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PubMed1983

The use of Selectron afterloading equipment to simulate and extend the Manchester System for intracavitary therapy of the cervix uteri.

When Selectron afterloading machines were introduced in the Christie Hospital the first aim was to reproduce, as closely as possible, the isodose distributions achieved with the traditional Manchester Radium System. This resulted in the establishment of standard pellet loading patterns, and standard treatment times, for programming the Selectron channels. However, the availability of whole-body CT scanning facilities provides a method of accurately locating the source positions with respect to the local anatomy and hence the possibility of dosage control based on doses to specific pelvic structures. Various computer programs have been written to extract source position data from the CT images, to allow the operator to propose pellet loading patterns and treatment times, and ultimately to display the resultant isodose distribution superposed on the cross-sectional scans. The effects on the dose distribution arising from changing the number of pellets, the pellet positions within the applicators, and the treatment times, are briefly discussed.

Brachytherapy↗
PubMed1999

A diversity of blood smear examination system of Thai public hospital.

A good laboratory practice is the heart of clinical laboratory quality. One must establish a standard system in order to achieve the quality. However, standard system is not only the technical but also a state of the art. The socioeconomic and culture are the influence factors. At present, technique of reporting the blood smear examination is still a nation controversy. We surveyed the blood smear examination reporting system of the public hospital in Thailand. There were 77 hospitals participated in this study. A questionnaire comprised of 23 questions was distributed to 105 clinical laboratory staffs of the public health hospitals. Results showed that there was a diversity of blood smear examination reporting system. Generally, there were 2 ways of blood smear review. Every smeared slide and only abnormal slides were re-examined by the conventional technique. When an abnormal white blood cell blood picture was observed. The presence of either blast cell or atypical lymphocyte has clinical significance. A majority of laboratory would report in form "counting number of abnormal cell within 100% of the differential count". For other abnormalities of white blood cell; i.e. the neutrophils with toxic granules, most of laboratory reported as "presence". Interestingly, the red blood cell reporting system varied from laboratory to laboratory. There was a total of nine reporting patterns. Results indicated that pattern 4 (few or some, 1+,2+,3+,4+ are 5-10%, 11-25%, 26-50%, 51-75% and 51-100% cell/oil field, respectively) was the most popular one in reporting anisocytosis and poikilocytosis. However, the reporting pattern on red blood cell staining was difference. Pattern 4 and pattern 7 (grading by the size of central pallor) obtained a same popularity on the consideration of hypochromia. But the pattern 9 (few or some, 1+,2+,3+ are 0-1, 1-3, 4-6 and >6 cell/oil field, respectively) was the most frequently used in reporting of polychromasia. Fortunately we found that the reporting system for platelet was not complicated. A majority of laboratory chose the qualitative pattern (reporting as adequate, increased and decreased). Our study indicated that Thai clinical laboratory encounter a diversity of blood smear reporting system. Every clinical laboratory should pay a great attention to this circumstance. Since a good laboratory practice is a knot of the knot-bolt system of healthcare service, therefore, a nation standard system must be established in the near future.

Hematologic Tests↗
PubMed1994

Health care expenditures for the elderly and reforms in the health care system in Japan.

In recent times, significant reforms have been instituted in Japan's health care system, such as the introduction of hospital categorization and the clarification of hospital roles, together with the establishment of geriatric health care facilities, and the reform of the pharmaceutical distribution and pricing system. These reforms are expected to improve the efficiency and quality of the health care system in Japan and to provide better care for the aging society. The changes will also eventually affect health care costs and patterns of services. This paper describes Japan's health care system, including the recent reforms, and then examines the costs and patterns of health care services for the elderly in the light of the recent changes in the system. While more resource allocation is necessary for training of workers for nursing, rehabilitation and care-giving, drugs should be more cost-effective and fit for use at home and in non-medically oriented institutions. Health care providers, health care industries and the government need further to properly respond to the changes in demography, patterns of diseases and disabilities and patients' wishes for better quality of life.

Aged↗
PubMed1995

An overview of the CERC ARTEMIS project.

The basic premise of this effort is that health care can be made more effective and affordable by applying modern computer technology to improve collaboration among diverse and distributed health care providers. Information sharing, communication, and coordination are basic elements of any collaborative endeavor. In the health care domain, collaboration is characterized by cooperative activities by health care providers to deliver total and real-time care for their patients. Communication between providers and managed access to distributed patient records should enable health care providers to make informed decisions about their patients in a timely manner. With an effective medical information infrastructure in place, a patient will be able to visit any health care provider with access to the network, and the provider will be able to use relevant information from even the last episode of care in the patient record. Such a patient-centered perspective is in keeping with the real mission of health care providers. Today, an easy-to-use, integrated health care network is not in place in any community, even though current technology makes such a network possible. Large health care systems have deployed partial and disparate systems that address different elements of collaboration. But these islands of automation have not been integrated to facilitate cooperation among health care providers in large communities or nationally. CERC and its team members at Valley Health Systems, Inc., St. Marys Hospital and Cabell Huntington Hospital form a consortium committed to improving collaboration among the diverse and distributed providers in the health care arena. As the first contract recipient of the multi-agency High Performance Computing and Communications (HPCC) Initiative, this team of computer system developers, practicing rural physicians, community care groups, health care researchers, and tertiary care providers are using research prototypes and commercial off-the-shelf technologies to develop an open collaboration environment for the health care domain. This environment is called ARTEMIS--Advanced Research TEstbed for Medical InformaticS.

