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PubMed2001

Cytochrome P450 database.

This paper describes a specialized database dedicated exclusively to the cytochrome P450 superfamily. The system provides the impression of superfamily's nomenclature and describes structure and function of different P450 enzymes. Information on P450-catalyzed reactions, substrate preferences, peculiarities of induction and inhibition is available through the database management system. Also the source genes and appropriate translated proteins can be retrieved together with corresponding literature references. Developed programming solution provides the flexible interface for browsing, searching, grouping and reporting the information. Local version of database manager and required data files are distributed on a compact disk. Besides, there is a network version of the software available on Internet. The network version implies the original mechanism, which is useful for the permanent online extension of the data scope.

Catalysis↗

PubMed2005

Diagnostic imaging pathways: development, dissemination, implementation, and evaluation.

ISSUE: There are signs of inappropriate application of medical imaging to diagnosis. Inappropriate imaging is a threat to effective diagnosis and effective allocation of resources. The development and deployment of knowledge-based clinical decision support systems is one strategy to reduce inappropriate imaging. DEVELOPMENT OF IMAGING PATHWAYS: A suite of 78 imaging pathways was conceived both as a decision support and educational tool. The pathways were drafted by imaging specialists, but further developed and modified, based on graded evidence and input from requesting clinicians. An electronic environment was developed to contain and deliver the pathways. DISSEMINATION AND IMPLEMENTATION: Imaging pathways were distributed via a hospital local area network and on compact disk. A multifaceted approach was used to raise general awareness of the pathways, followed by intensive 'marketing' activities. Two groups of clinicians were targeted; hospital-based clinicians and general practitioners. EVALUATION: There was increased awareness of imaging pathways. Clinicians judged them to be useful for education and decision support. The method of electronic delivery was adequate. Knowledge of diagnostic imaging and requesting behaviour tended to become more aligned with the pathways. The central objective to reduce inappropriate medical imaging seems to be achievable. LESSONS LEARNED: There is scope to improve the content and the electronic environment, achieve better integration into decision-making processes, and achieve better compliance. A linkage between imaging pathways and electronic requesting could provide alerts to 'non-compliant' requesting. The assignment of a higher cost, or a lower remuneration, to non-authorized and non-compliant imaging would provide tangible incentive to comply, unless there are compelling clinical contraindications.

Attitude of Health Personnel↗

PubMed2000

A brief history of the Journal of Bone and Joint Surgery.

The Journal of Bone and Joint Surgery had its origins in the Transactions of the American Orthopedic Association, which first were published in 1889. In 1903, the Transactions of the American Orthopedic Association, Volume 16, became the first volume of the American Journal of Orthopedic Surgery, still under the sponsorship of the American Orthopedic Association. In 1919, the word American was dropped from the title and the Journal of Orthopaedic Surgery became the official publication of the newly formed British Orthopaedic Association and the American Orthopedic Association. The name was changed to The Journal of Bone and Joint Surgery in 1921. Shortly after the founding of the American Academy of Orthopaedic Surgeons in 1933, The Journal became the official organ of the academy; however, ownership of The Journal remained with the American Orthopaedic Association. The British volume appeared in 1948. The Journal of Bone and Joint Surgery became an independent, not-for-profit corporation in 1954. The Journal, which continues to be a leader in the area of orthopaedic publication, began publishing the full text on compact disk in January 1992, the full text in electronic form through BRS/Saunders in 1995, and the full text on The Journal's website in December 1999.

History, 19th Century↗

PubMed1993

New perspectives in radioimmunoassay.

In addition to providing the basis of 'ultrasensitive' immunoassays, nonisotopic labels permit development of 'user friendly' methodologies, including simple devices designed for extralaboratory use and intended to provide yes/no answers to basic diagnostic questions, for example, the presence of an infectious disease, the commencement of pregnancy etc. Immunosensors are also intended to fulfil these objectives (albeit yielding quantitative information), but despite much research the prospect of adequately sensitive instruments of this type remains remote. Finally, nonisotopic labels enable the development of a new generation of miniaturized multianalyte assays permitting in principle the determination of entire analyte menus in small samples of body fluids. Such technologies will resemble those employed in compact disk recorders and other data-storage devices, differing only in that light emitted from discrete zones on a solid surface is fluorescent (or possibly chemiluminescent) rather than reflected, and yields chemical rather than physical information. The emergence of such technologies, will, inter alia, facilitate the screening of entire populations for infectious disease, endocrine dysfunctions, genetic abnormalities etc. using, for example, finger-tip blood samples, throat and endocervical swabs, and hopefully will contribute to the large-scale diagnosis and ultimate reduction of disease.

