[Information system in ophthalmology]. / Ophthalmologisches Informationssystem.

BACKGROUND: Rapid advances in digital imaging technology that characterised the early part of the 21 (st) century have caused modern hospital information systems (HIS) to face a big challenge. One of the key goals of their reorganisation is integration based on open standards in order to achieve optimal interoperability. METHODS: At the Department of Ophthalmology of the University Clinical Centre Maribor, we have set up an intranet integrating a variety of diagnostic procedures into a single network. All workstations are connected to a dedicated data server, which represents the core of the network. The system is compatible with the DICOM (Digital Imaging and Communications in Medicine) standard and ready for future integration with hospital information systems over the HL 7 (Health Level 7) protocol. RESULTS: With the integration of different systems we have achieved the availability of all administrative, clinical and photo documentation for each patient on every workstation. This kind of system enables numerous connections within different diagnostic units and workstations, which is most distinctive during the diagnostic work-up of complex clinical cases. CONCLUSIONS: At our department integration of different diagnostic units into one ophthalmology information system proved to be a helpful tool regarding patient care during diagnostic and therapeutic procedures and at the same time represents a reduction of burdens for the medical staff.

Improved prediction of decreased creatinine clearance by serum cystatin C: use in cancer patients before and during chemotherapy.

BACKGROUND: Serum cystatin C, a cysteine protease inhibitor, has been suggested as a new marker of glomerular filtration rate (GFR). This study explored the possibility of replacing the creatinine clearance (CrCl) estimation of GFR with cystatin C in early detection of renal impairment in cancer patients on chemotherapy. METHODS: Serum creatinine and cystatin C concentrations as well as 24-h CrCl were determined simultaneously in 72 cancer patients. Among them, 60 were treated with combined chemotherapy with cisplatin (CDDP). Creatinine was determined enzymatically with a spectrophotometric method. Serum cystatin C was determined by a particle-enhanced turbidimetric immunoassay. RESULTS: Cystatin C and creatinine correlated significantly (P = 0.001) with CrCl. The correlation was significantly better for cystatin C than creatinine (r = 0.84 vs 0.74; P = 0.01). Stepwise regression analysis identified no differences for the correlations between cystatin C and CrCl in patients with or without metastases (r = 0.82 and 0.84, respectively) as well as before treatment and before the fourth cycle of chemotherapy (r = 0.70 and 0.75, respectively). A cystatin C cutoff concentration of 1.33 mg/L had 87% sensitivity and 100% specificity for detecting CrCl <78 mL/min. ROC analysis indicated that cystatin C was superior to serum creatinine for predicting CrCl <78 mL/min (P <0.04). CONCLUSIONS: Serum cystatin C is superior to serum creatinine for detection of decreased CrCl and potentially for the estimation of GFR in cancer patients independent of the presence of metastases or chemotherapy.