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2.
J Am Med Inform Assoc ; 29(2): 354-363, 2022 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-34613410

RESUMO

OBJECTIVE: Accurate representation of clinical sex and gender identity in interoperable clinical systems is a major challenge for organizations intent on improving outcomes for sex- and gender-marginalized people. Improved data collection has been hindered by the historical approach that presumed a single, often binary, datum was sufficient. We describe the Health Level Seven International (HL7) Gender Harmony logical model that proposes an improved approach. MATERIALS AND METHODS: The proposed solution was developed via an American National Standards Institute (ANSI)-certified collaborative balloted process. As an HL7 Informative Document, it is an HL7 International-balloted consensus on the subject of representing sex and representing gender in clinical systems based on work of the gender harmony project led by the HL7 Vocabulary Work Group. RESULTS: The Gender Harmony Model is a logical model that provides a standardized approach that is both backwards-compatible and an improvement to the meaningful capture of gender identity, recorded sex or recorded gender, a sex for clinical use, the name to use, and pronouns that are affirmative and inclusive of gender-marginalized people. CONCLUSION: Most clinical systems and current standards in health care do not meaningfully address, nor do they consistently represent, sex and gender diversity, which has impeded interoperability and led to suboptimal health care. The Gender Harmony Project was formed to create more inclusive health information exchange standards to enable a safer, higher-quality, and embracing healthcare experience. The Gender Harmony Model provides the informative guidance for standards developers to implement a more thorough technical design that improves the narrow binary design used in many legacy clinical systems.


Assuntos
Identidade de Gênero , Troca de Informação em Saúde , Atenção à Saúde , Feminino , Nível Sete de Saúde , Humanos , Masculino
3.
J Biomed Inform ; 115: 103685, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33486066

RESUMO

The COVID-19 crisis led a group of scientific and informatics experts to accelerate development of an infrastructure for electronic data exchange for the identification, processing, and reporting of scientific findings. The Fast Healthcare Interoperability Resources (FHIR®) standard which is overcoming the interoperability problems in health information exchange was extended to evidence-based medicine (EBM) knowledge with the EBMonFHIR project. A 13-step Code System Development Protocol was created in September 2020 to support global development of terminologies for exchange of scientific evidence. For Step 1, we assembled expert working groups with 55 people from 26 countries by October 2020. For Step 2, we identified 23 commonly used tools and systems for which the first version of code systems will be developed. For Step 3, a total of 368 non-redundant concepts were drafted to become display terms for four code systems (Statistic Type, Statistic Model, Study Design, Risk of Bias). Steps 4 through 13 will guide ongoing development and maintenance of these terminologies for scientific exchange. When completed, the code systems will facilitate identifying, processing, and reporting research results and the reliability of those results. More efficient and detailed scientific communication will reduce cost and burden and improve health outcomes, quality of life, and patient, caregiver, and healthcare professional satisfaction. We hope the achievements reached thus far will outlive COVID-19 and provide an infrastructure to make science computable for future generations. Anyone may join the effort at https://www.gps.health/covid19_knowledge_accelerator.html.


Assuntos
Viés , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/virologia , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , SARS-CoV-2/isolamento & purificação , Adulto Jovem
4.
ANZ J Surg ; 90(10): 1975-1978, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32274843

RESUMO

BACKGROUND: Carcinoid tumours of the appendix are the most common primary malignant lesion of the appendix. However, the overall incidence remains low; found in as few as 0.3-0.9% appendicectomy specimens. Almost all appendiceal carcinoids are found incidentally during surgery for suspected appendicitis. METHODS: A retrospective review of all appendiceal carcinoids was performed in six hospitals from January 1990 until December 2013. Demographic data, operative technique, histopathological characteristics, clinic reviews and need for further treatment were recorded and compared with literature. RESULTS: Appendiceal carcinoids were identified in 175 specimens. The mean age is 32 years (range 8-87 years), with 69 (39.4%) males and 106 (60.6%) females (P < 0.0001). Of these, 106 underwent open surgery with standard McBurney incision, nine underwent full laparotomy and 60 underwent laparoscopic surgery. Six of the laparoscopic surgeries were converted to open procedures. We recorded 159 (90.75%) classical carcinoids and 16 (9.25%) goblet cell carcinoids. Overall, 131 (75.7%) had concurrent appendicitis; classical carcinoid 72.6% versus goblet cell carcinoid 93.8%. The median size of the goblet cell carcinoids was significantly larger than classical carcinoids. Classical carcinoids were mostly distal to the base, while goblet cell carcinoids had equal distribution. It appears that the involvement of resection margins was not influenced by the surgical technique. Thirty patients required further right hemicolectomy as treatment for high-risk features; open 19 (15.9%) versus laparoscopic 11 (20.4%). CONCLUSIONS: Laparoscopic appendicectomy did not seem to adversely influence the margin clearance in appendiceal carcinoid, though we recommend that all appendicectomies should include the mesoappendix.


