The IMIA History Working Group: Inception through the IMIA History Taskforce, and Major Events Leading Up to the 50th Anniversary of IMIA.

Background: The 50th Anniversary of IMIA will be celebrated in 2017 at the World Congress of Medical Informatics in China. This takes place 50 years after the International Federation of Information Processing (IFIP) Societies approved the formation of a new Technical Committee (TC) 4 on Medical Information Processing, which was the predecessor of IMIA, under the leadership of Dr. Francois Grémy. The IMIA History Working Group (WG) was approved in 2014 to document and write about the history of the field and its organizations. Objectives: The goals of this paper are to describe how the IMIA History WG arose and developed, including its meetings and projects, leading to the forthcoming 50th Anniversary of IMIA. Methods: We give a chronology of major developments leading up to the current work of the IMIA History WG and how it has stimulated writing on the international history of biomedical and health informatics, sponsoring the systematic compilation and writing of articles and stories from pioneers and leaders in the field, and the organization of workshops and panels over the past six years, leading towards the publication of the contributed volume on the 50th IMIA Anniversary History as an eBook by IOS Press. Conclusions: This article leads up to the IMIA History eBook which will contain original autobiographical retrospectives by pioneers and leaders in the field, together with professional organizational histories of the national and regional societies and working groups of IMIA, with commentary on the main themes and topics which have evolved as scientific and clinical practices have changed under the influence of new insights, technologies, and the changing socio-economic, cultural and professional circumstances around the globe over the past 50 years.

Nursing Informatics Certification Worldwide: History, Pathway, Roles, and Motivation.

INTRODUCTION: Official recognition and certification for informatics professionals are essential aspects of workforce development. OBJECTIVE: To describe the history, pathways, and nuances of certification in nursing informatics across the globe; compare and contrast those with board certification in clinical informatics for physicians. METHODS: (1) A review of the representative literature on informatics certification and related competencies for nurses and physicians, and relevant websites for nursing informatics associations and societies worldwide; (2) similarities and differences between certification processes for nurses and physicians, and (3) perspectives on roles for nursing informatics professionals in healthcare Results: The literature search for 'nursing informatics certification' yielded few results in PubMed; Google Scholar yielded a large number of citations that extended to magazines and other non-peer reviewed sources. Worldwide, there are several nursing informatics associations, societies, and workgroups dedicated to nursing informatics associated with medical/health informatics societies. A formal certification program for nursing informatics appears to be available only in the United States. This certification was established in 1992, in concert with the formation and definition of nursing informatics as a specialty practice of nursing by the American Nurses Association. Although informatics is inherently interprofessional, certification pathways for nurses and physicians have developed separately, following long-standing professional structures, training, and pathways aligned with clinical licensure and direct patient care. There is substantial similarity with regard to the skills and competencies required for nurses and physicians to obtain informatics certification in their respective fields. Nurses may apply for and complete a certification examination if they have experience in the field, regardless of formal training. Increasing numbers of informatics nurses are pursuing certification. CONCLUSIONS: The pathway to certification is clear and wellestablished for U.S. based informatics nurses. The motivation for obtaining and maintaining nursing informatics certification appears to be stronger for nurses who do not have an advanced informatics degree. The primary difference between nursing and physician certification pathways relates to the requirement of formal training and level of informatics practice. Nurse informatics certification requires no formal education or training and verifies knowledge and skill at a more basic level. Physician informatics certification validates informatics knowledge and skill at a more advanced level; currently this requires documentation of practice and experience in clinical informatics and in the future will require successful completion of an accredited two-year fellowship in clinical informatics. For the profession of nursing, a graduate degree in nursing or biomedical informatics validates specialty knowledge at a level more comparable to the physician certification. As the field of informatics and its professional organization structures mature, a common certification pathway may be appropriate. Nurses, physicians, and other healthcare professionals with informatics training and certification are needed to contribute their expertise in clinical operations, teaching, research, and executive leadership.

Discussion of "Evidence-based Health Informatics: How Do We Know What We Know?".

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Evidence-based Health Informatics: How Do We Know What We Know?" written by Elske Ammenwerth [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Ammenwerth paper. In subsequent issues the discussion can continue through letters to the editor. With these comments on the paper "Evidence-based Health Informatics: How do we know what we know?", written by Elske Ammenwerth [1], the journal seeks to stimulate a broad discussion on the challenges of evaluating information processing and information technology in health care. An international group of experts has been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.

