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Other notable purines are hypoxanthine 4 , xanthine 5 , theobromine 6 , caffeine 7 , uric acid 8 and isoguanine 9. Purine 1 itself, has not been found in nature, but it can be produced by organic synthesis. They may also function directly as neurotransmitters , acting upon purinergic receptors.

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Adenosine activates adenosine receptors. The word purine pure urine [6] was coined by the German chemist Emil Fischer in The product was reduced to purine 1 using zinc dust. Many organisms have metabolic pathways to synthesize and break down purines. Purines are biologically synthesized as nucleosides bases attached to ribose. Accumulation of modified purine nucleotides is defective to various cellular processes, especially those involving DNA and RNA. To be viable, organisms possess a number of deoxy purine phosphohydrolases, which hydrolyze these purine derivatives removing them from the active NTP and dNTP pools.

Higher levels of meat and seafood consumption are associated with an increased risk of gout , whereas a higher level of consumption of dairy products is associated with a decreased risk. Moderate intake of purine-rich vegetables or protein is not associated with an increased risk of gout. In addition to in vivo synthesis of purines in purine metabolism , purine can also be created artificially. This remarkable reaction and others like it have been discussed in the context of the origin of life.

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Oro, Orgel and co-workers have shown that four molecules of HCN tetramerize to form diaminomaleodinitrile 12 , which can be converted into almost all naturally-occurring purines. The Traube purine synthesis is a classic reaction named after Wilhelm Traube between an amine -substituted pyrimidine and formic acid. From Wikipedia, the free encyclopedia. CAS Number. Interactive image.

PubChem CID. Chemical formula. Solubility in water. Main article: Purine metabolism. Retrieved Textbook of Medical Physiology. A limitation of the study is its commissioned nature, which meant that the included countries and the questionnaire were chosen by the client. This also meant that a purposive sample was included and that some countries Mexico and Czech Republic only had one interviewee. We used a rapid approach and asked participants to respond within a short period of time two weeks and thus the answers were self-reported when no interview could take place.

However, this approach allowed us to share up-to-date and new insights into the information governance procedures and adoption and quality of EMR in a number of countries. Another limitation is that this study only assessed three aspects of data quality: type of fields, fill rates and closed-ended fields.

Other aspects of EMR systems, which vary on multiple dimensions, could not be assessed, including the details clinical data, non-clinical data , data source, level of complexity, incorporation of other documents digital images, scanned documents timeframe single occasion to complete health record and extent of integration with other services [ 5 ].

Nevertheless, this study provides an important overview of the most relevant aspects of the quality of EMR for extracting data for research. Future research in this area could explore other aspects of data quality and adoption. Both benefits, including data security, legibility, accessibility, completeness, comprehensiveness, efficiency, and risks such as paper persistence, patient disengagement, insecure data, increased time, and increased costs should be assessed [ 5 ].

Research is also needed on the views of patients and the public about data from their EMR being used in areas not directly related to providing them with clinical care [ 30 , 31 ]. This is the first international comparative study to shed light on the information governance procedures and adoption of EMR in several countries. We hope it will inform the discussions and development of policies that aim to accelerate adoption of EMR and seizing of the rich potential for the secondary uses of data arising from them. Data from EMR have considerable scope to improve the safety, quality and efficiency of healthcare; as well as being a valuable resource for research, particularly when linked to other data such as mortality records or genetic data.

It is therefore important that countries work towards making these data more accessible for their secondary uses. At the same time confidentiality of the data should be ensured. Also any concerns that patients and the public might have about their data being used for purposes other than providing them with clinical care should be addressed.

Last but not least, it is very important also to establish mechanisms for use of such data at national levels. They provide an invaluable source for policymakers, for measurement of disease burden and for planning of investments in healthcare as well as for pharmaceuticals to ensure safe and effective use of medications. We are sincerely grateful to all interviewees for offering their valuable time to us and to all participants who brought us in contact with the interviewees.

