Biomedical subjects

J Dudeck

Publications and source records attributed to J Dudeck.

At least 37 records · Page 2Linked to original sources

PubMed2000

Analysis of medical-decision making and the use of standards of care in oncology.

Guidelines in medicine have been proposed as a way to assist physicians in the clinical decision-making process. Increasingly, they form the basis for assessing accountability in the delivery of healthcare services. However, experiences with their evaluation, as the most important step in the continuous guidelines process, are rare. Patient Care Evaluation Studies have been developed by the Commission on Cancer in the United States. As they reflect the "real-world" medical practice they are helpful in evaluating the quality of diagnosis, therapy and follow-up of tumor diseases in hospitals and cancer center and the compliance with current standards of care. In this context, they can provide an infrastructure for the analysis of the decision-making process.

Databases, Factual↗

PubMed2000

A dictionary server for supplying context sensitive medical knowledge.

The Giessen Data Dictionary Server (GDDS), developed at Giessen University Hospital, integrates clinical systems with on-line, context sensitive medical knowledge to help with making medical decisions. By "context" we mean the clinical information that is being presented at the moment the information need is occurring. The dictionary server makes use of a semantic network supported by a medical data dictionary to link terms from clinical applications to their proper information sources. It has been designed to analyze the network structure itself instead of knowing the layout of the semantic net in advance. This enables us to map appropriate information sources to various clinical applications, such as nursing documentation, drug prescription and cancer follow up systems. This paper describes the function of the dictionary server and shows how the knowledge stored in the semantic network is used in the dictionary service.

Decision Support Systems, Clinical↗

PubMed2000

[Patient-oriented, treatment-accompanying documentation as a basis for evaluation with medical oncology as an example].

The documentation of patient characteristics, procedures of care and follow-up of the disease plays an important role in monitoring quality of care and support of clinical research. In order to evaluate the use of Clinical Practice Guidelines and their positive implications towards quality of care (especially patient's outcome), some closer reflections are needed to meet the special requirements. Our intention is to optimise content and extent of the collected information to characterise the different dimensions of the quality of medical care best possible. During the past two decades a comprehensive infrastructure concerning tumour documentation has evolved in Germany. To ensure the possibility to compare and evaluate diagnostic and therapeutic approaches in different medical institutions or health care systems, the systematic, patient-oriented treatment accompanying tumour documentation is a compelling requirement. It is a difficult task to describe pattern of care and measure both performance and outcome objectively. The paradigm of a patient-oriented treatment accompanying documentation includes the collection of clinical relevant process and outcome data in order to reflect the intention and way of thinking of the treating physicians and to get an impression of the "real world effectiveness" of the applied interventions.

Delivery of Health Care↗

PubMed2000

Structured clinical documentation for the assessment of medical care.

The developing infrastructure for tumour documentation in Germany offers the unique opportunity to provide the physicians with useful clinical information, to evaluate standards of care, and get an impression about the "real-world-effectiveness" of cancer care. In order to compare and evaluate diagnostic and therapeutic approaches in different medical institutions or health care systems, the systematic, patient-oriented, treatment accompanying tumour documentation is a compelling requirement. Our intention is to optimise content and extent of the collected information to characterise the different dimensions of the quality of medical care the best possible. We found that most of the problems are deriving from the contextually and timely correct documentation of medical procedures which includes diagnostic as well as therapeutic interventions. The content of the documentation together with standards of care, such as Clinical Practice Guidelines, should be parallel developed in interdisciplinary co-operation. This way, the fundamental domains of performance, such as appropriateness, availability, continuity, safety, effectiveness, and timeliness of medical care can described and evaluated objectively.

Documentation↗

PubMed2000

Decision support for infectious diseases--a working prototype.

This paper presents a decision support system for nosocomial infections and its integration in the large HIS of the University Hospital of Giessen. The model comprises five different engines and a data dictionary. It is designed to detect hospital acquired infections even in a situation where only a restricted amount of clinical data is available (the data is split up in different information systems). Furthermore the model prevents time consuming manual data entry. The five engines split the main task into 1) a preselection, which sort out patients who definitely do not have a nosocomial infection; 2) a rule based reasoning process which detects patients likely to have such an infection; 3) an alarm process which is responsible for the presentation of the alert; 4) an explanation process to follow up the reasoning and 5) statistic tools to answer specific hygienic questions. A data dictionary supplies the controlled vocabulary, but it is also required to understand datastructures used in the different clinical subsystems.

Artificial Intelligence↗

PubMed2000

XML structured clinical information: a practical example.

At Giessen university, a drug formulary comprising drug data and treatment guidelines is supplied to clinical users who can access the drug information by an index of drug substances and drug substance groups. The guideline itself is a textual description with related information such as drug substances and drug brand names. Since clinical users also want to access the information by drug names, we had to extract this information from the textual descriptions. The extraction however caused some effort. In order to not repeat this effort in the future, we used the eXtensible Markup Language (XML) to restructure the information sources. This paper describes our experiences with this kind of legacy to XML conversion and outlines a possible migration path towards the XML technology.

