Making Use of Comparable Health Data to Improve Quality of Care and Outcomes in Diabetes: The EUBIROD Review of Diabetes Registries and Data Sources in Europe.

Background: Registries and data sources contain information that can be used on an ongoing basis to improve quality of care and outcomes of people with diabetes. As a specific task of the EU Bridge Health project, we carried out a survey of diabetes-related data sources in Europe.

Objectives: We aimed to report on the organization of different sources of diabetes information, including their governance, information infrastructure and dissemination strategies for quality control, service planning, public health, policy and research.

Core Standards of the EUBIROD Project. Defining a European Diabetes Data Dictionary for Clinical Audit and Healthcare Delivery.

Background: A set of core diabetes indicators were identified in a clinical review of current evidence for the EUBIROD project. In order to allow accurate comparisons of diabetes indicators, a standardised currency for data storage and aggregation was required. We aimed to define a robust European data dictionary with appropriate clinical definitions that can be used to analyse diabetes outcomes and provide the foundation for data collection from existing electronic health records for diabetes.

Cross-border flow of health information: is 'privacy by design' enough? Privacy performance assessment in EUBIROD.

Background: The EUBIROD project aims to perform a cross-border flow of diabetes information across 19 European countries using the BIRO information system, which embeds privacy principles and data protection mechanisms in its architecture (privacy by design). A specific task of EUBIROD was to investigate the variability in the implementation of the EU Data Protection Directive (DPD) across participating centres.

Methods: Compliance with privacy requirements was assessed by means of a specific questionnaire administered to all participating diabetes registers.

Privacy impact assessment in the design of transnational public health information systems: the BIRO project.

Objectives: To foster the development of a privacy-protective, sustainable cross-border information system in the framework of a European public health project.

Materials And Methods: A targeted privacy impact assessment was implemented to identify the best architecture for a European information system for diabetes directly tapping into clinical registries. Four steps were used to provide input to software designers and developers: a structured literature search, analysis of data flow scenarios or options, creation of an ad hoc questionnaire and conduction of a Delphi procedure.

A networked electronic patient record system for diabetes.

This paper describes the development and clinical implementation of the SincroDiab--a synchronized diabetes register for the routine clinical practice in a LAN and for design of long-term trials and epidemiological studies based on the GEHR (Good European Health Record) architecture. The objectives of the SincroDiab system were to address the need to establish a more efficient and more effective information infrastructure to improve the ability to share patient record information among health care providers, to reduce the health care delivery costs, to meet the requirements of legal, regulatory or accreditation standards, to share comparable patients data among different sites within a multi-entity health care delivery system and to improve quality of care by network connecting the data repository to clinical workstations and departmental systems.

The Black Sea Tele-Diab System: development-implementation-clinical evaluation.

This paper describes the application of the GEHR (Good European Health Record) architecture to develop a system to enable the storage and exchange of EHCRs (Electronic Health Care Record) of patients with diabetes, in the Black Sea area. The objectives of the Black Sea Tele Diab System (BSTD) were to develop and evaluate the use of a fully-computerised healthcare record system in a clinical setting, to promote the use of electronic data exchange of healthcare information and to provide a framework for the epidemiological study and monitoring of diabetes care.

Black Sea TeleDiab: diabetes computer system with communication technology for Black Sea region.

BlackSea TeleDiab (BSTD) is a multidisciplinary research project whose aim is to promote the exchange of healthcare information between clinicians and scientists in countries of the Black Sea area to provide a means by which the care of patients with diabetes may be enhanced. The project is built on an existing organizational framework provided by the WHO Diabcare Quality Network (Q-Net) and the Black Sea Diab Action Project. The aim is to develop a standardized software package (in the national languages of the CCE/NIS Black Sea partners) for the storage and transfer of medical information and healthcare data between participating institutions.

Diabetic gangrene: medical and surgical causes and consequences.

Diabetic gangrene is the chronic complication which involves many medical, economic and social problems. In this study we have analyzed the medical and surgical causes and consequences of diabetic gangrene on three groups of patients: 120 patients (96 males and 24 females; aged (X +/- SD) 57 +/- 14 years hospitalised in the Clinic of Diabetes, Nutrition and Metabolic Diseases of the "N. Paulescu" Institute, 72 patients (59 males and 13 females; mean age 60 +/- 10 years) hospitalised in the Surgical Clinic of Cantacuzino Hospital; 29 patients (23 males and 6 females; mean age 58 +/- 11 years) hospitalised in the Cardiovascular Department of Fundeni Hospital.

