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At least 253 records · Page 14Linked to original sources

PubMed2002

Integration of a standard gastrointestinal endoscopy terminology in the UMLS Metathesaurus.

MST(c), a standard terminology for gastrointestinal endoscopy reporting, was integrated in the January 2002 UMLS Metathesaurus in order to ease the practical interoperability of clinical data repositories in gastroenterology. The integration required full specification of names, resolution of discrepancies between English, French and Italian versions of MST, appropriate categorization with UMLS Semantic Types and MST-level Class attributes, assignment of explicit intra-table (and some useful inter-table) relationships mainly at concept level but also at the source level in order to retain and fully represent the original explicit and implicit MST organization. Main results, problems encountered and future plans are discussed.

Endoscopy, Gastrointestinal↗

PubMed2002

Building a genome database using an object-oriented approach.

GOBASE is a relational database that integrates data associated with mitochondria and chloroplasts. The most important data in GOBASE, i. e., molecular sequences and taxonomic information, are obtained from the public sequence data repository at the National Center for Biotechnology Information (NCBI), and are validated by our experts. Maintaining a curated genomic database comes with a towering labor cost, due to the shear volume of available genomic sequences and the plethora of annotation errors and omissions in records retrieved from public repositories. Here we describe our approach to increase automation of the database population process, thereby reducing manual intervention. As a first step, we used Unified Modeling Language (UML) to construct a list of potential errors. Each case was evaluated independently, and an expert solution was devised, and represented as a diagram. Subsequently, the UML diagrams were used as templates for writing object-oriented automation programs in the Java programming language.

Databases, Genetic↗

PubMedDate not supplied

Being born in Manitoba: a look at perinatal health issues.

OBJECTIVE: The Manitoba Centre for Health Policy was commissioned by Manitoba's provincial health department to examine the health of newborns born 1994 through 1998, using three indicators: preterm birth (< 37 weeks gestation), birthweight, and type of infant feeding. METHODS: Data were derived from the Population Health Research Data Repository and the National Longitudinal Survey of Children and Youth 1996. Variation by 12 Regional Health Authorities (RHAs) and by 12 Winnipeg Community Areas (CAs) was examined, as well as associations with the population's health and socioeconomic well-being. RESULTS: Manitoba's preterm birth rate was 6.7% of live births, from 5.3% to 7.4% by RHA, and 5.7% to 8.0% by Winnipeg CA. Manitoba's low birthweight rate (< 2500 g) was 5.3%, from 2.7% to 5.7% by RHA, and 4.4% to 7.2% by Winnipeg CA. The lower the income, the greater the likelihood of low birthweight (p < 0.05). Manitoba's breastfeeding initiation rate was 78%, from 64% to 87% by RHA, and 66% to 90% by Winnipeg CA. The lower the income and the poorer the health status of the population, the lower the breastfeeding rate (p < 0.001). Of those initiating breastfeeding, 42% breastfed for at least six months. CONCLUSION: Factors affecting child health in Manitoba could be addressed through systematic programs both during pregnancy and during the postpartum period, including support for nutritional counselling, promotion of breastfeeding, smoking cessation programs, and social policy decisions designed to overcome disparities within low-income groups and populations with poorer health status.

Birth Rate↗

PubMedDate not supplied

Childhood injury rates in Manitoba: socioeconomic influences.

BACKGROUND: Injury is the leading cause of death among Canadian children between 1 and 19 years, and accounts for one sixth of all hospitalizations of children between 0 and 19 years. We examined the causes of injury in Manitoba children, and the relationship between injury rates and region of residence, premature mortality rate (PMR), and income. METHODS: Regional differences in injury death and hospitalization rates, and causes of injury were derived from the Population Health Research Data Repository. The relationship between injury rates and area income levels was assessed and correlations between regional premature mortality rates (PMR) and injury rates were calculated. RESULTS: Motor vehicle crashes were the leading cause of injury mortality. Falls were the leading cause of injury hospitalization. Regional differences were substantial. Rural-urban differences in injury rates were pronounced; northern Manitoba's rates were very high compared to the rest of the province. Regional PMR values correlated significantly with injury mortality and hospitalization rates. Both types of injury rates correlated significantly with income; higher injury rates were associated with lower income levels. CONCLUSION: Injuries are not random events, but are related to social factors.

