ARGOS policy brief on semantic interoperability

Semantic interoperability requires the use of standards, not only for Electronic Health Record (EHR) data to be transferred and structurally mapped into a receiving repository, but also for the clinical content of the EHR to be interpreted in conformity with the original meanings intended by its authors. Accurate and complete clinical documentation, faithful to the patient’s situation, and interoperability between systems, require widespread and dependable access to published and maintained collections of coherent and quality-assured semantic resources, including models such as archetypes and templates that would (1) provide clinical context, (2) be mapped to interoperability standards for EHR data, (3) be linked to well specified, multi-lingual terminology value sets, and (4) be derived from high quality ontologies. Wide-scale engagement with professional bodies, globally, is needed to develop these clinical information standards

‘So people know I'm a Sikh’: Narratives of Sikh masculinities in contemporary Britain

This article examines British-born Sikh men's identification to Sikhism. In particular, it focuses on the appropriation and use of Sikh symbols amongst men who define themselves as Sikh. This article suggests that whilst there are multiple ways of ‘being’ a Sikh man in contemporary post-colonial Britain, and marking belonging to the Sikh faith, there is also a collectively understood idea of what an ‘ideal’ Sikh man should be. Drawing upon Connell and Messerschmidt's discussion of locally specific hegemonic masculinities (2005. “Hegemonic Masculinity: Rethinking the Concept.” Gender and Society 19 (6): 829–859), it is suggested that an ideal Sikh masculine identity is partly informed by a Khalsa discourse, which informs a particular performance of Sikh male identity, whilst also encouraging the surveillance of young men's activities both by themselves and by others. These Sikh masculinities are complex and multiple, rotating to reaffirm, challenge and redefine contextualised notions of hegemonic masculinity within the Sikh diaspora in post-colonial Britain. Such localised Sikh masculinities may both assert male privilege and reap patriarchal dividends (Connell, W. 1995. Masculinities. Cambridge: Polity Press), resulting in particular British Sikh hegemonic masculinities which seek to shape the performance of masculinity, yet in another context these very same performances of masculinity may also signify a more marginalised masculinity vis-à-vis other dominant hegemonic forms

Optimizing weight control in diabetes: antidiabetic drug selection

S Kalra1, B Kalra1, AG Unnikrishnan2, N Agrawal3, S Kumar41Bharti Hospital, Karnal; 2Amrita Institute of Medical Science, Kochi; 3Medical College, Gwalior; 4Excel Life Sciences, Noida, IndiaDate of preparation: 18th August 2010Conflict of interest: SK has received speaker fees from Novo Nordisk, sanofi-aventis, MSD, Eli Lilly, BMS, and AstraZeneca.Clinical question: Which antidiabetic drugs provide optimal weight control in patients with type 2 diabetes?Results: Metformin reduces weight gain, and may cause weight loss, when given alone or in combination with other drugs. Pioglitazone and rosiglitazone use is associated with weight gain. Use of the glucagon-like peptide-1 (GLP-1) analogs, liraglutide and exenatide, is associated with weight loss. Dipeptidyl peptidase-4 (DPP-4) inhibitors are considered weight-neutral. Results with insulin therapy are conflicting. Insulin detemir provides weight control along with glycemic control.Implementation: • Weight gain is considered an inevitable part of good glycemic control using conventional modalities of treatment such as sulfonylureas.• Use of metformin, weight-sparing insulin analogs such as insulin detemir, and liraglutide, should be encouraged as monotherapy, or in combination with other drugs.Keywords: weight control, diabete

Towards an interoperable healthcare information infrastructure - working from the bottom up

