Challenges and Approaches to Make Multidisciplinary Team Meetings Interoperable - The KIMBo Project.

BACKGROUND: Multidisciplinary team meetings (MDTMs) are already in use for certain areas in healthcare (e.g. treatment of cancer). Due to the lack of common standards and accessibility for the applied IT systems, their potential is not yet completely exploited. OBJECTIVES: Common requirements for MDTMs shall be identified and aggregated into a process definition to be automated by an application architecture utilizing modern standards in electronic healthcare, e.g. HL7 FHIR. METHODS: To identify requirements, an extensive literature review as well as semi-structured expert interviews were conducted. RESULTS: Results showed, that interoperability and flexibility in terms of the process are key requirements to be addressed. An architecture blueprint as well as an aggregated process definition were derived from the insights gained. To evaluate the feasibility of identified requirements, methods of explorative prototyping in software engineering were used. CONCLUSION: MDTMs will become an important part of modern and future healthcare but the need for standardization in terms of interoperability is imminent.

Prefetching of medical imaging data across XDS affinity domains.

Prior studies as well as medical imaging data are crucial for a radiologist to diagnose a patient. In this paper the radiological workflow is analyzed from a patient's perspective in order to gain knowledge on how possible existing prefetching strategies still can be applied in connection with a standardized distributed health information system conforming to architectures defined by IHE and ELGA. As a result an adaption to such architectures is proposed and further evaluated in a testing environment. Although the approach presented works in terms of prefetching relevant prior studies together with medical imaging data, additional research has to be carried out on how to apply intelligent search strategies in order to narrow retrieved results concerning their possible utilization for a specific diagnosis.

Opioid receptors on white blood cells: effect of HIV infection and methadone treatment.

Opioid receptors (OR) are involved in many physiological and pathological immune functions. During recent years, the treatment of opiate addiction with methadone in HIV-positive and HIV-negative patients has become widely accepted. However, little is known on the occurrence and course of OR on lymphocytes of these individuals. The objective of the study was to detect and quantify OR on peripheral white blood cells (WBC) by fluorescence-activated cell sorting using polyclonal antibodies and reverse transcriptase polymerase chain reaction, and to assess the influence of HIV infection and methadone treatment. We compared OR levels in 80 HIV-positive homosexuals, 18 HIV-positive intravenous drug users (IVDU) treated with methadone, 18 HIV-negative IVDU receiving methadone and 25 healthy controls. HIV infection was shown to decrease the amount of OR on WBC, especially of the delta-subtype on lymphocytes and granulocytes. The decrease correlated with the duration of HIV-infection (P<0.01), and inversely with the HIV viral load (P<0.01). In contrast, chronic methadone administration led to a significant increase of OR exclusively in HIV-negative IVDU. In particular the delta-OR was increased by 31-, 62- and 42-fold on lymphocytes, monocytes and granulocytes of HIV-negative patients (each P<0.005), respectively, which was not observed in HIV-positive IVDU. Therefore, HIV seems to reduce OR particularly on lymphocytes and granulocytes regardless of the mode of HIV transmission. The quantification of OR on immune cells may help to elucidate the effects of opioid analogues in health and drug addiction.

Course of HIV disease does not depend on risk group: 7.5-year follow-up in 296 patients.

Several reports on the course and progression of HIV infection with regard to the mode of transmission have yielded different results. Since comparative studies of homosexuals and intravenous drug abusers are rare, we wanted to determine the course of HIV infection and survival in an HIV-seropositive patient cohort in a retrospective study at a single tertiary care referral centre. Two hundred and ninety-six HIV patients infected by one of the three predominant modes of HIV transmission (male homosexual contact, n = 193; injecting drug use, n = 64; or heterosexual contact, n = 39) were analysed. Using multivariate Cox regression analysis the overall survival did not depend on the patient's risk group. However, with regard to antiretroviral therapy, monotherapy was shown to shorten patients' lives, whereas only triple-therapy led to prolonged survival, when treatment usage was incorporated as a time-updated covariate. The course of HIV disease in a cohort study outside of clinical trials seems not to depend on the mode of transmission.

The role of singlet oxygen and oxygen concentration in photodynamic inactivation of bacteria.

New antibacterial strategies are required in view of the increasing resistance of bacteria to antibiotics. One promising technique involves the photodynamic inactivation of bacteria. Upon exposure to light, a photosensitizer in bacteria can generate singlet oxygen, which oxidizes proteins or lipids, leading to bacteria death. To elucidate the oxidative processes that occur during killing of bacteria, Staphylococcus aureus was incubated with a standard photosensitizer, and the generation and decay of singlet oxygen was detected directly by its luminescence at 1,270 nm. At low bacterial concentrations, the time-resolved luminescence of singlet oxygen showed a decay time of 6 +/- 2 micros, which is an intermediate time for singlet oxygen decay in phospholipids of membranes (14 +/- 2 micros) and in the surrounding water (3.5 +/- 0.5 micros). Obviously, at low bacterial concentrations, singlet oxygen had sufficient access to water outside of S. aureus by diffusion. Thus, singlet oxygen seems to be generated in the outer cell wall areas or in adjacent cytoplasmic membranes of S. aureus. In addition, the detection of singlet oxygen luminescence can be used as a sensor of intracellular oxygen concentration. When singlet oxygen luminescence was measured at higher bacterial concentrations, the decay time increased significantly, up to approximately 40 micros, because of oxygen depletion at these concentrations. This observation is an important indicator that oxygen supply is a crucial factor in the efficacy of photodynamic inactivation of bacteria, and will be of particular significance should this approach be used against multiresistant bacteria.