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Fritz F, Daratsianos N, Bourauel C, Papageorgiou SN, Jäger A. Changes in the distribution of occlusal forces in the course of the orthodontic retention phase : A prospective cohort study. J Orofac Orthop 2023:10.1007/s00056-023-00480-4. [PMID: 37382657 DOI: 10.1007/s00056-023-00480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/17/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Aim of the present study was to assess the relative distribution of occlusal forces after orthodontic treatment and during the first 3 months of the retention phase using a computerized occlusal analysis system (T-Scan, Tekscan Inc., Norwood, MA, USA). MATERIALS AND METHODS A total of 52 patients were included in this prospective cohort study and underwent analysis of occlusal forces on the level of tooth, jaw-half, and -quadrant during a 3-month period. Furthermore, differences between three retention protocols (group I: removable appliances in both jaws; group II: fixed 3-3 lingual retainers in both jaws; group III: removable appliance in the maxilla and fixed 3-3 lingual retainer in mandible) were assessed with Wilcoxon signed-rank tests at 5%. RESULTS Directly after debonding, measured forces distribution were similar to published references for untreated samples. In the following, no significant difference was found between retention protocols II and III with regard to the asymmetry of the anterior occlusal forces. Both groups maintained an asymmetric force distribution in the anterior segment during the study period. There was also no difference between groups II and III in the distribution of occlusal forces for the posterior segments. Both retention concepts kept the symmetrical distribution of occlusal forces stable over the observation period. The retention concept of group I demonstrated a symmetrical distribution of occlusal forces in the anterior segment after debonding and this remained stable during the 3‑month period. In the posterior segment, no improvement of the initially asymmetric masticatory force distribution could be observed. CONCLUSIONS All three studied retention protocols showed stability in retaining their original symmetrical or asymmetrical occlusal force distribution posteriorly/anteriorly during the 3‑month observation period. Therefore, an even distribution of occlusal forces should be the aim of the finishing phase, as no relative benefit of any single retention scheme in terms of post-debond improvement during the retention phase was seen.
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Affiliation(s)
- F Fritz
- Department of Orthodontics, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - N Daratsianos
- Department of Orthodontics, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - C Bourauel
- Department of Oral Technology, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - A Jäger
- Department of Orthodontics, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany.
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Zeleke AA, Naziyok T, Fritz F, Christianson L, Röhrig R. Data Quality and Cost-effectiveness Analyses of Electronic and Paper-Based Interviewer-Administered Public Health Surveys: Systematic Review. J Med Internet Res 2021; 23:e21382. [PMID: 33480859 PMCID: PMC7864777 DOI: 10.2196/21382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/03/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
Background A population-level survey (PLS) is an essential and standard method used in public health research that supports the quantification of sociodemographic events, public health policy development, and intervention designs. Data collection mechanisms in PLS seem to be a significant determinant in avoiding mistakes. Using electronic devices such as smartphones and tablet computers improves the quality and cost-effectiveness of public health surveys. However, there is a lack of systematic evidence to show the potential impact of electronic data collection tools on data quality and cost reduction in interviewer-administered surveys compared with the standard paper-based data collection system. Objective This systematic review aims to evaluate the impact of the interviewer-administered electronic data collection methods on data quality and cost reduction in PLS compared with traditional methods. Methods We conducted a systematic search of MEDLINE, CINAHL, PsycINFO, the Web of Science, EconLit, Cochrane CENTRAL, and CDSR to identify relevant studies from 2008 to 2018. We included randomized and nonrandomized studies that examined data quality and cost reduction outcomes, as well as usability, user experience, and usage parameters. In total, 2 independent authors screened the title and abstract, and extracted data from selected papers. A third author mediated any disagreements. The review authors used EndNote for deduplication and Rayyan for screening. Results Our search produced 3817 papers. After deduplication, we screened 2533 papers, and 14 fulfilled the inclusion criteria. None of the studies were randomized controlled trials; most had a quasi-experimental design, for example, comparative experimental evaluation studies nested on other ongoing cross-sectional surveys. A total of 4 comparative evaluations, 2 pre-post intervention comparative evaluations, 2 retrospective comparative evaluations, and 4 one-arm noncomparative studies were included. Meta-analysis was not possible because of the heterogeneity in study designs, types, study settings, and level of outcome measurements. Individual paper synthesis showed that electronic data collection systems provided good quality data and delivered faster compared with paper-based data collection systems. Only 2 studies linked cost and data quality outcomes to describe the cost-effectiveness of electronic data collection systems. Field data collectors reported that an electronic data collection system was a feasible, acceptable, and preferable tool for their work. Onsite data error prevention, fast data submission, and easy-to-handle devices were the comparative advantages offered by electronic data collection systems. Challenges during implementation included technical difficulties, accidental data loss, device theft, security concerns, power surges, and internet connection problems. Conclusions Although evidence exists of the comparative advantages of electronic data collection compared with paper-based methods, the included studies were not methodologically rigorous enough to combine. More rigorous studies are needed to compare paper and electronic data collection systems in public health surveys considering data quality, work efficiency, and cost reduction. International Registered Report Identifier (IRRID) RR2-10.2196/10678
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Affiliation(s)
- Atinkut Alamirrew Zeleke
- Medical Informatics, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,Division of Medical Informatics, Carl von Ossitetzky University Oldenburg, Oldenburg, Germany
| | - Tolga Naziyok
- Division of Medical Informatics, Carl von Ossitetzky University Oldenburg, Oldenburg, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Rainer Röhrig
- Division of Medical Informatics, Carl von Ossitetzky University Oldenburg, Oldenburg, Germany.,Institute for Medical Informatics, Medical Faculty of RWTH University Aachen, Aachen, Germany
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Zeleke AA, Naziyok T, Fritz F, Röhrig R. Data Quality and Cost-Effectiveness Analyses of Electronic and Paper-Based Interviewer-Administered Public Health Surveys: Protocol for a Systematic Review. JMIR Res Protoc 2019; 8:e10678. [PMID: 30698530 PMCID: PMC6372930 DOI: 10.2196/10678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/14/2018] [Accepted: 10/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background Population-level survey is an essential standard method used in public health research to quantify sociodemographic events and support public health policy development and intervention designs with evidence. Although all steps in the survey can contribute to the data quality parameters, data collection mechanisms seem the most determinant, as they can avoid mistakes before they happen. The use of electronic devices such as smartphones and tablet computers improve the quality and cost-effectiveness of public health surveys. However, there is lack of systematically analyzed evidence to show the potential impact on data quality and cost reduction of electronic-based data collection tools in interviewer-administered surveys. Objective This systematic review aims to evaluate the impact of interviewer-administered electronic device data collection methods concerning data quality and cost reduction in population-level surveys compared with the traditional paper-based methods. Methods We will conduct a systematic search on Medical Literature Analysis and Retrieval System Online, PubMed, CINAHL, PsycINFO, Global Health, Trip, ISI Web of Science, and Cochrane Library for studies from 2007 to 2018 to identify relevant studies. The review will include randomized and nonrandomized studies that examine data quality and cost reduction outcomes. Moreover, usability, user experience, and usage parameters from the same study will be summarized. Two independent authors will screen the title and abstract. A third author will mediate in cases of disagreement. If the studies are considered to be combinable with minimal heterogeneity, we will perform a meta-analysis. Results The preliminary search in PubMed and Web of Science showed 1491 and 979 resulting hits of articles, respectively. The review protocol is registered in the International Prospective Register of Systematic Reviews (CRD42018092259). We anticipate January 30, 2019, to be the finishing date. Conclusions This systematic review will inform policymakers, investors, researchers, and technologists about the impact of an electronic-based data collection system on data quality, work efficiency, and cost reduction. Trial Registration PROSPERO CRD42018092259; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID= CRD42018092259 International Registered Report Identifier (IRRID) PRR1-10.2196/10678
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Affiliation(s)
- Atinkut Alamirrew Zeleke
- Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Tolga Naziyok
- Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Rainer Röhrig
- Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Jemere AT, Yeneneh YE, Tilahun B, Fritz F, Alemu S, Kebede M. Access to mobile phone and willingness to receive mHealth services among patients with diabetes in Northwest Ethiopia: a cross-sectional study. BMJ Open 2019; 9:e021766. [PMID: 30679284 PMCID: PMC6347931 DOI: 10.1136/bmjopen-2018-021766] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed at determining access to mobile phone and willingness to receive mobile phone-based diabetes health services as well as identify associated factors in Northwest Ethiopia. DESIGN An institution-based cross-sectional survey was conducted from February to March 2016. PARTICIPANTS Systematic randomly selected 423 patients with diabetes. SETTING University of Gondar Hospital diabetic clinic. MAIN OUTCOME MEASURES The main outcome measure was willingness to receive diabetic health service via mobile phone voice call or messaging services. RESULTS Out of 423 patients with diabetes, 329 (77.8%) had access to a mobile phone. Among the latter, 232 (70.5%) were willing to receive mobile phone-based health services. The educational status of patients (adjusted OR (AOR): 2.6 (95% CI: 1.2 to 5.58)), route of medication (AOR: 3.2 (95% CI: 1.44 to 7.1)), transportation mechanism (AOR: 4.1 (95% CI: 1.2 to 13.57)), travel time to health facility (AOR: 0.3 (95% CI: 0.12 to 0.82)), current use of mobile phone as appointment reminder (AOR: 2.6 (95% CI: 1.07 to 6.49)) and locking mobile phone with passwords (AOR: 4.6 (95% CI: 1.63 to 12.95)) were significantly associated with the willingness to receive mobile phone-based diabetic health services. CONCLUSION Access to a mobile phone and willingness to receive mobile phone-based health services were high. Educational status, route of medication, transportation mechanism, time to reach the service, using mobile phone as appointment reminder and locking mobile phone with passwords were significantly associated factors. Given the high proportion of access and willingness of patients to receive mobile phone-based health services, mHealth interventions could be helpful.
