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PubMed2003

Beyond PACS: getting images to referring physicians.

The digital imaging hospital has the potential advantage that imaging studies are available anytime, and anywhere they are needed, with negligible loss. Fulfilling this promise in reality, however, presents challenges as described in this paper. No single best formula for successful deployment exists, since each institution is unique, and its medical staff may have varying preferences. This requires a collaborative team approach to design a solution acceptable to all parties, inside and outside of radiology. We have attempted to identify the significant issues. In addition, hardware and software technology continuously evolve and improve. What is clear is that all institutions will adopt this technology for the reasons described. The successful implementations will be those that are collaboratively and thoughtfully designed. User training of all members of the healthcare team involved with image study access is essential.

Computer Security↗

PubMed1984

Field studies with in-feed medication of pigs in the Netherlands using the anthelmintic thiophanate with particular reference to efficacy against Ascaris suum.

Studies on the efficacy in pigs of low level in-feed medication with the anthelmintic thiophanate at a minimum intake of 6 mg/kg/day for fourteen days are reported. A trial was conducted to compare a group of medicated fattening pigs with a similar unmedicated group on premises known to have a high challenge of Ascaris spp. Daily growth rate was improved whilst feed conversion ratio and the liver condemnation rate were reduced in the treatment group. Routine medication of a whole herd using this regime contributed to a great improvement of the herd production when assessed by the above criteria. User studies in various geographical areas of the Netherlands involving 1500 adult pigs and 1200 fattening pigs medicated with thiophanate in-feed for fourteen days demonstrated that the compound eliminated the faecal worm egg output and was readily accepted and tolerated by pigs.

Animal Feed↗

PubMedDate not supplied

N-nitrosamines in snuff and chewing tobacco on the Swedish market in 1983.

Snuff and chewing tobacco on the Swedish market in 1983 were analysed for tobacco-specific and volatile N-nitrosamines using gas chromatography--thermal energy analysis. All 36 samples of snuff analysed were found to contain detectable levels of N'-nitrosonornicotine, N'-nitrosoanatabine, N'-nitrosoanabasine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone. Total tobacco-specific N-nitrosamine levels between 2.5 and 51 mg/kg wet weight were found, the mean level being 8.8 mg/kg. Detectable levels of at least two of the four tobacco-specific N-nitrosamines were found in all 18 samples of chewing tobacco analysed. The total concentration of tobacco-specific N-nitrosamines found in chewing tobacco was between 0.1 and 7.8 mg/kg, the mean level being 2.1 mg/kg. The levels of volatile N-nitrosamines found in the 54 samples of snuff and chewing tobacco were very much lower--most of the samples contained less than 10 micrograms/kg and the highest concentration found was 550 micrograms/kg. Since snuff and chewing tobacco contain relatively high levels of carcinogenic N-nitrosamines and there is evidence of an association between the use of these tobacco products and human cancer, snuff and chewing tobacco users should be warned about the possible cancer risk involved in their habit. In addition, efforts should be made to reduce the levels of N-nitrosamines in snuff and chewing tobacco and the formation of these substances in the body from precursors originating from these tobacco products.

Chromatography, Gas↗

PubMed1998

Current perspectives on anabolic steroids.

Steroids are used outside the realm of competitive athletics in Australia among a wide variety of groups with different motivations and goals. This paper provides an overview of the reasons for use; rates of usage; physical and psychological side effects; and sources of steroids. Issues associated with injecting steroids; their current legal status; and drug education and prevention programmes are reviewed briefly. Research involving identified sub-populations is needed to determine user profiles and prevalence rates of users and potential users. Studies of Australian users are also needed to obtain baseline information on areas of potential harm associated with steroids use, e.g. aggressive behaviour, needle-sharing behaviour, physical side effects and potential for dependency. It is concluded that future deterrence strategies should focus more on demand reduction, rather than supply.

Journal Article↗

PubMed2005

A patient-identity security mechanism for electronic medical records during transit and at rest.

