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At least 163 records · Page 9Linked to original sources
PubMed1999

The study of wrist postures of musicians using the WristSystem (Greenleaf Medical System).

This study examined wrist motions of instrumentalists who have never experienced a cumulative traumatic disorder. Eighteen student musicians ranging from 18 to 29 years of age, with more than 9 years of playing experience participated in this study using the WristSystem (Greenleaf Medical System). The wrist motions were measured while participants played their instrument for five minutes. The results indicated a different pattern of wrist movements for each instrumentalist. Pianists demonstrated more ulnar deviation for both hands and more flexion for the left hand than any of the other instrumentalists. The average wrist range of motion for all four movements was under 15 degrees for violinists and violists. The right hand of the cellist had more flexion than any other instrumentalists. For both hands, flutists had more wrist extension than any other instrumentalists. This study provided information about wrist motions of musicians as one of the many factors that contribute to cumulative traumatic disorders. However, further research is needed to identify causal factors, and to promote prevention of the injury.

Journal Article↗
PubMed1999

Racial variation in the use of laparoscopic cholecystectomy in the Department of Veterans Affairs medical system.

BACKGROUND: While studies have found racial differences in the rates of use of established invasive cardiac and cerebrovascular procedures, no study has evaluated racial variation in the rates of adoption of new surgical procedures. For patients undergoing laparoscopic cholecystectomy, the procedure represents a new and safe option that shortens the duration of postoperative hospitalization by almost one week. In this study, we evaluated whether, in the equal access Veterans Affairs (VA) medical system, the rate of adoption of this procedure and improvements in the duration of postoperative hospitalization differed between African-American and Caucasian patients. STUDY DESIGN: Data were obtained from two sources-administrative claims files and prospectively compiled dinical data from medical records and patient interviews. In both data sets, frequency of use, length of stay, and outcomes for African-American and Caucasian patients undergoing minimally invasive and open gallbladder surgery were analyzed for the first four years of use of the procedure in the VA system (1992 to 1995). RESULTS: Analyses based on claims files indicated that, after adjustment for potentially confounding variables, African-American patients who underwent cholecystectomy in VA medical centers were 25% less likely to undergo a minimally invasive cholecystectomy during the first 4 years of use of the new procedure (adjusted odds ratio, 0.74; 95% confidence interval, 0.66-0.83). Shortening of the average postoperative length of stay from 9 days or more in the prelaparoscopic era to less than 4.5 days for patients undergoing the laparoscopic procedure occurred in the first year for Caucasian patients, but did not occur until the fourth year for African-American patients (p<0.001). The overall difference in postoperative length of stay between African-American and Caucasian patients more than doubled from 1.7 days before introduction of laparoscopic cholecystectomy to 3.8 days in the fourth year. In comparison, analyses based on nurse-compiled clinical data indicated that, after adjustment for relevant clinical factors, racial variations in the rate of laparoscopic surgery were even larger (adjusted odds ratio for laparoscopic versus open cholecystectomy for African-American versus Caucasian veterans, 0.68; 95% confidence interval, 0.55-0.84). CONCLUSIONS: Compared to Caucasian patients, African-American patients who underwent cholecystectomy in VA medical centers had an approximately 25% to 32% lower likelihood of undergoing minimally invasive cholecystectomy procedures. The differences in rates of adoption of laparoscopic surgery did not appear to be from more comorbid illnesses among African-American patients. African-American and Caucasian veterans may differ in their preference for new surgical procedures like laparoscopic cholecystectomy. Conversely, VA physicians may have been less likely to recommend laparoscopic cholecystectomies to African-American patients.

Adult↗
PubMed1999

Data control. Primary care practice improves productivity and profitability with electronic medical system.

UNLABELLED: Washington Primary Care Physicians, Washington, D.C. PROBLEM: Keeping up with 15,000 patients, 20 percent of whom were covered under Medicare and Medicaid, was proving impossible with WPCP's paper-based record system. SOLUTION: Implementing an electronic medical record. RESULTS: Fewer problems associated with lost or missing paper documents, lower medical records costs (e.g., filing and storage); and the elimination of duplicative manual tasks. KEYS TO SUCCESS: Patience and flexibility is critical. All involved must understand and believe that the transition from paper to electronic charts is a process and not an event.

