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Demystifying radiology information systems.

Selecting the right radiology information system (RIS) can be a difficult and tedious task for radiology managers. Sometimes the information systems department ends up selecting the RIS. As a radiology manager, you can help yourself and your department greatly by becoming more educated concerning the technology and terminology of radiology information systems. You can then participate in one of the most important decisions that will ever be made regarding your department. There is much confusion about the meanings of the terms interfaced and integrated. Two applications are generally considered integrated if they freely access and update each other's databases. Two applications are generally considered interfaced if they pass data to each other but don't directly access nor update the other's databases. Two more terms are centralized and decentralized. Centralized is the concept of "putting all of your eggs in one basket." Decentralization means you spread your resources out. The main difference between centralized and decentralized is that all components of a centralized system share the same fate (good or bad), while decentralized components operate independently and aren't affected directly by failures in another system. Another significant term relevant to RIS systems is HL7, which is a standardized data format that allows one application to pass data to another application in a format that the receiving application understands. RIS vendors generally fall in three categories: single-source vendors, multiproduct vendors and single-product vendors. Single-product vendors include best-of-breed vendors. No one approach is necessarily better than the others; which you choose will depend on your needs. When considering the purchase of an RIS system, there are important questions to ask yourself, the vendor and the vendors' customers as you gather information and prepare to make a decision.

Centralized Hospital Services↗

Matrix management in hospital pharmacy departments.

The results of a nationwide survey to determine the managerial structures of selected hospital departments are reported. A questionnaire was mailed in August 1990 to a random sample of 1792 hospital pharmacy directors. The survey included questions on hospital bed capacity and ownership and on the managerial structures used for several departments and services, including pharmacy, satellite pharmacy, home health care, and hospice care. Recipients were asked to indicate a centralized management structure if decisions were made by a single individual; decentralized if the responsibility was distributed down the hierarchy; functional if departments were grouped according to specialties, skills, and knowledge; and matrix if the vertical hierarchy was overlaid by lateral mechanisms of authority. A total of 567 usable responses were received, for a response rate of 31.6%. Across departments, the most frequently reported type of management was centralized. Functional systems and systems that included a combination of features were cited least often. Of the pharmacy departments, 24.5% had decentralized management. Matrix management was used for 11.8%, 9.7%, 7.0%, and 4.7% of the pharmacy, home health-care, hospice-care, and satellite pharmacy departments, respectively, and was used more often in large hospitals than small hospitals. Pharmacy departments in nonprofit hospitals tended to use decentralized management more often than those in for-profit institutions. Centralized management was used most frequently by pharmacy departments, followed by decentralized and matrix management structures. Few pharmacy directors reported plans to implement matrix management.

Ownership↗

[Biometry of intraocular lenses using Pentacam Scheimpflug images].

PURPOSE: To compare differences in intraocular lens (IOL) decentration, tilt and anterior chamber depth (ACD) using Pentacam-Scheimpflug System images in eyes having phacoemulsification with implantation of 1 of 3 types of IOLs. METHODS: This study comprised 117 cataractous eyes of 109 patients having phacoemulsification and IOL implantation. The eyes were randomized into 3 groups based on IOL type. The degree of IOL decentration, tilt and ACD was measured using Oculus Pentacam System 1 day and 1, 3, 6 and 12 months after surgery. RESULTS: There was no significant change during the 12 months follow-up period in decentration or tilt in each group (P > 0.05). There was no significant difference among the groups in IOL decentration or tilt at any time point (P > 0.05). The ACD did not change after surgery in the Acrysof SA60AT group (P > 0.05) but showed significant shallowing in the Tecnis Z9001 group and the Sensar AR40e group (P < 0.05). There was significant difference among the groups in ACD only at 1 day after surgery (P < 0.05). CONCLUSIONS: The IOL stability in eyes that received a 1-piece Acrysof SA60AT IOL with flexible haptics was better than the results with normal capsular bag IOL implantation and an intact continuous curvilinear capsulorhexis that received a 3-piece IOL with rigid haptics.

Aged↗

Sympathetic and parasympathetic nerves regulate postsynaptic alpha-2 adrenoceptor in salivary glands.