This paper proposes a patient-identity security mechanism, including an identity cipher/decipher and a user-authentication protocol, to ensure the confidentiality and authentication of patients' electronic medical records (EMRs) during transit and at rest. To support the confidentiality of an EMR, the identity cipher/decipher uses a data-hiding function and three logical-based functions to encrypt/decrypt a patient's identifying data and medical details in an EMR. The ciphertext of the patient's identifying data is patient-EMR related, whereas that of medical details is healthcare agent-EMR related. To support the authentication of an EMR, the user-authentication protocol based on a public key infrastructure uses certificates and dynamic cookies for verification/identification. The identity cipher has been simulated using C programming language running on a 1500 MHz Pentium PC with 512 MB of RAM. The experimental results show that healthcare agents can install large amounts of patients' encrypted EMRs in healthcare databases efficiently. In addition, separately storing the keys in a user's token and an EMR database for decryption increases the safety of patients' EMRs. For each user-authentication trail, the use of certificates and dynamic cookies for verification/identification ensures that only authorized users can obtain access to the EMR, and anyone involved cannot make false claims on the transmission made.

Computer Security↗

PubMed2001

Virtual reality: current urologic applications and future developments.

The concept of virtual reality (VR) involves the computer generation of environments with which a user can interact directly. Virtual reality is now being used for medical applications, especially in the area of surgical simulation. As technology advances, VR simulation will play an important training role for both residents and urologists already in practice. This paper examines the history of VR, current developments, and its future implications for the field of urology.

Computer Simulation↗

PubMed2005

Improving access for the poorest to public sector health services: insights from Kirivong Operational Health District in Cambodia.

This article presents research findings into the effectiveness of an innovative equity fund approach to improving access to public sector health services for the poor in Kirivong Operational Health District in Cambodia. The operational health district is the lowest organizational level in the Cambodian health system, providing services through health centres and a single referral hospital. An equity fund involves a third party identifying the poor and paying user fees on their behalf by reimbursing the service provider, thus relieving health staff of such responsibility. We explore the appropriateness of utilizing community members to identify the poorest. The impact of newly introduced pagoda-managed equity funds on access to public health services for the poorest, and on their out-of-pocket expenditure during illness episodes, is then examined. We conclude with an evaluation of the contribution of the equity funds to community participation. The research indicates that identification by community members of those eligible for equity funds is feasible, accrues minimal direct costs, and is effective. Households identified as eligible for equity fund benefits were poorer than those identified as non-beneficiaries. Direct costs associated with seeking care were considerably lower for equity fund beneficiaries than for non-beneficiaries, and fewer beneficiaries than non-beneficiaries initially consulted the private sector, providing evidence of the equity fund's ability to attract the poorest to the public sector. The level and nature of community participation was enhanced considerably following the introduction of the pagoda-managed equity funds. In order to maximize and sustain the equity benefits of such funds, we recommend that external agencies (such as international non-governmental organizations) limit their role to the provision of technical support and advice, rather than taking the lead on implementation and administration. Facilitating the design, implementation, administration and management of equity funds by indigenous community-based organizations has the advantage of not only greatly reducing administrative costs, allowing a large proportion of the fund to be spent on services for the poor, but also of enhancing local ownership, thus increasing the likelihood of equity funds being sustained in the future.

Adolescent↗

PubMed2006

An investigation of voxel geometries for MCNP-based radiation dose calculations.

Voxelized geometry such as those obtained from medical images is increasingly used in Monte Carlo calculations of absorbed doses. One useful application of calculated absorbed dose is the determination of fluence-to-dose conversion factors for different organs. However, confusion still exists about how such a geometry is defined and how the energy deposition is best computed, especially involving a popular code, MCNP5. This study investigated two different types of geometries in the MCNP5 code, cell and lattice definitions. A 10 cm x 10 cm x 10 cm test phantom, which contained an embedded 2 cm x 2 cm x 2 cm target at its center, was considered. A planar source emitting parallel photons was also considered in the study. The results revealed that MCNP5 does not calculate total target volume for multi-voxel geometries. Therefore, tallies which involve total target volume must be divided by the user by the total number of voxels to obtain a correct dose result. Also, using planar source areas greater than the phantom size results in the same fluence-to-dose conversion factor.

