Ambulatory EHR functionality: a comparison of functionality lists

There is a proliferation of lists intended to define and clarify the functionality of an ambulatory electronic health record system. These lists come from both private and public entities and vary in terminology, granularity, usability, and comprehensiveness. For example, functionality regarding a problem list includes the following possible definitions: * "Create and maintain patient-specific problem lists," from the HL7 Electronic Health Record Draft Standard for Trial Use. * "Provide a flexible mechanism for retrieval of encounter information that can be organized by diagnosis, problem, problem type," from the Bureau of Primary Health Care. * "The system shall associate encounters, orders, medications and notes with one or more problems," from the Certification Commission on Health Information Technology. * "Displays dates of problems on problem list," from COPIC Insurance Co. * "Shall automatically close acute problems using an automated algorithm," from the Physicians Foundations HIT Subcommittee. This article will compare the attributes of these five electronic health record functionality lists and their usefulness to different audiences-clinicians, application developers and payers.     

Pain and functionality in primary health care

Musculoskeletal pain and functionality are linked to the individual health and, thus, influence the mode of interaction between individuals and between them and the environment that surrounds them. However, there are not many studies that question such health issues concerning the population in general, especially when we look at these issues from the basic care point of view. The aim of this article is to present initial data on the subject of pain and functionality in individuals with musculoskeletal complaints enrolled in a primary care unit and prompt a discussion on how complete the services provided by these units are. This study was carried out in a primary care unit and various households, among subjects aging 20 years or older. A functionality assessment tool and a Visual Analogue Scale were applied, and social and demographic issues were also considered. By using these tools, it was made an attempt to evaluate the profile of individuals in association with their degree of musculoskeletal pain and the degree of functionality in the activities of their daily lives, ages and occupations. We found a predominance of women in both groups: 84.37% and 81.25%, respectively. Nearly half of all people with musculoskeletal pain were housewives, and the average age between groups was over 55.     

Technological functionality of inulin and oligofructose

Inulin and oligofructose are functional food ingredients which offer a unique combination of nutritional properties and important technological benefits. They are found in many vegetables and fruits and can be industrially obtained from chicory roots. In food formulations, inulin and oligofructose may significantly improve organoleptic characteristics. Their incorporation allows upgrading of both taste and mouthfeel in a wide range of food applications. Oligofructose is highly soluble and possesses technological properties that are closely related to those of sugar and glucose syrups. It is often used in combination with high intensity sweeteners. Inulin has a much lower solubility, improves the stability of foams and emulsions and shows exceptional fat-like characteristics when used under the form of a gel in water. Fat and carbohydrate replacement with chicory inulin and oligofructose offers the advantage of not compromising on taste and texture, while delivering nutritionally enhanced products.     

Application of clinical workstations: functionality and usability

Clinical workstations are software systems that support physicians and nurses in all their specific activities concerned with the medical care of inpatients. In the university hospital of Saarland, we are testing several commercial systems so as to whether they can give such comprehensive support. For their evaluation, we developed a list of criteria grouped in functions to support the physicians, functions to support the nurses, and general functions, together with a grading schema. Besides scope and quality of functions, the acceptance of clinical workstations strongly depends on organizational environment and human factors. To evaluate these conditions, we interviewed all people concerned with the system, using a checklist. The following are examples of problems that we detected: "Facts" (new design of work flow, eg, for examination or nursing procedures); some tasks have to be performed twice; reaction to emergencies; frequent changes of staff. Technical deficiencies (response times too long; mobile data collection was insufficient due to width of display and lack of data consistency, eg, during the doctor's visit). Psychological factors (fear of using computers; statements such as "Medical work cannot be planned" or "Too few benefits from the system"; in view of increasing "transparency," no use for electronic scheduling; insufficient understanding of work flow of automated tasks). The consequences of this study are the introduction of clinical workstations in hospital needs, as well as reengineering the business processes of the ward as a careful and intensive training of staff. This article will present and discuss methods and results of this evaluation study.     