The effects of sympathetic denervation or parasympathetic decentralization on the inhibitory effects of postsynaptic alpha-2 adrenoceptors were studied in the submaxillary and the sublingual gland of the rat. Chronic sympathetic denervation enhanced by a factor of 10 the potency of clonidine to inhibit the secretory responses of the submaxillary gland to either norepinephrine or methacholine. In denervated glands, clonidine (1 microgram/kg), reduced markedly the response to norepinephrine, but potentiated this response in control glands. Blockade of postsynaptic alpha-2 adrenoceptors with idazoxan (3 micrograms/kg) enhanced the secretory responses of denervated glands to norepinephrine. Parasympathetic decentralization also potentiated the inhibitory effects of the alpha-2 agonists. In the submaxillary gland the potency of guanabenz to decrease the secretory response to methacholine was increased by a factor of 30. Supersensitivity to the inhibitory effects of clonidine was also observed in parasympathetically decentralized sublingual glands. Parasympathetic decentralization increased the maximum binding site of [3H]clonidine binding by about 50% in both the submaxillary and sublingual glands. No changes in KD were detected. This surgical procedure also increased the maximum binding site of [3H]prazosin binding in submaxillary glands. The present findings show clearly that interruption of either branch of the autonomic nervous system induces supersensitivity of the inhibitory response mediated through postsynaptic alpha-2 adrenoceptors. The enhanced inhibitory activity could mask alpha-1 adrenoceptor supersensitivity after postganglionic sympathetic denervation.

Animals↗

A comparative study on the effects of morphine on central, peripheral and ganglionic stores of catecholamines.

The turnover and metabolism of catecholamines after i.p. administration of 10 (low dose) or 40 (high dose) mg/kg of morphine sulfate were measured in the brain, lumbar spinal cord, heart, celiac and superior cervical ganglia (SCG) of demedullated rats with unilaterally decentralized SCG. Demedullation significantly increased norepinephrine concentration and turnover in both sham operated and decentralized SCG, but demedullation failed to change the turnover of dopamine (DA) in both ganglia. Low doses of morphine only increased DA metabolism in the caudate nucleus. High doses of morphine failed to change the turnover of norepinephrine stored in heart and sympathetic ganglia but produced variable changes in norepinephrine turnover in the spinal cord and brain. High doses of morphine significantly increased DA turnover and metabolism in the celiac ganglion, SCG, caudate nucleus and the spinal cord of demedullated rats. These effects of morphine were antagonized by naloxone. DA metabolism in decentralized SCG of demedullated and SCG of intact rats remained unchanged after high doses of morphine. The action of morphine on DA metabolism was facilitated by demedullation, suggesting that the adrenal medulla secretes a modulator that can counteract the effects of opiate ligands on ganglionic small intensely fluorescent cells. Atropine and hexamethonium failed to antagonize the increase in the metabolism of ganglionic DA produced by morphine; and the increase in ganglionic DA metabolism caused by oxotremorine was not antagonized by naloxone, thus confirming a disassociation between the action on ganglionic DA mediated by cholinergic and opiate receptors. Since decentralization of the SCG abolishes the increase in DA metabolism induced by morphine, stimulation of extraganglionic opiate receptors reflects the metabolism of DA located in small intensely fluorescent cells.

Adrenal Medulla↗

[Utilization of health services by febrile patients in a malaria transmission area in Mexico].

OBJECTIVE: To analyze primary health care service (PHCS) utilization by febrile patients in a malarial area of Mexico. MATERIAL AND METHODS: A cross-sectional study was carried out in September, 1993, in 32 communities of Tabasco (decentralized health services) and Campeche (non-decentralized) states. Predictors of utilization were analyzed using descriptive statistics and logistic regression analysis. RESULTS: 817 febrile patients received care at home 55% of all febrile patients received care at home (SELF), 16.5% by PHCS and 17% by volunteer collaborators, with no significant differences in health services utilization between states. Febrile patients living in communities where PHCS was available used these facilities 11 times more than those without PHCS (C.I. 95%: 7.0-18.2%). Severely febrile patients used PHCS 2.8 times more than mild-moderate cases (C.I. 95%: 1.7-4.6%). Febrile patients under 13 years of age used PHCS 1.9 times more than older patients. Two per cent of febrile patients consisted of malaria cases. CONCLUSIONS: There was no difference between decentralized and non-decentralized health services regarding the utilization of PHCS. Fever symptoms must be evaluated as a single screening indicator of malarial disease.

