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Forensic web watch.

Now that one has logged onto the world wide web (WWW) and utilized one or more of the home pages listed previously (or used another equally good home page) to seek out basic information available to forensic practitioners, the question now arises of how to go about making the most of the information available. One feature consistent to most home pages is links to the home pages of Associations and Societies, one or more of which most practitioners will be members of. With access to the WWW not only have you access to your own association/society, but you can also keep up to date with all the others to which you have not paid subscriptions. Although an internet search using a WWW search engine or the 'top 6' home pages may assist in identifying a large number of association and society sites, one of the most useful places to start is the home page of the Indian Academy of Forensic Medicine (IAFM). This, to date, lists a total of 139 such sites. To access all the home pages listed may take in excess of 6 h so the following review looks at the range of sites available and recommends some places the author considers many people may wish to know and visit. Again, this is inevitably a personal choice and it is recognized that those sites not listed may, in fact, be the preferred choice for other users of the forensic WWW.

Journal Article↗

The diagnosis related groups enhanced electronic medical record.

PROBLEM: The introduction of Diagnosis Related Groups as a basis for hospital payment in Germany announced essential changes in the hospital reimbursement practice. A hospital's economical survival will depend vitally on the accuracy and completeness of the documentation of DRG relevant data like diagnosis and procedure codes. In order to enhance physicians' coding compliance, an easy-to-use interface integrating coding tasks seamlessly into clinical routine had to be developed. A generic approach should access coding and clinical guidelines from different information sources. METHODS: Within the Electronic Medical Record (EMR) a user interface ('DRG Control Center') for all DRG relevant clinical and administrative data has been built. A comprehensive DRG-related web site gives online access to DRG grouping software and an electronic coding expert. Both components are linked together using an application supporting bi-directional communication. Other web based services like a guideline search engine can be integrated as well. RESULTS: With the proposed method, the clinician gains quick access to context sensitive clinical guidelines for appropriate treatment of his/her patient and administrative guidelines for the adequate coding of the diagnoses and procedures. This paper describes the design and current implementation and discusses our experiences.

Diagnosis-Related Groups↗

ESS dot com.

BACKGROUND: The Internet is a rich but unregulated source of information, and no studies have evaluated sleep medicine content designed for patient or public use. OBJECTIVE: To examine how the Epworth Sleepiness Scale is presented on the World Wide Web. METHODS: We searched the web with eight search engines, in November 2000, for the terms 'ESS' or 'Epworth Sleepiness Scale' and examined every site that listed the full ESS. RESULTS: The 91 sites were sponsored by academic institutions (n=11), private medical groups (34), corporations (21), and web information services (25). No information on interpretation of ESS results was given by 24 (26%) of the sites; 37 (41%) of the sites stated that a score greater than 8, 9, 10, 11, or 12 merits consultation with a clinician. Few sites mentioned that insufficient sleep and depression are among the most common causes of excessive sleepiness, or that the meaning and value of the ESS are somewhat controversial. CONCLUSION: The ESS is widely available on web sites designed for public use, but information that would allow appropriate interpretation of results is often lacking, misleading, or incomplete.

Journal Article↗

Traditional Chinese Medicine and heart disease: what does Western medicine and nursing science know about it?

BACKGROUND: Interest in Traditional Chinese Medicine (TCM) is growing rapidly beyond China. This interest is driven by a combination of factors including recognition of potential benefits of TCM; dissatisfaction with the traditional Western medical model; an increasing commitment to holistic care and increasing evidence for the interaction of psychological factors and outcomes of disease and treatment and health consumer demand. AIMS: This review article was prompted by the need to understand and interpret the increasing trend towards the use of TCM in heart disease. In particular, this article defines and describes TCM, and analyses implications and challenges for Western health care delivery models. LITERATURE SEARCH: This article provides a review of accessible evidence, to English speaking health care professionals. The CINAHL, MEDLINE, HealthSTAR, Academic ASAP and Cochrane databases were searched, identifying literature published from 1982. Search engines on the Internet were also used. Examples of keywords used were "Traditional Chinese Medicine" and "heart". CONCLUSION: Difficulties in accessing information regarding TCM have implications for health education in coronary heart disease and patient safety. The rapid uptake of TCM in both Western and Chinese societies mandates an understanding of the principles and potential interactions when TCM is complemented with Western medical treatment for heart disease. Development of this knowledge and understanding is essential in order to provide safe and effective health care to patients who use combination therapies.

