Benefits of the DICOM Structured Report

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change. Biography Rita Noumeir is a professor at the Department of Electrical Engineering of the University of Quebec, école de Technologie Superieure in Montreal. A founding member of the Imaging, Vision, and Artificial Intelligence Laboratory (LIVIA), her main research interest is the Healthcare Information Technology, specifically, Interoperability, Electronic Patient Record, Security, Information Confidentiality, and Image Processing. As a member of both Technical and Planning International IHE Radiology Committees, Dr. Noumeir took part over the last 5 years in developing many Integrating the Healthcare Enterprise (IHE) Integration Profiles in Radiology and in organizing several Integration Demonstrations. She is a cofounder of IHE Canada. Dr. Noumeir contributed to many research and development projects in collaboration with several Canadian and international companies in medical imaging and healthcare information. Currently, she collaborates with the Diagnostic Imaging Team of Canada Health Infoway to define the principles and architecture for sharing imaging information between multiple healthcare institutions. She plays a leading role in the development of this solution that is published as an IHE Integration Profile for which she is the editor. Rita Noumeir holds a Ph.D. and a Masters degree in Biomedical Engineering from école Polytechnique of Montreal specializing in Medical Imaging. She is a professional engineer, and a member of the Ordre des ingénieurs du Québec.     

An integrative psychophysiological approach to brain hemisphere functions in schizophrenia

The present paper proposes a new psychophysiological approach to the genesis of positive and negative schizophrenic symptoms. According to this approach, the initial factor in schizophrenic disorders is a functional insufficiency of the right hemisphere which can be determined by early emotional experience in combination with subtle brain damage. This functional insufficiency causes (a) the inability to grasp and select information before its realization; and (b) the inability to produce a polysemantic context which is crucial for creativity, psychological defense, and the restoration of search activity, all of which determine psychophysiological adaptation to the environment. Right hemisphere insufficiency causes left hemisphere hyperactivity as an ineffective attempt to compensate for this functional deficiency. As a result, normal search activity is replaced by artificial search activity which is represented by “positive” symptoms, and which uses the predisposition of the left hemisphere's catecholamine system for its increased activity. The suggestion is made that cognitive impairment in schizophrenia (the inability to use appropriate previous information in relation to current perceptual input) is related to the competition between information processing which requires left hemisphere activity, and the formation of positive symptoms, also based on left hemisphere activity.     

Information Fusing Recognition of Traditional Chinese Medicine （TCM） Pulse State Based on Stochastic Fuzzy Neural Network

Based on the fuzzy characteristic of the pulse state and syndromes differentiation thinking mode of TCM, an information fusing recognition method of pulse states based on SFNN （Stochastic Fuzzy Neural Network） is presented in this paper. With the learning ability in parameters and structure, SFNN fuses the measurement information of three pulse-state sensors distributed in Cun, Guan, and Chi location of body for the pulse state recognition. The experimental results show that the percentage of correct recognition with new method is higher than that by single-data recognition one, with fewer off-line train numbers.     

How to Effectively Implement an Indicator System to Improve Performance from a Management Perspective: The Case of Taiwan Healthcare Indicator Series (THIS) System

This study uses the Taiwan Healthcare Indicator Series (THIS) system as an example to examine which determinants would improve performance by sharing indicators from a management perspective. This study population included all 227 hospitals participating in the THIS system in 2006. A structured questionnaire was sent to the director who was responsible for the THIS system via electronic mail. A total of 111 responses were returned by February 10, 2006. Questions included current implementation and impacts of the system. Hierarchical regression models were performed to identify which variables were significantly associated with performance improvement, adjusted for hospital characteristics. Four variables significantly associated with implementing the THIS system to improve performance were ‘senior management support,’ ‘benchmarking,’ ‘making departments improve the underperforming indicators and report the improvement results in performance management meetings,’ and ‘integration with the National Health Insurance payment regulations’. This study contributes substantially to the evidence base about what works to improve performance by information sharing. Although information sharing is the basis of efforts to improve performance, senior management support and how to effectively apply the information are the most important determinants of performance enhancement.     

脉冲电磁场影响人骨髓基质干细胞缝隙连接通讯的实验研究

目的研究脉冲电磁场(PEMFs)对人骨髓基质干细胞(hBMSCs)缝隙连接所介导细胞间通讯(GJIC)的影响。方法透射电镜观察BMSCs超微结构,应用荧光漂白恢复(FRAP)技术,通过激光共聚焦显微镜检测hBM-SCs经PEMFs刺激后GJIC的功能变化。结果经PEMFs刺激后的hBMSCs,平均荧光漂白恢复率为(64.12±0.83)%,较对照组犤(35.26±0.76)%犦有显著性增加(P<0.05)。结论PEMFs刺激能促进hBMSCs的缝隙连接通讯功能。     

Siblings of a child with cancer

Summary A total of 21 healthy siblings were interviewed about their experiences when a brother or sister is diagnosed with cancer. Information about the illness, opinions about who should inform siblings, social support, specific worries and worst memories were studied, as well as perceptions of any differences in the way they were treated by their parents. A short General Impact Scale was developed to assess the extent to which the siblings felt their lives had been disrupted by the illness. Results on these measures were compared with scores on four dimensions of the Sibling Perception Questionnaire (Carpenter & Sahler 1991). Siblings who reported some positive effects as a consequence of the illness (they had become more empathic toward others, or valued life more) perceived their interpersonal relations to be more negatively affected, i.e. there were greater difficulties in their relationships with others especially their parents. Higher scores on communication were related to less of an impact of the illness on life generally. However, these siblings also reported heightened concerns that their brother or sister might die. The data suggested that siblings should have opportunities to talk about implications of the disease, especially worries about death, and more efforts should be made to prepare siblings for visits to hospital and seeing the sick child.     

Communication skills training for medical students: an integrated approach

Skills of communication are not easily taught to medical students. Three main clinical departments (general practice, medicine and mental health) of the Medical Faculty of the Queen's University, Belfast, introduced an integrated course in January 1988 to teach the basic principles. The course is held at the beginning of clinical training and is an integral part of the introductory clinical course. It was introduced in response to the Report of a Working Party of the Education Committee of the General Medical Council (1987) which advocated the need for improved training in history-taking and communication. It is a 12-week course and every Monday and Friday afternoon from 1400 to 1700 hours 12 students are seconded from ward work, four to the Department of Medicine, four to the Department of General Practice and four to the Department of Mental Health. Hand-outs about information to be obtained and interview style are standardized and the principles to be followed are clearly defined in an aide-mémoire. Staff from the Departments of General Practice and Mental Health experienced in teaching communication by videotape feedback and analysis of consultations prepared 12 tutors for their role and responsibilities. Procedures to be followed were carefully explained to all students beforehand. General practice and psychiatry traditionally have established teaching programmes in communication but the inclusion of the Department of Medicine has made a significant impact. Students have come to realize that the taking of a good history demands as much skill as the physical examination of the patient and is an important aspect of any clinical assessment.