A database is an organized collection of data stored and accessed electronically from a computer system. Where databases are more complex they are developed using formal design and modeling techniques; the database management system is the software that interacts with end users and the database itself to capture and analyze the data. The DBMS software additionally encompasses; the sum total of the database, the DBMS and the associated applications can be referred to as a "database system". The term "database" is used to loosely refer to any of the DBMS, the database system or an application associated with the database. Computer scientists may classify database-management systems according to the database models that they support. Relational databases became dominant in the 1980s; these model data as rows and columns in a series of tables, the vast majority use SQL for writing and querying data. In the 2000s, non-relational databases became popular, referred to as NoSQL because they use different query languages.
Formally, a "database" refers to the way it is organized. Access to this data is provided by a "database management system" consisting of an integrated set of computer software that allows users to interact with one or more databases and provides access to all of the data contained in the database; the DBMS provides various functions that allow entry and retrieval of large quantities of information and provides ways to manage how that information is organized. Because of the close relationship between them, the term "database" is used casually to refer to both a database and the DBMS used to manipulate it. Outside the world of professional information technology, the term database is used to refer to any collection of related data as size and usage requirements necessitate use of a database management system. Existing DBMSs provide various functions that allow management of a database and its data which can be classified into four main functional groups: Data definition – Creation and removal of definitions that define the organization of the data.
Update – Insertion and deletion of the actual data. Retrieval – Providing information in a form directly usable or for further processing by other applications; the retrieved data may be made available in a form the same as it is stored in the database or in a new form obtained by altering or combining existing data from the database. Administration – Registering and monitoring users, enforcing data security, monitoring performance, maintaining data integrity, dealing with concurrency control, recovering information, corrupted by some event such as an unexpected system failure. Both a database and its DBMS conform to the principles of a particular database model. "Database system" refers collectively to the database model, database management system, database. Physically, database servers are dedicated computers that hold the actual databases and run only the DBMS and related software. Database servers are multiprocessor computers, with generous memory and RAID disk arrays used for stable storage.
RAID is used for recovery of data. Hardware database accelerators, connected to one or more servers via a high-speed channel, are used in large volume transaction processing environments. DBMSs are found at the heart of most database applications. DBMSs may be built around a custom multitasking kernel with built-in networking support, but modern DBMSs rely on a standard operating system to provide these functions. Since DBMSs comprise a significant market and storage vendors take into account DBMS requirements in their own development plans. Databases and DBMSs can be categorized according to the database model that they support, the type of computer they run on, the query language used to access the database, their internal engineering, which affects performance, scalability and security; the sizes and performance of databases and their respective DBMSs have grown in orders of magnitude. These performance increases were enabled by the technology progress in the areas of processors, computer memory, computer storage, computer networks.
The development of database technology can be divided into three eras based on data model or structure: navigational, SQL/relational, post-relational. The two main early navigational data models were the hierarchical model and the CODASYL model The relational model, first proposed in 1970 by Edgar F. Codd, departed from this tradition by insisting that applications should search for data by content, rather than by following links; the relational model employs sets of ledger-style tables, each used for a different type of entity. Only in the mid-1980s did computing hardware become powerful enough to allow the wide deployment of relational systems. By the early 1990s, relational systems dominated in all large-scale data processing applications, as of 2018 they remain dominant: IBM DB2, Oracle, MySQL, Microsoft SQL Server are the most searched DBMS; the dominant database language, standardised SQL for the relational model, has influenced database languages for other data models. Object databases were developed in the 1980s to overcome the inconvenience of object-relational impedance mismatch, which led to the coining of the term "post-relational" and the development of hybrid object-relational databas
A medical laboratory or clinical laboratory is a laboratory where clinical pathology tests are carried out on clinical specimens to obtain information about the health of a patient to aid in diagnosis and prevention of disease. Clinical Medical laboratories are an example of applied science, as opposed to research laboratories that focus on basic science, such as found in some academic institutions. Medical laboratories so offer a variety of testing services. More comprehensive services can be found in acute-care hospitals and medical centers, where 70% of clinical decisions are based on laboratory testing. Doctors offices and clinics, as well as skilled nursing and long-term care facilities, may have laboratories that provide more basic testing services. Commercial medical laboratories operate as independent businesses and provide testing, otherwise not provided in other settings due to low test volume or complexity. In hospitals and other patient-care settings, laboratory medicine is provided by the Department of Pathology, divided into two sections, each of which will be subdivided into multiple specialty areas.
