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PubMedDate not supplied

[Human vital function monitoring as a system with hybrid intelligence].

Monitoring system is considered in this work as a reanimatologist-monitor-patient-medium system. This work is an upgrade to the previous concept of monitoring systems as systems with hybrid intelligence acting under variable conditions of object and medium. Human cardiorespiratory system was considered within the framework of the P. K. Anokhin theory of functional systems. The problem of resuscitation was formulated for this system and volume of required information was determined. Environment characteristics in resuscitation and surgery departments were considered. The requirements for monitor were formulated on the basis of analysis of these systems. The law of mutual adaptation of reanimatologist and monitor was put forward and safety problems associated with human factor were considered. Implementation of these principles in the MITAR 01-R-D is described.

Artificial Intelligence↗
PubMed2004

Feasibility of rapid and automated importation of 3D echocardiographic left ventricular (LV) geometry into a finite element (FEM) analysis model.

BACKGROUND: Finite element method (FEM) analysis for intraoperative modeling of the left ventricle (LV) is presently not possible. Since 3D structural data of the LV is now obtainable using standard transesophageal echocardiography (TEE) devices intraoperatively, the present study describes a method to transfer this data into a commercially available FEM analysis system: ABAQUS. METHODS: In this prospective study TomTec LV Analysis TEE Software was used for semi-automatic endocardial border detection, reconstruction, and volume-rendering of the clinical 3D echocardiographic data. A newly developed software program MVCP FemCoGen, written in Delphi, reformats the TomTec file structures in five patients for use in ABAQUS and allows visualization of regional deformation of the LV. RESULTS: This study demonstrates that a fully automated importation of 3D TEE data into FEM modeling is feasible and can be efficiently accomplished in the operating room. CONCLUSION: For complete intraoperative 3D LV finite element analysis, three input elements are necessary: 1. time-gaited, reality-based structural information, 2. continuous LV pressure and 3. instantaneous tissue elastance. The first of these elements is now available using the methods presented herein.

Echocardiography, Three-Dimensional↗
PubMed1999

Image guidance: the Foundation for the Future Design of Neurosurgical Procedural Facilities.

Today's image guidance systems are the foundation of minimally invasive diagnosis and therapy and are the basis for the rational design of the neurosurgical operating room of the future. The building blocks of this procedural arena will be (1) high-resolution MR/CT anatomic imaging supplemented with (2) functional imaging using MR and magnetoencephalography, (3) real-time image monitoring using ultrasound probes, open MR and portable CT adapted to image guidance systems and (4) conformal radiosurgery systems. Although the initial investment in such facilities may be high, eventual cost saving through added precision and safety will result in shorter inpatient stays, lower morbidity and more complete realization of treatment goals.

Diagnostic Imaging↗
PubMed1992

The expert witness in forensic psychiatry.

Forensic psychiatry operates at the interface of the Justice and Health systems and has been defined as: "That branch of psychiatry which requires special knowledge and training in the law as it relates to the mental state of the offender, or alleged offender" [1]. As a consequence of working in this area, psychiatrists are often called into court to give evidence as "expert witnesses". This article examines some of the professional and legal issues involved in providing expert testimony. Secondly, it aims to outline some practical guidelines for giving evidence in the court-room. The predominant focus is on criminal, rather than civil, proceedings in which the forensic psychiatrist gives expert testimony; however much of the information is also relevant to other psychiatrists and psychologists undertaking this role in the legal arena.

Commitment of Persons with Psychiatric Disorders↗
PubMed1994

Comparison of the effects of urapidil and nitroprusside on hemodynamics and myocardial function in hypertension following cardiac surgery.