Adolescent↗

Endogenous circadian rhythm of basal pupil size in rabbits.

PURPOSE: The authors examined the circadian change of basal pupil size in light-dark entrained normal rabbits and in entrained rabbits with unilaterally decentralized ocular sympathetic nerves. The pattern of the circadian pupillary rhythm was compared with the circadian patterns of intraocular pressure (IOP) and body temperature in the same rabbits. METHODS: Adult male New Zealand albino rabbits were entrained to a daily 12-hour light-12-hour dark cycle. Using an infrared camera recording system, basal pupil sizes in seven entrained rabbits were videotaped under a constant dark environment at 1-hour intervals for 24 hours. Hourly IOP and rectal temperature in the same rabbits were measured separately under both the regular light-dark cycle and constant dark. In 10 entrained rabbits that underwent unilateral transection of the cervical sympathetic trunk, measurements of pupil size and IOP in constant dark were performed. RESULTS: In normal rabbits, a smaller basal pupil size in the subjective light phase and a consistently larger pupil size in the subjective dark phase were observed. Notably, pupil size increased sharply at the beginning of the subjective dark phase and peaked shortly. Circadian rhythms of IOP and body temperature were present under the regular light-dark cycle and in constant dark. As did pupillary enlargement, IOP rose sharply at the beginning of the subjective dark phase and peaked shortly thereafter. Body temperature, however, increased gradually and peaked in the late subjective dark phase. In rabbits with unilaterally decentralized ocular sympathetic nerves, the circadian rhythm of pupil size was present only in the intact eye. In addition, the circadian IOP elevation in the decentralized eye was reduced significantly. CONCLUSIONS: In light-dark entrained rabbits, basal pupil size changes in a circadian pattern and peaks at the beginning of the dark phase. The circadian pupillary rhythm disappears after ocular sympathetic decentralization. There are similar characteristics in the circadian rhythm of IOP. The increase of basal pupil size in the early dark phase is not related to the nocturnal increase of body temperature.

Animals↗

Alignment effects in videokeratography of keratoconus.

PURPOSE: To determine the effects of corneal apex decentration on videokeratography in subjects with keratoconus. We controlled corneal apex decentration by first locating the cone apex position and then shifting the fixation position by known amounts relative to the videokeratograph axis. METHODS: We evaluated the effect of keratoconus apex position on videokeratography by measuring 28 eyes (17 subjects) at 4 corneal positions: the vertex normal, apex, and 1 mm or 2 mm above the apex. RESULTS: When compared to the apex alignment values, the radius of 1 mm (mean difference: 0.27 mm; SD +/- 0.20 mm) and 2 mm (mean difference: 0.82 mm; SD +/- 0.50 mm). The corneal toricity was greater at apex alignment than at the 1 mm (mean: -0.35 D; SD +/- 1.76 D) and 2 mm (mean: 0.62 D; SD +/- 3.23 D) decentrations. CONCLUSIONS: Decentration of the corneal apex in keratoconus produces significant errors in videokeratography when using the standard alignment rather than alignment with the apex. When there is a decentered cone apex, videokeratograph power errors are greater with the standard (sagittal) power map than with the instantaneous (tangential) power map. The standard power map produces values for the apex position that are about 50% too high and values for the apex power that are from 10 to 40% too low. Most cone shapes have significant toricity that is often not detected with standard videokeratograph alignment.

Adolescent↗

Old priorities and new agenda of public health in India: is there a mismatch?

