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Computer Data Center

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13321. Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center. (PubMed)

either received academic detailing or did not. The intervention was prompted by an order for either levofloxacin or ceftazidime that led to a computer-based review of data for that patient. Orders for the 2 target antibiotics deemed unnecessary by a priori criteria were included in the study. The primary outcome examined was the number of days that unnecessary levofloxacin or ceftazidime was administered in intervention and control groups.Before the trial, intervention and control services had (...) Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center. Antibiotic misuse is common and costly and may promote antibiotic resistance. We tested the efficacy of a targeted one-on-one educational program ("academic detailing") designed to improve the appropriateness of broad-spectrum antibiotic use.A randomized controlled trial was conducted in a large US teaching hospital. During an 18-week study period, 17 general medical, oncology, and cardiology services

2001 Archives of internal medicine

13322. [The role of immune enhanced enteral nutrition on plasma amino acid, gut permeability and clinical outcome (a randomized, double blind, controlled, multi-center clinical trail with 120 cases)]. (PubMed)

informed consents were obtained.There were 120 patients enrolled in this protocol. After data were input to computer, open the code. 118 out of 120 patients completed the study and, 2 of them were dropped out. One is because the nasal jejunum tubes dropped and not willing to be replaced. Second patient had fistula of anastomosis on 4th days after operation. There were finally 60 patients in the study group and 58 in the control group. There were no liver or renal functions damage and, obvious adverse (...) [The role of immune enhanced enteral nutrition on plasma amino acid, gut permeability and clinical outcome (a randomized, double blind, controlled, multi-center clinical trail with 120 cases)]. To evaluate the role of arginine, RNA and omega 3 fatty acid enriched enteral nutrition.The study was designed as a prospective, randomized, double blind, multi-central trial. It was an isocaloric and isonitrogenous intake in both groups. The protocol was approved by the Ethic Committee and, written

2001 Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae

13323. Functional equality of coordinating centers in a multicenter clinical trial. Experience of the International Mexiletine and Placebo Antiarrhythmic Coronary Trial (IMPACT). (PubMed)

. These coordinating Centers were in turn monitored by an independent Data Audit Center located in Chicago, Illinois. This article describes how computer systems and operational procedures were developed to allow the three IMPACT centers to exchange processed files for a common analysis by the two Regional Coordinating Centers. The problems encountered and the advantages of this organization are described and discussed. (...) Functional equality of coordinating centers in a multicenter clinical trial. Experience of the International Mexiletine and Placebo Antiarrhythmic Coronary Trial (IMPACT). The International Mexiletine and Placebo Antiarrhythmic Coronary Trial (IMPACT) included clinical centers in both Europe and North America. The clinics were monitored by two Regional Coordinating Centers: one located in Baltimore, Maryland, for North American clinics; the other in Lyon, France, for European clinics

1986 Controlled clinical trials

13324. Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT--five-year experience at a major trauma center. (PubMed)

Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT--five-year experience at a major trauma center. To review the literature and the authors' experience with admission contrast material-enhanced computed tomography (CT) in patients admitted after blunt trauma.From January 1990 to December 1994, thoracic CT was performed to evaluate traumatic aortic injury in 677 patients with positive or equivocal findings at chest radiography. CT scans positive for mediastinal hemorrhage (...) ), and pseudocoarctation (n = 3). Findings at angiography were positive for traumatic aortic injury in 19 (90%). For aortic injury and mediastinal hemorrhage, respectively, specificity for traumatic aortic injury was 99% and 87% and sensitivity was 90% and 100%; at meta-analysis of data from the authors and the literature, sensitivity was 97.0% and 99.3% and specificity was 99.8% and 87.1%. Reliance on findings at admission CT rather than radiography to indicate suspicion for traumatic aortic injury before angiography

1996 Radiology

13325. Medical decision support: experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center. (PubMed)

Medical decision support: experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center. We began implementation of a medical decision support system (MDSS) at the Columbia-Presbyterian Medical Center (CPMC) using the Arden Syntax in 1992. The Clinical Event Monitor which executes the Medical Logic Modules (MLMs) runs on a mainframe computer. Data are stored in a relational database and accessed via PL/I programs known as Data Access Modules (DAMs). Currently we have (...) 18 clinical, 12 research and 10 administrative MLMs. On average, the clinical MLMs generate 50357 simple interpretations of laboratory data and 1080 alerts each month. The number of alerts actually read varies by subject of the MLM from 32.4% to 73.5%. Most simple interpretations are not read at all. A significant problem of MLMs is maintenance, and changes in laboratory testing and message output can impair MLM execution significantly. We are now using relational database technology and coded

