Telepathology overview: From concept to implementation

Telepathology is the practice of pathology at a distance by using video imaging and telecommunications. Significant progress has been made in telepathology. To date, 12 classes of telepathology systems have been engineered. Rapid and ultrarapid virtual slide processors may further expand the range of telepathology applications. Next-generation digital imaging light microscopes, such as miniaturized microscope arrays (MMA), may make virtual slide processing a routine laboratory tool. Diagnostic accuracy of telepathology is comparable with that of conventional light microscopy for most diagnoses. Current telepathology applications include intraoperative frozen sections services, routine surgical pathology services, second opinions, and subspecialty consultations. Three telepathology practice models are discussed: the subspecialty practice (SSP) model; the case triage practice (CTP) model; and the virtual group practice (VGP) model. Human factors influence performance with telepathology. Experience with 500 telepathology cases from multiple organs significantly reduces the video viewing time per case (P < .01). Many technology innovations can be represented as S-curves. After long incubation periods, technology use and/or efficiency may accelerate. Telepathology appears to be following an S-curve for a technical innovation.     

Anatomic evaluation of maxillary sinus septa: Surgery and radiology

The anatomical structure of the maxillary sinus is fundamental to maxillofacial surgery. The presence of septa, located at the inner surface of the maxillary sinus, increases the risk of sinus membrane perforation during sinus elevation for dental implant surgery. The aim of this study was to evaluate the anatomy of maxillary sinus septa.Data in this study was obtained from a total of 205 cases. One hundred and seventy‐seven patients were partially edentulous (PE) whereas 28 patients had no teeth. Dental computerized tomography (dental CT) was used in the assessment of 410 sinus segments (205 left and 205 right segments). The prevalence of sinus segments with septa was found to be 145/410. Septa were detected in 91 of the 177 PE cases. There were a total of 26 septa in 18 of the 28 completely edentulous (CE) cases. A total of 165 septa were detected in these segments. The prevalence of septa was 46.4% (26/56) in the CE, and 39.2% (139/354) in the PE segments. Thirty septa were found in the anterior, 110 in the middle and 25 in the posterior region. All detected septa were located mediolateral direction. Their relative position: lateral, middle or medial were also noted. The height measurements of the septa varied amongst the different positions. In view of the fact that septa of various heights and courses can develop in all parts of the maxillary sinus, timely and adequate assessment of the inner aspect of the maxillary sinus is essential to avoid complications during sinus augmentation procedures. Clin. Anat. 22:563–570, 2009. © 2009 Wiley‐Liss, Inc.     

Experience with implementation of a radiology speech recognition system

Recent advances in speech recognition technology have allowed development of computer systems for real-time radiologist-driven generation of reports. The transition to a speech recognition system is a technically complex process with many potential pitfalls that can decrease efficiency and disrupt workflow. In our recent experience with installation of such a system in an academic radiology department, factors that have worked against optimal performance have included environmental logistics, hardware incompatibilities, radiology information system interface problems, lack of suitable training, and inadequate technical support. Communication of our experience is intended to allow radiologists to anticipate complications of these systems and make informed decisions regarding the feasibility of such a system in their practices. With this information, potential buyers should be able to carefully scrutinize specifications for prospective systems and, by avoiding many of the possible pitfalls, make an easier transition to a speech recognition environment.     

Preventative and therapeutic vaccines for fungal infections: from concept to implementation

Many challenges confront the development of fungal vaccines for humans including differences in host susceptibility, varied pathogenic mechanisms employed by the different species of fungi and mechanisms of host resistance. Hence, no single antigen can be expected to serve as a pan fungal vaccine. Instead, it is likely that progress for fungal vaccines will have to be made at the level of each individual organism. In recent years, tremendous strides have been made in understanding the immunopathogenesis of medically important fungal infections and identifying putative vaccine candidates. Such discoveries will facilitate the introduction of fungal vaccines into the therapeutic armamentarium of clinicians. The fungi under discussion in this review include Candida spp., Aspergillus spp., Cryptococcus neoformans, Coccidioides spp., Histoplasma capsulatum, Blastomyces dermatitidis, Paracoccidioides brasiliensis and Pneumocystis jirovecii.     