Accidents, Traffic↗

PubMedDate not supplied

Health service utilization by Manitoba children.

OBJECTIVE: To compare physician and hospital utilization rates by children across subregions of Manitoba. METHODS: 1998/99 data for physician visits and hospitalizations for children aged 0 to 19 were extracted from the Population Health Research Data Repository. Rates of utilization were compared across 12 regions (RHAs) within Manitoba, and 12 community areas within Winnipeg. Rates were also compared across premature mortality rates (PMR) and area income levels. RESULTS: Substantial regional variation was found for utilization rates. The hospitalization rate for children from the three northern RHAs (highest PMRs) (114/1000) was almost four times the Winnipeg rate (30/1000) and almost double the rate for the rural south RHAs (lowest PMRs) (59/1000). The variation among regions in physician visits ranged from under 2 visits in 2 of the northern RHAs to almost 4 visits in urban areas. However, the low visit rates in rural RHAs are offset somewhat by greater use of nurses. Hospitalizations and physician visits were also related to area income level. CONCLUSION: Findings are discussed in terms of health care need.

Adolescent↗

PubMed2003

Building a comprehensive clinical information system from components. The approach at Intermountain Health Care.

OBJECTIVES: To discuss the advantages and disadvantages of an interfaced approach to clinical information systems architecture. METHODS: After many years of internally building almost all components of a hospital clinical information system (HELP) at Intermountain Health Care, we changed our architectural approach as we chose to encompass ambulatory as well as acute care. We now seek to interface applications from a variety of sources (including some that we build ourselves) to a clinical data repository that contains a longitudinal electronic patient record. RESULTS: We have a total of 820 instances of interfaces to 51 different applications. We process nearly 2 million transactions per day via our interface engine and feel that the reliability of the approach is acceptable. Interface costs constitute about four percent of our total information systems budget. The clinical database currently contains records for 1.45 m patients and the response time for a query is 0.19 sec. DISCUSSION: Based upon our experience with both integrated (monolithic) and interfaced approaches, we conclude that for those with the expertise and resources to do so, the interfaced approach offers an attractive alternative to systems provided by a single vendor. We expect the advantages of this approach to increase as the costs of interfaces are reduced in the future as standards for vocabulary and messaging become increasingly mature and functional.

Computer Systems↗

PubMed2004

U.S. Department of Veterans Affairs Enterprise Reference Terminology strategic overview.

The Veterans Health Affairs (VHA) branch of the Department of Veterans Affairs has undertaken an Enterprise Reference Terminology (ERT). VHA, arguably the largest integrated healthcare provider in the United States, has completely computerized virtually all clinical transactions, including physician orders and documentation. The VA is now integrating its clinical records across hundreds of sites of care by means of a Health Data Repository (HDR) project. ERT has been designed to provide a terminology development environment, terminology services, and maintenance services for the clinical and business content in HDR and other VHA applications. Drug, laboratory observations, and clinical document title files have been developed, and the ERT will encompass all HDR domains by 2008. Commercial tools are used to host the VHA's ERT terminology development and server environments. We will select and adopt both open-source and licensable terminology systems to provide ERT content, as well as reuse existing VA-specific terminology content.

Hospital Information Systems↗

PubMed2004

Evaluation of reliability in the use of endoscopic terminology.

