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Background: The journal Methods of Information in Medicine, founded in 1962, has now completed its 50th volume. Its publications during the last five decades reflect the formation of a discipline that deals with information in biomedicine and health care.Objectives: To report about 1) the journal's origin, 2) the individuals who have significantly contributed to it, 3) trends in the journal's aims and scope, 4) influential papers and 5) major topics published in Methods over the years.Methods: Methods included analysing the correspondence and journal issues in the archives of the editorial office and of the publisher, citation analysis using the ISI and Scopus databases, and analysing the articles' Medical Subject Headings (MeSH) in MEDLINE.Results: In the journal's first 50 years 208 editorial board members and/or editors contributed to the journal's development, with most individuals coming from Europe and North America. The median time of service was 11 years. At the time of analysis 2,456 articles had been indexed with MeSH. Topics included computerized systems of various types, informatics methodologies, and topics related to a specific medical domain. Some MeSH topic entries were heavily and regularly represented in each of the journal's five decades (e.g. information systems and medical records), while others were important in a particular decade, but not in other decades (e.g. punched-card systems and systems integration). Seven papers were cited more than 100 times and these also covered a broad range of themes such as knowledge representation, analysis of biomedical data and knowledge, clinical decision support and electronic patient records.Conclusions: Methods of Information in Medicine is the oldest international journal in biomedical informatics. The journal's development over the last 50 years correlates with the formation of this new discipline. It has and continues to stress the basic methodology and scientific fundamentals of organizing, representing and analysing data, information and knowledge in biomedicine and health care. It has and continues to stimulate multidisciplinary communication on research that is devoted to high-quality, efficient health care, to quality of life and to the progress of biomedicine and the health sciences. [ABSTRACT FROM AUTHOR]

Background: Founded in 1962 and, therefore, the oldest international journal in medical informatics, Methods of Information in Medicine will publish its 50th volume in 2011. At the start of the journal's sixth decade, a discussion on the journal's profile seems appropriate.Objectives: To report on the new opportunities for online access to Methods publications as well as on the recent strategic decisions regarding the journal's aims and editorial policies.Methods: Describing and analyzing the journal's aims and scope. Reflecting on recent publications and on the journal's development during the last decade.Results: From 2011 forward all articles of Methods from 1962 until the present can be accessed online. Methods of Information in Medicine stresses the basic methodology and scientific fundamentals of processing data, information and knowledge in medicine and health care. Although the journal's major focus is on publications in medical informatics, it has never been restricted to publications only in this discipline. For example, articles in medical biometry, in or close to biomedical engineering, and, later, articles in bioinformatics continue to be a part of this journal.Conclusions: There is a continuous and, as it seems, ever growing overlap in the research methodology and application areas of the mentioned disciplines. As there is a continuing and even growing need for such a publication forum, Methods of Information in Medicine will keep its broad scope. As an organizational consequence, the journal's number of associate editors has increased accordingly. [ABSTRACT FROM AUTHOR]

Planning the clinical evaluation of a computerized decision support system requires a strategy that encompasses the different aspects of the clinical problem, the technical difficulties of software and hardware integration and implementation, the behavioral aspects of the targeted users, and the discipline of study design. Although clinical information systems are becoming more widely available, only a few decision support systems have been formally evaluated in clinical environments. Published accounts of difficulties associated with the clinical evaluation of decision support systems remain scarce. The authors report on a variety of behavioral, logistical, technical, clinical, cost, and work flow issues that they had to address when choosing a study design for a clinical trial for the evaluation of an integrated, real-time decision support system for the automatic identification of patients likely to have pneumonia in an emergency department. In the absence of a true gold standard, they show how they created a credible, clinically acceptable, and economical reference standard for the diagnosis of pneumonia, to determine the overall accuracy of the system. For the creation of a reference standard, they describe the importance of recognizing verification bias and avoiding it. Finally, advantages and disadvantages of different study designs are explored with respect to the targeted users and the clinical setting. [ABSTRACT FROM AUTHOR]

