General Clinical Information Research Articles

Risk factors of adverse pregnancy outcomes during expectant management of early onset severe pre-eclampsia

To identify the risk factors of adverse pregnancy outcomes in expectant management of pregnant women with early onset severe pre-eclampsia (EOSP). Totally, 136 gravidas, who were diagnosed as ESOP and received expectant management from January 2007 to June 2008 in Beijing Obstetrics and Gynecology Hospital, were selected and divided into two groups: the favorable pregnancy outcome group (control, n = 101) and the adverse pregnancy outcome group (n = 35). The general clinical information, pregnancy outcomes, routine urine test, hemodynamic data, routine blood test, liver and renal function test on admission were collected and the risk factors for adverse outcomes were retrospectively analyzed. (1) General clinical information: more women complained of preeclamptic symptoms on admission in the adverse outcome group than in the control group (35.6% vs. 57.1%, P < 0.05). No significant differences was found between the two groups in the maternal age, times of previous pregnancies, prevalence of concurrent complications, pre-pregnant body mass index (BMI), proportion of women who had regular antenatal checks (P > 0.05). (2) Pregnant outcomes: the average duration of expectant management in the control group were similar to the adverse outcomes group [(6.5 +/- 8.2) days vs. (6.8 +/- 10.0) days, P > 0.05]. The main complications in the adverse outcome group included placental abruption (n = 13), heart failure and pulmonary edema (n = 10), hemolysis, elevated liver enzymes and low platelet syndrome (HELLP syndrome, n = 5), and no eclampsia was reported. However, none of these complications was reported from the control group. (3) Blood pressure and proteinuria: the gestation ages at the onset of EOSP and at delivery in the control group were earlier than those of the adverse outcome group [(31.3 +/- 3.4) weeks vs. (33.0 +/- 4.9) weeks, (32.1 +/- 3.0) weeks vs. (34.0 +/- 3.6) weeks, P < 0.05], the systolic blood pressure and urinary protein and the proportion of women with urinary protein of (+++) were also much higher in the adverse outcome group (all P < 0.05). (4) Hemodynamics and routine blood tests: the blood viscosity in the control group was obviously lower than that of the adverse outcome group (P < 0.05). But there was no significant difference in the cardiac output, cardiac index, peripheral resistance and vascular compliance between the two groups (P > 0.05). The adverse outcome group showed lower platelet (PLT) level and higher red blood cell (RBC) count and hematocrit compared with those of the control (all P < 0.01). (5) Liver and renal function: the alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), blood urea nitrogen (BUN) in the adverse outcome group were significantly higher than those of the control group (all P < 0.05), but the plasma level of total protein (TP), albumin (Alb), uric acid (UA) and creatinine (Cr) were similar between the two groups (P > 0.05). (6) Risk factor analysis: RBC count (OR = 3.68, 95%CI: 1.90-7.13), PLT count (OR = 0.99, 95%CI: 0.98-1.00) and the gestations at delivery (OR = 0.87, 95%CI: 0.80-0.94) were the risk factors of adverse pregnancy outcomes during the expectant management of EOSP. Elevated RBC count, reduced PLT count and earlier delivery weeks are the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.

Policy Adjuster-driven Grid Workflow Management for Collaborative Heart Disease Identification System

