基于虚拟网络计算技术的远程放射学诊断系统的建立

目的 建立基于虚拟网络计算技术、遵从DICOM协议的远程放射学诊断系统。方法 运用VC++6.0、Leadtools开发包、VNC源码在Windows 2000操作系统中开发。结果 本系统在Internet网和广域网环境下成功地实现了远程放射学影像的采集、浏览、处理、诊断与书写图文报告功能,在实际应用中取得了良好的效果。结论 基于VNC技术开发的远程放射学系统交互速度快、实时性强、影像清晰度好,在低带宽的网络条件下也能具备优异的速度和性能。本系统能够提升放射诊断学的信息化与网络化水平,促进放射学的远程交流,具有广阔的应用前景和推广价值。     

The clinical application of mobile technology to disaster medicine

Mobile health care technology (mHealth) has the potential to improve communication and clinical information management in disasters. This study reviews the literature on health care and computing published in the past five years to determine the types and efficacy of mobile applications available to disaster medicine, along with lessons learned. Five types of applications are identified: (1) disaster scene management; (2) remote monitoring of casualties; (3) medical image transmission (teleradiology); (4) decision support applications; and (5) field hospital information technology (IT) systems. Most projects have not yet reached the deployment stage, but evaluation exercises show that mHealth should allow faster processing and transport of patients, improved accuracy of triage and better monitoring of unattended patients at a disaster scene. Deployments of teleradiology and field hospital IT systems to disaster zones suggest that mHealth can improve resource allocation and patient care. The key problems include suitability of equipment for use in disaster zones and providing sufficient training to ensure staff familiarity with complex equipment. Future research should focus on providing unbiased observations of the use of mHealth in disaster medicine. Case T , Morrison C , Vuylsteke A . The clinical application of mobile technology to disaster medicine. Prehosp Disaster Med. 2012;27(5):1-9.     

Update on digital image management and PACS

Information technology is becoming a vital component of all health care enterprises, from managed care services to large hospital networks, that provides the basis of electronic patient records and hospital-wide information. The rationale behind such systems is deceptively simple: physicians want to sit down at a single workstation and call up all information, both clinical data and medical images, concerning a given patient. Picture archiving and communication systems (PACS) are responsible for solving the problem of acquiring, transmitting, and displaying radiologic images. The major benefit of PACS resides in its ability to communicate images and reports to referring physicians in a timely and reliable fashion. With the changes in economics and the shift toward managed and capitated care, the teleradiology component of PACS is rapidly gaining momentum. In allowing remote coverage of multiple sites by the same radiologists and remote consultations and expert opinion, teleradiology is in many instances the only option to maintain economically viable radiologic settings. The technical evolution toward more integrated systems and the shift toward Web-based technology is rapidly merging the two concepts of PACS and teleradiology in global image management and communication systems.     

Teleradiology at the 121st General Hospital in Yongsan,Korea

Summary. The 121st General Hospital in the Yongsan district of Seoul. Korea provides teleradiology services for the US Armed Forces in South Korea. The operation of this teleradiology service is a model of the support of rural teleradiology, providing radiology services to outlying clinics over a large geographic area. In a typical week this hospital receives and processes 225 radiological exams or 45 exams per day from 13 outlying clinics. During military exercises the load can increase dramatically. The result of the teleradiology service is a sharp improvement in the radiology service at the outlying clinics and faster more effective care for the patients of those clinics.     

Remote management of haemodialysis patients: Design and implementation of a telemedicine network

Summary. Telemedicine applications have been implemented in many clinical specialties. Some, like teleradiology, are now established applications with specific standards. Most applications still do not have protocols or standards, including telemedicine for haemodialysis. As part of Project Phoenix, a National Library of Medicine funded project set up to look at the access, cost and quality implications of telemedicine in a renal dialysis setting, we are establishing such protocols and standards. This paper discusses the design and implementation of a multimedia telemedicine application being undertakin by the Imaging Science and Information Systems (ISIS) Center of the Department of Radiology, the Clinical Economics Research Unit and the Division of Nephrology of the Department of Medicine at the Georgetown University Medical Center (GUMC). The Renal Care Patient Monitoring (RCPM) network links GUMC, a remote outpatient dialysis clinic, and a nephrologist's home. The primary functions of the network are to provide telemedicine services to renal dialysis patients, to create, manage, transfer and use electronic health data, and to provide decision support and information services for physicians, nurses and health care workers. This paper shows that the first step in establishing standards and operational protocols for various clinical applications is to start with specific clinical needs assessment followed by an iterative process of reassessment and evaluation. This allows flexibility and a dynamic approach in the optimal system design.     

