Biomedical subjects

F Borst

Publications and source records attributed to F Borst.

At least 37 records · Page 2Linked to original sources

PubMed1998

Use of a short-form screening procedure to detect unrecognized functional disability in the hospitalized elderly.

We performed an observational cohort study to test the ability of a short-form screening procedure to detect unrecognized functional disability, as well as its capacity to predict clinical outcome. This screening procedure was administered to 198 consecutive patients within 48 hours of admission. Clinical outcomes upon discharge from the acute care hospital and at 3 months were analyzed according to the number of functional disabilities present on admission. This brief test identified a mean of 1.8 and a median of 1 previously unrecognized functional disabilities per patient. The presence of two or more functional disabilities on admission (48% of the study population) was significantly associated with a negative outcome upon discharge (relative risk = 1.73; CI, 1.33-2.25; p = 0.0001) and at 3 months after discharge (relative risk = 1.34; CI, 1.10-1.64; p = 0.003) confirming the reliability of the short-form screening procedure.

Activities of Daily Living↗

PubMed1998

The higher injury risk of abnormal kidneys in blunt renal trauma.

OBJECTIVE: To investigate the vulnerability of abnormal kidneys in blunt trauma, and to determine clinical features which enable identification of patients at risk of renal abnormality, hence modifying their management. MATERIAL AND METHODS: The medical records of 120 patients with blunt renal trauma were reviewed. Presence of pre-existing renal abnormalities, clinical symptoms, contrast study findings, associated injuries and the estimated impact velocity were recorded. RESULTS: Pre-existing renal abnormalities were found in 23 patients (19%). Patients with renal abnormalities had a lower rate of associated trauma to other abdominal organs, a lower Injury Severity Score (ISS) and their kidneys were more frequently injured by low velocity impacts. Of the patients with normal kidneys requiring surgery, hemodynamics and/or severity of the renal lesions triggered the operative indications in all cases, whereas most (57%) of the abnormal kidneys were operated because of their underlying renal pathology. CONCLUSION: Patients at risk for harbouring renal pathology are characterized by the association of monotrauma, macroscopic hematuria and low impact velocity. In this clinical setting, contrast studies should be generously indicated, since the management of abnormal kidneys unmasked by trauma is, to a large extent, dependent on the type of pathology.

Abdominal Injuries↗

PubMed1998

Contribution of individual items to the performance of the Norton pressure ulcer prediction scale.

OBJECTIVES: To assess the specific contribution to overall scale performance of each of the five items that constitute the Norton pressure ulcer prediction scale. DESIGN: A comparison of statistical models based on cross-sectional surveys of hospitalized patients. SETTING: An urban teaching hospital in Geneva, Switzerland. PARTICIPANTS: 2373 hospitalized patients who were free of pressure ulcers on admission. MEASUREMENTS: Norton scale items measuring activity, mobility, physical condition, mental condition, and incontinence on a 4-point scale were examined as predictors of stage 1 or greater pressure ulcers. RESULTS: A total of 245 new pressure ulcers occurred between admission and patient observation. After adjustment for other independent predictors in proportional hazards models, only the activity and mobility items remained associated significantly with the risk of pressure ulcer. A simplified 2-item scale was more strongly associated with pressure ulcer risk than was the classic 5-item Norton scale. CONCLUSIONS: Our study suggests that the activity and mobility items of the Norton scale are sufficient to express the risk of pressure ulcers in hospitalized patients. Confirmation of this finding in prospective studies is warranted.

Adolescent↗

PubMed1998

Integrated computerized patient records: the DIOGENE 2 distributed architecture paradigm with special emphasis on its middleware design.

DIOGENE 2 is a full-scale distributed/open hospital information system that by June 1995 had already achieved its migration from a former mainframe system. Thanks to that architecture there is an obvious need for a common "glue" devoted to tightening up scattered applications into a middleware-based network of interoperability. After this the design of open/distributed Electronic Patient Records (EPRs) became feasible. A brief historical sketch of DIOGENE is presented from its initial to its present phase. A working prototype of these distributed EPRs is discussed showing current achievements during its first stage of production in the clinics of the University Hospitals of Geneva. On-going expansion to other public hospitals, as well as to general practioners (GPs) in the Geneva area, are partly described.

