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PubMed1997

[The disturbance of reversible operation in space in the early stage of Alzheimer's disease].

Constructional apraxia is one of the neuropsychological findings frequently observed in the early stage of the Alzheimer's disease, which may result from the visuo-spatial disturbances. The visual space consists of a variety of visual information processing, viewer-centered coordinate system, objects-centered coordinate system, integration of both coordinate systems, and verifying visual representation with the knowledge in the memory. The reversible operation in space, or mental rotation appears to play an important role in visuo-spatial functions, which refers to the operation of the visual representation at one orientation in viewer-centered coordinate system to construct the representation in object-centered coordinate system so that one can look like if it were presented at another orientation. To the present, little is known about reversible operation or mental rotation in patients with Alzheimer's disease. In this present paper, we attempted to investigate the ability of reversible operations in space so as to understand the mechanisms underlying constructional apraxia, or visuo-spatial disturbances in the early stage of Alzheimer's disease. The subjects were 12 patients with Alzheimer's disease in early stage (AD group), 12 patients with multi-infarcts dementia as disease control (MID group), 12 age matched persons as healthy control (HC group). In perspective taking tasks, that requires the subjects to imagine the spatial arrangement of the objects at the different view points from the subjects' one, AD group showed more severe deficits than MID group and HC group. Moreover, in a task that the subjects were asked to assume the photo-angle of the photograph taken of the model which was in front of them, AD group was imparied compared to the control groups. These disturbances were closely associated with deficits in Block Design test of WAIS. These results clearly demonstrate that the patients with Alzheimer's disease have disturbance in reversible operation in space and that the disturbance may be responsible for visuo-spatial dysfunctions, not only the constructional apraxia, but also a variety of performance deficits in the early stage of Alzheimer's disease.

Aged↗
PubMed1998

Anesthesia systems.

This report updates our 1996 Evaluation of systems used to administer inhalation (general) anesthesia (Health Devices 25[5-6], May-June 1996). In that issue, we evaluated a total of six systems (in nine configurations) manufactured by North American Drager (NAD) and Ohmeda. In this Update, we evaluate two additional models--the Cato and the Cicero EM, both of which are manufactured by Dräger Medizintechnik GmbH--according to the same test protocol. In the Conclusions section, we present a complete listing of the anesthesia systems we have evaluated to date in rating and ranking order. As in our original study, we base our conclusions largely on degree of system integration, suitability of the system for various types of procedures, and cost. Dräger Medizintechnik GmbH is the medical division of Drägerwerk AG (Lübeck, Germany), which is also the parent company of U.S.-based NAD--the manufacturer of three of the systems evaluated in our original study. Although both Dräger and NAD sell their products internationally, Drger's products are not sold in North America, and NAD's products are not sold in Germany. Thus, the two products evaluated in this issue are not available in the United States or Canada. This report, however, should be of interest to all our readers, including those in North America, because the newly evaluated systems have advanced features that, in the future, may be available in some form on systems marketed in North America.

Anesthesia, General↗
PubMed1998

Practising dermatology via telemedicine.

AIM: An interactive telemedicine service has been established between Taumarunui Hospital and the Department of Dermatology at Waikato Hospital. The first one hundred dermatological consultations were reviewed to see if the consultations were satisfactory for medical staff and patients. METHODS: A proprietary video conferencing system communicating via the Integrated Systems Digital Network was used to conduct dermatological consultations. Data were collected regarding waiting time, diagnosis and follow-up arrangements. Each patient was asked to complete a questionnaire after the consultation. RESULTS: Of these consultations, 83 were newly referred patients and the rest were follow-ups. The median waiting time for a new patient was 63 days. A variety of skin lesions (in 40 patients), inflammatory eruptions (31) and infections (13) were diagnosed and managed. Sixteen patients had to be seen at the base hospital for surgical treatment (7), face-to-face diagnosis (3), patch testing (3), a second opinion (2), or for personal reasons (1). The others were followed up locally. Savings in time and cost to patients were noted particularly. CONCLUSION: Only about 20% of consultations with new patients resulted in a further face-to-face appointment. The majority of patients found the telelink acceptable. The data supported the continuation and possible expansion of the dermatology telemedicine service. However, improved image quality is desirable.