AIM: Structural adjustment programs and health sector reforms in India create new agenda in health services. The aim of this study is the analysis of the mismatch between the new health services agenda and epidemiological priorities, and exploration of the possible alternatives, such as decentralization. METHOD: Analysis of the disease pattern, health, and demographic indicators versus the pattern of investments and policy changes was performed. The possible alternatives were explored by the study of decentralization process attempted in Kerala, by anthropological field work and examination of primary documents. RESULTS: The post-reform period has witnessed a rise in the cases of communicable diseases and an increase in the frequency of epidemics in different parts of the country. The infant mortality rate has risen or decline has slowed down in many states. The new agenda, which includes gradual withdrawal of the State in the provision of health services and the process of privatization, has already been initiated in the country as a part of health sector reforms. The process of decentralization in Kerala was examined to highlight the role of people's planning in health under growing conditions of mismatch between the epidemiological priorities and new agenda. CONCLUSIONS: The new agenda could pose a serious threat to effective implementation of public health programs including control of communicable diseases. Public health programs and allocation of resources need to be rooted in the epidemiological and social context. The process of decentralization attempted in Kerala could be used as a tool to achieve this aim.

Delivery of Health Care↗

Optimal size and location for corneal rotational autografts: a simplified mathematical model.

OBJECTIVE: To calculate clinical guidelines for the optimal location and size of a rotational autokeratoplasty. METHODS: The ideal graft size and trephine decentration for a rotational autograft were calculated based on scar location using geometric models. Mathematical variables were set to maximize postoperative visual acuity and for generalization of the geometric model. This model was used in a rotational autokeratoplasty of a patient with a history of a corneal scar and diplopia. An 8-mm autograft was decentered 0.5 mm superiorly and rotated 180 degrees to relocate the scar to the superior aspect of the cornea, out of the patient's vision. RESULTS: For cases that satisfy the given variables, a graft diameter of 8 mm with a decentration of 0.5 mm balances maximization of scar removal and scar movement superiorly, with minimization of discrepancy in corneal thickness after rotation. For scars that are alpha degrees from horizontal, the graft should be rotated 180 - alpha degrees . By using these calculations, the autograft in this case successfully resolved the diplopia and improved visual acuity. CONCLUSIONS: A rotational autograft can be an effective alternative to standard penetrating keratoplasty for some patients with corneal scars. We establish a mathematical model for most clinical instances of a rotational autograft, in which an 8-mm graft with a decentration of 0.5 mm best satisfies the goals of surgery.

Adult↗

Quantitation of tyrosine hydroxylase and neuropeptide Y immunoreactivity in single rat sympathetic neurons: effects of preganglionic nerve activity.

Using computerised densitometry to measure immunocytochemical reaction product in a model system, we established conditions that produced a linear relationship between the logarithm of antigen concentration and the measured intensity of staining. We then applied the densitometric technique to assess the changes in tyrosine hydroxylase (TH) and neuropeptide tyrosine (NPY) within sympathetic neurons of rat superior cervical ganglion following chronic decentralization and following reserpine treatment. One week after surgical or pharmacological decentralization, there was appreciable reduction of neuronal levels of both TH and NPY. However, there remained considerable variation in the immunoreactivities of individual cells. Three days of treatment with reserpine elevated TH levels but substantially reduced NPY. Both these effects were prevented by prior decentralization of the ganglia. No differences were seen between normotensive and the Otago strain of genetically hypertensive rats, either in basal TH or NPY immunoreactivities or in responses to the maneuvers performed. Comparison of our findings with previous biochemical data indicate that densitometric immunocytochemistry provides an accurate index of neuronally localised antigen concentrations but also allows analysis of interneuronal differences that are not otherwise apparent.

Animals↗

Beating intraocular hearts: light-controlled rate by autonomic innervation from host iris.

The sympathetic adrenergic ground plexus of the rat iris is able to innervate whole embryonic hearts transplanted to the anterior eye chamber. The transplants beat continuously from the time of transplantation and for at least five months, initially at 150-200 beats/min, and later approximately 250 beats/min. From seven days postoperatively onwards increased light to the eye produced deceleration while decreased light produced acceleration of the transplants. The rate changes coincided with changes in pupil diameter. Topical atropine reduced the light dependent rate variations of the transplants, especically the dramatic decrease in rate at white light. Waking stress caused a large rate increase. The "waking-effect" was strongly reduced by sympathetic decentralization and completely abolished by propranolol. The high rate seen in red light was decreased to the low rate of white light by decentralization. Isoprenaline restored red light rate levels in the decentralized transplant. The intraocular heart thus receives a dual functional autonomic input from the host iris and becomes a sensitive monitor of an autonomic nervous activity that can easily be varied at will in a physiological way by changing the light influx to the eye.

