Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Operating Room Information Systems”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

882 records · Page 49Linked to original sources
PubMed2000

A single-center 8-year experience with percutaneous dilational tracheostomy.

OBJECTIVE: To determine surgical, postoperative, and postdischarge complications associated with percutaneous dilational tracheostomy (PDT) in an 8-year experience at the University of Kentucky. SUMMARY BACKGROUND DATA: There are known risks associated with the transport of critically ill patients to the operating room for elective tracheostomy, and less-than-optimal conditions may interfere with open bedside tracheostomy. PDT has been introduced as an alternative to open tracheostomy. Despite information supporting its safety and utility, the technique has been criticized because advocates had not provided sufficient information regarding complications. METHODS: A prospective database was initiated on all patients who underwent PDT between September 1990 and May 1998. The database provided indication, procedure time, duration of intubation before PDT, and intraoperative and postoperative complications. Retrospective review of medical records and phone interviews provided long-term follow-up information. RESULTS: In the 8-year period, 827 PDTs were performed in 824 patients. Two patients were excluded because PDT could not be completed for technical reasons. There were 519 male and 305 female patients. Mean age was 56 years. Prolonged mechanical ventilatory support was the most common indication. Mean procedure time was 15 minutes, and the average duration of intubation before PDT was 10 days. The intraoperative complication rate was 6%, with premature extubation the most common complication. The procedure-related death rate was 0.6%. Postoperative complications were found in 5%, with bleeding the most common. With a mean follow-up of greater than 1 year, the tracheal stenosis rate was 1.6%. CONCLUSIONS: On the basis of this large, single-center study, the authors conclude that when performed by experienced surgeons, PDT is a safe and effective alternative to open surgical tracheostomy for intubated patients who require elective tracheostomy.

Databases, Factual↗
PubMed1994

Resource implications of head injuries on an acute surgical unit.

Head injuries are expensive and demanding in terms of resources. In the UK, most are cared for outside neurosurgical centres. In the absence of specialist rehabilitation services, patients with on-going disability add to those admitted for observation and treatment on acute surgical wards. We audited the workload pattern and financial implications related to head injuries on a general surgical unit in a central London teaching hospital. Data collected prospectively at the time of admission and derived from departmental computerized information systems included clinical outcome, hospital stay and its relationship to severity of injury and other factors. Ward, departmental (accident and emergency (A & E), intensive therapy unit (ITU), radiology, and theatre) and neurosurgical referral costs were derived. Long-term social and rehabilitation costs were not calculated. Over a 6 month period 899 patients with head injuries were treated in the A & E department, of whom 156 were admitted. Of the admitted patients 68% were classified as minor; 22% as moderate; and 10% as severe head injuries. Fifty-one per cent of adult admissions were intoxicated by alcohol. Prolonged hospital stay was related to age, severity of head injury, mechanism of injury, associated injuries and preexisting neuropsychiatric conditions (including alcoholism). Six patients died. The direct cost of these head injuries patients was estimated at 173,500 pounds, during which time they occupied 7.6% of our unit's adult inpatient capacity. Twenty-four hour observation of 76 patients with minor head injuries contributed 9700 pounds (5.6%) to this figure. Associated extracranial injuries cost a further 46,500 pounds.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

[BeKi--an initiative for nutrition education in children: program description and evaluation].

OBJECTIVES: The State Initiative Be KI is carried out statewide by the Baden-Württemberg Ministry for Nutrition/Food and Rural Area since 1980. Be KI addresses all target groups involved in the upbringing and education of children from age 6 months up to the end of the 6th grade and provides factual, validated, and independent information on child nutrition and nutrition education. Recently a comprehensive evaluation was carried out to assess the public health impact. Program, design and results of the evaluation are presented. METHODS: According to the RE-AIM Model for health promotion programs the evaluation assesses the public health impact in regard of individual and institutional reach, efficacy, adoption, implementation, and maintenance by various methods (e. g. written surveys and interviews with experts of child nutrition, in day care facilities and primary schools supplemented by internal data of the Ministry). RESULTS: Be KI represents the nutrition education program for children in the German language area with the longest uninterrupted operation span. The number of assignments of the child nutrition experts has been increasing ever since Be KI's official inception in 1980. During the school year 2004/2005 the experts carried out 6090 assignments, predominantly in primary schools which accounted for 60% of the assignments. About a third of schools know Be KI. The majority of kindergarten and school teachers who know the experts of child nutrition or the compilation use these offers. Many teachers use Be KI-components without knowing that they belong to Be KI. As a result of Be KI some of the teachers noticed short-time changes: pupils eat healthier break-time snacks and change their attitude towards a more balanced diet. Concerning the frequency of nutrition education and teachers attitude there are hardly any differences between institutions with Be KI and without Be KI. CONCLUSION: Be KI meets the main requirements of effective nutrition education programs for children: it is creative, engaging, inexpensive an widely dissiminated. Contents and methods of the provided materials correspond to the development level of the target groups. But communication and networking with educational institutions as well as public relations should be intensified and teachers in day care facilities and school teachers should be motivated to work with the Be KI-materials on their own (empowerment). Room for improvement exists in regard of a permanent straightforward evaluation system and a more pronounced orientation of the prevention program towards the social environment would be helpful.

