Electronic medical records in colorectal surgery

Electronic medical records (EMRs) are being widely implemented today, either as stand-alone applications in smaller practices or as systems-based integrated network solutions in larger health care organizations. Advantages include rapid accessibility, worldwide availability, ease of storage, and secure transfer of protected health information (PHI). Computerized physician order entry (CPOE) and decision-support capabilities such as the triggering of an alarm when multiple medications with known interactions are ordered, as well as the seemingly endless possibilities for electronic integration and extraction of PHI for clinical and research purposes, have created opportunities and pitfalls alike. Risks include breaches of confidentiality with a need to implement tighter measures for electronic security. These measures contrast efforts required for the realization of common data formats that have national and even international compatibility. EMRs provide a common platform that could potentially allow for the integration and administration of clinical care, research, and quality metrics, thus promoting optimal outcomes for patients. Technical and medicolegal difficulties need to be overcome in the years to come so that the safe use of PHI can be ensured while still maintaining the benefits and convenience of modern EMR systems.

The abuse, neglect and mistreatment of older people with dementia in care homes and hospitals in England: the potential for secondary data analysis: innovative practice

There is concern that people with dementia may be at particular risk of elder abuse however there is little data to confirm such fears. This paper presents findings from an up-dated investigation of secondary sources of data about the abuse of older people with dementia in England conducted in 2013. There are many sources of data about poor care, abuse and neglect of people with dementia in care home and hospital settings but these are collected for different purposes and hard to link. The article discusses the ways in which dementia care practitioners may be able to make the most of existing data.

16. Information

Effective disaster management requires systems for data acquisition and information management that enable responders to rapidly collect, process, interpret, distribute, and access the data and information required for disaster management. Effective information sharing depends on the types of users, the type of damage, alterations of the functional status of the affected society, and how the information is structured. Those in need of information should be provided with the information necessary for their tasks and not be overloaded with unnecessary information that could serve as a distraction. Such information systems must be designed and exercised. To disseminate and share data with the relevant users, all disaster responses must include effective and reliable information systems. This information includes that acquired from repeated assessments in terms of available and needed human and material resources, which resources no longer are needed, and the status of the relief and recovery workers. It is through this information system that vital decisions are made that are congruent with the overall picture as perceived by the most relevant coordination and control centre. It is essential that information systems be designed and tested regularly as part of preparedness. Such systems must have the capacity to acquire, classify, and present information in an organised and useful manner.

9. Assessments: structure, concepts, and methods

Assessments are an essential element of proper disaster management. Assessments help to define the damage and changes in functions at the time of the assessment. Assessments are transectional across the longitudinal phases of the disaster. Any intervention should be preceded by an assessment(s). The assessment process is deconstructed into a series of 10 steps: (1) need to know; (2) define the goal(s) and objectives(s) of an assessment; (3) select the appropriate indicators; (4) define the methods to be used for the assessment; (5) develop and test a plan for data collection; (6) train and brief data collectors; (7) gather (collect) the data; (8) synthesise the data and information collected; (9) output information for decision-making; and (10) compare findings with overarching goal and objectives. Steps 7-9 constitute a production process. Understanding this process is essential for identification of points of success and failure in achieving the desired assessment. Assessments require careful selection of indicators. The selected indicators are used throughout the process. Currently, no standardised set of indicators has been validated. Criteria for the composition of assessment teams are provided and common sources of error are discussed. Prior to, during, and following disasters, assessments are directed by the appropriate coordination and control entity.

Clinical Data for Informed Medication Use in Pregnancy: Strengths, Limitations, Gaps, and a Need to Continue Moving Forward

The objective of this paper is to explore the strengths, weaknesses, gaps, and needs in research on medication use in pregnancy, where opportunities have been bypassed to develop standards and collaborations for collecting data to better understand how medications can impact clinical outcomes in pregnant women and developing fetuses. The availability of existing data and the methods of its capture are reviewed, including registries, claims and health record databases, and meta-analyses. The paper focuses on why these efforts have not fundamentally provided benefit-risk information and clinical treatment algorithms for medication use in pregnant women. Methodological issues, such as lack of standardization and central data collection, are discussed. Common barriers are examined, including a lack of awareness and education, cultural hurdles, collaboration deficiency, and an insufficient development of new data collection methods.