Development of Hypertension Management Mobile Application based on Clinical Practice Guidelines.

This study aims to develop and evaluate a mobile application for hypertension management based on Clinical Practice Guidelines. The application was developed according to Web-Roadmap methodology. In planning phase, we defined the tasks and product of each phase, selected clinical practice guidelines and extracted intervention items for hypertension management. In analysis phase, we analysed intervention items and made data dictionary, rules, use-case diagram, hypertension management ontology and tailored recommendations for the application. In design phase, we developed an entity-relations diagram, algorithm, and user interface and coded them in the implementation phase. In evaluation phase, first, the knowledge-base was evaluated for its accuracy by experts and they proposed three more detailed recommendations, which were added to the application. Second, mobile heuristics were evaluated. The evaluators pointed out 33 usability-related problems on mobile heuristics items. Out of these, three problems were solved by reflecting evaluators' comments.

Confluence of disciplines in health informatics: an international perspective.

OBJECTIVE: To discuss international aspects as they relate to the convergence of disciplines in health informatics. METHOD: A group of international experts was invited at a symposium to present and discuss their perspectives on this topic. These have been collated in a single manuscript. RESULTS AND CONCLUSIONS: Significant challenges, as well as opportunities, appear when cumulating the intrinsic multidisciplinary nature of health informatics interventions with the diversity of contexts at the global level, in particular when considered in the perspective of a confluence, i.e., the mixing of different waters and their merging into a new, stronger entity. Health informatics experts reflect on key issues such as collaborative software development and distributed knowledge sourcing, social media and mobile technologies, the evolutions of the discipline from an historical perspective, as well as examples of challenges for implementing ubiquitous healthcare or for supporting disaster situations when infrastructures get disrupted.

Evaluation of the content coverage of SNOMED CT representing ICNP seven-axis version 1 concepts.

OBJECTIVES: The purpose of this study is to evaluate the ability of SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) to represent the concepts of the ICNP version 1--the seven-axis model. METHODS: The first author mapped 1658 concepts of the ICNP version 1 to SNOMED CT using CLUE browser 5.0. The second author from SNOMED Terminology Solutions--with a team of SNOMED CT experts--and the third author from the ICN with a team of ICNP experts validated the mapping result. If there was any disagreement during the validation process, the three of us convened online meetings to reach a consensus. RESULTS: In total, SNOMED CT covered 1331 out of 1658 (80%) ICNP seven-axis model concepts ranging from a 61% coverage rate of the Actions Axis concepts to a 94% coverage rate of the Judgment axis concepts. CONCLUSIONS: SNOMED CT can represent most (80%) of the ICNP version 1 concepts. However, improvements in the ICNP version 1 in terms of concept naming and definition, and the addition of missing concepts to SNOMED CT, would lead to a greater harmonization of the ICNP seven-axis model version 1 concepts with SNOMED CT.

Development and Validation of Detailed Clinical Models for Nursing Problems in Perinatal care.

OBJECTIVES: The aims of this study were to develop detailed clinical models (DCMs) for nursing problems related to perinatal care and to test the applicability of these detailed clinical models. METHODS: First, we extracted entities of nursing problems by analyzing nursing-problem statements from nursing records, reviewing the literature, and interviewing nurse experts. Second, we extracted attributes and possible values needed to describe the entities in more detail by again analyzing nursing statements, reviewing the literature, and consulting nurse experts. Third, DCMs were modeled by linking each entity with possible attributes with value sets and optionalities. Fourth, entities, attributes and value sets in the DCMs were mapped to the International Classification for Nursing Practice (ICNP) version 2. Finally, DCMs were validated by consulting a group of experts and by applying them to real clinical data and nursing care scenarios published in the literature. The adequacy of the entities, attributes, value sets, and optionalities of the attributes were validated. RESULTS: Fifty-eight entities were identified, 41 entities from nursing records, 12 entities from literature review and 5 entities from nurse experts. Sixty-five attributes with values were identified, 25 attributes from nursing records, 34 attributes from literature review, and 6 attributes from nurse experts. In total 58 DCMs were developed and validated. CONCLUSIONS: The DCMs developed in this study can ensure that electronic health records contain meaningful and valid information, and support the semantic interoperability of nursing information.

