Computing in medical practice

OBJECTIVE: currently, information technology is part of several aspects of our daily life. The objective of this paper is to analyze and discuss the use of information technology in both medical education and/or medical practice. SOURCES OF DATA: information was gathered through nonsystematic bibliographic review, including articles, official regulations, book chapters and annals. Direct search and search of electronic databanks in Medline and Lilacs databases were also performed. SUMMARY OF THE FINDINGS: this paper was structured in topics. First, there is a discussion on the electronic medical record. The following aspects are presented: history, functions, costs, benefits, ethical and legal issues, and positive and negative characteristics. Medical decision-support systems are also evaluated in view of the huge amount of information produced every year regarding healthcare. The impact of the Internet on the production and diffusion of knowledge is also analyzed. Telemedicine is assessed, since it presents new challenges to medical practice, and raises important ethical issues such as virtual medical consultation. Finally, a practical experience of modernization of a pediatric outpatient center by the introduction of computers and telecommunication tools is described. CONCLUSIONS: medical computing offers tools and instruments that support the administrative organization of medical visits, gather, store and process patient's data, generate diagnoses, provide therapeutical advice and access to information in order to improve medical knowledge and to make it available whenever and wherever adequate decision-making is required.OBJETIVO: a informática hoje participa em vários aspectos de nossa vida cotidiana. Os autores, através deste artigo de revisão, analisam e discutem sua inserção nos consultórios médicos assistenciais e/ou de ensino. FONTES DE DADOS: foram utilizadas informações obtidas através de revisão bibliográfica, não sistemática, abrangendo artigos, normas oficiais, capítulos de livros e anais, realizada, também, por busca direta e de bancos eletrônicos nas bases de dados Medline e Lilacs. SÍNTESE DOS DADOS: o artigo foi estruturado em tópicos, apresentando, inicialmente, uma discussão sobre o prontuário eletrônico, sua história, funções, custos e benefícios, aspectos éticos e legais e suas vantagens e desvantagens. Avalia-se, também, os sistemas de apoio à decisão em medicina frente à quantidade enorme de informações que surgem, a cada ano, na área da saúde. Foi analisado o impacto do uso da Internet na universalização e na democratização do conhecimento e avaliada a telemedicina, que cria novos desafios à prática médica, bem como levanta aspectos éticos importantes como os da consulta virtual e, finalizando, descreve-se uma experiência prática de modernização de um ambulatório de ensino em Pediatria, com a introdução das ferramentas de informática e telecomunicação. CONCLUSÕES: a área de informática médica hoje dispõe de ferramentas e instrumentos que podem apoiar a organização administrativa da consulta médica, a captura, o armazenamento e o processamento das informações do paciente, a geração do diagnóstico, a orientação terapêutica e o acesso às informações, visando a melhora do conhecimento médico e a disponibilidade deste conhecimento onde e quando ele for necessário, para uma adequada tomada da decisão.UNIFESP-EPM Departamento de PediatriaUNIFESP-EPM Departamento de Informática em SaúdeUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM Depto. de Informática em SaúdeSciEL

Culicoides obsoletus allergens for diagnosis of insect bite hypersensitivity in horses

