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PubMed1978

Comparison of immunofluorescence and immunoperoxidase staining for identification of rubella virus isolates.

To explore possible advantages which immunoperoxidase (IP) staining might have over immunofluorescence (IF) staining for identifying rubella virus isolates, direct comparative studies were done on the same coded clinical materials using the same rubella immune rabbit serum as the primary antiserum in both systems. The rubella immune rabbit serum and conjugated anti-rabbit immune globulins could be used more dilute in the IP system than in the IF system. Both IP and IF staining detected rubella antigen in all specimens which were positive by interference. IP staining also detected low levels of rubella antigen in a few additional specimens which had originally been positive for rubella virus, but which on retesting were negative by interference and IF staining. With second-cell-culture-passage material, IP and IF staining showed comparable specificity, and the few specimens which reacted nonspecifically generally did so in both systems. Cell cultures inoculated directly with urine specimens showed greater nonspecificity by IP than by IF, but this activity could be abolished by pretreatment with sodium azide and peroxide; other methods tried for inactivating endogenous peroxidase activity destroyed rubella antigen as well. The intensity of staining for positive specimens was comparable in the two systems. However, more antigen was demonstrable in both systems when BHK-21 cells were inoculated as a cell suspension and then permitted to grow into monolayers than when the same specimens were inoculated into preformed monolayers. IP staining was considered to be a highly satisfactory alternative to IF staining for identification of rubella virus isolates.

Animals↗
PubMed2000

Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards.

OBJECTIVE: To investigate the characteristics and outcomes of older patients with pelvic fracture admitted to medical and geriatric wards. METHODS: All patients admitted to medical and geriatric wards with a pelvic fracture over a four year period were identified using the hospital clinical coding database. Data were collected from casenotes, hospital and Family Health Services Authority databases. Where available, pelvic radiographs were graded according to the Singh index. RESULTS: The casenotes of 148 patients (126 women) were studied; 83% (n=123) of patients suffered a pelvic fracture in low energy trauma. Mean (SD) length of hospital stay was 21.3 (17.6) days. Single breaks of the pubic rami accounted for 47.2% (n=68) of all fractures. Inpatient mortality was 7.6% and at one year was 27%. There was a marked adverse effect on the mobility of survivors with all patients using at least a walking stick at discharge and 51.1% (n=70) needing assistance for mobility. Although 70.9% (n=83) of patients admitted from home (or warden aided accommodation) were able to return there, 84.3% (n=70) of them required extra community support. Rates of institutionalisation rose from 20.9% (n=31) at admission to 35.8% (49/137) of survivors at discharge. Altogether 93% (n=107) of 115 patients, in whom adequate quality pelvic radiographs were available, were assigned a Singh index grade of 4 or less indicating the presence of osteoporosis. CONCLUSIONS: Pelvic fractures are often the result of low energy trauma. They are associated with appreciable inpatient and considerable one year mortality. They also have marked negative effects on mobility in the short term. They result in increased levels of dependency in terms of higher levels of community support and rates of institutionalisation. On the evidence of Singh index grading, pelvic fractures are associated with low bone density.

Accidental Falls↗
PubMed2006

An examination of the levels of confidence that consultants have in routinely collected clinical information.

Anecdotal evidence suggests that consultants have a low level of confidence in routinely collected clinical data. The aims of this study were to assess the actual levels of confidence in clinical information experienced by consultants and to understand the factors affecting confidence. A questionnaire was devised incorporating a scale to measure levels of confidence. This was disseminated to 506 consultants and achieved a 57 per cent response rate. The confidence scale showed good internal reliability and the influential factors were modelled using multilinear regression. Consultant specialty, increased involvement in clinical coding, and participation in service planning/monitoring all had a significant effect. A small number of semi-structured interviews further examined these factors. Whilst the findings confirm there is scope to increase levels of confidence, the mean score indicated neither a high nor a low level of confidence. The results demonstrate that improving consultants' confidence in information is complex and requires a partnership approach.

Adult↗
PubMed2002

A simple method for serving Web hypermaps with dynamic database drill-down.

