Sağlık Bilgi Sistemlerinin zayıf yönlerinin belirlenmesi: Bir Deneysel E-sağlık Değerlendirme Çalışması [Determining the weak sides of Healthcare Information Systems: An Emprical e-Health Evaluation Study]

Abstract in Turkish Sağlık tüm sağlık teşkillerinin bir bilgi sistemi kullandığı teknoloji-yoğun bir alandır. Sağlık hizmetinin devamının sağlanması ve günlük sağlık bakımı işlemlerinin yürütülmesi sağlık bilgi sistemleri olmaksızın imkansız bir hale gelmiştir. Sağlık bilgi sistmleri sürelki değişen ihtiyaçları karşılamak için iyi yönetilmeli ve desteklenmeli, sürekli geliştirilmelidir. Bunun için yaşayan sistemler olmalıdırlar. Bu bağlamda, işletilen sistemlerin zayıf ve güçlü yanlarını belirlemek için değerlendirme çalışmaları yapılmaktadır. Sağlık bilişimi alanında değerlendirme çok önemli mbir konudur. Yatırımcılar ve yöneticiler bilgi sistemlerini geliştirebilmek için sistemlerinin başarı seviyesini ve zayıf noktalarını bilmek isterler. Burdan yola çıkarak, bir sağlık bilgi sisteminin değerlendirildiği bir çalışma yapılmıştır. Yeni kurulan labaratuvar bilgi sistemi (LBS), hem hastalara hem de kullanıcılara uygulanan anketler vasıtası ile very toplanarak değerlendirilmiştir. LBS Fonksiyon yeterliliği, İş yükü azaltma, Hız, Öğrenme kolaylığı, Hizmet kalitesini arttırma, Süreklilik, Yardım menüleri, Kulanıcı tatmini ve Hasta tatmini özellikleri bazında değerlendirmeye tabii tutulmuştur. Belirlenen eşik değerinin altında kalan özellikler geliştirme gerektiren özellikler olarak belirlenmişit.r Değişik eşik değerlerine göre hangi özelliklerin geliştirilmesi gerektiği bir tablo olarak verilerek, eşik değeri seçimi duruma özel olması nedeniyle değerlendirmeciye bırakılmıştır. Eşik değeri yükseldikçe geliştirme gereken özellik sayısı artmaktadır. [Healthcare is a technology-intensive area where all the healthcare organisations use an information system. Managing daily works and providing the continuity of healthcare is impossible without healthcare information systems. Healthcare information systems have to be well supported and managed, also have to be improved to meet the changing needs, they must be living systems. In this respect, evaluations are carried out to reveal the weak and strong sides of information systems in operation. Evaluation is an important subject for medical informatics domain. The investors and managers need to know the success level and poor sides of their information system to make improvements. In this sense, a case study is performed in this study, to evaluate a healthcare information system. Particularly, the recently deployed laboratory information system (LIS) is evaluated by means of questionnaires, applied to both patients and users of the laboratory information system. Laboratory information system is evaluated on the basis of Function sufficiency, Decreasing Work Load, Speed, Learning Ease, Improving Service Quality, Availability, Help Manuals, User Satisfaction, and Patient Satisfaction features. The features needing to be improved in terms of the effectiveness and efficiency of LIS are measured based on the threshold value. The results are presented in a variable table according to the threshold value selected by the evaluator. As the target threshold value increases, the number of features needing to be improved also increases.

Formation of Hydroxymethyl DNA Adducts in Rats Orally Exposed to Stable Isotope Labeled Methanol

Methanol is a large volume industrial chemical and widely used solvent and fuel additive. Methanol’s well known toxicity and use in a wide spectrum of applications has raised long-standing environmental issues over its safety, including its carcinogenicity. Methanol has not been listed as a carcinogen by any regulatory agency; however, there are debates about its carcinogenic potential. Formaldehyde, a metabolite of methanol, has been proposed to be responsible for the carcinogenesis of methanol. Formaldehyde is a known carcinogen and actively targets DNA and protein, causing diverse DNA and protein damage. However, formaldehyde-induced DNA adducts arising from the metabolism of methanol have not been reported previously, largely due to the absence of suitable DNA biomarkers and the inability to differentiate what was due to methanol compared with the substantial background of endogenous formaldehyde. Recently, we developed a unique approach combining highly sensitive liquid chromatography-mass spectrometry methods and exposure to stable isotope labeled chemicals to simultaneously quantify formaldehyde-specific endogenous and exogenous DNA adducts. In this study, rats were exposed daily to 500 or 2000 mg/kg [13CD4]-methanol by gavage for 5 days. Our data demonstrate that labeled formaldehyde arising from [13CD4]-methanol induced hydroxymethyl DNA adducts in multiple tissues in a dose-dependent manner. The results also demonstrated that the number of exogenous DNA adducts was lower than the number of endogenous hydroxymethyl DNA adducts in all tissues of rats administered 500 mg/kg per day for 5 days, a lethal dose to humans, even after incorporating an average factor of 4 for reduced metabolism due to isotope effects of deuterium-labeled methanol into account