Promoting outcome achievement in child welfare: predictors of evidence-informed practice

The use of data and evidence to inform practice in child welfare is the subject of increased discussion in the literature as well as in agencies striving to achieve child safety, permanency, and well-being. Survey data was collected from workers and supervisors in private agencies providing out-of-home care case management and residential treatment services to children and youth across three states. Hierarchical linear modeling tested the role of goal-oriented teamwork and supervisory practice involving the use of data to assess practice effectiveness in predicting evidence-informed practice. The partially mediated relationship showed that a more goal-oriented approach combined with supervisory practice led to increased use of evidence-informed practice. Implications for promoting evidence-informed practice in child welfare are discussed.

Concern about security and privacy, and perceived control over collection and use of health information are related to withholding of health information from healthcare providers

INTRODUCTION

This study assessed the perceptions and behaviors of US adults about the security of their protected health information (PHI).

METHODS

The first cycle of the fourth wave of the Health Information National Trends Survey was analyzed to assess respondents' concerns about PHI breaches. Multivariate logistic regression was used to assess the effect of such concerns on disclosure of sensitive medical information to a healthcare professional (p<0.05).

RESULTS

Most respondents expressed concerns about data breach when their PHI was being transferred between healthcare professionals by fax (67.0%; 95% CI 64.2% to 69.8%) or electronically (64.5%; 95% CI 61.7% to 67.3%). About 12.3% (95% CI 10.8% to 13.8%) of respondents had ever withheld information from a healthcare provider because of security concerns. The likelihood of information withholding was higher among respondents who perceived they had very little say about how their medical records were used (adjusted OR=1.42; 95% CI 1.03 to 1.96).

CONCLUSIONS

This study underscores the need for enhanced measures to secure patients' PHI to avoid undermining their trust.

Knowledge from data in the built environment

Data feedback is changing our relationship to the built environment. Both traditional and new sources of data are developing rapidly, compelled by efforts to optimize the performance of human habitats. However, there are many obstacles to the successful implementation of information-centered environments that continue to hinder widespread adoption. This paper identifies these obstacles and challenges and describes emerging data-rich analytic techniques in infrastructure, buildings, and building portfolios. Further, it speculates on the impact that a robust data sphere may have on the built environment and posits that linkages to other data sets may enable paradigm shifts in sustainability and resiliency.

Towards Principles-Based Approaches to Governance of Health-related Research using Personal Data

Technological advances in the quality, availability and linkage potential of health data for research make the need to develop robust and effective information governance mechanisms more pressing than ever before; they also lead us to question the utility of governance devices used hitherto such as consent and anonymisation. This article assesses and advocates a principles-based approach, contrasting this with traditional rule-based approaches, and proposes a model of principled proportionate governance. It is suggested that the approach not only serves as the basis for good governance in contemporary data linkage but also that it provides a platform to assess legal reforms such as the draft Data Protection Regulation.

The measurement and prevalence of an ideational model of family and economic development in Nepal

Developmental idealism (DI) is a system of beliefs and values that endorses modern societies and families and sees them as occurring together, with modern families as causes and consequences of societal development. This study was motivated by the belief that the population of Nepal has absorbed these ideas and that the ideas affect their family behaviour. We use data collected in Nepal in 2003 to show that Nepalis discuss ideas about development and its relationship to family life and that DI has been widely accepted. It is related in predictable ways to education, paid employment, rural-urban residence, and mass media exposure. Although it would be useful to know its influence on demographic decision-making and behaviour, we cannot evaluate this with our one-time cross-sectional survey. Our data and theory suggest that this influence may be substantial.

Mouse Colony Data Management

In this unit we discuss the importance of implementing a data management system for research animal colonies. We focus on drivers such as ethical considerations, cost, and data integrity. We also discuss keys to effective data management and important considerations for adopting or building a data management system, and present an overview of some of the currently available colony and laboratory data management systems.Curr. Protoc. Mouse Biol. 3:1-8 © 2013 by John Wiley & Sons, Inc.

Confined to ignorance: the absence of prisoner information from nationally representative health data sets

BACKGROUND

Incarceration is associated with poor health and high costs. Given the dramatic growth in the criminal justice system's population and associated expenses, inclusion of questions related to incarceration in national health data sets could provide essential data to researchers, clinicians and policy-makers.

OBJECTIVE

To evaluate a representative sample of publically available national health data sets for their ability to be used to study the health of currently or formerly incarcerated persons and to identify opportunities to improve criminal justice questions in health data sets. DESIGN & APPROACH: We reviewed the 36 data sets from the Society of General Internal Medicine Dataset Compendium related to individual health. Through content analysis using incarceration-related keywords, we identified data sets that could be used to study currently or formerly incarcerated persons, and we identified opportunities to improve the availability of relevant data.

