend to reduce the observed variance in nutrient exports, due to an increase in travel times and greater mixing, and therefore averaging, of sources; increasing the influence of legacy sources inflates the variance, with the level of inflation dictated by the residence time of the respective sources.

  6. The clinical demand for information and the radiation dose in pelvimetry and amniography

    International Nuclear Information System (INIS)

    Wilbrand, H.F.; Lindmark, G.; Ytterbergh, C.

    1982-01-01

    Radiographic measurements are an important part of antenatal care and are in fact used to a great extent in nulliparous women. In view of this clinical background and also for ethical reasons, reduction of the radiation doses is mandatory. As radiographic pelvimetry is used in so many pregnant women, it is of importance that no higher radiation doses are applied than are absolutely needed to guarantee correct and necessary information. Dose reduction is afforded in two different ways - by optimizing the imaging techniques and by closing a suitable film-screen combination. Measurement of absorbed doses in patients was carried out with highly sensitive lithium fluoride thermoluminiscence dosimeters (TLD) with a dimension of 3x3x0.9 mm (Harshaw type TLD-100). All TLD probes were calibrated with Co60 radiation between the measurement series. Absorbed radiation doses were measured in the rectum for different film-screen combinations. Depending on the position of the fetus in relation to the maternal pelvis, it is obvious that in any individual case varying parts of the fetus will lie directly in the radiation beam. In amniography the absorbed radiation doses will vary from case to case depending on the number of exposures, which should not exceed six, and the duration of fluoroscopy, which should be no longer than 1 min. With the use of lanex Regular screens and highly coned images the radiation dose will not exceed 3.0 mGy. Since a high image quality is mandatory for evaluation of disorders in the fetal skeleton, measurements were not performed with other high-speed screens. The MR 800 screen appears to provide further reduction of the radiation dose in this type of examination. (orig./MG)

  7. 14 Years longitudinal evaluation of clinical information systems acceptance: The HEGP case.

    Science.gov (United States)

    Hadji, Brahim; Martin, Guillaume; Dupuis, Isabelle; Campoy, Eric; Degoulet, Patrice

    2016-02-01

    Meaningful use and end-user satisfaction are two major components of the success of a clinical information system (CIS). The purpose of this study was to longitudinally measure and analyze the CIS use and satisfaction determinants in a multi-professional group at the Georges Pompidou university hospital (HEGP) in Paris. From the different evaluation surveys performed at HEGP, three periods were considered corresponding to 4, 8 and over 10 years after the first CIS deployment in 2000, respectively. Six acceptance dimensions were considered: CIS quality (CISQ), facilitating conditions (FC), perceived usefulness (PU), confirmation of expectations (CE), use, and global satisfaction (GS). Relationships between these constructs were tested through multiple regressions analysis and structural equation modeling (SEM). Responses were obtained from 298, 332, and 448 users for the three periods considered. CIS acceptance dimensions progressively and significantly increased over time. Significant differences between professions were observed with an initial low PU among medical staff. In the early deployment phase, GS appeared to be determined by CIS use, CISQ and PU (R(2)=.53 in SEM). In the very late post-adoption phase, GS was strongly determined by CISQ, CE, and PU (R(2)=.86 in SEM) and was no longer associated with CIS use. Acceptance models should be adapted to the phase of deployment of a CIS and integrate end-users' individual characteristics. Progressive reduction over time of the positive relationships between CIS use and satisfaction could possibly be considered as a maturity indicator of CIS deployment. These observations validate the introduction in post-adoption models of a continuance intention dimension. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. The feasibility of using electronic clinical outcome assessments in people with schizophrenia and their informal caregivers

    Directory of Open Access Journals (Sweden)

