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OBJECTIVE: The establishment of ongoing audits for first-trimester nuchal translucency (NT) measurements is of paramount importance. The exponentially weighted moving average (EWMA) chart has been published as an efficient tool for NT quality control with the advantages of being suitable for real-time long-term monitoring. This study aimed to assess the efficacy of real-time NT quality control using EWMA charts. MATERIALS AND METHODS: This was an ongoing prospective study conducted from January 2011 to December 2017 at the Centre for Fetal Medicine Gennet in Prague. The quality of NT measurements was assessed using the NT retrospective distribution parameters and EWMA charts, and the results were presented to the sonographers during collective meetings. RESULTS: Overall, 28,928 NT measurements obtained from six sonographers were eligible for the study. Looking at individual EWMA charts, we observed four main outcomes. First, there was a clear improvement in the performance of sonographers with initially poor performances. Second, the performance of sonographers with an initially satisfactory quality was maintained. Third, there was an observed deterioration of the performance without the audits. Last, the sonographers appreciated an unequivocal and straightforward graphical presentation of EWMA curves. CONCLUSION: EWMA proved to be an efficient and suitable tool for real-time monitoring of NT quality and led to an overall improvement of the sonographers' performance.

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OBJECTIVES: Our main objective is to design a method of, and supporting software for, interactive correction and semantic annotation of narrative clinical reports, which would allow for their easier and less erroneous processing outside their original context: first, by physicians unfamiliar with the original language (and possibly also the source specialty), and second, by tools requiring structured information, such as decision-support systems. Our additional goal is to gain insights into the process of narrative report creation, including the errors and ambiguities arising therein, and also into the process of report annotation by clinical terms. Finally, we also aim to provide a dataset of ground-truth transformations (specific for Czech as the source language), set up by expert physicians, which can be reused in the future for subsequent analytical studies and for training automated transformation procedures. METHODS: A three-phase preprocessing method has been developed to support secondary use of narrative clinical reports in electronic health record. Narrative clinical reports are narrative texts of healthcare documentation often stored in electronic health records. In the first phase a narrative clinical report is tokenized. In the second phase the tokenized clinical report is normalized. The normalized clinical report is easily readable for health professionals with the knowledge of the language used in the narrative clinical report. In the third phase the normalized clinical report is enriched with extracted structured information. The final result of the third phase is a semi-structured normalized clinical report where the extracted clinical terms are matched to codebook terms. Software tools for interactive correction, expansion and semantic annotation of narrative clinical reports has been developed and the three-phase preprocessing method validated in the cardiology area. RESULTS: The three-phase preprocessing method was validated on 49 anonymous Czech narrative clinical reports in the field of cardiology. Descriptive statistics from the database of accomplished transformations has been calculated. Two cardiologists participated in the annotation phase. The first cardiologist annotated 1500 clinical terms found in 49 narrative clinical reports to codebook terms using the classification systems ICD 10, SNOMED CT, LOINC and LEKY. The second cardiologist validated annotations of the first cardiologist. The correct clinical terms and the codebook terms have been stored in a database. CONCLUSIONS: We extracted structured information from Czech narrative clinical reports by the proposed three-phase preprocessing method and linked it to electronic health records. The software tool, although generic, is tailored for Czech as the specific language of electronic health record pool under study. This will provide a potential etalon for porting this approach to dozens of other less-spoken languages. Structured information can support medical decision making, quality assurance tasks and further medical research.

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The amount of available data relevant for clinical decision support is rising not only rapidly but at the same time much faster than our ability to analyze and interpret them. Thus, the potential of the data to contribute to determining the diagnosis, therapy and prognosis of an individual patient is not appropriately exploited. The hopes to obtain benefit from the data for an individual patient must be accompanied by a reliable and diligent biostatistical analysis which faces serious challenges not always clear to non-statisticians. The aim of this paper is to discuss principles of statistical analysis of big data in research and routine applications in clinical medicine, focusing on particular aspects of psychiatry. The paper brings arguments in favor of the idea that the biostatistical analysis of data in a specialty field requires different approaches and different experience compared to other clinical fields. This is illustrated by a description of common complications of the analysis of psychiatric data. Challenges of the analysis of big data in both psychiatric research and routine practice are explained, which are far from a routine service activity exploiting standard methods of multivariate statistics and/or machine learning. Important research questions, which are important in the current psychiatric research, are presented and discussed from the biostatistical point of view.

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The panel intended to collect data, opinions and views for a systematic and multiaxial approach for a comprehensive presentation of "History of Medical Informatics", treating both general (global) characteristics, but emphasizing the particular features for Europe. The topic was not only a subject of large interest but also of great importance in preparing a detailed material for celebration of forty years of medical informatics in Europe. The panel comprised a list of topics, trying to cover all major aspects to be discussed. Proposals of staging the major periods of medical informatics history were also discussed.

