An international summer school on health informatics: a collaborative effort of the Amsterdam Medical Informatics Program and IPhiE--the International Partnership for Health Informatics Education.

PURPOSE: Today, the need for health informatics training for health care professionals is acknowledged and educational opportunities for these professionals are increasing. To contribute to these efforts, a new initiative was undertaken by the Medical Informatics Program of the University of Amsterdam-Academic Medical Center and IPHIE (IPhiE)-the International Partnership for Health Informatics Education. In the year 2004, a summer school on health informatics was organized for advanced medical students from all over the world. METHODS: We elaborate on the goals and the program for this summer school. In developing the course, we followed the international guidelines of the International Medical Informatics Association-IMIA. Students provided feedback for the course through both summative and formative evaluations. As a result of these evaluations, we outline the lessons we have learned and what consequences these results have had in revising the course. RESULTS: Overall the results of both the summative and formative evaluation of the summer school showed that we succeeded in the goals we set at the beginning of the course. Students highly appreciated the course content and indicated that the course fulfilled their educational needs. The decision support and image processing computer practicums however proved too high level. We therefore will redesign these practicums to competence requirements of medical doctors as defined by IMIA. All participants recommended the summer school event to other students. CONCLUSIONS: Our experiences demonstrated a true need for health informatics education among medical students and that even a 2 weeks course can fulfill health informatics educational needs of these future physicians. Further establishment of health informatics courses for other health professions is recommended.

The International Partnership for Health Informatics Education: lessons learned from six years of experience.

OBJECTIVES: To inform the medical and health informatics community on the rational, goals, and the achievements of the International Partnership for Health Informatics Education--IPHIE, (I phi E), that was established at six universities in 1999. METHODS: We elaborate on the overall goals of I phi E and describe the current state of affairs: the activities undertaken and faculty and student experience related to these activities. In addition we outline the lessons we have learned over these past six years and our plans for the future. RESULTS: I phi E members first started to collaborate by supporting and encouraging the exchange of talented students and faculty and by establishing joint master classes for honors students. Following the success of these activities, new initiatives were undertaken such as the organization of student workshops at medical informatics conferences and a joint course on strategic information management in hospitals in Europe. CONCLUSIONS: International partnerships such as I phi E take time to establish, and, if they are to be successful, maintaining leadership continuity is critically important. We are convinced that I phi E promotes professionalism of future medical informatics specialists. There will be a continuing growth of globalization in higher education. It will therefore become increasingly important to offer educational programs with international components.

The International Partnership in Health Informatics Education.

The International Partnership for Health Informatics Education (IPHIE) seeks to promote education through international collaboration of graduate and undergraduate training programs in Medical and Health Informatics. In 1998 an International Partnership of Health Informatics Education was established at six universities: The University of Amsterdam, the Universities of Heidelberg and Heilbronn, the University of Health Informatics and Technology Tyrol at Innsbruck, the University of Minnesota and the University of Utah. The overall goal of this cooperation was to form a network for training and educating medical informatics faculty and students in order to prepare them for leading international positions in medical information and communication technology. In this paper we describe the current state of affairs of IPhiE: the activities undertaken, our experiences, the lessons we have learned over these past five years. In addition we outline our plans for the future.

IPHIE: an International Partnership in Health Informatics Education.

Medical informatics contributes significantly to high quality and efficient health care and medical research. The need for well educated professionals in the field of medical informatics therefore is now worldwide recognized. Students of medicine, computer science/informatics are educated in the field of medical informatics and dedicated curricula on medical informatics have emerged. To advance and further develop the beneficial role of medical informatics in the medical field, an international orientation of health and medical informatics students seems an indispensable part of their training. An international orientation and education of medical informatics students may help to accelerate the dissemination of acquired knowledge and skills in the field and the promotion of medical informatics research results on a more global level. Some years ago, the departments of medical informatics of the university of Heidelberg/university of applied sciences Heilbronn and the university of Amsterdam decided to co-operate in the field of medical informatics. Now, this co-operation has grown out to an International Partnership of Health Informatics Education (IPHIE) of 5 universities, i.e. the university of Heidelberg, the university of Heilbronn, the university of Minnesota, the university of Utah and the university of Amsterdam. This paper presents the rationale behind this international partnership, the state of the art of the co-operation and our future plans for expanding this international co-operation.

Prevalence of anaemia and iron deficiency in urban Haïtian children two to five years of age.