    Tolley C

    2015-03-01

    Full Text Available Chloe Tolley,1 Diana Rofail,2 Adam Gater,1 Justine K Lalonde31Adelphi Values Ltd, Bollington, UK; 2Roche Products Ltd, Welwyn Garden City, UK; 3Roche S.A.S, Paris, France Abstract: Many clinical outcome assessments (COAs were originally developed for completion via pen and paper. However, in recent years there have been movements toward electronic capture of such data in an effort to reduce missing data, provide time-stamped records, minimize administrative burden, and avoid secondary data entry errors. Although established in many patient populations, the implications of using electronic COAs in schizophrenia are unknown. In accordance with International Society for Pharmacoeconomics and Outcomes Research (ISPOR Task Force recommendations, in-depth cognitive debriefing and usability interviews were conducted with people with schizophrenia (n=12, their informal (unpaid caregivers (n=12, and research support staff (n=6 to assess the suitability of administration of various electronic COA measures using an electronic tablet device. Minimal issues were encountered by participants when completing or administering the COAs in electronic format, with many finding it easier to complete instruments in this mode than by pen and paper. The majority of issues reported were specific to the device functionality rather than the electronic mode of administration. Findings support data collection via electronic tablet in people with schizophrenia and their caregivers. The appropriateness of other forms of electronic data capture (eg, smartphones, interactive voice response systems, etc is a topic for future investigation. Keywords: ePRO, eCOA, mode of administration, electronic data capture, usability 

  9. Locating relevant patient information in electronic health record data using representations of clinical concepts and database structures.

    Science.gov (United States)

    Pan, Xuequn; Cimino, James J

    2014-01-01

    Clinicians and clinical researchers often seek information in electronic health records (EHRs) that are relevant to some concept of interest, such as a disease or finding. The heterogeneous nature of EHRs can complicate retrieval, risking incomplete results. We frame this problem as the presence of two gaps: 1) a gap between clinical concepts and their representations in EHR data and 2) a gap between data representations and their locations within EHR data structures. We bridge these gaps with a knowledge structure that comprises relationships among clinical concepts (including concepts of interest and concepts that may be instantiated in EHR data) and relationships between clinical concepts and the database structures. We make use of available knowledge resources to develop a reproducible, scalable process for creating a knowledge base that can support automated query expansion from a clinical concept to all relevant EHR data.

  10. Lessons learned in planning the Canadian Nuclear Legacy Liabilities Program

    International Nuclear Information System (INIS)

    Stephens, Michael E.; Brooks, Sheila M.; Miller, Joan M.; Mason, Robert A.

    2011-01-01

    In 2006, Atomic Energy of Canada Limited (AECL) and Natural Resources Canada (NRCan) began implementing a $7B CDN, 70-year Nuclear Legacy Liabilities Program (NLLP) to deal with legacy decommissioning and environmental issues at AECL nuclear sites. The objective of the NLLP is to safely and cost-effectively reduce the nuclear legacy liabilities and associated risks based on sound waste management and environmental principles in the best interest of Canadians. The liabilities include shutdown research and prototype power reactors, fuel handling facilities, radiochemical laboratories, support buildings, radioactive waste storage facilities, and contaminated lands at several sites located across eastern Canada from Quebec to Manitoba. The largest site, Chalk River Laboratories (CRL) in Ontario, will continue as an operational nuclear site for the foreseeable future. Planning and delivery of the Program is managed by the Liability Management Unit (LMU), a group that was formed within AECL for the purpose. The composition and progress of the NLLP has been reported in recent conferences. The NLLP comprises a number of interlinked decommissioning, waste management and environmental restoration activities that are being executed at different sites, and by various technical groups as suppliers to the LMU. Many lessons about planning and executing such a large, diverse Program have been learned in planning the initial five-year 'start-up' phase (which will conclude 2011 March), in planning the five-year second phase (which is currently being finalized), and in planning individual and interacting activities within the Program. The activities to be undertaken in the start-up phase were planned by a small group of AECL technical experts using the currently available information on the liabilities. Progress in executing the Program was slower than anticipated due to less than ideal alignment between some planned technical solutions and the actual requirements, as well as the

  11. What Information Does Your EHR Contain? Automatic Generation of a Clinical Metadata Warehouse (CMDW) to Support Identification and Data Access Within Distributed Clinical Research Networks.

    Science.gov (United States)

    Bruland, Philipp; Doods, Justin; Storck, Michael; Dugas, Martin

    2017-01-01

    Data dictionaries provide structural meta-information about data definitions in health information technology (HIT) systems. In this regard, reusing healthcare data for secondary purposes offers several advantages (e.g. reduce documentation times or increased data quality). Prerequisites for data reuse are its quality, availability and identical meaning of data. In diverse projects, research data warehouses serve as core components between heterogeneous clinical databases and various research applications. Given the complexity (high number of data elements) and dynamics (regular updates) of electronic health record (EHR) data structures, we propose a clinical metadata warehouse (CMDW) based on a metadata registry standard. Metadata of two large hospitals were automatically inserted into two CMDWs containing 16,230 forms and 310,519 data elements. Automatic updates of metadata are possible as well as semantic annotations. A CMDW allows metadata discovery, data quality assessment and similarity analyses. Common data models for distributed research networks can be established based on similarity analyses.