Assuntos
Neoplasias do Apêndice , Apêndice , Tumor Carcinoide , Laparoscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Neoplasias do Apêndice/epidemiologia , Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/epidemiologia , Tumor Carcinoide/cirurgia , Criança , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
5.
Appl Clin Inform ; 11(1): 23-33, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31914472

RESUMO

BACKGROUND: Electronic clinical quality measures (eCQMs) seek to quantify the adherence of health care to evidence-based standards. This requires a high level of consistency to reduce the effort of data collection and ensure comparisons are valid. Yet, there is considerable variability in local data capture, in the use of data standards and in implemented documentation processes, so organizations struggle to implement quality measures and extract data reliably for comparison across patients, providers, and systems. OBJECTIVE: In this paper, we discuss opportunities for harmonization within and across eCQMs; specifically, at the level of the measure concept, the logical clauses or phrases, the data elements, and the codes and value sets. METHODS: The authors, experts in measure development, quality assurance, standards and implementation, reviewed measure structure and content to describe the state of the art for measure analysis and harmonization. Our review resulted in the identification of four measure component levels for harmonization. We provide examples for harmonization of each of the four measure components based on experience with current quality measurement programs including the Centers for Medicare and Medicaid Services eCQM programs. RESULTS: In general, there are significant issues with lack of harmonization across measure concepts, logical phrases, and data elements. This magnifies implementation problems, confuses users, and requires more elaborate data mapping and maintenance. CONCLUSION: Comparisons using semantically equivalent data are needed to accurately measure performance and reduce workflow interruptions with the aim of reducing evidence-based care gaps. It comes as no surprise that electronic health record designed for purposes other than quality improvement and used within a fragmented care delivery system would benefit greatly from common data representation, measure harmony, and consistency. We suggest that by enabling measure authors and implementers to deliver consistent electronic quality measure content in four key areas; the industry can improve quality measurement.


Assuntos
Interoperabilidade da Informação em Saúde , Melhoria de Qualidade , Terminologia como Assunto , Artefatos , Neoplasias da Mama/diagnóstico , Depressão/diagnóstico , Infecções por HIV/diagnóstico , Humanos , Programas de Rastreamento
6.
Can J Cardiol ; 35(1): 61-67, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30595184

RESUMO

BACKGROUND: Cardiac surgery waitlist recommendations, which were developed based on expert opinion, poorly predict preoperative mortality. Studies reporting risk factors for waitlist mortality have not evaluated the risks including nonadherence to waitlist benchmarks. METHODS: In patients who underwent cardiac surgery or died on the waitlist between 2005 and 2015, we used a Fine and Gray competing risk model to identify independent predictors of waitlist mortality in 12,106 patients scheduled for urgent, semiurgent, or nonurgent surgery. The predictive variables were compared with Canadian Cardiovascular Society (CCS) waitlist recommendations using the Akaike information criterion. RESULTS: A total of 101 (0.8%) patients died awaiting surgery. The median wait times and frequency waitlist deaths among emergent, urgent, semi-urgent, and nonurgent surgery were 0.6, 7.4, 69.0, 55.5 days (P < 0.001) and 6.3%, 0.8%, 0.3%, 0.6% (P < 0.001), respectively. Adherence to CCS waitlist recommendations was higher in patients who died on the waitlist (51.6% vs 70.8%, P = 0.001) and was not predictive of waitlist mortality (hazard ratio 1.48, 95% confidence interval 0.62-0.56). Independent predictors of waitlist mortality were age, aortic surgery, ejection fraction < 35%, urgent surgery, prior myocardial infarction, haemodynamic instability during cardiac catheterization, hypertension, and dyslipidemia. These variables were superior to current CCS guidelines (Akaike information criterion 1251 vs 1317, likelihood ratio test P < 0.001). CONCLUSIONS: CCS waitlist recommendations were poorly predictive of waitlist mortality and the majority of waitlist deaths occur within recommended benchmarks. We identified variables associated with waitlist mortality with improved clinical performance. Our findings suggest a need to re-evaluate cardiac surgical triage criteria using evidence-based data.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doença das Coronárias/cirurgia , Fidelidade a Diretrizes , Vigilância da População , Medição de Risco/métodos , Triagem/métodos , Listas de Espera/mortalidade , Idoso , Alberta/epidemiologia , Doença das Coronárias/mortalidade , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo
7.
J Cell Biochem ; 120(1): 848-860, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30161276