Acupuncture Therapy↗

Minor's rights versus parental rights: review of legal issues in adolescent health care.

The right of adolescents to access confidential health care is sensitive and controversial. Recent challenges in the court system to adolescents' right to access abortion and contraception are eroding current law, including the Roe v Wade decision. The prospect of more than a million pregnancies in individuals under the age of 20 years in the United States with increasingly fewer alternatives to pregnancy is concerning. New regulations under the Health Insurance Portability and Accountability Act are adding yet another layer of complexity to the care of adolescents. Understanding legal issues surrounding adolescent rights to care can help the health care provider make appropriate care available to this age group. Keywords previously identified in CINAHL and MEDLINE were used to perform the literature search. LexisNexis was the search engine used to identify the laws and statutes.

Abortion, Legal↗

Intravenous and indocyanine green angiography.

BACKGROUND: Indocyanine green angiography (ICGA) is an adjunct procedure to intravenous sodium fluorescein angiography (IVFA) for evaluation of disorders of the retina. It has particular application when choroidal pathology is implicated or suspected. Indocyanine green (ICG) dye has been used in the medical field since 1956, when it was approved by the Federal Drug Administration for imaging cardiac and hepatic circulations. Indocyanine green is a well-tolerated, tricarbocyanine dye with a molecular weight of 775 daltons that absorbs light at 790 to 805 nm and has a peak emission at 835 nm. While the substance gives off 4% the fluorescence of sodium fluorescein, its spectral properties allow it to be visualized through ocular pigments, blood, and serous fluids. METHODS: Using search engines and library resources, clinically relevant ICGA studies were reviewed for their purpose, description, outcome, clinical importance, and compared and contrasted to IVFA. RESULTS: Information is presented that represents the current modalities of ICGA. CONCLUSION: ICGA still remains an adjunct therapy to traditional IVFA. However, as the technology improves--allowing easier recording and visualization of ICG angiograms--and as more studies are conducted on the best use of the information obtained from ICGA, this technique may emerge as an important diagnostic tool in the fight to prevent the severe vision loss associated with the various retinal disorders mentioned.

Choroid Diseases↗

Evaluation of Brazilian web site information on allergic rhinitis.

UNLABELLED: Nowadays, the World Wide Web (Internet) is an information source for non-experts and physicians. AIM: To evaluate, based on ethical principles, Brazilian web sites information about "allergic rhinitis". Allergic rhinitis is a very common disease, effecting more than 10% of the general population, leading to decrease in quality of life. STUDY DESIGN: Review. MATERIAL AND METHOD: We performed the evaluation of 173 Brazilian web sites, which were obtained from four search engines (Google, Yahoo, AltaVista and Radar Uol). The web sites were evaluated according to the Manual of Ethical Principles, Regional Council of Medicine of the state of Sao Paulo (CREMESP), regarding transparency, honesty, quality, privacy, medical ethics, informed consent, responsibility and origin. RESULTS: Among the analyzed web sites, 149 (86.1%) were not in accordance with the Manual of Ethical Principles of Regional Council of Medicine of the state of Sao Paulo (CREMESP). According to the analyzed items, the irregularities that were found were quality (84.4%), privacy (46.2%), honesty (18.5%), informed consent (15.6%), responsibility and origin (13.9%), transparency (12.1%), medical ethics (2.3%). There was inaccurate information in 24.3% of the analyzed sites. CONCLUSIONS: The majority of the websites regarding allergic rhinitis are not in accordance with the ethical principles of CREMESP. In general, the quality of a great part of the Brazilian web sites that address "allergic rhinitis", and the quality of the information disseminated by them, are insufficient to satisfy doctors and patients.

Access to Information↗

Nursing students respond to a computer assignment.