Education, practice, and research in nursing terminology: gaps, challenges, and opportunities.

OBJECTIVES: To provide an overview of nursing terminology education, research, and clinical use, to identify and analyze any gaps therein, and to propose ways to close those gaps. METHODS: We conducted an extensive Internet and literature search to establish the current status of nursing terminology education, research, and clinical use. We also surveyed 40 experts in nursing terminology from 15 countries to obtain more detailed information on nursing terminology education and clinical use. RESULTS: We found that there are gaps in nursing terminology education, research, and use, with the area of research being the most advanced. Nursing terminology is not taught widely in either informatics or nursing programs. Where it is taught, it constitutes only up to several hours of an informatics or nursing course. Research into nursing terminology has been very active, focusing mainly on the development and evaluation/validation of nursing terminology, using reference terminology models, and mapping between these and nursing terminologies. However, little research has been carried out on the use of nursing terminologies in clinical information systems. In addition, there are very few systems in which a standardized nursing terminology has been implemented. CONCLUSION: In order to close the gaps in nursing terminology education, research, and clinical use, qualified personnel are required to educate potential users as to the importance of terminology-based information systems for semantic interoperability. In addition, more research is required into the implementation of nursing terminologies in information systems, and we must demonstrate the usefulness and effectiveness of nursing terminology-based information systems.

Glutathione disulfide induces neural cell death via a 12-lipoxygenase pathway.

Oxidized glutathione (GSSG) is commonly viewed as a byproduct of GSH metabolism. The pathophysiological significance of GSSG per se remains poorly understood. Adopting a microinjection approach to isolate GSSG elevation within the cell, this work identifies that GSSG can trigger neural HT4 cell death via a 12-lipoxygenase (12-Lox)-dependent mechanism. In vivo, stereotaxic injection of GSSG into the brain caused lesion in wild-type mice but less so in 12-Lox knockout mice. Microinjection of graded amounts identified 0.5 mM as the lethal [GSSG]i in resting cells. Interestingly, this threshold was shifted to the left by 20-fold (0.025 mM) in GSH-deficient cells. This is important because tissue GSH lowering is commonly noted in the context of several diseases as well as in aging. Inhibition of GSSG reductase by BCNU is known to result in GSSG accumulation and caused cell death in a 12-Lox-sensitive manner. GSSG S-glutathionylated purified 12-Lox as well as in a model of glutamate-induced HT4 cell death in vitro where V5-tagged 12-Lox was expressed in cells. Countering glutamate-induced 12-Lox S-glutathionylation by glutaredoxin-1 overexpression protected against cell death. Strategies directed at improving or arresting cellular GSSG clearance may be effective in minimizing oxidative stress-related tissue injury or potentiating the killing of tumor cells, respectively.

Comparision of nirS, cnorB, MCR genes against water quality parameters to monitor uncontrolled landfills.

This study was conducted to investigate the possible relationship between a molecular biological investigation and water quality parameters in monitoring groundwater pollution at the immediate boundary of uncontrolled landfills and their downgradient aquifers, which may consequently facilitate unbiased monitoring for the sites. Two closed landfills, Jicksan and Taejang in Korea, were chosen for this study, where the diversity of the microbial community was characterized and three specific genes, i.e. nirS (nitrite reductase coding gene), cnorB (nitric oxide reductase coding gene) and MCR (methyl coenzyme M reductase coding gene), were quantified. The quantified genes were then compared with conventional water quality parameters. From the analyzed DNA sequences, Proteobacteria phylum was most dominantly observed. A quantitative analysis revealed that the copy numbers (gene abundance) of denitrification enzyme coding genes, i.e. nirS gene and cnorB gene in Jicksan (J) site, are seven and four times, respectively, higher than Taejang (T) site. This simply implied that denitrification was possibly higher in J site than T site. In addition, a methane production enzyme coding gene, i.e. MCR, in a J1 bore immediately bordering the sources in the J site showed the greatest concentration, but it was precipitously decreased in the downgradient direction toward the outer boundary of landfill. A comparative investigation between the copy numbers of three genes, i.e. nirS, cnorB, and MCR, and conventional monitoring parameters, i.e. Cl-, alkalinity, TOC, NH3-N, and NO2-N, showed that they had overall correlation as given by more than 0.99 of the squared correlation coefficient (R2) for almost all of the concerned bores. It was concluded that the comparison between the molecular biological investigation and the conventional groundwater monitoring parameters showed good relationship between them, so that both tools could be more efficiently used for assessing the levels of contamination and prediction of the fate of pollutants, rather than being applied separately.