Tecnological standards of teleradiology function in orthopedics and trauma care

Digital Image is a relatively new quality in orthopedic diagnostics, which allows transmitting the image instead of the patient. Digital or digitized image can be transmitted via Internet, e-mail or local net. Observations derived form literature and own experience indicate that teleradiology may effectively provide radiologic consultation or even improve the detailed radiologic evaluation. This article describes sufficiently the technologic problems of teleradiology and explains terminology used for this branch, what allows understanding the fundamentals of teleradiology even for person having little technical and informatics knowledge. Authors describe equipment demands and standards of function for teleradiologic services.     

A review of virtual reality technologies in the field of communication disability: implications for practice and research

Abstract

Background: Technology devices and applications including virtual reality (VR) are increasingly used in healthcare research and practice as tools to promote health and wellbeing. However, there is limited research examining the potential for VR to enable improved communication for people with communication disability.

Aims: To review: (a) current research using VR in speech-language pathology; and (b) the ethical and safety considerations of VR research, to inform an agenda for future research applying VR in the field of speech-language pathology.

Main contribution: This review reveals that there is an emergent body of literature applying VR to improve or develop physical, psychological and communication interventions. Use of non-immersive virtual environments to provide speech-language pathology assessment or intervention for people with communication disability has demonstrated positive outcomes, with emerging evidence of the transfer of functional communication skills from virtual to real-world environments. However, the use of VR technology and immersive virtual environments in communication disability practice and research introduces safety and ethical issues that must be carefully considered.

Conclusions: Research employing VR is in its infancy in the field of speech-language pathology. Early evidence from other healthcare disciplines suggests that VR is an engaging means of delivering immersive and interactive training to build functional skills that can be generalized to the real world. While the introduction of new technology requires careful consideration of research ethics and patient safety, future VR communication research could proceed safely with adequate engagement of interdisciplinary teams and technology specialists.

• Implications for rehabilitation

• Immersive virtual reality may be used in rehabilitation to simulate natural environments to practice and develop communication skills.

• The sense of immersion that can be achieved using virtual reality may promote the generalization of skills learnt during clinical rehabilitation to real-world situations.

• Ethical and safety considerations, including cybersecurity and cybersickness, must be carefully monitored during all virtual reality research.

     

Telerobotics in medicine and surgery

Summary. The application of telerobotic technologies to medicine and surgery strictly depends on research and development in five main areas: functionality, environment, physical constraints, communication, and security. The clinical application of robotic technology in the field of microsurgery, orthopaedic surgery, and minimally invasive surgery has shown promising results, pushing researchers to further develop computer-aided surgery as well as diagnostics systems and microrobots. Telemanipulation, interface technologies, sensors, vision systems, virtual reality and function integration are employed to re-design the operating theatre, thus enhancing future applications of robotics in surgery. Because of the restrictions in the surgical field, the construction of miniaturized mechanisms is required, being grounded on different technologies: silicon micro-mechanics, surface micro-engineering and LIGA technology. Nanotechnology, memory alloys and superelastic materials are also employed. Other technological issues are: the communication of vocal, visual, textual and numerical information via cable, satellite or laser satellite transmission. Security and confidentiality of data are fundamental for telematics applied to medicine. Problems to be solved are the quality of image transmission and the signal delay as well as those related to working in a dynamic environment.     

Designing augmentative and alternative communication applications: the results of focus groups with speech-language pathologists and parents of children with autism spectrum disorder

Purpose: The purpose of this study was to gain insight from speech-language pathologists (SLPs) and parents of children with autism spectrum disorder (ASD) regarding appealing features of augmentative and alternative communication (AAC) applications.

Method: Two separate 1-hour focus groups were conducted with 8 SLPs and 5 parents of children with ASD to identify appealing design features of AAC Apps, their benefits and potential concerns. Participants were shown novel interface designs for communication mode, play mode and incentive systems. Participants responded to poll questions and provided benefits and drawbacks of the features as part of structured discussion.

Results: SLPs and parents identified a range of appealing features in communication mode (customization, animation and colour-coding) as well as in play mode (games and videos). SLPs preferred interfaces that supported motor planning and instruction while parents preferred those features such as character assistants that would appeal to their child. Overall SLPs and parents agreed on features for future AAC Apps.

