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PubMed1988

Collation of student results in practical class experiments in physiology, using a BBC ECONET computer network.

Funding was provided to Queen's University by the Department of Education and by the Industrial Development Board for Northern Ireland to provide microcomputers for undergraduate use. An allocation from the grant to the Department of Physiology enabled the purchase of 20 BBC Master 128 microcomputers with monitors used as student work-stations connected together by an ECONET network with a file server using a dual floppy disc drive, two printer servers and two demonstrator stations. A BASIC program was written to analyse the students' practical class measurements which they entered manually at their work-station keyboards. Class results were presented to the students in the form of frequency distribution histograms or X/Y graphs. Program modifications to suit different practicals can be made relatively easily. The time taken to analyse data has been shortened. It is easy for the students to get immediate comparison of their own results with those of the rest of the class--particularly advantageous if the student's own experiment did not work. The class can be divided into groups to study different variations of the experiment and provide the data from each group to the whole class. The students' opinions on whether the equipment had (1) improved the teaching of physiology and (2) provided helpful preparation for the use of computers in medical practice were assessed by a questionnaire which showed that a clear majority felt these aims had been fulfilled.

Computer-Assisted Instruction↗
PubMed2004

Preliminary experience of shared clinical management between Milan and Pointe Noire using the INteractive TeleConsultation Network for Worldwide HealthcAre Services (INCAS): telemedicine between Milan and Africa.

This paper describes preliminary experience in shared clinical management of patients located in Pointe Noire, Africa, and a referral center, Sacco University Hospital, located in Milan, Italy. The employed infrastructure INteractive TeleConsultation Network for Worldwide HealthcAre Services (INCAS) jointly developed by CEFRIEL (Center of Excellence For Research, Innovation, Education & Industrial Labs partnership) and ENI (Ente Nazionale Idrocarburi) is based on commercial off-the-shelf technology. This minimizes maintenance problems, while permitting a simple and friendly sharing of data using the telephone and e-mail for store-and-forward applications. The critical aspect of the flow of events comprising the exchange of information is discussed. In 60% of cases, only one telemedicine consultation was required. In the remainder 40%, a number of telemedicine consultations were required for appropriate management of clinical cases. The project demonstrated flexibility as documented by the wide range of pathologies that can be dealt with it. Finally the possibility of using shared clinical management as a learning tool is highlighted by the steep and rising learning curve. We conclude, however, that the patient, although handled in a "virtual" manner, should be viewed as very "real," as some of them elected to close the gap physically between Pointe Noire and Milan, and chose to be treated at the referral site.

Congo↗
PubMed1999

Development and clinical implementation of an enhanced display algorithm for use in networked electronic portal imaging.

PURPOSE: To introduce and clinically validate a preprocessing algorithm that allows clinical images from an electronic portal imaging device (EPID) to be displayed on any computer monitor, without loss of clinical usability. The introduction of such a system frees EPI systems from the constraints of fixed viewing workstations and increases mobility of the images in a department. METHODS AND MATERIALS: The preprocessing algorithm, together with its variable parameters is introduced. Clinically, the algorithm is tested using an observer study of 316 EPID images of the pelvic region in the framework of treatment of carcinoma of the cervix and endometrium. Both anterior-posterior (AP/PA) and latero-lateral (LAT) images were used. The images scored were taken from six different patients, five of whom were obese, female, and postmenopausal. The result is tentatively compared with results from other groups. The scoring system, based on the number of visible landmarks in the port, is proposed and validated. Validation was performed by having the observer panel score images with artificially induced noise levels. A comparative study was undertaken with a standard automatic window and leveling display technique. Finally, some case studies using different image sites and EPI detectors are presented. RESULTS: The image quality for all images in this study was deemed to be clinically useful (mean score >1). Most of the images received a score which was second highest (AP/PA landmarks > or =6 and LAT landmarks > or =5). Obesity, which has been an important factor determining the image quality, was not seen to be a factor here. Compared to standard techniques a highly significant improvement was determined with regard to clinical usefulness. The algorithm performs fast (less than 9 seconds) and needs no additional user interaction in most of the cases. The algorithm works well on both direct detection portal imagers and camera-based imagers whether analog or digital cameras. CONCLUSIONS: We have demonstrated that it is possible to preprocess EPIs in such a way that the clinically relevant landmarks are easily detected on a generic computer screen. The algorithm is system-independent and fast. This allows for the encoding of EPIs in more generalized commercial formats so that distribution of images is facilitated.