Adaptation, Physiological↗

Long-term facilitation and long-term adaptation at synapses of a crayfish phasic motoneuron.

Stimulation of the phasic (fast) motor axon of the isolated crayfish claw preparation at relatively low frequency (0.1 Hz) leads to depression of the excitatory junction potential (EJP) recorded from single muscle fibers. When the same stimulation is delivered following depression of the EJP at a higher frequency (5 Hz), a potentiated EJP appears, which is more resistant to low frequency depression. The potentiation appears to be analogous to "long-term facilitation" observed after stimulation of a tonic motor axon in crayfish and crabs. Long-term facilitation can be detected in preparations made from claws of animals in which the phasic motoneuron was stimulated at 5 Hz for 2 h in situ. This effect lasts for at least one day after one conditioning trial. Long-term facilitation is observed after stimulation of decentralized axons in situ, indicating that the change is attributable to local changes in terminal regions of the axon, and does not require the cell body. When electrodes are implanted in situ and the phasic motoneuron stimulated at 5 Hz for 2 h each day, synaptic depression becomes less pronounced and initial EJP amplitude becomes smaller over a period of several days. The latter changes, which adapt the neuron to a more tonic activity pattern, usually require several days for completion. Adaptation of fatigability occurs more rapidly than adaptation of initial EJP amplitude, and once established, remains for many days without further superimposed activity. Long-term adaptation does not occur in decentralized axons. Long-term facilitation and long-term adaptation are different responses of the neuron to enhanced activity. The former can occur in isolated or decentralized axons and leads to enhancement of EJP amplitude for a period of several hours to at least one day after a single episode of conditioning. The latter requires more time to be established, and leads to reduction of initial EJP amplitude and to lessened fatigability which persists for many days.

Adaptation, Physiological↗

Sympathetic response to intracranial NGF infusion in the absence of afferent input: axonal sprouting without neurotransmitter production.

The anatomical relationships between postganglionic sympathetic neurons, their targets, and their afferent inputs provide an opportunity to experimentally distinguish between the anterograde and the retrograde influences on neuronal responsivity to growth factors. In the present study, the effect of decentralization of the superior cervical ganglion (SCG) on the NGF-induced sympathetic sprouting response by mature cerebrovascular axons was assessed in young adult rats. Growth by the perivascular axons associated with the intradural segment of the internal carotid artery was quantified using electron microscopy and changes in norepinephrine (NE) levels were monitored using high-performance liquid chromatography coupled with electrochemical detection. The mean number of perivascular axons observed in the treatment group receiving decentralization of the SCG prior to NGF infusion was not significantly different from that in NGF-infused cases, suggesting that central input was not required for axonal growth of intact sympathetic neurons. However, decentralization prevented the typical NGF-induced increase in perivascular NE associated with the ICA, indicating that afferent input was necessary for the neurotransmitter increase to occur. Thus, afferent input appears to play a role in the regulation of neurotransmitter expression of the sprouted axons but is not required for trophic factor-induced axonal growth.

Afferent Pathways↗

Origin and distribution of neuropeptide Y-, vasoactive intestinal polypeptide-and substance P-containing nerve fibers in the urinary bladder of the rat.

The origin and distribution in the urinary bladder of nerve fibers containing neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP) and substance P (SP) were investigated in rats. Experimental procedures comprised preganglionic decentralization or postganglionic denervation of the bladder and also chemical sympathectomy as well as capsaicin treatment of newborn rats. Nerve fibers containing NPY were richly distributed in the detrusor muscle and also in the pelvic ganglia. Numerous NPY-containing nerve cell bodies were found in pelvic ganglia. A rich occurrence of VIP fibers and a more sparse distribution of SP-containing fibers were also found in the bladder as well as a relatively rich representation of VIP-containing nerve cell bodies in the pelvic ganglia. After decentralization the intensity of VIP and NPY immunofluorescence increased in nerve cell bodies of the pelvic ganglia and in nerve fibers in the wall of the bladder. Postganglionic denervation, on the other hand, eliminated all peptides examined in the bladder wall. After postganglionic denervation the situation in the ganglia was approximately the same as after decentralization. Chemical sympathectomy (6-OHDA) did not seem to change significantly the frequency and distribution of VIP-, SP- and NPY-fibers in the muscle layer of the bladder or in the pelvic ganglia, while the NPY-containing nerve fibers in the submucosal layer and around blood vessels of the bladder disappeared. Adrenergic nerve fibers in the wall of the bladder (visualized by histofluorescence) were markedly reduced in number after administration of 6-OHDA.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Treatment of neurogenic bladder dysfunction in multiple sclerosis by ultrasound-controlled bladder training.