Computer-generated information is becoming increasingly important in nursing. Nursing schools are faced with the need to ensure that students have basic informatics skills and rudimentary computer literacy. This article describes the introduction of an assignment using electronic communication skills within a teaching-learning course in a baccalaureate program. The assignment was designed to introduce the students to several tasks that would be useful to them in their studies as well as in their care of clients. Students learned to send electronic mail, post to a class list, use search engines, access libraries, and critique web pages. They developed increased confidence and skill, advancing from informed user to proficient user status as identified by Ronald & Skiba. The students' appraisal of the assignment in terms of value to their nursing education and their nursing careers indicated that they recognized the value of these skills for their professional nursing lives. Activities were monitored for content and technical glitches. Lessons learned are highlighted, and "Inbox overload" is identified. The authors found that nursing curricula can be designed to meet the challenge of fostering computer literacy. The assignment could be easily adapted for continuing education or other professional education endeavors.

Attitude to Computers↗

A meta-analysis of negative symptoms in dual diagnosis schizophrenia.

BACKGROUND: According to the self-medication hypothesis, schizophrenia patients would abuse psychoactive substances to get a relief from their negative symptoms. Studies testing the self-medication hypothesis in dual diagnosis (DD) schizophrenia have not been conclusive, with some studies showing that DD patients experience fewer negative symptoms, whereas other studies have failed to detect such differences. One potential confounding factor for this discrepancy lies in the diverse scales used to evaluate the negative symptoms. A systematic quantitative review of the literature using computerized search engines has been undertaken. METHOD: Studies were retained in the analysis if: (i) they assessed negative symptoms using the SANS; (ii) groups of schizophrenia patients were divided according to substance use disorders (alcohol, amphetamines, cannabis, cocaine, hallucinogens, heroin and phencyclidine). RESULTS: Attainable published studies were screened. According to our inclusion criteria, 18 possible studies emerged. Data from 11 studies were available for mathematical analysis. A moderate effect size (total n = 1135, 451 DD, 684 single diagnosis, adjusted Hedges' g = -0.470, p = 0.00001) was obtained, within a random-effect model, suggesting that DD patients experience fewer negative symptoms. Groups did not differ in age, sex, and positive/general psychopathology. CONCLUSIONS: Using narrow criteria (e.g. SANS), the results of this meta-analysis show that schizophrenia patients with a substance use disorder experience fewer negative symptoms than abstinent schizophrenia patients. As such, these results suggest either that substance abuse relieves the negative symptoms of schizophrenia or that the patients with fewer negative symptoms would be more prone to substance use disorders.

Affect↗

Health needs assessment tools: progress and potential.

OBJECTIVES: Health needs has attracted the interest of policy-makers, health economists, and health professionals as modern health services try to satisfy individual and population health needs to optimize resource utilization. Health needs can be assessed by administering various types of survey or interview-based instruments. If health needs are to be satisfied in changing health agendas in developed and developing countries, it is essential to employ valid and reliable tools. Despite the importance of needs assessment, no comprehensive review of tools is currently available. We carried out a literature search to define and categorize existing health needs assessment tools. METHODS: We reviewed medical and social search engines for items containing specific health needs-related words to identify needs tools across a range of specialties. Papers were reviewed in terms of design, subject matter, psychometric features, and method of administration method. RESULTS: Thirty-one employed in 52 studies including cancer, mental health, palliative care, multiple sclerosis, and cardiovascular disease tools were identified. CONCLUSIONS: This report summarizes available health needs instruments in a range of diseases to assist researchers in accessing health needs resources more easily and to encourage further research in this field.

Community Participation↗

A literature review of palliative care, end of life, and dementia.

OBJECTIVE: Little attention has been paid in research to the palliative care of those dying with dementia. This literature review summarizes current research in the social sciences, including medical sociology on palliative care in the example of dementia. METHODS: A designated set of search words was applied to a comprehensive set of university-based search engines to ensure that relevant social science research since 200 was included. RESULTS: Primary themes discussed in the article include person-centered care, grief, agitation, aggression, pain management, care provision, training and education, decision-making, primary settings of care, and spirituality and dignity. Other key gaps in the literature are discussed. SIGNIFICANCE OF THE RESULTS: Given the projected increase within the next 20 years of people dying with dementia (Hanrahan et al., 2001), palliative care for those dying with dementia will become more relevant than ever.