Algorithms↗
PubMedDate not supplied

Design and implementation of a portal for the medical equipment market: MEDICOM.

BACKGROUND: The MEDICOM (Medical Products Electronic Commerce) Portal provides the electronic means for medical-equipment manufacturers to communicate online with their customers while supporting the Purchasing Process and Post Market Surveillance. The Portal offers a powerful Internet-based search tool for finding medical products and manufacturers. Its main advantage is the fast, reliable and up-to-date retrieval of information while eliminating all unrelated content that a general-purpose search engine would retrieve. The Universal Medical Device Nomenclature System (UMDNS) registers all products. The Portal accepts end-user requests and generates a list of results containing text descriptions of devices, UMDNS attribute values, and links to manufacturer Web pages and online catalogues for access to more-detailed information. Device short descriptions are provided by the corresponding manufacturer. The Portal offers technical support for integration of the manufacturers Web sites with itself. The network of the Portal and the connected manufacturers sites is called the MEDICOM system. OBJECTIVES: To establish an environment hosting all the interactions of consumers (health care organizations and professionals) and providers (manufacturers, distributors, and resellers of medical devices). METHODS: The Portal provides the end-user interface, implements system management, and supports database compatibility. The Portal hosts information about the whole MEDICOM system (Common Database) and summarized descriptions of medical devices (Short Description Database); the manufacturers servers present extended descriptions. The Portal provides end-user profiling and registration, an efficient product-searching mechanism, bulletin boards, links to on-line libraries and standards, on-line information for the MEDICOM system, and special messages or advertisements from manufacturers. Platform independence and interoperability characterize the system design. Relational Database Management Systems are used for the system s databases. The end-user interface is implemented using HTML, Javascript, Java applets, and XML documents. Communication between the Portal and the manufacturers servers is implemented using a CORBA interface. Remote administration of the Portal is enabled by dynamically-generated HTML interfaces based on XML documents. A representative group of users evaluated the system. The aim of the evaluation was validation of the usability of all of MEDICOM s functionality. The evaluation procedure was based on ISO/IEC 9126 Information technology - Software product evaluation - Quality characteristics and guidelines for their use. RESULTS: The overall user evaluation of the MEDICOM system was very positive. The MEDICOM system was characterized as an innovative concept that brings significant added value to medical-equipment commerce. CONCLUSIONS: The eventual benefits of the MEDICOM system are (a) establishment of a worldwide-accessible marketplace between manufacturers and health care professionals that provides up-to-date and high-quality product information in an easy and friendly way and (b) enhancement of the efficiency of marketing procedures and after-sales support.

Advertising↗
PubMed2002

Clinical neurophysiology in Uppsala, 1967-2001.

This is a review of the activities at the Department and Institution of Clinical Neurophysiology at Uppsala University Hospital from 1967 to 2001. The most important routine clinical methods are briefly described, and a summary of some of the research projects is given.

Electroencephalography↗
PubMedDate not supplied

HIS, RIS, and PACS.

In this paper the historical background of the concepts Hospital Information System, Radiology Information System, and Picture Archiving and Communication System (HIS, RIS, PACS) is presented. Next the present situation of the realization of the concepts is considered; the conceptual relation between the three is discussed. Accepting the existence of the three concepts, first the relation between HIS and RIS is analysed, next the relation between PACS and HIS/RIS is considered. It is concluded that such a relation is vital for the realization of a full-scale PACS. Moreover, it is concluded that not only data has to be exchanged but also information. The need for a generic description of an interface between the two is emphasized.

Hospital Information Systems↗
PubMed1994

Status quo and future prospects of the total hospital information system of a Japanese medical college.

