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PubMed1992

Visualization of 3-D treatment plans with fast neutrons.

The treatment planning for radiotherapy with fast neutrons requires modifications of the planning systems used for photons. The neutron- and photon-component of the treatment fields must be determined and can then be used for separate calculations. The corrections for inhomogeneities are performed by use of attenuation coefficients and the corresponding corrections for changes in the kerma. The treatment planning system MEVAPLAN (Siemens) was modified to follow these requirements. Thus treatment planning for 14 MeV DT-neutrons could be performed. The multiplanar option is used to calculate 3D-dose distributions based on up to 40 serial CT slices. The generated three-dimensional dose matrix and the CT data are transferred via magnetic tape to the visualization system VOXEL-MAN developed at the University Hospital of Hamburg. This system uses a ray casting algorithm based on the generalized Voxel-model to display detailed 3D-images of human anatomy together with the calculated dose distribution. Different treatment plans for neutrons and photons are calculated and visualized. Various manipulations of the data-sets are displayed to improve the critical examination of the simulated dose distribution and to discern the quality of treatment techniques.

Fast Neutrons↗
PubMed1981

[Methodical and critical analysis of the determination of target volumes in case of hypopharyngeal and epiglottic tumors and the adaptation of the dose distribution to their dimensions.--Part 1 (author's transl)].

After having discussed the problem of optimization with regard to the dose distribution in space, the authors enter into the particulars of the classification of hypopharyngeal and epiglottic tumors according to the TNM system. Taking into consideration the communications of literature and the cases of the Radiologic Hospital of the University of Heidelberg, the authors describe the clinical manifestations of these tumors, their histology, their distribution to age and sex, their symptomatology and time of anamnesis as well as the therapeutic results.

Adult↗
PubMed1980

Holder of record: A cooperative health sciences journal system in a hospital library network.

The cooperative acquisition and retention of health sciences journals by a group of small and medium-sized Veterans Administration hospital libraries is described. The "holder of record" system emphasizes a contractual agreement that has freed resources for expansion of the group's journal holdings and distributed responsibility for interlibrary loan among the libraries involved.

Interlibrary Loans↗
PubMed1995

An integrated approach for mobile information processing in hospitals.

Computer-based mobile information processing in hospitals is at a turning point of becoming a substantial and integral part of hospital information systems. Its necessity and potential require a comprehensive systematic approach to support the needs of health care professionals and thus to contribute to high quality patient care and medical research. From the authors' point of view, standardized digital documents could become an appropriate basis for distributed mobile information processing in hospitals. An architecture for the integrated co-operative use of conventional, stationary, and mobile information tools is a major research topic at Heidelberg University. The objective of this paper is to present a departmental prototype design to establish mobile information processing as an integral part of hospital information systems through the use of standardized digital documents.

Computer Communication Networks↗
PubMed1996

Correlates of cochlear implantation, 1986-1992.

There is a paucity of information regarding the use of cochlear implants within large populations. This article describes correlates of cochlear implantation procedures using a statewide hospital discharge database. Among the 146 implant procedures, 55% involved female patients, whereas the largest groups of patients were represented by younger and older persons (27% between ages 2 and 9 years and 24% 60 years and older). A bimodal distribution was apparent for average annual age-specific rates of cochlear implantation, with the highest rates among persons aged 2 to 9 years (5.4 implants per 1 million) and persons aged 60 to 69 years (3.7 implants per 1 million). Total hospital charges, excluding professional fees, exceeded $12,000 per implant and were found to vary significantly when examined by length of stay and by calendar year of procedure. The data presented are unique with regard to the total number of cochlear implant procedures included and the large, diverse population used. This study expands knowledge concerning the epidemiology and utilization of cochlear implantation.

Adolescent↗
PubMed2006

A revision of a job evaluation system.