This study was undertaken to assess the prevalence of anaemia and iron deficiency (ID) in 305 urban Haïtian children, 142 boys and 163 girls from low socioeconomic class, ranging in age from 2 to 5 years. Haemoglobin (Hb), serum ferritin (FERR), serum iron, total iron binding capacity (TIBC), transferrin saturation (TS), and red blood cell indices were measured by standard techniques. Although the means of these indices were within normal range, 58.4 per cent of children had at least one of the measurements in the abnormal range (FERR < 12 micrograms/l, TS < 12, HB < 10.7 g/l in 2 year old and < 10.9 g/dl in 3-5 year old children). The overall prevalence of anaemia (40 per cent) was slightly higher in boys (42 per cent) than in girls (36 per cent). Approximately 45 and 31 per cent of children had FERR < 12 micrograms/l TS < 12 per cent, respectively, with no difference between boys and girls. Despite the decrease in the prevalence of anaemia and ID with age, about one-third of the 5 year old children were either anaemic or iron deficient. Hypochromia and microcytosis were present in 60 and 66 per cent of children respectively. Although ID was the major cause of anaemia, protein-energy malnutrition as judged by low TIBC contributed to the high prevalence of anaemia. Megaloblastic anaemia and haemoglobinopathies did not significantly contribute to the high prevalence of anaemia. The frequency of fruit consumption, hence vitamin C, was lower in anaemic than non-anaemic children. We conclude that the eradication of anaemia and ID in this population will require improvement in overall nutritional status.

Network analytic methods for epidemiological risk assessment.

The authors measure the efficacy of three methods for predicting the time to infection for susceptible individuals in a population undergoing an HIV epidemic. The methods differ in whether they require detailed information of the contact network and whether they require knowledge of the initial source of infection. Efficacy is evaluated using simulations for 20 different contact patterns. Only the risk score that uses both kinds of information accounts for more than 15 per cent of individual variability. The efficacy of this score ranges from 10 per cent in very unstructured populations to 60 per cent for spatially localized contact networks. This improved performance may be explained by the larger fraction of the total variability not due to the disease dynamics. When all variables are dichotomized, the two poorer methods produce odds ratios between 1.4 and 2.3. The odds ratio for the risk score with full information ranges from 2.5 to 17. Risk assessment protocols and intervention programmes are encouraged to assess contact patterns and detect sources of infection.

Using serum cholesterol to identify high risk and stimulate behavior change: will it work?

If the measurement of serum cholesterol is to be used to identify a sub-population at high risk of subsequent disease and to stimulate behavior change in this group to lower serum cholesterol, the test must be able to both discriminate and motivate the group. The ability of the test to motivate has been documented in a randomized trial. This paper therefore tests, in a cohort of United States men ages 40-59 at entry, the ability of serum cholesterol to discriminate between individuals who would and would not die from coronary heart disease. While risk of death increased with increasing serum cholesterol, the values for men who developed coronary heart disease overlapped the values of the men who did not develop the disease. Overall test accuracy declined from 92% correctly classified when 5% of the population was defined as "at high risk" to 55% when 50% of the population was defined as "at high risk". On a receiver operating curve, defining 5% of the men as "high risk" yielded a false positive rate of 5% and a true positive rate of 8%. Increasing the proportion of men defined as "at high risk" to 50% increased the true positive rate to 75% but also increased the false positive rate to over 50%. Monte Carlo simulation demonstrated that lowering mean serum cholesterol 0.78 mmol/l in the entire population would lower deaths from coronary heart disease by 28%. The same effect could be achieved by lowering the serum cholesterol of all people in the top 20% of the distribution to 4.66 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Test of effect of lipid lowering by diet on cardiovascular risk. The Minnesota Coronary Survey.

The Minnesota Coronary Survey was a 4.5-year, open enrollment, single end-time double-blind, randomized clinical trial that was conducted in six Minnesota state mental hospitals and one nursing home. It involved 4393 institutionalized men and 4664 institutionalized women. The trial compared the effects of a 39% fat control diet (18% saturated fat, 5% polyunsaturated fat, 16% monounsaturated fat, 446 mg dietary cholesterol per day) with a 38% fat treatment diet (9% saturated fat, 15% polyunsaturated fat, 14% monounsaturated fat, 166 mg dietary cholesterol per day) on serum cholesterol levels and the incidence of myocardial infarctions, sudden deaths, and all-cause mortality. The mean duration of time on the diets was 384 days, with 1568 subjects consuming the diet for over 2 years. The mean serum cholesterol level in the pre-admission period was 207 mg/dl, falling to 175 mg/dl in the treatment group and 203 mg/dl in the control group. For the entire study population, no differences between the treatment and control groups were observed for cardiovascular events, cardiovascular deaths, or total mortality. A favorable trend for all these end-points occurred in some younger age groups.

Preventing heart disease: is treating the high risk sufficient?

Monte Carlo simulation was used to assess the effects of several intervention strategies on coronary heart disease mortality rates in a Finnish and a North American cohort. Lowering total serum cholesterol by 4%, smoking by 15%, and diastolic blood pressure by 3% for the whole cohort would be expected to reduce the incidence of non-fatal myocardial infarction by at least 13% and coronary heart disease deaths by at least 18%. Lowering serum cholesterol by 34%, diastolic blood pressure to 90 mmHg, and reducing smoking by 20% in the subset of the population with all three risk factors in the highest quartile would result in a 6-8% reduction in non-fatal myocardial infarction and a 2-9% reduction in deaths from coronary heart disease in these cohorts. These data demonstrate that in populations with a relatively high incidence of heart disease, treating the entire population will produce larger effects than focusing only on high-risk populations.