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OBJECTIVES: This study aimed to design an exponentially weighted moving average (EWMA) chart for the quality review of nuchal translucency (NT) and to assess its performance compared with the methods currently in use: retrospective distribution-based methods and the cumulative sum (CUSUM) chart. METHODS: The EWMA model was designed for NT quality review using simulation. The NT measurements obtained during routine first-trimester screening in our centre over a two-and-a-half-year period were retrieved from the database. The NT distribution parameters, EWMA and CUSUM chart were established, and the methods were compared. RESULTS: On the basis of the results from the simulation, the optimal EWMA settings were established. A set of 9338 NT measurements obtained from nine sonographers was used to construct the EWMA and CUSUM charts and to calculate the distribution parameters. Distribution-based methods were unable to reveal the temporal periods of poor performance. The EWMA model agreed closely with the CUSUM but had the advantage promptly indicating when the process returned to an in-control state, thus extending its use to long-term prospective and retrospective quality assessments. CONCLUSIONS: The EWMA provides a universal, easy and efficient tool for NT quality review when the prompt and effective detection of suboptimal performance is desired.

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BACKGROUND: Coronary heart disease (CHD) mortality has declined substantially in the Czech Republic over the last two decades. DESIGN: The purpose of this study was to determine what proportion of this CHD mortality decline could be associated with temporal trends in major CHD risk factors and what proportion with advances in medical and surgical treatments. METHODS: The validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of CHD management and risk factor trends in the Czech Republic in adults aged 25-74 years between 1985 and 2007. The main sources were official statistics, national quality of care registries, published trials and meta-analyses, and the Czech MONICA and Czech post-MONICA studies. RESULTS: Between 1985 and 2007, age-adjusted CHD mortality rates in the Czech Republic decreased by 66.2% in men and 65.4% in women in the age group 25-74 years, representing 12,080 fewer CHD deaths in 2007. Changes in CHD risk factors explained approximately 52% of the total mortality decrease, and improvements in medical treatments approximately 43%. Increases in body mass index and in diabetes prevalence had a negative impact, increasing CHD mortality by approximately 1% and 5%, respectively. CONCLUSIONS: More than half of the very substantial fall in CHD mortality in the Czech Republic between 1985 and 2007 was attributable to reduction in major cardiovascular risk factors. Improvement in treatments accounted for approximately 43% of the total mortality decrease. These findings emphasize the value of primary prevention and evidence-based medical treatment.

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The paper describes the history of medical informatics in Czechoslovakia and the Czech Republic. It focuses on the topics of medical informatics education and decision support methods and systems. Several conferences held in Czechoslovakia and in the Czech Republic organized in cooperation with IMIA or EFMI are described. Support of European Union and Czech agencies in several European and national projects focused on medical informatics topics highly contributed to medical informatics development in Czechoslovakia and the Czech Republic and to the establishment of the European Center for Medical Informatics, Statistics and Epidemiology as the joint workplace of Charles University in Prague and Academy of Sciences of the Czech Republic in 1994.

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We implemented a prototype of a decision support system called SIR which has a form of a web-based classification service for diagnostic decision support. The system has the ability to select the most relevant variables and to learn a classification rule, which is guaranteed to be suitable also for high-dimensional measurements. The classification system can be useful for clinicians in primary care to support their decision-making tasks with relevant information extracted from any available clinical study. The implemented prototype was tested on a sample of patients in a cardiological study and performs an information extraction from a high-dimensional set containing both clinical and gene expression data.

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The poster describes doctoral degree studies in biomedical informatics at Charles University in Prague. Particularly important in educational programmes and knowledge dissemination is the role of Internet. Therefore we also describe special activities concerned with the specific research at the First Faculty of Medicine of Charles University in Prague. These are selected tools for blended learning tools, ExaMe system and the role of the European Journal for Biomedical Informatics (EJBI), an official multilingual journal of EFMI, for Ph.D. student's cooperation and understanding the multidisciplinary field of biomedical informatics [1].

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The paper shows the importance of e-health applications for electronic healthcare development. It describes several e-health applications for health data collecting and sharing that are running in the Czech Republic. These are IZIP system, electronic health record MUDR and K4CARE project applications. The e3-health concept is considered as a tool for judging e-health applications in different healthcare settings.