AIMS: This paper reports a revision of the United Kingdom's National Health Service Job Evaluation System and tests the revised system in eight clinical nursing management jobs in four Turkish hospitals. BACKGROUND: A job evaluation system was developed in the United Kingdom in 2003-2004. Most studies have focused on how the whole system will be implemented in a health organization. No study investigating proficiency of the system in terms of factors and their level definitions was found. METHODS: The factors Knowledge, Training and experience and Working conditions were divided into five factors: Knowledge, Experience, Education, Environmental conditions and Hazards. To test the revised system, all the nursing management jobs in four hospitals were evaluated using a factor-based questionnaire including nurses' demographic information and 19 variables. The questionnaire was distributed to 57 supervisor nurses in 31 clinics at four hospitals in one Turkish city in 2005. All the questionnaires were analysed to evaluate the jobs. RESULTS: The job scores change depending on clinical conditions. Although the score range in the National Health Service Job Evaluation system has been determined as 405-465 points (band VI) for Nurse team leader and 469-536 points (band VII) for Nurse team manager jobs, the job scores in the present study were 363 (band V) - 557 points (band VIIIa) and 379 (band V) - 586 points (band VIIIa) respectively. CONCLUSION: Although this exploratory study was limited to four hospitals in one city in Turkey, the results indicated that two new jobs would be identified in the National Health Service system to match the jobs in the intensive care and emergency units.

Employee Performance Appraisal↗
PubMed1983

Computer applications in hospital pharmacy practice. I. Computer expectations/applications.

Following vendor selection of a pharmacy computer system, attention must be directed toward which computerized functions to include. Although most features are uniform among the various systems, a discussion is presented listing those applications considered the minimum acceptable for any hospital pharmacy computer system. The descriptions focus on computerization of those labor-intensive activities necessary to support drug distribution services. Computerized support of an intravenous (I.V.) admixture and unit dose program centers around label production and charging/crediting functions. Label production is used to generate a manual backup profile and unit dose cart fill list. The scope of information to include on I.V. and unit dose labels is described. Charging/crediting functions via computer are also discussed, with mention of free-form capabilities. Other computer applications mentioned include: medication profiling, drug interaction flagging, data confidentiality, census support, and hard copy reports. Feature selection depends on the aspects and unique needs that benefit most from computerization.

Accounting↗
PubMed2004

Access control mechanisms for distributed healthcare environments.

Today's IT-infrastructure provides more and more possibilities to share electronic patient data across several healthcare organizations and hospital departments. A strong requirement is sufficient data protection and security measures complying with the medical confidentiality and the data protection laws of each state or country like the European directive on data protection or the U.S. HIPAA privacy rule. In essence, the access control mechanisms and authorization structures of information systems must be able to realize the Need-To-Access principle. This principle can be understood as a set of context-sensitive access rules, regarding the patient's path across the organizations. The access control mechanisms of today's health information systems do not sufficiently satisfy this requirement, because information about participation of persons or organizations is not available within each system in a distributed environment. This problem could be solved by appropriate security services. The CORBA healthcare domain standard contains such a service for obtaining authorization decisions and administrating access decision policies (RAD). At the university hospital of Mainz we have developed an access control system (MACS), which includes the main functionality of the RAD specification and the access control logic that is needed for such a service. The basic design principles of our approach are role-based authorization, user rights with static and dynamic authorization data, context rules and the separation of three cooperating servers that provide up-to-date knowledge about users, roles and responsibilities. This paper introduces the design principles and the system design and critically evaluates the concepts based on practical experience.

Computer Security↗
PubMed1996

Implementing comprehensive pharmaceutical services at an academic tertiary care hospital.