Drug Information Services↗

PubMed2000

Design principles of a clinical information system for intensive care units (ICUData).

The aim of this project was to develop a cost-effective, standard-based and scalable clinical information system for use in Intensive Care Units (ICUs). The development started in 1998 at the University Giessen, Germany. Since its introduction as the basic documentation system at the ICU ward of the Department of Anesthesiology and Intensive Care Medicine in January 1999, all relevant clinical data of 1723 patients have been recorded. The implementation of the system in two further ICUs is scheduled for the year 2000. The following article describes some of the principal design goals of the system, including the medical vision that drove its interface design, and focuses on the technological underpinnings of the overall system architecture.

Computer Systems↗

PubMed2000

Development of an oncology data network in Germany.

In the 1990ies, an oncology data network has been set up mainly in the New States of Germany. Although not formally planned and established as a whole, it consists of a number of initiatives, that co-operate well and gain added value from this co-operation. From the technological view, the centre of the network is the Giessener Tumordokumentationssystem (GTDS), that was developed at Giessen University. We present important basic conditions in which this development took place, show some results and describe future directions of the development.

Computer Communication Networks↗

PubMed1999

Stepwise evaluation of information systems in an university hospital.

A prospective intervention study with historical control has been performed at Giessen University Hospital, Germany, to investigate the influence of electronic data processing systems on nurses' working environment. Two wards of the medical department were selected for this study, using the combined approach of work-sampling methods and questionnaires. In the first intervention a central information system with restricted functions was introduced. For the second intervention an additional nursing information system was installed. The distribution of nurses' worktime into the fields of general nursing care, specific nursing care and administrative activities was not influenced by electronic data processing. No time saving could be measured. Results of the questionnaires did, however, indicate a positive influence of the hospital information system on nurses' working environment.

Adult↗

PubMed1999

XML and its impact on content and structure in electronic health care documents.

Worldwide information networks have the requirement that electronic documents must be easily accessible, portable, flexible and system-independent. With the development of XML (eXtensible Markup Language), the future of electronic documents, health care informatics and the Web itself are about to change. The intent of the recently formed ASTM E31.25 subcommittee, "XML DTDs for Health Care", is to develop standard electronic document representations of paper-based health care documents and forms. A goal of the subcommittee is to work together to enhance existing levels of interoperability among the various XML/SGML standardization efforts, products and systems in health care. The ASTM E31.25 subcommittee uses common practices and software standards to develop the implementation recommendations for XML documents in health care. The implementation recommendations are being developed to standardize the many different structures of documents. These recommendations are in the form of a set of standard DTDs, or document type definitions that match the electronic document requirements in the health care industry. This paper discusses recent efforts of the ASTM E31.25 subcommittee.

Medical Records Systems, Computerized↗

PubMed1999

Integrated knowledge-based functions in a hospital cancer registry--specific requirements for routine applicability.

The background of the presented work is the design, realization, and routine use of integrated knowledge-based functions in the context of a hospital cancer registry. The first field of application was supporting registrars to detect data inconsistencies and incompleteness timely during the documentation process. Especially, we focused on the acceptance of the administrator of the underlying information system and on the phenomenon of duplicate and outdated messages. These aspects are specific for integrated knowledge based functions and a precondition for obtaining a routine applicability and acceptance.

Artificial Intelligence↗

PubMed1999

How to structure clinical information: a practical example.

In the frame of an European telemedicine project, we have designed and implemented an Andrology server that provides the user (e.g. physicians, students) with a set of anonymized andrology cases. Within this context we faced the problem of re-structuring existing clinical information sources and gained some experience on how much of the problem might be solved by the software engineer. This paper presents a method that partially automates the maintenance of the andrology case collection. Moreover, the potential benefit of XML for information representation will be discussed.

Humans↗

PubMed1999

Data warehousing as a tool for quality management in oncology.

At present, physicians are constrained by their limited skills to integrate and understand the growing amount of electronic medical information. To handle, extract, integrate, analyse and take advantage of the gathered information regarding the quality of patient care, the concept of a data warehouse seems to be especially interesting in medicine. Medical data warehousing allows the physicians to take advantage of all the operational data they have been collecting over the years. Our purpose is to build a data warehouse in order to use all available information about cancer patients. We think that with the sensible use of this tool, there are economic benefits for the Society and an improvement of quality of medical care for patients.

Ambulatory Care↗

PubMed1999

A model for integration and continuous development of standards for tumour documentation using relational database techniques and extensible markup language.

