Previous risk assessment scores for patients with coronary artery disease (CAD) have focused on primary prevention and patients with acute coronary syndrome. However, especially in stable CAD ...patients improved long-term risk prediction is crucial to efficiently apply measures of secondary prevention. We aimed to create a clinically applicable mortality prediction score for stable CAD patients based on routinely determined laboratory biomarkers and clinical determinants of secondary prevention.
We prospectively included 547 patients with stable CAD and a median follow-up of 11.3 years. Independent risk factors were selected using bootstrapping based on Cox regression analysis. Age, left ventricular function, serum cholinesterase, creatinine, heart rate, and HbA1c were selected as significant mortality predictors for the final multivariable model. The Vienna and Ludwigshafen Coronary Artery Disease (VILCAD) risk score based on the aforementioned variables demonstrated an excellent discriminatory power for 10-year survival with a C-statistic of 0.77 (P < 0.001), which was significantly better than an established risk score based on conventional cardiovascular risk factors (C-statistic = 0.61, P < 0.001). Net reclassification confirmed a significant improvement in individual risk prediction by 34.8% (95% confidence interval: 21.7-48.0%) compared with the conventional risk score (P < 0.001). External validation of the risk score in 1275 participants of the Ludwigshafen Risk and Cardiovascular Health study (median follow-up of 9.8 years) achieved similar results (C-statistic = 0.73, P < 0.001).
The VILCAD score based on a routinely available set of risk factors, measures of cardiac function, and comorbidities outperforms established risk prediction algorithms and might improve the identification of high-risk patients for a more intensive treatment.
To provide an introductory overview on selected areas of health-enabling and ambient-assistive technologies and to suggest relevant fields for future research.
Summarizing the state of the art for 1) ...ambient environments and 2) health-related sensor technologies, 3) presenting relevant medical conditions and their relation to health-enabling technologies, and 4) illustrating the application of those technologies for lifestyle management with examples for activity monitoring and prevention of overweight. The suggestions for future research are based on own research projects in this field.
Health-enabling and ambient-assistive technologies are regarded to have the potential to significantly improve quality of life and efficiency of health care in aging societies. Research on health-enabling and ambient-assistive technologies is highly multidisciplinary.
It still has, to a large extent, to be exploratory. An increasing amount of outcomes research through well-designed evaluation studies that explore technical solutions in a social context and in relation to individual needs will be crucial.
This article is part of a Focus Theme of METHODS of Information in Medicine on Health Record Banking.
Poor communication of health care information between health care providers (HCP) is still a ...major problem. One recent approach is the concept of Health Record Banking.
With this report we want to introduce the Lower Saxony Bank of Health (LSBH) to the international community. The main objective of this paper is to report and explain: 1) why this organization has been founded, 2) which basic principles have been set, 3) which services will be provided, 4) which type of organization has been chosen, and 5) which architectural framework has been selected.
To report and discuss how we plan to achieve the intended objectives.
The LSBH was founded as an entrepreneurial company, regarding itself as a neutral third-party information broker. The bank does not store medical documents on its central servers but offers a document registry with links to documents stored at participating health care providers. Subject to valid patient consent, the LSBH grants access to these documents to authorized health care providers. To implement our services, we chose the established technical frameworks of the Integrating the Healthcare Enterprise (IHE) initiative using cross-enterprise document sharing (XDS).
Different approaches to establish health information exchange (HIE) are in early stages and some have failed in the past. Health Record Banking can address major challenges described in the literature about HIE. The future will show if our provider-sponsored business model is sustainable. After reaching a stable network, we intend to add additional HCPs, e.g., care homes or ambulance services, to the network.
Health care network eHealth.Braunschweig has been started in the South-East region of Lower Saxony in Germany in 2009. It composes major health care players, participants from research institutions ...and important local industry partners.
The objective of this paper is firstly to describe the relevant regional characteristics and distinctions of the eHealth.Braunschweig health care network and to inform about the goals and structure of eHealth.Braunschweig; secondly to picture and discuss the main concepts and domain fields which are addressed in the health care network; and finally to discuss the architectural challenges of eHealth.Braunschweig regarding the addressed domain fields and defined requirements.
Based on respective literature and former conducted projects we discuss the project structure and goals of eHealth.Braunschweig, depict major domain fields and requirements gained in workshops with participants and discuss the architectural challenges as well as the architectural approach of eHealth.Braunschweig network.
The regional healthcare network eHealth.Braunschweig has been established in April 2009. Since then the network has grown constantly and a sufficient progress in network activities has been achieved. The main domain fields have been specified in different workshops with network participants and an architectural realization approach for the transinstitutional information system architecture in the healthcare network has been developed. However, the effects on quality of information processing and quality of patient care have not been proved yet. Systematic evaluation studies have to be done in future in order to investigate the impact of information and communication technology on the quality of information processing and the quality of patient care.
In general, the aspects described in this paper are expected to contribute to a systematic approach for the establishment of regional health care networks with lasting and sustainable effects on patient-centered health care in a regional context.
