No abstract available.
Delivery of Health Care ; Informatics

OBJECTIVE: Personal Digital Assistants (PDAs) have the potential to improve clinical trial data collection; however, most current PDA-based clinical data collection systems typically collect and store data in the offline mode, and then transfer the data to an operational database. The purpose of this study was to explore the usefulness of a wireless clinical data collection system for an irritable bowel syndrome trial compared with the traditional paper based data collection. METHODS: We have developed a PDA-based data capture system for clinical trials, and tested it in a double-blind trial. Sixty four patients with irritable bowel syndrome were randomly selected and divided into a control group that used the standard paper report forms (CRF) and an intervention group that used the electronic report forms (e-CRF), daily for five weeks. There were 630 data sets consisting of six questions each, and thus 3,570 data points total were collected. RESULTS: The response rate of the control group was significantly higher than that of the intervention group. However, the completeness of the response in the intervention group was higher and the number of input errors per person for the PDA group was lower than in the paper group. CONCLUSION: A PDA based electronic diary improved the response rate and decreased input errors in an IBS trial. We conclude that mobile devices can be very useful, especially when the proposed design and connectivity aspects have been taken into account.
Cellular Phone ; Computers, Handheld ; Data Collection ; Electronics ; Electrons ; Humans ; Irritable Bowel Syndrome

OBJECTIVE: The goal of this study was to develop a novel pupil and iris segmentation algorithm. We evaluated segmentation performance based on a fractal model. Two methods were compared: Daugman's and our new proposed method. METHODS: We received 200 anterior segment images with 3,872x2,592 pixels. Here we present an active contour model that accurately detects pupil boundaries in order to improve the performance of segmentation systems. We propose a method that uses iris segmentation based on a fractal model. We compared the performance of Daugman's method and the proposed new method and statistically analyzed the results. RESULTS: We manually compared segmentation with the Daugman's method and the new proposed method. The findings showed that the proposed segmentation accuracy was about 2.5 percent higher than Daugman's method. There was a significant difference (p<0.05) between the under and over data between the two methods. CONCLUSION: The results of this study show that the new proposed method was more accurate than the conventional method for the measurement of segmentation of the eye by CAD (Computer-aided Diagnosis).
Eye ; Fractals ; Iris ; Pupil

OBJECTIVE: The most widely used method for quantifying new blood vessel growth in tumor angiogenesis is the determination of microvessel density, which is reported to be associated with tumor progression and metastasis, and a prognostic indicator of patient outcome. In this study, we propose a method for the determination of microvessel density by image analysis, to improve the accuracy and the objectivity of determination of the microvessel density. METHODS: Four-micron-thick tissue sections of renal cell carcinoma samples were stained immunohistochemically for CD34. The regions with a high degree of vascularization were selected by an expert for digitization. Each image was digitized as a 24-bits/pixel image file with a resolution of 640x480 pixels. First, segmentation of the microvessels based on pixel classification using color features in hybrid color space was performed. After use of a correction process for microvessels with discontinuities and separation of touching microvessels, we counted the number of microvessels for the microvessel density measurement. RESULTS: The result was evaluated by comparison with manual quantification of the same images. The comparison revealed that our computerized microvessel quantification was highly correlated with manual counting by a pathologist. CONCLUSION: The results indicate that our method is better than the conventional computerized image analysis methods.
Blood Vessels ; Carcinoma, Renal Cell ; Chimera ; Diagnosis, Computer-Assisted ; Glycosaminoglycans ; Humans ; Microvessels ; Neoplasm Metastasis

OBJECTIVE: Cadaver's sectioned images with high resolution and real color could be used as the source of realistic three-dimensional images. If the sectioned images are registered to a patient's MRIs, three-dimensional images with high resolution and real color that fit the patient, can be produced; the three-dimensional images enable realistic virtual surgery for the patient. The objective of this study was to verify the registration of a cadaver's sectioned images to a patient's head MRIs. METHODS: The sectioned images of the heads of cadaver were associated with segmented images selected at 3 mm intervals. The patient had his head MR scanned at 3 mm intervals; the MRIs were segmented. Software to register the cadaver's sectioned images to the patient's MRIs was developed. On this software, the corresponding dots were identified on both the sectioned images and the MRIs either manually or automatically using segmented images. RESULTS: The registered sectioned images corresponded to the patient's MRIs. Both manual and automatic registrations were satisfied. CONCLUSION: Further study is needed for registering sectioned images to actual patients.
Cadaver ; Head ; Humans ; Imaging, Three-Dimensional

OBJECTIVE: This aim of this study was to evaluate the quality and agreement of electronic medical records with paper-based medical records. METHODS: Data was collected from the paper-based medical records generated during 2004 and electronic medical records during 2007, in patients hospitalized for arterial fibrillation. The categories evaluated included the chief complaint, history of present illness, past illness, medication history, admission history, family history, allergies, smoking history, and drinking history in admission record. RESULTS: The electronic medical records scored higher for: the existence of a medical record, level of information in the medical record and agreement of information. However, there were some categories of disagreement between the information from doctors and nurses, and there were several categories with no record by doctors or nurses. CONCLUSION: The results of this study confirmed that the quality of the electronic medical record is better than that of paper-based medical with regard to: the existence of the record, level and agreement of information. However, there are discrepancies in the information contained within both types of records.
Drinking ; Electronic Health Records ; Electronics ; Electrons ; Hospital Information Systems ; Humans ; Hypersensitivity ; Medical Records ; Smoke ; Smoking

