Effiziente IT-Lösungen in der Radiologie

For hospitals and radiology departments an efficient hospital information system (HIS), a radiology information system (RIS) and a picture archiving system (PACS) with high availability, reliability, flexibility and simple operation are necessary for survival. Besides the networking of patients and pictures data IT systems must also be capable of continuous process optimization in the dimensions of medical quality, service quality and profitability. What is not measurable is not improvable. A successful management demands current, medium-term and long-term indicators for the control. These performance and cost data are also available for benchmarking with other departments or for analysis for manpower requirements. In contrast to the past indicators must now concentrate on the use of resources by interdepartmental process treatment (clinical pathways and imaging pathways). The monitoring of image pathways is a future task. Without qualified IT personnel, optimal IT systems cannot be successful. In the complex treatment processes in hospitals high medical (radiological) quality is only possible in connection with optimal IT systems and excellent IT specialists.     

Human systems integration in remotely piloted aircraft operations

BACKGROUND: The role of humans in remotely piloted aircraft (RPAs) is qualitatively different from manned aviation, lessening the applicability of aerospace medicine human factors knowledge derived from traditional cockpits. Aerospace medicine practitioners should expect to be challenged in addressing RPA crewmember performance. METHODS: Human systems integration (HSI) provides a model for explaining human performance as a function of the domains of: human factors engineering; personnel; training; manpower; environment, safety, and occupational health (ESOH); habitability; and survivability. RPA crewmember performance is being particularly impacted by issues involving the domains of human factors engineering, personnel, training, manpower, ESOH, and habitability. RESULTS: Specific HSI challenges include: 1) changes in large RPA operator selection and training; 2) human factors engineering deficiencies in current RPA ground control station design and their impact on human error including considerations pertaining to multi-aircraft control; and 3) the combined impact of manpower shortfalls, shiftwork-related fatigue, and degraded crewmember effectiveness. Limited experience and available research makes it difficult to qualitatively or quantitatively predict the collective impact of these issues on RPA crewmember performance. CONCLUSION: Attending to HSI will be critical for the success of current and future RPA crewmembers. Aerospace medicine practitioners working with RPA crewmembers should gain first-hand knowledge of their task environment while the larger aerospace medicine community needs to address the limited information available on RPA-related aerospace medicine human factors. In the meantime, aeromedical decisions will need to be made based on what is known about other aerospace occupations, realizing this knowledge may have only partial applicability.     

CT imaging, then and now: a 30-year review of the economics of computed tomography

The first computed tomography (CT) scanner in the US was installed in June 1973 at the Mayo Clinic in Rochester, MN. By the end of 1974, 44 similar systems had been installed at medical facilities around the country. Less than 4 years after the introduction of CT imaging in the US, at least 400 CT systems had been installed. The practice of pneumoencephalography was eliminated. The use of nuclear medicine brain scans significantly diminished. At the time, CT imaging was limited to head studies, but with the introduction of contrast agents and full body CT systems the changes in the practice of medicine became even more significant. CT imaging was hailed by the US medical community as the greatest advance in radiology since the discovery of x-rays. But the rapid spread of CT systems, their frequency of use, and the associated increase in healthcare costs combined to draw the attention of decision-makers within the federal and state governments, specifically to establish policies regarding the acquisition and use of diagnostic technologies. Initially, CT imaging was limited to neurological applications, but in the 30 years since its inception, capabilities and applications have been expanded as a result of the advancements in technology and software development. While neurological disorders are still a common reason for CT imaging, many other medical disciplines (oncology, emergency medicine, orthopedics, etc.) have found CT imaging to be the definitive tool for diagnostic information. As such, the clinical demand for CT imaging has steadily increased. Economically, the development of CT imaging has been one of success, even in the face of governmental action to restrict its acquisition and utilization by healthcare facilities. CTimaging has increased the cost of healthcare, but in turn has added unquantifiable value to the practice of medicine in the US.     