Dermatology↗
PubMed1995

The challenges of governing integrated health care systems.

As health care delivery organizations develop into integrated health care systems, new and significant challenges arise with respect to how such systems should be governed. This article explores several key governance issues that organizations are likely to encounter as they attempt to effect the transition from hospital or multihospital system governance arrangements to those appropriate for integrated systems.

Communication↗
PubMed2003

An integrated treatment delivery system for CSRS and CSRT and clinical applications.

An integrated treatment delivery system for conformal stereotactic radiosurgery (CSRS) and radiotherapy (CSRT) has been developed through a collaboration involving Siemens Medical Systems, Inc., Tyco/Radionics, Inc., and The University of Texas M. D. Anderson Cancer Center. The system consists of a 6-MV linear accelerator (LINAC) equipped with a Tyco/Radionics miniature multileaf collimator (mMLC). For the conventional SRS treatment, the circular collimator housing can be attached to the opening window of the mMLC. The treatment delivery system is integrated with a radiotherapy treatment planning system and a record-and-verify system. The purpose of this study is to report the characteristics, performance, benefits, and the clinical applications of this delivery system. The technical specifications of the LINAC and mMLC were tested, and all the specifications were met. The 80% to 20% penumbral width for each mMLC leaf is approximately 3 mm and is nearly independent of the off-axis positions of a leaf. The maximum interleaf leakage is 1.4% (1.1% on average) and the maximum intra-leaf leakage is 1.0% (0.9% on average). The leaf position precision is better than 0.5 mm for all the leaves. The integration of the SRS/SRT treatment planning system, mMLC, and LINAC has been evaluated successfully for transferring the patient treatment data file through radiotherapy treatment planning system to the patient information and treatment record-and-verify server and the mMLC controller. Subsequently, the auto-sequential treatment delivery for SRS, CSRS/CSRT, and the step-and-shoot intensity-modulated radiotherapy has also been tested successfully. The accuracy of dose delivery was evaluated for a 2-cm spherical target in a Radiological Physics Center SRS head phantom with GAFChromic films and TLD. Five non-coplanar arcs, using a 2-cm diameter circular collimator, were used for this simulation treatment. The accuracy to aim the center of the spherical target was within 0.5 mm and the deviation of dose delivery to the isocenter of the target was within 2% of the calculated dose. For the irregularly shaped tumor, a tissue-equivalent head phantom was used to evaluate the accuracy of dose delivery for using either geometric conformal treatment or IMRT. The accuracy of dose delivery to the isocenter was within 2% and 3% of the calculated dose, respectively. From October 26, 1999 to September 30, 2002, we treated over 400 SRS patients and 70 SRT patients. Four representative cases are presented to illustrate the capabilities of this dedicated unit in performing conventional SRS, CSRS, and CSRT. For all the cases, the geometric conformal-plan dose distributions showed a high degree of conformity to the target shape. The degree of conformity can be evaluated using the target-volume-ratio (TVR). Our preferred TVR values for highly conformed dose distributions range from 1.6 to 2.0. The patient setup reproducibility for the Gill-Thomas-Cosman (GTC) noninvasive head frame ranges from 0.5 to 1 mm, and the head and neck noninvasive frame is within 2 mm. The integrated treatment delivery system offers excellent conformation for complicated planning target volumes with the stereotactic setup approach, ensuring that dose delivery can be achieved within the specified accuracy. In addition, the treatment time is comparable with that of single isocenter multiple-arc treatments.

Brain Neoplasms↗
PubMed1997

Telepresence in neurosurgery: the integrated remote neurosurgical system.

