Quantitative measurement of hypertrophic scar: interrater reliability and concurrent validity.

Science.gov (United States)

Nedelec, Bernadette; Correa, José A; Rachelska, Grazyna; Armour, Alexis; LaSalle, Léo

2008-01-01

Research into the pathophysiology and treatment of hypertrophic scar (HSc) remains limited by the heterogeneity of scar and the imprecision with which its severity is measured. The objective of this study was to test the interrater reliability and concurrent validity of the Cutometer measurement of elasticity, the Mexameter measurement of erythema and pigmentation, and total thickness measure of the DermaScan C relative to the modified Vancouver Scar Scale (mVSS) in patient-matched normal skin, normal scar, and HSc. Three independent investigators evaluated 128 sites (severe HSc, moderate or mild HSc, donor site, and normal skin) on 32 burn survivors using all of the above measurement tools. The intraclass correlation coefficient, which was used to measure interrater reliability, reflects the inherent amount of error in the measure and is considered acceptable when it is >0.75. Interrater reliability of the totals of the height, pliability, and vascularity subscales of the mVSS fell below the acceptable limit ( congruent with0.50). The individual subscales of the mVSS fell well below the acceptable level (0.89) for each study site with the exception of severe scar. Mexameter and DermaScan C reliability measurements were acceptable for all sites (>0.82). Concurrent validity correlations with the mVSS were significant except for the comparison of the mVSS pliability subscale and the Cutometer maximum deformation measure comparison in severe scar. In conclusion, the Mexameter and DermaScan C measurements of scar color and thickness of all sites, as well as the Cutometer measurement of elasticity in all but the most severe scars shows high interrater reliability. Their significant concurrent validity with the mVSS confirms that these tools are measuring the same traits as the mVSS, and in a more objective way.

Efficacy and safety of nerve growth factor for the treatment of neurological diseases：a meta-analysis of 64 randomized controlled trials involving 6,297 patients

Institute of Scientific and Technical Information of China (English)

Meng Zhao; Xiao-yan Li; Chun-ying Xu; Li-ping Zou

2015-01-01

OBJECTIVE:China is the only country where nerve growth factor is approved for large-scale use as a clinical medicine. More than 10 years ago, in 2003, nerve growth factor injection was listed as a national drug. The goal of this article is to evaluate comprehensively the efifcacy and safety of nerve growth factor for the treatment of neurological diseases. DATA RETRIEVAL:A computer-based retrieval was performed from six databases, including the Cochrane Library, PubMed, EMBASE, Sino Med, CNKI, and the VIP database, searching from the clinical establishment of nerve growth factor for treatment until December 31, 2013. The key words for the searches were “nerve growth factor, randomized controlled trials” in Chinese and in English. DATA SELECTION:Inclusion criteria: any study published in English or Chinese referring to randomized controlled trials of nerve growth factor; patients with neurological diseases such as peripheral nerve injury, central nerve injury, cranial neuropathy, and nervous system infections;patients older than 7 years; similar research methods and outcomes assessing symptoms; and measurement of nerve conduction velocities. The meta-analysis was conducted using Review Manager 5.2.3 software. MAIN OUTCOME MEASURES:The total effective rate, the incidence of adverse effects, and the nerve conduction velocity were recorded for each study. RESULTS:Sixty-four studies involving 6,297 patients with neurological diseases were included. The total effective rate in the group treated with nerve growth factor was significantly higher than that in the control group (P < 0.0001,RR: 1.35, 95%CI: 1.30–1.40). The average nerve conduction velocity in the nerve growth factor group was signiifcantly higher than that in the control group (P < 0.00001,MD: 4.59 m/s, 95%CI: 4.12–5.06). The incidence of pain or sclero-ma at the injection site in the nerve growth factor group was also higher than that in the control group (P < 0.00001,RR: 6.30, 95%CI: 3.53–11

Double-blinded, placebo-controlled study to evaluate an antipruritic shampoo for dogs with allergic pruritus.

Science.gov (United States)

Schilling, J; Mueller, R S

2012-07-28

Shampoo therapy is frequently used on pruritic dogs. However, there are few double-blinded, placebo-controlled studies of this form of therapy. This randomised, double-blinded, placebo-controlled study evaluated the efficacy of a commercial medicated shampoo (DermaTopic; Almapharm) containing chlorhexidine, lactoferrin, piroctone olamine, chitosan and essential fatty acids in 27 dogs with mild to moderate allergic pruritus without secondary skin infections. All dogs received shampoo therapy with either DermaTopic or a shampoo vehicle as placebo twice weekly for four weeks. The extent of pruritus was evaluated before the study and then on a daily basis by the owners using a visual analogue scale. Before beginning the treatment and after four weeks, the skin lesions were evaluated by an experienced clinician with a validated lesion score (Canine Atopic Dermatitis Extent and Severity Index - CADESI). The pruritus was reduced significantly by both DermaTopic and placebo. However, there was no significant difference between both groups. There was no statistically significant difference in the CADESI scores pre- and post-treatment in either group or between the two types of treatment. This study provides further evidence of the benefit of shampoo therapy for pruritic dogs.

Mesoscale influence on long-range transport — evidence from ETEX modelling and observations

Science.gov (United States)

Sørensen, Jens Havskov; Rasmussen, Alix; Ellermann, Thomas; Lyck, Erik

During the first European Tracer Experiment (ETEX) tracer gas was released from a site in Brittany, France, and subsequently observed over a range of 2000 km. Hourly measurements were taken at the National Environmental Research Institute (NERI) located at Risø, Denmark, using two measurement techniques. At this location, the observed concentration time series shows a double-peak structure occurring between two and three days after the release. By using the Danish Emergency Response Model of the Atmosphere (DERMA), which is developed at the Danish Meteorological Institute (DMI), simulations of the dispersion of the tracer gas have been performed. Using numerical weather-prediction data from the European Centre for Medium-Range Weather Forecast (ECMWF) by DERMA, the arrival time of the tracer is quite well predicted, so also is the duration of the passage of the plume, but the double-peak structure is not reproduced. However, using higher-resolution data from the DMI version of the HIgh Resolution Limited Area Model (DMI-HIRLAM), DERMA reproduces the observed structure very well. The double-peak structure is caused by the influence of a mesoscale anti-cyclonic eddy on the tracer gas plume about one day earlier.

Patient support systems

International Nuclear Information System (INIS)

Braden, A.B.; McBride, T.R.; Styblo, D.J.; Taylor, S.K.; Richey, J.B.

1979-01-01

A patient support system for use in computerized tomography (CT) is described. The system is particularly useful for CT scanning of the brain and also of the abdominal area. The support system consists of two moveable tables which may be translated into position for X-ray scanning of the patient's body and which may be translated incrementally and automatically to obtain scans at adjacent locations. For use with brain scans, the second table is replaced by a detachable restraint assembly which is described in detail. The support system is so designed that only a small volume of low density material will intercept the X-ray beam. (UK)

Clinical multiphoton FLIM tomography

Science.gov (United States)

König, Karsten

2012-03-01

This paper gives an overview on current clinical high resolution multiphoton fluorescence lifetime imaging in volunteers and patients. Fluorescence lifetime imaging (FLIM) in Life Sciences was introduced in Jena/Germany in 1988/89 based on a ZEISS confocal picosecond dye laser scanning microscope equipped with a single photon counting unit. The porphyrin distribution in living cells and living tumor-bearing mice was studied with high spatial, temporal, and spectral resolution. Ten years later, time-gated cameras were employed to detect dental caries in volunteers based on one-photon excitation of autofluorescent bacteria with long fluorescence lifetimes. Nowadays, one-photon FLIM based on picosecond VIS laser diodes are used to study ocular diseases in humans. Already one decade ago, first clinical twophoton FLIM images in humans were taken with the certified clinical multiphoton femtosecond laser tomograph DermaInspectTM. Multiphoton tomographs with FLIM modules are now operating in hospitals at Brisbane, Tokyo, Berlin, Paris, London, Modena and other European cities. Multiple FLIM detectors allow spectral FLIM with a temporal resolution down to 20 ps (MCP) / 250 ps (PMT) and a spectral resolution of 10 nm. Major FLIM applications include the detection of intradermal sunscreen and tattoo nanoparticles, the detection of different melanin types, the early diagnosis of dermatitis and malignant melanoma, as well as the measurement of therapeutic effects in pateints suffering from dermatitis. So far, more than 1,000 patients and volunteers have been investigated with the clinical multiphoton FLIM tomographs DermaInspectTM and MPTflexTM.

Patient tracking system

International Nuclear Information System (INIS)

Chapman, L.J.; Hakimi, R.; Salehi, D.; McCord, T.; Zionczkowski, B.; Churchill, R.

1987-01-01

This exhibit describes computer applications in monitoring patient tracking in radiology and the collection of management information (technologist productivity, patient waiting times, repeat rate, room utilization) and quality assurance information. An analysis of the reports that assist in determining staffing levels, training needs, and patient scheduling is presented. The system is designed to require minimal information input and maximal information output to assist radiologists, quality assurance coordinators, and management personnel in departmental operations

Atypical Post Kala Azar Dermal Leishmaniasis with ?Muzzle Area? Swelling

OpenAIRE

Arora, Sandeep; Bal, Arvinder Singh; Baveja, Sukriti; Sood, Aradhana; Rathi, Khushi Ram; Patil, Pradeep

2015-01-01

A 50-year-old male presented with recurrent swelling of the muzzle area of the face with history of low-grade intermittent fever of 3 year duration managed variously with antibiotics, systemic steroids, and antituberculous therapy. Skin biopsy revealed a granulomatous infiltration negative for acid-fast bacilli and leishmania donovan bodies. Immunochromatography test for rK 39 antigen and polymerase chain reaction for leishmania was positive. He was diagnosed as a case of post kala azar derma...

A Community Patient Demographic System

OpenAIRE

Gabler, James M.; Simborg, Donald W.

1985-01-01

A Community Patient Demographic System is described. Its purpose is to link patient identification, demographic and insurance information among multiple organizations in a community or among multiple registration systems within the same organization. This function requires that there be a competent patient identification methodology and clear definition of local responsibilities for number assignment and database editing.

Yawning, fatigue and cortisol: expanding the Thompson Cortisol Hypothesis.

OpenAIRE

Thompson, Simon

2014-01-01

Yawning and its involvement in neurological disorders has become the new scientific conundrum. Cortisol levels are known to rise during stress and fatigue; yawning may occur when we are under stress or tired. However, the link between yawning, fatigue, and cortisol has not been fully understood. Expansion of the Thompson Cortisol Hypothesis proposes that the stress hormone, cortisol, is responsible for yawning and fatigue especially in people with incomplete innervation such as multiple sclero...

Chemical Peels

Science.gov (United States)

... care Kids’ zone Video library Find a dermatologist Chemical peels Overview Chemical peels: Overview Also called chemexfoliation , derma peeling Do ... Overview Chemical peels: FAQs Chemical peels: Preparation FAQs Chemical peels: FAQs To help you decide whether this ...

Pupillometry and Saccades as Objective mTBI Biomarker

Science.gov (United States)

2016-10-01

football , hockey, soccer, and rugby [5,6,12,13]. All of 306 D.V. Walsh et al. / Journal of the Neurological Sciences 370 (2016) 305–309these studies have...and multiple sclero- sis [16], not acutemTBI as seen in the present study. But a recent KD test study on subjects recruited from an emergency ...Silverberg, T.M. Luoto, J. Ohman, G.L. Iverson, Assessment of mild traumatic brain injury with the King-Devick Test in an emergency department sample

Mixing height derived from the DMI-HIRLAM NWP model, and used for ETEX dispersion modelling

Energy Technology Data Exchange (ETDEWEB)

Soerensen, J.H.; Rasmussen, A. [Danish Meteorological Inst., Copenhagen (Denmark)

1997-10-01

For atmospheric dispersion modelling it is of great significance to estimate the mixing height well. Mesoscale and long-range diffusion models using output from numerical weather prediction (NWP) models may well use NWP model profiles of wind, temperature and humidity in computation of the mixing height. This is dynamically consistent, and enables calculation of the mixing height for predicted states of the atmosphere. In autumn 1994, the European Tracer Experiment (ETEX) was carried out with the objective to validate atmospheric dispersion models. The Danish Meteorological Institute (DMI) participates in the model evaluations with the Danish Emergency Response Model of the Atmosphere (DERMA) using NWP model data from the DMI version of the High Resolution Limited Area Model (HIRLAM) as well as from the global model of the European Centre for Medium-Range Weather Forecast (ECMWF). In DERMA, calculation of mixing heights are performed based on a bulk Richardson number approach. Comparing with tracer gas measurements for the first ETEX experiment, a sensitivity study is performed for DERMA. Using DMI-HIRLAM data, the study shows that optimum values of the critical bulk Richardson number in the range 0.15-0.35 are adequate. These results are in agreement with recent mixing height verification studies against radiosonde data. The fairly large range of adequate critical values is a signature of the robustness of the method. Direct verification results against observed missing heights from operational radio-sondes released under the ETEX plume are presented. (au) 10 refs.

EMR management system for patient pulse data.

Science.gov (United States)

Lee, Junyoung

2012-10-01

The purpose of this study is to build an integrated medical information system for effective database management of clinical information and to improve the existing Electronic Medical Record (EMR)-based system that is currently being used in hospitals. The integrated medical information system of hospitals consists of an Order Communication System (OCS), Picture Archiving Communication System (PACS), and Laboratory Information System (LIS), as well as Electronic Medical Record (EMR). It is designed so that remote health screening and patient data search can be accessed through a high speed network-even in remote areas-in order to effectively manage data on medical treatment that patients received at their respective hospitals. The existing oriental treatment system is one in which the doctor requires the patient to visit the hospital in person, so as to be able to check the patient's pulse and measure it with his hand for proper diagnosis and treatment. However, due to the recent development of digitalized medical measurement equipment, not only can doctors now check a patient's pulse without touching it directly, but the measured data are computerized and stored into the database as the electronic obligation record. Thus, even if a patient cannot visit the hospital, proper medical treatment is available by analyzing the patient's medical history and diagnosis process in the remote area. Furthermore, when a comprehensive medical testing center system including the people medical examination and diverse physical examination is established, the quality of medical service is expected to be improved than now.

System for Collecting Biosignal Data from Multiple Patient Monitoring Systems.

Science.gov (United States)

Yoon, Dukyong; Lee, Sukhoon; Kim, Tae Young; Ko, JeongGil; Chung, Wou Young; Park, Rae Woong

2017-10-01

Biosignal data include important physiological information. For that reason, many devices and systems have been developed, but there has not been enough consideration of how to collect and integrate raw data from multiple systems. To overcome this limitation, we have developed a system for collecting and integrating biosignal data from two patient monitoring systems. We developed an interface to extract biosignal data from Nihon Kohden and Philips monitoring systems. The Nihon Kohden system has a central server for the temporary storage of raw waveform data, which can be requested using the HL7 protocol. However, the Philips system used in our hospital cannot save raw waveform data. Therefore, our system was connected to monitoring devices using the RS232 protocol. After collection, the data were transformed and stored in a unified format. From September 2016 to August 2017, we collected approximately 117 patient-years of waveform data from 1,268 patients in 79 beds of five intensive care units. Because the two systems use the same data storage format, the application software could be run without compatibility issues. Our system collects biosignal data from different systems in a unified format. The data collected by the system can be used to develop algorithms or applications without the need to consider the source of the data.

Current developments in clinical multiphoton tomography

Science.gov (United States)

König, Karsten; Weinigel, Martin; Breunig, Hans Georg; Gregory, Axel; Fischer, Peter; Kellner-Höfer, Marcel; Bückle, Rainer

2010-02-01

Two-photon microscopy has been introduced in 1990 [1]. 13 years later, CE-marked clinical multiphoton systems for 3D imaging of human skin with subcellular resolution have been launched by the JenLab company with the tomograph DermaInspectTM. In 2010, the second generation of clinical multiphoton tomographs was introduced. The novel mobile multiphoton tomograph MPTflexTM, equipped with a flexible articulated optical arm, provides an increased flexibility and accessibility especially for clinical and cosmetical examinations. The multiphoton excitation of fluorescent biomolecules like NAD(P)H, flavins, porphyrins, elastin, and melanin as well as the second harmonic generation of collagen is induced by picojoule femtosecond laser pulses from an tunable turn-key near infrared laser system. The ability for rapid highquality image acquisition, the user-friendly operation of the system, and the compact and flexible design qualifies this system to be used for melanoma detection, diagnostics of dermatological disorders, cosmetic research, and skin aging measurements as well as in situ drug monitoring and animal research. So far, more than 1,000 patients and volunteers have been investigated with the multiphoton tomographs in Europe, Asia, and Australia.

[Cognitive function in patients with systemic sclerosis].

Science.gov (United States)

Straszecka, J; Jonderko, G; Kucharz, E J; Brzezińska-Wcisło, L; Kotulska, A; Bogdanowski, T

1997-09-01

Central nervous system involvement is seldom reported in patients with systemic sclerosis (SSc). Cognitive functions were determined in 21 patients with definite SSc and 42 healthy controls. Thyroid function was also measured in order to eliminate the effect of hypothyroidism on cognitive functioning. It was found that the SSc patients with normal thyroid function showed defective long-term and recent memory, learning ability, criticism, perception and visuo-perceptual skills, their simple reaction time was prolonged. Similar but less advanced cognitive defects were shown in the SSc patients with overt or latent hypothyroidism. The obtained results indicate that the central nervous system involvement is more common in patients with SSc than it has been reported earlier.

Abnormal pain perception in patients with Multiple System Atrophy.

Science.gov (United States)

Ory-Magne, F; Pellaprat, J; Harroch, E; Galitzsky, M; Rousseau, V; Pavy-Le Traon, A; Rascol, O; Gerdelat, A; Brefel-Courbon, C

2018-03-01

Patients with Parkinson's disease or Multiple System Atrophy frequently experience painful sensations. The few studies investigating pain mechanisms in Multiple System Atrophy patients have reported contradictory results. In our study, we compared pain thresholds in Multiple System Atrophy and Parkinson's disease patients and healthy controls and evaluated the effect of l-DOPA on pain thresholds. We assessed subjective and objective pain thresholds (using a thermotest and RIII reflex), and pain tolerance in OFF and ON conditions, clinical pain, motor and psychological evaluation. Pain was reported in 78.6% of Multiple System Atrophy patients and in 37.5% of Parkinson's disease patients. In the OFF condition, subjective and objective pain thresholds were significantly lower in Multiple System Atrophy patients than in healthy controls (43.8 °C ± 1.3 vs 45.7 °C ± 0.8; p = 0.0005 and 7.4 mA ± 3.8 vs 13.7 mA ± 2.8; p = 0.002, respectively). They were also significantly reduced in Multiple System Atrophy compared to Parkinson's disease patients. No significant difference was found in pain tolerance for the 3 groups and in the effect of l-DOPA on pain thresholds in Multiple System Atrophy and Parkinson's disease patients. In the ON condition, pain tolerance tended to be reduced in Multiple System Atrophy versus Parkinson's disease patients (p = 0.05). Multiple System Atrophy patients had an increase in pain perception compared to Parkinson's disease patients and healthy controls. The l-DOPA effect was similar for pain thresholds in Multiple System Atrophy and Parkinson's disease patients, but tended to worsen pain tolerance in Multiple System Atrophy. Copyright © 2017 Elsevier Ltd. All rights reserved.

77 FR 11120 - Patient Safety Organizations: Voluntary Relinquishment From UAB Health System Patient Safety...

Science.gov (United States)

2012-02-24

... Organizations: Voluntary Relinquishment From UAB Health System Patient Safety Organization AGENCY: Agency for... notification of voluntary relinquishment from the UAB Health System Patient Safety Organization of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005...

Providi ng derma tologic ca re in Bots swana

African Journals Online (AJOL)

raoul

Additionally, for over a month, we experienced a hospital-wide shortage of doxycycline. This was the best formulary medication for treating common dermatologic problems, including bacterial skin infections and acne vulgaris. Fortunately, doxycycline is an inexpensive medication. (1.5Pula/0.22USD per tablet), and all of our ...

From Safe Systems to Patient Safety

DEFF Research Database (Denmark)

Aarts, J.; Nøhr, C.

2010-01-01

for the third conference with the theme: The ability to design, implement and evaluate safe, useable and effective systems within complex health care organizations. The theme for this conference was "Designing and Implementing Health IT: from safe systems to patient safety". The contributions have reflected...... and implementation of safe systems and thus contribute to the agenda of patient safety? The contributions demonstrate how the health informatics community has contributed to the performance of significant research and to translating research findings to develop health care delivery and improve patient safety......This volume presents the papers from the fourth International Conference on Information Technology in Health Care: Socio-technical Approaches held in Aalborg, Denmark in June 2010. In 2001 the first conference was held in Rotterdam, The Netherlands with the theme: Sociotechnical' approaches...

[Development of operation patient security detection system].

Science.gov (United States)

Geng, Shu-Qin; Tao, Ren-Hai; Zhao, Chao; Wei, Qun

2008-11-01

This paper describes a patient security detection system developed with two dimensional bar codes, wireless communication and removal storage technique. Based on the system, nurses and correlative personnel check code wait operation patient to prevent the defaults. The tests show the system is effective. Its objectivity and currency are more scientific and sophisticated than current traditional method in domestic hospital.

Construction of a patient observation system using KINECTTM

International Nuclear Information System (INIS)

Miyaura, Kazunori; Kumazaki, Yu; Kato, Shingo; Fukushima, Chika; Saitoh, Hidetoshi

2014-01-01

Improvement in the positional accuracy of irradiation is expected by capturing patient motion (intra-fractional error) during irradiation. The present study reports the construction of a patient observation system using Microsoft® KINECT TM . By tracking movement, we made it possible to add a depth component to the acquired position coordinates and to display three-axis (X, Y, and Z) movement. Moreover, the developed system can be displayed in a graph which is constructed from the coordinate position at each time interval. Using the developed system, an observer can easily visualize patient movement. When the body phantom was moved a known distance in the X, Y, and Z directions, good coincidence was shown with each axis. We built a patient observation system which captures a patient's motion using KINECT TM .

Echocardiographic evaluation of patients with systemic lupus erythematosus

International Nuclear Information System (INIS)

Hameed, S.; Malik, L.M.

2007-01-01

Cardiac disease occurs in various forms and is a common cause of death in systemic lupus erythematosus. The objective was to detect cardiac abnormalities by transthoracic echocardiography and determine their association in SLE patients. We conducted a transthoracic echocardiographic study in 48 inpatients with systemic lupus erythematosus. Clinical and serological evaluation to confirm the diagnosis of lupus was done in all patients. There were 44 women (91.6%) and 4 men with a mean age of 26 years. Anti ds DNA was positive in 34 patients (68.75%). Transthoracic echocardiography revealed abnormality in 28 patients (58.33%). Of these, 16 patients (57%) had pericardial involvement with variable amount of effusion. Twelve patients (43%) had some valvular involvement and some degree of myocardial systolic dysfunction was found in 12 patients (43%). Only 4 patients (14%) had all three abnormalities. Anti ds DNA was positive in 71% of patients with cardiac abnormalities. Cardiac involvement is common in patients with systemic lupus erythematosus. Serological abnormalities had an association with cardiac abnormalities, and were found to be more prevalent in young patients. (author)

A Web-based patient information system--identification of patients' information needs.

Science.gov (United States)

Hassling, Linda; Babic, Ankica; Lönn, Urban; Casimir-Ahn, Henrik

2003-06-01

Research described here was carried out to explore possibilities of creating a web-based patient information system within the areas of thoracic surgery. Data were collected to distinguish and assess the actual information needs of patients (1) prior to surgical treatment, (2) before discharge, and (3) 8 months after the hospitalization using a follow-up questionnaire. Interviews were performed with patients undergoing heart surgery. The study included material of 19 consecutive patients undergoing coronary artery bypass surgery (12) and valve replacement (7), age 35-74, 13 males and 6 females with nonacademic background. Patient satisfaction with given information was high. Analysis of the interviews held at the hospital resulted in seven different categories describing and giving a picture of the patients' information needs and apprehension of received care. The results found in this study can be used as guidance for developers in their design and development process of a health information system.

Patient and health system delay among patients with pulmonary tuberculosis in Beira city, Mozambique.

Science.gov (United States)

Saifodine, Abuchahama; Gudo, Paula Samo; Sidat, Mohsin; Black, James

2013-06-07

TB control is based on the rapid identification of cases and their effective treatment. However, many studies have shown that there are important delays in diagnosis and treatment of patients with TB. The purpose of this study was to assess the prevalence of and identify risk factors associated with patient delay and health system delay among newly diagnosed patients with pulmonary TB. A cross sectional study was carried out in Beira city, Mozambique between September 2009 and February 2010. Patients in the first month of treatment were consecutively selected to this study if they had a diagnosis of pulmonary TB, had no history of previous TB treatment, and were 18 years or older and provided informed consent. Data was obtained through a questionnaire administered to the patients and from patients' files. Among the 622 patients included in the study the median age was 32 years (interquartile range, 26-40) and 272 (43.7%) were females. The median total delay, patient delay and health system delay was 150 days (interquartile range, 91-240), 61 days (28-113) and 62 days (37-120), respectively. The contribution of patient delay and health system delay to total delay was similar. Farming, visiting first a traditional healer, low TB knowledge and coexistence of a chronic disease were associated with increased patient delay. More than two visits to a health facility, farming and coexistence of a chronic disease were associated with increased health system delay. This study revealed a long total delay with a similar contribution of patient delay and health system delay. To reduce the total delay in this setting we need a combination of interventions to encourage patients to seek appropriate health care earlier and to expedite TB diagnosis within the health care system.

Development of Patient Status-Based Dynamic Access System for Medical Information Systems

Directory of Open Access Journals (Sweden)

Chang Won Jeong

2015-06-01

Full Text Available Recently, the hospital information system environment using IT communication technology and utilization of medical information has been increasing. In the medical field, the medical information system only supports the transfer of patient information to medical staff through an electronic health record, without information about patient status. Hence, it needs a method of real-time monitoring for the patient. Also, in this environment, a secure method in approaching healthcare through various smart devices is required. Therefore, in this paper, in order to classify the status of the patients, we propose a dynamic approach of the medical information system in a hospital information environment using the dynamic access control method. Also, we applied the symmetric method of AES (Advanced Encryption Standard. This was the best encryption algorithm for sending and receiving biological information. We can define usefulness as the dynamic access application service based on the final result of the proposed system. The proposed system is expected to provide a new solution for a convenient medical information system.

Patient QA systems for rotational radiation therapy

DEFF Research Database (Denmark)

Fredh, Anna; Scherman, J.B.; Munck af Rosenschöld, Per Martin

2013-01-01

The purpose of the present study was to investigate the ability of commercial patient quality assurance (QA) systems to detect linear accelerator-related errors.......The purpose of the present study was to investigate the ability of commercial patient quality assurance (QA) systems to detect linear accelerator-related errors....

A Home Integral Telecare System for HIV/AIDS Patients.

Science.gov (United States)

Caceres, Cesar; Gomez, Enrique J; Garcia, Felipe; Chausa, Paloma; Guzman, Jorge; Del Pozo, Francisco; Gatell, Jose Maria

2005-01-01

VIHrtual Hospital is a telemedicine web system for improving home integral care of chronic HIV patients through the Internet. Using the videoconference, chat or messaging tools included in the system, patients can visit their healthcare providers (physician, psychologist, nurse, psychiatrist, pharmacist, and social worker), having these access to the Electronic Patient Record. The system also provides a telepharmacy service that controls treatment adherence and side effects, sending the medication to the patient's home by courier. A virtual community has been created, facilitating communication between patients and improving the collaboration between professionals, creating a care plan for each patient. As a complement, there is a virtual library where users can find validated HIV/AIDS information helping to enhance prevention. This system has been developed using low cost technologies in order to extend the number of patients involved in its trial. Thus, VIHrtual Hospital is now on trial in the Hospital Clinic (Barcelona, Spain) involving a hundred patients and twenty healthcare professionals during two years.Although we are still waiting for the final results of the trial, we can already say that the use of telemedicine systems developed ad hoc for a chronic disease, like HIV/AIDS, improve the quality of care of the patients and their care team. The system described is a good example of the possibilities that technologies are offering to create new chronic patient care models based on telemedicine.

Assessment of a personalized and distributed patient guidance system.

Science.gov (United States)

Peleg, Mor; Shahar, Yuval; Quaglini, Silvana; Broens, Tom; Budasu, Roxana; Fung, Nick; Fux, Adi; García-Sáez, Gema; Goldstein, Ayelet; González-Ferrer, Arturo; Hermens, Hermie; Hernando, M Elena; Jones, Val; Klebanov, Guy; Klimov, Denis; Knoppel, Daniel; Larburu, Nekane; Marcos, Carlos; Martínez-Sarriegui, Iñaki; Napolitano, Carlo; Pallàs, Àngels; Palomares, Angel; Parimbelli, Enea; Pons, Belén; Rigla, Mercedes; Sacchi, Lucia; Shalom, Erez; Soffer, Pnina; van Schooten, Boris

2017-05-01

The MobiGuide project aimed to establish a ubiquitous, user-friendly, patient-centered mobile decision-support system for patients and for their care providers, based on the continuous application of clinical guidelines and on semantically integrated electronic health records. Patients would be empowered by the system, which would enable them to lead their normal daily lives in their regular environment, while feeling safe, because their health state would be continuously monitored using mobile sensors and self-reporting of symptoms. When conditions occur that require medical attention, patients would be notified as to what they need to do, based on evidence-based guidelines, while their medical team would be informed appropriately, in parallel. We wanted to assess the system's feasibility and potential effects on patients and care providers in two different clinical domains. We describe MobiGuide's architecture, which embodies these objectives. Our novel methodologies include a ubiquitous architecture, encompassing a knowledge elicitation process for parallel coordinated workflows for patients and care providers; the customization of computer-interpretable guidelines (CIGs) by secondary contexts affecting remote management and distributed decision-making; a mechanism for episodic, on demand projection of the relevant portions of CIGs from a centralized, backend decision-support system (DSS), to a local, mobile DSS, which continuously delivers the actual recommendations to the patient; shared decision-making that embodies patient preferences; semantic data integration; and patient and care provider notification services. MobiGuide has been implemented and assessed in a preliminary fashion in two domains: atrial fibrillation (AF), and gestational diabetes Mellitus (GDM). Ten AF patients used the AF MobiGuide system in Italy and 19 GDM patients used the GDM MobiGuide system in Spain. The evaluation of the MobiGuide system focused on patient and care providers

Fluorescence lifetime imaging of skin cancer

Science.gov (United States)

Patalay, Rakesh; Talbot, Clifford; Munro, Ian; Breunig, Hans Georg; König, Karsten; Alexandrov, Yuri; Warren, Sean; Neil, Mark A. A.; French, Paul M. W.; Chu, Anthony; Stamp, Gordon W.; Dunsby, Chris

2011-03-01

Fluorescence intensity imaging and fluorescence lifetime imaging microscopy (FLIM) using two photon microscopy (TPM) have been used to study tissue autofluorescence in ex vivo skin cancer samples. A commercially available system (DermaInspect®) was modified to collect fluorescence intensity and lifetimes in two spectral channels using time correlated single photon counting and depth-resolved steady state measurements of the fluorescence emission spectrum. Uniquely, image segmentation has been used to allow fluorescence lifetimes to be calculated for each cell. An analysis of lifetime values obtained from a range of pigmented and non-pigmented lesions will be presented.

Patient Populations, Clinical Associations, and System Efficiency in Healthcare Delivery System

Science.gov (United States)

Liu, Yazhuo

The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes' perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease' correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.

New system for bathing bedridden patients

Science.gov (United States)

Greenleaf, J. E.; Staley, R. A.; Payne, P. A.

1973-01-01

Multihead shower facility can be used with minimal patient handling. Waterproof curtain allows patient to bathe with his head out of shower. He can move completely inside shower to wash his face and hair. Main advantage of shower system is time saved in giving bath.

Systemic lupus erythematosus in a male patient

Science.gov (United States)

Sibarani, H.; Zubir, Z.

2018-03-01

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder with a broad spectrum of clinical presentations. Female to male ratio is approximately 9:1.A 20 years old male was admitted to HAM Hospital 3 months ago with chief complaint pain in both knees joint. After anamneses, physical examination and laboratory test the patient was diagnosed with systemic lupus erythematosus. The patient tested positive for ANA and anti-ds-DNA antibody test. The patient was with giving non-biologic DMARDS @myfortic 360mg, methylprednisolone, chloroquine and other symptomatic drugs.

A Computerized Hospital Patient Information Management System

Science.gov (United States)

Wig, Eldon D.

1982-01-01

The information processing needs of a hospital are many, with varying degrees of complexity. The prime concern in providing an integrated hospital information management system lies in the ability to process the data relating to the single entity for which every hospital functions - the patient. This paper examines the PRIMIS computer system developed to accommodate hospital needs with respect to a central patient registry, inpatients (i.e., Admission/Transfer/Discharge), and out-patients. Finally, the potential for expansion to permit the incorporation of more hospital functions within PRIMIS is examined.

Web-based audiovisual patient information system--a study of preoperative patient information in a neurosurgical department.

Science.gov (United States)

Gautschi, Oliver P; Stienen, Martin N; Hermann, Christel; Cadosch, Dieter; Fournier, Jean-Yves; Hildebrandt, Gerhard

2010-08-01

In the current climate of increasing awareness, patients are demanding more knowledge about forthcoming operations. The patient information accounts for a considerable part of the physician's daily clinical routine. Unfortunately, only a small percentage of the information is understood by the patient after solely verbal elucidation. To optimise information delivery, different auxiliary materials are used. In a prospective study, 52 consecutive stationary patients, scheduled for an elective lumbar disc operation were asked to use a web-based audiovisual patient information system. A combination of pictures, text, tone and video about the planned surgical intervention is installed on a tablet personal computer presented the day before surgery. All patients were asked to complete a questionnaire. Eighty-four percent of all participants found that the audiovisual patient information system lead to a better understanding of the forthcoming operation. Eighty-two percent found that the information system was a very helpful preparation before the pre-surgical interview with the surgeon. Ninety percent of all participants considered it meaningful to provide this kind of preoperative education also to patients planned to undergo other surgical interventions. Eighty-four percent were altogether "very content" with the audiovisual patient information system and 86% would recommend the system to others. This new approach of patient information had a positive impact on patient education as is evident from high satisfaction scores. Because patient satisfaction with the informed consent process and understanding of the presented information improved substantially, the audiovisual patient information system clearly benefits both surgeons and patients.

Unmet patient needs in systemic sclerosis.

Science.gov (United States)

Rubenzik, Tamara T; Derk, Chris T

2009-04-01

Assessment of systemic sclerosis patients has not directly addressed functioning from the patient's perspective. With this study, we aim to gain our patient's point of view by using a questionnaire to describe their unmet needs and understanding what demographic parameters influence these. A computer randomization program selected 50 patients, from 242 systemic sclerosis patients actively followed at our rheumatology clinic, to receive a survey about unmet needs. Twenty-five patients responded to the survey. Of 81 questions, 9 provided demographic data, whereas 72 questions addressed physical, daily living, psychologic, spiritual, existential, health services, health information, social support, and employment issues. A 4-point scale from no need to high need was used to rate all questions. Significant need was considered any issue for which more than 50% of patients reported a high need. The Fisher exact test was used to compare different demographic variables to unmet patient needs. The psychologic/spiritual/existential category had 9 questions reaching significance, the health services category had 5 significant questions, the physical category had 4 significant questions. Patients who had not attended college were more likely to have higher needs than patients who completed a college degree. Unmarried patients reported higher needs in 8 measures as compared with married patients, and patients in rural areas had higher needs in social support needs. The greatest prevalence of unmet needs in scleroderma patients were in the psychologic/spiritual/existential domain, such as being unable to do things they used to do, fear that the disease will worsen, anxiety and stress, feeling down or depressed, fears of physical disability, uncertainty about the future, change in appearance, keeping a positive outlook, and feeling in control. Significant differences were observed in unmet needs based on education, marital status, location, knowledge of disease, and age

Developing a patient-led electronic feedback system for quality and safety within Renal PatientView.

Science.gov (United States)

Giles, Sally J; Reynolds, Caroline; Heyhoe, Jane; Armitage, Gerry

2017-03-01

It is increasingly acknowledged that patients can provide direct feedback about the quality and safety of their care through patient reporting systems. The aim of this study was to explore the feasibility of patients, healthcare professionals and researchers working in partnership to develop a patient-led quality and safety feedback system within an existing electronic health record (EHR), known as Renal PatientView (RPV). Phase 1 (inception) involved focus groups (n = 9) and phase 2 (requirements) involved cognitive walkthroughs (n = 34) and 1:1 qualitative interviews (n = 34) with patients and healthcare professionals. A Joint Services Expert Panel (JSP) was convened to review the findings from phase 1 and agree the core principles and components of the system prototype. Phase 1 data were analysed using a thematic approach. Data from phase 1 were used to inform the design of the initial system prototype. Phase 2 data were analysed using the components of heuristic evaluation, resulting in a list of core principles and components for the final system prototype. Phase 1 identified four main barriers and facilitators to patients feeding back on quality and safety concerns. In phase 2, the JSP agreed that the system should be based on seven core principles and components. Stakeholders were able to work together to identify core principles and components for an electronic patient quality and safety feedback system in renal services. Tensions arose due to competing priorities, particularly around anonymity and feedback. Careful consideration should be given to the feasibility of integrating a novel element with differing priorities into an established system with existing functions and objectives. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Nanomedicine applications towards the cure of HIV.

Science.gov (United States)

Lisziewicz, Julianna; Tőke, Enikő R

2013-01-01

Combination antiretroviral therapy (cART) successfully suppresses HIV replication. However, daily and lifelong treatment is necessary to manage patient illness because cART neither eradicates infected cells from reservoirs nor reconstitutes HIV-specific immunity that could kill infected cells. Toward the cure of HIV, different nanomedicine classes have been developed with the following disease-modifying properties: to eradicate the virus by activation of latently infected CD4+ T-cells and reservoirs flushing; to kill the infected cells in the reservoirs by boosting of HIV-specific T cells; and to prevent infection by the use of microbicides with improved epithelial penetration and drug half-life. Preclinical and clinical trials consistently demonstrated that DermaVir, the most advanced nanomedicine, induces long-lasting memory T-cell responses and reduces viral load in comparison with placebo. DermaVir and the nanomedicine pipelines have the potential to improve the health of HIV-infected people at lower costs, to decrease antiretroviral drug exposure, and to contribute to the cure of HIV/AIDS. Despite the leaps and bounds in the development of antiretroviral therapy, HIV remains a significant public health challenge. In this review, applications of nanomedicine- based technologies are discussed in the context of HIV treatment, including virus elimination by activation of latently infected CD4+ T-cells; infected cell elimination in the reservoirs by boosting HIV-specific T cells, and by preventing infection by the use of microbicides with improved epithelial penetration and drug half-life. Copyright © 2013 Elsevier Inc. All rights reserved.

Clinical presentation in patients with systemic sclerosis

International Nuclear Information System (INIS)

Silvarino, R.; Rebella, M.; Alonso, J.; Cairoli, E.

2009-01-01

Introduction: systemic sclerosis is an autoimmune disease characterized by endothelial damage, and skin, vessel and internal organ fibrosis and inflammation. There are differences in terms of frequency, severity and prognosis for the different ethnic groups, what reinforces the importance of the study in each geographical region with the purpose of enabling early diagnosis of its incipient symptoms.Methods: we conducted a descriptive and retrospective study form March 2006 through March 2008, including patients with a final diagnosis of systemic sclerosis, who are treated at the Systemic Autoimmune Diseases Unit at the Clinicas Hospital. Results: 31 women were included in the study, average follow-up of patients was 39.2 months, and average age at the time of diagnosis was 47.6 years. Eleven patients (35,5) presented diffuse disease and 20 (64.5) of them evidenced limited disease. Thirty patients presented Raynaud's phenomenon. In 92 of cases capilaroscopy showed a sclerodermiform pattern. In terms of the respiratory system, we found interstitial pathology in 25 of cases, pulmonary arterial hypertension in 22.2 and are restrictive pattern in respiratory function studies in 35.5. Also, 67.7 presented digestive manifestations and 9.6 developed sclerodermic renal crisis. We found anti-nuclear antibodies (ANA) in 29 out of 31 patients (93,5) patients; 16 presented anticentromere antibodies and five anti-topoisomerasa-I antibodies. The four patients (12.9)who died during follow-up presented common elements such as diffuse sclerosis, digital ulcers and severe respiratory compromise. Conclusions: the clinical and immune characteristics found in our study were similar to those described in other series. Should there be no specific treatment, it is essential to perform regular assessment of visceral impact in order to control and delay complications which result in high morbimortality rates. (author) [es

BCI-FES system for neuro-rehabilitation of stroke patients

Science.gov (United States)

Jure, Fabricio A.; Carrere, Lucía C.; Gentiletti, Gerardo G.; Tabernig, Carolina B.

2016-04-01

Nowadays, strokes are a growing cause of mortality and many people remain with motor sequelae and troubles in the daily activities. To treat this sequelae, alternative rehabilitation techniques are needed. In this article a Brain Computer Interface (BCI) system to control a Functional Electrical Stimulation (FES) system is presented. It can be used as a novel tool in easy setup clinical routines, to improve the rehabilitation process by mean of detecting patient´s motor intention, performing it by FES and finally receiving appropriate feedback The BCI-FES system presented here, consists of three blocks: the first one decodes the patient´s intention and it is composed by the patient, the acquisition hardware and the processing software (Emotiv EPOC®). The second block, based on Arduino’s technology, transforms the information into a valid command signal. The last one excites the patient´s neuromuscular system by means of a FES device. In order to evaluate the cerebral activity sensed by the device, topographic maps were obtained. The BCI-FES system was able to detect the patient´s motor intention and control the FES device. At the time of this publication, the system it’s being employing in a rehabilitation program with patients post stroke.

Tailored patient information using a database system: Increasing patient compliance in a day surgery setting

DEFF Research Database (Denmark)

Grode, Jesper Nicolai Riis; Grode, Louise; Steinsøe, Ulla

rehabilitation. The hospital is responsible of providing the patients with accurate information enabling the patient to prepare for surgery. Often patients are overloaded with uncoordinated information, letters and leaflets. The contribution of this project is a database system enabling health professionals...... to empower patients through tailored individualized information. Performing 6500 operations per year at our Day Surgery Centre, health professionals need a computer based system to create individualized information material. Health professionals must be able to adapt the information material quickly...... was established to support these requirements. A relational database system holds all information pieces in a granular, structured form. Each individual piece of information can be joined with other pieces thus supporting the tailoring of information. A web service layer caters for integration with output systems...

Development of the electronic patient record system based on problem oriented system.

Science.gov (United States)

Uto, Yumiko; Iwaanakuchi, Takashi; Muranaga, Fuminori; Kumamoto, Ichiro

2013-01-01

In Japan, POS (problem oriented system) is recommended in the clinical guideline. Therefore, the records are mainly made by SOAP. We developed a system mainly with a function which enabled our staff members of all kinds of professions including doctors to enter the patients' clinical information as an identical record, regardless if they were outpatients or inpatients, and to observe the contents chronologically. This electric patient record system is called "e-kanja recording system". On this system, all staff members in the medical team can now share the same information. Moreover, the contents can be reviewed by colleagues; the quality of records has been improved as it is evaluated by the others.

Patient Accounting Systems: Are They Fit with the Users' Requirements?

Science.gov (United States)

Ayatollahi, Haleh; Nazemi, Zahra; Haghani, Hamid

2016-01-01

A patient accounting system is a subsystem of a hospital information system. This system like other information systems should be carefully designed to be able to meet users' requirements. The main aim of this research was to investigate users' requirements and to determine whether current patient accounting systems meet users' needs or not. This was a survey study, and the participants were the users of six patient accounting systems used in 24 teaching hospitals. A stratified sampling method was used to select the participants (n = 216). The research instruments were a questionnaire and a checklist. The mean value of ≥3 showed the importance of each data element and the capability of the system. Generally, the findings showed that the current patient accounting systems had some weaknesses and were able to meet between 70% and 80% of users' requirements. The current patient accounting systems need to be improved to be able to meet users' requirements. This approach can also help to provide hospitals with more usable and reliable financial information.

Patient Accounting Systems: Are They Fit with the Users' Requirements?

Science.gov (United States)

Ayatollahi, Haleh; Nazemi, Zahra

2016-01-01

Objectives A patient accounting system is a subsystem of a hospital information system. This system like other information systems should be carefully designed to be able to meet users' requirements. The main aim of this research was to investigate users' requirements and to determine whether current patient accounting systems meet users' needs or not. Methods This was a survey study, and the participants were the users of six patient accounting systems used in 24 teaching hospitals. A stratified sampling method was used to select the participants (n = 216). The research instruments were a questionnaire and a checklist. The mean value of ≥3 showed the importance of each data element and the capability of the system. Results Generally, the findings showed that the current patient accounting systems had some weaknesses and were able to meet between 70% and 80% of users' requirements. Conclusions The current patient accounting systems need to be improved to be able to meet users' requirements. This approach can also help to provide hospitals with more usable and reliable financial information. PMID:26893945

A 12-year retrospective review of bullous systemic lupus erythematosus in cutaneous and systemic lupus erythematosus patients.

Science.gov (United States)

Chanprapaph, K; Sawatwarakul, S; Vachiramon, V

2017-10-01

Objective The aim of this study was to investigate the clinical features, laboratory findings, systemic manifestations, treatment and outcome of patients with bullous systemic lupus erythematosus in a tertiary care center in Thailand. Methods We performed a retrospective review from 2002 to 2014 of all patients who fulfilled the diagnostic criteria for bullous systemic lupus erythematosus to evaluate for the clinical characteristics, extracutaneous involvement, histopathologic features, immunofluorescence pattern, serological abnormalities, internal organ involvement, treatments and outcome. Results Among 5149 patients with cutaneous lupus erythematosus and/or systemic lupus erythematosus, 15 developed vesiculobullous lesions. Ten patients had validation of the diagnosis of bullous systemic lupus erythematosus, accounting for 0.19%. Bullous systemic lupus erythematosus occurred after the diagnosis of systemic lupus erythematosus in six patients with a median onset of 2.5 months (0-89). Four out of 10 patients developed bullous systemic lupus erythematosus simultaneously with systemic lupus erythematosus. Hematologic abnormalities and renal involvement were found in 100% and 90%, respectively. Polyarthritis (40%) and serositis (40%) were less frequently seen. Systemic corticosteroids, immunosuppressants, antimalarials and dapsone offered resolution of cutaneous lesions. Conclusion Bullous systemic lupus erythematosus is an uncommon presentation of systemic lupus erythematosus. Blistering can occur following or simultaneously with established systemic lupus erythematosus. We propose that clinicians should carefully search for systemic involvement, especially hematologic and renal impairment, in patients presenting with bullous systemic lupus erythematosus.

Patient Posture Monitoring System Based on Flexible Sensors

Directory of Open Access Journals (Sweden)

Youngsu Cha

2017-03-01

Full Text Available Monitoring patients using vision cameras can cause privacy intrusion problems. In this paper, we propose a patient position monitoring system based on a patient cloth with unobtrusive sensors. We use flexible sensors based on polyvinylidene fluoride, which is a flexible piezoelectric material. Theflexiblesensorsareinsertedintopartsclosetothekneeandhipoftheloosepatientcloth. We measure electrical signals from the sensors caused by the piezoelectric effect when the knee and hip in the cloth are bent. The measured sensor outputs are transferred to a computer via Bluetooth. We use a custom-made program to detect the position of the patient through a rule-based algorithm and the sensor outputs. The detectable postures are based on six human motions in and around a bed. The proposed system can detect the patient positions with a success rate over 88 percent for three patients.

Supporting the Support System: How Assessment and Communication Can Help Patients and Their Support Systems.