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Affiliation(s)
- Adamu Takele Jemere
- University of Gondar, Institute of Public Health, Department of Health Informatics, Gondar, Ethiopia
| | - Yohannes Ezezew Yeneneh
- University of Gondar, Institute of Public Health, Department of Health Informatics, Gondar, Ethiopia
| | - Biniam Tilahun
- University of Gondar, Institute of Public Health, Department of Health Informatics, Gondar, Ethiopia
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Shitaye Alemu
- School of Medicine, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Mihiretu Kebede
- University of Gondar, Institute of Public Health, Department of Health Informatics, Gondar, Ethiopia
- Faculty of Health Sciences, University of Bremen, Bremen, Germany
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Stumpf A, Pfleiderer B, Fritz F, Osada N, Chen SC, Ständer S. Assessment of Quality of Life in Chronic Pruritus: Relationship Between ItchyQoL and Dermatological Life Quality Index in 1,150 Patients. Acta Derm Venereol 2018; 98:142-143. [PMID: 28853494 DOI: 10.2340/00015555-2782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Astrid Stumpf
- Department of Psychosomatics and Psychotherapy, University of Münster, Domagkstrasse 22, DE-48149 Münster, Germany
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Thoennissen GB, Görlich D, Bacher U, Aufenberg T, Hüsken AC, Hansmeier AA, Evers G, Mikesch JH, Fritz F, Bokemeyer C, Müller-Tidow C, Stelljes M, Mesters RM, Krug U, Kropff MH, Thoennissen NH, Berdel WE. Autologous Stem Cell Transplantation in Multiple Myeloma in the Era of Novel Drug Induction: A Retrospective Single-Center Analysis. Acta Haematol 2017; 137:163-172. [PMID: 28399522 DOI: 10.1159/000463534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/12/2017] [Indexed: 12/22/2022]
Abstract
Within this retrospective single-center study, we analyzed the survival of 320 multiple myeloma (MM) patients receiving melphalan high-dose chemotherapy (HDCT) and either single (n = 286) or tandem (n = 34) autologous stem cell transplantation (ASCT) from 1996 to 2012. Additionally, the impact of novel induction regimens was assessed. Median follow-up was 67 months, median overall survival (OS) 62 months, median progression-free survival (PFS) 33 months (95% CI 27-39), and treatment-related death (TRD) 3%. Multivariate analysis revealed age ≥60 years (p = 0.03) and stage 3 according to the International Staging System (p = 0.006) as adverse risk factors regarding PFS. Median OS was significantly better in newly diagnosed MM patients receiving induction therapy with novel agents, e.g., bortezomib, thalidomide, or lenalidomide, compared with a traditional regimen (69 vs. 58 months; p = 0.01). More patients achieved at least a very good partial remission in the period from 2005 to 2012 than from 1996 to 2004 (65 vs. 30%; p < 0.001), with a longer median OS in the later period (71 vs. 52 months, p = 0.027). In conclusion, our analysis confirms HDCT-ASCT as an effective therapeutic strategy in an unselected large myeloma patient cohort with a low TRD rate and improved prognosis due to novel induction strategies.
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Affiliation(s)
- Gabriela B Thoennissen
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, Hubertus Wald University Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Steinke S, Bruland P, Blome C, Osada N, Dugas M, Fritz F, Augustin M, Ständer S. Chronic pruritus: evaluation of patient needs and treatment goals with a special regard to differences according to pruritus classification and sex. Br J Dermatol 2017; 176:363-370. [DOI: 10.1111/bjd.14910] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 02/06/2023]
Affiliation(s)
- S. Steinke
- Center for Chronic Pruritus Department of Dermatology University Hospital Münster Von‐Esmarch‐Straße 58 48149 Münster Germany
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - P. Bruland
- Institute of Medical Informatics University of Münster Münster Germany
| | - C. Blome
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - N. Osada
- Institute of Medical Informatics University of Münster Münster Germany
| | - M. Dugas
- Institute of Medical Informatics University of Münster Münster Germany
| | - F. Fritz
- Institute of Medical Informatics University of Münster Münster Germany
| | - M. Augustin
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - S. Ständer
- Center for Chronic Pruritus Department of Dermatology University Hospital Münster Von‐Esmarch‐Straße 58 48149 Münster Germany
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Cowie MR, Blomster JI, Curtis LH, Duclaux S, Ford I, Fritz F, Goldman S, Janmohamed S, Kreuzer J, Leenay M, Michel A, Ong S, Pell JP, Southworth MR, Stough WG, Thoenes M, Zannad F, Zalewski A. Electronic health records to facilitate clinical research. Clin Res Cardiol 2016; 106:1-9. [PMID: 27557678 PMCID: PMC5226988 DOI: 10.1007/s00392-016-1025-6] [Citation(s) in RCA: 278] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/05/2016] [Indexed: 02/07/2023]
Abstract
Electronic health records (EHRs) provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research. Concerns have been raised about the increasing recruitment challenges in trials, burdensome and obtrusive data collection, and uncertain generalizability of the results. Leveraging electronic health records to counterbalance these trends is an area of intense interest. The initial applications of electronic health records, as the primary data source is envisioned for observational studies, embedded pragmatic or post-marketing registry-based randomized studies, or comparative effectiveness studies. Advancing this approach to randomized clinical trials, electronic health records may potentially be used to assess study feasibility, to facilitate patient recruitment, and streamline data collection at baseline and follow-up. Ensuring data security and privacy, overcoming the challenges associated with linking diverse systems and maintaining infrastructure for repeat use of high quality data, are some of the challenges associated with using electronic health records in clinical research. Collaboration between academia, industry, regulatory bodies, policy makers, patients, and electronic health record vendors is critical for the greater use of electronic health records in clinical research. This manuscript identifies the key steps required to advance the role of electronic health records in cardiovascular clinical research.
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Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK.
| | - Juuso I Blomster
- Astra Zeneca R&D, Molndal, Sweden
- University of Turku, Turku, Finland
| | | | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | | | | | - Jörg Kreuzer
- Boehringer-Ingelheim, Pharma GmbH & Co KG, Ingelheim, Germany
| | | | | | | | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Wendy Gattis Stough
- Campbell University College of Pharmacy and Health Sciences, Campbell, NC, USA
| | | | - Faiez Zannad
- INSERM, Centre d'Investigation Clinique 9501 and Unité 961, Centre Hospitalier Universitaire, Nancy, France
- Department of Cardiology, Nancy University, Université de Lorraine, Nancy, France
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Fritz F, Skornitzke S, Hackert T, Kauczor HU, Stiller W, Grenacher L, Klauss M. Dual-Energy Perfusion-CT in Recurrent Pancreatic Cancer - Preliminary Results. ROFO-FORTSCHR RONTG 2016; 188:559-65. [PMID: 27224576 DOI: 10.1055/s-0042-105765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of dual energy (DE) perfusion-CT for the differentiation between postoperative soft-tissue formation and tumor recurrence in patients after potentially curative pancreatic cancer resection. MATERIAL AND METHODS 24 patients with postoperative soft-tissue formation in the conventional regular follow-up CT acquisition after pancreatic cancer resection with curative intent were included prospectively. They were examined with a 64-row dual-source CT using a dynamic sequence of 34 DE acquisitions every 1.5 s (80 ml of iodinated contrast material, 370 mg/ml, flow rate 5 ml/s). Weighted average (linearly blended M0.5) 120kVp-equivalent dual-energy perfusion image data sets were evaluated with a body-perfusion CT tool (see above) for estimating blood flow, permeability, and blood volume. Diagnosis was confirmed by histological study (n = 4) and by regular follow-up. RESULTS Final diagnosis was local recurrence of pancreatic cancer in 15 patients and unspecific postoperative tissue formation in 9 patients. The blood-flow values for recurrence tissue trended to be lower compared to postoperative tissue formation with 16.6 ml/100 ml/min and 24.7 ml/100 ml/min, respectively for weighted average 120kVp-equivalent image data, which was not significant (n.s.) (p = 0.06, significance level 0.05). Permeability- and blood-volume values were only slightly lower in recurrence tissue (n.s.). CONCLUSION DE perfusion-CT is feasible in patients after pancreatic cancer resection and a promising functional imaging technique. As only a trend for lower perfusion values in local recurrence compared to unspecific postoperative alterations was found, the perfusion differences are not yet sufficient to differentiate between malignancy and unspecific postoperative alterations for this new technique. Further studies and technical improvements are needed to generate reliable data for this clinically highly relevant differentiation. KEY POINTS • DE Perfusion CT is feasible in patients after pancreatic cancer resection.• While reliable differentiation of unspecific postoperative tissue formation from recurrent malignancy cannot be achieved yet, it is within reach.• DE Perfusion CT has the potential to overcome todays limitations of pure morphological diagnosis of recurrent pancreatic cancer. Citation Format: • Fritz F, Skornitzke S, Hackert T et al. Dual-Energy Perfusion-CT in Recurrent Pancreatic Cancer - Preliminary RESULTS. Fortschr Röntgenstr 2016; 188: 559 - 565.