What stroke patients want to know and what medical professionals think they should know about stroke: Korean perspectives.

BACKGROUND AND PURPOSE: Patients and medical professionals are likely to have different perspectives of stroke, making what patients want to know about stroke different from what medical professionals think they should know. We wished to determine these differences for patients and medical professionals in South Korea, as well as to identify patients' characteristics associated with perceptions of stroke education. METHODS: Fifty consecutive patients with acute stroke admitted to Asan Medical Center, Seoul, Korea, and 88 medical professionals (31 doctors and 57 nurses) working in the Departments of Neurology or Neurosurgery were administered a structured questionnaire regarding various aspects of patient education concerning stroke. RESULTS: The average ranking of total items for stroke education was higher in nurses than in doctors or patients (P < 0.01 for each). Patients gave higher rankings than doctors for 'possibility to cure with drug treatment' (P < 0.01), 'stress management' (P < 0.01), and most items concerning 'general medical knowledge' and 'post-stroke diet management,' whereas doctors gave higher rankings than patients for most items concerning risk factor management and treatment with surgery. Items concerning 'post-stroke diet management' were ranked lower by male patients than females patients (P < 0.005), and were ranked lower by doctors than by patients or nurses (P < 0.001). Younger patients gave higher rankings than older patients for items concerning 'medical knowledge regarding stroke,' 'exercise,' and 'post-stroke sexual activities' (P < 0.001 for each). CONCLUSIONS: Perspectives on stroke education differ among doctors, nurses and patients. They also differ according to the situation of the patient. Education of stroke patients should be based on an understanding of these differences.

Cross-mapping the ICNP with NANDA, HHCC, Omaha System and NIC for unified nursing language system development. International Classification for Nursing Practice. International Council of Nurses. North American Nursing Diagnosis Association. Home Health Care Classification. Nursing Interventions Classification.

Nursing language plays an important role in describing and defining nursing phenomena and nursing actions. There are numerous vocabularies describing nursing diagnoses, interventions and outcomes in nursing. However, the lack of a standardized unified nursing language is considered a problem for further development of the discipline of nursing. In an effort to unify the nursing languages, the International Council of Nurses (ICN) has proposed the International Classification for Nursing Practice (ICNP) as a unified nursing language system. The purpose of this study was to evaluate the inclusiveness and expressiveness of the ICNP terms by cross-mapping them with the existing nursing terminologies, specifically the North American Nursing Diagnosis Association (NANDA) taxonomy I, the Omaha System, the Home Health Care Classification (HHCC) and the Nursing Interventions Classification (NIC). Nine hundred and seventy-four terms from these four classifications were cross-mapped with the ICNP terms. This was performed in accordance with the Guidelines for Composing a Nursing Diagnosis and Guidelines for Composing a Nursing Intervention, which were suggested by the ICNP development team. An expert group verified the results. The ICNP Phenomena Classification described 87.5% of the NANDA diagnoses, 89.7% of the HHCC diagnoses and 72.7% of the Omaha System problem classification scheme. The ICNP Action Classification described 79.4% of the NIC interventions, 80.6% of the HHCC interventions and 71.4% of the Omaha System intervention scheme. The results of this study suggest that the ICNP has a sound starting structure for a unified nursing language system and can be used to describe most of the existing terminologies. Recommendations for the addition of terms to the ICNP are provided.

Collaborative efforts for representing nursing concepts in computer-based systems: international perspectives.