Science.gov (United States)

Harkey, Jane; Young, Jared; Carter, Jolynne Jo; Demoratz, Michael

The benefits of having a support system, such as social relationships with close friends and family, have been well documented for patients with serious health issues. As scientific evidence has shown, individuals who have the lowest level of involvement in social relationships face a greater mortality risk. Support systems, however, are not infallible. Relationship stress can have a negative impact on people-patient and caregiver alike-behaviorally, psychosocially, and physiologically. The purpose of this article is to encourage case managers who take a patient-centered approach to also consider the existence and extent of the support system, as well as any stresses or tensions that are observable within the support system. Although the case manager is ethically obliged to advocate for the individual receiving case management services, that advocacy can be extended to the support system for the good of all. This discussion applies to numerous case management practices and work settings including (but not limited to) hospital-based case management, home health, geriatrics, catastrophic case management, mental health, palliative care, and end of life/hospice. As part of the assessment phase of the case management process, case managers determine the extent of the patient's support system or social support network such as family and close friends. Although their advocacy is primarily for the patient receiving case management services, case managers also become aware of the needs of the support system members as they face their loved one's serious illness, severe injury, geriatric care demands, or end of life. Case managers can use their communication skills, especially motivational interviewing, with patients and their support systems to identify stresses and issues that can impact the pursuit of health goals. In addition, case managers ensure that individuals and their support systems are kept informed such as about the health condition, stage of disease, plan of

IDIOPATHIC ERYTHEMA NODOSUM AND PREGNANCY: DESCRIPTION OF A CASE

Directory of Open Access Journals (Sweden)

B S Belov

2009-01-01

Full Text Available Erythema nodosum (EN is a dermatosis of unclear etiology, which is characterized by vascular lesion of the skin; it shows itself as hard painful nodes occurring in the derma or subcutaneous fat on the shins and thighs. EN has been described in many chronic infectious processes with some features of its clinical course. In most cases, the disease is regarded as a nonspecific immunoinflammatory response to a wide spectrum of etiological factors, including that in gestation, which presents certain problems in curing the patient. The example given below supports the need for timely testing for infectious markers in pregnancy and, in case of evolving EN, for using not only nonsteroidal anti-inflammatory drugs, but also pathogenetic treatment.

Brain magnetic resonance imaging findings in patients with systemic sclerosis.

Science.gov (United States)

Mohamed, Reem H A; Nassef, Amr A

2010-02-01

Systemic sclerosis is a multisystem disease where functional and structural abnormalities of small blood vessels prevail. Recently, transient ischemic attacks, ischemic stroke, and hemorrhages have been reported as primary consequence of vascular central nervous system affection in systemic sclerosis. Magnetic resonance imaging (MRI) is considered to be the most sensitive diagnostic technique for detecting symptomatic and asymptomatic lesions in the brain in cases of multifocal diseases. Evaluate brain changes in patients with systemic sclerosis using MRI. Thirty female patients with systemic sclerosis aged 27-61 years, with disease duration of 1-9 years and with no history of other systemic disease or cerebrovascular accidents, were enrolled. An age-matched female control group of 30 clinically normal subjects, underwent brain MR examination. Central nervous system involvement in the form of white matter hyperintense foci of variable sizes were found in significantly abundant forms in systemic sclerosis patients on MR evaluation than in the age-related control group, signifying a form of central nervous system vasculopathy. Such foci showed no definite correlation with disease duration, yet they showed significant correlation to severity of peripheral vascular disease, headaches, fainting attacks and depression in the group under study. Asymptomatic as well as symptomatic central nervous system ischemic vasculopathy is not uncommon in systemic sclerosis patients and MRI is considered a sensitive noninvasive screening tool for early detection of CNS involvement in patients with systemic sclerosis.

Patient safety - the role of human factors and systems engineering.

Science.gov (United States)

Carayon, Pascale; Wood, Kenneth E

2010-01-01

Patient safety is a global challenge that requires knowledge and skills in multiple areas, including human factors and systems engineering. In this chapter, numerous conceptual approaches and methods for analyzing, preventing and mitigating medical errors are described. Given the complexity of healthcare work systems and processes, we emphasize the need for increasing partnerships between the health sciences and human factors and systems engineering to improve patient safety. Those partnerships will be able to develop and implement the system redesigns that are necessary to improve healthcare work systems and processes for patient safety.

Patient Safety: The Role of Human Factors and Systems Engineering

Science.gov (United States)

Carayon, Pascale; Wood, Kenneth E.

2011-01-01

Patient safety is a global challenge that requires knowledge and skills in multiple areas, including human factors and systems engineering. In this chapter, numerous conceptual approaches and methods for analyzing, preventing and mitigating medical errors are described. Given the complexity of healthcare work systems and processes, we emphasize the need for increasing partnerships between the health sciences and human factors and systems engineering to improve patient safety. Those partnerships will be able to develop and implement the system redesigns that are necessary to improve healthcare work systems and processes for patient safety. PMID:20543237

Development and innovation of system resources to optimize patient care.

Science.gov (United States)

Johnson, Thomas J; Brownlee, Michael J

2018-04-01

Various incremental and disruptive healthcare innovations that are occurring or may occur are discussed, with insights on how multihospital health systems can prepare for the future and optimize the continuity of patient care provided. Innovation in patient care is occurring at an ever-increasing rate, and this is especially true relative to the transition of patients through the care continuum. Health systems must leverage their ability to standardize and develop electronic health record (EHR) systems and other infrastructure necessary to support patient care and optimize outcomes; examples include 3D printing of patient-specific medication dosage forms to enhance precision medicine, the use of drones for medication delivery, and the expansion of telehealth capabilities to improve patient access to the services of pharmacists and other healthcare team members. Disruptive innovations in pharmacy services and delivery will alter how medications are prescribed and delivered to patients now and in the future. Further, technology may also fundamentally alter how and where pharmacists and pharmacy technicians care for patients. This article explores the various innovations that are occurring and that will likely occur in the future, particularly as they apply to multihospital health systems and patient continuity of care. Pharmacy departments that anticipate and are prepared to adapt to incremental and disruptive innovations can demonstrate value in the multihospital health system through strategies such as optimizing the EHR, identifying telehealth opportunities, supporting infrastructure, and integrating services. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Wearable impedance monitoring system for dialysis patients.

Science.gov (United States)

Bonnet, S; Bourgerette, A; Gharbi, S; Rubeck, C; Arkouche, W; Massot, B; McAdams, E; Montalibet, A; Jallon, P

2016-08-01

This paper describes the development and the validation of a prototype wearable miniaturized impedance monitoring system for remote monitoring in home-based dialysis patients. This device is intended to assess the hydration status of dialysis patients using calf impedance measurements. The system is based on the low-power AD8302 component. The impedance calibration procedure is described together with the Cole parameter estimation and the hydric volume estimation. Results are given on a test cell to validate the design and on preliminary calf measurements showing Cole parameter variations during hemodialysis.

Patient relationship management: an overview and study of a follow-up system.

Science.gov (United States)

Oinas-Kukkonen, Harri; Räisänen, Teppo; Hummastenniemi, Niko

2008-01-01

Customer relationship management research is utilized to explain the need for a more patient-oriented support in patient care. This article presents a European study on how various hospital units of a single healthcare organization have utilized a patient relationship management system--in particular a patient treatment follow-up system--and how it affects patient care and the knowledge work performed by the medical staff. Eight physicians were interviewed at a university hospital on whether patient treatment was improved through a follow-up system that had been in use in the case organization for three years. The interviewees represented various hospital units, and all of them had used the system at their own unit. The results indicate that it is possible to improve patient care through more personalized treatment. The follow-up treatment system seems to be a tool to create and maintain better communication with the patients rather than just a technological solution. It may help better understand and analyze both individual patients and patient groups. For individual physicians it provides a way to reflect professional skills. The system was lacking in its support for one-to-one communication with patients. Nevertheless, the system is an example of patient relationship management which may help healthcare units to move towards a more patient-oriented care.

Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus

International Nuclear Information System (INIS)

Hosenpud, J.D.; Montanaro, A.; Hart, M.V.; Haines, J.E.; Specht, H.D.; Bennett, R.M.; Kloster, F.E.

1984-01-01

Accelerated coronary artery disease and myocardial infarction in young patients with systemic lupus erythematosus is well documented; however, the prevalence of coronary involvement is unknown. Accordingly, 26 patients with systemic lupus were selected irrespective of previous cardiac history to undergo exercise thallium-201 cardiac scintigraphy. Segmental perfusion abnormalities were present in 10 of the 26 studies (38.5 percent). Five patients had reversible defects suggesting ischemia, four patients had persistent defects consistent with scar, and one patient had both reversible and persistent defects in two areas. There was no correlation between positive thallium results and duration of disease, amount of corticosteroid treatment, major organ system involvement or age. Only a history of pericarditis appeared to be associated with positive thallium-201 results (p less than 0.05). It is concluded that segmental myocardial perfusion abnormalities are common in patients with systemic lupus erythematosus. Whether this reflects large-vessel coronary disease or small-vessel abnormalities remains to be determined

Automatic patient respiration failure detection system with wireless transmission

Science.gov (United States)

Dimeff, J.; Pope, J. M.

1968-01-01

Automatic respiration failure detection system detects respiration failure in patients with a surgically implanted tracheostomy tube, and actuates an audible and/or visual alarm. The system incorporates a miniature radio transmitter so that the patient is unencumbered by wires yet can be monitored from a remote location.

[Classification of severely injured patients in the G-DRG System 2008].

Science.gov (United States)

Juhra, C; Franz, D; Roeder, N; Vordemvenne, T; Raschke, M J

2009-05-01

Since the introduction of a per-case reimbursement system in Germany (German Diagnosis-Related Groups, G-DRG), the correct reimbursement for the treatment of severely injured patients has been much debated. While the classification of a patient in a polytrauma DRG follows different rules than the usual clinical definition, leading to a high number of patients not grouped as severely injured by the system, the system was also criticized in 2005 for its shortcomings in financing the treatment of severely injured patients. The development of financial reimbursement will be discussed in this paper. 167 patients treated in 2006 and 2007 due to a severe injury at the University-Hospital Münster and grouped into a polytrauma-DRG were included in this study. For each patient, cost-equivalents were estimated. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK cost-calculation method. The reimbursement was calculated using the G-DRG-Systems of 2007, 2008 and 2009. Cost-equivalents/costs and clinical parameters were correlated. A total of 167 patients treated in 2006 and 2007 for a severe injury at the Münster University Hospital and grouped into a polytrauma DRG were included in this study. Cost equivalents were estimated for each patient. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK (Institute for the Hospital Remuneration System) cost calculation method. Reimbursement was calculated using the G-DRG systems of 2007, 2008 and 2009. Cost equivalents/costs and clinical parameters were correlated. With the ongoing development of the G-DRG system, reimbursement for the treatment of severely injured patient has improved, but the amount of underfinancing remains substantial. As treatment of severely injured patients must be reimbursed using the G-DRG system, this system must be further adapted to better meet the needs of severely injured patients. Parameters such as total surgery time, injury

Systemic Assessment of Patients Undergoing Dental Implant ...

African Journals Online (AJOL)

Background: Procedure‑related and patient‑related factors influence the prognosis of dental implants to a major extent. Hence, we aimed to evaluate and analyze various systemic factors in patients receiving dental implants. Materials and Methods: Fifty‑one patients were included in the study, in which a total of 110 dental ...

Information security requirements in patient-centred healthcare support systems.

Science.gov (United States)

Alsalamah, Shada; Gray, W Alex; Hilton, Jeremy; Alsalamah, Hessah

2013-01-01

Enabling Patient-Centred (PC) care in modern healthcare requires the flow of medical information with the patient between different healthcare providers as they follow the patient's treatment plan. However, PC care threatens the stability of the balance of information security in the support systems since legacy systems fall short of attaining a security balance when sharing their information due to compromises made between its availability, integrity, and confidentiality. Results show that the main reason for this is that information security implementation in discrete legacy systems focused mainly on information confidentiality and integrity leaving availability a challenge in collaboration. Through an empirical study using domain analysis, observations, and interviews, this paper identifies a need for six information security requirements in legacy systems to cope with this situation in order to attain the security balance in systems supporting PC care implementation in modern healthcare.

Measuring trauma system performance: Right patient, right place-Mission accomplished?

Science.gov (United States)

Ciesla, David J; Pracht, Etienne E; Tepas, Joseph J; Namias, Nicholas; Moore, Frederick A; Cha, John Y; Kerwin, Andrew; Langland-Orban, Barbara

2015-08-01

A regional trauma system must establish and monitor acceptable overtriage and undertriage rates. Although diagnoses from discharge data sets can be used with mortality prediction models to define high-risk injury, retrospective analyses introduce methodological errors when evaluating real-time triage processes. The purpose of this study was to determine if major trauma patients identified using field criteria correlated with those retrospectively labeled high risk and to assess system performance by measuring triage accuracy and trauma center utilization. A statewide database was queried for all injury-related International Classification of Diseases, 9th Revision, code discharges from designated trauma centers and nontrauma centers for 2012. Children and burn patients were excluded. Patients assigned a trauma alert fee were considered field-triage(+). The International Classification Injury Severity Score methodology was used to estimate injury-related survival probabilities, with an International Classification Injury Severity Score less than 0.85 considered high risk. Triage rates were expressed relative to the total population; the proportion of low- and high-risk patients discharged from trauma centers defined trauma center utilization. There were 116,990 patients who met study criteria, including 11,368 (10%) high-risk, 70,741 field-triage(-) patients treated in nontrauma centers and 28,548 field-triage(-) and 17,791 field-triage(+) patients treated in trauma centers. Field triage was 86% accurate, with 10% overtriage and 4% undertriage. System triage was 66% accurate, with 32% overtriage and 2% undertriage. Overtriage patients more often, and undertriage patients less often, had severe injury characteristics than appropriately triaged patients. Trauma system performance assessed using retrospective administrative data provides a convenient measure of performance but must be used with caution. Residual mistriage can partly be attributed to error introduced by

Massive intracranial calcifications in a patient with systemic lupus erythematosus

International Nuclear Information System (INIS)

Gasparetto, Emerson L.; Carvalho Neto, Arnolfo de; Ono, Sergio E.

2004-01-01

Central nervous system involvement is frequently reported in patients with systemic lupus erythematosus. Computed tomography and magnetic resonance imaging studies usually show brain atrophy, cerebral infarction and/or intracranial bleeding. Extensive intracranial calcification in patients with systemic lupus erythematosus is rare. We report a case of a patient with systemic lupus erythematosus who presented with seizures and massive basal ganglia calcification and mild calcifications in the frontal lobes, seen on the brain computed tomography scan. Magnetic resonance imaging showed hyperintensity on FLAIR images and hypointense signals on T2 * gradient echo images in the basal ganglia. (author)

Constructing a Patient Education System: A Performance Technology Project

Science.gov (United States)

Bell, Edith E.

2009-01-01

The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance…

[Health management system in outpatient follow-up of kidney transplantation patients].

Science.gov (United States)

Zhang, Hong; Xie, Jinliang; Yao, Hui; Liu, Ling; Tan, Jianwen; Geng, Chunmi

2014-07-01

To develop a health management system for outpatient follow-up of kidney transplant patients. Access 2010 database software was used to establish the health management system for kidney transplantation patients in Windows XP operating system. Database management and post-operation follow-up of the kidney transplantation patients were realized through 6 function modules including data input, data query, data printing, questionnaire survey, data export, and follow-up management. The system worked stably and reliably, and the data input was easy and fast. The query, the counting and printing were convenient. Health management system for patients after kidney transplantation not only reduces the work pressure of the follow-up staff, but also improves the efficiency of outpatient follow-up.

Systemic fungal infections in patients with human inmunodeficiency virus.

Science.gov (United States)

Rodríguez-Cerdeira, C; Arenas, R; Moreno-Coutiño, G; Vásquez, E; Fernández, R; Chang, P

2014-01-01

Histoplasmosis is a systemic infection caused by the dimorphic fungus Histoplasma capsulatum. In immunocompromised patients, primary pulmonary infection can spread to the skin and meninges. Clinical manifestations appear in patients with a CD4(+) lymphocyte count of less than 150 cells/μL. Coccidioidomycosis is a systemic mycosis caused by Coccidioides immitis and Coccidioides posadasii. It can present as diffuse pulmonary disease or as a disseminated form primarily affecting the central nervous system, the bones, and the skin. Cryptococcosis is caused by Cryptococcus neoformans (var. neoformans and var. grubii) and Cryptococcus gattii, which are members of the Cryptococcus species complex and have 5 serotypes: A, B, C, D, and AD. It is a common opportunistic infection in patients with human immunodeficiency virus (HIV)/AIDS, even those receiving antiretroviral therapy. Histopathologic examination and culture of samples from any suspicious lesions are essential for the correct diagnosis of systemic fungal infections in patients with HIV/AIDS. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.

JPRS Report Science & Technology USSR: Life Sciences

Science.gov (United States)

1990-06-18

Fractionated Irradiation [V. N. Malakhovskiy, M. I. Bokk; RADIOBIOLOGIYA, Vol 29 No 3, May-Jun 89] 41 Melanin Acts as Radioprotector [A. Patyko...Alternaria alternata, Aureobasidium pullulans, Tricho- derma viride; but Aspergillus niger, Cladosporium her- barum, Stemphylium ilicis, and Ulocladium atrum...of the above. Melanin -producing micromycetes predominated on materials subjected to storage both in open fields and sheds. Determinations of

PADS (Patient Archiving and Documentation System): a computerized patient record with educational aspects.

Science.gov (United States)

Hohnloser, J H; Pürner, F

1992-01-01

Rapid acquisition and analysis of information in an Intensive Care Unit (ICU) setting is essential, even more so the documentation of the decision making process which has vital consequences for the lives of ICU patients. We describe an Ethernet based local area network (LAN) with clinical workstations (Macintosh fx, ci). Our Patient Archiving and Documentation System (PADS) represents a computerized patient record presently used in a university hospitals' ICU. Taking full advantage of the Macintosh based graphical user interface (GUI) our system enables nurses and doctors to perform the following tasks: admission, medical history taking, physical examination, generation of problem lists and follow up notes, access to laboratory data and reports, semiautomatic generation of a discharge summary including full word processor capabilities. Furthermore, the system offers rapid, consistent and complete automatic encoding of diagnoses following the International Classification of Disease (ICD; WHO, [1]). For educational purposes the user can also view disease entities or complications related to the diagnoses she/he encoded. The system has links to other educational programs such as cardiac auscultation. A MEDLINE literature search through a CD-ROM based system can be performed without exiting the system; also, CD-ROM based medical textbooks can be accessed as well. Commercially available Macintosh programs can be integrated in the system without existing the main program thus enabling users to customize their working environment. Additional options include automatic background monitoring of users learning behavior, analyses and graphical display of numerous epidemiological and health care related problems. Furthermore, we are in the process of integrating sound and digital video in our system. This system represents one in a line of modular departmental models which will eventually be integrated to form a decentralized Hospital Information System (HIS).

Development of the patient setting system for BNCT at JRR-4

International Nuclear Information System (INIS)

Kumada, H.; Yamamoto, K.; Torii, Y.

2000-01-01

A new treatment planning software: Computational Dosimetry System (JCDS) is in progress its development for BNCT with epithermal neutron beam in JAERI. Irradiation conditions such as beam angle to a patient are calculated by JCDS. In order to implement these conditions, it is necessary to precisely set the patient to actual irradiation position simulated by JCDS beforehand. Therefore, the Patient Setting System, which accurately and quickly sets the patient to the irradiation position, is being developed with JCDS concurrently. In this report, the current status of the development of JCDS and the Patient Setting System in JAERI will be described. (author)

Patient Safety Learning Systems: A Systematic Review and Qualitative Synthesis.

Science.gov (United States)

2017-01-01

A patient safety learning system (sometimes called a critical incident reporting system) refers to structured reporting, collation, and analysis of critical incidents. To inform a provincial working group's recommendations for an Ontario Patient Safety Event Learning System, a systematic review was undertaken to determine design features that would optimize its adoption into the health care system and would inform implementation strategies. The objective of this review was to address two research questions: (a) what are the barriers to and facilitators of successful adoption of a patient safety learning system reported by health professionals and (b) what design components maximize successful adoption and implementation? To answer the first question, we used a published systematic review. To answer the second question, we used scoping study methodology. Common barriers reported in the literature by health care professionals included fear of blame, legal penalties, the perception that incident reporting does not improve patient safety, lack of organizational support, inadequate feedback, lack of knowledge about incident reporting systems, and lack of understanding about what constitutes an error. Common facilitators included a non-accusatory environment, the perception that incident reporting improves safety, clarification of the route of reporting and of how the system uses reports, enhanced feedback, role models (such as managers) using and promoting reporting, legislated protection of those who report, ability to report anonymously, education and training opportunities, and clear guidelines on what to report. Components of a patient safety learning system that increased successful adoption and implementation were emphasis on a blame-free culture that encourages reporting and learning, clear guidelines on how and what to report, making sure the system is user-friendly, organizational development support for data analysis to generate meaningful learning outcomes

HOSPITAL INFORMATION SYSTEMS: A STUDY OF ELECTRONIC PATIENT RECORDS

Directory of Open Access Journals (Sweden)

Pedro Luiz Cortês

2011-05-01

Full Text Available The importance of patient records, also known as medical records, is related to different needs and objectives, as they constitute permanent documents on the health of patients. With the advancement of information technologies and systems, patient records can be stored in databases, resulting in a positive impact on patient care. Based on these considerations, a research question that arises is “what are the benefits and problems that can be seen with the use of electronic versions of medical records?” This question leads to the formulation of the following hypothesis: although problems can be identified during the process of using electronic record systems, the benefits outweigh the difficulties, thereby justifying their use. To respond to the question and test the presented hypothesis, a research study was developed with users of the same electronic record system, consisting of doctors, nurses, and administrative personnel in three hospitals located in the city of São Paulo, Brazil. The results show that, despite some problems in their usage, the benefits of electronic patient records outweigh possible disadvantages.

Assessment of a personalized and distributed patient guidance system

NARCIS (Netherlands)

Peleg, M.; Shahar, Y.; Quaglini, S.; Broens, T.; Budasu, R.; Fung, L.S.N.; Fux, A.; García-Sáez, G.; Goldstein, A.; González-Ferrer, A.; Hermens, Hermanus J.; Hernando, ME; Jones, Valerie M.; Klebanov, G.; Klimov, D.; Knoppel, D.; Larburu Rubio, Nekane; Marcos, C.; Martínez-Sarriegui, I.; Napolitano, C.; Pallàs, A.; Palomares, A.; Parimbelli, E.; Pons, B.; Rigla, M.; Sacchi, L.; Shalom, E.; Soffer, P.; van Schooten, B.W.

2017-01-01

Objectives: The MobiGuide project aimed to establish a ubiquitous, user-friendly, patient-centered mobile decision-support system for patients and for their care providers, based on the continuous application of clinical guidelines and on semantically integrated electronic health records. Patients

Development and Utilization of a Patient-Oriented Outpatient Guidance System.

Science.gov (United States)

Baek, Mira; Koo, Bo Kyung; Kim, Byoung Jae; Hong, Kyung-Ran; Kim, Jongdeuk; Yoo, Sooyoung; Hwang, Hee; Seo, Jeongwan; Kim, Donghyeok; Shin, Kichul

2016-07-01

To develop a tool which can easily access the hospital information system (HIS) to facilitate outpatient care and maximize patient satisfaction on his or her hospital visit. Our Center for Informatics developed an outpatient guidance system (OGS) after careful analysis of the list of daily tasks undergone by patients and related work processes. Bluetooth beacons were installed to assist patients, to inform them of points of interest, and to guide them along the proper routes to and within the hospital. The OGS conveniently provided patients' clinic schedules, routes to the hospital, and direct costs; all of this information was embedded in the HIS accessed from patients' personal mobile devices or kiosks. Patients were also able to identify their locations within the hospital, receiving proper directions to subsequent task. Since its launch in October 2014, the number of mobile accesses increased from 4,011 to 8,242 per month within a year. The substantial growth of interest in and use of our OGS in such a short period indicate that this system has been successfully incorporated into patients' daily activities. We believe that this system will continue to help improve health services and the well-being of those visiting the hospital.

[Interactive augmented reality systems : Aid for personalized patient education and rehabilitation].

Science.gov (United States)

Bork, F

2018-04-01

During patient education, information exchange plays a critical role both for patient compliance during medical or rehabilitative treatment and for obtaining an informed consent for an operative procedure. In this article the augmented reality system "Magic Mirror" as an additive tool during patient education, rehabilitation as well as anatomical education is highlighted. The Magic Mirror system allows the user of the system to inspect both a detailed model of the 3‑dimensional anatomy of the human body and volumetric slice images in a virtual mirror environment. First preliminary results from the areas of rehabilitation and learning anatomy indicate the broad potential of the Magic Mirror. Similarly, the system also provides interesting advantages for patient education situations in comparison to traditional methods of information exchange. Novel technologies, such as augmented reality are a door opener for many innovations in medicine. In the future, patient-specific systems, such as the Magic Mirror will be used increasingly more in areas such as patient education and rehabilitation. In order to maximize the benefits of such systems, further evaluation studies are necessary to find out about the best use cases and to start an iterative optimization process of these systems.

Clinical multiphoton tomography and clinical two-photon microendoscopy

Science.gov (United States)

König, Karsten; Bückle, Rainer; Weinigel, Martin; Elsner, Peter; Kaatz, Martin

2009-02-01

We report on applications of high-resolution clinical multiphoton tomography based on the femtosecond laser system DermaInspectTM with its flexible mirror arm in Australia, Asia, and Europe. Applications include early detection of melanoma, in situ tracing of pharmacological and cosmetical compounds including ZnO nanoparticles in the epidermis and upper dermis, the determination of the skin aging index SAAID as well as the study of the effects of anti-aging products. In addition, first clinical studies with novel rigid high-NA two-photon 1.6 mm GRIN microendoscopes have been conducted to study the effect of wound healing in chronic wounds (ulcus ulcera) as well as to perform intrabody imaging with subcellular resolution in small animals.

Gastrointestinal transit in patients with systemic sclerosis.

Science.gov (United States)

Fynne, Lotte; Worsøe, Jonas; Gregersen, Tine; Schlageter, Vincent; Laurberg, Søren; Krogh, Klaus

2011-10-01

Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis and collagen deposits. Gastrointestinal symptoms of SSc, including abdominal pain, bloating and discomfort, are common but diffuse and their pathophysiology remains obscure. To investigate the pathophysiology of abdominal pain and discomfort in individuals with SSc. A total of 15 individuals with SSc (13 women, median age 58 years), all suffering from diffuse abdominal symptoms, and 17 healthy volunteers (12 women, median age 52 years) were evaluated with the Motility Tracking System, MTS-1, measuring gastric emptying (GE) and velocity through the small intestine. SSc patients were also examined for bacterial overgrowth using the hydrogen breath test and with radiopaque markers to determine the total gastrointestinal transit time (GITT). Assessed with the MTS-1, the velocity through the proximal small intestine was significantly reduced in SSc patients (median 0.525 m/h, range 0.11-1.15) when compared to healthy subjects (median 0.91 m/h, range 0.51-1.74) (p = 0.02). Prolonged GE was found in 4 SSc patients (27%) but in none of the healthy volunteers (p = 0.04). Only 3 SSc patients (21%) had positive breath tests for small intestinal bacterial overgrowth. GITT was >3 days in 8 patients (53%). Slow small intestinal transit was associated with a prolonged GITT (p < 0.05). Velocity through the small intestine is significantly reduced in SSc patients with diffuse abdominal symptoms.

Systems automated reporting of patient dose in digital radiology

International Nuclear Information System (INIS)

Collado Chamorro, P.; Sanz Freire, C. J.; Martinez Mirallas, O.; Tejada San Juan, S.; Lopez de Gammarra, M. S.

2013-01-01

It has developed a procedure automated reporting of doses to patients in Radiology. This procedure allows to save the time required of the data used to calculate the dose to patients by yields. Also saves the time spent in the transcription of these data for the realization of the necessary calculations. This system has been developed using open source software. The characteristics of the systems of digital radiography for the automation of procedures, in particular the registration of dose should benefit from patient. This procedure is validated and currently in use at our institution. (Author)

Brain MRI screening showing evidences of early central nervous system involvement in patients with systemic sclerosis.

Science.gov (United States)

Mohammed, Reem Hamdy A; Sabry, Yousriah Y; Nasef, Amr A

2011-05-01

Systemic sclerosis is a multisystem autoimmune collagen disease where structural and functional abnormalities of small blood vessels prevail. Transient ischemic attacks, ischemic stroke, and hemorrhage have been reported as primary consequence of vascular central nervous system affection in systemic sclerosis. Magnetic resonance imaging is considered to be the most sensitive diagnostic technique for detecting symptomatic and asymptomatic lesions in the brain in cases of multifocal diseases. The objective of this study is to detect subclinical as well as clinically manifest cerebral vasculopathy in patients with systemic sclerosis using magnetic resonance imaging. As much as 30 female patients with systemic sclerosis aged 27-61 years old, with disease duration of 1-9 years and with no history of other systemic disease or cerebrovascular accidents, were enrolled. Age-matched female control group of 30 clinically normal subjects, underwent brain magnetic resonance examination. Central nervous system (CNS) involvement in the form of white matter hyperintense foci of variable sizes were found in significantly abundant forms in systemic sclerosis patients on magnetic resonance evaluation than in age-related control group, signifying a form of CNS vasculopathy. Such foci showed significant correlation to clinical features of organic CNS lesion including headaches, fainting attacks and organic depression as well as to the severity of peripheral vascular disease with insignificant correlation with disease duration. In conclusion, subclinical as well as clinically manifest CNS ischemic vasculopathy is not uncommon in systemic sclerosis patients and magnetic resonance imaging is considered a sensitive noninvasive screening tool for early detection of CNS involvement in patients with systemic sclerosis.

A PRIVACY MANAGEMENT ARCHITECTURE FOR PATIENT-CONTROLLED PERSONAL HEALTH RECORD SYSTEM

Directory of Open Access Journals (Sweden)

MD. NURUL HUDA

2009-06-01

Full Text Available Patient-controlled personal health record systems can help make health care safer, cheaper, and more convenient by facilitating patients to 1 grant any care provider access to their complete personal health records anytime from anywhere, 2 avoid repeated tests and 3 control their privacy transparently. In this paper, we present the architecture of our Privacy-aware Patient-controlled Personal Health Record (P3HR system through which a patient can view her integrated health history, and share her health information transparently with others (e.g., healthcare providers. Access to the health information of a particular patient is completely controlled by that patient. We also carry out intuitive security and privacy analysis of the P3HR system architecture considering different types of security attacks. Finally, we describe a prototype implementation of the P3HR system that we developed reflecting the special view of Japanese society. The most important advantage of P3HR system over other existing systems is that most likely P3HR system provides complete privacy protection without losing data accuracy. Unlike traditional partially anonymous health records (e.g., using k-anonymity or l-diversity, the health records in P3HR are closer to complete anonymity, and yet preserve data accuracy. Our approach makes it very unlikely that patients could be identified by an attacker from their anonymous health records in the P3HR system.

42 CFR 412.513 - Patient classification system.

Science.gov (United States)

2010-10-01

... LTC-DRG classification system provides a LTC-DRG, and an appropriate weighting factor, for those cases... intermediary decides that a different LTC-DRG should be assigned, the case will be reviewed by the appropriate... 42 Public Health 2 2010-10-01 2010-10-01 false Patient classification system. 412.513 Section 412...

Hematology Expert System (HES) For Tonsillectomy/Adenoidectomy Patients

Science.gov (United States)

Pizzi, Nicolino J.; Kapoor, Sandhya; Gerrard, Jon M.

1989-03-01

The purpose of this expert system is to assess a predisposition to bleeding in a patient undergoing a tonsillectomy and/or adenoidectomy as may occur with patients who have certain blood conditions such as hemophilia and von Willebrand's disease. This goal is achieved by establishing a correlation between the patients' responses to a medical questionnaire and the relative quantities of blood lost during the operation.

[Erectile complications after radical surgery for penile plastic induration].

Science.gov (United States)

Austoni, E; Mantovani, F; Colombo, F; Canclini, L; Mastromarino, G; Vecchio, D; Fenice, O

1994-02-01

The radical surgical option we propose for Peyronie's disease consists in removing the sclero-hyalinotic focus of disease and replacing it by an autologous dermal graft taken from the upper outer thigh area. Between 1981 and 1991, we operated 335 patients with IPP, 152 of whom underwent plaque excision and dermal graft. All could be assessed at two-year follow-up. Two main complications were observed: mild penile flexure due to scar retraction of the graft (35% of cases), and partial erectile deficit with decreased corporal rigidity (17% of cases). The degree of the graft retraction is linked to the individual's histologic response. A mild deviation of the penis can occur some months after surgery and is not a relapse flexure due to disease progression (as it should have evolutive characteristics) but is mere scar retraction and will spontaneously regress. As the patient will date the onset of a postoperative erectile deficit from the time of the operation, it is advisable to assess preoperatively the erectile ability of all patients. Furthermore, an impaired erectile response could result from hypoaesthesia of the glans, post-surgical stress, and fibrosis of the erectile tissue. A retrospective assessment of radical surgery cases involving plaque excision and dermal graft lead us to propose this option where precise indications apply, providing the presence of other alterations of the erectile function are pre-operatively assessed.

Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems.

Science.gov (United States)

Juhnke, Christin; Mühlbacher, Axel C

2013-01-01

Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser-Meyer-Olkin of 0.914 for the patients (experts: 38.427%, Kaiser-Meyer-Olkin = 0.797). Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

John M. Eisenberg Patient Safety Awards. System innovation: Veterans Health Administration National Center for Patient Safety.

Science.gov (United States)

Heget, Jeffrey R; Bagian, James P; Lee, Caryl Z; Gosbee, John W

2002-12-01

In 1998 the Veterans Health Administration (VHA) created the National Center for Patient Safety (NCPS) to lead the effort to reduce adverse events and close calls systemwide. NCPS's aim is to foster a culture of safety in the Department of Veterans Affairs (VA) by developing and providing patient safety programs and delivering standardized tools, methods, and initiatives to the 163 VA facilities. To create a system-oriented approach to patient safety, NCPS looked for models in fields such as aviation, nuclear power, human factors, and safety engineering. Core concepts included a non-punitive approach to patient safety activities that emphasizes systems-based learning, the active seeking out of close calls, which are viewed as opportunities for learning and investigation, and the use of interdisciplinary teams to investigate close calls and adverse events through a root cause analysis (RCA) process. Participation by VA facilities and networks was voluntary. NCPS has always aimed to develop a program that would be applicable both within the VA and beyond. NCPS's full patient safety program was tested and implemented throughout the VA system from November 1999 to August 2000. Program components included an RCA system for use by caregivers at the front line, a system for the aggregate review of RCA results, information systems software, alerts and advisories, and cognitive acids. Following program implementation, NCPS saw a 900-fold increase in reporting of close calls of high-priority events, reflecting the level of commitment to the program by VHA leaders and staff.

A Framework for the Comparison of Mobile Patient Monitoring Systems

NARCIS (Netherlands)

Pawar, P.; Jones, Valerie M.; van Beijnum, Bernhard J.F.; Hermens, Hermanus J.

A mobile patient monitoring system makes use of mobile computing and wireless communication technologies for continuous or periodic measurement and analysis of biosignals of a mobile patient. In a number of trials these systems have demonstrated their user-friendliness, convenience and effectiveness

Security in the Dutch electronic patient record system

NARCIS (Netherlands)

van 't Noordende, G.

2010-01-01

In this article, we analyze the security architecture of the Dutch Electronic Patient Dossier (EPD) system. Intended as a mandatory infrastructure for exchanging medical records of most if not all patients in the Netherlands among authorized parties (particularly, physicians), the EPD has to address

Changing tides: increasing evidence to embrace a patient classification system.

Science.gov (United States)

Malloch, Kathy

2012-01-01

The effective use of a patient classification system (PCS) in a way that provides value to all health care organizations has yet to be realized given the challenging developmental pathway of these systems. As the science and technology of workforce management emerges along with evidence to support the relationships between nurse work and patient care needs, it is no longer appropriate to rely on systems that provide aggregated and minimal data to address the need for safer patient care and retention of nurses. Specificity about patient care needs in a valid and reliable PCS is essential on our pathway to improved resource utilization, improved decision making, integration of nurse cognitive and knowledge work, and management of variances from planned resource use. Advancements with technology, the ability to create and monitor equitable nurse-patient assignments, conceptual clarity, evidence, regulatory requirements, and professional role development point to a new receptiveness for PCSs.

Design and Implementation of an User Centric M-Healthcare System for Patients

Directory of Open Access Journals (Sweden)

Pınar KIRCI

2016-12-01

Full Text Available Wireless sensor networks (WSNs and mobile devices have the ability of managing the health monitoring systems for medical care needing people. They provide mountable sensors and wireless sensors to ensure easy health monitoring. In the paper, a remote patient monitoring system is proposed as an android application together with wireless sensors for the patients. Our system has an easy to use structure. The data is collected by touching the finger of the patient. The gained data is sent to the patient's smartphone that has an android operating system. Then the data is transmitted to the hospital database and the patient’s doctor via patient’s medical record. Eventually, the system provides an easy medical data collecting and storing environment for medical people and patients.

Eosinophilic Esophagitis in Two Patients with Systemic Sclerosis

Directory of Open Access Journals (Sweden)

Tracy M. Frech

2016-01-01

Full Text Available The gastrointestinal tract (GIT is the most common extracutaneous organ system damaged in systemic sclerosis (SSc and is the presenting feature in 10% of patients. The esophagus as the portion of the GIT is the most commonly affected and there is an association of gastroesophageal reflux (GER with SSc interstitial lung disease (ILD. Thus, an aggressive treatment for GER is recommended in all SSc patients with ILD; however, it is recognized that a long-term benefit to this treatment is needed to understand its impact. In this case report we discuss the presence of eosinophilic esophagitis (EoE in two SSc patients and discuss the role for early EGD in SSc patients with moderate-severe GER symptoms for tissue study. Assessment of esophageal biopsy specimens for the presence of eosinophils and possibly ANA can help elucidate disease pathogenesis and direct therapy, as the presence of EoE in SSc has important management considerations, particularly with regards to dietary modification strategies.

A Cloud Computing Based Patient Centric Medical Information System

Science.gov (United States)

Agarwal, Ankur; Henehan, Nathan; Somashekarappa, Vivek; Pandya, A. S.; Kalva, Hari; Furht, Borko

This chapter discusses an emerging concept of a cloud computing based Patient Centric Medical Information System framework that will allow various authorized users to securely access patient records from various Care Delivery Organizations (CDOs) such as hospitals, urgent care centers, doctors, laboratories, imaging centers among others, from any location. Such a system must seamlessly integrate all patient records including images such as CT-SCANS and MRI'S which can easily be accessed from any location and reviewed by any authorized user. In such a scenario the storage and transmission of medical records will have be conducted in a totally secure and safe environment with a very high standard of data integrity, protecting patient privacy and complying with all Health Insurance Portability and Accountability Act (HIPAA) regulations.

A survey on automated wheeze detection systems for asthmatic patients

Directory of Open Access Journals (Sweden)

Syamimi Mardiah Shaharum

2012-11-01

Full Text Available The purpose of this paper is to present an evidence of automated wheeze detection system by a survey that can be very beneficial for asthmatic patients. Generally, for detecting asthma in a patient, stethoscope is used for ascertaining wheezes present. This causes a major problem nowadays because a number of patients tend to delay the interpretation time, which can lead to misinterpretations and in some worst cases to death. Therefore, the development of automated system would ease the burden of medical personnel. A further discussion on automated wheezes detection system will be presented later in the paper. As for the methodology, a systematic search of articles published as early as 1985 to 2012 was conducted. Important details including the hardware used, placement of hardware, and signal processing methods have been presented clearly thus hope to help and encourage future researchers to develop commercial system that will improve the diagnosing and monitoring of asthmatic patients.

Patient Safety Communication Among Differently Educated Nurses: Converging and Diverging Meaning Systems.

Science.gov (United States)

Anbari, Allison Brandt; Vogelsmeier, Amy; Dougherty, Debbie S

2017-12-01

Studies that suggest an increased number of bachelor's prepared nurses (BSNs) at the bedside improves patient safety do not stratify their samples into traditional bachelor's and associates (ADN) to BSN graduates. This qualitative study investigated potential differences in patient safety meaning among BSNs and ADN to BSN graduates. Guided by the theory of Language Convergence/Meaning Divergence, interview data from eight BSN and eight ADN to BSN graduates were analyzed. Findings indicate there are two meaning levels or systems, the local level and the systemic level. At the local level, the meaning of patient safety is focused at the patient's bedside and regulated by the nurse. The systemic level included the notion that health system factors such as policies and staffing are paramount to keeping patients safe. More frequently, ADN to BSN graduates' meaning of patient safety was at the local level, while BSNs' meaning centered at the systemic level.

Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

Directory of Open Access Journals (Sweden)

Christin Juhnke

2013-11-01

Full Text Available Introduction: Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. Methods: A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Results: Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkinof 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797. Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. Conclusion and Discussion: The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

Directory of Open Access Journals (Sweden)

Christin Juhnke

2013-11-01

Full Text Available Introduction: Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems.Methods: A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales.Results: Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkinof 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797. Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination.Conclusion and Discussion: The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

Zero insertion force socket for photoactivation patient treatment system

International Nuclear Information System (INIS)

Troutner, V.H.

1988-01-01

Automatic operating zero insertion force socket for use in a photoactivatable reagent treatment system wherein photoactivatable agents, in contact with patient blood cells, are irradiated extracorporeally and then returned to the patient

Patients' knowledge and attitude towards therapeutic reference pricing system in Slovenia.

Science.gov (United States)

Marđetko, Nika; Kos, Mitja

2016-10-01

Background The therapeutic reference pricing (TRP) in Slovenia was implemented for proton pump inhibitors in 2013 and for angiotensin-converting enzyme inhibitors and lipid-lowering medicines in 2014. Objective The study aimed to assess patients' knowledge and attitude towards the TRP system. Moreover, the patients' willingness to pay was evaluated for patients who rejected the substitution of a current medicine within a therapeutic class by the reference medicine for which no co-payment is needed. Setting Invitation of patients to participate in a survey and filling in the first part of the questionnaire was run in the community pharmacies in Slovenia. The second part of the questionnaire was filled in at patients' home. Method A representative sample of 676 patients that had been prescribed at least one medicine from the three therapeutic classes was surveyed. The survey was carried out from 15th May to 15th June 2014 in 40 community pharmacies with the help of the pharmacists, who filled in the first part of the questionnaire in the presence of the patients. The second part of the questionnaire was filled in by 475 patients at home and returned by prepaid mail. Main outcome measure Patients' knowledge of and attitude to the TRP system implemented into Slovenian health care practice. Results Most of the statements describing patient' rights and duties within the TRP system were known by approximately 50 % of the patients. Patients were inhomogeneous in their view about the necessity and benefits of the TRP system, most of them regarded it as an unnecessary burden. Among 50.4 % of the patients who were required to copay for their medicine, 46.7 % accepted and 3.7 % rejected co-payment. The average co-payment was € 6.92, while the expressed average willingness to co-pay was € 10.4 per 3 months of therapy. Conclusion Our results indicate that the implementation of the TRP system and potential upgrades represent a significant challenge for the patients.

Invasive fungal infections in Colombian patients with systemic lupus erythematosus.

Science.gov (United States)

Santamaría-Alza, Y; Sánchez-Bautista, J; Fajardo-Rivero, J F; Figueroa, C L

2018-06-01

Introduction Systemic lupus erythematosus is an autoimmune disease with multi-organ involvement. Complications, such as invasive fungal infections usually occur in patients with a greater severity of the disease. Objective The objective of this study was to determine the prevalence and risk variables associated with invasive fungal infections in a Colombian systemic lupus erythematosus population. Materials and methods A cross-sectional, retrospective study that evaluated patients with systemic lupus erythematosus for six years. The primary outcome was invasive fungal infection. Descriptive, group comparison and bivariate analysis was performed using Stata 12.0 software. Results Two hundred patients were included in this study; 84.5% of the patients were women and the median age was 36 years; 68% of the subjects had haematological complications; 53.3% had nephropathy; 45% had pneumopathy and 28% had pericardial impairment; 7.5% of patients had invasive fungal infections and the most frequently isolated fungus was Candida albicans. Pericardial disease, cyclophosphamide use, high disease activity, elevated ESR, C3 hypocomplementemia, anaemia and lymphopenia had a significant association with invasive fungal infection ( P lupus erythematosus, which was higher than that reported in other latitudes. In this population the increase in disease activity, the presence of pericardial impairment and laboratory alterations (anaemia, lymphopenia, increased ESR and C3 hypocomplementemia) are associated with a greater possibility of invasive fungal infections. Regarding the use of drugs, unlike other studies, in the Colombian population an association was found only with the previous administration of cyclophosphamide. In addition, patients with invasive fungal infections and systemic lupus erythematosus had a higher prevalence of mortality and hospital readmission compared with patients with systemic lupus erythematosus without invasive fungal infection.

Quantitative assessment of skin erythema due to radiotherapy--evaluation of different measurements

International Nuclear Information System (INIS)

Wengstroem, Yvonne; Forsberg, Christina; Naeslund, Ingemar; Bergh, Jonas

2004-01-01

Background and purpose: Visual assessment is the most common clinical investigation of skin reactions in radiotherapy. Due to the unquantitative and subjective nature of this method additional non-invasive methods are needed for more accurate evaluation of the visible acute adverse skin reactions due to radiotherapy. The purpose of this study was to evaluate a new objective measure with regard to reliability and validity and compare it with an established objective measure and a visual assessment. Patients and methods: A sample of 53 consecutive patients commencing curative tangential radiation therapy to the breast parenchyma were included in the study. The skin area of the treated breast was divided into five sections and assessed individually at 0, 24 and 50 Gy. The RTOG scoring system was used for the visual assessment of the skin reactions. The first objective measure included reflectance spectrometry (DermaSpectrometer) measures at fixed points within the treatment area. For the second objective measure digital images (Camera) were taken with a system using a digital camera and software. The images were analyzed using the Adobe Photoshop 5.0 software program. Results: The results provided significant evidence of the test-retest reliability of the camera. The correlation between the objective measures proved to be significant as the treatment progressed. Conclusions: The results suggest that the camera may be used in a reliable and valid way to measure skin erythema due to radiotherapy

Environ: E00509 [KEGG MEDICUS

Lifescience Database Archive (English)

Full Text Available E00509 Ganoderma applanatum fruit body Elfvingia Crude drug beta-(1->3),(1->4) D-g...AX:40483] ... Polyporaceae Ganoderma applanatum fruit body (dried) Component: beta-(...derma applanatum [TAX:29884], Fomes fomentarius [TAX:40442], Fomitopsis pinicola [T...3beta-stearate, Betulin [CPD:C08618], Palmitic acid [CPD:C00249], Oleic acid [CPD:C00712], Linolic acid, Ergosterol [CPD:C01694] Gano

Systemic and local collagen turnover in hernia patients

DEFF Research Database (Denmark)

Henriksen, Nadia A

2016-01-01

composition appears altered in fascial tissue but also in skin biopsies, suggesting that the collagen alterations are systemic. More pronounced collagen alterations are found in patients with hernia recurrences. Hypothetically, primary inguinal hernias are formed due to a systemic predisposition to altered...... connective tissue, whereas impaired healing influences on the development of incisional hernias and hernia recurrences. The overall objective of this thesis was to investigate the collagen turnover systemically and locally in patients with primary inguinal hernia, multiple hernias and incisional hernia...... repair after adjustment for gender, age and surgical approach. In a multivariable subgroup analysis, direct and recurrent inguinal hernia repair were associated with primary ventral hernia surgery, whereas only recurrent inguinal hernia repair was associated with secondary ventral hernia surgery...

Patients' Perceptions and Experiences of a mHealth Diabetes Self-management System.

Science.gov (United States)

Georgsson, Mattias; Staggers, Nancy

2017-03-01

Chronic diseases, including diabetes, constitute a substantial disease burden around the world. Mobile self-management systems now play a significant and increasingly important role in patients' disease management. Yet, patients' perceptions of these systems after longer-term use are largely unexplored. A random sample of 10 diabetes patients was assessed immediately after they exited a larger, 6-month randomized controlled trial on the use of a mHealth system called Care4Life. This descriptive, exploratory study assessed patients' perceptions and experiences of mHealth using a questionnaire and semistructured interview whose development was guided by the Technology Acceptance Model. Results indicated that patients saw clear benefits in using the technology and had favorable behavioral disease outcomes after using Care4Life. Suggestions for improving the system were highly individual despite the apparent homogeneity of the patient group. The study begins to fill the gap about the longer-term use of mHealth systems in chronic disease management and reflects the significance of individual needs for mHealth systems.

Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology

OpenAIRE

Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M. B.

2015-01-01

This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has ...

