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PubMed1998

Nocturnal hemodialysis: three-year experience.

There is evidence that high frequency, as well as long duration, hemodialysis provides better clinical outcomes. We developed nocturnal hemodialysis, a new innovative form of renal replacement therapy, which is performed six to seven nights per week for 8 to 10 h during sleep at home. Blood flow was set at 300 ml/min and dialysate flow at 100 ml/min. An internal jugular catheter was used as the vascular access. Special precautions were taken to prevent accidental disconnection during sleep, as well as air embolization. Dialysis functions from the patient's home were monitored continuously via a modem at the nocturnal hemodialysis center. Twelve patients have completed training and have been successfully performing nocturnal hemodialysis for up to 34 mo. This study represents 170 patient months of experience accumulated over 3 yr. There was hemodynamic stability and significant subjective improvement in patient well being. Nightly Kt/V was 0.99. Weekly removal of phosphate was twice as high and beta2 microglobulin 4 times as high as conventional hemodialysis. All patients have discontinued their phosphate binders and have increased dietary phosphate and protein intake. BP control was achieved with fewer medications. Dialyzer reuse has decreased the operating costs to the level of the other form of home dialysis. Complications were infrequent and were related primarily to the dialysis access. Nocturnal hemodialysis represents the most efficient form of dialysis at low cost and should be considered as an option for patients who can be trained for home hemodialysis.

Adult↗

PubMed2003

The principles of telemedicine in practice.

Telemedicine (distance medicine) represents a field of medicine that has been in a tremendous expansion over the last couple of years thanks to the fast development of telecommunications and reduction of their costs. It enables a direct communication (visual) between the peripheral hospitals and referral facilities in the interior of the country as well as a connection of centres with referral centres abroad in the fields of diagnostics, consultations or education. The main objective is to encourage interest in telemedicine among physicians and other health care experts, initiate an exchange of opinions, and experience about the application of telecommunication technology in medicine, so to reach a common perception of its role in the context of future development of the health care system in Bosnia and Herzegovina. As a standard, current equipment consists of computers, which are equipped with frame grabbers and communication modem for communication through a public telecommunication system. Input data can all be visual data (X-Ray, CT, MRI, ultrasound, ECG, histological finding, cariogram, and of course photos of the patients, of operational/surgical field. The Institute of Pathology of the Sarajevo Medical Faculty has actively participated in the experimental project "SHARED" (1996-2000) together with the Radiology and Ophthalmology Clinic of the Sarajevo Clinical Centre. The past experience in using telemedicine has shown that the introduction of such a telemedicine system in B&H would be of great significance in the future in the context of providing better and more efficient health services to the patients. In practice, that means a more simple approach to some services and data for patients, a better and faster circulation of information and experience of medical experts and health care workers with cost control at the same time.

Journal Article↗

PubMed1995

The rapid implementation of a statewide emergency health information system during the 1993 Iowa flood.

In the face of disastrous flooding, the Iowa Department of Public Health established the statewide Emergency Computer Communications Network to establish rapid electronic reporting of disaster-related health data, provide e-mail communications among all county health departments, monitor the long-range public health effects of the disaster, and institute a general purpose public health information system in Iowa. Based on software (CDC WONDER/PC) provided by the Centers for Disease Control and Prevention and using standard personal computers and modems, this system has resulted in a 10- to 20-fold increase in surveillance efficiency at the health department, not including time saved by county network participants. It provides a critical disaster assessment capability to the health department but also facilitates the general practice of public health.

Computer Communication Networks↗

PubMed2006

Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis.