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Affiliation(s)
- F Fritz
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - S Skornitzke
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - T Hackert
- Clinic of Surgery, University of Heidelberg, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - W Stiller
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
| | - L Grenacher
- Diagnostic Imaging Center, Diagnostik München, Germany
| | - M Klauss
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Germany
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Skornitzke S, Fritz F, Mayer P, Koell M, Hansen J, Pahn G, Klauß M, Grenacher L, Kauczor H, Stiller W. Quantitative Untersuchung linearer Modelle zur Approximation der CT-Perfusion auf der Grundlage von zum Zeitpunkt maximaler Gewebekontrastierung aufgenommenen Dual-Energy Jodkarten. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ständer S, Zeidler C, Riepe C, Steinke S, Fritz F, Bruland P, Soto‐Rey I, Storck M, Agner T, Augustin M, Blome C, Dalgard F, Evers A, Garcovich S, Gonçalo M, Lambert J, Legat F, Leslie T, Misery L, Raap U, Reich A, Şavk E, Streit M, Serra‐Baldrich E, Szepietowski J, Wallengren J, Weisshaar E, Dugas M. European
EADV
network on assessment of severity and burden of Pruritus (PruNet): first meeting on outcome tools. J Eur Acad Dermatol Venereol 2015; 30:1144-7. [DOI: 10.1111/jdv.13296] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Ständer
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - C. Zeidler
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - C. Riepe
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - S. Steinke
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - F. Fritz
- Institute of Medical Informatics University of Münster Münster Germany
| | - P. Bruland
- Institute of Medical Informatics University of Münster Münster Germany
| | - I. Soto‐Rey
- Institute of Medical Informatics University of Münster Münster Germany
| | - M. Storck
- Institute of Medical Informatics University of Münster Münster Germany
| | - T. Agner
- Department of Dermatology University of Copenhagen Copenhagen Denmark
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - C. Blome
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - F. Dalgard
- Department of Dermatology Oslo University Hospital Oslo Norway
| | - A.W.M. Evers
- Department of Health, Medical and Neuropsychology Institute of Psychology Leiden University Leiden The Netherlands
| | - S. Garcovich
- Catholic University of the Sacred Heart, Milano Lombardy Italy
| | - M. Gonçalo
- Department of Dermatology University Hospital and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - J. Lambert
- Department of Dermatology University Hospital of Antwerp Antwerp Belgium
| | - F.J. Legat
- Department of Dermatology Medical University of Graz Graz Austria
| | - T. Leslie
- Royal Free London and St John's Institute of Dermatology Guy's & St Thomas’ Hospital London United Kingdom
| | - L. Misery
- Department of Dermatology University Hospital of Brest Brest France
| | - U. Raap
- Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - A. Reich
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - E. Şavk
- Department of Dermatology Adnan Menderes University Aydın Turkey
| | - M. Streit
- Department of Dermatology Kantonsspital Aarau Aarau Switzerland
| | - E. Serra‐Baldrich
- Cutaneous Allergy Unit Department of Dermatology Hospital Sant Pau Universitat Autònoma Barcelona Barcelona Spain
| | - J. Szepietowski
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - J. Wallengren
- Department of Dermatology and Venereology University Hospital of Lund Lund Sweden
| | - E. Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology University of Heidelberg Heidelberg Germany
| | - M. Dugas
- Institute of Medical Informatics University of Münster Münster Germany
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Fritz F, Blome C, Augustin M, Koch R, Ständer S. Differences in patient and physician assessment of a dynamic patient reported outcome tool for chronic pruritus. J Eur Acad Dermatol Venereol 2015; 30:962-5. [DOI: 10.1111/jdv.13214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- F. Fritz
- Department of Medical Informatics; University of Münster; Münster Germany
| | - C. Blome
- Institute for Health Services Research in Dermatology and Nursing; University Medical Center Hamburg-Eppendorf; Münster Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing; University Medical Center Hamburg-Eppendorf; Münster Germany
| | - R. Koch
- Institute of Biostatistics and Clinical Research; University of Münster; Münster Germany
| | - S. Ständer
- Competence Center Chronic Pruritus; Department of Dermatology; University Hospital Münster; Münster Germany
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Warlich B, Fritz F, Osada N, Bruland P, Stumpf A, Schneider G, Dugas M, Pfleiderer B, St�nder S. Health-Related Quality of Life in Chronic Pruritus: An Analysis Related to Disease Etiology, Clinical Skin Conditions and Itch Intensity. Dermatology 2015; 231:253-9. [DOI: 10.1159/000437206] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022] Open
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Kebede M, Zeleke A, Asemahagn M, Fritz F. Willingness to receive text message medication reminders among patients on antiretroviral treatment in North West Ethiopia: A cross-sectional study. BMC Med Inform Decis Mak 2015; 15:65. [PMID: 26268394 PMCID: PMC4535252 DOI: 10.1186/s12911-015-0193-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 07/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-adherence to Antiretroviral Treatment (ART) is strongly associated with virologic rebound and drug resistance. Studies have shown that the most frequently mentioned reason for missing ART doses is the forgetfulness of patients to take their medications on time. Therefore using communication devices as reminder tools, for example alarms, pagers, text messages and telephone calls could improve adherence to ART. The aim of this study is to measure access to cellphones, willingness to receive text message medication reminders and to identify associated factors of ART patients at the University of Gondar Hospital, in North West Ethiopia. METHODS An institution based cross sectional quantitative study was conducted among 423 patients on ART during April 2014. Data were collected using structured interviewer-administered questionnaires. Data entry and analysis were done using Epi-Info version 7 and SPSS version 20 respectively. Descriptive statistics and multivariable logistic regression analysis were used to describe the characteristic of the sample and identify factors associated with the willingness to receive text message medication reminders. RESULTS A total of 415 (98% response rate) respondents participated in the interview. The majority of respondents 316 (76.1%) owned a cellphone, and 161(50.9%) were willing to receive text message medication reminders. Positively associated factors to the willingness were the following: Younger age group (AOR = 5.18, 95% CI: [1.69, 15.94]), having secondary or higher education (AOR = 4.61, 95% CI: [1.33, 16.01]), using internet (AOR = 3.94, 95% CI: [1.67, 9.31]), not disclosing HIV status to anyone other than HCP (Health Care Provider) (AOR = 3.03, 95% CI: [1.20, 7.61]), availability of radio in dwelling (AOR = 2.74 95% CI: [1.27, 5.88]), not answering unknown calls (AOR = 2.67, 95% CI: [1.34, 5.32]), use of cellphone alarm as medication reminder (AOR = 2.22, 95%CI [1.09, 4.52]), and forgetting to take medications (AOR = 2.13, 95% CI: [1.14, 3.96]). CONCLUSIONS A high proportion of respondents have a cell phone and are willing to use it as medication reminders. Age, educational status and using internet were the main factors that are significantly associated with the willingness of patients to receive text message medication reminders.
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Affiliation(s)
- Mihiretu Kebede
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Atinkut Zeleke
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Fleur Fritz
- Institute of Medical Informatics, University of Muenster, Münster, Germany
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Tilahun B, Fritz F. Modeling antecedents of electronic medical record system implementation success in low-resource setting hospitals. BMC Med Inform Decis Mak 2015; 15:61. [PMID: 26231051 PMCID: PMC4522063 DOI: 10.1186/s12911-015-0192-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the increasing implementation of Electronic Medical Record Systems (EMR) in developing countries, there is a growing need to identify antecedents of EMR success to measure and predict the level of adoption before costly implementation. However, less evidence is available about EMR success in the context of low-resource setting implementations. Therefore, this study aims to fill this gap by examining the constructs and relationships of the widely used DeLone and MacLean (D&M) information system success model to determine whether it can be applied to measure EMR success in those settings. METHODS A quantitative cross sectional study design using self-administered questionnaires was used to collect data from 384 health professionals working in five governmental hospitals in Ethiopia. The hospitals use a comprehensive EMR system since three years. Descriptive and structural equation modeling methods were applied to describe and validate the extent of relationship of constructs and mediating effects. RESULTS The findings of the structural equation modeling shows that system quality has significant influence on EMR use (β = 0.32, P < 0.05) and user satisfaction (β = 0.53, P < 0.01); information quality has significant influence on EMR use (β = 0.44, P < 0.05) and user satisfaction (β = 0.48, P < 0.01) and service quality has strong significant influence on EMR use (β = 0.36, P < 0.05) and user satisfaction (β = 0.56, P < 0.01). User satisfaction has significant influence on EMR use (β = 0.41, P < 0.05) but the effect of EMR use on user satisfaction was not significant. Both EMR use and user satisfaction have significant influence on perceived net-benefit (β = 0.31, P < 0.01; β = 0.60, P < 0.01), respectively. Additionally, computer literacy was found to be a mediating factor in the relationship between service quality and EMR use (P < 0.05) as well as user satisfaction (P < 0.01). Among all the constructs, user satisfaction showed the strongest effect on perceived net-benefit of health professionals. CONCLUSION EMR implementers and managers in developing countries are in urgent need of implementation models to design proper implementation strategies. In this study, the constructs and relationships depicted in the updated D&M model were found to be applicable to assess the success of EMR in low resource settings. Additionally, computer literacy was found to be a mediating factor in EMR use and user satisfaction of health professionals. Hence, EMR implementers and managers in those settings should give priority in improving service quality of the hospitals like technical support and infrastructure; providing continuous basic computer trainings to health professionals; and give attention to the system and information quality of the systems they want to implement.
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Affiliation(s)
- Binyam Tilahun
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, Münster, D-48149, Germany.
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, Münster, D-48149, Germany
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16
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Tilahun B, Fritz F. Comprehensive evaluation of electronic medical record system use and user satisfaction at five low-resource setting hospitals in ethiopia. JMIR Med Inform 2015; 3:e22. [PMID: 26007237 PMCID: PMC4460264 DOI: 10.2196/medinform.4106] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/12/2015] [Accepted: 02/17/2015] [Indexed: 11/18/2022] Open
Abstract
Background Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95% CI 3.23-17.01). Conclusions Health professionals’ use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock.
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Affiliation(s)
- Binyam Tilahun
- Institute of Medical Informatics, University of Münster, Münster, Germany.