  12. ‘Trial Exegesis’: Methods for Synthesizing Clinical and Patient Reported Outcome (PRO) Data in Trials to Inform Clinical Practice. A Systematic Review

    Science.gov (United States)

    Macefield, Rhiannon C.; Blencowe, Natalie S.; Brookes, Sara T.; Blazeby, Jane M.

    2016-01-01

    Purpose The CONSORT extension for patient reported outcomes (PROs) aims to improve reporting, but guidance on the optimal integration with clinical data is lacking. This study examines in detail the reporting of PROs and clinical data from randomized controlled trials (RCTs) in gastro-intestinal cancer to inform design and reporting of combined PRO and clinical data from trials to improve the ‘take home’ message for clinicians to use in practice. Materials and Methods The case study was undertaken in gastro-intestinal cancer trials. Well-conducted RCTs reporting PROs with validated instruments were identified and categorized into those combining PRO and clinical data in a single paper, or those separating data into linked primary and supplemental papers. Qualitative methods were developed to examine reporting of the critical interpretation of the trial results (trial exegesis) in the papers in relation of the PRO and clinical outcomes and applied to each publication category. Results were used to inform recommendations for practice. Results From 1917 screened abstracts, 49 high quality RCTs were identified reported in 36 combined and 15 linked primary and supplemental papers. In-depth analysis of manuscript text identified three categories for understanding trial exegesis: where authors reported a “detailed”, “general”, or absent PRO rationale and integrated interpretation of clinical and PRO results. A total of 11 (30%) and 6 (16%) combined papers reported “detailed” PRO rationale and integrated interpretation of results although only 2 (14%) and 1 (7%) primary papers achieved the same standard respectively. Supplemental papers provide better information with 11 (73%) and 3 (20%) achieving “detailed” rationale and integrated interpretation of results. Supplemental papers, however, were published a median of 20 months after the primary RCT data in lower impact factor journals (median 16.8 versus 5.2). Conclusion It is recommended that single

  13. Developmental Foundations and Clinical Applications of Social Information Processing: A Review.

    Science.gov (United States)

    Adrian, Molly; Lyon, Aaron R; Oti, Rosalind; Tininenko, Jennifer

    2010-07-01

    Social information processing has emerged as an important construct in understanding children's interpersonal functioning. This article reviews (a) the theoretical models guiding research, (b) the development of normative and atypical social problem solving, and (c) the connection between social information processing and individual differences in functioning. Finally, this review ends with a summary of efficacy of programs aimed at preventing social information processing biases or intervening with youth who display dysfunctional social information processing skills.

  14. Evaluating the Quality of Website Information of Private-Practice Clinics Offering Cell Therapies in Japan

    OpenAIRE

    Kashihara, Hidenori; Nakayama, Takeo; Hatta, Taichi; Takahashi, Naomi; Fujita, Misao

    2016-01-01

    Background Although the safety and effectiveness of stem cell therapies are yet to be proven, recent studies show that such therapies are being advertised with some questionable marketing techniques to effect positive portrayal of the therapies on the webpages of private-practice clinics to sell their therapies worldwide. In such context, those clinics communicate directly with consumers (patients and their family members) via the clinics? websites. Meanwhile, the Health Science Council at th...

  15. Catchment legacies and time lags: a parsimonious watershed model to predict the effects of legacy storage on nitrogen export.

    Directory of Open Access Journals (Sweden)