BACKGROUND: The functional outcomes following ankle arthrodesis are not known. The purpose of the present study was to compare the intermediate-term clinical results for a group of patients in whom an ankle arthrodesis had been performed with use of modern surgical techniques with the findings for a group of healthy gender and age-matched controls on the basis of validated outcome measures and gait analysis. METHODS: Twenty-six patients who had undergone ankle arthrodesis for the treatment of isolated unilateral ankle arthritis were identified and retrospectively assessed clinically and radiographically. The mean age at the time of surgery was fifty-four years, and the mean interval between surgery and assessment was forty-four months. A gender and age-matched control group of twenty-seven individuals was recruited for comparison. All subjects were evaluated with gait analysis, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, the Musculoskeletal Outcomes Data Evaluation and Management Systems (MODEMS) questionnaire, and the Ankle Osteoarthritis Scale (AOS). RESULTS: On preliminary review, twenty of the twenty-six patients were completely satisfied or satisfied with their surgical outcome. All patients but one stated that they would undergo the surgery again. Five patients stated that they did not notice a gait abnormality. Twelve patients wore orthotics, and all believed that the use of the orthotics improved their gait. When the functional outcome scores in the arthrodesis group were compared with those in the control group, specific scores assessing hindfoot pain and satisfaction were similar. However, scores focusing on ankle-hindfoot function and disability revealed significant differences. Gait analysis also identified significant differences between the two groups with regard to cadence and stride length. In addition, there was significantly decreased sagittal, coronal, and transverse range of motion of the hindfoot and midfoot during the stance and swing phases of gait in the arthrodesis group. Radiographic review demonstrated that four of the twenty-six patients had development of moderate to severe arthritis of the subtalar joint. CONCLUSIONS: In the intermediate term following an arthrodesis for the treatment of end-stage ankle arthritis, pain is reliably relieved and there is good patient satisfaction. However, there are substantial differences between patients and the normal population with regard to hindfoot function and gait. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function; however, it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of ipsilateral hindfoot arthritis.

Adolescent↗

PubMed1995

Operational aspects of Quality-of-Life Assessment. Choosing the right instrument.

In assessing quality of life, the most important goal is to develop a strategy that produces useable and useful information for decision making. Assessment design is complex, and whether an assessment is developed from scratch, or 1 or more portions of existing instruments are adapted, the focus must be on the quality of the theoretical and operational elements of the particular line of inquiry and its environment. The necessary and most often discussed focus on the theoretical dimensions of validity, reliability and responsiveness is not sufficient to insure that the data are of the requisite high quality. There is also a need, almost universally given little attention in the literature, to look at operational aspects, such as design, format, flow, appearance, and response-stimulus, of each assessment instrument. Searching for guidance in the quality-of-life (QOL) literature remains a challenge even with computers, modems, keywords, static guidebooks and bibliographic systems. The On-Line Guide to Quality-of-Life Assessments (OLGA) is presented as a personal computer-based system that is updated 3 times a year to provide QOL researchers and assessment developers with 2 databases: assessments providing full descriptions and contact information; and references providing fully keyed citations to the assessment use literature. These databases are made more useful by decision-logical programs that identify relevant assessments and supporting research literature. OLGA can thus save time and other resources by helping investigators concentrate on the most relevant elements of the existing literature. This focus will assist them in avoiding the problems of ending up with the right answers to the wrong questions.

Health Status↗

PubMed2000

[Microbes on the edge of global biosphere].

The search for life on the edge of global biosphere is a frontier to bridge conventional bio/ecology and exo/astrobiology. This communication reviews the foci of microbiological studies on the inhabitants of the selected "edges", i.e., deep-sea, deep subsurface and Antarctic habitats. The deep-sea is characterized as the no-light (non-photosynthetic) habitat, and the primary production is mostly due to the chemosynthetic autotrophy at the hydrothermal vents and methane-rich seeps. Formation of the chemosynthesis-dependent animal communities in the deep leads to the idea that such communities may be found in "ocean" of the Jovian satellite, Europa. The oxygen minimal layer (OML) in mid-water provides another field of deep-sea research. Modern OML is a relatively thin layer, found between the water depth of 200 and 1000 m, but was much thicker during the periods of oceanic anoxia events (OAEs) in the past. The history of oceanic biosphere is regarded as the cycle of OAE and non-OAE periods, and the remnants of the past OAEs may be seen in the modem OML. Anoxic (no-O2) condition is also characteristic of deep subsurface biosphere. Microorganisms in deep subsurface biosphere exploit every available oxidant, or terminal electron acceptor (TEA), for anaerobic respiration. Sulfate, nitrate, iron (III) and CO2 are the representative TEAs in the deep subsurface. Subsurface of hydrothermal vents, or sub-vent biosphere, may house brine (high salt) habitats and halophilic microorganisms. Some sub-vent halophiles were phylogenetically closely similar to the ones found in the Antarctic habitats which are extremely dry by the liophilizing climate. Below the 3000-4000 m-thick glacier on Antarctica, there have been >70 lakes with liquid water located. One of such sub-glacial lakes, Lake Vostok, has been a target of "life in extreme environments" and is about to be drill-penetrated for microbiological studies. These 'microbiological platforms' will provide new knowledge about the diversity and potential of the Earth's life and facilitate the capability of astrobiologial exploration.

