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At least 307 records · Page 17Linked to original sources

Innervated reverse dorsal digital island flap for fingertip reconstruction.

PURPOSE: Various methods of fingertip reconstruction with a sensory flap have been reported. Digital island flaps or cross-finger flaps have to be used for large defects; however, the digital artery is sacrificed when creating conventional homodigital island flaps and 2 surgeries are required for the cross-finger flap. We describe our experience with an innervated reverse dorsal digital island flap that does not require sacrifice of the digital artery. METHODS: We used innervated reverse dorsal digital flaps for fingertip reconstruction in 8 patients. The flap was supplied by the vascular network between the dorsal digital artery (the terminal branch of the dorsal metacarpal artery) and the dorsal branch of the digital artery. Venous drainage was through the cutaneous veins and the venous network associated with the dorsal arterial network. The flap was designed on either the dorsal proximal or the dorsal middle phalangeal region. The flap was harvested with the dorsal branch of the digital nerve (for the dorsal middle phalanx), the dorsal digital nerve (for the dorsal proximal phalanx), or the superficial branch of the radial nerve (for the thumb), which was anastomosed to the distal end of the digital nerve. After flap transfer the donor site was covered with a full-thickness skin graft. RESULTS: Of the 8 flaps, 6 survived completely, 1 had partial epithelial skin necrosis, and 1 showed central compression skin necrosis. Three flaps showed congestive changes from the first to the fifth day after surgery, which resolved by massage. All patients achieved satisfactory recovery of sensation; the static 2-point discrimination ranged from 3 mm to 5 mm and the Semmes-Weinstein test results ranged from 0.036 g to 0.745 g. CONCLUSIONS: The innervated reverse dorsal digital island flap provides another option for homodigital tip coverage. The advantages are that the digital artery is not sacrificed and only 1 surgery is needed. A disadvantage is the potential for venous congestion for the first 4 or 5 days after surgery.

Adult↗

Handwritten digit recognition using two-layer self-organizing maps.

In this paper, we present a two-layer self-organizing neural network based method for handwritten digit recognition. The network consists of a base layer self-organizing map and a set of corresponding maps in the second layer. The input patterns are partitioned into subspace in the first layer. Patterns in a subspace are led to the second layer and a corresponding map is built according to the first layer performance. In the classification process, each pattern searches for several closest nodes from the base map and then it is classified into a specified class by determining the nearest model of the corresponding maps in the second layer. The new method yielded higher accuracy and faster performance than the ordinary self-organizing neural network.

Handwriting↗

Quality management, certification and rating of health information on the Net with MedCERTAIN: using a medPICS/RDF/XML metadata structure for implementing eHealth ethics and creating trust globally.

MedCERTAIN (MedPICS Certification and Rating of Trustworthy Health Information on the Net, http://www.medcertain.org/) is a recently launched international project funded under the European Union's (EU) "Action Plan for safer use of the Internet". It provides a technical infrastructure and a conceptual basis for an international system of "quality seals", ratings and self-labelling of Internet health information, with the final aim to establish a global "trustmark" for networked health information. Digital "quality seals" are evaluative metadata (using standards such as PICS=Platform for Internet Content Selection, now being replaced by RDF/XML) assigned by trusted third-party raters. The project also enables and encourages self-labelling with descriptive metainformation by web authors. Together these measures will help consumers as well as professionals to identify high-quality information on the Internet. MedCERTAIN establishes a fully functional demonstrator for a self- and third-party rating system enabling consumers and professionals to filter harmful health information and to positively identify and select high quality information. We aim to provide a trustmark system which allows citizens to place greater confidence in networked information, to encourage health information providers to follow best practices guidelines such as the Washington eHealth Code of Ethics, to provide effective feedback and law enforcement channels to handle user complaints, and to stimulate medical societies to develop standard for patient information. The project further proposes and identifies standards for interoperability of rating and description services (such as libraries or national health portals) and fosters a worldwide collaboration to guide consumers to high-quality information on the web.

Certification↗

MedCERTAIN: quality management, certification and rating of health information on the Net.

