Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records

Purpose The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. Methods We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. Results We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Conclusions Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities.

Sexual dimorphism in a dioecious population of the wind-pollinated herb Mercurialis annua: the interactive effects of resource availability and competition.

Background and Aims Male-biased sex allocation commonly occurs in wind-pollinated hermaphroditic plants, and is often positively associated with size, notably in terms of height. Currently, it is not well established whether a corresponding pattern holds for dioecious plants: do males of wind-pollinated species exhibit greater reproductive allocation than females? Here, sexual dimorphism is investigated in terms of life history trade-offs in a dioecious population of the wind-pollinated ruderal herb Mercurialis annua.Methods The allocation strategies of males and females grown under different soil nutrient availability and competitive (i.e. no, male or female competitor) regimes were compared.Key Results Male reproductive allocation increased disproportionately with biomass, and was greater than that of females when grown in rich soils. Sexual morphs differentially adjusted their reproductive allocation in response to local environmental conditions. In particular, males reduced their reproductive allocation in poor soils, whereas females increased theirs, especially when competing with another female rather than growing alone. Finally, males displayed smaller above-ground vegetative sizes than females, but neither nutrient availability nor competition had a strong independent effect on relative size disparities between the sexes.Conclusions Selection appears to favour plasticity in reproductive allocation in dioecious M. annua, thereby maintaining a relatively constant size hierarchy between sexual morphs. In common with other dioecious species, there seems to be little divergence in the niches occupied by males and females of M. annua.

Expressão sexual do mamoeiro sob diferentes lâminas de irrigação na Região Norte Fluminense

O aparecimento de flores imperfeitas nas plantas hermafroditas do mamoeiro está relacionado a fatores genéticos, os quais são afetados pelo ambiente. Condições de alta umidade, altos teores de nitrogênio e de água no solo tendem a mudar o sexo das flores hermafroditas, produzindo frutos deformados. O objetivo deste trabalho foi estudar o comportamento do mamoeiro 'Improved Sunrise Solo 72/12', na produção dos diferentes tipos de flores hermafroditas, em relação à aplicação de diferentes lâminas de água, na região Norte Fluminense. O experimento foi conduzido sob delineamento em blocos casualizados com sete tratamentos (lâminas de irrigação), três repetições e cinco plantas úteis em cada parcela experimental. Foi utilizado um sistema de irrigação por microaspersão para aplicação de água. Os níveis de irrigação aplicados foram sete percentagens da evapotranspiração de referência (T1 = 0; T2 = 40; T3 = 80; T4 = 120; T5 = 160; T6 = 200 e T7 = 240 % da ET0). Após o início do florescimento foram avaliados, mensalmente, os números de flores estéreis, de frutos carpelóides e pentândricos. A ocorrência de flores estéreis foi responsável pelas maiores perdas na produção e foi maior no verão e agravada pelo déficit hídrico. A adoção de uma lâmina em torno de 120% da ETo minimizou as perdas pela produção de flores imperfeitas.

Evaluación de algunos aspectos del comportamiento sexual: instrumentos de medida para uso clínico

En este artículo se revisa el tema de la evaluación de los trastornos psicosexuales haciendo hincapié en los instrumentos de auto-evaluación. En la bibliografía anglosajona existen muchas referencias a estos inventarios. En los últimos 5 años sólo en la revista Journal of Sex Marital Therapy se citan 23 de los más usuales. En nuestro ámbito existen pocos, y estos son a menudo traducciones y adaptaciones no validadas de los referidos en las revistas anglosajonas. Hemos querido tratar en profundidad dos de los inventarios más conocidos: el Sexual Arousability Inventori (SAI) y el Sexual Interaction Inventory. El primero ha sido validado en muestras españolas. Se proporciona suficiente información para que el lector pueda utilizar estos instrumentos en su práctica clínica, y se le incita a que se ofrezcan datos obtenidos en muestras españolas para corroborar sus características psicométricas y de utilidad clínica.

Validación española del autoinforme de ansiedad y excitación sexual ampliado (SAI-E)

El objetivo del presente trabajo es el estudio de la fiabilidad y validez de la adaptación española del Sexual Arousability Inventory-Expanded (SAI-E), en una muestra de 350 mujeres de edades comprendidas entre los 19 y 45 años, con un nivel educativo medio o superior, y de considerable experiencia sexual. Los resultados obtenidos muestran niveles de consistencia interna y validez aceptables. Asimismo permiten disponer en nuestro ámbito de un instrumento de gran utilidad para el diagnóstico de los trastornos psicosexuales y para la investigación en epidemiología sexual.

Inventario de excitación y ansiedad sexual ampliado (SAI-E): subescalas por derivación factorial

Se realiza un análisis de componentes principales de las escalas de Excitación y Ansiedad del SAI-E a fin de derivar subescalas que proporcionen mejor y más información sobre el contenido del cuestionario. Los factores obtenidos mantienen una gran afinidad con los resultados de Chambless. Las subescalas de Excitación se encuentran muy correlacionadas con las variables de frecuencia de coito, frecuencia de masturbación y con un listado de variedad de conductas sexuales (Bentler). Las subescalas de Ansiedad muestran correlaciones negativas con las variables sexuales anteriores. La fiabilidad alfa de las subescalas derivadas factorialmente es aceptable.