District of Columbia↗
PubMed2004

Natural medicines used in the traditional Chinese medical system for therapy of diabetes mellitus.

The rapidly increasing diabetes mellitus is becoming a serious threat to mankind health in all parts of the world. The control and treatment of diabetes and its complications mainly depend on the chemical or biochemical agents, but the fact is that it has never been reported that someone had recovered totally from diabetes. With the distinctive traditional medical opinions and natural medicines mainly originated in herbs, the traditional Chinese medicine performed a good clinical practice and is showing a bright future in the therapy of diabetes mellitus and its complications. Based on a large number of chemical and pharmacological research work, numerous bioactive compounds have been found in Chinese medicinal plants for diabetes. The present paper reviews 86 natural medicines with regards to their origin, anti-diabetic active principles and/or pharmacological test results, which are commonly used in the traditional Chinese medical system and have demonstrated experimental or/and clinical anti-diabetic effectiveness. Among these natural medicines, 82 originate from plants and 4 from animals or insects, which covers 45 families. It is strongly significant to pay close attention to traditional Chinese medical therapeutics and natural medicines for treatment of diabetes mellitus and its complications.

Diabetes Mellitus↗
PubMed1992

Normalization of composition of triglyceride-rich lipoprotein subfractions in diabetic subjects during insulin infusion with programmable implantable medication system.

OBJECTIVE: To investigate whether long-term improved glycemic control by intraperitoneal insulin infusion normalizes the compositional abnormalities of triglyceride (TG)-rich lipoproteins in insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: Seven subjects were studied before and 12-14 mo after initiation of treatment with the programmable implantable medication system (PIMS). Plasma TG levels were measured, and the composition of three TG-rich lipoprotein subfractions (Svedberg flotation [Sf] greater than 400, 100-400, and 20-100) were analyzed before and every 1.5 for 7.5 h after ingestion of corn oil. RESULTS: PIMS significantly improved glycemic control, as measured by mean blood glucose (P less than 0.02), and HbA1 (P less than 0.001, paired t test) levels. Weight loss was also observed during PIMS treatment. Significant changes occurred in the composition of TG-rich lipoprotein subfractions during PIMS treatment in both the fasting (P less than 0.002) and the postprandial (P less than 0.0001) state. Most changes were in the direction of nondiabetic values. PIMS treatment reduced the total cholesterol enrichment in IDDM subjects in all three subfractions in the postprandial state and the very-low-density lipoprotein subfractions (Sf 100-400 and 20-100) in the fasting state. Multivariate analysis showed that the compositional changes were affected by improved glycemic control, as assessed by both mean blood glucose and HbA1, whereas the very-low-density lipoprotein compositional changes were by both the improved glycemic control and body weight. CONCLUSIONS: In IDDM subjects during PIMS treatment, there was normalization of most abnormalities in the composition of fasting and postprandial TG-rich lipoproteins, including enrichment in total cholesterol, which is considered atherogenic.

Adult↗
PubMed2005

Prospective assessment of integrating the existing emergency medical system with automated external defibrillators fully operated by volunteers and laypersons for out-of-hospital cardiac arrest: the Brescia Early Defibrillation Study (BEDS).

AIMS: There are few data on the outcomes of cardiac arrest (CA) victims when the defibrillation capability of broad rural and urban territories is fully operated by volunteers and laypersons. METHODS AND RESULTS: In this study, we investigated whether a programme based on diffuse deployment of automated external defibrillators (AEDs) operated by 2186 trained volunteers and laypersons across the County of Brescia, Italy (area: 4826 km(2); population: 1 112 628), would safely and effectively impact the current survival among victims of out-of-hospital CA. Forty-nine AEDs were added to the former emergency medical system that uses manual EDs in the emergency department of 10 county hospitals and in five medically equipped ambulances. The primary endpoint was survival free of neurological impairment at 1-year follow-up. Data were analysed in 692 victims before and in 702 victims after the deployment of the AEDs. Survival increased from 0.9% (95% CI 0.4-1.8%) in the historical cohort to 3.0% (95% CI 1.7-4.3%) (P=0.0015), despite similar intervals from dispatch to arrival at the site of collapse [median (quartile range): 7 (4) min vs. 6 (6) min]. Increase of survival was noted both in the urban [from 1.4% (95% CI 0.4-3.4 %) to 4.0% (95% CI 2.0-6.9 %), P=0.024] and in the rural territory [from 0.5% (95% CI 0.1-1.6%) to 2.5% (95% CI 1.3-4.2%), P=0.013]. The additional costs per quality-adjusted life year saved amounted to euro39 388 (95% CI euro16 731-49 329) during the start-up phase of the study and to euro23 661 (95% CI euro10 327-35 528) at steady state. CONCLUSION: Diffuse implementation of AEDs fully operated by trained volunteers and laypersons within a broad and unselected environment proved safe and was associated with a significantly higher long-term survival of CA victims.