    Kimberly J Van Meter

    Full Text Available Nutrient legacies in anthropogenic landscapes, accumulated over decades of fertilizer application, lead to time lags between implementation of conservation measures and improvements in water quality. Quantification of such time lags has remained difficult, however, due to an incomplete understanding of controls on nutrient depletion trajectories after changes in land-use or management practices. In this study, we have developed a parsimonious watershed model for quantifying catchment-scale time lags based on both soil nutrient accumulations (biogeochemical legacy and groundwater travel time distributions (hydrologic legacy. The model accurately predicted the time lags observed in an Iowa watershed that had undergone a 41% conversion of area from row crop to native prairie. We explored the time scales of change for stream nutrient concentrations as a function of both natural and anthropogenic controls, from topography to spatial patterns of land-use change. Our results demonstrate that the existence of biogeochemical nutrient legacies increases time lags beyond those due to hydrologic legacy alone. In addition, we show that the maximum concentration reduction benefits vary according to the spatial pattern of intervention, with preferential conversion of land parcels having the shortest catchment-scale travel times providing proportionally greater concentration reductions as well as faster response times. In contrast, a random pattern of conversion results in a 1:1 relationship between percent land conversion and percent concentration reduction, irrespective of denitrification rates within the landscape. Our modeling framework allows for the quantification of tradeoffs between costs associated with implementation of conservation measures and the time needed to see the desired concentration reductions, making it of great value to decision makers regarding optimal implementation of watershed conservation measures.

  16. Improving Clinical Information on Head CT Requisitions From the Emergency Department to Aid Interpretation and Billing Efficiency.

    Science.gov (United States)

    Barron, Dillon; Spiegel, Thomas; Katzman, Gregory L; Haas, Kateland; Ali, Saad

    2018-01-01

    The accuracy of radiologic interpretations is higher when appropriate clinical information is provided, as is the likelihood of reimbursement for the studies. The purpose of this project was to evaluate and improve the quality of clinical information provided on head CT requisitions from an urban emergency department (ED). In a prospective study conducted from July 2015 to May 2016, attending neuroradiologists evaluated 1100 randomly selected ED requisitions for unenhanced head CT, grading them for clinical and billing adequacy on a scale of 0-2. After acquisition of baseline data (400 studies), an intervention was performed that consisted of education of ED staff on the importance of clinical information in requisitions. A reminder slide was placed on a large screen in the ED staff working area with examples of appropriate history. Postintervention data (700 studies) were subsequently obtained. Mean scores and payment lag time before versus after the intervention were compared by Wilcoxon rank sum test. Statistically significant improvement was found in mean scores after the intervention for both clinical (1.32 to 1.43, p = 0.003) and billing (1.64 to 1.74, p = 0.02) adequacy categories. The percentage of studies with a score of 2 increased in both categories, and the percentages of 0 and 1 scores declined. There was a 21.1-day decrease in payment lag time (from 75.8 to 54.7 days, p Billing efficiency improved, and payment lag time decreased substantially.

  17. Internal Consistency and Associated Characteristics of Informant Discrepancies in Clinic Referred Youths Age 11 to 17 Years

    Science.gov (United States)

    De Los Reyes, Andres; Youngstrom, Eric A.; Pabon, Shairy C.; Youngstrom, Jennifer K.; Feeny, Norah C.; Findling, Robert L.

    2011-01-01

    In this study, we examined the internal consistency of informant discrepancies in reports of youth behavior and emotional problems and their unique relations with youth, caregiver, and family characteristics. In a heterogeneous multisite clinic sample of 420 youths (ages 11-17 years), high internal consistency estimates were observed across…

  18. Points to consider for sharing variant-level information from clinical genetic testing with ClinVar

    Science.gov (United States)

    Azzariti, Danielle R.; Riggs, Erin Rooney; Niehaus, Annie; Rodriguez, Laura Lyman; Ramos, Erin M.; Kattman, Brandi; Landrum, Melissa J.; Martin, Christa L.; Rehm, Heidi L.

    2018-01-01

    Data sharing between laboratories, clinicians, researchers, and patients is essential for improvements and standardization in genomic medicine; encouraging genomic data sharing (GDS) is a key activity of the National Institutes of Health (NIH)-funded Clinical Genome Resource (ClinGen). The ClinGen initiative is dedicated to evaluating the clinical relevance of genes and variants for use in precision medicine and research. Currently, data originating from each of the aforementioned stakeholder groups is represented in ClinVar, a publicly available repository of genomic variation, and its relationship to human health hosted by the National Center for Biotechnology Information at the NIH. Although policies such as the 2014 NIH GDS policy are clear regarding the mandate for informed consent for broad data sharing from research participants, no clear guidance exists on the level of consent appropriate for the sharing of information obtained through clinical testing to advance knowledge. ClinGen has collaborated with ClinVar and the National Human Genome Research Institute to develop points to consider for clinical laboratories on sharing de-identified variant-level data in light of both the NIH GDS policy and the recent updates to the Common Rule. We propose specific data elements from interpreted genomic variants that are appropriate for submission to ClinVar when direct patient consent was not sought and describe situations in which obtaining informed consent is recommended. PMID:29437798

  19. Information

    International Nuclear Information System (INIS)

    Boyard, Pierre.