Racial contrasts in hemoglobin levels and dietary patterns related to hematopoiesis in children: the Bogalusa Heart Study.

Racial differences in hemoglobin (Hgb) levels were explored in two groups of children at different maturational stages, the pre-adolescent (10-year-olds: Whites n = 160, Blacks n = 56,) and the adolescent (15-year-olds; Whites n = 60, Blacks n = 44). Mean Hgb levels were higher for Whites than Blacks in both age groups. When all the dietary components (i.e., iron, zinc, copper, folacin, ascorbic acid and vitamins B12, E and B6) were considered as a group, they accounted for 8.4 per cent of the Hgb variance in 10-year-olds and 10.1 per cent of variance in 15-year-olds. However, even after controlling for the variations in dietary patterns of the adolescents and pre-adolescents, race still accounted for a notable proportion of Hgb variance in both age groups (9.1 per cent in 10-year-olds and 7.0 per cent in 15-year-olds). Within each race, gender accounted for a greater percentage of the Hgb variance in the adolescents than in the pre-adolescents. Our results indicate that in all likelihood racial differences in Hgb levels during childhood exist independent of racial differences in intake of specific "blood building" nutrients and maturational changes.

External monitoring of a data coordinating center: experience of the National Cooperative Gallstone Study.

A Biostatistical Monitoring Committee was established to review periodically the procedures and performance of the data coordinating center of the National Cooperative Gallstone Study. The functions of this committee, the types of data coordinating center activities reviewed, the manner in which monitoring of these activities was carried out, and an assessment of the value of this committee to the study are discussed in this article.

Feasibility study of a statewide pathology-based cancer surveillance system in Minnesota. I. Information characteristics.

The Minnesota Department of Health has completed a 2-year feasibility study comparing the completeness and accuracy of information from pathology-based cancer ascertainment with that of the traditional surveillance method based on hospital discharge records. Overall, for incident cancers, the primary site designation of the pathology-based system was correct for 94.5% of the cancers, and the histologic designation was correct for 97.0% of the cancers. For prevalent cancers the accuracy of both site and histology designation was inadequate at 81.0 and 76.8% respectively. Pathology-based ascertainment was more complete than discharge-based surveillance (98.4% vs. 96.6%), which reflected the growing number of cancers diagnosed in hospital outpatient departments and medical clinics. The major limitation of the pathology-based system was the inability to determine from written pathology reports whether the cancer was newly diagnosed. However, when asked, pathologists correctly determined the incidence status for approximately 75% of the cancers. In light of the results of the feasibility study, Minnesota is implementing a pathology-based system as a cost-effective, scientifically valid method to meet the state's current and future needs for cancer surveillance.

Cost comparison of searching the Iowa Drug Information Service index manually and by computer.

A cost comparison of searching the Iowa Drug Information Service index manually and by computer is presented. Identical searches were performed on a computer system and by hand. The searches were timed and the results compared. Costs of start-up, maintenance, and operation were calculated for the manual and computer systems. Both systems yielded a similar number of relevant references. Start-up and maintenance costs were found more expensive for the computer system, but operational costs were less expensive (p less than 0.05). Operational costs varied according to the number of uses per year. Operational costs were found to increase faster for the manual system than the computer system. At 980 uses per year, the overall cost of the computer system was less than the manual system. A dedicated microcomputer system to search the Iowa Drug Information Service index was found less costly than, and as effective as, the common manual system.

Computer-aided real-time acquisition of physiological data: technical design and selection constraints.

For many years, physiological investigations have utilized the power and speed of analogue, digital and hybrid computers. Complex protocols often require the recording of large amounts of data in short periods, typically with simultaneous fine control of multiple experimental variables. Current systems often include data analysis in the same program which controls data acquisition. Although this is convenient from a package point of view, acquisition and analysis routines have different and sometimes conflicting purposes and requirements. This paper examines acquisition of continuous physiological signals by small dedicated computers in an attempt to separate these processes and to provide guidelines for computer selection, design and development.

Investigation of statistical decision rules for sequential hematologic laboratory tests.

A statistical data processing program for identifying patients who are likely to have abnormalities on various hematologic laboratory tests is described. The prediction of abnormal levels of serum vitamin B12, serum folate, transferrin saturation, and reticulocyte counts is based on a statistical analysis of the patient's age, sex, and routine blood cell measurements. The program was developed using data from normal-value studies and data from patients who had these laboratory abnormalities. The sensitivity and specificity of the program were evaluated in a controlled prospective study of about 5,000 ambulatory adult patients. The program's predictions also were compared with the laboratory tests requested by the patients' attending physicians. The program was most sensitive for predicting low serum vitamin B12 (74%) and low transferrin saturation (78%). In the prospective evaluation, the predictive values varied from 11% for predicting low serum folate to 65% for predicting low transferrin saturation.