We would like to greatly acknowledge Ayodele Adiat, Claire Dickie, Sabrina Spieck and Riham Arab for their hard work on collecting information for this study. The views expressed in this publication are those of the authors. This study received sponsorship from IMS Health. The funders had no role in data collection and analysis, decision to publish, or preparation of the manuscript. All authors made substantial contributions to conception and design of the study and acquisition and interpretation of data.

MHvV and NM analysed the data. MHvV wrote the paper. All authors approved the final version of the paper. Her thesis explored the application of mHealth-based collection of information relevant to childhood diarrhoea and pneumonia in rural China. His thesis explored the implementation and uptake of electronic medical records in Greece. He has a keen interest in connecting medicine and informatics and is an international authority on the use of data from electronic health records for research and development.

His thesis was on the application of context-sensitive quality data management for pervasive computing environments. Dr Car has published numerous academic articles, books, systematic reviews and reports in the field of eHealth. All participants gave consent to publish anonymised data from this study. No identifying information related to participants was included in the final manuscript.

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All participants gave verbal consent prior to participation. Additional file 1: K, pdf Information Governance; summarized results. EMR adoption in the countries based on literature review; description. Michelle Helena van Velthoven, Email: ku. Nikolaos Mastellos, Email: ku. Azeem Majeed, Email: ku. Josip Car, Email: ku.

National Center for Biotechnology Information , U. Published online Jul Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Jun 28; Accepted Jul 5.

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This article has been cited by other articles in PMC. Associated Data Data Availability Statement The data from the interviews has not been included in a public database as the interview transcripts contain information that could make identification of study participants possible. Abstract Background Electronic medical records EMR offer a major potential for secondary use of data for research which can improve the safety, quality and efficiency of healthcare. Results We found that procedures for information governance, levels of adoption and data quality varied across the countries studied.

Conclusions This is the first international comparative study to shed light on the feasibility of extracting EMR data across a number of countries. Electronic supplementary material The online version of this article doi Background Characteristics and benefits of electronic medical records EMR Electronic medical records EMR offer a major potential to improve the safety, quality and efficiency of healthcare [ 1 ]. Barriers to secondary use of EMR data Despite the large investments in EMR systems worldwide, some countries have yet to realise the potential of EMR to improve the quality, safety and efficiency of healthcare [ 13 , 14 ].

Aim of this study This study aimed to assess information governance procedures for extracting data from EMR across 16 countries, using the management of type 2 diabetic patients as an exemplar. Table 1 The scope of assessment of countries included in this study. Open in a separate window. Literature review We conducted a literature review on academic papers using EMR data from type 2 diabetic patients, as well as other EMR extracted data a description of the literature on adoption of EMR in the countries can be found in Additional file 3.

Interviews A structured interview questionnaire was used that included questions on: treatment setting of type 2 diabetes patients and EMR adoption within treatment settings; use of EMR data and existing relationships with EMR providers; information governance; trends and incentives on EMR use; and details of EMR systems. Data synthesis We synthesised all information from the literature review documents and interview questionnaires thematically Additional files 1 and 2. Results Information governance processes Authorities and processes for approval for EMR data extraction and use for research We obtained information regarding processes to obtain approval for EMR data extraction for research purposes in all countries apart from Austria where data from EMR systems were not yet meant to be used for research Additional file 1.

Table 2 EMR information governance: the example of China. Division of Medical Affairs and Division of Research: necessary if retrieving data from various provinces, or retrieving national data of various kinds such as public health, immunisation or epidemiology of emergency events.

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Not conclusive if required in mainland China. Although not applicable for anonymised data, users should comply with requirements under the PDPO personal data handling. Suspected breaches will be investigated. Ease of obtaining approval Relatively easy, as there are procedures in place and the process is quick.

The director of the hospital plays a key role in the approval process. Regional differences Regional differences exist, e.