RESUMO

Expression of the transcriptional regulator, E26 transformation-specific 1 (ETS1), is elevated in human prostate cancers, and this is associated with more aggressive tumor behavior and a rapid progression to castrate-resistant disease. Multiple ETS1 isoforms with distinct biological activities have been characterized and in 44 matched nonmalignant and malignant human prostate specimens, messenger RNAs for two ETS1 isoforms, ETS1p51 and ETS1p42, were detected, with ETS1p51 levels significantly lower in prostate tumor compared to matched nonmalignant prostate tissues. In contrast, ETS1p51 protein, the only ETS1 isoform detected, was expressed at significantly higher levels in malignant prostate. Analysis of epithelial-to-mesenchymal transition (EMT)-associated genes regulated following overexpression of ETS1p51 in the LNCaP prostate cancer cell line predicted promotion of transforming growth factor ß (TGFß) signaling and of EMT. ETS1p51 overexpression upregulated cellular levels of the EMT transcriptional regulators, ZEB1 and SNAIL1, resulted in reduced expression of the mesenchymal marker vimentin with concomitantly elevated levels of claudin 1, an epithelial tight junction protein, and increased prostate cancer cell migration and invasion. ETS1p51-induced activation of the pro-EMT TGFß signaling pathway that was predicted in polymerase chain reaction arrays was verified by demonstration of elevated SMAD2 phosphorylation following ETS1p51 overexpression. Attenuation of ETS1p51 effects on prostate cancer cell migration and invasion by inhibition of TGFß pathway signaling indicated that ETS1p51 effects were in part mediated by induction of TGFß signaling. Thus, overexpression of ETS1p51, the predominant ETS1 isoform expressed in prostate tumors, promotes an EMT program in prostate cancer cells in part via activation of TGFß signaling, potentially accounting for the poor prognosis of ETS1-overexpressing prostate tumors.


Assuntos
Transição Epitelial-Mesenquimal/genética , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/patologia , Proteína Proto-Oncogênica c-ets-1/genética , Proteína Proto-Oncogênica c-ets-1/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Benzamidas/farmacologia , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Dioxóis/farmacologia , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Invasividade Neoplásica , Fosforilação , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , RNA Mensageiro/genética , Receptor do Fator de Crescimento Transformador beta Tipo I/antagonistas & inibidores , Proteína Smad2/metabolismo , Fatores de Transcrição da Família Snail/metabolismo , Transfecção , Fator de Crescimento Transformador beta1/farmacologia , Homeobox 1 de Ligação a E-box em Dedo de Zinco/metabolismo
8.
Respirol Case Rep ; 6(6): e00331, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29850020

RESUMO

Non-caseating granulomatous pulmonary conditions resembling sarcoidosis secondary to industrial/occupation exposure to magnetite iron ore dusts have been rarely documented in the literature. This is a case report of a 58-year-old blast crew member involved in iron ore/magnetite mining who presented with a 12-month history of chronic dry cough. High-resolution computed tomography revealed bilateral interstitial opacities. Lung biopsy demonstrated sarcoid-like granulomatous inflammation. Oral corticosteroid treatment improved the cough. Radiological features did not resolve despite treatment and yet remained stable following no subsequent exposure to iron mining dust.

