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PubMed2004

A web-based federated neuroinformatics model for surgical planning and clinical research applications in epilepsy.

There is an increasing need to efficiently share diverse clinical and image data among different clinics, labs, and departments of a medical center enterprise to facilitate better quality care and more effective clinical research. In this paper, we describe a web-based, federated information model as a viable technical solution with applications in medical refractory epilepsy and other neurological disorders. We describe four such online applications developed in a federated system prototype: surgical planning, image analysis, statistical data analysis, and dynamic extraction, transforming, and loading (ETL) of data from a heterogeneous collection of data sources into an epilepsy multimedia data warehouse (EMDW). The federated information system adopts a three-tiered architecture, consisting of a user-interface layer, an application logic layer, and a data service layer. We implemented two complementary federated information technologies, i.e., XML (eXtensible Markup Language) and CORBA (Common Object Request Broker Architecture), in the prototype to enable multimedia data exchange and brain images transmission. The preliminary results show that the federated prototype system provides a uniform interface, heterogeneous information integration and efficient data sharing for users in our institution who are concerned with the care of patients with epilepsy and who pursue research in this area.

Animals↗
PubMed2005

[Health Risk drinking and problematic consumption of alcohol in Pomerania: comparative analysis of the Study of Health in Pomerania (SHIP) compared with the Federal German Health and Examination Survey in 1998].

PURPOSE: Epidemiological studies show a "North-South" gradient in drinking patterns in Germany, with the South-Eastern regions consuming more alcohol. Hence, patterns of alcohol consumption as well as at-risk drinking were evaluated in West Pomerania using a representative sample. In addition, the average daily quantities and the proportions of at-risk drinking were compared with representative data for Germany (Federal German Health and Examination Survey 1998 [FGHES]). METHODS: A representative random sample of the Pomeranian population (4,310 persons) was analysed. The response rate was 68.8 %. The amount and frequency of alcohol consumption was surveyed with a standardized questionnaire. Prevalence rates for at- risk drinking (> or = 30 g ethanol per day for men, > or = 20 g ethanol per day for woman), indications of abuse / dependence, and episodes of heavy drinking (number of days with 5 and more drinks consumed per day) are presented. To identify socio-economic correlates of high-risk drinking multiple logistic regression modelling was used. Alcohol consumption was evaluated via a frequency-quantity-measure and by using the "Luebeck Alcohol Dependence and Abuse Screening Test" (LAST). RESULTS: Average daily consumption of pure alcohol was about 11.8 g per day, 18.5 g per day for men and 5.8 g per day for women. The consumed quantities exceeded the levels calculated with the FGHES about 1.5 g, 1.8 g for men and 1.2 g for women. Prevalence of risk drinking and harmful alcohol use in Pomerania is higher than the FGHES as well. At-risk drinking was especially associated with age. In women, belonging to a higher social class at-risk drinking was higher, whereas in men of the lower social class consumption rates were higher. The highest alcohol consumption was observed among middle-aged men and women. CONCLUSIONS: The results suggest that alcohol consumption on a high level as well as high-risk drinking is a common phenomenon in the north-eastern part of Germany. Public health measures are indicated for this region. Such intervention projects should focus on population groups with higher alcohol intake.

Adult↗
PubMedDate not supplied

[Analysis of errors in ICD 9 diagnostic classification in compliance with the Federal health care regulation].

In the present study the diagnosis from 1221 letters of discharge of the years 1986 and 1987 were additionally coded by the documentation doctor of the orthopaedic department and compared with the documentation sheets and the computer lists of the administration. Supplementary to this after one year there was carried out an additional coding of the letters by the documentation doctor. The transfer errors of the administration were amounting to 1.72 p.c. with regard to three digit numbers and to 11.87 p.c. with regard to four digit coding. During the repeated examination the documentation doctor made an error of 4.3 p.c. for the three digit coding and of 15.6 p.c. if the maximum coding was required. The corresponding errors of the house physicians for three digit numbers (maximum) were amounting to 8 p.c. (33.6 p.c.) for frequent diagnoses, to 28 p.c. (48.5 p.c.) for rare diagnoses and totally 13.7 p.c. (37.8 p.c.). In the present documentation validity and reliability still shows a good result compared to other studies. Nevertheless a documentation with an error rate to such an extend is of no use for a base documentation, and this error rate must be taken into consideration in the interpretation of global medical statistics. Automatic coding systems integrated into medical writing service seems to be the only help in view of removing these problems.

