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Blasini R, Michel-Backofen A, Schneider H, Marquardt K. RD-MON - Building a Rare Disease Monitor to Enhance Awareness for Patients with Rare Diseases in Intensive Care. Stud Health Technol Inform 2023; 302:358-359. [PMID: 37203683 DOI: 10.3233/shti230139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Rare diseases are commonly defined by an incidence of less than 5/10000 inhabitants. There are some 8000 different rare diseases known. So even if a single rare disease is seldom, together they pose a relevant problem for diagnosis and treatment. This is especially true if a patient is treated for another common disease. University hospital of Gießen is part of the CORD-MI Project on rare diseases within the German Medical Informatics Initiative (MII) and a member of the MIRACUM consortium within the MII. As part of the ongoing Development for a clinical research study monitor within the use case 1 of MIRACUM, the study monitor has been configured to detect patients with rare diseases during their routine clinical encounters. The goal was to send a documentation request to the corresponding patient chart within the patient data management system for extended disease documentation to enhance clinical awareness for the patients' potential problems. The project was started in late 2022 and has so far been successfully tuned to detect patients with Mucoviscidosis and place notifications within the patient chart of the patient data management system (PDMS) on intensive care units.
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Affiliation(s)
- Romina Blasini
- Department of medical informatics, University of Gießen, Germany
| | - Achim Michel-Backofen
- Department of clinical and administrative data processing, University Hospital of Gießen and Marburg, site Gießen, Germany
| | | | - Kurt Marquardt
- Department of clinical and administrative data processing, University Hospital of Gießen and Marburg, site Gießen, Germany
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Majeed RW, Wilkins MR, Howard L, Hassoun PM, Anthi A, Cajigas HR, Cannon J, Chan SY, Damonte V, Elwing J, Förster K, Frantz R, Ghio S, Al Ghouleh I, Hilgendorff A, Jose A, Juaneda E, Kiely DG, Lawrie A, Orfanos SE, Pepe A, Pepke‐Zaba J, Sirenko Y, Swett AJ, Torbas O, Zamanian RT, Marquardt K, Michel‐Backofen A, Antoine T, Wilhelm J, Barwick S, Krieb P, Fuenderich M, Fischer P, Gall H, Ghofrani H, Grimminger F, Tello K, Richter MJ, Seeger W. Pulmonary Vascular Research Institute GoDeep: A meta-registry merging deep phenotyping datafrom international PH reference centers. Pulm Circ 2022; 12:e12123. [PMID: 36034404 PMCID: PMC9399782 DOI: 10.1002/pul2.12123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/08/2022] Open
Abstract
The Pulmonary Vascular Research Institute GoDeep meta-registry is a collaboration of pulmonary hypertension (PH) reference centers across the globe. Merging worldwide PH data in a central meta-registry to allow advanced analysis of the heterogeneity of PH and its groups/subgroups on a worldwide geographical, ethnical, and etiological landscape (ClinTrial. gov NCT05329714). Retrospective and prospective PH patient data (diagnosis based on catheterization; individuals with exclusion of PH are included as a comparator group) are mapped to a common clinical parameter set of more than 350 items, anonymized and electronically exported to a central server. Use and access is decided by the GoDeep steering board, where each center has one vote. As of April 2022, GoDeep comprised 15,742 individuals with 1.9 million data points from eight PH centers. Geographic distribution comprises 3990 enrollees (25%) from America and 11,752 (75%) from Europe. Eighty-nine perecent were diagnosed with PH and 11% were classified as not PH and provided a comparator group. The retrospective observation period is an average of 3.5 years (standard error of the mean 0.04), with 1159 PH patients followed for over 10 years. Pulmonary arterial hypertension represents the largest PH group (42.6%), followed by Group 2 (21.7%), Group 3 (17.3%), Group 4 (15.2%), and Group 5 (3.3%). The age distribution spans several decades, with patients 60 years or older comprising 60%. The majority of patients met an intermediate risk profile upon diagnosis. Data entry from a further six centers is ongoing, and negotiations with >10 centers worldwide have commenced. Using electronic interface-based automated retrospective and prospective data transfer, GoDeep aims to provide in-depth epidemiological and etiological understanding of PH and its various groups/subgroups on a global scale, offering insights for improved management.
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Affiliation(s)
- Raphael W. Majeed
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute of Medical InformaticsRWTH Aachen UniversityAachenGermany
| | - Martin R. Wilkins
- National Heart and Lung Institute and Imperial CollegeLondon NHS Healthcare TrustLondonUK
| | - Luke Howard
- National Heart and Lung Institute and Imperial CollegeLondon NHS Healthcare TrustLondonUK
| | - Paul M. Hassoun
- Department of MedicineDivision of Pulmonary and Critical Care Medicine, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Anastasia Anthi
- 1st Department of Critical CareNational & Kapodistrian University of Athens Medical School and Pulmonary Hypertension Clinic, Evangelismos General HospitalAthensGreece
| | - Hector R. Cajigas
- Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterNew YorkUSA
| | - John Cannon
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge Biomedical CampusCambridgeUK
| | - Stephen Y. Chan
- Department of Medicine, Division of Cardiology, Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine InstituteUniversity of Pittsburgh School of Medicine and University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Victoria Damonte
- Hospital de Niños, Hospital Privado Universitario, Clinica Universitaria Reina Fabiola and Instituto Oulton‐Catholic, University of CórdobaCórdobaArgentina
| | - Jean Elwing
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kai Förster
- Ludwig‐Maximilians University of MunichMunchenGermany
| | - Robert Frantz
- Department of CardiologyMayo ClinicRochesterNew YorkUSA
| | | | - Imad Al Ghouleh
- Department of Medicine, Division of Cardiology, Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine InstituteUniversity of Pittsburgh School of Medicine and University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | | | - Arun Jose
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Ernesto Juaneda
- Hospital de Niños, Hospital Privado Universitario, Clinica Universitaria Reina Fabiola and Instituto Oulton‐Catholic, University of CórdobaCórdobaArgentina
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and University of SheffieldSheffieldUK
| | - Allan Lawrie
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and University of SheffieldSheffieldUK
| | - Stylianos E. Orfanos
- 1st Department of Critical CareNational & Kapodistrian University of Athens Medical School and Pulmonary Hypertension Clinic, Evangelismos General HospitalAthensGreece
| | | | - Joanna Pepke‐Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge Biomedical CampusCambridgeUK
| | - Yuriy Sirenko
- Department of Symptomatic Hypertension“National Scientific Center ‘The M.D. Strazhesko Institute of Cardiology’” of National Academy of Medical ScienceKyivUkraine
| | - Andrew J. Swett
- Division of Pulmonary, Allergy, and Critical Care, and Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford UniversityStanfordCaliforniaUSA
| | - Olena Torbas
- Department of Symptomatic Hypertension“National Scientific Center ‘The M.D. Strazhesko Institute of Cardiology’” of National Academy of Medical ScienceKyivUkraine
| | - Roham T. Zamanian
- Division of Pulmonary, Allergy, and Critical Care, and Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford UniversityStanfordCaliforniaUSA
| | - Kurt Marquardt
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Achim Michel‐Backofen
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Tobiah Antoine
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Jochen Wilhelm
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | | | - Phillipp Krieb
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Meike Fuenderich
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Patrick Fischer
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Henning Gall
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
| | - Hossein‐Ardeschir Ghofrani
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Friedrich Grimminger
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Khodr Tello
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Manuel J. Richter
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
| | - Werner Seeger
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL)GiessenGermany
- Institute for Lung Health (ILH), Cardio‐Pulmonary Institute (CPI)GiessenGermany
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Michel-Backofen A, Pellizzari T, Zohner J, Blasini R, Marquardt K. Building a Comprehensive Clinical Data Repository Using FHIR, LOINC and SNOMED. Stud Health Technol Inform 2022; 294:563-564. [PMID: 35612145 DOI: 10.3233/shti220524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2018 the University Hospital of Giessen (UHG) moved its hospital information system from an in-house solution to commercial software. The introduction of MEONA and Synedra-AIM allowed for the successful migration of clinical documents. The large pool of structured clinical data has been addressed in a second step and is now consolidated in a HAPI-FHIR server and mapped to LOINC and SNOMED for semantic interoperability in multicenter research projects, especially the German Medical Informatics Initiative (MII) and the Medical Informatics in Research and Care in University Medicine (MIRACUM) consortium.