Abstract: This paper proposes a policy adjuster-driven Grid workflow management system for collaborative healthcare platform, which supports collaborative heart disease diagnosis applications. To select policies according to service level agreement of users and dynamic resource status, we devised a policy adjuster to handle workflow management polices and resource management policies using policy decision scheme. We implemented this new architecture with workflow management functions based on policy quorum based resource management system for providing poincare geometry-characterized ECG analysis and virtual heart simulation service. To evaluate our proposed system, we executed a heart disease identification application in our system and compared the performance to that of the general workflow system and PQRM system under different types of SLA. Keywords: Grid Worfklow, Collaborative Healthcare Platform, SLA, Policy Adjuster 1. Introduction There have been many attempts to create healthcare system or platform by combining the existing medical service with IT such as sensor and communication technology. In other words, the general health clinical data and information are exchanged electronically, and the patient, doctor, hospital and laboratories can be connected through communication network to perform medical practices. Such healthcare system is enabled and supported by IT, yet the core technology will be high-speed information exchange technology and high performance computing technology in distributed environment. Grid technology can meet these requirements by bringing heterogeneous resources together and allocating them efficiently to applications. Medical applications are no longer restricted to one medical institute. Some collaborated applications like heart disease simulator, an instance of workflow jobs, require several resources work together. So the healthcare platform requires collaborative job scheduling function based on resource status which is the core part of Grid resource management system [2][3]. However, the complexity of resource management for QoS guarantee in Grid significantly increases as the grid computing grows. One of the promising approaches trying to solve this problem is policy based resource management system [2] that is suitable to the complex management environments. To manage resource in Grid, it is required to have a sort of grid resource broker and scheduler that manage resources and jobs in the virtual Grid environment. Authors in [3] suggested policy-based resource management system (PQRM) architecture by consideration of Grid Service Level Agreement (SLA) and abstract architecture of grid resource management. In medical healthcare environment, beside most of single-program applications, there exist many applications which require co-process of many programs following a strict processing order. Since these applications are executed on Grid, they are called Grid workflows. Current Grid resource management systems do not consider complexity of collaborative medical applications and service level guarantee at workflow level. In this paper, we propose Grid workflow-driven healthcare platform for collaborative applications. In the sense of optimum management, PQRM [5] provides optimum resource quorum for applications, so we develop workflow-Integrated PQRM as one instance for this workflow-driven healthcare platform. PQRM’s available resource quorum is optimum resource set in resource management point of view and our workflow-driven system can provide optimum resource set in workflow management point of view. Two management philosophies require a policy decision scheme to adjust based on user’s SLA. We evaluate the proposed workflow-driven healthcare platform by measuring the completion time of collaborative heart disease simulator under different types of user SLA. DOI : 10.3745/JIPS.2008.4.3.103

The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use

Background: Inappropriate medication prescribing is a significant problem among older adults that may contribute to increased morbidity and mortality as well as increased costs of care. The development of specific lists of medications that are considered potentially inappropriate for older adults, such as the Beers criteria (BC), make it relatively easy to study prescribing practices in large numbers of patients. Objective: The goal of this study was to determine how frequently adverse drug events (ADEs) in the acute care setting are related to BC medications and to determine if BC medication prescribing is significantly associated with the occurrence of ADEs and other negative outcomes in older hospitalized adults. Methods: This was a retrospective review of patients aged ≥75 years admitted to 2 adult internal medicine services over 18 months (March 2000–August 2001). Data regarding general demographic and clinical information were collected; this information included place of residence before admission and at discharge; medications at admission, during the hospital stay, and at discharge; ADEs; length of stay; and in-hospital mortality Patient medical records were used to determine the occurrence of ADEs. Results: A total of 389 patients (68.9% female; mean age, ∼79 years) were included. Of these 389 eligible patients, 107 (27.5%) were prescribed a total of 116 BC medications, and 124 (31.9%) experienced a total of 131 ADEs. Only 9.2% (12/131) of the ADEs were attributed to medications listed among the BC. After controlling for covariates, prescription of a BC medication was not significantly associated with experiencing an ADE (adjusted odds ratio [OR], 1.51; 95% CI, 0.98–2.35; P = 0.064), length of stay (adjusted OR, 1.03; 95% CI, 0.64-1.63; P = 0.91), discharge to higher levels of care (adjusted OR, 1.39; 95% CI, 0.82–2.34; P = 0.22), or in-hospital mortality (adjusted OR, 1.49; 95% CI, 0.77–2.92; P = 0.24). Conclusions: Interventions targeted specifically at BC medications would have seemingly done little to change the risk of ADEs in this population. Interventions that are more comprehensive than the BC are necessary to reduce the risk of ADEs and the associated morbidity and mortality in acute care of the elderly.

