Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help ones reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Editorial
Year : 2009 | Month : February | Volume : 3 | Issue : 1 | Page : 1248 - 1254

Neonatal Database – An Open Source Data Framework

Callander I*, Jain H**, NICUS***

*Liverpool Hospital Sydney, **New Delhi, ***Neonatal Intensive Care Unit Study (NSW & ACT, Australia)

Correspondence Address :
Dr. Ian Callander, Newborn Care, Liverpool Hospital, Liverpool, NSW, Australia. email: Ian.Callander@sswahs.nsw.gov.au

Keywords

Neonatal Database, Networking, Open source, Nurseries

A free Neonatal Data system is now available from the download centre hosted by the Journal of Clinical and Diagnostic Research (JCDR). The system houses data in a SQL Server (accessible over a network) in a Patient centred relational table structure where most postnatal data is stored in DateTimed records. The frontend client runs in MSAccess and has Clinical, Audit and Follow-up modules which view overlapping subsets of the data. The Clinical module of the Neonatal Database, is a quasi live data entry system designed to assist in day to day clinical management as well as generate discharge summaries (this system is NOT designed to be an EMR or electronic chart) (Table/Fig 1). The traditional audit outcomes are automatically derived from the raw data after validation by a designated Audit Officer in the Audit Module. With a moderate prior knowledge of MSAccess you are able to configure the system to your own local requirements.

Evolution of Clinical Neonatal Databases
In the early 1980’s there was increasing development by interested clinicians of audit databases for use in the NICU (1) and commercial clinical systems were beginning to appear by the 1990’s often guided by clinicians who had developed home grown systems (2). In 1989 a survey was performed among the nurseries within united states with regard to use of database. Of the 305 centers responding to the survey, 78% had a database in use in 1989 and 15% planned to develop one in the future (3). The Vermont Oxford Network (VON) was established in 1988, the Network is today comprised of over 700 Neonatal Intensive Care Units around the world (4). This Network maintains a Database including information about the care and outcomes of high-risk newborn infants. Membership annual cost is 4000 USD per annum. Some countries now have formed a network to collect data into a national neonatal database. The Canadian Neonatal Network founded in 1995 maintains a standardized neonatal intensive care unit (NICU) database and includes members from 27 hospitals and 16 universities across Canada(5); there is also input from an increasing number of International Hospitals. Similarly Australia – New Zealand collaborate their data. Most of these databases only collect a very small number of summary data items.

Connecting Data Sources
There is an increasing mass of data being collected about healthcare delivery but up to now very little pooling of information from multiple sources. A hospital would dearly love to have a single database to run its business; however that just simply is not possible. Not only is the task huge with so many different stakeholders but it is also evolving and the data is needed well beyond the institutional needs. There have been attempts to use audit engine analysis of electronic text (discharge summaries) to look for keywords that can be detected (6),(7) however in the future we will have enough data sources that our problems will be the large amount of electronic information rather than the paucity of it. There have been several publications from Newborn Screening Programs that look at the issues of large scale data and potential uses of data linkage (8),(9),(10). There needs to be analytical tools developed to allow for non-human interpretation of large datasets (11),(12) this is both for clinical quality improvement (13),(14) and also for administrative use such as the DRG (15) . The Internet is being increasingly used to submit cases to a Clinical Registry (16) and for enrolment into RCTs (17) and with appropriate security is now an option for patient identified information. Developed countries are now achieving population scale datasets (18) but it is increasingly possible for under-resourced countries to commence the collection of large scale data (19),(20).

The Electronic Medical Record
Hospitals worldwide are moving towards Paperless systems. The Electronic Medical Record (EMR) is being tackled on a large scale with large commercial implications by many different companies. The majority have their origin from Patient Information Systems and then have incorporated patient data / images from laboratory and imaging departments then added medication prescribing modules and if lucky some clinical information (low priority). In an Intensive care environment like the NICU there is also a separate type of data system that is receiving data from many different types of equipment (monitors, ventilators, infusion pumps, incubators) and integrating this into an electronic charting system (21) for the nursing staff to use instead of paper charts.
Most hospitals on this path encounter many hurdles. One of these is the lack of sensitivity of most HIS systems to individual units requirements with the one enterprise solution for all patients. These systems have not been designed to properly perform clinical audit. Audit databases have in the past expected users to enter data in retrospect by audit officers. The presented Neonatal database tries to answer these short comings. Firstly it is clinician friendly and can be used as you go through the clinical rounds. Secondly it gives end user rights to enmesh it with the hospital HIS system. Though, sale of any EMR software which contains this software enmeshed is prohibited without prior permission of the developers.

