PubMed · 14710316
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Allen R Last. 2004. Good readers needed.. https://pubmed.ncbi.nlm.nih.gov/14710316/
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PURPOSE: Data on the impact of nutritional support (NS) on outcomes in surgical patients are reviewed. SUMMARY: While most patients will progress to oral nutrition after surgery and require little or no intervention, major surgery or postoperative complications can delay the prescription of an oral diet. In such patients, nutritional requirements are often increased to support wound healing and hypermetabolism associated with surgical recovery. Without adequate nutrition, muscle wasting, immune dysfunction, and declining visceral protein status are observed. While it would seem intuitive that early nutritional intervention is warranted for most patients, the literature to date suggests that early parenteral nutrition (PN) does not improve clinical outcomes. An exception may be for severely malnourished patients if NS is provided for at least seven days preoperatively. Such patients should be identified early through nutritional assessment. Early enteral nutrition (EN) may potentially improve patient outcomes compared with PN, but there are insufficient data to confirm this. High-dose parenteral glutamine may reduce infectious complications and the length of hospitalization for surgical patients, but a significant reduction in mortality has not been observed. Early EN with immune-enhancing formulas appears promising for general surgery patients. However, their use in the critically ill surgical patient is not unanimously supported, and some studies suggest potential harm. CONCLUSION: Surprisingly little evidence is available to support a significant impact of early NS on postoperative clinical outcomes.
PURPOSE: To build an infrastructure that enables radiologists on-call and external users a teleradiological access to the HTML-based image distribution system inside the hospital via internet. In addition, no investment costs should arise on the user side and the image data should be sent renamed using cryptographic techniques. MATERIALS AND METHODS: A pure HTML-based system manages the image distribution inside the hospital, with an open source project extending this system through a secure gateway outside the firewall of the hospital. The gateway handles the communication between the external users and the HTML server within the network of the hospital. A second firewall is installed between the gateway and the external users and builds up a virtual private network (VPN). A connection between the gateway and the external user is only acknowledged if the computers involved authenticate each other via certificates and the external users authenticate via a multi-stage password system. All data are transferred encrypted. External users get only access to images that have been renamed to a pseudonym by means of automated processing before. RESULTS: With an ADSL internet access, external users achieve an image load frequency of 0.4 CT images per second. More than 90 % of the delay during image transfer results from security checks within the firewalls. Data passing the gateway induce no measurable delay. CONCLUSION: Project goals were realized by means of an infrastructure that works vendor independently with any HTML-based image distribution systems. The requirements of data security were realized using state-of-the-art web techniques. Adequate access and transfer speed lead to a widespread acceptance of the system on the part of external users.