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PubMed1990

Principles and applications of Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) technology in orthopaedics.

The principles involved in Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) technology is presented in this article. It also highlights the current advances and capability of this technology. Application of the CAD/CAM technology in orthopaedics is relatively new. Three broad areas of applications can be defined: (1) three-dimensional reconstructions of skeletal structure based on any of the imaging technique, i.e. CT scan, MRI or X-ray, to analyse, simulate, design and evaluate orthopaedic procedures without having to actually perform the surgery; (2) the production of plastic or wax models for surgeons to have global impressions and understanding of complex cases of bone and joint disorders and the possibility of using the physical models as templates to sculpt allograft pre-operatively; and (3) to design and manufacture geometrically optimal standard and customised implants. CAD/CAM technology is also rapidly developing in the field of prosthetics, orthotics and orthopaedics footwear. The advantages offered include shorter delivery time, more consistent design, quantifiable rectification and "modern" or remote manufacturing. Apart from these applied usage, the CAD/CAM technology is also an effective tool for education and training. The application of CAD/CAM technology in orthopaedics and its related fields has been shown to have tremendous potential, but may appear to be too esoteric, complex and costly at the present moment. However, with improved generality, simplicity and cost-effectiveness of the system, it will become more practical.

Computer Simulation↗
PubMedDate not supplied

Maternal health services--the developing world.

Women in developing nations run 100 to 200 times the risk of dying in pregnancy and childbirth compared to women in affluent countries. The vast majority of these deaths are preventable. We examine 3 models of health development for their potential impact on maternal mortality. Although universal primary maternal health care would be ideal, resource limitations render its implementation impractical in many regions. The nonavailability of transport and referral services limits the impact of community-based programs. Selective primary health interventions have some role, but more costly and complex services are required to deal with hemorrhage, the complications of illegal abortion and to provide operative deliveries. Public health workers should focus on intersectoral programs at the community level which mobilize women around health issues. Sustainable development has the greatest potential to produce lasting changes in the risks of childbearing.

Developing Countries↗
PubMed1990

[One stage operation for annulo-aortic ectasia and pectus excavatum caused by Marfan's syndrome].

One stage operation was successfully performed on a 32-year-old man with annulo-aortic ectasia (AAE) and pectus excavatum caused by Marfan's syndrome. In the Bentall's operation for AAE, median sternotomy is usually carried out. In this case it was difficult to obtain a favorable viewing field due to an extremely deformed sternum and significant displacement of the heart into the left thoracic cavity. By removing the sternum en bloc, as a cost-sterno complex, the surgery was performed safely with an excellent operative field. In this surgery combined with the sternal turnover, the amount of intra and post operative bleeding was the same as occurs in other open heart surgeries.

Adult↗
PubMed1989

[Ambulatory long-term oxygen therapy].

Administration of oxygen is an accepted component of the treatment of acute diseases leading to temporary arterial hypoxemia. In addition, long-term oxygen therapy of patients with chronic hypoxemia secondary to chronic obstructive lung disease (COPD) has become increasingly common, after beneficial effects on quality of life and survival have been reported. This form of treatment, however, is costly, rather complex and demanding. Therefore, strict criteria have to be considered in the selection of hypoxemic patients with COPD. This article reviews the tests and criteria required for the prescription of long-term oxygen therapy as well as newer technical aspects in its application with special emphasis on transtracheal catheters.

Ambulatory Care↗
PubMedDate not supplied

Auxiliary substructure for screw-retained prostheses.

A double framework system is indicated when implant location could result in an overcontoured or compromised metal ceramic prosthesis. Precise design of the auxiliary substructure should provide for all necessary reorientations and corrections before constructing the metal ceramic framework. The additional cost and complexity of this technique must be weighed against the esthetic and morphologic requirements of the patient.

Adult↗
PubMed1987

[Surgery of primary hyperparathyroidism. Contribution of the peroperative assay of urinary cyclic AMP].

The increase of nephrogenic cyclic AMP is an excellent index of parathyroid hypersecretion. A successful treatment of primary hyperparathyroidism results in a rapid fall in nephrogenic cAMP. In a series of 24 patients with proven primary hyperparathyroidism (hyperplasia 3, adenoma 21) and 2 patients with suspected hyperparathyroidism, the success of surgical excision was evaluated by measuring the urinary cAMP/urinary creatinine ratio (R), which in the absence of renal impairment, is proportional to the level of nephrogenic cAMP. Sequential assays of urinary cAMP and creatinine were performed during surgery; laboratory results were available within less than one hour. Among 22 patients with elevated baseline value or R, R became normal in 18 and decreased by more than 50% in 3; these findings suggested that the operation would be successful. In 1 case, R was not measured as the patient had impaired renal function. In another patient with normal baseline value of R, R did not significantly decrease after excision. Surgery failed in 1 patient, although the high value of R at the end of the operation should have prompted us to continue. Finally, in 2 patients the diagnosis was erroneous since R was lower than 0.5 as in controls. Surgeons, therefore, now have a reliable biochemical method at their disposal, but its use will be limited by its cost and complexity.