Historically, the healthcare system has not made effective use of information technology. On the face of things, it would seem to provide a natural and richly varied domain in which to target benefit from IT solutions. But history shows that it is one of the most difficult domains in which to bring them to fruition. This paper provides an overview of the changing context and information requirements of healthcare that help to explain these characteristics.First and foremost, the disciplines and professions that healthcare encompasses have immense complexity and diversity to deal with, in structuring knowledge about what medicine and healthcare are, how they function, and what differentiates good practice and good performance. The need to maintain macro-economic stability of the health service, faced with this and many other uncertainties, means that management bottom lines predominate over choices and decisions that have to be made within everyday individual patient services. Individual practice and care, the bedrock of healthcare, is, for this and other reasons, more and more subject to professional and managerial control and regulation.One characteristic of organisations shown to be good at making effective use of IT is their capacity to devolve decisions within the organisation to where they can be best made, for the purpose of meeting their customers' needs. IT should, in this context, contribute as an enabler and not as an enforcer of good information services. The information infrastructure must work effectively, both top down and bottom up, to accommodate these countervailing pressures. This issue is explored in the context of infrastructure to support electronic health records.Because of the diverse and changing requirements of the huge healthcare sector, and the need to sustain health records over many decades, standardised systems must concentrate on doing the easier things well and as simply as possible, while accommodating immense diversity of requirements and practice. The manner in which the healthcare information infrastructure can be formulated and implemented to meet useful practical goals is explored, in the context of two case studies of research in CHIME at UCL and their user communities.Healthcare has severe problems both as a provider of information and as a purchaser of information systems. This has an impact on both its customer and its supplier relationships. Healthcare needs to become a better purchaser, more aware and realistic about what technology can and cannot do and where research is needed. Industry needs a greater awareness of the complexity of the healthcare domain, and the subtle ways in which information is part of the basic contract between healthcare professionals and patients, and the trust and understanding that must exist between them. It is an ideal domain for deeper collaboration between academic institutions and industry

Network orchestration in a large inter-organizational project

Multiple organizations working jointly on shared activities in inter-organizational projects for a defined period of time are used increasingly to coordinate the supply of complex products, subsystems, and services across many industries. Despite the growth in inter-organizational networks as an organizational form, scholars have only recently begun to identify how lead organizations orchestrate the coordination of multiple parties with disparate goals, responsibilities, and capabilities. Prior work offers limited insights into the choice of network governance forms, and how coordination is undertaken by the network orchestrator to govern these networks. We conducted a longitudinal study of four networks to deliver vital services into a large project. We identified how the choice of network governance form was based on task complexity. A shared governance form was chosen for networks developed to deliver routine services, whereas a lead organization governance form was chosen for networks set up to deliver complex services. However, findings showed that the selection of an appropriate governance form was not sufficient for ensuring high performance. The network orchestrator's mode of coordination (formal or informal), the intensity of coordination (active or passive), and fit with the form of governance form (shared or lead organization governed) was important in driving performance

Clinico hematological profile of pancytopenia in pediatric patients: an institutional experience in North Himalayan region of India

Background: Pancytopenia is a common clinical pattern with an extensive differential diagnosis, but literature search shows only limited studies of pancytopenia in Pediatrics patients in Uttarakhand state of India. The present study was therefore conducted to study the spectrum of pancytopenia with bone marrow and haematological profile in Pediatrics patients in this north Himalayan state of India.Methods: Prospective observational study was conducted in the Department of Pediatrics in the teaching institute situated in Uttarakhand state of India over a period of 12 months. The study included all the patients of pancytopenia below 18 years of age who underwent bone marrow examination after written informed consent.Results: The study included total 50 pediatrics patients of pancytopenia with male to female ratio of 1.38:1. The mean age of patients was 10.58±4.94 with median age of 12 years. Mean hemoglobin was 5.31±2.09 g/dl, total leukocyte count was 2492.68±941.76/mm3, platelet count was 34724±26423/mm3, mean corpuscular volume was 90.95±16.65 fl, mean corpuscular hemoglobin was 30.11±6.07 pg, mean corpuscular hemoglobin concentration was 33.06±1.65% and reticulocyte count was 1.21±1.10%. Nutritional deficiency (28%) was the most common cause for pancytopenia followed by aplastic anemia (24%). Megaloblastic anemia was the commonest cause of nutritional deficiency anemia (71.42%) with pancytopenia.Conclusions: Pancytopenia is an important presentation in Pediatrics population with the most common cause being nutritional anemia and aplastic anemia. Megaloblastic anemia is the commonest cause of nutritional anemia with pancytopenia. The clinicians should be aware of spectrum of pancytopenia with clinical and haematological presentation in Pediatrics patients of this region so as to avoid unnecessary work ups and delay in treatment