Attitude to Health↗
PubMed1999

Surgical smoke evacuation systems.

Surgical smoke evacuation systems are high-flow suction and filtering devices used to remove, or capture, the smoke generated at the surgical site during the use of lasers and electrosurgical units (ESUs). This process helps minimize patient and staff exposure to the aerosols and gases carried by the smoke. We originally evaluated smoke evacuators in our April 1997 issue (Health Devices 26[4]). For this Update Evaluation, we have tested seven additional units from seven suppliers, using the same criteria and test methods as in the earlier study. We also present update information for the previously evaluated units, along with comparative ratings for all the units we have evaluated to date. We rated nine units in our top group for general-purpose applications (in which a hand-held nozzle will be used for most or all procedures): the Buffalo Filter PlumeSafe 1202, PlumeSafe Whisper 602, PlumeSafe Whisper Turbo, and Porta PlumeSafe 602; the ConMed 1000 SES; the Niche Medical SmartVac; the Stackhouse AirSafe VersaVac2; and the Surgimedics Plume-inator and Surgi-Fresh Mini. We rated a 10th unit, the I.C. Medical Crystal Vision ICM-360, in our top group for applications in which the evacuator will be used only with an ESU-pencil-based wand.

Air Pollutants, Occupational↗
PubMedDate not supplied

Strategic planning for radiology: opening an outpatient diagnostic imaging center.

Launching a new diagnostic imaging center involves very specific requirements and roadmaps, including five major areas of change that have a direct impact on planning: Imaging and communication technology Finances and reimbursement Ownership structure of imaging entities Critical workforce shortages Imaging is moving outside radiology First, planning must focus on the strategic level of any organization, whether it is a multi-national corporation or a six-person radiology group. Think of all organizations as a triangle with three horizontal levels: strategic, managerial and operational. The strategic level of decision-making is at the top of the triangle, and here is where planning must take place. For strategic planning to work, there must be focused time and energy spent on this activity, usually away from the reading room and imaging center. There are five planning strategies, which must have the explicit goal of developing and growing the imaging center. The five strategies are: Clinical and quality issues, Governance and administration, Technology, Relationships, Marketing and business development. The best way to plan and implement these strategies is to create work groups of radiologists, technologists, and administrative and support staff. Once the group agrees on the strategy and tactic, it takes responsibility for implementation. Embarking on the launch of a new outpatient diagnostic imaging center is no small undertaking, and anyone who has struggled with such an endeavor can readily attest to the associated challenges and benefits. Success depends on many things, and one of the most important factors relates to the amount of time and the quality of effort spent on strategic planning at the outset. Neglecting or skimping on this phase may lead to unforeseen obstacles that could potentially derail the project.

Ambulatory Care Facilities↗
PubMed1993

ASHP national survey of hospital-based pharmaceutical services--1992.

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during summer 1992 are reported and compared with the results of earlier ASHP surveys. A simple random sample of community hospitals (short-term, nonfederal) was selected from community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 889. The net response rate was 58% (518 usable replies). The average number of hours of pharmacy operation per week was 105. Complete unit dose drug distribution was offered by 90% of the respondents, and 67% offered complete, comprehensive i.v. admixture programs. A total of 73% of the hospitals had centralized pharmaceutical services. Some 83% provided services to ambulatory-care patients, including clinic patients, emergency room patients, patients being discharged, employees, home care patients, and the general public. A computerized pharmacy system was present in 75% of the departments, and 86% had at least one microcomputer. More than 90% participated in adverse drug reaction, drug-use evaluation, drug therapy monitoring, and medication error management programs. Two thirds of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records, and the same proportion provided patient education or counseling. One third provided drug management of medical emergencies. One fifth provided drug therapy management planning, and 17% provided written histories. Pharmacokinetic consultations were provided by 57% and nutritional support consultations by 37%; three fourths of pharmacist recommendations were adopted by prescribers. A well-controlled formulary system was in place in 51% of the hospitals; therapeutic interchange was practiced by 69%. A total of 99% participated in group purchasing, and 95% used a prime vendor. The 1992 ASHP survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys (e.g., growth in clinical services, ambulatory-care services, computerization) and identified static areas that merit the attention of pharmacy leaders (e.g., provision of complete, comprehensive i.v. services).