Computer Communication Networks↗

PubMed1998

Happy birthday DIOGENE: a hospital information system born 20 years ago.

Since its birth in 1978, DIOGENE, the Hospital Information System of Geneva University Hospital has been constantly evolving, with a major change in 1995, when migrating from a centralized to an open distributed architecture. Since a few years, the hospital had to face health policy revolution with both economical constraints and opening of the healthcare network. The Hospital Information System DIOGENE plays a significant role by integrating four axes of knowledge medico-economical context for better understanding and influencing resources consumption the whole set of patient reports and documents (reports, encoded summaries, clinical findings, images, lab data, etc.) patient-dependent knowledge, in a vision integrating time and space external knowledge bases such as Medline (patient-independent knowledge) integration of these patient-dependent and -independent knowledges in a Case-Based Reasoning format, providing on the physician desktop all relevant information for helping him to take the most appropriate adequate decision.

Hospital Costs↗

PubMed1997

Oxybutynin in the treatment of early detrusor instability after transurethral resection of the prostate.

OBJECTIVE: To evaluate the symptomatic and urodynamic effects of oxybutynin in the control of irritative micturitional symptoms during the first week after transurethral resection of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Fifty-three patients (median age 67 years, interquartile range 62-72) were included prospectively in a double-blind placebo-controlled study. Pre-operatively, uroflowmetry and cystometrography (CMG) were performed, and the post-void residual volume (PVR) measured; symptoms were rated according to the Boyarski score. CMG was repeated on the first post-operative day and medication was started on the third day. Before withdrawing the catheter on the fifth day. CMG was repeated. Three days later, symptoms were evaluated according to the Boyarski score and uroflowmetry and the estimate of PVR reassessed. RESULTS: In comparison with placebo, oxybutynin significantly decreased frequency, urgency and detrusor pressure at first sensation of filling. However, oxybutynin did not lower the rate of pre-operative detrusor instability and exerted no effect on the maximal capacity of the bladder and corresponding detrusor pressure. Dryness of mouth was reported in 13% and 65% of patients receiving placebo and oxybutynin, respectively. CONCLUSION: Oxybutynin alleviates early irritative symptoms after transurethral resection of BPH, without consistently modifying bladder urodynamics.

Aged↗

PubMed1997

Safety and efficiency of laparoscopic varicocelectomy in one hundred consecutive cases.

The purpose of this study is to report the safety and efficiency of laparoscopic varicocelectomy in 100 consecutive patients operated at a single teaching institution. There were three indications: (1) infertility associated with oligo-astheno-teratospermia (n = 52); (2) chronic dragging sensation of the left testicle (n = 42), and (3) incidental finding of a large varicocele in young adolescents (n = 6). In group 1, the postoperative pregnancy rate was 47% and sperm quantity, concentration and mobility were significantly increased. The efficiency in pain control and clinical outcome amounted to 80 and 100% in groups 2 and 3, respectively. Complications were few and minor. There was no intraperitoneal organ or major vessel injury. The mean length of hospital stay (0.9 days) and median total recovery time (5 days) were remarkably short. In conclusion, laparoscopic varicocelectomy is a safe procedure. It is as efficient as open spermatic vein ligation, and provides the patient with a short hospital stay and quick full recovery.

Adult↗

PubMed1997

Medico-economical use of the medical record or the bridge between minimal and detailed data.

Medico-economical use of the medical record: the title encloses two different notions which represent two different trends within medical informatics. The first trend is worried about weighting aspects of health resources consumption, mainly about hospital acute care; their key-words are "DRG (Diagnostic Related Groups), Case-Mix, reimbursement by pathology, measurement of indicators (severity or outcome), costs". The other trend is looking for deeper understanding of the medical process and for better diffusion of relevant information helping the day-to-day care process; they speak of "CPR (Computerized patient record), full text reports and corresponding retrieval, detailed data, medical records on Internet, large access to literature and databases". It is mandatory to realize a bridge between these two trends for facing the information technology revolution entering into a self-revolutioning medicine. The purpose of this paper is to begin this bridge by showing what the DRG people expect from the CPR people and what the latter should receive from the former.

