Co-EditoRS in chiEf Virender Bhan, Md, FrCPC. director, dalhousie MS research Unit; Assistant Professor, department of Neurology, dalhousie University, halifax franois Grand'Maison, Md, FrCPC. Chief, Neurology, hpital Charles LeMoyne; director, Neuro rive-Sud MS Clinic; Associate Professor, University of Sherbrooke EditoRiAl BoARd douglas l. Arnold, Md. director, Clinical research Unit, Montral Neurological institute; Professor of Neurology, McGill University Amit Bar-or, Md, FrCPC. Assistant Professor, Neurology and Neurosurgery, Montral Neurological institute; Associate Professor in Microbiology and immunology, McGill University Mark S. freedman, Md, FrCPC. director, MS research Clinic, the ottawa hospital; Professor of Medicine Neurology ; , University of ottawa Andrew J. Gomori, bSc, Md, FAAN, FrCPC. Associate Professor, Section of Neurology, department of Medicine, University of Manitoba colleen harris, rN, MN, MScN. Nurse Practitioner Nurse Co-ordinator Calgary MS Clinic, Calgary.
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6 Current Pharmaceutical Design, 2006, Vol. 12, No. 1.
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The clinical utility of drug-resistance testing has gained a significant amount of steam over the past few years. For evidence of this, one need not look further than the most recent set of recommendations issued by a blue-ribbon panel--of which Dr. Hammer was a participant--convened by the International AIDS Society-USA IAS-USA ; . With several retrospective and prospective studies now concluded, the IAS-USA panelists were in agreement that drug-resistance testing should be officially incorporated into patient management in some settings Hirsch, 2000 ; . This is not to say that any drug-resistance testing recommendations are written in stone. The IAS-USA panelists dutifully warned clinicians in their May 2000 consensus statement in the Journal of the American Medical Association JAMA ; that "unresolved technical issues regarding drugresistance testing remain" and that "definitive data to support final recommendations are not yet available." Yet, based on and glucophage.
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The basic CLEF information flow is shown in Figure 1. The top cycle represents the information capture from the clinician into the repository and its use either for clinical care of research. Starting with the "Patient care and dictated text" at the top of the diagram, the flow is: Capture of the information. Some information comes from dictated and transcribed text .Other information comes directly from hospital information systems e.g. laboratory results, prescriptions, etc. Pseudonymisation of all information by removal of overt identifying items name, date of birth, etc - and by providing a CLEF Entry identifier that can only be reversed by the NHS provider or a trusted third party. Depersonalisation of the texts to remove any residual information that might risk identification e.g. names of relatives, nick names, place names, unusual occupations, etc. Information extraction of key information from the texts into predefined "templates", possibly with the help of context provided by the information already in the repository. Integration into the health record repository of all information including laboratories, radiology, and potentially genomic analyses Constructing the chronicle to infer a coherent view of the patient's history. Typically the same information occurs in many different documents with different levels of granularity, clarity and sometimes conflicts that must be reconciled. From this point the information can go in two directions. Back to the clinicians in the form of summaries for patient which can be reidentified by the hospital. Providing a concise up-to-date summary of a patients' condition is a prime request of clinicians for improving patient care. On to researchers in response to queries. The overall use of the repository for research is under the control of an Ethical Oversight Committee to which researchers must apply to gain access to anything except pre-computed results and metadata. Despite other precautions, it is assumed that if individual records can be read in detail, there is the risk of identification. Therefore, all information is treated with the as if it were for identifiable. [4]. Most researchers will be accredited only for aggregated results controlled through the privacy and glucotrol.
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