Six years have passed since the total hospital information system of Miyazaki Medical College, nicknamed PHOENIX, began its functions for the first time. It started with order entry systems, and has accomplished various systems, leaving one entry system unfinished; the injection order entry system which will be completed in the near future. It was revealed that the waiting period was most reduced at the hospital pharmacy. The waiting period for the visitors was also reduced. Usefulness of the PHOENIX system was greatly advanced by the function of a unique system of personal computer LAN, nicknamed PALM. This personal computer environments consisted of 200 or more Apple Macintosh computers. In this PALM environment, file servers, CD-ROM MEDLINE, clinical information databases, electronic mails (available in LAN and Internet) and sharing of printers are on service 24 hr a day.

Academic Medical Centers↗
PubMed1995

LabLink--the key to multi-computer interfacing.

The growing complexity of computing environments requires creative solutions to prevent the gain in productivity promised by computing advances from being swallowed up by the necessity of moving information from one environment to another. LabLink is an interfacing tool for accomplishing such transfers in a clinical laboratory environment. It handles the automated data transfer among four systems, as well as providing substantial back-up capacity for critical operations when systems are down for saves or maintenance.

Blood Banks↗
PubMed1995

An automated patient registration and treatment randomization system.

Centralized patient registration and treatment randomization for multicenter clinical trials has many advantages over other approaches. Our Automated Patient Registration and Treatment Randomization system is a fully automated Interactive Voice Response, microcomputer-based application which can operate unattended and is continuously available to provide patient registration and treatment randomization. Several techniques are employed to ensure security of the system and validity and accuracy of the data. Several randomization methods were implemented to support different study designs including balanced block randomization, stratified permuted block scheme, and a sophisticated randomization design based on the minimization method and Zelen's adaptive randomization method for institution balancing.

Clinical Trials as Topic↗
PubMed1991

Users' perceptions of a computerised information system in intensive care (ABICUS) on introduction and after 2 months use.

The aim of the present study was to assess the perceived utility of a computerised information system in an intensive care unit (ICU). Questionnaires were devised in which ICU staff indicated the ease or difficulty of obtaining and recording information (a) under the previous manual system, (b) soon after the introduction of the computerised system and (c) two months after computerisation. Results indicated the system was well received immediately and this favourable attitude persisted unchanged after two months experience. The questionnaire method also served to pinpoint some particular interface problems which are to be remedied in future versions of the system.

Attitude of Health Personnel↗
PubMed1986

Future use of computers in anesthesia.

Computers are beginning to appear in the operating room and intensive care units. At this time most computers are reserved for complex cases. However, it is now possible to discern what role the computer may play in the future, for routine cases. An outline of a conceivable integrated computerized system in anesthesia is presented.

Anesthesiology↗
PubMed1990

Automated anesthesia surgery medical record system.

Manual recording of physiological data in patients receiving anesthesia or intensive care infrequently meets medical requirements or legal documentation standards. Automated recording allows the generation of reliable data that can be integrated into the patient's medical record. Such a system is beginning to function at University Hospital at Stony Brook, New York. Bedside medical devices (pulse oximeters, non-invasive blood pressure monitors, capnographs, infusion pumps and physiological monitors) from 18 operating rooms and 16 beds in the Anesthesia Intensive Care Unit are connected to a baseband Ethernet system. Data from the above devices are stored in a MicroVAX computer system. Data compression and interpretation, computation of derived values, statistical analysis of data from two related parameters are done by the bedside graphical microcomputer workstation. The MicroVAX computer and the workstation are also connected to the Ethernet system. The overall architecture of the automatic record system conforms to emerging standards for information exchange between bedside monitors and computer systems. Health care recipients and providers are likely to reap the benefits.

Anesthesia↗
PubMed2002

Correction of nonuniform attenuation and image fusion in SPECT imaging by means of separate X-ray CT.