Hypertension associated with tachycardia, elevated filling pressures and increased systemic vascular resistance occurs in 30-60% of patients recovering from coronary artery surgery (1,2). It is usually present when the patients arrive from the operating room in the intensive care unit (ICU), or develops in the first two hours postoperatively. Traditionally sodium nitroprusside (S) is the drug of first choice for the i.v. treatment and prevention of hypertension and increased filling pressures developing after coronary artery surgery (CAS). Its major disadvantage is reflex tachycardia associated with increased myocardial oxygen consumption. Urapidil (U) has both peripheral alpha-1-adrenoreceptor blocking activity and a central antihypertensive effect at the level of the 5HT-1A serotonergic receptor, resulting in enhanced peripheral sympathetic inhibition (3,4). Informed consent and institutional approval for the study were obtained. When mean arterial blood pressure (MAP) increased above 90 mmHg within the first 2 hours after CAS, 53 patients were randomly allocated to one of two groups. 25 patients received U (bolus of 25 mg; initial infusion rate of 15-85 micrograms/kg/min; maintenance infusion rate of 2-7 micrograms/kg/min) and 28 patients received S (initial infusion rate of 1-2 micrograms/kg/min; maintenance infusion rate of max. 5 micrograms/kg/min). The infusion rate was then adjusted to maintain MAP between 80 and 90. Measuring points were: 1. baseline; 2. 30 min after starting the infusion; 3. 60 min after starting the infusion; and at 2 hour intervals thereafter until the next morning.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1990

Three years' experience with an all-digital nuclear medicine department.

We describe our all-digital, filmless, department of nuclear medicine, which has been fully operational for 3 years. The approach to the design and implementation of a nuclear medicine picture archiving and communication system (PACS) is discussed, as well as enhancements found to be necessary or desirable during our 3 years of experience using the system. Studies are initially viewed on remote monitors in the reading room, and transferred from multiple vendor's computers to the PACS by floppy disc network. Scans are analyzed on networked image workstations using a variety of software imaging tools. Reports are dictated into a digital voice storage system, allowing the referring physician immediate telephone access. The dictated report is typed into a computer, electronically edited, reviewed, billed, and printed for appropriate distribution on an integrated medical information system. The final report is stored on the PACS, along with the scan image and other patient information on 1-gigabyte removable optical discs. Two networked optical disc drives allow us to have approximately 3 years of our department's studies available instantly, allowing recall of previous studies for comparison with the current scan. Emergency night and weekend studies are sent via modern over normal phone lines to the on-call physician, who has a similar image workstation at home. Digital image storage allows for easy manipulation of the data, such as gray scale manipulation and cine (movie) display. Cost analysis shows significant savings compared with a film-based department. We conclude that an all-digital nuclear medicine department is practical, cost effective, and beneficial to both patients and staff.

Analog-Digital Conversion↗
PubMed2005

Family support and victim identification in mass casualty terrorist attacks: an integrative approach.

Terrorist bombing attacks in Israel between 2000 and 2004 caused mass casualties. After each attack in the north of Israel, Rambam Medical Center, the largest hospital in the region, absorbs the majority of injured, especially the more severely injured and unidentified victims. Immediately with the media reports of a terrorist attack, tens of relatives come to the hospital, looking for missing family members. This paper describes an assistance unit for families of unidentified victims. It is staffed by the hospital's social work department, and its tasks are to identify the unidentified victims, help relatives find and be united with them, and assist other relatives in the identification of bodies of deceased family members. The process involves gathering information from relatives and cross-checking it with data and pictures from the hospitals' emergency and operating rooms; and providing crisis intervention and psychological first aid to victims' relatives. The family assistance unit works with several other professional units in the hospital and in the community, and always adjusts its operations to the features of each event. Clearer guidelines for dynamic training of social workers and research-based interventions to prevent compassion fatigue among the workers must be further developed.

Blast Injuries↗
PubMed1993

Intracardiac echocardiography in humans using a small-sized (6F), low frequency (12.5 MHz) ultrasound catheter. Methods, imaging planes and clinical experience.