ESUMS: a mobile system for continuous home monitoring of rehabilitation patients.

Science.gov (United States)

Strisland, Frode; Svagård, Ingrid; Seeberg, Trine M; Mathisen, Bjørn Magnus; Vedum, Jon; Austad, Hanne O; Liverud, Anders E; Kofod-Petersen, Anders; Bendixen, Ole Christian

2013-01-01

The pressure on the healthcare services is building up for several reasons. The ageing population trend, the increase in life-style related disease prevalence, as well as the increased treatment capabilities with associated general expectation all add pressure. The use of ambient healthcare technologies can alleviate the situation by enabling time and cost-efficient monitoring and follow-up of patients discharged from hospital care. We report on an ambulatory system developed for monitoring of physical rehabilitation patients. The system consists of a wearable multisensor monitoring device; a mobile phone with client application aggregating the data collected; a service-oriented-architecture based server solution; and a PC application facilitating patient follow-up by their health professional carers. The system has been tested and verified for accuracy in controlled environment trials on healthy volunteers, and also been usability tested by 5 congestive heart failure patients and their nurses. This investigation indicated that patients were able to use the system, and that nurses got an improved basis for patient follow-up.

The complexity of patient safety reporting systems in UK dentistry.

Science.gov (United States)

Renton, T; Master, S

2016-10-21

Since the 'Francis Report', UK regulation focusing on patient safety has significantly changed. Healthcare workers are increasingly involved in NHS England patient safety initiatives aimed at improving reporting and learning from patient safety incidents (PSIs). Unfortunately, dentistry remains 'isolated' from these main events and continues to have a poor record for reporting and learning from PSIs and other events, thus limiting improvement of patient safety in dentistry. The reasons for this situation are complex.This paper provides a review of the complexities of the existing systems and procedures in relation to patient safety in dentistry. It highlights the conflicting advice which is available and which further complicates an overly burdensome process. Recommendations are made to address these problems with systems and procedures supporting patient safety development in dentistry.

A Clinical Decision Support System for Breast Cancer Patients

Science.gov (United States)

Fernandes, Ana S.; Alves, Pedro; Jarman, Ian H.; Etchells, Terence A.; Fonseca, José M.; Lisboa, Paulo J. G.

This paper proposes a Web clinical decision support system for clinical oncologists and for breast cancer patients making prognostic assessments, using the particular characteristics of the individual patient. This system comprises three different prognostic modelling methodologies: the clinically widely used Nottingham prognostic index (NPI); the Cox regression modelling and a partial logistic artificial neural network with automatic relevance determination (PLANN-ARD). All three models yield a different prognostic index that can be analysed together in order to obtain a more accurate prognostic assessment of the patient. Missing data is incorporated in the mentioned models, a common issue in medical data that was overcome using multiple imputation techniques. Risk group assignments are also provided through a methodology based on regression trees, where Boolean rules can be obtained expressed with patient characteristics.

Development of a computer-aided clinical patient education system to provide appropriate individual nursing care for psychiatric patients.

Science.gov (United States)

Tseng, Kuan-Jui; Liou, Tsan-Hon; Chiu, Hung-Wen

2012-06-01

A lot of researches have proven that health education can help patients to maintain and improve their health. And it also shortens the time staying in hospital to save medication resource. Because the patients are willing to get healthcare knowledge to enhance the ability of self-care, they pay more attention to the health education. In Taiwan, the clinical nurses play an important role in patient education, and the health education take most time in their daily work. Such work includes the collection, production and delivery of education materials. To generate the correct and customized health education material is the key of success of patient education. In this study, we established a computer-aided health education contents generating system for psychiatric patients by integrating the databases for disease, medicine and nursing knowledge to assist nurse generating the customized health education document suitable for different patients. This system was evaluated by clinical nurses in usability and feasibility. This system is helpful for nurse to carry out the clinical health education to patients and further to encourage patient to pay attention to self-health.

Surgical management of gastroesophageal reflux disease in patients with systemic sclerosis.

Science.gov (United States)

Yan, Jingliang; Strong, Andrew T; Sharma, Gautam; Gabbard, Scott; Thota, Prashanti; Rodriguez, John; Kroh, Matthew

2018-02-12

Systemic sclerosis (scleroderma) is frequently associated with both gastroesophageal reflux disease (GERD) and simultaneous esophageal dysmotility. Anti-reflux procedures in this patient population must account for the existing physiology of each patient and likely disease progression. We aim to compare perioperative and intermediate outcomes of fundoplication versus gastric bypass for the treatment of GERD. After IRB approval, patients with systemic sclerosis undergoing fundoplication or gastric bypass for the treatment of GERD from 2004 to 2016 were identified. Demographics, perioperative data, immediate complications, and symptom improvement were retrieved and analyzed. Fourteen patients with systemic sclerosis underwent surgical treatment of GERD during the defined study period. Average body mass index was 26 kg/m 2 . Seven fundoplications (2 Nissens, 4 Toupets, and 1 Dor) and 7 Roux-en-Y gastric bypasses (RYGB) were performed. No 30-day mortality was observed in either group. Median follow-up was 97 months for the fundoplication group (range 28-204 months), and 19 months for the RYGB group (range 1-164 months). Preoperatively, dysphagia, heartburn, and regurgitation were present in 71% (n = 10), 86% (n = 12), and 64% (n = 9) of patients, respectively. Eleven patients had pH study prior to surgical intervention, and 91% of them had abnormal acid exposure. Esophagitis was evident in 85% (n = 11) of patients during preoperative upper endoscopy, and two patients had Barrett's esophagus. Impaired esophageal motility was present in all RYGB patients and 71% of fundoplication patients. Of the patients who had assessment of their GERD symptoms at follow-up, all five patients in the RYGB group and only 3 (50%) patients in the fundoplication group reported symptom improvement or resolution. Laparoscopic RYGB as an anti-reflux procedure is safe and may provide an alternative to fundoplication in the treatment of GERD for systemic sclerosis patients

Effects of Jae-Seng Acupuncture Treatment on the Improvement of Nasolabial Folds and Eye Wrinkles

Directory of Open Access Journals (Sweden)

Jin Hyong Cho

2015-01-01

Full Text Available The microneedle therapy system (MTS, a mechanical method involving making minute multiple holes in the skin, reportedly improves skin condition, such as by reducing flushing and melanin. A newly attempted bloodletting therapy, Jae-Seng Acupuncture, has several advantages over traditional mechanical punching methods because it allows the practitioner to regulate the depth and direction of needle stimulations and to choose whether to stimulate the muscle layers. This study was conducted to determine the efficacy of Jae-Seng Acupuncture in the treatment of nasolabial folds and eye wrinkles. The nasolabial folds and eye wrinkles of 107 patients ranging in age from their 20s to their 70s were subjected to DermaVision, a digital skin image analyzer, before the treatment and one to six months after treatment. Additionally, stimulation of the meridians, such as Taeyang, Tongjaryo, Chongmyong, Sungup, Sabaek, Yonghyang, Chichang, Taeyong, was performed to improve the function of the stomach, large intestine. Analyses of the images indicate that Jae-Seng Acupuncture improved nasolabial folds and eye wrinkles, suggesting that this technique is a safe and effective method for the improvement of facial skin conditions.

A Baseline Patient Model to Support Testing of Medical Cyber-Physical Systems.

Science.gov (United States)

Silva, Lenardo C; Perkusich, Mirko; Almeida, Hyggo O; Perkusich, Angelo; Lima, Mateus A M; Gorgônio, Kyller C

2015-01-01

Medical Cyber-Physical Systems (MCPS) are currently a trending topic of research. The main challenges are related to the integration and interoperability of connected medical devices, patient safety, physiologic closed-loop control, and the verification and validation of these systems. In this paper, we focus on patient safety and MCPS validation. We present a formal patient model to be used in health care systems validation without jeopardizing the patient's health. To determine the basic patient conditions, our model considers the four main vital signs: heart rate, respiratory rate, blood pressure and body temperature. To generate the vital signs we used regression models based on statistical analysis of a clinical database. Our solution should be used as a starting point for a behavioral patient model and adapted to specific clinical scenarios. We present the modeling process of the baseline patient model and show its evaluation. The conception process may be used to build different patient models. The results show the feasibility of the proposed model as an alternative to the immediate need for clinical trials to test these medical systems.

Clinical validation of the CHRONIOUS wearable system in patients with chronic disease.

Science.gov (United States)

Bellos, Christos; Papadopoulos, Athanassios; Rosso, Roberto; Fotiadis, Dimitrios I

2013-01-01

The CHRONIOUS system defines a powerful and easy to use framework which has been designed to provide services to clinicians and their patients suffering from chronic diseases. The system is composed of a wearable shirt that integrate several body sensors, a portable smart device and a central sub-system that is responsible for the long term storage of the collected patient's data. A multi-parametric expert system is developed for the analysis of the collected data using intelligent algorithms and complex techniques. Apart for the vital signals, dietary habits, drug intake, activity data, environmental and biochemical parameters are recorded. The CHRONIOUS platform is validated through clinical trials in several medical centers and patient's home environments recruiting patients suffering from Chronic Obstructive pulmonary disease (COPD) and Chronic Kidney Disease (CKD) diseases. The clinical trials contribute in improving the system's accuracy, while Pulmonologists and Nephrologists experts utilized the CHRONIOUS platform to evaluate its efficiency and performance. The results of the utilization of the system were very encouraging. The CHRONIOUS system has been proven to be a well-validated real-time patient monitoring and supervision platform, providing a useful tool for the clinician and the patient that would contribute to the more effective management of chronic diseases.

Periodontal treatment reduces chronic systemic inflammation in peritoneal dialysis patients.

Science.gov (United States)

Siribamrungwong, Monchai; Yothasamutr, Kasemsuk; Puangpanngam, Kutchaporn

2014-06-01

Chronic systemic inflammation, a non traditional risk factor of cardiovascular diseases, is associated with increasing mortality in chronic kidney disease, especially peritoneal dialysis patients. Periodontitis is a potential treatable source of systemic inflammation in peritoneal dialysis patients. Clinical periodontal status was evaluated in 32 stable chronic peritoneal dialysis patients by plaque index and periodontal disease index. Hematologic, blood chemical, nutritional, and dialysis-related data as well as highly sensitive C-reactive protein were analyzed before and after periodontal treatment. At baseline, high sensitive C-reactive protein positively correlated with the clinical periodontal status (plaque index; r = 0.57, P periodontal disease index; r = 0.56, P periodontal therapy, clinical periodontal indexes were significantly lower and high sensitivity C-reactive protein significantly decreased from 2.93 to 2.21 mg/L. Moreover, blood urea nitrogen increased from 47.33 to 51.8 mg/dL, reflecting nutritional status improvement. Erythropoietin dosage requirement decreased from 8000 to 6000 units/week while hemoglobin level was stable. Periodontitis is an important source of chronic systemic inflammation in peritoneal dialysis patients. Treatment of periodontal diseases can improve systemic inflammation, nutritional status and erythropoietin responsiveness in peritoneal dialysis patients. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

RUGs and "Medi-Cal" systems for classifying nursing home patients.

Science.gov (United States)

Grimaldi, P L

1985-12-01

Medicare and most state Medicaid programs currently use indirect case-mix measures to determine reimbursement for nursing home care. In the future, however, they probably will incorporate more direct case-mix measures into their payment systems. Care must be exercised in designing a case-based prospective payment system to ensure that its financial incentives motivate providers to expedite recovery, prevent deterioration, and admit heavy-care patients. For example, although use of a services-rendered approach helps guarantee that care will be provided when needed, it also offers providers an incentive to furnish a service regardless of whether it is in the patient's best interest. Consideration must be given to the frequency with which patients are reassessed. The implications of the timing of reassessments for quality of care also must be studied. Ideally, quality would be measured on an outcome basis--that is, payment would depend on whether targeted goals for individual patients are reached--rather than on structural or process measures alone. Two recent classification systems--Resource Utilization Groups and Medi-Cal groups--may serve as models for case-based prospective payment systems. Each method classifies patients into distinct, meaningful categories based on activities of daily living and services received.

An electromechanical, patient positioning system for head and neck radiotherapy

Science.gov (United States)

Ostyn, Mark; Dwyer, Thomas; Miller, Matthew; King, Paden; Sacks, Rachel; Cruikshank, Ross; Rosario, Melvin; Martinez, Daniel; Kim, Siyong; Yeo, Woon-Hong

2017-09-01

In cancer treatment with radiation, accurate patient setup is critical for proper dose delivery. Improper arrangement can lead to disease recurrence, permanent organ damage, or lack of disease control. While current immobilization equipment often helps for patient positioning, manual adjustment is required, involving iterative, time-consuming steps. Here, we present an electromechanical robotic system for improving patient setup in radiotherapy, specifically targeting head and neck cancer. This positioning system offers six degrees of freedom for a variety of applications in radiation oncology. An analytical calculation of inverse kinematics serves as fundamental criteria to design the system. Computational mechanical modeling and experimental study of radiotherapy compatibility and x-ray-based imaging demonstrates the device feasibility and reliability to be used in radiotherapy. An absolute positioning accuracy test in a clinical treatment room supports the clinical feasibility of the system.

ICT use for information management in healthcare system for chronic disease patient

Science.gov (United States)

Wawrzyniak, Zbigniew M.; Lisiecka-Biełanowicz, Mira

2013-10-01

Modern healthcare systems are designed to fulfill needs of the patient, his system environment and other determinants of the treatment with proper support of technical aids. A whole system of care is compatible to the technical solutions and organizational framework based on legal rules. The purpose of this study is to present how can we use Information and Communication Technology (ICT) systemic tools in a new model of patient-oriented care, improving the effectiveness of healthcare for patients with chronic diseases. The study material is the long-term process of healthcare for patients with chronic illness. Basing on the knowledge of the whole circumstances of patient's ecosystem and his needs allow us to build a new ICT model of long term care. The method used is construction, modeling and constant improvement the efficient ICT layer for the patient-centered healthcare model. We present a new constructive approach to systemic process how to use ICT for information management in healthcare system for chronic disease patient. The use of ICT tools in the model for chronic disease can improve all aspects of data management and communication, and the effectiveness of long-term complex healthcare. In conclusion: ICT based model of healthcare can be constructed basing on the interactions of ecosystem's functional parts through information feedback and the provision of services and models as well as the knowledge of the patient itself. Systematic approach to the model of long term healthcare assisted functionally by ICT tools and data management methods will increase the effectiveness of patient care and organizational efficiency.

Breast Ultrasound Examination with Video Monitor System: A Satisfaction Survey among Patients

International Nuclear Information System (INIS)

Ryu, Jung Kyu; Kim, Hyun Cheol; Yang, Dal Mo

2010-01-01

The purpose of this study is to assess the patients satisfaction with a newly established video-monitor system and the associated basic items for performing breast ultrasound exams by conducting a survey among the patients. 349 patients were invited to take the survey and they had undergone breast ultrasound examination once during the 3 months after the monitor system has been introduced. The questionnaire was composed of 8 questions, 4 of which were about the basic items such as age, gender and the reason of their taking the breast ultrasound exam, their preference for the gender of the examiner and the desired length of time for the examination. The other 4 question were about their satisfaction with the video monitor. The patients were divided into two groups according to the purposes of taking the exams, which were screening or diagnostic purposes. The results were compared between these 2 groups. The satisfaction with the video monitor system was assessed by using a scoring system that ranged from 1 to 5. For the total patients, the screening group was composed of 124 patients and the diagnostic group was composed of 225. The reasons why the patients wanted to take the examinations in the diagnostic group varied. The questionnaire about the preference of the gender of the examiner showed that 81.5% in the screening group and 79.1% in the diagnostic group preferred a woman doctor. The required, suitable time for the breast ultrasound examination was 5 to 10 minutes or 10 to 15 minutes for about 70% of the patients. The mean satisfaction score for the video monitor system was as high as 3.95 point. The portion of patients in each group who answered over 3 points for their satisfaction with the monitor system was 88.7% and 94.2%, respectively. Our study showed that patients preferred 5-15 minutes for the length of the examination time and a female examiner. We also confirmed high patient satisfaction with the video monitor system

Breast Ultrasound Examination with Video Monitor System: A Satisfaction Survey among Patients

Energy Technology Data Exchange (ETDEWEB)

Ryu, Jung Kyu; Kim, Hyun Cheol; Yang, Dal Mo [East-West Neo Medical Center, Kyung-Hee University, Seoul (Korea, Republic of)

2010-03-15

The purpose of this study is to assess the patients satisfaction with a newly established video-monitor system and the associated basic items for performing breast ultrasound exams by conducting a survey among the patients. 349 patients were invited to take the survey and they had undergone breast ultrasound examination once during the 3 months after the monitor system has been introduced. The questionnaire was composed of 8 questions, 4 of which were about the basic items such as age, gender and the reason of their taking the breast ultrasound exam, their preference for the gender of the examiner and the desired length of time for the examination. The other 4 question were about their satisfaction with the video monitor. The patients were divided into two groups according to the purposes of taking the exams, which were screening or diagnostic purposes. The results were compared between these 2 groups. The satisfaction with the video monitor system was assessed by using a scoring system that ranged from 1 to 5. For the total patients, the screening group was composed of 124 patients and the diagnostic group was composed of 225. The reasons why the patients wanted to take the examinations in the diagnostic group varied. The questionnaire about the preference of the gender of the examiner showed that 81.5% in the screening group and 79.1% in the diagnostic group preferred a woman doctor. The required, suitable time for the breast ultrasound examination was 5 to 10 minutes or 10 to 15 minutes for about 70% of the patients. The mean satisfaction score for the video monitor system was as high as 3.95 point. The portion of patients in each group who answered over 3 points for their satisfaction with the monitor system was 88.7% and 94.2%, respectively. Our study showed that patients preferred 5-15 minutes for the length of the examination time and a female examiner. We also confirmed high patient satisfaction with the video monitor system

Trust, temporality and systems: how do patients understand patient safety in primary care? A qualitative study.

Science.gov (United States)

Rhodes, Penny; Campbell, Stephen; Sanders, Caroline

2016-04-01

Patient safety research has tended to focus on hospital settings, although most clinical encounters occur in primary care, and to emphasize practitioner errors, rather than patients' own understandings of safety. To explore patients' understandings of safety in primary care. Qualitative interviews were conducted with patients recruited from general practices in northwest England. Participants were asked basic socio-demographic information; thereafter, topics were largely introduced by interviewees themselves. Transcripts were coded and analysed using NVivo10 (qualitative data software), following a process of constant comparison. Thirty-eight people (14 men, 24 women) from 19 general practices in rural, small town and city locations were interviewed. Many of their concerns (about access, length of consultation, relationship continuity) have been discussed in terms of quality, but, in the interviews, were raised as matters of safety. Three broad themes were identified: (i) trust and psycho-social aspects of professional-patient relationships; (ii) choice, continuity, access, and the temporal underpinnings of safety; and (iii) organizational and systems-level tensions constraining safety. Conceptualizations of safety included common reliance on a bureaucratic framework of accreditation, accountability, procedural rules and regulation, but were also individual and context-dependent. For patients, safety is not just a property of systems, but personal and contingent and is realized in the interaction between doctor and patient. However, it is the systems approach that has dominated safety thinking, and patients' individualistic and relational conceptualizations are poorly accommodated within current service organization. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Type 2 diabetes patients assessment of the COMODITY12 mHealth system

Directory of Open Access Journals (Sweden)

Przemyslaw Kardas

2015-11-01

Full Text Available Background: Patient acceptance is one of the major barriers toward widespread use of mHealth. The aim of this study was to assess patients’ experience with their use of COMMODITY12 telehealth system. Methods: DM2 patients assessed COMMODITY12 system after its 6 weeks’ long use within clinical trial. Patients opinions were collected with 7-item questionnaire, assessing different aspects of system use, as well as EuroQol-5D-5L generic questionnaire, assessing health-related quality of life. Results: Thirty patients (female, 13, male, 17, mean age +/- SD 59.9 +/- 5.3 completed study. All dimensions of experience with system use were assessed well, with maximum values for clearness of instructions, and ease of use (4.80, and 4.63, respectively. Health related quality of life, as assessed with general utility measure, improved significantly (P<0.05. Conclusions: Study proved that the COMODITY12 system is accepted well by type 2 diabetes patients taking part in clinical trial. Nevertheless, before future commercialisation of the system, several minor problems identified during the study need to be addressed.

Human factors and systems engineering approach to patient safety for radiotherapy.

Science.gov (United States)

Rivera, A Joy; Karsh, Ben-Tzion

2008-01-01

The traditional approach to solving patient safety problems in healthcare is to blame the last person to touch the patient. But since the publication of To Err is Human, the call has been instead to use human factors and systems engineering methods and principles to solve patient safety problems. However, an understanding of the human factors and systems engineering is lacking, and confusion remains about what it means to apply their principles. This paper provides a primer on them and their applications to patient safety.

Human Factors and Systems Engineering Approach to Patient Safety for Radiotherapy

International Nuclear Information System (INIS)

Rivera, A. Joy; Karsh, Ben-Tzion

2008-01-01

The traditional approach to solving patient safety problems in healthcare is to blame the last person to touch the patient. But since the publication of To Err is Human, the call has been instead to use human factors and systems engineering methods and principles to solve patient safety problems. However, an understanding of the human factors and systems engineering is lacking, and confusion remains about what it means to apply their principles. This paper provides a primer on them and their applications to patient safety

Safe Handover : Safe Patients - The Electronic Handover System.

Science.gov (United States)

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS.

Travel patterns of cancer surgery patients in a regionalized system.

Science.gov (United States)

Smith, Andrew K; Shara, Nawar M; Zeymo, Alexander; Harris, Katherine; Estes, Randy; Johnson, Lynt B; Al-Refaie, Waddah B

2015-11-01

Regionalization of complex surgeries has increased patient travel distances possibly leaving a substantial burden on those at risk for poorer surgical outcomes. To date, little is known about travel patterns of cancer surgery patients in regionalized settings. To inform this issue, we sought to assess travel patterns of those undergoing a major cancer surgery within a regionalized system. We identified 4733 patients who underwent lung, esophageal, gastric, liver, pancreatic, and colorectal resections from 2002-2014 within a multihospital system in the Mid-Atlantic region of the United States. Patient age, race and/or ethnicity, and insurance status were extracted from electronic health records. We used Geographical Information System capabilities in R software to estimate travel distance and map patient addresses based on cancer surgery type and these characteristics. We used visual inspection, analysis of variance, and interaction analyses to assess the distribution of travel distances between patient populations. A total of 48.2% of patients were non-white, 49.9% were aged >65 y, and 54.9% had private insurance. Increased travel distance was associated with decreasing age and those undergoing pancreatic and esophageal resections. Also, black patients tend to travel shorter distances than other racial and/or ethnic groups. These maps offer a preliminary understanding into variations of geospatial travel patterns among patients receiving major cancer surgery in a Mid-Atlantic regionalized setting. Future research should focus on the impact of regionalization on timely delivery of surgical care and other quality metrics. Copyright © 2015 Elsevier Inc. All rights reserved.

Condition Help: A Patient- and Family-Initiated Rapid Response System.

Science.gov (United States)

Eden, Elizabeth L; Rack, Laurie L; Chen, Ling-Wan; Bump, Gregory M

2017-03-01

Rapid response teams (RRTs) help in delivering safe, timely care. Typically they are activated by clinicians using specific parameters. Allowing patients and families to activate RRTs is a novel intervention. The University of Pittsburgh Medical Center developed and implemented a patient- and family-initiated rapid response system called Condition Help (CH). When the CH system is activated, a patient care liaison or an on-duty administrator meets bedside with the unit charge nurse to address the patient's concerns. In this study, we collected demographic data, call reasons, call designations (safety or nonsafety), and outcome information for all CH calls made during the period January 2012 through June 2015. Two hundred forty patients/family members made 367 CH calls during the study period. Most calls were made by patients (76.8%) rather than family members (21.8%). Of the 240 patients, 43 (18%) made multiple calls; their calls accounted for 46.3% of all calls (170/367). Inadequate pain control was the reason for the call in most cases (48.2%), followed by dissatisfaction with staff (12.5%). The majority of calls involved nonsafety issues (83.4%) rather than safety issues (11.4%). In 41.4% of cases, a change in care was made. Patient- and family-initiated RRTs are designed to engage patients and families in providing safer care. In the CH system, safety issues are identified, but the majority of calls involve nonsafety issues. Journal of Hospital Medicine 2017;12:157-161. © 2017 Society of Hospital Medicine

Designing an Authorization System Based on Patient Privacy Preferences in Japan.

Science.gov (United States)

Morris, Kensuke; Yamamoto, Goshiro; Hiragi, Shusuke; Ohtera, Shosuke; Sakai, Michi; Sugiyama, Osamu; Okamoto, Kazuya; Nambu, Masayuki; Kuroda, Tomohiro

2018-01-01

High accessibility of Electronic Health Record systems can increase usability but creates simultaneously patients' anxieties about privacy issues. In order to reduce the privacy concerns, we focused on control and awareness, and designed an approach that can provide availability of patient's clinical data to doctors in two scenarios; (S1) direct control by the patient when they are conscious, (S2) control by a trusted representative when the patient is unconscious. In this paper, we show further analysis in a survey (n = 310, age range: 19-91) done to test the acceptability of our concept of a using a trusted representative and to further understand the concerns of Japanese citizens to improve our system design. These results in S1 suggest that patients concerned about control have a stronger inclination to also choose full awareness. We found also that patients tended to choose the same level of awareness for the representative as they did for themselves in S2. In addition, patients who chose awareness in S1 tended to choose the same for their representative in S2 and themselves after recovery from unconsciousness. We also discuss the significant differences found between the age-groups 20-39 and 60-79. We conclude that the system design of privacy aware EHR systems must be improved to consider patients who want to preserve their choice of control in the event they become unconscious but do not want to use a representative to maintain control.

Home Automated Telemanagement (HAT System to Facilitate Self-Care of Patients with Chronic Diseases

Directory of Open Access Journals (Sweden)

Joseph Finkelstein

2003-06-01

Full Text Available Successful patient self-management requires a multidisciplinary approach that includes regular patient assessment, disease-specific education, control of medication adherence, implementation of health behavior change models and social support. Existing systems for computer-assisted disease management do not provide this multidisciplinary patient support and do not address treatment compliance issues. We developed the Home Automated Telemanagement (HAT system for patients with different chronic health conditions to facilitate their self-care. The HAT system consists of a home unit, HAT server, and clinician units. Patients at home use a palmtop or a laptop connected with a disease monitor on a regular basis. Each HAT session consists of self-testing, feedback, and educational components. The self-reported symptom data and objective results obtained from disease-specific sensors are automatically sent from patient homes to the HAT server in the hospital. Any web-enabled device can serve as a clinician unit to review patient results. The HAT system monitors self-testing results and patient compliance. The HAT system has been implemented and tested in patients receiving anticoagulation therapy, patients with asthma, COPD and other health conditions. Evaluation results indicated high level of acceptance of the HAT system by the patients and that the system has a positive impact on main clinical outcomes and patient satisfaction with medical care.

A total patient monitoring system for point-of-care applications

Science.gov (United States)

Whitchurch, Ashwin K.; Abraham, Jose K.; Varadan, Vijay K.

2007-04-01

Traditionally, home care for chronically ill patients and the elderly requires periodic visits to the patient's home by doctors or healthcare personnel. During these visits, the visiting person usually records the patient's vital signs and takes decisions as to any change in treatment and address any issues that the patient may have. Patient monitoring systems have since changed this scenario by significantly reducing the number of home visits while not compromising on continuous monitoring. This paper describes the design and development of a patient monitoring systems capable of concurrent remote monitoring of 8 patient-worn sensors: Electroencephalogram (EEG), Electrocardiogram (ECG), temperature, airflow pressure, movement and chest expansion. These sensors provide vital signs useful for monitoring the health of chronically ill patients and alerts can be raised if certain specified signal levels fall above or below a preset threshold value. The data from all eight sensors are digitally transmitted to a PC or to a standalone network appliance which relays the data through an available internet connection to the remote monitoring client. Thus it provides a real-time rendering of the patient's health at a remote location.

Closed-loop strategies for patient care systems.

Science.gov (United States)

Pauldine, Ronald; Beck, George; Salinas, Jose; Kaczka, David W

2008-04-01

Military operations, mass casualty events, and remote work sites present unique challenges to providers of immediate medical care, who may lack the necessary skills for optimal clinical management. Moreover, the number of patients in these scenarios may overwhelm available health care resources. Recent applications of closed-loop control (CLC) techniques to critical care medicine may offer possible solutions for such environments. Here, feedback of a monitored variable or group of variables is used to control the state or output of a dynamic system. Some potential advantages of CLC in patient management include limiting task saturation when there is simultaneous demand for cognitive and active clinical intervention, improving quality of care through optimization of the titration of medications, conserving limited consumable supplies, preventing secondary insults in traumatic brain injury, shortening the duration of mechanical ventilation, and achieving appropriate goal-directed resuscitation. The uses of CLC systems in critical care medicine have been increasingly explored across a wide range of therapeutic modalities. This review will provide an overview of control system theory as applied to critical care medicine that must be considered in the design of autonomous CLC systems, and introduce a number of clinical applications under development in the context of deployment of such applications to austere environments.

Security of patient data when decommissioning ultrasound systems.

Science.gov (United States)

Moggridge, James

2017-02-01

Although ultrasound systems generally archive to Picture Archiving and Communication Systems (PACS), their archiving workflow typically involves storage to an internal hard disk before data are transferred onwards. Deleting records from the local system will delete entries in the database and from the file allocation table or equivalent but, as with a PC, files can be recovered. Great care is taken with disposal of media from a healthcare organisation to prevent data breaches, but ultrasound systems are routinely returned to lease companies, sold on or donated to third parties without such controls. In this project, five methods of hard disk erasure were tested on nine ultrasound systems being decommissioned: the system's own delete function; full reinstallation of system software; the manufacturer's own disk wiping service; open source disk wiping software for full and just blank space erasure. Attempts were then made to recover data using open source recovery tools. All methods deleted patient data as viewable from the ultrasound system and from browsing the disk from a PC. However, patient identifiable data (PID) could be recovered following the system's own deletion and the reinstallation methods. No PID could be recovered after using the manufacturer's wiping service or the open source wiping software. The typical method of reinstalling an ultrasound system's software may not prevent PID from being recovered. When transferring ownership, care should be taken that an ultrasound system's hard disk has been wiped to a sufficient level, particularly if the scanner is to be returned with approved parts and in a fully working state.

New prognostic factors and scoring system for patients with skeletal metastasis.

Science.gov (United States)

Katagiri, Hirohisa; Okada, Rieko; Takagi, Tatsuya; Takahashi, Mitsuru; Murata, Hideki; Harada, Hideyuki; Nishimura, Tetsuo; Asakura, Hirofumi; Ogawa, Hirofumi

2014-10-01

The aim of this study was to update a previous scoring system for patients with skeletal metastases, that was proposed by Katagiri et al. in 2005, by introducing a new factor (laboratory data) and analyzing a new patient cohort. Between January 2005 and January 2008, we treated 808 patients with symptomatic skeletal metastases. They were prospectively registered regardless of their treatments, and the last follow-up evaluation was performed in 2012. There were 441 male and 367 female patients with a median age of 64 years. Of these patients, 749 were treated nonsurgically while the remaining 59 underwent surgery for skeletal metastasis. A multivariate analysis was conducted using the Cox proportional hazards model. We identified six significant prognostic factors for survival, namely, the primary lesion, visceral or cerebral metastases, abnormal laboratory data, poor performance status, previous chemotherapy, and multiple skeletal metastases. The first three factors had a larger impact than the remaining three. The prognostic score was calculated by adding together all the scores for individual factors. With a prognostic score of ≥7, the survival rate was 27% at 6 months, and only 6% at 1 year. In contrast, patients with a prognostic score of ≤3 had a survival rate of 91% at 1 year, and 78% at 2 years. Comparing the revised system with the previous one, there was a significantly lower number of wrongly predicted patients using the revised system. This revised scoring system was able to predict the survival rates of patients with skeletal metastases more accurately than the previous system and may be useful for selecting an optimal treatment. © 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Performance of a video-image-subtraction-based patient positioning system

International Nuclear Information System (INIS)

Milliken, Barrett D.; Rubin, Steven J.; Hamilton, Russell J.; Johnson, L. Scott; Chen, George T.Y.

1997-01-01

Purpose: We have developed and tested an interactive video system that utilizes image subtraction techniques to enable high precision patient repositioning using surface features. We report quantitative measurements of system performance characteristics. Methods and Materials: Video images can provide a high precision, low cost measure of patient position. Image subtraction techniques enable one to incorporate detailed information contained in the image of a carefully verified reference position into real-time images. We have developed a system using video cameras providing orthogonal images of the treatment setup. The images are acquired, processed and viewed using an inexpensive frame grabber and a PC. The subtraction images provide the interactive guidance needed to quickly and accurately place a patient in the same position for each treatment session. We describe the design and implementation of our system, and its quantitative performance, using images both to measure changes in position, and to achieve accurate setup reproducibility. Results: Under clinical conditions (60 cm field of view, 3.6 m object distance), the position of static, high contrast objects could be measured with a resolution of 0.04 mm (rms) in each of two dimensions. The two-dimensional position could be reproduced using the real-time image display with a resolution of 0.15 mm (rms). Two-dimensional measurement resolution of the head of a patient undergoing treatment for head and neck cancer was 0.1 mm (rms), using a lateral view, measuring the variation in position of the nose and the ear over the course of a single radiation treatment. Three-dimensional repositioning accuracy of the head of a healthy volunteer using orthogonal camera views was less than 0.7 mm (systematic error) with an rms variation of 1.2 mm. Setup adjustments based on the video images were typically performed within a few minutes. The higher precision achieved using the system to measure objects than to reposition

Adaptive process triage system cannot identify patients with gastrointestinal perforation

DEFF Research Database (Denmark)

Bohm, Aske Mathias; Tolstrup, Mai-Britt; Gögenur, Ismail

2017-01-01

INTRODUCTION: Adaptive process triage (ADAPT) is a triage tool developed to assess the severity and address the priority of emergency patients. In 2009-2011, ADAPT was the most frequently used triage system in Denmark. Until now, no Danish triage system has been evaluated based on a selective group...... triaged as green or yellow had a GIP that was not identified by the triage system. CONCLUSION: ADAPT is incapable of identifying one of the most critically ill patient groups in need of emergency abdominal surgery. FUNDING: none. TRIAL REGISTRATION: HEH-2013-034 I-Suite: 02336....

Does a new steam meal catering system meet patient requirements in hospital?

Science.gov (United States)

Hickson, M; Fearnley, L; Thomas, J; Evans, S

2007-10-01

It has been consistently observed that a significant proportion of hospital inpatients are malnourished and many actually develop malnutrition in hospital. The NHS provides over 300 million meals each year at a cost of pound 500 million, yet there is relatively little research evaluating how well different catering systems provide for the needs of hospital inpatients. The aim of the study was to: (i) evaluate whether a new steam meal catering system (Steamplicity) enables patients in theory to meet their energy requirements in hospital and (ii) compare energy and protein intake using Steamplicity with a traditional bulk cook-chill system. Patients not at nutritional risk had their food intake at one lunchtime assessed. Energy intake was compared with the patients' energy requirements and energy and protein intake were compared with previous data from a bulk system. Fifty-seven patients had a median daily energy requirement of 7648 kJ (1821 kcal) [inter-quartile range (IQR): 6854-9164 kJ]. Assuming 30% [2293 kJ (546 kcal)] should be supplied by the lunch meal the average intake of 1369 kJ (326 kcal) fell short by 40%. Patients served meals from Steamplicity ate less energy [1369 kJ versus 1562 kJ (326 kcal versus 372 kcal) P = 0.04] but similar protein (18 g versus 19 g P = 0.34) to the bulk system. The largest difference was the energy provided by the dessert since the bulk system served more hot high-calorie desserts. Patient intakes did not meet their estimated requirements. The patients in this study were eating well and not at nutritional risk, thus patients with a poor appetite will be even less likely to meet their nutritional requirements. Steamplicity meals result in a lower energy intake than meals from a bulk cook-chill system, but similar protein intakes.

Two patients with osteoporosis : initial presentation of systemic mastocytosis

NARCIS (Netherlands)

Donker, Marjolein L.; Bakker, Nicolaas A.; Jaspers, Wim J. M.; Verhage, Albert H.

In two patients with osteoporosis, systemic mastocytosis ultimately turned out to be the underlying disease. Both patients had a history of anaphylactic reactions caused by wasp stings but did not have any skin or other symptoms. This observation reflects the need for careful history taking and

Managing patients' wait time in specialist out-patient clinic using real-time data from existing queue management and ADT systems.

Science.gov (United States)

Ju, John Chen; Gan, Soon Ann; Tan Siew Wee, Justine; Huang Yuchi, Peter; Mei Mei, Chan; Wong Mei Mei, Sharon; Fong, Kam Weng

2013-01-01

In major cancer centers, heavy patients load and multiple registration stations could cause significant wait time, and can be result in patient complains. Real-time patient journey data and visual display are useful tools in hospital patient queue management. This paper demonstrates how we capture patient queue data without deploying any tracing devices; and how to convert data into useful patient journey information to understand where interventions are likely to be most effective. During our system development, remarkable effort has been spent on resolving data discrepancy and balancing between accuracy and system performances. A web-based dashboard to display real-time information and a framework for data analysis were also developed to facilitate our clinics' operation. Result shows our system could eliminate more than 95% of data capturing errors and has improved patient wait time data accuracy since it was deployed.

Changing patient classification system for hospital reimbursement in Romania.

Science.gov (United States)

Radu, Ciprian-Paul; Chiriac, Delia Nona; Vladescu, Cristian

2010-06-01

To evaluate the effects of the change in the diagnosis-related group (DRG) system on patient morbidity and hospital financial performance in the Romanian public health care system. Three variables were assessed before and after the classification switch in July 2007: clinical outcomes, the case mix index, and hospital budgets, using the database of the National School of Public Health and Health Services Management, which contains data regularly received from hospitals reimbursed through the Romanian DRG scheme (291 in 2009). The lack of a Romanian system for the calculation of cost-weights imposed the necessity to use an imported system, which was criticized by some clinicians for not accurately reflecting resource consumption in Romanian hospitals. The new DRG classification system allowed a more accurate clinical classification. However, it also exposed a lack of physicians' knowledge on diagnosing and coding procedures, which led to incorrect coding. Consequently, the reported hospital morbidity changed after the DRG switch, reflecting an increase in the national case-mix index of 25% in 2009 (compared with 2007). Since hospitals received the same reimbursement over the first two years after the classification switch, the new DRG system led them sometimes to change patients' diagnoses in order to receive more funding. Lack of oversight of hospital coding and reporting to the national reimbursement scheme allowed the increase in the case-mix index. The complexity of the new classification system requires more resources (human and financial), better monitoring and evaluation, and improved legislation in order to achieve better hospital resource allocation and more efficient patient care.

Plasma D-dimer concentration in patients with systemic sclerosis

Directory of Open Access Journals (Sweden)

Montagnana Martina

2006-01-01

Full Text Available Abstract Background Systemic sclerosis (SSc is an autoimmune disorder of the connective tissue characterized by widespread vascular lesions and fibrosis. Little is known so far on the activation of the hemostatic and fibrinolytic systems in SSc, and most preliminary evidences are discordant. Methods To verify whether SSc patients might display a prothrombotic condition, plasma D-dimer was assessed in 28 consecutive SSc patients and in 33 control subjects, matched for age, sex and environmental habit. Results and discussion When compared to healthy controls, geometric mean and 95% confidence interval (IC95% of plasma D-dimer were significantly increased in SSc patients (362 ng/mL, IC 95%: 361–363 ng/mL vs 229 ng/mL, IC95%: 228–231 ng/mL, p = 0.005. After stratifying SSc patients according to disease subset, no significant differences were observed between those with limited cutaneous pattern and controls, whereas patients with diffuse cutaneous pattern displayed substantially increased values. No correlation was found between plasma D-dimer concentration and age, sex, autoantibody pattern, serum creatinine, erythrosedimentation rate, nailfold videocapillaroscopic pattern and pulmonary involvement. Conclusion We demonstrated that SSc patients with diffuse subset are characterized by increased plasma D-dimer values, reflecting a potential activation of both the hemostatic and fibrinolytic cascades, which might finally predispose these patients to thrombotic complications.

High Dk piggyback contact lens system for contact lens-intolerant keratoconus patients.

Science.gov (United States)

Sengor, Tomris; Kurna, Sevda Aydin; Aki, Suat; Ozkurt, Yelda

2011-01-01

The aim of the study was to examine the clinical success of high Dk (oxygen permeability) piggyback contact lens (PBCL) systems for the correction of contact lens intolerant keratoconus patients. Sixteen patients (29 eyes) who were not able to wear gas-permeable rigid lenses were included in this study. Hyper Dk silicone hydrogel (oxygen transmissibility or Dk/t = 150 units) and fluorosilicone methacrylate copolymer (Dk/t = 100 units) lenses were chosen as the PBCL systems. The clinical examinations included visual acuity and corneal observation by biomicroscopy, keratometer reading, and fluorescein staining before and after fitting the PBCL system. INDICATIONS FOR USING PBCL SYSTEM WERE: lens stabilization and comfort, improving comfort, and adding protection to the cone. Visual acuities increased significantly in all of the patients compared with spectacles (P = 0). Improvement in visual acuity compared with rigid lenses alone was recorded in 89.7% of eyes and no alteration of the visual acuity was observed in 10.3% of the eyes. Wearing time of PBCL systems for most of the patients was limited time (mean 6 months, range 3-12 months); thereafter they tolerated rigid lenses alone except for 2 patients. The PBCL system is a safe and effective method to provide centering and corneal protection against mechanical trauma by the rigid lenses for keratoconus patients and may increase contact lens tolerance.

REASONS FOR PATIENT DELAYS & HEALTH SYSTEM DELAYS FOR TUBERCULOSIS IN SOUTH INDIA

Directory of Open Access Journals (Sweden)

Kapil Goel

2011-12-01

Full Text Available Background: Globally, the burden of Tuberculosis is escalating. Early diagnosis and prompt initiation of tuberculosis treatment is essential for an effective tuberculosis control programme. Objectives: To study the self reported reasons for patient and health system (diagnosis & treatment delays in Tuberculosis patients. Methods: A community based cross sectional study was conducted among 98 new sputum positive TB cases aged > 15 years registered under RNTCP from Oct 2006 to June 2007 & receiving treatment under DOTS in Udupi taluk by interviewing them. Results: Total 98 patients were recruited and 68% were males. Out of 17 patients with patient delays, 82% felt that their symptoms were not severe, 71% felt that patient delay was due to lack of awareness and 71% did not take it seriously. Out of 86 patients with health system delays, 82.6% of patients mentioned that doctor has not advised for sputum examination, 76.7% of patients told that they first consulted a private doctor, 21% of them mentioned that doctor was unaware to diagnose TB. Conclusion: Symptoms not severe is the main reason for the patient delay and doctor didn’t advise for sputum examination is the main reason for health system delays.

A comparison of two systems of patient immobilization for prostate radiotherapy

International Nuclear Information System (INIS)

White, Peter; Yee, Chui Ka; Shan, Lee Chi; Chung, Lee Wai; Man, Ng Ho; Cheung, Yik Shing

2014-01-01

Reproducibility of different immobilization systems, which may affect set-up errors, remains uncertain. Immobilization systems and their corresponding set-up errors influence the clinical target volume to planning target volume (CTV-PTV) margins and thus may result in undesirable treatment outcomes. This study compared the reproducibility of patient positioning with Hipfix system and whole body alpha cradle with respect to localized prostate cancer and investigated the existing CTV-PTV margins in the clinical oncology departments of two hospitals. Forty sets of data of patients with localized T1-T3 prostate cancer were randomly selected from two regional hospitals, with 20 patients immobilized by a whole-body alpha cradle system and 20 by a thermoplastic Hipfix system. Seven sets of the anterior-posterior (AP), cranial-caudal (CC) and medial-lateral (ML) deviations were collected from each patient. The reproducibility of patient positioning within the two hospitals was compared using a total vector error (TVE) parameter. In addition, CTV-PTV margins were computed using van Herk’s formula. The resulting values were compared to the current CTV-PTV margins in both hospitals. The TVE values were 5.1 and 2.8 mm for the Hipfix and the whole-body alpha cradle systems respectively. TVE associated with the whole-body alpha cradle system was found to be significantly less than the Hipfix system (p < 0.05). The CC axis in the Hipfix system attained the highest frequency of large (23.6%) and serious (7.9%) set-up errors. The calculated CTV to PTV margin was 8.3, 1.9 and 2.3 mm for the Hipfix system, and 2.1, 3.4 and 1.8 mm for the whole body alpha cradle in CC, ML and AP axes respectively. All but one (CC axis using Hipfix) margin calculated did not exceed the corresponding hospital protocol. The whole body alpha cradle system was found to be significantly better than the Hipfix system in terms of reproducibility (p < 0.05), especially in the CC axis. The whole body alpha

A comparison of two systems of patient immobilization for prostate radiotherapy.

Science.gov (United States)

White, Peter; Yee, Chui Ka; Shan, Lee Chi; Chung, Lee Wai; Man, Ng Ho; Cheung, Yik Shing

2014-01-22

Reproducibility of different immobilization systems, which may affect set-up errors, remains uncertain. Immobilization systems and their corresponding set-up errors influence the clinical target volume to planning target volume (CTV-PTV) margins and thus may result in undesirable treatment outcomes. This study compared the reproducibility of patient positioning with Hipfix system and whole body alpha cradle with respect to localized prostate cancer and investigated the existing CTV-PTV margins in the clinical oncology departments of two hospitals. Forty sets of data of patients with localized T1-T3 prostate cancer were randomly selected from two regional hospitals, with 20 patients immobilized by a whole-body alpha cradle system and 20 by a thermoplastic Hipfix system. Seven sets of the anterior-posterior (AP), cranial-caudal (CC) and medial-lateral (ML) deviations were collected from each patient. The reproducibility of patient positioning within the two hospitals was compared using a total vector error (TVE) parameter. In addition, CTV-PTV margins were computed using van Herk's formula. The resulting values were compared to the current CTV-PTV margins in both hospitals. The TVE values were 5.1 and 2.8 mm for the Hipfix and the whole-body alpha cradle systems respectively. TVE associated with the whole-body alpha cradle system was found to be significantly less than the Hipfix system (p < 0.05). The CC axis in the Hipfix system attained the highest frequency of large (23.6%) and serious (7.9%) set-up errors. The calculated CTV to PTV margin was 8.3, 1.9 and 2.3 mm for the Hipfix system, and 2.1, 3.4 and 1.8 mm for the whole body alpha cradle in CC, ML and AP axes respectively. All but one (CC axis using Hipfix) margin calculated did not exceed the corresponding hospital protocol. The whole body alpha cradle system was found to be significantly better than the Hipfix system in terms of reproducibility (p < 0.05), especially in the CC axis. The whole body alpha

Cognitive functions and autoantibodies in patients with systemic lupus erythematosus

Directory of Open Access Journals (Sweden)

Anna Bogaczewicz

2016-06-01

Full Text Available Introduction: Autoantibodies may occur in the course of various diseases. In the case of systemic lupus erythematosus the presence of specific autoantibodies is included in the classification criteria of the disease. The aim of the study was to investigate whether the presence of the serologic markers of systemic lupus erythematosus, i.e. anti-dsDNA, anti-Sm and anticardiolipin antibodies of the class IgM and IgG are linked with the results of neuropsychological tests evaluating selected cognitive functions in patients without overt neuropsychiatric lupus and without antiphospholipid syndrome. Material and methods: The study included 22 patients with systemic lupus erythematosus. For the assessment of anti-dsDNA, anti-Sm and anticardiolipin antibodies the immunoenzymatic method was used. For neuropsychological estimation of the selected cognitive functions the attention switching test and the choice reaction time were applied, in which the results are expressed as the average delay i.e. mean correct latency, using the computer-based Cambridge Neuropsychological Test Automated Battery (CANTAB. Results: The results of attention switching test in patients with anti-Sm antibodies were lower, but not significantly different from those obtained by the patients without such antibodies: 75.0 (73.12–88.12 vs. 92.5 (85–95. Choice reaction time was significantly longer in patients with anti-Sm antibodies in comparison to the patients without antiSm antibodies: 614.9 (520.6–740.8 vs. 476.7 (396.6–540 (p = 0.01. No significant difference was demonstrated in the results of attention switching test and choice reaction time with regard to the presence of anti-dsDNA antibodies. The results of attention switching test and choice reaction time were not different between the groups of patients with and without anticardiolipin antibodies in the IgM and IgG class. Conclusions: Anti-Sm antibodies seem to contribute to

KERMA-based radiation dose management system for real-time patient dose measurement

Science.gov (United States)

Kim, Kyo-Tae; Heo, Ye-Ji; Oh, Kyung-Min; Nam, Sang-Hee; Kang, Sang-Sik; Park, Ji-Koon; Song, Yong-Keun; Park, Sung-Kwang

2016-07-01

Because systems that reduce radiation exposure during diagnostic procedures must be developed, significant time and financial resources have been invested in constructing radiation dose management systems. In the present study, the characteristics of an existing ionization-based system were compared to those of a system based on the kinetic energy released per unit mass (KERMA). Furthermore, the feasibility of using the KERMA-based system for patient radiation dose management was verified. The ionization-based system corrected the effects resulting from radiation parameter perturbations in general radiography whereas the KERMA-based system did not. Because of this difference, the KERMA-based radiation dose management system might overestimate the patient's radiation dose due to changes in the radiation conditions. Therefore, if a correction factor describing the correlation between the systems is applied to resolve this issue, then a radiation dose management system can be developed that will enable real-time measurement of the patient's radiation exposure and acquisition of diagnostic images.