The two sections are: Anatomic pathology: areas included here are histopathology and electron microscopy. Clinical pathology, which includes the following areas:Clinical Microbiology: This encompasses several different sciences, including bacteriology, parasitology and mycology. Clinical Chemistry: This area includes automated analysis of blood specimens, including tests related to enzymology and endocrinology. Hematology: This area includes manual analysis of blood cells, it often includes coagulation. Blood Bank involves the testing of blood specimens in order to provide blood transfusion and related services. Molecular diagnostics DNA testing may be done along with a subspecialty known as cytogenetics. Reproductive biology testing is available in some laboratories, including Semen analysis, Sperm bank and assisted reproductive technology. Layouts of clinical laboratories in health institutions vary from one facility to another. For instance, some health facilities have a single laboratory for the microbiology section, while others have a separate lab for each specialty area.
The following is an example of a typical breakdown of the responsibilities of each area: Microbiology includes culturing of clinical specimens, including feces, blood, cerebrospinal fluid, synovial fluid, as well as possible infected tissue. The work here is concerned with cultures, to look for suspected pathogens which, if found, are further identified based on biochemical tests. Sensitivity testing is carried out to determine whether the pathogen is sensitive or resistant to a suggested medicine. Results are reported with the identified organism and the type and amount of drug that should be prescribed for the patient. Parasitology is. For example, fecal samples may be examined for evidence of intestinal parasites such as tapeworms or hookworms. Virology is concerned with identification of viruses in specimens such as blood and cerebrospinal fluid. Hematology analyzes whole blood specimens to perform full blood counts, includes the examination of Blood films. Other specialized tests include cell counts on various bodily fluids.
Coagulation testing determines various blood clotting times, coagulation factors, platelet function. Clinical Biochemistry performs dozens of different tests on serum or plasma; these tests automated, includes quantitative testing for a wide array of substances, such as lipids, blood sugar and hormones. Toxicology is focused on testing for pharmaceutical and recreational drugs. Urine and blood samples are the common specimens. Immunology/Serology uses the process of antigen-antibody interaction as a diagnostic tool. Compatibility of transplanted organs may be determined with these methods. Immunohaematology, or Blood bank determines blood groups, performs compatibility testing on donor blood and recipients, it prepares blood components and products for transfusion. This area determines a patient's blood type and Rh status, checks for antibodies to common antigens found on red blood cells, cross matches units that are negative for the antigen. Urinalysis tests urine including microscopically. If more precise quantification of urine chemicals is required, the specimen is processed in the clinical biochemistry lab.
Histopathology processes solid tissue removed from the body for evaluation at the microscopic level. Cytopathology examines smears of cells from all over the body for evidence of inflammation and other conditions. Molecular diagnostics includes specialized tests involving DNA analysis. Cytogenetics involves using blood and other cells to produce a DNA karyotype; this can be helpful in cases of prenatal diagnosis as well as in some cancers which can be identified by the presence of abnormal chromosomes. Surgical pathology examines organs, tumors and other tissues biopsied in surgery such as breast mastectomies; the staff of clinical laboratories may include: Pathologist Clinical Biochemist Pathologists' Assistant Biomedical Scientist in the UK, Medical Laboratory Scientist in the US or Medical Laboratory Technologist in Canada Medical Laboratory Technician/Clinical Laboratory Technician Medical Laboratory Assistant Phlebotomist Histotechnologist/Histology Technician In the United States, there is a documented shortage of working laboratory professionals.
