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Bitewing and digital bitewing radiography for detection of caries lesions.

When radiography is applied in the clinic for caries detection, the recommended technique is bitewing projection (Gröndahl, 1994). This technique was introduced by Raper (1925) and has continued with only minor alterations. The aims of this report are to provide evidence for (1) optimal bitewing recording for individual examinations and clinical trials, (2) advantages and disadvantages of digital receptors for bitewing examinations, (3) the diagnostic outcomes and limitations of bitewing radiography, and (4) computer-automated detection of caries.

Clinical Trials as Topic↗

Breast and colorectal cancer screening among low-income women with psychiatric disorders.

This study investigated breast and colorectal cancer screening among 196 low-income women being treated for psychiatric illnesses. Main outcome measures included breast self-examination (BSE), clinical breast examination (CBE), mammography, digital rectal examination (DRE), and fecal occult blood test (FOBT). Results indicated that 49% and 66% of women 40 years of age or older had obtained mammograms and CBEs, respectively, in the preceding year. Forty-four per cent of women 20 years of age or older reported monthly BSE. Forty-six per cent and 35% of women 50 years of age or older reported having digital rectal exams (DRE) or fecal occult blood tests (FOBT), respectively, in the preceding year. Multivariate analyses showed that physician recommendation of screening was the strongest predictor of having obtained a mammogram, CBE, DRE or FOBT in the preceding year. Physician recommendation and self-confidence in performing BSE were the strongest predictors of monthly BSE. These results highlight the importance of physician recommendation of adherence to screening guidelines for breast and colorectal cancer. Because psychiatrists frequently treat psychiatric patients on a regular basis, they are in a unique position to encourage cancer screening and to monitor compliance with their recommendations.

Adult↗

Awareness and use of osteopathic physicians in the United States: results of the Second Osteopathic Survey of Health Care in America (OSTEOSURV-II).

The Second Osteopathic Survey of Health Care in America (OSTEOSURV-II), a national telephone survey conducted during 2000 using random-digit dialing, was used to address questions about public awareness of the osteopathic medical profession and use of osteopathic physicians. A total of 499 adult, noninstitutionalized, household respondents were surveyed. The main outcomes included prevalence of and multivariate factors associated with awareness and use of osteopathic physicians. The overall response rate was 64%. The prevalence of awareness, lifetime use, and current use of osteopathic physicians among unscreened respondents was 46%, 16%, and 7%, respectively. Among lifetime users, 84% received primary care; 52%, osteopathic manipulative treatment; and 25%, specialty care. The multivariate factors most strongly associated with awareness of osteopathic physicians were college education (rate ratio [RR], 1.86; 95% confidence interval [CI], 1.43-2.40), 60 or more years of age (RR, 1.52; 95% CI, 1.15-2.01), and Midwest residence (RR, 1.39; 95% CI, 1.05-1.84). Nonwhites, including Hispanics, were less likely to be aware of osteopathic physicians (RR, 0.54; 95% CI, 0.38-0.76). Respondents with college education (RR, 2.34; 95% CI, 1.44-3.79), respondents of intermediate age (RR, 1.71; 95% CI, 1.12-2.61), and women (RR, 1.68; 95% CI, 1.12-2.52) were more likely to report lifetime use of osteopathic physicians. Nonwhites were less likely to report lifetime use (RR, 0.25; 95% CI, 0.11-0.57). Greater promotional efforts are needed to increase awareness of osteopathic medicine and to remove barriers to using osteopathic physicians, particularly among nonwhites.

Awareness↗

Assessment of costs and benefits in the introduction of digital radiology systems.

A discussion is presented of cost and benefit considerations in establishing digital radiology systems and an approach to assessment of such factors. Costs of digital radiology systems need to be defined and compared appropriately. Assessments should consider capital and replacement costs, but also less tangible items such as effects on staff and training requirements, hospital infrastructure, productivity, file integrity and diagnostic accuracy. Benefits of digital radiology systems could be assessed using cost-benefit and social audit analysis techniques, yielding a matrix of monetary items and also summaries of non-monetary benefits. Such analysis would define the major participants in the digital radiology process and the nature of their interests and assess the costs and benefits impacting on each of them. Economic evaluation of digital radiology to date has focused on the cost side of the appraisal. Analyses of benefits of digital radiology systems have been limited and have given inconclusive results. There is a need for better definition of comparative costs and benefits to inform interested parties, including hospital staff and health policy makers. Such economic analysis is an important way of asking the right questions about resource usage and could usually be carried out in a pilot setting before there is wider diffusion of digital radiology systems.