9.
AMIA Annu Symp Proc ; 2018: 480-489, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30815088

RESUMO

This paper focuses on value sets as an essential component in the health analytics ecosystem. We discuss shared repositories of reusable value sets and offer recommendations for their further development and adoption. In order to motivate these contributions, we explain how value sets fit into specific analytic tasks and the health analytics landscape more broadly; their growing importance and ubiquity with the advent of Common Data Models, Distributed Research Networks, and the availability of higher order, reusable analytic resources like electronic phenotypes and electronic clinical quality measures; the formidable barriers to value set reuse; and our introduction of a concept-agnostic orientation to vocabulary collections. The costs of ad hoc value set management and the benefits of value set reuse are described or implied throughout. Our standards, infrastructure, and design recommendations are not systematic or comprehensive but invite further work to support value set reuse for health analytics. The views represented in the paper do not necessarily represent the views of the institutions or of all the co-authors.


Assuntos
Ciência de Dados , Interoperabilidade da Informação em Saúde , Vocabulário Controlado , Armazenamento e Recuperação da Informação , Web Semântica
11.
BMJ Case Rep ; 20152015 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-26475873

RESUMO

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign mesenchymal proliferative process, initially described by Vuitch et al. We report an unusual case of a 46-year-old woman who presented with a 6-week history of bilateral massive, asymmetrical, painful enlargement of her breasts, without a history of trauma. On clinical examination, both breasts were markedly enlarged and oedematous, but there were no discrete palpable masses. Preoperative image-guided core biopsies and surgery showed PASH. PASH is increasingly recognised as an incidental finding on image-guided core biopsy performed for screen detected lesions. There are a few reported cases of PASH presenting as rapid breast enlargement. In our case, the patient presented with painful, asymmetrical, massive breast enlargement. Awareness needs to be raised of this entity as a differential diagnosis in massive, painful breast enlargement.


Assuntos
Angiomatose/complicações , Doenças Mamárias/complicações , Mama/anormalidades , Hiperplasia/complicações , Hipertrofia/etiologia , Angiomatose/diagnóstico , Angiomatose/patologia , Mama/patologia , Doenças Mamárias/diagnóstico , Doenças Mamárias/patologia , Diagnóstico Diferencial , Feminino , Humanos , Hiperplasia/diagnóstico , Hiperplasia/patologia , Hipertrofia/diagnóstico , Hipertrofia/patologia , Mastodinia/diagnóstico , Mastodinia/patologia , Pessoa de Meia-Idade
12.
Pathology ; 46(3): 205-10, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24614722

RESUMO

The aim of this study was to determine the frequency of Merkel cell polyomavirus (MPyV) and p63 positivity by immunohistochemistry in a large cohort of primary Merkel cell carcinoma (MCC) from a region with high rates of actinic damage. We also aimed to determine whether there is any relationship between these markers and histological correlates of chronic sun exposure and to identify whether these markers have prognostic significance in our population. Ninety-five cases of primary cutaneous MCC were identified and stained with immunohistochemical markers for MPyV and p63. The presence of solar elastosis and squamous dysplasia in the overlying/adjacent skin were recorded as markers of actinic damage. Follow up data were obtained from the Western Australian Cancer Registry. MPyV was detected by immunohistochemistry in 23% of cases. There was a statistically significantly lower rate of positivity in tumours associated with markers of chronic sun damage as assessed by the presence of solar elastosis and squamous dysplasia. There was no association with overall or disease specific survival. p63 positivity was detected in 17% of cases. There was no association with markers of actinic damage or with overall or disease specific survival.Our data demonstrate a significant difference in rates of immunohistochemical positivity for MPyV between MCC in sun-damaged and non-sun-damaged sites. This may go some way to explaining previously identified geographical differences. When compared with a number of studies from Europe and North America, p63 positivity is less common in our population and does not show the strong prognostic significance that has been found in these other regions.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma de Célula de Merkel/patologia , Proteínas de Membrana/metabolismo , Poliomavírus das Células de Merkel/isolamento & purificação , Infecções por Polyomavirus/patologia , Neoplasias Cutâneas/patologia , Infecções Tumorais por Vírus/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/metabolismo , Carcinoma de Célula de Merkel/virologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Poliomavírus das Células de Merkel/imunologia , Pessoa de Meia-Idade , Infecções por Polyomavirus/metabolismo , Infecções por Polyomavirus/virologia , Prognóstico , Neoplasias Cutâneas/metabolismo , Infecções Tumorais por Vírus/metabolismo , Infecções Tumorais por Vírus/virologia , Austrália Ocidental
13.
Psychiatry Res ; 211(1): 1-10, 2013 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-23142194

