Evaluation of the design and development of the HeLe newborn hearing screening tele-audiology systems for the Philippines

Introduction@#There is increasing interest in innovation development and management in the Philippines, especially in the last decade. In the advocacy for universal hearing health, the HeLe, “Hearing for Life’’ Research Program was implemented. HeLe developed novel telehealth technologies and field tested a proof-of-concept service delivery model to improve provision of newborn hearing screening and intervention services in the Philippines. @*Objective@#As the HeLe research period concludes, this appraisal was organized to document and assess the health information technology systems of the HeLe. @*Methods@#The evaluation follows the elements of the Centers for Disease Control and Prevention (CDC) guidelines for evaluation of public health surveillance systems. It centers on the status of the eHealth-based components of the HeLe NHS interventions: HeLe NHS module in the Community Health Information Tracking System (CHITS) electronic medical records system, the Tele-Audiology module in National Telehealth System (NTS), and the HeLe NHS registry. The evaluation is based on interviews of key HeLe research staff and documentation review. @*Results@#The HeLe system has a stable, SQL-Server-based architecture. It is a secure, web-based system with clean separation of back-end database and front-end Web, using Secure Socket Layer (SSL) technology. Standardization of data via mapping ensures reliable, comparable measures. HeLe demonstrates that NHS data collected by the HeLe NHS device can be sent to, stored in, and extracted from the CHITS electronic medical record system and exchanged across platforms. Where actual patient and NHS data were available, this HeLe system is validated to be efficacious to capture and seamlessly exchange data across various eHealth platforms. These eHealth technologies are described to be at Technology Readiness Level 5, “technologies are validated in a relevant environment”. The HeLe program, however, needs to address completeness in documentation as a standard practice, if only to ensure better management of risks introduced by novel eHealth systems in patient care. The CDC public health surveillance checklist used for this assessment is useful in identifying gaps in research management for the HeLe inventors. It is recommended to be incorporated to be standard and implemented early in the next iteration of the HeLe research. @*Conclusions@#Overall, the HeLe technologies, in this initial stage of research, have achieved the purpose for which they were developed. As a novel technologybased NHS system, HeLe is a potentially powerful tool to assist in monitoring newborn hearing disease caseloads by community-based primary care clinics, NHS facilities, and hospitals that provide definitive medical services. As other health systems strengthening reforms take root in the Philippines, secure exchange of data electronically across the country would depend on sound technologies, including those used in hearing health. This paper can be instructive to the emerging research community in the eHealth and biomedical development space especially in resource-challenged settings. Likewise, lessons can reinforce institutional support from research agencies, clinicians, and state/county or subnational health departments for policy and resource mobilization to better manage those identified with congenital hearing loss.

A modified transoral approach for carotid artery type Eagle syndrome: technique and outcomes.

OBJECTIVE: This article aimed to summarize our clinical experience with a standardized tonsil-sparing transoral surgical approach used for treatment of styloid process-carotid artery Eagle's syndrome. METHODS: Eleven consecutive patients, from 2007 to 2013, underwent surgical treatment to remove elongated styloid apophyses transorally. Outcomes were assessed in terms of intraoperative and postoperative complications and patients' evolution. RESULTS: No patient experienced any intraoperative or postoperative complications. All patients have been followed up to present and 10 of them have shown complete relief of the symptoms and improvement of functional ability. CONCLUSION: The tonsil-sparing transoral surgical approach described is suitable for treating patients with elongated styloid apophyses.

Standardizing laboratory data by mapping to LOINC.

The authors describe a pilot project to standardize local laboratory data at five Indian Health Service (IHS) medical facilities by mapping laboratory test names to Logical Observation Identifier Names and Codes (LOINC). An automated mapping tool was developed to assign LOINC codes. At these sites, they were able to map from 63% to 76% of the local active laboratory tests to LOINC using the mapping tool. Eleven percent to 27% of the tests were mapped manually. They could not assign LOINC codes to 6% to 19% of the laboratory tests due to incomplete or incorrect information about these tests. The results achieved approximate other similar efforts. Mapping of laboratory test names to LOINC codes will allow IHS to aggregate laboratory data more easily for disease surveillance and clinical and administrative reporting efforts. This project may provide a model for standardization efforts in other health systems.

The map to LOINC project.

We describe a pilot project to standardize local laboratory test names to Logical Observation Identifier Names and Codes (LOINC) at five Indian Health Service (IHS) medical facilities. An automated mapping tool was developed to assign LOINC codes. The laboratory test names not mapped to LOINC by the mapping tool were assigned LOINC codes manually. The results achieved matched current benchmarks.

Effects of pirenzepine and atropine on gastroduodenal motor patterns in duodenal ulcer patients.

The aim of this study was to compare the effects of pirenzepine with those of atropine a non-selective antimuscarinic agent, on gastroduodenal motor patterns in duodenal ulcer patients. Twenty patients were allocated at random to 2 groups of 10 subjects each. The drugs were administered by bolus intravenous injection as equiactive antisecretory doses of 10 mg pirenzepine and 1 mg atropine. Before and 15 min after drug administration all patients underwent a gastroduodenal manometric and reflexogenic study with a specially designed probe and three inflatable latex balloons. Both drugs significantly decreased antral and duodenal pressure, but atropine was much more effective than pirenzepine: 91 +/- 2% verus 54 +/- 9% decrease in the motility index for the antrum and 95 +/- 1% versus 49 +/- 7% for the duodenum (p less than 0.01). The antral motor threshold was not modified by either drug. The results of this study confirm the selectivity of action of pirenzepine on gastric function.