Endogenous sex hormone levels in postmenopausal women with Alzheimer's disease.

A cross-sectional study examined whether there was a difference in endogenous serum sex hormone levels between community-dwelling postmenopausal women with Alzheimer's disease (AD) and healthy controls. Total morning levels of serum estrone, estradiol, androstenedione, testosterone, and cortisol were measured in 52 nondepressed women with AD and 60 postmenopausal women who were neither depressed nor cognitively impaired. Estradiol was undetectable in 35.

A multimedia approach to raising awareness of information and communications technology amongst healthcare professionals.

This study is concerned with the application of advanced multimedia technology to the development of a programme aimed at raising awareness of information and communications technology (ICT) amongst health professionals in Ireland. The programme is delivered in the form of a symposium supplemented by a multimedia CD and associated web site. It examines how ICT can be used effectively in healthcare across all sectors - primary, secondary and tertiary - with a strong emphasis on supporting shared care.

An IT awareness programme for the health sector in Ireland.

This paper describes an Awareness Programme delivered throughout Ireland which aims to increase the level of understanding of healthcare professionals as to the benefits of Information and Communications Technology (ICT) and of emerging trends in Health Informatics in Europe. The programme examines the use of ICT across the whole health sector--primary, secondary and tertiary. It has been delivered at over 30 centres to more than 1500 health professionals.

Federated healthcare record server--the Synapses paradigm.

The delivery of healthcare relies on the sharing of patient information between those who are providing for the care of the patient and this information is increasingly being expressed in terms of a 'record'. Further, it is desirable that these records are available in electronic form as Electronic HealthCare Records. As it is likely that patient records or parts of records will be stored in many different information systems and in the form of disparate record architectures, uniform access to patient records would be problematic.

Vitamin D-fortified liquid milk: benefits for the elderly community-based population.

To assess the efficacy and acceptability of vitamin D-fortified liquid milk in the management of hypovitaminosis D we carried out a double-blind, randomized, controlled trial on 51 community-based, elderly subjects with serum 25 hydroxyvitamin D (25OHD) levels of less than 12.9 ng/ml (normal range 10-80 ng/ml). Each subject had a dietary assessment, mental test score, outdoor score, serum 25 hydroxyvitamin D level, and a general biochemical screening at baseline in April 1993 which was repeated in September 1993, April 1994, and September 1994.

Cutaneous abnormalities and metabolic disturbance of porphyrins in patients on maintenance haemodialysis.

Blistering disorders may occur in patients with chronic renal failure. Photoactive medication may account for some, and others may be attributable to porphyria cutanea tarda (PCT), but most appear idiopathic. Seventy haemodialysis patients at the National Renal Transplant Centre were therefore screened to determine the prevalence of cutaneous disease and to establish a reference range for plasma porphyrins in this population.

Porphyrin abnormalities in acquired immunodeficiency syndrome.

Objective: To examine prospectively porphyrin metabolism in a human immunodeficiency virus (HIV)-positive population.

Setting: Specialist referral unit at the Department of Genitourinary Medicine, St James's Hospital, Dublin, Ireland.

Patients: Twenty-eight men and 5 women (age range, 18-35 years).

Patient result validation services.

Patient result validation is a vital final stage of laboratory quality assurance and is usually the responsibility of senior laboratory staff. Computerised validation systems have recently been introduced to autovalidate data meeting certain pre-defined criteria, thereby allowing senior staff to focus on problematic cases. This article describes the patient results validation service module developed for an advanced instrument workstation in the OpenLabs project.

A new clinical laboratory information system architecture from the OpenLabs project offering advanced services for laboratory staff and users.

The OpenLabs project aims to improve the efficiency and effectiveness of clinical laboratory services by integrating decision support systems with laboratory information systems and equipment. Standards for electronic data interchange between laboratories and other medical systems using the EUCLIDES/OpenLabs coding scheme and an open architecture for clinical laboratory information systems have been specified. This article gives an account of the proposed architecture and outlines new software applications being developed using the architecture which provide advanced services for ordering and reporting of laboratory tests, advanced instrument workstation and laboratory management services, including an OpenLabs Service Manager application which co-ordinates the available services.

Porphyrin metabolism in hepatitis C infection.

Hepatitis C virus has been implicated as a major precipitating factor in porphyria cutanea tarda (PCT). To determine whether hepatitis C infection alone is sufficient to induce PCT, we screened two groups of patients with hepatitis C infection. The first group comprised women who had become HCV positive secondary to immunization with anti-D immunoglobulin (group 1).

Are hydrogen breath tests valid in the elderly?

