The use of information technology in improving medical performance. Part I. Information systems for medical transactions

Investment in medical information technologies reached $15 billion in 1996. However, these technologies have not had the wide impact predicted in streamlining bureaucracy, improving communications, and raising the effectiveness of care. In this series, we identify how such technologies are being used to improve quality and performance, the future directions for advancement, and the policy and research developments required to maximize public benefit from these technologies. Each of these articles focuses on a different type of information technology: (1) information systems to manage medical transactions; (2) physician-support technologies to improve medical practice; and (3) patient-focused technologies designed to change how people manage their own care. This first article of a 3-part series examines the successes of and opportunities for using advanced information systems that track and manage medical transactions for large populations to improve performance. Examples of such systems include: HEDIS, which gathers standardized data from health plans on quality of care; the USQA Health Services Research Program, which tracks treatment patterns and outcomes for 14 million insurance members; Ford's program to collect medical data for over 600,000 employees; and Harvard Pilgrim Health Care's system of computerized laboratory, pharmacy, ambulatory, and hospital admission records for its 1.5 million members. Data from these systems have led to modest improvements in knowledge and practice patterns for some diseases. Significant barriers are slowing efforts to add outcomes data to these databases and broaden the databases to cover larger populations. Nonetheless, existing data in currently evolving systems could be used to greater benefit in tracking public health and in identifying more effective treatments and causes of diseases.     

Inflammation-mediated hyperexcitability of sensory neurons

One of the most prominent signs of tissue injury and inflammation is pain and pain continues to be the primary reason people seek medical attention. Inflammatory pain reflects, at least in part, an increase in the excitability, or sensitization, of subpopulations of primary afferent neurons. While the sensitization of high threshold afferents was observed almost 40 years ago, the basis for this phenomenon continues to be an active and fertile area of research today. This review will summarize recent advances in our mechanistic understanding of sensitization, focusing on four general areas where re search has been most active or productive. These include: (1) the characterization of second messenger pathways underlying inflammation-induced changes in afferent excitability; (2) the impact of previous injury on the afferent response to subsequent inflammation; (3) the impact of target of innervation on the specific afferent response to inflammation, and (4) the impact of sex hormones on the sensitization of high threshold afferents. Work in these areas highlights how much has been learned about this process as well as how much there is yet to learn.     

The Role of Local Knowledge in Medical Practice: A Trans-historical Perspective

This article explores the role ofparticipant-observation and ethnographic writing inthe shaping of medical practice since Hippocrates. Drawing on a range of historical sources and genresthat include the 17th- and 18th-centurymedical topographies and medical geographies,19th-century medical ethnography and folklore,and their marginal persistence into the 20thcentury in the form of Mexican pasante reports,I argue that these writings should not be approachedas part of the history of anthropology, but asspecifically medical genres related to medicalpractice. The abandonment of these ethnographicpractices by modern biomedicine is, I conclude, aconsequence of two related developments: the hegemonyof clinical epistemology and the depersonalization anddepoliticization of physicians' commitment to theirpatients.To Eduardo L. Menéndez     

Artificial intelligence and the medical physics profession - A Swedish perspective

BackgroundThere is a continuous and dynamic discussion on artificial intelligence (AI) in present-day society. AI is expected to impact on healthcare processes and could contribute to a more sustainable use of resources allocated to healthcare in the future. The aim for this work was to establish a foundation for a Swedish perspective on the potential effect of AI on the medical physics profession.Materials and methodsWe designed a survey to gauge viewpoints regarding AI in the Swedish medical physics community. Based on the survey results and present-day situation in Sweden, a SWOT analysis was performed on the implications of AI for the medical physics profession.ResultsOut of 411 survey recipients, 163 responded (40%). The Swedish medical physicists with a professional license believed (90%) that AI would change the practice of medical physics but did not foresee (81%) that AI would pose a risk to their practice and career. The respondents were largely positive to the inclusion of AI in educational programmes. According to self-assessment, the respondents’ knowledge of and workplace preparedness for AI was generally low.ConclusionsFrom the survey and SWOT analysis we conclude that AI will change the medical physics profession and that there are opportunities for the profession associated with the adoption of AI in healthcare. To overcome the weakness of limited AI knowledge, potentially threatening the role of medical physicists, and build upon the strong position in Swedish healthcare, medical physics education and training should include learning objectives on AI.     