精准医学的临床部署：顶层架构设计及关键信息技术

随着世界范围内研究者对多维度信息融合分析投入越来越多的关注,精准医学成为一种全新的医学模式。精准医学的核心是通过多维度信息分析患者的个体差异以达到精准预防、精准治疗的目的。精准医学的优势在于借助新的生物学技术及信息技术,将基因组信息整合入临床实践,提供临床决策支持,以实现对疾病的发病机制、分型等进行全新的探索和诠释。精准医学的关键技术包括疾病亚型分组技术、临床决策支持系统、电子病历的改版升级、伦理学挑战及知情同意管理、术语控制与本体开发及全表型组关联分析技术等。作者旨在结合全球范围内精准医学取得的进展对中国精准医学临床部署进行规划,以提高疾病的治愈率,改善患者的预后及生活质量,提升国民健康水平。     

Bloodless surgery developments accommodate patients' choice of treatment

The medical and ethical challenge of treating Jehovah's Witnesses without blood transfusions is being met by dedicated professionals around the world. Jehovah's Witnesses have assisted by setting up a research department (Hospital Information Services), with relevant information available at 100 branches world wide. They have appointed over 1,300 Hospital Liaison Committees in major medical centres throughout the world which disseminate relevant medical and legal literature to obviate misunderstandings. The members of these committees receive regular training and are internationally networked to assist medical and legal professionals and to avoid unnecessary confrontations. They already list over 90,000 doctors world wide who provide bloodless medical care. Around the world more than 190 hospitals offer bloodless medicine and surgery programmes.     

A narrative review of e-learning in professional education of healthcare professionals in medical imaging and radiation therapy

ObjectivesThis literature review attempts to explore the characteristics of e-learning tools used to develop the qualifications and skills of healthcare professionals in medical imaging and radiation therapy, and to promote the effectiveness and acceptance of e-learning through highlighting the outcomes of its implementation where applicable.Key findingsFrom the literature search in the PubMed and ResearchGate databases we concluded to 21 articles, which were included in the qualitative synthesis. Acceptance of e-learning tools was confirmed. Also, e-learning can be part of healthcare professionals' blended learning. The acquisition of new or improvement of existing knowledge, the improvement of clinical skills and the increase of the self-confidence of healthcare professionals in their daily practice were recorded, as outcomes of the e-learning implementation. The importance of human–computer interaction for the comprehension of theoretical concepts and practical aspects using multimedia was also captured. No significant findings emerged among the 21 articles against the adoption of the e-learning for the training of healthcare professionals. The Internet is the channel used for synchronous and asynchronous interaction of trainees with instructors.ConclusionsWe concluded that e-learning is an attractive training method, equally or occasionally more effective than the traditional educational methods for the lifelong training of healthcare professionals in the field of medical imaging and radiation therapy. Also, many collaborative web-based applications provide the necessary means to build an e-learning program, according to the training needs of each professional team.Implications for practiceThis new knowledge corroborates the perspective of e-learning beneficial contribution to remote interaction and collaboration of healthcare professionals in medical imaging and radiation therapy. Collaborative web-based tools are already available to decision makers and stakeholders, who want to develop an e-learning program.     

Management of medical confidentiality in English professional football clubs: some ethical problems and issues

OBJECTIVE: To examine the ways in which confidential matters are dealt with in the context of the relationship between the club doctor (or physiotherapist) and the player as patient in English professional football clubs. METHODS: Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. RESULTS: There is among club doctors and physiotherapists no commonly held code of ethics governing how much and what kind of information about players may properly be passed on to managers; associated with this, there is considerable variation from one club to another in terms of the amount and kind of information passed on to managers. In some clubs, medical staff attempt to operate more or less on the basis of the rules governing confidentiality that apply in general practice, but in other clubs, medical staff are more ready to pass on personal information about players. In some situations, this raises serious ethical questions. CONCLUSIONS: Guidelines dealing with confidentiality in practitioner-patient relationships in medical practice have long been available and have recently been restated, specifically in relation to the practice of sports medicine, by the British Olympic Association, the British Medical Association, and the Football Association. This is a welcome first step. However, if the guidelines are to have an impact on practice, detailed consideration needs to be given to ensuring their effective implementation; if this is to be achieved, consideration also needs to be given to identifying those aspects of the culture and organisation of professional football clubs that may hinder the full and effective implementation of those guidelines.     