Variability in the reporting of gastrointestinal endoscopic findings may affect the validity of analyses of data collected from clinical reports of those findings. In this project, images of 10 endoscopic findings were collected from the data repository of the Clinical Outcomes Research Initiative (CORI), all of which had been described by the reporting endoscopist. These images were presented to 52 experienced endoscopists recruited from the clinical affiliates of CORI who were asked to assign each a term from the Minimum Standard Terminology for Digestive Endoscopy. Proportion of agreement with the endoscopist varied by finding from 84.3% to 51.0% (overall 67.6% with 95% CI 63.4-71.8%). Proportion of agreement among the subjects varied by finding from 76.3% to 38.5%.(overall 55.6% with 95% CI 52.4-58.8%). Possible reasons for this lack of agreement are discussed.

Databases, Factual↗

PubMed2004

The need for a time-machine in the distributed HER.

It is widely expected that the Electronic Health Record (EHR) will become an important tool for healthcare professionals when delivering care. The use of this tool will not for long be optional, it will become a professional responsibility to use this tool when appropriate. Until now the focus in the design and implementation of the EHR is on its real-time behaviour. In this paper it is argued that there is a need to be able to reproduce the EHR as it would have presented itself to a specified health care professional at a specified point of time in the past (a "time-machine"). This to be able to assess whether the behaviour of the health care professional was appropriate in view of the data he did retrieve or could have retrieved from the EHR at that point in time. Next the consequences of the implementation of such functionality are explored, these are found to be huge. It would require substantial investments to implement this functionality. So it is important that clarity is created on the need for this time-machine. The professional associations involved and the bodies responsible for the quality of care have to be involved in further discussion on this issue. IMIA might take the lead. Because implementation of the time-machine would have consequences for any information system that contributes in real-time to the EHR, it may well be that the need for this functionality will affect the current common opinion that medical patient data should remain stored in the information systems of the health care establishments where the data were generated and be requested from these systems by the virtual EHR when needed. Uploading medical patient data from the operational systems in the health care establishments to medical data repositories could reduce the number of systems affected considerably.

Computer Communication Networks↗

PubMed2002

A networked electronic patient record system for diabetes.

This paper describes the development and clinical implementation of the SincroDiab--a synchronized diabetes register for the routine clinical practice in a LAN and for design of long-term trials and epidemiological studies based on the GEHR (Good European Health Record) architecture. The objectives of the SincroDiab system were to address the need to establish a more efficient and more effective information infrastructure to improve the ability to share patient record information among health care providers, to reduce the health care delivery costs, to meet the requirements of legal, regulatory or accreditation standards, to share comparable patients data among different sites within a multi-entity health care delivery system and to improve quality of care by network connecting the data repository to clinical workstations and departmental systems.

Diabetes Mellitus↗

PubMedDate not supplied

Mortality comparisons of First Nations to all other Manitobans: a provincial population-based look at health inequalities by region and gender.

BACKGROUND: To examine inequalities in health status of Registered First Nations Manitobans compared to all other Manitobans. METHODS: Three mortality indicators--premature mortality rate (PMR) defined as an age- and sex-adjusted rate of death before age 75 years; life expectancy from birth; and potential years of life lost (PYLL)--are compared between Registered First Nations (RFN) people and all other Manitobans (AOM) by geographical areas of Manitoba. Data were derived from the Population Health Research Data Repository, linked to the federal Status Verification System (SVS) files for the years 1995 through 1999. RESULTS: First Nations experienced double the PMR compared to all other Manitobans (6.6 versus 3.3 deaths per thousand, p < 0.05), an eight-year gap in life expectancy (males: 68.4 versus 76.1 years; females 73.2 versus 81.4 years), and over twice the PYLL (males 158.3 versus 62.5 years of life lost per thousand; females 103.3 versus 36.5). RFN male life expectancy was geographically-related (better health status in the north), and inversely related to the corresponding regional AOM life expectancy (r = -0.61, 9 df, one-tailed, p < 0.03). As regional percentage of RFN decreased, male life expectancy decreased (r = 0.77, 9 df, one-tailed, p < 0.003). In contrast, RFN female indicators showed no such relationship. CONCLUSION: The inequality in health status between RFN and all other Manitobans is large, but also shows differential geographical and gender effects.