Objectives: Prolonged emergency department (ED) length of stay (LOS) is linked to adverse outcomes, decreased patient satisfaction, and ED crowding. This multicenter study identified factors associated with increased LOS.Methods: This retrospective study included 9 EDs from across the United States. Emergency department daily operational metrics were collected from calendar year 2009. A multivariable linear population average model was used with log-transformed LOS as the dependent variable to identify which ED operational variables are predictors of LOS for ED discharged, admitted, and overall ED patient categories.Results: Annual ED census ranged from 43,000 to 101,000 patients. The number of ED treatment beds ranged from 27 to 95. Median overall LOS for all sites was 5.4 hours. Daily percentage of admitted patients was found to be a significant predictor of discharged and admitted patient LOS. Higher daily percentage of discharged and eloped patients, more hours on ambulance diversion, and weekday (vs weekend) of patient presentation were significantly associated with prolonged LOS for discharged and admitted patients (P < .05). For each percentage of increase in discharged patients, there was a 1% associated decrease in overall LOS, whereas each percentage of increase in eloped patients was associated with a 1.2% increase in LOS.Conclusions: Length of stay was increased on days with higher percentage daily admissions, higher elopements, higher periods of ambulance diversion, and during weekdays, whereas LOS was decreased on days with higher numbers of discharges and weekends. This is the first study to demonstrate this association across a broad group of hospitals. [ABSTRACT FROM AUTHOR]

The goal of this study was to determine the accuracy and the impact of 5 different claims-based pneumonia definitions. Three International Classification of Diseases, Version 9, (ICD-9), and 2 diagnosis-related group (DRG)-based case identification algorithms were compared against an independent, clinical pneumonia reference standard. Among 10748 patients, 272 (2.5%) had pneumonia verified by the reference standard. The sensitivity of claims-based algorithms ranged from 47.8% to 66.2%. The positive predictive values ranged from 72.6% to 80.8%. Patient-related variables were not significantly different from the reference standard among the 3 ICD-9-based algorithms. DRG-based algorithms had significantly lower hospital admission rates (57% and 65% vs 73.2%), lower 30-day mortality (5.0% and 5.8% vs 10.7%), shorter length of stay (3.9 and 4.1 days vs 5.6 days), and lower costs (USD $4543 and USD $5159 vs USD $8585). Claims-based identification algorithms for defining pneumonia in administrative databases are imprecise. ICD-9-based algorithms did not influence patient variables in our population. Identifying pneumonia patients with DRG codes is significantly less precise. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the rate and type of errors in biomedical informatics journal article references. METHODS: References in articles from the first 2004 issues of five biomedical informatics journals, Journal of the American Medical Informatics Association, Journal of Biomedical Informatics, International Journal of Medical Informatics, Methods of Information in Medicine, and Artificial Intelligence in Medicine were compared with MEDLINE for journal, authors, title, year, volume, and page number accuracy. If discrepancies were identified, the reference was compared with the original publication. Two reviewers independently evaluated each reference. RESULTS: The five journal issues contained 37 articles. Among the 656 eligible references, 225 (34.3%) included at least one error. Among the 225 references, 311 errors were identified. One or more errors were found in the bibliography of 31 (84%) of the 37 articles. The reference error rates by journal ranged from 22.1% to 40.7%. Most errors (39.0%) occurred in the author element, followed by the journal (31.2%), title (17.7%), page (7.4%), year (3.5%), and volume (1.3%) information. CONCLUSION: The study identified a considerable error rate in the references of five biomedical informatics journals. Authors are responsible for the accuracy of references and should more carefully check them, possibly using informatics-based assistance. [ABSTRACT FROM AUTHOR]