KEY RESULTS

While 12 (33%) data sets returned keyword matches, none could be used to study incarcerated persons. Three (8%) could be used to study the health of formerly incarcerated individuals, but only one data set included multiple questions such as length of incarceration and age at incarceration. Missed opportunities included: (1) data sets that included current prisoners but did not record their status (10, 28%); (2) data sets that asked questions related to incarceration but did not specifically record a subject's status as formerly incarcerated (8, 22%); and (3) longitudinal studies that dropped and/or failed to record persons who became incarcerated during the study (8, 22%).

CONCLUSIONS

Few health data sets can be used to evaluate the association between incarceration and health. Three types of changes to existing national health data sets could substantially expand the available data, including: recording incarceration status for study participants who are incarcerated; recording subjects' history of incarceration when this data is already being collected; and expanding incarceration-related questions in studies that already record incarceration history.

Injury epidemiology after the 2001 Gujarat earthquake in India: a retrospective analysis of injuries treated at a rural hospital in the Kutch district immediately after the disaster

BACKGROUND

The number of injured far exceeds those dead and the average injury to mortality ratio in earthquakes stands at 3:1. Immediate effective medical response significantly influences injury outcomes and thus the overall health impact of earthquakes. Inadequate or mismanagement of injuries may lead to disabilities. The lack of precise data from immediate aftermath is seen as a remarkable weak point in disaster epidemiology and warrants evidence generation.

OBJECTIVE

To analyze the epidemiology of injuries and the treatment imparted at a secondary rural hospital in the Kutch district, Gujarat, India following the January 26, 2001 earthquake.

DESIGN/METHODS

Discharge reports of patients admitted to the hospital over 10 weeks were analyzed retrospectively for earthquake-related injuries.

RESULTS

Orthopedic injuries, (particularly fractures of the lower limbs) were predominant and serious injuries like head, chest, abdominal, and crush syndrome were minimal. Wound infections were reported in almost 20% of the admitted cases. Surgical procedures were more common than conservative treatment. The most frequently performed surgical procedures were open reduction with internal fixation and cleaning and debridement of contaminated wounds. Four secondary deaths and 102 transfers to tertiary care due to complications were reported.

CONCLUSION

The injury epidemiology reported in this study is in general agreement with most other studies reporting injury epidemiology except higher incidence of distal orthopedic injuries particularly to the lower extremities. We also found that young males were more prone to sustaining injuries. These results warrant further research. Inconsistent data reporting procedures against the backdrop of inherent disaster data incompleteness calls for urgent standardization of reporting earthquake injuries for evidence-based response policy planning.

What is biomedical informatics?

Biomedical informatics lacks a clear and theoretically-grounded definition. Many proposed definitions focus on data, information, and knowledge, but do not provide an adequate definition of these terms. Leveraging insights from the philosophy of information, we define informatics as the science of information, where information is data plus meaning. Biomedical informatics is the science of information as applied to or studied in the context of biomedicine. Defining the object of study of informatics as data plus meaning clearly distinguishes the field from related fields, such as computer science, statistics and biomedicine, which have different objects of study. The emphasis on data plus meaning also suggests that biomedical informatics problems tend to be difficult when they deal with concepts that are hard to capture using formal, computational definitions. In other words, problems where meaning must be considered are more difficult than problems where manipulating data without regard for meaning is sufficient. Furthermore, the definition implies that informatics research, teaching, and service should focus on biomedical information as data plus meaning rather than only computer applications in biomedicine.

Use of health information technology to advance evidence-based care: lessons from the VA QUERI program

BACKGROUND

As the Department of Veterans Affairs (VA) Health Services Research and Development Service's Quality Enhancement Research Initiative (QUERI) has progressed, health information technology (HIT) has occupied a crucial role in implementation research projects.

OBJECTIVES

We evaluated the role of HIT in VA QUERI implementation research, including HIT use and development, the contributions implementation research has made to HIT development, and HIT-related barriers and facilitators to implementation research.

PARTICIPANTS

Key informants from nine disease-specific QUERI Centers.

APPROACH

Documentation analysis of 86 implementation project abstracts followed up by semi-structured interviews with key informants from each of the nine QUERI centers. We used qualitative and descriptive analyses.

RESULTS

We found: (1) HIT provided data and information to facilitate implementation research, (2) implementation research helped to further HIT development in a variety of uses including the development of clinical decision support systems (23 of 86 implementation research projects), and (3) common HIT barriers to implementation research existed but could be overcome by collaborations with clinical and administrative leadership.