For example, in 2016 vacan
Electronic health record
An electronic health record, or electronic medical record, is the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, billing information. A decade ago, electronic health records were touted as key to increasing of quality care. Today, providers are using data from patient records to improve quality outcomes through their care management programs. Combining multiple types of clinical data from the system's health records has helped clinicians identify and stratify chronically ill patients. EHR can improve quality care by using the data and analytics to prevent hospitalizations among high-risk patients.
EHR systems are designed to store data and to capture the state of a patient across time. It eliminates the need to track down a patient's previous paper medical records and assists in ensuring data is accurate and legible, it can reduce risk of data replication as there is only one modifiable file, which means the file is more up to date, decreases risk of lost paperwork. Due to the digital information being searchable and in a single file, EMRs are more effective when extracting medical data for the examination of possible trends and long term changes in a patient. Population-based studies of medical records may be facilitated by the widespread adoption of EHRs and EMRs; the terms EHR, electronic patient record and EMR have been used interchangeably, although differences between the models are now being defined. The electronic health record is a more longitudinal collection of the electronic health information of individual patients or populations; the EMR, in contrast, is the patient record created by providers for specific encounters in hospitals and ambulatory environments, which can serve as a data source for an EHR.
In contrast, a personal health record is an electronic application for recording personal medical data that the individual patient controls and may make available to health providers. While there is still a considerable about of debate around the superiority of electronic health records over paper records, the research literature paints a more realistic picture of the benefits and downsides; the increased transparency and accessibility acquired by the adoption of electronic medical records may increase the ease with which they can be accessed by healthcare professionals, but can increase the amount of stolen information by unauthorized persons or unscrupulous users versus paper medical records, as acknowledged by the increased security requirements for electronic medical records included in the Health Information and Accessibility Act and by large-scale breaches in confidential records reported by EMR users. Concerns about security contribute to the resistance shown to their adoption. Handwritten paper medical records may be poorly legible.
Pre-printed forms, standardization of abbreviations and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records may help with the standardization of forms and data input. Digitization of forms facilitates the collection of data for clinical studies. However, standardisation may create challenges for local practice. Overall, those with EMRs, that have automated notes and records, order entry, clinical decision support had fewer complications, lower mortality rates, lower costs. EMRs can be continuously updated. If the ability to exchange records between different EMR systems were perfected, it would facilitate the co-ordination of health care delivery in non-affiliated health care facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance. However, it is difficult to remove data from its context.
Ambulance services in Australia, the United States and the United Kingdom have introduced the use of EMR systems. EMS Encounters in the United States are recorded using various platforms and vendors in compliance with the NEMSIS standard; the benefits of electronic records in ambulances include: patient data sharing, injury/illness prevention, better training for paramedics, review of clinical standards, better research options for pre-hospital care and design of future treatment options, data based outcome improvement, clinical decision support. Automated handwriting recognition of ambulance medical forms has been successful. For example, Intermedix TripTix offers handwriting support across all elements of the NEMSIS 3.3.4 and 3.4.0 standard as well as custom forms on Windows devices. These systems allow traditionally paper-based medical documents to be converted to digital at the time of entry with less cost overhead; the data can be efficiently used for epidemiological analysis, including de-identified data at the National level.
Digital formatting enables information to be used and shared over secure networks Track care and outcomes Trigger warnings and reminders Send and receive orders and results Decrease billing processing time and create more accurate billing systemHealth Information Exchange Technical and social fram
Simplified Chinese characters
Simplified Chinese characters are standardized Chinese characters prescribed in the Table of General Standard Chinese Characters for use in mainland China. Along with traditional Chinese characters, they are one of the two standard character sets of the contemporary Chinese written language; the government of the People's Republic of China in mainland China has promoted them for use in printing since the 1950s and 1960s to encourage literacy. They are used in the People's Republic of China and Singapore. Traditional Chinese characters are used in Hong Kong and the Republic of China. While traditional characters can still be read and understood by many mainland Chinese and the Chinese community in Malaysia and Singapore, these groups retain their use of simplified characters. Overseas Chinese communities tend to use traditional characters. Simplified Chinese characters may be referred to by their official name colloquially; the latter refers to simplifications of character "structure" or "body", character forms that have existed for thousands of years alongside regular, more complicated forms.