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Zohner J, Marquardt K, Schneider H, Michel Backofen A. Challenges and Opportunities in Changing Data Structures of Clinical Document Archives from HL7-V2 to FHIR-Based Archive Solutions. Stud Health Technol Inform 2019; 264:492-495. [PMID: 31437972 DOI: 10.3233/shti190270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2018, a major replacement of clinical applications took place at the University Hospital of Giessen. One key part was the clinical document archive containing a vast collection of clinical data from the last 30 years. The aim of this sub-project was to move all data to a new system without any loss, while maintaining all functionality and all communication interfaces. This project successively resulted in a complete paradigm change in document storage. While the legacy clinical data repository (LCDR) was designed according to HL7-V2 principles, the replacement resulted in an HL7-FHIR implementation. The aim of this work is to discuss the differences between both approaches, the obstacles that appeared during migration, but also the opportunities resulting from the new philosophy, especially as far as the impact on the use of scientific data is concerned.
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Affiliation(s)
- Jochen Zohner
- Department of Medical Informatics, Justus Liebig University, Giessen, Hesse, Germany
| | - Kurt Marquardt
- Department of Medical Informatics, Justus Liebig University, Giessen, Hesse, Germany
| | - Henning Schneider
- Department of Medical Informatics, Justus Liebig University, Giessen, Hesse, Germany
| | - Achim Michel Backofen
- Department of Medical Informatics, Justus Liebig University, Giessen, Hesse, Germany
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Prokosch HU, Acker T, Bernarding J, Binder H, Boeker M, Boerries M, Daumke P, Ganslandt T, Hesser J, Höning G, Neumaier M, Marquardt K, Renz H, Rothkötter HJ, Schade-Brittinger C, Schmücker P, Schüttler J, Sedlmayr M, Serve H, Sohrabi K, Storf H. MIRACUM: Medical Informatics in Research and Care in University Medicine. Methods Inf Med 2018; 57:e82-e91. [PMID: 30016814 PMCID: PMC6178200 DOI: 10.3414/me17-02-0025] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/13/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION This article is part of the Focus Theme of Methods of Information in Medicine on the German Medical Informatics Initiative. Similar to other large international data sharing networks (e.g. OHDSI, PCORnet, eMerge, RD-Connect) MIRACUM is a consortium of academic and hospital partners as well as one industrial partner in eight German cities which have joined forces to create interoperable data integration centres (DIC) and make data within those DIC available for innovative new IT solutions in patient care and medical research. OBJECTIVES Sharing data shall be supported by common interoperable tools and services, in order to leverage the power of such data for biomedical discovery and moving towards a learning health system. This paper aims at illustrating the major building blocks and concepts which MIRACUM will apply to achieve this goal. GOVERNANCE AND POLICIES Besides establishing an efficient governance structure within the MIRACUM consortium (based on the steering board, a central administrative office, the general MIRACUM assembly, six working groups and the international scientific advisory board), defining DIC governance rules and data sharing policies, as well as establishing (at each MIRACUM DIC site, but also for MIRACUM in total) use and access committees are major building blocks for the success of such an endeavor. ARCHITECTURAL FRAMEWORK AND METHODOLOGY The MIRACUM DIC architecture builds on a comprehensive ecosystem of reusable open source tools (MIRACOLIX), which are linkable and interoperable amongst each other, but also with the existing software environment of the MIRACUM hospitals. Efficient data protection measures, considering patient consent, data harmonization and a MIRACUM metadata repository as well as a common data model are major pillars of this framework. The methodological approach for shared data usage relies on a federated querying and analysis concept. USE CASES MIRACUM aims at proving the value of their DIC with three use cases: IT support for patient recruitment into clinical trials, the development and routine care implementation of a clinico-molecular predictive knowledge tool, and molecular-guided therapy recommendations in molecular tumor boards. RESULTS Based on the MIRACUM DIC release in the nine months conceptual phase first large scale analysis for stroke and colorectal cancer cohorts have been pursued. DISCUSSION Beyond all technological challenges successfully applying the MIRACUM tools for the enrichment of our knowledge about diagnostic and therapeutic concepts, thus supporting the concept of a Learning Health System will be crucial for the acceptance and sustainability in the medical community and the MIRACUM university hospitals.
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Affiliation(s)
- Hans-Ulrich Prokosch
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Till Acker
- Institute of Neuropathology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Johannes Bernarding
- Chair of Medical Informatics, Institute for Biometry and Medical Informatics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Harald Binder
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center – University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center – University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- Institute of Molecular Medicine and Cell Research and Comprehensive Cancer Center Freiburg (CCCF), University Medical Center, Faculty of Medicine, University of Freiburg; German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK) partner site Freiburg, Freiburg, Germany
| | | | - Thomas Ganslandt
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Department of Biomedical Informatics, University Medicine Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Jürgen Hesser
- Experimental Radiation Oncology Department, University Medical Center Mannheim, Central Institute for Scientific Computing (IWR), Central Institute for Computer Engineering (ZITI), Heidelberg University, Mannheim, Germany
| | - Gunther Höning
- Department of Information Technology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Neumaier
- Chair for Clinical Chemistry, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Kurt Marquardt
- University Hospital of Giessen and Marburg, Giessen, Germany
| | - Harald Renz
- Chair for Clinical Chemistry, Philipps University Marburg, Medical Director of the University Clinic Marburg, Marburg, Germany
| | - Hermann-Josef Rothkötter
- Institute of Anatomy, Otto-von-Guericke-University Magdeburg, Dean of the Medical Faculty, Magdeburg, Germany
| | - Carmen Schade-Brittinger
- Chair of the Coordinating Centre for Clinical Trials, Philipps University Marburg, Marburg, Germany
| | - Paul Schmücker
- University of Applied Sciences Mannheim, Institute for Medical Informatics, Mannheim, Germany
| | - Jürgen Schüttler
- Department of Anesthesiology, University of Erlangen-Nürnberg, Dean of the Medical Faculty, Erlangen, Germany
| | - Martin Sedlmayr
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Institute of Medical Informatics and Biometrics, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Hubert Serve
- Department of Hematology and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences – THM, Giessen, Germany
| | - Holger Storf
- Medical Informatics Group, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Junger A, Quinzio L, Michel A, Sciuk G, Fuchs C, Marquardt K, Hempelmann G, Benson M. Data Processing at the Anesthesia Workstation: from Data Entry to Data Presentation. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract:Main requirements for an Anesthesia Information Management System (AIMS) are the supply of additional information for the anesthesiologist at his workstation and complete documentation of the anesthetic procedure. With the implementation of an AIMS (NarkoData) and effective user support, the quality of documentation and the information flow at the anesthesia workstation could be increased. Today, more than 20,000 anesthesia procedures are annually recorded with the AIMS at 112 decentralized workstations. The network for data entry and the presentation and evaluation of data, statistics and results directly available at the clinical workstation was made operational.
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Dudeck J, Junghans G, Marquardt K, Sebald P, Michel A, Prokosch HU. WING – Entering a New Phase of Electronic Data Processing at the Gießen University Hospital. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractAt the Gielßen University Hospital electronic data processing systems have been in routine use since 1975. In the early years developments were focused on ADT functions (admission/discharge/transfer) and laboratory systems. In the next decade additional systems were introduced supporting various functional departments. In the mid-eighties the need to stop the ongoing trend towards more and more separated standalone systems was realized and it was decided to launch a strategic evaluation and planning process which sets the foundation for an integrated hospital information system (HIS). The evaluation of the HELP system for its portability into the German hospital environment was the first step in this process. Despite its recognized capabilities in integrating decision support and communication technologies, and its powerful HIS development tools, the large differences between American and German hospital organization, influencing all existing HELP applications, and the incompatibility of the HELP tools with modern software standards were two important factors forcing the investigation of alternative solutions. With the HELP experience in mind, a HIS concept for the Gießen University Hospital was developed. This new concept centers on the idea of a centralized relational patient database on a highly reliable database server, and clinical front-end applications which might be running on various other computer systems (mainframes, departmental UNIX satellites or PCs in a LAN) integrated into a comprehensive open HIS network. The first step towards this integrated approach was performed with the implementation of ADT and results reporting functions on care units.
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Junger A, Quinzio L, Michel A, Sciuk G, Brammen D, Marquardt K, Hempelmann G, Benson M. An Anesthesia Information Management System (AIMS) as a Tool for Controlling Resource Management of Operating Rooms. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objectives: In our department, we have been using an Anesthesia Information Management System (AIMS) for five years. In this study, we tested to what extent data extracted from the AIMS could be suitable for the supervision and time-management of operating rooms.
Methods: From 1995 to 1999, all relevant data from 103,264 anesthetic procedures were routinely recorded online with the automatic anesthesia record keeping system NarkoData. The program is designed to record patient related time data, such as the beginning of anesthesia or surgical procedure, on a graphical anesthesia record sheet. The total number of minutes of surgery and anesthesia for each surgical subspecialty per hour/day and day of the year was calculated for each of the more than 40 ORs, amounting to a total of 112 workstations.