Cost-Benefit Analysis↗

The Baltic Health Network - Taking Secure, Internet-based Healthcare Networks to the Next Level.

Internet-based health care networks are a step forward compared to first generation health care networks, which has been limited to pushing text-based messages between different systems. An Internet-based network can also "pull" data - and not only text but any digital data - for instance images and video sequences. The Internet-based networks can more effectively fulfil the vision of access to relevant data regardless of time and location. Although far from identical, the health delivery systems of Denmark, Norway and Sweden are similar. They also share a shortage of specialized health personnel - not least radiologists and in some regions obstetricians. Furthermore, over the past ten years they have implemented an IT-strategy to increase efficiency in the delivery of healthcare services. Part of this strategy has been to build three national networks on top of the existing regional, secure and Internet-based healthcare networks. These national networks connect not only all hospitals in the three countries, but also a majority of the other stakeholders in the healthcare sector (GPs, private specialists, laboratories, homecare services etc.). The organizations behind the three networks are now working on creating a trans-national network, the Baltic Health Network (BHN), which will be one of the outcomes of the Baltic eHealth project and will not only connect the three national networks but also add two hospital networks from Lithuania and Estonia. The BHN is expected to be operational by June 2005. One of major advantages of the BHN is that the many rural hospitals of the Baltic Sea Area with a few mouse clicks can reach a specialist for second opinion in any of the approximately 200 hospitals connected to the network. For instance the midwives in the rural areas of Västerbottan County, Sweden, are awaiting the establishment of BHN to get access to second opinions from specialists at National Center for Foetal Medicine at the University Hospital of Trondheim, Norway. The BHN will remove a very important technical barrier for collaboration between health professionals and the Baltic eHealth project hopes that this and other project initiatives will facilitate the large-scale usage of second opinion from available health care experts regardless of institutional, regional and even national borders. This will lift the quality of service to patients in the Baltic Sea Region - especially in the rural areas where highly specialized health professionals tend to be geographically far away.

Cooperative Behavior↗

Heritage retention and bean intake correlates to dietary fiber intakes in Hispanic mothers--Qué Sabrosa Vida.

OBJECTIVE: To determine the correlation between fruit/vegetable and bean stage of change and heritage retention with fiber intake in Hispanic mothers. DESIGN: Cross-sectional study design used baseline survey data from the Qué Sabrosa Vida nutrition intervention developed by the University of Texas School of Public Health, Human Nutrition Center (Houston, TX). Participants were recruited and data gathered from telephone surveys using random digit dial methodology ensuring proportional representation of demographic subgroups. SUBJECTS: Hispanic mothers (N=293) responded to the baseline survey in El Paso, TX. ANALYSES: Using SPSS version 11.0 (SPSS Inc, Chicago, IL), descriptive statistics, chi2 , correlations, and analyses of variance were used to determine the relationship of variables to fiber intake. Potential confounding variables included were grain stage of change, age, education level, and marital status. RESULTS: Mean fiber intake for mothers was 21.9 g/day and mean age was 35.8 years. Chi2 of fruit/vegetable stage was P =.784. Chi 2 of bean stage, heritage retention score, age, and education to fiber intake were significant, P =.008, P =.004, P =.005, and P =.001, respectively. Bean stage, heritage retention score, age, and education level were significantly correlated. One-way analysis of variance of bean stage, heritage retention score, age, and education level by fiber intake were significant, P =.006, P =.001, P =.004, and P =.002, respectively. CONCLUSIONS: Older Hispanic mothers in the action/maintenance bean stage with strong heritage retention score had greater fiber intakes than younger mothers in pre-action bean stage with weak heritage retention score. As education level increased fiber intake decreased. Encouragement of bean consumption and heritage retention may increase fiber intake in this Hispanic mother population.

Acculturation↗

Adherence of low-income women to cancer screening recommendations.