OBJECTIVE: Post-marketing surveillance (PMS) is an adverse events monitoring practice of pharmaceutical drugs on the market. Traditional PMS methods are labor intensive and expensive to perform, because they are largely based on manual work including phone-calling, mailing, or direct visits to relevant subjects. The objective of this study was to develop and validate a PMS methodology based on the clinical data warehouse (CDW). METHODS: We constructed a archival DB using a hospital information system and a refined CDW from three different hospitals. Fluoxetine hydrochloride, an antidepressant, was selected as the target monitoring drug. Corrected QT prolongation on ECG was selected as the target adverse outcome. The Wilcoxon signed rank test was performed to analyze the difference in the corrected QT interval before and after the target drug administration. RESULTS: A refined CDW was successfully constructed from three different hospitals. Table specifications and an entity-relation diagram were developed and are presented. A total of 13 subjects were selected for monitoring. There was no statistically significant difference in the QT interval before and after target drug administration (p=0.727). CONCLUSION: The PMS method based on CDW was successfully performed on the target drug. This IT-based alternative surveillance method might be beneficial in the PMS environment of the future.
Electrocardiography ; Fluoxetine ; Hospital Information Systems ; Postal Service ; Retrospective Studies

Recently, many hospitals have been adopting clinical data warehouses (CDW) as well as electronic medical records. These new hospital information systems are inevitably introducing very large amounts of clinical data that might be useful for further analysis. However, the electronic clinical data in the CDW are usually byproducts of clinical practice rather than the product of research. Therefore, they include inconsistent and sometimes erroneous information that might not have the specific context of the clinical situations. Data miners usually have various academic backgrounds such as electronics, informatics, statistics, biomedicine, and public health. If the complex situations surrounding the clinical data are not well understood, investigators performing data mining in clinical fields may have problems assessing the information they are confronted with. Here, we would like to introduce some basic concepts on the principles of data mining in clinical fields including legal and ethical considerations as well as technical concerns.
Machine Learning ; Data Mining ; Electronic Health Records ; Electronics ; Electrons ; Hospital Information Systems ; Humans ; Informatics ; Public Health ; Research Personnel

OBJECTIVE: To identify the technical considerations in implementing a barcode-based medication system and propose practical solutions for successful implementation of the system. In order to reduce medical errors related to medication and blood transfusion, we analyze various factors that hinder the successful implementation of the barcode-based medication system and discuss issues involved in the effective adoption of such a system. METHODS: The barcode-based medication system of this research uses one-dimensional, barcode bands on patients' wrists and two-dimensional barcodes attached to drug bags and blood bags. PDAs with barcode reading capability and wireless networking function are used, which enables Point of Care. The business process for applying the developed system and the current status of the system usage are analyzed. RESULTS: The factors causing a variety of system failures in the demonstration and pilot periods were identified and categorized as including PDA malfunction, PDA battery discharge due to users' carelessness, confusion in reading barcodes and so on. CONCLUSIONS: It is expected that the analyzed obstructive factors and the proposed technical considerations addressed in this paper can help other hospitals implement similar barcode-based medication systems successfully. Ultimately, this research will contribute to reducing medical errors and improving quality of patient care.
Adoption ; Blood Transfusion ; Commerce ; Medical Errors ; Medication Errors ; Medication Systems ; Patient Care ; Wrist

OBJECTIVE: The Clinical Decision Support System (CDSS) for drug prescriptions was developed by integrating the computerized physician order entry (CPOE) system to support doctors and pharmacists in making correct decisions on prescribing drugs in line with the prescription guidelines by the Health Insurance Review Agency (HIRA). The objective of this study was to evaluate the performance of the CDSS with respect to system quality, information quality, and user satisfaction in reducing prescription errors. METHODS: The study was based on survey data from 38 hospitals that were using the CDSS for drug prescriptions. To identify factors influencing the performance of CDSS, multiple linear regression and chi-square analyses were performed. RESULTS: Regression analysis showed that the variables for system quality and information quality significantly influenced the overall system performance. Specifically, ease of understanding the results and terminology assystem quality measures significantly influenced user satisfaction. Furthermore, based on chi-square analysis, two independent variables (ease of understanding results and decision support functions) were statistically significant with respect to all four dependent variables (information satisfaction, system satisfaction, willingness to recommend to other hospitals, and drug safety). CONCLUSION: Based on this study, users should be educated to improve their understanding of the system,and system and information quality should be continuously monitored to improve user satisfaction.
Drug Prescriptions ; Humans ; Insurance, Health ; Linear Models ; Pharmacists ; Prescriptions