Process Coverage and Use Case Support of Health Registry Software in Germany.

Registries usually operate an IT-infrastructure supporting at least data management as one of the business processes. Several activities in Germany between 2007 and 2018 surveyed the market of respective software products. Combining a survey with representatives of software products with a workshop protocol of software demonstrations, a detailed insight into the market of IT-components arose. A comparison between 2015 and 2018 revealed little progress. The focus is still electronic data capture functionality. With the presented activities, rich material is available to assist registry developers in the planning of their IT-infrastructure and the selection of software products.

Survival benefit of tamoxifen and aromatase inhibitor in male and female breast cancer.

BACKGROUND: Our goal was to compare the survival advantage of tamoxifen (TAM) and aromatase inhibitor (AI) in female (FBC) and male breast cancer (MBC). PATIENTS AND METHODS: We performed a retrospective study of 2785 FBC and 257 MBC patients treated with hormonal therapy. RESULTS: The median follow-up was 106 months (range 3-151 months) and 42 months (range 2-115 months) for FBC and MBC, respectively. The patients were divided into two groups according to the hormonal therapy used: TAM-treated and AI-treated. MBC was characterized by older age, advanced tumor stage, and higher rate of lymph node metastases, in comparison with FBC. Matching analysis was performed using six prognostic criteria: patient age, tumor stage, tumor grade, lymph node status, human epidermal growth factor receptor (HER2) status, and administration of chemotherapy. The female and male patients were matched 2:1. In this analysis, 316 women and 158 men treated with TAM, and 60 women and 30 men treated with AI, were included. The overall survival (OS) was estimated by the Kaplan-Meier method and was compared between FBC and MBC. TAM-treated FBC and MBC patients had similar 5-year OS, 85.1 and 89.2%, respectively (p = 0.972). Notably, FBC patients treated with AI had significantly greater 5-year OS (85.0%) in comparison with AI-treated MBC patients (5-year OS of 73.3%; p = 0.028). CONCLUSIONS: The OS of TAM-treated patients with MBC was similar to the OS of TAM-treated FBC patients, whereas AI treatment is associated with poorer survival of MBC patients.

Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients.

To determine the impact of adjuvant treatment with tamoxifen and aromatase inhibitors (AI) on the survival of men with breast cancer. We analyzed 257 male patients with hormone-receptor-positive breast cancer from numerous German population-based cancer registries treated with tamoxifen (N = 207) or aromatase inhibitors (N = 50). The median follow-up was 42.2 (range 2-115) months. Median age at diagnosis was 68 (range 36-91) years. Thirty-seven (17.9 %) patients treated with tamoxifen and 16 (32.0 %) patients treated with AI died (log rank p = 0.007). After the adjustment for the patient's age, tumor size, node status, and tumor grading, the AI treatment was linked to a 1.5-fold increase in risk of mortality compared to tamoxifen (HR 1.55; 95 % CI: 1.13-2.13; p = 0.007). The overall survival in male breast cancer was significantly better after adjuvant treatment with tamoxifen compared to an aromatase inhibitor. Tamoxifen should be considered as the treatment of choice for hormone-receptor-positive male breast cancer.

A reference model for clinical tumour documentation.

The definition of common system semantics is an explicit and generally accepted precondition for comparability and exchangeability of data from different systems. We have looked back on 15 years of experience with a data model that was developed in a co-operative effort by experts from various hospital cancer registries as the foundation of a new tumour documentation system (GTDS). The data model is based on the definition of a common basic data set for hospital cancer registries which is agreed by the German Association of Comprehensive Cancer Centres (ADT). This paper presents an "entity relationship" view of this model. Since data exchange among registries and with hospital or practice information systems is becoming increasingly important we describe our method to import data from such systems. We discuss the requirements that systems have to have for a most effective way of exchanging data with a hospital cancer registry. The most important feature is the possibility to associate disease phenomena and therapies with each other and with an entity that represents the tumour across encounters. The reference model we present respectively the requirements we propose for other communicating systems might also fit for other chronic diseases.

Representation of medical informatics in the wikipedia and its perspectives.

A wiki is a technique for collaborative development of documents on the web. The Wikipedia is a comprehensive free online encyclopaedia based on this technique which has gained increasing popularity and quality. This paper's work explored the representation of Medical Informatics in the Wikipedia by a search of specific and less specific terms used in Medical Informatics and shows the potential uses of wikis and the Wikipedia for the specialty. Test entries into the Wikipedia showed that the practical use of the so-called WikiMedia software is convenient. Yet Medical Informatics is not represented sufficiently since a number of important topics is missing. The Medical Informatics communities should consider a more systematic use of these techniques for disseminating knowledge about the specialty for the public as well as for internal and educational purposes.

XML-based application interface services--a method to enhance integrability of disease specific systems.

Disease specific systems usually offer excellent functionality for the management of the covered diseases. But the restriction to a certain disease often hampers their wide spread use since they are not optimised for clinical workflow. The Giessener Tumordokumentationssystem (GTDS) is a disease specific system that is not only designed for the use in tumour registries but also to support clinical care. In order to integrate it into hospital information systems, we implemented standard communication interfaces. However, interfaces are not satisfactory since they do not consider aspects of the normal workflow of a clinical user. Therefore, we developed a strategy that should ease the access to the system in the environment of existing systems. From the technical point of view, XML with its capabilities to represent even complex data in a rather simple way helped to implement this strategy. We use XML to communicate with API-like services and created a WWW environment to demonstrate the access to these services. Since HTML based access itself is a means to integrate systems, we intend to expand this environment to an appropriate region based means to improve the communication with registries. Another application using the services is the transfer of data between two registries with common patients.

Plug-and-play XML: a health care perspective.

The application of XML (Extensible Markup Language) is still costly. The authors present an approach to ease the development of XML applications. They have developed a Web-based framework that combines existing XML resources into a comprehensive XML application. The XML framework is model-driven, i.e., the authors primarily design XML document models (XML schema, document type definition), and users can enter, search, and view related XML documents using a Web browser. The XML model itself is flexible and might be composed of existing model standards. The second part of the paper relates the approach of the authors to some problems frequently encountered in the clinical documentation process.