OBJECTIVES: This study was designed to determine the clinical utility and feasibility of using 12.5-MHz ultrasound catheters for intracardiac echocardiography. BACKGROUND: Intracardiac echocardiography is a potentially useful technique of cardiac imaging and monitoring in certain settings. The feasibility of intracardiac echocardiography using 20-MHz ultrasound catheters in patients has been demonstrated. High resolution images of normal cardiac structures as well as cardiac abnormalities have been obtained. However, imaging has been limited by the shallow depth of field inherent in high frequency ultrasound imaging. METHODS: Intracardiac echocardiography with 12.5-MHz catheters was performed in eight mongrel dogs and 92 patients. Catheters were introduced percutaneously in 80 patients studied in the catheterization laboratory and directly into the heart in 12 patients in the operating room. Right heart imaging was performed in 68 patients and arterial and left heart imaging in 35 patients. RESULTS: When these catheters were introduced into the venous system, the right atrium, tricuspid valve, right ventricle, pulmonary valve and pulmonary artery were visualized. Pericardial effusion, intracardiac masses and atrial septal defects were correctly identified. The left ventricle, left atrium, mitral valve, aortic valve, aorta and coronary arteries could be imaged from the arterial circulation. Diseases identified included valvular aortic stenosis, subvalvular aortic stenosis and Kawasaki disease. Average imaging time was 10 min. No complications occurred as a result of intracardiac echocardiography. CONCLUSIONS: Intracardiac echocardiography with 12.5-MHz ultrasound catheters is safe and feasible; it also provides anatomic and physiologic information. This feasibility study provides a foundation for wider clinical use of intracardic echocardiography.

Adolescent↗
PubMed2005

[Comparison of the bispectral index and spectral entropy in gynecological surgery].

OBJECTIVES: Spectral entropy quantifies variations in cortical electrical activity measured by electroencephalography and frontal activity measured by electromyography. The aim of this study, in the context of general anesthesia, was to compare bispectral index values with the two components of spectral entropy: state entropy and response entropy. MATERIAL AND METHODS: Sixteen women (ASA I-II) undergoing gynecological surgery were enrolled. The bispectral index was maintained between 40 and 50 for all patients. Both sensors, for monitoring the bispectral index and spectral entropy, were placed on each patient. Simultaneous readings were recorded at the following moments: operating room arrival, induction, relaxation, intubation, switching on the vaporizer, start of surgery, traction of the intestinal mesenteries and maneuvering of the electric scalpel, switching off the vaporizer, end of surgery, during cough, extubation, and eye opening. The data sets were subjected to analysis of variance, and the intraclass correlation coefficient (ICC) was used to analyze agreement. RESULTS: Differences between mean values of the bispectral index, state entropy and response entropy were observed at operating room arrival, intubation, and induction. Differences when the patient awakened from anesthesia were observed only between the bispectral index and response entropy, on the one hand, and state entropy on the other. There was no agreement (ICC<0.7) upon operating room arrival, maneuvering the electric scalpel, or awakening from anesthesia. CONCLUSION: The bispectral index, state entropy, and response entropy show good agreement during recordings that reflect the effects of anesthesia. The differences observed at baseline and upon awakening can be attributed to frontal electromyographic activity. Distinguishing cortical electrical activity from frontal electromyographic activity may provide additional information in these situations.

Anesthesia, General↗
PubMedDate not supplied

Automated assistance for human factors analysis in complex systems.

A tool and a method for scenario-based workload assessment and performance validation in complex socio-technical systems design, such as command and control rooms of military vessels, are described. We assess workload in terms of communication and the task load that each agent is able to handle. The method employs subjective task and communication estimates used to calculate the workload of human operators, using static and scenario-based analyses. This enables the identification of bottlenecks to be addressed by the designer with the appropriate allocation of function between humans and smart technology. This task is supported by the functional allocation adviser tool. A case study demonstrating the use of the tool for the design of the command and control room of a military vessel is presented.

Automation↗
PubMed1991

Length-tension recording system for strabismus surgery.