Caregivers↗

Protein identification by MALDI-TOF-MS peptide mapping: a new strategy.

A new strategy for identifying proteins by MALDI-TOF-MS peptide mapping is reported. In contrast to current approaches, the strategy does not rely on a good relative or absolute mass accuracy as the criterion that discriminates false positive results. The protein sequence database is first searched for all proteins that match a minimum five of the submitted masses within the maximum expected relative errors when the default or externally determined calibration constants are used, for instance, +/-500 ppm. Typically, this search retrieves many thousand candidate sequences. Assuming initially that each of these is the correct protein, the relative errors of the matching peptide masses are calculated for each candidate sequence. Linear regression analysis is then performed of the calculated relative errors as a function of m/z for each candidate sequence, and the standard deviation to the regression is used to distinguish the correct sequence among the candidates. We show that this parameter is independent of whether the mass spectrometric data were internally or externally calibrated. The result is a search engine that renders internal spectrum calibration unnecessary and adapts to the quality of the raw data without user interference. This is made possible by a dynamic scoring algorithm, which takes into account the number of matching peptide masses, the percentage of the protein's sequence covered by these peptides and, as new parameter, the determined standard deviation. The lower the standard deviation, the less cleavage peptides are required for identification and vice versa. Performance of the new strategy is demonstrated and discussed. All necessary computing has been implemented in a computer program, free access to which is provided in the Internet.

Algorithms↗

A method for assessing the statistical significance of mass spectrometry-based protein identifications using general scoring schemes.

This paper investigates the use of survival functions and expectation values to evaluate the results of protein identification experiments. These functions are standard statistical measures that can be used to reduce various protein identification scoring schemes to a common, easily interpretably representation. The relative merits of scoring systems were explored using this approach, as well as the effects of altering primary identification parameters. We would advocate the widespread use of these simple statistical measures to simplify and standardize the reporting of the confidence of protein identification results, allowing the users of different identification algorithms to compare their results in a straightforward and statistically significant manner. A method is described for measuring these distributions using information that is being discarded by most protein identification search engines, resulting in accurate survival functions that are specific to any combination of scoring algorithms, sequence databases, and mass spectra.

Mass Spectrometry↗

Web and database software for identification of intact proteins using "top down" mass spectrometry.

For the identification and characterization of proteins harboring posttranslational modifications (PTMs), a "top down" strategy using mass spectrometry has been forwarded recently but languishes without tailored software widely available. We describe a Web-based software and database suite called ProSight PTM constructed for large-scale proteome projects involving direct fragmentation of intact protein ions. Four main components of ProSight PTM are a database retrieval algorithm (Retriever), MySQL protein databases, a file/data manager, and a project tracker. Retriever performs probability-based identifications from absolute fragment ion masses, automatically compiled sequence tags, or a combination of the two, with graphical rendering and browsing of the results. The database structure allows known and putative protein forms to be searched, with prior or predicted PTM knowledge used during each search. Initial functionality is illustrated with a 36-kDa yeast protein identified from a processed cell extract after automated data acquisition using a quadrupole-FT hybrid mass spectrometer. A +142-Da delta(m) on glyceraldehyde-3-phosphate dehydrogenase was automatically localized between Asp90 and Asp192, consistent with its two cystine residues (149 and 153) alkylated by acrylamide (+71 Da each) during the gel-based sample preparation. ProSight PTM is the first search engine and Web environment for identification of intact proteins (https://prosightptm.scs.uiuc.edu/).

Amino Acid Sequence↗

Molecular-level description of proteins from saccharomyces cerevisiae using quadrupole FT hybrid mass spectrometry for top down proteomics.