Computer Communication Networks↗
PubMed1986

Antepartum fetal heart rate recording and subsequent fast transmission by a distributed microprocessor-based dedicated system.

Fetal heart rate monitoring in high-risk pregnancies can require admission to hospital over prolonged periods, or the even less satisfactory alternative of routine weekly or sporadic outpatient monitoring. We have developed a digital system for distant fetal heart rate recording with the facility of later rapid transmission by telephone into the hospital. A completed half-hour recording is transmitted to the central computer and permanently stored in less than 30 s, then immediately displayed for verbal reporting. One hundred and seventeen recordings have been made in 27 patients' homes and of these 111 (95%) were easy to interpret. This expandable system meets the major functional requirements for practical and economical antenatal fetal heart rate monitoring at a distance.

Computers↗
PubMed2000

[Development of DICOM image viewing software for efficient image reading and evaluation of distributed server system for diagnostic environment].

To construct an efficient diagnostic environment using computer displays, the author investigated the time of network transmission using clinical images. In our hospital, we introduced optical-fiber 100Base-Fx Ethernet connections between 22 HIS-segments and one RIS-segment. Although Ethernet architecture is inexpensive, the speed of image transmission becomes 2371 KB/sec. (4.6 CT-slice/sec.) in the RIS-segment and 996 KB/sec. (1.9 CT-slice/sec.) from the RIS-segment to HIS-segments. Because one examination is transmitted in one minute, it does not disturb image reading. Otherwise, a distributed server system using inexpensive personal computers helps in constructing an efficient system. This investigation showed that commercially based Digital Imaging and Communications in Medicine(DICOM) servers and RSNA Central Test Node servers are not so different in transmission speed. The author programmed and developed DICOM transmission and viewing software for Macintosh computers. This viewer includes two inventions, dynamic tiling window system (DTWS) and window binding mode(WBM). On DTWS, windows, tiles, and images are independent objects, which are movable and resizable. The tile-matrix is changeable by mouse dragging, which realizes suitable tile rectangles for wide-low or narrow-high images. The arranging window tool prevents windows from scattering. Using WBM, any operation affects each window similarly. This means that the relationship of compared images is always equivalent. DTWS and WBM contribute greatly to a filmless diagnostic environment.

Computer Communication Networks↗
PubMed2001

Intranet meets hospital information systems: the solution to the integration problem?

Based on the results of an extensive market analysis and technology assessment, this paper summarizes the state of the art in web technology and compares it with the needs of integration in hospital information systems. Web technology and intranet have evolved to a core technology for distributed computing and distributed information systems. The advantage of platform independent distribution of information has led to euphoric visions of future integrated systems. However, true integration takes more than transparent access to heterogeneous information sources. To overcome the essential problems related to integration of autonomous systems it is important to find a common ontological basis for future component based systems.

Computer Communication Networks↗
PubMed2005

Tele-surgical simulation system for training in the use of da Vinci surgery.

Laparoscopic surgery including robotic surgery allows the surgeon to be able to conduct minimally invasive surgery. A surgeon is required to master difficult skills for this surgery to compensate for the narrow field of view, limitation of work space, and the lack of depth sensation. To counteract these drawbacks, we have been developing a training simulation system that can allow surgeons to practice and master surgical procedures. In addition, our system aims to distribute a simulation program, to provide a means of collaboration between remote hospitals, and to be able to provide a means for guidance from an expert surgeon. In this paper, we would like to show the surgery simulation for da Vinci surgery, in particular a cholecystectomy. The integral parts of this system are a soft tissue model which is created by the sphere-filled method enabling real-time deformations based on a patient's data, force feedback devices known as a PHANToM and the Internet connection. By using this system a surgeon can perform surgical maneuvers such as pushing, grasping, and detachment in real-time manipulation. Moreover, using the broadband communication, we can perform the tele-surgical simulation for training.

Computer Simulation↗
PubMedDate not supplied

[Nurses attitude toward the manual recording system of medical records].

The main goal of this work was to identify factors related to nurses' understanding about the manual recording system, through a descriptive-exploratory approach, developed with two hundred nursing professionals working at different hospital institutions located in the city of João Pessoa/Paraíba, Brazil. Data were collected with special forms using the Likert's behavioral scale. Results identified five factors such as: a) lack of knowledge about information systems; b) dissatisfaction with the manual recording system; c) needs of an informatized recording system to be used in nursing care; d) desire to utilize a classification system with all steps of the nursing process; and e) difficulties with nursing diagnosis related to manual recording. Findings demonstrated the dissatisfaction of nursing professionals about the manual recording system, requiring deep changes in the established recording model.