Humans↗

PubMed1989

Treatment of drug misuse in the general practice setting.

Despite several decades of contact between health workers and drug misusers and recent publicity aimed at increasing the use of this contact to control HIV infection, there remains a persistent belief that control of drug taking is possible either by medical intervention with substitute drugs or provision of facilities to detoxify those addicted. This paper describes, in the absence of a cure or control for drug abuse, the role of the primary care physician in preventing illness and promoting less damaging drug use among drug users and their social, sexual and domestic contacts. Extensive involvement with family and non-statutory workers is seen as the best way to understand the pressures and dangers to which individual patients are exposed.

Acquired Immunodeficiency Syndrome↗

PubMed2000

A study of the patterns and correlates of substance use among adolescents applying for drug treatment.

OBJECTIVE: To inform planners by providing a psychosocial and drug-use profile of adolescents who have applied for a drug-treatment program. METHOD: The setting was a residential drug-treatment program in Sydney for adolescents from NSW and the ACT. The design was a descriptive study of consecutive program applicants over 18 months. Study participants were 14-18 years, 53% were male. Most assessments were telephone interviews. The instrument incorporated the Opiate Treatment Index, Adolescent Drug Abuse Diagnosis, Severity of Dependence Scale and Symptom Checklist 90-Revised (SCL-90-R). RESULTS: Study participants tended to be poly-substance users, mostly using cannabis, heroin and/or alcohol. Heavy use in terms of frequency and amounts of use were reported, e.g. 50% of the sample used heroin daily and the mean number of standard drinks consumed on the last day of drinking was 18. High levels of problems in the areas of social functioning, criminal activity, psychological distress, physical health, HIV risk and substance dependence were reported. For example, most participants were unemployed and 88% had committed a crime in the previous month. Higher rates of some problems were identified among females, heroin users and benzodiazepine users. CONCLUSIONS: The sample reported a high level of involvement in substance use and associated problems. The profile suggested that improvements might be difficult to achieve and to maintain. IMPLICATIONS: A comprehensive, intensive, longer-term drug-treatment program to address the number and extent of substance-related problems for such adolescents is recommended.

Adolescent↗

PubMedDate not supplied

A method for selective removal of out-of-plane structures in digital tomosynthesis.

The quality of the reconstructed images in Digital Tomosynthesis is often limited by the presence of artifacts due to blur from planes other than the fulcrum plane. A technique has been developed for the separation and subsequent removal of unrelated structures from the reconstructed plane. The method involves the reconstruction of the blur originating in user-selected "noisy" planes as it appears on the plane of interest. This is achieved by projecting the reconstructed images of the selected plane on the image formation plane for all viewing angles, and subsequently, synthesizing its blurred image on the plane of interest. There are no restrictions as to the identity of the planes to be removed. Reproduction of the noise is performed using the tomosynthesis algorithm itself, thus the technique can be modified to suit any reconstruction algorithm. The proposed technique was implemented on the Multiple Projection Algorithm and was experimentally evaluated using a radiotherapy simulator unit.

Algorithms↗

PubMed2006

Emergency presentations by vulnerable road users: implications for injury prevention.

Most emergency presentations by vulnerable road users were the result of collisions that did not involve a motor vehicle. Many injuries occurred off-road without police attendance. Hence, reliance on official police records would underestimate the magnitude and scope of these injuries. Suggestions to provide a safer road environment are given.

Accidental Falls↗

PubMedDate not supplied

Systematic assessment of World Wide Web materials for medical education: online, cooperative peer review.