Diagnosis-Related Groups↗

PubMed1997

[Distal humeral fracture in adults: functional evaluation and measurement of isometric strength].

PURPOSE: The purpose of the study was to determine prognostic parameters in adult distal humeral fracture. MATERIAL: Thirty patients were reviewed retrospectively at a mean follow-up of 5 years. According to the AO classification there were 5 type A, 5 type B and 20 type C fractures, of which 7 were open. An internal fixation was performed in 27 patients while 3 cases were treated conservatively. An olecranon osteotomy was performed in 8 patients. A bilaterotricipital approach according to Alonso-Llames was performed in 8 cases while 6 times a V-shaped section of the triceps and 3 times a transtricipital approach were performed. A lateral approach and a combined medial and lateral approach were performed one time each. Active-assisted motion begun in 19 patients before the fifth post-op day. Three secondary displacements required reoperation. METHOD: The assessment included a questionnaire, a physical as well as radiological examination and measurements of isometric flexion and extension strength of both elbows. Statistical correlations were performed using non parametric tests at a P < 0.05 level. RESULTS: Average flexion was 127 degrees, while there was an average lack of extension of 29 degrees. Pronation and supination were respectively 68 degrees and 85 degrees. Twenty-two patients were subjectively satisfied with their elbow. The measurements of isometric strength of the fractured elbow showed that the right side which was dominant in the whole population was statistically weaker at follow-up than the left side. This difference was significant for flexion strength (Wilcoxon test P = 0.028) and highly significant for extension strength (Wilcoxon test P = 0.0002). The surgical approaches also influenced strengths. The Alonso-Llames approach was thought to give a better result than the other approaches. Patients mobilized before the fifth post-op day showed a statistically better flexion than patients mobilized later on (exact Fisher test P = 0.013). The difference was not statistically significant for the extension. DISCUSSION AND CONCLUSION: The distal humeral fracture produces a decrease of the elbow strength which is more severe for the dominant side. The reason is unknown. The Alonso-Llames approach seems to be the most favorable approach while the V-shaped section of the triceps shows a deleterious effect on strength. Early post-op exercises seem to have a positive effect on the long term ROM. Neither the fracture type (classification) nor the ROM, nor the strength are correlated with the subjective feeling of the patient. On the other hand statistical correlations show that unsatisfied patients are heavy workers (exact Fisher test P = 0.033) and patients younger than 60 years old (exact Fisher test P = 0.029).

Adult↗

PubMed1996

Integrated computerized patient records: a two-year Geneva experience.

The UNIDOC system of computer-based medical records that was developed and made operational within the DIOGENE-2 Hospital Information System (HIS), is based upon a fully standardized and distributed open systems architecture. It should also be emphasized that UNIDOC illustrates a feasible marriage of the two technologies, UNIX and MS-DOS, is in many respects successful enough to be recommended as a sound general solution to medical office integration into a HIS.

Abstracting and Indexing↗

PubMed1996

The doctor's view on education and training aspects of secure communication.

Using two examples of installed applications that are widely spread in a large teaching hospital, the awareness of secure communication is highlighted. Teaching to the rotating medical staff is organised on a regular basis. The physicians learn the responsibility they accept when entering the hospital information system (HIS). In a distributed environment, the confidentiality aspects change with the technology when the users perform with on-line helps and graphical interfaces.

Attitude of Health Personnel↗

PubMed1996

[Results of surgical treatment of hepatic metastasis of colorectal origin].