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17
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Soto-Rey I, Trinczek B, Girardeau Y, Zapletal E, Ammour N, Doods J, Dugas M, Fritz F. Efficiency and effectiveness evaluation of an automated multi-country patient count cohort system. BMC Med Res Methodol 2015; 15:44. [PMID: 25928269 PMCID: PMC4423123 DOI: 10.1186/s12874-015-0035-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/22/2015] [Indexed: 11/29/2022] Open
Abstract
Background With the increase of clinical trial costs during the last decades, the design of feasibility studies has become an essential process to reduce avoidable and costly protocol amendments. This design includes timelines, targeted sites and budget, together with a list of eligibility criteria that potential participants need to match. The present work was designed to assess the value of obtaining potential study participant counts using an automated patient count cohort system for large multi-country and multi-site trials: the Electronic Health Records for Clinical Research (EHR4CR) system. Methods The evaluation focuses on the accuracy of the patient counts and the time invested to obtain these using the EHR4CR platform compared to the current questionnaire based process. This evaluation will assess the patient counts from ten clinical trials at two different sites. In order to assess the accuracy of the results, the numbers obtained following the two processes need to be compared to a baseline number, the “alloyed” gold standard, which was produced by a manual check of patient records. Results The patient counts obtained using the EHR4CR system were in three evaluated trials more accurate than the ones obtained following the current process whereas in six other trials the current process counts were more accurate. In two of the trials both of the processes had counts within the gold standard’s confidence interval. In terms of efficiency the EHR4CR protocol feasibility system proved to save approximately seven calendar days in the process of obtaining patient counts compared to the current manual process. Conclusions At the current stage, electronic health record data sources need to be enhanced with better structured data so that these can be re-used for research purposes. With this kind of data, systems such as the EHR4CR are able to provide accurate objective patient counts in a more efficient way than the current methods. Additional research using both structured and unstructured data search technology is needed to assess the value of unstructured data and to compare the amount of efforts needed for data preparation. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0035-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iñaki Soto-Rey
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1/A11, D-48149, Münster, Germany.
| | - Benjamin Trinczek
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1/A11, D-48149, Münster, Germany.
| | - Yannick Girardeau
- Département d'Informatique Hospitalière, AP-HP, Hôpital Européen Georges Pompidou, 75015, Paris, France. .,Centre de Recherche des Cordeliers, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1138, F-75006, Paris, France.
| | - Eric Zapletal
- Département d'Informatique Hospitalière, AP-HP, Hôpital Européen Georges Pompidou, 75015, Paris, France.
| | - Nadir Ammour
- Sanofi-Aventis R&D, 1 avenue Pierre Brossolette, F-91380, Chilly-Mazarin, France.
| | - Justin Doods
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1/A11, D-48149, Münster, Germany.
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1/A11, D-48149, Münster, Germany.
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1/A11, D-48149, Münster, Germany.
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Skornitzke S, Fritz F, Klauß M, Hansen J, Pahn G, Grenacher L, Kauczor H, Stiller W. Quantitativer Vergleich einzeitiger Dual-Energy Jodkarten als dosisreduzierte Alternative abdomineller CT-Perfusionsmessungen. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Fritz F, Tilahun B, Dugas M. Success criteria for electronic medical record implementations in low-resource settings: a systematic review. J Am Med Inform Assoc 2015; 22:479-88. [PMID: 25769683 DOI: 10.1093/jamia/ocu038] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Electronic medical record (EMR) systems have the potential of supporting clinical work by providing the right information at the right time to the right people and thus make efficient use of resources. This is especially important in low-resource settings where reliable data are also needed to support public health and local supporting organizations. In this systematic literature review, our objectives are to identify and collect literature about success criteria of EMR implementations in low-resource settings and to summarize them into recommendations. MATERIALS AND METHODS Our search strategy relied on PubMed queries and manual bibliography reviews. Studies were included if EMR implementations in low-resource settings were described. The extracted success criteria and measurements were summarized into 7 categories: ethical, financial, functionality, organizational, political, technical, and training. RESULTS We collected 381 success criteria with 229 measurements from 47 articles out of 223 articles. Most papers were evaluations or lessons learned from African countries, published from 1999 to 2013. Almost half of the EMR systems served a specific disease area like human immunodeficiency virus (HIV). The majority of criteria that were reported dealt with the functionality, followed by organizational issues, and technical infrastructures. Sufficient training and skilled personnel were mentioned in roughly 10%. Political, ethical, and financial considerations did not play a predominant role. More evaluations based on reliable frameworks are needed. CONCLUSIONS Highly reliable data handling methods, human resources and effective project management, as well as technical architecture and infrastructure are all key factors for successful EMR implementation.
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Affiliation(s)
- Fleur Fritz
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Binyam Tilahun
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
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20
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Stumpf A, Ständer S, Warlich B, Fritz F, Bruland P, Pfleiderer B, Heuft G, Schneider G. Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men. Br J Dermatol 2015; 172:1323-8. [PMID: 25350351 DOI: 10.1111/bjd.13492] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although sex and gender are becoming more important in diagnostics and therapy, there is still little knowledge about sex-specific differences in chronic pruritus (CP). OBJECTIVES To compare, taking into consideration the characteristics of pruritus, sex-specific differences in psychological symptoms in patients with CP. METHODS Sociodemographic data, data on the clinical characteristics of the skin and CP were documented over a 1-year period in all patients attending the Competence Center Chronic Pruritus of the University Hospital Münster for the first time. All patients completed the Hospital Anxiety and Depression Scale. Student's t-tests for independent study groups and linear regression analyses were applied. RESULTS A total of 619 patients (278 men, 341 women) were included in the analysis. Women were more anxious than men, but were not more depressed. A linear regression analysis indicated that depression and anxiety scores in women were related to the average intensity of pruritus during the previous 4 weeks and to a more generalized pruritus at the beginning of CP; older age in women also correlated with the scores on the depression subscale. Interestingly, the associations were different in men: scores on the depression scale were associated with the diagnosis of CP pruritus with multiple scratch lesions. CONCLUSIONS There are sex-specific differences in the relationship between the psychological symptoms and clinical characteristics of CP; higher anxiety scores were achieved by women. Whether psychological symptoms can be reversed when CP and scratch lesions improve is an issue that needs further exploration.
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Affiliation(s)
- A Stumpf
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ständer
- Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
| | - B Warlich
- Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
| | - F Fritz
- Department of Medical Informatics, University Hospital Münster, Münster, Germany
| | - P Bruland
- Department of Medical Informatics, University Hospital Münster, Münster, Germany
| | - B Pfleiderer
- Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - G Heuft
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - G Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
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Ständer S, Pogatzki-Zahn E, Stumpf A, Fritz F, Pfleiderer B, Ritzkat A, Bruland P, Lotts T, Müller-Tidow C, Heuft G, Pavenstädt HJ, Schneider G, Van Aken H, Heindel W, Wiendl H, Dugas M, Luger TA. Facing the challenges of chronic pruritus: a report from a multi-disciplinary medical itch centre in Germany. Acta Derm Venereol 2015; 95:266-71. [PMID: 25136974 DOI: 10.2340/00015555-1949] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The complex nature and difficult-to-establish aetiology of chronic pruritus (CP) makes it challenging to provide medical care for patients with CP. This challenge can only be met with a multidisciplinary approach. The first multidisciplinary Itch Centre in Germany was established at the University of Münster in 2002 to meet the needs of this patient population. More than 2,500 outpatients and 400 inpatients are diagnosed and receive treatment each year. To ensure evidence-based medical care, an electronic system for medical documentation and patient-reported outcomes was established. Automated data transfer to a research database enables comprehensive data analysis. Our translational research has characterized peripheral and central itch mechanisms, provided novel clustering of CP patients, and identified novel target-specific therapies (e.g. neurokinin 1 receptor-antagonist). The multidisciplinary approach, combined with basic, clinical and translational research, enables comprehensive medical care of patients as well as implementation of high-quality experimental and clinical studies.
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Affiliation(s)
- Sonja Ständer
- Department of Dermatology, Competence Center Chronic Pruritus, University Hospital of Münster, Von-Esmarch-Str. 58, DE-48149 Münster, Germany.
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Tilahun B, Fritz F. Service Quality: A Main Determinant Factor for Health Information System Success in Low-resource Settings. Stud Health Technol Inform 2015; 216:927. [PMID: 26262229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With the increasing implementation of different health information systems in developing countries, there is a growing need to measure the main determinants of their success. The results of this evaluation study on the determinants of HIS success in five low resource setting hospitals show that service quality is the main determinant factor for information system success in those kind of settings.
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Affiliation(s)
- Binyam Tilahun
- Institute of Medical Informatics, University of Münster, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Germany
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Doods J, Lafitte C, Ulliac-Sagnes N, Proeve J, Botteri F, Walls R, Sykes A, Dugas M, Fritz F. A European inventory of data elements for patient recruitment. Stud Health Technol Inform 2015; 210:506-510. [PMID: 25991199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION In the last few years much work has been conducted in creating systems that support clinical trials for example by utilizing electronic health record data. One of these endeavours is the Electronic Health Record for Clinical Research project (EHR4CR). An unanswered question that the project aims to answer is which data elements are most commonly required for patient recruitment. METHODS Free text eligibility criteria from 40 studies were analysed, simplified and elements were extracted. These elements where then added to an existing inventory of data elements for protocol feasibility. RESULTS We simplified and extracted data elements from 40 trials, which resulted in 1170 elements. From these we created an inventory of 150 unique data elements relevant for patient identification and recruitment with definitions and referenced codes to standard terminologies. DISCUSSION Our list was created with expertise from pharmaceutical companies. Comparisons with related work shows that identified concepts are similar. An evaluation of the availability of these elements in electronic health records is still ongoing. Hospitals that want to engage in re-use of electronic health record data for research purposes, for example by joining networks like EHR4CR, can now prioritize their effort based on this list.
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Affiliation(s)
- Justin Doods
- Institute of Medical Informatics, University Münster, Albert-Schweitzer-Campus 1/A11, D-48149 Münster, Germany
| | - Caroline Lafitte
- Sanofi R&D - Feasibility Management Department - 1 rue Pierre Brossolette - 91385 CHILLY MAZARIN, France
| | - Nadine Ulliac-Sagnes
- Sanofi R&D - Feasibility Management Department - 1 rue Pierre Brossolette - 91385 CHILLY MAZARIN, France
| | - Johan Proeve
- Global Strategy and Development Advisor, Global Data Sciences and Analytics, Bayer Vital GmbH, BV-PH-MED-GDSA, 51368 Leverkusen, K 9, 413, Germany
| | | | - Robert Walls
- Real World Data Science, F.Hoffmann-La Roche Ltd, CH-4070 Basel, Switzerland
| | - Andy Sykes
- Projects, Clinical Platforms & Sciences - Metabolic Pathways and Cardiovascular, GlaxoSmithKline, 1-3 Iron Bridge Road, Stockley ParkUxbridge, UK UB11 1BT
| | - Martin Dugas
- Institute of Medical Informatics, University Münster, Albert-Schweitzer-Campus 1/A11, D-48149 Münster, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University Münster, Albert-Schweitzer-Campus 1/A11, D-48149 Münster, Germany
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Soto-Rey I, Dugas M, Fritz F. Clinical Trial Feasibility Study Questionnaire Analysis. Stud Health Technol Inform 2015; 216:1029. [PMID: 26262329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With the growing complexity and cost of clinical trials (CTs) over the past few decades, Protocol Feasibility (PF) studies have become one of the most critical CT steps in order to avoid costly protocol amendments and ensure the success of CTs. The PF process includes interaction with clinicians located at targeted clinical sites, which results in slow and cumbersome process steps. These process steps are normally supported by information systems that allow users to create, share and collect responses to feasibility questionnaires. This investigation analyzes the systems and questionnaires utilized at several clinical research companies for PF. In addition, it provides recommendations that could eventually improve current methods and systems in place.
