Physician's expectations regarding prescribing clinical decision support systems in a Belgian hospital.

OBJECTIVES: Developing and implementing clinical decision support systems (CDSSs) is time-consuming and costly. Therefore, prioritization of the most relevant systems is warranted. The physician's perceived usefulness has been identified as a decisive reason for using CDSSs. The objective of this study was to investigate the physician's perceived usefulness of different types of CDSSs and to identify the user needs and expectations regarding future CDSSs. METHODS: Cross-sectional single-centre survey among physicians with a clinical assignment in a university hospital. Physicians were questioned about their current experiences with drug prescribing and the perceived usefulness and desired features of future CDSSs. RESULTS: One hundred and sixty-four physicians completed the survey (52·6%). The majority acknowledged that it is very difficult to take all relevant information into account when prescribing drugs. Drug-drug interaction checking, drug-allergy checking, and dosing guidance were considered as most useful. Automated clinical guidelines and adverse drug event monitoring were considered as least useful. The user-friendliness of the systems, clinical relevance of the alerts, and prevention of alert fatigue were perceived as important aspects for a successful implementation. CONCLUSIONS: From the physicians' perspective drug-drug interaction checking, drug-allergy checking, and dosing guidance should receive the highest priority for development and implementation. Because the perceived usefulness has been identified as a decisive reason for using CDSSs, it seems feasible to take into account this prioritization when developing and implementing CDSSs. In order to overcome the physicians' perceived disadvantages, attention should go to the development of user-friendly systems that deliver clinical relevant alerts.

An integrated drug prescription and distribution system: challenges and opportunities.

Using the hospital's drug prescription and distribution system as a guide, benefits and drawbacks of a medical activity management system that is tightly integrated with the supply chain management of a hospital will be discussed from the point of view of various participating healthcare actors.

Framework for a clinical information system.

The design and implementation of Clinical Information System architecture is presented. This architecture has been developed and implemented based on components following a strong underlying conceptual and technological model. Common Object Request Broker and n-tier technology featuring centralised and departmental clinical information systems as the back-end store for all clinical data are used. Servers located in the "middle" tier apply the clinical (business) model and application rules. The main characteristics are the focus on modelling and reuse of both data and business logic. Scalability as well as adaptability to constantly changing requirements via component driven computing are the main reasons for that approach.

[Physiotherapy for the recreational athlete]. / Physiotherapie beim Freizeitsportler.

Physiotherapy plays a significant role in the treatment of sport injuries and can be especially adapted for this purpose. The physiotherapist has two tasks: 1. As a therapist treating a well defined pathologic entity or functional deficit. 2. Instructing the patient in further self-treatment and appropriate measures, behavioral changes and preventive approaches. The therapeutic emphasis is presented in seven interdependent groups: pain/swelling, flexibility, strength, coordination, endurance, psychological measures, preventive measures. The aim of treatment is to resume training activities. For each group there is a description of clinical symptoms, diagnosis according to functional tests and recommended treatment measures. The therapy group(s) and their priorities should be listed when making an individual therapeutic decision.

Mann-Whitney/Wilcoxon's nonparametric cumulative probability distribution.

It is demonstrated how complete nonparametric, cumulative probability distributions for Mann-Whitney/Wilcoxon's nonparametric, two-sample test can be constructed based on algorithms published earlier in this journal. These procedures provide cumulative probabilities for all possible rank sums in the nonparametric two-sample test. Separate programs for MS(PC)-DOS and Macintosh computers are offered.

Framework for a clinical information system.

The current status of our work towards the design and implementation of a reference architecture for a Clinical Information System is presented. This architecture has been developed and implemented based on components following a strong underlying conceptual and technological model. Common Object Request Broker and n-tier technology featuring centralised and departmental clinical information systems as the back-end store for all clinical data are used. Servers located in the 'middle' tier apply the clinical (business) model and application rules to communicate with so-called 'thin client' workstations. The main characteristics are the focus on modelling and reuse of both data and business logic as there is a shift away from data and functional modelling towards object modelling. Scalability as well as adaptability to constantly changing requirements via component driven computing are the main reasons for that approach.

Towards a component driven infrastructure for integrated healthcare systems.

A high level summarised description of the distributed clinical information system implemented in the hospital of the free university of Brussels (AZ-VUB) is described. It evolves towards a component based clinical distributed system that consists of a set of co-operating middelware software components running on a number of computers connected by a network that will foster the integration of applications, data servers and other resources in the medical field. This system is implemented in the University Hospital of Brussels (AZ-VUB) a full-service 800-bed university hospital that provides care for 23,000 inpatients, supports over 300,000 outpatient visits and receives 32,000 emergency patients a year.

Failure of liver transplantation to diminish cardiac deposits of amylopectin and leukocyte inclusions in type IV glycogen storage disease.