For improved detection of diverse posttranslational modifications (PTMs), direct fragmentation of protein ions by top down mass spectrometry holds promise but has yet to be achieved on a large scale. Using lysate from Saccharomyces cerevisiae, 117 gene products were identified with 100% sequence coverage revealing 26 acetylations, 1 N-terminal dimethylation, 1 phosphorylation, 18 duplicate genes, and 44 proteolytic fragments. The platform for this study combined continuous-elution gel electrophoresis, reversed-phase liquid chromatography, automated nanospray coupled with a quadrupole-FT hybrid mass spectrometer, and a new search engine for querying a custom database. The proteins identified required no manual validation, ranged from 5 to 39 kDa, had codon biases from 0.93 to 0.083, and were primarily associated with glycolysis and protein synthesis. Illustrations of gene-specific identifications, PTM detection and subsequent PTM localization (using either electron capture dissociation or known PTM data stored in a database) show how larger scale proteome projects incorporating top down may proceed in the future using commercial Q-FT instruments.

Acetylation↗

MASPIC: intensity-based tandem mass spectrometry scoring scheme that improves peptide identification at high confidence.

Algorithmic search engines bridge the gap between large tandem mass spectrometry data sets and the identification of proteins associated with biological samples. Improvements in these tools can greatly enhance biological discovery. We present a new scoring scheme for comparing tandem mass spectra with a protein sequence database. The MASPIC (Multinomial Algorithm for Spectral Profile-based Intensity Comparison) scorer converts an experimental tandem mass spectrum into a m/z profile of probability and then scores peak lists from potential candidate peptides using a multinomial distribution model. The MASPIC scoring scheme incorporates intensity, spectral peak density variations, and m/z error distribution associated with peak matches into a multinomial distribution. The scoring scheme was validated on two standard protein mixtures and an additional set of spectra collected on a complex ribosomal protein mixture from Rhodopseudomonas palustris. The results indicate a 5-15% improvement over Sequest for high-confidence identifications. The performance gap grows as sequence database size increases. Additional tests on spectra from proteinase-K digest data showed similar performance improvements demonstrating the advantages in using MASPIC for studying proteins digested with less specific proteases. All these investigations show MASPIC to be a versatile and reliable system for peptide tandem mass spectral identification.

Algorithms↗

ProFound: an expert system for protein identification using mass spectrometric peptide mapping information.

We describe the protein search engine "ProFound", which employs a Bayesian algorithm to identify proteins from protein databases using mass spectrometric peptide mapping data. The algorithm ranks protein candidates by taking into account individual properties of each protein in the database as well as other information relevant to the peptide mapping experiment. The program consistently identifies the correct protein(s) even when the data quality is relatively low or when the sample consists of a simple mixture of proteins. Illustrative examples of protein identifications are provided.

Algorithms↗

Predicting the genotoxicity of secondary and aromatic amines using data subsetting to generate a model ensemble.

Binary quantitative structure-activity relationship (QSAR) models are developed to classify a data set of 334 aromatic and secondary amine compounds as genotoxic or nongenotoxic based on information calculated solely from chemical structure. Genotoxic endpoints for each compound were determined using the SOS Chromotest in both the presence and absence of an S9 rat liver homogenate. Compounds were considered genotoxic if assay results indicated a positive genotoxicity hit for either the S9 inactivated or S9 activated assay. Each compound in the data set was encoded through the calculation of numerical descriptors that describe various aspects of chemical structure (e.g. topological, geometric, electronic, polar surface area). Furthermore, five additional descriptors that focused on the secondary and aromatic nitrogen atoms in each molecule were calculated specifically for this study. Descriptor subsets were examined using a genetic algorithm search engine interfaced with a k-Nearest Neighbor fitness evaluator to find the most information-rich subsets, which ultimately served as the final predictive models. Models were chosen for their ability to minimize the total number of misclassifications, with special attention given to those models that possessed fewer occurrences of positive toxicity hits being misclassified as nontoxic (false negatives). In addition, a subsetting procedure was used to form an ensemble of models using different combinations of compounds in the training and prediction sets. This was done to ensure that consistent results could be obtained regardless of training set composition. The procedure also allowed for each compound to be externally validated three times by different training set data with the resultant predictions being used in a "majority rules" voting scheme to produce a consensus prediction for each member of the data set. The individual models produced an average training set classification rate of 71.6% and an average prediction set classification rate of 67.7%. However, the model ensemble was able to correctly classify the genotoxicity of 72.2% of all prediction set compounds.

Algorithms↗