RESUMO
Due to the immense volumes of medical data, the architecture of the future healthcare decision support systems focus more on interoperability than on integration. With the raising need for the creation of unified knowledge base, the federated approach to distributed data warehouses (DWH) is getting increasing attention. In this paper, we explore the idea of a federation technology and its uses within the domain of health, particularly in the conceptualization of DWH federation as a sustainable, appropriate and legitimate solution. Further, we present a federated DWH model which enables the interoperability between heterogeneous and distributed medical IS, which includes a sense and response mechanism and facilitates evidence-based medicine in order to primarily support the physicians at the point of care. A real-world scenario illustrates a possible application field in the area of emergency and intensive care.
Assuntos
Cuidados Críticos/métodos , Bases de Dados Factuais , Medicina Baseada em Evidências/métodos , Terapia Assistida por Computador/métodos , HumanosAssuntos
Cádmio/metabolismo , Cloretos/farmacologia , Poluentes do Solo/metabolismo , Thlaspi/efeitos dos fármacos , Triticum/efeitos dos fármacos , Zinco/farmacologia , Biodegradação Ambiental , Cádmio/análise , Brotos de Planta/efeitos dos fármacos , Brotos de Planta/crescimento & desenvolvimento , Brotos de Planta/metabolismo , Poluentes do Solo/análise , Poluentes do Solo/toxicidade , Thlaspi/crescimento & desenvolvimento , Thlaspi/metabolismo , Triticum/crescimento & desenvolvimento , Triticum/metabolismo , Zinco/análise , Zinco/metabolismoRESUMO
In a retrospective study, on a sample of 1021 patients with carcinoma of the lips, oral cavity and oropharynx, the clinically available factors at the time of the patient's first admission are analysed with reference to their prognostic relevance. Prognostically relevant factors are determined by both univariate and multivariate analyses. Of the 18 factors analysed, the following seven finally proved to be prognostically relevant: tumour size, degree of infiltration, degree of histological differentiation and site by organ of the primary tumour, the combination of evidence + clinical appearance + degree of fixation of the regional lymph nodes, age of the patient, and evidence of distant metastases. On the basis of these results it will be possible to create a prognostic index. This prognostic index should be eligible for use in clinical practice, as opposed to usual classification models.