To meet the need for both scientific information and a clinical means for measurement of the mechanical parameters of the most difficult individual strabismus cases we present a technique for directly measuring and plotting the length-tension characteristics of the tissues supporting the eye. Semiconductor strain gauges mounted on the shanks of a custom machined eye forceps and an ultrasonic method of making continuous duction measurements of the eye have proved feasible. When the forceps are interfaced with a dedicated microcomputer, the system provides a permanent, quantitative, length-tension record displayed in real-time. The instrumented length-tension forceps system has provided a noninvasive means for quickly and simply assessing the mechanical underlying determinants of strabismus pathology in the office, the laboratory or in the operating room, and can aid in the planning and immediate intraoperative alteration of strabismus surgery. Under operator coordination, measurements can be made which precisely define the mechanical load which the eye muscles must move. The resulting objectively determined tissue stiffness asymmetries and muscle restrictions limiting ocular motion indicate the purely mechanical contributions to a patient's strabismus. Measurements of active force indicate the magnitudes and patterns of innervation over the entire range of gaze. By comparison of these active force and passive stiffness records, nerve signal imbalances may be quantitatively distinguished from mechanical imbalances in strabismus. It is the detailed interaction of these nonlinear muscle forces and mechanical elements which determines the position of each eye in strabismus and therefore the proper surgical treatment. A brief description of actual use and a few examples of clinical results are included from over 200 human records.

Calibration↗
PubMed2000

Robotics and allied technologies in endoscopic surgery.

Endoscopic surgery was developed in the 1970s and 1980s, with initial work conducted by pioneering surgeons. After the development of laparoscopic cholecystectomy, the breakthrough of endoscopic surgery had a great effect on all surgical specialties. Starting with rather simple procedures, such as cholecystectomy, a rapid progression toward more complex procedures, such as reflux or colonic surgery, took place. It was realized at this time that the existing endoscopic instruments allowed only a limited preciseness when performing the procedures, and part of the information from inside the abdominal cavity was not available to the surgeon. This prompted a discussion with engineers concerning the development of more advanced technologies to give those performing endoscopic surgery the same quality of information and manipulation that surgeons have when performing open surgery. These qualities include (1) instruments and manipulators that allow surgical action under endoscopic control with all degrees of freedom; (2) devices that provide surgeons with tactile feedback; and (3) vision systems that provide surgeons with the same quality of visual information as with open surgery, namely, high resolution, excellent color quality, precise spatial information, and a constant clear view for optimal surgical action. At the end of 1999, some of the aforementioned quality concepts found their way into the surgical routine, but most of the concepts are still being developed. Another decade will pass before endoscopic surgery procedures will be closer to the technological goals.

Endoscopy↗
PubMed2000

Workplace-related complaints due to exposure to contaminated humidifier water and the VDI guideline 6022

We describe a case report of one patient with hypersensitivity pneumonitis (humidifier lung) due to exposure to contaminated humidifier water and another four patients with related complaints. The setting was a building with photographic laboratories and corresponding office rooms that were supported with air by a humidification, ventilation, and air conditioning (HVAC) system. In the humidifier water, we found different fungi, particularly species of the genus Verticillium, as well as gramnegative bacteria, but no Legionella species. Colony counts were done according to the German Drinking Water Regulations and the VDI Guideline 6022 at 20 degrees C and 36 degrees C; the results exceeded the recommended level of 103 cfu/ml. The hygienic role of the isolated microorganisms and their products (e.g., antigens, endotoxins) is discussed. The case report emphasizes the importance of careful maintenance and control of HVAC systems. The new VDI guideline 6022 (issue July 1998) gives detailed information on this subject and pays special attention to qualifications and training of the HVAC operations staff.

Journal Article↗
PubMed1985

Increased intracranial pressure: management with an intraventricular catheter.

A patient returns from the operating room with an intracranial pressure (ICP) of 25 mm Hg as measured by an intraventricular catheter. What measures will decrease his ICP, what is the most threatening risk of an intraventricular catheter, and what nursing measures will decrease those risks? The clinical nurse caring for a patient with an intraventricular catheter must understand the dynamics of intracranial anatomy and physiology as well as the methods and rationale for medical and nursing management. An adequate knowledge base of each aspect of the intraventricular catheter and drainage system, from insertion to removal, is very important in decreasing the risks that confront these patients. These risks include infection, collapse of the ventricles, rapid ventricular drainage, increased potential for subdural hematoma, and subarachnoid hemorrhage. Familiarity with this information will minimize nursing uncertainties and fears, enabling the nurse to care for such patients with the required expertise and confidence.

Barbiturates↗
PubMed2006

Electrical impedance spectroscopy and the diagnosis of bladder pathology.

