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PubMed2001

Cost analysis of Turku University Central Hospital PACS in 1998.

Introduction of a picture archiving and communication system (PACS) into an old hospital poses several problems since the system cannot be implemented instantaneously. We analysed the costs of a halfway implemented PACS in Turku University Central Hospital (TUCH) during 1998. Manual and digital archiving in 1998 continued parallel so that only 10% reduction of film usage was achieved. A 21% increase in image manipulation and storage expenses occurred. A calculation based on potential 90% reduction of film usage and changes in the amount of personnel suggest some direct savings. Also, indirect savings due to more efficient patient treatment and the reduction of time spent in the hospital, and overhead costs of information handling are expected to lead to savings. However, these savings were not included in our calculations. When full-scale PACS is installed, equipment investments, network and digital ware maintenance costs will drop from 121 to 116% compared with traditional film archiving activity costs.

Academic Medical Centers↗
PubMed2006

[Standard of integration management at company level and its auditing].

SITUATION: Responsibility at company level for the employment of workers with health-related problems or disabilities has increased, inter alia because of integration management at company level according to section 84 (2) of the German Social Code Book IX. Although several recommendations exist, no standard is available for auditing and certification. Such a standard could be a basis for granting premiums according to section 84 (3) of Book IX of the German Social Code. AUDIT AND CERTIFICATION: One product of the international "disability management" movement is the "Consensus Based Disability Management Audit" (CBDMA). The Audit is a systematic and independent measurement of the effectiveness of integration management at company level. CBDMA goals are to give evidence of the quality of the integration management implemented, to identify opportunities for improvement and recommend appropriate corrective and preventive action. In May 2006, the integration management of Ford-Werke GmbH Germany with about 23 900 employees was audited and certified as the first company in Europe. STANDARD OF INTEGRATION MANAGEMENT AT COMPANY LEVEL: In dialogue with corporate practitioners, the international standard of CBDMA has been adapted, completed and verified concerning its practicability. Process orientation is the key approach, and the structure is similar to DIN EN ISO 9001:2000. Its structure is as follows: (1) management-labour responsibility (goals and objectives, program planning, management-labour review), (2) management of resources (disability manager and DM team, employees' participation, cooperation with external partners, infrastructure), (3) communication (internal and external public relations), (4) case management (identifying cases, contact, situation analysis, planning actions, implementing actions and monitoring, process and outcome evaluation), (5) analysis and improvement (analysis and program evaluation), (6) documentation (manual, records).

Disability Evaluation↗
PubMedDate not supplied

Caring for Hispanic patients interactively: simulations and practices for allied health professionals.

Healthcare providers have a new tool for navigating the challenges of cross-cultural communication when treating Hispanic patients: CHISPA e-learning environment. CHISPA, which means "spark" in Spanish, stands for Caring for the Hispanic Patient Interactively: Simulations and Practices for Allied Health Professionals. It is a computer-based training program that provides solutions to both cultural and linguistic barriers to care. The program allows users to interact with Hispanic patients in realistic patient-care scenarios and receive feedback on their choices, along with a wealth of information on cultural variables, advice on overcoming language barriers, and language exercises to facilitate learning medical terms and expressions in Spanish.

Allied Health Personnel↗
PubMed2004

Developments in the CCP4 molecular-graphics project.

Progress towards structure determination that is both high-throughput and high-value is dependent on the development of integrated and automatic tools for electron-density map interpretation and for the analysis of the resulting atomic models. Advances in map-interpretation algorithms are extending the resolution regime in which fully automatic tools can work reliably, but at present human intervention is required to interpret poor regions of macromolecular electron density, particularly where crystallographic data is only available to modest resolution [for example, I/sigma(I) < 2.0 for minimum resolution 2.5 A]. In such cases, a set of manual and semi-manual model-building molecular-graphics tools is needed. At the same time, converting the knowledge encapsulated in a molecular structure into understanding is dependent upon visualization tools, which must be able to communicate that understanding to others by means of both static and dynamic representations. CCP4 mg is a program designed to meet these needs in a way that is closely integrated with the ongoing development of CCP4 as a program suite suitable for both low- and high-intervention computational structural biology. As well as providing a carefully designed user interface to advanced algorithms of model building and analysis, CCP4 mg is intended to present a graphical toolkit to developers of novel algorithms in these fields.