Short-Term Dietary Supplementation of Blueberry Polyphenolics: Beneficial Effects on Aging Brain Performance and Peripheral Tissue Function

Emerging evidence from our lab indicate that fruits and vegetables, in particular blueberry (BB) extracts, are able to ameliorate age-related declines in neuronal and cognitive function, common in disorders such as Alzheimer disease. The current study examined if the beneficial effects were also discernable with supplementation of BB extracts, in an already well balanced diet. Indeed, following an 8 week supplementation regime, age-related declines in several behavioral parameters such as balance, coordination, working memory and reference memory were still protected against. Similarly, BB extracts also potentiated oxotremorine enhancement of K⁺-evoked release of dopamine from striatal slices. Decline in the dopaminergic system have been shown to have a profound effect on cognitive functions. The improvement in dopamine release may have been due in part to the observed increase in striatal vitamin C levels. Although assessment of serum transaminase levels in BB supplemented animals appeared to suggest improved liver function, this was not thought to be the reason for the elevated vitamin C levels. The underlying mechanism for this is unclear. Together these findings highlight the diverse in vivo actions of dietary polyphenolics, a number of which may be important against age-related declines in certain brain functions. Furthermore they are to be able to mediate protective effects despite the diet containing sufficient concentrations of antioxidants.     

Total phenolic contents and free-radical scavenging activities of grape (Vitis vinifera L.) and grape products

Grape is one of the world's largest fruit crops, with an approximate annual production of 58 million metric tons, and it is well known that the grape skins, seeds and stems, waste products generated during wine and grape juice processing, are rich sources of polyphenols. It contains flavonoids, phenolic acids and stilbenes. In this study, we tried to determine antioxidant properties and phenolic contents of grape and grape products (fresh fruit, seed, dried fruit, molasses, pestil, vinegar) of ethanol and water extracts. Antioxidant properties of extracts were investigated by DPPH^√, ABTS^√+, superoxide, H₂O₂ scavenging, reducing power, metal chelating activity and determination of total phenolic contents. The seed extracts revealed highest ABTS^√+, DPPH^√, H₂O₂ scavenging and reducing power activities. Furthermore, these extracts showed higher total phenolic contents than other grape product extracts.     

Evaluation of fatty acid profiles and mineral content of grape seed oil of some grape genotypes

The grape seeds of seven grape cultivars (Alphonse Lavallée, Muscat of Hamburg, Alicante Bouschet, Razak?, Narince, Öküzgözü and Horoz karas?) and two rootstocks (Salt creek and Cosmo 2) were evaluated in terms of quality properties including protein, oil, moisture, ash, fatty acid composition and mineral contents. The oil contents were found to be different for each cultivar, which ranged from 10.45% (Razak?) to 16.73% (Salt creek). Saturated fatty acid values were less than the values of monounsaturated fatty acids and polyunsaturated fatty acids in all genotypes. Among the identified fatty acids, linoleic acid (C18:2) was the predominant fatty acid and followed by oleic acid (C18:1) and palmitic acid (C16:0) in all varieties. The results of mineral analysis showed that all varieties contained considerable amount of macro and micro elements. These grape seeds could be used as a food supplement to improve the nutritive value of the human diet.     

Evaluation of fatty acid profiles and mineral content of grape seed oil of some grape genotypes

The grape seeds of seven grape cultivars (Alphonse Lavallée, Muscat of Hamburg, Alicante Bouschet, Razaki, Narince, Oküzg?zü and Horoz karasi) and two rootstocks (Salt creek and Cosmo 2) were evaluated in terms of quality properties including protein, oil, moisture, ash, fatty acid composition and mineral contents. The oil contents were found to be different for each cultivar, which ranged from 10.45% (Razaki) to 16.73% (Salt creek). Saturated fatty acid values were less than the values of monounsaturated fatty acids and polyunsaturated fatty acids in all genotypes. Among the identified fatty acids, linoleic acid (C18:2) was the predominant fatty acid and followed by oleic acid (C18:1) and palmitic acid (C16:0) in all varieties. The results of mineral analysis showed that all varieties contained considerable amount of macro and micro elements. These grape seeds could be used as a food supplement to improve the nutritive value of the human diet.     

高效液相色谱法测定葡萄皮和葡萄籽中白藜芦醇的含量

测定不同品种葡萄皮和葡萄籽及酿酒后的葡萄皮渣中白藜芦醇的含量。应用乙腈 -水 (2 6∶74 )为流动相 ,检测波长 (λ)为 30 3nm ,柱温为 35℃ ,色谱柱 :SUPELCOSILTMLC 18(2 5 0mm× 4 6mm ,5 μm)。结果显示 ,葡萄皮中的白藜芦醇含量高于葡萄籽 ;不同品种葡萄皮中白藜芦醇含量差异较大 ,琐琐葡萄最低为0 985 0 μg g ,红克里米斯克葡萄最高为 15 4 195 μg g;同一产地同一品种葡萄皮中白藜芦醇含量依次为酿酒后的葡萄皮 >新鲜葡萄皮 >陈旧葡萄皮 ,且差异有统计学意义     

Issues in the design, analysis and interpretation of condom functionality studies

Background

Male condom functionality studies are typically crossover trials in which enrolled couples use both experimental and latex control condoms for sexual intercourse. Noninferiority of the experimental type is assessed using confidence intervals for differences in breakage and slippage probabilities. Seemingly straightforward, the design, analysis and interpretation of functionality studies are complicated by the choice of noninferiority criterion, study population and the potential for learning effects.

