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At least 325 records · Page 18Linked to original sources
PubMed2003

Rapid prototyping strategy for a surgical data warehouse.

OBJECTIVES: Healthcare processes typically generate an enormous volume of patient information. This information largely represents unexploited knowledge, since current hospital operational systems (e.g., HIS, RIS) are not suitable for knowledge exploitation. Data warehousing provides an attractive method for solving these problems, but the process is very complicated. This study presents a novel strategy for effectively implementing a healthcare data warehouse. METHODS: This study adopted the rapid prototyping (RP) method, which involves intensive interactions. System developers and users were closely linked throughout the life cycle of the system development. The presence of iterative RP loops meant that the system requirements were increasingly integrated and problems were gradually solved, such that the prototype system evolved into the final operational system. RESULTS: The results were analyzed by monitoring the series of iterative RP loops. First a definite workflow for ensuring data completeness was established, taking a patient-oriented viewpoint when collecting the data. Subsequently the system architecture was determined for data retrieval, storage, and manipulation. This architecture also clarifies the relationships among the novel system and legacy systems. Finally, a graphic user interface for data presentation was implemented. CONCLUSIONS: Our results clearly demonstrate the potential for adopting an RP strategy in the successful establishment of a healthcare data warehouse. The strategy can be modified and expanded to provide new services or support new application domains. The design patterns and modular architecture used in the framework will be useful in solving problems in different healthcare domains.

Colorectal Surgery↗
PubMed1997

[Surgical information systems as instruments in quality assurance].

In various aspects, it is important to document medical procedures performed in surgical management. These records have become even more relevant because, in realizing the German health structure law, new forms of remuneration have been established, which are correlated with defined services. This means that data from medical documentation records today "rule" on financial compensation and, consequently, on the total economy of a hospital. Data are to be gathered considering multiple clinical and administrative requests; they have to register all pre-, intra- and postoperative details in their complex correlations; and, they are subject to strictly limited periods of compulsory availability. To meet these demands, data can only be recorded and evaluated by adequate computerized information systems. Starting out from a general data profile in response to questions from inside and outside of the hospitals, general criteria will be presented on what is to be recorded and how data are to be structured by surgery information systems. We will also refer to the interfaces required with information systems of other clinical departments that are part of the overall hospital information system. On this basis, guidelines are set up on how to plan, select, introduce and efficiently run these systems.

Cost Savings↗
PubMed1997

[Evaluation and internal quality assurance in general and abdominal surgery].

The measuring of perioperative risk, the finding of intraoperative influences and the objective rating of quality of treatment were achieved by our program of quality assurance. With our system it is possible to measure differences between several surgeons and also differences in comparison to national and international results. Through optimised therapy the program can lead to an improvement of quality.

Data Collection↗
PubMed2001

Real-time Internet connections: implications for surgical decision making in laparoscopy.

OBJECTIVE: To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. SUMMARY BACKGROUND DATA: Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. METHODS: Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were "grabbed" from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. RESULTS: The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is inexpensive, effective, and almost ubiquitous. Use of these inexpensive, portable technologies will allow sharing of surgical procedures and decisions regardless of location. Internet telemedicine consistently supported real-time intraoperative consultation in laparoscopic surgery. The implications are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation.

Cholecystectomy, Laparoscopic↗
PubMed1991

Developing a system for surgical audit.

A system for surgical audit, which has been developed during a 6 year period in an active surgical unit of a teaching hospital, is described. Following a review of the first 3 years of our computerized audit, major modifications to the audit processes and computer program were made. The key lessons for systematic practical surgical audit include the collection of essential data only, establishing audit processes within current department practices, verification of data by consultants, and the provision of incentives for all users. The current system is proving a valuable resource for quality assurance, surgical training and departmental management.

Computer Systems↗
PubMed1990

[Clinical basic documentation in surgery].