Disease↗
PubMed2003

Analysis of occupational doses of workers on the dose registry of the Federal Radiation Protection Service in 2000 and 2001.

In 2000 and 2001 about 279 and 221 radiation workers, respectively, were monitored by the Federal Radiation Protection Service, University of Ibadan, in Nigeria. The distribution of the occupational doses shows that the majority of workers received doses below 4 mSv in each of the two years. The radiation workers in the two years are classified into two occupational categories: medicine and industry. The mean annual effective doses, collective doses and the collective dose distribution ratios for workers in each category and the entire monitored workers were calculated. The mean annual effective doses were compared with their corresponding worldwide values quoted by UNSCEAR. In each of the two years, a few workers in industry received doses higher than 50 mSv. The collective dose distribution ratio was found to be about 0.49, which is very close to the highest value of 0.5 in the range of values considered by UNSCEAR as normal for this parameter. This suggests that extra measures have to be taken, particularly in industry, to ensure that the proportion of workers at risk does not go outside this normal range. The occupational doses were also modelled by both the log-normal and Weibull distributions. Both distributions were found to describe the data in almost the same way.

Adult↗
PubMed1989

[Current status of stuttering therapy in preschool and school-age children in the Federal Republic of Germany: results of a questionnaire study among therapists and analysis of the literature].

It is evident that no empirical research has been carried out within the preschool age-group of stuttering children and also that information on the subject published in international and especially in the Anglo-American literature has not received the attention of German therapists. Rather than concentrating upon the stuttering child's speech and language, they attempt to convey to the child a greater pleasure in speaking and in communicating; this may result in symptoms that could aggravate prognosis. More than half of the therapists maintain the same attitude toward school-age children. The review of the literature and the replies to the questionnaire show that German therapists require new orientation toward scientific investigation and new concepts in the treatment of stuttering preschool children.

Child↗
PubMed1995

[Overview, analysis and evaluation of the 1995 public health structural law and the federal social care law from the viewpoint of the trauma surgery department of a university clinic. Measures for preparation of a new reimbursement system and documentation requirements].

All doctors in Germany are required to cooperate in the implementation of the health system reform and the new system for reimbursement of the hospitals to limit the negative consequences to the patients. It would be absolutely wrong to leave the medical services of the insurance companies to define the diagnosis-related groups and determine the charges. The revision of the health system is beneficial in that it supports the economical independence of hospital departments. It is a good idea for them to be paid by results; however, there are no established methods of measuring results or efficacy in medicine. Germany is about 10 years behind the USA in this, so that our country is not yet ready for this reform. Hospital departments do have the freedom to make economic decisions, being heavily dependent on the insurances and the government, because most people who work in hospital are paid from these sources. Departments of trauma or orthopaedic surgery are disadvantaged by the reform, because of the number and kind of diagnosis related groups and the method of reimbursement. This leads to a profit-oriented system of medical documentation, with possible upcoding of diagnoses in future. The present health reform most probably will not increase the efficiency of hospitals; it will not be possible to attain cost reductions with the same level of medical care. The reduced reimbursement will force doctors to cut down their expenses and restrict diagnostic and therapeutic procedures. On the other hand the administration sector in hospitals and insurances will expand dramatically in future.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMedDate not supplied

Successful development and implementation of' a tactical emergency medical technician training program for United States federal agents.