RESUMO

UNLABELLED: Caudate and hippocampal volume differences in patients with schizophrenia are associated with disease and antipsychotic treatment, but local shape alterations have not been thoroughly examined. Schizophrenia patients randomly assigned to haloperidol and olanzapine treatment underwent magnetic resonance imaging (MRI) at 3, 6, and 12 months. The caudate and hippocampus were represented as medial representations (M-reps); mesh structures derived from automatic segmentations of high resolution MRIs. Two quantitative shape measures were examined: local width and local deformation. A novel nonparametric statistical method, adjusted exponentially tilted (ET) likelihood, was used to compare the shape measures across the three groups while controlling for covariates. Longitudinal shape change was not observed in the hippocampus or caudate when the treatment groups and controls were examined in a global analysis, nor when the three groups were examined individually. Both baseline and repeated measures analysis showed differences in local caudate and hippocampal size between patients and controls, while no consistent differences were shown between treatment groups. Regionally specific differences in local hippocampal and caudate shape are present in schizophrenic patients. Treatment-related related longitudinal shape change was not observed within the studied timeframe. Our results provide additional evidence for disrupted cortico-basal ganglia-thalamo-cortical circuits in schizophrenia. CLINICAL TRIAL INFORMATION: This longitudinal study was conducted from March 1, 1997 to July 31, 2001 at 14 academic medical centers (11 in the United States, one in Canada, one in the Netherlands, and one in England). This study was performed prior to the establishment of centralized registries of federally and privately supported clinical trials.


Assuntos
Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Núcleo Caudado/patologia , Haloperidol/uso terapêutico , Hipocampo/patologia , Esquizofrenia/patologia , Adulto , Antipsicóticos/farmacologia , Benzodiazepinas/farmacologia , Núcleo Caudado/efeitos dos fármacos , Método Duplo-Cego , Feminino , Haloperidol/farmacologia , Hipocampo/efeitos dos fármacos , Humanos , Processamento de Imagem Assistida por Computador , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Olanzapina , Tamanho do Órgão/efeitos dos fármacos , Esquizofrenia/tratamento farmacológico
14.
Schizophr Res ; 98(1-3): 29-39, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17976957

RESUMO

The first aim of this pilot study was to determine if longitudinal change in caudate volume could be detected in chronic schizophrenic patients after 12 weeks of atypical antipsychotic treatment. A sub-aim of the first aim was to determine if similar results could be obtained from an operator-assisted segmentation tool for volumetric imaging (ITK-SNAP) and voxel-based morphometry (VBM) methods in the caudate. The second aim was to determine if frontal and temporal lobe grey matter, white matter, ventricular and sulcal cerebrospinal fluid volume change could be detected after 12 weeks of atypical antipsychotic treatment with VBM. Ten chronic schizophrenic inpatients, with illness duration averaging 10.6 years, underwent two MRI scans. The first scan was obtained after a mean of 39.4 days of antipsychotic withdrawal. The second MRI was obtained following twelve weeks of atypical antipsychotic treatment. Caudate volume change was first measured with ITK-SNAP. Then the location of grey matter volume change in the caudate was identified with VBM. Finally, the location of frontal and temporal lobe grey matter, white matter, ventricular and sulcal cerebrospinal fluid volume changes were identified with VBM. No longitudinal change in caudate volume or grey matter volume was observed after brief periods of atypical antipsychotic treatment. ITK-SNAP and VBM methods showed very similar results in the caudate. No statistically significant change was identified in the volume of frontal or temporal lobe grey matter, white matter, and lateral, third, or fourth ventricular cerebrospinal fluid. Although the results do not directly show that brief periods of atypical antipsychotic treatment are associated with basal ganglia and cortical volume change, there is much evidence to suggest that such an association exists.