Adverse Drug Reaction Reporting Systems↗
PubMed1997

Heart rate, heart rate variability, and blood pressure during perioperative stressor events in abdominal surgery.

STUDY OBJECTIVE: To define the behavior of power spectral heart rate variability (PSHR) during potentially stressful events in the perioperative period, and relate it to changes in blood pressure (BP) and heart rate (HR). DESIGN: Longitudinal clinical study. SETTING: Operating room and recovery suites of a large tertiary care referral center. PATIENTS: 26 ASA physical status I, II, and III patients undergoing elective abdominal surgery. INTERVENTIONS: Anesthesia was induced with thiopental sodium and fentanyl, and maintained with isoflurane/nitrous oxide (N2O)/relaxant or enflurane/N2O/relaxant. The trachea was intubated and intraabdominal surgery was performed. MEASUREMENTS AND MAIN RESULTS: Observations consisted of HR, noninvasive blood pressure, and PSHR. They were made before and after induction of anesthesia, tracheal intubation, and surgical incision, and during maximal surgical stimulation and skin closure. HR and mean arterial pressure (MAP) maxima were also recorded for one hour before and after emergence from anesthesia. PSHR was obtained using a special algorithm and data acquisition system for real time spectral analysis of the instantaneous HRversus time function. The HR power spectrum parameters analyzed were low-frequency (LFA; powerband = 0.04 to 0.10 Hz), respiratory-induced frequency (RFA; powerband = respiratory frequency +/- 0.06 Hz), and the ratio of LFA to RFA. With induction of anesthesia, only RFA power decreased significantly. LFA power reduction became significant only after intubation and continued so until after incision. Immediately after induction, the decline in RFA power (vs. preinduction) was more pronounced when compared with the decline in LFA power (76% vs. 34%; p = 0.01). Hence, the ratio LFA/RFA increased significantly after induction of anesthesia. It was significantly higher than at postintubation, preincision, or skin closure. A significant elevation in LFA, LFA/RFA ratio, and BP occurred with maximal abdominal surgical stimulation. Only preinduction LFA, RFA, and LFA/ RFA ratio were predictive of MAP changes with induction of anesthesia (p = 0.006). In 8 of the 15 patients who had MAP changes of at least 10 mmHg with induction, PSHR indices correctly predicted a change of this magnitude. Late intraoperative HR maxima were positively correlated with the change in HR and incision (r2 = 0.58; p < 0.01). The change in BP with incision was positively correlated with early postoperative HR maxima (r2 = 0.60; p < 0.01). CONCLUSIONS: On anesthetic induction, preoperative, but not intraoperative, spectral indices were predictive of BP changes. Power spectral analysis of HR may provide information about the autonomic state that is not evident from BP or HR. The HR power spectrum, in particular, indicated a striking autonomic imbalance immediately after the induction of anesthesia despite stable HR and BP. LFA and LFA/RFA ratio appeared to track sympathetic autonomic activation during abdominal surgical stimulation, but not during other perioperative stressor events.

Abdomen↗
PubMed2004

A multidisciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities.

STUDY OBJECTIVE: To reinforce concepts presented in the lectures; understand the complexity and speed of casualty and information generation during a Weapons of Mass Destruction and Terrorism (WMD/T) event; experience the novelty of combined weapons' effects; recognize the time course of the various chemical, biological, and radiation agents; and make challenging decisions with incomplete and conflicting information. SETTINGS: Two environments simulated simultaneously: one a major trauma center emergency room (ER) with two patient simulators and several human actors; the other an Emergency Operations Command Center (EOC). TARGET AUDIENCE: Students for this course included: clinicians, scientists, military and intelligence officers, lawyers, administrators, and logistic personnel whose jobs involve planning and executing emergency response plans to WMD/T. SIMULATION SCRIPT: A WMD/T attack in Washington, D.C., has occurred. Clinical students performed in their real life roles in the simulated ER, while nonclinical students did the same in the simulated EOC. Six ER casualties with combined WMD/T injuries were presented and treated over 40 minutes. In the EOC, each person was given his or her role title with identification tag. The EOC scenario took cues from the action in the ER via two television (TV) news feeds and telephone calls from other Emergency Operations Assets. PERFORMANCE EXPECTATIONS: Students were expected to actively engage in their roles. Student performances were self-evaluated during the debriefing. DEBRIEFING: The two groups were reunited and debriefed utilizing disaster crisis resource management tools. ASSESSMENT OF EFFECTIVENESS: Students answered an 18-point questionnaire to help evaluate the usefulness and acceptance of multimodality patient simulation. LESSONS LEARNED: Large-scale multimodality patient simulation can be used to train both clinicians and nonclinicians for future events of WMD/T. Students accepted the simulation experience and thought that scenario was appropriately realistic, complex, and overwhelming. Difficulties include the extensive man-hours involved in designing and presenting the live simulations. EOC-only sessions could be staged with only a few video cassette recorders, TVs, telephones, and callers.

