Performance Analysis of a Medical Record Exchanges Model(SCI)

[[abstract]]Electronic medical record exchange among hospitals can provide more information for physician diagnosis and reduce costs from duplicate examinations. In this paper, we proposed and implemented a medical record exchange model. According to our study, exchange interface servers (EISs) are designed for hospitals to manage the information communication through the intra and interhospital networks linked with a medical records database. An index service center can be given responsibility for managing the EIS and publishing the addresses and public keys. The prototype system has been implemented to generate, parse, and transfer the health level seven query messages. Moreover, the system can encrypt and decrypt a message using the public-key encryption algorithm. The queuing theory is applied to evaluate the performance of our proposed model. We estimated the service time for each queue of the CPU, database, and network, and measured the response time and possible bottlenecks of the model. The capacity of the model is estimated to process the medical records of about 4000 patients/h in the 1-MB network backbone environments, which comprises about the 4% of the total outpatients in Taiwan. Performance Analysis of a Medical Record Exchanges Model (PDF Download Available). Available from: https://www.researchgate.net/publication/51375541_Performance_Analysis_of_a_Medical_Record_Exchanges_Model [accessed Jan 15, 2016]

MTL-CEBPA, a Small Activating RNA Therapeutic Upregulating C/EBP-α, in Patients with Advanced Liver Cancer: A First-in-Human, Multicenter, Open-Label, Phase I Trial.

PURPOSE: Transcription factor C/EBP-α (CCAAT/enhancer-binding protein alpha) acts as a master regulator of hepatic and myeloid functions and multiple oncogenic processes. MTL-CEBPA is a first-in-class small activating RNA oligonucleotide drug that upregulates C/EBP-α. PATIENTS AND METHODS: We conducted a phase I, open-label, dose-escalation trial of MTL-CEBPA in adults with advanced hepatocellular carcinoma (HCC) with cirrhosis, or resulting from nonalcoholic steatohepatitis or with liver metastases. Patients received intravenous MTL-CEBPA once a week for 3 weeks followed by a rest period of 1 week per treatment cycle in the dose-escalation phase (3+3 design). RESULTS: Thirty-eight participants have been treated across six dose levels (28-160 mg/m2) and three dosing schedules. Thirty-four patients were evaluable for safety endpoints at 28 days. MTL-CEBPA treatment-related adverse events were not associated with dose, and no maximum dose was reached across the three schedules evaluated. Grade 3 treatment-related adverse events occurred in nine (24%) patients. In 24 patients with HCC evaluable for efficacy, an objective tumor response was achieved in one patient [4%; partial response (PR) for over 2 years] and stable disease (SD) in 12 (50%). After discontinuation of MTL-CEBPA, seven patients were treated with tyrosine kinase inhibitors (TKIs); three patients had a complete response with one further PR and two with SD. CONCLUSIONS: MTL-CEBPA is the first saRNA in clinical trials and demonstrates an acceptable safety profile and potential synergistic efficacy with TKIs in HCC. These encouraging phase I data validate targeting of C/EBP-α and have prompted MTL-CEBPA + sorafenib combination studies in HCC

Design and Development of a Tele-Healthcare Information System Based on Web Service and HL7 Standards

[[abstract]]Information and communication technologies progress rapidly and many novel applications have been developed in many domains of human life. In recent years, the demand for healthcare services has been growing because of the increase in the elderly population. Consequently, a number of healthcare institutions have focused on creating technologies to reduce extraneous work and improve the quality of service. In this study, an information platform for tele- healthcare services was implemented. The architecture of the platform included a web-based application server and client system. The client system was able to retrieve the blood pressure and glucose levels of a patient stored in measurement instruments through Bluetooth wireless transmission. The web application server assisted the staffs and clients in analyzing the health conditions of patients. In addition, the server provided face-to-face communications and instructions through remote video devices. The platform deployed a service-oriented architecture, which consisted of HL7 standard messages and web service components. The platform could transfer health records into HL7 standard clinical document architecture for data exchange with other organizations. The prototyping system was pretested and evaluated in a homecare department of hospital and a community management center for chronic disease monitoring. Based on the results of this study, this system is expected to improve the quality of healthcare services

