Diabetes Clinical Medical Record Information Management System Design And Development Applications

PARTâ… The design and development of diabetic clinicalinformation systemIt's urgent to obtain a clinical information system to help the managementof clinical patient records accumulated over a long period. The requiredfunctions include easily importing records and convenient store of data,easily adding records and repeated stores, easily distilling records anddata according to the user-defined conditions with a pioneer descriptivestatistics or charts, and the distilled records and data can be easilyexported as an open format file which could be analysised further more byother nowaday and powerful dada processing tools. To meet the need ofdiabetic clinical practices and researches, a clinical information systemfor the management of diabetic patient records was designed employingthe current database theory and technology, then programmed with Delphiand transcoded into a setup package with Inno Setup. This system has themain function mentioned above, providing a powerful tool to manage theaccumulating diabetic patient records and to utilize the data for clinicalreseach conveniently and efficiently。 PARTâ…¡The application of diabetic clinical information systemObjectives:â‘ To survery the current conditions of the diabetics in theinpatient department.â‘¡To aware the functions and utilities of clinicalinformation system for the management of diabetic patient records.â‘¢Toinvestigate the clinical characteristics and risk factors of diabetes ketosis(DK) and diabetes ketoacidosis (DKA).Methods:â‘ All data of the diabetic patient records were imported intothe diabetic clinical information system by a full time employee. 10%records were spot-checked every month. Data distilling and pioneerstatistics or charts were performed by the "Distill & Star." moduleprovided in the diabetic clinical information system.â‘¡All the diabeticpatients of inpatient department in 2006 were divided into ketosis group(including DK and DKA) and nonketosis group; compare the metabolicand biochemical markers and thyroid hormones between these two groups.The relationship between study factors and DK/DKA was analyzed bymultivariate Logistic regression, and the cutpoints were detected by ROCcurve.Results:â‘ This clinical information system for the management ofdiabetic patient records can be used to import and store case records easily,and can easily distill records and data according to the user-definedconditions with a pioneer descriptive statistics or charts, and the distilledrecords and data can be easily exported as an open format file which could be analysised further more by other dada processing tools.â‘¡There are766 diabetic records of the patients of inpatient department with the firstrecords of diabetes in 2006, total 423 male cases and 343 female cases,5.4% cases are type 1 diabetes, the average age is 56.4y±15.8y. Only22% patients reach the control goal of hemoglobin Alc(HbAlc＜6.5%),81.6% patients have high blood pressure and about half of patients havedyslipideamia over the control goal, more than 2/3 patinets have sufferedat least one complication.â‘¢Only 13.4% patients have been measuredtheir waist circumference. Only a few patients underwent the sceening testfor their eyes, macrovasculars and never system. There are lack of theenquiries of the diet, exercise, self-management, the score of thepsychology and the qulity of life in all patient records, and no case hasbeen diagnosed with depression.â‘£The average age, blood pressure,fasting and postchallenge C peptide, free T₃ in ketosis group aresignificantly lower than those in the control group (p＜0.05). HbAlc,fructosamine, fasting serum glucose in ketosis group are significantlyhigher than those in the control.⑤Patients with poor educationalbackground, infectious disease, or type 1 diabetes more likely suffer fromketosis.â‘¥HbAlc, fructosamine, and cooccurrence of infectious diseaseare the most important risk factors of ketosis (OR＞1). Age, educationalbackground and C peptide are less important (OR＜1). (2)The cutpoint ofHbAlc for prediction of ketosis is 8.85%, while the cutpoint of fructosamine for prediction of ketosis is 2.455mmol/L.Conclusions:â‘ This diabetic clinical information system can providepowerful functions to manage the accumulating diabetic patient recordsand to utilize the data for clinical reseach conveniently and efficiently.â‘¡A majority of diabetic patients have not reached the control goal and havea high prevalence of complications.â‘¢The clinicians should enhancetheir clinical practice in enquiries, physical examinations, and screeningtest for the chronic complications.â‘£DK and DKA can result in decreaseof free T₃, which may be a self-regulation and self-defense.⑤Persistenthigh blood glucose for a long time (2week or more) may be the mostimportant risk factor of ketosis. It may be reseanable to suggest thatpatients with high HbAlc (＞8.85ï¼…) or high fructosamine (＞2.455mmol/L)should undergo screening test to exclude ketosis.