Humans↗

PubMed1998

Bladder injury during laparoscopic surgery.

The objective of this review is to present the incidence of latrogenic bladder injury associated with diagnostic and/or operative laparoscopic surgery; to determine the type of primary laparoscopic operation, the time at which the reported injuries occurred, the location of injuries, and the method(s) used to repair those injuries; to decide which laparoscopic procedure carries the highest risk for bladder injury; and to establish the most frequent surgical instruments with which injuries happened. World literature published between 1970 and 1996 was reviewed. The appropriate Medical Subject Heading (MeSH) terms were selected and used in a search of the MEDLINE, ACOGNET, OVID Compact Disk Version database. A total of 1372 articles on laparoscopic surgery complications were reviewed. Of that number, a total of 77 articles identified bladder injuries, and these were analyzed for the objectives of this study. There are a wide range of bladder injuries during laparoscopic procedures. In the studied articles, the incidence of bladder injury during laparoscopic procedures ranged from 0.02 to 8.3 percent of cases. Most frequently, these injuries occurred during laparoscopic-assisted vaginal hysterectomy. Sharp electrosurgical dissection was the leading instrument causing injury. An intraoperative diagnosis of bladder injury was made in 53.24 percent of all bladder injury cases. The bladder dome was the most commonly injured structure. Less than half (29.87 percent) of the bladder injuries were corrected laparoscopically.

Female↗

PubMed2003

Dynamic three-dimensional spiral computed tomographic cysto-urethrography: a novel technique for evaluating post-traumatic posterior urethral defects.

OBJECTIVE: To present a new method of identifying the anatomy of posterior urethral distraction defects (PUDDs) using three-dimensional spiral computed tomography/cysto-urethrography (CTCUG), as conventional two-dimensional CUG can give a false interpretation of the exact anatomy. PATIENTS AND METHODS: Twenty-one patients presenting with a PUDD were assessed between February 2001 and October 2002. All patients initially underwent combined ascending and micturating CUG (ACUG), followed by CTCUG analysed using special software. In this technique all soft-tissue densities were subtracted from the volume of interest leaving only high-density images, i.e. pelvic bony structure and the contrast medium-filled bladder and urethra. The images were taken over a sequence and 36 different images viewed by 'roll and spin' techniques, each of which had a different plane of vision. Images were supplied as static CT films and as a movie on a compact disk using a computer program. RESULTS: The technique allows one CT image to be viewed from 36 different angles both dynamically and statically, allowing the surgeon the unique opportunity to view the PUDD through several planes and precisely identify its anatomy. By comparing the data obtained with this technique to those obtained by conventional ACUG, and each in relation to the operative findings, the following aspects could be more thoroughly evaluated by CTCUG: the location of the distraction injury, the length of the distraction defect, the degree and direction of urethral end-alignment, the relation of the ectopic bony fragments and bone callus to the urethra, and the presence of various pathological defects, e.g. fistulae, false passages and diverticulae. CONCLUSION: With CTCUG, both static and dynamic images can be obtained, allowing the easier staging of a PUDD and thus better surgical planning and consequently better results from reconstruction.

Adult↗

PubMed2003

Acoustic detection of manatee vocalizations.

The West Indian manatee (trichechus manatus latirostris) has become endangered partly because of a growing number of collisions with boats. A system to warn boaters of the presence of manatees, that can signal to boaters that manatees are present in the immediate vicinity, could potentially reduce these boat collisions. In order to identify the presence of manatees, acoustic methods are employed. Within this paper, three different detection algorithms are used to detect the calls of the West Indian manatee. The detection systems are tested in the laboratory using simulated manatee vocalizations from an audio compact disk. The detection method that provides the best overall performance is able to correctly identify approximately 96% of the manatee vocalizations. However, the system also results in a false alarm rate of approximately 16%. The results of this work may ultimately lead to the development of a manatee warning system that can warn boaters of the presence of manatees.

Algorithms↗

PubMed2004

Independent component analysis for automatic note extraction from musical trills.