Current nursing terminology efforts have converged toward meeting the demand for a reference terminology for nursing concepts by building on the foundation of existing interface and administrative terminologies and by collaborating with terminology efforts across the spectrum of health care. In this article, the authors illustrate how collaboration is promoting convergence toward a reference terminology for nursing by briefly summarizing a wide range of exemplary activities. These include: 1) the International Classification of Nursing Practice (ICNP) activities of the International Council of Nurses (ICN), 2) work in Brazil and Korea that has contributed to, and been stimulated by, ICNP developments, 3) efforts in the United States to improve understanding of the different types of terminologies needed in nursing and to promote harmonization and linking among them, and 4) current nursing participation in major multi-disciplinary standards initiatives. Although early nursing terminology work occurred primarily in isolation and resulted in some duplicative efforts, the activities summarized in this article demonstrate a tremendous level of collaboration and convergence not only in the discipline of nursing but in multi-disciplinary standards initiatives. These efforts are an important prerequisite for ensuring that nursing concepts are represented in computer-based systems in a manner that facilitates multi-purpose use at local, national, regional, and international levels.

Nursing students' experience of ethical problems and use of ethical decision-making models.

Using a conceptual framework and method combining ethical enquiry and phenomenology, we asked 73 senior baccalaureate nursing students to answer two questions: (1) What is nursing students' experience of an ethical problem involving nursing practice? and (2) What is nursing students' experience of using an ethical decision-making model? Each student described one ethical problem, from which emerged five content categories, the largest being that involving health professionals (44%). The basic nature of the ethical problems consisted of the nursing students' experience of conflict, resolution and rationale; 85% of the students stated that using an ethical decision-making model was helpful. Although additional research is needed, these findings have important implications for nursing ethics education and practice.

Efficacy of screening for gastric cancer in a Korean adult population: a case-control study.

While gastric cancer is the most common malignancy in the Korean adult population, little is known of the efficacy of gastric cancer screening among Koreans. To study the efficacy of gastric cancer screening, this case-control study was conducted. From November 1996 to July 1998, 441 newly diagnosed gastric cancer (321 advanced, 120 early) patients were enrolled at the Department of General Surgery and 107 controls were enrolled at the inpatient Department of Family Medicine and Otolaryngology. History of gastric examinations and possible risk factors were collected through interview with a structured questionnaire. Patients with advanced gastric cancer were 61% less likely to have had a gastric examination than those with early gastric cancer (OR 0.39; 95%CI 0.23-0.65). Patients with advanced gastric cancer were 53% less likely to have had a gastric examination within two years of diagnosis (OR 0.47; 95%CI 0.23-0.98) and 69% less likely to have had a gastric examination within three years of diagnosis (OR 0.31; 95%CI 0.11-0.86). The data, showing a significant relationship between the history of gastric examinations and severity of gastric cancer, suggests that gastric cancer screening is effective in catching gastric cancer at early stages. It also suggests less than three years for screening interval.

Development of a Web-based CAI program for maternity nursing practice.

This quasi-experimental study was conducted to explore what kind of impact a Web-based educational program can have on nursing students and how nursing students react to this educational program. A Web-based computer assisted instruction for maternity nursing practice was developed by researchers using Instruction System Design model and serviced for nursing students on the WWW. To study educational effect of this program on nursing students 30 senior students at a school of nursing were selected. They were assigned into experimental and control groups based on their maternity nursing practice schedule. The effect of the Web-based CAI was measured using Achievement score, attitude toward learning experience and attitude toward computer and Internet, and compared between two groups. There were significant differences between two groups in achievement and attitude score. And students in the experimental group showed positive response to the Web-based CAI program. These results suggest that Web-based CAI is useful as a new teaching tool for maternity nursing practice as well as other nursing courses. Comments on program improvement and operational issues were collected from students. These will be used for program improvement in future.

Development of a computerized patient classification and staffing system.

Korean health care agencies are trying to find ways to survive amid strong competition within the health care industry and pressure to open health care market from abroad. One way to survive is to improve health care quality at present or reduced expenditure. Nursing is the largest manpower in health care agencies and plays an important role in determining quality of care through direct interaction with patients., thus, nursing manpower management is an essential part of survival strategies. If the nursing department can adapt to dynamic changes in the health care environment in terms of quality and quantity of service needed, health care agencies' quality and efficient management will be achieved at the same time. A computerized prototype patient classification and nursing staffing system was developed using Microsoft Visual Basic 3.0. This system allows a user to use GUI(Graphic User Interface) with an icon and a mouse. By applying this computerized system to clinical practice, nursing managers will receive accurate information regarding nursing manpower management at nursing unit level as well as departmental levels. Then nursing managers can achieve effective nursing manpower management, which will improve nursing care by allocating more nursing staff time to direct patient care.