Electronic medical file exchange between on-duty care providers and the attending paediatrician: a Belgian paediatric pilot project.

The authors propose the introduction of a pilot project: "paediatric core file exchange in emergencies" (PCF-EXEM) which enables the exchange of medical data between the attending paediatrician (AP), holder of the medical record, and on-duty medical units (i.e. general practitioners, paediatricians, surgeons, emergency physicians,...). This project is based on two pillars: a protected server (PCF-server) containing paediatric core files (PCF), with important clinical data that should be available for the physician in order to quickly get a clear insight into the relevant clinical medical history of the child, and secondly, the possibility to provide feedback to the attending physician about the findings recorded during the on-call duty. The permanent availability of health data on the PCF-server and the possibility to provide feedback represent together the PCF-EXEM-project. This project meets the demand of the care providers to have relevant medical information permanently available in order to guarantee high quality care in emergency situations. The frail balance between the right to informative privacy and professional confidentiality on the one hand and the right to quality health care on the other hand has been taken into account. The technical and practical feasibility of this project is described. The objectives and vision of the PCF-EXEM project are conform to Belgian legislation concerning the processing of medical data and are in line with the still under consideration European projects which are focusing on interoperability and the development of a common access control to databanks containing health data for care providers. PCF-EXEM could therefore be a model for other EU countries as well.

Validity of an information and communication technology system for data capture in epidemiological studies.

The Belgian National Institute of Health Insurance is implementing an oral health data registration and surveillance system. This study aimed to develop and validate a system of electronic data capture for oral health surveys at a national level - Oral Survey-B - and to identify the advantages and disadvantages of the electronic system in comparison with the traditional handwritten data capture. Six series of full-mouth recordings simulating the clinical examination of 6 patients were set up in a Powerpoint presentation. The validation was undertaken by 52 general practitioners. A randomized one-period crossover design was used with two formats of data capture, i.e. electronic followed by handwritten or handwritten followed by electronic system. Further, 6 benchmarked handwritten forms were transferred to the electronic format. For the electronic data capture, 86.5% of the practitioners had a correct completion rate of ≥95%. The corresponding value for the handwritten data capture and transfer was 78.8% (p = 0.25, McNemar test). The overall accuracy of forms without any error was 73.4% for the electronic and 62.5% for the handwritten data capture (p < 0.001, signed-rank test). Significantly lower percentages of errors and less time were observed for the electronic data capture (p < 0.001, signed-rank test). Practitioners considered the electronic data capture as being much more difficult to carry out (p < 0.001). As information technology has turned into an ever more necessary working tool in epidemiology, there should be an important potential for uptake of further improvements in electronic data capture in the future.

MedSkills: a learning environment for evidence-based medical skills.

OBJECTIVES: EBP (evidence-based practice) is becoming the standard paradigm in modern healthcare. Therefore different healthcare providers have the need for easily accessible evidence-based information. The Internet creates new opportunities to fill the gaps in education that are experienced by healthcare workers. Contributing to solutions and filling in the needs in the above-mentioned scope, the University of Brussels initiated a European project called MedSkills in 2004. METHODS: MedSkills' main goal was to create a copyright-free reference work containing valuable evidence-based information on medical skills for all levels of healthcare professionals (paramedics, nurses and physicians, teachers of medical skills and students). RESULTS: We succeeded in designing and creating a framework to suit the requirements of different users, in 'cellular', 'organ', 'body' and 'best treatment' content maps. A wiki tool was installed to allow the project to be built and in order to maintain itself. CONCLUSIONS: This multi-professional and international initiative, unique in its kind aims at contributing to a gold standard for European healthcare, via the creation of a freely available, consistent and updatable evidence-based teaching environment.

Internet and nuclear medicine.

This paper aims in analyzing the effectiveness of the technological impact of internet technology on nuclear medicine. To make this evaluation we will first determine what we consider is the 'internet technology' and then see how the 'production line' in nuclear medicine benefits from this internet technology, putting both side by side.

Optimal sample frequency in computerized rhinomanometry. Development and method.

The authors studied the pressure/flow signals generated during active anterior rhinomanometry of 25 subjects, presenting a normal transnasal breathing. By means of a Fourier transformation, the frequency content of these signals was analyzed. This investigation demonstrated clearly that signals with a frequency of more than 50 Hz no longer yield any further information about the transnasal ventilation.

[Statistical value of the various mathematical models in rhinomanometry]. / Statistische waarde van de verschillende mathematische modellen in de rhinomanometrie.

By means of rhinomanometry, analogue physiological transnasal pressure and corresponding flow signals are simultaneously recorded during quiet nasal breathing. In order to describe the sigmoid shaped pressure/flow curves or relationship, several mathematical models have been developed. In this study, the authors wanted to demonstrate which model best describes the curvilinearity of the pressure/flow curves. By their approach, they found that polynomial models like delta p = K0 + K1V + K2V2 as well as the Broms' polar coordinate model best fit the recorded pressure/flow data. Since the parameters and exponents of such a model characterize the degree of laminar and turbulent behaviour of transnasal flow, a diagnostic potential may be offered in the future, to qualify and quantify the phenomenon of nasal obstruction.