Automation↗
PubMed2000

Validation of the CAS Medical Systems, inc. OscilloMitt, hand-blood-pressure cuff.

BACKGROUND: There are technical difficulties in accurately measuring blood pressure of individuals with varying arm and body sizes. OBJECTIVE: To perform validation testing with 109 children of a novel cuff that occludes the palm rather than the upper arm. METHODS: This cuff, the OscilloMitt made by CAS Medical Systems, Inc. , was used in conjunction with a commercially available monitor. Readings of blood pressure taken by trained auscultatory observers were compared with those of the OscilloMitt monitor. The mean difference in systolic blood pressure was 1.13mmHg and the mean difference in diastolic blood pressure was 0.94mmHg. The OscilloMitt was tolerated very well, especially by the young children (those aged <5years). CONCLUSION: The OscilloMitt is accurate and its use should be preferable to traditional upper-arm placement of cuffs for assessing many specific groups of patients. We recommend its use for persons aged 2 years and more.

Adolescent↗
PubMed2003

Administration of corticosteroids for acute spinal cord injury: the current practice of trauma medical directors and emergency medical system physician advisors.

OBJECTIVE: In 1997, the results from the Third National Acute Spinal Cord Injury Study (NASCIS 3) were published. We undertook the present study to determine the treatment protocols for patients with spinal cord injuries in Colorado and assess whether there were any barriers to the administration of corticosteroids. STUDY DESIGN: Cross-sectional. METHODS: In May 1999, surveys were mailed to every trauma facility medical director and emergency medical system physician advisor in the state. Physicians were asked to provide information about their facilities' or agencies' current practice(s) for administering steroids to patients with spinal cord injuries. They were also asked about their opinion on whether the data on corticosteroid treatment for spinal cord injury support its use. RESULTS: Ninety-eight percent (39 out of 41) of the medical directors who responded and treat patients with spinal cord injuries said that their facilities do administer steroids to those patients. Fourteen percent reported following the NASCIS 3 protocol; 75%, the NASCIS 2 protocol. About half of the medical directors were either uncertain or did not believe that the data regarding the corticosteroid treatment for spinal cord injury supported its use. The majority of physician advisors responded that they do not authorize the administration of corticosteroids to patients with spinal cord injuries in the field, primarily because of short transport times. CONCLUSIONS: Our study demonstrated relatively poor compliance with the NASCIS 3 protocol, but good compliance with the NASCIS 2 protocol. There was skepticism about the efficacy of corticosteroid treatment among some Colorado physicians that treat patients with spinal cord injuries acutely; however, this does not completely explain the findings.

Acute Disease↗
PubMed1996

Out-of-hospital cardiac arrest. Evaluation of one year of activity in Saint-Etienne's emergency medical system using the Utstein style.

OBJECTIVE: To provide researchers with a description of the method of dealing with out-of-hospital cardiac arrests, and the results thereof, using the Utstein style. DESIGN: a series of out-of-hospital cardiac arrests between 1 October 1991 and 31 September 1992. SETTING: a French 'departement' (administrative subdivision). POPULATION: 570,000 inhabitants; area: 2600 km2; emergency medical system consisting of two levels of response: the Emergency and Resuscitation Mobile Unit and the Fire Service. PATIENTS: a sample of 380 patients found to have neither palpable pulse nor independent respiration. RESULTS: of the 234 (61%) patients in whom resuscitation was attempted, 41 (17%) were hospitalised and 12 (5%) discharged were still alive at 1 year follow-up. Of the patients who showed signs of cardiac arrest of cardiac aetiology, classified as having initial ventricular fibrillation (VF) rhythms: 62% of the cases (5/8) were alive at 1 year if the cardiac arrest occurred in the presence of emergency medical personnel; 6% of the cases (2/31) were alive at 1 year if the cardiac arrest occurred in the presence of non-specialised bystanders.