The method of principal component analysis, which is based on second-order statistics (or linear independence), has long been used for redundancy reduction of audio data. The more recent technique of independent component analysis, enforcing much stricter statistical criteria based on higher-order statistical independence, is introduced and shown to be far superior in separating independent musical sources. This theory has been applied to piano trills and a database of trill rates was assembled from experiments with a computer-driven piano, recordings of a professional pianist, and commercially available compact disks. The method of independent component analysis has thus been shown to be an outstanding, effective means of automatically extracting interesting musical information from a sea of redundant data.

Acoustics↗

PubMed1994

Computerized scientific exhibit in radiology: a valuable format for delivering scientific information.

The computerized scientific exhibit (CSE) is gaining acceptance as a tool for delivering scientific information at meetings of radiologic societies. CSEs allow presentation of more material in a more space-efficient manner than do conventional exhibits, and the viewer can control the order and detail in which material is reviewed. As a disadvantage, currently, the radiologist must use a support team and learn new tools to create a CSE. The preparation and cost may also be greater. Meeting attendees must overcome a reluctance to use computers to benefit from a CSE. Creation of a CSE has design, production, and presentation phases. A team of content authors, software author, graphics acquisition person, and project manager works together through brainstorming, conceptual ordering, storyboarding, prototyping, and selection of authoring tools to design the exhibit. Production must include use of common word processing and image file formats, as well as standardization of image resolution. Accurate equipment specification is needed to ensure that the exhibit can be run on the equipment provided by the meeting organizers. In addition, some security steps are needed to prevent misuse of the exhibit. In addition to display at assemblies, the CSE can be made available to a larger audience by delivery on media such as compact disks and the Internet and can be continually modified as new material becomes available.

Computers↗

PubMed1995

A low-cost CD-ROM--based image archival system.

Many radiologists have large collections of original or copied radiographs, as well as 35-mm slides of radiographs that require conventional carousel-type projectors for display. These images cannot be digitally manipulated or displayed in other formats. The authors used compact disk, read-only memory (CD-ROM) technology as a low-cost method of digitally storing these images. The CD-ROM disks were created from slide images optically scanned and digitally transferred to a disk. The images may be incorporated into any type of computer application, used on multiple computer platforms, and are easily transportable. The process is a low-cost, high-quality method of transferring images to digital media and is currently available to anyone with a conventional 35-mm camera, a CD-ROM reader, and a computer.

CD-ROM↗

PubMedDate not supplied

Computer-aided design and modeling of workstations and radiology reading rooms for the new millennium.

Three-dimensional (3D) computer modeling, simulation, and rendering techniques were used to redesign the diagnostic workstations and radiology reading rooms for a proposed hospital with particular attention given to lighting conditions, noise reduction, and optimal use of limited workspace. The results were presented to a panel of multidisciplinary experts and iteratively improved and redesigned with the development or addition of new design criteria or requirements. These 3D techniques allowed faster, more efficient design and presentation of multiple options than is possible with traditional two-dimensional drawings, thereby expediting decision making and resulting in significant savings. The current workstation designs can easily be developed and implemented with available technology at a reasonable cost. They can also accommodate anticipated advances in computer and display technology as well as new imaging paradigms (eg, changes in keyboard and control ergonomics such as adjustable virtual keys on touch-sensitive screens, digital drawing tablets for annotations and controls, direct film digitizing, personal identification devices, offline media readers such as compact disks and digital videodisks, and speech recognition and voice activation). Use of 3D techniques in designing other parts of the radiology department (eg, examination rooms, technologists' areas, physicians' offices) could greatly improve and facilitate the design and implementation of complex settings in these work areas.

Computer Simulation↗

PubMed1989

Hypermedia techniques for diagnostic imaging instruction: videodisk echocardiography encyclopedia.

Because of the visual complexity of medical images and the intensive tutorial experience required to develop image recognition expertise, professional training programs have concentrated on educating limited numbers of experts. Videodisk and CD-ROM (compact disk read only memory) image storage media now make it possible for a microcomputer workstation to provide a learning environment substantially equivalent to that of conventional time-consuming tutorial methods. A demonstration hypermedia program on echocardiography was constructed that provides a user-controlled learning environment with instant access to 54,000 video frames encompassing 1,200 clinical items. The instructional module is controlled by a microcomputer, which provides electronic linkage to relevant graphics, animations, text, categorized data bases, and digitized sound. The system has been successfully used in a residency program as the primary instructional tool for achieving an intermediate level of clinical expertise. Hypermedia offer substantial advantages over conventional books as a clinical reference source.