Polymer multilayers with pH-triggered release of antibacterial agents

We report on the layer-by-layer design principles of poly(methacrylic acid) (PMAA) ultrathin hydrogel coatings that release antimicrobial agents (AmAs) in response to pH variations. The studied AmAs include gentamicin and an antibacterial cationic peptide L5. Adipic acid dihydrazide (AADH) is a cross-linker which, relative to ethylenediamine (EDA), increases the hydrogel hydrophobicity and introduces centers for hydrogen bonding to AmAs. AmA retention in AADH-cross-linked hydrogels in high-salt solutions was enhanced while AmA release at low pH was suppressed. L5 retains its antibacterial activity toward planktonic Staphylococcus epidermidis after release from PMAA hydrogels in response to pH decreases in the surrounding medium due to bacterial growth. Staphylococcus epidermidis adhesion and colonization was almost completely inhibited by L5 loading of hydrogels. The AmA-releasing and AmA-retaining properties of these hydrogel coatings provide new opportunities to study the fundamental mechanisms of AmA-coating-bacteria interactions and develop a new class of clinically relevant antibacterial coatings for medical devices.     

Survey of Lifestyle,Past Medical History and Complementary and Alternative Medicine Use Among Adult Patients Participating in the National Cancer Institute's Exceptional Responders Initiative

IntroductionThe Exceptional Responders Initiative (ERI) at the National Cancer Institute attempts to correlate unusually good outcomes in patients with cancer with genetic targets in tumors and the therapies the patients received. It is not known if other factors might contribute to exceptional responses or outcomes. We explored aspects of the medical history, lifestyle changes, complementary and alternative medicine (CAM) use and communication between health care practitioners and patients who experienced an exceptional response following cancer treatment.MethodsAll subjects whose case was submitted to the ERI were eligible to participate in the survey. A 121-question survey questionnaire was developed to assess aspects of the subject's past medical history, lifestyle (e.g., diet, exercise, spirituality) and use of CAM.ResultsThirty subjects completed and returned the questionnaire from approximately 88 patients invited to participate (approximate response rate = 34%). Approximately 68% were female and 32% were male. Fifty percent of subjects changed their diet after their cancer diagnosis. Eighteen patients (60%) reported using a CAM therapy (not including oral vitamins/minerals or spiritual practices) during their Exceptional Response (ER).ConclusionMultiple factors, including features of the tumor itself, the patient, or the environment, could affect tumor response or patient survival, either solely or in combination with the treatments received. Many patients use other medications, change their diet or physical activity or use CAM interventions after their cancer diagnosis. Investigators attempting to understand the exceptional response phenomenon should acquire rich data sets of their subjects that include information about these factors.     

United Nations system efforts to support the response to AIDS in China

In the last two years, we have seen a remarkable intensification in the response to AIDS in China. A number of organizations have joined and contributed to the efforts of the Chinese government in responding the AIDS epidemic in China. This article specifically describes the role of the United Nations (UN) in supporting and strengthening those responses. Achievements of the United Nations highlighted in the article include: strengthened leadership and political commitment to respond to AIDS; improved HIV/AIDS surveillance and information; expanded prevention efforts; improved treatment, care and support to people living with HIV and increased resources for AIDS programs. Additional roles of the United Nations system in the near future include strengthening national leadership by supporting the 'three ones', i.e., one national plan on AIDS; one national coordinating authority for AIDS; and one monitoring and evaluation system for AIDS. In addition, the UN system is expected to strengthen alignment and harmonization of activities of all international organizations and improved accountability and oversight. Remaining challenges identified include increasing awareness of AIDS and reducing stigma and discrimination; reducing vulnerability and risk behaviour among specific groups; providing improved treatment, care and support for people living with HIV; promoting stronger engagement by civil society, and; addressing the gender dimensions of AIDS.     

HIV disease prevention and treatment. A model for local planning.

Since first reported in 1981, about a fourth of all cases of the acquired immunodeficiency syndrome in the United States have occurred in California. In response to the human immunodeficiency virus (HIV) epidemic, California has developed a five-point strategy consisting of epidemiologic surveillance; prevention education; the provision of medical treatment and supportive services; research; and continuous planning, evaluation, and coordination of programs. Given the size and tremendous environmental and cultural diversity of California, as well as the variable local impact of HIV disease local jurisdictions need to develop HIV disease prevention and treatment plans specifically tailored to the circumstances of their communities. At a minimum, these plans should include central participatory planning, epidemiologic surveillance, HIV antibody testing and prevention education programs, provision for medical treatment and social support services, and coordination of financing mechanisms. We present a model for such plans.     