Results: It was possible to analyze the usage and the utilization of ORs at the hospital for each day of the year since 1997. In addition, annual and monthly evaluations are made available. It is possible to scrutinize data of OR usage from different points of view: queries on the usage of an individual OR, the usage of ORs on certain days or the usage of ORs by a certain surgical subspecialty may be formulated. These data has been used repeatedly in our hospital for decision making in OR management and planning. Conclusions: In assessing the results of our study, it should be considered that the system used is not a specialized OR management tool. Despite these restrictions, the system contains data which can be used for an exact and relevant presentation of OR utilization
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Junger A, Quinzio L, Fuchs C, Michel A, Sciuk G, Marquardt K, Dudeck J, Hempelmann G, Benson M. Influence of the Method of Data Collection on the Documentation of Blood-pressure Readings with an Anesthesia Information Management System (AIMS). Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract:The influence of methods for record keeping on the documentation of vital signs was assessed for the Anesthesia Information Management System (AIMS) NarkoData. We compared manually entered blood-pressure readings with automatically collected data. These data were stored in a database and subsequently evaluated and analyzed. The data sets were split into two groups, ”manual“ and ”automatic“. We evaluated the effect of automatic data collection on the incidence of corrected data, data validity and data variation. Blood-pressure readings of 37,726 data sets were analyzed. We could assess that the method of documentation did influence the data quality. It could not be assessed whether the incorrectness of data during automatic data gathering was caused by artefacts or by the anesthesiologist.
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Abstract
AIM The present study evaluates the risk of progression of cytologic diagnoses which do not require immediate therapy but do need follow-up. The presented data can contribute to risk-adapted management strategies, according to Munich Nomenclature III. METHODS Between January 2014 and March 2016, 3396 women were diagnosed as group II-p, IIID1, III-p, IIID2, IVa-p, IVb-p, and V‑p and represent the study population. Follow-up information on all subsequent cytologic and histologic findings were collected up to July 2017. For the initial cytologic diagnosis, the cumulative risk of CIN2+ or CIN3+ and the risk for persistent pathologic findings was calculated. RESULTS The cumulative risk of CIN2+ for initial findings II-p, IIID1, III-p, and IIID2 is calculated as 7.3, 17.1, 46.3, and 62.4%, respectively, after a mean observation period of 24.4, 21.1, 15.6, and 14.3 months. The cumulative risk of CIN3+ (%) is determined as 5.0, 9.3, 37.6, and 45.8. For persistent cytologic diagnoses II-p, IIID1, III-p, and IIID2, the risk of CIN2+ increases significantly after the second result (0 to 3.6, 0.21 to 3.6, 7.2 to 58.3, and 8.1 to 64.7%). Risk of CIN2+ and CIN3+ for group III-p is significantly higher for women <35 years and <30 years compared with women of higher age. There are no significant age-dependent differences for findings II-p, IIID1, and IIID2. CONCLUSIONS The Munich Nomenclature III classifies cytologic findings according to risk. The diagnostic groups of the Munich Nomenclature III provide a solid basis for a risk-adapted clinical management, if the cytologic history of the individual patient is taken into account.
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Affiliation(s)
- K Marquardt
- Praxis für Pathologie, Güstrower Str. 34, 19055, Schwerin, Deutschland.
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Marquardt K, Stubbe M, Broschewitz U. [Cervical cancer in Mecklenburg-Western Pomerania. Tumor stage, histological tumor type, age and screening participation of 985 patients]. Pathologe 2017; 37:78-83. [PMID: 26660458 DOI: 10.1007/s00292-015-0120-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In view of the discussion on primary human papillomavirus (HPV) screening it was necessary to evaluate recent and reliable data from the current cytology-based screening program. METHODS Since the year 2004 all cases of cervical cancer must be reported to the Joint State Quality Control Commission in Mecklenburg-Western Pomerania, corrected and supplemented by data of the State Cancer Registry. The screening histories of all patients, age, tumor stages and histological tumor types were analyzed. RESULTS Over a 10-year period (2004-2013) 985 women with invasive cervical cancer and complete data were identified, of whom 573 patients (58 %) had not had a cervical smear within the past 5 years, an irregular screening history was found in 312 patients (32 %) and 100 patients (10 %) had cervical cancer despite regular participation. In women who did not participate in the screening program, tumor stages T1b and higher were found in 85 %. In the group of women with regular screening 53 % were diagnosed with microinvasive cancer and in 38 % of women with irregular screening. The age distribution showed a peak for cervical cancer in the age group of 40-54 years. Squamous cell carcinoma dominated and adenocarcinoma was found in 17 % which showed a tendency to increase over the investigation time period. CONCLUSION Most cervical cancers and the advanced stages were found in women who did not participate in the screening program.
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Affiliation(s)
- K Marquardt
- Praxis für Pathologie, Güstrower Str. 34, 19055, Schwerin, Deutschland.
| | - M Stubbe
- Praxis für Pathologie, Rostock, Deutschland
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Rudloff-Grund J, Brenker FE, Marquardt K, Kaminsky FV, Schreiber A. STEM EDX Nitrogen Mapping of Nanoinclusions in Milky Diamonds from Juina, Brazil, Using a Windowless Silicon Drift Detector System. Anal Chem 2016; 88:5804-8. [PMID: 27128863 DOI: 10.1021/acs.analchem.6b00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Energy-dispersive X-ray spectroscopy (EDX) performed using scanning transmission electron microscopy (STEM) in combination with a windowless detector setup allows high-resolution imaging and chemical composition mapping even of light elements present in low concentrations. The used TEM-system combines a field emission electron source with four silicon drift detectors allowing for high detection sensitivity. We used this enhanced system to investigate 20 to 200 nm sized inclusions in milky diamonds from Rio Soriso, Juina area, Brazil. The diamonds act as a chemical inert container and therefore protect their inclusions from further chemical reactions with their surroundings. We visualize the presence and distribution of nitrogen within focused ion beam (FIB) slices containing these nanoinclusions. The investigation of these specific diamonds may open a new window to deeper parts of the Earth (>660 km) as they represent pristine material of this deep mantle environment.
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Affiliation(s)
- J Rudloff-Grund
- Geoscience Institute, Goethe University , Altenhoeferallee 1, 60438 Frankfurt am Main, Germany
| | - F E Brenker
- Geoscience Institute, Goethe University , Altenhoeferallee 1, 60438 Frankfurt am Main, Germany
| | - K Marquardt
- Bayerisches Geoinstitut, University Bayreuth , Universitaetsstraße 30, 95447 Bayreuth, Germany
| | - F V Kaminsky
- KM Diamond Exploration Ltd., 2446 Shadbolt Lane, West Vancouver, British Columbia V7S 3J1, Canada
| | - A Schreiber
- Department 3.3, Chemistry and Physics of Earth Materials, GeoForschungsZentrum Potsdam , 14473 Potsdam, Germany
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13
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Christoph J, Griebel L, Leb I, Engel I, Köpcke F, Toddenroth D, Prokosch HU, Laufer J, Marquardt K, Sedlmayr M. Secure Secondary Use of Clinical Data with Cloud-based NLP Services. Towards a Highly Scalable Research Infrastructure. Methods Inf Med 2014; 54:276-82. [PMID: 25377309 DOI: 10.3414/me13-01-0133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 10/08/2014] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The secondary use of clinical data provides large opportunities for clinical and translational research as well as quality assurance projects. For such purposes, it is necessary to provide a flexible and scalable infrastructure that is compliant with privacy requirements. The major goals of the cloud4health project are to define such an architecture, to implement a technical prototype that fulfills these requirements and to evaluate it with three use cases. METHODS The architecture provides components for multiple data provider sites such as hospitals to extract free text as well as structured data from local sources and de-identify such data for further anonymous or pseudonymous processing. Free text documentation is analyzed and transformed into structured information by text-mining services, which are provided within a cloud-computing environment. Thus, newly gained annotations can be integrated along with the already available structured data items and the resulting data sets can be uploaded to a central study portal for further analysis. RESULTS Based on the architecture design, a prototype has been implemented and is under evaluation in three clinical use cases. Data from several hundred patients provided by a University Hospital and a private hospital chain have already been processed. CONCLUSIONS Cloud4health has shown how existing components for secondary use of structured data can be complemented with text-mining in a privacy compliant manner. The cloud-computing paradigm allows a flexible and dynamically adaptable service provision that facilitates the adoption of services by data providers without own investments in respective hardware resources and software tools.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - M Sedlmayr
- Dr. Martin Sedlmayr, Lehrstuhl für Medizinische Informatik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Wetterkreuz 13, 91058 Erlangen, Germany, E-mail:
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Marquardt K, Saha M, Mishina M, Young JW, Brigman JL. Loss of GluN2A-containing NMDA receptors impairs extra-dimensional set-shifting. Genes Brain Behav 2014; 13:611-7. [PMID: 25059550 DOI: 10.1111/gbb.12156] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/08/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Abstract
Glutamate neurotransmission via the N-methyl-D-aspartate receptor (NMDAR) is thought to mediate the synaptic plasticity underlying learning and memory formation. There is increasing evidence that deficits in NMDAR function are involved in the pathophysiology of cognitive dysfunction seen in neuropsychiatric disorders and addiction. NMDAR subunits confer different physiological properties to the receptor, interact with distinct intracellular postsynaptic scaffolding and signaling molecules, and are differentially expressed during development. Despite these known differences, the relative contribution of individual subunit composition to synaptic plasticity and learning is not fully elucidated. We have previously shown that constitutive deletion of GluN2A subunit in the mouse impairs discrimination and re-learning phase of reversal when exemplars are complex picture stimuli, but spares acquisition and extinction of non-discriminative visually cued instrumental response. To investigate the role of GluN2A containing NMDARs in executive control, we tested GluN2A knockout (GluN2A(KO) ), heterozygous (GluN2A(HET) ) and wild-type (WT) littermates on an attentional set-shifting task using species-specific stimulus dimensions. To further explore the nature of deficits in this model, mice were tested on a visual discrimination reversal paradigm using simplified rotational stimuli. GluN2A(KO) were not impaired on discrimination or reversal problems when tactile or olfactory stimuli were used, or when visual stimuli were sufficiently easy to discriminate. GluN2A(KO) showed a specific and significant impairment in ventromedial prefrontal cortex-mediated set-shifting. Together these results support a role for GluN2A containing NMDAR in modulating executive control that can be masked by overlapping deficits in attentional processes during high task demands.