Disasters↗
PubMed1994

Multisite evaluation of a continuous intraarterial blood gas monitoring system.

BACKGROUND: We compared the performance of a new, continuous intraarterial blood gas (CIABG) monitor with arterial values obtained periodically and analyzed by conventional equipment. METHODS: A CIABG monitoring system consisting of a sterile, disposable, fiberoptic sensor and a microprocessor-controlled monitor with a self-contained calibration unit and detachable display panel was used. The sensor was inserted through a 20-G radial artery cannula. Light was transmitted from the monitor to the sensor tip where it reacted with fluorescent dyes sensitive to oxygen or hydrogen ions (analytes). The change in the intensity of the photoluminescent radiation caused by the analytes was measured every 20 s and derived blood gas values were displayed. Twenty-nine sensors were evaluated in 29 surgical or intensive care unit patients at one of three institutions (Stanford University Hospital, Evanston Memorial Hospital, and the Palo Alto Veterans Administration Hospital). The duration of study averaged 6 h (5-8 h) in the operating room, and 46 h (7-121 h) in the intensive care unit. A total of 552 values were compared with those obtained at regular intervals and analyzed in the hospital blood gas laboratory. Average bias (mean difference between lab value and CIABG), precision (SD of difference), and drift (change in the bias with time were determined. RESULTS: At arterial oxygen tension (PO2) values of 32-528 mmHg, the average bias was -1% meaning that the average CIABG monitor values were 1% lower than those obtained by conventional equipment. The precision was 15%. At arterial PO2 values of 32-99 mmHg, average bias and precision were -0.3 +/- 8.9 mmHg. At arterial carbon dioxide tension (PCO2) values of 24-54 mmHg, average bias and precision were 1.3 +/- 3.3 mmHg, and at pHa values of 7.23-7.57, average bias and precision were 0.01 +/- 0.04. Observed drift per day was -1.2% for arterial PO2, 0.3 mmHg for arterial PCO2, and 0.01 for pH. Bias and precision for samples compared in two pairs of like-model in vitro blood gas analyzers were 0.4 +/- 4.6% for arterial PO2 over the full range, and 0.4 +/- 3.7 mmHg for values less than 100 mmHg, -0.5 +/- 1.8 mmHg for arterial PCO2, and 0.01 +/- 0.01 for pHa. Although the occasional marked discrepancies between one or more CIABG and in vitro values could sometimes be corrected by flushing the arterial catheter or repositioning the sensor, usually we could not determine the cause of the discrepancy or which values were the more accurate. CONCLUSIONS: Over the range of values and under the clinical conditions studied, CIABG monitoring provides immediate blood gas results and trend information with sufficient agreement with in vitro results to be reliable for decision making in most clinical circumstances. Generally, the differences in the values between the two methods of analysis were the result of the combination of the inherent errors of each method. Additional studies need to be undertaken to evaluate the performance of the CIABG monitor across wider ranges of blood gas values, especially for arterial PO2 values less than 60 mmHg and arterial PCO2 values greater than 50 mmHg.

Adult↗
PubMed2001

Objective laparoscopic skills assessments of surgical residents using Hidden Markov Models based on haptic information and tool/tissue interactions.

