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Biomedical subjects

R Bindels

Publications and source records attributed to R Bindels.

10 recordsLinked to original sources
PubMed2006

EGOOZ: specifying the components of electronic patient record-related education.

OBJECTIVE: To determine whether educators consider electronic patient record (EPR)-related education necessary and if so, what subjects have to be taught more extensively in the future. METHODS: A list of possibly relevant subjects was determined from the literature. A questionnaire was designed which contained those subjects and the respondents were asked to indicate, for each subject, its competency level and required competency level in current teaching. Since the response rate was low a second questionnaire was developed to have the results of the analysis of the first questionnaire validated by a larger group of educators. RESULTS: In total 45 learning goals were identified from the literature. The questionnaire was sent to representatives of several disciplines: basic medical education, medical specializations, pharmacy, dentistry and nursing. The analysis of the first questionnaire resulted in nine subjects that needed more attention in the future. Because of the low response the needs could not be specified for the individual disciplines. This insight was obtained from a second questionnaire. The response to this questionnaire was high. From the analysis of the second questionnaire differences between views of educators involved in the training of GPs and educators involved in the training of other specializations were observed. CONCLUSION: Educators find EPR-related education important. There are different opinions about the phase in which EPR-related education should be given.

Curriculum↗
PubMed2001

Validation of a knowledge based reminder system for diagnostic test ordering in general practice.

We describe the validation of a real-time automated reminder system that assists General Practitioners (GP) in appropriate test ordering. We compared the comments of human experts with the comments of the reminder system using a retrospective random selection of 253 request forms. A panel of three expert physicians judged the requested tests independently based on their interpretations of the practice guidelines. The majority assessment of the physicians was compared with the assessment of the reminder system. In case the system's output differed from the majority assessment the written practice guidelines were consulted. On average 1.75 reminders were produced per form. In total 32 of the 442 given reminders (7%) were given incorrectly. The amount of information and the level of detail (the specificity of the terms) in which the GP describes the patients' medical status are crucial for the reminder system to react correctly.

Adult↗
PubMed2001

Reliability of the assessment of appropriateness of diagnostic test request behavior.

We describe the reliability of the assessment of the appropriateness of requested diagnostic tests. We used a retrospective random selection of 253 request forms with in total 1217 requested tests. Three experts made an independent assessment of each requested test. Interrater kappa values ranged from 0.33 to 0.44. The kappa values of intrarater agreement ranged from 0.65 to 0.68. The reliability coefficient for all three reviewers was 0.66. This reliability is not sufficient to make case-by-case decisions, for example to give individual feedback on the appropriateness of requested tests. Sixteen reviewers are necessary to obtain a reference with a reliability of 0.95.

Decision Support Systems, Clinical↗
PubMed2000

A test ordering system with automated reminders for primary care based on practice guidelines.

In this article we describe a real-time automated reminder system that has been developed to change Family Physicians' (FP) test ordering behavior. The system focuses on the appropriateness of test requests. We aim at using the system as a substitute for written feedback by human experts. The reminder system consists of a knowledge base, an order entry system and modules to provide passive and active support in the form of reminders to FPs. The system generates critical comments about the rationality of the test requests at the moment the FP orders a test that is not in line with national or regional guidelines. For the first validation of the knowledge base we compared the comments of a human expert to the comments of the reminder system on three random samples of test requests. The overall agreement in the subsequent validation rounds was 46, 60 and 69%. The corrections made in the knowledge base after each validation round resulted in a reminder system with 149 reminders concerning various medical problems. Due to the corrections in the knowledge base the reminder system reacts better over the subsequent validation rounds.

Diagnostic Tests, Routine↗
PubMed2000

Acute regulation of the betaine/GABA transporter BGT-1 expressed in Xenopus oocytes by extracellular pH.