各种挥发油的药理活性及在医学方面的应用

通过查阅文献对近年来有关挥发油的药理活性及在医学方面应用的研究进行综述。结果表明挥发油具有抗过敏,酶抑制,抗炎,抗突变,抗癌,抗微生物,抗病毒,驱虫,抗氧化和对中枢神经系统的镇静作用等药理活性并在医学方面具有多种用途。本文兹在为今后进一步研究挥发油的药理活性提供依据。     

Should We Reject Donated Organs on Moral Grounds or Permit Allocation Using Non‐Medical Criteria?: A Qualitative Study

Conditional and directed deceased organ donations occur when donors (or often their next of kin) attempt to influence the allocation of their donated organs. This can include asking that the organs are given to or withheld from certain types of people, or that they are given to specified individuals. Donations of these types have raised ethical concerns, and have been prohibited in many countries, including the UK. In this article we report the findings from a qualitative study involving interviews with potential donors (n = 20), potential recipients (n = 9) and transplant staff (n = 11), and use these results as a springboard for further ethical commentary. We argue that although participants favoured unconditional donation, this preference was grounded in a false distinction between ‘medical’ and ‘non‐medical’ allocation criteria. Although there are good reasons to maintain organ allocation based primarily upon the existing ‘medical’ criteria, it may be premature to reject all other potential criteria as being unacceptable. Part of participants' justification for allocating organs using ‘medical’ criteria was to make the best use of available organs and avoid wasting their potential benefit, but this can also justify accepting conditional donations in some circumstances. We draw a distinction between two types of waste – absolute and relative – and argue that accepting conditional donations may offer a balance between these forms of waste.     

Euthanasia—An Overview for Our Time A Report by the CMA Committee for Continuing Study of Evolving Trends in Society Affecting Life

The Committee for the Continuing Study of Evolving Trends in Society Affecting Life was established by the CMA House of Delegates in 1971, following the consideration of a number of resolutions on the topic of abortion. The committee''s charge was broadened, however, to include topics such as euthansia, biomedical engineering, medicine and religion, ecology and education. The committee''s discussions, as its name indicates can cover a wide range of fields of interest to the medical profession. The following article is the first of several which the committee plans to publish, although the products of its deliberations may take the form of resolutions to future meetings of the House of Delegates.     

United Nations system efforts to support the response to AIDS in China

In the last two years, we have seen a remarkable intensification in the response to AIDS in China. A number of organizations have joined and contributed to the efforts of the Chinese government in responding the AIDS epidemic in China. This article specifically describes the role of the United Nations in supporting and strengthening those responses.Achievements of the United Nations (UN) highlighted in the article include: strengthened leadership and political commitment to respond to AIDS; improved HIV/AIDS surveillance and information; expanded prevention efforts; improved treatment, care and support to people living with HIV and increased resources for AIDS programs. Additional roles of e., one national plan on AIDS; one national coordinating authority for AIDS; and one monitoring and evaluation system for AIDS. In addition, the UN system is expected to strengthen alignment and harmonization of activities of all international organizations and improved accountability and oversight. Remaining challenges identified include increasing awareness of AIDS and reducing stigma and discrimination; reducing vulnerability and risk behaviour among specific groups;providing improved treatment, care and support for people living with HIV; promoting stronger engagement by civil society, and; addressing the gender dimensions of AIDS.     

利用人工智能预测癌症的易感性、复发性和生存期

癌症具有较高的发病率和致死率,对人类健康具有重大威胁。癌症预后分析可以有效避免过度治疗及医疗资源的浪费,为医务人员及家属进行医疗决策提供科学依据,已成为癌症研究的必要条件。随着近年来人工智能技术的迅速发展,对癌症患者的预后情况进行自动化分析成为可能。此外,随着医疗信息化的发展,智慧医疗的理念受到广泛关注。癌症患者作为智慧医疗的重要组成部分,对其进行有效的智能预后分析十分必要。本文综述现有基于机器学习的癌症预后方法。首先,对机器学习与癌症预后进行概述,介绍癌症预后及相关的机器学习方法,分析机器学习在癌症预后中的应用;然后,对基于机器学习的癌症预后方法进行归纳,包括癌症易感性预测、癌症复发性预测、癌症生存期预测,梳理了它们的研究现状、涉及到的癌症类型与数据集、用到的机器学习方法及预后性能、特点、优势与不足;最后,对癌症预后方法进行总结与展望。     