AInsect Bite Hypersensitivity (IBH) is the most common skin allergy in horses and involves a Type I (IgE mediated) hypersensitivity reaction against bites of insects, mainly of the Culicoides species. Welfare of affected horses is seriously reduced and no fully curative treatment is yet available. Furthermore, current diagnostic tests are unreliable because of their low sensitivity and specificity. Aim of our research was to increase the understanding of immunological aspects of IBH, with special attention to improving diagnosis by the characterization and production of recombinant allergens. Whole body extracts (WBE) of three Culicoides species: C. obsoletus C. nubeculosus and C. sonorensis were evaluated for their applicability for diagnosis of IBH in horses in The Netherlands. They were tested for IgE binding by ELISA and Western blotting and for their capacity to degranulate basophils in a histamine release test. For all tests, best results were obtained with C. obsoletus. The ELISA was further evaluated using C. obsoletus extract on approximately 200 IBH affected and healthy horses, which demonstrated high test sensitivity and specificity. C. obsoletus-specific IgE serum levels were found to be the same in the IBH season and off season, suggesting that the test can be used to diagnose horses in winter when clincial symptoms are absent. Since C. obsoletus was found to be the most important species for diagnosis of IBH in The Netherlands, mRNA of this Culicoides species was sequenced and assembled to create a transcriptome. Using the sequences from in literature described allergens from C. nubeculosus and C. sonorensis, similarity searches were performed on this transcriptome,. This resulted in the identification of seven allergens from C. obsoletus. These allergens were cloned and expressed as recombinant proteins in E. coli and named Cul o 1 – Cul o 7. The frequency of positive test results by ELISA within IBH affected horses ranged from 38 % to 67 %. The capability of the allergens to induce Type I hypersensitivity reaction in IBH affected horses was demonstrated by an intradermal test. The applicability of the 7 C. obsoletus derived recombinant allergens was further evaluated and compared with C. obsoletus WBE in an IgE ELISA using a large number of horses.The highest test accuracy was obtained with WBE, followed by Cul o 2, 3 and 5. Two ELISA’s with a combination of recombinant allergens, combi-1 (Cul o 3, 5 and 7) and combi-2 (Cul o 1, 2, 5 and 7) were additionally performed and both resulted in high test accuracies close to that obtained with WBE. Both combi-1 and combi-2 resulted in a lower test sensitivity with samples collected in winter compared to samples collected in IBH season, but most IBH affected horses could still also be correctly diagnosed in winter. The association between several factors and IgE levels against C. obsoletus whole body extract and the 7 recombinant allergens was quantified. Furthermore, the relation between IgE levels and severity of symptoms was examined. Severity of symptoms and IgE levels against several C. obsoletus allergens were found to be related. Factors that were found to be associated with IgE levels were: breed, age, month of scoring, interaction between IBH status and month of scoring, degree of itchiness and number of seasons horses were affected with IBH. The general discussion discussed the prospects to use the produced recombinant allergens for immunotherapy treatment of IBH affected horses. The panel of all 7 recombinant allergens allows to determine for which exact components of C. obsoletus the IBH horses are allergic (“component resolved diagnosis”). This will enable a tailor made composition of (recombinant) allergens for use in immunotherapy.</p

A Note on the Hydrogen Bonding in Isomeric Aminopyridines in Relation to their Basicities

Physicians commonly advise patients to begin disease modifying therapies (DMT's) shortly after the establishment of a diagnosis of Multiple Sclerosis (MS) to prevent further relapses and disease progression. However, little is known about the meaning for patients going through the process of the diagnosis of MS and of making decisions on DMT's in early MS.To explore the patient perspective on using DMT's for MS. Methods: Ten participants with a recent (< 2 years) relapsing-remitting MS diagnosis were interviewed. Seven of them were using DMT's at the time of the interview. All interviews were transcribed and analyzed using a hermeneutical-phenomenological approach.The analysis revealed the following themes: (1) Constant confrontation with the disease, (2) Managing inevitable decline, (3) Hope of delaying the progression of the disease, and, (4) The importance of social support. The themes show that patients associate the recommendation to begin DMT's (especially injectable DMT's) with views about their bodies as well as their hopes about the future. Both considering and adhering to treatment are experienced by patients as not only matters of individual and rational deliberation, but also as activities that are lived within a web of relationships with relatives and friends.From the patient perspective, the use of DMT's is not a purely rational and individual experience. More attention to the use of DMT's as relational and lived phenomena will improve the understanding of the process of decision-making for DMT's in MS

Differences between remaining ability and loss of capacity in maximum aerobic impairment

In the evaluation of exercise intolerance of patients with respiratory diseases the American Medical Association (AMA) and the American Thoracic Society (ATS) have proposed similar classifications for rating aerobic impairment using maximum oxygen uptake (VO2max) normalized for total body weight (ml min-1 kg-1). However, subjects with the same VO2max weight-corrected values may have considerably different losses of aerobic performance (VO2max expressed as % predicted). We have proposed a new, specific method for rating loss of aerobic capacity (VO2max, % predicted) and we have compared the two classifications in a prospective study involving 75 silicotic claimants. Logistic regression analysis showed that the disagreement between rating systems (higher dysfunction by the AMA/ATS classification) was associated with age >50 years (P<0.005) and overweight (P = 0.04). Interestingly, clinical (dyspnea score) and spirometric (FEV1) normality were only associated with the VO2max, % predicted, normal values (P<0.01); therefore, in older and obese subjects the AMA/ATS classification tended to overestimate the aerobic dysfunction. We conclude that in the evaluation of aerobic impairment in patients with respiratory diseases, the loss of aerobic capacity (VO2max, % predicted) should be used instead of the traditional method (remaining aerobic ability, VO2max, in ml min-1 kg-1).Universidade Federal de São Paulo (UNIFESP)Universidade Estadual de CampinasHarbor-UCLA Medical CenterUNIFESPSciEL