    1981-01-01

    The fear for nuclear energy and more particularly for radioactive wastes is analyzed in the sociological context. Everybody agree on the information need, information is available but there is a problem for their diffusion. Reactions of the public are analyzed and journalists, scientists and teachers have a role to play [fr

  20. Exploring informed consent in HIV clinical trials: A case study in Uganda

    Directory of Open Access Journals (Sweden)

    Agnes Ssali

    2016-11-01

    Conclusion: This study’s findings indicated that obtaining a volunteer’s signature or thumbprint on a consent form did not necessarily mean that the participant was fully-informed about the information relevant to their taking part nor that they understood all the information shared with them. Informed consent requires sufficient time in the research process to have staff trained well enough before research begins. Ensuring and gaining informed consent should be understood and treated as a relation-centred, dynamic supportive process throughout the duration of a research study.

  1. Facilitating Consumer Clinical Information Seeking by Maintaining Referential Context: Evaluation of a Prototypic Approach

    Science.gov (United States)

    Lobach, David F.; Waters, Andrew; Silvey, Garry M.; Clark, Shelly J.; Kalyanaraman, Sri; Kawamoto, Kensaku; Lipkus, Isaac

    2009-01-01

    Millions of consumers seek health information on the Internet. Unfortunately, this searching often falls short because of design limitations of many consumer-oriented Web sites. In this paper, we describe an approach that addresses several known barriers to consumer health information seeking. This approach primarily involves maintaining the referential context throughout a consumer’s search for information. To maintain referential context, this approach uses multiple levels of hierarchical constructs to organize complex information, and data elements are toggled to minimize the need for scrolling. An information resource based on this approach was implemented for information about smoking using standard Web technologies. The resource was evaluated by 31 diverse consumers through standardized usability instruments. Consumers found the resource to be easy to navigate and to use. We conclude that the approach described in this manuscript could be applied more broadly to facilitate the organization and presentation of consumer health information. PMID:20351884

  2. 77 FR 6808 - Proposed Collection; Comment Request: Information Program on Clinical Trials; Maintaining a...

    Science.gov (United States)

    2012-02-09

    ... research. While many clinical studies are registered voluntarily, FDAAA requires the registration of... on Clinical Trials; Maintaining a Registry and Results Databank Summary: In compliance with the... public comment on proposed data collection projects, the National Library of Medicine (NLM), the National...

  3. Forging a new legacy of trust in research with Alaska Native college students using CBPR.

    Science.gov (United States)

    Lopez, Ellen D S; Sharma, Dinghy Kristine B; Mekiana, Deborah; Ctibor, Alaina

    2012-01-01

    Disparities in the rates of matriculation and graduation are of concern to Alaska Native (AN) students and the universities committed to their academic success. Efforts to reduce attrition require a keen understanding of the factors that impact quality of life (QOL) at college. Yet, a long-standing legacy of mistrust towards research poses challenges to conducting inquiry among AN students. We introduced a partnership between the University of Alaska Fairbank's Rural Student Services (RSS) and the Center for Alaska Native Health Research (CANHR) within which we conducted the "What makes life good?" study aimed towards developing a QOL measure for AN students. Equally important was building a legacy of research trust among AN partners. We describe Phase I of a 2-phase study that employed a sequential mixed methods approach. Discussed are facilitators, challenges and lessons learned while striving to adhere to the principles of community-based participatory research (CBPR). Phase I included formative focus groups and QOL measurement development. The research involved the interplay among activities that were co-developed with the goal of enhancing trust and research capacity. Emphasis was placed on ensuring that data collection and analyses were student driven. All partners resided at the same university. However, trust and collaboration could not be assumed. Working within a collaborative framework, our partnership achieved the aim of developing a culturally informed QOL measure, while also creating an empowering experience for all partners who became co-investigators in a process that might normally be regarded with mistrust.