The systemic nature of mustard lung: Comparison with COPD patients

Directory of Open Access Journals (Sweden)

Shahriary Alireza

2017-11-01

Full Text Available Sulphur mustard (SM is a powerful blister-causing alkylating chemical warfare agent used by Iraqi forces against Iran. One of the known complications of mustard gas inhalation is mustard lung which is discussed as a phenotype of chronic obstructive pulmonary disease (COPD. In this complication, there are clinical symptoms close to COPD with common etiologies, such as in smokers. Based on information gradually obtained by conducting the studies on mustard lung patients, systemic symptoms along with pulmonary disorders have attracted the attention of researchers. Changes in serum levels of inflammatory markers, such as C-reactive protein (CRP, tumor necrosis factor alpha (TNF-α, nuclear factor κB (NF-κB, matrix metalloproteinases (MMPs, interleukin (IL, chemokines, selectins, immunoglobulins, and signs of imbalance in oxidant-antioxidant system at serum level, present the systemic changes in these patients. In addition to these, reports of extra-pulmonary complications, such as osteoporosis and cardiovascular disease are also presented. In this study, the chance of developing the systemic nature of this lung disease have been followed on using the comparative study of changes in the mentioned markers in mustard lung and COPD patients at stable phases and the mechanisms of pathogenesis and phenomena, such as airway remodeling in these patients.

Altered balance in the autonomic nervous system in schizophrenic patients

DEFF Research Database (Denmark)

Nielsen, B M; Mehlsen, J; Behnke, K

1988-01-01

.05). Heart-rate response to inspiration was greater in non-medicated schizophrenics compared to normal subjects (P less than 0.05), whereas no difference was found between medicated and non-medicated schizophrenics. The results show that the balance in the autonomic nervous system is altered in schizophrenic...... patients with a hyperexcitability in both the sympathetic and the parasympathetic division. Our study has thus indicated a dysfunction in the autonomic nervous system per se and the previous interpretations of attentional orienting responses in schizophrenia is questioned. Medication with neuroleptics......The aim of the present study was to evaluate the autonomic nervous function in schizophrenic patients. Twenty-eight patients (29 +/- 6 years) diagnosed as schizophrenics and in stable medication were included, together with ten schizophrenic patients (25 +/- 5 years) who were unmedicated. Eleven...

Computerized database management system for breast cancer patients.

Science.gov (United States)

Sim, Kok Swee; Chong, Sze Siang; Tso, Chih Ping; Nia, Mohsen Esmaeili; Chong, Aun Kee; Abbas, Siti Fathimah

2014-01-01

Data analysis based on breast cancer risk factors such as age, race, breastfeeding, hormone replacement therapy, family history, and obesity was conducted on breast cancer patients using a new enhanced computerized database management system. My Structural Query Language (MySQL) is selected as the application for database management system to store the patient data collected from hospitals in Malaysia. An automatic calculation tool is embedded in this system to assist the data analysis. The results are plotted automatically and a user-friendly graphical user interface is developed that can control the MySQL database. Case studies show breast cancer incidence rate is highest among Malay women, followed by Chinese and Indian. The peak age for breast cancer incidence is from 50 to 59 years old. Results suggest that the chance of developing breast cancer is increased in older women, and reduced with breastfeeding practice. The weight status might affect the breast cancer risk differently. Additional studies are needed to confirm these findings.

Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients

DEFF Research Database (Denmark)

Møller, S; Hansen, E F; Becker, U

2000-01-01

the acute effects of terlipressin on central and systemic haemodynamics. METHODS: Sixteen patients with alcoholic cirrhosis and portal hypertension had their systemic, central, and splanchnic haemodynamics determined at baseline and after a blind randomised bolus infusion (2 mg) of terlipressin...... vascular resistance (r=-0.52, pportal hypertensive patients without a further contraction of the central and arterial blood volume. The systemic haemodynamic...... increased by 36% (pportal pressure and hepatic blood flow decreased (17% and 29%, both pportal pressure after terlipressin was significantly related to the increase in systemic...

Caring for the Patient With Limited Systemic Scleroderma.

Science.gov (United States)

Lachner, Kelly Denise

2016-01-01

Systemic scleroderma (systemic sclerosis) is a rare, autoimmune, collagen-vascular disease of unknown etiology that affects the connective tissues of the skin, internal organs, as well as the small blood vessels. There are 3 subclasses of systemic scleroderma: limited cutaneous, diffuse cutaneous, and sine scleroderma. Prognosis depends on the extent of organ involvement. Complications of systemic scleroderma can involve the cardiovascular, pulmonary, gastrointestinal, renal, integumentary, and the skeletal-muscular systems. Because systemic scleroderma is not common, many orthopaedic nurses may be unfamiliar with how to best provide care. This article provides information about the complexity of the different types of this disease and the basic nursing care of the patient with the most common subclass of systemic scleroderma, limited cutaneous systemic scleroderma.

Neuropathic pain in Systemic Sclerosis patients: A cross-sectional study.

Science.gov (United States)

Sousa-Neves, Joana; Cerqueira, Marcos; Santos-Faria, Daniela; Afonso, Carmo; Teixeira, Filipa

2018-01-31

To investigate if patients with Systemic Sclerosis (SSc) show a higher prevalence of neuropathic pain (NP) in comparison with controls. To study the relationship between clinical variables of the disease and NP among SSc patients. 48 patients and 45 controls were included. Presence of NP was assessed applying the DN4 "Douleur Neuropathique en 4 Questions" questionnaire. Different clinical variables were also assessed in patients. Statistical analysis included parametric, nonparametric tests and multivariate logistic regression. NP was significantly higher in SSc patients (56.2% vs 13.3%, p<0.001). Mean Modified Rodnan Skin Score was independently associated with the presence of NP (p<0.05, OR 1.90). Peripheral nervous system involvement in SSc is not well studied and, as far as the authors are aware, this is the first study published evaluating NP in SSc patients and controls. These findings should raise the awareness of the clinician to recognize and address the presence of NP in these patients, especially in those with severe skin involvement. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Development of Information System for Patients with Cleft Lip and Palate undergoing Operation.

Science.gov (United States)

Augsornwan, Darawan; Pattangtanang, Pantamanas; Surakunprapha, Palakorn

2015-08-01

Srinagarind Hospital has 150-200 patients with cleft lip and palate each year. When patients are admitted to hospital for surgery patients and family feel they are in a crisis of life, they feel fear anxiety and need to know about how to take care of wound, they worry if patient will feel pain, how to feed patients and many things about patients. Information is very important for patients/family to prevent complications and help their decision process, decrease parents stress and encourage better co-operation. To develop information system for patients with cleft lip-palate undergoing operation. This is an action research divided into 3 phases. Phase 1 Situation review: in this phase we interview, nursing care observation, and review nursing documents about the information giving. Phase 2 Develop information system: focus groups, for discussion about what nurses can do to develop the system to give information to patients/parents. Phase 3 evaluation: by interviewing 61 parents using the structure questionnaire. 100 percent of patients/parents received information but some items were not received. Patients/parents satisfaction was 94.9 percent, no complications. The information system development provides optimal care for patients and family with cleft lip and palate, but needs to improve some techniques or tools to give more information and evaluate further the nursing outcome after.

The prevalence of median neuropathy at wrist in systemic sclerosis patients at Srinagarind Hospital

Directory of Open Access Journals (Sweden)

Thanaporn Nimitbancha

2015-01-01

Full Text Available Objectives: To determine the prevalence and factor related with median neuropathy at wrist (MNW in systemic sclerosis patients. Study Design: Cross-sectional study. Setting: Srinagarind Hospital, Khon Kaen, Thailand. Participants: Systemic sclerosis patients who attended the Scleroderma Clinic, Srinagarind Hospital. Materials and Methods: Seventyfive systemic sclerosis patients were prospectively evaluated by questionnaire, physical examination, and electrodiagnostic study. The questionnaire consisted of the symptoms, duration, and type of systemic sclerosis. The physical examination revealed skin score of systemic sclerosis, pinprick sensation of median nerve distribution of both hands, and weakness of both abductor pollicis brevis muscles. The provocative test which were Tinel′s sign and Phalen′s maneuver were also examined. Moreover, electrodiagnostic study of the bilateral median and ulnar nerves was conducted. Results: The prevalence of MNW in systemic sclerosis patients was 44% - percentage of mild, moderate, and severe were 28%, 9.3%, and 6.7%, respectively. The prevalence of asymptomatic MNW was 88%. There were no association between the presence of MNW and related factors of systemic sclerosis. Conclusions: MNW is one of the most common entrapment neuropathies in systemic sclerosis patients. Systemic sclerosis patients should be screened for early signs of MNW.

Single-centre experience with Renal PatientView, a web-based system that provides patients with access to their laboratory results.

Science.gov (United States)

Woywodt, Alexander; Vythelingum, Kervina; Rayner, Scott; Anderton, John; Ahmed, Aimun

2014-10-01

Renal PatientView (RPV) is a novel, web-based system in the UK that provides patients with access to their laboratory results, in conjunction with patient information. To study how renal patients within our centre access and use RPV. We sent out questionnaires in December 2011 to all 651 RPV users under our care. We collected information on aspects such as the frequency and timing of RPV usage, the parameters viewed by users, and the impact of RPV on their care. A total of 295 (45 %) questionnaires were returned. The predominant users of RPV were transplant patients (42 %) followed by pre-dialysis chronic kidney disease patients (37 %). Forty-two percent of RPV users accessed their results after their clinic appointments, 38 % prior to visiting the clinic. The majority of patients (76 %) had used the system to discuss treatment with their renal physician, while 20 % of patients gave permission to other members of their family to use RPV to monitor results on their behalf. Most users (78 %) reported accessing RPV on average 1-5 times/month. Most patients used RPV to monitor their kidney function, 81 % to check creatinine levels, 57 % to check potassium results. Ninety-two percent of patients found RPV easy to use and 93 % felt that overall the system helps them in taking care of their condition; 53 % of patients reported high satisfaction with RPV. Our results provide interesting insight into use of a system that gives patients web-based access to laboratory results. The fact that 20 % of patients delegate access to relatives also warrants further study. We propose that online access to laboratory results should be offered to all renal patients, although clinicians need to be mindful of the 'digital divide', i.e. part of the population that is not amenable to IT-based strategies for patient empowerment.

Quality of patient positioning during cerebral tomotherapy irradiation using different mask systems

Energy Technology Data Exchange (ETDEWEB)

Leitzen, C.; Wilhelm-Buchstab, T.; Garbe, S.; Luetter, C.; Muedder, T.; Simon, B.; Schild, H.H.; Schueller, H. [Universitaetsklinik Bonn, Radiologische Klinik, FE Strahlentherapie, Bonn (Germany)

2014-04-15

Patient immobilization during brain tumor radiotherapy is achieved by employing different mask systems. Two innovative mask systems were developed to minimize the problems of claustrophobic patients. Our aim was to evaluate whether the quality of patient immobilization using the new mask systems was equivalent to the standard mask system currently in use. Thirty-three patients with cerebral target volumes were irradiated using the Hi-Art II tomotherapy system between 2010 and 2012. Each group of 11 patients was fitted with one of the two new mask systems (Crystal {sup registered} or Open Face {sup registered} mask, Orfit) or the standard three-point mask (Raycast {sup registered} -HP, Orfit) and a total of 557 radiotherapy fractions were evaluated. After positioning was checked by MV-CT, the necessary table adjustments were noted. Data were analyzed by comparing the groups, and safety margins were calculated for nonimage-guided irradiation. The mean values of the table adjustments were: (a) lateral (mm): -0.22 (mask 1, standard deviation (σ): 2.15); 1.1 (mask 2, σ: 2.4); -0.64 (mask 3, σ: 2.9); (b) longitudinal (mm): -1 (mask 1, σ: 2.57); -0.5 (mask 2, σ: 4.7); -1.22 (mask 3, σ: 2.52); (c) vertical (mm): 0.62 (mask 1, σ: 0.63); 1.2 (mask 2, σ: 1.0); 0.57 (mask 3, σ: 0.28); (d) roll: 0.35 (mask 1, σ: 0.75); 0 (mask 2, σ: 0.8); 0.02 (mask 3, σ: 1.12). The outcomes suggest necessary safety margins of 5.49-7.38 mm (lateral), 5.4-6.56 mm (longitudinal), 0.82-3.9 mm (vertical), and 1.93-4.5 (roll). There were no significant differences between the groups. The new mask systems improve patient comfort while providing consistent patient positioning. (orig.)

Quality of patient positioning during cerebral tomotherapy irradiation using different mask systems

International Nuclear Information System (INIS)

Leitzen, C.; Wilhelm-Buchstab, T.; Garbe, S.; Luetter, C.; Muedder, T.; Simon, B.; Schild, H.H.; Schueller, H.

2014-01-01

Patient immobilization during brain tumor radiotherapy is achieved by employing different mask systems. Two innovative mask systems were developed to minimize the problems of claustrophobic patients. Our aim was to evaluate whether the quality of patient immobilization using the new mask systems was equivalent to the standard mask system currently in use. Thirty-three patients with cerebral target volumes were irradiated using the Hi-Art II tomotherapy system between 2010 and 2012. Each group of 11 patients was fitted with one of the two new mask systems (Crystal registered or Open Face registered mask, Orfit) or the standard three-point mask (Raycast registered -HP, Orfit) and a total of 557 radiotherapy fractions were evaluated. After positioning was checked by MV-CT, the necessary table adjustments were noted. Data were analyzed by comparing the groups, and safety margins were calculated for nonimage-guided irradiation. The mean values of the table adjustments were: (a) lateral (mm): -0.22 (mask 1, standard deviation (σ): 2.15); 1.1 (mask 2, σ: 2.4); -0.64 (mask 3, σ: 2.9); (b) longitudinal (mm): -1 (mask 1, σ: 2.57); -0.5 (mask 2, σ: 4.7); -1.22 (mask 3, σ: 2.52); (c) vertical (mm): 0.62 (mask 1, σ: 0.63); 1.2 (mask 2, σ: 1.0); 0.57 (mask 3, σ: 0.28); (d) roll: 0.35 (mask 1, σ: 0.75); 0 (mask 2, σ: 0.8); 0.02 (mask 3, σ: 1.12). The outcomes suggest necessary safety margins of 5.49-7.38 mm (lateral), 5.4-6.56 mm (longitudinal), 0.82-3.9 mm (vertical), and 1.93-4.5 (roll). There were no significant differences between the groups. The new mask systems improve patient comfort while providing consistent patient positioning. (orig.)

A system for diagnostic quality radiographic alignment of radiotherapy patients

International Nuclear Information System (INIS)

Gall, Kenneth P.; Zygmanski, Piotr; Thornton, Allan F.

1996-01-01

Purpose In order to achieve highly accurate positioning of radiotherapy patients treated on a standard fractionation schedule we have developed a digital imaging system and associated repositioning algorithms. The system is efficient enough that it is usable on a routine basis. The system is intended to allow stereotactic level precision of patient positioning in fractionated therapy which in turn allows treatment fields to be designed with tighter margins. This may allow higher target doses to be delivered and thereby higher local control to be achieved for certain classes of patients. Materials and Methods Patients to be treated under a standard fractionation schedule for intracranial or head and neck targets have a set of three radiopaque fiducial markers implanted in the outer table of the skull. As part of the 3 dimensional treatment plan the locations of the fiducial markers is determined on the planning CT scan. The positions of the markers relative to the beam direction and isocenter constitute a 3 dimensional position prescription for the treatment. At the time of treatment a pair of orthogonal images is obtained with diagnostic xray tubes aligned to isocenter and a digital imaging system. The imaging system consists of a thermoelectrically cooled CCD camera which views a Gadolinium based xray intensifying screen. The field of view of the imager is 30 x 30 cm which gives a 1.5 lp/mm spatial resolution at isocenter using a 1.5 xray magnification geometry. The user identifies the approximate position of the fiducial markers on the digital image using a mouse and a standard PC computer running an imaging software routine. The identified area is then analyzed to determine the projected position of the marker with sub-pixel (<0.5mm) accuracy. An algorithm based on rigid body transformations computes the three dimensional realignment motions necessary to bring the patient to the desired position for treatment. Results We have been using a system to reposition

PASTE: patient-centered SMS text tagging in a medication management system.

Science.gov (United States)

Stenner, Shane P; Johnson, Kevin B; Denny, Joshua C

2012-01-01

To evaluate the performance of a system that extracts medication information and administration-related actions from patient short message service (SMS) messages. Mobile technologies provide a platform for electronic patient-centered medication management. MyMediHealth (MMH) is a medication management system that includes a medication scheduler, a medication administration record, and a reminder engine that sends text messages to cell phones. The object of this work was to extend MMH to allow two-way interaction using mobile phone-based SMS technology. Unprompted text-message communication with patients using natural language could engage patients in their healthcare, but presents unique natural language processing challenges. The authors developed a new functional component of MMH, the Patient-centered Automated SMS Tagging Engine (PASTE). The PASTE web service uses natural language processing methods, custom lexicons, and existing knowledge sources to extract and tag medication information from patient text messages. A pilot evaluation of PASTE was completed using 130 medication messages anonymously submitted by 16 volunteers via a website. System output was compared with manually tagged messages. Verified medication names, medication terms, and action terms reached high F-measures of 91.3%, 94.7%, and 90.4%, respectively. The overall medication name F-measure was 79.8%, and the medication action term F-measure was 90%. Other studies have demonstrated systems that successfully extract medication information from clinical documents using semantic tagging, regular expression-based approaches, or a combination of both approaches. This evaluation demonstrates the feasibility of extracting medication information from patient-generated medication messages.

[Evaluation of postural control systems in elderly patients with repeated falls].

Science.gov (United States)

González Ramírez, Alfonso; Lázaro del Nogal, Montserrat; Ribera Casado, José Manuel

2008-01-01

a) to describe postural control disorders in elderly patients with recurrent falls; b) to analyze the influence of sensory deficits on centre of gravity control mechanisms; and c) to assess the functional consequences of balance disorders and falls in this group of patients. patients aged more than 65 years old referred to a falls unit with two or more falls in the previous 6 months were included in this study. The protocol included posturographic studies with a Neurocom Balance Master. To evaluate motor control, Rhythmic Weight Shift (RWS test) was performed. To assess sensorial control, Modified Clinical Test of Sensory Interaction on Balance (MCT test) was used. Other tests performed were the Sit to Stand (SS test), Walk across (WA test) and Step up over (SO test). a total of 109 patients (85.3% women) were studied. Mean age was 78.01 years (SD: 5.38). Disorders in one or more afferent sensorial systems were found in 51.7% of the patients (27.5% visual deficiencies, 17.6% vestibular alterations, and 6.6% somatosensorial deficits). Two afferent systems were compromised in 25.3%, and all three were compromised in 11.1% of the patients. No significant differences were found in directional control (RWS) when compared with the number of altered systems. posturographic studies provide sensitive information on static and dynamic centre of gravity control systems, eventual sensory deficits, and patients' ability to carry out basic activities of daily living. In our sample, the most frequent deficit was visual impairment. This information is essential to establish a correct management programme.

Wireless Patient Monitoring System Using Point to Multi Point Zigbee Technology

Directory of Open Access Journals (Sweden)

Aung Soe Phyo

2015-06-01

Full Text Available ABSTRACT A ZigBee sensor network for data acquisition and monitoring is presented in this paper. A ZigBee module is connected via a USB interface to a Microsoft Windows PC which works as a base station in the network. Data collected by sensor devices are sent to the base station PC which is set as Wireless sensorNetwork WSN. ZigBee is low power consumption built-in security method and ratified specifications make it very suitable to be used with medical sensor devices.This application of Zigbee based network consists of two transmitter sections and a receiver section.Each transmitter section consists of heartbeat sensor body temperature sensor microcontroller Zigbee and LCD module.In the proposed system the patients health is continuously monitored and theacquired data is analyzed at a personal computer using Graphical User InterfaceGUI. If a particular patients health parameter is higher or lower the threshold values an alarm system is used to alert the doctor. The aim of this system is to know the condition of patients health by the doctor immediately and to reduce the load of the staff taking care of the patient in the hospitals. In this paper wireless point to multipoint system is used between doctor and patient.

Anaesthetic management of a patient with multiple system atrophy ...

African Journals Online (AJOL)

Multiple system atrophy (MSA) is a rare adult-onset neurodegenerative disease. Symptoms vary from autonomic dysfunction to Parkinsonism and cerebellar ataxia, in any combination. MSA affects many organ systems with many possible complications and makes perioperative management of a patient with this condition ...

[Meaning in life and mental health: personal meaning systems of psychotherapists and psychotherapy patients].

Science.gov (United States)

Löffler, Sabine; Knappe, Rainer; Joraschky, Peter; Pöhlmann, Karin

2010-01-01

This study investigated differences in the personal meaning systems of psychotherapists and psychotherapy patients as well as correlations between meaning in life and mental health. We qualitatively assessed the content and structure of the personal meaning systems of 41 psychotherapists and 77 psychotherapy patients. In addition, the participants completed questionnaires measuring meaning in life (LRI-r-d), sense of coherence (SOC-9L), self-esteem (RSES), satisfaction with life (SWLS), self-efficacy (SWK), and depression (BDI). The personal meaning systems of psychotherapists were more complex and coherent compared to psychotherapy patients. In the group of psychotherapy patients, a more elaborate structure of the personal meaning system correlated with the subjective sense of meaning. We were able to confirm correlations between meaning in life and mental health for most of the instances. Psychotherapists had more elaborate and coherent meaning systems than psychotherapy patients. Especially for psychotherapy patients elaborate and coherent meaning systems turned out to be important for mental health.

[Multicenter evaluation of the Nutri-Expert Telematic System in diabetic patients].

Science.gov (United States)

Turnin, M C; Bolzonella-Pene, C; Dumoulin, S; Cerf, I; Charpentier, G; Sandre-Banon, D; Valensi, P; Grenier, J L; Cathelineau, G; Mattei, C

1995-02-01

Nutri-Expert is a system for self-monitoring and dietetic education, accessible through Minitel. A preliminary randomised evaluation of one hundred diabetic patients in the Midi-Pyrénées region showed that Nutri-Expert improved dietetic knowledge, dietary habits and metabolic balance. The aim of the present study was to show that the system can be successfully prescribed to patients by physicians outside the center which originated it, indicating the benefit of a wider use of Nutri-Expert, among the diabetic population. One hundred and fifty-five patients, recruited by six French centres of diabetology, used Nutri-Expert from their homes for six months. Clinical examination, tests of dietetic knowledge and biological tests, including lipid fractions, were carried out before and after six months of use. After six months, there was a significant improvement in the patients' dietetic knowledge and in some biological parameters. Nutri-Expert is thus useful even when prescribed by a centre other than the hospital which devised the system. It is an additional beneficial tool in the ambulatory management of diabetic patients.

Urban meteorological modelling for nuclear emergency preparedness

International Nuclear Information System (INIS)

Baklanov, Alexander; Sorensen, Jens Havskov; Hoe, Steen Cordt; Amstrup, Bjarne

2006-01-01

The main objectives of the current EU project 'Integrated Systems for Forecasting Urban Meteorology, Air Pollution and Population Exposure' (FUMAPEX) are the improvement of meteorological forecasts for urban areas, the connection of numerical weather prediction (NWP) models to urban air pollution and population dose models, the building of improved urban air quality information and forecasting systems, and their application in cities in various European climates. In addition to the forecast of the worst air-pollution episodes in large cities, the potential use of improved weather forecasts for nuclear emergency management in urban areas, in case of hazardous releases from nuclear accidents or terror acts, is considered. Such use of NWP data is tested for the Copenhagen metropolitan area and the Oresund region. The Danish Meteorological Institute (DMI) is running an experimental version of the HIRLAM NWP model over Zealand including the Copenhagen metropolitan area with a horizontal resolution of 1.4 km, thus approaching the city-scale. This involves 1-km resolution physiographic data with implications for the urban surface parameters, e.g. surface fluxes, roughness length and albedo. For the city of Copenhagen, the enhanced high-resolution NWP forecasting will be provided to demonstrate the improved dispersion forecasting capabilities of the Danish nuclear emergency preparedness decision-support system, the Accident Reporting and Guidance Operational System (ARGOS), used by the Danish Emergency Management Agency (DEMA). Recently, ARGOS has been extended with a capability of real-time calculation of regional-scale atmospheric dispersion of radioactive material from accidental releases. This is effectuated through on-line interfacing with the Danish Emergency Response Model of the Atmosphere (DERMA), which is run at DMI. For local-scale modelling of atmospheric dispersion, ARGOS utilises the Local-Scale Model Chain (LSMC), which makes use of high-resolution DMI

Sclero-topometry Metrology in Valorisation of Waste Oil for Micro-machining of Ductile Cast Iron

Directory of Open Access Journals (Sweden)

Eymard S.

2013-12-01

Full Text Available During the time, the specific characteristics and the efficient lifetime of oil progressively decrease, due to complex pollution, ultimately making the oil unsuitable for the initial applications. The strategy to regenerate and to valorise waste oils is investigated using improved combinations of sclerometric and topometric tests on ductile nodular cast iron. Tribo-abrasive tests are performed in critical conditions, with base oil, waste oil and regenerated oil, of similar viscosities in order to discriminate their interfacial performances. The forms of the scratch traces indicate wear resistance and tendency to elasto-plastic deformation. The mechanisms of deformation and frictional behaviours were evaluated using optical and Scanning Electron Microscopy and measured for various tribological conditions with tactile and optical profilometry. The Energy Dispersive X ray Spectroscopy completes the chemical superficial distribution of pertinent elements. The surface topography metrology is used to characterize the scratch profiles and to determine the volume of the displaced and removed material, as well as maximum pit height. The originality of this paper is that it is a unique approach specifically devoted to transformer oil concerning tribological conditions.

The monitoring system using laser light for the patient movement during radiation therapy

International Nuclear Information System (INIS)

Sano, Naoki; Onishi, Hiroshi; Yamaguchi, Motoshi; Kuriyama, Kengo; Akiyama, Saburou; Nakamura, Osamu; Araki, Tsutomu

1997-01-01

Purpose: The purpose of this study is to evaluate the usefulness of a newly developed real-time patient movement monitoring system built into the patient positioning light from the frontal and horizontal view. Materials and Techniques: This system is composed of 4 parts. They are a laser light projector, a retro-reflected tape, a sensor of photo-diode, and an alarm devise. First, this system projects a laser light for the patient movement monitor into the center of the crossed lines of the patient positioning light. The laser light (a diameter of 1.5mm and power of 0.5mW) for the patient movement monitor has a different wave length(633nm) from the patient positioning light. Then it is reflected into the direction of incidence with a retro-reflection tape affixed on three patient positioning points. And the system has a photo-diode which can sense the reflected laser light. This retro-reflected tape is made of tiny high reflective beads of glass which is fixed on a sheet with the thickness of 0.12mm and is able to be cut into any shape. This has a maximum retro-reflection angle of 70 degrees. We can select a tolerance of the patient movement by changing its shape and size. A buzzer strikes and a lamp is turned on to alarm for the error when the retro-reflected laser light is not sensed with the photo-diode. Results: The real-time monitoring accuracy of this system is only 0.17mm in the dimension of error for a selected tolerance of the phantom examination. Conclusion: This patient positioning system can be made simply and inexpensively and has a high monitoring accuracy. We can apply this system for a high-precision irradiation such as the three dimensional irradiation and small target irradiation

Patient setup aid with wireless CCTV system in radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Park, Yang Kyun; Cho, Woong; Park, Jong Min [Seoul National University Graduate School, Seoul (Korea, Republic of); Ha, Sung Whan; Ye, Sung Joon [Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Suk Won [Chung-Ang University Cellege of Medicine, Seoul (Korea, Republic of); Huh, Soon Nyung [Seoul National University Hospital, Seoul (Korea, Republic of)

2006-12-15

To develop a wireless CCTV system in semi-beam's eye view (BEV) to monitor daily patient setup in radiation therapy. In order to get patient images in semi-BEV, CCTV cameras are installed in a custom-made acrylic applicator below the treatment head of a linear accelerator. The images from the cameras are transmitted via radio frequency signal ( {approx} 2.4 GHz and 10 mW RF output). An expected problem with this system is radio frequency interference, which is solved utilizing RF shielding with Cu foils and median filtering software. The images are analyzed by our custom-made software. In the software, three anatomical landmarks in the patient surface are indicated by a user, then automatically the 3 dimensional structures are obtained and registered by utilizing a localization procedure consisting mainly of stereo matching algorithm and Gauss-Newton optimization. This algorithm is applied to phantom images in investigate the setup accuracy. Respiratory gating system is also researched with real-time image processing. A line-laser marker projected on a patient's surface is extracted by binary image processing and the breath pattern is calculated and displayed in real-time. More than 80% of the camera noises from the linear accelerator are eliminated by wrapping the camera with copper foils. The accuracy of the localization procedure is found to be on the order of 1.5 {+-} 0.7 mm with a point phantom and sub-millimeters and degrees with a custom-made head/neck phantom. With line-laser marker, real-time respiratory monitoring is possible in the delay time of {approx} 0.7 sec. The wireless CCTV camera system is the novel tool which can monitor daily patient setups. The feasibility of respiratory gating system with the wireless CCTV is hopeful.

Patient setup aid with wireless CCTV system in radiation therapy

International Nuclear Information System (INIS)

Park, Yang Kyun; Cho, Woong; Park, Jong Min; Ha, Sung Whan; Ye, Sung Joon; Park, Suk Won; Huh, Soon Nyung

2006-01-01

To develop a wireless CCTV system in semi-beam's eye view (BEV) to monitor daily patient setup in radiation therapy. In order to get patient images in semi-BEV, CCTV cameras are installed in a custom-made acrylic applicator below the treatment head of a linear accelerator. The images from the cameras are transmitted via radio frequency signal ( ∼ 2.4 GHz and 10 mW RF output). An expected problem with this system is radio frequency interference, which is solved utilizing RF shielding with Cu foils and median filtering software. The images are analyzed by our custom-made software. In the software, three anatomical landmarks in the patient surface are indicated by a user, then automatically the 3 dimensional structures are obtained and registered by utilizing a localization procedure consisting mainly of stereo matching algorithm and Gauss-Newton optimization. This algorithm is applied to phantom images in investigate the setup accuracy. Respiratory gating system is also researched with real-time image processing. A line-laser marker projected on a patient's surface is extracted by binary image processing and the breath pattern is calculated and displayed in real-time. More than 80% of the camera noises from the linear accelerator are eliminated by wrapping the camera with copper foils. The accuracy of the localization procedure is found to be on the order of 1.5 ± 0.7 mm with a point phantom and sub-millimeters and degrees with a custom-made head/neck phantom. With line-laser marker, real-time respiratory monitoring is possible in the delay time of ∼ 0.7 sec. The wireless CCTV camera system is the novel tool which can monitor daily patient setups. The feasibility of respiratory gating system with the wireless CCTV is hopeful

Patient-specific system for prognosis of surgical treatment outcomes of human cardiovascular system

Science.gov (United States)

Golyadkina, Anastasiya A.; Kalinin, Aleksey A.; Kirillova, Irina V.; Kossovich, Elena L.; Kossovich, Leonid Y.; Menishova, Liyana R.; Polienko, Asel V.

2015-03-01

Object of study: Improvement of life quality of patients with high stroke risk ia the main goal for development of system for patient-specific modeling of cardiovascular system. This work is dedicated at increase of safety outcomes for surgical treatment of brain blood supply alterations. The objects of study are common carotid artery, internal and external carotid arteries and bulb. Methods: We estimated mechanical properties of carotid arteries tissues and patching materials utilized at angioplasty. We studied angioarchitecture features of arteries. We developed and clinically adapted computer biomechanical models, which are characterized by geometrical, physical and mechanical similarity with carotid artery in norm and with pathology (atherosclerosis, pathological tortuosity, and their combination). Results: Collaboration of practicing cardiovascular surgeons and specialists in the area of Mathematics and Mechanics allowed to successfully conduct finite-element modeling of surgical treatment taking into account various features of operation techniques and patching materials for a specific patient. Numerical experiment allowed to reveal factors leading to brain blood supply decrease and atherosclerosis development. Modeling of carotid artery reconstruction surgery for a specific patient on the basis of the constructed biomechanical model demonstrated the possibility of its application in clinical practice at approximation of numerical experiment to the real conditions.

PERFORM: a system for monitoring, assessment and management of patients with Parkinson's disease.

Science.gov (United States)

Tzallas, Alexandros T; Tsipouras, Markos G; Rigas, Georgios; Tsalikakis, Dimitrios G; Karvounis, Evaggelos C; Chondrogiorgi, Maria; Psomadellis, Fotis; Cancela, Jorge; Pastorino, Matteo; Waldmeyer, María Teresa Arredondo; Konitsiotis, Spiros; Fotiadis, Dimitrios I

2014-11-11

In this paper, we describe the PERFORM system for the continuous remote monitoring and management of Parkinson's disease (PD) patients. The PERFORM system is an intelligent closed-loop system that seamlessly integrates a wide range of wearable sensors constantly monitoring several motor signals of the PD patients. Data acquired are pre-processed by advanced knowledge processing methods, integrated by fusion algorithms to allow health professionals to remotely monitor the overall status of the patients, adjust medication schedules and personalize treatment. The information collected by the sensors (accelerometers and gyroscopes) is processed by several classifiers. As a result, it is possible to evaluate and quantify the PD motor symptoms related to end of dose deterioration (tremor, bradykinesia, freezing of gait (FoG)) as well as those related to over-dose concentration (Levodopa-induced dyskinesia (LID)). Based on this information, together with information derived from tests performed with a virtual reality glove and information about the medication and food intake, a patient specific profile can be built. In addition, the patient specific profile with his evaluation during the last week and last month, is compared to understand whether his status is stable, improving or worsening. Based on that, the system analyses whether a medication change is needed--always under medical supervision--and in this case, information about the medication change proposal is sent to the patient. The performance of the system has been evaluated in real life conditions, the accuracy and acceptability of the system by the PD patients and healthcare professionals has been tested, and a comparison with the standard routine clinical evaluation done by the PD patients' physician has been carried out. The PERFORM system is used by the PD patients and in a simple and safe non-invasive way for long-term record of their motor status, thus offering to the clinician a precise, long-term and

A comparison of two systems of patient immobilization for prostate radiotherapy

Science.gov (United States)

2014-01-01

Background Reproducibility of different immobilization systems, which may affect set-up errors, remains uncertain. Immobilization systems and their corresponding set-up errors influence the clinical target volume to planning target volume (CTV-PTV) margins and thus may result in undesirable treatment outcomes. This study compared the reproducibility of patient positioning with Hipfix system and whole body alpha cradle with respect to localized prostate cancer and investigated the existing CTV-PTV margins in the clinical oncology departments of two hospitals. Methods Forty sets of data of patients with localized T1-T3 prostate cancer were randomly selected from two regional hospitals, with 20 patients immobilized by a whole-body alpha cradle system and 20 by a thermoplastic Hipfix system. Seven sets of the anterior-posterior (AP), cranial-caudal (CC) and medial-lateral (ML) deviations were collected from each patient. The reproducibility of patient positioning within the two hospitals was compared using a total vector error (TVE) parameter. In addition, CTV-PTV margins were computed using van Herk’s formula. The resulting values were compared to the current CTV-PTV margins in both hospitals. Results The TVE values were 5.1 and 2.8 mm for the Hipfix and the whole-body alpha cradle systems respectively. TVE associated with the whole-body alpha cradle system was found to be significantly less than the Hipfix system (p < 0.05). The CC axis in the Hipfix system attained the highest frequency of large (23.6%) and serious (7.9%) set-up errors. The calculated CTV to PTV margin was 8.3, 1.9 and 2.3 mm for the Hipfix system, and 2.1, 3.4 and 1.8 mm for the whole body alpha cradle in CC, ML and AP axes respectively. All but one (CC axis using Hipfix) margin calculated did not exceed the corresponding hospital protocol. The whole body alpha cradle system was found to be significantly better than the Hipfix system in terms of reproducibility (p < 0.05), especially

A Comprehensive Rehabilitation Approach in a Patient With Serious Neuropsychiatric Systemic Lupus Erythematosus.

Science.gov (United States)

Ko, Yong Jae; Lee, Yang Gyun; Park, Ji Woong; Ahn, Sung Ho; Kwak, Jin Myoung; Choi, Yoon-Hee

2016-08-01

Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.

Applying the Toyota Production System: using a patient safety alert system to reduce error.

Science.gov (United States)

Furman, Cathie; Caplan, Robert

2007-07-01

In 2002, Virginia Mason Medical Center (VMMC) adapted the Toyota Production System, also known as lean manufacturing. To translate the techniques of zero defects and stopping the line into health care, the Patient Safety Alert (PSA) system requires any employee who encounters a situation that is likely to harm a patient to make an immediate report and to cease any activity that could cause further harm (stopping the line). IMPLEMENTING THE PSA SYSTEM--STOPPING THE LINE: If any VMMC employee's practice or conduct is deemed capable of causing harm to a patient, a PSA can cause that person to be stopped from working until the problem is resolved. A policy statement, senior executive commitment, dedicated resources, a 24-hour hotline, and communication were all key features of implementation. As of December 2006, 6,112 PSA reports were received: 20% from managers, 8% from physicians, 44% from nurses, and 23% from nonclinical support personnel, for example. The number of reports received per month increased from an average of 3 in 2002 to 285 in 2006. Most reports were processed within 24 hours and were resolved within 2 to 3 weeks. Implementing the PSA system has drastically increased the number of safety concerns that are resolved at VMMC, while drastically reducing the time it takes to resolve them. Transparent discussion and feedback have helped promote staff acceptance and participation.

[The treatment of skin ulcers in patients with systemic sclerosis].

Science.gov (United States)

Fiori, G; Amanzi, L; Moggi Pignone, A; Braschi, F; Matucci-Cerinic, M

2004-01-01

Systemic Sclerosis (Ssc) is a complex disease of the connective tissue, characterized by progressive thickening and fibrosis of the skin and the internal organs and by diffused damage of the microvascular system. The fibrosis ones of the skin associated to the characteristic vascular alterations lead to the genesis of ulcers, more or less extended, often multiple, peripheral localization, chronic course, painful, able to influence patient's quality of life. Indeed, immunity reactivity, the thinning and the loss of elasticity of the skin, the peripheral neurological damage and the eventual drug assumption that can reduce regenerative/reparative abilities, can easily make an ulcer chronic and become infected complicating still more the patient disease, rendering more difficult the cure often, ulcer evolves to gangrene, and in some cases, in amputation too. For all these reasons, we have begun to study ulcers therapy (local and systemic), considering this activity it leave integrating of the charitable distance of the sclerodermic patient, putting to point on strategy both diagnostic and therapeutic, but above all with the primary scope, if possible, is to prevent ulcers, in contrary case, to alleviate the pain and to render the quality of the life of the patient better.

Retinal vasculopathy in patients with systemic lupus erythematosus.

Science.gov (United States)

Gao, N; Li, M T; Li, Y H; Zhang, S H; Dai, R P; Zhang, S Z; Zhao, L D; Wang, L; Zhang, F C; Zhao, Y; Zeng, X F

2017-10-01

A retrospective case control study was conducted in the Peking Union Medical College Hospital. Medical records were reviewed for demographic data, clinical features, laboratory results, systemic lupus erythematosus (SLE) disease activity evaluations, and ophthalmic examinations to investigate the clinical characteristics and significance of retinal vasculopathy (RV) in Chinese patients with systemic lupus erythematosus. The prevalence of RV was approximately 0.66% (35/5298) in SLE patients. A total of 60 eyes were involved. The ocular presentations included decrease of visual acuity (48/60, 80%), visual field loss (7/60, 11.7%), and diplopia (3/60, 5%). Ophthalmic fundoscopic examination revealed cotton-wool spots (30/60, 50%), retinal vascular attenuation (31/60, 51.6%), and hemorrhages (41/60, 68.3%). Retinal angiogram showed that 72.7% (16/22) eyes had vaso-occlusion. The ophthalmic episodes could occur at any stage of SLE duration, with a median of 12 months (0-168 months) following SLE onset. Twenty-one (35%) eyes did not recover, or even worsened, during hospital stay. RV was found to be significantly associated with neuropsychiatric lesions (51.4% vs. 21.3%, p = .005) and hematological disturbance (62.9% vs. 34.3%, p = .005). SLE patients with RV had significantly higher SLE disease activity index scores than controls (19.9 ± 0.9 vs. 10.2 ± 0.7, p < .001). An inverse association of anti-SSA antibody with RV was detected (34.3% vs. 67.1%, p = .001). Nervous system disturbance (odds ratio (OR) = 4.340, 95% confidence interval (CI) 1.438, 13.094, p = .009) and leukocytopenia (OR = 6.385, 95% CI 1.916, 21.278, p = .003) were independent risk factors, while anti-SSA antibody positivity (OR = 0.249, 95% CI 0.087, 0.710, p = .009) was a protective factor for RV in SLE patients. In certain cases, RV is a threatening condition for SLE patients presenting with clinical ocular manifestations. Ophthalmo

The Danish patient safety experience: the Act on Patient Safety in the Danish Health care system

DEFF Research Database (Denmark)

Lundgaard, Mette; Rabøl, Louise; Jensen, Elisabeth Agnete Brøgger

2005-01-01

This paper describes the process that lead to the passing of the Act for Patient Safety in the Danisk health care sytem, the contents of the act and how the act is used in the Danish health care system. The act obligates frontline health care personnel to report adverse events, hospital owners...... to act on the reports and the National Board of Health to commuicate the learning nationally. The act protects health care providers from sanctions as a result of reporting. In January 2004, the Act on Patient Safety in the Danish health care system was put into force. In the first twelve months 5740...... adverse events were reported. the reports were analyzed locally (hospital and region), anonymized ad then sent to the National Board af Health. The Act on Patient Safety has driven the work with patient safety forward but there is room for improvement. Continuous and improved feedback from all parts...

A security analysis of the Dutch electronic patient record system

NARCIS (Netherlands)

van 't Noordende, G.

2010-01-01

In this article, we analyze the security architecture of the Dutch Electronic Patient Dossier (EPD) system. Intended as a national infrastructure for exchanging medical patient records among authorized parties (particularly, physicians), the EPD has to address a number of requirements, ranging from

Physical activity influences the immune system of breast cancer patients

Directory of Open Access Journals (Sweden)

Thorsten Schmidt

2017-01-01

Full Text Available It has been suggested that physical activity in breast cancer patients can not only improve quality of life. Influences on physical and psychological levels have been evaluated, but effects on the immune system of breast cancer patients are hardly known. A PubMed search identified relevant trials and meta-analyses from 1970 to 2013. This review summarizes the results of international studies and the current discussion of effects of physical activity on the immune system of breast cancer patients. Highlighted are effects of physical activity on the immune system. Seven original articles and 14 reviews included in this review. Two original and the review articles includes other tumor entities besides breast cancer.Evaluated methods such as dose-response relationships for exercise in oncology, hardly exist. Increased immunological anti-cancer activity due to physical activity is probably mediated via an increase in number and cytotoxicity of monocytes and natural killer cells and cytokines.

Mini Combat Trauma Patient Simulation System Defense Acquisition Challenge Program (DACP): Mini Combat Trauma Patient Simulation (Mini CTPS)

National Research Council Canada - National Science Library

2004-01-01

.... It consists of networked realistic casualty generators, patient simulators and computer-based casualty simulations, virtual patients and equipment, data and sensor recorders, and an After- Action Review System...

Safe Handover : Safe Patients – The Electronic Handover System

Science.gov (United States)

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS. PMID:26734244

The patient work system: an analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers.

Science.gov (United States)

Holden, Richard J; Schubert, Christiane C; Mickelson, Robin S

2015-03-01

Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in "patient-engaged human factors," or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n = 30) and their informal caregivers (n = 14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients' biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domains-physical-spatial, social-cultural, and organizational-and multiple "spaces" such as "at home," "on the go," and "in the community." Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, contexts, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

In vivo identical reversibility of rad-bio-chem lesions in blood, bone marrow, liver, endocrine system and on the whole body

International Nuclear Information System (INIS)

Stan, C.

2009-01-01

The fundamental scientific researches of a new patented pharmaceutical product STANOSIMAGNE, was initiated, directed and developed since 1995, as interdisciplinary challenge for in vivo decorporation on natural way of radio-toxic uranium (235U) and radionuclides, and the treatment of lesions induced by radiation injury, or heavy metals. The synergic effect - decorporation and reversibility - for in vivo identical reversibility of rad-bio-chem lesions in blood, bone marrow, liver, endocrine system, derma and vital organs verifies and sustains the scientific discovery. The safety and efficiency of clinical administration of the medicine STANOSIMAGNE capsules and ointment is based on the non-clinic (pre-clinic) practical pharmacological research on 635 standard laboratory animals regarding the absence of any kind of toxicity. The pharmacology researches have been carried out, along with medical, pharmaceutical and biochemical didactic specialists, coming from the Laboratories Departments of Pharmacology, Phytochemistry, Biochemistry, Chemistry and Pharmaceutical Technique of the University of Medicine and Pharmacy 'Carol Davila', Bucharest. The treatment of the persons exposed to irradiation or heavy metals contamination, in risk areas, and the continuation of the pilot clinical studies on several cases, that could not be solved by regular medical methods and treatments, are in accordance with the Directive 2001/20/CE, of the Parliament of the European Union, which implement the norms of good practice, in clinical studies.(author)

Is there an association between glaucoma and capillaroscopy in patients with systemic sclerosis?

Science.gov (United States)

Gomes, Beatriz Fiuza; Souza, Rebeca; Valadão, Thiago; Kara-Junior, Newton; Moraes, Haroldo Vieira; Santhiago, Marcony R

2018-02-01

To evaluate the relationship between glaucoma diagnosis and the nailfold capillaroscopy pattern in patients with systemic sclerosis. An observational study in a cohort of patients with SSc was conducted. Patients with at least one nailfold videocapillaroscopy and one ophthalmology examination at the same year were included. Data collected were: age, sex; type of systemic sclerosis according to the degree of skin impairment, self-reported ethnicity, disease duration, current use and dosage of systemic corticosteroid, current use and dosage of bosentan ® , intraocular pressure, central corneal thickness, diagnosis of glaucoma and capillaroscopy pattern. Thirty-one patients with systemic sclerosis were enrolled, 23% had glaucoma. There was no statistically significant association between glaucoma diagnosis and the capillaroscopic pattern (p = 0.86). There was also no significant difference (p = 0.66) regarding intraocular pressure between patients with mild (13.9 ± 3.8 mmHg) and severe capillaroscopic pattern (14.4 ± 2.8 mmHg). The odds ratio of glaucoma for severe capillaroscopic pattern compared to mild was 1.6 (95% confidence interval: 0.3-9.5). Up to 23% of patients with SSc have glaucoma. The high prevalence of glaucoma in SSc suggests a possible systemic vascular disturbance as the cause. However, there seems to be no significant association between the capillaroscopy pattern and glaucoma in systemic sclerosis. Further research is required to improve the understanding of glaucoma in the context of systemic sclerosis.