The implementation and impact of comprehensive pharmaceutical services at a hospital are described. Before 1992, pharmaceutical services at Detroit Receiving Hospital and University Health Center were comparable to those of many departments serving similar academic tertiary care institutions. A major conflict with the principles of pharmaceutical care existed in that specific tasks were assigned to pharmacists, so that up to four pharmacists may have been involved in one patient's drug therapy while other patients were ignored. Several steps were taken to solve this problem. The department's mission and vision statements were modified to embrace pharmaceutical care. The support of administration and department leaders was secured, pharmacist evaluations were adjusted to make pharmaceutical care skills baseline competencies, and staffing was reconfigured. A voluntary pharmaceutical care committee was formed to transform pharmaceutical services at the hospital. It was decided that all staff pharmacists would provide clinical and distributive services on a rotating basis. The drug distribution system was altered to free more pharmacist time for patient care, and two technician positions were added. The clinical program was made more patient focused. The program was implemented in a stepwise manner beginning in September 1992. Computerized systems for tracking workload and documenting clinical interventions and drug cost savings were established. Later changes included making pharmacists responsible for all patients on a medical service rather than for specific problems in a particular location and changing scheduling to enhance the continuity of care. The number of clinical interventions by pharmacists increased from 3,563 in 1993 to 15,476 (projected) in 1995, and drug cost savings and avoidance increased from $239,248 in 1992 to $562,402 (projected) in 1995. Major change was necessary to implement comprehensive pharmaceutical services at an academic tertiary care hospital.

Cost Savings↗
PubMed2006

Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center.

STUDY DESIGN: We performed a retrospective review of 48 cases of pyogenic spinal infection presenting over a 12-year period to the National Spinal Injuries Unit (NSIU) of the Republic of Ireland. The NSIU is the tertiary referral center for all adult spinal injuries and diseases of the spine warranting surgical intervention in the Republic of Ireland. OBJECTIVES: The objective of this study was to analyze the presentation, etiology, management, and outcome of nontuberculous pyogenic spinal infection in adults. SUMMARY OF BACKGROUND DATA: Pyogenic spinal infection encompasses a broad range of clinical entities, including spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. Management of pyogenic spinal infection can involve conservative methods and surgical intervention. METHODS: The medical records, radiologic imaging, and bacteriology results of 48 patients with pyogenic vertebral osteomyelitis from 1992 through 2004 were reviewed. The Hospital Inpatient Enquiry (HIPE) System and the NSIU Database were used to identify our study cohort. RESULTS: The average age of presentation was 59 years with an even distribution between males and females. Most patients (21 of 48) were symptomatic for between 2 and 6 weeks before presenting to hospital. The most frequently isolated pathogen was Staphylococcus aureus, in 23 of 48 cases (48%); 35 of 48 cases (73%) were managed by conservative measures alone, including antibiotic therapy and spinal bracing. However, in 13 of 48 cases (27%), surgical intervention was required because of neurologic compromise or mechanical instability. CONCLUSIONS: In the majority of cases, conservative management of pyogenic spinal infection with antibiotic therapy and spinal bracing is very successful. However, in a minority of cases, surgical intervention is warranted and referral to a specialist center is appropriate.

Adult↗
PubMed1998

Managing health services: how administrative data and population-based analyses can focus the agenda.

University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for providing answers to such questions as: which populations need more physician services? Which need fewer? Are high-risk populations poorly served or do they have poor health outcomes despite being well served? Does high utilization represent overuse or utilization related to high need? More specifically, this system provides decision-makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics, and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and counties, utilization review within a single hospital, and longitudinal research on health reform. A particularly interesting application to planning physician supply and distribution is discussed. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.

Canada↗
PubMed1988

What should hospitals be doing in health promotion services?

The role of health services in Australia is slowly changing from illness treatment to illness prevention. The Health Targets and Implementation Committee has indicated that there needs to be a distribution of resources and services within the health care system to better enable us to actively promote the health of the community. This paper discusses the level of health promotion services that each hospital or Area Health Service should offer the community. A model for the delineation of health promotion services is presented. This model offers a useful tool for senior administrators who are responsible for the planning and delivery of the new "health promotion services".

Health Promotion↗