Assessment of WRF-3DVAR Data Assimilation on Simulation of Heavy Rainfall Events Associated with Monsoon Depressions over Bay of Bengal

The present study examines the performance of the Advance Research Weather Research and Forecasting model with three-dimensional variational data assimilation (WRF-3DVAR) associated with four heavy rainfall events (HREs) in the presence of monsoon depressions (MDs) over the Bay of Bengal (BoB). We have carried out two numerical experiments, control experiment (CNTL; without data assimilation) and 3DV (assimilation of observations from Global Telecommunication system). The resultant high-resolution analysis obtained from the successful insertion of additional observations through 3DVAR assimilation technique recaptures the better convection and synoptic features associated with the MDs. The 3DV-simulated values of hydrometeors (rainwater, cloud water, and ice + snow + graupel) are found to be reasonably well captured, compared to CNTL simulation. The MDs evolution at various phases of its life span is reasonably well simulated in the 3DV compared to the CNTL experiment. The qualitative and quantitative precipitations are examined with respect to satellite-estimated rainfall data. The quantitative validation of model simulated 24-h accumulated precipitation is evaluated through the feature-based diagnostic evaluation method. Numerous statistical skill scores are evaluated by virtue of the object-oriented tool and results revealed that the simulated rainfall is remarkably improved in 3DV experiment. The study envisages that the assimilation of observations through 3DVAR have positive impact for simulation of HREs due to the presence of MDs

Cost-effectiveness of magnetic resonance imaging in cervical clearance of obtunded blunt trauma after a normal computed tomographic finding

© 2018 American Medical Association. All rights reserved. IMPORTANCE Magnetic resonance imaging (MRI) continues to be performed for cervical clearance of obtunded blunt trauma, despite poor evidence regarding its utility after a normal computed tomographic (CT) finding. OBJECTIVE To evaluate the utility and cost-effectiveness of MRI vs no follow-up after a normal cervical CT finding in patients with obtunded blunt trauma. DESIGN, SETTING AND PARTICIPANTS This cost-effectiveness analysis evaluated an average patient aged 40 years with blunt trauma from an institutional practice. The analysis used a Markov decision model over a lifetime horizon from a societal perspective with variables from systematic reviews and meta-analyses and reimbursement rates from the Centers for Medicare & Medicaid Services, National Spinal Cord Injury Database, and other large published studies. Data were collected from the most recent literature available. INTERVENTIONS No follow-up vs MRI follow-up after a normal cervical CT finding. RESULTS In the base case of a 40-year-old patient, the cost of MRI follow-up was $14 185 with a health benefit of 24.02 quality-adjusted life-years (QALY); the cost of no follow-up was$1059 with a health benefit of 24.11 QALY, and thus no follow-up was the dominant strategy. Probabilistic sensitivity analysis showed no follow-up to be the better strategy in all 10 000 iterations. No follow-up was the better strategy when the negative predictive value of the initial CT was relatively high (\u3e98%) or the risk of an injury treated with a cervical collar turning into a permanent neurologic deficit was higher than 25% or when the risk of a missed injury turning into a neurologic deficit was less than 58%. The sensitivity and specificity of MRI were varied simultaneously in a 2-way sensitivity analysis, and no follow-up remained the optimal strategy. CONCLUSIONS AND RELEVANCE Magnetic resonance imaging had a lower health benefit and a higher cost compared with no follow-up after a normal CT finding in patients with obtunded blunt trauma to the cervical spine, a finding that does not support the use of MRI in this group of patients. The conclusion is robust in sensitivity analyses varying key variables in the model. More literature on these key variables is needed before MRI can be considered to be beneficial in the evaluation of obtunded blunt trauma