Besides uptake of Na(+) and Cl(-), mammalian cells counteract osmotic cell shrinkage also by Na(+)-coupled uptake of osmolytes, e. g., myo-inositol, taurine or betaine. The expression of the corresponding transporters is transcriptionally regulated by the ambient pH and osmolarity and is increased upon cell shrinkage, a process requiring hours. The present study has been performed to disclose rapid regulation by pH of osmolyte transport via BGT-1. Transport of GABA was investigated by using the two-electrode voltage-clamp technique with BGT-1 expressing Xenopus oocytes. GABA was used as a substrate, because of the low oocyte endogenous transport activity. Extracellular acidification to pH 5.5 reversibly decreased and extracellular alkalinization to pH 8.5 increased GABA-induced currents. Kinetic analysis revealed that extracellular alkalinization increases the affinity for Cl(-) as reflected by a decrease of the apparent K(m)-value for Cl(-) from >500 mM to 55.8 +/- 4.7 mM upon an increase of the pH from 7.0 to 8.5. The apparent K(m)- values for Na(+) and GABA remained unaltered in the pH range from 6.0 to 8.5. Instead, alkalinization increased the maximal current induced by saturating Na(+) and GABA concentrations. The results are compatible with a model of interference of H(+) ions with Cl(-) binding and a pH-dependent reduction of V(max) for Na(+) and GABA.

Animals↗
PubMed2000

Comparing assessment of appropriateness of diagnostic tests between a human expert and an automated reminder system.

This paper describes the validation of the GRIF automated reminder system. The reminder system has been developed to influence diagnostic test ordering of General Practitioners (GPs). It generates critical comments on the basis of accepted guidelines. A retrospective random selection of 253 request forms has been taken. We compared the comments of a human expert to the comments of the reminder system. A panel of two independent reviewers judged the requested tests based on the strict interpretation of the guidelines. The sensitivity, specificity and 'predictive values' of the comments of the reminder system and the human expert were calculated using the judgement of the two reviewers as 'gold standard'.

Artificial Intelligence↗
PubMed1999

Development of a reminder system for general practitioners.

In this contribution we describe a prototype reminder system that has been developed to influence General Practitioners' (GP) test request behaviour. It is intended to substitute conventional written feedback by human experts. The system generates critical comments about the rationality of the test request at the moment the GP requests a test that is not in line with national or regional guidelines.

Artificial Intelligence↗
PubMed1997

A modified confocal laser scanning microscope allows fast ultraviolet ratio imaging of intracellular Ca2+ activity using Fura-2.

A confocal, ultraviolet laser scanning microscope (LSM) for reliable ratio measurements of localized intracellular Ca2+ gradients using the Ca2+-sensitive dye Fura-2 was developed. In a commercial LSM, the filter wheels for the excitation band-pass filters and the grey filters were replaced by acousto-optic tunable filters (AOTF) for rapid switching (</=1.5 micros) of the ultraviolet (351 and 364 nm) and the visible (457, 476, 488, 514 nm) excitation light. This enabled dual wavelength excitation of Fura-2, or 2'7'-biscarboxyethyl-5(6)-carboxyfluorescein (BCECF) for pH measurements. Changing to a transmitted-light detector of high sensitivity allowed for simultaneous recording of differential interference contrast images of the preparation with the excitation light. The AOTF fine control of the intensity of the excitation light and improvements in the emission detector sensitivity enabled the acquisition of up to 120 ratio pairs of high-quality images from a single cell. The optical capabilities and limitations of the instrument were evaluated with fluorescent beads and dye-loaded cultured cells. Agonist-induced intracellular Ca2+ transients in HT29 cells were recorded to test for the instrument's ability to measure changes in [Ca2+]i. Ratio z-sections from Fura-2-loaded cells showed an inhomogeneity of the Fura-2 loading with an accumulation of the dye mostly in the mitochondria. We show, as an example of the microscope's achievable resolution, the spatial and temporal heterogeneity of [Ca2+]i signals in mitochondria and the cytosol in response to agonist-evoked stimulation of HT29 cells. In addition, we show that the lipophilic, membrane-bound Fura-2 derivative Fura-C18, for measurements of near-membrane Ca2+ changes, can be used with this confocal microscope. This new LSM is expected to deepen our understanding of localized [Ca2+]i signals; for example, the nuclear Ca2+ signalling or the [Ca2+]i changes that occur during stimulation of ion secretion in polarized epithelial cells.

Calcium↗