醫院實施電子病歷與醫療資訊安全之近況探討

[[abstract]]全面實施電子病歷是政府既定的政策，也是多年來醫療業務電腦化的努力目標，由於病歷涉及病人隱私，所以實施電子病歷的過程中，是否達成資訊安全的要求，已經成為重要的議題。最近衛生署積極推動加速醫療院所實施電子病歷系統計畫及醫院實施電子病歷互通補助計畫，對於醫療院所的資訊安全及電子病歷的簽章都有相關規定，本文收集衛生主管機關對於電子病歷與醫療資訊安全的相關規定加以探討

Generating Standardized Clinical Documents for Medical Information Exchanges

[[abstract]]The author mentions that in order to facilitate the exchange of medical information, Taiwan's Department of Health supported a project to standardize electronic medical records. Part of this project involved developing a system that automatically generates samples for the 108 different types of standard documents. The paper discusses the efforts to create a comprehensive specification system to help hospital staffs create EMRs that conform to the HL7 CDA. The guidelines comprise online documents and formats, categorized according to the various paper forms used in different hospitals. For ease of use, the Standardization Clinical Document Generation System was also developed. The system generates sample documents automatically, thereby maintaining consistency and reducing human errors

Design and Impelementaion of a Web-based HL7 Message Generation and Validation System

[[abstract]]Health level 7 (HL7) is the standard of electronic data interchange in the health domain. We have developed a web-based message generation and validation system for testing the message format of the data exchange among hospitals and health organizations. Compared with other existing ones, this system has incorporated several novel functions that optimize medical data exchange and helps medical students in learning HL7 messages. When receiving HL7 message from another system with the hypertext transmission protocol or accepting an uploaded HL7 message file, the system shows the validation result through a web browser. In this platform, users may input and edit medical data on-line to test and generate standard HL7 messages. The system supports various data formats and is capable of transforming HL7 messages between the standard delimiter format and the extensible markup language format. This system has been successfully passed our system evaluation among 139 student users for HL7 training. Most of the users agreed that the system is helpful for medical data exchange

[[alternative]]Design and Implementation of a Multimedia Education System for Nursing Physical Examination

[[abstract]]護理身體評估是所有護理學生都必須學習的一門課程，學理與實務並重，以評估問診的方式來達到收集患者健康情形的相關資訊，在教學的過程中，通常需要配合圖片及影片的示範講解，才能夠讓學生徹底了解。目前市面上雖然已經有身體評估相關的書籍與教材，但是都屬於靜態的說明，學生自行閱讀的成效不佳。近年來由於資訊及網路科技的進步，多媒體線上教學系統的製作越來越容易，網路教材可以打破時空限制，具備許多傳統教材的優點，利用網路線上的學習，可以將加強學習者的記憶，也可以使學習者方便且挑選配合自己的時問做最佳的學習，多媒體介面的活潑生動性，更吸引學習的的注意，進而提高學習者的學習效率。 本文是針對身體評估的教材區分為呼吸、循環、神經及腸胃等系統，建立了資料庫，加入多圖片及影片等多媒體資料，並建置了資料庫伺服器、應用系統伺服器及影音串流伺服器，提供網路學習的環境。使用者只要使用一般的電腦連結上網，就可以依照身體的各部位逐一閱讀檢視教材，也可以透過全文資料系統，迅速的由資料庫尋找所需的資料，在各章節之後，並加入了互動式的練習題，以檢測使用者了解的程度。本系統製作的經驗，可以作為將來開發網路相關教材的參考。[[abstract]]Physical examination is one of the required classes in nursing. This course is designed to emphasize both theory and hand-on experiences. To let students thoroughly understand the course content, a teacher prefers to use multimedia to teach students the correct way of collecting a patient's medical data. However, current teaching materials on the market are mostly based on printed texts and have very limited benefits to student learning. With the rapid progress of computer and Internet, multimedia based education has become widely available. In addition to having all the advantages in traditional education, the computer and Internet based teaching scheme also offers flexibility in the time and location of a learning process. For example, a student can easily refresh his or her memory after class, as long as computer and Internet are available to the student. Furthermore, the multimedia teaching is a multi-dimensional learning environment. The interactive function of a multimedia tends to catch a student's attention and makes a learning process more efficient. This paper describes a multimedia based database for teaching physical examination. The scope of the database covers the breathing, circulation, neurotics, and abdomen systems. The course materials are stored into a database chapter by chapter Pictures and videos can be presented through an Internet browser. A distance learning environment can be constructed through the implementation of the database, application, and video-stream servers. When a user is on-line, he or she can learn through the materials by following the sequence of the systems or can locate the materials of a particular subject from the database. There are also review questions in each chapter for self-evaluation. In this paper, we would like to share our experience in implementing a multimedia teaching environment through computer and Internet. This experience could be valuable for developing Internet courses in the future