This paper describes the Integrated Remote Neurosurgical System (IRNS), a remotely-operated neurosurgical microscope with high-speed communications and a surgeon-accessible user interface. The IRNS will allow high quality bidirectional mentoring in the neurosurgical suite. The research goals of this effort are twofold: to develop a clinical system allowing a remote neurosurgeon to lend expertise to the OR-based neurosurgical team and to provide an integrated training environment. The IRNS incorporates a generic microscope/transport model, Called SuMIT (Surgical Manipulator Interface Translator). Our system is currently under test using the Zeiss MKM surgical transport. A SuMIT interface is also being constructed for the Robotics Research 1607. The IRNS Remote Planning and Navigation Workstation incorporates surgical planning capabilities, real-time, 30 fps video from the microscope and overhead video camera. The remote workstation includes a force reflecting handcontroller which gives the remote surgeon an intuitive way to position the microscope head. Bidirectional audio, video whiteboarding, and image archiving are also supported by the remote workstation. A simulation mode permits pre-surgical simulation, post-surgical critique, and training for surgeons without access to an actual microscope transport system. The components of the IRNS are integrated using ATM switching to provide low latency data transfer. The research, along with the more sophisticated systems that will follow, will serve as a foundation and test-bed for extending the surgeon's skills without regard to time zone or geographic boundaries.

Humans↗
PubMed1990

[Model of an information system for veterinary fertility monitoring as part of an integrated herd management system].

The requirements of the veterinarian's work are changing by reason of an increasing intensity of dairy industry. The model of an information system for monitoring and managing dairy herd health and management system is described. General and special requirements are illustrated. The program requires urgent development for the use of veterinarians and herd owners, including the provision of a data communication link to a veterinary-agricultural information system. The system should integrate the veterinarians into the animal production in order to improve herd health and to secure the veterinarian's role in, and facilitate the development of novel scientific approaches to, dairy herd health and management.

Animal Husbandry↗
PubMed1995

The health care professional multimedia workstation: development and integration issues.

Workstations for health care professionals provide access to distributed healthcare information systems. They are complex systems that have to manage, in a unified framework, the distributed and multimedia information needed for optimal patient care. The objective is to provide the end-user with a virtual and unified device that conceals the complexity of the underlying information system. Integration and reuse of modular software components are important in the development of such a workstation. A reference set of evaluation criteria is proposed that includes functional, technical, organizational, medical, cultural and ethical, economic and industrial components.

Computer Communication Networks↗
PubMed1995

Effects of a static textured background on motion integration.

We studied how the visual system integrates locally ambiguous velocities into global unambiguous coherent motion in the presence or absence of a textured background. Line drawings of complex figures were presented through invisible (i.e. same luminance and hue as the background) circular apertures such that only straight line segments were visible. These figures were either presented against a uniform background or embedded in static textures made of similar line segments in such a way that figures cannot be detected if they remain static. Under our experimental conditions, the figures translated clockwise or counterclockwise along a circular path and observers were required to discriminate the global direction of motion. Because of the aperture problem, a single moving segment cannot disambiguate the global direction of the figures and integration across multiple line segments is therefore necessary to perform the task. We found that with figures at high contrast, the presence of a texture enhanced direction discrimination, while direction discrimination of figures at low contrast was impaired by the presence of the texture. These paradoxical effects of a static texture were further tested by manipulating the relative contrast between figures and texture, the motion onset asynchrony (the delay between stimulus onset and motion onset or MOA), the density, the orientation and the distribution of texture elements. The effects of the texture, either facilitation or suppression, increase with texture contrast. Accuracy improves with MOA and decreases with texture density. In general, at high figure contrast, accuracy is better whenever referents are present in the image. We suggest that facilitation by the texture at high figure contrast is accounted for by reduced salience of segmentation cues such as line terminators and increased accuracy of local velocity measurements. On the other hand, decreased performance at low figure contrast may reflect lateral suppression of the responses to motion signals by the texture.

Contrast Sensitivity↗
PubMed1988

A general purpose computer analysis system for chromatographic data.

A manual integration system for the analysis of chromatographic data is described. The analog output produced by an HPLC absorbance monitor is passed to a non-inverting signal amplifier. This amplified signal is sent to an IBM PC where an analog to digital converter is used to digitize the data. A set of six computer programs which collect, store and analyze these data are presented. This system was used to analyze the nucleotide content of the anaerobic organism Clostridium acetobutylicum by strong anion-exchange HPLC.