Assuntos
Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Encéfalo/patologia , Núcleo Caudado/patologia , Imageamento por Ressonância Magnética/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Esquizofrenia/patologia , Adulto , Encéfalo/efeitos dos fármacos , Mapeamento Encefálico , Núcleo Caudado/efeitos dos fármacos , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/patologia , Doença Crônica , Feminino , Seguimentos , Hospitalização , Humanos , Processamento de Imagem Assistida por Computador , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Síndrome de Abstinência a Substâncias/patologia , Fatores de Tempo
15.
Stud Health Technol Inform ; 129(Pt 2): 930-4, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17911852

RESUMO

Interoperable support of electronic health records and clinical decision support technology are central to the vision of sustainable information infrastructure. Efforts to implement interoperable clinical guidelines for immunization practice have been sparse. We used the SAGE knowledge workbench to develop a knowledge base to provide immunization decision support in primary care. We translated the written clinical guideline into a structured decision logic format. The semantic content to completely capture CDC clinical decision logic required 197 separate concepts but was completely captured with SNOMED CT and LOINC. Although 88% of concepts employed precoordinated codes, 6% of guideline concepts required expanded vocabulary services employing Boolean logical definition using two or more SNOMED concepts. Postcoordination requirements were modest, representing just 6% of guideline semantic concepts. We conclude that creation of interoperable knowledge bases employing clinical vocabulary standards is achievable and realistic. Employment of information model (HL7 RIM) and vocabulary (SNOMED CT, LOINC) standards is a necessary and feasible requirement to achieve interoperability in clinical decision support.


Assuntos
Tomada de Decisões Assistida por Computador , Sistemas de Apoio a Decisões Clínicas/normas , Guias de Prática Clínica como Assunto/normas , Vocabulário Controlado , Humanos , Imunização , Bases de Conhecimento
16.
J Health Organ Manag ; 21(2): 101-20, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17713176

RESUMO

PURPOSE: The main intension of this paper is to challenge the dominance of emotional labour in professional nursing. DESIGN/METHODOLOGY/APPROACH: The article begins by evaluating the central conceptual and definitional aspects of emotional labour, emotion work and emotional work. The purpose of this discussion is to argue against the false public and private dichotomy that has plagued emotional labour and emotion work. Second, it is proposed that the central and helpful defining aspects of emotional labour and emotion work are Marx's concepts of exchange-value and use-value. These defining attributes are used in conjunction with other re-conceptualisations, which unite these terms in order to create more encompassing constructs that are useful for focusing on the waged and unwaged aspects of professional nurses' emotional work response behaviours. Finally, the use of emotional labour in professional nursing is contested on the grounds that the construct has limited theoretical and empirical utility for researching the complex nature of professional nurses' emotional work response behaviours. FINDINGS: It is recommended that a more robust encompassing concept needs to be developed, which accurately reflects the nature and complexity of professional nurses' waged and unwaged emotional work response behaviours, as they are important overlooked facets of behaviour that can be theoretically related to professional nurses' contextual performance. ORIGINALITY/VALUE: The paper provides a better understanding of professional nurses' emotional work response behaviours, which benefit nursing research and practice by drawing on other areas of theory and research.


Assuntos
Adaptação Psicológica , Emoções , Recursos Humanos de Enfermagem/psicologia , Austrália , Humanos
17.
J Am Med Inform Assoc ; 14(5): 589-98, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17600098

RESUMO

The SAGE (Standards-Based Active Guideline Environment) project was formed to create a methodology and infrastructure required to demonstrate integration of decision-support technology for guideline-based care in commercial clinical information systems. This paper describes the development and innovative features of the SAGE Guideline Model and reports our experience encoding four guidelines. Innovations include methods for integrating guideline-based decision support with clinical workflow and employment of enterprise order sets. Using SAGE, a clinician informatician can encode computable guideline content as recommendation sets using only standard terminologies and standards-based patient information models. The SAGE Model supports encoding large portions of guideline knowledge as re-usable declarative evidence statements and supports querying external knowledge sources.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Guias de Prática Clínica como Assunto/normas , Sistemas de Informação Hospitalar , Humanos , Bases de Conhecimento , Sistemas de Registro de Ordens Médicas , Modelos Teóricos , Software , Integração de Sistemas , Interface Usuário-Computador , Vocabulário Controlado
18.
Psychiatry Res ; 148(2-3): 121-32, 2006 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-17097276