UNLABELLED: Laparoscopic surgical skills evaluation of surgery residents is usually a subjective process, carried out in the operating room by senior surgeons. By its nature, this process is performed using fuzzy criteria. The objective of the current study was to develop and assess an objective laparoscopic surgical skill scale using Hidden Markov Models (HMM) based on haptic information, tool/tissue interactions and visual task decomposition. METHODS: Eight subjects (six surgical trainees: first year surgical residents 2 x R1, third year surgical residents 2 x R3 fifth year surgical residents 2 x R5; and two expert laparoscopic surgeons: 2 x ES) performed laparoscopic cholecystectomy following a specific 7 steps protocol on a pig. An instrumented laparoscopic grasper equipped with a three-axis force/torque sensor located at the proximal end with an additional force sensor located on the handle, was used to measure the forces and torques. The hand/tool interface force/torque data was synchronized with a video of the tool operative maneuvers. A synthesis of frame-by-frame video analysis was used to define 14 different types of tool/tissue interactions, each one associated with unique force/torque (F/T) signatures. HMMs were developed for each subject representing the surgical skills by defining the various tool/tissue interactions as states and the associated F/T signatures as observations. The statistical distance between the HMMs representing residents at different levels of their training and the HMMs of expert surgeons were calculated in order to generate a learning curve of selected steps during laparoscopic cholecystectomy. RESULTS: Comparison of HMM's between groups showed significant differences between all skill levels, supporting the objective definition of a learning curve. The major differences between skill levels were: (i) magnitudes of F/T applied (ii) types of tool/tissue interactions used and the transition between them and (iii) time intervals spent in each tool/tissue interaction and the overall completion time. The objective HMM analysis showed that the greatest difference in performance was between R1 and R3 groups and then decreased as the level of expertise increased, suggesting that significant laparoscopic surgical capability develops between the first and the third years of their residency training. The power of the methodology using HMM for objective surgical skill assessment arises from the fact that it compiles enormous amount of data regarding different aspects of surgical skill into a very compact model that can be translated into a single number representing the distance from expert performance. Moreover, the methodology is not limited to in-vivo condition as demonstrated in the current study. It can be extended to other modalities such as measuring performance in surgical simulators and robotic systems.

Animals↗
PubMedDate not supplied

Why PACS is no longer a four-letter word.

The real value of PACS is not realized until widespread adoption exists among physicians other than interpreting radiologists. Referring physicians at the office level, in the operating room and in other departments must be willing to embrace the reading of images on monitors. That takes time. The payoff for a PACS system is therefore not realized until sometime in the future. Given the huge up-front capital expenditure required of PACS solutions, it is no wonder that the decision has historically been a difficult one to make. Enter the application service provider (ASP). The marriage of the ASP model to PACS seems to be one of the true "killer apps" currently available in the healthcare technology space. An ASP can host and maintain the software inherent in PACS solutions. Images are centrally archived over the short-, medium-, and long-term timeframe, utilizing state-of-art data management facilities. Some ASPs also provide the necessary bandwidth to office sites and the small amount of hardware that is required onsite, such as viewing stations or monitors. Costs for Internet-based image management under the ASP model rely on a pay-as-you-go formula, which may include all software, support, required hardware and bandwidth as part of the service. There may be a minor up-front fee for installation. The ASP pricing model eliminates the huge gamble an organization takes on "big iron" PACS purchases. Those benefits rely on the first rule of finance: a dollar today is worth more than a dollar tomorrow. PACS and ASPs were made for one another. Because the financial benefits of PACS are realized over time, the timing of cash flows is extremely important. Other benefits inherent in the ASP model such as scalability, diminished need for IT personnel, software version integrity and better pricing because of economies of scale are attractive also.

Capital Expenditures↗
PubMed2004

Study of self-referral factors in the three-level healthcare delivery system, Kashan, Iran, 2000.