Female↗

PubMedDate not supplied

Health services use of Manitoba First Nations people: is it related to underlying need?

BACKGROUND: To compare health status and health services use of Registered First Nations to all other Manitobans (AOM). If the Canadian health care system is meeting underlying need, those experiencing the greatest burden of morbidity and mortality should show the highest rates of health service use. METHODS: Registered First Nations' (n = 85,959) hospitalization and physician visit rates were compared to rates of all other Manitobans (n = 1,054,422) for fiscal year 1998/99. The underlying "need" for health care was measured using premature mortality (PMR), an age- and sex-adjusted rate of death before age 75. Data were derived from Manitoba's Population Health Research Data Repository, linked to federal Status Verification System files to determine Registered First Nations status. RESULTS: Registered First Nations' PMR was double the rate of all other Manitobans (6.61 vs. 3.30 deaths per thousand, p < 0.05). Registered First Nations ambulatory physician visit rates (6.13 vs. 4.85 visits per person, p < 0.05), hospital separation rates (0.348 vs. 0.156 separations per person, p < 0.05) and total days of hospital care (1.75 vs. 1.05 days per person, p < 0.05) were higher than AOM rates. Consultation rates (first visit to a specialist) were slightly higher for Registered First Nations (0.29 vs. 0.27 visits per person, p < 0.05), and overall specialist visit rates were lower (0.895 vs. 1.284 visits per person, p < 0.05) compared with AOM. CONCLUSION: Although hospitalization and ambulatory physician visit rates for First Nations reflect their poorer health status, consult and specialist rates do not reflect the underlying need for health care services.

Ambulatory Care↗

PubMed2005

Prognostic value of automated quantification of 99mTc-sestamibi myocardial perfusion imaging.

UNLABELLED: Although human interpretation of (99m)Tc-sestamibi SPECT myocardial perfusion imaging has been repeatedly validated in the diagnostic and prognostic assessment of coronary artery disease, it remains unclear if automated computer-derived quantitative indices of perfusion have similar or independent prognostic information. METHODS: We studied 718 patients referred for (99m)Tc-sestamibi SPECT myocardial perfusion imaging who were followed for 5.6 +/- 1.1 y (mean +/- SD). The SPECT studies were initially interpreted visually without benefit of computer-based analysis and were then subjected to a blinded reprocessing to extract quantitative indices of perfusion. Follow-up was through the Manitoba Population Health Research Data Repository. Acute myocardial infarction or cardiac death occurred in 79 individuals (11.0% of the cohort). RESULTS: Visual and quantitative categorization of scan perfusion abnormalities showed similar prognostic value for predicting acute myocardial infarction or cardiac death. Discordance between the visual and quantitative categorizations defined a group at intermediate risk. There was a gradient of risk with increasing severity of the summed stress score (SSS) or summed difference score (SDS). The automated SSS and SDS provided incremental prognostic information over that obtained from visual interpretation. CONCLUSION: Automated quantification of (99m)Tc-sestamibi SPECT myocardial perfusion scans provides objective prognostic information and may complement the conventional visual image interpretation.

Causality↗

PubMed1992

Disease prevention strategies for Army aviators: clues from a descriptive analysis of the flying duty medical examination.

The U.S. government spends approximately $300,000 to train an Army aviator. Maintaining a healthy aviator population is important not only to the completion of the aviation mission, but also for budgetary reasons. We reviewed Army aviator physical examinations and self-reported risk behavior questionnaires from the Aeromedical Epidemiological Data Repository at Fort Rucker, Alabama, to assess aviator health. Overall, aviators are healthy adults; however, the health status of aviators can be improved by reducing tobacco use, limiting cholesterol and fat intake, and wearing hearing protection devices both during and off duty.

Adult↗

PubMed2006

Outlook for grid service technologies within the @neurIST eHealth environment.

