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ABSTRACT: The identification of clinically relevant information enables improvement in user interfaces and in data management. However, it is difficult to identify what information is important in daily clinical care, and what is used occasionally. This study aims to determine for how long clinical documents are used in a Hospital Information System (HIS).
The access logs of 3 years of usage of a HIS were analysed concerning report departmental source, type of hospital encounter, and inpatient encounter ICD-9-CM main diagnosis. Reports median life indicates the median time elapsed between information creation and its usage. The models that better explains report views over time were explored.
The number of report views in the study period was 656,583. Fifty two percent of the reports viewed by medical doctors in emergency encounters were from previous encounters - 21% at outpatient attendance, 19% in inpatient (wards) and 12% during emergency encounters. In an inpatient setting, 20% of the reports viewed were produced in previous encounters. The median life of information in documents is 1.5 days for emergency, 4.8 days for inpatient and 37.8 days for outpatient encounters. Immune-hemotherapy reports reach their median lives faster (7 days) than clinical pathology (15 days), gastroenterology (80 days) and pathology (118 days). The median life of reports produced in inpatient encounters varied from 36 days for neoplasms as the main diagnosis to 0.7 days for injury and poisoning. The model with the best fit (R2 > 0.9) was the exponential.
The usage of past patient information varied significantly according to patient age, type of information, type of hospital encounter and medical cause (main diagnosis) for the encounter. The exponential model is a good fit to model how the reports are seen over time, so the design of user interfaces and repository management algorithms should take it in consideration.
BMC Medical Informatics and Decision Making 03/2010; 10:15. · 1.48 Impact Factor
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ABSTRACT: Abstract
Background
The identification of clinically relevant information enables improvement in user interfaces and in data management. However, it is difficult to identify what information is important in daily clinical care, and what is used occasionally. This study aims to determine for how long clinical documents are used in a Hospital Information System (HIS).
Methods
The access logs of 3 years of usage of a HIS were analysed concerning report departmental source, type of hospital encounter, and inpatient encounter ICD-9-CM main diagnosis. Reports median life indicates the median time elapsed between information creation and its usage. The models that better explains report views over time were explored.
Results
The number of report views in the study period was 656 583. Fifty two percent of the reports viewed by medical doctors in emergency encounters were from previous encounters - 21% at outpatient attendance, 19% in inpatient (wards) and 12% during emergency encounters. In an inpatient setting, 20% of the reports viewed were produced in previous encounters. The median life of information in documents is 1.5 days for emergency, 4.8 days for inpatient and 37.8 days for outpatient encounters. Immune-haemotherapy reports reach their median lives faster (7 days) than clinical pathology (15 days), gastroenterology (80 days) and pathology (118 days). The median life of reports produced in inpatient encounters varied from 36 days for neoplasms as the main diagnosis to 0.7 days for injury and poisoning. The model with the best fit (R<sup>2 </sup>> 0.9) was the exponential.
Conclusions
The usage of past patient information varied significantly according to patient age, type of information, type of hospital encounter and medical cause (main diagnosis) for the encounter. The exponential model is a good fit to model how the reports are seen over time, so the design of user interfaces and repository management algorithms should take it in consideration.
BMC Medical Informatics and Decision Making. 01/2010;
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ABSTRACT: Neither the rate of endoscopic remission (ER) in Crohn's disease (CD) after therapy nor its role in patients' prognosis is well defined.
To systematically review the current evidence on the proportion of ER of different therapies in patients with Crohn's disease and its relation with clinical outcomes.
Databases (MEDLINE and Cochrane) and manual search of manuscripts found 482 titles. Data was extracted from 24 manuscripts.