Improvements in image quality and quantitation measurement, and the addition of detailed anatomical structures are important topics for single-photon emission tomography (SPECT). The goal of this study was to develop a practical system enabling both nonuniform attenuation correction and image fusion of SPECT images by means of high-performance X-ray computed tomography (CT). A SPECT system and a helical X-ray CT system were placed next to each other and linked with Ethernet. To avoid positional differences between the SPECT and X-ray CT studies, identical flat patient tables were used for both scans; body distortion was minimized with laser beams from the upper and lateral directions to detect the position of the skin surface. For the raw projection data of SPECT, a scatter correction was performed with the triple energy window method. Image fusion of the X-ray CT and SPECT images was performed automatically by auto-registration of fiducial markers attached to the skin surface. After registration of the X-ray CT and SPECT images, an X-ray CT-derived attenuation map was created with the calibration curve for 99mTc. The SPECT images were then reconstructed with scatter and attenuation correction by means of a maximum likelihood expectation maximization algorithm. This system was evaluated in torso and cylindlical phantoms and in 4 patients referred for myocardial SPECT imaging with Tc-99m tetrofosmin. In the torso phantom study, the SPECT and X-ray CT images overlapped exactly on the computer display. After scatter and attenuation correction, the artifactual activity reduction in the inferior wall of the myocardium improved. Conversely, the incresed activity around the torso surface and the lungs was reduced. In the abdomen, the liver activity, which was originally uniform, had recovered after scatter and attenuation correction processing. The clinical study also showed good overlapping of cardiac and skin surface outlines on the fused SPECT and X-ray CT images. The effectiveness of the scatter and attenuation correction process was similar to that observed in the phantom study. Because the total time required for computer processing was less than 10 minutes, this method of attenuation correction and image fusion for SPECT images is expected to become popular in clinical practice.

Algorithms↗
PubMed2000

Simulation of disaster recovery of a picture archiving and communications system using off-site hierarchal storage management.

The purpose of this communication is to report on the testing of the disaster recovery capability of our hierarchical storage management (HSM) system. Disaster recovery implementation is a requirement of every mission-critical information technology project. Picture archiving and communications systems (PACS) certainly falls into this category, even though the counterpart, conventional film archive, has no protection against fire, for example. We have implemented a method for hierarchical storage with wavelet technology that maximizes on-site case storage (using lossy compression), retains bit-preserved image data for legal purposes, provides an off-site backup (lossless bit-preserving wavelet transform), and provides for disaster recovery. Recovery from a natural (earthquake and subsequent fire) or technical (system crash and data loss) disaster was simulated by attempting to restore from the off-site image and database backup to clean core PACS components. The only existing loaded software was the operating system. The database application was reloaded locally, and then the database contents and image store were loaded from the off-site component of the HSM system. The following measurements were analyzed: (1) the ability to recover all data; (2) the integrity of the recovered database and image data; (3) the time to recover the database relative to the number of studies and age of the archive, as well as bandwidth between the local and remote site; and (4) the time to recover image data relative to compression ratio, number of studies, number of images, and time depth of the archive. This HSM system, which maximizes on-site storage, maintains a legal record, and provides off-site backup, also facilitates disaster recovery for a PACS.

Computer Storage Devices↗
PubMed1998

Impact of filmless imaging on the frequency of clinician review of radiology images.

The purpose of this study was to determine the impact of filmless imaging on the frequency with which physicians access radiology images and to assess clinician perception of image accessibility using a hospital-wide Picture Archival and Communication System (PACS). Quantitative data were collected at the Baltimore VA Medical Center (BVAMC), prior to and after conversion to filmless imaging, to determine the frequency with which clinicians access radiology images. Survey data were also collected to assess physician preferences of image accessibility, time management, and overall patient care when comparing filmless and film-based modes of operation. In general, there was a significant increase in the average number of radiology images reviewed by clinicians throughout the hospital. However, the one are in the hospital where this trend was not observed was in the intensive care unit (ICU), where the frequency of image assess was similar between film and filmless operations. Ninety-eight percent of clinicians surveyed reported improved accessibility of images in a filmless environment resulting in improved time management. The mean clinician estimate of time saved due to the use of PACS was 44 minutes. The study documented a combination of clinician perception of improved accessibility and substantial time savings with the use of a hospital-wide PACS, which was supported by objective measurements. The increased frequency of image review by clinicians and rapid image access should provide a further impetus to radiologists to decrease report turnaround time to provided "added value" for patient care.

Baltimore↗