RESUMO

The purpose of this pilot study was to: (1) determine if regional brain volume change occurs in schizophrenia patients during very short periods of withdrawal from, or stable treatment with, antipsychotics, and; (2) compare results of region-of-interest (ROI) to voxel-based morphometry (VBM) methods. In two small groups of schizophrenic inpatients, magnetic resonance imaging was performed before and after antipsychotic withdrawal, and at two time points during stable chronic antipsychotic treatment. Regional brain volumes were measured using ROI methods. Grey matter volume was measured with VBM. The medication withdrawal group showed no effect of treatment state or antipsychotic type on regional brain volumes with ROI analysis, but effects of both treatment state and antipsychotic type on grey matter volume were observed with VBM in right middle frontal, right medial frontal, right and left superior frontal, right cingulate, and right superior temporal gyrii as well as in the right and left hippocampal gyrii. The chronic stable treatment group showed an effect of time on right caudate, left hippocampal, and total cerebrospinal fluid volumes with ROI analysis, while effects of both time and antipsychotic type were observed with VBM on grey matter volume in the left superior temporal lobe. No findings survived correction for multiple comparisons. A positive correlation between regional volume change and emerging psychopathology was demonstrated using ROI methods in the medication withdrawal group. Treatment state and emergent symptoms in schizophrenia patients were associated with regional volume change over very short time periods. Longitudinal regional brain volume change in schizophrenia patients is likely physiologic and therefore potentially reversible.


Assuntos
Antipsicóticos/efeitos adversos , Encéfalo/efeitos dos fármacos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Atrofia , Encéfalo/patologia , Núcleo Caudado/efeitos dos fármacos , Núcleo Caudado/patologia , Líquido Cefalorraquidiano/efeitos dos fármacos , Líquido Cefalorraquidiano/fisiologia , Dominância Cerebral/fisiologia , Feminino , Lobo Frontal/efeitos dos fármacos , Lobo Frontal/patologia , Giro do Cíngulo/efeitos dos fármacos , Giro do Cíngulo/patologia , Hipocampo/efeitos dos fármacos , Hipocampo/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/diagnóstico , Síndrome de Abstinência a Substâncias/diagnóstico , Lobo Temporal/efeitos dos fármacos , Lobo Temporal/patologia
19.
Br J Psychiatry ; 188: 510-8, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16738340

RESUMO

BACKGROUND: Studies of people with schizophrenia assessed using magnetic resonance imaging (MRI) usually include patients with first-episode and chronic disease, yet brain abnormalities may be limited to those with chronic schizophrenia. AIMS: To determine whether patients with a first episode of schizophrenia have characteristic brain abnormalities. METHOD: Systematic review and meta-analysis of 66 papers comparing brain volume in patients with a first psychotic episode with volume in healthy controls. RESULTS: A total of 52 cross-sectional studies included 1424 patients with a first psychotic episode; 16 longitudinal studies included 465 such patients. Meta-analysis suggests that whole brain and hippocampal volume are reduced (both P<0.0001) and that ventricular volume is increased (P<0.0001) in these patients relative to healthy controls. CONCLUSIONS: Average volumetric changes are close to the limit of detection by MRI methods. It remains to be determined whether schizophrenia is a neurodegenerative process that begins at about the time of symptom onset, or whether it is better characterised as a neurodevelopmental process that produces abnormal brain volumes at an early age.


Assuntos
Encéfalo/patologia , Esquizofrenia/patologia , Adolescente , Adulto , Ventrículos Cerebrais/patologia , Feminino , Hipocampo/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Projetos de Pesquisa
20.
AMIA Annu Symp Proc ; : 784-8, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17238448

RESUMO

Developing computer-interpretable clinical practice guidelines (CPGs) to provide decision support for guideline-based care is an extremely labor-intensive task. In the EON/ATHENA and SAGE projects, we formulated substantial portions of CPGs as computable statements that express declarative relationships between patient conditions and possible interventions. We developed query and expression languages that allow a decision-support system (DSS) to evaluate these statements in specific patient situations. A DSS can use these guideline statements in multiple ways, including: (1) as inputs for determining preferred alternatives in decision-making, and (2) as a way to provide targeted commentaries in the clinical information system. The use of these declarative statements significantly reduces the modeling expertise and effort required to create and maintain computer-interpretable knowledge bases for decision-support purpose. We discuss possible implications for sharing of such knowledge bases.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Quimioterapia Assistida por Computador , Hipertensão/tratamento farmacológico , Bases de Conhecimento , Guias de Prática Clínica como Assunto , Humanos , Software , Interface Usuário-Computador
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