Adult↗
PubMedDate not supplied

Digital image management and communication in medicine.

With the rapid development of digital imaging modalities in medicine, there is an increasing need for an efficient management and archival of medical images in digital form. Picture Archiving and Communication Systems (PACS) are becoming an essential component of medical imaging equipment, allowing for medical images to be accessed and stored directly in digital form. This paper describes a hospital-wide PACS currently under development at the University Hospital of Geneva, based on an open architecture, regrouping equipment from different vendors in a distributed topology. The image archival is organized in multiple locations geographically distributed in the hospital. The PACS database is fully integrated with the concurrent Radiology Information System (RIS) and Hospital Information System (HIS). A standard image storage format called the PAPYRUS format was developed for the storage of medical images from a variety of imaging modalities. To provide a more uniform user interface on a variety of different workstations, a common platform for image display and manipulation called OSIRIS was developed.

Computer Communication Networks↗
PubMed1987

Bacterial survey of well water--Tehran, Iran.

One hundred twenty-one wells throughout the city of Tehran were monitored during the four seasons of the year for the presence of bacterial indicators of fecal pollution. None of the sites monitored was connected to Tehran's main water distribution system but represented drinking water sources for small communities, individual factories, hospitals, etc. Only 17 samples showed no indication of fecal bacterial contamination throughout the study. The remaining sites were positive for at least one of the following at some season of the year: Escherichia coli, Shigella sp., Citrobacter sp., Klebsiella-Enterobacter group, Clostridium perfringens, or Streptococcus faecalis.

Enterobacteriaceae↗
PubMed1996

Technology and automation in pharmaceutical care.

Pharmacy computer systems in the future will help pharmacists assess patients' medication needs, evaluate drug therapy, and manage patient information. Technology companies are developing systems for automatic dispensing and for distributing medications from nurses' stations in hospitals and long-term care facilities. Bar codes are being used in medication dispensing, verifying prescriptions, selecting patient brochures, and screening for drug interactions. Pharmacies in the future will rely on information networks to store, manage, and communicate patient information. Drug use review databases offer highly developed drug therapy screening.

Humans↗
PubMed1985

The rapid transit system for patients with fractures of proximal femur.

The rapid transit system for patients with fractures of the proximal femur consists of immediate internal fixation or replacement of the fractured bone under spinal anaesthesia, without any sedation. Patients are mobilised within hours of surgery and sent home as soon as they can walk. They are supervised at home by both an experienced physiotherapist and a visiting nurse. Sixty nine patients admitted to a metropolitan teaching hospital were considered for the system and 50 were accepted. Their age distribution and level of general ill health were comparable with those in other series. The rapid transit system resulted in 90% of patients accepted being discharged to their homes within the first five days, with a lower morbidity and a mortality at three months of 7%. Using the rapid transit system rehabilitation in the original environment is difficult only if the patient lives alone, and even then temporary support is often enough to allow them to return home.

Adult↗
PubMed2003

Intravenous immune globulin use in Canada.

OBJECTIVES: To determine the amount of intravenous immune globulin (IVIG) used across indications in Canada and which Canadian medical specialties prescribe IVIG. To assess the proportion of IVIG that was used in appropriate off-label and labelled indications versus those deemed to be inappropriate off-label indications. METHODS: In Canada, all IVIG is distributed by the Canadian Blood System to Canadian blood banks within the hospital setting. Hospital blood banks then dispense IVIG to individual patients as it is prescribed and, as such, many institutions maintain a comprehensive database inventory on IVIG use. This study is a retrospective review of IVIG use as obtained from 10 teaching and community hospital blood bank databases in Ontario, Quebec, Alberta and British Columbia. Two of these 10 institutions were pediatric teaching hospitals whereas the remaining eight centres were adult care sites. Product usage was assessed between 1997 and 1999 in adult care sites, and 1997 and 1998 in the pediatric hospitals. The information collected included the number of grams of IVIG dispensed, the indications, the prescribing physician's specialty and the number of patients treated for a given indication, all assessed on an annual basis. A separate analysis was performed to determine the appropriateness of IVIG use where appropriateness was based on the published 1997 and 1999 Canadian Consensus Guidelines for IVIG use. RESULTS: IVIG was prescribed for 90 different indications, six of which are licensed in Canada. When considered as separate populations, adult and pediatric use accounted for 61 and 65 different indications, respectively. Licensed use for all known indications represented approximately 47% and 62% in adult and pediatric settings, respectively. Twenty-nine per cent of IVIG use in adult and 17% in pediatric settings was not reported and is therefore unknown. Although off-label use by definition is approximately 53% in adults and 38% in pediatrics, the majority of overall IVIG use (89% in both populations) is considered appropriate by guideline definition. Hematologists and neurologists were the most prevalent prescribers of IVIG. CONCLUSIONS: Based on guideline definition, appropriate off-label use of IVIG is very high in Canada.

Adolescent↗