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Establishing radiologic image transmission via a transmission control protocol internet protocol network between two teaching hospitals in Houston

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 88-90页

作者： Shepherd, B Univ Texas Sch Med Dept Radiol Houston TX 77030 USA

The technical and management considerations necessary for the establishment of a network link between computed tomography (CT) and magnetic resonance imaging (MRI) networks of two geographically separated teaching hospitals are presented. The University of Texas Medical School at Houston Department of Radiology provides radiology residency training at its primary teaching hospital and at a second county-run hospital located approximately 12 miles away, A direct network link between the two hospitals was desired to permit timely consultative services to residents and professional colleagues. The network link was established by integrating the county hospital free-standing imaging network into the network infrastructure of the Medical School and the main teaching hospital. Technical issues involved in the integration were reassignment of internet protocol (IP) addresses, determination of data transmission protocol compatibilities, proof of connectivity and image transmission, transmission speeds and network loading, and management of the new network, These issues were resolved in a planned stepwise fashion and despite the fact that the system has a rate-limiting T1 segment between the county hospital and the teaching hospital the transmission speed was deemed suitable. The project has proven successful and can provide a guide for planning similar projects elsewhere. It has in fact made possible several new services for the teaching and research activities of the department's faculty and residents, which were not envisaged before the implementation of this connection. Copyright (C) 1999 by W.B. Saunders Company.

关键词：计算机系统数据库管理系统诊断显像医院县医院教学因特网实习医师和住院医师职务磁共振成像放射学/教育放射学信息系统转诊和会诊院校医学系统综合远程放射学得克萨斯体层摄影术 X线计算机人类

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University and practice based physicians' input on the content of a surgical curriculum

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AMERICAN JOURNAL OF SURGERY 1999年第1期178卷 78-84页

作者： Curet, MJ DaRosa, D Mennin, S Univ New Mexico Hlth Sci Ctr Dept Surg Sch Med Albuquerque NM 87131 USA Northwestern Univ Chicago IL USA

BACKGROUND: The specific surgical knowledge and skills students learn during surgical rotations are reconsidered in light of recent changes in medical school curricula. The purpose of this study was to determine the priorities of a surgical curriculum based on input from three groups: surgical faculty (SF), primary care faculty (PCF), and community-based, practicing primary care physicians (PCP). METHODS: A questionnaire was developed in which SF (n = 54), PCF (n = 85), and PCP (n = 876) were asked to rank the importance of 145 areas of knowledge and 48 areas of clinical skills on a 5-point Likert-type scale. Responses were rank ordered by the mean of importance ratings for each group. Differences among groups were evaluated using ANOVA. RESULTS: Response rates were best for faculty (100% SF, 88% PCF, 61% PCP). All three groups considered general surgery related topics and general skills very important. Primary care physicians and PCF consistently ranked otolaryngology, ophthalmology, and orthopedic topics and skills higher than did SF. Surgery faculty ranked invasive surgical procedures higher than did PCP while PCP ranked orthopedic procedural skills more highly. CONCLUSIONS: There is significant overlap among physicians about what medical students should learn during a surgical rotation. Differences between groups centered on surgical subspecialty knowledge and clinical skills. These results provide a broad perspective about required subjects for a core surgical clerkship curriculum, which should include surgical subspecialty training, Am J Surg. 1999;178:78-84. (C) 1999 by Excerpta Medica, Inc.

关键词：课程数据收集循证医学实习医师和住院医师职务医师诊疗模式医师的作用初级卫生保健专业医学/教育外科学/教育人类

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Evaluation of physician preferences for guideline implementation

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AMERICAN JOURNAL OF MEDICAL QUALITY 1999年第4期14卷 170-177页

作者： Stone, TT Kivlahan, CH Cox, KR Univ Missouri Sch Med Program Hlth Serv Management Dept Hlth Management & Informat Columbia MO 65211 USA Univ Missouri Off Clin Outcomes & Med Management Ctr Hlth Sci Columbia MO 65211 USA

Although current literature supports the use of evidence-based clinical practice guidelines (CPGs) by physicians, there is limited research concerning operational issues that may be inhibiting effective CPG implementation. The objective of our research was to increase under standing of clinical practice patterns by identifying physician preferences for CPG accessibility, format, content and learning strategies. Semistructured interviews were conducted with resident and faculty physicians in an academic medical center after they were presented with a CPG during treatment of a patient with acute pancreatitis. The results of our study revealed that physicians prefer CPGs in the form of evidence-based algorithms with treatment-specific information that is placed on the front of the patient chart during treatment. In addition, they felt that discussion of the guideline with colleagues, reminder notes/stickers on front of the patient chart, and verbal reminders from a nurse were the most effective means of encouraging utilization.