Algorithms↗
PubMed1979

Systems development: trends, issues and implications.

Integrated systems are developing and growing in the U.S. health care industry. This phenomenon has many implications for health care institutions, communities and health care consumers across the country.

Centralized Hospital Services↗
PubMed2000

Computerised information systems in English mental health care providers in 1998.

BACKGROUND: This study formed part of the background work for the development work of a new Mental Health Minimum Data Set in England. It surveyed the range and nature of information systems currently used by English mental health care provider Trusts. It also surveyed relevant aspects of their organisational arrangements. METHOD: Information was collected by a telephone survey of Trust information and clinical service managers. RESULTS: Most Trusts have a complex array of different information systems--the median number is four. Even where fully integrated systems are in place, these do not necessarily cover all data areas over the whole of the Trust's operations. Sixty-three percent of Trusts use more than one patient numbering system. Sixty-percent have implemented or formally piloted routine collection of outcome scoring, 51% using the Health of the Nation Outcome Scale (HoNOS). A simple model suggested that the proposed data set could realistically be implemented nationally over a 4-year timescale. CONCLUSIONS: Given the current information system context and planned developments it would be realistic to implement the proposed Mental Health Minimum Data Set over a 4-year timescale.

Data Collection↗
PubMed2007

SYSTOMONAS--an integrated database for systems biology analysis of Pseudomonas.

To provide an integrated bioinformatics platform for a systems biology approach to the biology of pseudomonads in infection and biotechnology the database SYSTOMONAS (SYSTems biology of pseudOMONAS) was established. Besides our own experimental metabolome, proteome and transcriptome data, various additional predictions of cellular processes, such as gene-regulatory networks were stored. Reconstruction of metabolic networks in SYSTOMONAS was achieved via comparative genomics. Broad data integration is realized using SOAP interfaces for the well established databases BRENDA, KEGG and PRODORIC. Several tools for the analysis of stored data and for the visualization of the corresponding results are provided, enabling a quick understanding of metabolic pathways, genomic arrangements or promoter structures of interest. The focus of SYSTOMONAS is on pseudomonads and in particular Pseudomonas aeruginosa, an opportunistic human pathogen. With this database we would like to encourage the Pseudomonas community to elucidate cellular processes of interest using an integrated systems biology strategy. The database is accessible at http://www.systomonas.de.

Bacterial Proteins↗
PubMed1998

CareWeb, a web-based medical record for an integrated healthcare delivery system.

With the advent of Integrated Healthcare Delivery Systems, medical records are increasingly distributed across multiple institutions. Timely access to these medical records is a critical need for healthcare providers. The CareWeb project provides an architecture for World Wide Web-based retrieval of electronic medical records from heterogeneous data sources. Using Health Level 7 (HL7), web technologies and readily available software components, we consolidated the electronic records of Boston's Beth Israel and Deaconess Hospitals. We report on the creation of CareWeb (freya.bidmc.harvard.edu/careweb.htm) and propose it as a means to electronically link Integrated Health Care Delivery Systems and geographically distant information resources.

Computer Communication Networks↗
PubMed1999

Implementation and evaluation of workflow based on hospital information system/radiology information system/picture archiving and communications system.

The purpose of this presentation is to review and evaluate computerized workflow of selected sites that have integrated systems of the hospital information system (HIS), radiology information system (RIS), and picture archiving and communications system (PACS). We then focus on some essential points of integration of those systems, such as avoiding multiple entries of patients demographic data, prefetching current and previous images to the correspondent workstations, and workflow management. To realize them by integrating multiple subsystems such as HIS/RIS/PACS integration, there must be exchange of the workflow control information, and consistency of the information between subsystems.

Computer Systems↗
PubMed1995

Integrated clinical information system.