Study Objective: Ewig et al. proposed a new definition of severe community-acquired pneumonia in 1999, which was adopted by the American Thoracic Society in 2001. We evaluated this definition in an independent population of emergency department patients.Design: We compared the 2001 American Thoracic Society definition of severe community-acquired pneumonia using emergency department data to intensive care unit (ICU) admission, use of mechanical ventilation, and administration of vasopressors.Setting: LDS Hospital, a tertiary care, university-affiliated hospital with 520 total beds and 68 ICU beds in Salt Lake City, UT.Patients: We studied 980 consecutive emergency department patients with a radiographically confirmed diagnosis of pneumonia between June 1995 and June 1999. Of these patients, 498 were admitted to the hospital, immunocompetent, and without a "do-not-resuscitate" order within 24 hrs of admission.Measurements and Main Results: Forty-seven patients met the criteria for severe community-acquired pneumonia in the emergency department and were admitted to the ICU. Three hundred eighty patients did not meet the criteria and were admitted to a hospital unit. Nineteen patients met the definition but were admitted to a hospital unit; only one required subsequent ICU admission. Two of the 19 died after a do-not-resuscitate order was entered >24 hrs after admission; the remainder recovered. Fifty-two patients were triaged to the ICU but did not initially meet the definition of severe pneumonia. Sixteen of these 52 patients required mechanical ventilation, 13 of the 16 within 24 hrs of admission to the ICU. The sensitivity for the 2001 American Thoracic Society definition in our population was 44%, specificity was 95%, positive predictive value was 71%, and negative predictive value was 88%.Conclusion: The 2001 American Thoracic Society definition of severe community-acquired pneumonia had high specificity but lower sensitivity in our population compared with the derivation population. Additional factors not reflected in the definition may contribute to ICU admission and the need for mechanical ventilation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Do-not-resuscitate (DNR) orders and advance directives are increasingly prevalent and may affect medical interventions and outcomes. Simple, automated techniques to identify patients with DNR orders do not currently exist but could help avoid costly and time-consuming chart review. This study hypothesized that a decision to withhold cardiopulmonary resuscitation would be included in a patient's dictated reports. The authors developed and validated a simple computerized search method, which screens dictated reports to detect patients with DNR status. METHODS: A list of concepts related to DNR order documentation was developed using emergency department, hospital admission, consult, and hospital discharge reports of 665 consecutive, hospitalized pneumonia patients during a four-year period (1995-1999). The list was validated in an independent group of 190 consecutive inpatients with pneumonia during a five-month period (1999-2000). The reference standard for the presence of DNR orders was manual chart review of all study patients. Sensitivity, specificity, predictive values, and nonerror rates were calculated for individual and combined concepts. RESULTS: The list of concepts included: DNR, Do Not Attempt to Resuscitate (DNAR), DNI, NCR, advanced directive, living will, power of attorney, Cardiopulmonary Resuscitation (CPR), defibrillation, arrest, resuscitate, code, and comfort care. As determined by manual chart review, a DNR order was written for 32.6% of patients in the derivation and for 31.6% in the validation group. Dictated reports included DNR order-related information for 74.5% of patients in the derivation and 73% in the validation group. If mentioned in the dictated report, the combined keyword search had a sensitivity of 74.2% in the derivation group (70.0% in the validation group), a specificity of 91.5% (81.5%), a positive predictive value of 80.9% (63.6%), a negative predictive value of 88.0% (85.5%), and a nonerror rate of 85.9% (77.9%). DNR and resuscitate were the most frequently used and power of attorney and advanced directives the least frequently used terms. CONCLUSION: Dictated hospital reports frequently contained DNR order-related information for patients with a written DNR order. Using an uncomplicated keyword search, electronic screening of dictated reports yielded good accuracy for identifying patients with DNR order information. [ABSTRACT FROM AUTHOR]

The article offers information on the 14th World Congress on Medical and Health Informatics (Medlnfo2013) conference to be held in Copenhagen, Denmark from August 20-23, 2013.