Ten different methods were used to assess endoscopic outcomes. Corticosteroids induced a pooled proportion of patients with no ulcerations at endoscopic follow-up of 17% (95% confidence interval: 12-22%) lower than that found with infliximab [44% (34-53%)], diet [43% (33-52%)] or azathioprine [54% (38-69%)] (P<0.0001). Enteric diets and infliximab were associated with 61% (52-70%) and 70% (62-78%) reduction in endoscopic scores, respectively, significantly higher than corticosteroids [45% (39-52%)] (P=0.01) and placebo [12% (1-22%)] (P<0.0001). A linear relation between ER and clinical remission was observed with infliximab (r=0.931). Only one study tried to assess the direct correlation between ER and patients' prognosis.
Available treatments induce significant endoscopic improvement. However, pooled results should be cautiously interpreted because of the diversity of measurements. A better definition of endoscopic outcomes and a prospective validation of their relevance in patients with Crohn's disease are needed.
European journal of gastroenterology & hepatology 03/2009; 21(5):491-503. · 1.66 Impact Factor
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ABSTRACT: EMR is an accepted method for resection of superficial lesions in the GI tract. However, because it leads, not unusually, to piecemeal resection, histopathologic interpretation problems and an increased risk of recurrence are noticeable. Endoscopic submucosal dissection (ESD) allows a higher rate of en bloc resection, with low recurrence. Nevertheless, this technique, namely in the upper-GI tract, has rarely been described in Western countries, probably because of the rarity of gastric cancer in most countries.
To describe the efficacy and safety of ESD for gastric superficial lesions in a European country.
Consecutive case-series report.
A tertiary specialized center.
Nineteen patients with gastric superficial lesions (15-30 mm), with high-grade (n = 15) or low-grade (n = 4) noninvasive epithelial neoplasias, in the antrum (n = 12), incisura angularis (n = 2), body (n = 3), and cardia (n = 2).
ESD with the patient under general anesthesia in the endoscopic room (40-300 minutes) by using an insulated-tip-knife.
Complete (R0) and en bloc resection, and complications.
ESD was achieved in all cases, with 89% R0 resection and 79% en bloc resection rates observed. Major bleeding was reported in 1 case (5%); there were no cases of perforation. With a median follow-up of 10 months, a single recurrence (5%) was observed.
A small series at a single center, with a short median follow-up time.
We report the feasibility and effectiveness of gastric ESD in Europe. A further description of a Western series is expected, and guidelines for its dissemination are desirable to define the role of this technique in Western countries.
Gastrointestinal endoscopy 03/2009; 69(2):350-5. · 6.71 Impact Factor
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ABSTRACT: To evaluate the use of web-based technologies to assess the learning curve and reassess reproducibility of a simplified version of a classification for gastric magnification chromoendoscopy (MC).
As part of a multicenter trial, a hybrid approach was taken using a CD-ROM, with 20 films of MC lasting 5 s each and an "autorun" file triggering a local HTML frameset referenced to a remote questionnaire through an Internet connection. Three endoscopists were asked to prospectively and independently classify 10 of these films randomly selected with at least 3 d apart. The answers were centrally stored and returned to participants together with adequate feedback with the right answer.
For classification in 3 groups, both intra- [Cohen's kappa (kappa) = 0.79-1.00 to 0.89-1.00] and inter-observer agreement increased from 1st (moderate) to 6th observation (kappa = 0.94). Also, agreement with reference increased in the last observations (0.90, 1.00 and 1.00, for observers A, B and C, respectively). Validity of 100% was obtained by all observers at their 4th observation. When a 4th (sub)group was considered, inter-observer agreement was almost perfect (kappa = 0.92) at 6th observation. The relation with reference clearly improved into kappa (0.93-1.00) and sensitivity (75%-100%) at their 6th observations.
This MC classification seems to be easily explainable and learnable as shown by excellent intra- and inter-observer agreement, and improved agreement with reference. A web system such as the one used in this study may be useful for endoscopic or other image based diagnostic procedures with respect to definition, education and dissemination.