INTRODUCTION: In any healthcare system an appropriate structure is essential to operational efficiency. Patients must be able to easily access healthcare workers and/or health centers in their own community. In the first contact with a healthcare practitioner, particularly if that contact is with a GP, 90% of patient needs can be met. If the initial problem cannot be managed, the decision will be made to refer the patient to a specialist. Except in an emergency, all patients should be seen first by a primary healthcare physician who decides whether a referral to secondary care is necessary. This avoids system inefficiencies such as disadvantaged groups suffering from lack of specialist care due to specialist doctors being overwhelmed by the inappropriate self-referrals. In the Kashan region, Islamic Republic of Iran, patients can be classified according to their type of health insurance, which dictates the type of specialist referral available: (1) Closed-loop referral (Imam-Khomeini Welfare Committee); (2) Semi-closed-loop referral (Rural Health System Insurance); and (3) Open referral (social security insurance, therapeutic services insurance, self-insured [private] and the non-insured). The organisation of the Iranian health system has been proposed by WHO as a model for other communities. The present study examined patterns of patient self-referral direct to specialist according to health insurance system in the rural Kashan region, and established the reasons for patient self-referral to specialists. METHODS: A random sample of 1036 individuals was selected from people attending public outpatient clinics and specialists' offices in the private health sector. Of the sample, 413 (40%) were insured by the Imam-Khomeini Welfare Committee (closed loop referral); 145 (14%) by rural health system insurance (semi-closed-loop referral); and 478 (46%) were covered by social security or therapeutic services insurance, out of pocket and other cost payment procedures (open referral). The subjects were interviewed individually in the waiting room by means of a questionnaire before or after their specialist visit. The self-referral rate in the triple insurance structure was calculated. The data were analyzed using a chi2 statistical test. RESULTS: Of the closed-loop referral system patients, 6.8% were self-referred, as were 29.7% of semi-closed referral system patients and 75.5% of open referral system patients (chi2 = 504; p <0.0001). The self-referral rate to the public sector was 60.5%, while to the private sector it was 36.4%, (chi2 = 449; p <0.001). The main reason patients gave for by-passing GPs and self-referring to specialists were: the specialist's high degree of skill in the specific area of the health problem (54%); waste of time to see the GP for a referral (14.9%); and that the patient's information about the referral system was poor (10.5%). CONCLUSION: The findings of this small study demonstrate the high degree of difference in the rates of referral by GP and self-referral according to the healthcare delivery system structure (insurance type and sector). The universal availability of health insurance may be one of the reasons for the similar health status of rural and urban populations in Iran. The findings may be regarded as preliminary to further research into this area of health system design.

Journal Article↗
PubMed1999

On-line computer system to minimize laser injuries during surgery: preliminary system layout and proposal of the key features.

The aim of this paper is to investigate some new user interface ideas and related application packages which aim to improve the degree of safety in an operating room during surgical operations in which an invasive laser beam is deployed. The overall value of the proposition is that a means is provided which ensures the successful completion of the surgical case while minimizing the risk of thermal and mechanical injuries to healthy tissues adjacent to the surgical field. According to surgeons operating with a variety of CO2 lasers available at both the National Cancer Institute in Milan, Italy, and the Sackler School of Medicine, Tel Aviv University, Israel, each laser device presents different cutting and coagulation properties. In order to identify which 'ideal' procedure might corroborate the subjective impression of each surgeon and also to provide one common tool to ensure procedures with a high level of safety, the author has worked for several months with surgeons and technicians of both Institutions to define the general design of a new on-line surgical operation planning and design system to be used during the pre-operative briefing activities and also as a consultation tool during operation. This software package will be developed and tested on both 'C' and FORTRAN compilers running on a commercially available PC which is driving a continuous wave (CW) CO2 laser device via its Instrument Bus interface. The present proposal describes the details of a software package called LCA (Laser-beam Controller and Adviser) which performs several controls in parallel on the key output parameters of a laser beam device during its utilization in delicate surgical operations. The required performances of this device needed during a given surgical operation are pre-simulated and compared against the well-known safety limits, which are stored in the computer's mass storage. If the surgeon's decision about the laser device set-up are considered to be too close to the required physiological safety limits, then the SW alerts the surgeon and proposes alternatives based on other combinations of both HW and SW configurations. An additional application of LCA uses this SW as a warning tool during the operation itself. If a wrong set-up of the laser device is accidentally used, an alarm will be generated and the laser beam automatically switched-off prior to an 'incident report' printout. The operation will continue only when the surgeon validates the choices that the SW suggests for implementation. If necessary, the surgeon can switch off the device and continue to operate it manually. In this case, the surveillance mode will be totally excluded.

Bone Cements↗
PubMed1991

The critical path system. The road toward an efficient OR.

Since January 1990, surgeons have been able to make their incision within 15 minutes of the scheduled time. Total joint procedures, craniotomies, open heart surgery, and thoracic surgeries have had incision times within 15 minutes of the critical path timetable. Daily analysis of activity is done by reviewing the time study. The monthly delay report is becoming a quality assurance monitor for the hospital. Reports are sent to nurse managers, the director of surgical services, and the vice president of nursing. Daily review of the time study points out trends that can be addressed before they become a major problem. For example, in one month a surgical group had three delays. An informal meeting was held with the SDS nurse manager and the surgeon. The SDS manager and I met with the business manager of the group and the problem was resolved. In another example, a surgeon established a trend of consistently being late for cases. After a brief hallway chat, the problem was identified and an agreement reached that his time would be moved to 8 AM induction time. The last example concerns equipment failures. In one month, we had 20 delays due to equipment failures. By the next month, we had reduced equipment failures to 10, and by the end of the following month, we had three delays due to equipment failure. This was achieved through accurate documentation of the failures and frequent follow-up calls until the equipment was repaired. Surgeons and anesthesiologists still complain about delays, but not as often. Using the critical path concept has improved our efficiency and our image. This is only one facet of achieving timeliness in the OR. The teamwork between the OR nursing staff, surgical nursing staff, anesthesia staff, and the surgeons makes this program successful. Daily maintenance of the path with timely follow-up keeps the path working.

