Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service / 대한의료정보학회지

OBJECTIVES: To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. METHODS: We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. RESULTS: The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. CONCLUSIONS: We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs.

Effect of Muscle Strength Training on Urinary Incontinence and Physical Function: A Randomized Controlled Trial in Long-term Care Facilities

PURPOSE: This study was done to determine whether muscle strength training programs have an impact on improving symptoms of urinary incontinence (UI) and physical function among elderly women with UI who reside in long-term care facilities. METHODS: A randomized controlled trial was conducted. Participants had to be over 65 years, score over 15 score on the mini-mental state examination, and be able to walk alone or with an assistant. Seventy residents were randomly allocated to either the training group (n=35) or control group (n=35). The program consisted of 50 minutes, twice a week for 8 weeks, and included Kegel's exercise, Thera-band training and indoor walking. Main outcomes were UI symptoms, peak vaginal pressure and physical functions measured with timed up and go test (TUG), one leg standing test (OLST), activities of daily living (ADL) and grip strength. Changes in outcome measurements were calculated from baseline to 4 weeks and to 8 weeks using repeated measures ANOVA. RESULTS: There were significant differences in peak vaginal pressure (p<.001), TUG (p<.001), OLST (p=.012) and grip strength (p<.001) in the interaction between groups and time. CONCLUSION: Future studies are suggested to confirm the effect of muscle strength training in long-term care facilities where elderly women with UI reside.

Clinical Features Associated with Blood Cultures According to the Use of Antimicrobial Agents Prior to Blood Collection / 대한임상미생물학회지

BACKGROUND: Previous antibiotic exposure may inhibit the growth of microorganisms in blood culture bottles. The authors investigated the frequency of previous antibiotic usage and analyzed the relationships among antibiotic usage, microbiological culture results and mortality of sepsis patients. METHODS: From April to May 2011, all blood cultures requested from inpatients were analyzed according to the admitted ward and antibiotic prescription records. The BacT/Alert 3D system (bioMerieux Inc.) was used with a standard bottle (SA, SN) for blood culture. RESULTS: Of 900 inpatients, 48% had been receiving antimicrobial agents when blood cultures were ordered. This group had a significantly higher mortality rate (36.2%) compared to the patients who had not received antibiotics (11.1%). Gram-negative rod bacteremia (37.1%) and candidemia (100%) resulted in a significantly higher mortality rate compared to Gram-positive cocci bacteremia (16.4%). In the analysis of 21 cases resulting in death, 15 (71.4%) patients died before or on the date when blood culture results were reported. CONCLUSION: Patients who receive antibiotics prior to blood collection may be at a higher risk for mortality. In the present study, Gram-negative rod bacteremia and candidemia cases showed a rapid progression of sepsis as indicated by Gram staining and thus should be regarded seriously.

Comparison of Chlorhexidine-Alcohol and Povidone-Iodine for Skin Antisepsis and the Effect of Increased Blood Volume in Blood Culture / 대한임상미생물학회지

BACKGROUND: Reducing skin contamination rate and improving the positive rate in blood culture is essential for the correct diagnosis and management of sepsis. Chlorhexidine-alcohol was compared with povidone-iodine for the efficiency of disinfection. Positive rates were compared between the collection of 10 mL and 20 mL of blood per sample. METHODS: The study population included adult patients > or = 18 years old requested for blood culture in the Emergency Department. Povidone-iodine (10%) was used for antiseptic skin preparation from March to June 2011, and 0.5% chlorhexidine-alcohol from July to October 2011. The standard for blood collection was 10 mL in the first period and 20 mL in the second period. The dedicated phlebotomists had been educated on the optimal skin preparation and sample collection. RESULTS: After 10% povidone-iodine application, 31 of 2,755 samples (1.1%) were considered to be contaminated; whereas, a total of 60 of 3,064 samples (2.0%) were contaminated (P=0.011) after application of 0.5% chlorhexidine-alcohol. The positive rate of blood culture was 12.5% (345/2,755) in the first period versus 17.1% (524/3,064) in the second period (P<0.001). CONCLUSION: Both disinfectants appeared acceptable for skin preparation for blood culture collection, although chlorhexidine-alcohol had a higher contamination rate than povidone-iodine. The positive rate of blood culture was in accordance with the amount of sample collected. Continuous education and monitoring are needed for the proper collection and management of blood culture.