BACKGROUND: African-American and low-income women have lower rates of cancer screening and higher rates of late-stage disease than do their counterparts. OBJECTIVE: To examine the effects of primary care, health insurance, and HMO participation on adherence to regular breast, cervical, and colorectal cancer screening. DESIGN: Random-digit-dial and targeted household telephone survey of a population-based sample. SETTING: Washington, D.C. census tracts with > or =30% of households below 200% of federal poverty threshold. PARTICIPANTS: Included in the survey were 1,205 women over age 40, 82% of whom were African American. MAIN OUTCOME MEASURES: Adherence was defined as reported receipt of the last 2 screening tests within recommended intervals for age. RESULTS: The survey completion rate was 85%. Overall, 75% of respondents were adherent to regular Pap smears, 66% to clinical breast exams, 65% to mammography, and 29% to fecal occult blood test recommendations. Continuity with a single primary care practitioner, comprehensive service delivery, and higher patient satisfaction with the relationships with primary care practitioners were associated with higher adherence across the 4 screening tests, after considering other factors. Coordination of care also was associated with screening adherence for women age 65 and over, but not for the younger women. Compared with counterparts in non-HMO plans, women enrolled in health maintenance organizations were also more likely to be adherent to regular screening (e.g., Pap, odds ratio [OR] 1.89, 95% confidence interval [CI] 1.11 to 3.17; clinical breast exam, OR 2.04, 95% CI 1.21 to 3.44; mammogram, OR 1.95, 95% CI 1.15 to 3.31; fecal occult blood test, OR 1.70, 95% CI 1.01 to 2.83.) CONCLUSIONS: Organizing healthcare services to promote continuity with a specific primary care clinician, a comprehensive array of services available at the primary care delivery site, coordination among providers, and better patient-practitioner relationships are likely to improve inner-city, low-income women's adherence to cancer screening recommendations.

Adult↗

Development and Validation of Machine Learning Models for Predicting Early Cognitive Decline Using Home Sensor-Derived Behavioral Data: Sensors in-Home for Elder Wellbeing (SINEW) Cohort Study.

BACKGROUND: As the global population continues to age, the prevalence of geriatric conditions, including dementia and frailty, is also increasing. Early identification of individuals at an elevated risk of these conditions, such as those presenting with mild cognitive impairment (MCI) or prefrailty, can provide a critical window for prompt intervention aimed at preventing or reversing disease progression. To promote such early identification, there is a burgeoning interest in the use of digital sensor technology and predictive modeling. OBJECTIVE: This study aimed to use a continuous, home-based monitoring sensor system for older adults to distinguish those exhibiting normal aging from those with MCI, early dementia, prefrailty, or frailty, and to predict their transition from normal aging to one of these conditions. METHODS: This longitudinal cohort study will recruit 200 community-dwelling adults aged ≥65 years with normal cognition or MCI at baseline. A multi-sensor system will be installed in participants' homes, including passive infrared motion sensors, door contact sensors, bed sensors, medication box sensors, wearable activity bands, and Bluetooth proximity beacons. These devices will continuously capture spatiotemporal activity patterns, mobility indicators, sleep behaviors, and medication-taking routines. Annual assessments will include standardized cognitive tests (eg, Montreal Cognitive Assessment, Mini-Mental State Examination, Rey Auditory-Verbal Learning Test, digit span, Color Trails Test, semantic fluency, Stroop), frailty measures (modified Fried phenotype, gait speed, grip strength), mental health scales, sleep quality, and psychosocial indicators. Sensor-derived features-such as gait variability, activity regularity, sleep fragmentation, and medication adherence patterns-will be integrated with clinical data to develop supervised machine learning models. Planned approaches include logistic regression, random forests, gradient boosting, and deep learning. Model performance will be evaluated using cross-validation and independent test sets. Primary metrics will include area under the receiver operating characteristic curve, sensitivity, specificity, precision, recall, and F1-score. Models will be benchmarked against gold-standard clinical diagnoses and validated using temporal subsets of the dataset. RESULTS: Enrollment for this study started in November 2019 and will continue until March 2030. As of June 2025, we have enrolled 138 participants. Full data analysis has yet to begin. CONCLUSIONS: We aim to develop a reliable and effective sensor system for in-home use that will facilitate the early detection of cognitive and physical decline. In so doing, it will add to our current understanding of digital biomarkers. It is common for older adults to seek clinical intervention only when their cognitive impairment has already reached an advanced stage. The implementation of readily deployable sensor systems within community settings presents us with opportunities for prompt intervention, which holds the potential for delaying or reversing disease progression and allowing for a greater number of functional and meaningful years.