Algorithms↗
PubMed1991

[Endoscopic treatment of intracranial lesions. Apropos of 8 cases].

The authors describe their initial experience involving endoscopic techniques used in the treatment of eight patients with varied brain lesions. Two tumours and a colloid cyst of the third ventricle, two paraventricular symptomatic cysts, one arachnoid cyst, one chronic intracerebral hematoma and one case of free catheter extraction in the lateral ventricle. The common characteristics of all these lesions were their liquid character and/or intraventricular location. Rigid endoscopes were used, with 9 and 6 mm work channels and independent aspiration and irrigation systems. The optic elbow makes direct visualization and adaptation to the TV monitor possible. The endoscope was manually directed at the lesion through a 12 mm burr hole in five cases and by means of a stereotactic frame in three cases. Biopsies were obtained in six cases. In three cases a communication between the cyst and the ventricular system or adjacent cisterns was established and in two cases vaporization of the lesion using a CO2 laser was performed. Tolerance to the endoscopic procedures was good in all cases. In the authors' opinion, endoscopic techniques constitute a low risk method, midway between stereotactic techniques and the microsurgical approach, and are especially indicated in the treatment of cystic brain lesions or those situated in or near the ventricular system. Their most notable advantages are: providing direct visualization of the lesion without interference from the instruments in the operating field; non-repercussion of the spatial changes derived from the liquid outlet and possibility of lesion coagulation and manipulation. Their disadvantages, related to the use of very long instruments and from a reduced work channel, must be overcome by specialized training.

Adult↗
PubMed1998

Role of speech therapy and sign language prior to cochlear implantation.

The speech therapist should assess and develop the communication skills of the deaf child prior and after a cochlear implantation. The goals are first the acquisition of a useful communication system by the deaf child (for avoiding a cognitive stimulation lack) and parallely the acquisition of good oral language competencies. The different modes of communication useable in the profoundly deaf education are presented. Exclusive sign language use is not indicated in implanted children. It is well demonstrated that an exclusive oral communication is associated with an insufficient knowledge of the oral language. The total communication (combination of listening, speech reading, signing with or without finger spelling) is a defective communication mode with a bad representation of the morpho-syntactic and the phonologic aspects of the oral language. The best choice seems to be the simultaneously use of a spoken language and a manually coding of their phonological structures. The limits of this alternative are discussed.

Child↗
PubMed1999

Unprompted recall and reporting of hidden objects by a chimpanzee (Pan troglodytes) after extended delays.

The ability to recall features of environments not present to the senses is important in human thinking, planning, and communication, but to date there are almost no data on recall capabilities in nonverbal animals. In this study, the author used symbol knowledge as a tool to study chimpanzee memory. An 11-year-old female chimpanzee (Pan troglodytes) that had already learned a large number of arbitrarily designated geometric forms (lexigrams) watched as an experimenter hid an object in the woods outside her outdoor enclosure. The type and location of the object varied across trials. After an imposed delay of up to 16 h, the chimpanzee could interact indoors with a person who did not know that an object had been hidden, let alone the type or location of the object. A keyboard in the indoor cage displayed 256 lexigrams. From Trial 1, the chimpanzee seemed to do whatever it took to catch the person's attention and then touched the lexigram corresponding to the type of object hidden, pointed outdoors, went outdoors (if followed), and continued to point manually toward the object and vocalize until the person found the object. The subject indicated nonfood objects as well as more than 20 food types.

Animal Communication↗
PubMed1999

PACS: the second time around.

Conquest Hospital was a Picture Archiving and Communication Systems development site, designed to inform the specification of low cost systems and to provide information on benefits and drawbacks. The American College of Radiologists/National Electrical Manufacturers Association 2.0 protocol was used for image management. The Regional Health Authority sponsored the system, initially installed in mid 1992. It used a high-speed dedicated optical fibre distributed data interface network and for teleradiology an Integrated Services Digital Network solution. Image and other data were captured and archived satisfactorily. Image reporting folders were manually constructed and sent to reporting viewstations. Radiologists were able to directly request 'ad hoc' images from archive. The reporting function of the associated but unlinked radiology information system was satisfactory. Identification was made of data transfer, ergonomic, single point of failure and many other issues. These informed re-specification and the commercial approach for a Digital Images Communication in Medicine/Hyper Text Mark-up Language Picture Archiving and Communication System, the first stages of which have been whole hospital re-networking, Intranet introduction, installation of new Computed Radiography/Fluorography and Computed Tomography/Magnetic Resonance Imaging segments and a new Radiology Information System. The Picture Archiving and Communication System is now seen as part of a full Electronic Patient Record system. Networking and provision of high quality Personal Computer hardware for data review are seen as a corporate responsibility and a hospital overhead, no longer borne by individual projects. Our present work is synergistic with the procurement of a new Clinical Information System and the further development of the hospital Intranet.