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Affiliation(s)
- Iñaki Soto-Rey
- Institute of Medical Informatics, University of Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Germany
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Soto-Rey I, Trinczek B, Amo JI, Bauselas J, Dugas M, Fritz F. Web-based multi-site feasibility questionnaire tool. Stud Health Technol Inform 2015; 212:88-93. [PMID: 26063262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The design of clinical trial (CT) study protocols, currently supported by clinicians, is often a slow and cumbersome process. The Electronic Health Records for Clinical Research (EHR4CR) project supports the design of study protocols through a multi-site patient count cohort system. However, there is still a need to improve the process step in which the clinicians are involved. This research aims to enhance the EHR4CR platform with a tool to support the contact of CT sponsors with clinical investigators to obtain their input regarding feasibility data for the CT protocol design. From a list of requirements, a technical architecture that responds to the needs of feasibility assessments was modelled. With this architecture as a basis, a system that allows users to generate, send, fill out and visualise results of feasibility questionnaires across clinical sites was developed and integrated within the EHR4CR platform. The resulting system improves the current methods by providing direct contact to clinical investigators, facilitating the creation and answer of feasibility questionnaires for CTs.
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Affiliation(s)
- Iñaki Soto-Rey
- Institute of Medical Informatics, University of Münster, Germany
| | | | | | - Jesús Bauselas
- School of Computer Engineering, University of Valladolid, Spain
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Germany
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Bruland P, Hänse W, Schedel F, Ständer S, Fritz F. PIACS: A System for the Automatic Detection, Categorization and Comparison of Scratch-Related Skin Lesions in Dermatology. Stud Health Technol Inform 2015; 216:1042. [PMID: 26262341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the treatment of chronic pruritus-related, scratch-induced skin lesions the categorization, counting and temporal comparison are common methodologies. The observation requires a good memory and expertise in this field to gain comparable findings for this time-consuming process. Digital image processing aims at supporting such manual detections. The objective is to develop a software tool for automatic image detection and comparison. The new photographic setting implies the usage of markers to derive the brightness and size of lesions. MATLAB has been used for the software development. The newly defined setting allows taking standardized images of pruritus-associated cutaneous lesions for detection and comparison. The tool named PIACS (Prurigo Image Analyzing and Comparing System) allows automatically detecting, categorizing and comparing lesions based on digital images.
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Affiliation(s)
- Philipp Bruland
- Institute of Medical Informatics, University of Münster, Germany
| | - Waldemar Hänse
- Institute of Medical Informatics, University of Münster, Germany
| | - Fiona Schedel
- Department of Dermatology, University of Münster, Germany
| | - Sonja Ständer
- Department of Dermatology, University of Münster, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Germany
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Fritz F, Kebede M, Tilahun B. The need for cost-benefit analyses of eHealth in low and middle-income countries. Stud Health Technol Inform 2015; 216:981. [PMID: 26262283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cost and benefit analyses are crucial for eHealth interventions, especially in low and middle income countries (LMIC). We performed a scoping review, with goals to acquire an overview of cost-benefit studies and to collect indicators that are being used for costs and savings with respect to eHealth. Of all retrieved articles, 29 were included in our analysis and 21 contained cost/savings indicators which we categorized into outcome measures with respect to providers, patients and other stakeholders. Nearly all authors stated that more evidence from economic analyses by health economists are urgently needed and that pilot projects should collect cost related data for evaluation.
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Affiliation(s)
- Fleur Fritz
- Institute of Medical Informatics, University of Münster, Germany
| | - Mihiretu Kebede
- Department of Health Informatics, University of Gondar, Ethiopia
| | - Binyam Tilahun
- Institute of Medical Informatics, University of Münster, Germany
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Skornitzke S, Fritz F, Klauss M, Pahn G, Hansen J, Hirsch J, Grenacher L, Kauczor HU, Stiller W. Qualitative and quantitative evaluation of rigid and deformable motion correction algorithms using dual-energy CT images in view of application to CT perfusion measurements in abdominal organs affected by breathing motion. Br J Radiol 2014; 88:20140683. [PMID: 25465353 DOI: 10.1259/bjr.20140683] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare six different scenarios for correcting for breathing motion in abdominal dual-energy CT (DECT) perfusion measurements. METHODS Rigid [RRComm(80 kVp)] and non-rigid [NRComm(80 kVp)] registration of commercially available CT perfusion software, custom non-rigid registration [NRCustom(80 kVp], demons algorithm) and a control group [CG(80 kVp)] without motion correction were evaluated using 80 kVp images. Additionally, NRCustom was applied to dual-energy (DE)-blended [NRCustom(DE)] and virtual non-contrast [NRCustom(VNC)] images, yielding six evaluated scenarios. After motion correction, perfusion maps were calculated using a combined maximum slope/Patlak model. For qualitative evaluation, three blinded radiologists independently rated motion correction quality and resulting perfusion maps on a four-point scale (4 = best, 1 = worst). For quantitative evaluation, relative changes in metric values, R(2) and residuals of perfusion model fits were calculated. RESULTS For motion-corrected images, mean ratings differed significantly [NRCustom(80 kVp) and NRCustom(DE), 3.3; NRComm(80 kVp), 3.1; NRCustom(VNC), 2.9; RRComm(80 kVp), 2.7; CG(80 kVp), 2.7; all p < 0.05], except when comparing NRCustom(80 kVp) with NRCustom(DE) and RRComm(80 kVp) with CG(80 kVp). NRCustom(80 kVp) and NRCustom(DE) achieved the highest reduction in metric values [NRCustom(80 kVp), 48.5%; NRCustom(DE), 45.6%; NRComm(80 kVp), 29.2%; NRCustom(VNC), 22.8%; RRComm(80 kVp), 0.6%; CG(80 kVp), 0%]. Regarding perfusion maps, NRCustom(80 kVp) and NRCustom(DE) were rated highest [NRCustom(80 kVp), 3.1; NRCustom(DE), 3.0; NRComm(80 kVp), 2.8; NRCustom(VNC), 2.6; CG(80 kVp), 2.5; RRComm(80 kVp), 2.4] and had significantly higher R(2) and lower residuals. Correlation between qualitative and quantitative evaluation was low to moderate. CONCLUSION Non-rigid motion correction improves spatial alignment of the target region and fit of CT perfusion models. Using DE-blended and DE-VNC images for deformable registration offers no significant improvement. ADVANCES IN KNOWLEDGE Non-rigid algorithms improve the quality of abdominal CT perfusion measurements but do not benefit from DECT post processing.
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Affiliation(s)
- S Skornitzke
- 1 Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Tilahun B, Kauppinen T, Keßler C, Fritz F. Design and development of a linked open data-based health information representation and visualization system: potentials and preliminary evaluation. JMIR Med Inform 2014; 2:e31. [PMID: 25601195 PMCID: PMC4288106 DOI: 10.2196/medinform.3531] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 08/04/2014] [Accepted: 08/23/2014] [Indexed: 11/13/2022] Open
Abstract
Background Healthcare organizations around the world are challenged by pressures to reduce cost, improve coordination and outcome, and provide more with less. This requires effective planning and evidence-based practice by generating important information from available data. Thus, flexible and user-friendly ways to represent, query, and visualize health data becomes increasingly important. International organizations such as the World Health Organization (WHO) regularly publish vital data on priority health topics that can be utilized for public health policy and health service development. However, the data in most portals is displayed in either Excel or PDF formats, which makes information discovery and reuse difficult. Linked Open Data (LOD)—a new Semantic Web set of best practice of standards to publish and link heterogeneous data—can be applied to the representation and management of public level health data to alleviate such challenges. However, the technologies behind building LOD systems and their effectiveness for health data are yet to be assessed. Objective The objective of this study is to evaluate whether Linked Data technologies are potential options for health information representation, visualization, and retrieval systems development and to identify the available tools and methodologies to build Linked Data-based health information systems. Methods We used the Resource Description Framework (RDF) for data representation, Fuseki triple store for data storage, and Sgvizler for information visualization. Additionally, we integrated SPARQL query interface for interacting with the data. We primarily use the WHO health observatory dataset to test the system. All the data were represented using RDF and interlinked with other related datasets on the Web of Data using Silk—a link discovery framework for Web of Data. A preliminary usability assessment was conducted following the System Usability Scale (SUS) method. Results We developed an LOD-based health information representation, querying, and visualization system by using Linked Data tools. We imported more than 20,000 HIV-related data elements on mortality, prevalence, incidence, and related variables, which are freely available from the WHO global health observatory database. Additionally, we automatically linked 5312 data elements from DBpedia, Bio2RDF, and LinkedCT using the Silk framework. The system users can retrieve and visualize health information according to their interests. For users who are not familiar with SPARQL queries, we integrated a Linked Data search engine interface to search and browse the data. We used the system to represent and store the data, facilitating flexible queries and different kinds of visualizations. The preliminary user evaluation score by public health data managers and users was 82 on the SUS usability measurement scale. The need to write queries in the interface was the main reported difficulty of LOD-based systems to the end user. Conclusions The system introduced in this article shows that current LOD technologies are a promising alternative to represent heterogeneous health data in a flexible and reusable manner so that they can serve intelligent queries, and ultimately support decision-making. However, the development of advanced text-based search engines is necessary to increase its usability especially for nontechnical users. Further research with large datasets is recommended in the future to unfold the potential of Linked Data and Semantic Web for future health information systems development.
