Paragraph-oriented structure for narratives in medical documentation.

The authors present a 6 years experiment using a document- centered electronic patient record, based on a central document repository. The document management system is paragraph oriented and all documents are built automatically before editing using predefined ordered sets of para-graphs. Paragraphs can be preloaded with templates, text or images. Once edited, signed and printed, documents are again decomposed in paragraphs and permanently stored. This system, though the compositional aspect of paragraphs is limited and their semantic content wide, offers numerous advantages. The typology is easy to build and to maintain, it has been implemented widely in our hospitals without need for any natural language processing techniques and is used daily within commercially available text editors. The actual state of the system is discussed, emphasizing the structure of the documents, the various attributes and properties that have been needed in order to meet user's needs.

The bridge between administrative and clinical information system.

On one side, physicians are asked to record administrative information, such as activity measurement, case-mix of their specialty, billing, for statistical, legal or reimbursement purposes; and on the other side, they need to gather detailed information about their own patients in terms of clinical evolution, for the day-to-day care of the patients or for clinical research purposes. Many other actors are also involved with these processes, both on the administrative side, such as registration officers, administrators and on the clinical side, nurses and other care providers. Applications have been developed within hospital information systems for capturing and disseminating information according to these specific actors and dedicated purposes. But more and more appears the need to integrate these data for insuring the coherence of information and avoiding redundancy of data capture. How to conciliate these objectives? We describe the Geneva's approach for integrating the administrative and the clinical systems.

Happy birthday DIOGENE: a hospital information system born 20 years ago.

Since its birth in 1978, DIOGENE, the Hospital Information System of Geneva University Hospital has been constantly evolving, with a major change in 1995, when migrating from a centralized to an open distributed architecture. Since a few years, the hospital had to face health policy revolution with both economical constraints and opening of the healthcare network. The Hospital Information System DIOGENE plays a significant role by integrating four axes of knowledge medico-economical context for better understanding and influencing resources consumption the whole set of patient reports and documents (reports, encoded summaries, clinical findings, images, lab data, etc.) patient-dependent knowledge, in a vision integrating time and space external knowledge bases such as Medline (patient-independent knowledge) integration of these patient-dependent and -independent knowledges in a Case-Based Reasoning format, providing on the physician desktop all relevant information for helping him to take the most appropriate adequate decision.

Medical office automation integrated into the distributed architecture of a hospital information system.

Patient histories, discharge summaries, and medical consultant reports are made up of written texts. Therefore, the gathering and archiving of these texts in machine-readable form has many characteristics of computer-based medical records. In Geneva, approximately 1,540 PCs are connected to the Hospital Information System DIOGENE 2, with the possibility of accessing all the functions offered by the system without losing any of their MS-DOS word processing capabilities. The UNIDOC system, presented in this paper, takes all these features into account, a real marriage of technologies between the MS-DOS environment and the distributed client-server architecture. The INGRES database management system supports the entire archiving process of the medical patient texts, structured by prelabelled paragraphs and automatically indexed. Both the quality and accessibility of the records are enhanced, while the archiving capacity is neither too limited nor too expensive.

[Role of metabolites in the relationship between pharmacokinetics and the effect of beta blockers. Studies on tolamolol and bufuralol]. / Rôle des métabolites dans les relations entre la pharmacocinétique et l'effet des agents beta-bloquants. Expériences avec le tolamolol et le bufuralol.

Plasma concentrations of tolamolol and bufuralol (beta-blocking agents) were measured after oral and intravenous administration to healthy volunteers. The plasma levels of their main metabolite was also determined. Simultaneously, the effect of the drugs on the heart rate and blood pressure was monitored under various stimuli (isoproterenol, exercise or orthostatism) and Valsalva maneuver. When given orally, the two drugs are extensively metabolized by a hepatic first-pass effect. After reaching the systemic circulation, they are metabolized in the liver to hydroxylated derivatives with similar pharmacologic activity as the parent molecule. For tolamolol it is possible to demonstrate a good correlation between parent drug blood levels and the pharmacodynamic effect; this relation is less evident for bufuralol. The pharmacokinetic analysis of the behaviour of the two beta-blocking agents and their main metabolite makes it possible to explain this difference in part. The results of the present study emphasize the importance of measuring metabolites when dose-action relationships are investigated.

[Side effects of nalidixic acid in a patient with severe renal failure. Clinical study and proposal of a pharmacokinetic model]. / Effets secondaires de l'acide nalidixique chez une patiente atteinte d'insuffisance rénale sévère. Etude clinique et proposition d'un modéle pharmacocinétique

Side effects due to ingestion of nalidixic acid in a 46 year old patient with phenacetine-induced interstitial nephritis and severe renal failure are reported. This observation underlines the point that, besides the direct neurotoxic effect of nalidixic acid, disturbance of the acid-basic equilibrium could be seen in patients with renal failure in particular. A hypothetical pharmacokinetic model suggests that two metabolites of nalidixic acid could provide enough hydrogen ion to induce acidosis in cases of renal failure.

[Pharmacokinetics of two beta blocking drugs: detection of a pharmacogenetic abnormality]. / Pharmacocinétique de deux médicaments bêta-bloquants: détection d'une anomalie pharmacogénétique

10 healthy male volunteers received orally either 100 mg tolamolol or 20 mg bufuralol. These experiments were repeated by intravenous administration of 10 and 5 mg respectively of these two drugs. Plasma levels of the parent drugs and their main metabolite were measured. In one subject, the apparent half-life of elimination was increased from 2.5 h (normal subjects) to 5 h for both drugs. This prolongation of the half-life is associated with low plasma levels of the metabolites, a peculiarity which can be explanined by a decreased rate of metabolism for these two drugs. This anomaly may explain the marked orthostatic hypotension observed only in this subject. The likelihood of a pharmacogenetic defect is discussed.

[Clinical pharmacokinetics]. / Pharmacocinétique clinique

The action of a drug depends on the quantity which reaches the site of its pharmacological action and how long it remains there. The necessary vital processes of the body dilute the active principle into different compartments of distribution, transform it into metabolites, and excrete it. Since a time duration of drug presence at the site of action is vital for the cure of disease, a comprehensive and quantitative expression of these time courses of drug distribution as a function of dose and route of administration is necessary for the establishment of proper dosage regimens for the treatment of disease and the avoidance of toxicities. The purpose of pharmacokinetics is to study these phenomena and to construct models suitable to explain them and to predict the behavior of drugs in conditions not yet studied. In this review some basic principles of pharmacokinetics (i.e. the compartment, the volume of distribution, the elimination half-life, etc.) are explained. Their clinical implications are shown in the case of multiple dose administration and in the study of the relations existing between blood levels of digoxin and the pharmacological action of this drug.

A strategy of approaching the fit of a compartmental model applied to the behaviour of aspirins in humans.

A compartmental model has been set up with five parts. Formulation and testing of the model have been performed by simultaneous experiments involving measurement of blood levels of ASA and SA for four different preparations of aspirin investigated in four different patients. The hypotheses of the present study had been based upon a four-compartment model. However, such a model did not appear to be adequate and a new model with five compartments has been substituted for the former one. The five-compartment model has led to the formulation and testing of new physiological hypotheses; it has also provided the development of a fitting method using powerful convergence algorithms. A general analytical formulation has been set up which has made it possible to circumscribe the multiple roots of the characteristic polynomial when they have to be taken into consideration.