Appointments and Schedules↗
PubMed2006

The use of rapid assessment of enteric ICC and neuronal morphology may improve patient management in pediatric surgery: a new clinical pathological protocol.

Alterations in interstitial cells of Cajal (ICC) distribution and density may seriously influence gut motility. We and others have documented a disturbance of ICC and neurons in Hirschsprung's disease (HD), intestinal ischemia, and inflammation. The ability to remove intestine with permanent dysmotility improves significantly the prognosis. This may be important in the developing intestine especially in HD. More complete pathological information increases the accuracy of surgical decisions. Therefore we sought to develop a rapid, intraoperative immunohistochemical protocol for ICC and neurons in surgical specimens for routine diagnostic and therapeutic assessment of pediatric patients. To date, cKit is the only reliable immunohistochemistry for ICC identification. There are multiple antibodies in use for neuronal identification. A comparison of fixation methods and immunostaining using cKit and multiple intestinal neuronal antibodies was done. Fresh segments of surgically resected intestine were sectioned and stained using antibodies for ICC cell identification (anti-cKit) and for neuronal characterization. By carefully changing tissue fixation methods, different neuronal antibodies were tested to determine an optimal rapid protocol. Each suggested protocol was tested on normal and pathological intestinal tissue and compared to the previous overnight immunostaining of the same tissue. A new rapid tissue fixation and immunostaining protocol using cKit for ICC identification and NF 68 was developed. By employing this protocol, we could obtain ICC and neuro-immunohistochemistry in unfixed frozen sections within 1 h with tissue vibration to diminish the time for immunostaining. Without vibration the protocol takes 3 h. ICC and enteric neuronal changes could be readily observed and the quality of staining was comparable to standard immunohistochemistry. Each gut pathology displayed characteristic changes in ICC and neuronal density/distribution in the affected bowel. The time-scale of the 1-h immunoprocessing is still longer than the standard clinical pathological "quick" sections using H&E staining; however, the protocol duration is within the surgery timescale. Standard H&E stain used in combination with our rapid neuronal and ICC immunohistochemistry protocol enables a fast, comprehensive, and accurate assessment of the pathophysiology of signaling networks controlling gut motility while the patient is still in the operating room. We propose that the addition of this simple and rapid immunohistochemical assessment in the pathologist evaluation of surgical specimens would result in a more complete characterization for diagnosis and prognosis of the pediatric patient. Specifically, we propose that this test will differentiate good versus poor prognosis HD patients based on their neuron/ICC ratio and present a rapid, standardized method for use in general pathology.

Colon↗
PubMed1997

Investment in new technology research can save future health care dollars.

OBJECTIVE: To perform a cost analysis of the emerging technology of lymphatic mapping for patients with malignant melanoma. DESIGN: A retrospective, computer-aided chart and financial cost and charge review of consecutive patients with the diagnosis of melanoma registered at a cancer center from December, 1995 to March, 1996. PARTICIPANTS: 73 consecutive patients with the diagnosis of Stage 1 and 2 melanoma (cutaneous disease only) had nodal staging of their disease with either a sentinel node (SLN) biopsy or an elective complete node dissection (ELND). This was determined largely by patient choice and the protocol in operation at the time of the presentation of the patient to the clinic. OUTCOMES MEASURED: There were no deaths in the series. Patient morbidity endpoints included rates of infection, incidence of extremity lymphedema, development of a seroma in the regional nodal basin wound and wound healing. Clinical outcome was measured by the ability to obtain complete nodal staging information with the new lymphatic mapping technology, and recurrence rates in the nodal basin after a negative SLN biopsy. Total charges, direct costs and total costs were calculated from all hospital, OR, pathology and lab charges. Professional fees were included in the analysis. RESULTS: Group 1 patients (50) had melanomas greater than 0.76 mm in thickness treated with a wide local excision (WLE), lymphatic mapping and SLN biopsy under general anesthesia. Five patients (Group 2) had their procedure performed under a straight local anesthesia. Group 3 patients (18) had nodal staging performed with an elective node dissection. In Groups 1 and 2, if the SLN was positive for micrometastases, the patients were taken back to the OR for a complete node dissection. The total charges per patient were $13,835, $6,853 and $19,285, respectively. Significant dollar savings were achieved if the nodal staging could be accomplished with the lymphatic mapping technology (p = 0.001). Morbidity was significantly less in Groups 1 and 2 compared to Group 3. After a mean follow-up of three years, only one patient has recurred in a SLN negative basin. CONCLUSIONS: With 38,300 new cases of melanoma diagnosed each year in the United States, a projected savings of $172 million per year (general anesthesia) and $350 million per year (local anesthesia) could be realized if this new mapping technology could be incorporated into the care of the melanoma patient. Patient morbidity is minimized, nodal staging is complete and patients return to work sooner. Recently approved adjuvant therapy can be applied in a selective fashion, treating only those patients in which a documented benefit has been obtained, saving the health care system more dollars. Initial investment in defining the technology was minimal.