Aged↗
PubMed1988

Hazardous Substance Center: a poison center's workers right to know program.

Workers Right To Know (WRTK) legislation has been enacted in several states. It is landmark advocacy legislation for employees and communities who may be exposed to hazardous chemicals, but it is also a complex and costly problem for business, industry, and nonprofit organizations. The Hazardous Substance Center (HSC), a division of the Pittsburgh Poison Center, was created to develop and implement programs to enable the business community to comply with the requirements of WRTK legislation. Specifically, the HSC provides the client with a 24-hour toxicology resource which objectively assists employees in the interpretation of the health-related effects information on material safety data sheets (MSDS) and assists them and medical professionals in the management of acute and chronic exposures. A variety of online databases and reference materials are utilized to respond to these inquiries. Each case is documented using the AAPCC Report Form. Data is analyzed to identify trends which can be used to assist the client in complying with the educational component. The HSC also provides a labeling program to the client to identify and classify hazardous substances. The service is provided for an annual contractual fee and creates an additional source of poison center revenue.

Humans↗
PubMed1987

Continuing medical education in the United States. An enterprise in transition.

The nation's continuing medical education (CME) enterprise is undergoing profound change. Once a simple teacher-to-learner activity, CME has now grown into an immense undertaking that is increasingly complex and costly. Simultaneously, it has evoked reactions from certain critics who find fault with its premises, its methods, and its outcomes. But CME's age-old mission--to help practicing physicians maintain their competence in patient care--has not changed, and even today's unwieldy, perhaps flawed, enterprise has not strayed from that basic commitment. Moreover, CME is showing encouraging indications of a willingness to incorporate into its process sound principles of adult education. Even more encouraging are the signs that CME is beginning to make use of computer and other electronic technologies in ways that promise to mend some of its flaws and restore its historical learner-oriented focus.

Education, Medical, Continuing↗
PubMedDate not supplied

A comparative clinical assessment of a hollow-fibre membrane oxygenator (Capiox II) and a bubble oxygenator (Harvey 1500).

Personal experience is reported on the use of a membrane oxygenator, the Capiox II, which is clinically compared with a bubble oxygenator for medium-term perfusion. The characteristics considered were the efficiency of the heat exchanger, the oxygenating capacity, traumatic effects on the blood and the direct effect on the renal and cardiopulmonary systems. The Capiox II demonstrated a better oxygenating capacity, less platelet damage, a smaller variation in the free plasma haemoglobin, a significant difference in postoperative bleeding and blood transfusion requirements, but showed no variation in renal and cardiopulmonary function. The authors suggest that the Capiox II is to be preferred for extra-corporeal circulation of medium duration, for which it combines the advantages of both bubble and membrane oxygenators, while being less complex and costly than previously marketed membrane devices.

Blood Gas Analysis↗
PubMed1987

Impact of Système International conversion on laboratory information systems.

As laboratories in the United States convert to reporting test results in Système International (SI) units, certain requirements will be placed on laboratory computers. Old and new results must be related to different reference ranges. Interpretive reporting and reflexive testing algorithms must be updated to the new units. Reporting in minimum increments is worthwhile, regardless of the SI conversion timetable. On the other hand, dual reporting is not advisable, as it would clutter reports and increase the cost and complexity of SI conversion, without yielding benefits. Results should be converted to SI units at the instrument, not by the computer. The Greek mu (mu) may be represented as u. Conversion graphs can be printed on the unused reverse side of report forms. The most important factors in the success of conversion to SI reporting will be thorough education of those reading the reports, and coordination of the conversion process within each locality.

Clinical Laboratory Information Systems↗
PubMed1979

Modern management of tetanus neonatorum.

Five infants with neonatal tetanus were managed with neuromuscular blockade and positive pressure ventilation. All survived. Tetanus was frequently confused with neonatal seizures at time of presentation. All infants were delivered at home. Mean age of onset of symptoms of poor suck, hypertonicity, and generalized spasms was 5.4 days with hospital admission at 6.4 days. Mean duration of mechanical ventilation was 34 days. Although hospital management of tetanus neonatorum may be expected to have a satisfactory outcome, it represents a costly and complex approach to a preventable disease.

Female↗
PubMed1979

Comparison of bubble and membrane oxygenators in short and long perfusions.