OBJECTIVE: : To develop a generic methodology for the online assessment of medical education materials available on the World Wide Web and to implement it for pilot subject areas. DESIGN: An online questionnaire was developed, based on an existing scheme for computer-based learning material. It was extended to involve five stages, covering general suitability, local suitability, the user interface, educational style, and a general review. It is available on the Web, so expert reviewers may be recruited from outside the home institution. The methodology was piloted in three subjects areas--clinical chemistry, radiology, and medical physics--concentrating initially on undergraduate teaching. MEASUREMENTS: The contents of completed questionnaires were stored in an offline database. Selected fields, likely to be of use to students and educators searching for material, were input into an online database. RESULTS: The online assessment was used successfully in clinical chemistry and medical physics but less well in radiology. Fewer resources were found to fit local needs than expected. CONCLUSION: The methodology was found to work well for topics where teaching is highly structured and formal and is potentially applicable in other such disciplines. The approach produces more structured and applicable lists of resources than can be obtained from search engines.

Computer Communication Networks↗

PubMed2007

Crack cocaine: a five-year follow-up study of treated patients.

OBJECTIVES: To follow-up a group of 131 crack cocaine users and examine drug use, treatment experience, employment status, involvement in crime and mortality at 2 and 5 years. METHODS: Consecutive crack-dependent patients who were admitted to a detoxification unit in São Paulo between 1992 and 1994 were re-interviewed on two occasions: 1995-1996 and 1998-1999. RESULTS: 5 years after treatment information was obtained on 124 (95%) of the original cohort. 39.7% (n = 52) of the patients reported having been abstinent from cocaine for at least the last year, and 21.4% (n = 28) had used the drug. Of those subjects not using cocaine at 2 years, 19 (62%) were still abstinent at 5 years. Twenty-three (17.6%) patients had died by the 5-year follow-up with homicide, due to firearms or other weapons, being the commonest cause (n = 13). The annual adjusted mortality rate for the sample was 24.92 deaths/1,000 individuals, the excess mortality rate was of 21.64 deaths/1,000 individuals, and the standardized mortality ratio was 7.60. A history of injecting drug use, unemployment at the time of the index admission and administrative discharge at the index admission were factors that contributed to the risk of dying over the next 5 years. CONCLUSIONS: There was a progressive movement towards abstinence over the follow-up period, and there was evidence that once abstinence had been achieved it was maintained. On the other hand, the mortality rate was extremely high and was higher among those who were still using crack at 2 years.

Adolescent↗

PubMed2003

Life with an indwelling urinary catheter: the dialectic of stigma and acceptance.

The purpose of this hermeneutic phenomenology was to describe and interpret the lived experience of long-term users of urinary catheters. Living with a urinary catheter involved a dialectical swing between acknowledgment that the catheter was "a part of me" and feelings of alienation and vulnerability when it was experienced as a stigma. Themes include Adjusting to embodied changes by perceiving the catheter as a "part of me," Shame and responding to shame by normalizing, and Embarrassment and coping with embarrassment by humor. Providers can minimize stigma related to the visibility of the catheter by coaching patients in strategies to manage going out of the home with a minimum of urine accidents or by helping develop ways to conceal the urine bag.

Adaptation, Psychological↗

PubMedDate not supplied

Current issues surrounding women and minorities in drug trials.