MedCERTAIN (MedPICS Certification and Rating of Trustworthy Health Information on the Net, http://www.medcertain.org/) is a recently launched international project funded under the European Union's (EU) "Action Plan for safer use of the Internet. It provides a technical infrastructure and a conceptual basis for an international system of "quality seals", ratings and self-labelling of Internet health information, with the final aim to establish a "trustmark" for networked health information. Digital "quality seals" are evaluative metadata (using standards such as PICS = Platform for Internet Content Selection, now being replaced by RDF/XML) assigned by trusted third-party raters. The project also enables and encourages self-labelling with descriptive meta-information by web authors. Together these measures will help consumers as well as professionals to identify high-quality information on the Internet. MedCERTAIN establishes a fully functional demonstrator for a self- and third-party rating system enabling consumers and professionals to filter harmful health information and to positively identify and select high quality information. We aim to provide a system which allows citizens to place greater trust in networked information, exemplified in the domain of health information, whilst also making a significant contribution for similar projects with different target domains. The project will demonstrate how PICS-based content rating and filtering technologies can automate and exploit value-adding resource description services. It further proposes standards for interoperability of rating services.

Databases as Topic↗

Computerized plastic surgery office.

PURPOSE OF REVIEW: Technology in general and computer capabilities in particular are growing at an exponential rate. Keeping current with the latest technological capacities and means of incorporating this technology into the facial plastic surgeon's office poses a significant challenge. This review will document the most appropriate method of incorporation and the latest available technological tools. RECENT FINDINGS: Recent developments in wireless networking, systems integration, digital photography and video, powerful inexpensive computer systems, and the growth of personal digital assistant integration have all contributed to a surge in technological advances. Implementing any or all can significantly benefit the busy facial plastic surgery office. SUMMARY: Keeping abreast of technological advances is a daunting task. Adaptation of these advances into the office can at times be overwhelming. This review will assist the practicing physician in incorporating selective technological tools to streamline his or her systems and increase efficiency.

Ambulatory Care Information Systems↗

[New coronary imaging modality. I. Digital angiography (cineless) and low-energy digital fluoroangioscopy systems].

The advent of digital medical imaging offered unique new possibilities of analyzing, visualizing and communicating medical images. This article reviews the impact of the digital technology in the cardiac catheterization laboratory and covers a range of topics such as the standard DICOM, the transition to cineless angiography, the digital cardiac archive, the network system for imaging exchange and the role of the cardiac digital mobile imaging systems.

Angiography, Digital Subtraction↗

Image and report distribution on the Internet.

The Internet links together millions of computers to share a wide variety of information--words, sounds and images--which makes it ideally suited for applications in diagnostic imaging departments. Timely availability of patient information is critical to patient care. In the form of a report, image or both, information is the final product of every imaging department. Internet applications can allow physicians easy access to and review of patient information. Many imaging departments already have the basic components of Internet technology in place, which may include an existing image distribution network. At the University of Kansas Medical Center (UKMC), we had a good network base and digital digitation and distribution system, but had not found an appropriate PACS for image distribution and display. When a home page was designed for the radiology department at UKMC, it was intended for report distribution. However, we quickly discovered that it could also function as a low-cost/low-resolution image distribution system. Before making confidential patient information accessible on the Internet, appropriate information security requirements must be in place. At UKMC, access is strictly controlled through the medical records department. Programmers in the radiology department at UKMC are also using the Internet to develop applications for on-line review, editing and electronic signature. Early experience with the Internet as a basis for radiology image and report distribution has been extremely successful and popular with referring physicians at UKMC.

Academic Medical Centers↗

[Network of surgical wound centers using a new electronic data processing documentation system].

UNLABELLED: Care of chronic wounds is of enormous medical, social and economic importance. Nevertheless there is a lack of epidemiological and economical data. A network of ten wound care centers was created and data were documented in a new computerized wound documentation system. METHODS: Treatment was performed according to a comprehensive and standardized wound care protocol. The new documentation system is a network-capable solution. Digital images and planimetry as well as patient and wound related data are recorded. RESULTS: During the first year the ten centers treated and documented already 3281 wounds. There is a wide spectrum of different chronic wounds treated in the participating centers. Despite of long wound duration of several wounds with a median of 5 weeks (range 0-62 years), the healing rate was 80% within 455 days. CONCLUSION: Large amounts of data can be collected and scientifically evaluated in the wound net. This is realized by a new computerized documentation system, which was integrated into the clinical routine and enables clear and standardized documentation. Therefore even large multicenter therapy studies may be performed easily in the wound net and economical data could be collected.

Chronic Disease↗

Integrating multiple clinical information systems using the Java message service framework to enable the delivery of urgent exam results at the point of care.