Humans↗

Behavioral Risk Factor Surveillance, 1991: monitoring progress toward the nation's year 2000 health objectives.

PROBLEM/CONDITION: Risk reduction is a major focus of the national health objectives for the year 2000. Progress toward several of these objectives can be evaluated by using data from the Behavioral Risk Factor Surveillance System (BRFSS). Year 2000 objective areas measurable by BRFSS data include those for overweight, lack of physical activity, smoking, safety belt use, and medical screening for breast and cervical cancer and elevated blood cholesterol. BRFSS data have been used to guide health promotion/disease prevention programs. REPORTING PERIOD: 1991. DESCRIPTION OF SYSTEM: BRFSS is a state-based random-digit-dialing telephone survey of noninstitutionalized adults (> or = 18 years of age); 47 states and the District of Columbia participated in BRFSS in 1991. RESULTS: Some year 2000 objectives appear to be readily attainable for many states, whereas others do not. For example, among participating states, a median 57.8% (range = 45.6%-82.8%) of women ages > or = 50 years reported having had both a clinical breast examination and a mammogram in the previous 2 years (year 2000 objective: > or = 60%). In contrast, a median 37.3% (range = 22.1%-52.5%) of persons with annual family income < $20,000 reported that they did not engage in leisure-time physical activity--more than twice the year 2000 objective (> or = 17%). INTERPRETATION: BRFSS data demonstrate substantial state-to-state variation in progress toward year 2000 objectives and highlight areas (e.g., lack of leisure-time physical activity) in which substantial progress remains to be made in most states. Action taken: The BRFSS will continue to report data that relate to year 2000 health objectives. BRFSS data will enable states to monitor progress toward these objectives and develop health policies aimed at achieving them.

Adult↗

Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample.

BACKGROUND: The Veterans Health Administration (VHA) has introduced an integrated electronic medical record, performance measurement, and other system changes directed at improving care. Recent comparisons with other delivery systems have been limited to a small set of indicators. OBJECTIVE: To compare the quality of VHA care with that of care in a national sample by using a comprehensive quality-of-care measure. DESIGN: Cross-sectional comparison. SETTING: 12 VHA health care systems and 12 communities. PATIENTS: 596 VHA patients and 992 patients identified through random-digit dialing. All were men older than 35 years of age. MEASUREMENTS: Between 1997 and 2000, quality was measured by using a chart-based quality instrument consisting of 348 indicators targeting 26 conditions. Results were adjusted for clustering, age, number of visits, and medical conditions. RESULTS: Patients from the VHA scored significantly higher for adjusted overall quality (67% vs. 51%; difference, 16 percentage points [95% CI, 14 to 18 percentage points]), chronic disease care (72% vs. 59%; difference, 13 percentage points [CI, 10 to 17 percentage points]), and preventive care (64% vs. 44%; difference, 20 percentage points [CI, 12 to 28 percentage points]), but not for acute care. The VHA advantage was most prominent in processes targeted by VHA performance measurement (66% vs. 43%; difference, 23 percentage points [CI, 21 to 26 percentage points]) and least prominent in areas unrelated to VHA performance measurement (55% vs. 50%; difference, 5 percentage points [CI, 0 to 10 percentage points]). LIMITATIONS: Unmeasured residual differences in patient characteristics, a lower response rate in the national sample, and differences in documentation practices could have contributed to some of the observed differences. CONCLUSIONS: Patients from the VHA received higher-quality care according to a broad measure. Differences were greatest in areas where the VHA has established performance measures and actively monitors performance.

Cross-Sectional Studies↗

White matter hyperintensities are related to physical disability and poor motor function.