BACKGROUND: HealthCyberMap http://healthcybermap.semanticweb.org aims at mapping parts of health information cyberspace in novel ways to deliver a semantically superior user experience. This is achieved through "intelligent" categorisation and interactive hypermedia visualisation of health resources using metadata, clinical codes and GIS. HealthCyberMap is an ArcView 3.1 project. WebView, the Internet extension to ArcView, publishes HealthCyberMap ArcView Views as Web client-side imagemaps. The basic WebView set-up does not support any GIS database connection, and published Web maps become disconnected from the original project. A dedicated Internet map server would be the best way to serve HealthCyberMap database-driven interactive Web maps, but is an expensive and complex solution to acquire, run and maintain. This paper describes HealthCyberMap simple, low-cost method for "patching" WebView to serve hypermaps with dynamic database drill-down functionality on the Web. RESULTS: The proposed solution is currently used for publishing HealthCyberMap GIS-generated navigational information maps on the Web while maintaining their links with the underlying resource metadata base. CONCLUSION: The authors believe their map serving approach as adopted in HealthCyberMap has been very successful, especially in cases when only map attribute data change without a corresponding effect on map appearance. It should be also possible to use the same solution to publish other interactive GIS-driven maps on the Web, e.g., maps of real world health problems.

Journal Article↗
PubMed2004

Atrial fibrillation and survival in colorectal cancer.

BACKGROUND: Survival in colorectal cancer may correlate with the degree of systemic inflammatory response to the tumour. Atrial fibrillation may be regarded as an inflammatory complication. We aimed to determine if atrial fibrillation is a prognostic factor in colorectal cancer. PATIENTS AND METHODS: A prospective colorectal cancer patient database was cross-referenced with the hospital clinical-coding database to identify patients who had underwent colorectal cancer surgery and were in atrial fibrillation pre- or postoperatively. RESULTS: A total of 175 patients underwent surgery for colorectal cancer over a two-year period. Of these, 13 patients had atrial fibrillation pre- or postoperatively. Atrial fibrillation correlated with worse two-year survival (p = 0.04; log-rank test). However, in a Cox regression analysis, atrial fibrillation was not significantly associated with survival. CONCLUSION: The presence or development of atrial fibrillation in patients undergoing surgery for colorectal cancer is associated with worse overall survival, however it was not found to be an independent factor in multivariate analysis.

Journal Article↗
PubMed2005

Information governance standards for managing e-health information.

Integrity of patient information, from both a quality and a security perspective, is critical to patient care. In the UK, the information governance initiative of the National Health Service (NHS) provides a framework to monitor and control the management of confidential patient data. Information governance standards grew out of the Data Accreditation Programme, first proposed in the 1998 NHS document Information for Health. The Data Accreditation Programme was based on a three-stage assessment of data quality in acute hospitals. Stage one required internal review of policy and procedures for data input into computerized patient administration systems. Stage two involved an external audit to verify compliance with the standards. Stage three mandated audits of data outputs, focusing on clinical coding quality. Before stage three of the programme was fully implemented, the standards were incorporated into the information governance initiative, in which standards were expanded to include primary care and other health-care settings. These standards address many information management issues, including security and data quality, which are key concerns in telemedicine and e-health applications. Compliance is essential for the successful implementation of the NHS Care Records Service, which will allow sharing of electronically stored patient information across the UK.

Confidentiality↗
PubMed1989

Human immunodeficiency virus type 1 (HIV-1) infection a median of 18 months before a diagnostic western blot. Evidence from a cohort of homosexual men.

STUDY OBJECTIVE: To study the natural history of human immunodeficiency virus type 1 (HIV-1) infection, we used an in-vitro amplification technique to detect HIV-1 nucleic acid sequences in sequential aliquots of peripheral blood mononuclear cells from homosexual men enrolled in the Multicenter AIDS Cohort Study. DESIGN AND PATIENTS: Blinded, longitudinal study of 24 homosexual men who were positive for HIV-1 antibodies at a recent follow-up visit. MEASUREMENTS AND MAIN RESULTS: Coded clinical samples were evaluated using two enzyme-linked immunosorbent assays (whole virus and gp120-gp41 fragment), Western blot, a p24 antigen capture assay, virus cocultivation, and in-vitro amplification of conserved regions from the HIV-1 gag and env open-reading frames. In 20 of the 24 men an HIV-1 enzymatically amplified product was detected before HIV-1 antibody seroconversion: at 42 months before seroconversion in two cases; at 36 months in one case; at 30 months in one case; at 24 months in four cases; at 18 months in eight cases; at 12 months in one case; and at 6 months in three cases (median, 18 months). In the four other men, detection of an HIV-1 enzymatically amplified product was concurrent with confirmation of antibody seroconversion by Western blot. CONCLUSIONS: There is a long and variable interval between virus acquisition and a diagnostic serum antibody response, perhaps due to the prolonged, persistent infection characteristic of the lentiviruses (family Retroviridae).

