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Observer detection performance in radiology using a retransmission-free network communication protocol.

RATIONALE AND OBJECTIVES: We measured the effect of image data loss on diagnostic accuracy to test the possibility of using a retransmission-free network communication protocol for transferring radiologic images. METHODS: Mammograms transferred over a simulated network with 0%, 15%, and 25% transmission packet loss were presented randomly to 10 observers who typically read mammograms. Observers reported on the presence or absence of microcalcification clusters and the number of calcifications per cluster. RESULTS: Performance with 15% loss did not differ from performance with 0% loss. The 25% loss condition resulted in a significant decrease in performance. Accuracy of counting individual microcalcifications was high in all three loss conditions. CONCLUSION: Up to 15% packet loss can be tolerated without affecting diagnostic performance. These data suggest that in some radiologic applications retransmission-free communication protocols may be useful.

Breast Diseases↗

E-mail: what is e-mail?

This third part of the series explains what e-mail is and why it is the most widely used service on the internet. The principles behind sending and receiving e-mail messages are described. Also the various uses of e-mail are discussed.

Computer Communication Networks↗

Progressive adriamycin nephropathy in mice: sequence of histologic and immunohistochemical events.

BACKGROUND: As an experimental analogue of human focal glomerular sclerosis (FGS), adriamycin (ADR)-induced nephropathy is well-characterized in rats. Previously, this model has not been fully established in mice. The extension of this model to the mouse would be useful in the application of genetic and monoclonal antibody technology to characterize mechanisms of progressive renal disease. Herein, we describe a stable and reproducible murine model of chronic proteinuria induced by ADR. METHODS: Male BALB/c mice were intravenously injected with a single dose of ADR (10 to 11 mg/kg). Seven mice were sacrificed at weeks 1, 2, 4, and 6. Renal function, quantitative morphometric analysis, and electron microscopic studies were performed. Peripheral CD4+ and CD8+ T cells were evaluated using flow cytometric analysis of splenocytes. The leukocytic inflammatory pattern was analyzed by immunohistochemical examination. RESULTS: Overt proteinuria was observed from day 5 and remained significantly elevated throughout the study period. A focal increase in reabsorption droplets in tubular cells appeared at weeks 1 and 2, and numerous intraluminal casts were present after two weeks. Glomerular vacuolation and mild FGS appeared at week 4. At week 6, extensive focal and even global glomerular sclerosis, associated with moderate interstitial expansion and severe inflammation, were observed. A prominent macrophage infiltration appeared within both interstitium and glomeruli at week 2, followed by accumulation of both CD4+ and CD8+ T cells in interstitium but not glomeruli. There were almost no B lymphocytes seen at any time. CONCLUSION: This model should be useful in unraveling the pathogenesis of glomerular and interstitial inflammation and fibrosis in chronic proteinuric renal disease.

Animals↗

The release of unsuitable units through misinterpretation of laboratory results transmitted by facsimile.

BACKGROUND: Preventable errors in transfusion medicine that have a significant risk of adverse outcome include the erroneous administration of blood of the wrong type or blood with unsuitable laboratory test results. Mandatory reports of errors by facilities providing blood services in New York State offer the opportunity for review and analysis of common factors. The state also collects statistics on the collection, laboratory testing, distribution, and disposition of blood in these facilities. CASE REPORTS: Three serious errors in transfusion medicine occurred within 3 months as a result of the misinterpretation of laboratory test results transmitted by facsimile. Two unsuitable units of blood were erroneously released, and a unit mislabeled as to the ABO group was incorporated into the hospital inventory. One of the unsuitable units was repeatedly reactive for HIV (although negative on confirmatory testing), and the other was confirmed positive for HCV. CONCLUSIONS: The vast majority of blood collected in New York State is tested by reference laboratories. Results are often transmitted by facsimile. Facsimile results may be misinterpreted because of distortion during transmission, misreading, or failure to note a separate report of pending results. Such misinterpretation results in an increased risk of adverse outcome for transfusion recipients. Laboratory results to be transmitted by facsimile could readily-and should-be clarified.

Humans↗

Fax technology for collecting outcomes data in a computer database.