OBJECTIVE: To determine the impact of white matter hyperintensities (WMHs) on physical health and cognitive function in 60-64 year old individuals residing in the community. METHODS: A subsample of 478 persons aged 60-64 from a larger community sample underwent brain magnetic resonance imaging (MRI) scans. WMHs on T2 weighted FLAIR (fluid attenuated inversion recovery) MRI scans were assessed using an automated procedure. Subjects were assessed for global cognitive function, episodic memory, working memory (digit span), information processing speed (Symbol Digit Modalities Test; SDMT), fine motor dexterity (Purdue Pegboard), and grip strength, and completed the Physical Component Summary of the Short Form Health Survey (SF-12). Regression analyses were used to examine the effect of WMHs on physical and cognitive function. RESULTS: Deep and periventricular WMHs were present in all subjects, with women having slightly more lesions than men. WMHs were significantly associated with poorer reported physical health on the SF-12 scale, after adjusting for depression, cognitive function, and brain atrophy. WMHs were also related to lower scores on the Purdue Pegboard test, grip strength, choice reaction time, and SDMT, but not on tests of episodic memory, working memory, general intellectual function, and global cognitive function. On regression analyses, the Purdue Pegboard test and grip strength were related to physical disability. CONCLUSION: WMHs are common, albeit mild, in middle adult life. They are associated with physical disability, possibly through reduced speed, fine motor coordination, and muscular strength. They are also related to slowed information processing speed but not other cognitive functions.

Automation↗

Predictors of health-promoting behavior of African-American and white caregivers of impaired elders.

Several longitudinal studies have examined declines in health of caregivers, but few have explored the health-promoting behavior Because caregivers neglect their health, they are at risk for developing a number of physical and psychological problems. What is not well known are the factors that contribute to increased health-promoting behavior ultimately preventing poor health and premature death. Therefore, the purpose of this study was to explore the predictors and the change in predictors of health-promoting behavior in African-American and White caregivers over a 3-year period. Pender, Murdaugh, and Parsons' (2002) health promotion model guided the study. This present study is a secondary data analysis of a larger study aimed at examining predictors of health-promoting behavior among 66 African-American (n=66) and 110 (n=110) and White caregivers of impaired older adults recruited primarily through random digit dialing. The larger data set consisted of 391 (N=391) subjects (n=136 African-American; n=255 White). The larger prospective study was based on face-to-face interviews. In the original study, trained interviewers collected data on depression, psychological distress, self-perceived health, religiosity, number of chronic conditions, and demographic characteristics using well-established instruments. Data in this present study were collected at three time points over a three-year period with one-year intervals at Time1 (T1), Time2 (T2), and Time3 (T3). Analysis of the data in this present study suggested that, although, the number of health-promoting behaviors significantly differed for African-American and White caregivers at T1, T2, and T3, no predictors were significantly associated with a change in health-promoting behavior over time. Nonetheless, this finding suggests that nurses can develop useful information in helping to focus more attention on the health of caregivers in the future.

Adult↗

Processor quality assurance using digital imaging.

The purpose of this study was to develop and test a computer imaging method for assessing longitudinal processor variability. A technique called adaptive histogram equalization was used to test deviation in automatic processing when a test film is compared with a time-temperature processed standard at two different kVp's and film speeds. In a 14-day study we found that the density ranges for the standard film did not change, while the density range of the automatically processed films changed by a factor of two. These results suggest that if automatic processing is to be used for films taken as part of a longitudinal study-for example, subtraction-then processor variation can potentially lead to incorrect inference of bone gain or loss.

Absorptiometry, Photon↗

Psychological well-being, mid-life and the menopause.

Few studies of women's health in the menopausal years have formally assessed well being. The present study aimed to determine whether well-being during mid-life related to menopausal status, social circumstance, health status, interpersonal stress, attitudes and lifestyle behaviours. A random sample of 2000 Melbourne women aged 45-55 years were sought by random digital telephone dialling. A response rate of 70.6% was achieved. Interviews conducted on the telephone included a well-being scale--the Affectometer 2. The final data set, comprising 1503 individuals, was subjected to analyses of variance. Menopausal status did not significantly affect well-being. Well-being was found to be significantly related to current health status variables of general psychosomatic symptoms, general respiratory symptoms, history of premenstrual complaints, overall health assessment and interpersonal stress. Attitudes to ageing and to menopause were also significantly related to well-being scores. Lifestyle behaviors of smoking, exercise and marital status were also significantly related to well-being. Thus well-being of urban Australian-born, mid-aged women was related to current health status, psychosocial and lifestyle variables rather than to endocrine changes of the menopause.

Affect↗

Maps of the brain.