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Affiliation(s)
- Binyam Tilahun
- Institute for Medical Informatics, University of Münster, Münster, Germany.
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Bruland P, Forster C, Breil B, Ständer S, Dugas M, Fritz F. Does single-source create an added value? Evaluating the impact of introducing x4T into the clinical routine on workflow modifications, data quality and cost-benefit. Int J Med Inform 2014; 83:915-28. [PMID: 25220487 DOI: 10.1016/j.ijmedinf.2014.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 03/14/2014] [Accepted: 08/21/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The first objective of this study is to evaluate the impact of integrating a single-source system into the routine patient care documentation workflow with respect to process modifications, data quality and execution times in patient care as well as research documentation. The second one is to evaluate whether it is cost-efficient using a single-source system in terms of achieved savings in documentation expenditures. METHODS We analyzed the documentation workflow of routine patient care and research documentation in the medical field of pruritus to identify redundant and error-prone process steps. Based on this, we established a novel documentation workflow including the x4T (exchange for Trials) system to connect hospital information systems with electronic data capture systems for the exchange of study data. To evaluate the workflow modifications, we performed a before/after analysis as well as a time-motion study. Data quality was assessed by measuring completeness, correctness and concordance of previously and newly collected data. A cost-benefit analysis was conducted to estimate the savings using x4T per collected data element and the additional costs for introducing x4T. RESULTS The documentation workflow of patient care as well as clinical research was modified due to the introduction of the x4T system. After x4T implementation and workflow modifications, half of the redundant and error-prone process steps were eliminated. The generic x4T system allows direct transfer of routinely collected health care data into the x4T research database and avoids manual transcription steps. Since x4T has been introduced in March 2012, the number of included patients has increased by about 1000 per year. The average entire documentation time per patient visit has been significantly decreased by 70.1% (from 1116±185 to 334±83 s). After the introduction of the x4T system and associated workflow changes, the completeness of mandatory data elements raised from 82.2% to 100%. In case of the pruritus research study, the additional costs for introducing the x4T system are €434.01 and the savings are 0.48ct per collected data element. So, with the assumption of a 5-year runtime and 82 collected data elements per patient, the amount of documented patients has to be higher than 1102 to create a benefit. CONCLUSION Introduction of the x4T system into the clinical and research documentation workflow can optimize the data collection workflow in both areas. Redundant and cumbersome process steps can be eliminated in the research documentation, with the result of reduced documentation times as well as increased data quality. The usage of the x4T system is especially worthwhile in a study with a large amount of collected data or a high number of included patients.
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Affiliation(s)
- Philipp Bruland
- Institute of Medical Informatics, University of Münster, Germany.
| | | | - Bernhard Breil
- Faculty of Health Care, University of Applied Sciences, Krefeld, Germany
| | - Sonja Ständer
- Competence Center Chronic Pruritus, Department of Dermatology, University of Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Germany
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Doods J, Bache R, McGilchrist M, Daniel C, Dugas M, Fritz F. Piloting the EHR4CR feasibility platform across Europe. Methods Inf Med 2014; 53:264-8. [PMID: 24954881 DOI: 10.3414/me13-01-0134] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/26/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pharmaceutical clinical trials are primarily conducted across many countries, yet recruitment numbers are frequently not met in time. Electronic health records store large amounts of potentially useful data that could aid in this process. The EHR4CR project aims at re-using EHR data for clinical research purposes. OBJECTIVE To evaluate whether the protocol feasibility platform produced by the Electronic Health Records for Clinical Research (EHR4CR) project can be installed and set up in accordance with local technical and governance requirements to execute protocol feasibility queries uniformly across national borders. METHODS We installed specifically engineered software and warehouses at local sites. Approvals for data access and usage of the platform were acquired and terminology mapping of local site codes to central platform codes were performed. A test data set, or real EHR data where approvals were in place, were loaded into data warehouses. Test feasibility queries were created on a central component of the platform and sent to the local components at eleven university hospitals. RESULTS To use real, de-identified EHR data we obtained permissions and approvals from 'data controllers' and ethics committees. Through the platform we were able to create feasibility queries, distribute them to eleven university hospitals and retrieve aggregated patient counts of both test data and de-identified EHR data. CONCLUSION It is possible to install a uniform piece of software in different university hospitals in five European countries and configure it to the requirements of the local networks, while complying with local data protection regulations. We were also able set up ETL processes and data warehouses, to re-use EHR data for feasibility queries distributed over the EHR4CR platform.
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Affiliation(s)
- J Doods
- Justin Doods, Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, 48149 Münster, Germany, E-mail:
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Skornitzke S, Fritz F, Klauß M, Pahn G, Grenacher L, Kauczor HU, Stiller W. Untersuchung der Effektivität von rigiden und deformierenden Algorithmen zur Bewegungskorrektur für die CT-Perfusionsmessung für abdominelle Organe unter Einfluss der Atembewegung. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Doods J, Botteri F, Dugas M, Fritz F. A European inventory of common electronic health record data elements for clinical trial feasibility. Trials 2014; 15:18. [PMID: 24410735 PMCID: PMC3895709 DOI: 10.1186/1745-6215-15-18] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/13/2013] [Indexed: 11/10/2022] Open
Abstract
Background Clinical studies are a necessity for new medications and therapies. Many studies, however, struggle to meet their recruitment numbers in time or have problems in meeting them at all. With increasing numbers of electronic health records (EHRs) in hospitals, huge databanks emerge that could be utilized to support research. The Innovative Medicine Initiative (IMI) funded project ‘Electronic Health Records for Clinical Research’ (EHR4CR) created a standardized and homogenous inventory of data elements to support research by utilizing EHRs. Our aim was to develop a Data Inventory that contains elements required for site feasibility analysis. Methods The Data Inventory was created in an iterative, consensus driven approach, by a group of up to 30 people consisting of pharmaceutical experts and informatics specialists. An initial list was subsequently expanded by data elements of simplified eligibility criteria from clinical trial protocols. Each element was manually reviewed by pharmaceutical experts and standard definitions were identified and added. To verify their availability, data exports of the source systems at eleven university hospitals throughout Europe were conducted and evaluated. Results The Data Inventory consists of 75 data elements that, on the one hand are frequently used in clinical studies, and on the other hand are available in European EHR systems. Rankings of data elements were created from the results of the data exports. In addition a sub-list was created with 21 data elements that were separated from the Data Inventory because of their low usage in routine documentation. Conclusion The data elements in the Data Inventory were identified with the knowledge of domain experts from pharmaceutical companies. Currently, not all information that is frequently used in site feasibility is documented in routine patient care.
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Affiliation(s)
| | | | | | - Fleur Fritz
- Institute of Medical Informatics, University Münster, Albert-Schweitzer-Campus 1/A11, D-48149 Münster, Germany.
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Tilahun B, Zeleke A, Fritz F, Zegeye D. New bachelors degree program in health informatics in Ethiopia: curriculum content and development approaches. Stud Health Technol Inform 2014; 205:798-802. [PMID: 25160297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
With a widespread use of information technology in healthcare organizations, there is a pressing need for professionals who are both skilled in the use and management of information systems and knowledgeable in the field of healthcare. To fill this need, the department of health informatics at the University of Gondar started a new bachelor's degree in the health informatics program commencing in 2012. The curriculum was developed by a thorough needs assessment and considering the recommendations of the international medical informatics association. The program has duration of 4 years with a total of 249 ECTS. Currently there are 57 students enrolled in the program and 15 full time academic staffs are involved in the teaching and research activity of the department. To share our experience for other countries, in this paper we explain the curriculum development process and its content to the health informatics community.
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Affiliation(s)
- Binyam Tilahun
- Institute of Medical Informatics, University of Münster, Germany
| | - Atinkut Zeleke
- Department of Health Informatics, University of Gondar, Ethiopia
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Germany
| | - Desalegn Zegeye
- Department of Health Informatics, University of Gondar, Ethiopia
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Storck M, Trinczek B, Dugas M, Fritz F. Towards a trial-ready mobile patient questionnaire system. Stud Health Technol Inform 2014; 205:768-772. [PMID: 25160291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Gathering patient-reported data enables physicians to know a patient and his/her health-related needs in a more comprehensive way. One method to collect these data is to let the patient fill out electronic questionnaires on a mobile device, e.g. a tablet. Although having successfully implemented a prototype, the mobile questionnaire system at this site has been stretched to its limits within both routine care and clinical trials. By collecting user feedback and analysing the capabilities and limits of the underlying framework, we identified key issues of the prototype. A new implementation addresses these obstacles while keeping the overall application logic and usability. This leads to a trial-ready mobile patient questionnaire system.
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Affiliation(s)
- Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Benjamin Trinczek
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Münster, Germany
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Doods J, Dugas M, Fritz F. Analysis of eligibility criteria from ClinicalTrials.gov. Stud Health Technol Inform 2014; 205:853-857. [PMID: 25160308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Electronic health care records are being used more and more for patient documentation. This electronic data can be used for secondary purposes, for example through systems that support clinical research. Eligibility criteria have to be processable for such systems to work, but criteria published on ClinicalTrials.gov have been shown to be complex, making them challenging to re-use. We analysed the eligibility criteria on ClinicalTrials.gov using automatic methods to determine whether the criteria definition and number changed over time. From 1998 to 2012 the average number of words used to describe eligibility criteria per year increased by 46%, while the average number of lines used per year only slightly increases until 2000 and stabilizes afterwards. Whether the increase of words resulted in increased criteria complexity or whether more data elements are used to describe eligibility needs further investigation.