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The role of folates as coenzymes in 1-carbon metabolism and the clinical consequences of disturbed folate metabolism are widely known. Folate status is a complex trait determined by both exogenous and endogenous factors. This study analyzed the association between 12 genetic variants and folate status in a Czech population with no folate fortification program. These 12 genetic variants were selected from 56 variant alleles found by resequencing the coding sequences and adjacent intronic regions of 6 candidate genes involved in folate metabolism or transport (FOLR1, FOLR2, FOLR3, MTHFR, PCFT, and RFC) from 29 individuals with low plasma and erythrocyte folate concentrations. Regression analyses of a cohort of 511 Czech controls not taking folate supplements revealed that only 2 variants in the MTHFR gene were associated with altered folate concentrations in plasma and/or erythrocytes. In our previous study, we observed that the common variant MTHFR c.665C > T (known as c.677C > T; p.A222V) was associated with decreased plasma folate concentrations. In the present study, we show in addition that the rare variant MTHFR c.1958C > T (p.T653M) is associated with significantly increased erythrocyte folate concentrations (P = 0.02). Multivariate regression analysis revealed that this uncommon variant, which is present in 2% of Czech control chromosomes, explains 0.9% of the total variability of erythrocyte folate concentrations; the magnitude of this effect size was comparable with that of the common MTHFR c.665C > T variant. This result indicates that the rare genetic variants may determine folate status to a similar extent as the common allelic variant.

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BACKGROUND: Narrative medical reports do not use standardized terminology and often bring insufficient information for statistical processing and medical decision making. Objectives of the paper are to propose a method for measuring diversity in medical reports written in any language, to compare diversities in narrative and structured medical reports and to map attributes and terms to selected classification systems. METHODS: A new method based on a general concept of f-diversity is proposed for measuring diversity of medical reports in any language. The method is based on categorized attributes recorded in narrative or structured medical reports and on international classification systems. Values of categories are expressed by terms. Using SNOMED CT and ICD 10 we are mapping attributes and terms to predefined codes. We use f-diversities of Gini-Simpson and Number of Categories types to compare diversities of narrative and structured medical reports. The comparison is based on attributes selected from the Minimal Data Model for Cardiology (MDMC). RESULTS: We compared diversities of 110 Czech narrative medical reports and 1119 Czech structured medical reports. Selected categorized attributes of MDMC had mostly different numbers of categories and used different terms in narrative and structured reports. We found more than 60% of MDMC attributes in SNOMED CT. We showed that attributes in narrative medical reports had greater diversity than the same attributes in structured medical reports. Further, we replaced each value of category (term) used for attributes in narrative medical reports by the closest term and the category used in MDMC for structured medical reports. We found that relative Gini-Simpson diversities in structured medical reports were significantly smaller than those in narrative medical reports except the "Allergy" attribute. CONCLUSIONS: Terminology in narrative medical reports is not standardized. Therefore it is nearly impossible to map values of attributes (terms) to codes of known classification systems. A high diversity in narrative medical reports terminology leads to more difficult computer processing than in structured medical reports and some information may be lost during this process. Setting a standardized terminology would help healthcare providers to have complete and easily accessible information about patients that would result in better healthcare.

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EuroMISE Center was established in the year 1994bas the joint workplace of Charles University in Prague and Academy of Sciences of the Czech Republic with the support of the European project focused on higher education in methodology field of healthcare. Nowadays, the EuroMISE Center is working as the joint workplace of five organizations. We describe in more details history and nowadays activities of the EuroMISE Center in the field of research, higher education and e3 Health applications.

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This paper summarizes the evaluation of two standardized approaches to implementation of messages for demographic data exchange between the preventive cardiology outpatient department located at the Institute of Computer Science AS CR, v.v.i. in Prague and the Outpatients Department of Cardiology of Municipal Hospital in Caslav. Our setting consists of four independent systems maintaining different clinical data (scheduling system, hospital information system, EHR system and a digital ECG). The aim is to avoid repetitive patient demographic data entry. We evaluate the suitability of IHE Patient Administration Management Profile (including HL7 v.2.5) and Czech national standard DASTA using Standard Evaluation Framework proposed and published in 2008 by J. Mykkänen et al. Besides the evaluation of standards, we also discuss some aspects of the framework.

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PURPOSE: Groin pain is one of the complications after TVT-O procedure. The aim was to examine the position and safety of the tape after TVT-O procedure. METHODS: We inserted TVT-O in 14 formalin-embalmed bodies with legs malpositioned (group 1) and in 5 fresh-frozen bodies with legs malpositioned (group 2) and in 5 fresh-frozen bodies with legs correctly positioned (group 3). After dissection distances from the branches of obturator nerve were measured. RESULTS: In group 1, the mean distance from the anterior branch of the obturator nerve was 8.6 mm on the left, 7.1 mm on the right. Mean distance from the posterior branch of the obturator nerve was 8.4 mm on the left, 8.9 mm on the right. In group 2, the mean distance from the anterior branch of the obturator nerve was 8.0 mm on the left, 8.0 mm on the right. Mean distance from the posterior branch of the obturator nerve was 5.0 mm on the left, 8.00 mm on the right. In group 3, the mean distance from the anterior branch of the obturator nerve was 24 mm on the left, 23 mm on the right. Mean distance from the posterior branch of the obturator nerve was 23 mm on the left, 23 mm on the right. Statistical analysis was performed with confirmation of significant difference between group of bodies with legs positioned correctly and other groups with malpositioned legs. CONCLUSIONS: The position of the legs is crucial for correct placement of TVT-O.