The aim of this study is to determine if network-enabled personal digital assistants (PDAs) can be used to facilitate the timely delivery of urgent radiological exam results by reducing the interval from when the radiologist's initial interpretation is available to when it is first viewed by an emergency department (ED) physician. A web- and Java message service (JMS)-based application was built to replace the original fax-based wet-read procedure. The new system allows radiologists to enter wet-reads from the picture archiving and communication system (PACS) display station and to track discrepancies between the wet-read and final report. It also notifies the ED physicians when exam results are available via the PDAs and permits them to view the full text of the wet-read and final reports from the devices. The new system is compared to the original procedure with the results showing improvements with the wireless method. Furthermore, feedback from a qualitative survey of PDA users was positive, suggesting that PDAs may provide one means for accessing urgent clinical data at the point of care.

Computer Communication Networks↗

Microcomputer data acquisition and control.

In medicine and biology there are many tasks that involve routine well defined procedures. These tasks are ideal candidates for computerized data acquisition and control. As the performance of microcomputers rapidly increases and cost continues to go down the temptation to automate the laboratory becomes great. To the novice computer user the choices of hardware and software are overwhelming and sadly most of the computer sales persons are not at all familiar with real-time applications. If you want to bill your patients you have hundreds of packaged systems to choose from; however, if you want to do real-time data acquisition the choices are very limited and confusing. The purpose of this chapter is to provide the novice computer user with the basics needed to set up a real-time data acquisition system with the common microcomputers. This chapter will cover the following issues necessary to establish a real time data acquisition and control system: Analysis of the research problem: Definition of the problem; Description of data and sampling requirements; Cost/benefit analysis. Choice of Microcomputer hardware and software: Choice of microprocessor and bus structure; Choice of operating system; Choice of layered software. Digital Data Acquisition: Parallel Data Transmission; Serial Data Transmission; Hardware and software available. Analog Data Acquisition: Description of amplitude and frequency characteristics of the input signals; Sampling theorem; Specification of the analog to digital converter; Hardware and software available; Interface to the microcomputer. Microcomputer Control: Analog output; Digital output; Closed-Loop Control. Microcomputer data acquisition and control in the 21st Century--What is in the future? High speed digital medical equipment networks; Medical decision making and artificial intelligence.

Artificial Intelligence↗

Implementation and day-to-day usage of a client-server-based radiology information system.

Implementation of a second-generation radiology information system (RIS) requires attention to many issues, including work flow, system design, training, consideration for emerging technologies, and support. This presentation covers the issues, and solutions, involved in implementation and subsequent day-to-day usage of a client-server-based RIS tightly integrated with a hospital information system (HIS) using "thin client" software to limit hardware requirements for the client computers. The software and hardware implementation had to be designed for potential enterprise-wide scalability of the RIS for a system involving 11 hospitals. Issues arose regarding initial increased turnaround times, errors in importation of historical data, and problems with implementation of interfaces between the RIS and the billing system and between the RIS and the digital dictation system. Network errors and difficulties in using a thin client implementation had to be overcome. Hierarchical training was implemented, as support was switched from an "on-site" support group to a central Information System Division with responsibility to the entire enterprise.

Computer Systems↗

Meta-manager: a requirements analysis.

The digital imaging network-picture-archiving and communications system (DIN-PACS) will be implemented in ten sites within the Great Plains Regional Medical Command (GPRMC). This network of PACS and teleradiology technology over a shared T1 network has opened the door for round the clock radiology coverage of all sites. However, the concept of a virtual radiology environment poses new issues for military medicine. A new workflow management system must be developed. This workflow management system will allow us to efficiently resolve these issues including quality of care, availability, severe capitation, and quality of the workforce. The design process of this management system must employ existing technology, operate over various telecommunication networks and protocols, be independent of platform operating systems, be flexible and scaleable, and involve the end user at the outset in the design process for which it is developed. Using the unified modeling language (UML), the specifications for this new business management system were created in concert between the University of Arizona and the GPRMC. These specifications detail a management system operating through a common object request brokered architecture (CORBA) environment. In this presentation, we characterize the Meta-Manager management system including aspects of intelligence, interfacility routing, fail-safe operations, and expected improvements in patient care and efficiency.

Arizona↗

The philosophy of benchmark testing a standards-based picture archiving and communications system.

The Department of Defense issued its requirements for a Digital Imaging Network-Picture Archiving and Communications System (DIN-PACS) in a Request for Proposals (RFP) to industry in January 1997, with subsequent contracts being awarded in November 1997 to the Agfa Division of Bayer and IBM Global Government Industry. The Government's technical evaluation process consisted of evaluating a written technical proposal as well as conducting a benchmark test of each proposed system at the vendor's test facility. The purpose of benchmark testing was to evaluate the performance of the fully integrated system in a simulated operational environment. The benchmark test procedures and test equipment were developed through a joint effort between the Government, academic institutions, and private consultants. Herein the authors discuss the resources required and the methods used to benchmark test a standards-based PACS.