The Neonatal Database Project (Table/Fig 2)
Timeline
The Neonatal Intensive Care Unit Study (NICUS) was formed in 1990 to collect audit data for New South Wales (and ACT) and now contributes about 1/3 of the babies in the ANZNN (Australia and New Zealand Neonatal Network) collection.
There was an extensive review of data system requirements and methodology commencing at the National Perinatal Data System Planning Workshop in 2004. The new Neonatal Database has been constructed by NICUS members with minimal funding using MS SQL Data Server to house data, and MS Access as the user frontend. The system has been implemented in all 10 member tertiary hospitals with no significant cost required; Historical NICUS Data has been loaded into the new database, and new NICUS data has been entered since the beginning of 2007. The majority of the units are also using the Clinical Module for patient management and it is expected that in early 2009 we will achieve full networking between all participating units in NSW, including another 5 intermediate nurseries that routinely provide CPAP.

Data Methodology (Table/Fig 3)
Maternal, Pregnancy, Patient (PMI) and Identity data are separated into related tables and then postnatal information is entered as DateTimed records where possible, using the OHIO (Observational Historical Investigations Outcomes) Principle and Audit Outcomes are then derived.

There is every attempt to match a new baby / pregnancy with mothers who have had a previous baby in Neonatal Intensive Care in order to provide retrospective and longitudinal information. The majority of Hospitals in NSW are using the ‘ObstetriX’ system for collecting obstetric data and so an import program has been developed in order to seed patient data in the majority of cases. Importation from or connectivity with other data sources can be achieved with relative ease using the SQL Server.

Clinical Interface (Table/Fig 4)
Although the data is housed in a ‘complex’ but logical table structure, it is represented to the user via the MSAccess frontend in a way that allows intuitive data entry. The vast majority of the patient information is contained within a single tabbed form that selectively shows / hides relevant data and contains hyperlinks where relevant. Parts of the dataset are summarised for review or graphed for trend analysis.
The clinical module is designed to be used ‘quasi – live’; mostly this has been done on medical ward rounds using either a wireless laptop or bedside PC’s. When the system is kept up to date then data entry is fast once the user is familiar with the system. Data changes are only needed to START or STOP treatments/ results / problems and there are DateTime shortcuts that speed this up considerably. A Medical Discharge Summary is easily produced when data has been entered during the inpatient stay and is more comprehensive as well as more time efficient.

Audit Data Quality (Table/Fig 5)
The vast majority of quality Neonatal Audit is completely separated from clinical data systems which are known to be of dubious quality. The NICUS group has pride in the quality of the data being collected; there is a funded Audit Officer at each member Tertiary Hospital and a process of data quality assurance. The quality of the audit data has to be maintained when merging with a clinical system. For those hospitals using the clinical module, it is the practice of the nominated NICUS Audit Officer to perform data cleaning of a subset of the clinical data (plus addition of a small number of specific Audit data items) via the Audit Module after the patient has been discharged for several weeks (to allow for readmission). When the Audit officer is happy with the data quality the patient record is locked (still viewable from the clinical module). At the time of locking there is an automated data checking program and the generation of an output record of calculated summary items for that baby (same as entered manually in previous database). Once the patient has been thus closed the data is immediately available for analysis, and the NICUS group is currently looking at enabling ‘live’ inter-hospital benchmarking.

Reporting Functionality (Table/Fig 6)
Some reports are built into the MSAccess frontend (e.g. Discharge Summary, Monthly Unit Report, NICUS Inter-hospital comparisons) but the most flexible reporting can be achieved using Ad Hoc Queries. In the same way as the MSAccess frontend makes the table structure more easy to navigate, Queries (= Views) can represent data in a simple way from a complex underlying table arrangement, and can be saved and even used in further Queries as if they were another ‘table’. These Queries can be viewed and created from MSAccess (behind the user interface), and can also retrieve data directly from SQL Server to other outside programs such as Excel, Word or PowerPoint (tables, pivot tables, charts & mail merge), SPSS (or other statistics packages), Internet Explorer or other SQL Servers. The Open Source design makes anything possible without the need to pay for the software vendor to make changes for you.

Software, Hardware and Connectivity
The data sits on a single computer running SQL Server (Version 2000 or 2005); Microsoft has made available free Desktop versions of both – MSDE ( desktop version of SQL2000 ) is available from the Neonatal Database Download Centre, and is capable of running over a small network. To Purchase the full version of SQL2005 would cost around $US 2000 depending on local deals however it is very probable that your hospital already has SQL Server available to host the database, and this would be the preferable option if you wish to run a multi-PC environment.

Each Client PC would generally need to have MSOffice Professional (incl MSAccess) 2000 or higher (2003 preferred) installed on it, although it is possible to have the Client PC act as a dummy terminal for a Citrix server that runs MSOffice for multiple clients.
There is a free runtime version of MSAccess2007, but it has not been extensively tested by us.