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1995 Proceedings of the Annual Symposium on Computer Application in Medical Care

13326. The patient care component: patient-centered horizontal integration in a vertical world. (PubMed)

The patient care component: patient-centered horizontal integration in a vertical world. This paper describes the structure and operational properties of the Patient Care Component, a patient care data system developed by the Indian Health Service to support primary care in a multi-site, decentralized, health care organization. Sharing the same technology base as the Department of Veterans Affairs Distributed Hospital Computer Program, the system requires a minimal level of investment

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1994 Proceedings of the Annual Symposium on Computer Application in Medical Care

13327. Pesticide poisoning surveillance through regional poison control centers. (PubMed)

Pesticide poisoning surveillance through regional poison control centers. The purpose of this study is to describe pesticide exposure in the population of callers to Minnesota Regional Poison Centers. Case files from 1988 reporting pesticide exposure to humans were identified in cooperation with the Minnesota Center for Health Statistics. Data analysis was conducted by computer using SAS statistical package. Of the 1,428 case files indicating pesticide as the primary substance of exposure (...) the most common types of pesticide call, herbicide has surpassed insecticide in production and sales in the US. In this study, herbicide type exposure calls present a much different picture than other pesticide types. The usefulness of poison control centers for examination of pesticide poisoning is explored. Since reporting occurs coincidental with the exposure and its associated symptoms, each pesticide poisoning report could potentially serve as a true sentinel health event.

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1991 American Journal of Public Health

13328. Error correction and quantitative subanalysis of optical coherence tomography data using computer-assisted grading. (PubMed)

Error correction and quantitative subanalysis of optical coherence tomography data using computer-assisted grading. To demonstrate feature subanalysis and error correction of optical coherence tomography (OCT) data by using computer-assisted grading.The raw exported StratusOCT (Carl Zeiss Meditec, Inc., Dublin, CA) scan data from 20 eyes of 20 patients were analyzed using custom software (termed OCTOR) designed to allow the user to define manually the retinal borders on each radial line scan (...) . Measurements calculated by the software, including thickness of the nine standard macular subfields, foveal center point (FCP), and macular volume, were compared between two graders and with the automated Stratus analysis. Mean and range of differences for each parameter were calculated and assessed by Bland-Altman plots and Pearson correlation coefficients. Additional cases with clinically relevant subretinal findings were selected to demonstrate the capabilities of this system for quantitative feature

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2007 Investigative Ophthalmology & Visual Science

13329. The Impact of Helical Computed Tomography on the Negative Appendectomy Rate: A Multi-center Comparison. (PubMed)

The Impact of Helical Computed Tomography on the Negative Appendectomy Rate: A Multi-center Comparison. Emergency departments have different strategies concerning the use of computed tomography (CT) for diagnosing appendicitis. We explored the association between CT utilization rates and the negative appendectomy rates in patients with suspected appendicitis at three medical centers. A retrospective multi-center comparative study was conducted to determine the association between CT use (...) and negative appendectomy rates at three different medical centers. Standardized extraction of data from medical records and operative reports was performed by trained investigators. Of the 339 patients included, 242 (71.4%) were imaged with abdominal CT before appendectomy (CT group), whereas the remaining patients were not (non-CT group). Thirty-six of the 339 patients (10.6%) were found to have negative appendectomies. The CT group had a significantly lower negative appendectomy rate than the non-CT

2007 Journal of Emergency Medicine

13330. Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. (PubMed)

Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. The early clinical management of patients with major trauma still represents a challenge. To clinically evaluate the full extent of a patient's injuries is difficult, especially when the patient is unconscious. Before December 2002, trauma patients admitted to our emergency room (ER) underwent a diagnostic protocol including physical (...) " using several variables. Time periods from admission to the ER to admission to the intensive care unit were compared as well as outcome parameters such as length of ICU stay, ventilation period and rates of organ. Dichotomous data were analyzed by Chi-square analysis; continuous data were analyzed by Student's t test. Any values of p < 0.05 were considered significant for any test.No significant differences were found regarding demographic data. The full extent of injuries was definitively diagnosed

2007 Journal of Trauma

13331. A client-computer interface for questionnaire data. (PubMed)

A client-computer interface for questionnaire data. Our purpose was to assess efficiency and patient acceptance of a simple, inexpensive method of direct client-computer interface. A computerized version of the Sickness Impact Profile (SIP) was developed with the standard keyboard replaced by a numeric keypad. Forty-eight volunteer clients of an occupational rehabilitation center completed both the paper format and the computer format in randomized order, then were asked to compare the two (...) , and overall scores were very acceptable being greater than 0.90. These data indicate that a simple client-computer interface for the SIP is preferred by clients and is more efficient compared to the paper and pencil format.

