Journal of Health & Medical Informatics

The effect of early intervention in breech presentation is investigated by outcomes of two indices: the breech delivery rate and the breech cesarean rate. Historically-controlled retrospective study was performed from 1985 to 2012. We intervene the breech presentation with tocolysis and external cephalic version (ECV) after 32 weeks’ of pregnancy and compared two indices before introduction of ECV (1985-87) and after (1986-2012). Statistical study was carried by kaisu are test and P value less than 0.05 is significant. Utilized tocolytic agents were ritdor in hydrochloride and magnesium sulfate. ECV was performed after 24 hrs in admission. Within enrolled case of 478, one hundred and sixty two cases were office ECV was excluded due to no controls (unsuccessful cases). Adopted 316 cases of admission-controlled ECV was divided into two groups of ECV (245 cases) and no ECV (71 cases). Spontaneous version had occurred in 20 cases of ECV and in 58 cases of no ECV, so overall spontaneous version rate was 25% (78/316) and overall successful ECV rate was 66% (161/245) under low reversion rate of 2.8% (9/323). In this way, two indices of the breech delivery rate and breech cesarean section rate had reduced from 3.3 to 2.1% and from 21.3 to 12.7% respectively (p<0.01). Furthermore we have not experienced serious complications. So we considered early intervention in breech presentation with tocolysis and ECV is useful for reduction of breech delivery and breech cesarean section.

Background: Under nutrition is one of the leading causes of morbidity and mortality in children under the age of five in most developing countries including Ethiopia. The main objective of this study was to design a model that predicts the nutritional status of under-five children using data mining techniques.
Methods: This study followed hybrid methodology of Knowledge Discovery Process to achieve the goal of building predictive model using data mining techniques and used secondary data from 2011 Ethiopia Demographic and Health Survey (EDHS) dataset. Hybrid process model was selected since it combines best features of Cross-Industry Standard Process for Data Mining and Knowledge Discovery in Database methodology to identify and describe several explicit feedback loops which are helpful in attaining the research objectives. WEKA 3.6.8 data mining tools and techniques such as J48 decision tree, Naïve Bayes and PART rule induction classifiers were utilized as means to address the research problem.
Result: In this particular study, the predictive model developed using PART pruned rule induction found to be best performing having 92.6% of accurate results and 97.8% WROC area. Promising result has been achieved from the rules regarding nutritional status prediction.
Conclusion: The results from this study were encouraging and confirmed that applying data mining techniques could indeed support a predictive model building task that predicts nutritional status of under-five children in Ethiopia. In the future, integrating large demographic and health survey dataset and clinical dataset, employing other classification algorithms, tools and techniques could yield better results.

Background: Maternal outcomes are good in most countries of the developed world while the same is not true in many developing countries. The likelihood of the occurrence of incontinence after successful surgical repair makes predicting urinary fistula surgical repair outcome is important for decision making during treatment and follow up. Therefore, this research is aimed to apply data mining techniques to build a model that can assist in predicting surgical outcome of urinary fistula repair based on clinical assessments done just before surgical repair.
Methods: The six-step hybrid knowledge discovery process model is used as a framework for the overall activities in the study. 15961 instances that have undergone urinary fistula repair in Addis Ababa Fistula Hospital are used for both predictive association rule extraction and predictive model building. Apriori algorithm is used to extract association rules while classification algorithms J48, PART, Naïve Bayes and multinomial logistic regression are used to build predictive models. Support and confidence are used as interestingness measure for association rules while area under the WROC and ROC curve for each specific outcome is sequentially used to compare performances of models from the predictive algorithms.
Results: Predictive association rules from Apriori have shown frequent co-occurrence of less severity of injury with cured outcome. The predictive model from PART-M2-C0.05-Q1 scheme has shown an area under WROC curve of 0.742. Area under the ROC curve for residual outcome (ROC_Residual=0.822) from this algorithm is better than Naïve Bayes and logistic, while the areas under the ROC curves for the other outcomes are greater than the model from J48.
Conclusion: Predictive model is developed with the use of PART-M2-C0.05-Q1. The predictive association rules and predictive model built with the use of data mining techniques can assist in predicting urinary fistula surgical repair outcome. Therefore, it is better in detecting residual outcome than the logistic regression model.

Background: The implementation of hospital electronic health records software is considered a significant modernization in healthcare. Objective: The objective of this study was to evaluate the impact of electronic health records and the addition of clinical documentation specialists as a clinical support group on hospitalist documentation using case mix index (CMI) as a measurement tool.
Methods: A two-group pre/postimplementation retrospective research design was used to evaluate the impact of electronic health records and clinical documentation specialists on CMI in a single 125-bed full-service community hospital in the greater Los Angeles area. All hospitalist medical records were reviewed in the pre/postphases. A total of 3,536 records were reviewed over the two phases. Phase one included a review of 1,712 hospitalist medical records before implementation of electronic health records. Phase two included a review of 1,824 hospitalist medical records after implementation of electronic health records and clinical documentation specialists. Change in CMI data were analyzed over the two phases. CMI data were treated as interval data and analyzed by parametric descriptive statistics in two phases by one-way ANOVA to compare the means between the two phases.
Results: The mean CMI value for phase one was 1.65 and 1.68 for phase two. One-way ANOVA yielded no difference between the mean CMI values for the two phases (p.53).
Conclusion: The implementation of electronic health records and clinical documentation specialists as a clinical support group did not make any significant difference in hospitalist documentation using CMI as a measurement tool.

There are two pulsed Doppler ultrasound including continuous wave (CW) Doppler and pulsed Doppler, where the safety is discussed in the pulsed Doppler, because of its higher ultrasound intensity, due to longer pulse and higher pulse repetition frequency than simple B-mode ultrasound, and obstetrical setting of ultrasound devices determines the thermal and mechanical indices below one in pulsed Doppler. Ultrasound user is responsible to ultrasound safety, where the user lowers the ultrasound thermal and mechanical indices below one, when indices are higher than one. The use of pulsed Doppler in the first trimester is regulated by ISUOG committee.