The Trauma Patient Tracking System: implementing a wireless monitoring infrastructure for emergency response.

Science.gov (United States)

Maltz, Jonathan; C Ng, Thomas; Li, Dustin; Wang, Jian; Wang, Kang; Bergeron, William; Martin, Ron; Budinger, Thomas

2005-01-01

In mass trauma situations, emergency personnel are challenged with the task of prioritizing the care of many injured victims. We propose a trauma patient tracking system (TPTS) where first-responders tag all patients with a wireless monitoring device that continuously reports the location of each patient. The system can be used not only to prioritize patient care, but also to determine the time taken for each patient to receive treatment. This is important in training emergency personnel and in identifying bottlenecks in the disaster response process. In situations where biochemical agents are involved, a TPTS may be employed to determine sites of cross-contamination. In order to track patient location in both outdoor and indoor environments, we employ both Global Positioning System (GPS) and Television/ Radio Frequency (TVRF) technologies. Each patient tag employs IEEE 802.11 (Wi-Fi)/TCP/IP networking to communicate with a central server via any available Wi-Fi basestation. A key component to increase TPTS fault-tolerance is a mobile Wi-Fi basestation that employs redundant Internet connectivity to ensure that tags at the disaster scene can send information to the central server even when local infrastructure is unavailable for use. We demonstrate the robustness of the system in tracking multiple patients in a simulated trauma situation in an urban environment.

Clinicopathologic review of 19 patients with systemic candidiasis with skin lesions.

Science.gov (United States)

Bae, Gee Young; Lee, Hae Woong; Chang, Sung Eun; Moon, Kee Chan; Lee, Mi Woo; Choi, Jee Ho; Koh, Jai Kyoung

2005-07-01

A diagnosis of systemic candidiasis is often delayed or missed owing to the absence of sensitive, specific, and timely diagnostic tools. Skin lesions are not common, but they can help to rapidly establish a diagnosis. We report on a 14-year experience of systemic candidiasis with skin lesions in our institution. We report the prevalence, clinical findings, histologic findings, etiologic Candida species, underlying conditions, treatment modalities, and outcomes of the cases and compare them with the previous reports. We reviewed the medical records and laboratory data of patients diagnosed with systemic candidiasis from June 1989 to September 2002 at Asan Medical Center, Seoul, Korea. We thoroughly reviewed the data on those patients with characteristic skin lesions. We included the cases in which Candida organisms were either shown or cultured from the skin. We also included the patients who had developed the characteristic rash at the onset of infection if there was no other possible explanation for the rash. Of 53 documented systemic candidiasis cases, 19 (35.8%) had the characteristic skin lesions. Fifteen patients (78.9%) had hematologic problems and were neutropenic. The skin lesions were a maculopapular or nodular rash and plaques. In addition to the trunk and proximal extremities, the rash also involved the face and distal extremities. The rashes were mostly purpuric, not consistently associated with underlying thrombocytopenia but also associated with underlying vascular damage as a result of Candida organisms. The underlying vascular damage also caused intraepidermal necrotic and vesicular change. One case of transepidermal elimination of organisms was newly found. The most common causative species was Candida tropicalis in the 19 patients with skin lesions, in contrast with Candida albicans in a total of 53 patients. The mortality rate was 84.2%. The prevalence of systemic candidiasis-associated skin lesions may be higher than previously reported

An Investigation of an RFID-based Patient-tracking and Mobile Alert System

Directory of Open Access Journals (Sweden)

C.L. Yeung

2011-02-01

Full Text Available In the modern era, patient health is no longer the only concern for hospitals. Hospitals have to bear the responsibility of the patient safety and the patient comfort. However, due to the overcrowded and understaffed clinical areas with complex workflow patterns, there are different forms of medical care errors arisen in the healthcare system. According to recent statistic from World Health Organization, ten of milions of patient around the world are injured or dead every yearas a result of incorrect medical care. Rroughly 10% patients admitted to hospital in developed countries suffered some forms of medical care errors or medical adverse events. It is about 1.4 million of world population.In order to enhance the patient safety and patient comfort in the current medical service system, an RFID‐based Patient Tracking and Mobile Alert System integrated with information communications technology was designed and developed. Apart from identifying different patient’s whereabouts, instant alerts are generated through mobile devices so as to enhance patients’ safety and comfort. With a view of investigating the feasibility of RFID and mobile technology in the healthcare environment, a pilot study was conducted in Mindset Club in the Castle Peak Hospital in Hong Kong.

Systemic therapy in younger and elderly patients with advanced biliary cancer

DEFF Research Database (Denmark)

McNamara, Mairéad Geraldine; Bridgewater, John; Lopes, Andre

2017-01-01

BACKGROUND: Outcomes in younger (ABC) receiving palliative chemotherapy are unclear. This study assessed outcomes in those receiving monotherapy or combination therapy in thirteen prospective systemic-therapy trials. METHODS......: Multivariable analysis explored the impact of therapy on progression-free (PFS) and overall survival (OS) in two separate age cohort groups: ... = 0.58, P = 0.66) or OS (P = 0.18, P = 0.75). CONCLUSIONS: In ABC, younger patients are rare, and survival in elderly patients in receipt of systemic therapy for advanced disease, whether monotherapy or combination therapy, is similar to that of non-elderly patients, therefore age alone should...

A patient positioning system in head and neck irradiation

International Nuclear Information System (INIS)

Bormann, U.; Strauch, B.; Schmitt, G.

1986-01-01

A holding system is presented which allows a good, easy, and reproducable positioning of the patient in percutanous head and neck radiotherapy. The patients are lying comfortably on a neck support and are fixed in such a way that they are not able to turn in a lateral or longitudinal direction. The distance chin-jugulum can be easily determined by an integrated measuring tape. Due to the use of UV ink and UV lamps, the field marking of the patient's skin cannot be seen in the spectrum of visible light. (orig.) [de

Meningococcal Two-Partner Secretion Systems and Their Association with Outcome in Patients with Meningitis

Science.gov (United States)

Piet, Jurgen R.; van Ulsen, Peter; ur Rahman, Sadeeq; Bovenkerk, Sandra; Bentley, Stephen D.

2016-01-01

Two-partner secretion (TPS) systems export large TpsA proteins to the surface and extracellular milieu. In meningococci, three different TPS systems exist, and of these, TPS system 2 (TPS2) and TPS3 can be detected by the host's immune system. We evaluated the distribution of TPS systems among clinical isolates from two prospective cohort studies comprising 373 patients with meningococcal meningitis. TPS system 1 was present in 91% of isolates, and system 2 and/or 3 was present in 67%. The TPS system distribution was related to clonal complexes. Infection with strains with TPS2 and/or TPS3 resulted in less severe disease and better outcomes than infection with strains without these systems. Using whole-blood stimulation experiments, we found no differences in the host cytokine response between patients infected with TPS system 2 and 3 knockout strains and patients infected with a wild-type strain. In conclusion, meningococcal TPS system 2 and/or 3 is associated with disease severity and outcome in patients with meningitis. PMID:27324486

21 CFR 880.6300 - Implantable radiofrequency transponder system for patient identification and health information.

Science.gov (United States)

2010-04-01

... patient identification and health information. 880.6300 Section 880.6300 Food and Drugs FOOD AND DRUG... radiofrequency transponder system for patient identification and health information. (a) Identification. An implantable radiofrequency transponder system for patient identification and health information is a device...

Educational potential of a virtual patient system for caring for traumatized patients in primary care.

Science.gov (United States)

Ekblad, Solvig; Mollica, Richard F; Fors, Uno; Pantziaras, Ioannis; Lavelle, James

2013-08-19

Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC). A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system's usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data. Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results. Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on improving clinical diagnosis and

Lessons learnt from the development of the Patient Safety Incidents Reporting an Learning System for the Spanish National Health System: SiNASP.

Science.gov (United States)

Vallejo-Gutiérrez, Paula; Bañeres-Amella, Joaquim; Sierra, Eduardo; Casal, Jesús; Agra, Yolanda

2014-01-01

To describe the development process and characteristics of a patient safety incidents reporting system to be implemented in the Spanish National Health System, based on the context and the needs of the different stakeholders. Literature review and analysis of most relevant reporting systems, identification of more than 100 stakeholder's (patients, professionals, regional governments representatives) expectations and requirements, analysis of the legal context, consensus of taxonomy, development of the software and pilot test. Patient Safety Events Reporting and Learning system (Sistema de Notificación y Aprendizajepara la Seguridad del Paciente, SiNASP) is a generic reporting system for all types of incidents related to patient safety, voluntary, confidential, non punitive, anonymous or nominative with anonimization, system oriented, with local analysis of cases and based on the WHO International Classification for Patient Safety. The electronic program has an on-line form for reporting, a software to manage the incidents and improvement plans, and a scoreboard with process indicators to monitor the system. The reporting system has been designed to respond to the needs and expectations identified by the stakeholders, taking into account the lessons learned from the previous notification systems, the characteristics of the National Health System and the existing legal context. The development process presented and the characteristics of the system provide a comprehensive framework that can be used for future deployments of similar patient safety systems. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care

Science.gov (United States)

Daker-White, Gavin; Hays, Rebecca; McSharry, Jennifer; Giles, Sally; Cheraghi-Sohi, Sudeh; Rhodes, Penny; Sanders, Caroline

2015-01-01

Objective Studies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model. Method Meta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies. Results Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients’ perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from ‘grand’ systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system. Conclusion Overall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or

Systemic challenges in bipolar disorder management: A patient-centered approach.

Science.gov (United States)

Nestsiarovich, Anastasiya; Hurwitz, Nathaniel G; Nelson, Stuart J; Crisanti, Annette S; Kerner, Berit; Kuntz, Matt J; Smith, Alicia N; Volesky, Emma; Schroeter, Quentin L; DeShaw, Jason L; Young, S Stanley; Obenchain, Robert L; Krall, Ronald L; Jordan, Kimmie; Fawcett, Jan; Tohen, Mauricio; Perkins, Douglas J; Lambert, Christophe G

2017-12-01

As part of a series of Patient-Centered Outcomes Research Institute-funded large-scale retrospective observational studies on bipolar disorder (BD) treatments and outcomes, we sought the input of patients with BD and their family members to develop research questions. We aimed to identify systemic root causes of patient-reported challenges with BD management in order to guide subsequent studies and initiatives. Three focus groups were conducted where patients and their family members (total n = 34) formulated questions around the central theme, "What do you wish you had known in advance or over the course of treatment for BD?" In an affinity mapping exercise, participants clustered their questions and ranked the resulting categories by importance. The research team and members of our patient partner advisory council further rated the questions by expected impact on patients. Using a Theory of Constraints systems thinking approach, several causal models of BD management challenges and their potential solution were developed with patients using the focus group data. A total of 369 research questions were mapped to 33 categories revealing 10 broad themes. The top priorities for patient stakeholders involved pharmacotherapy and treatment alternatives. Analysis of causal relationships underlying 47 patient concerns revealed two core conflicts: for patients, whether or not to take pharmacotherapy, and for mental health services, the dilemma of care quality vs quantity. To alleviate the core conflicts identified, BD management requires a coordinated multidisciplinary approach including: improved access to mental health services, objective diagnostics, sufficient provider visit time, evidence-based individualized treatment, and psychosocial support. © 2017 The Authors. Bipolar Disorders Published by John Wiley & Sons Ltd.

The opinion of Turkish cardiologists on current malpractice system and an alternative patient compensation system proposal: PCS study group.

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Olcay, Ayhan; Emren, Sadık Volkan; Babür Güler, Gamze; Güler, Ekrem; Ertunç, Vedat; Berilgen, Rida; Aslan, Abdullah; Şimşek, Ersin Çağrı; Gölcük, Şükriye Ebru; Yalın, Kıvanç

2017-10-01

Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system. The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message. A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients. The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.

How Cancer Patients Use and Benefit from an Interactive Cancer Communication System.

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Han, Jeong Yeob; Hawkins, Robert; Baker, Timothy; Shah, Dhavan V; Pingree, Suzanne; Gustafson, David H

2017-10-01

Despite the mounting evidence of efficacy of eHealth interventions, their mechanisms of action remain unknown. The current study analyzed patient log data as each patient engaged in an eHealth system called the Comprehensive Health Enhancement Support System (CHESS) and reports on how patients engage with different combinations of eHealth services over time. Newly diagnosed breast cancer patients (N = 443) were given access for 6 months to one of four different configurations of CHESS: (1) Information, (2) Information and Support, (3) Information, Support, and Coaching (Full CHESS), and (4) Full CHESS and Mentor. Besides a baseline survey, three follow-up posttests were administered. Action log data on how patients engaged with the CHESS were also collected and merged with surveys to examine how patients benefit during the cancer experience. The findings suggest that usage patterns were not competitive, implying that cancer patients' access to more complex tools generates more use with their time spreading out over the diverse services. Despite overall decline in usage rates, it was less severe in Full CHESS and Mentor condition, suggesting that communication functions drive long-term engagement with the system. Notably, the strongest relation between use and cancer information competence appeared late in the follow-up period.

Implementation of DICOM Modality Worklist at Patient Registration Systems in Radiology Unit

Science.gov (United States)

Kartawiguna, Daniel; Georgiana, Vina

2014-03-01

Currently, the information and communication technology is developing very rapidly. A lot of hospitals have digital radiodiagnostic modality that supports the DICOM protocol. However, the implementation of integrated radiology information system with medical imaging equipment is still very limited until now, especially in developing countries like Indonesia. One of the obstacles is high prices for radiology information system. Whereas the radiology information systems can be widely used by radiologists to provide many benefit for patient, hospitals, and the doctors themselves. This study aims to develop a system that integrates the radiology administration information system with radiodiagnostic imaging modalities. Such a system would give some benefits that the information obtained is more accurate, timely, relevant, and accelerate the workflow of healthcare workers. This research used direct observation method to some hospital radiology unit. Data was collected through interviews, questionnaires, and surveys directly to some of the hospital's radiology department in Jakarta, and supported by the literature study. Based on the observations, the prototype of integrated patient registration systems in radiology unit is developed and interfaced to imaging equipment radiodiagnostic using standard DICOM communications. The prototype of radiology patient registration system is tested with the modality MRI and CT scan.

Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems.

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Meyerhoefer, Chad D; Sherer, Susan A; Deily, Mary E; Chou, Shin-Yi; Guo, Xiaohui; Chen, Jie; Sheinberg, Michael; Levick, Donald

2018-05-16

The installation of EHR systems can disrupt operations at clinical practice sites, but also lead to improvements in information availability. We examined how the installation of an ambulatory EHR at OB/GYN practices and its subsequent interface with an inpatient perinatal EHR affected providers' satisfaction with the transmission of clinical information and patients' ratings of their care experience. We collected data on provider satisfaction through 4 survey rounds during the phased implementation of the EHR. Data on patient satisfaction were drawn from Press Ganey surveys issued by the healthcare network through a standard process. Using multivariable models, we determined how provider satisfaction with information transmission and patient satisfaction with their care experience changed as the EHR system allowed greater information flow between OB/GYN practices and the hospital. Outpatient OB/GYN providers became more satisfied with their access to information from the inpatient perinatal triage unit once system capabilities included automatic data flow from triage back to the OB/GYN offices. Yet physicians were generally less satisfied with how the EHR affected their work processes than other clinical and non-clinical staff. Patient satisfaction dropped after initial EHR installation, and we find no evidence of increased satisfaction linked to system integration. Dissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction. Care must be taken during EHR implementations to maintain good communication with patients while satisfying documentation requirements.

Power and resistance within the hospital's hierarchical system: the experiences of chronically ill patients.

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Griscti, Odette; Aston, Megan; Warner, Grace; Martin-Misener, Ruth; McLeod, Deborah

2017-01-01

To explore experiences of chronically ill patients and registered nurses when they negotiate patient care in hospital settings. Specifically, we explored how social and institutional discourses shape power relations during the negotiation process. The hospital system is embedded in a hierarchical structure where the voice of the healthcare provider as expert is often given more importance than the patient. This system has been criticised as being oppressive to patients who are perceived to be lower in the hierarchy. In this study, we illustrate how the hospital's hierarchical system is not always oppressing but can also create moments of empowerment for patients. A feminist poststructuralist approach informed by the teaching of Foucault was used to explore power relations between nurses and patients when negotiating patient care in hospital settings. Eight individuals who suffered from chronic illness shared their stories about how they negotiated their care with nurses in hospital settings. The interviews were tape-recorded. Discourse analysis was used to analyse the data. Patients recounted various experiences when their voices were not heard because the current hospital system privileged the healthcare provider experts' advice over the patients' voice. The hierarchical structure of hospital supported these dynamics by privileging nurses as gatekeepers of service, by excluding the patients' input in the nursing notes and through a process of self-regulation. However, patients in this study were not passive recipients of care and used their agency creatively to resist these discourses. Nurses need to be mindful of how the hospital's hierarchical system tends to place nurses in a position of power, and how their authoritative position may positively or adversely affect the negotiation of patient care. © 2016 John Wiley & Sons Ltd.

High resolution computed tomography in patients with various forms of systemic sclerosis

International Nuclear Information System (INIS)

Lewszuk, A.; Rozycki, J.; Tarasow, E.; Kowal-Bielecka, O.

2008-01-01

Pulmonary lesions are, besides renal and cardiac complications, one of the main causes of mortality among patients with systemic sclerosis (scleroderma). Pathologic changes in the respiratory system take the form of interstitial fibrosis clinically manifested by progressive exertion dyspnea and abnormalities of respiratory restriction type in functional tests. The aim of the study was systematization of pulmonary lesion symptomatology in conventional chest radiography and high resolution computed tomography (HRCT) in patients with various forms of scleroderma, as well as determination of the frequency and localization of the particular lesion types. The study was carried out in a group of 49 patients with systemic sclerosis (47 women and 2 men), who underwent conventional radiography and high resolution computed tomography of the chest. In patients with systemic sclerosis, HRCT revealed most frequently interstitial changes of ground glass type, as well as linear and reticular opacities, whereas bronchiectasis and honeycombing type lesions were less frequent. Pulmonary lesions were seen with increasing frequency towards the lung base and were localized mainly in the posterior, inferior and peripheral parts of the lungs. Comparison of the patients with limited and diffuse scleroderma demonstrated that the diffuse form is associated with more frequent involvement of the respiratory system and more advanced pulmonary lesions. The observed characteristics of pulmonary lesions show similarity between interstitial lung disease in the course of systemic sclerosis and nonspecific interstitial pneumonia (NSIP), which supports classification of interstitial lung disease associated with scleroderma as belonging to that group of interstitial inflammations. (author)

Small intestinal bacterial overgrowth in patients with systemic sclerosis

Directory of Open Access Journals (Sweden)

Saara Rawn

2017-01-01

Full Text Available Small intestinal bacterial overgrowth (SIBO is common in patients with systemic sclerosis (SSc yet often goes underrecognized in clinical practice. In patients with SSc, untreated SIBO may result in marked morbidity and possible mortality. The pathogenesis of SIBO is multifactorial and relates to immune dysregulation, vasculopathy, and dysmotility. This article reviews various diagnostic approaches and therapeutic options for SIBO. Treatment modalities mainly include prokinetics, probiotics, and antibiotics.

Use the Bar Code System to Improve Accuracy of the Patient and Sample Identification.

Science.gov (United States)

Chuang, Shu-Hsia; Yeh, Huy-Pzu; Chi, Kun-Hung; Ku, Hsueh-Chen

2018-01-01

In time and correct sample collection were highly related to patient's safety. The sample error rate was 11.1%, because misbranded patient information and wrong sample containers during January to April, 2016. We developed a barcode system of "Specimens Identify System" through process of reengineering of TRM, used bar code scanners, add sample container instructions, and mobile APP. Conclusion, the bar code systems improved the patient safety and created green environment.

Patients' Data Management System Protected by Identity-Based Authentication and Key Exchange.

Science.gov (United States)

Rivero-García, Alexandra; Santos-González, Iván; Hernández-Goya, Candelaria; Caballero-Gil, Pino; Yung, Moti

2017-03-31

A secure and distributed framework for the management of patients' information in emergency and hospitalization services is proposed here in order to seek improvements in efficiency and security in this important area. In particular, confidentiality protection, mutual authentication, and automatic identification of patients are provided. The proposed system is based on two types of devices: Near Field Communication (NFC) wristbands assigned to patients, and mobile devices assigned to medical staff. Two other main elements of the system are an intermediate server to manage the involved data, and a second server with a private key generator to define the information required to protect communications. An identity-based authentication and key exchange scheme is essential to provide confidential communication and mutual authentication between the medical staff and the private key generator through an intermediate server. The identification of patients is carried out through a keyed-hash message authentication code. Thanks to the combination of the aforementioned tools, a secure alternative mobile health (mHealth) scheme for managing patients' data is defined for emergency and hospitalization services. Different parts of the proposed system have been implemented, including mobile application, intermediate server, private key generator and communication channels. Apart from that, several simulations have been performed, and, compared with the current system, significant improvements in efficiency have been observed.

Clinical optical coherence tomography combined with multiphoton tomography for evaluation of several skin disorders

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König, Karsten; Speicher, Marco; Bückle, Rainer; Reckfort, Julia; McKenzie, Gordon; Welzel, Julia; Koehler, Martin J.; Elsner, Peter; Kaatz, Martin

2010-02-01

The first clinical trial of optical coherence tomography (OCT) combined with multiphoton tomography (MPT) and dermoscopy is reported. State-of-the-art (i) OCT systems for dermatology (e.g. multibeam swept source OCT), (ii) the femtosecond laser multiphoton tomograph DermaInspectTM, and (iii) digital dermoscopes were applied to 47 patients with a diversity of skin diseases and disorders such as skin cancer, psoriasis, hemangioma, connective tissue diseases, pigmented lesions, and autoimmune bullous skin diseases. Dermoscopy, also called 'epiluminescent microscopy', provides two-dimensional color images of the skin surface. OCT imaging is based on the detection of optical reflections within the tissue measured interferometrically whereas nonlinear excitation of endogenous fluorophores and the second harmonic generation are the bases of MPT images. OCT cross sectional "wide field" image provides a typical field of view of 5 x 2 mm2 and offers fast information on the depth and the volume of the investigated lesion. In comparison, multiphoton tomography presents 0.36 x 0.36 mm2 horizontal or diagonal sections of the region of interest within seconds with submicron resolution and down to a tissue depth of 200 μm. The combination of OCT and MPT provides a synergistic optical imaging modality for early detection of skin cancer and other skin diseases.

A systematic review of patient tracking systems for use in the pediatric emergency department.

Science.gov (United States)

Dobson, Ian; Doan, Quynh; Hung, Geoffrey

2013-01-01

Patient safety is of great importance in the pediatric emergency department (PED). The combination of acutely and critically ill patients and high patient volumes creates a need for systems to support physicians in making accurate and timely diagnoses. Electronic patient tracking systems can potentially improve PED safety by reducing overcrowding and enhancing security. To enhance our understanding of current electronic tracking technologies, how they are implemented in a clinical setting, and resulting effect on patient care outcomes including patient safety. Nine databases were searched. Two independent reviewers identified articles that contained reference to patient tracking technologies in pediatrics or emergency medicine. Quantitative studies were assessed independently for methodological strength by two reviewers using an external assessment tool. Of 2292 initial articles, 22 were deemed relevant. Seventeen were qualitative, and the remaining five quantitative articles were assessed as being methodologically weak. Existing patient tracking systems in the ED included: infant monitoring/abduction prevention; barcode identification; radiofrequency identification (RFID)- or infrared (IR)-based patient tracking. Twenty articles supported the use of tracking technology to enhance patient safety or improve efficiency. One article failed to support the use of IR patient sensors due to study design flaws. Support exists for the use of barcode-, IR-, and RFID-based patient tracking systems to improve ED patient safety and efficiency. A lack of methodologically strong studies indicates a need for further evidence-based support for the implementation of patient tracking technology in a clinical or research setting. Copyright © 2013 Elsevier Inc. All rights reserved.

Healthcare Blockchain System Using Smart Contracts for Secure Automated Remote Patient Monitoring.

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Griggs, Kristen N; Ossipova, Olya; Kohlios, Christopher P; Baccarini, Alessandro N; Howson, Emily A; Hayajneh, Thaier

2018-06-06

As Internet of Things (IoT) devices and other remote patient monitoring systems increase in popularity, security concerns about the transfer and logging of data transactions arise. In order to handle the protected health information (PHI) generated by these devices, we propose utilizing blockchain-based smart contracts to facilitate secure analysis and management of medical sensors. Using a private blockchain based on the Ethereum protocol, we created a system where the sensors communicate with a smart device that calls smart contracts and writes records of all events on the blockchain. This smart contract system would support real-time patient monitoring and medical interventions by sending notifications to patients and medical professionals, while also maintaining a secure record of who has initiated these activities. This would resolve many security vulnerabilities associated with remote patient monitoring and automate the delivery of notifications to all involved parties in a HIPAA compliant manner.

Development and validation of a patient-reported questionnaire assessing systemic therapy induced diarrhea in oncology patients.

Science.gov (United States)

Lui, Michelle; Gallo-Hershberg, Daniela; DeAngelis, Carlo

2017-12-22

Systemic therapy-induced diarrhea (STID) is a common side effect experienced by more than half of cancer patients. Despite STID-associated complications and poorer quality of life (QoL), no validated assessment tools exist to accurately assess STID occurrence and severity to guide clinical management. Therefore, we developed and validated a patient-reported questionnaire (STIDAT). The STIDAT was developed using the FDA iterative process for patient-reported outcomes. A literature search uncovered potential items and questions for questionnaire construction used by oncology clinicians to develop questions for the preliminary instrument. The instrument was evaluated on its face validity and content validity by patient interviews. Repetitive, similar and different themes uncovered from patient interviews were implemented to revise the instrument to the version used for validation. Patients starting high-risk STID treatments were monitored using the STIDAT, bowel diaries and EORTC QLQ-C30. The STIDAT was evaluated for construct validity using exploratory factor analysis (EFA) using minimal residual method with Promax rotation, reliability and consistency. A weighted scoring system was developed and a receiver-operating characteristic (ROC) curve evaluated the tool's ability to detect STID occurrence. Median scores and variability were analysed to determine how well it differentiates between diarrhea severities. A post-hoc analysis determined how diarrhea severity impacted QoL of cancer patients. Patients defined diarrhea based on presence of watery stool. The STIDAT assessed patient's perception of having diarrhea, daily number of bowel movements, daily number of diarrhea episodes, antidiarrheal medication use, the presence of urgency, abdominal pain, abdominal spasms or fecal incontinence, patient's perception of diarrhea severity, and QoL. These dimensions were sorted into four clusters using EFA - patient's perception of diarrhea, frequency of diarrhea, fecal

The value of patient reporting to the pharmacovigilance system: a systematic review.

Science.gov (United States)

Inácio, Pedro; Cavaco, Afonso; Airaksinen, Marja

2017-02-01

Current trends in pharmacovigilance systems are veering towards patient involvement in spontaneous reporting of adverse drug reactions (ADRs). The aim of the current systematic review was to identify what is known and what remains unknown with respect to patient reporting to pharmacovigilance systems. A systematic literature search was conducted in PubMed, CINAHL, Journals@Ovid and the Cochrane Library. Studies were included if they contained: (i) reviews about patient reporting; (ii) evaluation of patient reports to national or supranational pharmacovigilance authorities; (iii) a comparison between patient and healthcare professional (HCP) reports submitted to pharmacovigilance authorities; and (iv) surveys of patient experiences, opinions and awareness about reporting ADRs. The methodological quality of the studies was assessed according to principles of Grading of Recommendations, Assessment, Development and Evaluations (GRADE). A total of thirty four studies were included. Five of the studies were reviews (two of which systematic reviews), fourteen retrospective observational studies, nine surveys and six applied mixed research methods. Patient reporting has the advantages of bringing novel information about ADRs. It provides a more detailed description of ADRs, and reports about different drugs and system organ classes when compared with HCP reporting. In addition, patients describe the severity and impact of ADRs on daily life, complementing information derived from HCPs. Patient reporting is relatively rare in most countries. Patient reporting adds new information, and perspective about ADRs in a way otherwise unavailable. This can contribute to better decision-making processes in regulatory activities. The present review identified gaps in knowledge that should be addressed to improve our understanding of the full potential and drawbacks of patient reporting. © 2016 The British Pharmacological Society.

Statin Induced Myopathy a Patient with Multiple Systemic Diseases

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Özgül Uçar

2011-04-01

Full Text Available Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins are the most successful class of drugs for the treatment of hypercholesterolaemia and dyslipidaemia. However, the popular profile of statins in terms of efficacy has been maligned by theiradverse effects. Statin induced myopathy, which can be seen at any time during the course of therapy, is a clinically important cause of statin intolerance and discontinuation. When a patient with multiple systemic diseases who use numerous medications represent with myalgia and muscle cramps, statin induced myopathy may not be remembered at first. We present a patient with multiple systemic diseases, alcohol and morphine abuse in whom myopathy developed. After exclusion of other etiologies, we concluded that myopathy was related to statin therapy.

Glutathione Redox System in β-Thalassemia/Hb E Patients

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Ruchaneekorn W. Kalpravidh

2013-01-01

Full Text Available β-thalassemia/Hb E is known to cause oxidative stress induced by iron overload. The glutathione system is the major endogenous antioxidant that protects animal cells from oxidative damage. This study aimed to determine the effect of disease state and splenectomy on redox status expressed by whole blood glutathione (GSH/glutathione disulfide (GSSG and also to evaluate glutathione-related responses to oxidation in β-thalassemia/Hb E patients. Twenty-seven normal subjects and 25 β-thalassemia/Hb E patients were recruited and blood was collected. The GSH/GSSG ratio, activities of glutathione-related enzymes, hematological parameters, and serum ferritin levels were determined in individuals. Patients had high iron-induced oxidative stress, shown as significantly increased serum ferritin, a decreased GSH/GSSG ratio, and increased activities of glutathione-related enzymes. Splenectomy increased serum ferritin levels and decreased GSH levels concomitant with unchanged glutathione-related enzyme activities. The redox ratio had a positive correlation with hemoglobin levels and negative correlation with levels of serum ferritin. The glutathione system may be the body’s first-line defense used against oxidative stress and to maintain redox homeostasis in thalassemic patients based on the significant correlations between the GSH/GSSH ratio and degree of anemia or body iron stores.

[Applying Neuman's Systems Model to a neuroleptic malignant syndrome psychiatric patient and his caregiver].

Science.gov (United States)

Wang, Shu-Mi; Lai, Chien-Yu

2010-04-01

This article describes a nurse's experience using Neuman's Systems Model to care for a chronic psychiatric patient and his caregiver. The patient was diagnosed as suffering from neuroleptic malignant syndrome (NMS). Nursing care described in this article was administered from October 23 to December 4, 2007. The patient developed NMS in the third month of a three-month period of hospitalization, which endangered his life as well as the health of his caregiver. Nursing care was provided to the patient and his caregiver based on Neuman's Systems Model, which included assessments of intrapersonal, interpersonal, and extra-personal forces as well as of environmental factors affecting the health of the patient and his caregiver. The four nursing care issues identified included: existing self-care deficit, sensory/perceptual alteration, sleep pattern disturbance, and caregiver role strain. Following Neuman's systems model, primary, secondary, and tertiary prevention were used to strengthen the flexible lines of defense, internal lines of resistance, and supporting existing strengths of both patient and caregiver, as well as to conserve client system energy. Significant improvements in patient and caregiver abilities were apparent in nursing intervention outcomes. This experience shows the Neuman's systems model to be an efficient model in psychiatric nursing care.

System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Terkelsen, Christian Juhl; Sørensen, Jacob Thorsted; Maeng, Michael

2010-01-01

Timely reperfusion therapy is recommended for patients with ST-segment elevation myocardial infarction (STEMI), and door-to-balloon delay has been proposed as a performance measure in triaging patients for primary percutaneous coronary intervention (PCI). However, focusing on the time from first...... contact with the health care system to the initiation of reperfusion therapy (system delay) may be more relevant, because it constitutes the total time to reperfusion modifiable by the health care system. No previous studies have focused on the association between system delay and outcome in patients...

When do the symptoms of autonomic nervous system malfunction appear in patients with Parkinson's disease?

Science.gov (United States)

De Luka, Silvio R; Svetel, Marina; Pekmezović, Tatjana; Milovanović, Branislav; Kostić, Vladimir S

2014-04-01

Dysautonomia appears in almost all patients with Parkinson's disease (PD) in a certain stage of their condition. The aim of our study was to detect the development and type of autonomic disorders, find out the factors affecting their manifestation by analyzing the potential association with demographic variables related to clinical presentation, as well as the symptoms of the disease in a PD patient cohort. The patients with PD treated at the Clinic of Neurology in Belgrade during a 2-year period, divided into 3 groups were studied: 25 de novo patients, 25 patients already treated and had no long-term levodopa therapy-related complications and 22 patients treated with levodopa who manifested levodopa-induced motor complications. Simultaneously, 35 healthy control subjects, matched by age and sex, were also analyzed. Autonomic nervous system malfunction was defined by Ewing diagnostic criteria. The tests, indicators of sympathetic and parasympathetic nervous systems, were significantly different in the PD patients as compared with the controls, suggesting the failure of both systems. However, it was shown, in the selected groups of patients, that the malfunction of both systems was present in two treated groups of PD patients, while de novo group manifested only sympathetic dysfunction. For this reason, the complete autonomic neuropathy was diagnosed only in the treated PD patients, while de novo patients were defined as those with the isolated sympathetic dysfunction. The patients with the complete autonomic neuropathy differed from the subjects without such neuropathy in higher cumulative and motor unified Parkinson's disease rating score (UPDRS) (p nervous system disturbances among PD patients from the near onset of disease, with a predominant sympathetic nervous system involvement. The patients who developed complete autonomic neuropathy (both sympathetic and parasympathetic) were individuals with considerable level of functional failure, more severe clinical

Radioimmunoassay determination of urinary prostaglandins in patients with progressive systemic sclerosis

International Nuclear Information System (INIS)

Ramirez P, P.; Erbessd, M.L.; Mares, G.; Recinos, G.; Graef S, A.; Lavalle, C.

1985-01-01

The results of urinary determinations of E-2 prostaglandines by radioimmunoassay (RIA) in 24-hour urine are presented for three groups: progressive systemic sclerotic patients with normotension and with elevated or normal APR, progressive systemic sclerotic patients with hypertension and with normal or low APR, control group of normal subjects. In a recent report of progressive systemic sclerosis in patients we demonstrated changes in the urine concentratrion of APR levels, sodium excretion and in total blood volume. Based on these findings we felt the need to perform quantifications of E-2 prostaglandines (PGE-2) in 24-hour recently taken urine samples stored at 70 0 and measure the sodium amounts excreted in the urine. We concluded that urinary determination of E-2 prostaglandines was the most suitable for our study as it allowed the establishment of relationships between APR, aldosterone and metabolic sodium balance. (author)

Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness.

Science.gov (United States)

Wysham, Nicholas G; Abernethy, Amy P; Cox, Christopher E

2014-10-01

Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with integrated electronic patient-reported outcomes to optimize patient-centered care, including critical care outcome prediction. A learning health system infrastructure integrating electronic patient-reported outcomes may aid in the management of critical illness-associated conditions and yield tools to improve prognostication of patient-centered outcomes in critical illness.

Patient dose monitoring systems: A new way of managing patient dose and quality in the radiology department.

Science.gov (United States)

Fitousi, N

2017-12-01

Due to the upcoming European Directive (2013/59/EURATOM) and the increased focus on patient safety in international guidelines and regulations, Patient Dose Monitoring Systems, also called Dose Management Systems (DMS), are introduced in medical imaging departments. This article focusses on the requirements for a DMS, its benefits and the necessary implementation steps. The implementation of a DMS can be perceived as a lengthy, yet worthy, procedure: users have to select the appropriate system for their applications, prepare data collection, validate, perform configuration, and start using the results in quality improvement projects. A state of the art DMS improves the quality of service, ensures patient safety and optimizes the efficiency of the department. The gain is multifaceted: the initial goal is compliance monitoring against diagnostic reference levels. At a higher level, the user gets an overview of the performance of the devices or centers that are under his supervision. Error identification, generation of alerts and workflow analysis are additional benefits. It can also enable a more patient-centric approach with personalized dosimetry. Skin dose, size-specific dose estimates and organ doses can be calculated and evaluated per patient. A DMS is a powerful tool and essential for improved quality and patient care in a radiology department. It can be configured to the needs of medical physicists, radiologists, technologists, even for the management of the hospital. Collaboration between all health professionals and stakeholders, input-output validation and communication of findings are key points in the process of a DMS implementation. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Aging-related systemic manifestations in COPD patients and cigarette smokers.

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Laurent Boyer

Full Text Available Chronic obstructive pulmonary disease (COPD is often associated with age-related systemic abnormalities that adversely affect the prognosis. Whether these manifestations are linked to the lung alterations or are independent complications of smoking remains unclear.To look for aging-related systemic manifestations and telomere shortening in COPD patients and smokers with minor lung destruction responsible for a decline in the diffusing capacity for carbon monoxide (DLCO corrected for alveolar volume (KCO.Cross-sectional study in 301 individuals (100 with COPD, 100 smokers without COPD, and 101 nonsmokers without COPD.Compared to control smokers, patients with COPD had higher aortic pulse-wave velocity (PWV, lower bone mineral density (BMD and appendicular skeletal muscle mass index (ASMMI, and shorter telomere length (TL. Insulin resistance (HOMA-IR and glomerular filtration rate (GFR were similar between control smokers and COPD patients. Smokers did not differ from nonsmokers for any of these parameters. However, smokers with normal spirometry but low KCO had lower ASMMI values compared to those with normal KCO. Moreover, female smokers with low KCO, had lower BMD and shorter TL compared to those with normal KCO.Aging-related abnormalities in patients with COPD are also found in smokers with minor lung dysfunction manifesting as a KCO decrease. Decreased KCO might be useful, particularly among women, for identifying smokers at high risk for aging-related systemic manifestations and telomere shortening.

Performance of an automatic dose control system for CT. Patient studies

Energy Technology Data Exchange (ETDEWEB)

Stumpp, P.; Gosch, D.; Kuehn, A.; Sorge, I.; Kahn, T. [Universitaetsklinikum Leipzig (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie; Weber, D. [St. Elisabeth-Krankenhaus Leipzig (Germany). Roentgendiagnostik; Lehmkuhl, L. [Leipzig Univ. - Herzzentrum (Germany). Diagnostische und Interventionelle Radiologie; Nagel, H.D. [Dr. HD Nagel, Wissenschaft und Technik fuer die Radiologie, Buchholz (Germany)

2013-02-15

Purpose: To study the effect of an automatic dose control (ADC) system with adequate noise characteristic on the individual perception of image noise and diagnostic acceptance compared to objectively measured image noise and the dose reductions achieved in a representative group of patients. Materials and Methods: In a retrospective study two matched cohorts of 20 patients each were identified: a manual cohort with exposure settings according to body size (small - regular - large) and an ADC cohort with exposure settings calculated by the ADC system (DoseRight 2.0 trademark, Philips Healthcare). For each patient, 12 images from 6 defined anatomic levels from contrast-enhanced scans of chest and abdomen/pelvis were analyzed by 4 independent readers concerning image noise and diagnostic acceptance on a five-point Likert scale and evaluated for objectively measured image noise. Radiation exposure was calculated from recorded exposure data. Results: Use of the ADC system reduced the average effective dose for patients by 36 % in chest scans (3.2 vs. 4.9 mSv) and by 17 % in abdomen/pelvis scans (7.6 vs. 8.3 mSv). Average objective noise was slightly lower in the manual cohort (11.1 vs. 12.8 HU), correlating with a slightly better rating in subjective noise score (4.4 vs. 4.2). However, diagnostic acceptance was rated almost equal in both cohorts with excellent image quality (4.6 vs. 4.5). Conclusion: Use of an ADC system with adequate noise characteristic leads to significant reductions in radiation exposure for patients while maintaining excellent image quality. (orig.)

Measuring mobile patient safety information system success: an empirical study.

Science.gov (United States)

Jen, Wen-Yuan; Chao, Chia-Cheng

2008-10-01

The Health Risk Reminders and Surveillance (HRRS) system was designed to deliver critical abnormal test results of severely ill patients from Laboratory, Radiology, and Pathology departments to physicians within 5 min using cell phone text messages. This paper explores the success of the HRRS system. This study employed an augmented version of the DeLone and McLean IS success model. Seven variables (system quality, information quality, system use, user satisfaction, mobile healthcare anxiety, impact on the individual and impact on the organization) were used to evaluate the success of the HRRS system. The interrelationships between the seven variables were hypothesized and the hypotheses were empirically tested. The results indicate that the information quality of the HRRS system is positively associated with both system use and user satisfaction. In addition, system use is positively associated with user satisfaction, which is also positively associated with mobile healthcare anxiety. Moreover, results indicate that impact on the individual is positively associated with both user satisfaction and mobile healthcare anxiety. Finally, the impact of the organization is positively associated with impact on the individual. The results of the study provide an expanded understanding of the factors that contribute to mobile patient safety information system (IS) success. Implications of the relationship between system use and physician mobile healthcare anxiety are discussed.

Benefits of remote real-time side-effect monitoring systems for patients receiving cancer treatment.

Science.gov (United States)

Kofoed, Sarah; Breen, Sibilah; Gough, Karla; Aranda, Sanchia

2012-03-05

In Australia, the incidence of cancer diagnoses is rising along with an aging population. Cancer treatments, such as chemotherapy, are increasingly being provided in the ambulatory care setting. Cancer treatments are commonly associated with distressing and serious side-effects and patients often struggle to manage these themselves without specialized real-time support. Unlike chronic disease populations, few systems for the remote real-time monitoring of cancer patients have been reported. However, several prototype systems have been developed and have received favorable reports. This review aimed to identify and detail systems that reported statistical analyses of changes in patient clinical outcomes, health care system usage or health economic analyses. Five papers were identified that met these criteria. There was wide variation in the design of the monitoring systems in terms of data input method, clinician alerting and response, groups of patients targeted and clinical outcomes measured. The majority of studies had significant methodological weaknesses. These included no control group comparisons, small sample sizes, poor documentation of clinical interventions or measures of adherence to the monitoring systems. In spite of the limitations, promising results emerged in terms of improved clinical outcomes (e.g. pain, depression, fatigue). Health care system usage was assessed in two papers with inconsistent results. No studies included health economic analyses. The diversity in systems described, outcomes measured and methodological issues all limited between-study comparisons. Given the acceptability of remote monitoring and the promising outcomes from the few studies analyzing patient or health care system outcomes, future research is needed to rigorously trial these systems to enable greater patient support and safety in the ambulatory setting.

Physical factors that influence patients' privacy perception toward a psychiatric behavioral monitoring system: a qualitative study.

Science.gov (United States)

Zakaria, Nasriah; Ramli, Rusyaizila

2018-01-01

Psychiatric patients have privacy concerns when it comes to technology intervention in the hospital setting. In this paper, we present scenarios for psychiatric behavioral monitoring systems to be placed in psychiatric wards to understand patients' perception regarding privacy. Psychiatric behavioral monitoring refers to systems that are deemed useful in measuring clinical outcomes, but little research has been done on how these systems will impact patients' privacy. We conducted a case study in one teaching hospital in Malaysia. We investigated the physical factors that influence patients' perceived privacy with respect to a psychiatric monitoring system. The eight physical factors identified from the information system development privacy model, a comprehensive model for designing a privacy-sensitive information system, were adapted in this research. Scenario-based interviews were conducted with 25 patients in a psychiatric ward for 3 months. Psychiatric patients were able to share how physical factors influence their perception of privacy. Results show how patients responded to each of these dimensions in the context of a psychiatric behavioral monitoring system. Some subfactors under physical privacy are modified to reflect the data obtained in the interviews. We were able to capture the different physical factors that influence patient privacy.

Wrinkle and roughness measurement by the Antera 3D and its application for evaluation of cosmetic products.

Science.gov (United States)

Messaraa, C; Metois, A; Walsh, M; Hurley, S; Doyle, L; Mansfield, A; O'Connor, C; Mavon, A

2018-01-24

Skin topographic measurements are of paramount importance in the field of dermo-cosmetic evaluation. The aim of this study was to investigate how the Antera 3D, a multi-purpose handheld camera, correlates with other topographic techniques and changes in skin topography following the use of a cosmetic product. Skin topographic measurements were collected on 26 female volunteers aged 45-70 years with the Antera 3D, the DermaTOP and image analysis on parallel-polarized pictures. Different filters for analysis from the Antera 3D were investigated for repeatability, correlations with other imaging techniques and ability to detect improvements of skin topography following application of a serum. Most of Antera 3D parameters were found to be strongly correlated with the DermaTOP parameters. No association was found between the Antera 3D parameters and measurements on parallel-polarized photographs. The measurements repeatability was comparable among the different filters for analysis, with the exception of wrinkle max depth and roughness Rt. Following a single application of a tightening serum, both Antera 3D wrinkles and texture parameters were able to record significant improvements, with the best improvements observed with the large filter. The Antera 3D demonstrated its relevance for cosmetic product evaluation. We also provide recommendations for the analysis based on our findings. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Development of the cancer patient financial aid system and analysis of user satisfaction.

Science.gov (United States)

Park, Joon Ho; Park, Eun-Cheol; Lee, Myung Ha; Kim, Yun-Mi; Choi, Soo Mi

2006-01-01

A financial aid program for low income cancer patients in Korea was initiated in 2005, which required a web-based system. Therefore, the Cancer Patient Financial Aid System (CPFAS) was developed. To improve the CPFAS, we evaluated the nationwide satisfaction of public health center users.

Mass Medication Clinic (MMC) Patient Medical Assistant (PMA) System Training Initiative

Science.gov (United States)

2007-06-01

AD_________________ Award Number: W81XWH-06-2-0045 TITLE: Mass Medication Clinic (MMC) Patient ...SUBTITLE 5a. CONTRACT NUMBER Mass Medication Clinic (MMC) Patient Medical Assistant (PMA) System Training Initiative 5b. GRANT NUMBER W81XWH-06-2...sections will describe the events, results, and accomplishments of this study. With validation through this project the Patient Medical Assistant

[Activity of the sympatho-adrenal system in patients with hysterical psychopathy and psychasthenia].

Science.gov (United States)

Trunova, M M

1978-01-01

The paper is concerned with studies of the sympathoadrenal system activity by the indices of urine excretion of catecholamine and dofa in patients with hysterical and psychasthenic psychopathy. The disorders inherent in each of the groups are demonstrated. The patients with hysterical psychopathy show an exhaustion of all links in the catecholamine metabolism, while the patients with psychasthenical psychopathy an exhaustion of the noradrenaline link. In attempting to explain the mechanisms of disturbed activity in the sympathoadrenal system in both groups the role of the functional state of nonspecific activizing brain systems was taken into consideration.

Enhancing requirements engineering for patient registry software systems with evidence-based components.

Science.gov (United States)

Lindoerfer, Doris; Mansmann, Ulrich

2017-07-01

Patient registries are instrumental for medical research. Often their structures are complex and their implementations use composite software systems to meet the wide spectrum of challenges. Commercial and open-source systems are available for registry implementation, but many research groups develop their own systems. Methodological approaches in the selection of software as well as the construction of proprietary systems are needed. We propose an evidence-based checklist, summarizing essential items for patient registry software systems (CIPROS), to accelerate the requirements engineering process. Requirements engineering activities for software systems follow traditional software requirements elicitation methods, general software requirements specification (SRS) templates, and standards. We performed a multistep procedure to develop a specific evidence-based CIPROS checklist: (1) A systematic literature review to build a comprehensive collection of technical concepts, (2) a qualitative content analysis to define a catalogue of relevant criteria, and (3) a checklist to construct a minimal appraisal standard. CIPROS is based on 64 publications and covers twelve sections with a total of 72 items. CIPROS also defines software requirements. Comparing CIPROS with traditional software requirements elicitation methods, SRS templates and standards show a broad consensus but differences in issues regarding registry-specific aspects. Using an evidence-based approach to requirements engineering for registry software adds aspects to the traditional methods and accelerates the software engineering process for registry software. The method we used to construct CIPROS serves as a potential template for creating evidence-based checklists in other fields. The CIPROS list supports developers in assessing requirements for existing systems and formulating requirements for their own systems, while strengthening the reporting of patient registry software system descriptions. It may be

Evaluation of the function of the vestibular system in patients with migraine.