SIDOCI (Système Informatisé de DOnnées Cliniques Intégrées) is a Canadian joint venture introducing newly-operating paradigms into hospitals. The main goal of SIDOCI is to maintain the quality of care in todayUs tightening economy. SIDOCI is a fully integrated paperless patient-care system which automates and links all information about a patient. Data is available on-line and instantaneously to doctors, nurses, and support staff in the format that best suits their specific requirements. SIDOCI provides a factual and chronological summary of the patient's progress by drawing together clinical information provided by all professionals working with the patient, regardless of their discipline, level of experience, or physical location. It also allows for direct entry of the patient's information at the bedside. Laboratory results, progress notes, patient history and graphs are available instantaneously on screen, eliminating the need for physical file transfers. The system, incorporating a sophisticated clinical information database, an intuitive graphical user interface, and customized screens for each medical discipline, guides the user through standard procedures. Unlike most information systems created for the health care industry, SIDOCI is longitudinal, covering all aspects of the health care process through its link to various vertical systems already in place. A multidisciplinary team has created a clinical dictionary that provides the user with most of the information she would normally use: symptoms, signs, diagnoses, allergies, medications, interventions, etc. This information is structured and displayed in such a manner that health care professionals can document the clinical situation at the touch of a finger. The data is then encoded into the patient's file. Once encoded, the structured data is accessible for research, statistics, education, and quality assurance. This dictionary complies with national and international nomenclatures. It also contains personalized profiles: questionnaires based on the predetermined choices of the information most relevant to the specific user. The SIDOCI clinical dictionary also includes the hospital's suggested or mandatory interventions, clinical guidelines, and protocols. These clinical guidelines are customized at the hospital, service, and professional levels. Common interventions have been regrouped so that health professionals may apply the appropriate diagnostic, therapeutic, educational, or other intervention plans. The clinical dictionary also serves as a teaching and continuing education tool. The patient profile is a permanent record containing information on allergies, blood type, primary and secondary diagnoses, ongoing treatments, and prior hospitalizations. The problem list dealing with the current hospitalization includes symptoms, signs, and diagnoses. This standard clinical record facilitates communication between the services and provides a quick overview of the patient's history should emergency treatment be required. This health information system integrates Requests and Results, Progress Notes, and Analysis of the results. In addition, functions inherent to a patient's clinical cycle such as Administrative Management of episodes, Adaptation to physical and professional structures of the hospital, Messages between health professionals, and Electronic signature constitute the basis of SIDOCI. The most exciting aspect of this research project is its social impact: a more efficient health care system will improve the lives of all citizens. Moreover this applied research project involves the information industry and directly calls for the input of users such as doctors, nurses and hospital support staff.

Hospital Information Systems↗
PubMed1994

Evaluation of the pulsatility of a new pulsatile left ventricular assist device--the integrated cardioassist catheter--in dogs.

A new pulsatile left ventricle-femoral artery bypass system (integrated cardioassist catheter system) has been developed for rapid, percutaneous insertion as a left ventricular assist device. Previous experiments revealed its superiority over the intraaortic balloon pump system in maintaining the peripheral circulation and in improving myocardial blood flow and afterload. Our objective was to determine whether the pulsatility of left ventricular bypass of this system would be preferable for maintaining the peripheral circulation and managing the ischemic myocardium as compared with nonpulsatile left ventricular bypass. Ten dogs with profound heart failure were supported by this system. Their hemodynamic status and myocardial blood flow were measured under control, nonpulsatile left ventricular bypass, or synchronous pulsatile left ventricular bypass. Significant differences between the nonpulsatile bypass group and the pulsatile bypass group were observed in the mean increase in aortic pressure (3.5% versus 22.2%, respectively; p < 0.001), total cardiac output (13.0% versus 21.7%; p = 0.004), and myocardial blood flow (9.5% versus 21.8%; p < 0.001). No differences were found between groups in the decrease in left atrial pressure (-20.2% versus -20.2%; p > 0.05). The ratio of diastolic time index/tension time index was shown to be improved significantly in the pulsatile bypass group compared with that of control and nonpulsatile bypass groups (p < 0.001). Thus, the pulsatility of the integrated cardioassist catheter system may support the peripheral circulation and improve the myocardial blood flow and oxygen supply/demand ratio.

Animals↗