1994 Archives of physical medicine and rehabilitation

13332. Factors influencing the use of computer technology in the collection of clinical data in a predominantly African-American population. (PubMed)

Factors influencing the use of computer technology in the collection of clinical data in a predominantly African-American population. To determine the cognitive and demographic factors that affect the performance of a predominantly African-American population in the use of a computerized version of the Center for Epidemiologic Studies Depression Scale (CES-D).Cross-sectional.University Medical Center and Veterans Affairs Medical Center in Baltimore, Maryland.Forty-three healthy community (...) -dwelling adults from a predominantly African-American Apostolic church; mean age +/- standard deviation 57 +/- 14 (range 29-83).Cognitive measurements (Mini-Mental State Examination, digits span, word list learning, letter number sequencing, executive interview, and clock-drawing task), education level, computer experience, and age. The CES-D was administered on three occasions: a paper form CES-D once and a computerized version twice. Time to completion the computer CES-D (Time 1), differential

2002 Journal of the American Geriatrics Society

13333. Protecting clinical data on Web client computers: the PCASSO approach. (PubMed)

environments. The Patient Centered Access to Secure Systems Online (PCASSO) project extends the protections for person-identifiable health data on Web client computers. PCASSO uses several approaches, including physical protection of authentication information, execution containment, graphical displays, and monitoring the client system for intrusions and co-existing programs that may compromise security. (...) Protecting clinical data on Web client computers: the PCASSO approach. The ubiquity and ease of use of the Web have made it an increasingly popular medium for communication of health-related information. Web interfaces to commercially available clinical information systems are now available or under development by most major vendors. To the extent that such interfaces involve the use of unprotected operating systems, they are vulnerable to security limitations of Web client software

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1998 Proceedings of the AMIA Symposium

13334. Using group mean centering for computing adjusted means by site in a randomized experimental design. The case of California's Work Pays Demonstration Project. (PubMed)

Using group mean centering for computing adjusted means by site in a randomized experimental design. The case of California's Work Pays Demonstration Project. When analyzing data from a randomized experiment that is replicated across multiple sites and includes covariates, the covariates can adjust for differences from either the grand mean or the group (site) mean. The analysis strategy determines the reference point. Pooling the sites and using a standard analysis of covariance (ANCOVA (...) ) adjusts for differences around the grand mean, whereas analyzing each site separately adjusts for differences around each group (site) mean. This article demonstrates that group mean centering permits pooling data from multiple sites into a single analysis while still using the group mean as a reference point for evaluating the covariate.

1999 Evaluation review

13335. Evaluating the Discriminatory Power of a Computer-based System for Assessing Penetrating Trauma on Retrospective Multi-Center Data (PubMed)

Evaluating the Discriminatory Power of a Computer-based System for Assessing Penetrating Trauma on Retrospective Multi-Center Data To evaluate the discriminatory power of TraumaSCAN-Web, a system for assessing penetrating trauma, using retrospective multi-center case data for gunshot and stab wounds to the thorax and abdomen.80 gunshot and 114 stab cases were evaluated using TraumaSCAN-Web. Areas under the Receiver Operator Characteristic Curves (AUC) were calculated for each condition modeled (...) in TraumaSCAN-Web.Of the 23 conditions modeled by TraumaSCAN-Web, 19 were present in either the gunshot or stab case data. The gunshot AUCs ranged from 0.519 (pericardial tamponade) to 0.975 (right renal injury). The stab AUCs ranged from 0.701 (intestinal injury) to 1.000 (tracheal injury).

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2005 AMIA Annual Symposium Proceedings

13336. Data management in multi-center clinical trials and the role of a nation-wide computer network. A 5 year evaluation. (PubMed)

Data management in multi-center clinical trials and the role of a nation-wide computer network. A 5 year evaluation. Multidisciplinary collaboration in multi-center trials needs a formalized data management structure to ensure true progress monitoring and high quality research data. Cadans, a customized facility for data management, related to the Interuniversity Cardiology Institute of the Netherlands, designed a computer-based data management system for multidisciplinary multi-center (...) collaborative research projects. In this paper we describe the system and the role of integrated access to research databases on a data network. Areas of concern are also discussed.

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1993 Proceedings of the Annual Symposium on Computer Application in Medical Care

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