AIDS Serodiagnosis↗
PubMed2002

Towards a semantic medical Web: HealthCyberMap's tool for building an RDF metadata base of health information resources based on the Qualified Dublin Core Metadata Set.

BACKGROUND: HealthCyberMap (http://healthcybermap.semanticweb.org/) aims at mapping Internet health information resources in novel ways for enhanced retrieval and navigation. This is achieved by collecting appropriate resource metadata in an unambiguous form that preserves semantics. MATERIAL/METHODS: We modelled a qualified Dublin Core (DC) metadata set ontology with extra elements for resource quality and geographical provenance in Prot g -2000. A metadata collection form helps acquiring resource instance data within Prot g . The DC subject field is populated with UMLS terms directly imported from UMLS Knowledge Source Server using UMLS tab, a Prot g -2000 plug-in. The project is saved in RDFS/RDF. RESULTS: The ontology and associated form serve as a free tool for building and maintaining an RDF medical resource metadata base. The UMLS tab enables browsing and searching for concepts that best describe a resource, and importing them to DC subject fields. The resultant metadata base can be used with a search and inference engine, and have textual and/or visual navigation interface(s) applied to it, to ultimately build a medical Semantic Web portal. Different ways of exploiting Prot g -2000 RDF output are discussed. CONCLUSIONS: By making the context and semantics of resources, not merely their raw text and formatting, amenable to computer 'understanding,' we can build a Semantic Web that is more useful to humans than the current Web. This requires proper use of metadata and ontologies. Clinical codes can reliably describe the subjects of medical resources, establish the semantic relationships (as defined by underlying coding scheme) between related resources, and automate their topical categorisation.

Humans↗
PubMed1975

Substituted phenylacetylguanidines: a new class of antihypertensive agents.

The synthesis of a new series of phenylacetylguanidines is described. Several of them exhibited high antihypertensive activity in the rat. The most potent member of the series is N-amidino-2-(2,6-dichlorophenyl)acetamide hydrochloride [2,6-dichlorophenylacetylguanidine hydrochloride, compound 19], which is now in clinical study under the clinical code number BS 100-141. The structure-activity relationships in this class of compounds are discussed.

Animals↗
PubMed2003

Health telematics and telemedicine for improving patients' care.

Current problems and solutions to establish health telematics and telemedicine for patient's seamless care have been analysed referring to experiences of advanced institutions especially in, but not restricted to, the USA. In that context, problems at institutional boundaries as well as technical and personal problems for communication and co-operation have been explored. Entering coded clinical data and the ubiquitous access to that information are crucial challenges to be met.

Access to Information↗
PubMed2006

Avoidable hospitalisations: potential for primary and public health initiatives in Canterbury, New Zealand.

AIM: To investigate the extent of potentially "avoidable hospitalisations" in the Canterbury District Health Board area; specifically, to identify the leading causes, recent trends, and estimated costs of avoidable hospitalisations. METHODS: All hospitalisations in Christchurch Hospital from 2000 to 2004 were analysed and potentially "avoidable admissions" were categorised using ICD10 clinical codes. Costs of these admissions were estimated for the financial year ending 30 June 2003 using diagnostic-related groups (DRGs). RESULTS: The leading causes of potentially "avoidable hospitalisations" in Christchurch Hospital were cardiovascular disease, stroke, respiratory, gastrointestinal, and urinary disorders. The total estimated costs of avoidable hospitalisations in 2003 were NZ 96.6 million dollars, accounting for an estimated 94,462 bed days. The estimated costs of cardiovascular admissions (excluding stroke) were 50.6 million dollars, with stroke accounting for an additional 6.2 million dollars. CONCLUSION: Potentially "avoidable admissions" to Christchurch Hospital comprised 31% of all hospital admissions. There is considerable opportunity to invest in public and primary health initiatives aimed at early detection and intervention, with the major opportunities being identified as cardiovascular disease, stroke, respiratory, gastrointestinal, and urinary disorders.

