A technique is described, using a mobile radiographic x-ray unit, for determining the effective size of the input phosphor of an image intensifier (I.I.), in particular for a unit with over-table x-ray tube, under-table II, and with the I.I. physically inaccessible. The techniques described also enable (1) locating the central axis of the I.I.; (2) the ratio, R, of the dimensions of the radiological image incident upon the front of the I.I. to the dimensions of the image on the monitor screen; and (3) the distance between the input phosphor and the table top, which is needed to determine the distance from focal spot to input phosphor.

Biophysical Phenomena↗

PubMed1997

Telementoring: pushing the telemedicine envelope.

Telemedicine offers significant advantages in bringing consulting support to distant colleagues. Our aim in this study was to evaluate the role of telementoring in the training of advanced laparoscopic surgical procedures. Student surgeons received a uniform training format to enhance their laparoscopic skills and intracorporeal suturing techniques and specific procedural training in laparoscopic colonic resections and Nissen fundoplication. Subsequently, operating rooms were equipped with three cameras. A telestrator (teleguidance device), instant replay (to critique errors), and CD-ROM programs (to provide reference information) were used as intraoperative, educationally assistant tools. In phase 1, four colonic resections were performed with the mentor in the operating room (group A), and four colonic resections were performed with the mentor on the hospital grounds but not in the operating room (group B). The voice and video signals were received at the mentor's location using coaxial cable. In phase 2, two Nissen fundoplications were performed with the mentors in the operating room (group C), and two Nissen fundoplications were performed with the mentors 5 miles away from the operating room (group D) using existing land lines at the T1 level. We found no differences in the performances of the surgeons or the outcomes of the operations between groups A and B and groups C and D. Intraoperative problems were tackled effectively. Preliminarily, we conclude that the telementoring concept is potentially a safe and cost-effective option for advanced training in laparoscopic operations. Further investigation is necessary before routine transcontinental patient applications are attempted.

Colectomy↗

PubMed1996

Informed choice for users of health services: views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers.

With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concerned that the leaflets would raise women's anxiety, reduce uptake of scans, disrupt hospital organisation, and reinforce media messages about the poor safety record of ultrasonography. Midwives thought that the leaflets would inform women, help them to talk about their care with health professionals, and help them to get better care. Women were shocked at some of the contents but thought that it was appropriate to include both advantages and disadvantages of routine scanning in the leaflet. This case study highlights the resistance of some health professionals to evidence based health care; underlying conflicts with the principle of professional autonomy; concern that informed choice may create anxiety; and professional and organisational barriers to allowing informed choice.

Attitude of Health Personnel↗

PubMed1996

CD-ROM multimedia. The step before virtual reality.

Applications developed using key multimedia elements are finding their way into a number of training and information exchange environments including the laparoscopy training market. Emerging multimedia-based applications range from procedural information for patients to interactive CD-ROM-based applications used to train highly skilled surgeons. These products are designed with a high level of interactivity that allows the surgeon to plan a surgical procedure, review detailed patient information and then merge that information into the surgical planning process. Using this new technology, a surgeon now has the ability to review CD-ROM-based course materials and efficiently meet continuing education requirements. The factor found most limiting in the development of multimedia-based applications for laparoscopy training is generally not the technology, but the limits placed on the technology because of one's reluctance to think beyond what is accepted as the norm. Properly implemented, multimedia applications developed for laparoscopy training reduce the cost and time associated with learning new materials, assist a user in retaining more of the information reviewed, and in many cases make the learning experience much more enjoyable.

Audiovisual Aids↗

PubMed1994

The anatomical basis for laparoscopic hernia repair revisited.

With the development of the transabdominal preperitoneal secured prosthetic mesh repair, many laparoscopic surgeons feel not only that they have a procedure with a low recurrence rate, but that the procedure also has historic academic credibility. This repair emulates well-established open procedures. Shortcomings of this repair include a demand for more precise identification of structures, more careful dissection, and a higher risk of injury to important anatomical entities. There have been anecdotal reports of injuries to nerves such as the lateral femoral cutaneous nerve, the femoral nerve, and the genital branch of the genital-femoral nerve. This article reviews inguinal anatomy from the laparoscopic vantage point and identifies the areas where injury to nerves can occur.

Groin↗

PubMed1991

Rubella research and the Rosser family.

Explore the source record for details and available documents.

Adolescent↗