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INTRODUCTION AND HYPOTHESIS: The objective is to describe the anatomical position of tension-free vaginal tape Secur (TVT-S) in the U position regarding possible injury and fixation site. METHODS: We placed TVT-S inserters bilaterally in 13 embalmed and five fresh frozen female bodies. After dissection, we measured distances from the obturator bundle. RESULTS: In embalmed bodies, the mean distance of TVT-S from the obturator bundle was 2.83 cm (standard deviation (SD) 0.87 cm) on the left, 2.92 cm (SD 1.24 cm) on the right. Perforation of the fascia of obturator internus muscle occurred in 38.5%. In fresh frozen bodies, results were fundamentally similar (p > 0.05). CONCLUSIONS: There is a risk of injury to the obturator bundle and urinary bladder during TVT-S; however, there is a significant risk of inserting the TVT-S inserter outside the obturator internus muscle (into the lesser pelvis). The position of TVT-S does not change significantly after legs mal-positioning.

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The paper describes several classification systems that could improve patient safety through semantic interoperability among contemporary electronic health record systems (EHR-Ss) with support of the HL7 v3 standard. We describe a proposal and a pilot implementation of a semantic interoperability platform (SIP) interconnecting current EHR-Ss by using HL7 v3 messages and concepts mappings on most widely used classification systems. The increasing number of classification systems and nomenclatures requires designing of various conversion tools for transfer between main classification systems. We present the so-called LIM filler module and the HL7 broker, which are parts of the SIP, playing the role of such conversion tools. The analysis of suitability and usability of individual terminological thesauri has been started by mapping of clinical contents of the Minimal Data Model for Cardiology (MDMC) to various terminological classification systems. A national-wide implementation of the SIP would include adopting and translating international coding systems and nomenclatures, and developing implementation guidelines facilitating the migration from national standards to international ones. Our research showed that creation of such a platform is feasible; however, it will require a huge effort to adapt fully the Czech healthcare system to the European environment.

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OBJECTIVE: To establish the effect of chlorinated organic compounds on fertility. DESIGN: We analyzed the influence of polychlorinated biphenyls (PCBs) and pesticides in follicular fluid on the number of fertilized oocytes, the quality of oocytes and embryos, pregnancy rate, and number of embryos cryoconserved in IVF-ET program. SETTING: Department of Gynecology and Obstetrics, Charles University, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic. PATIENT(S): Patients from the Center of Assisted Reproduction. INTERVENTION(S): We collected the follicular fluid of 99 infertile women. MAIN OUTCOME MEASURE(S): The levels of xenobiotics in follicular fluid were examined by high-resolution mass spectrometry and gas chromatography. Correlations between the levels of xenobiotics and IVF-ET program results were statistically analyzed. RESULT(S): The PCB levels varied from 0.1 to 254.6 ng/g of fat. Levels of DDT and its metabolites varied from 0.3 to 35 228.8 ng/g of fat. A correlation was found between the number of diploid oocytes and the level of DDT, the fertilization of oocytes and level of PCB 158, and the pregnancy rate and the number of embryos cryoconserved and levels of PCB 47. CONCLUSION(S): Xenobiotics can be detected in the fat compartment of the follicular fluid. Some correlation to the IVF-ET program results was established, to a degree that might be considered of concern, although it was not statistically significant at the 5% level.

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Allele frequencies for 17 short tandem repeats (STRs) autosomal loci (D2S1338, D3S1358, D5S818, D7S820, D8S1179, D13S317, D16S539, D18S51, D19S433, D21S11, CSF1PO, FGA, PentaD, PentaE, TH01, TPOX, vWA) were studied in an extensive sample (max. N=1411) of unrelated individuals originating from the Czech Republic. Population and forensic parameters were estimated. Except for FGA and Penta E loci, no deviations from the Hardy-Weinberg equilibrium were detected. A comparative analysis with published data revealed significant differences in allele frequencies for some loci from the Polish population and three Hungarian populations (Ashkenazim population and Romany populations from Debrecen and Baranya County, respectively). A combination of these 17 STR loci provides a powerful tool for forensic identification in the native Czech population.

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