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Affiliation(s)
- K Marquardt
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, USA
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15
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Griesser H, Marquardt K, Jordan B. Remarks on the “Comments on the Publication of Munich Nomenclature III by the Cytology Coordination Conference” by A. Schneider and P. Hillemanns (Geburtsh Frauenheilk 2014; 74: 242–243). Geburtshilfe Frauenheilkd 2014; 74:636. [DOI: 10.1055/s-0034-1368548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- H. Griesser
- Fachabteilung für Pathologie und Zytodiagnostik, Laboratoriumsmedizin Köln, Dres. med. Wisplinghoff und Kollegen, Cologne
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16
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Hoeppner K, Ferch M, Eisenreich M, Marquardt K, Hahn R, Mackowiak P, Mukhopadhyay B, Ngo HD, Gernhardt R, Toepper M, Lang KD. Design, Fabrication and Testing of Silicon-integrated Li-ion Secondary Micro Batteries with Side-by-Side Electrodes. ACTA ACUST UNITED AC 2013. [DOI: 10.1088/1742-6596/476/1/012086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Budde PI, Ostendorf B, Lueking A, von Darl M, Sörgel A, Theek C, Goehler H, Schwermann J, Gamer M, Marquardt K, Telaar A, Chamrad D, Vordenbäumen S, Schulz-Knappe P, Schneider M. AB0746 Diagnostic autoantibody signatures of rheumatoid arthritis patients identified with a bead-based assay approach. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Lueking A, Vordenbäumen S, Budde P, Göhler H, Schwermann J, Gamer M, Marquardt K, Telaar A, Chamrad D, Theek C, Ostendorf B, Schulz-Knappe P, Schneider M. FRI0473 Autoantibody signatures of systemic lupus erythematosus (SLE) patients identified with a bead-based assay approach. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Portmann-Lanz CB, Ochsenbein-Kölble N, Marquardt K, Lüthi U, Zisch A, Zimmermann R. Manufacture of a Cell-free Amnion Matrix Scaffold that Supports Amnion Cell Outgrowth In Vitro. Placenta 2007; 28:6-13. [PMID: 16516964 DOI: 10.1016/j.placenta.2006.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Revised: 01/02/2006] [Accepted: 01/10/2006] [Indexed: 12/01/2022]
Abstract
We manufactured a cell-free extracellular matrix scaffolds in order to obtain a support material for amnion cell outgrowth, eventually being used for repair of prematurely ruptured fetal membrane. Human preterm or term amnion tissue was separated into its collagenous extracellular matrix and cell components. The acellular scaffold was explored for its capacity to support regrowth of isolated human amnion epithelial or mesenchymal cells in vitro. The outgrowth of amnion cells on and in the scaffold was investigated by scanning and transmission electron microscopy, and confocal laser scanning microscopy. Cell-free amnion matrix scaffolds demonstrated a porous collagen fiber network similar as in native amnion. Inoculation of acellular amnion scaffolds with human amnion cells revealed that its property to support amnion cell outgrowth was retained. Amnion epithelial and mesenchymal cells were found to grow into dense layers on the surface of the scaffold within 3-4 days and 7-8 days, respectively, and to some extent, invaded the scaffold during the culture period. Manufactured acellular amnion matrix retains structural and functional properties required for cell outgrowth in vitro. It may become useful to repair prematurely ruptured fetal membranes.
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Affiliation(s)
- C B Portmann-Lanz
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland
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20
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Ochsenbein-Kölble N, Jani J, Verbist G, Lewi L, Marquardt K, Zimmermann R, Deprest J. Closure of Fetoscopic Access Sites with Amniotic Extracellular Matrix Scaffolds in an In Vivo Model. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Michel-Backofen A, Demming R, Röhrig R, Benson M, Marquardt K, Hempelmann G. Realizing a Realtime Shared Patient Chart using a Universal Message Forwarding Architecture. Stud Health Technol Inform 2005; 116:509-14. [PMID: 16160308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The goal of this paper is to describe the clinical needs and the informational methodology which led to the realization of a realtime shared patient chart. It is an integral part of the communications infrastructure of the Patient Data Management System (PDMS) ICUData which is in routine use at the intensive care unit (ICU) of the Department for Anesthesiology and Intensive Care Medicine at the University Hospital of Giessen, Germany, since February 1999. ICUData utilizes a four tier system architecture consisting of modular clients, message forwarders, application servers and a relational database management system. All layers communicate with health level seven messages. The innovative aspect of this architecture consists of the interposition of a message forwarder layer which allows for instant exchange of patient data between the clients without delays caused by database access. This works even in situations with high workload as in patient monitoring. Therefore a system with many workstations acts a blackboard for patient data allowing shared access under realtime conditions. Realized first as an experimental feature, it has been embraced by the clinical users and served well during the documentation of more than 18000 patient stays.
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Affiliation(s)
- Achim Michel-Backofen
- Department of Medical and Administrative Data Processing, University of Gießen, Gießen, Germany
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Abstract
BACKGROUND AND OBJECTIVES Transmission of cytomegalovirus (CMV) to seronegative, immunocompromised recipients can cause serious and fatal complications. Although the seroprevalence of CMV is high, the risk of primary CMV infection among healthy blood donors has not yet been analysed in a large population. MATERIALS AND METHODS We developed an algorithm to determine the rate of CMV seroconversion in an overall cohort of 24,260 subjects who donated 176,474 blood units during an 11-year observation period. RESULTS We detected CMV seroconversion in all relevant age groups (18-60 years) with an overall seroconversion rate of 0.55% per year. Both CMV seroconversion and seroprevalence occurred more frequently in female donors (P = 0.02 and P < 0.001, respectively). We identified 30-35-year-old blood donors as the group with the highest rate of CMV seroconversion per year (1.33% vs. 0.46%; P < 0.0001). CONCLUSIONS We conclude that the risk of primary CMV infection is a continuous lifelong event and correlates with age and female gender.
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Affiliation(s)
- M Hecker
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Giessen, Germany
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Michel A, Junger A, Benson M, Brammen DG, Hempelmann G, Dudeck J, Marquardt K. A data model for managing drug therapy within a patient data management system for intensive care units. Comput Methods Programs Biomed 2003; 70:71-79. [PMID: 12468128 DOI: 10.1016/s0169-2607(01)00197-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The major intent of this article was to describe the design principles of the drug-therapy documentation module of the Patient Data Management System (PDMS) ICUData, in routine use at the intensive care unit (ICU) of the Department of Anesthesiology and Intensive Care Medicine at the University Hospital of Giessen, Germany, since February 1999. The new drug management system has been in routine use since March 2000. Until 8 January 2001, 1140 patients have been documented using this approach. It could be demonstrated that it was possible to transform the formerly unstructured text-based documentation into a detailed and structured model. The mediated benefit resulted in the automatic calculation of fluid balance. Further, detailed statistical analyses of therapeutic behavior in drug administration are now possible.
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Affiliation(s)
- Achim Michel
- Department of Medical and Administrative Data Processing, University Hospital Giessen, Giessen, Germany.