  4. Satisfaction Survey on Information Technology-Based Glucose Monitoring System Targeting Diabetes Mellitus in Private Local Clinics in Korea

    Directory of Open Access Journals (Sweden)

    Hun-Sung Kim

    2017-06-01

    Full Text Available BackgroundPrivate local clinics in Korea have little experience with information technology (IT-based glucose monitoring (ITGM. Our aim is to examine user satisfaction and the possibility of using ITGM service practically.MethodsPatients sent their blood glucose levels to physicians in local clinics. The physicians reviewed the blood glucose values online and provided personal consultations through text messaging or phone calls. Thereafter, a satisfaction survey on the ITGM service, the modified Morisky scale, and patient assessment of chronic illness care were administered.ResultsOne hundred and seventy patients from seven private local clinics used the ITGM. Overall satisfaction, including that about the ITGM service, the device, and its usefulness, was rated higher than “mostly satisfied” (score 4.2±0.8 out of 5.0 and even higher among the elderly. Satisfaction was positively associated with age, especially in those older than 60 years. The main reason for intent for future use of the service was the time/place flexibility. Highly motivated patients tended to answer positively regarding information satisfaction (P=0.0377.ConclusionOur study is the first to investigate ITGM satisfaction in private local clinics. The feasibility of users utilizing ITGM should be clarified, and future clinical research on the service's clinical effects and cost-benefit analysis is needed.

  5. [Local communalization of clinical records between the municipal community hospital and local medical institutes by using information technology].

    Science.gov (United States)

    Iijima, Shohei; Shinoki, Keiji; Ibata, Takeshi; Nakashita, Chisako; Doi, Seiko; Hidaka, Kumi; Hata, Akiko; Matsuoka, Mio; Waguchi, Hideko; Mito, Saori; Komuro, Ryutaro

    2012-12-01

    We introduced the electronic health record system in 2002. We produced a community medical network system to consolidate all medical treatment information from the local institute in 2010. Here, we report on the present status of this system that has been in use for the previous 2 years. We obtained a private server, set up a virtual private network(VPN)in our hospital, and installed dedicated terminals to issue an electronic certificate in 50 local institutions. The local institute applies for patient agreement in the community hospital(hospital designation style). They are then entitled to access the information of the designated patient via this local network server for one year. They can access each original medical record, sorted on the basis of the medical attendant and the chief physician; a summary of hospital stay; records of medication prescription; and the results of clinical examinations. Currently, there are approximately 80 new registrations and accesses per month. Information is provided in real time allowing up to date information, helping prescribe the medical treatment at the local institute. However, this information sharing system is read-only, and there is no cooperative clinical pass system. Therefore, this system has a limit to meet the demand for cooperation with the local clinics.

  6. Legacy model integration for enhancing hydrologic interdisciplinary research

    Science.gov (United States)

    Dozier, A.; Arabi, M.; David, O.

    2013-12-01

    Many challenges are introduced to interdisciplinary research in and around the hydrologic science community due to advances in computing technology and modeling capabilities in different programming languages, across different platforms and frameworks by researchers in a variety of fields with a variety of experience in computer programming. Many new hydrologic models as well as optimization, parameter estimation, and uncertainty characterization techniques are developed in scripting languages such as Matlab, R, Python, or in newer languages such as Java and the .Net languages, whereas many legacy models have been written in FORTRAN and C, which complicates inter-model communication for two-way feedbacks. However, most hydrologic researchers and industry personnel have little knowledge of the computing technologies that are available to address the model integration process. Therefore, the goal of this study is to address these new challenges by utilizing a novel approach based on a publish-subscribe-type system to enhance modeling capabilities of legacy socio-economic, hydrologic, and ecologic software. Enhancements include massive parallelization of executions and access to legacy model variables at any point during the simulation process by another program without having to compile all the models together into an inseparable 'super-model'. Thus, this study provides two-way feedback mechanisms between multiple different process models that can be written in various programming languages and can run on different machines and operating systems. Additionally, a level of abstraction is given to the model integration process that allows researchers and other technical personnel to perform more detailed and interactive modeling, visualization, optimization, calibration, and uncertainty analysis without requiring deep understanding of inter-process communication. To be compatible, a program must be written in a programming language with bindings to a common

  7. Two tales of legacy effects on stream nutrient behaviour

    Science.gov (United States)

    Bieroza, M.; Heathwaite, A. L.