Development of a Deterministic XML Schema by Resolving Structure Ambiguity of HL7 Messages

[[abstract]]Health level 7 (HL7) is a standard for medical information exchange. It defines data transfers for the application systems in the healthcare environment. Alternatively, the extensible markup language (XML) is a standard for data exchange using the Internet. If exchange messages follow the content and the sequence defined by HL7 and are expressed in the XML format, the system may benefit from the advantages of both standards. In creating the XML schema, we found ambiguities in HL7 message structures that cause the XML schema to be non-deterministic. These ambiguous expressions are summarized within 12 structures and can be replaced with equivalent or similar unambiguous structures. The finite state automata are used to verify expression equivalence. Applying this schema, an XML document may eliminate redundant segment group definitions and make the structure simple and easy to reproduce. In this paper, we discuss the methods and our experience in resolving ambiguous problems in HL7 messages to generate a deterministic XML schema

A population‐based study on the determinants of hospice utilization in the last year of life for Taiwanese cancer decedents, 2001–2006

[[abstract]]Background: No population‐based studies conducted outside Western countries have identified determinants of hospice utilization for all ages and cancer groups.  Objective: To evaluate associations between hospice utilization in the last year of life and patient demographics, disease characteristics, physician specialty, hospital characteristics, and availability of healthcare resources at the hospital and regional levels in Taiwan.  Methods: Retrospective cohort study using administrative data among 204, 850 Taiwanese cancer decedents, 2001–2006.  Results: Rates of hospice utilization increased significantly (12.99–17.24%) over the study period. Hospice utilization was more likely for cancer patients who were female; over 65 years old; currently or formerly married; with ≤1 concurrent disease; diagnosed with breast cancer or cancer having a poorer prognosis; with distant metastasis, and longer illness duration (>2 months since diagnosis); receiving care in a teaching hospital or hospital with an inpatient‐hospice unit; and receiving care in a region with greater density of inpatient‐hospice beds. However, patients with hematological malignancies and esophageal cancer were less likely to use hospice care.  Conclusions: Despite the 1.33 times increase in hospice utilization among cancer patients who died from 2001 to 2006, only one in six Taiwanese cancer decedents used hospice care in their last year of life. Our findings regarding determinants of hospice utilization should be used by healthcare professionals and policy makers to guide the development of policies and interventions that facilitate prognosis disclosure and EOL care discussions between physicians and patients, especially younger patients, to help the transition from curative to palliative care

The effects of quality of life and ability to perform activities of daily living on mild cognitive impairment in older people living in publicly managed congregate housing

[[abstract]]Background: Mild cognitive impairment (MCI) is characterized by a decrease in cognitive abilities that does not affect the ability to perform activities of daily living (ADLs). Therefore, this condition is easily overlooked. The prevalence and factors of influence for MCI in older people living in publicly managed congregate housing are currently unknown. Purpose: This study investigated the prevalence and distribution of MCI in older people living in publicly managed congregate housing and assessed the correlations among quality of life (QoL), ADL, and MCI. Methods: This study applied a correlational study design. The participants were older people who met the study criteria and who lived in public housing in Wanhua District, Taipei City, Taiwan. One-on-one interviews were conducted to measure the cognitive abilities of the participants, and 299 valid samples were collected. Results: The prevalence of MCI in older people living in publicly managed congregate housing was 16.1%. The χ test was employed to evaluate the distribution of MCI prevalence and indicated that the group with higher MCI prevalence exhibited the following characteristics: older than 81 years; married; lived in public housing for more than 20 years; cohabiting; had a history of drinking; and exhibited severe memory regression, physical disabilities, psychological distress, and low QoL. The difference between the groups achieved statistical significance (p < .05). After performing logistical regression analysis to control demographic variables, we found that QoL and ADL were critical for predicting MCI. Conclusions/implications for practice: This study confirmed that QoL and ADL correlate significantly with MCI in older people. Maintaining an open and supportive community enables older people to maintain sufficient mental activity, which has been shown to reduce MCI. These findings may provide an important reference for policy makers, educators, researchers, and community practitioners in their development of service strategies for older people