Anesthesia, General↗
PubMed2005

[My Kumamoto life of 19 years].

In this paper titled "My Kumamoto Life of 19 Years; The Travel for Times", the memorial lecture on my retirement from Kumamoto National University Corporation Integrated Medical and Pharmaceutical Sciences, Department of Biomedical Informatics (Chairman) is summarized. As they say "Time flies", time extends from seconds to years. The lecture includes a summary of my short term research and long term studies, such as age-dependant and gene-related changes in ageing over 5 or more years in the healthy elderly. Short-term study mostly involved of newly evaluated assay methods for important substances such as the second level in the cell life span in the variation of lipid metabolite of cardiovascular diseases based on atherosclerosis, Alzheimer disease, and their evaluation by homogeneous assay of HDL-C, LDL-C, enzymatic assay for choline relating metabolites, and lipoperoxide as the results of free radical reactions. The intermediate-term studies were mainly on the development of total laboratory automation (TLA) for the management of the laboratory of the university hospital. The hospital has various degrees of sophistication in its laboratory services. Technicians were allowed to transport specimens immediately by using an air-shooter system after drawing blood, from the emergency room to the central laboratory. Routine specimens could be measured within 30 min and the results could be automatically sent to the physician's office. It greatly minimized reporting errors, decreased the exposure to biohazards, reduced labor expense, improved operation efficiency, and shortened turnaround time. Moreover, for the outpatients and emergency laboratories, we constructed a robotic measuring system which was assembled into a sequential method for the analysis of chemistry, hematology and urinalysis specimens by using a polyarticular robot. The robot arm extends to a bar-coded tube, picking up and placing test tubes on a turn table of autoanalyzers for analysis without manpower. This is the first known effective unmanned procedure for assay in the world of laboratory medicine. Also, our research on pathological informatics was begun. Our laboratory had 7 themes; the study of the reference intervals in the elderly as one of strategy of standardization on laboratory data (Drs. Uji Y, Sugiuchi H), the study of the activation mechanism of ribosomal proteins by the functions of blood cells (Drs. Shibuya Y, Senba U), the evaluation of diagnostic methods in latent ailments by gene analysis (Dr. Ando Y), the evaluation of a highly sensitive method for disseminated intravascular coagulopathy (Okajima K), the study of the neogenesis of blood vessels by physical invasion (Uchiba M), the study of the deposition mechanism of amyloid proteins and evaluation of the diagnostic methods in the autonomic system(Drs. Ando Y, Nakamura M), and the study of the function of blood stem cells in blood transfusion services (Drs. Yamaguchi K, Yonemura M, Tsunemi M). Finally, my long term work also included research into the early diagnosis and prediction of latent ailments and the variation of serum proteins levels in the healthy aged. The conclusion was that the reference value of healthy populations and individuals (intra-personal) who had no combined ailments, in follow-up for 5 years, categorized by age, sex, and social conditions, gave a narrower range of variation than did large mixed populations (inter-personal), in laboratory tests and activity of daily living (ADL). Concerning the early diagnosis and prediction studies for the latent ailments in the aged, variations of serum protein levels in the healthy aged were classified into 3 types: serum proteins levels increased with advancing age (alphaAT, mainly acute phase reactant proteins), those that decreased with advancing age (albumin mainly transporting proteins) and proteins with no significant variation. The higher increase of the alpha1AT/beta2 III ratio in the healthy aged over 60 years old is suspected to create symptoms in the near future. The papers presented concerning ageing studies were presented at the APCCC Symposium (India, 2002) and the IFCC Symposium (Kyoto, 2002), and the TLA study was also presented at the Symposium of XX World Congress of Pathology and Laboratory Medicine (San Paulo Brazil 1999).

Clinical Laboratory Information Systems↗
PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