A data model to support the evaluation of coordinating care EU programmes in the context of the ACT programme.

Advancing Care Coordination and Telehealth Deployment (ACT) is a European Union (EU) project, completed last October, which has developed a framework for evaluating and improving pioneering health care programs regarding coordinating care and telehealth (CC & TH) across specific EU regions. In this paper we present the key design decisions of the project's data model and the challenges faced. We focus on the definition of the multi-dimensional indicators in order to overcome data incompleteness and heterogeneity issues. Finally, we also suggest a graph based approach that could facilitate development of such data models in similar projects.

Interoperability and HealthGRID.

OBJECTIVES: GRID technology, with initiatives like the GGF, will have the potential to allow both competition and interoperability not only among applications and toolkits, but also among implementations of key services. The pyramid of eHealth interoperability should be achieved from standards in communication and data security, storage and processing, to the policy initiatives, including organizational protocols, financing procedures, and legal framework. The open challenges for GRID use in clinical fields illustrate the potential of the combination of grid technologies with medical routine into a wider interoperable framework. METHODS: The Telemedicine Alliance is a consortium (ESA, WHO and ITU), initiated in 2002, in building a vision for the provision of eHealth to European citizens by 2010. After a survey with more that 50 interviews of experts, interoperability was identified as the main showstopper to eHealth implementation. RESULTS: There are already several groups and organizations contributing to standardization. TM-Alliance is supporting the "e-Health Standardization Coordination Group" (eHSCG). CONCLUSIONS: It is now, in the design and development phase of GRID technology in Health, the right moment to act with the aim of achieving an interoperable and open framework. The Health area should benefit from the initiatives started at the GGF in terms of global architecture and services definitions, as well as from the security and other web services applications developed under the Internet umbrella. There is a risk that existing important results of the standardization efforts in this area are not taken up simply because they are not always known.

Intraoral reconstruction with the nasolabial island flap. A modified technique.

The nasolabial flap has been used for intraoral reconstruction since last century. In this paper, a modification is proposed in order to increase the amount of skin available in male patients. Simple closure of the donor area is not possible and a cheek rotation flap is suggested for closure.

[Treatment of acute tuberculous meningitis]. / Tratamiento de las meningitis tuberculosas agudas.

Authors present their experience in 4 children with acute tuberculous meningitis. All of them were in deep coma, with abnormal motor responses, documented increased intracranial pressure and severe hydrocephallia. External ventricular drainage during 18 to 35 days, plus specific antituberculous treatment was performed in all of them without untoward effects. Clinical evolution was excellent. This particular type of tuberculous meningitis and its' physiopathology are reviewed. Importance of computed cranial tomography in early diagnosis and treatment and follow up evaluation are stressed.

[Diabetic food competition. Another way of teaching]. / Concurso de comida para diabéticos. Otra forma de educar.

OBJECTIVE: To employ a different and appetizing method of food education. DESIGN: A descriptive, crossover, observational study. SETTING: Las Fuentes Norte Health Centre, Zaragoza, jointly with a civic centre in the neighbourhood. PARTICIPANTS: 54 people out of a population of 492,521 (over 15). One was excluded and 21 dishes were chosen. INTERVENTION: Composing posters with a day's complete menu, including one of the dishes chosen in each menu. Choice of the three best dishes presented. RESULTS: 18.8% of the dishes selected were proposed by diabetics (with a mean of 387.22 +/- 150.72 calories, SD 171.95, with 30.74% proteins, 25.59% lipids and 43.65% CH). 24.5% were proposed by carers (mean of 378.1 +/- 103.86 calories, SD 118.65, with 30.89% proteins, 31.11% lipids and 37.99% CH). 30% were proposed by members of diabetics' families (mean of 197.43 mame 149.33 calories, SD 152.38, with 36.3% proteins, 20.07% lipids and 43.61% CH). 26.5% of dishes bore no relationship to this disease (mean of 422.15 +/- 148.09 calories, SD 199.91 and 31.15% proteins, 34.23% lipids and 34.6% CH), with no statistical significance between the different groups. Using the data of the means calculated as a basis, we obtained a meal of 1,141.3 calories with 29.3% proteins, 29.6% lipids and 41.1% CH. CONCLUSIONS: Combining the results in one meal would not only give a high amount of calories, but a high proportion of proteins, mainly at the expense of CH.