The aim of the @neurIST project is to create an IT infrastructure for the management of all processes linked to research, diagnosis and treatment development for complex and multi-factorial diseases. The IT infrastructure will be developed for one such disease, cerebral aneurysm and subarachnoid haemorrhage, but its core technologies will be transferable to meet the needs of other medical areas. Since the IT infrastructure for @neurIST will need to encompass data repositories, computational analysis services and information systems handling multi-scale, multi-modal information at distributed sites, the natural basis for the IT infrastructure is a Grid Service middleware. The project will adopt a service-oriented architecture because it aims to provide a system addressing the needs of medical researchers, clinicians and health care specialists (and their IT providers/systems) and medical supplier/consulting industries.

Database Management Systems↗

PubMed2006

Evaluation of the effect of endovascular options on infrarenal abdominal aortic aneurysm repair.

Endovascular devices designed to exclude flow to infrarenal abdominal aortic aneurysms (AAA) were approved by the Food and Drug Administration in the United States in 1999. This action allowed widespread use of this technology for AAA exclusion. The purpose of this report is to examine trends for use of these modalities, rates of rupture of AAA, and to compare results of open AAA repair with endovascular repair. Results were collected for all hospitals, except for Veterans Administration hospitals, by a state-wide repository. Data for the years 1996 through 1998 and 2001 through 2002 were evaluated, and data from 1999 through 2000 were excluded because no separate codes were available to distinguish between open and endovascular repair. The information gathered is based on the All Patient Refined Diagnostic Related Group (APRDRG; 3M, St. Paul, MN). An average of 718 open, elective AAA was performed between 1996 and 1998. This dropped to 503 open repairs from 2001 to 2002 (P < 0.005). During that same interval, 308 endovascular elective AAA repairs were performed, therefore the total rate of elective repair increased by 100. The average rate of ruptured AAA repairs from 1996 to 1998 was 121 per year, and this dropped to 89 from 2001 to 2002 (P < 0.005). The mortality of open AAA repair during the 1996 to 1998 and 2001 to 2002 intervals was unchanged (4.7%). Mortality from endovascular AAA repair between 2001 and 2002 was 1.9 per cent (P = 0.003). Major morbidity was 14.5 per cent for open, elective AAA repair and 6.3 per cent for endovascular elective repair from 2001 to 2002 (P < 0.001). These data suggest that the advent of endovascular AAA repair has contributed to a reduction in the rate of ruptured AAA repairs, an increase in total procedures performed, and a significant decrease in perioperative deaths and major complications when compared with open AAA repair.

Aged↗

PubMed1990

Renal calculi in army aviators.

A study of U.S. Army active duty aviators was done using the Aeromedical Epidemiology Data Repository (AEDR) for the period of January 1984 through December 1987 to determine the incidence of renal calculi in this population. Age-specific rates were found to be highest in the 30-54 year age group. The overall annual incidence was determined to be 4.7/1000 population of white male aviators. After standardization to the 1960 U.S. white population, the incidence in aviators was found to be 2.2/1000, almost double that of a Rochester, MN male population (1.2/1000). The aviation environment may predispose Army aviators to dehydration and play an etiologic role in the genesis of renal calculi. Medical evaluation, treatment, and administrative disposition of Army aviators with renal calculi are also briefly discussed.

Adult↗

PubMed1980

Physical standards for high-performance fighter aircraft pilots.

The new generation of high-performance aircraft has clearly emphasized man's physiological limitations to withstand sustained high G loading. The selection and retention standards required to function in this environment have not been completely defined. The authors will offer a format of standards and screening tests, placing special emphasis on the detection of subclinical disease, particularly coronary artery disease. Cases which illustrate the spectrum of asymptomatic coronary disease will be presented. Other entities discussed will include conduction defects, mild valvular lesions, arrhythmias, and degenerative joint disease of the spine. An overall approach based on age, screening milestones, and specialized tests will be presented. Finally, a data repository on all pilots with chronic high G exposure will be discussed.

Adult↗