Neural networks in radiology: an introduction and evaluation in a signal detection task

Neural networks are a computer architecture, implementable in software or hardware, that allow an entirely new approach to the computerized perception of data. These so-called connectionist models are inspired by what is known about the architecture of biological neurons, in which the "intelligence" or processing capability of the network is a result of the interconnection strengths between large arrays of nonlinear processing nodes. Neural networks are described and then are used to analyze the common radiological problem of pattern recognition on a noisy background. Classical signal detection theory is used to compare network performance against that of human observers, using computer-generated sets of very simple "nodules." The neural network performed with better accuracy, relative to human observer performance, in the detection of this elementary test object. Although these results may not scale up with more complex images, the favorable performance of neural networks at this level suggests that further investigation is warranted.     

Revising the Belgian Nursing Minimum Dataset: from concept to implementation

The process of revising the Belgian Nursing Minimum Dataset (B-NMDS) started in 2000 and entailed four major phases. The first phase (June-October 2002) involved the development of a conceptual framework based on a literature review and secondary data analysis. The Nursing Interventions Classification (NIC) was selected as a framework for the revision of the original B-NMDS. The second phase (November 2002-September 2003) focused on language development for six care programs evaluated by panels of clinical experts (N=75). These panels identified the following items as priorities for the revised B-NMDS: hospital financing, nurse staffing allocation, assessment of the appropriateness of hospitalisation, and quality management. During this period, we developed a draft instrument with 92 variables using the NIC. This led to an alpha version of a revised B-NMDS. The third phase (October 2003-December 2004) focused on data collection and validation of the new tool. The revised B-NMDS (alpha version) was tested in 158 nursing wards in 66 Belgian hospitals from December 2003 until March 2004. This test generated data for some 95,000 in-patient days. The interrater reliability of the revised B-NMDS was assessed. The criterion-related validity of the revised B-NMDS was compared to that of the original B-NMDS. The discriminative power of the revised B-NMDS was also assessed to select the most relevant variables for data collection. This resulted in a beta version of the revised B-NMDS in December 2004. The records of the revised B-NMDS were linked to the Hospital Discharge Dataset and other mandatory datasets to integrate the revised B-NMDS into the overall healthcare management system. The fourth phase (January 2005-December 2005) is presently focusing on information management. Nationwide implementation is foreseen by January 2007.     

Design,implementation and evaluation of amicrocomputer-based portable arrhythmia monitor

The design of a portable, battery-operated microcomputer-based monitor for ambulatory ECG recording and analysis is described. Designed for real-time cardiac arrhythmia analysis, it is suitable for use on ambulator, patients for several weeks, and is about the size and weight of a Holter recorder. The device differs from a Holter recorder in that is does not store normal complexes but recognises and alarms on significant arrhythmias. It sotres 16 s of the arrhythmic event, which it can transmit by telephone to a central receiving station for immediate appraisal by a cardiologist. The monitor uses a CMOS microcomputer and has 2kbytes of program memory and 2kbytes of data memory. The arrhythmia monitor program recognises tachycardia, bradycardia, asystole, dropped beats, and PVCs. The alarm limits are physician programmable. The performance of the monitor was evaluated with standard annotated ECG tapes provided by MIT/BIH. This device should be useful for applications such as antiarrhythmic drug studies, for pacemaker and postsurgery evaluations, and for detecting premonitory as well as life-threatening arrhythmias.     