Ambulances↗
PubMed2001

[Comprehensive evaluation of medical system by using generalized fuzzy set theory].

Based on the theory of generalized fuzzy set, a comprehensive evaluation model has been built, which provides residuals estimate, evaluate function and test methods needed. Verified by the prognosis of 30 patients with myocardial infarction in a motion experiment during rehabilitation, its coincidence rate was found to be above 90%. This model can be developed and applied to medical system and other systems for evaluations as well.

Evaluation Studies as Topic↗
PubMed1984

The emergency medical system in Japan.

In Japan, ambulance service was originated by the Osaka Branch Office of the Japan Red Cross in 1931. In 1933 the fire department organ of Yokohama started ambulance service. It was, however, without any legal requirements. Since the early 1960s, Japan has experienced a rapid development of industry and economy, so that traffic accidents have increased, necessitating a nationwide ambulance service system. In October 1961 the Director-General of the Fire Defense Agency organized the Fire Defense Council to study the problem of ambulance service. In response, the Fire Defense Act was amended in 1963, assigning ambulance service responsibilities to Fire Defense organs. During 1982 total ambulance runs numbered 2,125,447, and the total number of transported persons was 2,049,487. Response time is excellent in Japan. More than 50% of persons who called an ambulance could get help within five minutes. First-aid management was given to 56% of total transported persons. Of these, temperature regulation was most often administered, followed by oxygen inhalation, dressing, and hemostasis. Currently, 2,965 (91.1%) municipalities provide ambulance services to 98.3% of the population. The Japanese emergency medical system has serious problems, however, such as an inadequate number of general hospitals and a flood of nonemergent patients. To alleviate such problems, the Ministry of Health and Welfare developed the critical emergency transfer system in 1977.

Ambulances↗
PubMed2004

The turning point from an archaic Arab medical system to an early modern European system in Jerusalem according to the Swiss physician Titus Tobler (1806-77).

Until the end of the Ottoman period the Hippocratic-Galenic doctrine, which had been improved by medieval Muslim medicine, was the pre-dominant medicine in the Holy Land. The penetration of modern medicine into the region was a slow process, advancing step by step over the years until it was established around the end of the 19th century.Dr. Titus Tobler, a Swiss physician of many talents, first visited Jerusalem in 1835, then again in 1845, 1857, and 1865. He reported his experiences and impressions in several books and articles. His publications portray the condition of medicine in the city before the advent of European physicians, their arrival, and the establishment of the first hospitals in the city. Thanks to his endeavours, a professional description of the medical conditions prevailing in Jerusalem in the mid-19th century is available to the public. Tobler's writings include descriptions of the healers, blood-letters, quacks, medicinal substances and their market, and the diseases and illnesses from which the inhabitants suffered. In addition, Tobler produced a detailed report of the different hospitals, pharmacies, European physicians, and their experiences. A digest of Tobler's information, its fresh systematic arrangement, and its comparison with other historical sources, early as well as recent, produces a better picture than ever previously available of the medical conditions of the city in the final years of the ascendancy of Arab medical systems and in the early stages of early modern European medicine in Jerusalem and the Holy Land.

Europe↗
PubMed2004

[Encounters of the Korean body with the traditional and modern medical systems].

The body has been an intense focus of attention since the 1990s both in academic and mundane discourse. In philosophy, literature critique, sociology and anthropology the body has been found to have various implications and auras around it.I try to explain the body as the subject of medicine rather philosophically, in terms of nature, culture and phenomena. And then I look into the Korean body of the late 19th century when western biomedicine was first introduced. The Korean body was encountering traditional and modern biomedical medicines in three different spaces i.e., corporal, social and moral. The corporal space was the space into which direct intervention such as surgery was performed. The body was also situated in the social space where imperative social measures such as sanitation and sterilization was imposed. The body also had the moral space, invasion into which evoked great moral upheaval. It was when the government ordered the public to cut the long and bound hair, which had long been the symbol of their identity. Reflecting upon the philosophical perspectives and examining concrete cases of the encounters of the body with the two medical systems, I argue that we should have new perspectives that embodies the historical and phenomenological experiences of the body.

History, 19th Century↗
PubMed2001

Characterization of patients presenting with male factor infertility in an equal access, no cost medical system.