An examination of the role of military medical chief information officer

Although research has described the roles, responsibilities, and skills of effective chief information officers (CIOs) in for-profit organizations, little is known regarding the traits and skills that characterize effective military medical CIOs. This study identifies skills a military medical CIO needs to act as a technology strategist who can successfully identify information technology (IT) innovations and convert those innovations into organizational health IT solutions. We assessed the level of necessary informational, decisional, and interpersonal skills in a cross-sectional survey of 48 military medical CIOs. We also compared military medical CIO characteristics to general CIO characteristics. Our results show that both decisional and interpersonal skills are strongly related to informational skills necessary to convert innovations into organizational IT solutions. Further, decisional skills are strongly related to a CIO's ability to act as a technology strategist. Our study provides implications for research and practice.     

Enterprise PACS and image distribution.

Around the world now, because of the need to improve operation efficiency and better cost effective healthcare, many large-scale healthcare enterprises have been formed. Each of these enterprises groups hospitals, medical centers, and clinics together as one enterprise healthcare network. The management of these enterprises recognizes the importance of using PACS and image distribution as a key technology in cost-effective healthcare delivery in the enterprise level. As a result, many large-scale enterprise level PACS/image distribution pilot studies, full design and implementation, are underway. The purpose of this paper is to provide readers an overall view of the current status of enterprise PACS and image distribution. reviews three large-scale enterprise PACS/image distribution systems in USA, Germany, and South Korean. The concept of enterprise level PACS/image distribution, its characteristics and ingredients are then discussed. Business models for enterprise level implementation available by the private medical imaging and system integration industry are highlighted. One current system under development in designing a healthcare enterprise level chest tuberculosis (TB) screening in Hong Kong is described in detail.     

High altitude medicine education in China: exploring a new medical education reform

China has the largest plateau in the world, which includes the whole of Tibet, part of Qinghai, Xinjiang, Yunnan, and Sichuan. The plateau area is about 257.2×10(4) km(2), which accounts for about 26.8% of the total area of China. According to data collected in 2006, approximately twelve million people were living at high altitudes, between 2200 to 5200?m high, on the Qinghai-Tibetan Plateau. Therefore, there is a need for medical workers who are trained to treat individuals living at high altitudes. To train undergraduates in high altitude medicine, the College of High Altitude Military Medicine was set up at the Third Military Medical University (TMMU) in Chongqing in 1999. This is the only school to teach high altitude medicine in China. Students at TMMU study natural and social sciences, basic medical sciences, clinical medical sciences, and high altitude medicine. In their 5(th) year, students work as interns at the General Hospital of Tibet Military Command in Lhasa for 3 months, where they receive on-site teaching. The method of on-site teaching is an innovative approach for training in high altitude medicine for undergraduates. Three improvements were implemented during the on-site teaching component of the training program: (1) standardization of the learning progress; (2) integration of formal knowledge with clinical experience; and (3) coaching students to develop habits of inquiry and to engage in ongoing self-improvement to set the stage for lifelong learning. Since the establishment of the innovative training methods in 2001, six classes of high altitude medicine undergraduates, who received on-site teaching, have graduated and achieved encouraging results. This evidence shows that on-site teaching needs to be used more widely in high altitude medicine education.     

医学期刊在转化医学中的作用

临床医学界、基础医学界、预防医学界多个领域已表现出了对转化医学的极大关注。作为医学期刊,理应在转化医学的传播中发挥主观能动作用,为转化医学提供强大动力。但国内转化医学研究水平与国外差距较大,仍需进一步发挥医学期刊对转化医学的推动作用。医学期刊承载着传播医学信息、报道医学新进展和新方法的功能。深入理解编辑在传播转化医学中的职责,开展转化医学专题策划,借助新媒体,促进转化医学成果的有效传播。编辑应帮助转化医学研究者相关写作知识的提高。医学期刊作为一有效的沟通媒介,在基础医学与临床医学之间起到纽带的作用。作者就国内外转化医学现状及医学期刊在转化医学中的作用作一介绍。     

Information needs of naval primary care providers and patients at sea

OBJECTIVE: To optimally practice medicine, and to live healthy lives, providers and patients need convenient access to authoritative information. The goal of this study was to determine the information needs of naval primary care providers and patients at sea to aid development of a digital health sciences library for naval primary care providers and patients. METHOD: A literature-based needs assessment was conducted from articles identified using MEDLINE searching and U.S. Navy health care information sources. Recurring medical problems/diseases/topics were identified and categorized. RESULTS: Eighty-one articles and books were reviewed and abstracted, representing a broad base of naval medicine. Twenty-one medical and surgical theme areas and 125 medical problems/diseases/topics were recurrently identified. CONCLUSIONS: The common naval medical problems identified are nearly identical to the common medical problems in the general population, have changed little from the 18th century, and were consistent with first-hand information from naval primary care providers.     