An evaluation of direct access radiology in general practice

An analysis of the use of direct access to radiology by 71 general practitioners in Scotland is described and is based on 2,596 x-ray examinations in 2,409 patients during a period of six months. Almost half of the patients had to travel more than five miles for their examinations, but time lost in travelling was a much less important factor than the interval elapsing before the requested examination was completed. Nearly one third waited at least two weeks. Referral for diagnosis was by far the commonest reason and direct access was estimated to save 270 hospital outpatient appointments per month. I believe that general practitioners under-use rather than abuse radiology, which might be extended by a selective system of appointments.     

Development and implementation of the Veterans Administration’s multihospital radiology information system

Unknown to most radiology professionals, the Veterans Administration (VA) is implementing an automated radiology information system as an integrated component of its Decentralized Hospital Computer Program. The basic design has been evaluated and refined over the past 5 years. It is now becoming available in all 172 VA medical facilities. Radiology services are provided in a complex management and fiscal environment. The primary purpose of the information system is to improve the efficient processing, performance, and reporting of requests for radiologic consultations and procedures. The automatic capturing of demographic and medical statistics will provide local and national managers more complete data with which to plan future financial, equipment, and personnel requirements. The VA radiology module has the potential to influence the shape of all future systems, commercial and public. This report describes the development of this radiology information system, its current status, and its potential impact on the largest health care system in the country. The module serves as an example of what can or should be expected from the radiology portion of a comprehensive medical information management system.     

Avoiding multiple pregnancies in ART: evaluation and implementation of new strategies.

Strategies for reducing the multiple pregnancies which increase perinatal mortality and morbidity in women undergoing IVF are discussed. Elective single embryo transfer with the promise of subsequent transfer of frozen-thawed embryos would achieve the goal of a single healthy child as a result of IVF treatment. The urgent establishment of a definitive trial comparing elective single versus double embryo transfer is advocated.     

Recommendations for the design,implementation and evaluation of social support in online communities,networks, and groups

A new model of health care is emerging in which individuals can take charge of their health by connecting to online communities and social networks for personalized support and collective knowledge. Web 2.0 technologies expand the traditional notion of online support groups into a broad and evolving range of informational, emotional, as well as community-based concepts of support. In order to apply these technologies to patient-centered care, it is necessary to incorporate more inclusive conceptual frameworks of social support and community-based research methodologies. This paper introduces a conceptualization of online social support, reviews current challenges in online support research, and outlines six recommendations for the design, evaluation, and implementation of social support in online communities, networks, and groups. The six recommendations are illustrated by CanConnect, an online community for cancer survivors in middle Tennessee. These recommendations address the interdependencies between online and real-world support and emphasize an inclusive framework of interpersonal and community-based support. The applications of these six recommendations are illustrated through a discussion of online support for cancer survivors.     

Qualitative and quantitative evaluation of charge capture by a radiology information system

Installation of a radiology information management system (RIS) is usually justified on the basis of improved departmental efficiency and improved charge capture. However, evaluation of the success of these expected improvements is often difficult. The installation and operation of such a system in a medium-sized tertiary care hospital has permitted the effects of the RIS on the operation of the department to be studied and the improvements in charge capture provided by the system to be quantitatively assessed. As a result of a side-by-side comparison with a conventional check-sheet manual billing system, it is apparent that the RIS reduces the errors inherent in manual systems. Subjectively, it is also apparent that personnel prefer the computerized system to the manual charge sheets.     

Hypermedia in radiology: Computer-assisted education

Hypertext is a new computer-based method of presenting information that provides greater flexibility than conventional methods of continuing education. With a hypertext system, an individual using the computer can acquire more information on a word or concept that needs to be pursued in depth. Hypermedia is an expanded concept which uses the computer's ability to incorporate images, sounds, and video images in addition to text. This interactive, multimedia approach customizes information for more effective learning. The authors devised a prototype hypermedia textbook of nuclear medicine using a personal computer with hypermedia software that contains text, graphs, tables, figures, literature citations, and an easily persuable image database. All the information is organized with multiple cross-references, allowing instant branching to relevant facts, in different levels of detail. The system's applications and the ease of expansion or modification by the user are described.     