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Junger A, Benson M, Quinzio L, Michel A, Sciuk G, Brammen D, Marquardt K, Hempelmann G. An Anesthesia Information Management System (AIMS) as a tool for controlling resource management of operating rooms. Methods Inf Med 2002; 41:81-5. [PMID: 11933770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES In our department, we have been using an Anesthesia Information Management System (AIMS) for five years. In this study, we tested to what extent data extracted from the AIMS could be suitable for the supervision and time-management of operating rooms. METHODS From 1995 to 1999, all relevant data from 103,264 anesthetic procedures were routinely recorded online with the automatic anesthesia record keeping system NarkoData. The program is designed to record patient related time data, such as the beginning of anesthesia or surgical procedure, on a graphical anesthesia record sheet. The total number of minutes of surgery and anesthesia for each surgical subspecialty per hour/day and day of the year was calculated for each of the more than 40 ORs, amounting to a total of 112 workstations. RESULTS It was possible to analyze the usage and the utilization of ORs at the hospital for each day of the year since 1997. In addition, annual and monthly evaluations are made available. It is possible to scrutinize data of OR usage from different points of view: queries on the usage of an individual OR, the usage of ORs on certain days or the usage of ORs by a certain surgical subspecialty may be formulated. These data has been used repeatedly in our hospital for decision making in OR management and planning. CONCLUSIONS In assessing the results of our study, it should be considered that the system used is not a specialized OR management tool. Despite these restrictions, the system contains data which can be used for an exact and relevant presentation of OR utilization.
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Affiliation(s)
- A Junger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Giessen, Germany
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25
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Junger A, Engel J, Benson M, Böttger S, Grabow C, Hartmann B, Michel A, Röhrig R, Marquardt K, Hempelmann G. Discriminative power on mortality of a modified Sequential Organ Failure Assessment score for complete automatic computation in an operative intensive care unit. Crit Care Med 2002; 30:338-42. [PMID: 11889305 DOI: 10.1097/00003246-200202000-00012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the discriminative power on mortality of a modified Sequential Organ Failure Assessment (SOFA) score and derived measures (maximum SOFA, total maximum SOFA, and delta SOFA) for complete automatic computation in an operative intensive care unit (ICU). DESIGN Retrospective study. SETTING Operative ICU of the Department of Anesthesiology and Intensive Care Medicine. PATIENTS Patients admitted to the ICU from April 1, 1999, to March 31, 2000 (n = 524). Data from patients under the age of 18 yrs and patients who stayed <24 hrs were excluded. In the case of patient readmittance, only data from the patient's last stay was included in the study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The main outcome measure was survival status at ICU discharge. Based on Structured Query Language (SQL) scripts, a modified SOFA score for all patients who stayed in the ICU in 1 yr was calculated for each day in the ICU. Only routine data were used, which were supplied by the patient data management system. Score evaluation was modified in registering unavailable data as being not pathologic and in using a surrogate of the Glasgow Coma Scale. During the first 24 hrs, 459 survivors had an average SOFA score of 4.5 +/- 2.1, whereas the 65 deceased patients averaged 7.6 +/- 2.9 points. The area under the receiver operating characteristic (ROC) curve was 0.799 and significantly >0.5 (p <.01). A confidence interval (CI) of 95% covers the area (0.739-0.858). The maximum SOFA presented an area under the ROC of 0.922 (CI: 0.879-0.966), the total maximum SOFA of 0.921 (CI: 0.882-0.960), and the delta SOFA of 0.828 (CI: 0.763-0.893). CONCLUSION Despite a number of differences between completely automated data sampling of SOFA score values and manual evaluation, the technique used in this study seems to be suitable for prognosis of the mortality rate during a patient's stay at an operative ICU.
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Affiliation(s)
- Axel Junger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen, Giessen, Germany
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Junger A, Michel A, Benson M, Quinzio LA, Hafer J, Hartmann B, Brandenstein P, Marquardt K, Hempelmann G. Evaluation of the suitability of a patient data management system for ICUs on a general ward. Int J Med Inform 2001; 64:57-66. [PMID: 11673102 DOI: 10.1016/s1386-5056(01)00202-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The development of the ICUData patient data management system (PDMS) for intensive care units (ICU), by IMESO GmbH, Hüttenberg, Germany, was based on the assumption that processes and therapies at ICU are the most complex with the highest data density compared with those in other wards. Based on experience with the system and on a survey conducted among users at our pain clinic, we evaluated whether the concept of the present software architecture, which sufficiently reproduces processes and data at an ICU, is suitable as a PDMS for general wards. The highly modular and client-centric approach of the PDMS is founded on a message-based communications architecture (HL7). In the beginning of the year 2000, the system was implemented at the pain management clinic (12 beds) of our hospital. To assess its user friendliness, we conducted a survey of medical staff (n=14). From April 1st 2000 to August 31st 2000, all clinical and administrative data of 658 patients at the pain management clinic were recorded with the PDMS. From the start, all users had access to data and information of other connected data management systems of the hospital (e.g. patient administrative data, patient clinical data). Staff members found the system mostly useful, clearly presented, practical, and easy to learn and use. Users were relatively satisfied with stability and performance of the program but mentioned having only limited knowledge of the program's features. The need for external support during a computer crash was rated negatively. Despite the need for further usage training and improved program performance, the software architecture described seems to be a promising starting point for the construction of a PDMS for general wards.
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Affiliation(s)
- A Junger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany
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Abstract
Hydroxychloroquine overdoses are rarely reported with 7 previous cases found in the English medical literature. We report a case and review the literature. A 16-year-old girl ingested a handful of hydroxychloroquine 200mg, 30 minutes before presentation and presented with tachycardia (heart rate 110 beats/min), hypotension (systolic blood pressure 63 mm Hg), central nervous system depression, conduction defects (QRS = 0.14 msec), and hypokalemia (K = 2.1 meq/L). She was treated with fluid boluses and dopamine, oxygen, and potassium supplementation. Toxicologic tests confirmed the presence of hydroxychloroquine. The patient's hypotension resolved within 4.5 hours, serum potassium stabilized in 24 hours, and tachycardia gradually decreased over 3 days. Although hydroxychloroquine overdoses are very rare, life-threatening hypotension, conduction problems, and hypokalemia can occur within 30 minutes of ingestion. Symptoms are similar to chloroquine and treatment must be implemented quickly and should be modeled after experience with chloroquine overdoses. Treatment modalities need further study, but current recommendations are: (1) diazepam for seizures and sedation; (2) early intubation and mechanical ventilation; (3) epinephrine for treatment of vasodilation and myocardial depression; (4) potassium replacement with close monitoring of levels; (5) charcoal for gastrointestinal decontamination if ingestion occurred within an hour; (6) high dose diazepam for life-threatening symptoms, until more information becomes available. No value was found for serum alkalinization or extracorporeal methods of drug removal.
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Affiliation(s)
- K Marquardt
- California Poison Control System, Sacramento Division, Sacramento, CA 95817, USA
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Benson M, Junger A, Quinzio L, Fuchs C, Michel A, Sciuk G, Marquardt K, Dudeck J, Hempelmann G. Influence of the method of data collection on the documentation of blood-pressure readings with an Anesthesia Information Management System (AIMS). Methods Inf Med 2001; 40:190-5. [PMID: 11501631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The influence of methods for record keeping on the documentation of vital signs was assessed for the Anesthesia Information Management System (AIMS) NarkoData. We compared manually entered blood-pressure readings with automatically collected data. These data were stored in a data-base and subsequently evaluated and analyzed. The data sets were split into two groups, "manual" and "automatic". We evaluated the effect of automatic data collection on the incidence of corrected data, data validity and data variation. Blood-pressure readings of 37,726 data sets were analyzed. We could assess that the method of documentation did influence the data quality. It could not be assessed whether the incorrectness of data during automatic data gathering was caused by artefacts or by the anesthesiologist.
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Affiliation(s)
- M Benson
- Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
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Graf R, Schiesser M, Scheele GA, Marquardt K, Frick TW, Ammann RW, Bimmler D. A family of 16-kDa pancreatic secretory stress proteins form highly organized fibrillar structures upon tryptic activation. J Biol Chem 2001; 276:21028-38. [PMID: 11278730 DOI: 10.1074/jbc.m010717200] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A group of 16-kDa proteins, synthesized and secreted by rat pancreatic acinar cells and composed of pancreatic stone protein (PSP/reg) and isoforms of pancreatitis-associated protein (PAP), show structural homologies, including conserved amino acid sequences, cysteine residues, and highly sensitive N-terminal trypsin cleavage sites, as well as conserved functional responses in conditions of pancreatic stress. Trypsin activation of recombinant stress proteins or counterparts contained in rat pancreatic juice (PSP/reg, PAP I and PAP III) resulted in conversion of 16-kDa soluble proteins into 14-kDa soluble isoforms (pancreatic thread protein and pancreatitis-associated thread protein, respectively) that rapidly polymerize into insoluble sedimenting structures. Activated thread proteins show long lived resistance to a wide spectrum of proteases contained in pancreatic juice, including serine proteases and metalloproteinases. In contrast, PAP II, following activation with trypsin or pancreatic juice, does not form insoluble structures and is rapidly digested by pancreatic proteases. Scanning and transmission electron microscopy indicate that activated thread proteins polymerize into highly organized fibrillar structures with helical configurations. Through bundling, branching, and extension processes, these fibrillar structures form dense matrices that span large topological surfaces. These findings suggest that PSP/reg and PAP I and III isoforms consist of a family of highly regulated soluble secretory stress proteins, which, upon trypsin activation, convert into a family of insoluble helical thread proteins. Dense extracellular matrices, composed of helical thread proteins organized into higher ordered matrix structures, may serve physiological functions within luminal compartments in the exocrine pancreas.