Science.gov (United States)

Rzeski, Maciej; Stepień, Adam; Kaczorowski, Zbigniew

2008-01-01

Migraine is a common disorder with 1-year prevalence of 17.2% in women and 6% in men. Otoneurological symptoms such as phonophobia, tinnitus, vertigo, and dizziness are quite common in migraine. It is estimated that vertigo and dizziness are associated with migraine in 10% of all dizzy patients. The aim of the study was to evaluate the function of the vestibular system using electronystagmography (ENG) and videonystagmography (VNG) in patients with migraine compared to healthy controls. Sixty-two patients (46 women and 16 men) aged 20-35 years (mean age: 28.4 years) with migraine were qualified to the study. All other illnesses that can cause dysfunction of the vestibular system were excluded. The control group consisted of 31 healthy volunteers fulfilling the same demographic criteria as the migraine group (mean age: 29.2 years). Vertigo or dizziness was reported by 41 patients with migraine (66.1%). In ENG/VNG examination changes suggesting impairment of the peripheral or central part of the vestibular system were found in 34 patients (54.8%). In the control group, any abnormalities in ENG/VNG examination were present in 22.6% of individuals (p=0.0031). No statistical significance was found in the frequency of any ENG/VNG abnormalities in subgroups of patients with migraine with aura and migraine without aura. Factors predisposing to dysfunction of the vestibular system in our group of migraineurs were the frequency and duration of the migraine. Vertigo and dizziness are frequent co-existing symptoms in patients with migraine. ENG/VNG abnormali-ties are significantly more frequent in migraineurs than in healthy controls.

Base stock system for patient vs impatient customers with varying demand distribution

Science.gov (United States)

Fathima, Dowlath; Uduman, P. Sheik

2013-09-01

An optimal Base-Stock inventory policy for Patient and Impatient Customers using finite-horizon models is examined. The Base stock system for Patient and Impatient customers is a different type of inventory policy. In case of the model I, Base stock for Patient customer case is evaluated using the Truncated Exponential Distribution. The model II involves the study of Base-stock inventory policies for Impatient customer. A study on these systems reveals that the Customers wait until the arrival of the next order or the customers leaves the system which leads to lost sale. In both the models demand during the period [0, t] is taken to be a random variable. In this paper, Truncated Exponential Distribution satisfies the Base stock policy for the patient customer as a continuous model. So far the Base stock for Impatient Customers leaded to a discrete case but, in this paper we have modeled this condition into a continuous case. We justify this approach mathematically and also numerically.

Prevalence of dependent loops in urinary drainage systems in hospitalized patients.

Science.gov (United States)

Danek, Gale; Gravenstein, Nikolaus; Lizdas, David E; Lampotang, Samsun

2015-01-01

The purpose of this study was to measure the prevalence and configuration of dependent loops in urinary drainage systems in hospitalized, catheterized adults. The study sample comprised 141 patients with indwelling urinary catheters; subjects were hospitalized at an academic health center in northern Florida. We measured the prevalence of dependent loops in urine drainage systems and the incidence of urine-filled dependent loops over a 3-week period. We measured the heights of the crest (H(c)), trough (H(t)), and, when urine-filled dependent loops were present, the patient-side (H(p)) and bag-side (H(b)) menisci with a laser measurement system. All variables were measured in centimeters. The majority of observed urine drainage systems (85%) contained dependent loops in the drainage tubing and 93.8% of the dependent loops contained urine. H(c) and H(t) averaged 45.1 ± 11.1 and 27 ± 16.7 cm, respectively. Meniscus height difference (H(b) - H(p)) averaged 8.2 ± 5.8 and -12.2 ± 9.9 cm when H(p) H(b) (32.7%), respectively. We found that dependent loops are extremely common in urinary drainage systems among hospitalized patients despite the manufacturer recommendations and nursing and hospital policies. Maintaining the urine drainage tubing free of dependent loops would require incorporation into nursing care priorities and workflow as inadvertent force on the tubing, for example, patient movement or nurse contact can change tubing configuration and allow excess drainage tubing to re-form a dependent loop.

Histological Features of Antiphospholipid Nephropathy in Patients with Systemic Lupus Erythematosus

International Nuclear Information System (INIS)

Naseeb, F.; Arfaj, A. A..; Hamdani, A.; Parvez, K.; Mogairen, S. A.; Kfoury, H.

2015-01-01

Objective:To determine the histological features of renal biopsies of Systemic Lupus Erythematosus (SLE) patients with and without antiphospholipid antibodies in Saudi population. Study Design: Cross-sectional, comparative study. Place and Duration of Study: King Khalid University Hospital, Riyadh, Saudi Arabia, from January to December 2013. Methodology: Consecutive SLE patients admitted to King Khalid University Hospital, Riyadh for renal biopsy for evaluation of proteinuria or deterioration of renal function were recruited. SLE patients with renal involvement were divided in two groups. Group one included patients with positive APS antibodies and group two included patients with negative APS antibodies. The histological features of renal biopsies of the two patients groups were compared. Data was analyzed using simple statistical analysis. Results: The mean age of APS antibodies-positive patients was 30.37 ± 10.714 years while mean age of APS negative patients was 33.62 ± 11.717 years (p=0.224). Twenty five (83.33 percentage) patients were females and 5 (16.67 percentage) patients were males in APS positive patients while 42 (89.36 percentage) were females and 5 (10.63 percentage) were males in group two. Acute lesions like thrombotic microangiopathy were in 2 (6.7 percentage) of APS positive patients while chronic lesions like focal cortical atrophy was found in 6 (20 percentage) and fibrous intimal hyperplasia was found in 9 (30 percentage). Other significant histological findings in APS antibodies positive group were glomerular basement membrane wrinkling in 12 (40 percentage), glomerular double wall contour in 17 (56.7 percentage), fibrous adhesions in 11 (36.7 percentage) patients with APS antibodies. Conclusion:Systemic Lupus Erythematosus (SLE) patients with positive APS antibodies has specific histological findings suggesting an important role of APS antibodies in the pathogenesis of APS nephropathy. (author)

Systemic Sclerosis Sine Scleroderma in Mexican Patients. Case Reports.

Science.gov (United States)

Vera-Lastra, Olga; Sauceda-Casas, Christian Alexis; Domínguez, María Del Pilar Cruz; Alvarez, Sergio Alberto Mendoza; Sepulceda-Delgado, Jesús

2017-01-03

Systemic sclerosis sine scleroderma (ssSSc) is a form of systemic sclerosis that is characterized by Raynaud's phenomenon (RP), visceral involvement without thickening of skin and anticentromere antibodies (ACA). We studied 10 ssSsc patients with a prevalence of 2%. The clinical signs were: RP 9/10, esophageal manifestations 8/10, pulmonary arterial hypertension 4/10, interstitial lung disease 4/10, cardiac signs 3/10 and ACA 8/10. In patients with RP, esophageal dysmotility, interstitial lung disease and pulmonary arterial hypertension should be tested for ACA in order to establish a prompt diagnosis and treatment of ssSSc. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Different types of headache in patients with systemic lupus erythematosus.

Science.gov (United States)

Badry, Reda; Gamal, Rania M

2015-05-01

Headache in patients with systemic lupus erythematosus (SLE) is considered a common neurological finding, although the relationship is unclear. In this study, we aimed to evaluate frequency and characteristics of different types of headache in patients with SLE. 40 SLE patients were chosen from those referred to the out patient clinic using the American College of Rheumatology (ACR) criteria for the diagnosis of SLE. Headache classification was done regarding the ICD-II criteria in the patients. Headache severity was assessed by visual analog scale (VAS), and subjects with VAS ≥4 were included in the study. 30 patients out of 40 SLE patients (75%) have different headache types: tension type in 37.5% (n = 15) and migraine in 30% (n = 12), cluster 2.5% (n = 1), and intracranial hypertension 5% (n = 2) of all patients. Headache is frequent in SLE especially tension and migraine types, but overall, it is not associated with disease activity.

Integrating patient reported outcomes with clinical cancer registry data: a feasibility study of the electronic Patient-Reported Outcomes From Cancer Survivors (ePOCS) system.

Science.gov (United States)

Ashley, Laura; Jones, Helen; Thomas, James; Newsham, Alex; Downing, Amy; Morris, Eva; Brown, Julia; Velikova, Galina; Forman, David; Wright, Penny

2013-10-25

Routine measurement of Patient Reported Outcomes (PROs) linked with clinical data across the patient pathway is increasingly important for informing future care planning. The innovative electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system was developed to integrate PROs, collected online at specified post-diagnostic time-points, with clinical and treatment data in cancer registries. This study tested the technical and clinical feasibility of ePOCS by running the system with a sample of potentially curable breast, colorectal, and prostate cancer patients in their first 15 months post diagnosis. Patients completed questionnaires comprising multiple Patient Reported Outcome Measures (PROMs) via ePOCS within 6 months (T1), and at 9 (T2) and 15 (T3) months, post diagnosis. Feasibility outcomes included system informatics performance, patient recruitment, retention, representativeness and questionnaire completion (response rate), patient feedback, and administration burden involved in running the system. ePOCS ran efficiently with few technical problems. Patient participation was 55.21% (636/1152) overall, although varied by approach mode, and was considerably higher among patients approached face-to-face (61.4%, 490/798) than by telephone (48.8%, 21/43) or letter (41.0%, 125/305). Older and less affluent patients were less likely to join (both Pplanning and for targeting service provision.

Development of an electronic radiation oncology patient information management system.

Science.gov (United States)

Mandal, Abhijit; Asthana, Anupam Kumar; Aggarwal, Lalit Mohan

2008-01-01

The quality of patient care is critically influenced by the availability of accurate information and its efficient management. Radiation oncology consists of many information components, for example there may be information related to the patient (e.g., profile, disease site, stage, etc.), to people (radiation oncologists, radiological physicists, technologists, etc.), and to equipment (diagnostic, planning, treatment, etc.). These different data must be integrated. A comprehensive information management system is essential for efficient storage and retrieval of the enormous amounts of information. A radiation therapy patient information system (RTPIS) has been developed using open source software. PHP and JAVA script was used as the programming languages, MySQL as the database, and HTML and CSF as the design tool. This system utilizes typical web browsing technology using a WAMP5 server. Any user having a unique user ID and password can access this RTPIS. The user ID and password is issued separately to each individual according to the person's job responsibilities and accountability, so that users will be able to only access data that is related to their job responsibilities. With this system authentic users will be able to use a simple web browsing procedure to gain instant access. All types of users in the radiation oncology department should find it user-friendly. The maintenance of the system will not require large human resources or space. The file storage and retrieval process would be be satisfactory, unique, uniform, and easily accessible with adequate data protection. There will be very little possibility of unauthorized handling with this system. There will also be minimal risk of loss or accidental destruction of information.

Development of an electronic radiation oncology patient information management system

Directory of Open Access Journals (Sweden)

Mandal Abhijit

2008-01-01

Full Text Available The quality of patient care is critically influenced by the availability of accurate information and its efficient management. Radiation oncology consists of many information components, for example there may be information related to the patient (e.g., profile, disease site, stage, etc., to people (radiation oncologists, radiological physicists, technologists, etc., and to equipment (diagnostic, planning, treatment, etc.. These different data must be integrated. A comprehensive information management system is essential for efficient storage and retrieval of the enormous amounts of information. A radiation therapy patient information system (RTPIS has been developed using open source software. PHP and JAVA script was used as the programming languages, MySQL as the database, and HTML and CSF as the design tool. This system utilizes typical web browsing technology using a WAMP5 server. Any user having a unique user ID and password can access this RTPIS. The user ID and password is issued separately to each individual according to the person′s job responsibilities and accountability, so that users will be able to only access data that is related to their job responsibilities. With this system authentic users will be able to use a simple web browsing procedure to gain instant access. All types of users in the radiation oncology department should find it user-friendly. The maintenance of the system will not require large human resources or space. The file storage and retrieval process would be be satisfactory, unique, uniform, and easily accessible with adequate data protection. There will be very little possibility of unauthorized handling with this system. There will also be minimal risk of loss or accidental destruction of information.

Hypoactivation of reward motivational system in patients with newly diagnosed hypertension grade I-II.

Science.gov (United States)

Aftanas, L I; Brak, I V; Gilinskaya, O M; Korenek, V V; Pavlov, S V; Reva, N V

2014-08-01

In patients with newly diagnosed untreated grade I-II hypertension, EEG oscillations were recorded under conditions activation of the two basic motivational systems, defensive motivational system and positive reinforcement system, evoked by recall of personally meaningful emotional events. The 64-channel EEG and cardiovascular reactivity (beat-by-beat technology) were simultaneously recorded. At rest, hypertensive patients had significantly reduced platelet serotonin concentrations in comparison with healthy individuals. The patients experiencing emotional activation were characterized by significantly lower intensity of positive emotions associated with more pronounced suppression of EEG activity in the delta (2-4 Hz) and theta (ranges of frequency 4-6 and 6-8 Hz) oscillators in the parieto-occipital cortex (zones P and PO) in both hemispheres of the brain. The findings attest to insufficient function of the brain serotonin system and hypoactivation of the reward/reinforcement system in patients with primary hypertension.

Scaling-up health information systems to improve HIV treatment: An assessment of initial patient monitoring systems in Mozambique.

Science.gov (United States)

Hochgesang, Mindy; Zamudio-Haas, Sophia; Moran, Lissa; Nhampossa, Leopoldo; Packel, Laura; Leslie, Hannah; Richards, Janise; Shade, Starley B

2017-01-01

The rapid scale-up of HIV care and treatment in resource-limited countries requires concurrent, rapid development of health information systems to support quality service delivery. Mozambique, a country with an 11.5% prevalence of HIV, has developed nation-wide patient monitoring systems (PMS) with standardized reporting tools, utilized by all HIV treatment providers in paper or electronic form. Evaluation of the initial implementation of PMS can inform and strengthen future development as the country moves towards a harmonized, sustainable health information system. This assessment was conducted in order to 1) characterize data collection and reporting processes and PMS resources available and 2) provide evidence-based recommendations for harmonization and sustainability of PMS. This baseline assessment of PMS was conducted with eight non-governmental organizations that supported the Ministry of Health to provide 90% of HIV care and treatment in Mozambique. The study team conducted structured and semi-structured surveys at 18 health facilities located in all 11 provinces. Seventy-nine staff were interviewed. Deductive a priori analytic categories guided analysis. Health facilities have implemented paper and electronic monitoring systems with varying success. Where in use, robust electronic PMS facilitate facility-level reporting of required indicators; improve ability to identify patients lost to follow-up; and support facility and patient management. Challenges to implementation of monitoring systems include a lack of national guidelines and norms for patient level HIS, variable system implementation and functionality, and limited human and infrastructure resources to maximize system functionality and information use. This initial assessment supports the need for national guidelines to harmonize, expand, and strengthen HIV-related health information systems. Recommendations may benefit other countries with similar epidemiologic and resource

Turning challenges into design principles: Telemonitoring systems for patients with multiple chronic conditions.

Science.gov (United States)

Sultan, Mehwish; Kuluski, Kerry; McIsaac, Warren J; Cafazzo, Joseph A; Seto, Emily

2018-01-01

People with multiple chronic conditions often struggle with managing their health. The purpose of this research was to identify specific challenges of patients with multiple chronic conditions and to use the findings to form design principles for a telemonitoring system tailored for these patients. Semi-structured interviews with 15 patients with multiple chronic conditions and 10 clinicians were conducted to gain an understanding of their needs and preferences for a smartphone-based telemonitoring system. The interviews were analyzed using a conventional content analysis technique, resulting in six themes. Design principles developed from the themes included that the system must be modular to accommodate various combinations of conditions, reinforce a routine, consolidate record keeping, as well as provide actionable feedback to the patients. Designing an application for multiple chronic conditions is complex due to variability in patient conditions, and therefore, design principles developed in this study can help with future innovations aimed to help manage this population.

Cheilitis in acne vulgaris patients with no previous use of systemic retinoid products.

Science.gov (United States)

Balighi, Kamran; Daneshpazhooh, Maryam; Lajevardi, Vahideh; Talebi, Shahin; Azizpour, Arghavan

2017-08-01

Isotretinoin is commonly used in the treatment of acne vulgaris. While one of the more common side-effects is cheilitis, we have observed an increased incidence of cheilitis prior to the commencement of systemic isotretinoin. The aim of this study was to assess the prevalence of cheilitis among acne vulgaris patients. A non-interventional cross-sectional study of patients with acne vulgaris. Patients with previous use of systemic retinoids were excluded. The patients were examined for signs and symptoms of cheilitis. Of a total of 400 patients, 134 (34%) had evidence of cheilitis at initial presentation. Two-thirds (63%) were female (P acne excorie, compared with only 8% of patients with no signs of cheilitis. Our findings suggest that cheilitis is quite common among acne vulgaris patients even before treatment with isotretinoin. © 2016 The Australasian College of Dermatologists.

[Measures to prevent patient identification errors in blood collection/physiological function testing utilizing a laboratory information system].

Science.gov (United States)

Shimazu, Chisato; Hoshino, Satoshi; Furukawa, Taiji

2013-08-01

We constructed an integrated personal identification workflow chart using both bar code reading and an all in-one laboratory information system. The information system not only handles test data but also the information needed for patient guidance in the laboratory department. The reception terminals at the entrance, displays for patient guidance and patient identification tools at blood-sampling booths are all controlled by the information system. The number of patient identification errors was greatly reduced by the system. However, identification errors have not been abolished in the ultrasound department. After re-evaluation of the patient identification process in this department, we recognized that the major reason for the errors came from excessive identification workflow. Ordinarily, an ultrasound test requires patient identification 3 times, because 3 different systems are required during the entire test process, i.e. ultrasound modality system, laboratory information system and a system for producing reports. We are trying to connect the 3 different systems to develop a one-time identification workflow, but it is not a simple task and has not been completed yet. Utilization of the laboratory information system is effective, but is not yet perfect for patient identification. The most fundamental procedure for patient identification is to ask a person's name even today. Everyday checks in the ordinary workflow and everyone's participation in safety-management activity are important for the prevention of patient identification errors.

Clinical features of patients with systemic lupus erythematosus (SLE ...

African Journals Online (AJOL)

of this study was to determine the most common features of patients with systemic lupus erythematosus ... Conclusion: Most of the findings correlate with similar studies worldwide. .... Sciences, University of the Free State to conduct the study.

Damage to the medial motor system in stroke patients with motor neglect

Directory of Open Access Journals (Sweden)

Raffaella eMigliaccio

2014-06-01

Full Text Available Background and objectives. Motor neglect (MN is a clinically important condition whereby patients with unilateral brain lesions fail to move their contralateral limbs, despite normal muscle strength, reflexes, and sensation. MN has been associated with various lesion sites, including the parietal and frontal cortex, the internal capsule, the lenticulostriate nuclei, and the thalamus. In the present study, we explored the hypothesis that MN depends on a dysfunction of the medial motor system by performing a detailed anatomical analysis in four patients with MN.Methods. Ten patients participated in the study: four with MN, four with left visual neglect but without MN, and three patients with left hemiplegia without MN. We used specific scales for clinical and neuropsychological assessment. We drew the lesion borders directly onto the original brain images of each patient, and plotted the lesions on anatomical atlases for grey and white matter. Results. Lesion locations were highly heterogeneous in our MN patients, and included frontal and parietal sites, basal ganglia and white matter. The only consistently damaged structure across all MN patients was the cingulum bundle, a major pathway of the medial motor system important for motor initiative, and a key connection with limbic structures crucial for motivational aspects of actions. Three MN patients with additional damage to lateral fronto-parietal networks had also signs of contralesional visual neglect. The cingulum bundle was intact in all the control patients with visual neglect or hemiplegia.Conclusions. Cingulum damage may induce MN through unilateral dysfunction of the medial motor system. Additional lateral fronto-parietal dysfunction can result in the association with visual neglect.

Aging-Related Systemic Manifestations in COPD Patients and Cigarette Smokers

Science.gov (United States)

Boyer, Laurent; Marcos, Elisabeth; Margarit, Laurent; Le Corvoisier, Philippe; Vervoitte, Laetitia; Hamidou, Leila; Frih, Lamia; Audureau, Etienne; Covali-Noroc, Ala; Andujar, Pascal; Saakashvili, Zakaria; Lino, Anne; Ghaleh, Bijan; Hue, Sophie; Derumeaux, Geneviève; Housset, Bruno; Dubois-Randé, Jean-Luc; Boczkowski, Jorge; Maitre, Bernard; Adnot, Serge

2015-01-01

Rationale Chronic obstructive pulmonary disease (COPD) is often associated with age-related systemic abnormalities that adversely affect the prognosis. Whether these manifestations are linked to the lung alterations or are independent complications of smoking remains unclear. Objectives To look for aging-related systemic manifestations and telomere shortening in COPD patients and smokers with minor lung destruction responsible for a decline in the diffusing capacity for carbon monoxide (DLCO) corrected for alveolar volume (KCO). Methods Cross-sectional study in 301 individuals (100 with COPD, 100 smokers without COPD, and 101 nonsmokers without COPD). Measurements and Main Results Compared to control smokers, patients with COPD had higher aortic pulse-wave velocity (PWV), lower bone mineral density (BMD) and appendicular skeletal muscle mass index (ASMMI), and shorter telomere length (TL). Insulin resistance (HOMA-IR) and glomerular filtration rate (GFR) were similar between control smokers and COPD patients. Smokers did not differ from nonsmokers for any of these parameters. However, smokers with normal spirometry but low KCO had lower ASMMI values compared to those with normal KCO. Moreover, female smokers with low KCO, had lower BMD and shorter TL compared to those with normal KCO. Conclusions Aging-related abnormalities in patients with COPD are also found in smokers with minor lung dysfunction manifesting as a KCO decrease. Decreased KCO might be useful, particularly among women, for identifying smokers at high risk for aging-related systemic manifestations and telomere shortening. PMID:25785739

Dose audit for patients undergoing two common radiography examinations with digital radiology systems.

Science.gov (United States)

İnal, Tolga; Ataç, Gökçe

2014-01-01

We aimed to determine the radiation doses delivered to patients undergoing general examinations using computed or digital radiography systems in Turkey. Radiographs of 20 patients undergoing posteroanterior chest X-ray and of 20 patients undergoing anteroposterior kidney-ureter-bladder radiography were evaluated in five X-ray rooms at four local hospitals in the Ankara region. Currently, almost all radiology departments in Turkey have switched from conventional radiography systems to computed radiography or digital radiography systems. Patient dose was measured for both systems. The results were compared with published diagnostic reference levels (DRLs) from the European Union and International Atomic Energy Agency. The average entrance surface doses (ESDs) for chest examinations exceeded established international DRLs at two of the X-ray rooms in a hospital with computed radiography. All of the other ESD measurements were approximately equal to or below the DRLs for both examinations in all of the remaining hospitals. Improper adjustment of the exposure parameters, uncalibrated automatic exposure control systems, and failure of the technologists to choose exposure parameters properly were problems we noticed during the study. This study is an initial attempt at establishing local DRL values for digital radiography systems, and will provide a benchmark so that the authorities can establish reference dose levels for diagnostic radiology in Turkey.

Patients' participation in decision-making in the medical field--'projectification' of patients in a neoliberal framed healthcare system.

Science.gov (United States)

Glasdam, Stinne; Oeye, Christine; Thrysoee, Lars

2015-10-01

This article focuses on patients' participation in decision-making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision-making meetings within a Foucauldian perspective. Patients' participation in decision-making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From the perspective of patients, there is a tendency for healthcare professionals to supply the patients with the information that they think are necessary for them to make their own decision. But patients do not always want to be a 'customer' in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to some parts of the decision-making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision-making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A 'projectification' of the patient occurs, whereby the patient becomes responsible for his/her choices in treatment and care and the professionals support him/her with knowledge, preferences, and alternative views, out of which he/she must make his/her own choices, and the responsibility for those choices now and in the future. At the same time, there is a tendency towards de-professionalization. In that light, participation of patients in decision-making can be regarded as a tacit governmentality strategy that shapes the location of responsibility between individual and society, and independent patients and healthcare professionals, despite the basically desirable, appropriate, and necessary idea of involving patients in their own

The Healthcare Future for the iGeneration: Integrating the Patient and the Healthcare System

Directory of Open Access Journals (Sweden)

Kristina D. Wood

2013-01-01

Full Text Available Objective: To propose a vision to integrate patients, their health-related data, and their wellness plans into the healthcare system using smartphone and tablet computer technology. Setting: Ambulatory care and community practice Practice Innovation: Utilization of smartphone and tablet computer technology to assess health care conditions, educate and involve patients, and facilitate seamless communication between the patient, electronic health record, pharmacy system, third-party payers, point-of-care testing, and all health-care providers. Main Outcome Measures: By providing integrated and customized information at the point of use, medication adherence and access to care will be increased and patients will engage in healthy behaviors more often resulting in an improved level of care for patients. Results: In the future, the authors believe if the vision is achieved, the health care system and patients will see improved health outcomes and more efficient utilization of the healthcare system. Conclusions: Our proposed use of technology provides an opportunity to empower patients to positively improve their own health which could be a vital advancement in health care, especially in the areas of medication adherence, improving access to care, and health behavior support. As pharmacists, we may also embrace technology opportunities to expand our roles as health care professionals as we continue to partner with patients and the health care team to improve outcomes.   Type: Idea Paper

The Healthcare Future for the iGeneration: Integrating the Patient and the Healthcare System

Directory of Open Access Journals (Sweden)

Cathy H. Ficzere, PharmD, BCPS

2013-01-01

Full Text Available Objective: To propose a vision to integrate patients, their health-related data, and their wellness plans into the healthcare system using smartphone and tablet computer technology.Setting: Ambulatory care and community practicePractice Innovation: Utilization of smartphone and tablet computer technology to assess health care conditions, educate and involve patients, and facilitate seamless communication between the patient, electronic health record, pharmacy system, third-party payers, point-of-care testing, and all health-care providers.Main Outcome Measures: By providing integrated and customized information at the point of use, medication adherence and access to care will be increased and patients will engage in healthy behaviors more often resulting in an improved level of care for patients.Results: In the future, the authors believe if the vision is achieved, the health care system and patients will see improved health outcomes and more efficient utilization of the healthcare system.Conclusions: Our proposed use of technology provides an opportunity to empower patients to positively improve their own health which could be a vital advancement in health care, especially in the areas of medication adherence, improving access to care, and health behavior support. As pharmacists, we may also embrace technology opportunities to expand our roles as health care professionals as we continue to partner with patients and the health care team to improve outcomes.

Achievement report for fiscal 1998. Home rehabilitation system for aphasia patients; 1998 nendo seika hokokusho. Shitsugosho zaitaku rehabilitation shien system

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-05-01

Development has been made on the element technologies for a home rehabilitation system for aphasia patients. First, studies were performed on an authoring procedure for aphasia patient training, and partial trial production and development were carried out on an authoring system for the training program formula. Then, studies were executed on a training simulation and analysis filter, and partial trial production and development were implemented on a home rehabilitation supporting and self-teaching system. Next, an input and output mechanism for voice signal processing was studied, and aphasia patient and caregiver human interface was partially fabricated on a trial basis. In addition, a remote rehabilitation communicating method was researched, and partial trial production was carried out on a remote rehabilitation evaluation and diagnosis support means. Finally, communication assisting means were researched, and a communication assisting system was partially produced on a trial basis. Good evaluation results were given on a demonstration system. Although partial indications were given on minute parts, practical agreement was obtained as a whole. Great expectation was given particularly on the remote rehabilitation system and the authoring system. (NEDO)

Proton spectroscopy study of the masseter in patients with systemic sclerosis

International Nuclear Information System (INIS)

Marcucci, Marcelo; Abdala, Nitamar

2009-01-01

Objective: To evaluate metabolite concentration in the masseter of patients with systemic sclerosis, by analyzing creatine, choline, lipid and lactate levels, and correlating them with the presence of mandibular osteolysis. Materials and methods: The sample included 25 individuals, 15 of them with diagnosis of systemic sclerosis, divided into two groups according to the presence (group I) or absence (group II) of osteolysis, and 10 healthy individuals (group III, control). All of them were submitted to proton magnetic resonance spectroscopy with PRESS sequence and 3D acquisition. Results: Metabolite analysis showed that the creatine and lipid levels were the same for the three groups. Patients in group I presented higher levels of choline when compared with group III. On the other hand, lower lactate levels were observed in groups I and II when compared with the healthy individuals. Creatine/lipid and choline/lactate ratios were the same in the three groups. Conclusion: Lower lactate levels were observed in the patients with systemic sclerosis (groups I and II). Choline levels were increased in the patients with mandibular osteolysis (group I). Creatine/choline, lipid/lactate and choline/lipid ratios were different among the three groups. Further studies are necessary to understand the role played by the masseter in the development of mandibular osteolysis. (author)

Getting personal: can systems medicine integrate scientific and humanistic conceptions of the patient?

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Vogt, Henrik; Ulvestad, Elling; Eriksen, Thor Eirik; Getz, Linn

2014-12-01

The practicing doctor, and most obviously the primary care clinician who encounters the full complexity of patients, faces several fundamental but intrinsically related theoretical and practical challenges - strongly actualized by so-called medically unexplained symptoms (MUS) and multi-morbidity. Systems medicine, which is the emerging application of systems biology to medicine and a merger of molecular biomedicine, systems theory and mathematical modelling, has recently been proposed as a primary care-centered strategy for medicine that promises to meet these challenges. Significantly, it has been proposed to do so in a way that at first glance may seem compatible with humanistic medicine. More specifically, it is promoted as an integrative, holistic, personalized and patient-centered approach. In this article, we ask whether and to what extent systems medicine can provide a comprehensive conceptual account of and approach to the patient and the root causes of health problems that can be reconciled with the concept of the patient as a person, which is an essential theoretical element in humanistic medicine. We answer this question through a comparative analysis of the theories of primary care doctor Eric Cassell and systems biologist Denis Noble. We argue that, although systems biological concepts, notably Noble's theory of biological relativity and downward causation, are highly relevant for understanding human beings and health problems, they are nevertheless insufficient in fully bridging the gap to humanistic medicine. Systems biologists are currently unable to conceptualize living wholes, and seem unable to account for meaning, value and symbolic interaction, which are central concepts in humanistic medicine, as constraints on human health. Accordingly, systems medicine as currently envisioned cannot be said to be integrative, holistic, personalized or patient-centered in a humanistic medical sense. © 2014 The Authors. Journal of Evaluation in Clinical

The impact of major trauma network triage systems on patients with major burns.

Science.gov (United States)

Nizamoglu, Metin; O'Connor, Edmund Fitzgerald; Bache, Sarah; Theodorakopoulou, Evgenia; Sen, Sankhya; Sherren, Peter; Barnes, David; Dziewulski, Peter

2016-12-01

Trauma is a leading cause of death and disability worldwide. Patients presenting with severe trauma and burns benefit from specifically trained multidisciplinary teams. Regional trauma systems have shown improved outcomes for trauma patients. The aim of this study is to determine whether the development of major trauma systems have improved the management of patients with major burns. A retrospective study was performed over a four-year period reviewing all major burns in adults and children received at a regional burns centre in the UK before and after the implementation of the regional trauma systems and major trauma centres (MTC). Comparisons were drawn between three areas: (1) Patients presenting before the introduction of MTC and after the introduction of MTC. (2) Patients referred from MTC and non-MTC within the region, following the introduction of MTC. (3) Patients referred using the urban trauma protocol and the rural trauma protocol. Following the introduction of regional trauma systems and major trauma centres (MTC), isolated burn patients seen at our regional burns centre did not show any significant improvement in transfer times, admission resuscitation parameters, organ dysfunction or survival when referred from a MTC compared to a non-MTC emergency department. There was also no significant difference in survival when comparing referrals from all hospitals pre and post establishment of the major trauma network. No significant outcome benefit was demonstrated for burns patients referred via MTCs compared to non-MTCs. We suggest further research is needed to ascertain whether burns patients benefit from prolonged transfer times to a MTC compared to those seen at their local hospitals prior to transfer to a regional burns unit for further specialist care. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Peripheral nervous system assessment in acromegaly patients under somatostatin analogue therapy.

Science.gov (United States)

Alibas, H; Gogas Yavuz, D; Kahraman Koytak, P; Uygur, M; Tanridag, T; Uluc, K

2017-01-01

Acromegaly is known to affect peripheral nervous system (PNS) causing carpal tunnel syndrome (CTS) and polyneuropathy. The frequency of these disorders and the evaluation methods vary among studies. In the present study, we aimed to examine PNS of acromegaly patients under somatostatin analogue (SSA) therapy. Forty-eight acromegaly patients (26 F/22 M, 45.58 ± 11.6 years) under SSA treatment and 44 healthy controls (25 F/19 M, 47.46 ± 8.7 years) were assessed by symptom questionnaires, neurologic examination and electrophysiological studies. 87.5 % of the acromegaly patients had at least one abnormal finding regarding PNS. With the incorporation of palm-wrist median nerve conduction velocity method, we detected CTS in 50 % of patients. Polyneuropathy was less frequent (29.2 %). Both conditions were independent from the coexisting diabetes mellitus (p = 0.22 for CTS, p = 0.71 for polyneuropathy). Polyneuropathy but not CTS was more common among biochemically uncontrolled acromegaly patients rather than those under control (p = 0.03; p = 0.68, respectively). Our findings emphasize the high prevalence of peripheral nervous system involvement in acromegaly patients under SSA therapy and importance of neurological evaluation of these patients. Early diagnosis and treatment of the disease may reduce the PNS involvement.

Patient Health Record Systems Scope and Functionalities: Literature Review and Future Directions.

Science.gov (United States)

Bouayad, Lina; Ialynytchev, Anna; Padmanabhan, Balaji

2017-11-15

A new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels. The objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice. We conducted a review of the literature to assess PHR data types and functionalities. We searched PubMed, Embase, and MEDLINE databases from 1966 to 2015 for studies of PHRs, resulting in 1822 articles, from which we selected a total of 106 articles for a detailed review of PHR data content. We present several key findings related to the scope and functionalities in PHR systems. We also present a functional taxonomy and chronological analysis of PHR data types and functionalities, to improve understanding and provide insights for future directions. Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices and data types such as time-series data. Chronological data analysis showed an evolution of PHR system functionalities over time, from simple data access to data modification and, more recently, automated assessment, prediction, and recommendation. Efforts are needed to improve (1) PHR data quality through patient-centered user interface design and standardized patient-generated data guidelines, (2) data integrity through consolidation of various types and sources, (3) PHR functionality through application of new data analytics methods, and (4) metrics to evaluate clinical outcomes associated with automated PHR

Patients at the centre: methodological considerations for evaluating evidence from health interventions involving patients use of web-based information systems.

Science.gov (United States)

Cummings, Elizabeth; Turner, Paul

2010-09-15

Building an evidence base for healthcare interventions has long been advocated as both professionally and ethically desirable. By supporting meaningful comparison amongst different approaches, a good evidence base has been viewed as an important element in optimising clinical decision-making and the safety and quality of care. Unsurprisingly, medical research has put considerable effort into supporting the development of this evidence base, and the randomised controlled trial has become the dominant methodology. Recently however, a body of research has begun to question, not just this methodology per se, but also the extent to which the evidence it produces may marginalise individual patient experiences, priorities and perceptions.Simultaneously, the widespread adoption and utilisation of information systems (IS) in health care has also prompted initiatives to develop a stronger base of evidence about their impacts. These calls have been stimulated both by numerous system failures and research expressing concerns about the limitations of information systems methodologies in health care environments. Alongside the potential of information systems to produce positive, negative and unintended consequences, many measures of success, impact or benefit appear to have little to do with improvements in care, health outcomes or individual patient experiences.Combined these methodological concerns suggest the need for more detailed examination. This is particularly the case, given the prevalence within contemporary clinical and IS discourses on health interventions advocating the need to put the 'patient at the centre' by engaging them in their own care and/or 'empowering' them through the use of information systems.This paper aims to contribute to these on-going debates by focusing on the socio-technical processes by which patients' interests and outcomes are measured, defined and evaluated within health interventions that involve them using web-based information systems

Performance of an automated electronic acute lung injury screening system in intensive care unit patients.

Science.gov (United States)

Koenig, Helen C; Finkel, Barbara B; Khalsa, Satjeet S; Lanken, Paul N; Prasad, Meeta; Urbani, Richard; Fuchs, Barry D

2011-01-01

Lung protective ventilation reduces mortality in patients with acute lung injury, but underrecognition of acute lung injury has limited its use. We recently validated an automated electronic acute lung injury surveillance system in patients with major trauma in a single intensive care unit. In this study, we assessed the system's performance as a prospective acute lung injury screening tool in a diverse population of intensive care unit patients. Patients were screened prospectively for acute lung injury over 21 wks by the automated system and by an experienced research coordinator who manually screened subjects for enrollment in Acute Respiratory Distress Syndrome Clinical Trials Network (ARDSNet) trials. Performance of the automated system was assessed by comparing its results with the manual screening process. Discordant results were adjudicated blindly by two physician reviewers. In addition, a sensitivity analysis using a range of assumptions was conducted to better estimate the system's performance. The Hospital of the University of Pennsylvania, an academic medical center and ARDSNet center (1994-2006). Intubated patients in medical and surgical intensive care units. None. Of 1270 patients screened, 84 were identified with acute lung injury (incidence of 6.6%). The automated screening system had a sensitivity of 97.6% (95% confidence interval, 96.8-98.4%) and a specificity of 97.6% (95% confidence interval, 96.8-98.4%). The manual screening algorithm had a sensitivity of 57.1% (95% confidence interval, 54.5-59.8%) and a specificity of 99.7% (95% confidence interval, 99.4-100%). Sensitivity analysis demonstrated a range for sensitivity of 75.0-97.6% of the automated system under varying assumptions. Under all assumptions, the automated system demonstrated higher sensitivity than and comparable specificity to the manual screening method. An automated electronic system identified patients with acute lung injury with high sensitivity and specificity in diverse

A double closed loop to enhance the quality of life of Parkinson's Disease patients: REMPARK system.

Science.gov (United States)

Samà, Albert; Pérez-López, Carlos; Rodríguez-Martín, Daniel; Moreno-Aróstegui, J Manuel; Rovira, Jordi; Ahlrichs, Claas; Castro, Rui; Cevada, João; Graça, Ricardo; Guimarães, Vânia; Pina, Bernardo; Counihan, Timothy; Lewy, Hadas; Annicchiarico, Roberta; Bayés, Angels; Rodríguez-Molinero, Alejandro; Cabestany, Joan

2014-01-01

This paper presents REMPARK system, a novel approach to deal with Parkinson's Disease (PD). REMPARK system comprises two closed loops of actuation onto PD. The first loop consists in a wearable system that, based on a belt-worn movement sensor, detects movement alterations that activate an auditory cueing system controlled by a smartphone in order to improve patient's gait. The belt-worn sensor analyzes patient's movement through real-time learning algorithms that were developed on the basis of a database previously collected from 93 PD patients. The second loop consists in disease management based on the data collected during long periods and that enables neurologists to tailor medication of their PD patients and follow the disease evolution. REMPARK system is going to be tested in 40 PD patients in Spain, Ireland, Italy and Israel. This paper describes the approach followed to obtain this system, its components, functionalities and trials in which the system will be validated.

Implementation and evaluation of a prototype consumer reporting system for patient safety events.

Science.gov (United States)

Weingart, Saul N; Weissman, Joel S; Zimmer, Karen P; Giannini, Robert C; Quigley, Denise D; Hunter, Lauren E; Ridgely, M Susan; Schneider, Eric C

2017-08-01

No methodologically robust system exists for capturing consumer-generated patient safety reports. To address this challenge, we developed and pilot-tested a prototype consumer reporting system for patient safety, the Health Care Safety Hotline. Mixed methods evaluation. The Hotline was implemented in two US healthcare systems from 1 February 2014 through 30 June 2015. Patients, family members and caregivers associated with two US healthcare systems. A consumer-oriented incident reporting system for telephone or web-based administration was developed to elicit medical mistakes and care-related injuries. Key informant interviews, measurement of website traffic and analysis of completed reports. Key informants indicated that Hotline participation was motivated by senior leaders' support and alignment with existing quality and safety initiatives. During the measurement period from 1 October 2014 through 30 June 2015, the home page had 1530 visitors with a unique IP address. During its 17 months of operation, the Hotline received 37 completed reports including 20 mistakes without harm and 15 mistakes with injury. The largest category of mistake concerned problems with diagnosis or advice from a health practitioner. Hotline reports prompted quality reviews, an education intervention, and patient follow-ups. While generating fewer reports than its capacity to manage, the Health Care Safety Hotline demonstrated the feasibility of consumer-oriented patient safety reporting. Further research is needed to understand how to increase consumers' use of these systems. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

SMSaúde: Design, Development, and Implementation of a Remote/Mobile Patient Management System to Improve Retention in Care for HIV/AIDS and Tuberculosis Patients.

Science.gov (United States)

Nhavoto, José António; Grönlund, Åke; Chaquilla, Walter Ponce

2015-03-09

The widespread and low cost of mobile phones and the convenience of short message service (SMS) text messaging suggest potential suitability for use with alternative strategies for supporting retention in care and adherence to the treatment of various chronic diseases, such as HIV and tuberculosis (TB). Despite the growing body of literature reporting positive outcomes of SMS text message-based communication with patients, there is yet very little research about the integration of communication technologies and electronic medical records or electronic patient tracking systems. To design, develop, and implement an integrated mobile phone text messaging system used to follow up with patients with HIV and TB in treatment in Mozambique. Following the design science research methodology, we developed a Web-based system that provides support to patients. A case study involving three health care sites in Mozambique was a basis for discussing design issues for this kind of system. We used brainstorming techniques to solicit usability requirements, focus group meetings to discuss and define system architecture, and prototyping to test in real environments and to improve the system. We found six sets of system requirements that need to be addressed for success: data collection, telecommunication costs, privacy and data security, text message content, connectivity, and system scalability. A text messaging system was designed and implemented in three health facilities. These sites feed data into a central data repository, which can be used for analysis of operations and decision support. Based on the treatment schedule, the system automatically sent SMS text message appointment reminders, medication reminders, as well as motivational and educational messages to patients enrolled in antiretroviral therapy and TB treatment programs. We successfully defined the requirements for, designed, and implemented a mobile phone text messaging system to support HIV and TB treatments

Peripheral nervous system involvement in patients with diabetes mellitus

Directory of Open Access Journals (Sweden)

P. R. Kamchatnov

2016-01-01

Full Text Available Diabetes mellitus is a widespread disease often affecting peripheral nervous system. This include diabetic autonomous neuropathy that can endanger the patient's life. Timely detection of complications of diabetes mellitus as well as its adequate therapy can improve prognosis of the disease. The possibilities of Milgamma and Tiogamma for pathogenic therapy in patients with diabetic polyneuropathy are considered in this paper. Gabagamma can be effectively relieve neuropathic pain and used together with other drugs that normalize nerve tissue metabolism.

The Healthcare Future for the iGeneration: Integrating the Patient and the Healthcare System

OpenAIRE

Cathy H. Ficzere, PharmD, BCPS; Traci M. Poole, PharmD, BCACP; Rachel B. Franks, PharmD, BCACP; Elisa M. Greene, PharmD, BCACP; Kristina D. Wood, PharmD, BCACP; Philip E. Johnston, PharmD

2013-01-01

Objective: To propose a vision to integrate patients, their health-related data, and their wellness plans into the healthcare system using smartphone and tablet computer technology. Setting: Ambulatory care and community practice Practice Innovation: Utilization of smartphone and tablet computer technology to assess health care conditions, educate and involve patients, and facilitate seamless communication between the patient, electronic health record, pharmacy system, third-party p...

Review of dextromethorphan administration in 18 patients with subacute methotrexate central nervous system toxicity.

Science.gov (United States)

Afshar, Maryam; Birnbaum, Daniel; Golden, Carla

2014-06-01

The pathogenesis of methotrexate central nervous system toxicity is multifactorial, but it is likely related to central nervous system folate homeostasis. The use of folinate rescue has been described to decrease toxicity in patients who had received intrathecal methotrexate. It has also been described in previous studies that there is an elevated level of homocysteine in plasma and cerebrospinal fluid of patients who had received intrathecal methotrexate. Homocysteine is an N-methyl-D-aspartate receptor agonist. The use of dextromethorphan, noncompetitive N-methyl-D-aspartate receptor receptor antagonist, has been used in the treatment of sudden onset of neurological dysfunction associated with methotrexate toxicity. It remains unclear whether the dextromethorphan impacted the speed of recovery, and its use remains controversial. This study reviews the use of dextromethorphan in the setting of subacute methotrexate central nervous system toxicity. Charts of 18 patients who had sudden onset of neurological impairments after receiving methotrexate and were treated with dextromethorphan were reviewed. The use of dextromethorphan in most of our patients resulted in symptomatic improvement. In this patient population, earlier administration of dextromethorphan resulted in faster improvement of impairments and led to prevention of recurrence of seizure activity induced by methotrexate central nervous system toxicity. Our study provides support for the use of dextromethorphan in patients with subacute methotrexate central nervous system toxicity. Copyright © 2014 Elsevier Inc. All rights reserved.

Pre-Liver Transplant: Tips Versus Distal Splenorenal Shunt

Directory of Open Access Journals (Sweden)

Thomas W. Faust

1997-01-01

Full Text Available Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT. Endoscopic sclero-therapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS. In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients or DSRS (17 patients for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P=0.014 but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132±725 ml/min in the TIPS group compared with 1120±351ml/min in the DSRS group (P<0.001. Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P=0.1. We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intra0Perative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.

The treatment of skin ulcers in patients with systemic sclerosis

Directory of Open Access Journals (Sweden)

M. Matucci- Cerinic

2011-09-01

Full Text Available Systemic Sclerosis (Ssc is a complex disease of the connective tissue, characterized by progressive thickening and fibrosis of the skin and the internal organs and by diffused damage of the microvascular system. The fibrosis ones of the skin associated to the characteristic vascular alterations lead to the genesis of ulcers, more or less extended, often multiple, peripheral localization, chronic course, painful, able to influence patient’s quality of life. Indeed, immunity reactivity, the thinning and the loss of elasticity of the skin, the peripheral neurological damage and the eventual drug assumption that can reduce regenerative/reparative abilities, can easy chronicizzate an ulcer and become infected complicating still more the patient disease, rendering more difficult the cure often, ulcer evolves to gangrene, and in some cases, in amputation too. For all these reasons, we have begun to study ulcers therapy (local and systemic, considering this activity it leave integrating of the charitable distance of the sclerodermico patient, putting to point on strategy both diagnostic and therapeutic, but above all with the primary scope, if possible, is to prevent ulcers, in contrary case, to alleviate the pain and to render the quality of the life of the patient better.

Productiont transtibial prothesis TSB using vacuum system in patients with diabetes

OpenAIRE

Debs, Maher

2015-01-01

Title: Production transtibial prosthesis TSB using a liner and vacuum system in patients with diabetes. Target work: My work consists of a general part which provides a brief overview of each step of treatment after the surgery, rehabilitation and prosthetic diabetic patient with transtibial amputation. In a special section describes the different types of stubs sockets, and their diference the attachment to stump for determining the type of administrative stub beds for diabetic patients with...

Body posture recognition and turning recording system for the care of bed bound patients.

Science.gov (United States)

Hsiao, Rong-Shue; Mi, Zhenqiang; Yang, Bo-Ru; Kau, Lih-Jen; Bitew, Mekuanint Agegnehu; Li, Tzu-Yu

2015-01-01

This paper proposes body posture recognition and turning recording system for assisting the care of bed bound patients in nursing homes. The system continuously detects the patient's body posture and records the length of time for each body posture. If the patient remains in the same body posture long enough to develop pressure ulcers, the system notifies caregivers to change the patient's body posture. The objective of recording is to provide the log of body turning for querying of patients' family members. In order to accurately detect patient's body posture, we developed a novel pressure sensing pad which contains force sensing resistor sensors. Based on the proposed pressure sensing pad, we developed a bed posture recognition module which includes a bed posture recognition algorithm. The algorithm is based on fuzzy theory. The body posture recognition algorithm can detect the patient's bed posture whether it is right lateral decubitus, left lateral decubitus, or supine. The detected information of patient's body posture can be then transmitted to the server of healthcare center by the communication module to perform the functions of recording and notification. Experimental results showed that the average posture recognition accuracy for our proposed module is 92%.

Ocular Perfusion Pressure and Pulsatile Ocular Blood Flow in Normal and Systemic Hypertensive Patients.