企业级医疗影像信息集成平台研究

目的:探讨大型医院内部各影像系统信息共享和医疗资源整合方法.方法:采用IHE技术框架为理论指导,结合国内医院实际提出"企业级医疗影像信息集成平台"及其开放整合方案,通过各厂商的密切配合、实施,初步实现对全院DICOM影像的统一归档和统一发布.结果:经过实践验证,集成平台切实有效,既提高临床医生对医学影像信息的使用效率,提高诊疗质量,又便于医信技术人员对影像信息的集成管理.结论:基于IHE技术框架的企业级影像信息集成平台研究被证明是可行、可靠和有效的.     

PACS for surgery and interventional radiology: features of a Therapy Imaging and Model Management System (TIMMS)

Appropriate use of information and communication technology (ICT) and mechatronic (MT) systems is viewed by many experts as a means to improve workflow and quality of care in the operating room (OR). This will require a suitable information technology (IT) infrastructure, as well as communication and interface standards, such as specialized extensions of DICOM, to allow data interchange between surgical system components in the OR. A design of such an infrastructure, sometimes referred to as surgical PACS, but better defined as a Therapy Imaging and Model Management System (TIMMS), will be introduced in this article.A TIMMS should support the essential functions that enable and advance image guided therapy, and in the future, a more comprehensive form of patient-model guided therapy. Within this concept, the “image-centric world view” of the classical PACS technology is complemented by an IT “model-centric world view”. Such a view is founded in the special patient modelling needs of an increasing number of modern surgical interventions as compared to the imaging intensive working mode of diagnostic radiology, for which PACS was originally conceptualised and developed. The modelling aspects refer to both patient information and workflow modelling.Standards for creating and integrating information about patients, equipment, and procedures are vitally needed when planning for an efficient OR. The DICOM Working Group 24 (WG-24) has been established to develop DICOM objects and services related to image and model guided surgery. To determine these standards, it is important to define step-by-step surgical workflow practices and create interventional workflow models per procedures or per variable cases.As the boundaries between radiation therapy, surgery and interventional radiology are becoming less well-defined, precise patient models will become the greatest common denominator for all therapeutic disciplines. In addition to imaging, the focus of WG-24 is to serve the therapeutic disciplines by enabling modelling technology to be based on standards.     

医务人员临床工作绩效内涵及指标体系构建:基于工作职责和个体绩效结构演化的探析

 目的 深化对医务人员临床工作职责及其绩效内涵的认识,提升个体绩效理论在制定绩效评价指标体系中的应用价值,为医务人员临床工作绩效评价研究提供新的视角和途径。方法 基于临床工作职责,结合个体绩效研究成果,界定医务人员临床工作绩效内涵。结果 (1)医务人员临床工作绩效包含工作能力、工作表现和取得的工作成果。(2)医务人员临床工作绩效评价指标体系可包含专业诊治、医患交流、职业自律3个一级指标;诊疗产出、诊疗行为、诊疗能力、沟通成效、沟通行为、沟通能力、自律成就、自律行为和自律能力9个二级指标。结论 将工作职责与“结果—行为—能力”三因素绩效结构模型相结合提取绩效评价指标,可强化指标层级之间的逻辑关联,具有一定的科学性和合理性。初步构建的医务人员临床工作绩效评价指标体系有待进一步细化、验证和完善。     

The Defence Medical Library Service and military medicine

The Defence Medical Library Service (DMLS) supports the clinical practice and career development of military health professionals across the world. Clinical governance and the need for medical knowledge to be evidence-based means the DMLS has a central role to play in support of defence medicine. The DMLS is important for enabling health professionals to make sense of the evidence-based pyramid and the hierarchy of medical knowledge. The Royal Centre for Defence Medicine (RCDM) in Birmingham is recognised as an international centre of excellence. The information, knowledge and research requirements of the RCDM will provide opportunities for the DMLS to support and engage with the academic community.     