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Affiliation(s)
- R Graf
- Pancreatitis Research Laboratory, Department of Visceral Surgery, University Hospital, Zürich, 8091, Switzerland
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Benson M, Junger A, Michel A, Sciuk G, Quinzio L, Marquardt K, Hempelmann G. Comparison of manual and automated documentation of adverse events with an Anesthesia Information Management System (AIMS). Stud Health Technol Inform 2001; 77:925-9. [PMID: 11187690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
In this study, an Anesthesia Information Management System (AIMS) is used for the comparison of manually recorded adverse events with automatically detected events from anesthesiological procedures. In 1998, data from all anesthesia procedures, including the data set for quality assurance defined by the German Society of Anesthesiology and Intensive Care Medicine (DGAI), were recorded online with the documentation software NarkoData 4 (IMESO GmbH, Hüttenberg, Germany) followed by storage into a relational database (Oracle Corporation). The occurrence of manually recorded adverse events, as defined by the DGAI, is compared with automatically detected events. Automated detection was done with SQL-statements. The following adverse events were selected: hypotension, hypertension, bradycardia, tachycardia and hypovolemia. Data obtained from 16,019 electronic anesthesia records show that in 911 patients (5.7%), one of the selected adverse events was documented manually whereas in 2,996 patients (18.7%) a adverse event was detected automatically. The incidence of automatically detected events is obviously higher compared to manually recorded events. With the help of an AIMS, automatic detection proved significant deficiencies in the manual documentation of adverse events.
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Affiliation(s)
- M Benson
- Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany
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Michel A, Benson M, Junger A, Sciuk G, Hempelmann G, Dudeck J, Marquardt K. Design principles of a clinical information system for intensive care units (ICUData). Stud Health Technol Inform 2001; 77:921-4. [PMID: 11187689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The aim of this project was to develop a cost-effective, standard-based and scalable clinical information system for use in Intensive Care Units (ICUs). The development started in 1998 at the University Giessen, Germany. Since its introduction as the basic documentation system at the ICU ward of the Department of Anesthesiology and Intensive Care Medicine in January 1999, all relevant clinical data of 1723 patients have been recorded. The implementation of the system in two further ICUs is scheduled for the year 2000. The following article describes some of the principal design goals of the system, including the medical vision that drove its interface design, and focuses on the technological underpinnings of the overall system architecture.
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Affiliation(s)
- A Michel
- Department of Medical and Administrative Data Processing, Justus-Liebig-University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany
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Fuchs C, Benson M, Michel A, Junger A, Brammen D, Marquardt K, Hempelmann G. [Linkage of an anesthesia information management systems to a patient data management system in an intensive care unit]. Stud Health Technol Inform 2001; 77:504-8. [PMID: 11187603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- C Fuchs
- Abteilung Anaesthesiologie und Operative Intensivmedizin, Justus-Liebig-Universität, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany
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Junger A, Benson M, Quinzio L, Fuchs C, Michel A, Marquardt K, Hempelmann G. [User satisfaction with patient data management systems (PDMS) in intensive care medicine]. Stud Health Technol Inform 2001; 77:513-7. [PMID: 11187606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- A Junger
- Abteilung Anaesthesiologie und Operative Intensivmedizin, Justus-Liebig-Universität, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany
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Benson M, Junger A, Quinzio L, Michel A, Sciuk G, Fuchs C, Marquardt K, Hempelmann G. Data processing at the anesthesia workstation: from data entry to data presentation. Methods Inf Med 2000; 39:319-24. [PMID: 11191700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Main requirements for an Anesthesia Information Management System (AIMS) are the supply of additional information for the anesthesiologist at his workstation and complete documentation of the anesthetic procedure. With the implementation of an AIMS (NarkoData) and effective user support, the quality of documentation and the information flow at the anesthesia workstation could be increased. Today, more than 20,000 anesthesia procedures are annually recorded with the AIMS at 112 decentralized workstations. The network for data entry and the presentation and evaluation of data, statistics and results directly available at the clinical workstation was made operational.
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Affiliation(s)
- M Benson
- Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
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Benson M, Junger A, Quinzio L, Michel A, Sciuk G, Böttger S, Marquardt K, Hempelmannn G. [Using an anesthesia information management system (AIMS) for documentation in a day care unit for ambulatory surgery]. Anaesthesist 2000; 49:810-5. [PMID: 11076269 DOI: 10.1007/s001010070053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED From January 1997 until June 1999, the complete durations of stay of 3152 outpatients were entered into a computerized documentation system. The scope of the data entry went from patient admission to patient release. The objective was to determine the usefulness of the anaesthesia information management system (AIMS) in producing complete and high-quality documentation in the field of outpatient operations. Some aspects and results from routine work are presented here. METHOD The system was installed in eight bedside computers, in addition to a further client connected to the existing AIMS via Ethernet. Patient medical courses were documented both preoperatively and postoperatively in outpatient bedsides until their discharge or admission. The online documentation software NarkoData (Version 4, Imeso GmbH, Hüttenberg, Germany) was used to document and store patient data in a database. This program contains all relevant information concerning the course of anaesthesia and outpatient duration of stay, including application of drugs, vital signs, observation times, and medical findings as well as the data sets of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), ICD, and ICPM. Data was analyzed by exporting from the database into a statistical program using "structured query language." RESULTS Data sets of 3152 outpatients were entered into the online documentation software. Most (54.2%) of the ambulatory surgical procedures were performed by the Department of Traumatology. General Surgery followed with 16.0%, and Urology managed 9.5% of the cases. The most frequent ambulatory surgical procedures were: diagnostic arthroscopy (923, 31.2%), removal of osteosynthetic material (410, 13.8%), and circumcision (250, 8.4%). Anesthesia procedures consisted of inhalative (38.6%, n = 1218) and intravenous anesthesia (IVA) (29.9%, n = 938). In 22.6% (713) of the cases, regional anaesthesia was performed. The average postoperative observation time was 289.2 +/- 140.1 minutes. One hundred sixty-nine patients (5.4%) were unexpectedly admitted to overnight care. The decision to admit patients to normal wards took place within the first 3 postoperative hours in 51.9% of the cases. CONCLUSION The AIMS described above is sufficient in documenting the entire care process of patients in a day care unit. Integration into the existing AIMS was an important prerequisite for the integrity of the documentation chain. This allowed for a sensitive communication with other clinical data processing systems. The quality of documentation and flow of information at the workplaces in the day care unit were increased, similarly to other anaesthesiological workplaces in the hospital. Medical and administrative data and information for analyses of clinical processes are possible with such tools.
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Affiliation(s)
- M Benson
- Abteilung Anaesthesiologie und Operative Intensivmedizin, Justus-Liebig-Universität Giessen.
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Benson M, Junger A, Quinzio L, Michel A, Sciuk G, Fuchs C, Marquardt K, Hempelmannn G. [From data entry to data presentation at a clinical workstation--experiences with Anesthesia Information Management Systems (AIMS)]. Z Arztl Fortbild Qualitatssich 2000; 94:613-9. [PMID: 11048347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Anesthesia Information Management Systems (AIMS) are required to supply large amounts of data for various purposes such as performance recording, quality assurance, training, operating room management and research. It was our objective to establish an AIMS that enables every member of the department to independently access queries at his/her work station and at the same time allows the presentation of data in a suitable manner in order to increase the transfer of different information to the clinical workstation. Apple Macintosh Clients (Apple Computer, Inc. Cupertino, California) and the file- and database servers were installed into the already partially existing hospital network. The most important components installed on each computer are the anesthesia documenting software NarkoData (ProLogic GmbH, Erkrath), HIS client software and a HTML browser. More than 250 queries for easy evaluation were formulated with the software Voyant (Brossco Systems, Espoo, Finland). Together with the documentation they are the evaluation module of the AIMS. Today, more than 20,000 anesthesia procedures are recorded each year at 112 decentralised workstations with the AIMS. In 1998, 90.8% of the 20,383 performed anesthetic procedures were recorded online and 9.2% entered postopeatively into the system. With a corresponding user access it is possible to receive all available patient data at each single anesthesiological workstation via HIS (diagnoses, laboratory results) anytime. The available information includes previous anesthesia records, statistics and all data available from the hospitals intranet. This additional information is of great advantage in comparison to previous working conditions. The implementation of an AIMS allowed to greatly enhance the quota but also the quality of documentation and an increased flow of information at the anesthesia workstation. The circuit between data entry and the presentation and evaluation of data, statistics and results directly available at the clinical workstation was put into practice.