Conclusion: SLPs and parents have valuable input in regards to future AAC app design informed by their experiences with children with ASD. Both groups are key stakeholders in the design process and should be included in future design and research endeavors.

• Implications for Rehabilitation

• AAC applications for the iPad are often designed based on previous devices without consideration of new features.

• Ensuring the design of new interfaces are appealing and beneficial for children with ASD can potentially further support their communication.

• This study demonstrates how key stakeholders in AAC including speech language pathologists and parents can provide information to support the development of future AAC interface designs.

• Key stakeholders may be an untapped resource in the development of future AAC interfaces for children with ASD.

     

The impact of artificial intelligence on radiography as a profession: A narrative review

Background and PurposeArtificial intelligence (AI) algorithms, particularly deep learning, have made significant strides in image recognition and classification, providing remarkable diagnostic accuracy to various diseases. This domain of AI has been the focus of many research papers as it directly relates to the roles and responsibilities of a radiologist. However, discussions on the impact of such technology on the radiography profession are often overlooked. To address this gap in the literature, this paper aims to address the application of AI in radiography and how AI's rapid emergence into healthcare is impacting not only standard radiographic protocols but the role of the radiographic technologist as well.MethodsA review of the literature on AI and radiography was performed, using databases within PubMed, Google Scholar, and ScienceDirect. Video presentations from YouTube were also utilized to weigh the varying opinions of world leaders at the fore of artificial intelligence.ResultsAI can augment routine standard radiographic protocols. It can automatically ensure optimal patient positioning within the gantry as well as automate image processing. As AI technologies continue to emerge in diagnostic imaging, practicing radiologic technologists are urged to achieve threshold computational and technical literacy to operate AI-driven imaging technology.ConclusionThere are many applications of AI in radiography including acquisition and image processing. In the near future, it will be important to supply the demand for radiographers skilled in AI-driven technologies.     

Interpersonal and communication skills development in general nursing preceptorship education and training programmes: A scoping review

AimThe aim of this systematic scoping review is to examine and synthesise the available literature on developing interpersonal and communication skills in general nursing preceptorship education programmes.BackgroundHighly developed interpersonal and communication skills are an essential component of nursing preceptorship. Preceptors are integral in facilitating, guiding, and developing positive interpersonal relationships between the nursing student (the preceptee), the qualified nurse (the preceptor), and patients. They also have a responsibility to foster and develop preceptees' interpersonal and communication skills and assess and deem preceptees as competent in such skills. Furthermore, preceptors require effective interpersonal and communication skills to carry out key responsibilities of their role, including creating a safe clinical learning environment, teaching, and providing effective feedback.DesignA scoping review was conducted using the methodological framework of Arksey and O'Malley. The PRISMA Extension for Scoping Reviews guided the reporting.MethodsFive electronic databases were searched for relevant articles in consultation with a librarian, supplemented by hand-searching and internet searches for grey literature. A total of 19,431 potentially relevant articles published between Jan 2000 and August 2021 were retrieved from the initial search, and an additional six articles were obtained from the supplemental search. A total of 146 articles were independently reviewed by two researchers, resulting in 24 articles eligible for inclusion in the review.ResultsSeveral themes were identified in the literature that influenced the development of interpersonal and communication skills in preceptorship education and training programmes, including design and development of programmes, key learning outcomes, pedagogical approaches of preceptorship education and training programmes and interpersonal & communication skills development in preceptorship education and training programmes. ConclusionsThis review highlighted that research on developing interpersonal and communication skills amongst preceptors is mainly absent from the literature. Further research to address these knowledge gaps is warranted. The results from this review can be used to inform future curriculum design and development of nursing preceptorship education and training programmes.     

Image storage,transmission and manipulation

Summary

Medical imaging is the study of human functions and anatomy through pictorial information. During the past 15 years all new medical imaging modalities introduced are digital-based systems. Firstly the concept of digital imaging, the meaning of spatial and density resolutions, and signal-to-noise ratio is reviewed. Based on these definitions, the current technology in image storage and transmission is discussed including the magnetic disk, the parallel transfer disk, the optical disk, Ethernet, the fibre distributed data interface (FDDI), and Ultranet.

Among many image manipulation functions, two simple types which are commonly used in clinical applications are discussed, one for visualization enhancement and the other for quantification.     

Current and future applications of CT coronary calcium assessment

Introduction: Computed tomographic (CT) coronary artery calcium scoring (CAC) has been validated as a well-established screening method for cardiovascular risk stratification and treatment management that is used in addition to traditional risk factors. The purpose of this review is to present an update on current and future applications of CAC.