Orthotopic liver transplantation has been used to treat glycogen storage disease type IV. Most long-term surviving patients who have undergone liver transplantation have been free of neuromuscular and cardiac morbidity, and regression of cardiac amylopectin infiltration has been reported after liver transplantation. Leukocyte inclusions in glycogen storage disease type IV have also been reported. We present the case of a child who underwent orthotopic liver transplantation for glycogen storage disease type IV. In contrast to previous reports, at autopsy 2 1/2 years after transplantation, there was massive amylopectin deposits in his heart. Further, peripheral leukocytes never showed loss of amylopectin inclusions after transplantation. Orthotopic liver transplantation for type IV glycogen storage disease may not, in all cases, result in improvement in other affected organs. Consideration of multiorgan transplantation appears warranted.

Chemiluminescent detection of Fiji disease virus with biotinylated DNA probes.

Biotinylated Fiji disease fijivirus specific cDNA probes detected the presence of the virus in total nucleic acid extracts from infected sugarcane plants. Hybridised biotinylated probes were detected with streptavidin-alkaline phosphatase conjugate and the light generating substrate AMPPD. Samples were either blotted manually, or by alkaline capillary transfer using 100 mM NaOH. Transfer of nucleic acids to charge modified nylon with sodium hydroxide was superior to denaturation with glyoxal or formamide and salt-citrate buffer transfer as the bands were clearly resolved and no degradation of the FDV dsRNA was observed. Transfer of either total nucleic acid extracts or purified dsRNA in manifold blots generated false positive signals with the non-radio-active chemiluminescent detection systems tested. Manual or northern blots had a limit of detection for purified target double-stranded RNA of approximately 10 pg and 0.5 pg respectively. Manual blots were tested for practical application to screen germplasma for FDV infection. The virus was detected in leaf samples from FDV-infected plants, in some instances prior to development of the characteristic gall symptom.

Hepatocellular adenoma in glycogen storage disease type IV.

The development of hepatocellular adenoma has been recognized in association with glycogen storage disease type I and, less often, with glycogen storage disease type III, but, to our knowledge, it has not been reported in glycogen storage disease type IV. We had the opportunity to study an 11-month-old male infant who underwent orthotopic liver transplantation for cirrhosis that developed in the setting of glycogen storage disease type IV. A clinically unsuspected hepatocellular adenoma was present in the explanted liver. Glycogen storage disease type IV should be considered as a potential precursor to the development of hepatocellular adenoma. Recognition of this association is important, both in terms of the differential diagnosis of tumors that occur in this setting and also to anticipate potential complications of this benign neoplasm.

PCR amplification of a specific double-stranded RNA region of Fiji disease virus from diseased sugarcane.

A 450-bp region from one species of the segmented dsRNA genome of Fiji disease virus (FDV) was amplified from total nucleic acid extracts of diseased plants by reverse transcription with MMLV, followed by amplification with Taq DNA polymerase (RT-PCR). Other FDV-specific regions (c 150 bp and c 270 bp) were also amplified from the dsRNA template. FDV cDNA was only synthesised when the viral dsRNA template was boiled and quenched with FDV-specific or random hexamer primers. The reverse transcriptase/DNA polymerase enzyme rTth appeared to yield only the 150 bp fragment from the dsRNA template under the conditions used. The level of sensitivity of RT-PCR for purified FDV dsRNA was 100 ag, approximately 10(4)-fold more sensitive than detection with biotinylated DNA probe.

Secretion of a TGF-beta-like growth inhibitor by normal rat mammary epithelial cells in vitro.

We have examined conditioned medium (CM) from cultures of normal rat mammary epithelial (RME) cells for growth factor activity on fresh RME cell cultures. RME cell-derived CM contained potent growth inhibitory activity toward fresh RME cell cultures when the medium was acidified by dialysis against 1% acetic acid prior to concentration. Dialysis of the CM at neutral pH resulted in CM that had growth stimulatory activity and no inhibitory activity. The acid-activated growth inhibitor was heat and acid stable, protease sensitive, and eluted from a Bio-Gel p60 column with a peak of activity in the 28 kDa range. Incubation of the acidified-concentrated CM with neutralizing antiserum (affinity purified IgG) against transforming growth factor (TGF)-beta completely abolished the inhibitory activity of the CM. Furthermore, RME cell growth in the presence of the growth inhibitor plus TGF-beta antiserum was greater than that observed in growth medium alone. Subsequent experiments demonstrated that addition of TGF-beta antiserum alone to serum-free medium enhanced RME cell growth, whereas addition of nonimmune IgG was without effect even at 25-fold higher concentrations. Zymographic analysis of RME-CM revealed the presence of plasminogen activator proteases that may mediate the partial activation of the latent growth factor. These results indicate that normal RME cells secrete a latent TGF-beta-like growth factor into conditioned medium. Furthermore, the results indicate that some of the latent growth factor is activated in situ and contributes to the growth potential of the cells in primary culture in an autocrine manner.

Immunopathology of interstitial cystitis.