CONCLUSIONS

Our review of the implementation research progress in the VA revealed interdependency on an HIT infrastructure and research-based development. Collaboration with multiple stakeholders is a key factor in successful use and development of HIT in implementation research efforts and in advancing evidence-based practice.

Nursing informatics implications from a study of unmet nursing care needs

A number of issues related to data collection and analysis have impeded researchers from documenting a process of nursing care-outcome link. While health services research (HSR) continues to develop and test novel research methods to better understand the quality paradigm there has been steady progress in informatics research to represent, acquire, and store nursing data. The use of HSR methods may provide empirical and theoretical support for nursing informatics research. Moreover, large clinical datasets that include standardized nursing data provide an important basis for HSR.

On sparse Fisher discriminant method for microarray data analysis

One of the applications of the discriminant analysis on microarray data is to classify patient and normal samples based on gene expression values. The analysis is especially important in medical trials and diagnosis of cancer subtypes. The main contribution of this paper is to propose a simple Fisher-type discriminant method on gene selection in microarray data. In the new algorithm, we calculate a weight for each gene and use the weight values as an indicator to identify the subsets of relevant genes that categorize patient and normal samples. A l(2) - l(1) norm minimization method is implemented to the discriminant process to automatically compute the weights of all genes in the samples. The experiments on two microarray data sets have shown that the new algorithm can generate classification results as good as other classification methods, and effectively determine relevant genes for classification purpose. In this study, we demonstrate the gene selection's ability and the computational effectiveness of the proposed algorithm. Experimental results are given to illustrate the usefulness of the proposed model.

Normalized, segmented or called aCGH data?

Array comparative genomic hybridization (aCGH) is a high-throughput lab technique to measure genome-wide chromosomal copy numbers. Data from aCGH experiments require extensive pre-processing, which consists of three steps: normalization, segmentation and calling. Each of these pre-processing steps yields a different data set: normalized data, segmented data, and called data. Publications using aCGH base their findings on data from all stages of the pre-processing. Hence, there is no consensus on which should be used for further down-stream analysis. This consensus is however important for correct reporting of findings, and comparison of results from different studies. We discuss several issues that should be taken into account when deciding on which data are to be used. We express the believe that called data are best used, but would welcome opposing views.

Database management system for the control of malaria in Arunachal Pradesh, India

The Arunachal Pradesh state in India is epidemic for malaria, caused by P.vivax and P.falciparum. Despite the implementation of several control strategies, the outbreak of malaria in the state is mainly due to lack of proper information regarding the disease. Hence, we completed a database to help implement appropriate control strategy for the public health officials in Arunachal Pradesh.

AVAILABILITY

www.envisiict.org.

A database of 389 medicinal plants for diabetes

Medicinal plants used to treat hypoglycemic and hyperglycemic conditions are of considerable interest to ethno-botanical community as they are recognized to contain valuable medicinal properties in different parts of the plant. The active principles of many plant species with desired properties are isolated to cure ailments such as diabetes type-1 and type-2, respectively. Here, we describe DiaMedBase, a database containing information of medicinal plants for diabetes.

AVAILABILITY

http://www.progenebio.in/DMP/DMP.htm.

A Logical Model of Conceptual Integrity in Data Integration

Conceptual integrity is required for the result of data integration to be cohesive and sensible. Compromised conceptual integrity results in "semantic faults," which are commonly blamed for latent integration bugs. A logical model of conceptual integrity in data integration and a simple example application are presented. Unlike constructive models that attempt to prevent semantic faults, this model allows both correct and incorrect integrations to be described. Imperfect legacy systems can therefore be modeled, allowing a more formal analysis of their flaws and the possible remedies.

CRYSTMET-The NRCC Metals Crystallographic Data File

CRYSTMET is a computer-readable database of critically evaluated crystallographic data for metals (including alloys, intermetallics and minerals) accompanied by pertinent chemical, physical and bibliographic information. It currently contains about 60 000 entries and covers the literature exhaustively from 1913. Scientific editing of the abstracted entries, consisting of numerous automated and manual checks, is done to ensure consistency with related, previously published studies, to assign structure types where necessary and to help guarantee the accuracy of the data and related information. Analyses of the entries and their distribution across key journals as a function of time show interesting trends in the complexity of the compounds studied as well as in the elements they contain. Two applications of CRYSTMET are the identification of unknowns and the prediction of properties of materials. CRYSTMET is available either online or via license of a private copy from the Canadian Scientific Numeric Database Service (CAN/SND). The indexed online search and analysis system is easy and economical to use yet fast and powerful. Development of a new system is under way combining the capabilities of ORACLE with the flexibility of a modern interface based on the Netscape browsing tool.