Areas covered: The topic of CAC is summarized from its introduction to current application with focus on the validation and clinical integration including cardiovascular risk prediction and outcome, cost-effectiveness, impact on downstream medical testing, and the technical advances in scanner and software technology that are shaping the future of CAC. Furthermore, this review aims to provide guidance for the appropriate clinical use of CAC.

Expert commentary: CAC is a well-established screening test in preventive care that is underused in daily clinical practice. The widespread clinical implementation of CAC will be decided by future technical advances in CT image acquisition, cost-effectiveness, and reimbursement status.     

Handover and transport of critically ill children: An integrative review

BackgroundThe handover and transport of critically ill pediatric patients requires communication amongst multiple disciplines. Poor communication is a leading cause of sentinel events and human factors affect handover and transport.ObjectivesTo synthesize published data on pediatric handover and transport and identify gaps to provide direction for future investigation.MethodsIntegrative literature review.ResultsForty research studies were reviewed and revealed the following themes: risk for patient complications, standardized communication, and specialized teams and teamwork were associated with improved outcomes. No articles were identified regarding transportation of critically ill pediatric patients from the emergency room to the intensive care unit. There was a knowledge gap in best practices in handover and transport within the unique subsets of the pediatric population including neonate, toddler, school-aged, and adolescents.ConclusionsResearch supported a combined approach of specialized teams using standardized communication in the handover and transport of the pediatric patient to improve outcomes. Further study is warranted on interprofessional (team to team) handover practices, select subsets of the pediatric population, and the handover and transport of critically ill patients from the emergency room to the intensive care unit.     

Design and evaluation of interprofessional cross-cultural communication sessions

Abstract

The 2013 National Standards for Culturally and Linguistically Appropriate Services (CLAS) call for healthcare professionals to provide quality care and services that are responsive to diverse cultural health beliefs and practices. Accreditation organizations for health professional programs require their curriculum to adequately prepare future practitioners for serving culturally and linguistically diverse populations. Another common curricular need of health professional programs is interprofessional education (IPE). This study presents data that evaluates two IPE culturally competent communication sessions designed for pharmacy and nursing students. Teams of nursing and pharmacy students (n?=?160) engaged in case studies focused on developing cross-cultural communication skills, using the LEARN model. Quantitative survey data collected pre-test and post-test measured cultural competency (including subscales of perceived skills, perceived knowledge, confidence in encounter, and attitude) and knowledge related to culturally competent communication. Univariate ANOVA results indicate that actual knowledge as measured by the test and all four Clinical Cultural Competency Questionnaire (CCCQ) subscales significantly increased after the IPE sessions. Pharmacy students scored higher than nursing students on the knowledge pre-test, and nursing students had a more positive attitude at pre-test. The IPE sessions effectively addressed all learning outcomes and will continue in future course offerings. Using cross-cultural communication as a thematic area for IPE program development resulted in educational benefits for the students. To further strengthen nursing and pharmacy students’ interprofessional practice, additional IPE opportunities are to be explored.     

The use of computer mediated communication in providing patient support: A review of the research literature

ObjectivesThe aim of this study is to explore how computer mediated communication has been used by a variety of healthcare,professionals to support their patients and discuss the implication that this may have for future practice.DesignA systematized review of the literature.Data sourcesA review of empirical studies within the literature was carried out in April 2016 in CINAHL, MEDLINE, ASSIA, BNI, Psychinfo, and Web of Science databases.Review methodsThe databases searched produced 2930 titles, of which 190 publications were considered relevant to the objectives. Titles and abstracts were then reviewed and duplicates removed producing 67 publications. Exclusion and inclusion criteria were applied. The inclusion criteria were (1) interventions that facilitate two-way communication between any healthcare professional and their patients via a computer; (2) Interventions aimed at providing any type of support e.g. emotional, tangible, informational, or esteem support; (3) English language; (4) Primary empirical studies. Data quality was assessed and thematic analysis applied.ResultsThirty-one publications were included in this study. Intervention types included Email (n = 8), Videoconferencing (n = 7), Online Social Support Groups (n = 9) and multifaceted interventions (n = 7). Three themes emerged from the data including increasing access to healthcare, adding value to healthcare delivery and improving patient outcomes. Twenty-five (81%) of the studies found that computer mediated communication could produce positive effects.ConclusionsComputer mediated communication could be both what patients want and a way of delivering support to patients in a resource tight environment. This has implications for a range of health support needs and professionals including nurses, midwives and allied healthcare professionals. Reviewing the lessons learnt will ensure future interventions are tailored to the support needs of the patients, carefully planned and mindful of the risks.     