Local allergic rhinitis: concept, pathophysiology, and management

Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy characterized by local production of specific IgE (sIgE) antibodies, a T(H)2 pattern of mucosal cell infiltration during natural exposure to aeroallergens, and a positive nasal allergen provocation test response with release of inflammatory mediators (tryptase and eosinophil cationic protein). Although the prevalence remains to be established, a number of patients previously given a diagnosis of nonallergic rhinitis or idiopathic rhinitis are now being classified as having LAR. Culprit allergens responsible include house dust mite, grass and olive pollens, and many others. For the diagnosis of LAR, neither skin prick testing nor determination of the presence of serum sIgE antibodies is useful, and a nasal allergen provocation test is needed to identify the culprit allergen or allergens. In a certain proportion of cases, local sIgE can be detected, and conjunctivitis, asthma, or both can be associated. Whether patients with LAR will have systemic atopy in the future is a matter of debate. Further studies are needed for examine the prevalence of this phenomenon in different areas, to improve the diagnostic methods to better identify these patients, and to develop therapeutic approaches, including the use of immunotherapy.     

A generic concept for the implementation of medical image retrieval systems

This paper presents a technical framework to support the development and installation of system for content-based image retrieval in medical applications (IRMA). A strict separation of feature extraction, feature storage, feature comparison, and the user interfaces is suggested. This allows to reuse implemented components in different retrieval algorithms, which improves software quality, shortens the development cycle for applications, and allows to introduce standardized end-user interfaces. Based on the proposed framework, the IRMA engine has been established, which is currently used to evaluate content-based retrieval methods on a collection of 20,000 medical and 135,000 non-medical images.     

Development, implementation, and a cognitive evaluation of a definitional question answering system for physicians

The published medical literature and online medical resources are important sources to help physicians make patient treatment decisions. Traditional sources used for information retrieval (e.g., PubMed) often return a list of documents in response to a user’s query. Frequently the number of returned documents from large knowledge repositories is large and makes information seeking practical only “after hours” and not in the clinical setting. This study developed novel algorithms, and designed, implemented, and evaluated a medical definitional question answering system (MedQA). MedQA automatically analyzed a large number of electronic documents to generate short and coherent answers in response to definitional questions (i.e., questions with the format of “What is X?”). Our preliminary cognitive evaluation shows that MedQA out-performed three other online information systems (Google, OneLook, and PubMed) in two important efficiency criteria; namely, time spent and number of actions taken for a physician to identify a definition. It is our contention that question answering systems that aggregate pertinent information scattered across different documents have the potential to address clinical information needs within a timeframe necessary to meet the demands of clinicians.     

The ethics of relationality in implementation and evaluation research in global health: reflections from the Dream-A-World program in Kingston,Jamaica

Background

Despite recent developments aimed at creating international guidelines for ethical global health research, critical disconnections remain between how global health research is conducted in the field and the institutional ethics frameworks intended to guide research practice.

Discussion

In this paper we attempt to map out the ethical tensions likely to arise in global health fieldwork as researchers negotiate the challenges of balancing ethics committees’ rules and bureaucracies with actual fieldwork processes in local contexts. Drawing from our research experiences with an implementation and evaluation project in Jamaica, we argue that ethical research is produced through negotiated spaces and reflexivity practices that are centred on relationships between researchers and study participants and which critically examine issues of positionality and power that emerge at multiple levels. In doing so, we position ethical research practice in global health as a dialectical movement between the spoken and unspoken, or, more generally, between operationalized rules and the embodied relational understanding of persons.

Summary

Global health research ethics should be premised not upon passive accordance with existing guidelines on ethical conduct, but on tactile modes of knowing that rely upon being engaged with, and responsive to, research participants. Rather than focusing on the operationalization of ethical practice through forms and procedures, it is crucial that researchers recognize that each ethical dilemma encountered during fieldwork is unique and rooted in social contexts, interpersonal relationships, and personal narratives.