Simultaneous Determination of Cyclosporine A, Tacrolimus, Sirolimus, and Everolimus in Whole-Blood Samples by LC-MS/MS

Objectives. Cyclosporine A (CyA), tacrolimus (TRL), sirolimus (SIR), and everolimus (RAD) are immunosuppressive drugs frequently used in organ transplantation. Our aim was to confirm a robust sensitive and selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for determination of CyA, TRL, SIR, and RAD in whole-blood samples. Materials and Methods. We used an integrated online solid-phase extraction-LC-MS/MS system and atmospheric pressure ionization tandem mass spectrometry (API-MS/MS) in the multiple reaction monitoring (MRM) detection mode. CyA, TRL, SIR, and RAD were simultaneously analyzed in whole blood treated with precipitation reagent taken from transplant patients. Results. System performance parameters were suitable for using this method as a high-throughput technique in clinical practice. The high concentration of one analyte in the sample did not affect the concentration of other analytes. Total analytical time was 2.5 min, and retention times of all analytes were shorter than 2 minutes. Conclusion. This LC-MS/MS method can be preferable for therapeutic drug monitoring of these immunosuppressive drugs (CyA, TRL, SRL, and RAD) in whole blood. Sample preparation was too short and simple in this method, and it permits robust, rapid, sensitive, selective, and simultaneous determination of these drugs

Protective efficiacy of taurine against pulmonary edema progression: experimental study

Re-expansion pulmonary edema (RPE) is an acute, rare and potentially lethal complication [1,2]. Its beginning is sudden and dramatic. The mechanism is not yet fully understood [1]. Some authors suggest that it may occur after rapid re-inflation of a collapsed lung [1]. It was reported by other authors that it may relate to surfactant depletion or may result from hypoxic capillary damage, leading to increased capillary permeability [1,3]. In RPE, unilateral lung injury is initiated by cytotoxic oxygen metabolites and temporally associated with an influx of polymorphonuclear neutrophils [1]. These toxic oxygen products are the results of re-oxygenation of a collapsed lung. Treatment of re-expansion pulmonary edema is basically preventive [4]

A nationwide multicentre study in Turkey for establishing reference intervals of haematological parameters with novel use of a panel of whole blood

IntroductionA nationwide multicentre study was conducted to establish well-defined reference intervals (RIs) of haematological parameters for the Turkish population in consideration of sources of variation in reference values (RVs). Materials and methodsK2-EDTA whole blood samples (total of 3363) were collected from 12 laboratories. Sera were also collected for measurements of iron, UIBC, TIBC, and ferritin for use in the latent abnormal values exclusion (LAVE) method. The blood samples were analysed within 2 hours in each laboratory using Cell Dyn and Ruby (Abbott), LH780 (Beckman Coulter), or XT-2000i (Sysmex). A panel of freshly prepared blood from 40 healthy volunteers was measured in common to assess any analyser-dependent bias in the measurements. The SD ratio (SDR) based on ANOVA was used to judge the need for partitioning RVs. RIs were computed by the parametric method with/without applying the LAVE method. ResultsAnalyser-dependent bias was found for basophils (Bas), MCHC, RDW and MPV from the panel test results and thus those RIs were derived for each manufacturer. RIs were determined from all volunteers’ results for WBC, neutrophils, lymphocytes, monocytes, eosinophils, MCV, MCH and platelets. Gender-specific RIs were required for RBC, haemoglobin, haematocrit, iron, UIBC and ferritin. Region-specific RIs were required for RBC, haemoglobin, haematocrit, UIBC, and TIBC. ConclusionsWith the novel use of a freshly prepared blood panel, manufacturer-specific RIs’ were derived for Bas, Bas%, MCHC, RDW and MPV. Regional differences in RIs were observed among the 7 regions of Turkey, which may be attributed to nutritional or environmental factors, including altitude

