硬件还原技术在PACS报告工作站管理中的应用

本文阐述了通过硬件还原技术解决PACS报告工作站存在问题的方法。硬件还原技术的引入实现了报告工作站稳定、高效的运行,降低了软件维护时间与成本,提升了放射科医生的工作效率。     

What would you do? Challenges in shoulder surgery

Dr. Evan Flatow moderates a panel of experts and discusses complex shoulder arthroplasty cases dealing with bone loss, malunions, arthroplasty revision, implant failure, and more. Panel includes Dr. Jon P. Warner, Dr. Gerald Williams, Dr. William Levine, Dr. William Seitz, and Dr. Evan Lederman.     

Distal Forearm Fracture Open Reduction–Internal Fixation: Sonographic Detection of Hardware Malalignment and Associated Tendon Injuries Missed by Radiography

Tendon injury is a known complication of distal radius fracture plate and screw fixation. Targeted musculoskeletal sonography is uniquely capable of assessing both tendon integrity and hardware abnormalities not recognized on radiographs. Each of the 3 patients described presented with pain after an open reduction–internal fixation following a distal forearm fracture. In each patient, radiographic findings, specifically the hardware position, were interpreted as normal. Important radiographically occult observations were subsequently made with sonography, including 3 proud screws and tendon injuries, all of which required surgical treatment. This case series demonstrates the clinical utility of musculoskeletal sonography in symptomatic patients after distal radius open reduction–internal fixation with negative radiographic findings. In our practice, sonography has been the most useful modality for precluding missing or delaying the diagnosis and treatment of these hardware complications. We advocate its use as an adjunct in any department performing musculoskeletal imaging.     

Allergy Considerations in Implanted Neuromodulation Devices

ObjectivesAllergic reactions are rare and poorly understood complications of neuromodulation device implantation. There are currently no guidelines for management of allergic reactions to these devices and their components. Here we review the published cases of allergic reactions to implanted neuromodulatory devices and leverage the experiences of other specialties that deal with similar complications to formulate recommendations for prevention and management.Materials and MethodsA review and assessment of the literature.ResultsAllergic reactions to a number of implantable devices have been observed and published. In dentistry and orthopedics, metals such as nickel are the most frequent cause of allergic reactions. In interventional cardiology, where devices closely resemble neuromodulatory devices, titanium, silicone, and polyurethanes are the most common causes of allergic reactions. In neurosurgery, allergic reactions to implantable neuromodulatory devices are rare, and we summarize 13 cases published to date. Such allergic reactions generally present as local dermatitis, erythema, and pruritus, which can be difficult to distinguish from surgical site infection. In one published case, symptoms resolved with corticosteroid treatment, but all other cases required explantation. The successful reimplantation with a modified device was reported in some cases.ConclusionsPatients should be screened for a personal history of contact allergy before implantation procedures. A multidisciplinary approach to suspected cases of postoperative allergic reactions involving collaboration between neurosurgeons and other implanting physicians, dermatologists or allergists, and device manufacturers is recommended. In cases where an allergic reaction is suspected, an infectious etiology should be ruled out first. Clinical suspicion can then be supported with the use of patch testing, interpreted by an experienced dermatologist or allergist. If patch testing supports an allergic etiology, the implanting physician and the device manufacturer can work together to modify the device for safe reimplantation.     

Instillation negative pressure wound therapy: An effective approach for hardware salvage

Wound infection involving hardware can be notoriously difficult to treat, often requiring the removal of the infected implant. The goal of this study was to determine the utility of instillation negative pressure wound therapy to help eradicate infection and allow for definitive wound closure in patients without removing the infected hardware. A retrospective review was performed on the outcomes of 28 patients who presented with open wounds with exposed or infected hardware and who were treated with a combination of surgical debridement and negative pressure wound therapy with instillation (NPWTi). Eleven patients were treated for infected spinal hardware, 12 for extremity, and 5 for sternal hardware. Twenty‐five of 28 (89%) patients had successful retention or replacement of hardware, with clearance of infection and healed wounds. Original hardware was maintained in 17 of 28 (61%) patients. In 11 patients, original hardware was removed, with subsequent replacement in eight of those patients after a clean wound was achieved. Average time to definitive closure was 12.6 days. Average follow‐up was 135 days. This series supports NPWTi as an effective adjunct therapy to help expeditiously eradicate hardware infection, allowing for hardware retention.     

医院信息系统的切换方案及实践

目的：探讨医院信息系统切换的准备工作及实施过程,为系统切换提供实践指导。方法：从组织准备、数据整理、操作培训、软硬件配置、应急预案、后续维护等方面入手,完成医院新旧信息系统的切换。结果：在充分的前期准备及后续支持到位的保障下,本次系统切换顺利完成,医院整体业务平稳过渡。结论：医院信息系统切换是一项复杂的工作,稍有不慎将导致切换失败,若在前期能参考其他医院的经验并结合本单位的实际情况进行充分准备,实施过程中沉着应对,即可切换成功。     

数字化医院的危机识别

医院数字化后,一旦系统停止运行整个医疗活动都将受到较大影响。识别出影响医院数字化体系软件运行的可能“事件”,将其纳入到医院危机管理体系中,才能降低风险,消除突发“事件”的负面影响。本文对此进行阐述,并分析了“事件”产生的原因,对维护好、使用好医院信息系统具有一定的借鉴意义。