Operating room personnel (ORP) operating mobile image intensifier systems (C-arms) need training to produce high quality radiographs with a minimum of time and X-ray exposure. Our study aims at ...evaluating acceptance, usability and learning effect of the CBT system virtX that simulates C-arm based X-ray imaging in the context of surgical case scenarios.
Prospective, interventional study conducted during an ORP course with three groups: intervention group 1 (training on a PC using virtX), and 2 (virtX with a C-arm as input device), and a control group (training without virtX) - IV1, IV2 and CG. All participants finished training with the same exercise. Time needed to produce an image of sufficient quality was recorded and analyzed using One-Way-ANOVA and Dunnett post hoc test (alpha = .05). Acceptance and usability of virtX have been evaluated using a questionnaire.
CG members (n = 21) needed more time for the exercise than those of IV2 (n = 20): 133 +/- 55 vs. 101 +/- 37 sec. (p = .03). IV1 (n = 12) also performed better than CG (128 +/- 48 sec.), but this was not statistically significant. Seventy-nine participants returned a questionnaire (81% female, age 34 +/- 9 years, professional experience 8.3 +/- 7.6 years; 77% regularly used a C-arm). 83% considered virtX a useful addition to conventional C-arm training. 91% assessed virtual radiography as helpful for understanding C-arm operation.
Trainees experienced virtX as substantial enhancement of C-arm training. Training with virtX can reduce the time needed to perform an imaging task.
Objectives: To summarise current research that takes advantage of "Big Data" in health and biomedical informatics applications. Methods: Survey of trends in this work, and exploration of literature ...describing how large-scale structured and unstructured data sources are being used to support applications from clinical decision making and health policy, to drug design and pharmacovigilance, and further to systems biology and genetics. Results: The survey highlights ongoing development of powerful new methods for turning that large-scale, and often complex, data into information that provides new insights into human health, in a range of different areas. Consideration of this body of work identifies several important paradigm shifts that are facilitated by Big Data resources and methods: in clinical and translational research, from hypothesis-driven research to data-driven research, and in medicine, from evidence-based practice to practice-based evidence. Conclusions: The increasing scale and availability of large quantities of health data require strategies for data management, data linkage, and data integration beyond the limits of many existing information systems, and substantial effort is underway to meet those needs. As our ability to make sense of that data improves, the value of the data will continue to increase. Health systems, genetics and genomics, population and public health; all areas of biomedicine stand to benefit from Big Data and the associated technologies.
Cardiovascular death represents a major cause of mortality in patients with a functioning graft (1). Classical cardiovascular risk factors underestimate cardiovascular risk in renal transplants: ...therefore we the need to define new biomarkers to better characterize patients at risk. Endothelial injury, leading to endothelial dysfunction constitutes the first stage of atheromatosis. Bone marrow derived endothelial progenitor cells (EPCs) are crucial in the endothelial repair process by replacing detached and apoptotic endothelial cells (2, 3). In the general population, a decreased number of EPC-CFU (endothelial cell colony-forming units) is associated with endothelial dysfunction and an increased Framingham cardiovascular risk score, while in patients with coronary artery disease, a reduced number of circulating EPCs is associated with cardiovascular events at one year of follow up (3). These data suggest that EPC are crucial to preserve endothelial function and EPCs number and/or function might represent a surrogate of endothelial dysfunction and cardiovascular risk.
BACKGROUNDEndothelial progenitor cell (EPC) counts are proposed surrogate markers for vascular function and cardiovascular risk. The effect of tacrolimus (TAC) on EPC is unknown.
METHODSIn this ...randomized controlled trial, we assigned 148 stable long-term kidney transplant recipients (KTR) to maintaining ciclosporin (CSA) or to commencing TAC-based immunosuppression at a 2:1 ratio. EPC counts (CD34/KDR) after 24 months were defined as primary endpoint.
RESULTSThe intent-to-treat analysis included 141 KTR (estimated glomerular filtration rate, 46.7 40.1–61.8 mL/min per 1.73 m). Median (interquartile range IQR) EPC counts at baseline and month 24 were 6 (2–9) and 3 (1–9) cells and 4 (2–8) and 2 (0–5) cells per 5×10 mononuclear cells in CSA and TAC, respectively. Median (IQR) circulating angiogenic cells at baseline and month 24 were 28 (10.7–57) and 44.33 (14.6–59.8) cells and 22 (10.8–41) and 21 (9.7–49.5) cells per high-power field in CSA and TAC, respectively. Median (IQR) endothelial cell colony-forming units count per well at baseline and month 24 were 10.5 (3.3–34.3) and 4.38 (1.7–26.5) in CSA and significantly declined from 9.31 (1.8–29.3) to 4.13 (1.1–9.5) in TAC (P=0.003). There were no cardiovascular events in either group.
CONCLUSIONAlthough late conversion from CSA to TAC appears safe in KTR, conversion to TAC has no favorable effect on EPC. Low EPC levels are associated with a higher risk of subsequent cardiovascular events and are therefore of prognostic value. Their trend to decline over time deserves further examination.
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