Hydrogen breath testing (HBT) is frequently used as an alternative to small bowel aspiration in the diagnosis of small intestinal bacterial overgrowth (SIBO). The role of the glucose HBT was assessed in 30 elderly patients. A positive HBT was recorded in 15 of 20 SIBO cases and 7 of 10 culture negatives (sensitivity 75% and specificity 30%).

Hypovitaminosis D in the healthy elderly.

Hypovitaminosis D is a common finding in the healthy elderly population and has significant sequelae. No clear dietary or sunlight-related risk factors were identified by dietary assessment and modified outdoor score. Fortified liquid milk and vitamin supplements were associated with significantly higher serum 25-hydroxyvitamin D levels.

Effect of Bacteroides melaninogenicus culture supernatant and deconjugated bile salt on lipid absorption.

Lipid malabsorption is a common clinical manifestation of small bowel bacterial overgrowth. Its pathogenesis, however, remains controversial. Bacteroides melaninogenicus ssp.

The OpenLabs project. A suggested approach for more effective use of information technology in clinical laboratories.

The OpenLabs project is a major European initiative in laboratory medicine with a global audience in mind. OpenLabs aims to improve the efficiency and effectiveness of clinical laboratory services by integrating knowledge-based systems (using OpenLabs modules) with laboratory information systems and equipment. Standards for electronic data interchange between laboratories and other medical systems using the OpenLabs coding system and an open architecture for clinical laboratory information systems are being specified.

The OpenLabs approach to clinical laboratory computing.

This paper describes the architectural infrastructure to support a number of advanced functionalties for the clinical laboratory developed by OpenLabs. This infrastructure is based on an open distributed computing platform. A brief overview is given of the advanced functionalities provided by the OpenLabs modules through the novel application of knowledge-based systems, databases, and telematics; we also describe the communications architecture which allows these modules to interoperate with each other and with existing Laboratory Information Systems and instruments.

OpenLabs: the application of advanced informatics and telematics for optimization of clinical laboratory services.

OpenLabs has four major objectives: to improve the efficiency and effectiveness of clinical laboratory services by the integration of Knowledge Based Systems (KBSs) with Laboratory Information Systems (LISs) and equipment; to provide and implement standard solutions for Electronic Data Interchange (EDI) between laboratories and other medical systems; to specify a fully Open architecture for an integrated Clinical LIS and demonstrate the integration of various KBS modules on the open architecture platform; and to demonstrate the integration of OpenLabs modules with existing LISs.

KAVAS-2: Knowledge Acquisition, Visualization and Assessment System.

The objective of KAVAS-2 is the development of a tool, named KAVIAR, with which domain experts can make their knowledge explicit. It contains components for (computer assisted) knowledge elicitation and for machine learning. A key issue in KAVAS is the assessment of the quality of the classification and domain models built.

A methodology for evaluation of knowledge-based systems in medicine.

Evaluation is critical to the development and successful integration of knowledge-based systems into their application environment. This is of particular importance in the medical domain--not only for reasons of safety and correctness, but also to reinforce the users' confidence in these systems. In this paper we describe an iterative, four-phased development evaluation cycle covering the following areas: (i) early prototype development, (ii) validity of the system, (iii) functionality of the system, and (iv) impact of the system.

Small intestinal bacterial overgrowth--an incidental finding?

Objectives: To assess the prevalence of typical clinical features and need for treatment of small intestinal bacterial overgrowth (SIBO) in the elderly.

Design: Random selection of patients, regardless of their nutritional status.

Setting: Acute admissions ward in the Dept.

Knowledge based lipid management system for general practitioners.

The aim of this system is to provide computer generated interpretative reports with management advice for General Practitioners (GPs). The lipid domain was chosen because of its importance in preventive medicine. Request forms to elicit extra clinical information were designed and distributed to a group of randomly selected GPs.

Interpretative reporting and alarming based on laboratory data.

The utilisation of laboratory services for patient diagnosis and management involves many steps with both clinical and laboratory components. The clinical components include the decision to order a test, interpretation of the test results and actions taken on the basis of the results. The laboratory components on the other hand include receipt of the request, specimen collection, preparation and analysis, result entry, test result validation and verification and reporting of the results.

Supporting interoperability between medical knowledge-based systems: experience from pilot implementations.

Interoperability may be defined as the ability of knowledge-based systems to function together in a symbiotic manner. Cooperativity implies interoperability but with the added benefit that the output quality of the cooperative network exceeds the overall performance of the participating sub-systems. A number of candidate architectures to support interoperability and cooperativity between medical knowledge-based systems in laboratory medicine domains are now becoming available.