Sexual Harassment in Radiology: Prevalence and Opportunities for Improvement

Radiologists have a key role in the delivery of modern medicine and interface with almost every medical subspecialty within health care systems. Radiology requires collaborative team science and continued communication across providers. Essential to these ends is an inclusive and respectful environment. Therefore, sexual harassment cannot be tolerated. This perspective provides an overview of the existing literature on sexual harassment in medicine and sexual harassment in radiology and suggestions for creating change within the field of radiology to address sexual harassment. This article also discusses specific ways that radiologists can be engaged as bystanders who intervene effectively to stop or mitigate problematic situations as they occur. Although individual changes in behavior can be impactful, ultimately, wholesale cultural transformation is key to preventing sexual harassment. Leaders in radiology, like leaders everywhere, must make clear that harassing behaviors will not be tolerated and that those who have committed harassment will be held accountable.     

Trends in nuclear medicine in developing countries

This article describes trends in nuclear medicine in the developing world as noted by nuclear medicine professionals at the International Atomic Energy Agency (IAEA). The trends identified are based on data gathered from several sources, including information gathered through a database maintained by the IAEA; evaluation of country program frameworks of various IAEA Member States; personal interactions with representatives in the nuclear medicine field from different regions of the world; official proceedings and meeting reports of the IAEA; participation in numerous national, regional, and international conferences; discussions with the leadership of major professional societies; and relevant literature. The information presented in this article relied on both objective and subjective observations. The aims of this article were to reflect on recent developments in the specialty of nuclear medicine and to envision the directions in which it is progressing. These issues are examined in terms of dimensions of practice, growth, and educational and training needs in the field of nuclear medicine. This article will enable readers to gain perspective on the status of nuclear medicine practice, with a specific focus on the developing world, and to examine needs and trends arising from the observations.     

Networks in the radiology department and the hospital

Data networks are a basic technology with regard to an appropriate design of the information technology (IT) infrastructure for the hospital. Due to the distributed workflow within the hospital, an integrated Hospital Information System (HIS) is based mostly on a set of network applications facing specific items. Medical communication standards, i. e., HL 7, DICOM, and in the near future the migration towards XML, support the interoperability between the IT subsystems and pave the way to patient information systems with access to unified and complete electronic medical records (EMR). Furthermore, with standardized communication techniques, such as CORBAmed, an object-oriented design of Healthcare applications will be possible in the near future. The intent of this paper is to give an overview of which basic technologies are suitable for building comprehensive, flexible, and reliable hospital networks and which also meet the special demands of the radiology department. Received: 14 April 2000/Accepted: 17 May 2000     

Patient preparation for diagnostic nuclear medicine imaging procedures: an analysis of ward nurse knowledge

Purpose This study examined ward nurse understanding of diagnostic nuclear medicine imaging procedures in order to assess whether they were adequately informed to prepare their patients for nuclear medicine imaging examinations.Method A questionnaire was used to establish ward nurse knowledge and understanding of nuclear medicine. The questionnaire had two sections: nurse characteristics and nurse knowledge of information sources about nuclear medicine; knowledge assessment. The knowledge assessment had two elements—self-assessment of knowledge and objective assessment of knowledge based upon multiple choice questions. One hundred questionnaires were distributed to nurses of varying grades on six wards in a district general hospital. The six wards routinely referred patients for nuclear medicine imaging examinations. For the past four years each of these wards had been provided with information booklets for ward staff. These booklets were to provide ward staff with adequate background knowledge to prepare, physically and psychologically, their patients for diagnostic nuclear medicine imaging procedures.Results Knowledge varied considerably between nurses. Overall the nurses had a poor understanding of nuclear medicine, however their self-assessment ratings suggested they generally considered themselves inadequately informed to prepare their patients for the nuclear medicine imaging procedures. Several factors were identified to explain their lack of understanding. These included lack of specific training and education basic nursing courses and the ward nurses not knowing that information booklets were available on the ward for them.Conclusions/recommendations Ward nurse knowledge needs to be improved and inter-nurse knowledge variations need to be minimised. This may help ward nurses prepare their patients more adequately for the diagnostic nuclear medicine imaging procedures. Selection of nurses, through self-selection, may be a reliable method of deciding which nurses require additional training. However the data suggests that those nurses with a better knowledge and understanding may underrate their true ability.