On the other hand, the official name refers to the modern systematically simplified character set, which includes not only structural simplification but substantial reduction in the total number of standardized Chinese characters. Simplified character forms were created by reducing the number of strokes and simplifying the forms of a sizable proportion of Chinese characters; some simplifications were based on popular cursive forms embodying graphic or phonetic simplifications of the traditional forms. Some characters were simplified by applying regular rules, for example, by replacing all occurrences of a certain component with a simplified version of the component. Variant characters with the same pronunciation and identical meaning were reduced to a single standardized character the simplest amongst all variants in form. Many characters were left untouched by simplification, are thus identical between the traditional and simplified Chinese orthographies; some simplified characters are dissimilar to and unpredictably different from traditional characters in those where a component is replaced by a simple symbol.
This has led some opponents of simplification to complain that the'overall process' of character simplification is arbitrary. Proponents counter that the system of simplification is internally consistent. Proponents have emphasized a some particular simplified characters as innovative and useful improvements, although many of these have existed for centuries as longstanding and widespread variants. A second round of simplifications was promulgated in 1977, but was retracted in 1986 for a variety of reasons due to the confusion caused and the unpopularity of the second round simplifications. However, the Chinese government never dropped its goal of further simplification in the future. In August 2009, the PRC began collecting public comments for a modified list of simplified characters; the new Table of General Standard Chinese Characters consisting of 8,105 characters was implemented for use by the State Council of the People's Republic of China on June 5, 2013. Although most of the simplified Chinese characters in use today are the result of the works moderated by the government of the People's Republic of China in the 1950s and 60s, character simplification predates the PRC's formation in 1949.
Cursive written text always includes character simplification. Simplified forms used in print are attested as early as the Qin dynasty. One of the earliest proponents of character simplification was Lufei Kui, who proposed in 1909 that simplified characters should be used in education. In the years following the May Fourth Movement in 1919, many anti-imperialist Chinese intellectuals sought ways to modernise China. Traditional culture and values such as Confucianism were challenged. Soon, people in the Movement started to cite the traditional Chinese writing system as an obstacle in modernising China and therefore proposed that a reform be initiated, it was suggested that the Chinese writing system should be either simplified or abolished. Lu Xun, a renowned Chinese author in the 20th century, stated that, "If Chinese characters are not destroyed China will die". Recent commentators have claimed that Chinese characters were blamed for the economic problems in China during that time. In the 1930s and 1940s, discussions on character simplification took place within the Kuomintang government, a large number of Chinese intellectuals and writers maintained that character simplification would help boost literacy in China.
In 1935, 324 simplified characters collected by Qian Xuantong were introduced as the table of first batch of simplified characters, but they were suspended in 1936. The PRC issued its first round of official character simplifications in two documents, the first in 1956 and the second in 1964. Within the PRC, further character simplification became associated with the leftists of the Cultural Revolution, culminating with the second-round simplified characters, which were promulgated in 1977. In part due to the shock and unease felt in the wake of the Cultural Revolution and Mao's death, the second-round of simplifications was poorly received. In 1986 the authorities retracted the second round completely. In the same year, the authorities promulgated a final list of simplifications, identical to the 1964 list except for six changes (including the restoration of three characters, simplified in the First Round: 叠, 覆, 像.