THE LEVELS OF 15 SLE ASSOCIATED AUTOANTIBODIES IN SERUM AND THEIR CLINICAL VALUES

Objective: To explore the levels of 15 SLE-associated autoantibodies in serum samples from 71 healthy individuals and 20 new SLE patients, and to discuss their clinical values for SLE. Methods: 15 SLE-associated autoantibodies were detected in serum of 71 healthy individuals and 20 new SLE patients by ELISA methods. General information and clinical information were collected. The 32 controls were selected from the healthy individuals. The levels of each autoantibody in each group and their correlations were described, the clinical roles of the autoantibodies were analysed, while their roles for SLE diagnosis were discussed. Results: In the normal group, at least one autoantibodies were detected positive in 10 individuals(14.1%), the positive numbers of anti-ssDNA and anti-β2GP1 were the highest. The OD450 of anti-MPO in males were higher than that in females; significant differences were found for AHA and other 5 autoantibodies among different age groups. Positive rank correlation were found between 24 autoantibodies pairs, and negative rank correlation between 3. In the case group, 0 to 8 auantibodies were detected positive for a same patient, 4 auantibodies were negative. The anti-ssDNA's positive rate (85%) was the highest, there were positive rank correlation between the autoantibodies in 19 pairs. Positive rank correlation were found between the number of positive autoantibodies and disease duration. There were significant associations of rRNP with photaesthesia and of AHA with nephritis. When the early appearance of clinical manifestation was analysed, there were significant associations of AnuA with discoid erythema and of anti-U1RNP with photaesthesia and of anti-Sm with nephritis and of anti-β2GP1 with other clinical manifestations. There were no significant difference of anti-centromeres and anti-β2GP1 between the case and control group. For the autoantibodies clinical value, the sensitivities of anti-ssDNA and other three autoantibodies were high, the specificities of AHA and other nine autoantibodies were high. While the Youden's index of anti-ssDNA being highest. The strength of agreement comparison for diagnosis were high in anti-dsDNA and AnuA and other four autoantibodies pairs. The AUCROC of anti-U1RNP was the highest, while 13 autoantibodies were effective for the diagnosis for SLE expect for ACA and anti-β2GP1. As for the antibody combinations, the anti-centromeres were frequently involved in the establishes functions which coincidence were high. 5 autoantibodies were involved in the stepwise establishes functions with coincidence being 96.7%. Conclusions: These autoantibodies were rarely detected in the normal group, there were significant differences between different age and gender groups for these autoantibodies. There were positive correlations between most of the autoantibodies pairs. The levels of 13 autoantibodies in the case group were significantly greater than that in the control group. Most of the autoantibodies were related with the specified clinical manifestations for SLE. 13 autoantibodies were effective for the diagnosis for SLE. Anti-U1RNP and anti-centromeres were important for the diagnosis for SLE. The coincidence of the stepwise establishes functions was high.

Three steps to data quality.

The quality of data in general practice clinical information systems varies enormously. This variability jeopardizes the proposed national strategy for an integrated care records service and the capacity of primary care organisations to respond coherently to the demands of clinical governance and the proposed quality-based general practice contract. This is apparent in the difficulty in automating the audit process and in comparing aggregated data from different practices. In an attempt to provide data of adequate quality to support such operational needs, increasing emphasis is being placed on the standardisation of data recording. To develop a conceptual framework to facilitate the recording of standardised data within primary care. A multiprofessional group of primary care members from the South Thames Research Network examined leading guidelines for best practice. Using the nominal group technique the group prioritized the information needs of primary care organisations for managing coronary heart disease according to current evidence. Information needs identified were prioritized and stratified into a functional framework. It has been possible within the context of a primary care research network to produce a framework for standardising data collection. Motivation of front-line clinicians was achieved through the incorporation of their views into the synthesis of the dataset.

Good clinical practice in east Africa: a review.

To call for harmonisation of good clinical practice guidelines in East Africa as one of the necessary precedents to enhancing their quality and quantity in the region. There were two main sources of background information for this review. The first was a series of articles discussing and documenting the harmonisation process in East Asia and in Latin America. The other was a short survey conducted in Kenya in July 2000. STUDY AREA SELECTION: Most of the survey participants were drawn from the Kenya Medical Research Institute (KEMRI) in Nairobi, Kisumu and Kilifi with a few coming from the vicinity of these areas. DATA PROCESSING AND ANALYSIS: The survey tool was a fourteen page questionnaire seeking information in various areas. These were: personal information, general clinical research information, medical practitioners, clinical research experience, human subject participation, sponsors, clinical trial supplies, investigator sites and general comments. Data entry was performed in Microsoft Access. Forty four researchers participated in a period of three weeks. Data summaries and reports were performed in SAS. The advancing capacity for clinical research in East Africa will be accelerated by harmonising clinical research requirements and guidelines.

A framework for evaluating e-health: Systematic review of studies assessing the quality of health information and services for patients on the Internet

A framework for evaluating e-health: Systematic review of studies assessing the quality of health information and services for patients on the Internet

A framework for evaluating e-health: Systematic review of studies assessing the quality of health information and services for patients on the Internet

A framework for evaluating e-health: Systematic review of studies assessing the quality of health information and services for patients on the Internet

Iontophoresis--recent developments.

This paper addresses the development and optimization of the technology of iontophoresis as a non-invasive approach to transdermal diagnosis and therapy. The rationale for this work is that the skin offers a unique and easily accessible body surface through which drugs can be delivered and general clinical monitoring information can be extracted.

Recognising meningococcal disease in primary care: qualitative study of how general practitioners process clinical and contextual information

Objectives: To describe the presentation of meningococcal disease in primary care; to explore how general practitioners process clinical and contextual information in children with meningococcal disease; and to describe how...