Science.gov (United States)

Kanadani, Fabio N; Figueiredo, Carlos R; Miranda, Rafaela Morais; Cunha, Patricia Lt; M Kanadani, Tereza Cristina; Dorairaj, Syril

2015-01-01

Glaucomatous neuropathy can be a consequence of insufficient blood supply, increase in intraocular pressure (IOP), or other risk factors that diminish the ocular blood flow. To determine the ocular perfusion pressure (OPP) in normal and systemic hypertensive patients. One hundred and twenty-one patients were enrolled in this prospective and comparative study and underwent a complete ophthalmologic examination including slit lamp examination, Goldmann applanation tonometry, stereoscopic fundus examination, and pulsatile ocular blood flow (POBF) measurements. The OPP was calculated as being the medium systemic arterial pressure (MAP) less the IOP. Only right eye values were considered for calculations using Student's t-test. The mean age of the patients was 57.5 years (36-78), and 68.5% were women. There was a statistically significant difference in the OPP of the normal and systemic hypertensive patients (p cite this article: Kanadani FN, Figueiredo CR, Miranda RM, Cunha PLT, Kanadani TCM, Dorairaj S. Ocular Perfusion Pressure and Pulsatile Ocular Blood Flow in Normal and Systemic Hypertensive Patients. J Curr Glaucoma Pract 2015;9(1):16-19.

Cardiac MRI in patients with complex CHD following primary or secondary implantation of MRI-conditional pacemaker system.

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Al-Wakeel, Nadya; O h-Ici, Darach; Schmitt, Katharina R; Messroghli, Daniel R; Riesenkampff, Eugénie; Berger, Felix; Kuehne, Titus; Peters, Bjoern

2016-02-01

In patients with CHD, cardiac MRI is often indicated for functional and anatomical assessment. With the recent introduction of MRI-conditional pacemaker systems, cardiac MRI has become accessible for patients with pacemakers. The present clinical study aims to evaluate safety, susceptibility artefacts, and image reading of cardiac MRI in patients with CHD and MRI-conditional pacemaker systems. Material and methods CHD patients with MRI-conditional pacemaker systems and a clinical need for cardiac MRI were examined with a 1.5-T MRI system. Lead function was tested before and after MRI. Artefacts and image readings were evaluated using a four-point grading scale. A total of nine patients with CHD (mean age 34.0 years, range 19.5-53.6 years) received a total of 11 cardiac MRI examinations. Owing to clinical indications, seven patients had previously been converted from conventional to MRI-conditional pacemaker systems. All MRI examinations were completed without adverse effects. Device testing immediately after MRI and at follow-up showed no alteration of pacemaker device and lead function. Clinical questions could be addressed and answered in all patients. Cardiac MRI can be performed safely with high certainty of diagnosis in CHD patients with MRI-conditional pacemaker systems. In case of clinically indicated lead and box changing, CHD patients with non-MRI-conditional pacemaker systems should be considered for complete conversion to MRI-conditional systems.

Causal Attributions about Disease-Onset and Relapse in Patients with Systemic Vasculitis

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Grayson, Peter C.; Amudala, Naomi A.; McAlear, Carol A.; Leduc, Renée L.; Shereff, Denise; Richesson, Rachel; Fraenkel, Liana; Merkel, Peter A.

2014-01-01

Objectives Patients vary in their beliefs related to the cause of serious illness. The impact of these beliefs among patients with systemic vasculitis is not known. This study aimed to describe causal attributions about disease-onset and relapse in systemic vasculitis and to examine whether causal beliefs a) differ by type of vasculitis; and b) are associated with negative health outcomes. Methods Patients with vasculitis were recruited to complete an online questionnaire. Categories of causal beliefs were assessed with the Revised Illness Perception Questionnaire (IPQ-R). Differences in beliefs about disease-onset versus relapse were compared across different forms of vasculitis. Causal beliefs were assessed in association with several health outcomes including fatigue, functional impairments, and personal understanding of the condition. Results 692 patients representing 9 forms of vasculitis completed the questionnaire. The majority (90%) of patients had beliefs about the cause of their illness. Causal attributions were highly variable, but altered immunity and stress were the most commonly agreed upon causal beliefs. Frequencies of causal beliefs were strikingly similar across different forms of vasculitis, with few notable exceptions primarily in Behçet’s disease. Beliefs differed about causes of disease-onset versus relapse. Specific beliefs about disease-onset and relapse were weakly associated with fatigue, functional impairments, and understanding of the condition. Conclusion Patient beliefs related to the cause of systemic vasculitis are highly variable. Patterns of causal beliefs are associated with important negative health outcomes. Clinicians who care for patients with vasculitis should be mindful of these associations and consider asking about patients’ causal beliefs. PMID:24634202

PERFORM: A System for Monitoring, Assessment and Management of Patients with Parkinson’s Disease

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Alexandros T. Tzallas

2014-11-01

Full Text Available In this paper, we describe the PERFORM system for the continuous remote monitoring and management of Parkinson’s disease (PD patients. The PERFORM system is an intelligent closed-loop system that seamlessly integrates a wide range of wearable sensors constantly monitoring several motor signals of the PD patients. Data acquired are pre-processed by advanced knowledge processing methods, integrated by fusion algorithms to allow health professionals to remotely monitor the overall status of the patients, adjust medication schedules and personalize treatment. The information collected by the sensors (accelerometers and gyroscopes is processed by several classifiers. As a result, it is possible to evaluate and quantify the PD motor symptoms related to end of dose deterioration (tremor, bradykinesia, freezing of gait (FoG as well as those related to over-dose concentration (Levodopa-induced dyskinesia (LID. Based on this information, together with information derived from tests performed with a virtual reality glove and information about the medication and food intake, a patient specific profile can be built. In addition, the patient specific profile with his evaluation during the last week and last month, is compared to understand whether his status is stable, improving or worsening. Based on that, the system analyses whether a medication change is needed—always under medical supervision—and in this case, information about the medication change proposal is sent to the patient. The performance of the system has been evaluated in real life conditions, the accuracy and acceptability of the system by the PD patients and healthcare professionals has been tested, and a comparison with the standard routine clinical evaluation done by the PD patients’ physician has been carried out. The PERFORM system is used by the PD patients and in a simple and safe non-invasive way for long-term record of their motor status, thus offering to the clinician a

Relation between clinical and anthropometric data and systemic inflammation in patients with COPD

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Pertseva Т.А.

2015-11-01

Full Text Available Recently, much attention is devoted to systemic inflammation in patients with chronic obstructive pulmonary disease (COPD. The aim of our study was to determine the relationship between clinical and anthropometric data with systemic inflammation in stable COPD patients. According to the study CRP levels were raised in 44% of patients (7.9 [7,1-10,9. Serum CRP was significantly higher in stable COPD patients than in control subjects (p=0.04. CRP correlated well with the pack/years index(p = 0,032 and disease duration (p=0,01. It wasn’t established link between CRP levels and height, weight, stage, disease category. CRP level affected the frequency of exacerbations (r=0,50; p=0,01. Patients with high CRP level had significantly more exacerbations in the past year (p=0.01. Patients who received any type of therapy for a long period of time had lower CRP levels, than patients who did not reseive any therapy.

Preliminary report on a breathing coaching and assessment system for use by patients at home

International Nuclear Information System (INIS)

Fox, C.D.; Kron, T.; Winton, J.R.S.; Rothwell, R.

2010-01-01

Full text: Respiratory-gated radiotherapy requires consistent breathing. Therefore, we developed a system that will assess breathing consistency and allow patients to train themselves at home. Real-time feedback is to be provided visually to patients against a reference breathing track derived from their own breathing pattern. The system would need to generate the reference track and to use this reference track for coaching. The system should be simple, robust and affordable, without complex setup. Results The system uses a net book with a USB connected data acquisition module (DAQ). The patient's breathing is sampled by the DAQ, measuring intra-nasal pressure through nasal prongs. Software was written in collaboration with the Victorian eResearch Strategic Initiative (YERSi). The system is used to collect a patient reference breathing track. This track is processed to generate a 'golden breathing cycle' (GBC), normalised in both amplitude and duration, containing the shape of the breathing cycle. After training, the patient takes the system home for a number of sessions of coaching and assessment. In coaching mode the patient is asked to maintain a graphic representation of their current state of breathing in close correlation to the golden breathing cycle as it moves across the screen. Displayed GBC amplitude and duration respond dynamically to the patient's breathing rhythm. Statistics are collected measuring the patient's ability to conform to the GBC and may be used to decide suitability for gated therapy. Conclusion The DAQ hardware is completed, and software is approaching completion. Sample data has been collected from volunteers.

The exchange of radiotherapy data as part of an electronic patient-referral system

International Nuclear Information System (INIS)

Lomax, Antony; Grossmann, Martin; Cozzi, Luca; Tercier, Pierre-Alain; Boehringer, Terence; Schneider, Uwe; Logean, Marianne; Volken, Werner; Ratib, Osman; Miralbell, Raymond

2000-01-01

Purpose: To describe the implementation and use of an electronic patient-referral system as an aid to the efficient referral of patients to a remote and specialized treatment center. Methods and Materials: A system for the exchange of radiotherapy data between different commercial planning systems and a specially developed planning system for proton therapy has been developed through the use of the PAPYRUS diagnostic image standard as an intermediate format. To ensure the cooperation of the different TPS manufacturers, the number of data sets defined for transfer has been restricted to the three core data sets of CT, VOIs, and three-dimensional dose distributions. As a complement to the exchange of data, network-wide application-sharing (video-conferencing) technologies have been adopted to provide methods for the interactive discussion and assessment of treatments plans with one or more partner clinics. Results: Through the use of evaluation plans based on the exchanged data, referring clinics can accurately assess the advantages offered by proton therapy on a patient-by-patient basis, while the practicality or otherwise of the proposed treatments can simultaneously be assessed by the proton therapy center. Such a system, along with the interactive capabilities provided by video-conferencing methods, has been found to be an efficient solution to the problem of patient assessment and selection at a specialized treatment center, and is a necessary first step toward the full electronic integration of such centers with their remotely situated referral centers

Dose audit for patients undergoing two common radiography examinations with digital radiology systems

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İnal, Tolga; Ataç, Gökçe

2014-01-01

PURPOSE We aimed to determine the radiation doses delivered to patients undergoing general examinations using computed or digital radiography systems in Turkey. MATERIALS AND METHODS Radiographs of 20 patients undergoing posteroanterior chest X-ray and of 20 patients undergoing anteroposterior kidney-ureter-bladder radiography were evaluated in five X-ray rooms at four local hospitals in the Ankara region. Currently, almost all radiology departments in Turkey have switched from conventional radiography systems to computed radiography or digital radiography systems. Patient dose was measured for both systems. The results were compared with published diagnostic reference levels (DRLs) from the European Union and International Atomic Energy Agency. RESULTS The average entrance surface doses (ESDs) for chest examinations exceeded established international DRLs at two of the X-ray rooms in a hospital with computed radiography. All of the other ESD measurements were approximately equal to or below the DRLs for both examinations in all of the remaining hospitals. Improper adjustment of the exposure parameters, uncalibrated automatic exposure control systems, and failure of the technologists to choose exposure parameters properly were problems we noticed during the study. CONCLUSION This study is an initial attempt at establishing local DRL values for digital radiography systems, and will provide a benchmark so that the authorities can establish reference dose levels for diagnostic radiology in Turkey. PMID:24317331

Relapsing and Progressive Tumefactive Demyelinating Form of Central Nervous System Involvement in a Patient with Progressive Systemic Sclerosis

International Nuclear Information System (INIS)

Kim, Ho Kyun; Lee, Hui Joong

2013-01-01

White matter hyper intensities (WMHI) on MRI are not rare in patients with progressive systemic sclerosis (PSS). In this presentation, WMHI were developed in both middle cerebellar peduncles and temporal white matter in a patient with PSS, and regressed after medication of high dose steroid. However, new lesions were developed in the subcortices of both precentral gyri, and progressed rapidly to tumefactive hyperintensity on MRI. We report an unusual relapsing and progressive tumefactive demyelinating form of central nervous system involvement in PSS.

Neurogenic vision loss: Causes and outcome. An experience from a tertiary center in Northern India

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Rajesh Verma

2014-01-01

Full Text Available Introduction: Vision loss can be a consequence of numerous disorders of eye and neural pathway conveying visual input to brain. A variety of conditions can affect visual pathway producing neurogenic vision loss. The presentation and course of vision loss depends on the site of involvement and underlying etiology. We conducted this unprecedented study to evaluate the characteristics and outcome of various diseases of the visual pathway. Materials and Methods: In this prospective cohort study, we evaluated 64 patients with neurogenic visual impairment. Ophthalmological causes were excluded in all of them. Their presentation, ophthalmological characteristics and investigation findings were recorded. These patients were followed up till 6 months. Results: Out of 69 patients evaluated, 5 were excluded as they had ophthalmological abnormalities. The remaining 64 cases (113 eyes were enrolled. 54 cases were due to diseases of anterior visual pathway and rest 10 had cortical vision loss. The etiologic distribution is as follows: Isolated optic neuritis- 12 (19%, multiple sclerosis- 4 (6.3%, neuromyelitis optica- 5 (7.9%, tubercular meningitis- 15 (23.8%, non-arteritic ischemic optic neuropathy, ischemic optic neuropathy complicating cavernous sinus thrombosis, cryptococcal meningitis, malignant infiltration of optic nerve, Crouzon′s syndrome, calvarial thickening and traumatic occipital gliosis- 1 (1.6% case each, idiopathic intracranial hypertension, pituitary adenoma, acute disseminated encephalomyelitis, posterior reversible leukoencephalopathy- 3 (4.8% cases each, cortical venous thrombosis 5 (7.9%, subacute scleroing panencephalitis- 4 (6.3% cases. Conclusions: The diseases of anterior visual pathway were much more common than cortical vision loss. A majority of our patients had severe impairment of vision at presentation.

Association between academic performance and cognitive dysfunction in patients with juvenile systemic lupus erythematosus

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Renan Bazuco Frittoli

2016-06-01

Full Text Available Abstract Objective To determine whether there is an association between the profile of cognitive dysfunction and academic outcomes in patients with juvenile systemic lupus erythematosus (JSLE. Methods Patients aged ≤18 years at the onset of the disease and education level at or above the fifth grade of elementary school were selected. Cognitive evaluation was performed according to the American College of Rheumatology (ACR recommendations. Symptoms of anxiety and depression were assessed by Beck scales; disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI; and cumulative damage was assessed by Systemic Lupus International Collaborating Clinics (SLICC. The presence of autoantibodies and medication use were also assessed. A significance level of 5% (p < 0.05 was adopted. Results 41 patients with a mean age of 14.5 ± 2.84 years were included. Cognitive dysfunction was noted in 17 (41.46% patients. There was a significant worsening in mathematical performance in patients with cognitive dysfunction (p = 0.039. Anxiety symptoms were observed in 8 patients (19.51% and were associated with visual perception (p = 0.037 and symptoms of depression were observed in 1 patient (2.43%. Conclusion Patients with JSLE concomitantly with cognitive dysfunction showed worse academic performance in mathematics compared to patients without cognitive impairment.

Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea.

Science.gov (United States)

Lee, Youngin; Lee, Seung Hun; Kim, Yun Jin; Lee, Sang Yeoup; Lee, Jeong Gyu; Jeong, Dong Wook; Yi, Yu Hyeon; Tak, Young Jin; Hwang, Hye Rim; Gwon, Mieun

2018-03-07

This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, "old" and "new," by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups. Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p system registers lower patient out-of-pocket expenses (p payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.

Prostate Cancer Patients' Understanding of the Gleason Scoring System: Implications for Shared Decision-Making.

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Tagai, Erin K; Miller, Suzanne M; Kutikov, Alexander; Diefenbach, Michael A; Gor, Ronak A; Al-Saleem, Tahseen; Chen, David Y T; Fleszar, Sara; Roy, Gem

2018-01-15

The Gleason scoring system is a key component of a prostate cancer diagnosis, since it indicates disease aggressiveness. It also serves as a risk communication tool that facilitates shared treatment decision-making. However, the system is highly complex and therefore difficult to communicate: factors which have been shown to undermine well-informed and high-quality shared treatment decision-making. To systematically explore prostate cancer patients' understanding of the Gleason scoring system (GSS), we assessed knowledge and perceived importance among men who had completed treatment (N = 50). Patients were administered a survey that assessed patient knowledge and patients' perceived importance of the GSS, as well as demographics, medical factors (e.g., Gleason score at diagnosis), and health literacy. Bivariate analyses were conducted to identify associations with patient knowledge and perceived importance of the GSS. The sample was generally well-educated (48% with a bachelor's degree or higher) and health literate (M = 12.9, SD = 2.2, range = 3-15). Despite this, patient knowledge of the GSS was low (M = 1.8, SD = 1.4, range = 1-4). Patients' understanding of the importance of the GSS was moderate (M = 2.8, SD = 1.0, range = 0-4) and was positively associated with GSS knowledge (p decision-making. Future studies are needed to explore the potential utility of a simplified Gleason grading system and improved patient-provider communication.

An emergency call system for patients in locked-in state using an SSVEP-based brain switch.

Science.gov (United States)

Lim, Jeong-Hwan; Kim, Yong-Wook; Lee, Jun-Hak; An, Kwang-Ok; Hwang, Han-Jeong; Cha, Ho-Seung; Han, Chang-Hee; Im, Chang-Hwan

2017-11-01

Patients in a locked-in state (LIS) due to severe neurological disorders such as amyotrophic lateral sclerosis (ALS) require seamless emergency care by their caregivers or guardians. However, it is a difficult job for the guardians to continuously monitor the patients' state, especially when direct communication is not possible. In the present study, we developed an emergency call system for such patients using a steady-state visual evoked potential (SSVEP)-based brain switch. Although there have been previous studies to implement SSVEP-based brain switch system, they have not been applied to patients in LIS, and thus their clinical value has not been validated. In this study, we verified whether the SSVEP-based brain switch system can be practically used as an emergency call system for patients in LIS. The brain switch used for our system adopted a chromatic visual stimulus, which proved to be visually less stimulating than conventional checkerboard-type stimuli but could generate SSVEP responses strong enough to be used for brain-computer interface (BCI) applications. To verify the feasibility of our emergency call system, 14 healthy participants and 3 patients with severe ALS took part in online experiments. All three ALS patients successfully called their guardians to their bedsides in about 6.56 seconds. Furthermore, additional experiments with one of these patients demonstrated that our emergency call system maintains fairly good performance even up to 4 weeks after the first experiment without renewing initial calibration data. Our results suggest that our SSVEP-based emergency call system might be successfully used in practical scenarios. © 2017 Society for Psychophysiological Research.

"We as Human Beings Get Farther and Farther Apart": the experiences of patients with remote monitoring systems.

Science.gov (United States)

Ottenberg, Abigale L; Swetz, Keith M; Mueller, Luke A; Gerhardson, Samantha; Mueller, Paul S

2013-01-01

To explore the experiences of patients living with an implantable cardioverter-defibrillator (ICD) who had received remote monitoring (RM). Anecdotal evidence suggests that not all patients with RM use the technology. Focus groups of patients with an ICD who received an RM system. Transcripts reviewed using thematic analysis. Nine patients (3 women and 6 men; median [range] age, 73 [58-91] years) received an RM system. Patients were assigned to a group in regard to RM system use (nonusers, n = 5; users, n = 4). Few nonusers recalled having prior conversations about the system. Users described it as "simple" and "easy" to use. Nonusers often were unsure whether their system was correctly transmitting information. System benefits perceived by users included convenience and security. Nonusers expressed mistrust. Recommendations included early education and help lines. Patient adherence to RM systems can be improved by explaining perceived benefits and addressing barriers to use. Copyright © 2013 Elsevier Inc. All rights reserved.

Medical ADP Systems: Automated Medical Records Hold Promise to Improve Patient Care

Science.gov (United States)

1991-01-01

automated medical records. The report discusses the potential benefits that automation could make to the quality of patient care and the factors that impede...information systems, but no organization has fully automated one of the most critical types of information, patient medical records. The patient medical record...its review of automated medical records. GAO’s objectives in this study were to identify the (1) benefits of automating patient records and (2) factors

Portable, space-saving medical patient support system

Science.gov (United States)

Bzorgi,; Fariborz, [Knoxville, TN

2011-02-01

A support platform having a stowed configuration and a deployed configuration on a floor. The support platform is related to stretcher devices that are used for transporting, confining, or conducting medical procedures on medical patients in medical emergencies. The support platform typically includes a work surface that has a geometric extent. A base that typically includes a plurality of frame members is provided, and the frame members are disposed across the geometric extent of, and proximal to, the work surface in the stowed configuration. The frame members are typically disposed on the floor in the deployed configuration. There is a foldable bracing system engaged with the work surface and engaged with the base. At least a portion of the foldable bracing system is disposed substantially inside at least a portion of the plurality of frame members in the stowed configuration. Further, the foldable bracing system is configured for translocation of the work surface distal from the base in the deployed configuration.

Using technology to develop and distribute patient education storyboards across a health system.

Science.gov (United States)

Kisak, Anne Z; Conrad, Kathryn J

2004-01-01

To describe the successful implementation of a centrally designed and managed patient education storyboard project using Microsoft PowerPoint in a large multihospital system and physician-based practice settings. Journal articles, project evaluation, and clinical and educational experience. The use of posters, bulletin boards, and storyboards as educational strategies has been reported widely. Two multidisciplinary committees applied new technology to develop storyboards for patient, family, and general public education. Technology can be used to coordinate centralized development of patient education posters, improving accuracy and content of patient education across a healthcare system while streamlining the development and review process and avoiding duplication of work effort. Storyboards are excellent sources of unit-based current, consistent patient education; reduce duplication of efforts; enhance nursing computer competencies; market nursing expertise; and promote nurse educators.

A Real-Time Health Monitoring System for Remote Cardiac Patients Using Smartphone and Wearable Sensors

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Priyanka Kakria

2015-01-01

Full Text Available Online telemedicine systems are useful due to the possibility of timely and efficient healthcare services. These systems are based on advanced wireless and wearable sensor technologies. The rapid growth in technology has remarkably enhanced the scope of remote health monitoring systems. In this paper, a real-time heart monitoring system is developed considering the cost, ease of application, accuracy, and data security. The system is conceptualized to provide an interface between the doctor and the patients for two-way communication. The main purpose of this study is to facilitate the remote cardiac patients in getting latest healthcare services which might not be possible otherwise due to low doctor-to-patient ratio. The developed monitoring system is then evaluated for 40 individuals (aged between 18 and 66 years using wearable sensors while holding an Android device (i.e., smartphone under supervision of the experts. The performance analysis shows that the proposed system is reliable and helpful due to high speed. The analyses showed that the proposed system is convenient and reliable and ensures data security at low cost. In addition, the developed system is equipped to generate warning messages to the doctor and patient under critical circumstances.

A Real-Time Health Monitoring System for Remote Cardiac Patients Using Smartphone and Wearable Sensors.

Science.gov (United States)

Kakria, Priyanka; Tripathi, N K; Kitipawang, Peerapong

2015-01-01

Online telemedicine systems are useful due to the possibility of timely and efficient healthcare services. These systems are based on advanced wireless and wearable sensor technologies. The rapid growth in technology has remarkably enhanced the scope of remote health monitoring systems. In this paper, a real-time heart monitoring system is developed considering the cost, ease of application, accuracy, and data security. The system is conceptualized to provide an interface between the doctor and the patients for two-way communication. The main purpose of this study is to facilitate the remote cardiac patients in getting latest healthcare services which might not be possible otherwise due to low doctor-to-patient ratio. The developed monitoring system is then evaluated for 40 individuals (aged between 18 and 66 years) using wearable sensors while holding an Android device (i.e., smartphone under supervision of the experts). The performance analysis shows that the proposed system is reliable and helpful due to high speed. The analyses showed that the proposed system is convenient and reliable and ensures data security at low cost. In addition, the developed system is equipped to generate warning messages to the doctor and patient under critical circumstances.

Low prevalence of Pneumocystis pneumonia in hospitalized patients with systemic lupus erythematosus: review of a clinical data warehouse.

Science.gov (United States)

Kapoor, T M; Mahadeshwar, P; Nguyen, S; Li, J; Kapoor, S; Bathon, J; Giles, J; Askanase, A

2017-12-01

Objective In the era of powerful immunosuppression, opportunistic infections are an increasing concern in systemic lupus erythematosus. One of the best-studied opportunistic infections is Pneumocystis pneumonia; however, the prevalence of Pneumocystis pneumonia in systemic lupus erythematosus is not clearly defined. This study evaluates the prevalence of Pneumocystis pneumonia in hospitalized systemic lupus erythematosus patients, with a focus on validating the Pneumocystis pneumonia and systemic lupus erythematosus diagnoses with clinical information. Methods This retrospective cohort study evaluates the prevalence of Pneumocystis pneumonia in all systemic lupus erythematosus patients treated at Columbia University Medical Center-New York Presbyterian Hospital between January 2000 and September 2014, using electronic medical record data. Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and patients with renal transplants (including both early and late post-transplant patients) represented immunocompromised control groups. Patients with systemic lupus erythematosus, Pneumocystis pneumonia, HIV/AIDS, or renal transplant were identified using diagnostic codes from the International Classification of Diseases, Ninth Revision (ICD-9). Results Out of 2013 hospitalized systemic lupus erythematosus patients, nine had presumed Pneumocystis pneumonia, yielding a low prevalence of Pneumocystis pneumonia in systemic lupus erythematosus of 0.45%. Three of the nine Pneumocystis pneumonia cases were patients with concomitant systemic lupus erythematosus and HIV/AIDS. Only one of these nine cases was histologically confirmed as Pneumocystis pneumonia, in a patient with concomitant systemic lupus erythematosus and HIV/AIDS and a CD4 count of 13 cells/mm 3 . The prevalence of Pneumocystis pneumonia in renal transplant patients and HIV/AIDS patients was 0.61% and 5.98%, respectively. Conclusion Given the reported high rate of adverse effects

Hospital triage system for adult patients using an influenza-like illness scoring system during the 2009 pandemic--Mexico.

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Eduardo Rodriguez-Noriega

2010-05-01

Full Text Available Pandemic influenza A (H1N1 virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI was implemented at Hospital Civil de Guadalajara, Mexico.A medical history, laboratory and radiology results were collected on emergency room (ER patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1 patients versus test-negative patients were compared by Pearson's Chi(2, Fisher's Exact, and Wilcoxon rank-sum tests.Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score = 15, and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score = 11, and 1324 untreated (median ILI-score = 5. Fourteen (1% untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score = 19. Of 371 patients tested by RT-PCR, 104 (28% had pandemic influenza and 42 (11% had seasonal influenza A detected. Twenty (91% of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38% of 61 imaged hospital test-negative patients (p<0.001. One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died.The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services.

A new system for continuous and remote monitoring of patients receiving home mechanical ventilation.

Science.gov (United States)

Battista, L

2016-09-01

Home mechanical ventilation is the treatment of patients with respiratory failure or insufficiency by means of a mechanical ventilator at a patient's home. In order to allow remote patient monitoring, several tele-monitoring systems have been introduced in the last few years. However, most of them usually do not allow real-time services, as they have their own proprietary communication protocol implemented and some ventilation parameters are not always measured. Moreover, they monitor only some breaths during the whole day, despite the fact that a patient's respiratory state may change continuously during the day. In order to reduce the above drawbacks, this work reports the development of a novel remote monitoring system for long-term, home-based ventilation therapy; the proposed system allows for continuous monitoring of the main physical quantities involved during home-care ventilation (e.g., differential pressure, volume, and air flow rate) and is developed in order to allow observations of different remote therapy units located in different places of a city, region, or country. The developed remote patient monitoring system is able to detect various clinical events (e.g., events of tube disconnection and sleep apnea events) and has been successfully tested by means of experimental tests carried out with pulmonary ventilators typically used to support sick patients.

Varicella-zoster virus immunity in dermatological patients on systemic immunosuppressant treatment.

LENUS (Irish Health Repository)

Hackett, C B

2012-02-01

BACKGROUND: Primary varicella infection is caused by varicella-zoster virus (VZV). It is a common childhood infection, which is usually benign but can occasionally cause morbidity and mortality. In immunosuppressed adults, atypical presentation and disseminated disease can occur with significant morbidity and mortality. A VZV vaccine is available. OBJECTIVES: This study was designed to measure the prevalence of immunity to VZV and to determine the predictive value of a self-reported history of varicella infection in a population of dermatological patients receiving systemic immunosuppressant therapy. We sought to assess the need for routine serological testing for varicella-zoster immunity in this cohort. METHODS: Serological testing for VZV immunity was done on 228 patients receiving systemic immunosuppressive treatment for a dermatological condition. Information regarding a history of previous primary VZV infection was obtained from each patient. RESULTS: Two hundred and twenty-eight patients had VZV serology performed. The mean age of the patients was 49.6 years. The prevalence of VZV seropositivity in this cohort was 98.7%. One hundred and two patients (44.7%) reported having a definite history of primary VZV. The sensitivity of a self-reported history of VZV infection was 45.3% with a specificity of 100%. The positive and negative predictive values of a self-reported history of VZV for serologically confirmed immunity were 100% and 2.3%, respectively. CONCLUSIONS: The prevalence of VZV IgG antibodies in our cohort of Irish dermatology patients receiving immunosuppressive therapy is 98.7%. A recalled history of varicella infection is a good predictor of serological immunity. This study has shown that there are VZV-susceptible individuals within our cohort. These patients did not have a clear history of previous infection. We recommend serological testing of patients without a clear history of infection prior to the commencement of immunosuppressive therapy and

Effect of systemic family therapy on rehabilitation in patients with schizophrenia

Directory of Open Access Journals (Sweden)

Wei Zhang

2016-12-01

Full Text Available Objective: To explore the effect of systemic family therapy on the rehabilitation in patients with schizophrenia. Methods: A total of 86 patients with schizophrenia who were admitted in our hospital from February, 2011 to February, 2014 were included in the study and randomized into the observation group and the control group. A total of 43 healthy individuals for physical examinations were served as the healthy group. The patients in the control group were given risperidone in a single dose, and telephone follow-up. On this basis, the patients in the observation group were given systemic family therapy. The morning fasting venous blood before treatment and 3 months after treatment in the healthy group and patients with schizophrenia was collected. BDNF, NGF, GFAP, IL-6, and TNF-α were detected. After 6-month treatment, SCL-90 was used to evaluate the psychological state. Results: The serum BDNF and NGF levels before and after treatment in the observation group and the control group were significantly lower than those in the healthy group, while GFAP level was significantly higher than that in the healthy group (P0.05. The serum IL-6 and TNF-α levels before and after treatment in the observation group and the control group were significantly higher than those in the healthy group (P0.05. After 6-month treatment, the scores of somatization, interpersonal relationship, fear, anxiety, hostility, paranoid, depression, obsession, and mental disorder in the observation group were significantly reduced when compared with before treatment (P0.05. Conclusions: The systemic family therapy is an effective adjuvant method for the rehabilitation in patients with schizophrenia, and can effectively improve the mental health status; therefore, it deserves to be widely recommended in the clinic.

Effect of systemic family therapy on rehabilitation in patients with schizophrenia

Institute of Scientific and Technical Information of China (English)

Wei Zhang; Na Li; Ying-Ting Li; Shu-Qing Dong; Li-Mei Feng

2016-01-01

Objective:To explore the effect of systemic family therapy on the rehabilitation in patients with schizophrenia.Methods: A total of 86 patients with schizophrenia who were admitted in our hospital from February, 2011 to February, 2014 were included in the study and randomized into the observation group and the control group. A total of 43 healthy individuals for physical examinations were served as the healthy group. The patients in the control group were given risperidone in a single dose, and telephone follow-up. On this basis, the patients in the observation group were given systemic family therapy. The morning fasting venous blood before treatment and 3 months after treatment in the healthy group and patients with schizophrenia was collected. BDNF, NGF, GFAP, IL-6, and TNF-α were detected. After 6-month treatment, SCL-90 was used to evaluate the psychological state.Results: The serum BDNF and NGF levels before and after treatment in the observation group and the control group were significantly lower than those in the healthy group, while GFAP level was significantly higher than that in the healthy group (P0.05). The serum IL-6 and TNF-α levels before and after treatment in the observation group and the control group were significantly higher than those in the healthy group (P0.05). After 6-month treatment, the scores of somatization, interpersonal relationship, fear, anxiety, hostility, paranoid, depression, obsession, and mental disorder in the observation group were significantly reduced when compared with before treatment (P0.05).Conclusions:The systemic family therapy is an effective adjuvant method for the rehabilitation in patients with schizophrenia, and can effectively improve the mental health status; therefore, it deserves to be widely recommended in the clinic.

Developing patient portals in a fragmented healthcare system.

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Otte-Trojel, Terese; de Bont, Antoinette; Aspria, Marcello; Adams, Samantha; Rundall, Thomas G; van de Klundert, Joris; de Mul, Marleen

2015-10-01

Use of patient portals may contribute to improved patient health and experiences and better organizational performance. In the Netherlands, patient portals have gained considerable attention in recent years, as evidenced by various policy initiatives and practical efforts directed at developing portals. Due to the fragmented setup of the Dutch healthcare system patient portals that give patients access to information and services from across their providers are developed in inter-organizational collaboration. The objective of this paper is to identify and describe the types of collaborations, or networks, that have been established to develop patient portals in the Netherlands. Understanding the characteristics of these networks as well as the development of their respective portals enables us to assess the enabling and constraining effects of different network types on patient portal initiatives. We used qualitative methods including interview and documents analysis. In a first step, we interviewed eighteen experts and reviewed relevant national policy and strategy documents. Based on this orientation, we selected three networks we deemed to be representative of inter-organizational efforts to develop Dutch patient portals in 2012. In a second step, we interviewed twelve representatives of these patient portal networks and collected documents related to the portals. We applied content analytic techniques to analyze data from the three cases. The three studied networks differed in their number and diversity of actors, the degree to which these actors were mutually dependent, the degree to which network governance was decentralized, and the dynamics of the network structures. We observed that the portals developed in networks displaying the highest degree of these characteristics experienced most difficulties associated with developing patient portals - such as achieving interoperability, successful implementation, regulatory complaisance, and financial

Manual versus computerized filing system in nuclear medicine - a regression. A simple but effectiv system for patient calling in in-vivo diagnosis

International Nuclear Information System (INIS)

Spitz, J.

1985-01-01

A patient-filing and calling system is described which uses colour-coded data carriers and a special board. The system proved to be useful for stock display and handling of labelled activity ready for injection in patients. (orig.) [de

Identification of COPD patients' health status using an intelligent system in the CHRONIOUS wearable platform.

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Bellos, Christos C; Papadopoulos, Athanasios; Rosso, Roberto; Fotiadis, Dimitrios I

2014-05-01

The CHRONIOUS system offers an integrated platform aiming at the effective management and real-time assessment of the health status of the patient suffering from chronic obstructive pulmonary disease (COPD). An intelligent system is developed for the analysis and the real-time evaluation of patient's condition. A hybrid classifier has been implemented on a personal digital assistant, combining a support vector machine, a random forest, and a rule-based system to provide a more advanced categorization scheme for the early and in real-time characterization of a COPD episode. This is followed by a severity estimation algorithm which classifies the identified pathological situation in different levels and triggers an alerting mechanism to provide an informative and instructive message/advice to the patient and the clinical supervisor. The system has been validated using data collected from 30 patients that have been annotated by experts indicating 1) the severity level of the current patient's health status, and 2) the COPD disease level of the recruited patients according to the GOLD guidelines. The achieved characterization accuracy has been found 94%.

Comparative Evaluation of Periodontal Status of Chronic Renal Failure Patients and Systemically Healthy Individuals.

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Gupta, Radhika; Kumar, Uttam; Mallapragada, Siddharth; Agarwal, Pallavi

2018-03-01

Periodontitis, a chronic infectious disease, affects most of the population at one time or the other and its expression is a combination of hosts, microbial agents, and environmental factors. Extensive literature exists for the relationship between periodontal disease and diabetes mellitus, cardiovascular diseases, and adverse pregnancy outcomes. Only a few studies performed in a limited number of patients have reported peri-odontal health status in chronic renal failure patients. Hence, the aim of the present study is to assess and compare the periodontal status of patients with chronic renal failure undergoing dialysis, predialysis with systemically healthy individuals. A total of 90 patients were divided into three groups. Group I: 30 renal dialysis patients. Group II: 30 predialysis patients. Control group comprised 30 systemically healthy patients who formed group III. Periodontal examination was carried out using oral hygiene index-simplified (OHI-S), plaque index (PI), gingival index (GI), probing depth, and clinical attachment loss. The results of the study showed that the periodontal status of patients with chronic renal failure undergoing dialysis (dialysis group) and patients with chronic renal failure not undergoing renal dialysis (predialysis) when compared with systemically healthy subjects showed significantly higher mean scores of OHI-S, PI, and clinical attachment loss. Thus, patients with chronic renal failure showed poor oral hygiene and higher prevalence of periodontal disease. The dental community's awareness of implications of poor health within chronic renal failure patients should be elevated.

Identifying Facilitators and Barriers for Patient Safety in a Medicine Label Design System Using Patient Simulation and Interviews

DEFF Research Database (Denmark)

Dieckmann, Peter; Clemmensen, Marianne Hald; Sørensen, Trine Kart

2016-01-01

Objectives Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. Methods The study design is qualitative and explora......Objectives Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. Methods The study design is qualitative...... of the system and some inconsistencies (different meaning of colors) posed challenges, when considered with the actual application context, in which there is little time to get familiar with the design features. Conclusions For optimizing medicine labels and obtaining the full benefit of label design features...

Tuberculosis in patients with systemic lupus erythematosus: Spain's situation.

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Arenas Miras, María del Mar; Hidalgo Tenorio, Carmen; Jimenez Alonso, Juan

2013-01-01

There has recently been an increase in the incidence of patients with systemic lupus erythematosus (SLE) due mainly to earlier diagnosis, and increased survival. Tuberculosis in our country is one of the most prevalent infectious diseases, and one of the underlying causes would be HIV infection and increased immigration from areas with high tuberculosis prevalence; this phenomenon is truly important in patients with autoimmune diseases, as clinical presentation, severity and prognosis of tuberculosis are often different to that of immunocompetent patients. Studies of tuberculosis in patients with SLE are scarce and inconclusive, with many doubts existing about the performance or non-tuberculous prophylaxis in this population and the absence of a protocol due to lack of conclusive studies. New techniques for diagnosis of tuberculosis (IGRAs) may be useful in this population due to higher sensitivity than Mantoux, helping avoid false negatives. Copyright © 2012 Elsevier España, S.L. All rights reserved.

White matter lesions and brain atrophy in systemic lupus erythematosus patients: correlation to cognitive dysfunction in a cohort of systemic lupus erythematosus patients using different definition models for neuropsychiatric systemic lupus erythematosus.

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Cannerfelt, B; Nystedt, J; Jönsen, A; Lätt, J; van Westen, D; Lilja, A; Bengtsson, A; Nilsson, P; Mårtensson, J; Sundgren, P C

2018-06-01

Aim The aim of this study was to evaluate the extent of white matter lesions, atrophy of the hippocampus and corpus callosum, and their correlation with cognitive dysfunction (CD), in patients diagnosed with systemic lupus erythematosus (SLE). Methods Seventy SLE patients and 25 healthy individuals (HIs) were included in the study. To evaluate the different SLE and neuropsychiatric SLE (NPSLE) definition schemes, patients were grouped both according to the American College of Rheumatology (ACR) definition, as well as the more stringent ACR-Systemic Lupus International Collaborating Clinics definition. Patients and HIs underwent a 3 Tesla brain MRI and a standardized neuropsychological test. MRI data were evaluated for number and volume of white matter lesions and atrophy of the hippocampus and corpus callosum. Differences between groups and subgroups were evaluated for significance. Number and volume of white matter lesions and atrophy of the hippocampus and corpus callosum were correlated to cognitive dysfunction. Results The total volume of white matter lesions was significantly larger in SLE patients compared to HIs ( p = 0.004). However, no significant differences were seen between the different SLE subgroups. Atrophy of the bilateral hippocampus was significantly more pronounced in patients with NPSLE compared to those with non-NPSLE (right: p = 0.010; left p = 0.023). Significant negative correlations between cognitive test scores on verbal memory and number and volume of white matter lesions were present. Conclusion SLE patients have a significantly larger volume of white matter lesions on MRI compared to HIs and the degree of white matter lesion volume correlates to cognitive dysfunction, specifically to verbal memory. No significant differences in the number or volume of white matter lesions were identified between subgroups of SLE patients regardless of the definition model used.

Feasibility test of a UK-scalable electronic system for regular collection of patient-reported outcome measures and linkage with clinical cancer registry data: The electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system

Directory of Open Access Journals (Sweden)

Velikova Galina

2011-10-01

Full Text Available Abstract Background Cancer survivors can face significant physical and psychosocial challenges; there is a need to identify and predict which survivors experience what sorts of difficulties. As highlighted in the UK National Cancer Survivorship Initiative, routine post-diagnostic collection of patient reported outcome measures (PROMs is required; to be most informative, PROMs must be linked and analysed with patients' diagnostic and treatment information. We have designed and built a potentially cost-efficient UK-scalable electronic system for collecting PROMs via the internet, at regular post-diagnostic time-points, for linking these data with patients' clinical data in cancer registries, and for electronically managing the associated patient monitoring and communications; the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system. This study aims to test the feasibility of the ePOCS system, by running it for 2 years in two Yorkshire NHS Trusts, and using the Northern and Yorkshire Cancer Registry and Information Service. Methods/Design Non-metastatic breast, colorectal and prostate cancer patients (largest survivor groups, within 6 months post-diagnosis, will be recruited from hospitals in the Yorkshire Cancer Network. Participants will be asked to complete PROMS, assessing a range of health-related quality-of-life outcomes, at three time-points up to 15 months post-diagnosis, and subsequently to provide opinion on the ePOCS system via a feedback questionnaire. Feasibility will be examined primarily in terms of patient recruitment and retention rates, the representativeness of participating patients, the quantity and quality of collected PROMs data, patients' feedback, the success and reliability of the underpinning informatics, and the system running costs. If sufficient data are generated during system testing, these will be analysed to assess the health-related quality-of-life outcomes reported by patients, and to explore

Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study.

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Barken, Tina Lien; Thygesen, Elin; Söderhamn, Ulrika

2017-12-28

Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision

Visual System Involvement in Patients with Newly Diagnosed Parkinson Disease.

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Arrigo, Alessandro; Calamuneri, Alessandro; Milardi, Demetrio; Mormina, Enricomaria; Rania, Laura; Postorino, Elisa; Marino, Silvia; Di Lorenzo, Giuseppe; Anastasi, Giuseppe Pio; Ghilardi, Maria Felice; Aragona, Pasquale; Quartarone, Angelo; Gaeta, Michele

2017-12-01

Purpose To assess intracranial visual system changes of newly diagnosed Parkinson disease in drug-naïve patients. Materials and Methods Twenty patients with newly diagnosed Parkinson disease and 20 age-matched control subjects were recruited. Magnetic resonance (MR) imaging (T1-weighted and diffusion-weighted imaging) was performed with a 3-T MR imager. White matter changes were assessed by exploring a white matter diffusion profile by means of diffusion-tensor imaging-based parameters and constrained spherical deconvolution-based connectivity analysis and by means of white matter voxel-based morphometry (VBM). Alterations in occipital gray matter were investigated by means of gray matter VBM. Morphologic analysis of the optic chiasm was based on manual measurement of regions of interest. Statistical testing included analysis of variance, t tests, and permutation tests. Results In the patients with Parkinson disease, significant alterations were found in optic radiation connectivity distribution, with decreased lateral geniculate nucleus V2 density (F, -8.28; P Parkinson disease and that the entire intracranial visual system can be involved. © RSNA, 2017 Online supplemental material is available for this article.

Peripheral aneurysm rupture in a patient with inactive systemic lupus erythematosus

Energy Technology Data Exchange (ETDEWEB)

Engelke, Christoph; Sabharwal, Tarun; Reidy, John F. [Department of Radiology, Guy' s and St. Thomas' Hospital Trust, St. Thomas' Street, London SE1 9RT (United Kingdom); Mohan, Aarthi R. [Department of Chest Medicine, Guy' s and St. Thomas' Hospital Trust, St. Thomas' Street, London SE1 9RT (United Kingdom)

2002-12-01

We describe a patient with inactive systemic lupus erythematosus (SLE) presenting with sudden haemothorax, due to a ruptured internal mammary artery (IMA) aneurysm 7 years after the corticosteroid treatment was terminated. The unusual imaging findings and the treatment with embolization are discussed with a view to the role of a regular vascular screening in this patient group. (orig.)

Metabolic syndrome in Iranian patients with systemic lupus erythematosus and its determinants.

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Fatemi, Alimohammad; Ghanbarian, Azadeh; Sayedbonakdar, Zahra; Kazemi, Mehdi; Smiley, Abbas

2018-01-05

The aim of this study was to determine the prevalence of metabolic syndrome (MetS) in Iranian patients with systemic lupus erythematosus (SLE) and its determinants. In a cross-sectional study, 98 patients with SLE and 95 controls were enrolled. Prevalence of MetS was determined based on American Heart Association and National Heart, Lung, and Blood Institute (AHA/NHLBI) and 2009 harmonizing criteria. In addition, demographic features and lupus characteristics such as disease duration, pharmacological treatment, laboratory data, SLE disease activity index (SLEDAI), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage index (SDI) were recorded. The predictors of MetS were obtained by backward stepwise regression analysis. Using AHA/NHLBI, MetS was observed in 35 (35.7%) patients and 28 (29.8%) controls (P = 0.4). Using harmonizing criteria, MetS was observed in 37 (37.7%) patients and 33 (35.1%) controls (P = 0.7). There was no difference in frequency distribution of MetS components between the patients and the controls. In multivariate regression analysis, low C3, blood urea nitrogen (BUN), and body mass index were independent determinants of MetS in lupus patients. BUN, low C3, and body mass index were the major determinants of MetS in lupus patients.

Open source electronic health record and patient data management system for intensive care.

Science.gov (United States)

Massaut, Jacques; Reper, Pascal

2008-01-01

In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed a PDMS and EHR based on open source software and components. The software was designed as a client-server architecture running on the Linux operating system and powered by the PostgreSQL data base system. The client software was developed in C using GTK interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in February 2004, the PDMS was used to care more than three thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of the Mirth HL7 communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on open source software components was able to respond to the medical needs of the local ICU environment. The use of OSS for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

Frequent hemodialysis with NxStage system in pediatric patients receiving maintenance hemodialysis.

Science.gov (United States)

Goldstein, Stuart L; Silverstein, Douglas M; Leung, Jocelyn C; Feig, Daniel I; Soletsky, Beth; Knight, Cathy; Warady, Bradley A

2008-01-01

Recent evidence from adult hemodialysis (HD) patient studies reveal improved biochemical control and reported health-related quality of life after transition from conventional thrice weekly to daily home maintenance HD treatment. Published pediatric frequent dialysis experiences demonstrate similar improvement but all used conventional HD machines, which employ a treated municipal water supply, thereby frequently exposing patients to proinflammatory components. We report our pediatric experience with six-times-weekly HD using the NxStage system, which uses sterile dialysis fluid to provide dialysis in the home or center setting. Four patients (weight range 38-61.4 kg) completed the 16-week study. Patients exhibited progressive reductions in casual pretreatment systolic and diastolic blood pressures, discontinuation of antihypertensive medications, and decreased blood pressure load by ambulatory blood pressure monitoring. Mean serum phosphorus improved without change in phosphorus binder medication, and all three patients with a normalized protein catabolic rate 1.1 g/kg per day. Patients reported no adverse effects. Variable changes in proinflammatory cytokine levels were observed. We suggest that frequent HD with the NxStage system be considered for children who would benefit from home-based maintenance dialysis.

Using a Radiofrequency Identification System for Improving the Patient Discharge Process: A Simulation Study.

Science.gov (United States)

Shim, Sung J; Kumar, Arun; Jiao, Roger

2016-01-01

A hospital is considering deploying a radiofrequency identification (RFID) system and setting up a new "discharge lounge" to improve the patient discharge process. This study uses computer simulation to model and compare the current process and the new process, and it assesses the impact of the RFID system and the discharge lounge on the process in terms of resource utilization and time taken in the process. The simulation results regarding resource utilization suggest that the RFID system can slightly relieve the burden on all resources, whereas the RFID system and the discharge lounge together can significantly mitigate the nurses' tasks. The simulation results in terms of the time taken demonstrate that the RFID system can shorten patient wait times, staff busy times, and bed occupation times. The results of the study could prove helpful to others who are considering the use of an RFID system in the patient discharge process in hospitals or similar processes.