Bladder pathology is usually investigated visually by cystoscopy. At present, definitive diagnosis of the bladder can be made by biopsy only, usually under general anaesthesia. This is a relatively high-cost procedure in terms of both time and money and is associated with discomfort for the patient and morbidity. Thus, we used an electrical impedance spectroscopy technique for differentiating pathological changes in the urothelium and improving cystoscopic detection. For ex vivo study, a whole or part of the patient's urinary bladder was used to take the readings less than half an hour after excision at room temperature, about 27 degrees C, using the Mk3.5 Sheffield System (2-384 kHz in 24 frequencies). In this study, 145 points (from 16 freshly excised bladders from patients) were studied in terms of their biopsy reports matching to the electrical impedance measurements. For in vivo study, a total of 106 points from 38 patients were studied to take electrical impedance and biopsy samples. The impedance data were evaluated in both malignant and benign groups, and revealed a significant difference between these two groups. The impedivity of the malignant bladder tissue was significantly higher than the impedivity of the benign tissue, especially at lower frequencies (p < 0.001). In addition, the receiver operating characteristic (ROC) curve for impedance measurements indicated that this technique could provide diagnostic information (individual classification is possible). Thus, the authors have investigated the application of bio-impedance measurements to the bladder tissue as a novel and minimally invasive technique to characterize human bladder urothelium. Therefore, this technique, especially at lower frequencies, can be a complementary method for cystoscopy, biopsy and histopathological evaluation of the bladder abnormalities.

Cystitis↗
PubMed1990

A computer workstation for clinical medicine.

New computer tools for physicians, nurses, and the medical care team will become common in the 1990s. This paper describes a clinical workstation (CWS) development project that uses new technology that moves the technical support for medical decision making from the computer room to the nursing station. Collection, processing, and display of clinical information including patient identification, laboratory, and radiology results and current medications are carried out in the environment of a multi-windowed computer workstation. Easy access to automated medical literature databases from the workstation is also provided. This pilot project has successfully demonstrated a CWS operating on an acute general neurology and neurosurgical inpatient nursing unit and a critical care unit at The Johns Hopkins Hospital.

Baltimore↗
PubMed1995

Continuous intraoperative electromyographic recording during spinal surgery.

One hundred fifty patients underwent spinal surgery for radiculopathy; of these, 120 underwent lumbar surgery and 30 had cervical operations. All of the surgeries were performed to alleviate symptoms due to disc herniation, spondylosis, or both. During the surgical procedures continuous intraoperative electromyograph recordings were taken from the muscle corresponding to the involved nerve root. In baseline recordings taken in the operating room 10 minutes before lumbar surgery, electrical discharge or firing was recorded from the muscle in 18% (22 of 120 patients) of the cases. Once the nerve was decompressed, muscle firing ceased. Electrical discharges were produced with regularity on nerve root retraction. This study concludes that continuous electromyograph monitoring can be accomplished easily and yields valuable information that indicates when the nerve root is adequately decompressed or when undue retraction is exerted on the root.

Aged↗
PubMed1997

Economic evaluation of 2 treatments for pediatric femoral shaft fractures.

The purpose of this study was to assess the relative health system costs of early hip spica cast immobilization and external fixation for pediatric femoral shaft fractures. A cost analysis was performed from the viewpoint of the study hospital and physicians using protocols based on current practice. Cost estimates were based on patient and financial information from April 1, 1993, to January 31, 1994, including the fully allocated inpatient and outpatient costs. A sensitivity analysis was conducted to analyze the effect of complications on costs. Total estimated costs (in 1994 Canadian dollars, $1.00 = $0.75 US) of uncomplicated external fixation and hip spica treatments were $7626.30 and $5970.11, respectively. Fifty percent of this difference was attributable to longer inpatient stays for the external fixation treatment. The remaining difference was because of the cost of the fixator, additional operating room staff time costs, and additional professional and technical fees. Total expected costs of treatment complicated by loss of reduction, pin tract infection, and return to the operating room were $7716.01 and $6128.44 for the external fixation and hip spica treatment options, respectively. For the range of complication probabilities considered, expected total costs were always greater with the external fixation option than with the hip spica treatment.

Canada↗