W.R.M. Dassen

Pacemaker registration by E-mail

In the Netherlands, many pacemaker clinics use a computer to store their implant and follow-up data in a database. Still, there are quite a number of clinics that only use their computer for word processing. In order to improve the accuracy of the received data, we developed a data entry package where the data is checked, after which it is sent to the central registry by E-mail.

Evaluation of a DICOM-3 link between a referring and a university hospital

As catheterization laboratories are switching from cinefilm to digital recorded images, the transportation of the images between hospitals can be realized in digital mode. This paper describes the transportation of angiographic images between a referring and a university hospital. Besides the more technical information about transmission speed, etc., it elucidates on those patient categories that clearly profit from these new possibilities.

A patient planning and tracking system for a cardiac surgery department

Patients undergoing cardiac surgery occupy a cascade of beds during their stay in hospital. The length of stay at each sub-department depends on many factors such as the condition of the patient, the performed therapeutic procedure and the attending staff. The patient throughput therefore may be hampered in many ways and is subject to vast communication processes in which copying of information is a substantial component. In order to optimize this throughput a software package has been developed based on a computer model predicting the average stay of a patient on each sub-department, given the surgical procedure and his clinical condition. This way the overall flow of patients can be predicted and potential problems in patient logistics can be foreseen. Furthermore sharing of information will reduce the workload and the number of misinterpretations.

Guideline assessment and implementation in congestive heart failure

In this study the feasibility of representing guidelines on the pharmacological management of heart failure was assessed using a toolbox specially designed to enter and during runtime manipulate guidelines. The toolbox distinguishes three layers to define guidelines. In the first layer, the flow charts derived from the guidelines are drawn, and annotated using natural language. Secondly, the respective rules are entered, using a domain specific vocabulary. The decision support system applies this guideline knowledge to the actual patient status and relevant laboratory results, entered by the physician or obtained from an existing data source, resulting in advice regarding this patient. In this limited study the selection and titration of three classes of drugs was modeled and for each category a prescription strategy was defined, based on severity of overfilling, co-medication and laboratory data. The decision support system selects, based on the current clinical state of the patient, the underlying pathophysiology and presence of comorbidity, the most appropriate drug strategy.

Application of intranet and internet techniques in conducting clinical trials

Clinical trials require the availability of forms and information concerning procedures at different times and at a number of places in the hospital. By representing this information using web based tools it becomes possible to organize the information in a much simpler way by linking corresponding elements. By storing this information on a web-server within the hospital protected by a firewall against access from outside, the information becomes available to everybody with a username and password for that web-server. With the help of a Perl script patient information collected in previous parts of the trial can be recalled and used during further investigations, for instance the settings of X-ray equipment to allow for identical follow-up registrations. Multi-center trials in which information is passing the firewall require additional protection to guarantee data security while keeping the firewall intact.

Uniform pacemaker and ICD information system in the Netherlands

In the Netherlands the Central Pacemaker Patient Registry (CPPR) collects information of pacemaker and ICD (implantable cardio defibrillator) patients from all 109 Dutch hospitals. Many pacemaker clinics use a computer to store their implant and follow-up data in a database. Because the devices are getting more and more complex more clinical data is needed for optimal use of the device. Since 1989 databases have been developed by several pacemaker industries and some clinics use databases developed themselves. When using these databases you depend on individual persons for support and update of the database. In order to improve the accuracy of received data and to ensure continuity a uniform pacemaker and ICD information system is developed where data is checked, after which it is sent to the central registry by e-mail and where support is guaranteed by the NPRF.

Unravelling gene interactions to find the cause of artherosclerosis, a multigenic disease, using an artificial neural network

To understand the etiology of multigenic diseases like atherosclerosis, a polymerase chain reaction (PCR) based gene array containing 65 single nucleotide polymorphisms (SNPs) was analyzed. To asses the possibilities of pattern recognition techniques in detecting unfavorable genetic combinations, two approaches were analysed. A selection of these 65 SNPs formed the input both to binary logistic regression models and to self-learning artificial neural networks (ANNs). Repeated analyses showed that both methods performed equally well. Further research to improve the differentiating power of both methods should focus first on decreasing the number of otherwise indeterminable polymorphisms.

A diagnostic component for the EPD-Car project

This paper describes a diagnostic module which is a part of the EPD-CAR (Electronic Patient Dossier for Cardiology) project of the Interuniversity Cardiology Institute of the Netherlands. It consists of 13 coding trees, each containing between 3 and 20 subitems. The scheme evolved from daily practice where standard coding schemes proved insufficient. It consists of one main diagnosis and up to 10 optional subdiagnoses. Back-end integration is achieved through conversion tables to ICD-9 and ICD-10. The current system is in use now,for over 1.5 years and contains diagnoses of over 11000 patients. The system is written in Visual Foxpro 6.0 and is an ActiveX-component.

Application of digital echocardiographic images during cardiac catheterization

During cardiac catheterization left ventricular angiograms are frequently performed to assess left ventricular function. In a substantial percentage, on line available echocardiographic images may be considered as a clinical substitute for left ventricular angiograms. The potential advantages include: (1) Less complications. Avoiding a left ventricular angiogram causes reduction of the amount of contrast fluid used and reduction of the total radiation exposure, leading to less complications such as deterioration of renal function. (2) Lower costs due to reduction in the use of angiographic materials such as catheters, syringes and contrast fluid and shorter procedural time.

Analysis and monitoring of patient logistics in the cardiology outpatient clinic

This paper describes the AMOC project which aims at the improvement of patient throughput in the outpatient clinics. Indicators describing the workflow were extracted and serve as a base for a so called continuous improvement model. As pro actively monitoring the workflow turned out to be the best tool to optimize the throughput, a computer system was developed to present in a ldquodashboardrdquo like manner the state of the indicators.