Clinical basic documentation allows a cost lowering and personal saving application of modern data processing technology within the clinical routine. The concept presented in this article has been successful for ten years. Soon after its installation this documentation provides its user with valuable data for internal quality control. Listings of diagnosis, surgical procedures, length of stay and frequencies of complications can be created without extensive knowledge of data processing and computer programming. Based on this concept special documentations for statistical analysis of certain patient groups or diseases are easily established.

Documentation↗
PubMed2004

Interrogation of patient data delivered to the operating theatre during hepato-pancreatic surgery using high-performance computing.

OBJECTIVE: The Op3D visualization system allows, for the first time, a surgeon in the operating theatre to interrogate patient-specific medical data sets rendered in three dimensions using high-performance computing. The hypothesis of this research is that the success rate of hepato-pancreatic surgical resections can be improved by replacing the light box with an interactive 3D representation of the medical data in the operating theatre. MATERIALS AND METHODS: A laptop serves as the client computer and an easy-to-use interface has been developed for the surgeon to interact with and interrogate the patient data. To date, 16 patients have had 3D reconstructions of their DICOM data sets, including preoperative interrogation and planning of surgery. RESULTS: Interrogation of the 3D images live in theatre and comparison with the surgeons' operative findings (including intraoperative ultrasound) led to the operation being abandoned in 25% of cases, adoption of an alternative surgical approach in 25% of cases, and helpful image guidance for successful resection in 50% of cases. CONCLUSIONS: The clinical value of the latest generation of scanners and digital imaging techniques cannot be realized unless appropriate dissemination of the images takes place. This project has succeeded in translating the image technology into a user-friendly form and delivers 3D reconstructions of patient-specific data to the "sharp end"-the surgeon undertaking the tumor resection in theatre, in a manner that allows interaction and interpretation. More time interrogating the 3D data sets preoperatively would help reduce the incidence of abandoned operations-this is part of the surgeons' learning curve. We have developed one of the first practical applications to benefit from remote visualization, and certainly the first medical visualization application of this kind.

Digestive System Surgical Procedures↗
PubMed1999

Tools for precision enhancement in minimally invasive cardiac surgery: three dimensional visualization, computer enhancement and robotics.

This article is a current update of the rationale for development of new enabling technologies in minimally invasive cardiac surgery. Specifically the potential advantages of three dimensional visualization, computer enhancement technology and robotics in performance of totally endoscopic coronary artery bypass grafts will be addressed.

Computer Systems↗
PubMed2003

[The registration of complications of medical treatment].

The National Surgical Adverse Event Registration (LHCR) software has been fully implemented in 25 (18.7%) departments of surgery in the Netherlands. This is a relatively low percentage considering that 92.5% of all hospitals are already using a local registration system for complications. Software difficulties in creating a link between the LHCR and local systems is suggested to be the main impeding factor. There are still a number of questions, notably concerning the validity of the system for registration of all complications versus a selected group of (severe) complications, the issue of the implications of the registration system in terms of quality control and subsequent regulation or centralization of procedures, and the importance for other specialists, in particular those performing invasive procedures, to introduce a complication registration system to establish a quality control system in those areas as well.

General Surgery↗
PubMed1997

Perioperative system design and evaluation.

Moving toward an electronic record is both challenging and rewarding. The implementation of a computerized scheduling and management system for the operating room is evaluated. Components of the system include Scheduling, Personnel, Supply, Intraoperative, and InSight modules.

Equipment and Supplies, Hospital↗
PubMed2003

[New concepts in image assisted surgery: automated patient registration based on the jaw and external ear].