[Attempt to adapt measurement of serum iron levels to the Centrifichem with a direct method using bathophenanthroline sulfonate-guanidine. Value and limits]. / Essai d'adaptation du dosage du fer sérique sur Centrifichem par une méthode directe à la bathophénanthroline sulfonée-guanidine. Intérêt et limites.

The authors have studied a direct automated colorimetric determination of iron serum on Centrifichem. Accuracy and linearity are the same than these obtained by the SFBC recommended method. Precision is poor: the coefficient of variation is about 15% for low values. No alteration in the absorbance is recognized by bilirubin, even in the serum which contains 342 mumol.l-1 of bilirubin. The value of serum iron increases significantly as hemoglobin and copper are added to the serum.

Specific cytochemical stains in the image analysis of subcellular organelles.

This paper describes our work concerning densitometry and morphometry of subcellular structures in thin sections. The techniques of automatic image analysis were applied to light and electron microscopic observations of enzymatically stained lysosomes, renal brush borders and mitochondria (in human and rat kidney) and peroxisomes (in human liver). To obtain significant measurements of the enzymatic activity, specific staining techniques were developed and applied, including an improved staining of acid phosphatase for lysosomes. Optical densities were obtained by videodensitometry and electron densities of peroxisomes were obtained by digitizing and processing scanning transmission electron microscopic images. In subsequent steps, delineations and parameter estimation are performed by software. Included was an examination of delineation techniques, which showed improved results from the use of a newly developed local boundary search algorithm. The combination of these techniques was used to study changes in peroxisome and lysosome compartment in liver and kidney, some results of which are also reported.

[Detection of hyperamylasuria. Value of a quick test]. / Dépistage d'une hyperamylasurie. Intérêt d'un test rapide.

A new reactive strip was used in a hospital admission unit, to detect amylasuria in the urine of 76 patients consulting for abdominal pain (population A) and of 68 unselected patients (population B). Detection on admission by this method was concordant with subsequent laboratory detection in 93% of the cases. The fast test was positive for amylasuria in 17 patients: 13 (17.1%) in population A and 4 (5.9%) in population B. The 8 patients recorded as "+" had moderate amylasuria with multiple but ill-defined symptoms mostly abdominal. The 9 patients recorded as "++" had marked amylasuria highly suggestive of an abdominal disease, including 4 cases of chronic pancreatitis.

A computerized mathematical model of arterial thrombi recorded by light transmission.

For several years, the formation and evolution of thrombi in small arteries of rats has been quantitatively studied at the laboratory of PHYSIOLOGY and PHYSIOPATHOLOGY at the V.U.B. Global size parameters can be determined by projecting the image of a small arterial segment onto photosensitive cells. The transmitted light intensity is a measure for the thrombotic phenomenon. This unique method permitted extensive in vivo study of the platelet-vessel wall interaction and local thrombosis. We actually attempt to refine the spatial resolution of these measurements in order to get information on texture and form of the thrombotic mass at any stage of its evolution. Therefore a thorough understanding of how light propagates through non hemolyzed blood is essential. Application of results from Twersky's multiple scattering theory, combined with appropriate border conditions and parameter values was attempted. It is well known that the erythrocytes are mostly aligned in the direction of the blood flow. In order to explain the measured intensity profiles, we had to postulate alignment in the plane perpendicular to the flow as well. The theoretical predictions are in good agreement with the experimental values if we assume almost perfect alignment of the erythrocytes such that their short axes are pointing in the direction of the center of the artery. Conclusive evidence of the interaction between local flow properties and light transmission could be found by observing arteries with perturbated flow.

Continuous assay of serum 5-nucleotidase activity with inosine 5'-monophosphate as substrate and total automation using a transfer-analyzer (Kem-O-Mat).

The continuous spectrophotometric assay of 5'-nucleotidase originally described by Heinz et al. ((1980) J. Clin. Chem. Clin. Biochem. 18, 781-788) was modified and fully automated on a Kem-O-Mat transfer analyzer, using inosine 5'-monophosphate as substrate. The reaction product was hydrogen peroxide and the reduction of NADP was observed for 10 minutes at 340 nm and at a reaction temperature of 30 degrees C. The different factors involved in the enzyme reaction were checked, including the substrate concentration, reaction rate, linearity and substrate preservation. Normal values ranged from 1 to 13 U/l. Between-day reproducibility was estimated with two different commercial control sera, and the coefficient of variation was 5% for the upper limit of normal activity (23 U/l). There was good agreement between the present method and a semi-automatic colorimetric technique (for 100 sera tested by both methods, the correlation coefficient was 0.974 and the regression line equation, y = 0.85 x- 1.5). Despite the lengthy reagent mixture preparation procedure, the method permitted assay of 50 samples per hour. The occurrence of high serum blanks in certain pathological states is discussed.

Single line CCD camera to improve positioning.

This article describes an opto-electronic device that allows on-line visualization of the optical intensity function along a strip. The use of a linear optical charge-coupled device (CCD) array eliminates all moving parts. This makes adaptation to a standard microscope possible without modifications. The setup described here is essential where precise positioning of a reference graticule on diffuse lines must be performed.