Benchmarking↗

[Virtual microscopy and digital pathology].

Virtual microscopy has advanced considerably and is bound to be integrated into routine diagnostics in the very near future. Its integration into existing information systems builds up digital pathology. In this review, we present details, advantages and limitations of this novel technology and describe solutions regarding its adaptation to routine workflow. The chief aim is to define an uniform data format for virtual specimens to guarantee an interoperability between different systems. In the long term, digital archives and networks will be established that will allow for a worldwide access to virtual specimens.

Humans↗

Department of Defense picture archiving and communication system acceptance testing: results and identification of problem components.

The PACS implementation process is complicated requiring a tremendous amount of time, resources, and planning. The Department of Defense (DOD) has significant experience in developing and refining PACS acceptance testing (AT) protocols that assure contract compliance, clinical safety, and functionality. The DOD's AT experience under the initial Medical Diagnostic Imaging Support System contract led to the current Digital Imaging Network-Picture Archiving and Communications Systems (DIN-PACS) contract AT protocol. To identify the most common system and component deficiencies under the current DIN-PACS AT protocol, 14 tri-service sites were evaluated during 1998-2000. Sixteen system deficiency citations with 154 separate types of limitations were noted with problems involving the workstation, interfaces, and the Radiology Information System comprising more than 50% of the citations. Larger PACS deployments were associated with a higher number of deficiencies. The most commonly cited systems deficiencies were among the most expensive components of the PACS.

Civil Defense↗

A context-free data compression approach to measuring information transmission by action potentials.

Action potentials allow nervous systems to transmit information rapidly and efficiently over considerable distances, but what is the information they carry and how much can be carried by one neuron? Often, qualitative and vague descriptions are used, such as the firing rate representing intensity. Recent attempts to quantify information transmission by action potentials have concentrated on treating neurons as communication channels, whose information capacity can be estimated from their signal-to-noise ratios. However, this only indicates how much information could theoretically be carried, not the actual amount at any given time, and the ratio itself depends on assumptions about information coding. Here we introduce a different approach based on the concept of data compression, which has become familiar with the widespread use of digital computers and networks. Compression takes advantage of redundancy in a sequence of numbers to reduce its size, but allows it to be reconstructed later without error. We show that data compression by a context-free grammar can quantitatively estimate the real information content of action potential signals without any prior assumptions about coding, or knowledge of neural inputs. Measurements of information coding by mechanosensory neurons are used as examples, but a major advantage of this approach is its generality. It can estimate information transmission by any neuron whose output can be measured, regardless of neuronal type, connectivity or function.

Action Potentials↗

Occupational exposure to radiofrequency fields in antenna towers.

Exposure of workers to radiofrequency fields was assessed in two medium-sized antenna towers. Towers had transmitting antennas from different networks, e.g. mobile phone networks, radio and digital TV sub-stations and amateur radio. The levels of radiofrequency fields were measured close to the ladders of the towers. All measured values were below ICNIRP occupational reference levels.

Cell Phone↗

Design and implementation of an electronic data recording and processing system for physics quality control checks in external beam radiotherapy.

Quality control (QC) of external beam radiotherapy equipment ensures that commissioning performance is maintained. Paper based data recording is still used for QC, but this is resource intensive in terms of data calculation and processing. Electronic systems of data recording have many advantages; for example, they facilitate the analysis of data on a regular basis, allowing the user to examine the "health" of each machine; they help review and audit local frequencies of each check and can possibly predict component failure. They also allow for secure calculation of results and automatic charting for routine trend analysis. Initially, data recording at our centre was paper-based for daily, weekly and monthly checks. This paper system has been successfully replaced with an electronic system for QC data recording and processing for linear accelerators and superficial units. The system makes use of personal digital assistants and networked laptops for online recording of data, and networked desktop PCs for offline work. The systems of data recording have been designed using the power of macros within Microsoft Excel, which automatically calculate each QC parameter and charts the data recorded for long-term analysis of trends. As of the beginning of 2006, these systems have been fully implemented. The benefits of implementing such a system are numerous, for example, central storage, backup and archiving of data, for greater security and reducing operator errors in calculations. Other benefits are discussed within the paper. In the future, we hope to develop similar systems of data recording for QC checks on other radiotherapy equipment.

Computers, Handheld↗