OBJECTIVES: Demographic information on patients presenting for the diagnosis and treatment of male factor infertility has been limited in the past by the paucity of subspecialty trained providers and concentrated sequential patient information. Previously reported studies looking at the characteristics of patients being evaluated for male subfertility may represent a selected subset of patients able to access these services. The changes in the diagnostic modalities available in the 1990s and new diagnostic categories may also affect the characterization of patients seen with the diagnosis of male factor infertility. METHODS: A retrospective analysis was performed using a centralized database of patient records at a single military male infertility clinic. Seven hundred consecutive patients were studied to obtain information on patient and spouse age, race, length of subfertile period, medical history and examination, and laboratory evaluation. A single provider categorized the etiology of male factor infertility after the evaluation. RESULTS: The mean patient age was 36 years (range 17 to 68). The mean spouse age was 31.2 years (range 19 to 50). The mean subfertile period was 5.5 years (range 0.5 to 35). Of the 700 patients, 51% were white, 10% African American, 2% Hispanic, and 37% other/unknown. Eleven percent of the patients were active smokers. The most common etiologic category groups describing male subfertility were previous vasectomy (56%), varicocele (14%), idiopathic infertility (8%), and nonobstructive azoospermia (6%). CONCLUSIONS: An equal access, no cost medical system mirrors the demographics of the military population served. The clinical characteristics of patients presenting with male factor infertility have changed significantly during the past 30 years. Obstruction from a previous vasectomy is now the most common presenting complaint of patients visiting an infertility clinic. Vasectomy reversal may be more frequently requested when the cost is not a factor in providing fertility services. Idiopathic male factor infertility occurs in less than 10% of patients.

Adolescent↗
PubMed2000

ECG scores for a triage of patients with acute myocardial infarction transported by the emergency medical system.

Prehospital triage of cardiac patients for bypass from community hospitals to cardiac centers may improve survival. This article determines if electrocardiogram (ECG)-based scoring triage methods (Aldrich MI scoring, QRS distortion, and the TIMI classification) and location of infarct (via 12 lead ECG) are associated with mortality before and after adjusting for age, sex, and race. It is a retrospective study of 291 AMI adult patients transported by ambulance to community hospitals or cardiac centers. Patients with an ED chief complaint of chest pain or dyspnea, presence of MI as defined by ECG findings of 0.1 mV of ST segment elevation in two leads or positive CPK-MB were eligible for the study. The primary outcome variable was 2-year mortality as determined with a metropolitan Detroit tri-county death index. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (with 95% CIs) of the predictor variables with mortality. Of the initial population selected for the study (n = 291), 229 patients were eligible for the analysis. The mean age was 66 years (SD of 14.4) with 63.8% being male and 54% being white. The overall mortality point estimate was 21.3% (95% CI of 15.2 to 27.3%). Aldrich scores and QRS distortion (yes/no) were not associated with mortality. Patients classified as a "high risk" for AMI per TIMI status were almost 3 times more likely to die than those at "low risk" and reached borderline statistical significance (P = .06) after adjusting for the covariates. Having an anterior infarct, as opposed to an inferior infarct, was significantly associated with death before and after adjusting for the covariates (Unadjusted OR = 2.6, Adjusted OR = 2.8). Properly training emergency medical system professionals in this area may prove useful for identifying higher risk AMI patients in the prehospital setting.

Aged↗
PubMedDate not supplied

Methods of automatically acquiring images from digital medical systems.

Automated image acquisition plays an important role in a picture archiving and communication system (PACS). However, there is no single solution for automated data acquisition from existing digital medical imaging systems. We have gained a great deal of experience on automatic acquiring data by interfacing imaging scanners of major manufacturers. In this paper, we categorize the interface methods supported by the current image scanners. This categorization consists of five architectural models: (a) sequential chain; (b) direct interface; (c) memory access; (d) shared disk; and (e) interconnected network. The cost, rate of data transfer, and ease of implementation of each model are discussed. To ensure the integrity and availability of patient images in a PACS system, automated fault tolerance design in image acquisition is required. Based upon our field data, we report common scenarios which cause the acquisition to fail. We also describe techniques employed to automatically restart the operations which include recovery from acquisition processes' errors and traps, image acquisition computer down-time occurrence, and shutdown occurrence of medical imaging system.

Automation↗