Biomedical subjects
Publications and source records attributed to S Graeber.
Modern computer-based hospital information systems are mostly distributed with several heterogeneous subsystems connected together by specialized communication services. The common standard to integrate subsystems is HL7. By the example of subsystem integration for a pulmonary function test lab, we discuss the possibilities of HL7, the limits we encountered and how we overcame these.
Galectin-3 is a member of the galectin family of beta-galactoside-specific animal lectins. Here we show that galectin-3 is constitutively expressed in 15 out of 16 glioma cell lines tested, but not by normal or reactive astrocytes, oligodendrocytes, glial O-2A progenitor cells and the oligodendrocyte precursor cell line Oli-neu. Galectin-3 is also expressed by one oligodendroglioma cell line, but not by primitive neuroectodermal tumor and 4 neuroblastoma cell lines tested so far. In all galectin-3 expressing cell lines, the lectin is predominantly, if not exclusively, localized intracellularly and carries an active carbohydrate recognition domain (shown for C6 rat glioma cells). Moreover, in contrast to primary astrocytes, glioma cells do not or only weakly adhere to substratum-bound galectin-3, probably reflecting an unusual glycosylation pattern. Our findings indicate that the expression of galectin-3 selectively correlates with glial cell transformation in the central nervous system and could thus serve as a marker for glial tumor cell lines and glial tumors.
The application of the principles of evidence-based medicine is based on a rigorous analysis of clinical research tailored to the individual characteristics of a specific patient. Thus the physician must have information about the patient and about the latest results of clinical research simultaneously. We present a computer-based clinical workstation offering sources for both kinds of information: the current patient data is delivered by access to the electronic patient record and the results of research may be searched at the Internet, Intranet, or other online databases. Performing an evaluation study we are testing this configuration in the setting of a university hospital. The physicians are interviewed about their use of the single information sources and their consequences for clinical research and evidence-based medicine. We hope to show that in spite of some technical and methodological problems the clinical workstation is a promising tool for decision-making at the clinical workplace.
Medical students in Germany have to study the basics of medical information processing within a special curriculum which is part of the ecological course. This curriculum offers an introduction to principles of medical informatics. Starting with a conventional textbook, a computer-based training (CBT) program has been developed using the technologies of the internet and the World Wide Web (WWW). Features of the program include a well structured presentation of the information within the software and a high degree of interactivity. Early experiences suggest that this program enhances the learning in the domain of medical information processing. The program may be viewed via the URL: htfp.//www.med-rz.uni-sb.de/med_fak/imbei/pro jekt.
Planning principles and development are described of a communication server which controls and performs all information exchange between distributed and heterogeneous applications in a hospital information system. The analysis is based on business process modeling. At present, the core of the server uses a commercial product (Cloverleaf). This allows to connect both old systems with no or few interface features and new systems with modern interface facilities (such as HL7). Prerequisites, functions, and configuration of the server software are described in detail. Experiences, advantages, and disadvantages are discussed.
We have chosen an object-oriented approach for the modeling of a hospital information system; this avoids some disadvantages of the classic methods (i.e., a combination of Structured Analysis and Entity-Relationship-Model). The primary goal of this procedure was to find and represent the needs of communication in the computer-based part of the information system and, with that, to configure an information server that handles all the interactions. Furthermore, we wanted to develop communication interfaces for the application programs on an object-oriented level.
There is controversy as to whether increased plasma levels of human atrial natriuretic peptide (hANP) in patients with type 1 diabetes mellitus may contribute to the development of diabetic nephropathy. Therefore, we decided to conduct two studies to examine the relationship of hANP levels to urinary albumin excretion and blood pressure. In a cross-sectional study, 83 randomly selected type 1 diabetic patients were investigated. 19 of the patients had increased urinary albumin excretion. 45 healthy volunteers served as controls. In a longitudinal study, 19 type 1 diabetic patients were examined for one year at monthly intervals. An increased risk of eventually developing diabetic nephropathy was identified in 7 out of these patients by repeatedly revealing increased urinary albumin excretion. On the average, hANP levels were increased in type 1 diabetic patients in comparison to controls (P < 0.001). In both studies, hANP levels were positively related (P < 0.05) to mean arterial blood pressure. There was no correlation between hANP levels and metabolic control. hANP levels lay within normal range irrespective of normal or elevated urinary albumin excretion provided that mean arterial blood pressure was normal. In the longitudinal study, increased urinary albumin and alpha-1-microglobulin excretion preceded the increase in both hANP levels and mean arterial blood pressure. Although hANP levels were evidently not related to the disease mechanisms of early diabetic nephropathy, it is tempting to speculate that hANP may contribute to the vicious circle connecting diabetic kidney disease to hypertension once that its levels are increased by elevated blood pressure.
Divergent findings in recent clinical and experimental studies have caused considerable controversy as to whether or how elevated plasma levels of human atrial natriuretic peptide (hANP) may contribute to the pathogenesis of diabetic nephropathy in type I diabetic patients. Therefore, we decided to examine potential changes of urinary albumin excretion (UAE), urinary excretion of alpha-1-microglobulin (A-1-M), mean arterial blood pressure (MAP), hANP levels, creatinine clearance and HbA1 in the course of a prospective one-year study in 19 patients (13 females, six males, age 29 +/- 2 years). All patients had intensified insulin treatment. Seven patients at increased risk for eventually developing nephropathy (group 1) were identified by repeatedly showing elevated UAE ( > 30 mg/24 h). The other patients served as controls (group 2). Patients in group 1 differed from those in group 2 in increased A-1-M (maximal difference, 10.1 +/- 1.5 vs. 5.5 +/- 1.0 mg/l, p < 0.01). In the second half of the study, 43% of the MAP measurements in group 1 exceeded 100 mmHg in comparison to 19% in group 2 (p < 0.01). Simultaneously, 38% of the hANP levels in plasma in group 1 were higher than 25 pg/ml (upper limit of normal range) in comparison to 15% in group 2 (p < 0.05). There were no differences in creatinine clearance between both groups. 58% of the HbA1 concentrations measured in group 1 in the course of the study exceeded 8.5% in comparison to 47% in group 2 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical workstations are software systems that support physicians and nurses in all their specific activities concerned with the medical care of inpatients. In the university hospital of Saarland, we are testing several commercial systems so as to whether they can give such comprehensive support. For their evaluation, we developed a list of criteria grouped in functions to support the physicians, functions to support the nurses, and general functions, together with a grading schema. Besides scope and quality of functions, the acceptance of clinical workstations strongly depends on organizational environment and human factors. To evaluate these conditions, we interviewed all people concerned with the system, using a checklist. The following are examples of problems that we detected: "Facts" (new design of work flow, eg, for examination or nursing procedures); some tasks have to be performed twice; reaction to emergencies; frequent changes of staff. Technical deficiencies (response times too long; mobile data collection was insufficient due to width of display and lack of data consistency, eg, during the doctor's visit). Psychological factors (fear of using computers; statements such as "Medical work cannot be planned" or "Too few benefits from the system"; in view of increasing "transparency," no use for electronic scheduling; insufficient understanding of work flow of automated tasks). The consequences of this study are the introduction of clinical workstations in hospital needs, as well as reengineering the business processes of the ward as a careful and intensive training of staff. This article will present and discuss methods and results of this evaluation study.