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Affiliation(s)
- M Benson
- Abteilung Anaesthesiologie und Operative Intensivmedizin, Justus-Liebig-Universität Giessen
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Benson M, Junger A, Quinzio L, Fuchs C, Sciuk G, Michel A, Marquardt K, Hempelmann G. Clinical and practical requirements of online software for anesthesia documentation an experience report. Int J Med Inform 2000; 57:155-64. [PMID: 10961571 DOI: 10.1016/s1386-5056(00)00059-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this paper is the presentation of a new version of the anesthesia documentation software, NarkoData, that has been used in routine clinical work in our department as part of an anesthesia information management system (AIMS) since 1995. The performance of this software is presented along with requirements for future development of such a system. The originally used version, NarkoData 3.0, is an online anesthesia documentation software established by the software company ProLogic GmbH. It was primarily developed as a disk-based system for the MacOS operating system (Apple Computer Inc.). Based on our routine experience with the system, a catalogue of requirements was developed that concentrated on improvement in the sequence of work, administration and data management. In 1996, the concepts developed in our department, in close co-operation with medical personnel and the software company, led to a considerable enlargement of the program functions and the subsequent release of a new version of NarkoData. Since 1997, more than 20 000 anesthesia procedures have been recorded annually with this new version at 115 decentralized work stations at our university hospital.
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Affiliation(s)
- M Benson
- Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig University, Giessen, Germany.
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Benson M, Junger A, Quinzio L, Michel A, Marquardt K, Hempelmann G. [Experiences fo three year's routine operation of an anesthesia information management system (AIMS) at a university clinic in Giessin]. Anasthesiol Intensivmed Notfallmed Schmerzther 1999; 34:17-23. [PMID: 10073251 DOI: 10.1055/s-1999-168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE In 1994, the Department of Anaesthesiology and Intensive Care Medicine of the Justus Liebig University at Giessen decided to install an Anaesthesia Information Management System (AIMS). Individual aspects and results from routine operation are presented, demonstrating the quality of the documentation and the value of information at the anaesthesiological workstation. The paper discusses which adaptations are necessary according to the experience gathered. METHODS For the installation of the system Apple Macintosh Clients (Apple Computer, Inc., Cupertino, California) and a File Server were integrated into the partially existing hospital network. The hospital network had to be enlarged during the project according to the Anaesthesiological requirements. The software of the Hospital Information System (HIS) and an HTML browser were installed at individual workstation computers in addition to the Anaesthesia documentation software NarkoData (ProLogic GmbH, Erkrath). The remote control software Timbuktu (Farallon, Alameda, USA) has been added to facilitate remote administration. The file administration programme FileWave (Wave Research, Berkeley, USA) is used for file distribution. Since 1995, all anaesthesia procedures have been documented with the system, either by online or postoperative recording. Since 1997, the recorded information has been stored in a relational Oracle 7 data bank (Oracle Corporation). RESULTS From 1995 to 1997, 60,405 anaesthesiological procedures have been recorded with the help of this AIMS at 111 decentralised workstations. In 1997, 87.8% of the 21,130 performed anaesthesia procedures have been recorded online with the system and 12.2% postoperatively. From 1995 to 1997, the number of recorded procedures increased by 6.4% from 19,854 to 21,130. Because of lacking interfaces at some patient monitoring stations, the automatic recording of patient data could only be implemented at 69 workstations (62%). With the corresponding access rights, important patient information from the HIS (diagnoses, laboratory results, etc.), records of previous Anaesthesia procedures, numerous statistics, and the whole information from the hospital's intranet (including e-mail) are available at the anaesthesiological workstation at any time. CONCLUSION The implementation of the AIMS and an effective user support have been able to increase significantly the quality of documentation, the flow of information at the anaesthesia workplace and the number of recorded Anaesthesia procedures. All recorded data can be analysed immediately The expansion of the automatic data transfer from the patient monitoring, interfaces to other computer subsystems of the hospital and a practicable evaluation programme are necessary for further enhancing the efficiency of the AIMS.
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Affiliation(s)
- M Benson
- Abteilung Anaesthesiologie und Operative Intensivmedizin, Justus-Liebig-Universität Giessen.
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Horowitz BZ, Swensen E, Marquardt K. Wound botulism associated with black tar heroin. JAMA 1998; 280:1479-80. [PMID: 9809721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Abstract
BACKGROUND Calcium polysulfide or lime-sulfur solution is a common agricultural product used as a fungicide. Despite its easy availability, only two prior cases of intentional ingestion, both from Japan, have been reported in the literature. CASE REPORTS Two cases of calcium polysulfide ingestion are presented. In the first case severe acidosis, coma and cardiac arrest occurred. Despite aggressive supportive therapy, the patient expired. Autopsy examination revealed hemorrhagic necrosis of the gastric mucosa. The second patient also exhibited altered mental status and metabolic acidosis. He experienced liver dysfunction, rhabdomyolysis, renal dysfunction, and aspiration pneumonia. He had endoscopically proven esophageal and gastric mucosal burns which developed into esophageal strictures. CONCLUSIONS Calcium polysulfide ingestions cause direct caustic injury to the upper gastrointestinal tract, coma and severe metabolic acidosis.
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Affiliation(s)
- B Z Horowitz
- Division of Emergency Medicine and Clinical Toxicology, University of California, Davis Medical Center, Sacramento 95817, USA
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Michel A, Marquardt K, Dudeck J. From WING to MMSA: experiences with the implementation of a distributed HIS. Stud Health Technol Inform 1996; 45:192-8. [PMID: 10175363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The following paper analyses the transition from a host centered to a client-server based Hospital Information System (HIS) which takes place at the University Hospital of Giessen, Germany, since 1995. It focuses on the overall concept and practical realisation of the cornerstone within this transition, the Macintosh Mosaic Software Architecture (MMSA) which delivers now more than 90% of the clinical data which is entered on the wards and within the operating rooms. Besides the technical problems of the project, the paper also describes some aspects of the organisational challenges which took place within a typical German University Hospital during the last 4 Years and which mainly affect the daily management of a large HIS.
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Affiliation(s)
- A Michel
- Department of Medical Informatics, University Hospital of Giessen, Germany
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Qiu D, Junghans G, Marquardt K, Kroll H, Mueller-Eckhardt C, Dudeck J. Discovering objects in a blood recipient information system. Med Inform (Lond) 1995; 20:209-228. [PMID: 8882560 DOI: 10.3109/14639239508995006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Application of object-oriented (OO) methodologies has been generally considered as a solution to the problem of improving the software development process and managing the so-called software crisis. Among them, object-oriented analysis (OOA) is the most essential and is a vital prerequisite for the successful use of other OO methodologies. Though there are already a good deal of OOA methods published, the most important aspect common to all these methods: discovering objects classes truly relevant to the given problem domain, has remained a subject to be intensively researched. In this paper, using the successful development of a blood recipient information system as an example, we present our approach which is based on the conceptual framework of responsibility-driven OOA. In the discussion, we also suggest that it may be inadequate to simply attribute the software crisis to the waterfall model of the software development life-cycle. We are convinced that the real causes for the failure of some software and information systems should be sought in the methodologies used in some crucial phases of the software development process. Furthermore, a software system can also fail if object classes essential to the problem domain are not discovered, implemented and visualized, so that the real-world situation cannot be faithfully traced by it.
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Affiliation(s)
- D Qiu
- Department of Medical Computing of the University Hospital Giessen, FR Germany
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Jaeger P, Redha F, Marquardt K, Uhlschmid G, Hauri D. Morphological and functional changes in canine kidneys following extracorporeal shock-wave treatment. Urol Int 1995; 54:48-58. [PMID: 7770999 DOI: 10.1159/000282687] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Extracorporeal shock-wave lithotripsy (ESWL) has rapidly become established worldwide as a routine method for treatment of nephro- and ureterolithiasis. Although initial studies showed no tissue-damaging effect by the shock waves, we found, in an animal experiment using canine kidneys, that the ESWL-induced damage to the renal parenchyma is more marked than originally assumed. The damage is limited to the area that was focused on, and heals relatively rapidly by connective tissue encapsulation with final cicatrisation without any further residual effects being observed up to the present. This parenchymal damage is probably also the cause of the macrohematuria that is always observed during therapy. The resulting tissue damage is not extensive enough to cause a demonstrable reduction of function as measured by the usual methods (serum creatinine, creatinine clearance, isotopy renography, i.v. urography). In serum we observed a transient decrease of calcium, an immediate increase of lactate-dehydrogenase, transaminases (SGOT and SGPT) and a delayed increase of alkaline phosphates. Creatinine, blood urea nitrogen, sodium, potassium and amylase remained within normal limits. In urine, a decrease of creatinine and an increase of glucose excretion were noted. We believe that these changes represent a relatively mild and transient damage of renal cells and do not reflect the occasionally heavy morphological changes observed after shock-wave exposure. The main clinical complication is the large subcapsular hematoma which, according to the present knowledge, could well result from a lesion of the larger peripheral vessels. Damage to other organs such as subserous colonic and small bowel hematomata are to be expected although they do not lead to clinical symptoms.
