Supporting the systematic assessment of clinical processes: the MedFlow method.

OBJECTIVES: Healthcare is characterized by complex cooperation between highly specialized healthcare departments. This often leads to inefficient clinical processes. In order to improve these processes, a systematic assessment method is needed. Such methods are still missing. The objective of this paper is to propose and evaluate a method to support the systematic and semi-automatic assessment of clinical processes, with special focus on the quality of information logistics. METHODS: Criteria for the quality of information logistics were collected based on literature research and system analysis. Appropriate quality checks for these criteria were developed. An extended process modelling notation was developed. The method was evaluated in a pilot study. RESULTS: An own model integrates four sub-models with each concentrating on distinct process aspects (i.e., control flow, data flow, tool usage, organizational information). In order to assess the quality of a process, selected process details are combined in "views". Weak points are then detected by applying specific rule-sets on these views. Each rule-set represents a pattern of critical cross-points which are searched for in the appropriate view-matrix. The MedFlow method was evaluated in a first pilot study in radiological departments--applying quality checks for the detection of e.g. media cracks or testing the transcription of information objects. CONCLUSION: The MedFlow method is best used to assess clinical processes regarding their control flow and information handling. The latter directly influences the quality of communication and thus the quality of whole processes. However, this must be evaluated in further studies.

[Plasma serine protease inhibitors in patients with liver cirrhosis]. / Osoczowe inhibitory proteaz serynowych u chorych na marskosc watroby.

In 28 patients with liver cirrhosis as compared with the control group decreased concentrations of alpha 2-antiplasmin, antithrombin III and activator plasminogen inhibitor were observed. Decrease of these inhibitors was lower in advanced stages of cirrhosis accompanied by hypoalbuminemia and hyperbilirubinemia.

[Results of liver examination in drug addicts infected with HIV virus]. / Wyniki badan watroby u narkomanów zakazonych wirusem HIV.

Investigations included 52 drug-addicts with asymptomatic HIV virus infection. 8 of them suffered some years ago, from virus hepatitis of type B. Physical examinations did not reveal in examined persons any deviations from normal condition except for hepatomegaly. Results of liver biochemical investigations remained within normal limits. In each of them one confirmed presence of serological markers of HBV infection and in 35 of them of HCV and in 5 of them in parallel HDV. In all the examined persons one carried out liver biopsy and routine morphological examinations. In every case one disclosed a liver injury of drug-induced type. Further, in 31 examined persons one detected a coexistence of chronic, active inflammatory process of liver hepatitis minimal--17 hepatitis chronica persistent--12 hepatitis chronica aggressivE--1 cirrhosis hepatis--1 and in four of them changes of the type fibrosis periportal. In HIV infected drug-addicts it comes about to clinically asymptomatic, chronic hepatitis coexisting with morphological changes of drug-induced type liver.

[Gastroduodenal reflux and histological changes in the gastric mucosa in patients with liver cirrhosis caused by HBV]. / Refluks dwunastniczo-zoladkowy i zmiany histologiczne blony sluzowej zoladka u chorych na marskosc watroby o etiologii HBV.

Endoscopic and histologic examinations of the gastric mucosa were performed in a group of 35 patients with HBV liver cirrhosis and 30 healthy persons. From among the patients 2 groups were singled out according to a liver disease progression: cirrhosis during liver functional compensation (n - 20). Cirrhosis over the period of liver functional unbalance (n - 15). In the two groups of patients examined the authors found pathological changes in the gastric mucosa, those in the group of patients with liver functional unbalance being more frequent and progressed. A statistically significant relationship was found between the duodenal contents in the stomach and the appearance of inflammatory changes in the mucosa.

[Hepatitis C (personal observations]. / Wirusowe zapalenie watroby typu C (obserwacje wlasne).

In 222 patients treated in the Department of Infectious Diseases Medical School of Bydgoszcz, one carried out immunoenzymatic examinations to find out presence of HCV antibodies. Among them, there were 33NANBH patients as well as 32 diagnosed as CAH NANB origin, 55 chronic hemodialysis patients and finally 102 IVDU. It was pointed out that the patients suffering from acute and chronic hepatitis type NANB were often HCV infected. Drug addicts (IVDU) and chronic hemodialysis patients constitute high risk groups of these infections. It should be stressed that these infections are asymptomatic in just these groups of patients. One discussed some epidemiological and clinical aspects of 19 hepatitis C cases.

[Serological markers of selected viral infections transmitted by parenteral route in drug addicts]. / Serologiczne markery wybranych zakazen wirusowych przenoszacych sie droga parenteralna u narkomanów.

Investigations included a group 80 asymptomatic drug addicts. They were examined immunoenzyme method aiming at detection infection by HIV, HBV, HCV and HDV. Cases of seropositive HIV results were confirmed by means WB. In 68 examined patients serological evidence of virus HBV was discovered. In 60 of them one also found out coexisting HIV serological markers, in 51 of HCV markers. HDV antibodies were disclosed in 7 cases. Infection with hepatotropic viruses were more frequent in group of HIV(+) drug addicts.

[Errors in the diagnosis of chronic intrahepatic cholestasis]. / Bledy w rozpoznawaniu przewleklej cholestazy wewnatrzwatrobowej.

In nine out of ten patients referred in the years 1982-1987 to the Infectious Diseases Department of the Medical Academy in Bydgoszcz with the diagnosis of chronic (sometimes lasting several years) intrahepatic cholestasis an extrahepatic etiology of cholestasis was recognised. The main causes of the made errors were, it seems, an excessive confidence in the results of laboratory examinations carried out by modern diagnostic methods and a not very careful analysis of the disease. Exploratory laparotomy should be the examination of decisive importance in cholestasis of unclear etiology.

[Organization of health care for persons from the groups of high risk of HIV infection in Bydgoszcz]. / Organizacja opieki nad osobami z grup wysokiego ryzyka zakazenia HIV w Bydgoszczy.

The existing in Bydgoszcz infectivity infrastructure was made available to AIDS infection risk groups. The AIDS infected patients make use of ambulatory and in-patient health service together with other sick people. Among 72 detected infections only 2 cases remain without any connection with drug addiction. In this paper one presented advantages of the accepted organisational model as well as the effects of its functioning.

[Pathomechanism of Zieve's syndrome--observation of patients treated at the Infectious Disease Clinic, Medical Academy, in Bydgoszcz]. / Patomechanizm zespolu Zievego--obserwacja chorych leczonych w Klinice Chorób Zakaznych AM w Bydgoszczy.

The views are presented on the pathological mechanism of Zieve's syndrome with description of 3 cases diagnosed in this Department. The clinical manifestations of the syndrome contains no pathognomonic symptoms and suggests rather cholecystopathy. This is possibly the cause of rare recognition of the syndrome.