The pattern of the electrodermal activity as indicator of stress related reaction.

The aim of the present study was to characterize the patterns of signals associated with noninvasively detected skin sudomotor transient reflexes in a group of 221 apparently healthy people, aged between 16 and 72 years. By means of two pairs of surface electrodes applied respectively to the palm of the hand and to the sole of the foot skin impedance changes were recorded as two electrodermal parameters: skin electrical resistance and skin electrical capacitance. The recordings were obtained under standard conditions initially in the basal resting state of the subject and then, after the application of some standardized stimuli (evoked electrodermal responses).

Peripheral sympathetic neuropathy evaluated by recording the evoked electrodermal response using an impedance reactometer.

Autonomic nervous dysfunction was indirectly evaluated on the basis of the skin electrical resistance relative variation (SERV), recorded by our recently developed system, with two pairs of surface electrodes placed on the palm and on the sole of the foot, after the application to the subject of a sensory stimulus (sound 60 dB, 860 Hz, 0.5 s duration) or in the course of a Valsalva manoeuvre. The results were digitally measured and recorded on thermosensitive millimetric paper analysing the following parameters: latency (LT), i.

Improved technique for testing autonomic dysfunction: evaluation of transient behaviour of the autonomic response.

The transient behaviour of the autonomic response has been studied by means of a reactometer incorporating self-balancing of the electrodermal impedance. This instrument has been used for the indirect measurement of certain parameters associated with the autonomic response detected as skin electrical resistance relative variation (SERV) and capacitance (SECV). Transient signals of the electrodermal impedance response were obtained online by differentiating the analogue output of the impedance reactometer: d(SERV)/dt and d(SECV)/dt.

Quantitative noninvasive electrophysiological evaluation of the activity of the cutaneous division of the sympathetic nervous system.

The functional status of the cutaneous division of the orthosympathetic nervous system was indirectly and non-invasively assessed by monitoring the skin electrical relative resistance variations (SERV). The advantages of our recording system of second generation were (1) simultaneous recording on two or four channels of the evoked electrodermal response to psychic or to sensorial stimulus; (2) self-balancing system which allows the recording of the relative variation of the electric parameter, i.e.

Measurement of perception threshold to an electric stimulus using a phase-sensitive technique in normal and diabetic subjects.

To evaluate the functional state of peripheral sensitivity we measured the perception threshold to an electrical stimulus applied deeply at the level of the lower limbs in both diabetic and nondiabetic patients. The data were obtained using a phase-sensitive technique with a sinusoidal applied voltage at 1592 Hz. The test signal applied through needle electrodes was monitored using a current-to-voltage convertor, the current being considered to have two components, one resistive (IR) in phase with the voltage V across the electrodes, and the other capacitive (IC) 90 degrees out of phase.

The perception threshold to an electric stimulus deeply applied in the lower limbs in normal and diabetic subjects.

The loss of sensitivity to nociceptive stimuli is one of the main factors involved in the pathogeny of diabetic gangrene. The aim of this study was to develop a simple and practical method for selecting the cases prone to such a complication. The perception threshold (either voltage, mV or current, microA) was determined in 137 randomly selected diabetic patients and 38 non-diabetic controls, by an original electronic device using sinusoidal waves, delivered through two electrode needles introduced at a depth of 0.

Evaluation in autonomic diabetic neuropathy using a dual-channel self-balancing impedance reactometer. Preliminary study.

The electrodermal reflex to an external acoustic stimulus was determined by means of an original device "'The Neurovegetative Reactometer", as variation of the skin electric resistance delta R/R (recorded on millimetric paper) and latency in the appearance of the response (seconds), in 39 diabetic patients (20 males, 19 females, aged 55 +/- 10 years, and the duration of diabetes of 6 +/- 4 years) with or without clinical neuropathy and, comparatively, in 24 apparently healthy controls. The results showed a statistically significant difference both between the amplitude of the skin electric resistance variation evaluated on millimetric paper (6.77 +/- 4.

Electroacupunctogram: a new recording technique of the acupoint potentials.

The monitoring of the bioelectric activity of acupoints by means of electroacupunctogram (EAG) represents a direct and precise recording technique of the acupoints functional state. The EAG recording is done by introduction in the acupoint at corresponding depth of a standard silvered-steel electrode-needle and the measurements are made bipolar, i.e.