The use of artificial intelligence in computed tomography image reconstruction - A literature review

Background and purposeThe use of AI in the process of CT image reconstruction may improve image quality of resultant images and therefore facilitate low-dose CT examinations.MethodsArticles in this review were gathered from multiple databases (Google Scholar, Ovid and Monash University Library Database). A total of 17 articles regarding AI use in CT image reconstruction was reviewed, including 1 white paper from GE Healthcare.ResultsDLR algorithms performed better in terms of noise reduction abilities, and image quality preservation at low doses when compared to other reconstruction techniques.ConclusionFurther research is required to discuss clinical application and diagnostic accuracy of DLR algorithms, but AI is a promising dose-reduction technique with future computational advances.     

Defining effective communication for critically ill patients with an artificial airway: An international multi-professional consensus

ObjectivesTo define effective communication and identify its key elements specific to critically ill patients with an artificial airway.DesignA modified Consensus Development Panel methodology.SettingInternational video-conferences.Main outcome measuresDefinition of effective communication and it’s key elements.ResultsEight experts across four international regions and three professions agreed to form the Consensus Development Panel together with a Chair and one person with lived experience who reviewed the outputs prior to finalisation. “Communication for critically ill adult patients with an artificial airway (endotracheal or tracheostomy tube) is defined as the degree in which a patient can initiate, impart, receive, and understand information, and can range from an ineffective to effective exchange of basic to complex information between the patient and the communication partner(s). Effective communication encompasses seven key elements including: comprehension, quantity, rate, effort, duration, independence, and satisfaction. In critically ill adults, communication is impacted by factors including medical, physical and cognitive status, delirium, fatigue, emotional status, the communication partner and the nature of the ICU environment (e.g., staff wearing personal protective equipment, noisy equipment, bright lights).” The panel agreed that communication occurs on a continuum from ineffective to effective for basic and complex communication.ConclusionWe developed a definition and list of key elements which constitute effective communication for critically ill patients with an artificial airway. These can be used as the basis of standard terminology to support future research on the development of communication-related outcome measurement tools in this population.Implications for clinical practiceThis study provides international multi-professional consensus terminology and a definition of effective communication which can be used in clinical practice. This standard definition and key elements of effective communication can be included in our clinical impressions of patient communication, and be used in discussion with the patient themselves, their families and the multi-professional team, to guide care, goal development and intervention.     

An insight into the current perceptions of UK radiographers on the future impact of AI on the profession: A cross-sectional survey

IntroductionAs a profession, radiographers have always been keen on adapting and integrating new technologies. The increasing integration of artificial intelligence (AI) into clinical practice in the last five years has been met with scepticism by some, who predict the demise of the profession, whilst others suggest a bright future with AI, full of opportunities and synergies. Post COVID-19 pandemic need for economic recovery and a backlog of medical imaging and reporting may accelerate the adoption of AI. It is therefore timely to appreciate practitioners’ perceptions of AI used in clinical practice and their perception of the short-term impact on the profession.AimThis study aims to explore the perceptions of AI in the UK radiography workforce and to investigate its current AI applications and future technological expectations of radiographers.MethodsAn online survey (Qualtrics^?) was created by a team of radiography AI experts. The survey was disseminated via social media and professional networks in the UK. Demographic information and perceptions of the impact of AI on several aspects of the radiography profession were gathered, including the current use of AI in practice, future expectations and the perceived impact of AI on the profession.Results411 responses were collected (80% diagnostic radiographers (DR); 20% therapeutic radiographers (TR)). Awareness of AI used in clinical practice is low, with DR respondents suggesting AI will have the most value/potential in cross sectional imaging and image reporting. TR responses linked AI as having most value in treatment planning, contouring, and image acquisition/matching. Respondents felt that AI will impact radiographers’ daily work (DR, 79.6%; TR, 88.9%) by standardising some aspects of patient care and technical factors of radiography practice. A mixed response about impact on careers was reported.ConclusionsRespondents were unsure about the ways in which AI is currently used in practice and how AI will impact on careers in the future. It was felt that AI integration will lead to increased job opportunities to contribute to decision making as an end user. Job security was not identified as a cause for concern.