INTRODUCTION: The emerging need for tactical operations in law enforcement often places personnel involved at risk. Tactical operations often are carried out in environments in which access to emergency care is limited. With the war against terrorism expanding, special operations involving United States federal agents are occurring worldwide. Currently, there are very few tactical medicine curricula training traditional emergency medical services (EMS) providers to operate in these high-risk missions. Trainees in existing programs must have previous EMS experience, and are selected from a wide range of backgrounds. The goal of this study is to examine a Special Agent Emergency Medical Technician (SAEMT) training curriculum developed specifically for federal special agents with prior experience in tactical operations, but without previous medical training. METHODS: An analysis of the SAEMT Program given to federal agents of the Drug Enforcement Administration (DEA) in Quantico, Virginia between July 2000 and April 2002 was performed. The SAEMT curriculum provided enrolled agents 181.5 hours of training in tactical emergency topics, including medical mission planning, logistics, operations, evacuation, and weapons training. In addition, SAEMT concurrently provides emergency medical technician (EMT) training. All of the participants were DEA agents with no previous medical training. Upon completion of the course, all participants took the National Registry of EMT-Basic examination. Measured endpoints included course completion rate and performance on certifying examinations. RESULTS: Ninety-five agents were enrolled and successfully completed the SAEMT course between July 2000 and April 2002. Of the agents enrolled, 84 (88%) passed the National Registry of EMTs-Basic examination within two attempts. CONCLUSION: The SAEMT Program provides basic emergency medical training to federal special agents with no previous medical experience. The design of this program provides a useful template to meet the expanding demand for tactical emergency medical personnel.

Certification↗
PubMed1976

Issues of public policy in the USA raised by amniocentesis.

Amniocentesis, a procedure which can detect during pregnancy whether or not the fetus will develop into a mongol or one affected by other serious chromosomal defects, if given to all pregnant women aged 40 and over, would save both human suffering and economic loss to the community. The procedure is not at present widely used for various reasons, not all of them medical, and, if the test result is positive abortion is the remedy. The author describes an important clinical trial being conducted in the USA at the present time but suggests that an educational programme should be undertaken to inform the public of the existence of this procedure and its applications even before the results of the American large-scale trial can be known and evaluated. Amniocentesis and its use, Professor Etzioni concludes, is not the only genetic tool which should be reviewed in a manner which would give an overall picture. He compares those who are concerned with these matters to the citizens of Britain when they saw the first steam engine. They did not perceive the social changes--the industrial revolution--that would follow. In our time a 'genetic revolution' may not be long delayed.

Amniocentesis↗
PubMed1987

Health care institutions in a regional network: a longitudinal case study of inter-organizing.

This is a second article reporting on the functioning of a regional federation in the Dutch health care field. It is a heterogeneous federation of health care delivery institutions (clinical, ambulatory, and primary care) within a geographical area of about 250,000 inhabitants. The first article on this subject, published in this journal in 1981, dealt with the facilities and obstacles during the founding process of the federation and with the problems concerning the making of a policy program (Soc. Sci. Med. 15A, 41-48, 1981). That was about five years after the inception of the federation and it seemed both possible and fruitful to carry out further evaluation of this particular case. A content analysis of all the 41 meetings of the federation could be performed on the agendas, minutes and other relevant documents. The results of this analysis, taken together with a substantial amount of information gathered by participant observation during these sessions, gave rise to certain conclusions and interpretations. They concerned the numbers and kinds of subjects discussed, the changes in their composition over the years, the varying amount of energy put into the development of the federation's organization, the evolution of the federation's task and its effectiveness in preparing regional plans for health care provision. The results of the analysis seemed to encourage this approach to regionalization. Developments during the most recent period, since 1982, will be described in a third article. Although in a legislative sense this year was important, the related enactment processes went on very slowly.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Planning Councils↗
PubMed2005

An ethical analysis of exception from informed consent regulations.

Federal regulations enacted in 1996 allow clinical research with an exception from informed consent in select emergency circumstances. Such research is only permitted when the therapy may directly benefit the research participant and it is not possible to conduct the research with informed consent. Among others, protective mechanisms include a process of community consultation and public disclosure and the establishment of a mandatory data safety monitoring board. Although the regulations do not preserve the right of self-determination of the research participant, the author argues that they do provide an ethical means to advance the science of resuscitation.

Beneficence↗
PubMed1995

Economic implications of migration into the Federal Republic of Germany, 1988-1992.