Surgery is the only treatment which can achieve long-term survival of patients with colorectal liver secondaries. This study reports the results in 71 patients with liver metastases who underwent hepatic resection from January 1980 to December 1994. The mean age was 60 years (range 37 and 80 years). Operations included 33 right hepatectomies, 5 extended right hepatectomies, 6 left hepatectomies, 11 left lobectomies,. Surgery was macroscopically and microscopically curative in 61 patients. Information was not available in 2 patients. Significant morbidity was observed in 37% of patients. Actuarial survival at 1, 3 and 5 years was 83%, 27% and 20% respectively. At the end of the follow-up, 50 patients had died and 6 were lost to follow-up. Techniques of hepatic resection for secondaries are well established and postoperative mortality is low. Pending advances in chemotherapy, we recommend surgery as being the only way of improving long-term survival in patients with colorectal hepatic metastases.

Adult↗

PubMed1996

Automatic alerts for methicillin-resistant Staphylococcus aureus surveillance and control: role of a hospital information system.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an escalating problem in hospitals worldwide. The hospital reservoir for MRSA includes recognized and unrecognized colonized or infected patients, as well as previously colonized or infected patients readmitted to the hospital. Early and appropriate infection control measures (ICM) are key elements to reduce MRSA transmission and to control the hospital reservoir. OBJECTIVE: To describe the role of an expert system applied to the control of MRSA at a large medical center (1,600 beds) with high endemic rates. METHODS: The University Hospital of Geneva has an extended hospital information system (HIS), DIOGENE, structured with an open distributed architecture. It includes administrative, medical, nursing, and laboratory applications with their relational databases. Among available patient databases, clinical microbiology laboratory and admission-discharge-transfer (ADT) databases are used to generate computer alerts. A laboratory alert (lab alert) is printed daily in the Infection Control Program (ICP) offices, listing all patients with cultures positive for MRSA detected within the preceding 24 hours. Patients might be either newly detected patients colonized or infected with MRSA, or previously recognized MRSA patients having surveillance cultures. The ICP nurses subsequently go to the ward or call the ward personnel to implement ICM. A second alert, the "readmission alert," detects readmission to the hospital of any patient previously colonized or infected with MRSA by periodic queries (q 1 min) to the ADT database. The readmission alert is printed in the ICP offices, but also forwarded with added guidelines to the emergency room. RESULTS: During the first 12 months of application (July 1994 to June 1995), the lab alert detected an average of 4.6 isolates per day, corresponding to 314 hospital admissions (248 patients); the use of this alert saved time for the ICP nurses by improving work organization. There were 438 readmission alerts (1.2 alerts per day) over the study period; of 347 patients screened immediately upon readmission, 114 (33%) were positive for MRSA carriage. Delayed recognition of readmitted MRSA carriers decreased significantly after the implantation of this alert; the proportion of MRSA patients recognized at the time of admission to the hospital increased from 13% in 1993 to 40% in 1995 (P < .001). CONCLUSIONS: Hospital information system-based alerts can play an important role in the surveillance and early prevention of MRSA transmission, and it can help to recognize patterns of colonization and transmission.

Cross Infection↗

PubMed1995

Recurrent infections in children observed throughout electronic medical record.

This paper shows the usefulness of routinely collected structured clinical findings in an computerized patient record. Medical observations are collected as detailed clinical findings, without any interpretation, according to a time structure, visit by visit. In the present example, the role of the microbial colonization is studied in relationship with infected organs and other processes which could facilitate the infection.

Child↗

PubMed1995

Fifteen years of medical encoding in the Diogene HIS.

Obtaining good quality encoded medical information is a major issue for patient documentation, hospital management, and epidemiological statistics. In this paper, the experience of encoding medical information in Geneva since 1978 is described, following 1988 IMIA WG6 recommendations: "There is a need to enhance the involvement of physicians and other health care professionals in the original entry of medical and other relevant data to increase its accuracy and quality".

Hospital Information Systems↗

PubMed1994

Dobutamine-atropine stress echocardiography and clinical data for predicting late cardiac events in patients with suspected coronary artery disease.