Mortality and causes of death of 344 Danish patients with systemic sclerosis (scleroderma)

DEFF Research Database (Denmark)

Jacobsen, Søren; Halberg, P; Ullman, S

1998-01-01

To determine survival, mortality and causes of death in Danish patients with systemic sclerosis (scleroderma), and to analyse how these parameters are influenced by demographic variables and the extent of skin involvement.......To determine survival, mortality and causes of death in Danish patients with systemic sclerosis (scleroderma), and to analyse how these parameters are influenced by demographic variables and the extent of skin involvement....

Benefit of revascularisation to critical limb ischaemia patients evaluated by a patient-oriented scoring system.

Science.gov (United States)

Chisci, E; Perulli, A; Iacoponi, F; Setacci, F; de Donato, G; Palasciano, G; Cappelli, A; Setacci, C

2012-05-01

The concept of patency and limb salvage are physician-oriented endpoints in critical limb ischaemia (CLI). These endpoints have failed to enhance function after revascularisation. The aim of this study was to create a scoring system to predict 1-year functional status and to assess the benefit to patients possible by revascularisation. During the period 2007-2009, 480 consecutive patients (mean age ± SD, 83.2 ± 8.7 years) underwent repair for CLI. Preoperative, operative and functional status characteristics and post-operative outcomes were recorded. The following patient-oriented outcomes were investigated pre- and postoperatively: basic and instrumental activities of daily living (BADL and IADL) and ambulatory and living status. Statistical analysis was performed to assess predictors of functional benefit from revascularisation. The variables significant on multivariable analysis were used to generate a scoring system to pre and postoperatively grade individual patient risk of losing baseline functional status at 1 year (CLI functional score). Ninety-three of 480 patients (19.3%) were in Rutherford class IV, 208 (43.3%) in class V and 179 (37.4%) in class VI. Surgical, endovascular and hybrid operations were performed in 108 (22.5%), 319 (66.5%) and 53 (11%) patients, respectively; mean follow-up was 408 ± 363 days. Improved or unchanged functional status was observed in 276 patients (57.5%). Preoperative mean ± SD BADL and IADL (4.26 ± 1.98 and 3.92 ± 2.69, respectively) were modified from mean values at 1-year follow-up (4.19 ± 2.06 and 4.12 ± 3, respectively) (p = 0.401 and p 80% indicates that patients are likely to lose functional abilities and require assistance for ambulation or ADL, as well as risking outcomes such as major amputation, new CLI-related hospitalisation or re-operation (p 2 cm, infection and poor tibial runoff), American Society of Anesthesiologists (ASA) score > II, previous cerebrovascular event and heart

[Depressive disorder in Mexican pediatric patients with systemic lupus erythematosus (SLE)].

Science.gov (United States)

Carbajal-Alonso, Hilda Lilian; García-Moreno, Norberta Prisilia; Rodríguez-Arreola, Brenda; Barrera de León, Juan Carlos

2016-01-01

To identify the prevalence of depression in Mexican pediatric patients with systemic lupus erythematosus. Analytical transversal study including patients aged 7-16 years with a diagnosis of systemic lupus erythematosus seen at the Pediatric Rheumatology Consultation Service. The disease was classified by means of the MEX-SLEDAI questionnaire. Descriptive statistics with central tendency and dispersion and comparative measurements with chi-squared and Mann-Whitney U tests. Logistic regression and association with odds ratios. SPSS v.21.0 statistical software package. We evaluated 45 patients who presented depression, n=9 (20%), including eight females (89%) and one male (11%), median age 13 years (range, 7-16) in children with depression vs. 13 years (range, 9-14) p=0.941, depression more frequent in schoolchildren. Habitual residence, disease evolution time, and duration of the immunosuppressor did not show a significant difference between both groups. Divorced parents p=0.037. Neuropsychiatric manifestations of lupus presented in 2.2% of all patients and in 100% of patients with depression. Disease activity index (MEX-SLEDAI) did not demonstrate a relationship with the presence of depression. Prevalences in pediatric populations are less that that reported in adults, association with disease activity, evolution time, and immunosuppressor use and duration not found.

Healthy lifestyle habits for patients with systemic lupus erythematosus: A systemic review.

Science.gov (United States)

Rodríguez Huerta, Maria Dolores; Trujillo-Martín, Maria M; Rúa-Figueroa, Íñigo; Cuellar-Pompa, Leticia; Quirós-López, Raúl; Serrano-Aguilar, Pedro

2016-02-01

To assess the effects of lifestyle habits on the disease activity and damage, the occurrence of flares and quality of life of people with systemic lupus erythematosus (SLE). A systematic literature review was performed. MEDLINE, EMBASE, and SCI/SSCI were searched. Experimental and observational studies evaluating the effect of lifestyles for SLE patients were included. Two independent reviewers selected studies and extracted relevant data. Critical appraisal of the studies was assessed following SIGN criteria. Eligibility criteria were met by 21 studies, five analyzed the effect of tobacco consumption, nine the effect of physical exercise and seven the effect of diet. Three studies on tobacco observed an association with increased SLE activity and the onset of cutaneous damage. The studies on physical exercise, of heterogeneous quality, reported that aerobic activity is safe for SLE patients, leading to an increase of tolerance to exercise, physical and functional capacity for those with moderate or low activity. A reduction in fatigue, anxiety and depression, as well as improved quality of life, is also suggested though evidence for these outcomes is limited. Better-quality studies on diet analyzed the effect of polyunsaturated fatty acids on disease activity. Three of the four randomized placebo-controlled trials revealed a positive effect both on overall SLE indices and individual symptoms that affect patients. Tobacco smoking increases the risk of skin damage and disease activity in patients with SLE. A diet rich in polyunsaturated fatty acids, avoiding a sedentary lifestyle and supervised exercise should be recommended for patients with stable SLE. Copyright © 2015 Elsevier Inc. All rights reserved.

Warfarin for the prevention of systemic embolism in patients with non-valvular atrial fibrillation

DEFF Research Database (Denmark)

Andersen, L V; Vestergaard, P; Deichgraeber, P

2008-01-01

Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism.......Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism....

Patients at the Centre: Methodological Considerations for Evaluating Evidence from Health Interventions Involving Patients Use of Web-Based Information Systems

Science.gov (United States)

Cummings, Elizabeth; Turner, Paul

2010-01-01

Building an evidence base for healthcare interventions has long been advocated as both professionally and ethically desirable. By supporting meaningful comparison amongst different approaches, a good evidence base has been viewed as an important element in optimising clinical decision-making and the safety and quality of care. Unsurprisingly, medical research has put considerable effort into supporting the development of this evidence base, and the randomised controlled trial has become the dominant methodology. Recently however, a body of research has begun to question, not just this methodology per se, but also the extent to which the evidence it produces may marginalise individual patient experiences, priorities and perceptions. Simultaneously, the widespread adoption and utilisation of information systems (IS) in health care has also prompted initiatives to develop a stronger base of evidence about their impacts. These calls have been stimulated both by numerous system failures and research expressing concerns about the limitations of information systems methodologies in health care environments. Alongside the potential of information systems to produce positive, negative and unintended consequences, many measures of success, impact or benefit appear to have little to do with improvements in care, health outcomes or individual patient experiences. Combined these methodological concerns suggest the need for more detailed examination. This is particularly the case, given the prevalence within contemporary clinical and IS discourses on health interventions advocating the need to put the ‘patient at the centre’ by engaging them in their own care and/or ‘empowering’ them through the use of information systems. This paper aims to contribute to these on-going debates by focusing on the socio-technical processes by which patients’ interests and outcomes are measured, defined and evaluated within health interventions that involve them using web

Evaluation of central nervous system in patients with glycogen storage disease type 1a.

Science.gov (United States)

Aydemir, Yusuf; Gürakan, Figen; Saltık Temizel, İnci Nur; Demir, Hülya; Oğuz, Kader Karlı; Yalnızoğlu, Dilek; Topçu, Meral; Özen, Hasan; Yüce, Aysel

2016-01-01

We aimed to evaluate structure and functions of central nervous system (CNS) in children with glycogen storage disease (GSD) type 1a. Neurological examination, psychometric tests, electroencephalography (EEG), magnetic resonance imaging (MRI), visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) were performed. The results were compared between patients with good and poor metabolic control and healthy children. Twenty-three patients with GSD type 1a were studied. Twelve patients were in poor metabolic control group and 11 patients in good metabolic control group. Five patients had intellectual disability, 10 had EEG abnormalities, seven had abnormal VEP and two had abnormal BAEP results. MRI was abnormal in five patients. There was significant correlation between the number of hypoglycemic attacks and MRI abnormalities. Central nervous system may be affected in GSD type 1a even in patients with normal neurologic examination. Accumulation of abnormal results in patients with poor metabolic control supports the importance of metabolic control in GSD type 1a.

Effects of patient health literacy, patient engagement and a system-level health literacy attribute on patient-reported outcomes: a representative statewide survey.

Science.gov (United States)

Kaphingst, Kimberly A; Weaver, Nancy L; Wray, Ricardo J; Brown, Melissa L R; Buskirk, Trent; Kreuter, Matthew W

2014-10-07

The effects of health literacy are thought to be based on interactions between patients' skill levels and health care system demands. Little health literacy research has focused on attributes of health care organizations. We examined whether the attribute of individuals' experiences with front desk staff, patient engagement through bringing questions to a doctor visit, and health literacy skills were related to two patient-reported outcomes. We administered a telephone survey with two sampling frames (i.e., household landline, cell phone numbers) to a randomly selected statewide sample of 3358 English-speaking adult residents of Missouri. We examined two patient-reported outcomes - whether or not respondents reported knowing more about their health and made better choices about their health following their last doctor visit. Multivariable logistic regression models were used to examine the independent contributions of predictor variables (i.e., front desk staff, bringing questions to a doctor visit, health literacy skills). Controlling for self-reported health, having a personal doctor, time since last visit, number of chronic conditions, health insurance, and sociodemographic characteristics, respondents who had a good front desk experience were 2.65 times as likely (95% confidence interval [CI]: 2.13, 3.30) and those who brought questions were 1.73 times as likely (95% CI: 1.32, 2.27) to report knowing more about their health after seeing a doctor. In a second model, respondents who had a good front desk experience were 1.57 times as likely (95% CI: 1.26, 1.95) and those who brought questions were 1.66 times as likely (95% CI: 1.29, 2.14) to report making better choices about their health after seeing a doctor. Patients' health literacy skills were not associated with either outcome. Results from this representative statewide survey may indicate that one attribute of a health care organization (i.e., having a respectful workforce) and patient engagement through

Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology.

Science.gov (United States)

Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M B

2015-01-01

This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has been processed in Labview where the digital filter techniques have been implemented to remove the noise from the acquired signal. After processing, the algorithm was developed to calculate the heart rate and to analyze the arrhythmia condition. Finally, SMTP technology has been added in our work to make device more communicative and much more cost-effective solution in telemedicine technology which has been key-problem to realize the telediagnosis and monitoring of ECG signals. The technology also can be easily implemented over already existing Internet.

Cost Savings Associated with the Adoption of a Cloud Computing Data Transfer System for Trauma Patients.

Science.gov (United States)

Feeney, James M; Montgomery, Stephanie C; Wolf, Laura; Jayaraman, Vijay; Twohig, Michael

2016-09-01

Among transferred trauma patients, challenges with the transfer of radiographic studies include problems loading or viewing the studies at the receiving hospitals, and problems manipulating, reconstructing, or evalu- ating the transferred images. Cloud-based image transfer systems may address some ofthese problems. We reviewed the charts of patients trans- ferred during one year surrounding the adoption of a cloud computing data transfer system. We compared the rates of repeat imaging before (precloud) and af- ter (postcloud) the adoption of the cloud-based data transfer system. During the precloud period, 28 out of 100 patients required 90 repeat studies. With the cloud computing transfer system in place, three out of 134 patients required seven repeat films. There was a statistically significant decrease in the proportion of patients requiring repeat films (28% to 2.2%, P < .0001). Based on an annualized volume of 200 trauma patient transfers, the cost savings estimated using three methods of cost analysis, is between $30,272 and $192,453.

[Multiple sclerosis management system 3D. Moving from documentation towards management of patients].

Science.gov (United States)

Schultheiss, T; Kempcke, R; Kratzsch, F; Eulitz, M; Pette, M; Reichmann, H; Ziemssen, T

2012-04-01

The increasing therapeutic options for relapsing-remitting multiple sclerosis require a specific treatment and risk management to recognize the individual response as well as potential side effects. To switch from pure MS documentation to MS management by implementing a new multiple sclerosis management and documentation tool may be of importance. This article presents the novel computer-based patient management system "multiple sclerosis management system 3D" (MSDS 3D). MSDS 3D allows documentation and visualization of visit schedules and mandatory examinations via defined study modules by integration of data input from patients, attending physicians and MS nurses. It provides forms for the documentation of patient visits as well as clinical and diagnostic findings. Information is collected via interactive touch screens. A specific module which is part of MSDS 3D's current version allows the monthly monitoring of patients under treatment with natalizumab. A checklist covering clinical signs of progressive multifocal leukoencephalopathy (PML) and a detailed questionnaire about the handling of natalizumab in practice have additionally been added. The MS patient management system MSDS 3D has successfully been implemented and is currently being evaluated in a multi-centre setting. Advanced assessment of patient data may allow improvements in clinical practice and research work. The addition of a checklist and a questionnaire into the natalizumab module may support the recognition of PML during its early, treatable course.

The influences of patient's satisfaction with medical service delivery, assessment of medical service, and trust in health delivery system on patient's life satisfaction in China.

Science.gov (United States)

Tang, Liyang

2012-09-14

Patient's satisfaction with medical service delivery/assessment of medical service/trust in health delivery system may have significant influence on patient's life satisfaction in China's health delivery system/in various kinds of hospitals.The aim of this study was to test whether and to what extent patient's satisfaction with medical service delivery/patient's assessments of various major aspects of medical service/various major aspects of patient's trust in health delivery system influenced patient's life satisfaction in China's health delivery system/in various kinds of hospitals. This study collaborated with National Bureau of Statistics of China to carry out a 2008 national urban resident household survey in 17 provinces, autonomous regions, and municipalities directly under the central government (N = 3,386), and specified ordered probit models were established to analyze dataset from this household survey. The key considerations in generating patient's life satisfaction involved patient's overall satisfaction with medical service delivery, assessment of doctor-patient communication, assessment of medical cost, assessment of medical treatment process, assessment of medical facility and hospital environment, assessment of waiting time for medical service, trust in prescription, trust in doctor, and trust in recommended medical examination. But the major considerations in generating patient's life satisfaction were different among low level public hospital, high level public hospital, and private hospital. The promotion of patient's overall satisfaction with medical service delivery, the improvement of doctor-patient communication, the reduction of medical cost, the improvement of medical treatment process, the promotion of medical facility and hospital environment, the reduction of waiting time for medical service, the promotion of patient's trust in prescription, the promotion of patient's trust in doctor, and the promotion of patient's trust in

Radionuclide study of the hepatobiliary system function in patients with diabetes mellitus

International Nuclear Information System (INIS)

Slavnov, V.M.; Savich, O.A.; Markov, V.V.

2002-01-01

The functional state of the liver parenchyma, concentration and motor functions of the gallbladder in patients with diabetes mellitus (DM) was studied. To analyze hepatobiliary system disorders depending on the type of DM, presence of complications, duration of the disease and the age of the patients

System requirements for a computerised patient record information system at a busy primary health care clinic

Directory of Open Access Journals (Sweden)

PJ Blignaut

2001-09-01

Full Text Available A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.

Optimization of the pharmaceutical care system for diabetes patients using modern pharmaceutical informatics methodology

Directory of Open Access Journals (Sweden)

Андрій Ігорович Бойко

2016-04-01

Full Text Available Aim. Implementation of pharmaceutical informatics methods in the system of pharmaceutical care for diabetes patients in Ukraine.Methods. System method was used for the analysis of status and reforming the pharmaceutical care for patients with diabetes; program-oriented management at informatization project realization; pharmaceutical informatics in the creation of computer pharmaceutical knowledge bases; methods of data synthesis and summarizing.Results. System analysis of the basic directions of reforming the pharmaceutical care for patients with diabetes in Ukraine was carried out. Ways of it’s of optimization were processed: establishment of specialized pharmacies with implementation of modern information technologies and special postgraduate education for pharmacists. Structure and information providing of computer knowledge base “Pharmaceutical care for patients with diabetes” was substantiated.Conclusion. Based on the regional project “Informatization of prescription antidiabetic drugs circulation in Ukraine” realization, the necessity of establishment of specialized pharmacies providing pharmaceutical care for patients with diabetes was substantiated. Ways for optimization of postgraduate education for pharmacists of the specialized pharmacies by implementation of special thematic improvement cycles were proceed. Computer knowledge base as an effective tool for optimization of pharmaceutical care for patients with diabetes was realized

Telemedicine: Development of a distance care system for pre-dialysis chronic kidney disease patients.

Science.gov (United States)

Fernandes, Natália Maria da Silva; Bastos, Marcus Gomes; Oliveira, Nivalda A C de; Costa, Alex do Vale; Bernardino, Heder Soares

2015-01-01

The focus in the treatment of CKD is to prevent its progression through optimal medical control. The large number of patients with CKD has pressed nephrologists to assess more patients into ever-smaller periods of consultation. The use of light technologies as a promising form of health care. The internet offers the opportunity to manipulate the doctor in his professional contact with the user. To develop a web system to attend the patients with CKD not on dialysis and clinically stable stages at distance. Developed a system using the Java language, MySQL database and PrimeFaces framework; available on a Glassfish application server. The initial access is performed by the nephrologist, which registers the patients with their personal information and access data. After being registered, the patient (or family doctor) can enter the data of your query and these will be following, passed on to the nephrologist for evaluation. The form with the data of interest is pre-determined, but there is possibility to add free-form information. The system enables, in addition, there is exchange of messages between doctors and patients. In addition, users receive messages via e-mail alerting them of their duties. Confidentiality is guaranteed by individual passwords for doctors and patients. This tool will enable to increase the coverage area of nephrologists, reduce costs and bring the patient to the primary care physician, using the Family Health Program as an interface between the patient and the nephrology secondary care.

The Systemic Inflammatory Response Syndrome (SIRS in acutely hospitalised medical patients: a cohort study

Directory of Open Access Journals (Sweden)

Storgaard Merete

2009-12-01

Full Text Available Abstract Background Sepsis is an infection which has evoked a systemic inflammatory response. Clinically, the Systemic Inflammatory Response Syndrome (SIRS is identified by two or more symptoms including fever or hypothermia, tachycardia, tachypnoea and change in blood leucocyte count. The relationship between SIRS symptoms and morbidity and mortality in medical emergency ward patients is unknown. Methods We conducted a prospective cohort study of the frequency of SIRS and its relationship to sepsis and death among acutely hospitalised medical patients. In 437 consecutive patients, SIRS status, blood pressure, infection and comorbidity on admission was registered together with 28-day mortality. Results A hundred and fifty-four patients (35% had SIRS on admission, 211 patients (48% had no SIRS, and 72 patients (16% had insufficient data to evaluate their SIRS status. SIRS patients were 2.2 times more frequently infected, with 66/154 SIRS patients versus 41/211 non-SIRS patients: p Conclusion We found SIRS status on admission to be moderately associated with infection and strongly related to 28-day mortality.

[MMPI-2 profiles in groups of systemic autoimmune disease - rheumatoid arthritis and systemic lupus erythematosus - patients].

Science.gov (United States)

Csókási, Krisztina; Hargitai, Rita; Járai, Róbert; Nagy, László; Czirják, László; Kiss, Enikö Csilla

2015-01-01

Systemic autoimmune diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are characterized by the alteration of immunological response, which can damage many organs and systems and result in a wide variety of clinical presentations. In addition to physical symptoms, psychiatric disorders are also common to many autoimmune diseases. Anxiety, depression, psychosis and cognitive deficits have the highest prevalence. The aim of this study was to display the degree of psychopathological symptoms in patients with RA and SLE. Female inpatients with RA (N=68) and SLE (N=78) were recruited from the Rheumatology and Immunology Clinic of the University of Pecs and were asked to complete the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and a short demografical form. The clinical personality profiles of the patient groups were explored and compared with each other. High scores (above 64T) were detected on the Hypochondriasis (Hs), Depression (D) and Hysteria (Hy) scales in both groups. Besides, the participants performed elevated scores on the Masculinity-Feminity (Mf), Psychasthenia (Pt) and Social Introversion (Si) clinical scales. They scored in the elevated range on the Physical Malfunctioning, Subjective Depression, Lassitude-Malaise and Somatic Complaints subscales of the neurotic triad. No significant difference was found on the ten clinical scales between the SLE and RA patients. Characteristics of MMPI-2 profiles in SLE and RA patients seem to be the consequence of the disease and a common feature of chronic conditions. High scores on the neurotic triad scales may reflect the comorbid psychiatric disorders and the somatic symptoms alike, so further investigations with the revised Hungarian MMPI-2 are needed.

Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis

Directory of Open Access Journals (Sweden)

Marija Vavlukis

2015-11-01

CONCLUSION: The acquired antiphospholipid syndrome is common condition in patients with systemic autoimmune diseases, but relatively rare in patients with systemic sclerosis. Never the less, we have to be aware of it when treating the patients with systemic sclerosis.

Secondary infiltration of the central nervous system in patients with diffuse large B-cell lymphoma

Directory of Open Access Journals (Sweden)

Talita Maira Bueno da Silveira da Rocha

2013-01-01

Full Text Available OBJECTIVE: To investigate the incidence and risk factors of infiltration of the central nervous system after the initial treatment of diffuse large B-cell lymphoma in patients treated at Santa Casa de Misericórdia de São Paulo. METHODS: A total of 133 patients treated for diffuse large B-cell lymphoma from January 2001 to April 2008 were retrospectively analyzed in respect to the incidence and risk factors of secondary central nervous system involvement of lymphoma. Intrathecal prophylaxis was not a standard procedure for patients considered to be at risk. This analysis includes patients whether they received rituximab as first-line treatment or not. RESULTS: Nine of 133 (6.7% patients developed central nervous system disease after a mean observation time of 29 months. The median time to relapse or progression was 7.9 months after diagnosis and all but one patient died despite the treatment administered. Twenty-six (19.5% patients of this cohort received rituximab as first-line treatment and nine (7.1% received intrathecal chemoprophylaxis. Of the nine patients that relapsed, seven (77.7% had parenchymal central nervous system involvement; seven (77.7% had stage III or IV disease; one (11.1% had bone marrow involvement; two (22.2% had received intrathecal chemoprophylaxis; and 3 (33.3% had taken rituximab. In a multivariate analysis, the risk factors for this infiltration were being male, previous use of intrathecal chemotherapy and patients that were refractory to initial treatment. CONCLUSION: Central nervous system infiltration in this cohort is similar to that of previous reports in the literature. As this was a small cohort with a rare event, only three risk factors were important for this infiltration

Nutritional support in patients with systemic sclerosis.

Science.gov (United States)

Ortiz-Santamaria, Vera; Puig, Celia; Soldevillla, Cristina; Barata, Anna; Cuquet, Jordi; Recasens, Asunción

2014-01-01

Systemic sclerosis (SSc) is a chronic multisystem autoimmune disease which involves the gastrointestinal tract in about 90% of cases. It may contribute to nutritional deterioration. To assess whether the application of a nutritional support protocol to these patients could improve their nutritional status and quality of life. Single center prospective study, performed on an outpatient basis, in a county hospital. The Malnutrition Universal Screening Tool (MUST) was used to screen risk for malnutrition. Health questionnaire SF-36 and the Hospital Anxiety and Depression Scale were used to assess quality of life and psychopathology respectively. Weight, height, energy and protein requirements, macronutrient intake and nutritional biochemical parameters were evaluated. Nutritional intervention was performed in patients at risk for malnutrition. Of the 72 patients, 12.5% were at risk for malnutrition. Iron deficiency anemia (18.35%) and vitamin D deficiency (54%) were the most frequently observed nutritional deficits. The questionnaires on psychopathology and quality of life showed a high prevalence of anxiety and depression, and lower level poor quality of life in the physical and mental component. No significant improvements were observed in the weight, food intake, nutritional biochemical parameters, psychopathology and quality of life follow-up. Dietary intervention was able to maintain body weight and food intake. Iron deficiency anemia and vitamin D deficiency improved with iron and vitamine D supplements. No deterioration was observed in psychological assessment or quality of life. Studies with larger numbers of patients are needed to assess the efficacy of this intervention. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Norwegians GPs' use of electronic patient record systems.

Science.gov (United States)

Christensen, Tom; Faxvaag, Arild; Loerum, Hallvard; Grimsmo, Anders

2009-12-01

To evaluate GPs use of three major electronic patient record systems with emphasis on the ability of the systems to support important clinical tasks and to compare the findings with results from a study of the three major hospital-wide systems. A national, cross-sectional questionnaire survey was conducted in Norwegian primary care. 247 (73%) of 338 GPs responded. Proportions of the respondents who reported to use the EPR system to conduct 23 central clinical tasks, differences in the proportions of users of different EPR systems and user satisfaction and perceived usefulness of the EPR system were measured. The GPs reported extensive use of their EPR systems to support clinical tasks. There were no significant differences in functionality between the systems, but there were differences in reported software and hardware dysfunction and user satisfaction. The respondents reported high scores in computer literacy and there was no correlation between computer usage and respondent age or gender. A comparison with hospital physicians' use of three hospital-wide EPR systems revealed that GPs had higher usage than the hospital-based MDs. Primary care EPR systems support clinical tasks far better than hospital systems with better overall user satisfaction and reported impact on the overall quality of the work. EPR systems in Norwegian primary care that have been developed in accordance with the principles of user-centered design have achieved widespread adoption and highly integrated use. The quality and efficiency of the clinical work has increased in contrast to the situation of their hospital colleagues, who report more modest use and benefits of EPR systems.

Health Care: Report on the DoD Patient Movement System

National Research Council Canada - National Science Library

Joseph, Michael A; Tonkovic, Timothy J; Hanlon, Robert J; Martin, Anna P; Hatten, Danny O; Hubbell, Mary A; Ali, Tamika S; Noell, Monica L

2005-01-01

The primary mission of the DoD patient movement system is to safely transport U.S. military casualties from a combat zone to fixed medical treatment facilities and field hospitals in or out of the combat theater...

Irradiation chamber for photoactivation patient treatment system

International Nuclear Information System (INIS)

Lee, K.H.; Troutner, V.H.; Goss, J.; King, M.J.

1988-01-01

A flat plate irradiation chamber is described for use in a patient treatment system for altering cells, including treating the cells with a photoactivatable agent and passing the cells and the agent through a field of photoactivating radiation whereby the agent is caused to be activated and to affect the cells. The agent and the cells are contained in the irradiation chamber during irradiation. The flat plate irradiation chamber comprises: a rigid top sheet matably joined with a rigid bottom sheet, forming therebetween a rigid serpentine pathway for conducting the cells through the field of radiation; and pump block means for holding tubing means in fluid communication with the serpentine pathway and adapted for engaging a peristaltic pump whereby rotation of the pump causes the cells to flow through the serpentine pathway, and wherein the chamber is removable from the system and disposable

Periodontal and systemic diseases among Swedish dental school patients - a retrospective register study.

Science.gov (United States)

Marjanovic, Marija; Buhlin, Kåre

2013-01-01

To investigate if patients with periodontitis attending the Dental School in Huddinge, Sweden presented with more signs of systemic diseases, such as cardiovascular disease, diabetes mellitus and respiratory diseases, compared to healthy and gingivitis patients. In this retrospective study, dental charts were examined where the periodontal diagnoses of patients were known. A total of 325 patients with severe periodontitis and 149 patients without periodontitis, born 1928 to 1968, were identified. Diagnosis regarding the systemic diseases was self-reported. Odds ratios for cardiovascular diseases, diabetes mellitus and respiratory diseases were calculated with a logistic regression model that was adjusted for age, gender and smoking. It was observed that more cases of periodontitis were found in older individuals than the controls (61.7 vs 56.2 years; P < 0.001). A total of 44.3% of patients with severe periodontitis also suffered from cardiovascular diseases, 19.1% respiratory diseases and 21.2% from diabetes mellitus. Among the controls, 30.9% had cardiovascular disease, 23.5% suffered from respiratory diseases and 6.7% had diabetes mellitus. Across both groups, hypertension was the most frequent diagnosis. There was a significant association between periodontitis and cardiovascular disease (odds ratio [OR] = 1.79, confidence interval [CI] 1.12-2.86), but not between respiratory diseases and periodontitis (OR= 0.88, CI 0.53-1.47). The risk of diabetes mellitus was greater among those patients with periodontitis (OR= 2.95, CI 1.45- 6.01). This study found that patients with periodontitis presented with more systemic diseases, such as cardiovascular disease and diabetes mellitus than control patients. However, no association was found between periodontitis and respiratory diseases. At the present time, the reasons for the associations or lack of association are unknown.

Remote Monitoring Systems for Chronic Patients on Home Hemodialysis: Field Test of a Copresence-Enhanced Design.

Science.gov (United States)

Liu, Na; Kim, Jinman; Jung, Younhyun; Arisy, Adani; Nicdao, Mary Ann; Mikaheal, Mary; Baldacchino, Tanya; Khadra, Mohamed; Sud, Kamal

2017-08-29

Patients undertaking long-term and chronic home hemodialysis (HHD) are subject to feelings of isolation and anxiety due to the absence of physical contact with their health care professionals and lack of feedback in regards to their dialysis treatments. Therefore, it is important for these patients to feel the "presence" of the health care professionals remotely while on hemodialysis at home for better compliance with the dialysis regime and to feel connected with health care professionals. This study presents an HHD system design for hemodialysis patients with features to enhance patient's perceived "copresence" with their health care professionals. Various mechanisms to enhance this perception were designed and implemented, including digital logbooks, emotion sharing, and feedback tools. The mechanism in our HHD system aims to address the limitations associated with existing self-monitoring tools for HHD patients. A field trial involving 3 nurses and 74 patients was conducted to test the pilot implementation of the copresence design in our HHD system. Mixed method research was conducted to evaluate the system, including surveys, interviews, and analysis of system data. Patients created 2757 entries of dialysis cases during the period of study. Altogether there were 492 entries submitted with "Very Happy" as the emotional status, 2167 entries with a "Happy" status, 56 entries with a "Neutral" status, 18 entries with an "Unhappy" status, and 24 entries with a "Very unhappy" status. Patients felt assured to share their emotions with health care professionals. Health care professionals were able to prioritize the review of the entries based on the emotional status and also felt assured to see patients' change in mood. There were 989 entries sent with short notes. Entries with negative emotions had a higher percentage of supplementary notes entered compared to the entries with positive and neutral emotions. The qualitative data further showed that the HHD system was

AToMS: A Ubiquitous Teleconsultation System for Supporting AMI Patients with Prehospital Thrombolysis

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Bruno S. P. M. Correa

2011-01-01

Full Text Available The latest population-based studies in the medical literature worldwide indicate that acute myocardial infarction (AMI patients still experience prolonged delay to be rescued, which often results in morbidity and mortality. This paper reports from a technological standpoint a teleconsultation and monitoring system named AToMS. This system addresses the problem of prehospital delivery of thrombolysis to AMI patients by enabling the remote interaction of the paramedics and a cardiologist available at a Coronary Care Unit (CCU. Such interaction allows the diagnosis of the patient eligibility to the immediate application of thrombolysis, which is meant to reduce the delay between the onset of symptoms and the eventual application of proper treatment. Such delay reduction is meant to increase the AMI patient's chances of survival and decrease the risks of postinfarction sequels. The teleconsultation is held with the support of wireless and mobile technologies, which also allows the cardiologist to monitor the patient while he/she is being taken to the nearest CCU. All exchanged messages among paramedics and cardiologists are recorded to render an auditable system. AToMS has been deployed in a first stage in the city of Rio de Janeiro, where the medical team involved in the project has conducted commissioned tests.

Some Aspects of the Renin-Angiotensin-System in Hemodialysis Patients

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Umar Malik

2015-11-01

Full Text Available Understanding of the renin-angiotensin system (RAS has changed remarkably over the past decade. Renin, angiotensin converting enzyme (ACE, angiotensin II (Ang II, and Ang II receptors are the main components of the RAS. Recent studies identified the ACE2/Ang 1-7/Mas receptor axis, which counter-regulates the classical RAS. Many studies have examined the effects of the RAS on the progression of cardiovascular disease and chronic kidney disease (CKD. In addition, many studies have documented increased levels of ACE in hemodialysis (HD patients, raising concerns about the negative effects of RAS activation on the progression of renal disease. Elevated ACE increases the level of Ang II, leading to vasoconstriction and cell proliferation. Ang II stimulation of the sympathetic system leads to renal and cardiovascular complications that are secondary to uncontrolled hypertension. This review provides an overview of the RAS, evaluates new research on the role of ACE2 in dialysis, and reviews the evidence for potentially better treatments for patients undergoing HD. Further understanding of the role of ACE and ACE2 in HD patients may aid the development of targeted therapies that slow the progression of CKD and cardiovascular disease.

[Dyslipidaemia and atherogenic risk in patients with systemic lupus erythematosus].

Science.gov (United States)

Batún Garrido, José Antonio de Jesús; Radillo Alba, Hugo Alberto; Hernández Núñez, Éufrates; Olán, Francisco

2016-07-15

Dyslipidaemia is a common comorbidity in patients with systemic lupus erythematosus. Fifty-one patients were included. Variables associated with the disease and the drugs used were recorded. Atherogenic risk was calculated. Chi square was used for categorical variables. ANOVA was performed and a logistic regression model to determine the association of the variables with the presence of dyslipidaemia. A percentage of 68.6 had dyslipidaemia. A significant difference between the presence of dyslipidaemia and activity index measured by SLEDAI was found, the presence of lupus nephritis, use of prednisone≥20mg/day, evolution of the disease<3 years. Significance between the absence of dyslipidaemia and use of hydroxychloroquine was found. SLEDAI≥4 and the use of prednisone≥20mg/day were independently associated with the presence of dyslipidaemia. The average of Castelli rate was 5.02, the Kannel index was 2.97 and triglyceride/HDL-C ratio was 5.24. Patients with systemic lupus erythematosus have a high prevalence of dyslipidaemia and a high atherogenic rate, which increases cardiovascular risk significantly. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Organ involvement in Argentinian systemic sclerosis patients with "late" pattern as compared to patients with "early/active" pattern by nailfold capillaroscopy.

Science.gov (United States)

Marino Claverie, Lucila; Knobel, Elizabeth; Takashima, Lorena; Techera, Lorena; Oliver, Marina; Gonzalez, Paula; Romanini, Félix E; Fonseca, María L; Mamani, Marta N

2013-06-01

Changes in nailfold capillaroscopy in systemic sclerosis patients could be related to the disease severity. The aim of this study was to investigate whether patients with "late" scleroderma (SD) pattern have more organ involvement than patients with "early/active" SD pattern. Forty-six Argentinian patients (44 women and 2 men), with a diagnosis of systemic sclerosis, were distributed in two groups based on the presence of late and early/active patterns. Organ involvement was assessed as follows: pulmonary function by chest radiography, high-resolution chest tomography (HRCT), lung volume tests, and diffusing capacity for carbon monoxide (DLCO); esophageal involvement by manometry; and pulmonary arterial hypertension (PAH) by Doppler echocardiography and six-minute walk test. Honeycombing of the lungs evaluated by HRCT was more frequently present in patients with late pattern compared with early/active patients (p = 0.01). We also found statistically significant differences in lung volume tests (p = 0.03) and DLCO (p = 0.02) between the two SD pattern groups. Esophageal manometry showed a significantly higher frequency of motility disorders in the group with late pattern (p = 0.0024). In this study, patients with late pattern had higher frequency of pulmonary and esophageal involvement compared with patients with early/active pattern.

Hydroxychloroquine decreases Th17-related cytokines in systemic lupus erythematosus and rheumatoid arthritis patients

Directory of Open Access Journals (Sweden)

Juliana Cruz da Silva

2013-06-01

Full Text Available OBJECTIVES: Hydroxychloroquine is an antimalarial agent that has been used in systemic lupus erythematosus and rheumatoid arthritis treatment for many years. Recently, novel mechanisms of action have been proposed, thereby broadening the therapeutic perspective of this medication. The purpose of this study was to evaluate the immunomodulatory activity of hydroxychloroquine in T helper 17 (Th17 cytokines in healthy individuals and patients. METHODS: Eighteen female patients with systemic lupus erythematosus (mean age 39.0±12.9 years and 13 female patients with rheumatoid arthritis (mean age 51.5±7.7 years were recruited from Universidade Federal de Pernambuco-Brazil. The patients were included after fulfilling four classification criteria for systemic lupus erythematosus or rheumatoid arthritis from the American College of Rheumatology. After being stimulated with phorbol 12-myristate 13-acetate and ionomycin in the absence or presence of different concentrations of hydroxychloroquine, the interleukin 6, 17 and 22 levels were quantified with an enzyme-linked immunosorbent assay in culture supernatants of peripheral blood mononuclear cells from healthy individuals and patients. RESULTS: We demonstrated that in peripheral blood mononuclear cells from healthy volunteers and in systemic lupus erythematosus and rheumatoid arthritis patients, there was a significant reduction in the IL-6, IL-17 and IL-22 supernatant levels after adding hydroxychloroquine. CONCLUSIONS Our in vitro results demonstrated that hydroxychloroquine inhibits IL-6, IL-17 and IL-22 production and contributes to a better understanding of the mechanism of action of this medication.

A Coordinated Patient Transport System for ICU Patients Requiring Surgery: Impact on Operating Room Efficiency and ICU Workflow.

Science.gov (United States)

Brown, Michael J; Kor, Daryl J; Curry, Timothy B; Marmor, Yariv; Rohleder, Thomas R

2015-01-01

Transfer of intensive care unit (ICU) patients to the operating room (OR) is a resource-intensive, time-consuming process that often results in patient throughput inefficiencies, deficiencies in information transfer, and suboptimal nurse to patient ratios. This study evaluates the implementation of a coordinated patient transport system (CPTS) designed to address these issues. Using data from 1,557 patient transfers covering the 2006-2010 period, interrupted time series and before and after designs were used to analyze the effect of implementing a CPTS at Mayo Clinic, Rochester. Using a segmented regression for the interrupted time series, on-time OR start time deviations were found to be significantly lower after the implementation of CPTS (p < .0001). The implementation resulted in a fourfold improvement in on-time OR starts (p < .01) while significantly reducing idle OR time (p < .01). A coordinated patient transfer process for moving patient from ICUs to ORs can significantly improve OR efficiency, reduce nonvalue added time, and ensure quality of care by preserving appropriate care provider to patient ratios.

Comparing demographics, clinical presentation, treatments and outcome between systemic lupus erythematosus patients treated in a public and private health system in Santa Fe, Argentina.

Science.gov (United States)

Schmid, María Marcela; Roverano, Susana Graciela; Paira, Sergio Oscar

2014-01-01

The study includes 159 SLE patients seen between 1987 and 2011, of whom 116 were treated in the public health system and 43 in private practice. In the comparison between both groups, it was shown that patients in the public health system were younger at first consultation and at the onset of SLE, and that the mean duration of their disease prior to nephropathy was statistically significantly shorter. They also presented with more SLE activity (measured by Systemic Lupus Erythematosus Activity Index) such as fever, lower levels of C4, and elevated erythrocyte sedimentation rate. Although cyclophosphamide was administered more frequently to patients in the public health system group, there were no statistically significant differences in renal histological findings. A second renal biopsy was performed on 20 patients due to the presence of persistent proteinuria, peripheral edema, urinary casts, or because of previous defective renal specimens. The overall 10-year survival of the patients in the public health system was 78% compared to a survival rate of 91% for the patients in private practices. When survival was evaluated at 15 years, however, no differences were found (log rank test: 0.65). Patients from both public and private groups attended medical specialist practices and received early diagnoses and close follow-ups. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Evaluation of the cardiovascular system by digital subtraction angiography in 246 patients

Energy Technology Data Exchange (ETDEWEB)

Higuma, Kikuhiko; Ohta, Takashi; Hiroto, Seiji

1987-07-01

Usefulness of intravenous digital subtraction angiography (DSA) was examined in 246 patients with cardiovascular disorders. This examination was done by centrally intravenous DSA (CIVDSA) in all patients to reduce the risks and discomforts by peripheral intravenous DSA. 1) CIVDSA could be done safely in patients aged 18 to 81 years. 2) The good diagnostic quality by CIVDSA was obtained in 81.3% of patients. These images were classified into 7 groups according to the cardiovascular system, that is, the jugular arteries, the upper extremity arteries, the thoracic aorta, the left ventricle, the abnominal aorta, the renal arteries, and the lower extremity arteries, whose rate of good diagnostic quality were 100%, 70%, 67.7%, 79.5%, 84.8%, 87%, and 71.4% respectively. 3) The poor diagnostic quality was obtained in 18.7%. 4) The severe complications were not found in any case during this examination. Our results indicate that DSA is the safe, simple and useful method to obtain the diagnostic quality image of the cardiovascular system, especially, of the occulsive arterial disease, the aortic aneurisma, the renovascular stenosis and the cardiac function of postmyocardial infarction, even in aged patients.

Evaluation of the cardiovascular system by digital subtraction angiography in 246 patients

International Nuclear Information System (INIS)

Higuma, Kikuhiko; Ohta, Takashi; Hiroto, Seiji

1987-01-01

Usefulness of intravenous digital subtraction angiography (DSA) was examined in 246 patients with cardiovascular disorders. This examination was done by centrally intravenous DSA (CIVDSA) in all patients to reduce the risks and discomforts by peripheral intravenous DSA. 1) CIVDSA could be done safely in patients aged 18 to 81 years. 2) The good diagnostic quality by CIVDSA was obtained in 81.3 % of patients. These images were classified into 7 groups according to the cardiovascular system, that is, the jugular arteries, the upper extremity arteries, the thoracic aorta, the left ventricle, the abnominal aorta, the renal arteries, and the lower extremity arteries, whose rate of good diagnostic quality were 100 %, 70 %, 67.7 %, 79.5 %, 84.8 %, 87 %, and 71.4 % respectively. 3) The poor diagnostic quality was obtained in 18.7 %. 4) The severe complications were not found in any case during this examination. Our results indicate that DSA is the safe, simple and useful method to obtain the diagnostic quality image of the cardiovascular system, especially, of the occulsive arterial disease, the aortic aneurisma, the renovascular stenosis and the cardiac function of postmyocardial infarction, even in aged patients. (author)

HPV infection and vaccination in Systemic Lupus Erythematosus patients: What we really should know

NARCIS (Netherlands)

I. Grein (Ingrid); N. Groot (Noortje); Lacerda, M.I. (Marcela Ignacchiti); N.M. Wulffraat (Nico); G. Pileggi (Gecilmara)

2016-01-01

textabstractPatients with Systemic Lupus Erythematosus (SLE) are at increased risk for infections. Vaccination is a powerful tool to prevent infections, even in immunocompromised patients. Most non-live vaccines are immunogenic and safe in patients with SLE, even if antibody titres are frequently

Description of web-enhanced virtual character simulation system to standardize patient hand-offs.

Science.gov (United States)

Filichia, Lori; Halan, Shivashankar; Blackwelder, Ethan; Rossen, Brent; Lok, Benjamin; Korndorffer, James; Cendan, Juan

2011-04-01

The 80-h work week has increased discontinuity of patient care resulting in reports of increased medication errors and preventable adverse events. Graduate medical programs are addressing these shortcomings in a number of ways. We have developed a computer simulation platform called the Virtual People Factory (VPF), which allows us to capture and simulate the dialogue between a real user and a virtual character. We have converted the system to reflect a physician in the process of "checking-out" a patient to a covering physician. The responses are tracked and matched to educator-defined information termed "discoveries." Our proof of concept represented a typical post-operative patient with tachycardia. The system is web enabled. So far, 26 resident users at two institutions have completed the module. The critical discovery of tachycardia was identified by 62% of users. Residents spend 85% of the time asking intraoperative, postoperative, and past medical history questions. The system improves over time such that there is a near-doubling of questions that yield appropriate answers between users 13 and 22. Users who identified the virtual patient's underlying tachycardia expressed more concern and were more likely to order further testing for the patient in a post-module questionnaire (P = 0.13 and 0.08, respectively, NS). The VPF system can capture unique details about the hand-off interchange. The system improves with sequential users such that better matching of questions and answers occurs within the initial 25 users allowing rapid development of new modules. A catalog of hand-off modules could be easily developed. Wide-scale web-based deployment was uncomplicated. Identification of the critical findings appropriately translated to user concern for the patient though our series was too small to reach significance. Performance metrics based on the identification of critical discoveries could be used to assess readiness of the user to carry off a successful hand

Non-invasive imaging of skin cancer with fluorescence lifetime imaging using two photon tomography

Science.gov (United States)

Patalay, Rakesh; Talbot, Clifford; Alexandrov, Yuriy; Munro, Ian; Breunig, Hans Georg; König, Karsten; Warren, Sean; Neil, Mark A. A.; French, Paul M. W.; Chu, Anthony; Stamp, Gordon W.; Dunsby, Christopher

2011-07-01

Multispectral fluorescence lifetime imaging (FLIM) using two photon microscopy as a non-invasive technique for the diagnosis of skin lesions is described. Skin contains fluorophores including elastin, keratin, collagen, FAD and NADH. This endogenous contrast allows tissue to be imaged without the addition of exogenous agents and allows the in vivo state of cells and tissues to be studied. A modified DermaInspect® multiphoton tomography system was used to excite autofluorescence at 760 nm in vivo and on freshly excised ex vivo tissue. This instrument simultaneously acquires fluorescence lifetime images in four spectral channels between 360-655 nm using time-correlated single photon counting and can also provide hyperspectral images. The multispectral fluorescence lifetime images were spatially segmented and binned to determine lifetimes for each cell by fitting to a double exponential lifetime model. A comparative analysis between the cellular lifetimes from different diagnoses demonstrates significant diagnostic potential.

Concomitant parenteral nutrition and systemic cytotoxic therapy in a metastatic colorectal cancer patient

Directory of Open Access Journals (Sweden)

A. A. Popov

2012-01-01

Full Text Available Pathologic nutrients metabolism presents a severe problem in metastatic colorectal cancer patients, especially those with canceromatosis. A hypermetabolism-catabolism syndrome frequently develops in in patients with progressing canceromatosis. This leads to cachexia anorexia syndrome, which significantly impedes available treatment options. Artificial nutrition allows to improve available treatment in such patients. We present a successful case of concomitant parenteral nutrition and systemic cytotoxic therapy in metastatic colorectal cancer patient with peritoneal canceromatosis.

System theory in industrial patient monitoring: an overview.

Science.gov (United States)

Baura, G D

2004-01-01

Patient monitoring refers to the continuous observation of repeating events of physiologic function to guide therapy or to monitor the effectiveness of interventions, and is used primarily in the intensive care unit and operating room. Commonly processed signals are the electrocardiogram, intraarterial blood pressure, arterial saturation of oxygen, and cardiac output. To this day, the majority of physiologic waveform processing in patient monitors is conducted using heuristic curve fitting. However in the early 1990s, a few enterprising engineers and physicians began using system theory to improve their core processing. Applications included improvement of signal-to-noise ratio, either due to low signal levels or motion artifact, and improvement in feature detection. The goal of this mini-symposium is to review the early work in this emerging field, which has led to technologic breakthroughs. In this overview talk, the process of system theory algorithm research and development is discussed. Research for industrial monitors involves substantial data collection, with some data used for algorithm training and the remainder used for validation. Once the algorithms are validated, they are translated into detailed specifications. Development then translates these specifications into DSP code. The DSP code is verified and validated per the Good Manufacturing Practices mandated by FDA.

Educational potential of a virtual patient system for caring for traumatized patients in primary care

Science.gov (United States)

2013-01-01

Background Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC). Methods A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system’s usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data. Results Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results. Conclusions Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on

Fellowship Program in Health System Improvement: A novel approach integrating leadership development and patient-centred health system transformation.

Science.gov (United States)