In oncology various international and national standards exist for different aspects of a disease. These standards, maintained by different organisations, have multiple relationships with each other. A common data dictionary like UMLS would facilitate the reorganisation of such relationships when a new version of a standard is published. While the modelling of relationships usually is restricted to types having a relevant frequency, there are often relationships which are expressed in texts like definitions or explanations. Such texts are a very important supplement for the acceptance and the safe use of coding systems, but often are neglected when implementing coding systems in computerised systems, because they are costly to implement. This paper discusses potentials when integrating various sources in a common, database based dictionary enhanced by XML (Extensible Markup Language) techniques.

Databases as Topic↗

PubMed1999

Transferring data from one EPR to another: content--syntax--semantic.

When data are transmitted between electronic patient record (EPR) systems, we can distinguish several tasks. One task is the definition of structure and semantic content of the data in a message structure. Another task is the mapping of the sending EPR's structure to this message structure. A third task is the mapping of the message structure to the receiving EPR's structure. We describe an approach, which distinguishes clearly between these different tasks and activities. Using this approach we have implemented a data transfer procedure between a cancer registry application and a middleware for healthcare information systems. Our experience showed that the proposed systematic approach helped identify problems for data transfer in an early design phase. It also allowed us to limit modifications of the data exchange procedure to certain tasks or activities when one of the EPR applications was updated. In the end, we could even exchange the underlying message format without having to reimplement the complete interface.

Humans↗

PubMed1998

Urologic tumors in the Federal Republic of Germany: data on 56,013 cases from hospital cancer registries.

BACKGROUND: Since 1985, a special work group involved in the coordination of hospital cancer registries in Germany (the Arbeitsgruppe zur Koordination Klinischer Krebsregister) has been collecting, storing, and analyzing data on tumor patients received from cancer centers, oncologic departments, and specialized practices. METHODS: The documentation of tumor patients is based on information concerning localization, histologic findings, and tumor spread, among other things. The data are stored in a central data base administered by the work group. It currently contains data on approximately 500,000 oncologic patients. RESULTS: During the period 1987-1992, 56,013 initial entries were made concerning patients with urologic tumors. Of these cases, tumors of the kidney (n = 11,424) constituted 20.4%. In 94.6% of the cases, histologic investigation revealed a renal cell carcinoma, classified as follows: pT1, 5.8%; pT2, 53.6%; pT3, 37.2%; and pT4, 3.4%. Tumors of the urinary bladder (n = 16,246) constituted 29.0% of all urologic tumors. In 93.8% of cases, a transitional cell carcinoma was detected, classified as follows: pTis, 1.0%; pTa, 36.9%; pT1, 29.6%; pT2, 16.9%; pT3, 11.4%; and pT4, 4.4%. Transitional cell carcinomas of the ureter or of the collecting system (n = 1846) constituted 3.3% of the cases. The proportion of testicular tumors (n 6594) amounted to 11.8%; 53.6% of the germ cell tumors (n = 6281) were seminomas and 46.6% were nonseminomas; 66.3% of the cases were lymph node negative. Tumors of the prostate (n = 19,903) constituted 35.5% of the cases. During the period 1987-1992, the proportion of lymph node positive prostate carcinomas decreased, from 39.8% to 16.2%. CONCLUSIONS: A detailed analysis of these data shows how hospital cancer registries can contribute to the discussion of issues regarding diagnosis and therapy of urologic tumors.

Aged↗

PubMed1998

Aspects of implementing and harmonizing healthcare communication standards.

A variety of healthcare communication standards (HCS) have been developed during the last decade. They have improved the interoperability and the connectivity in open hospital information systems to a large extent. They have also reduced time and efforts during the implementation of standard interfaces. However, the implementation of communication standards is still far from the expected plug and play. The two reasons which are the main cause the current drawbacks are identified--the lack of a standardized terminology and the restricted flexibility of the currently used interchange formats. On the one hand the standardization of the terminology can not be solved by the standards development organizations. It is a general challenge for the medical informatics community. On the other hand the movement to a new interchange format can be initiated by standards development organizations. The application of SGML/XML as an interchange format for communication standards offers a much greater flexibility and adaptability to user needs than the currently used interchange formats. Concepts for a smooth change to a new direction are discussed.

Computer Communication Networks↗

PubMed1998

On the way to a Web based hospital information system: concepts for the use of a medical data dictionary to present context sensitive information in an intranet environment.

Many authors have promoted the www-paradigm to build modern hospital information systems. However currently web-based applications are better suited to information "browsing" than to build complex data entry features. This prompted us to start with our first web based developments inside the Giessen University Hospital Information System in the field of pure presentation of stored knowledge and information. This article describes the concepts which will be used in Giessen to convert available information sources to the www paradigm and to implement context-sensitive knowledge presentation mechanisms inside the clinical information system. The approach is based upon a web-based medical data dictionary server. The data dictionary is used to map terms of interest, chosen from the clinical user during work with a HIS-application, to a semantic network of relationships. The dictionary server will follow those semantic links in order to find and display the webpages, which are linked to the subject.

Dictionaries as Topic↗