We review recent developments in brain mapping and computational anatomy that have greatly expanded our ability to analyze brain structure and function. The enormous diversity of brain maps and imaging methods has spurred the development of population-based digital brain atlases. These atlases store information on how the brain varies across age and gender, across time, in health and disease, and in large human populations. We describe how brain atlases, and the computational tools that align new datasets with them, facilitate comparison of brain data across experiments, laboratories, and from different imaging devices. The major methods are presented for the construction of probabilistic atlases, which store information on anatomic and functional variability in a population. Algorithms are reviewed that create composite brain maps and atlases based on multiple subjects. We show that group patterns of cortical organization, asymmetry, and disease-specific trends can be resolved that may not be apparent in individual brain maps. Finally, we describe the creation of four-dimensional (4D) maps that store information on the dynamics of brain change in development and disease. Digital atlases that correlate these maps show considerable promise in identifying general patterns of structural and functional variation in human populations, and how these features depend on demographic, genetic, cognitive, and clinical parameters.

Algorithms↗

Design of a survey to inform state health decision making: a collaborative effort.

BACKGROUND: The North Carolina Health Profile (NCHP), a statewide telephone survey, was introduced as part of the state's Health Policy Information Project aimed at enhancing the use of health data for state policy decision making and program management. A key factor in the creation of the NCHP was a collaboration between the State Center for Health Statistics and the Survey Research Unit at the University of North Carolina at Chapel Hill. The purpose of this article is to describe our partnership, the development of the survey design, and the dissemination of survey results. METHODS: Three designs were considered during the planning and development of the survey. The final design consisted of a random digit dialing sample of 2,400 households in the state's noninstitutionalized population. The questionnaire was comprised of an adult module (addressing adult health care use and insurance coverage), a child module (addressing health care use and insurance coverage of children ages 0-17 years), and a young child module (addressing child development and safety for children ages 0-5 years). RESULTS: Several statistical briefs, a report, a public dataset, and accompanying public use documentation were prepared for a variety of audiences, including state legislative committees and commissions, state agencies, and advocacy groups. DISCUSSION: We learned several lessons in our research and practice partnership including the need for collaboration between data creators and users, for addressing obstacles in soliciting policy information needs, and for prioritization in meeting information needs.

Cooperative Behavior↗

Digital rectal examination in the early detection of prostate cancer.

Screening using digital rectal examination improves the clinical stage distribution of prostate cancer and prolongs survival. Unfortunately, digital rectal examination may not be sensitive enough to detect the small-volume tumors that are most amenable to cure. In several studies, approximately 50 per cent of cancers detected through screening had already spread beyond the prostate. Regardless, the key to demonstrating overall benefit from screening is a diminished disease-specific mortality rate. To date, this has not been shown. Lower mortality rates from prostate cancer can be demonstrated only through a randomized study comparing screened and unscreened populations. Such a study, which has recently been approved and funded by the National Institutes of Health, will require 10 to 15 years to complete. Until that time, the value of screening for prostate cancer by digital rectal examination or any other method will be unknown. Beyond a lack of proved benefit, screening for prostate cancer may be harmful because of the variable natural history of the disease and the morbidity and mortality rates associated with treatment. There exists a large population of patients with pathologically detectable prostate cancer who will never have clinical disease. The detection of some of these tumors may expose those patients to the risks of unnecessary treatment. Large-scale prostate cancer screening studies may ultimately be shown to be advantageous. The sooner this occurs, the earlier aggressive screening can be advocated, similar to screening for breast cancer. However, the temptation to embark on such screening programs without first demonstrating clear benefit should be resisted.

Humans↗

Straight talk: new approaches in healthcare. The digital hospital comes of age.

When the Indiana Heart Hospital opens Feb. 17, 2003, it will operate a nearly paperless and filmless environment. The 88-bed hospital is a joint venture between Community Health Network, a four-hospital system in Indianapolis, and a group of cardiologists and cardiovascular surgeons. When Phoenix Children's Hospital opened its 300-bed facility May 24, 2002, it went live with its core information systems in place. The non-profit hospital plans to add, improve, and integrate systems over the next few years, eventually becoming a mostly digital environment as well. In the seventh installment of Straight Talk, we discuss the steps necessary to become a paperless facility. Modern Healthcare and PricewaterhouseCoopers present Straight Talk. The session on the Digital hospital was held on October 8, 2002 at Modern Healthcare's Chicago Headquarters. Charles S. Lauer, publisher of Modern Healthcare, was the moderator.

Arizona↗