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Affiliation(s)
- Justin Doods
- Insitute of Medical Informatics, University of Münster, Germany
| | - Martin Dugas
- Insitute of Medical Informatics, University of Münster, Germany
| | - Fleur Fritz
- Insitute of Medical Informatics, University of Münster, Germany
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Soto-Rey I, Trinczek B, Karakoyun T, Dugas M, Fritz F. Protocol feasibility workflow using an automated multi-country patient cohort system. Stud Health Technol Inform 2014; 205:985-989. [PMID: 25160335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Electronic Health Record for Clinical Research (EHR4CR) project aims to improve the current process of clinical trials, providing a technological platform that supports the design and execution of trials. For the protocol feasibility scenario, the system currently allows the user to create a set of in-/exclusion criteria to find patients matching these criteria across sites located in several countries. The automated multi-country patient cohort system developed in EHR4CR implies substantial changes on the current protocol feasibility process, which will be reflected in this study.
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Affiliation(s)
- Iñaki Soto-Rey
- Institute of Medical Informatics, University of Münster, Germany
| | | | - Töresin Karakoyun
- Coordination Centre for Clinical Trials, Medical Faculty at the Heinrich-Heine-University Hospital Düsseldorf, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Germany
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Doods J, Holzapfel K, Dugas M, Fritz F. Development of best practice principles for simplifying eligibility criteria. Stud Health Technol Inform 2013; 192:1153. [PMID: 23920927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Real world data is crucial for clinical research. In hospitals this information is more and more stored in electronic health records (EHR) and could be used for clinical trial feasibility and patient recruitment. On the other side eligibility criteria within study protocols are complex and usually not written in a way that is intuitively understandable or electronically usable. As part of overcoming the gap between eligibility criteria and the data that is available in EHRs we simplified eligibility criteria and created a guideline with best practice principles. The guideline explains how understandable criteria should be formulated and illustrates with examples what 'good' and 'bad' criteria are.
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Affiliation(s)
- Justin Doods
- Institute of Medical Informatics, University of Münster, Germany
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Soto-Rey I, Bache R, Dugas M, Fritz F. Query engine optimization for the EHR4CR protocol feasibility scenario. Stud Health Technol Inform 2013; 192:1080. [PMID: 23920854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
An essential step when recruiting patients for a Clinical Trial (CT) is to determine the number of patients that satisfy the Eligibility Criteria (ECs) for that trial. An innovative feature of the Electronic Health Records for Clinical Research (EHR4CR) platform is that when automatically determining patient counts, it also allows the user to view counts for subsets of the ECs. This is helpful because some combinations of ECs may be so restrictive that they yield very few or zero patients. If we wanted to show all possible combinations of ECs, the number of queries we would have to execute would be of 2n, where n is the total number of ECs. Assuming that an average study has between 20 and 30 ECs, the program would have to execute between 220 (1,048,576) and 230 (1,073,741,824) queries. This is not only computationally expensive but also impractical to visualise. The purpose of our research is to reduce possible combinationsto a manageable number.
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Affiliation(s)
- Iñaki Soto-Rey
- Institute of Medical Informatics, University of Münster, Münster, Germany
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Fritz F, Dugas M. Are physicians interested in the quality of life of their patients? usage of EHR-integrated patient reported outcomes data. Stud Health Technol Inform 2013; 192:1039. [PMID: 23920813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In addition to clinical findings, patient reported outcomes (PRO) are a valuable source of information. However, the available time of a physician per patient is limited. Under these constraints, do physicians look into PRO data? By using an, electronic health record (EHR) integrated system for the documentation of PRO the data is directly available during treatment. To evaluate whether this information is used we analyzed access patterns for two types of PRO forms. 56% and 74% of these forms were accessed within routine care while 74% and 100% were analyzed for clinical research.
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Affiliation(s)
- Fleur Fritz
- Institute of Medical Informatics, University of Münster, Germany
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Ständer S, Blome C, Breil B, Bruland P, Darsow U, Dugas M, Evers A, Fritz F, Metz M, Phan NQ, Raap U, Reich A, Schneider G, Steinke S, Szepietowski J, Weisshaar E, Augustin M. [Assessment of pruritus - current standards and implications for clinical practice : consensus paper of the Action Group Pruritus Parameter of the International Working Group on Pruritus Research (AGP)]. Hautarzt 2012; 63:521-2, 524-31. [PMID: 22733240 DOI: 10.1007/s00105-011-2318-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
With a prevalence of 20%, chronic pruritus is a symptom of many diseases with major impact on healthcare costs. The lack of specific therapeutic measures makes the development of new drugs and their testing in clinical trials urgent. It is not possible to measure pruritus in an objective way. For these reasons, it is necessary to have a series of standardized measures to characterize pruritus in a reliable way. Intensity scales such as the visual analog scale (VAS) are most frequently used to document the course of the symptoms. However, for assessing pruritus intensity, VAS is not an optimal instrument, although it cannot be dispensed with. The VAS should be combined with other scales in clinical studies in order to internally test the consistency of data. Other instruments for assessing intensity and course of pruritus are in the process of development. Presently scratch activity and scratch-associated lesions can be documented in a descriptive fashion. There are some studies that have employed devices to document scratch activity; however, methodological studies are not yet available. The patient-benefit index is an indispensable tool in clinical trials. A questionnaire for gathering data on the history and some pruritus-specific parameters has been developed and published. Questionnaires on patient quality of life, anxiety and depression are helpful in obtaining data on other cost-relevant parameters. A questionnaire on the quality of life, for instance, can provide important help in the assessment of the burden of the disease. The results of these questionnaires can be correlated with data on pruritus intensity scales. The relevant questionnaires have been partially digitalized so that they are available immediately as part of patient care. Additional methodological developments and studies are required in order to define a robust set of instruments for measuring pruritus in daily practice and in clinical studies.
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Affiliation(s)
- S Ständer
- Klinik für Hautkrankheiten und Kompetenzzentrum Chronischer Pruritus, Universitätsklinikum Münster, Deutschland.
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Phan NQ, Blome C, Fritz F, Gerss J, Reich A, Ebata T, Augustin M, Szepietowski JC, Ständer S. Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. Acta Derm Venereol 2012; 92:502-7. [PMID: 22170091 DOI: 10.2340/00015555-1246] [Citation(s) in RCA: 305] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The most commonly used tool for self-report of pruritus intensity is the visual analogue scale (VAS). Similar tools are the numerical rating scale (NRS) and verbal rating scale (VRS). In the present study, initiated by the International Forum for the Study of Itch assessing reliability of these tools, 471 randomly selected patients with chronic itch (200 males, 271 females, mean age 58.44 years) recorded their pruritus intensity on VAS (100-mm line), NRS (0-10) and VRS (four-point) scales. Re-test reliability was analysed in a subgroup of 250 patients after one hour. Statistical analysis showed a high reliability and concurrent validity (r>0.8; p<0.01) for all tools. Mean values of all scales showed a high correlation. In conclusion, high reliability and concurrent validity was found for VAS, NRS and VRS. On re-test, higher correlation and less missing values were observed. A training session before starting a clinical trial is recommended.
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Affiliation(s)
- Ngoc Quan Phan
- Competence Center for Chronic Pruritus, Department of Dermatology, University Hospital, Münster, Germany
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Breil B, Kenneweg J, Fritz F, Bruland P, Doods D, Trinczek B, Dugas M. Multilingual Medical Data Models in ODM Format: A Novel Form-based Approach to Semantic Interoperability between Routine Healthcare and Clinical Research. Appl Clin Inform 2012; 3:276-89. [PMID: 23620720 DOI: 10.4338/aci-2012-03-ra-0011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 06/24/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Semantic interoperability between routine healthcare and clinical research is an unsolved issue, as information systems in the healthcare domain still use proprietary and site-specific data models. However, information exchange and data harmonization are essential for physicians and scientists if they want to collect and analyze data from different hospitals in order to build up registries and perform multicenter clinical trials. Consequently, there is a need for a standardized metadata exchange based on common data models. Currently this is mainly done by informatics experts instead of medical experts. OBJECTIVES We propose to enable physicians to exchange, rate, comment and discuss their own medical data models in a collaborative web-based repository of medical forms in a standardized format. METHODS Based on a comprehensive requirement analysis, a web-based portal for medical data models was specified. In this context, a data model is the technical specification (attributes, data types, value lists) of a medical form without any layout information. The CDISC Operational Data Model (ODM) was chosen as the appropriate format for the standardized representation of data models. The system was implemented with Ruby on Rails and applies web 2.0 technologies to provide a community based solution. Forms from different source systems - both routine care and clinical research - were converted into ODM format and uploaded into the portal. RESULTS A portal for medical data models based on ODM-files was implemented (http://www.medical-data-models.org). Physicians are able to upload, comment, rate and download medical data models. More than 250 forms with approximately 8000 items are provided in different views (overview and detailed presentation) and in multiple languages. For instance, the portal contains forms from clinical and research information systems. CONCLUSION The portal provides a system-independent repository for multilingual data models in ODM format which can be used by physicians. It serves as a platform for discussion and enables the exchange of multilingual medical data models in a standardized way.
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Affiliation(s)
- B Breil
- Institute of Medical Informatics, University of Münster , Germany
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Thoennissen GB, Thoennissen NH, Fritz F, Hilbig A, Kerkhoff A, Liersch R, Krug U, Koschmieder S, Müller-Tidow C, Mesters R, Kropff M, Berdel WE. POEMS syndrome treated with melphalan high-dose therapy and autologous blood stem cell transplantation: a single-institution experience. Ann Hematol 2012; 91:1419-25. [DOI: 10.1007/s00277-012-1473-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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Fritz F, Balhorn S, Riek M, Breil B, Dugas M. Qualitative and quantitative evaluation of EHR-integrated mobile patient questionnaires regarding usability and cost-efficiency. Int J Med Inform 2012; 81:303-13. [PMID: 22236957 DOI: 10.1016/j.ijmedinf.2011.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 12/15/2011] [Accepted: 12/16/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The objective of this evaluation study is to assess a web-based application, currently available on iPad, to document questionnaires regarding patient reported outcomes such as quality of life. Based on the single source approach, the results of these questionnaires are available in the electronic health record to be used for treatment and research purposes. The assessment focuses on the usability and efficiency of the system. METHODS The system usability scale questionnaire with seven additional items was used to rate the usability by the patients. It was formally validated by a Cronbach Alpha test. In addition, semi-structured interviews were conducted with patients and medical staff. Time and cost measures, based on official tables of costs, were taken through workflow observations. This study was conducted in the department of dermatology at the University Hospital of Münster, Germany from April to June 2011. RESULTS Using the web-based application questionnaire, results about patient reported outcomes like quality of life are immediately available in the electronic health record and can be used for treatment or research purposes. 118 patients and four staff members participated in the study. The usability score reached 80 from 100 points and patients as well as medical staff stated in the interviews that the usability of the web-based system was high, and they preferred it to the previously used paper-based questionnaires. In the setting of our pilot department the mobile devices amortized their costs after 6.7 months. In general, depending on the professional group who are going to post process the paper-based forms, the earliest break-even point to use mobile questionnaires is at 1737 paper sheets per year. CONCLUSION The mobile patient questionnaires, integrated into the electronic health record, were well accepted in our pilot setting with high usability scores from patients and medical staff alike. The system has also proved to be cost-efficient compared to the paper-based workflow, given that a certain number of questionnaires is used per year.