国外公众健康信息学发展研究

通过分析国外公众健康信息学研究的年代分布特点、核心期刊、重要作者和研究热点,探索国外公众健康信息学研究的历史、现状和发展趋势,为国内公众健康信息学领域的研究与实践提供理论参考。利用TDA、Excel等工具,从时间、期刊和作者分布三方面对SCIE数据库收录的公众健康信息学领域的研究文献进行时空维度分析,再进行关键词和高频被引文献分析。从发文量来看国外公众健康信息学研究的发展比较平缓,核心期刊包括医学互联网研究杂志与国际医学信息学杂志,重要作者有Eysenbach Gunther、Keselman Alla等。1994~2013年公众健康信息学研究热点包括基本问题、卫生系统和个人健康记录、健康传播和患者教育以及医学信息学相关学科。高频被引文献内容涵盖公众健康信息学科,公众健康信息系统,电子病历和个人健康记录,互联网对公众健康行为的影响等几个方面。     

Discovery of oxidative burst in the field of plant immunity: Looking back at the early pioneering works and towards the future development

This article is introductory to the series of works presented in this special issue on the homeostasis and the signaling roles of reactive oxygen species (ROS) in plants. Upper half of this article briefly describes the history of the ROS study in the field of plant immunity research initiated by the observation that the attacks by pathogenic microorganisms possibly stimulate the burst of ROS production in the plant tissues. The topics covered in the series of works presented here include the plants'' responses to abiotic oxidative stress (atmospheric ozone), regulation of seed germination, chemical interaction between parasitic and host plants and the draught tolerance, all controlled through homeostasis of ROS at biochemical and molecular biological levels. Lastly a discussion forum was proposed to further deepen our understanding of ROS behaviors in plants.Key words: hypersensitive response, NADPH oxidase, oxidative burst, plant immunity, reactive oxygen species     

Genetic and environmental factors in complex diseases: the older Finnish Twin Cohort.

In studies on the Finnish Twin Cohort, we investigate genetic and environmental determinants of common, complex diseases, and their behavioral risk factors in Finland, a genetically unique and culturally homogenous population. We have formed the following databases: 1) Like-sexed twin pairs (13,888 pairs of known zygosity) form the older Twin Cohort. They have participated since 1975 in mail surveys, in clinical examinations for subsamples, and have been followed-up for morbidity using national medical registers; 2) The older Twin Cohort was expanded in 1996 to include opposite-sex pairs born 1938-1957 (c. 8000 pairs); 3) Two, new longitudinal studies of adolescent twins and their families, form a complementary, ongoing study base described in more detail in an accompanying article. Genetic and environmental effects vary over the life-span, and only longitudinal studies in genetically informative data sets permits the evaluation of such effects. Finally, the inclusion of DNA-based genetic information in a phenotypically rich family data base will offer a unique resource for research in genetic epidemiology and behavioral medicine.     

Ideas on Loan for Printmaking

The purpose of this article is to examine the fundamentals of the Individuals with Disabilities Education Act and its impact on music educators. Topics include: (a) zero reject, (b) non-discriminatory evaluations, (c) free appropriate public education, (d) least restrictive environment, (e) procedural due process, (f) parental involvement, and (g) response to intervention (RTI). Detailed explanations of policy are provided along with strategies for implication in the music classroom.     

The roles of GRP81 as a metabolic sensor and inflammatory mediator

GPR81 (also named as HCA1) is a member of a subfamily of orphan G-protein coupled receptors (GPCRs), coupled to G_i-type G proteins. GPR81 was discovered in 2001 and identified as the only known endogenous receptor of lactate under physiological conditions in 2008, which opened a new field of research on how lactate may act as a signal molecule along with the GPR81 expression in the roles of metabolic process and inflammatory response. Recent studies showed that the physiological functions of GPR81 include lipid metabolism in adipose tissues, metabolic excitability in the brain, cellular development, and inflammatory response modulation. These findings may reveal a novel therapeutic strategy to treat clinical, metabolic, and inflammatory diseases. This article will summarize past research on GPR81, including its characteristics of distribution and expression, functional residues, pharmacological, and physiological agonists, involvement in signal transduction, and pharmacological applications.