Capacity building in e-health and health informatics: a review of the global vision and informatics educational initiatives of the American Medical Informatics Association.

Substantial global and national commitment will be required for current healthcare systems and health professional practices to become learning care systems utilizing information and communications technology (ICT) empowered by informatics. To engage this multifaceted challenge, a vision is required that shifts the emphasis from silos of activities toward integrated systems. Successful systems will include a set of essential elements, e.g., a sufficient ICT infrastructure, evolving health care processes based on evidence and harmonized to local cultures, a fresh view toward educational preparation, sound and sustained policy support, and ongoing applied research and development. Increasingly, leaders are aware that ICT empowered by informatics must be an integral part of their national and regional visions. This paper sketches out the elements of what is needed in terms of objectives and some steps toward achieving them. It summarizes some of the progress that has been made to date by the American and International Medical Informatics Associations working separately as well as collaborating to conceptualize informatics capacity building in order to bring this vision to reality in low resource nations in particular.

Security and confidentiality approach for the Clinical E-Science Framework (CLEF).

OBJECTIVES: CLEF is an MRC sponsored project in the E-Science programme that aims to establish methodologies and a technical infrastructure for the next generation of integrated clinical and bioscience research. METHODS: The heart of the CLEF approach to this challenge is to design and develop a pseudonymised repository of histories of cancer patients that can be accessed by researchers. Robust mechanisms and policies have been developed to ensure that patient privacy and confidentiality are preserved while delivering a repository of such medically rich information for the purposes of scientific research. RESULTS: This paper summarises the overall approach adopted by CLEF to meet data protection requirements, including the data flows, pseudonymisation measures and additional monitoring policies that are currently being developed. CONCLUSION: Once evaluated, it is hoped that the CLEF approach can serve as a model for other distributed electronic health record repositories to be accessed for research.

Transforming healthcare in the Internet Era.

Healthcare services will be transformed in the Internet Era by developments in biotechnology, bioinformatics, health informatics, assimilation of modern business processes, and changing policy expectations. Discoveries in biology and communications technology offer the potential for improvements in health status of individuals and populations. Improved access to information about health and disease will typify early progress. Care in hospitals will shift toward palliation and end-of-life care; curing and prevention will increase in outpatient settings and/or within the home or workplace. Barriers include resistance to change and a lack of a global health information infrastructure that includes financing, standards, and coherent policy.

A new health system and its quality agenda.

This article reviews recent work on healthcare quality, highlights findings and recommendations of the Institute of Medicine (IOM) reports on medical errors and quality, and describes response to the reports to date. In it, Detmer, chair of the IOM's Board of Health Care Services and a member of its Committee on Quality of Health Care in America, identifies implications of the reports for healthcare delivery organizations and professionals and outlines ways organizations and professionals can improve the six dimensions of patient quality defined by the IOM. Sustained efforts at the point of care and in policy development are needed to overcome cultural inertia, realign incentives, support innovation, and address technical and human resource issues. Success requires that healthcare executives embrace the goal of transforming the healthcare sector into a true system and provide leadership for their organizations and communities in this most fundamental of challenges for twenty-first century healthcare.

Concurrent periostalgia and chronic proximal deep posterior compartment syndrome in a collegiate track and field athlete: a case report.

OBJECTIVE: Exercise-induced leg pain may be triggered by abnormally high compartment pressure. In addition to the more widely publicized anterior compartment syndrome, the deep posterior compartment syndrome can just as frequently occur, resulting in severe pain and disability due to muscle and nerve ischemia. BACKGROUND: Obtaining a thorough history and compartmental pressure measurements are the usual components in the accurate diagnosis of compartment syndromes. While few other disorders mimic compartment syndromes, differential diagnoses must be considered. Surgical management of deep compartment syndrome, consisting of fasciotomy or fasciectomy, or both, is successful for most patients. DIFFERENTIAL DIAGNOSIS: Tibial stress fracture or microfracture, tibial periostitis, tibial periostalgia, distal deep posterior chronic compartment syndrome, proximal deep chronic compartment syndrome, superficial lateral compartment syndrome, deep venous thrombosis, popliteal artery entrapment, or chronic compartment syndrome. UNIQUENESS: Chronic deep compartment syndrome is one of the most common causes of exercise-induced leg pain in aerobic athletes. Therefore, the athletic trainer must be able to recognize the condition. Signs, symptoms, diagnosis, and surgical management of chronic deep compartment syndrome, chronic periostalgia, and superficial lateral compartment syndrame in a 21-year-old Division IA track and field athlete are presented. CONCLUSIONS: With the correct diagnosis, persistent and methodical reevaluation, and appropriate management, the athlete can expect a successful treatment outcome.

Veterans Affairs residency realignment and National Graduate Medical Education policy.

The supply of physicians in the United States is affected by a variety of complex factors. Given the current abundance, if not oversupply, of physicians and the dramatic changes under way in the US health care delivery system, policy makers have renewed efforts to implement strategies that will lead to an appropriate balance of physicians in the United States. Several organizations have recommended specific strategies for achieving that goal. The Veterans Health Administration has already decided to change the number and distribution of its residency training positions. These changes cannot, however, be viewed in isolation. The Veterans Health Administration plays an important role in the graduate medical education of many physicians in the United States, and the magnitude of the intended changes could have a significant impact on residency opportunities.

The future of the IAIMS in a managed care environment: a call for private action and public investment.

A national public and private "grand challenge" initiative should be undertaken to assure the American public that the telecommunications and computing revolutions improve health care, health education, and biomedical and health services research, and secure accountability for cost, quality, and access. The initiative should focus on meeting the needs of the patient and society at large. It needs to be a national vision, but it also ought to have regional focus. A plan for action would include a health-infrastructure strategy, a service strategy, an education strategy, a research and development strategy, and an international-linkages strategy. Without this type of initiative, health care will lack the basic building blocks it needs to more effectively deal with the transformational forces that have already been unleashed. These forces will strengthen or weaken health care in the next century depending on whether and how the nation--including the leadership in health care and the informatics community--responds to this challenge.

Anatomical dissection of the deep posterior compartment and its correlation with clinical reports of chronic compartment syndrome involving the deep posterior compartment.

Patients with clinical presentation of deep posterior chronic compartment syndrome (CCS) frequently have symptoms limited to either proximal or distal components of the deep posterior compartment. In this study the posterior aspect of 15 cadaver legs was dissected to document anatomical separations and delineate boundaries, if any, of the deep posterior compartment and to correlate the findings to these patients. Origins of flexor hallucis longus (FHL), flexor digitorum longus (FDL), and tibialis posterior (TP), as well as whether TP existed in its own osseofascial compartment, were noted. Ten specimens had an identifiable distinct layer of tissue separating the deep posterior compartment into two potentially clinically relevant components. Much of this layer was derived from origins of FDL and its anatomical position in relation to the TP muscle. In seven of these cases, FDL had a significant fibular origin in addition to the well-established tibial origin. This essentially compartmentalized the distal third of the tibialis posterior as it descends anterior and medial to FDL in the lower one-third of the leg in five specimens. No cadaver possessed a significant fascial septum encasing TP and separating it from other deep posterior muscles. This study confirms the existence of a proximal and distal sub-compartment of the deep posterior compartment as a variant and supports the most frequent clinical presentation of deep posterior CCS as involving either the distal or proximal deep compartment, rather than the entire deep posterior compartment. The anatomic arrangement of muscles in the deep posterior compartment creates sub-compartments, which may explain the successful outcomes following a deep compartment release limited to symptomatic portion(s) of the deep compartment.