Antarctic Regions↗

PubMed1994

Solo practice management: value of a computerized reporting system.

OBJECTIVE. A computerized reporting system based on keyed entry of acronyms and eponyms was developed to reduce transcription delays and speed report output for a solo radiology practice that covers several community hospitals in a large region. The purpose was to improve practice outcomes, quality assessments, continuing medical education, and billing efficiency. SYSTEM AND APPLICATIONS. Over a 10-year period, problems in accurate reporting, transcription delays, slowed report deliveries, and incomplete or lost billings were described to computer programmers. These programmers composed 31,000 lines of computer code designed to address the problems. The resultant program was applied to 100,000 imaging procedures. Entry of commonly used clinical acronyms, eponyms, and other symbol strings chosen by the interpreting radiologist triggered the immediate printing of a report's text at the radiologist's desk. After the reports were proofread, electronically authenticated, and/or hand signed, they were sent to distant locales by facsimile transmission. During new case interpretations, potentially erroneous statements of fact or judgement were prevented by enabling the interpreter to instantly review old reports, informative elements of a patient's history, and pertinent medical literature, all of which was placed in various caches of the computer's memory. Billing labor was reduced by automatically providing the number identifying each procedure and the diagnoses made during image interpretation. OPERATION. The acronym/eponym-based reporting system was time- and cost-effective. The new system reduced typing strokes by 84%, and reports were generated in 1 min, while the studies were being interpreted. With the retrieval and monitoring techniques operating on old, stored information, new reporting errors, as well as some diagnostic oversights, were reduced by 50%. Counting the acronyms and symbols representing imaging quality and technical problems showed an 11% mistake rate. Modem transmission of automatically included current procedural terms and disease classification numbers reduced billing labor by 50% and reduced lost charges to zero. The same messaging mechanism of the program sent the text of interpretations to remote clinics and hospitals a few minutes after the radiologist's interpretation was made. CONCLUSION. My experience suggests that a computerized reporting and messaging system based on acronyms and eponyms is a time- and cost-effective technique for managing a solo radiology practice. By using a programmable relational data base, one can modify the system to include educational, quality improvement, and billing functions.

Abbreviations as Topic↗

PubMed1999

The virtual lecture: delivery of live and recorded presentations over the Internet.

OBJECTIVE: Our objective was to deliver live and recorded lectures, with images, over the Internet using streaming media. CONCLUSION: Streaming media are an emerging technology that can deliver live lectures over the Internet using standard PCs and modems. These lectures are also simultaneously recorded and can be played back at any time by individuals with access to the Web.

Education, Distance↗

PubMed2000

The virtual course: delivery of live and recorded continuing medical education material over the Internet.

OBJECTIVE: Our objective was to deliver live and recorded lectures from a continuing medical education course, including the representations of original slides, over the Internet, using streaming audio media. CONCLUSION: The streaming audio media, an emerging technology, not only delivers large lectures over the Internet using commercially available PCs and modems, but also allows review at any time by individuals with access to the Web. An interactive conference of continuing medical education curriculum can thus be delivered and continuing medical education credit earned without leaving home.

Education, Distance↗

PubMed2005

[Modern aspects of the ankle fracture treatment].

The ankle fractures continue to be a topical issue in orthopedic surgery. X-ray diagnostics, but primarily also other modem diagnostic procedures such as CT, MRI, and arthroscopy enable detection of not only fractures but also osteocartilaginous fractures and soft-tissue ligamentary lesions, which are frequent causes of pain and instability of the ankle. The key segment is the posterio-lateral segment and tibio-fibular syndesmosis whose integrity is sometimes only surgically establishable. In the ankle treatment, stable fixation - since recently by means of resorptive osteofixation materials - and early rehabilitation of the operated ankle are aimed at. The open and pylon fractures, as the most severe forms of ankle fractures, are treated by external fixation with minimum internal fixation (hybrid fixation) of the ankle with conversion of the rigid into a dynamic (articulated) external fixator enabling movement and nutrition of the damaged articular cartilage.