Cardiovascular Diseases↗
PubMed1991

Hepatitis of viral origin in Leporidae: introduction and aetiological hypotheses.

In less than ten years, two very serious viral hepatic diseases have spread through Leporidae populations (rabbits and hares) in numerous countries. In May 1989, the Office International des Epizooties designated this new disease of rabbits "viral haemorrhagic disease" and entered it as a List B disease in the International Animal Health Code. Clinically, the disease is very similar to the European brown hare syndrome. However, numerous uncertainties prevail today on the true nature of the viruses of the two species. Although they are related, the viruses appear to be different and cross infection between species has given contradictory results. Hepatitis of Leporidae have probably existed in Europe for several years, although their viral aetiology has been demonstrated only recently. The acute form has occurred in hares in Northern Europe since approximately 1980, while the inapparent (or ignored) form has been present in rabbits in Czechoslovakia since 1975. These diseases of Leporidae are true viral hepatitis which, in their fulminating forms, bear a remarkable resemblance to human viral hepatitis (B and non-A non-B) with regard to clinical symptoms, pathological lesions and mode of transmission. The dominant faecal-oral transmission observed for types A and E hepatitis would explain the particular susceptibility of family-kept rabbits, as they are fed potentially contaminated fodder. As the clinically similar fulminating hepatitis in human beings is caused by a diversity of viruses (both RNA and DNA), the disease in Leporidae might also be caused by different viruses.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1979

[Bicyclic 3-hydrazinopyridazines with antihypertensive action (author's transl)].

The synthesis of a series of 3-hydrazinopyridazines is described. Several of these compounds exhibited high antihypertensive activity in the rat. The most potent member of the series is l-benzoyl-3-hydrazino-5,6,7,8-tetrahydropyrido-[4,3-c]pyridazine, compound 28 [1], which is now under clinical trial [2] under the clinical code number BQ 22-708 (endrazaline, Miretilan). It was possible to discover certain structure-activity relationships.

Animals↗
PubMed1998

HEDIS 3.0 updated for 1998.

The third version of the Health Plan Employer Data and Information Set (HEDIS) has been revised for 1998. Many changes affect either the clinical codes that determine whether a member received a service or the content of the service being measured. The updated version contains 15 fewer measures than did its predecessor.

Databases, Factual↗
PubMed1994

Supplement to the code of practice for clinical proton dosimetry. ECHED (European Clinical Heavy Particle Dosimetry Group).

The 'Code of Practice for Clinical Proton Dosimetry' (Vynckier, S., Bonnett, D.E. and Jones, D.T.L. Code of practice for clinical proton dosimetry. Radiother. Oncol. 20: 53-63, 1991) was published in 1991, but since then new data for mass stopping powers have been reported and consideration has been given to the specification of absorbed dose in water instead of the original recommendation of absorbed dose in tissue. This supplement summarises the basic recommendations of the original Code of Practice and incorporates the new stopping power data for dose specification in water.

Absorption↗
PubMed1980

A coding scheme for veterinary clinical signs.

An emphasis on diagnostic coding in present methods for classification of veterinary clinical data limits retrieval of information on clinical signs for teaching a research. A classification scheme has been developed which allows coding of information based on clinical signs.

Animal Diseases↗
PubMedDate not supplied

Bar codes and the clinical laboratory: adaptation perspectives.

This paper provides an overview of the functional capabilities of bar-code technology within the laboratory environment and assesses the problems and solutions encountered during its introduction in our laboratory. An idea of the potential costs and personnel savings is offered, demonstrating that we have saved an entire full-time equivalent (FTE) medical technologist in clinical chemistry with an associated improvement in the accuracy of patient identification and a marked improvement in turnaround time for both chemistry and hematology routine procedures. We have estimated the savings of two FTE medical technologists while improving service and accuracy. Hardware costs should be recovered in 2 years.

California↗