Protective efficiacy of taurine against pulmonary edema progression: experimental study

Re-expansion pulmonary edema (RPE) is an acute, rare and potentially lethal complication [1,2]. Its beginning is sudden and dramatic. The mechanism is not yet fully understood [1]. Some authors suggest that it may occur after rapid re-inflation of a collapsed lung [1]. It was reported by other authors that it may relate to surfactant depletion or may result from hypoxic capillary damage, leading to increased capillary permeability [1,3]. In RPE, unilateral lung injury is initiated by cytotoxic oxygen metabolites and temporally associated with an influx of polymorphonuclear neutrophils [1]. These toxic oxygen products are the results of re-oxygenation of a collapsed lung. Treatment of re-expansion pulmonary edema is basically preventive [4]

Detection of PIGO-Deficient Cells Using Proaerolysin: A Valuable Tool to Investigate Mechanisms of Mutagenesis in the DT40 Cell System

While isogenic DT40 cell lines deficient in DNA repair pathways are a great tool to understand the DNA damage response to genotoxic agents by a comparison of cell toxicity in mutants and parental DT40 cells, no convenient mutation assay for mutagens currently exists for this reverse-genetic system. Here we establish a proaerolysin (PA) selection-based mutation assay in DT40 cells to identify glycosylphosphatidylinositol (GPI)-anchor deficient cells. Using PA, we detected an increase in the number of PA-resistant DT40 cells exposed to MMS for 24 hours followed by a 5-day period of phenotype expression. GPI anchor synthesis is catalyzed by a series of phosphatidylinositol glycan complementation groups (PIGs). The PIG-O gene is on the sex chromosome (Chromosome Z) in chicken cells and is critical for GPI anchor synthesis at the intermediate step. Among all the mutations detected in the sequence levels observed in DT40 cells exposed to MMS at 100 µM, we identified that ∼55% of the mutations are located at A:T sites with a high frequency of A to T transversion mutations. In contrast, we observed no transition mutations out of 18 mutations. This novel assay for DT40 cells provides a valuable tool to investigate the mode of action of mutations caused by reactive agents using a series of isogenic mutant DT40 cells

A Versatile, User Driven, Flexible And Scalable Decision Making Tool In Toxicology

Background. Drug poisoning is a frequent problem in emergency services. Rapid decision making in toxicological assessment is very important especially in acute poisoning. Since their limited experience, non-toxicologist physician in emergency services usually needs extra information, i.e. decision support tools, to manage acute situation. Reasoning systems could be go either in a known intoxication to give physicians better advice about drugs ingested or in an unknown intoxication to identify products according to clinical manifestations. The aim of this study is to provide a user driven, flexible, scalable and easy to use computer-based decision support system for toxicological assessment. Methods. Our system offers access to the information available in clinical toxicology. Towards this goal, decision making could be used either to refer to a predefined structured database obtained from relevant reports from the textbook, namely predefined system -default-, or to carry out a part of medical reasoning which could be defined by user, namely user defined structure. This system was developed by using Microsoft Visual Basic programing language and Access is the database management system. The system mainly based on answering predefined or user created questions, i.e. what is the heart rate of the patients, to determine drugs affecting cardiovascular system. It is easy to maintain the whole stucture of the system even if some questions could also be inserted to in any of the others anytime. Advices to an assessment question or a group of related questions could be defined as a decision making purpose. In addition, answers to question could be exported as a report file which very useful for either clinican or for laboratory staff and it also could be exported as a database file for statistical evaluation and future considerations. Results. Preliminary evaluations upon our toxicological assessment system promising and it offers higher clinical success and higher user satisfaction. It is easy to use and easy to maintain. It enables continous improvement in the knowledge of clinical toxicology and to transfer it from experienced staff to non-toxicologist pyhsician. Further evaluation will be conducted to clarify the effectiveness of the system. Conclusion. We have developed a versatile, user driven, flexible, scalable, easy to use and easy to maintain toxicological assessment system which promises higher user satisfaction and higher clinical effectiveness. Since it enables user driven usage, our developed decision making tool could be easily adopted to other medical are