"An analysis of the effects of the last wave of migration into West Germany on labor markets, public finances and economic growth, this study points at the often ignored fact that the migrants were rather successful in finding jobs and thus helped in eliminating labor shortages in certain industries. Simulations with a macroeconometric model for the FRG indicate that in 1992 the GDP was almost 6 percent higher than without migration, that 90,000 jobs were created and that migration created a surplus of DM14 billion in the public sector, compared to the baseline. This study also makes clear, however, that these effects mainly depend on a quick absorption of migrants by FRG labor markets, and as to the social system, the relief may be only transitory."

Demography↗
PubMed2003

[Current trends of cardiovascular morbidity and mortality of children in Russian Federation. Structure of cardiac pathology in childhood].

Analysis of structure and prevalences of cardiovascular diseases among children and adolescents is presented and recent trends of cardiovascular morbidity and mortality as well as regional differences in dynamics of these parameters in this age group are discussed. Current situation is characterized by pronounced lowering of age of onset of cardiovascular diseases previously considered as diseases of the adult. Clinical picture and prognosis of many pathological states also has been changed. Since the beginning of the nineties steep rise (more than 2 fold) of morbidity and total number of children with cardiovascular pathology has occurred. This is directly linked with improved diagnostics. While all cause and infant mortality becomes lower cardiovascular mortality remains stable and even has tendency to increase. Mortality from cardiac and vascular diseases is significantly lower in regions with higher prevalence of these states. Substantial effect on lowering of mortality produces intensity of work of specialized services providing timely diagnosis, treatment and rehabilitation of children with heart diseases. The authors suggest some parameters allowing to assess progressive or negative trends in development of specialized care of children with cardiovascular pathology.

Adolescent↗
PubMed1990

National supported employment initiative: a preliminary analysis.

A survey of 27 states receiving federal supported employment grants was conducted. Results indicated that the number of participating individuals increased 157% during the 3-year study period. Further, over 1,400 programs of supported employment were authorized by state agencies during this time. Individual placement options remained prevalent and employment outcomes associated with this approach appeared to be superior to outcomes associated with other models. Persons with mental retardation were the most frequent participants; individuals experiencing other handicapping conditions or those considered severely handicapped were not well represented. Implications of these results for the continued implementation of this new service alternative were discussed.

Disability Evaluation↗
PubMed2003

Comparison of three methods for the determination of body fat in patients on long-term hemodialysis therapy.

OBJECTIVE: To compare three simple methods of body composition analysis for the assessment of body fat in patients on long-term hemodialysis therapy. DESIGN: Cross-sectional study using the skinfold thickness, bioelectrical impedance analysis, and near-infrared interactance techniques after a hemodialysis session. SUBJECTS/SETTING: Ninety clinically stable patients (57 male/33 female) undergoing hemodialysis at the Dialysis Unit of the Federal University of São Paulo. STATISTICAL ANALYSIS: Analysis of variance, intraclass correlation coefficient, and Bland-Altman plot analysis were used for the comparative analysis between the methods. RESULTS: Body fat measurements obtained by skinfold thickness (13.5+/-6.2 kg) and bioelectrical impedance analysis (13.7+/-6.7 kg) were similar, whereas those measured by near-infrared interactance (11.3+/-5.1 kg) were significantly lower in comparison with skinfold thickness and bioelectrical impedance analysis (P<.001). The strongest intraclass correlation coefficient was found between bioelectrical impedance analysis and skinfold thickness (r=0.87), and near-infrared interactance vs skinfold thickness and bioelectrical impedance analysis methods yielded r=0.78 and r=0.76, respectively. Near-infrared interactance showed a progressive underestimation of body fat values in comparison with the bioelectrical impedance analysis technique in patients with higher amount of adiposity. CONCLUSION: In our study, we cannot consider that one method of body composition analysis is more accurate than the other because we did not apply a gold standard method. However, the most simple, long-established, and inexpensive method of skinfold thickness seems to be still very useful to the dietitians' routine for assessing body fat in patients on long-term hemodialysis therapy.

Adipose Tissue↗