Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records

<p>Abstract</p> <p>Background</p> <p>We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined "meaningful use" criteria.</p> <p>Methods</p> <p>We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content.</p> <p>Results</p> <p>All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified.</p> <p>Conclusion</p> <p>If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.</p

Nutritive value of unconventional fibrous ingredients fed to Guinea pigs in the Democratic Republic of Congo

peer reviewedThe energy and protein value for Guinea pigs (GP) of 9 forages (7 dicots and 2 grasses) and 5 hay-based diets was determined. The apparent faecal digestibility of dry matter, organic matter, crude protein and energy was measured on GP housed in metabolic cages. The forages and the diets were digested in vitro using pepsin and pancreatin hydrolysis and gas fermentation test to simulate stomach, small intestine and large intestine, respectively. Most of the dicots had high digestible crude protein content (152–201 g/kg DM) and the 2 grasses showed lower values (80–85 g/kg DM). Digestible energy content of the forages ranged between 5.79 to 13.08 MJ/kg DM. None of the forage species or hay-based diets provided sufficient energy to supply the 11.7 MJ/kg metabolic energy requirements. The influence of intestinal fermentation on energy and protein values was highlighted by correlations (P<0.05) between in vivo and in vitro data, including gas fermentation. It is the first time that such relationships are reported in single-stomach animals

The Influence of Manga on the Graphic Novel

This material has been published in The Cambridge History of the Graphic Novel edited by Jan Baetens, Hugo Frey, Stephen E. Tabachnick. This version is free to view and download for personal use only. Not for re-distribution, re-sale or use in derivative works. © Cambridge University PressProviding a range of cogent examples, this chapter describes the influences of the Manga genre of comics strip on the Graphic Novel genre, over the last 35 years, considering the functions of domestication, foreignisation and transmedia on readers, markets and forms

Paraneoplastic PRES from lymphoma induced hypercalcemia: Case report and review of the literature

Hypercalcemia from tumors has been associated with Posterior Reversible Encephalopathy Syndrome (PRES) but the mechanism remains unclear. In this article, we describe a case of PRES caused by hypercalcemia from lymphoma. We summarize the available scientific evidence linking hypercalcemia to failure of cerebral autoregulation and potentially PRES. A major link is the hypomagnesemia induced by hypercalcemia. While this concept requires further clinical testing and validation, it is clinically significant for the management of PRES, even when not directly caused by hypercalcemia. Keywords: PRES, Lymphoma, Hypercalcemia, Magnesium, Paraneoplasti

The Demographic Transition and the Sexual Division of Labor

This paper presents a theory in which increases in female labor force participation and reductions in the gender-wage gap are generated as part of a single process of demographic transition, initially characterized by reductions in mortality and fertility. The paper suggests a relationship between gains in life expectancy and changes in the role of women in society that has not been identified before in the literature. Mortality reductions affect the incentives of individuals to invest in human capital and to have children, with implications for female labor force participation and the wage differential between men and women. The paper also presents some empirical evidence to support the predictions of the theory. (c) 2008 by The University of Chicago. All rights reserved..

Array-based comparative genomic hybridization analysis to identify prognostic markers for resected pancreatic cancer.

Background: The clinical relevance of genomic imbalances in pancreatic cancer is uncertain. The aim of this study was to evaluate whether alterations in specific genes influenced clinical outcome in resected pancreatic cancer patients. Methods: Recurrent copy number alterations of cytobands and genes were analyzed by array comparative genomic hybridization (aCGH) in 44 resected pancreatic cancer specimens from a Korean cohort, including 24 patients who received adjuvant chemotherapy regimens with gemcitabine or 5-fluorouracil. Statistical analysis enabled us to assess the interaction of copy number alterations with clinicopathological variables and overall survival (OS). Prognostic markers identified by aCGH were validated by PCR gene copy number assay in an independent Italian cohort of 61 resected pT3N1Mx stage pancreatic cancers treated with gemcitabine adjuvant therapy. Results: Recurrent copy number gains were observed in chromosome 1q, 11q, 18q11.1-11.2, and 20q13.13; and losses in chromosome 2p, 9p, 10q, 14q, 15q, 18q12.2-23, 19q, 20q11.1, 21p, and 22q. Loss of cytoband 18q22.3 (in 8 patients) was significantly more frequent in patients surviving shorter than the median OS (p=0.021, Fisher-Exact test). This cytoband encodes 5 genes, including CNDP2, whose copy number was associated with OS (p=0.019, log-rank test). The copy number of this gene was subsequently assessed in the Italian cohort, where patients with deletion (N=41) had shorter OS (p=0.003, log-rank test). Multivariate analysis of the two cohorts showed that loss/deletion of 18q22.3/CNDP2 was an independent poor prognostic factor for OS (hazard ratio 2.72, p=0.0007) after adjusting for other factors influencing clinical outcome. Conclusions: Through aCGH analysis, we identified loss/deletion of 18q22.3/CNDP2 as a potentialindependent poor prognostic factor in resected pancreatic cancer. Given the heterogeneity of the two cohorts, further confirmation on a large number of patients is warranted. However, the combined Cox model suggests that this genetic alteration may have a meaningful impact on OS of pancreatic cancer patients, and its biological implications are being investigated