PURPOSE: To compare the relative value of clinical variables with dobutamine-atropine stress echocardiography to predict cardiac events during long-term follow-up. Dobutamine stress echocardiography is increasingly used for the detection of coronary artery disease, but little is known of its prognostic value. PATIENTS AND METHODS: A total of 430 patients (310 men; mean age 61 years, range 22 to 90) were enrolled in the study. Patients were referred for chest pain complaints and were unable to perform an adequate exercise stress test. All patients underwent dobutamine-atropine stress test (incremental dobutamine infusion: 10 to 40 micrograms/kg/minute, continued with atropine 0.25 to 1 mg intravenously if necessary to achieve 85% of the age predicted maximal heart rate, without symptoms or signs of ischemia) and clinical cardiac evaluation. Follow-up was 17 +/- 5 months, with a minimum of 6 months; 3 patients were lost to follow-up. Cardiac events were defined as cardiac death, nonfatal myocardial infarction, and coronary revascularization. RESULTS: Seventy-nine cardiac events occurred in 76 patients: cardiac death (n = 11), nonfatal myocardial infarction (n = 18), and coronary revascularization (n = 50). By multivariate regression analysis, the prognostic value of the stress test in addition to common clinical variables was assessed. (1) Cardiac death was predicted by age greater than 70 years (odds ratio 5.6, 1.5 to 20) or new wall motion abnormalities in a study that is normal at rest (odds ratio 4.1, 1.1 to 15). (2) Death or myocardial infarction was predicted by a history of myocardial infarction (odds ratio 4.8, 1.8 to 13) or age greater than 70 years (odds ratio 2.3, 1.1 to 5.4), and the stress test outcome provided no additional information. (3) If all events were combined, only stress test results were prognostic: new wall motion abnormalities in a study that is normal at rest (odds ratio 3.1, 1.9 to 5.1), wall motion abnormalities at rest (wall motion score at rest > or = 1.12) (odds ratio 2.5, 1.4 to 4.0), or any new wall motion abnormalities during stress (odds ratio 2.0, 1.4 to 3.8). The positive predictive value of any new wall motion abnormality during stress for all late cardiac events was 25% (95% confidence interval [CI] 19 to 31) with a negative predictive value of 87% (95% CI 83 to 91). CONCLUSION: In a large cohort of unselected patients with chest pain syndromes, new wall motion abnormalities induced by dobutamine provide additional information for late cardiac events, independent of clinical variables.

Adult↗

PubMed1994

[Computer alert and quality of care: application to the surveillance of hospital infections].

The Centre Informatique of Geneva University Hospital is developing, in the environment of its hospital information system, DIOGENE, a computerized alert system for surveillance of hospital infections. This hospital information system is based on an open distributed architecture and a relational database system, and covers many medical applications. This environment allows the development of alerts useful for detecting patients at risk. The alerts offer to clinicians a mean to control their efficacy in patient care. They are a new application of telematics for surveillance in clinical epidemiology, and are a tool for quality assurance. Two examples of alerts established for hospital infection control activities are presented. The first alert systematically detects all cases of patients colonized by or infected with methicillin-resistant Staphylococcus aureus (MRSA). The second alert helps to organize prospective surveillance of bloodstream infections in order to identify some risk factors for infection and propose preventive measures.

Cost of Illness↗

PubMed1994

Acute left colonic diverticulitis in young patients.

BACKGROUND: This prospective study was done to compare acute left-sided colonic diverticulitis in young patients (50 years of age or less) and older patients (more than 50 years of age) for severity of disease and immediate and late outcome. STUDY DESIGN: Of the 265 patients studied, 61 were 50 years of age or less; of these, 49 were men. In all instances, diagnosis was confirmed radiologically or histologically. RESULTS: Operations were performed less often upon younger patients than older patients (15 versus 33 percent, p = 0.001). Severe diverticulitis was found more often in younger men than older men (39 versus 23 percent). After successful conservative treatment during the first hospitalization period, younger men had a statistically greater risk of poor outcome than older men (29 versus 5 percent, p = 0.003). CONCLUSIONS: Although younger men have severe acute diverticulitis more often than older men, operative treatment during the first episode is less often needed. On the other hand, after conservative treatment, younger men have a statistically greater chance of poor secondary outcome than older men.

Abscess↗