Ankle Injuries↗

PubMed2004

Telecare for patients with type 1 diabetes and inadequate glycemic control: a randomized controlled trial and meta-analysis.

OBJECTIVE: To determine the efficacy of telecare (modem transmission of glucometer data and clinician feedback) to support intensive insulin therapy in patients with type 1 diabetes and inadequate glycemic control. RESEARCH DESIGN AND METHODS: Thirty-one patients with type 1 diabetes on intensive insulin therapy and with HbA1c >7.8% were randomized to telecare (glucometer transmission with feedback) or control (glucometer transmission without feedback) for 6 months. The primary end point was 6-month HbA1c. To place our findings in context, we pooled HbA1c change from baseline reported in randomized trials of telecare identified in a systematic review of the literature. RESULTS: Compared with the control group, telecare patients had a significantly lower 6-month HbA1c (8.2 vs. 7.8%, P = 0.03, after accounting for HbA1c at baseline) and a nonsignificant fourfold greater chance of achieving 6-month HbA1c < or =7% (29 vs. 7%; risk difference 21.9%, 95% CI -4.7 to 50.5). Nurses spent 50 more min/patient giving feedback on the phone with telecare patients than with control patients. Meta-analysis of seven randomized trials of adult patients with type 1 diabetes found a 0.4% difference (95% CI 0-0.8) in HbA1c mean change from baseline between the telecare and control groups. CONCLUSIONS: Telecare is associated with small effects on glycemic control in patients with type 1 diabetes on intensive insulin therapy but with inadequate glycemic control.

Adult↗

PubMed2001

[Computer communication between an ambulatory centre and its hospital of reference].

BACKGROUND: To analyse the demand for medical information requested by a primary care team from its hospital of reference over an 18 month period. MATERIAL AND METHODS: Patients assigned to 5 surgeries of a primary care team, which had computerised clinical records available in its hospital of reference. In 1995 computerised communication via modem was set up between this team and the "Local Area Network" of its hospital of reference. This connection allows members of the team to carry out real time consultations of the hospital clinical records of their patients (reports, complementary explorations...) and the laboratory and radiology reports requested by the primary care team. Consultations made over an 18 month period (March 96 - August 97) were analysed. RESULTS: Five hundred and twenty three consultations were made (29.06 per month). Ninety three point seven per cent of the patients concerning whom consultations were made had a computerised clinical record available. The most consulted services were: Radiology (28.7%), Laboratory (25.2%) and Internal Medicine (16.3%). The most consulted parts of the clinical record were those corresponding to the results of complementary tests: simple radiology (27.3%), haematology and biochemistry (24.7%), other explorations (23.7%). Some 67.5% of the searches were considered "resolutive" by the consulting doctor. An average of 4 minutes 13 seconds were employed per consultation. CONCLUSIONS: The information principally required by the family doctor was the results of complementary tests and, in particular, from the laboratory and radiology. Computerised communication between primary care and specialised care is going to be an effective, and probably efficient, system for improving communication between the two levels.

English Abstract↗

PubMed1986

Transmitting deaf sign language over the telecommunications network.

An experimental investigation is reported into the use of moving cartoon images for two-way communication by the deaf. The images are derived by special signal-processing operations on the output of a conventional television camera, according to a new theory of perceptually important human features. Calculations show that, using facsimile-type coding and digital modems, the images are capable of transmission over the Public Switched Telephone Network; in enhanced form (with more resolution and optional voice accompaniment) they could be carried on the emerging Integrated Services Digital Network or transmitted over teletext.

Communication Devices for People with Disabilities↗

PubMedDate not supplied

A fast communication aid for non-verbal subjects with severe motor handicaps.

A computer-based communication system for non-verbal persons with severely deficient coordination of the upper extremities is described. The device doubles as an environmental control unit. Modular design is chosen throughout. Commercially available subunits are used to reduce cost. Input is by a 3 x 3 keyboard, when the user has some command over his hands. Otherwise a binary 'autoscan' access mode is used, which is controlled by repeated closures of a single binary switch. Output is in written form on a display or acoustical by synthesized speech. Hard-copy output can also be provided. Remote communication is possible by modem or by synthesized speech. Speed of message generation is increased by establishing a vocabulary, which contains, in addition to signs and letters of the alphabet, whole words and stereotyped phrases. The data blocks of the latter are accessed by a single input cycle similar to that used for the selection of isolated letters, symbols, etc.