World Journal of Gastroenterology 01/2009; 14(46):7086-92. · 2.47 Impact Factor
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ABSTRACT: To examine the possible role of the Epstein-Barr Virus (EBV) in the development of gastric adenocarcinoma (GC). It is unclear whether EBV is involved in GC development or is a consequence of gastric inflammation secondary to immunosuppressive treatments.
A systematic review was carried out of all published observational studies on the temporal association between EBV and GC, with a view to determine a causal relationship.
The present study showed that the worldwide crude prevalence of EBV in gastric adenocarcinoma was 8.29%. The prevalence varied from 7.08% for intestinal type and 9.82% for diffuse type of GC. It was observed that Western and Central Asian countries had a significantly higher frequency of EBV positive cases compared to South-Eastern countries. America had the highest EBV-GC prevalence whereas Europe had the lowest.
The present review has demonstrated a high prevalence of EBV in gastric adenocarcinoma. However, studies designed to assess a temporal relationship and histological association using sensitive techniques should be carried out to establish the role of EBV in GC carcinogenesis.
World Journal of Gastroenterology 08/2008; 14(27):4347-51. · 2.47 Impact Factor
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ABSTRACT: A hypercoagulable state has been recognized in patients with inflammatory bowel disease.
The aim of this study was to determine the frequency of single and combined thrombophilic abnormalities in patients from northern Portugal with Crohn's disease or ulcerative colitis, without a history of thrombosis. METHODS A cross-sectional study involving 116 patients (42 with ulcerative colitis, 74 with Crohn's disease), and 141 randomly chosen asymptomatic blood donors was carried out. Prothrombotic variables and genetic abnormalities were assessed.
The prevalence of single prothrombotic abnormalities (only one alteration) in inflammatory bowel disease patients was higher than in the reference population (26% and 18%, respectively; P < 0.02). The allelic frequency of genetic polymorphisms was higher in Crohn's disease and ulcerative colitis for MTHFR C677T, ACE Del and PAI-1 4G (P < 0.001) than in the reference population. The prevalence of combined thrombophilic abnormalities (at least two alterations) in both Crohn's disease and ulcerative colitis was also higher (22% and 21%, respectively) than in the reference population (9%; P < 0.01). These differences were not related to age or gender; however, in Crohn's disease the frequency of two or more abnormalities was related to disease activity (odds ratio 3.0 [1.3-6.7]).
Higher prevalences of single and combined thrombophilic defects were found in inflammatory bowel disease patients, factors that could be involved in the disease pathogenesis.
European Journal of Gastroenterology & Hepatology 11/2003; 15(11):1157-63. · 1.76 Impact Factor
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ABSTRACT: The natural history of chronic hepatitis C virus (HCV) infection still has some details to be established, namely in what concerns progression to hepatic cirrhosis (HC). The study aims to define predictive factors for progression to HC in patients with HCV chronic infection.
A cross-sectional study was performed on 129 patients consecutively submitted to liver biopsy. Thirty-six percent (n=46) had HC at histological evaluation.
Patients with HC did not show statistically significant differences on gender, viruses genotypes, alcohol consumption or proportion of positivity to markers of previous hepatitis B virus (HBV) infection - anti-HBc/anti-HBs+. Patients with HC seem to have had their infection sporadically (50%) or post-transfusion (35%) -p=0.052, and iv drugs addiction was related to non-HC patients (39%) -p=0.006. Age at infection, time of infection and positivity for anti-HBc/anti-HBs were factors independently related to HC (multivariate analysis). Patients older than 40 years by the time of infection [OR=4.5 (95% CI=1.9-10.8], those with less than 5 years of time of infection [OR=4.2 (95% CI=1.6-10.8)], and patients with previous HBV infection [OR=2.51 (1.00-6.69)] are at higher risk for HC.
We argue that older patients, with a shorter time interval between HCV infection and diagnosis, and namely those with markers for previous HBV infection represent patients with higher risk for progression to hepatic cirrhosis.
Hepato-gastroenterology 52(61):176-9. · 0.66 Impact Factor