Computer-Assisted Instruction↗

PubMedDate not supplied

Integration of a multimedia teaching and reference database in a PACS environment.

In one radiology department, a computerized authoring and editing environment was developed and integrated with the picture archiving and communication systems (PACS) for creation of image-based electronic teaching files to replace a collection of printed film images. This multimedia database and authoring environment allows physicians to create reference databases for teaching and research directly from clinical cases being reviewed on PACS diagnostic workstations. The database engine allows users to generate stand-alone CD-ROMs (compact disks, read-only memory) and World Wide Web-based teaching files. The system is fully compliant with the Digital Imaging and Communications in Medicine (DICOM) standard and supports a large number of standard multimedia image file formats. The focus of the development was on convenience and ease of use of a generic system adaptable to all users. The software was integrated on the PACS workstations to allow users to add new cases to the database at any time and anywhere in the department. A pilot system was implemented in clinical operation, with a central server and several client units.

CD-ROM↗

PubMedDate not supplied

Integrating the healthcare enterprise: a primer. Part 6: the fellowship of IHE: year 4 additions and extensions.

Recently, one of my friends, a computer wizard, paid me a visit. As we were talking, I mentioned that I had recently installed a picture archiving and communication system and a radiology information system. I told him how happy I was with the system and showed him a compact disk (CD) from it. To my surprise, he threw it into my microwave oven and turned it on. Instantly I got very upset, because the System had become precious to me, but he said, "Do not worry, it is unharmed." After a few minutes, he took the CD out, gave it to me and said, "Take a close look at it." To my surprise, the CD was quite cold to hold and it seemed to be heavier than before. At first, I could not see anything, but on the inner edge of the central hole, I saw an inscription, an inscription finer than anything I had ever seen before. The inscription shone piercingly bright, and yet remote, as if out of a great depth: 12413AEB2ED4FA5E6F7D78E78BEDE8209450920F923A40Eel0E50CC98D444AA08E324. "I cannot understand the fiery letters," I said in a timid voice. "No, but I can," he said. "The letters are Hex, of an ancient mode, but the language is that of DICOM, which I shall not utter here. But in common English, this is what it says: Two integration profiles to schedule work flow. Five for radiology with room to grow. One for the bacon to bring it home. One for HIPAA all alone. And one for results for those who would know. One technical framework in which to find them. One technical framework to guide them. One technical framework to bring them all. And in the Connect-a-thon bind them. In the Land of Lincoln where no shadows are. We continue the saga of the fellowship of the IHE: clinicians, radiologists, informaticians, administrators, technologists, imaging system vendors, and non-imaging system vendors, as they begin their year 4 transactions.

Computer Communication Networks↗

PubMed1991

Comparison and evaluation of nine bibliographic databases concerning adverse drug reactions.

Few evaluations and statistical comparisons of bibliographic databases have been published. As a drug information center, we were particularly interested in databases providing references on adverse drug reactions (ADRs). Ten drugs were randomly chosen from the 2000 files at our center. Nine databases were selected according to the high frequency of references concerning ADRs: eight online systems (MEDLINE, BIOSIS, TOXLINE, Iowa Drug Information System, PASCAL, EMBASE, PHARMLINE, and International Pharmaceutical Abstracts [IPA]), and one Compact Disk Read Only Memory (CD-ROM) system (Core MEDLINE). The total number of references, the number of references from 1987 to 1989, and the number of relevant references from 1987 to 1989 were analyzed using the Friedman two-way ANOVA by ranks. The overlap between databases for only one drug, carboplatin, and the quality:cost ratio were also studied. Considering the total number of references, TOXLINE and EMBASE were significantly superior to IPA, PHARMLINE, PASCAL, and Core MEDLINE. For the period 1987-1989, EMBASE was significantly superior to PASCAL, IPA, PHARMLINE, and Core MEDLINE with regard to total number of references, and significantly superior to PASCAL, Core MEDLINE, and IPA with regard to relevance. MEDLINE, TOXLINE, and EMBASE had the best quality:cost ratio. EMBASE had the slightest overlap of references, with 53 percent of the unique references on carboplatin. This comparative evaluation showed that the ability of bibliographic databases to provide information on ADRs is dependent on both the size and the quality of each database.

Databases, Bibliographic↗

PubMed2006

Quantification in echocardiography.