Communication Devices for People with Disabilities↗

PubMed2000

Intraocular gas tamponades.

Intraocular gas tamponades are an important part of vitreoretinal surgery and have become a standard of care. The use of intraocular gas began in 1911. Modem use of intraocular gases as a surgical adjunct is continuously broadening. Today, sulfur hexafluoride and perfluoropropane are increasingly being used as intraocular gas tamponades for a wide range of complicated vitreoretinal diseases. This article reviews the types and function of commonly used gases, their indications and efficacy in certain types of vitreoretinal diseases, and their complications.

Air↗

PubMedDate not supplied

Data quality of a computerized medical birth registry.

Processed by a computerized medical birth registry system, the birth records of 20,103 deliveries, from February 1992 to February 1993, were digitized with medium registry. From 1 January to 28 February 1993, the original records (n = 2840 cases) of all 10 collaborative hospitals were requested for assessment of data quality. Thirty-six items were scored, data of poor quality was found in eight; acceptable quality in four; and good quality in 28. The feasibility of data transfer by floppy disc and per modem was evaluated. This registry system had effectively shortened data processing time and improved mutual feedback between the data centre and the delivery units. Errors resulting from technical faults originating in the preparation of data for computerization at hospital level could be effectively reduced. The validity of diagnosis remained as the major source of errors.

Birth Certificates↗

PubMed2003

Prognostic significance of annexin VII expression in glioblastomas multiforme in humans.

OBJECT: Glioblastoma multiforme (GBM) is the most common and lethal primary brain tumor in adults. It is nearly uniformly fatal, with a median survival time of approximately 1 year, despite modem treatment modalities. Nevertheless, a range of survival times exists around this median. Efforts to understand why some patients live longer or shorter than the average may provide insight into the biology of these neoplasms. The annexin VII (ANX7) gene is located on the human chromosome 10q21, a site long hypothesized to harbor tumor suppressor genes associated with prostate and other cancers. To test whether ANX7 expression might be a predictor for GBMs, we examined ANX7 expression, p53 accumulation, and the MIB-1 labeling index in a retrospective series of 99 GBMs. METHODS: In all 99 cases, the patient's age, Karnofsky Performance Scale (KPS) score before surgery, extent of surgery, tumor location, and immunohistochemical features were analyzed using univariate and multivariate analyses to identify whether any significance exists among ANX7 expression, p53 accumulation, the MIB-1 labeling index, and survival time. Kaplan-Meier analyses demonstrated that a higher KPS score before surgery (< 0.0001), total tumor excision (p = 0.0072), young patient age (p = 0.03), and ANX7 expression (p = 0.0006) correlated with longer survival. Multivariate Cox regression analyses demonstrated that ANX7 expression was the strongest predictor of outcome (p < 0.0001), independent of all other variables. In addition, ANX7 expression correlated with higher MIB-1 immunostaining, but did not correlate with p53 accumulation. Moreover, a significant positive correlation was observed between p53 and MIB-1 staining. CONCLUSIONS: These findings indicate that a higher KPS score before surgery, total tumor excision, young patient age, and ANX7 expression correlate with longer survival in patients with GBMs. Multivariate Cox regression analyses demonstrated that ANX7 expression was the strongest predictor of outcome (p < 0.0001) and was independent of all other variables.

Adult↗

PubMed2005

The Mayo brothers and Harvey Cushing: a review of their 39-year friendship through their personal letters.

Mayo Clinic founders, William J. Mayo and Charles H. Mayo, and Harvey W. Cushing were among the most significant pioneers of modem American surgery. A review of their personal correspondence reveals a special relationship among these three individuals, particularly between William Mayo and Cushing. Their interactions within the Society of Clinical Surgery initiated their close personal and professional association, which would endure for 39 years. William Mayo strongly supported Cushing's efforts to develop the specialty of neurological surgery, and Cushing sought Mayo's advice in making important career-related decisions. Their supportive friendship and professional alliance remains an example for future generations of neurological surgeons.

Correspondence as Topic↗