Eighty patients had cardiopulmonary bypass (CPB), half having short (109 +/- 11 minutes) perfusions and half having long (188 +/- 14 min) perfusions. Twenty patients in each group were perfused with bubble oxygenators (Bentley, Harvey, or Galen) and 20 with membrane oxygenators (Modulung or Teflo). Hemodilution to a hematocrit value of 22.5% +/- 1.4% and hypothermia to 28 degrees +/- 2 degrees C were used in all patients. Complete hemograms, sequential multiple analyzer 18 tests, coagulation profiles, blood gases and pH, three immunoglobulins, and two complement fraction proteins were sampled as follows: three times before perfusion, one to ten times during perfusion, 1 hour immediately after perfusion, and 4, 24, and 48 hours postoperatively. Data in concentration terms were compared statistically and reported as mean and standard error for each subset. Additionally, rates of gain or loss were calculated in terms of quantity per liter of blood pumped per minute. During perfusion for both duration sets, use of a membrane oxygenator resulted in greater pump flows (4.55 +/- 0.15 L/min versus 3.75 +/- 0.11 L/min), lower total peripheral resistances (1,125 +/- 63 dynes.sec.cm-5 versus 1,652 +/- 115 dynes.sec.cm-5), and greater urinary outputs (9.4 +/- 1.1 ml/min versus 2.2 +/- 0.6 ml/min) than in the bubble oxygenator subsets. Comparisons of measured and calculated data in the immediate postperfusion interval showed no differences between bubble and membrane oxygenator subsets for short perfusions. In long perfusions, the membrane subset had lower plasma hemoglobin and white cell concentrations and generation rates, smaller (3 to 8 1/2 times) losses of IgG, IgM, C3 and shed blood necessitating less transfusion, and greater C4 losses. The membrane oxygenator systems used were more complex and costly and offered no advantages for short perfusion in adults. In anticipated long perfusions or where bleeding may be a problem, a membrane oxygenator appears more efficacious than bubble systems. For perfusions of less than 2 hours, membrane oxygenators had no biochemical or hematologic advantage over the bubble devices used in this study.

Blood Cell Count↗
PubMedDate not supplied

Prospects for improved contraception.

Some important new birth control methods have been developed in the postpill, post-IUD era; others are on the way. But shrinking dollars in research (especially R&D), inadequate coordination and planning by donors and programs, and costly and complex regulatory requirements frustrate efforts to use current knowledge to make major breakthroughs.

Contraceptive Agents↗
PubMed1983

Current diagnosis and management of upper extremity ischemia.

Although the causes of upper extremity ischemia are diverse, their management follows well established surgical principles in most instances. Evaluation that emphasizes precise physical examination and exploits simple noninvasive determinations aids in reducing cost and complexity. Subclavian occlusive lesions are optimally managed by bypass procedures that avoid thoracotomy. Occlusions in the arm may usually be treated with bypass grafts of reversed autogenous saphenous vein. Brachial artery occlusion after cardiac catheterization should be approached with early exploration, using local reconstruction of the artery if necessary. Vasospastic symptoms should be evaluated thoroughly in an attempt to identify their cause. Most often they may be treated with medications, singly or in combination. Sympathectomy is of benefit only in unusual instances, when no specific cause of the vasospastic symptoms can be found after prolonged evaluations.

Arm↗
PubMed1984

On transferring certain patients from medicine to psychiatry: a biopsychosocial analysis of turfing.

Turfing is a process by which unwanted patients are transferred from one hospital service to another for a variety of biopsychosocial reasons. Turfing results from a complex cost-benefit analysis conducted by physicians who are influenced by personal and institutional pressures, as well as by the patients' specific clinical problems, illness behaviors, and personality. A set of interventions that deal comprehensively with such phenomena must take all these influences into account.

Hospital Departments↗
PubMed1982

[Counting active movements of the fetus: could it be useful?].

In most cases a count of the active movements of the fetus by the mother is a good index of fetal activity. The information provided compares favourably with that furnished by analysis of the fetal heart rate and hormone levels in the mother's plasma. Counting the fetal movements every day for 1 or 2 hours starting at the 24th to 26th week of pregnancy is a simple, inexpensive and noninvasive method that could be used as and screening test for fetal distress. More complex and costly investigations necessitating hospitalization could then be reserved for patients noting an abnormal count. However, this scheme demands intelligence and motivation of the mother, and one must expect a certain rate of refusal or dropout.

Amniotic Fluid↗
PubMed1980

[Organizational features and uses of computers for private veterinarians (author's transl)].

A number of organizational features and uses are considered in the light of experience in human health care. Although the apparatus is becoming increasingly cheaper, the complexity and costs of software require combining knowledge and experience. For the use of computers to be successful, an early start should be made with the standardization and unification of procedures and recording of data. This is the only means of ensuring over-all solutions and an effective interchange of data in the future. Proceeding from a subsequent rendering of services, interaction is perceptible between the organization of labour and practical uses of computers. It is essential that mutual arrangements should be incorporated in the current procedures at an early state. This will ensure early acceptance of the use of computers by future users.

Computers↗