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Affiliation(s)
- P Jaeger
- Urological Clinic, University Hospital, Zurich, Switzerland
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Affiliation(s)
- L K von Segesser
- Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland
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Prokosch HU, Puhle B, Müller M, Wagner R, Junghans G, Marquardt K, Dudeck J. From HIS to IAIMS: expanding the scope of information processing applications in a German university hospital. Proc Annu Symp Comput Appl Med Care 1994:115-9. [PMID: 7949903 PMCID: PMC2247913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Since the mid eighties the department of medical informatics at the University Hospital of Giessen (Germany) has been engaged in the development of a comprehensive hospital information system. The installation of a campus wide network has set the basis to provide not only clinical patient-oriented information, but also general information resources for research, medical education and administrative purposes, thus creating an environment which in the U.S. became known as an integrated academic information management system (IAIMS). The underlying concept of the whole approach is to provide one-stop information shopping capabilities at the clinicians and administrators desktop in order to meet the increasing information needs of health professionals with the emerging reality of the potential benefits of computer and communication technologies. This paper describes the various steps performed to realize this concept at Giessen University Hospital and the evaluation results derived from analysis of the acceptance of these new technologies among our hospital staff.
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Affiliation(s)
- H U Prokosch
- Department of Medical Informatics, University of Giessen, Germany
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von Segesser LK, Gyurech DD, Schilling JJ, Marquardt K, Turina MI. Can protamine be used during perfusion with heparin surface coated equipment? ASAIO J 1993; 39:M190-4. [PMID: 8268526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Left heart bypass (LHBP) with heparin coated perfusion equipment including an arterial filter (pore size: 40 microns) was performed in five canine experiments after full systemic heparinization (heparin 300 IU/kg; activated coagulation time [ACT] > 480 sec). The heparin coated filter was replaced after 45 min with a second heparin coated filter. Protamine (1:1) was added after 45 min and perfusion was continued for another 45 min before the second filter was replaced with an uncoated control filter. In addition to continuous hemodynamic monitoring, all filters were disassembled and analyzed morphometrically with a scanning electron microscope (deposits on screens were expressed as percent of surface covered with fibrin or number of cells/100 micron 2, respectively). For the first heparin coated filter (ACT > 480), 0.3 +/- 0.5% of the surface was covered with fibrin, 0.7 +/- 0.7% with platelets, and 0.02 +/- 0.0% with red cells. For the second heparin coated filter exposed to neutralization of heparin with protamine, surface coverage was fibrin in 22 +/- 15%, platelets in 3.2 +/- 0.8%, and red cells in 0.2 +/- 0.1% (p < 0.05 for all comparisons with filter 1). For uncoated control filters (ACT = 120), surface coverage was fibrin in 31 +/- 33%, platelets in 3.7 +/- 2.9%, and red cells in 0.2 +/- 0.1% (not significant [NS] for all comparisons with filter 2). Although all arterial filters used in this study remained patent throughout the scheduled period, it became clear that protamine given during perfusion reduces the antithrombotic activity of bonded heparin. Hence, protaminization during perfusion with heparin coated equipment cannot be recommended.
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Affiliation(s)
- L K von Segesser
- Clinic for Cardiovascular Surgery, Zürich University Hospital, Switzerland
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Staub JJ, Althaus BU, Engler H, Ryff AS, Trabucco P, Marquardt K, Burckhardt D, Girard J, Weintraub BD. Spectrum of subclinical and overt hypothyroidism: effect on thyrotropin, prolactin, and thyroid reserve, and metabolic impact on peripheral target tissues. Am J Med 1992; 92:631-42. [PMID: 1605145 DOI: 10.1016/0002-9343(92)90782-7] [Citation(s) in RCA: 206] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Subclinical hypothyroidism is found in about 7.5% of females and in about 3% of males. It appears to be a risk factor for atherosclerosis and for coronary heart disease and can affect various other target organs. The morbidity and clinical significance of subclinical hypothyroidism are controversial. Therefore, we evaluated the metabolic impact of progressive thyroid failure in patients with various degrees of hypothyroidism compared with control subjects. PATIENTS AND METHODS We investigated 86 female patients with the whole spectrum of subclinical hypothyroidism (n = 69) and of overt hypothyroidism (n = 17) and 52 euthyroid women as controls. All subjects underwent full medical and endocrine evaluations (including measurements of thyrotropin [TSH], TSH beta- and alpha-subunits, and prolactin before and after oral administration of thyrotropin-releasing hormone [TRH]) as well as lipid profiles and different tests of peripheral thyroid hormone action. All hypothyroid patients were divided into five categories according to disease severity: grades I to III (subclinical hypothyroidism, with normal thyroxine [T4] levels) and grades IV and V (overt hypothyroidism, with diminished T4). RESULTS In grade I subclinical hypothyroidism (basal TSH below 6 mU/L), we found significant changes in the clinical index (p less than 0.05), apoprotein A-I level (p less than 0.05), and stimulated prolactin level after oral TRH (p less than 0.001). The findings were similar in grade II (TSH 6 to 12 mU/L). Further changes could be demonstrated in grade III (TSH above 12 mU/L) with a definite elevation of ankle reflex time (p less than 0.001), serum myoglobin level (p less than 0.01), and, to a lesser extent, creatine kinase (p greater than 0.1). The mean low-density lipoprotein cholesterol (LDL-C) level showed an increase of 18%, which was not significant because of marked individual variations (p = 0.15). The frequency of elevated LDL-C levels was definitely higher in patients with grade III disease compared with the controls (42.9% versus 11.4%, p less than 0.05) and with patients with grades I and II disease. Total cholesterol, triglycerides, apoprotein B, and the systolic time intervals (pre-ejection period, corrected for heart rate [PEPc]) were clearly elevated only in overt hypothyroidism (grades IV and V) (p less than 0.01). CONCLUSION Subclinical hypothyroidism has significant effects on some peripheral target organs at an early stage (grades I and II), but affects LDL-C, skeletal muscle, and myocardial contractility only at a later stage (grades III, IV, and V). Our data of elevated LDL-C in grade III subclinical hypothyroidism provide a likely pathophysiologic explanation for the reported association of coronary heart disease with this syndrome. The impact of increased prolactin secretion, observed in subclinical hypothyroidism, on gonadal function and infertility has yet to be clarified. Therapy with thyroxine should be recommended in at least some patients with subclinical hypothyroidism. Patients with high TSH levels (above 12 mU/L) will require treatment because of the metabolic effects on several target organs. Before treatment is advocated in all patients with subclinical hypothyroidism, the benefits and long-term side effects of thyroid hormone therapy should be clarified by prospective studies in larger groups of patients.
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Affiliation(s)
- J J Staub
- Division of Endocrinology and Metabolism, University of Basel, Switzerland
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Prokosch HU, Dudeck J, Junghans G, Marquardt K, Sebald P, Michel A. WING--entering a new phase of electronic data processing at the Giessen University Hospital. Methods Inf Med 1991; 30:289-98. [PMID: 1762583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
At the Giessen University Hospital electronic data processing systems have been in routine use since 1975. In the early years developments were focused on ADT functions (admission/discharge/transfer) and laboratory systems. In the next decade additional systems were introduced supporting various functional departments. In the mid-eighties the need to stop the ongoing trend towards more and more separated stand-alone systems was realized and it was decided to launch a strategic evaluation and planning process which sets the foundation for an integrated hospital information system (HIS). The evaluation of the HELP system for its portability into the German hospital environment was the first step in this process. Despite its recognized capabilities in integrating decision support and communication technologies, and its powerful HIS development tools, the large differences between American and German hospital organization, influencing all existing HELP applications, and the incompatibility of the HELP tools with modern software standards were two important factors forcing the investigation of alternative solutions. With the HELP experience in mind, a HIS concept for the Giessen University Hospital was developed. This new concept centers on the idea of a centralized relational patient database on a highly reliable database server, and clinical front-end applications which might be running on various other computer systems (mainframes, departmental UNIX satellites or PCs in a LAN) integrated into a comprehensive open HIS network. The first step towards this integrated approach was performed with the implementation of ADT and results reporting functions on care units.
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Affiliation(s)
- H U Prokosch
- Department of Medical Informatics, Justus-Liebig University, Giessen, Germany
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