Methods

Power calculations, secondary data analyses and simulations were used to illustrate concerns and make recommendations.

Results

The probability of failure can be too low to draw meaningful conclusions in certain population subgroups. Learning effects among inexperienced users can exaggerate differences in performance and undermine power. A product which is, on average, inferior to latex may still be a viable prophylactic for a large percentage of couples.

Conclusions

Heterogeneity of failure probabilities, combined with small acceptable differences in performance, requires care when selecting study participants. Pilot data, adequate training on condom use and reasonable expectations regarding performance of a new condom type are essential to maximizing the chance of identifying a noninferior product.     

Plant protein ingredients with food functionality potential

Proteins play many technological, physicochemical and sensory roles (i.e. functionalities) in foods, including solubility, emulsifying, gelling, foaming and flavour creation. In comparison with animal proteins, plant proteins have different structure, composition and food functionality. This review discusses how protein can be extracted from plant materials to produce protein‐rich ingredients for creating plant‐based foods. It explores the potential for a new generation of semi‐purified plant‐derived ingredients with greater sustainability and health benefits.     

葡萄籽提取物的体外抗脂质过氧化作用

以大鼠肝、脑组织匀浆为材料研究葡萄籽提取物 (GSE)的抗氧化作用。组织匀浆与GSE共浴后 ,比色法测定丙二醛 (MDA)生成量。组织匀浆与GSE共浴后 ,分别以自由基诱导剂CCl4、H2 O2 和铁离子 -抗坏血酸 (Fe2 + VC)激发脂质过氧化作用 ,以MDA产生和还原型谷胱甘肽 (GSH)耗竭作为脂质过氧化作用程度指标。结果表明 ,GSE可明显降低大鼠肝、脑组织自发性MDA的生成 ,减轻CCl4、H2 O2 、Fe2 + VC所致的肝脏脂质过氧化反应 ,减轻肝组织GSH耗竭。提示GSE具有良好的抗脂质过氧化作用。     

Review: Production and functionality of active peptides from milk

In recent years, research on the production of active peptides obtained from milk and their potential functionality has grown, to a great extent. Bioactive peptides have been defined as specific protein fragments that have a positive impact on body functions or conditions, and they may ultimately have an influence on health. Individual proteins of casein or milk-derived products such as cheese and yogurt have been used as a protein source to study the isolation and activity of peptides with several applications. Currently, the milk whey waste obtained in the production of cheese also represents a protein source from which active peptides could be isolated with potential industrial applications. The active properties of milk peptides and the results found with regard to their physiological effects have led to the classification of peptides as belonging to the group of ingredients of protein nature, appropriate for use in functional foods or pharmaceutical formulations. In this study, the main peptides obtained from milk protein and the past research studies about its production and biological activities will be explained. Second, an analysis will be made on the methods to determinate the biological activities, the separation of bioactive peptides and its structure identification. All of these form the base required to obtain synthetic peptides. Finally, we explain the experimental animal and human trials done in the past years. Nevertheless, more research is required on the design and implementation of equipment for the industrial production and separation of peptides. In addition, different authors suggest that more emphasis should therefore be given to preclinical studies, proving that results are consistent and that effects are demonstrated repeatedly by several research human groups.     

Safety, functionality and acceptability of a prototype polyurethane condom

Male condoms made from synthetic materials offer an alternative to latexcondoms that may be more acceptable to users, thereby potentially resultingin more protected acts of intercourse. A prospective, noncomparativeclinical study was conducted to evaluate the safety of using certainpolyurethane materials to make condoms. Fifty-one healthy, contracepting,mutually monogamous couples were recruited between June 30 and November 24,1993 to use a prototype roll-on polyurethane condom developed by FamilyHealth International. Couples were to use the condoms for 10 consecutiveacts of vaginal intercourse over a 4-week period. Baseline and postexposuregenital examinations, including colposcopy for female participants, wereperformed. Fifty couples completed the study requirements and 517 acts ofintercourse occurred using the condoms. Two adverse events were reported:irritation of introitus in a female participant and a small irritatederythematous lesion on a male participants penis. Neither event wasconsidered to be serious and both were resolved without treatment. Breakageand slippage rates were similar to those reported for latex condoms. Theseresults suggest that polyurethane condoms represent a safe, functional andacceptable alternative to latex condoms.