Computer Communication Networks↗
PubMed1994

ORATEL: telematic system for quality assurance in oral health care (AIM Project A2029).

ORATEL is a 3-year project with the ultimate objective of improving oral health through use of appropriate computerized information systems. These tools will promote quality assurance and development in oral health care by using common quality indicators/standards. The project has completed its first phase, during which two European surveys were made, one on quality assurance clinical practices, and another on existing computerized information systems in oral health care. Pan European consensus was reached on 3 and 4 September 1992 when quality assurance indicators for oral health care services were endorsed. A manual on quality assurance indicators in oral health care has also been issued by the project.

Computer Communication Networks↗
PubMed1995

Strategies deaf mothers use when reading to their young deaf or hard of hearing children.

The purpose of the study was to examine behaviors utilized by deaf mothers when reading to their deaf or hard of hearing children aged three to five years. Six deaf mothers were video-taped while reading the same book. The videotapes were transcribed and coded by two observers. Data analysis revealed six specific strategies that the mothers used while reading. These included sign placement, text paired with signed demonstration, real world connection between text and child's experience, attention maintenance, physical demonstrations of character changes, and non-manual signals as questions.

Attention↗
PubMed1993

A joining of forces. The promise of community health information management systems (CHIMSs).

Every time you buy a bag of Frito-Lay corn chips, information regarding your purchase becomes part of a customer database within hours. America's snack food "needs" are analyzed and decisions are made about filling the shelves of every corner convenience store in the nation with exactly the right product. This system has saved the company more than $20 million a year through increased efficiency. But when you buy a diagnostic test to identify a potentially life-threatening condition, results can remain unavailable for days. If we can bring computerized efficiencies to marketing corn chips, why aren't we doing it for healthcare? Imagine--managers of community health systems who know their customers' needs so precisely that they "fill the shelves" of local "convenience health stops" with exactly the right services to maximize the health of the customers. As a by-product, they save a few million dollars per year in costs. Managers of other industries use information technology to deliver the right product or service to customers at just the right time, to differentiate their services by adding value, to compete effectively on cost and/or quality. Many members of the healthcare industry, where only 2.6 percent of expenditures go to information systems (compared to 5 percent in manufacturing and 7 percent in banking) and where the basic unit of work--the patient record--is still a manual process, are years behind in their thinking about how information systems can make their business better.

Community Health Services↗
PubMed1991

Standards for the electronic transfer of clinical data: progress and promises.

Data exchange standards have two components: the message format or syntax and the dictionary of codes (semantics). For many applications, message standards already have been developed. For a few kinds of clinical entities, such as drugs, these code systems (e.g., the National Drug Code) are virtually complete, but a few gaps must be filled and an agreement must be reached about the level of granularity needed. The available codes for clinical descriptors are inadequate but the National Library of Medicine's Universal Medical Language (UML) project will do much to redress this deficiency. Codes for clinical variables such as blood pressure and blood glucose which have methods, units, normal ranges, and physiologic correlates are very inadequate. CPT4 provides some of the needed codes but has huge gaps. An early effort to extend CPT4 is included in ASTM 1238. Work being done by ASTM E31.12 and the Euclides project will offer robust codes for clinical laboratory measurements. If we want to pool data from different institutions for clinical and policy research, universal codes for observations are prerequisite. And agreement of an international coding system for observation-bearing variables should be a major agenda item for standards groups in the next year. Our goal has been to standardize the communication of clinical data between clinical systems, not the systems themselves or their internal operation. In fact, standardizing the internals of clinical application could be counterproductive at the present. It would deflect energy from, and delay the spread of, CDI standards. Moreover, it gives undue attention to computer systems, rather than the data they contain. The data are the most expensive part of any data system. They are the raison d'être for such systems. Computer systems come and go. The data last forever. Yet we have been mesmerized by the computer system while ignoring its contents. As a result, most computer-stored clinical data must live like the tragic boy in the bubble. They cannot "live" outside of the computer system in which they were born. So, we find at every hospital the bizarre rituals of humans reading computer-generated reports so they can type this information in another computer. Electronic (e.g., stored clinical) data should not depend upon the internals of a particular program, language, or machine for its interpretation. The clinical data entered into one computer system should be directly available to any other computer system that now receives them through manual transcription. Data interchange standards give life to our data--independent of the source system.