Digital Imaging and Communications in Medicine is the standard for the communication and management of medical imaging information and related data. DICOM is most used for storing and transmitting medical images enabling the integration of medical imaging devices such as scanners, workstations, network hardware, picture archiving and communication systems from multiple manufacturers, it has been adopted by hospitals, is making inroads into smaller applications like dentists' and doctors' offices. DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format; the different devices come with DICOM Conformance Statements which state which DICOM classes they support, the standard includes a file format definition and a network communications protocol that uses TCP/IP to communicate between systems. The National Electrical Manufacturers Association holds the copyright to the published standard, developed by the DICOM Standards Committee, whose members are partly members of NEMA.
It is known as NEMA standard PS3, as ISO standard 12052:2017 "Health informatics -- Digital imaging and communication in medicine including workflow and data management". DICOM is used worldwide to store and transmit medical images. DICOM has been central to the development of modern radiological imaging: DICOM incorporates standards for imaging modalities such as radiography, computed tomography, magnetic resonance imaging, radiation therapy. DICOM includes protocols for image exchange, image compression, 3-D visualization, image presentation, results reporting; the DICOM standard is divided into independent parts. DICOM is a standard developed by American College of Radiology and National Electrical Manufacturers Association. In the beginning of the 1980s, it was difficult for anyone other than manufacturers of computed tomography or magnetic resonance imaging devices to decode the images that the machines generated. Radiologists and medical physicists wanted to use the images for dose-planning for radiation therapy.
ACR and NEMA joined forces and formed a standard committee in 1983. Their first standard, ACR/NEMA 300, was released in 1985. Soon after its release, it became clear that improvements were needed; the text had internal contradictions. In 1988 the second version was released; this version gained more acceptance among vendors. The image transmission was specified as over a dedicated 2 pair cable; the first demonstration of ACR/NEMA V2.0 interconnectivity technology was held at Georgetown University, May 21–23, 1990. Six companies participated in this event, DeJarnette Research Systems, General Electric Medical Systems, Merge Technologies, Siemens Medical Systems, Vortech and 3M. Commercial equipment supporting ACR/NEMA 2.0 was presented at the annual meeting of the Radiological Society of North America in 1990 by these same vendors. Many soon realized that the second version needed improvement. Several extensions to ACR/NEMA 2.0 were created, like Papyrus and SPI, driven by Siemens Medical Systems and Philips Medical Systems.
The first large-scale deployment of ACR/NEMA technology was made in 1992 by the US Army and Air Force, as part of the MDIS program based at Ft. Detrick, Maryland. Loral Aerospace and Siemens Medical Systems led a consortium of companies in deploying the first US military PACS at all major Army and Air Force medical treatment facilities and teleradiology nodes at a large number of US military clinics. DeJarnette Research Systems and Merge Technologies provided the modality gateway interfaces from third party imaging modalities to the Siemens SPI network; the Veterans Administration and the Navy purchased systems from this contract. In 1993 the third version of the standard was released, its name was changed to "DICOM". New service classes were defined, network support added and the Conformance Statement was introduced; the latest version of the standard is still 3.0. It has been updated and extended since 1993, but most changes are forward and backward compatible, except in rare cases where the original specification was not interoperable or conflicted with another standard.
The standard should be referenced without specification of the date of release of a particular edition, except when specific conformance requirements are invoked that depend on a particular change. While the DICOM standard has achieved a near universal level of acceptance amongst medical imaging equipment vendors and healthcare IT organizations, the standard has its limitations. DICOM is a standard directed at addressing technical interoperability issues in medical imaging, it is not a architecture for achieving a useful clinical workflow. The Integrating the Healthcare Enterprise initiative layered on top of DICOM defines profiles to select features from these standards to implement transactions for specific medical imaging interoperability use cases. Though always Internet compatible and based on transport over TCP, over time there has been an increasing need to support port 80 HTTP transport to make use easier within the web browser. Most a family of DICOM RESTful web services have been defined to allow mobile device friendly access to DICOM objects and services, which include WADO-RS, STOW-RS and QIDO-RS, which together constitute the DICOMweb initiative.