    2017-12-01

    Intensive agriculture has led to large-scale land use conversion, shortening of flow pathways and increased loads of nutrients in streams. This legacy results in gradual build-up of nutrients in agricultural catchments: in soil for phosphorus (biogeochemical legacy) and in the unsaturated zone for nitrate (hydrologic legacy), controlling the water quality in the long-term. Here we investigate these effects on phosphorus and nitrate stream concentrations using high-frequency (10-5 - 100 Hz) sampling with in situ wet-chemistry analysers and optical sensors. Based on our 5 year study, we observe that storm flow responses differ for both nutrients: phosphorus shows rapid increases (up to 3 orders of magnitude) in concentrations with stream flow, whereas nitrate shows both dilution and concentration effects with increasing flow. However, the range of nitrate concentrations change is narrow (up to 2 times the mean) and reflects chemostatic behaviour. We link these nutrient responses with their dominant sources and flow pathways in the catchment. Nitrate from agriculture (with the peak loading in 1983) is stored in the unsaturated zone of the Penrith Sandstone, which can reach up to 70 m depth. Thus nitrate legacy is related to a hydrologic time lag with long travel times in the unsaturated zone. Phosphorus is mainly sorbed to soil particles, therefore it is mobilised rapidly during rainfall events (biogeochemical legacy). The phosphorus stream response will however depend on how well connected is the stream to the catchment sources (driven by soil moisture distribution) and biogeochemical activity (driven by temperature), leading to both chemostatic and non-chemostatic responses, alternating on a storm-to-storm and seasonal basis. Our results also show that transient within-channel storage is playing an important role in delivery of phosphorus, providing an additional time lag component. These results show, that consistent agricultural legacy in the catchment (high

  8. A Multi-Level Model of Information Seeking in the Clinical Domain

    Science.gov (United States)

    Hung, Peter W.; Johnson, Stephen B.; Kaufman, David R.; Mendonça, Eneida A.

    2008-01-01

    Objective: Clinicians often have difficulty translating information needs into effective search strategies to find appropriate answers. Information retrieval systems employing an intelligent search agent that generates adaptive search strategies based on human search expertise could be helpful in meeting clinician information needs. A prerequisite for creating such systems is an information seeking model that facilitates the representation of human search expertise. The purpose of developing such a model is to provide guidance to information seeking system development and to shape an empirical research program. Design: The information seeking process was modeled as a complex problem-solving activity. After considering how similarly complex activities had been modeled in other domains, we determined that modeling context-initiated information seeking across multiple problem spaces allows the abstraction of search knowledge into functionally consistent layers. The knowledge layers were identified in the information science literature and validated through our observations of searches performed by health science librarians. Results: A hierarchical multi-level model of context-initiated information seeking is proposed. Each level represents (1) a problem space that is traversed during the online search process, and (2) a distinct layer of knowledge that is required to execute a successful search. Grand strategy determines what information resources will be searched, for what purpose, and in what order. The strategy level represents an overall approach for searching a single resource. Tactics are individual moves made to further a strategy. Operations are mappings of abstract intentions to information resource-specific concrete input. Assessment is the basis of interaction within the strategic hierarchy, influencing the direction of the search. Conclusion: The described multi-level model provides a framework for future research and the foundation for development of an

  9. Production design as a storytelling tool in the writing of Danish TV drama series The Legacy

    DEFF Research Database (Denmark)

    Redvall, Eva Novrup; Sabroe, Iben Albinus

    2016-01-01

    Production design not only sets the scene for the action of a film or television series, it holds great potential to convey story and character information. However, most literature on production design describe how the work of production designers only begin in pre-production when they are ‘given...... of the Danish drama series Arvingerne/The Legacy (2014–), the article analyses the implications of creator Maya Ilsøe’s close collaboration with the series’ production designer Mia Stensgaard. This collaboration not only centred on creating a special visual universe for the series, but also involved having...... the production design perform crucial back story and character information related to the inheritance drama and to the portrayal of the artist matriarch Veronika who was intended to haunt the lives of her children throughout the series even though she dies in the very first episode....

  10. Integrated Mapping and Imaging at a Legacy Test Site (Invited)

    Science.gov (United States)

    Sussman, A. J.; Schultz-Fellenz, E. S.; Kelley, R. E.; Sweeney, J. J.; Vigil, S.; DiBenedetto, J.; Chipman, V.