Neurogenic bladder dysfunction, the main cause of chronic urinary tract infections in multiple sclerosis (MS), is efficiently treated by bladder training with ultrasound control of the residual urine. However, the beneficial effects of bladder training in the hospital are often lost within a short time when the patient returns to his home. Reexamination at home of 97 MS patients with increased residual urine and/or chronic urinary tract infections showed that the group which claimed to continue bladder training at home had significantly less residual urine at home than the group which did not continue bladder training at home. The residual urine decreased from 210 ml on average to almost normal while the patients did bladder training in the hospital, but the volume nearly doubled within a short time at home. Thus, more decentralized rehabilitation by family members, volunteer personnel or local nurses is necessary. Decentralized symptomatic therapy is the most efficient treatment of MS at present. Family members. volunteers, and local nurses, however, need training. Without these improvements in decentralized rehabilitation the hospital treatment of MS is of little benefit because urinary tract infection quickly recurs at home. For efficient bladder training the patient needs feedback regarding the residual urine; this can be provided with minimum risk by ultrasound sonocystography. In those rare cases in which bladder training does not work, intermittent catheterization must be carried out by the patients or their families, volunteer personnel or a local nurse. A continuous indwelling catheter should not be used. antibiotic treatment should be applied only on the basis of a precise bacteriological diagnosis.

Adult↗

The closure of a major psychiatric hospital. Reactions of the psychogeriatric nursing staff.

A political decision to decentralize psychiatric care in a province in Sweden was arrived at in October 1984, leading to the closing down of the only psychiatric hospital in the area (290,000 inh.). The hospital is of the traditional type with 490 beds and 1,294 staff. It has units for long-term care, short-term care and rehabilitation, as well as a unit for research and education. The psychogeriatric patients are to be transferred to their home districts. All of the psychogeriatric staff have been guaranteed new jobs under the auspices of the County Council's medical services. This study is concerned with the nursing staff's reactions to the decentralization and the kind of problems they were faced with. A questionnaire was sent to all nursing staff, and for the psychogeriatric unit (199 patients) the personnel turnover was also registered. The results show that the greatest problems for the nursing staff were the splitting up of their working teams and having to establish relations with new colleagues. They were also worried about longer and more expensive journeys to new places of work. Most of the nursing staff considered the information given about the consequences of the political decision very poor. More than half of the nursing staff (54%) thought the patients would be provided with better care by decentralized psychiatric health services. Many stated that the decision had affected them so that their interest in further education (37%) and in working in a new type of psychiatric care (43%) had increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Perceptual development in relation to nutritional status.

The present study was conducted on 180 children in the age group 5-10 years. These children were divided accordingly their ages into 3 sub-groups i.e. 5-6, 7-8 and 9-10 years respectively. In each group 60 children were studied. For the assessment of perceptual skills each child was tested with the help of Picture Ambiguity Test. Responses to the ambiguous cards were scored with respect to time taken to react in each card and ability of the child to perceive figure and ground relationship i.e. centration and decentration. The observations showed that with increase in age, centration effect reduces and majority of the children start decentring their perception by middle childhood. Further, children in higher age group took lesser time to respond on different ambiguous cards. When the responses of well-nourished and undernourished children were compared for perceptual flexibility in terms of part-whole perception i.e. centration and decentration; no difference was observed between the two groups. There was a significant difference in the performance of well-nourished and undernourished children when time to respond on ambiguous card was compared. Well-nourished children took lesser time to respond on different ambiguous cards. These observations in general suggest that poor nutrition may result in impaired perceptual abilities in children.

Analysis of Variance↗