This study describes histologic, ultrastructural, and immunofluorescence microscopy findings of cystoscopically directed biopsies of lesional tissue and uninvolved bladder from 308 patients with chronic interstitial cystitis (IC) and no evidence of infection, collagen vascular, or other systemic disease. The majority of cases exhibited strong urothelial cell staining for immunoglobulin A (IgA), which was focal or diffusely involved all layers of the epithelium. Electron microscopy revealed widening of the interstitium between urothelial cells, which may explain leakage of IgA into the urine in cystitis patients. Staining for fibrinogen and IgA was present both in lesional biopsies and uninvolved bladder tissue, suggesting a response to injury affecting the entire bladder urothelium. A minor patient population with idiopathic IC revealed granular IgM (with or without C3) in vessel walls of the lamina propria, suggesting immune complex disease. Ultrastructural evidence of vascular damage included necrosis of endothelial cells, fibrin deposition, and reduplication of basement membranes. Staining for IgE correlated with presence of mast cells and was present in less than 2% of cases, indicating that these cells do not play a prominent role in the pathogenesis of the disease. In the majority of patients with IC mucosal staining for IgA and fibrinogen was a characteristic pattern representing increased IgA secretion and a reaction pattern to injury of unknown cause. A subgroup of patients had evidence of vascular damage and immune complex disease. This study therefore defines two main reaction patterns in interstitial cystitis, which may have implications on prognosis and therapy of the disorder.

cAMP levels in proliferating rat mammary epithelial cells in vitro and in vivo.

Agents that elevate intracellular cAMP levels are required for growth of many cell types in culture including normal rat mammary epithelial (RME) cells. To determine if the intracellular levels of cAMP that result from stimulation by agents such as cholera toxin (CT) or prostaglandin E-1 (PGE-1) are within the physiological range, cAMP levels were determined in RME cells growing in primary culture and compared to levels measured in freshly isolated mammary epithelium. The results indicate that the cAMP levels of mammary epithelial organoids obtained from 45-day-old virgin rats are 4 to 6 pmol/10(6) cells. Growth of RME cells in primary culture in the presence of CT results in cAMP levels of approximately 15 to 20 pmol/10(6) cells early in culture when cells are proliferating rapidly. As cells approach confluence, cAMP concentrations decrease to levels observed in fresh organoids. CT-stimulated cAMP levels appear to be within the range of those found in pregnant mammary epithelium in vivo. Growth of RME cells in medium supplemented with PGE-1 instead of CT results in cAMP levels equivalent to those found in fresh mammary epithelial organoids and under these conditions the growth rate is approximately half that found in CT-stimulated cells. These results indicate cAMP to be a positive regulator of cell growth in vivo at levels that are within the physiological range.

Optimal conditions for the use of cDNA probes to measure the concentration of barley yellow dwarf virus in barley (Hordeum vulgare).

Experiments which optimise the conditions for the measurement of the relative concentration of BYDV in barley (Hordeum vulgare) tissues using cDNA probes are described herein. These studies have shown that both the pH of the buffer and the ratio of buffer to tissue used to homogenise plant material greatly affects the amount of cDNA probe which hybridises to leaf extracts immobilised on nitrocellulose. These studies also showed that the measurement of this virus was greatly facilitated by using a dot-blot apparatus which allows samples contact with a piece of nitrocellulose 10 mm in diameter rather than a 3 mm (approx) diameter piece of nitrocellulose as is the case with most commercial dot-blot apparatuses. Further experiments using this technique showed that there was a large difference in the rate of replication of the PAV, BYDV serotype between BYDV-resistant and BYDV-susceptible cultivars of barley. These data suggest that a BYDV-resistant cultivar can easily be distinguished from a BYDV-susceptible one if the BYDV content of leaves is measured between 7 and 14 days after inoculation.

Presynaptic serotonin receptors regulate the release of 3H-serotonin in hypothalamic slices of the rabbit.

Hypothalamic slices of the rabbit brain were incubated with 10(-7) M of 3H-serotonin (3H-5HT). After the incubation and an initial washout period, a nearly constant basal efflux of tritium was detected. This basal efflux was not significantly altered by Ca2+-free solution or by the 5HT-antagonist metitepin (10(-5) M), but was augmented by chlorimipramine (10(-5) M) and by unlabelled 5HT (10(-6) M); the acceleration caused by unlabelled 5HT was absent in presence of chlorimipramine (10(-5) M). Both electrical stimulation (4 Hz, 50 mA, 2 min) and high K+ (50 mM) induced an overflow of 3H. This overflow was nearly abolished in Ca2+-free solution. In presence of chlorimipramine (10(-5) M) both the tritium overflow evoked by electrical stimulation and that evoked by high K+ were augmented by metitepin (10(-5) M) and decreased in a concentration dependent manner by unlabelled serotonin (10(-8) - 10(-6) M); the latter effect was antagonized by metitepin (10(-6) M and 10(-5) M). These experiments suggest that in rabbit hypothalamic slices, the release of 3H-5HT is controlled by a negative feedback mechanism acting via presynaptic serotonin receptors.