Until recently, more than 2200 Swan Ganz catheters were used annually in the operating rooms (OR) and intensive care unit (ICU) of the Catharina Hospital in Eindhoven, The Netherlands. After cardiologists who were specialists in echocardiography (ECHO) trained anesthesiologists in ECHO, the need for these catheters in cardiac and noncardiac surgery was reduced. Initially intended as a local teaching project, an ECHO teaching compact disk (CD) was produced during the training and distributed later worldwide, thanks to a positive review in a major anesthesiology publication. By reducing the number of Swan Ganz catheters, the hospital could finance and acquire two echocardiography machines for the OR and ICU. The availability of these machines resulted in a further reduction of the number of Swan Ganz catheters. However, the need for quantification (eg, measurements of cardiac output) remained. During the creation of the ECHO teaching CD, the idea was born to apply indicator-dilution principles on injected echo contrast. This study was performed in cooperation with the Signal Processing Department of the Eindhoven University of Technology. Advanced signal processing and modelling were used to develop algorithms to enable quantification of intrapulmonary blood volume, ejection-fraction, and flow from the transesophageal echocardiography approach. These quantitative measurements, which can be performed on an outpatient basis, may become a real asset in cardiology, anesthesiology, and intensive care.

Algorithms↗

PubMed2006

Optimal evaluation of digital electroencephalograms.

Currently available digital EEG equipment provides considerably greater opportunities for clinical data analysis than is generally appreciated especially when appropriate software is used. Data from 7 different laboratories that had been obtained for routine diagnostic evaluations on 7 different EEG instruments and stored on compact disks were investigated. Since the instruments do not filter the data at input, ultra slow activity down to 0.01 Hz is currently being recorded but the attenuation factor is instrument dependent. Nevertheless, relevant clinical information is potentially available in these data and needs to be explored. Several examples in regard to epilepsy are presented. Determination of seizure onset may depend on the frequencies that are examined. The use of appropriate filter settings and viewing windows for the clinical question to be answered is stressed. Differentiation between simple and complex spike wave discharges, as well as spread of spikes, can readily be achieved by expanding the time base to 1 or 2 seconds and placing a cursor on the peak of the negative spike. Latencies in the millisecond range can then become apparent. EEGs co-registered with MEG should be evaluated with the same software in order to allow an adequate assessment of the similarities and differences between electrical and magnetic activity. An example of a comparison of EEG, planar gradiometers and magnetometers for an averaged spike is shown.

Brain Diseases↗

PubMed2006

Morphine sulfate attenuates hemorrhagic shock-induced hyperpermeability.

Morphine sulfate is often administered for patients requiring surgical intervention for the control of hemorrhage. Recent data implicate morphine as an immune modulator that affects white blood cells and increases infection rates. In addition, morphine releases histamine, an inflammatory mediator that increases microvascular permeability. Both of these actions of morphine could aggravate the inflammatory progress after hemorrhagic shock. In this study, we evaluated the role of morphine sulfate on microvascular permeability and its effects on leukocyte adherence after hemorrhagic shock. After a control period, blood was withdrawn to reduce the mean arterial blood pressure to 40 mm Hg for 1 h in urethane-anesthetized Sprague-Dawley rats. Mesenteric postcapillary venules in a transilluminated segment of small intestine were examined to quantify changes in permeability and leukocyte adherence. The rats received an IV injection of fluorescein isothiocyanate-bovine albumin during the control period. The fluorescent light intensity emitted from the fluorescein isothiocyanate-bovine albumin was recorded with digital microscopy within the lumen of the microvasculature and compared with the intensity of light in the extraluminal space over time. These images were downloaded to a computerized image analysis program that quantitates changes in light intensity. This change in light intensity represents albumin extravasation. In addition, bright-field images were recorded on compact disk for playback to determine leukocyte adherence. Leukocytes stationary for more than 30 s or longer in a 100-micron segment of venule was considered adherent. Our results demonstrated a marked increase in fluorescein isothiocyanate-bovine albumin leakage into the extravascular space after hemorrhagic shock. Hemorrhagic shock was also associated with an increase in leukocytes adhering to the postcapillary venular endothelium. Morphine sulfate 10 microg/kg given before the shock period, attenuated both the hyperpermeability (P < 0.05) and the increase in leukocyte adherence (P < 0.05) after hemorrhagic shock. These results suggest that instead of aggravating the inflammatory response after hemorrhagic shock, morphine may provide protection to the microvasculature.

Animals↗