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Affiliation(s)
- Fleur Fritz
- Institute of Medical Informatics, University Münster, Albert-Schweitzer-Campus 1/A11, 48149 Münster, Germany.
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Bruland P, Breil B, Fritz F, Dugas M. Interoperability in clinical research: from metadata registries to semantically annotated CDISC ODM. Stud Health Technol Inform 2012; 180:564-568. [PMID: 22874254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Planning case report forms for data capture in clinical trials is a labor-insensitive and not formalized process. These CRFs are often neither standardized nor using defined data elements. Metadata registries as the NCI caDSR provide the capability to create forms based on common data elements. However, an exchange of these forms into clinical trial management systems through a standardized format like CDISC ODM is currently not offered. Thus, our objectives were to develop a mapping model between NCI forms and ODM. We analyzed 3012 NCI forms and included common data elements regarding their frequency and uniqueness. In this paper, we have created a mapping model between both formats and identified limitations in the conversion process: Semantic codes requested from the caDSR registry did not allow a proper mapping to ODM items and information like the number of module repetitions got lost. Summarized, it can be stated that our mapping model is feasible. However, mapping of semantic concepts in ODM needs to be specified more precisely.
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Affiliation(s)
- Philipp Bruland
- Institute of Medical Informatics, University of Münster, Germany
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Breil B, Fritz F, Thiemann V, Dugas M. Mapping turnaround times (TAT) to a generic timeline: a systematic review of TAT definitions in clinical domains. BMC Med Inform Decis Mak 2011; 11:34. [PMID: 21609424 PMCID: PMC3125312 DOI: 10.1186/1472-6947-11-34] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 05/24/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessing turnaround times can help to analyse workflows in hospital information systems. This paper presents a systematic review of literature concerning different turnaround time definitions. Our objectives were to collect relevant literature with respect to this kind of process times in hospitals and their respective domains. We then analysed the existing definitions and summarised them in an appropriate format. METHODS Our search strategy was based on Pubmed queries and manual reviews of the bibliographies of retrieved articles. Studies were included if precise definitions of turnaround times were available. A generic timeline was designed through a consensus process to provide an overview of these definitions. RESULTS More than 1000 articles were analysed and resulted in 122 papers. Of those, 162 turnaround time definitions in different clinical domains were identified. Starting and end points vary between these domains. To illustrate those turnaround time definitions, a generic timeline was constructed using preferred terms derived from the identified definitions. The consensus process resulted in the following 15 terms: admission, order, biopsy/examination, receipt of specimen in laboratory, procedure completion, interpretation, dictation, transcription, verification, report available, delivery, physician views report, treatment, discharge and discharge letter sent. Based on this analysis, several standard terms for turnaround time definitions are proposed. CONCLUSION Using turnaround times to benchmark clinical workflows is still difficult, because even within the same clinical domain many different definitions exist. Mapping of turnaround time definitions to a generic timeline is feasible.
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Affiliation(s)
- Bernhard Breil
- Institute of Medical Informatics, University of Münster, Domagkstraße 9, 48149 Münster, Germany.
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Fritz F, Ständer S, Breil B, Riek M, Dugas M. CIS-based registration of quality of life in a single source approach. BMC Med Inform Decis Mak 2011; 11:26. [PMID: 21510866 PMCID: PMC3107772 DOI: 10.1186/1472-6947-11-26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 04/21/2011] [Indexed: 12/29/2022] Open
Abstract
Background Documenting quality of life (QoL) in routine medical care and using it both for treatment and for clinical research is not common, although such information is absolutely valuable for physicians and patients alike. We therefore aimed at developing an efficient method to integrate quality of life information into the clinical information system (CIS) and thus make it available for clinical care and secondary use. Methods We piloted our method in three different medical departments, using five different QoL questionnaires. In this setting we used structured interviews and onsite observations to perform workflow and form analyses. The forms and pertinent data reports were implemented using the integrated tools of the local CIS. A web-based application for mobile devices was developed based on XML schemata to facilitate data import into the CIS. Data exports of the CIS were analysed with statistical software to perform an analysis of data quality. Results The quality of life questionnaires are now regularly documented by patients and physicians. The resulting data is available in the Electronic Health Record (EHR) and can be used for treatment purposes and communication as well as research functionalities. The completion of questionnaires by the patients themselves using a mobile device (iPad) and the import of the respective data into the CIS forms were successfully tested in a pilot installation. The quality of data is rendered high by the use of automatic score calculations as well as the automatic creation of forms for follow-up documentation. The QoL data was exported to research databases for use in scientific analysis. Conclusion The CIS-based QoL is technically feasible, clinically accepted and provides an excellent quality of data for medical treatment and clinical research. Our approach with a commercial CIS and the web-based application is transferable to other sites.
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Affiliation(s)
- Fleur Fritz
- Institute of Medical Informatics, University Münster, Domagkstrasse 9, 48149 Münster, Germany.
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Breil B, Semjonow A, Müller-Tidow C, Fritz F, Dugas M. HIS-based Kaplan-Meier plots--a single source approach for documenting and reusing routine survival information. BMC Med Inform Decis Mak 2011; 11:11. [PMID: 21324182 PMCID: PMC3053219 DOI: 10.1186/1472-6947-11-11] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 02/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival or outcome information is important for clinical routine as well as for clinical research and should be collected completely, timely and precisely. This information is relevant for multiple usages including quality control, clinical trials, observational studies and epidemiological registries. However, the local hospital information system (HIS) does not support this documentation and therefore this data has to generated by paper based or spreadsheet methods which can result in redundantly documented data. Therefore we investigated, whether integrating the follow-up documentation of different departments in the HIS and reusing it for survival analysis can enable the physician to obtain survival curves in a timely manner and to avoid redundant documentation. METHODS We analysed the current follow-up process of oncological patients in two departments (urology, haematology) with respect to different documentation forms. We developed a concept for comprehensive survival documentation based on a generic data model and implemented a follow-up form within the HIS of the University Hospital Muenster which is suitable for a secondary use of these data. We designed a query to extract the relevant data from the HIS and implemented Kaplan-Meier plots based on these data. To re-use this data sufficient data quality is needed. We measured completeness of forms with respect to all tumour cases in the clinic and completeness of documented items per form as incomplete information can bias results of the survival analysis. RESULTS Based on the form analysis we discovered differences and concordances between both departments. We identified 52 attributes from which 13 were common (e.g. procedures and diagnosis dates) and were used for the generic data model. The electronic follow-up form was integrated in the clinical workflow. Survival data was also retrospectively entered in order to perform survival and quality analyses on a comprehensive data set. Physicians are now able to generate timely Kaplan-Meier plots on current data. We analysed 1029 follow-up forms of 965 patients with survival information between 1992 and 2010. Completeness of forms was 60.2%, completeness of items ranges between 94.3% and 98.5%. Median overall survival time was 16.4 years; median event-free survival time was 7.7 years. CONCLUSION It is feasible to integrate survival information into routine HIS documentation such that Kaplan-Meier plots can be generated directly and in a timely manner.
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Affiliation(s)
- Bernhard Breil
- Department of Medical Informatics, University Muenster, Domagkstraße 9, 48149 Münster, Germany.
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Herzberg S, Fritz F, Rahbar K, Stegger L, Schäfers M, Dugas M. HIS-Based Support of Follow-Up Documentation - Concept and Implementation for Clinical Studies. Appl Clin Inform 2011; 2:1-17. [PMID: 23616857 DOI: 10.4338/aci-2010-08-ra-0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 12/20/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Follow-up data must be collected according to the protocol of each clinical study, i.e. at certain time points. Missing follow-up information is a critical problem and may impede or bias the analysis of study data and result in delays. Moreover, additional patient recruitment may be necessary due to incomplete follow-up data. Current electronic data capture (EDC) systems in clinical studies are usually separated from hospital information systems (HIS) and therefore can provide limited functionality to support clinical workflow. In two case studies, we assessed the feasibility of HIS-based support of follow-up documentation. METHODS We have developed a data model and a HIS-based workflow to provide follow-up forms according to clinical study protocols. If a follow-up form was due, a database procedure created a follow-up event which was translated by a communication server into an HL7 message and transferred to the import interface of the clinical information system (CIS). This procedure generated the required follow-up form and enqueued a link to it in a work list of the relating study nurses and study physicians, respectively. RESULTS A HIS-based follow-up system automatically generated follow-up forms as defined by a clinical study protocol. These forms were scheduled into work lists of study nurses and study physicians. This system was integrated into the clinical workflow of two clinical studies. In a study from nuclear medicine, each scenario from the test concept according to the protocol of the single photon emission computer tomography/computer tomography (SPECT/CT) study was simulated and each scenario passed the test. For a study in psychiatry, 128 follow-up forms were automatically generated within 27 weeks, on average five forms per week (maximum 12, minimum 1 form per week). CONCLUSION HIS-based support of follow-up documentation in clinical studies is technically feasible and can support compliance with study protocols.
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