OBJECTIVE: Our principal objective is to make readers aware of conflicting demands placed on investigators and the pharmaceutical industry regarding inclusion of women and minorities in clinical research. Tremendous pressures have been placed to expedite the drug approval process. Moreover, during the last decade certain segments of society, particularly women and minorities, have demanded greater participation in clinical drug trials and earlier access to investigational drug therapies. Regulations that have served the clinical research community (pharmaceutical industry, investigators, institutional review boards) as guidelines for safe conduct of human clinical trials are being challenged by social and political change. This article provides an overview of some of the controversy relative to federal regulations governing clinical trials; scientific concerns; social, political and legal trends; and ethical principles applied to human clinical research. DATA SOURCES: Literature for this paper was retrieved from a variety of sources including the nonmedical press, editorials, peer-reviewed journals, Department of Health and Human Services regulations, National Institutes of Health policy, the Belmont Report, and regulations of the Food and Drug Administration. DATA SYNTHESIS: Scientists evaluating new therapeutic agents ask specific research questions to assess safety, efficacy, and the mechanism(s) of action. Because of concerns for scientific validity, safety, liability, and convenience, many early evaluations of new drugs involve patient populations that may not represent the ultimate users of a new drug. Federal regulations and ethical principles allow certain groups of people to be excluded from early research proposals because they are thought to be putting themselves at greater risk by participating than are other groups. However, women, minorities, and other populations are demanding greater access to investigational drugs. The focus has changed from protection from research risks and burdens to the potential benefits a person or class of people may obtain by participating in a study. CONCLUSIONS: Scientists, the pharmaceutical industry, regulators, and society must agree on a safe and efficient mechanism for new drug development that permits more equitable participation of subjects in the various phases of research.

Clinical Trials as Topic↗

PubMed1988

The potential contribution of computerized school-based record systems to the monitoring of the disease prevention and health promotion objectives for the nation.

This article discusses the potential contribution of computerized school-based record systems to help monitor the 1990 and future health objectives for the nation, to provide a continuing health data base on nearly 50 million Americans, and to improve current school health record-keeping practices. Limitations of paper-based health record systems and the state-of-the-art and future potential of computerized record systems are described. Several key obstacles to computerization of school health records are considered, including technological problems, difficulties in appreciating and evaluating the benefits of computerization, costs, acceptability to individuals and organizational users, standardization problems, and concerns about confidentiality. Implementation steps involving research and surveillance measures for attaining the 1990 objectives that may be facilitated by improved school health records and information systems are specified. As school health education and school health services increasingly become vehicles for achieving national public health objectives, including those set for 1990, it will be desirable to establish data systems that link information collected in individual schools with research and surveillance activities at the state and national level. Moreover, it will be desirable for school's health records and information systems to contain data describing students' health-related knowledge, attitudes, behaviors, and physiological risk factors, in addition to the data traditionally maintained in such records.

Attitude to Computers↗

PubMedDate not supplied

Consumer understanding and satisfaction associated with a 3-tier prescription drug benefit.

OBJECTIVE: The purpose of this research was to investigate consumer understanding and satisfaction associated with a 3-tier prescription drug benefit among users of the prescription drug benefit. METHODS: This study involved a self-administered postal questionnaire and the use of prescription drug claims to evaluate utilization of prescription medications. Fifteen hundred subjects were randomly selected based on the following inclusion criteria. Each subject had to (1) be enrolled in a 3-tier copayment ($10 generic, $20 formulary brand, $35 nonformulary brand) prescription drug benefit; (2) be the primary beneficiary (cardholder); (3) be >18 years of age; (4) have received at least 1 prescription medication using his or her prescription drug insurance; and (5) have a mailing address on file. RESULTS: A total of 479 usable responses were returned (35% response rate). The mean (SD) understanding score was 2.22 (1.54) (range: 0 to 6). Fewer than 1% of respondents correctly answered all 6 items used to measure the level of understanding. The mean (SD) satisfaction score was 54.32 (19.69) (range: 0 to 100). Experience with purchasing a medication within a particular copayment tier was predictive of correctly answering the item related to that tier.s copayment amount. Multiple regression analysis revealed a relationship between the amount of use of the drug benefit and the degree of satisfaction with the drug benefit. There was no significant relationship between the level of understanding and the degree of satisfaction with prescription drug insurance. CONCLUSION: The average level of beneficiary understanding of the 3-tier copayment prescription drug benefit was very low, and the average degree of respondent satisfaction appeared to be near neutral. There was no significant relationship between the level of understanding and the degree of satisfaction with prescription drug benefits. The level of understanding was proportional to the amount of drug benefit use, but the degree of satisfaction was not related to the amount of drug benefit use.

Adolescent↗