Mapping the Entire Record—An Alternative Approach to Data Access from Medical Logic Modules

Objectives This study aimed to describe an alternative approach for accessing electronic medical records (EMRs) from clinical decision support (CDS) functions based on Arden Syntax Medical Logic Modules, which can be paraphrased as “map the entire record.” Methods Based on an experimental Arden Syntax processor, we implemented a method to transform patient data from a commercial patient data management system (PDMS) to tree-structured documents termed CDS EMRs. They are encoded in a specific XML format that can be directly transformed to Arden Syntax data types by a mapper natively integrated into the processor. The internal structure of a CDS EMR reflects the tabbed view of an EMR in the graphical user interface of the PDMS. Results The study resulted in an architecture that provides CDS EMRs in the form of a network service. The approach enables uniform data access from all Medical Logic Modules and requires no mapping parameters except a case number. Measurements within a CDS EMR can be addressed with straightforward path expressions. The approach is in routine use at a German university hospital for more than 2 years. Conclusion This practical approach facilitates the use of CDS functions in the clinical routine at our local hospital. It is transferrable to standard-compliant Arden Syntax processors with moderate effort. Its comprehensibility can also facilitate teaching and development. Moreover, it may lower the entry barrier for the application of the Arden Syntax standard and could therefore promote its dissemination.

Professionals’ involvement of relatives – only good intentions?

Purpose The purpose of this paper is to explore how, and under what conditions, professionals involve relatives in clinical practice. Design/methodology/approach Two cases were constructed from two studies in Denmark, theoretically inspired by Bourdieu’s concepts of doxa and position and analyzed with focus on the involvement of relatives from the perspective of professionals. Findings Support to relatives in practice is rarely included in the way that treatment and care are organized in healthcare. Professionals’ views of the involvement of relatives were characterized by the values of neoliberal ideology and medical-professional rationality, in which relatives are not regarded as a subject of care and support in clinical practice. The involvement of relatives aimed to ensure patients’ participation in randomized clinical trial and to help professionals to care for patients when the professionals were not absolutely needed. Professionals were relatively higher positioned in the clinic than relatives were, which allowed professionals to in – and exclude relatives. Neoliberal ideology and medical-professional rationality go hand in hand when it comes to patient treatment, care and the involvement of relatives; it is all about efficiency, treatment optimization and increased social control of the diagnosed patient. These neoliberal, organizational values consolidate doxa of the medical field and the positions that govern the meeting with patients’ relatives – if it takes place at all. Originality/value The results put into perspective how the combination of neoliberalism and medical logic work as an organizing principle in contemporary healthcare systems, and challenge a normative, humanistic view on involving patients’ relatives in the medical clinic.

After war

In the United States – as in other places in the ambit of biomedicine – the efforts exerted on and by injured soldiers’ bodies in the aftermath of war are generally understood under the familiar medical rubric of ‘rehabilitation’. This reflection troubles that term by moving away from the medical logic of rehabilitation and its telos of injury and healing, and the logics that see injured soldiers as promising bodies. Instead, the think piece explores a wider range of practices of attention to injured soldiers’ bodies that emerge ethnographically, and traces embodied forms of being made within unsteady temporalities of life, health, and death after war, forms that call the temporality of rehabilitation into question and highlight care’s collateral affects. I reflect on the phenomenon of heterotopic ossification – bone growth at the site of injury that is a sign of healing that is also itself a form of injury – to think through the confounding analytical, ethical, political, and corporeal implications of such a space.

A Case Study of Modern Medical Practice and Islamic Complementary Therapy on a Patient with Over 2000 Embedded Nails

<p>In South East Asia, patients often resort to various forms of complementary therapy apart from utilizing mainstream modern medicine in Hospitals. Islamic-based complementary therapy employs various forms of bio-physical, psychological, social, cultural, and spiritual interventional methods based on the prevailing belief and cultural system to provide a holistic <em>Syariah</em> compliant approach in patient management. The concept of diseases caused by sorcery and paranormal means using intermediaries like Jinn and evil spirits that have been in existence since time immemorial across religions, cultures and societies around the world, for example, Homer in Ancient Greece, the legendary Medea, and Witch of Endor in the Bible. Currently, the practice of black magic and the belief in the paranormal still widely exist in the midst of modern civilization in this region. Modern medical practice has no definitive answer for a person with an unusual medical illness who is believed to have been afflicted by black magic because of its non-specific clinical presentation and non-response to conventional management paradigm which defies medical logic. In this paper, we describe a true case of a lady, 25 years-of-age, who suffered from more than 2000 nails embedded inside her body for one and a half years. Upon admission to a Hospital in Indonesia, she underwent a surgical procedure to remove all of the nails but to no avail; the nails re-appeared at other parts of her body. The surgical team later decided to conduct an Islamic complementary therapy on the patient, and subsequently, managed to extract all of the remaining nails without further bleeding. In conclusion, unusual or mysterious medical illness, sometimes referred to as idiopathic in etiology, not responding to conventional medical or surgical intervention, may potentially benefit from the use of Islamic complementary therapy.</p>

A Case Study of Modern Medical Practice and Islamic Complementary Therapy on a Patient with Over 2000 Embedded Nails

<p>In South East Asia, patients often resort to various forms of complementary therapy apart from utilizing mainstream modern medicine in Hospitals. Islamic-based complementary therapy employs various forms of bio-physical, psychological, social, cultural, and spiritual interventional methods based on the prevailing belief and cultural system to provide a holistic <em>Syariah</em> compliant approach in patient management. The concept of diseases caused by sorcery and paranormal means using intermediaries like Jinn and evil spirits that have been in existence since time immemorial across religions, cultures and societies around the world, for example, Homer in Ancient Greece, the legendary Medea, and Witch of Endor in the Bible. Currently, the practice of black magic and the belief in the paranormal still widely exist in the midst of modern civilization in this region. Modern medical practice has no definitive answer for a person with an unusual medical illness who is believed to have been afflicted by black magic because of its non-specific clinical presentation and non-response to conventional management paradigm which defies medical logic. In this paper, we describe a true case of a lady, 25 years-of-age, who suffered from more than 2000 nails embedded inside her body for one and a half years. Upon admission to a Hospital in Indonesia, she underwent a surgical procedure to remove all of the nails but to no avail; the nails re-appeared at other parts of her body. The surgical team later decided to conduct an Islamic complementary therapy on the patient, and subsequently, managed to extract all of the remaining nails without further bleeding. In conclusion, unusual or mysterious medical illness, sometimes referred to as idiopathic in etiology, not responding to conventional medical or surgical intervention, may potentially benefit from the use of Islamic complementary therapy.</p>