Biomedical subjects

K Adelhard

Publications and source records attributed to K Adelhard.

26 records · Page 2Linked to original sources

PubMed1998

[The filmless hospital--a legal challenge].

PURPOSE: This article concerns the legal aspects of digital archiving of radiological images, in particular with regard to the resolution passed by the 37th Committee meeting of the Federal Board of "RöV" (x-ray ordinance). Concepts of filmless hospitals must therefore be tested for compliance with all present legal requirements. MATERIAL AND METHODS: The literature concerning the legal aspects of digital medical archiving of x-ray documents is reviewed. The concept of a digital archive was compared with these aspects and tested for compliance with the respective legal rules. RESULTS: There are no legal obstacles to realizing our concept of a filmless hospital. However, there are no civil court rulings on record, since there have not been any legal proceedings to date. CONCLUSIONS: There are no legal objections to a complete digital archiving in a hospital in the absence of any court rulings to the contrary.

Confidentiality↗

PubMed1998

[Evaluation of medical internet resources: quality criteria].

Quality Criteria: On the Internet medical information is provided for laymen as well as for medical experts. This is frequently used to answer specific medical questions and is likely to exercise a direct influence on health related behaviour. Several authors and institutions set up quality criteria for medical information resources on the Internet to establish a basis for a reliable service to patients and physicians. Existing information resources can be evaluated according to these criteria.

Computer Communication Networks↗

PubMed1998

[Evaluation of medical Internet sources: outcome].

A large number of medical information is available on the Internet for laymen as well as for medical experts. This is used to answer medical questions in concrete situations and is likely to influence health related behaviour directly. Therefore the questions arises how health is affected and how the effects can be measured. The classical way of performing clinical studies can be applied to the Internet only in part. New methods must be developed and evaluated in individuals studies.

Computer Communication Networks↗

PubMed1997

Thirty-year results of Starr-Edwards prostheses in the aortic and mitral position.

BACKGROUND: Between 1963 and 1977 a total of 415 patients admitted to the University Hospital Munich underwent an isolated valve replacement with a Starr-Edwards prosthesis in the aortic or mitral position. METHODS: A retrospective follow-up of 87.1% of the patients representing 4,254 patient-years was completed. Surviving patients were examined by means of echocardiography. RESULTS: Survival rates after 10, 20, and 30 years were 62.3%, 39.4%, and 19.9% after aortic valve replacement and 75%, 36.5%, and 22.6% after mitral valve replacement (operative mortality excluded). Freedom from all valve-related complications, reoperations, and valve-related death was 66.4%, 43.3%, and 23.8% after aortic valve replacement and 73.4%, 35.4%, and 14.3% after mitral valve replacement. Of the surviving patients, 82% and 76% who received aortic or mitral valves, respectively, are in New York Heart Association class I or II. The pressure gradients of the aortic valves were between 20 and 73 mm Hg; those of the mitral valves were between 9 and 30 mm Hg. Fifty-two percent of aortic and 68% of mitral valves show no echocardiographic peculiarities. The left ventricular function in both groups is normal in 64%. CONCLUSIONS: The long-term results together with the echocardiographic results show that after 30 years the Starr-Edwards valve represents a standard that still needs to be achieved by newer prostheses.

Adult↗

PubMed1996

25 years follow-up of patients after replacement of the aortic valve with a Smeloff-Cutter prosthesis.

Thirty years ago the Smeloff-Cutter double-caged ball prosthesis was developed for aortic valve replacement. Between 1967 and 1977 a total of 46 patients admitted to the University Hospital Munich underwent an isolated aortic valve replacement with the Smeloff-Cutter prosthesis. Postoperatively all patients received anticoagulation treatment with phenprocoumon (Marcumar). A retrospective follow-up of 95.6% of patients, representing 842 patient years, was completed. The corresponding actuarial survival rates after 10, 20, and 25 years were 69.1%, 47.4%, and 31.4%. The actuarial freedom rates from either valve-related complications, reoperations, or death were 72.9%, 47.4%, and 20.3%. Thromboembolism occurred in 1.41% per patient year, bleeding in 1.90%. The rates of valvular dysfunction, reoperation, and endocarditis were 1.16%, 1.16%, and 0.2% per patient-year. Today, of the surviving patients 81% are in NYHA Class I or II, 19% in NYHA Class III. No surviving patient deteriorated over the reported time in his or her functional NYHA classification. After 25 years the Smeloff-Cutter valve has proved to be a reliable prosthesis for aortic valve replacement and-together with the Starr-Edwards prosthesis-it has set a standard in longterm durability by which all other valve designs will have to be measured.

Adolescent↗

PubMed1996

[Correlation between symptoms and diagnosis in pharmacotherapeutic decision process].

Evaluation of influence of psychopathological symptoms (AMDP System) and diagnosis (ICD-9) on the choice of drug therapy (neuroleptics or antidepressants) for psychiatric in-patients was the aim of this work. Statistical analysis of 3745 patients led to three different decision-making procedures. These procedures are based on symptoms or diagnoses alone or on both symptoms and diagnosis. CART-Analysis was used for statistical analysis. Reclassification errors for neuroleptics were always larger than reclassification errors for antidepressants. The results show that both symptoms (error neuroleptics 20.2%, respectively antidepressants 15.0%) and diagnosis (20.8%, resp. 11.9%) alone are not sufficient to explain the choice of drug therapy. Lowest error rates were gained in a hierarchical model for the choice of drug treatment where both diagnosis and symptoms were used (17.1%, resp. 10.1%).

Antidepressive Agents↗

PubMed1996

Design elements of a telemedical medical record.

Computerized Patient Records are becoming telemedical and multimedia documents. They should accompany the patients their whole lifetime and collect data from many different sites. Special requirements are arising to fulfill these demands. A prototype of such a system was designed and implemented at the university hospital in Grosshadern, Germany to show its feasibility, discuss the design elements and demonstrate its capabilities. A Flexible data model, interpretable contents, open communication structures and physical compilation are the cornerstones of this approach that allows communication via Internet or Smart cards.

Computer Communication Networks↗

PubMedDate not supplied

A prototype of a computerized patient record.

Computerized medical record systems (CPRS) should present user and problem oriented views of the patient file. Problem lists, clinical course, medication profiles and results of examinations have to be recorded in a computerized patient record. Patient review screens should give a synopsis of the patient data to inform whenever the patient record is opened. Several different types of data have to be stored in a patient record. Qualitative and quantitative measurements, narratives and images are such examples. Therefore, a CPR must also be able to handle these different data types. New methods and concepts appear frequently in medicine. Thus a CPRS must be flexible enough to cope with coming demands. We developed a prototype of a computer based patient record with a graphical user interface on a SUN workstation. The basis of the system are a dynamic data dictionary, an interpreter language and a large set of basic functions. This approach gives optimal flexibility to the system. A lot of different data types are already supported. Extensions are easily possible. There is also almost no limit concerning the number of medical concepts that can be handled by our prototype. Several applications were built on this platform. Some of them are presented to exemplify the patient and problem oriented handling of the CPR.

Humans↗