OBJECTIVE: Automatic and marker less patient registration based on natural anatomical interfaces may considerably reduce the radiation load and logistical input prior to computer-assisted surgical interventions, as it is not necessary to place and measure reference markers. The present study was to find out if, apart from the facial skin, also auricles as well as the upper and lower jaw can be used as anatomical interfaces for the intraoperative registration of the patient's position. MATERIAL AND METHOD: Prior to surgical intervention the positions of 20 patients were registered by a high-resolution 3D laser scan and correlated with the preoperative CT data set. Tumors, skeletal malformations, and foreign bodies were indications for surgical intervention. Auricles as well as the upper and lower jaw were used to register the patient's positions. The accuracy of this basically marker less method was clinically evaluated through the additionally placed conventional registration markers. RESULTS AND CONCLUSION: The marker less patient registration based on natural anatomical interfaces was successful in the upper jaw (deviation: 0.8+/-0.3 mm). The tongue and mobile floor of the mouth led to geometric incongruence and inadequate laser registration in the lower jaw. As far as the auricles were concerned, high accuracy could only be achieved as long as the auricles had not been deformed during CT imaging (deviation: 1.9+/-0.9 mm). The usual CT acquisition with a conventional head support, however, led to temporary auricular deformations in more than half of the patients, which made an exact laser scan registration impossible.

Artifacts↗
PubMed1992

[Computerized monitoring system in the operating center with UNIX and X-window].

We previously reported the fully automated data logging system in the operating center. Presently, we revised the system using a highly integrated operating system, UNIX instead of OS/9. With this multi-task and multi-window (X-window) system, we could monitor all 12 rooms in the operating center at a time. The system in the operating center consists of 2 computers, SONY NEWS1450 (UNIX workstation) and Sord M223 (CP/M, data logger). On the bitmapped display of the workstation, using X-window, the data of all the operating rooms can be visualized. Furthermore, 2 other minicomputers (Fujitsu A50 in the conference room, and A60 in the ICU) and a workstation (Sun3-80 in the ICU) were connected with ethernet. With the remote login function (NFS), we could easily obtain the data during the operation from outside the operating center. This system works automatically and needs no routine maintenance.

Operating Room Information Systems↗
PubMed1995

Decreases in anesthesia-controlled time cannot permit one additional surgical operation to be reliably scheduled during the workday.

We tested whether anesthesiologists can decrease operating room (OR) costs by working more quickly. Anesthesia-controlled time (ACT) was defined as the sum of 1) the time starting when the patient enters an OR until preparation or surgical positioning can begin plus 2) the time starting when the dressing is finished and ending when the patient leaves the OR. Case time was defined as the time starting when one patient undergoing an operation leaves an OR and ending when the next patient undergoing the same operation leaves the OR. An actual case series was constructed of 709 consecutive patients who underwent one of 11 elective operations at a tertiary care center. Statistical analysis of measured OR times showed that ACt would have to be decreased by more than 100% to permit one additional scheduled, short (30-min) operation to be performed in an OR during an 8-h workday after a prior series of cases, each lasting more than 45 min. Anesthesiologists alone cannot reasonably decrease case times sufficiently to permit one extra case to be reliably scheduled during a workday. Methods to decrease ACT (e.g., using preoperative intravenous catheter teams, procedure rooms, and/or shorter acting drugs) may simply increase costs.

Ambulatory Surgical Procedures↗
PubMed1991

Data recording and trend display during anaesthesia using 'MacLab'.

A single screen display of variables monitored during anaesthesia may be ergonomically superior to the 'stack' of monitors seen in many anaesthetising locations. A system based on a MacLab (Analogue Digital Instruments) analogue-to-digital convertor used in conjunction with a Macintosh computer was evaluated. The system was configured to provide trend displays of up to eight variables on a single screen. It was found to be a useful adjunct to monitoring during anaesthesia. Advantages of this system are low cost, flexibility, and the quality of the software and support provided. Limitations of this and other similar systems are discussed.

Analog-Digital Conversion↗
PubMed1992

ORSOS goes to theatre!

The presence of computers in the operating theatre is on the increase. Sheena Craig, theatre manager at the Western General Hospital, Edinburgh, describes how the Operating Room Scheduling and Office System (ORSOS) was installed in her theatre suite and asks, 'Was it worth the effort'?!

Attitude of Health Personnel↗