The system runs over a typical hospital network, although some IT support may be required, particularly if not running a standard Windows Network. Multiple hospitals on the same network can automatically be connected to the same server. To connect hospitals from multiple networks, we would suggest that a central server connecting to peripheral servers be used, although a single WAN SQL Server could be used if the WAN was fast and reliable and the server capable of handling the simultaneous workload.

Data from other systems should be used to augment the system (and vice versa) when possible. As we have done for the ObstetriX program being used in NSW, importation of obstetric data to seed a neonatal admission is particularly useful. In this case we had the vendor create an ASCII text file output and wrote a conversion program (no different in principle to HL-7 import). If however external data is being held in a SQL accessible relational table structure then an automatic link / import from you SQL server would be ideal.

MERITS
Advances in Technology means that the Neonatal Units will increasingly have data downloaded from equipment, which will both replace paper and make data more accessible. Data from multiple sources will become 'connected' and will in turn offer the opportunity to audit data of a different magnitude, this includes longitudinal data (not just neonatal follow-up data but also data into adult life). Quality of the data needs to be considered when performing audit (even though the data item may be the same for clinical and audit use), but sheer quantity may still make some data (especially equipment derived) useful.

The current 'gold standard' of scientific evidence (RCT) is very expensive, time consuming, minutely focussed and often out of date at the time of publication. Audit data has in the past been considered by the research purist to be unworthy to be called “Evidence”. If quasi real-time massive population (?international) data collections can be analysed using data mining tools, then we have the capacity to detect associations well before detection would be possible by a human (if at all). In some cases the 'audit evidence' would be so strong that a RCT would not even be necessary.
Emerging countries with large populations but restricted finances (such as India) have the potential to collect audit data (if they have a PC and we give them free software) that if amalgamated would not only advance their own care but that of advanced countries because of scale.

The non-commercial neonatal database illustrated on the website is available for anyone who wants it (download or by arrangement on DVD with everything including instructional movies). This is to offer advanced audit capability (plus other trimmings) to those that would not otherwise be enabled to collect it, however our ultimate goal is the amalgamation of large scale audit data from any source, and for the recognition of the value of such collection by governments.

Merits Summary

>Clinician Friendly
>Free download available
>Already in use for more than 2 years among various nurseries
>Open to local customization
>Allows itself to be linked to local hospital HIS
>Can be installed in local machine or across hospital network
>Gives user control over his own data
>Data can be easily be accessed from Excel (refreshable)
>Development of the software continues in a collaborative environment

Project Support
As with any new initiative there have been teething troubles. Every attempt has been made to overcome these and we are keen to continuously improve the software. We wholly encourage the users to send us the feedback so that the database evolves further and is pertinent for the times. As the database is a free initiative and has been developed by clinicians with minimal IT support the installation process is less automated. We encourage users who find the database useful to support the project through voluntary donations, spreading it in units they know or in any way they can contribute.

The Future
There has been incredible change in the use of computers and data in health care.
Within health organisations there is progressive implementation of electronic systems that reach beyond the role of Patient Administration System (PAS) and we are headed inevitably to the ‘Electronic Medical Record’, ‘Electronic Charting’ and ‘Electronic Prescribing’. Large Database systems that try and perform all tasks for everybody are expensive and extremely slow to deliver what the clinician wants. In the Neonatal Intensive Care setting we have a relatively small number of patients connected to multiple machines capable of electronic output, being managed by a favourable ratio of staff who are becoming rapidly computer enlightened. There will continue to be evolution of parallel data systems, with some amalgamation along the way, but an increasing need to allow for data to be communicated between systems.

In the future, a box of obstetric medication being delivered to the pharmacy at Hospital A will become ‘connected’ to a neonatal saturation reading from a monitor at Hospital B – there will be common patient(s) and a temporal relationship. The sheer scale of data that will be available for analysis will mean that newer techniques will be needed, that do not depend on human inquisition. Data Mining techniques will be used to detect previously unknown associations (known associations would be adjusted for) in very large datasets. With such detection systems, both positive and negative effects of treatments could be noticed before a human could possibly notice an association. We should attempt to begin this process with the data available to us and increase the granularity of the data when we have the resources.

More information is available at the Neonatal Database Homepage

http://www.jcdr.net/NeoDB/NeoDB_Home.asp


Conclusion

There is a demand for a Neonatal database which is clinician friendly captures most clinical data and can be filled in along with routine clinical work ( is not dependent on the audit officer) and is cost effective. Another need is the control over your data. A clinician should be able to with minimal expertise explore their data and draw conclusions. The Neonatal Database platform being offered by the journal fulfills these needs. This database has been in use in many nurseries around the world in the prelauch trial period and has matured after valuable feedback. Since the Database is free it is hoped that its use becomes widespread and is not inhibited by subscription fees.

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