Abstracting and Indexing↗
PubMed2006

Automated detection of tunneling nanotubes in 3D images.

BACKGROUND: This paper presents an automated method for the identification of thin membrane tubes in 3D fluorescence images. These tubes, referred to as tunneling nanotubes (TNTs), are newly discovered intercellular structures that connect living cells through a membrane continuity. TNTs are 50-200 nm in diameter, crossing from one cell to another at their nearest distance. In microscopic images, they are seen as straight lines. It now emerges that the TNTs represent the underlying structure of a new type of cell-to-cell communication. METHODS: Our approach for the identification of TNTs is based on a combination of biological cell markers and known image processing techniques. Watershed segmentation and edge detectors are used to find cell borders, TNTs, and image artifacts. Mathematical morphology is employed at several stages of the processing chain. Two image channels are used for the calculations to improve classification of watershed regions into cells and background. One image channel displays cell borders and TNTs, the second is used for cell classification and displays the cytoplasmic compartments of the cells. The method for cell segmentation is 3D, and the TNT detection incorporates 3D information using various 2D projections. RESULTS: The TNT- and cell-detection were applied to numerous 3D stacks of images. A success rate of 67% was obtained compared with manual identification of the TNTs. The digitalized results were used to achieve statistical information of selected properties of TNTs. CONCLUSION: To further explore these structures, automated detection and quantification is desirable. Consequently, this automated recognition tool will be useful in biological studies on cell-to-cell communication where TNT quantification is essential.

Algorithms↗
PubMed1994

Interhemispheric integration of simple visuomotor responses in patients with partial callosal defects.

Because of the organization of visual and motor pathways, simple manual responses to a light stimulus in the right or left visual hemifields are performed faster with uncrossed hand-field combinations than with crossed hand-field combinations. Uncrossed responses can be integrated within a single hemisphere, whereas crossed responses require a time-consuming interhemispheric transfer via the corpus callosum which is reflected in the difference between crossed and uncrossed reaction times. We investigated crossed-uncrossed differences (CUDs) in speed of simple visuomotor responses to lateralized flashes in seven subjects with an anterior section of the corpus callosum sparing the splenium and in one subject with an agenetic absence of the splenium due to a cerebrovascular malformation. There was no evidence of an abnormal prolongation of the CUDs in any of these subjects, in sharp contrast with the very long CUDs exhibited by an epileptic subject with a complete callosal section and two subjects with total callosal agenesis tested in the same experimental situation [1]. The normality of the CUDs in the subjects with partial callosal defects was not due to a postoperatory reorganization of interhemispheric communication, since there was no indication of an increased CUD in a patient tested as early as 5 days after the anterior callosotomy. These results are compatible with the assumption that both anterior and posterior callosal routes may subserve the integration of speeded manual responses to a visual stimulus directed to the hemisphere ipsilateral to the responding hand.

Adult↗
PubMed1986

Sensitive drawings of sexual activity in human sexuality textbooks: an analysis on communication and bias.

Sensitive drawings are a distinctive genre of explicit sexual imagery which has become a standard way of illustrating sexual acts in human sexuality textbooks. This essay presents an analysis of signs defining age, ethnic status, class, and sexual identity encoded in such sensitive drawings as used in 23 recent textbooks and of the biases which this encoding reflects. The strong class and heterosexual biases characterizing the images are consistent with those found in the sex manuals which inspired the style of drawing. Functions of the drawings and their relationship to the texts' written materials are discussed, and it is argued that the biases mirror problems in treatment of social class and sexuality and in the treatment of sexual acts, e.g., masturbation, oral sex, and sex, and coitus, as they relate to sexual identities.

Attitude↗