In this era of cost containment, outcomes research is becoming more prevalent. Therefore, various technologies allowing for flexibility in study design and the capture of specific clinical information need to be examined and used. These technologies include fax data systems, pocket scanners, automated telephone equipment, and hand-held computer devices. Fax data systems convert a fax machine into an automated data-entry system. Data-filled forms are faxed to a computer, the fax is converted, and the data are entered into preset fields in a database. Applications for fax systems include acute care-based and ambulatory care-based drug-use evaluations, drug recall systems, and patient-completed surveys of health status. Pocket scanners are hand-held instruments for rapid data entry and transport. Applications for pocket scanning include patient interview responses, procedure and disease analysis, and procedure coding. Options for automated telephone equipment include surveys with interactive voice-mail responses or keypad data entry, pharmacist-monitored drug information and survey services, fax-back and mail-out services, and patient-generated disease intervention programs. Hand-held computer technology is a source of information on multiple protocols and care pathways. All these technologies improve data collection with respect to accuracy and speed, facilitate data analysis, and promote cost-efficient information sharing. The purpose of this study was to evaluate the use of fax technology in data collection for a prospective, multicenter study of the outcomes and cost-effectiveness of two drugs used in the treatment of cancer. Details for the pharmacoeconomic study can be found elsewhere. Fax technology was selected because of the ease with which those responsible for managing the data collection could be trained to use it, the affordability and efficiency of the technology, the ease with which data could be analyzed, and the accuracy of data collection.

Cost-Benefit Analysis↗

Faxes, modems, and fax/modems.

Although the use of computers for word processing and spreadsheet analysis is widespread, other less well-known uses can also increase efficiency and productivity. In this bimonthly column, Dr. Nicoll discusses a variety of computer applications to help the nurse executive catch up, keep up, and get ahead.

Communication↗

Personal computer teleradiology interhospital image transmission to facilitate tertiary pediatric telephone consultation and patient transfer: soft-tissue lateral neck and elbow radiographs.

Although teleradiology systems are available commercially, they are expensive ($30,000), and different makes are incompatible with each other, making them unusable for interhospital image transfers. Standard components were added to a personal computer (PC) to build a functional teleradiology unit capable of interhospital image transmission at a low cost ($600 upgrade). This PC teleradiology system was studied to assess its accuracy in the interpretation of soft-tissue lateral neck x-rays with epiglottitis or retropharyngeal abscesses and elbow x-rays with joint effusions, fractures, or both. A radiologist and a pediatric emergency physician were asked to read the PC teleradiology images. Both physicians read 13 of 13 soft-tissue lateral neck x-rays and 15 of 15 elbow x-rays correctly. This study supports the premise that PC teleradiology can be used to facilitate telephone consultation and patient transfers between tertiary pediatric emergency centers by transmitting pertinent radiographic information over a phone line. Although verbal communication can often suffice in a telephone consultation or transfer, there are many instances when visualizing a radiographic image such as an x-ray or computed tomography scan can provide important information that cannot be optimally described verbally. Rural hospitals can form interhospital image transmission links with tertiary center resources. Tertiary centers may elect to organize interhospital image transmission and referral networks with their rural hospital sources.

Adolescent↗

A decade of rare donor services in the United States. Report of the American Red Cross Rare Donor Registry (1981-1990).

Between 1981 and 1990, the American Red Cross Rare Donor Registry supplied 9,872 units of red cell components with rare phenotypes to blood centers in the United States and abroad. Approximately 51% were from donors with high-frequency antigen-negative phenotypes and 49% were from donors with multiple antigen-negative phenotypes. Since 1989, the disease category requiring the largest number of units has been sickle cell disease. Strategies to ensure that the Registry will have adequate resources to meet future requirements include testing selected donors for rare phenotypes and blood conservation programs, such as intraoperative salvage and the treatment of anemia of chronic renal failure with recombinant erythropoietin.

Anemia, Sickle Cell↗

Using a facsimile (fax) as an aid for communication in maxillectomy planning between the prosthodontist and surgeon.

Preoperative communication between the prosthodontist and surgeon is required for properly planning the surgical prostheses that are often indicated for maxillectomy patients. When geography or long distances preclude face-to-face consultation, electronic means of correspondence are necessary to minimize delays in the fabrication of surgical prostheses. This article presents a time-efficient procedure for facilitation of the necessary communication between the prosthodontist and surgeon before maxillectomy surgical procedures.

Communication↗