    2013-12-01

    A team of multi-disciplinary geoscientists was tasked to characterize and evaluate a legacy nuclear detonation site in order to develop research locations with the long-term goal of improving treaty monitoring, verification, and other national security applications. There was a test at the site of interest that was detonated on June 12, 1985 in a vertical emplacement borehole at a depth of 608m below the surface in rhyolites. With announced yield of 20-150 kt, the event did not collapse to the surface and form a crater, but rather experienced a subsurface collapse with more subtle surface expressions of deformation. This result provides the team with an opportunity to evaluate a number of surface and subsurface inspection technologies in a broad context. The team collected ground-based visual observation, ground penetrating radar, electromagnetic, ground-based and airborne LiDAR, ground-based and airborne hyperspectral, gravity and magnetics, dc and induction electrical methods, and active seismic data during field campaigns in the summers of 2012 and 2013. Detection of features was performed using various approaches that were assessed for accuracy, efficiency and diversity of target features. For example, whereas the primary target of the ground-based visual observation survey was to map the surface features, the target of the gravity survey was to attempt the detection of a possible subsurface collapse zone which might be located as little as 200 meters below the surface. The datasets from surveys described above are integrated into a geographical information system (GIS) database for analysis and visualization. Other presentations during this session provide further details as to some of the work conducted. Work by Los Alamos National Laboratory and Lawrence Livermore National Laboratory was sponsored by the National Nuclear Security Administration Award No. DE-AC52-06NA25946/NST10-NCNS-PD00. Work by National Security Technologies, LLC, was performed under

  11. What is a clinical pathway? Development of a definition to inform the debate

    Directory of Open Access Journals (Sweden)

    Snow Pamela

    2010-05-01

    Full Text Available Abstract Background Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature. Methods We undertook a four-stage process aiming to develop criteria to define a clinical pathway: (1 identify publications exploring the definition of a clinical pathway; (2 derive draft criteria; (3 pilot test the criteria; and (4 modify criteria to maximise agreement between review authors. Results Previous literature and liaison with the European Pathways Association resulted in five criteria being used to define a clinical pathway: (1 the intervention was a structured multidisciplinary plan of care; (2 the intervention was used to translate guidelines or evidence into local structures; (3 the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions'; (4 the intervention had timeframes or criteria-based progression; and (5 the intervention aimed to standardise care for a specific clinical problem, procedure or episode of healthcare in a specific population. After pilot testing it was decided that if an intervention met the first criteria (a structured multidisciplinary plan of care plus three out of the other four criteria then it was included as a clinical pathway for the purposes of this review. In all, 27 studies were included in the final review. The authors of the included studies referred to these interventions as 'clinical pathways', 'protocols', 'care model

  12. Impact of Information Technology, Clinical Resource Constraints, and Patient-Centered Practice Characteristics on Quality of Care

    Directory of Open Access Journals (Sweden)

    JongDeuk Baek

    2015-02-01

    Full Text Available Objective: Factors in the practice environment, such as health information technology (IT infrastructure, availability of other clinical resources, and financial incentives, may influence whether practices are able to successfully implement the patient-centered medical home (PCMH model and realize its benefits. This study investigates the impacts of those PCMH-related elements on primary care physicians’ perception of quality of care. Methods: A multiple logistic regression model was estimated using the 2004 to 2005 CTS Physician Survey, a national sample of salaried primary care physicians (n = 1733. Results: The patient-centered practice environment and availability of clinical resources increased physicians’ perceived quality of care. Although IT use for clinical information access did enhance physicians’ ability to provide high quality of care, a similar positive impact of IT use was not found for e-prescribing or the exchange of clinical patient information. Lack of resources was negatively associated with physician perception of quality of care. Conclusion: Since health IT is an important foundation of PCMH, patient-centered practices are more likely to have health IT in place to support care delivery. However, despite its potential to enhance delivery of primary care, simply making health IT available does not necessarily translate into physicians’ perceptions that it enhances the quality of care they provide. It is critical for health-care managers and policy makers to ensure that primary care physicians fully recognize and embrace the use of new technology to improve both the quality of care provided and the patient outcomes.

  13. Impact of Information Technology, Clinical Resource Constraints, and Patient-Centered Practice Characteristics on Quality of Care.

    Science.gov (United States)

    Baek, JongDeuk; Seidman, Robert L

    2015-01-01

    Factors in the practice environment, such as health information technology (IT) infrastructure, availability of other clinical resources, and financial incentives, may influence whether practices are able to successfully implement the patient-centered medical home (PCMH) model and realize its benefits. This study investigates the impacts of t