关键词：医学科学研究中心急性病算法医务工作者的态度评价研究循证医学全体教工医学院校坚持准则实习医师和住院医师职务胰腺炎/治疗医师诊疗模式/统计学和数值数据问卷调查专业医学美国人类

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Comparison of the first 100 coronary bypass patients of a supervised resident with his first 100 as an attending surgeon at the same institution

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AMERICAN JOURNAL OF SURGERY 1999年第4期178卷 348-350页

作者： Roberts, CS Bocanegra, NR Univ N Carolina Sch Med Div Cardiothorac Surg Chapel Hill NC 27599 USA

BACKGROUND: Although coronary artery bypass grafting (CABG) has been analyzed intensely for 30 years, little information is available on the characteristics and outcome of CABG patients operated upon by resident trainees or first-year attending surgeons in a public teaching hospital. METHODS: The first 100 CABG patients operated upon by a supervised resident were compared with the first 100 CABG patients under the cave of the same person as an attending surgeon at the same institution. In the first group, the resident was directly supervised by one of three different staff surgeons. In the second group, the same person, as an attending, performed 60 operations and directly supervised one of two trainees in 40. RESULTS: Comparing the resident group versus the attending group, mean age (62 versus 61 years), percentage of females (37 and 37), tobacco use (74 versus 77), obesity (43 versus 55), insulin-dependent diabetes mellitus (20 versus 17), ejection fraction less than or equal to 0.5 (29 versus 35), and previous myocardial infarction (56 versus 54) were similar. Three or move coronary anastomoses were performed in 83 patients in the first group and in 74 in the second group. Early mortality (in-hospital and/or less than or equal to 30 days) occurred in 2 patients in the resident group and 3 in the attending group;each patient had a low ejection fraction and severe narrowing of all three major epicardial coronary arteries. Morbidity in the two groups was similar. CONCLUSION: If properly supervised by experienced staff surgeons, a resident trainee can achieve satisfactory results in CABG in a heterogeneous group of patients. Furthermore, the transition to attending surgeon can be achieved with a good outcome for the patients. (C) 1999 by Excerpta Medica, Inc.

关键词：心脏病学/教育临床工作能力冠状动脉分流术/方法实习医师和住院医师职务医务人员医院治疗结果成年人老年人老年人 80以上人类中年人

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Curriculum recommendations for resident training in geriatrics interdisciplinary team care

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JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 1999年第9期47卷 1149-1150页

作者： Fulmer, T IndianaUniversitySchoolofMedicine Indianapolis46202USA.

Sets out guidelines that have been developed to facilitate the development of geriatrics interdisciplinary team care experiences within residency training programs, the Task Force on Resident Training in Geriatrics Interdisciplinary Team Care of the American Geriatrics Society (AGS) Education Committee. The recommendations are intended to assist program directors in developing curriculum in geriatrics interdisciplinary team care and provide a framework for evaluating their current training in geriatrics interdisciplinary team care. (Original abstract - amended)

关键词：课程老年医学/教育实习医师和住院医师职务病人医疗小组人类

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Cancer pain management through a pharmacist-based analgesic dosing service

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 1999年第11期56卷 1119-1125页

作者： Lothian, ST Fotis, MA von Gunten, CF Lyons, J Von Roenn, JH Weitzman, SA NW Mem Hosp Dept Pharm Analges Dosing Serv Chicago IL 60611 USA NW Mem Hosp Dept Pharm Drug Informat Ctr Chicago IL 60611 USA Northwestern Univ Sch Med Dept Prevent Med Chicago IL USA

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Laparoscopic tubal sterilization - Methods, effectiveness, and sequelae

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OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA 1999年第1期26卷 83-+页

作者： Ryder, RM Vaughan, MC Eastern Virginia Med Sch Div Gynecol Norfolk VA 23507 USA

Worldwide, tubal sterilization is the most commonly chosen form of contraception by women who have completed their desired childbearing. In the United States, it is chosen by more married or formerly married women than any other method. Sterilization has enjoyed increasing popularity since the 1950s, primarily owing to the technologic advances and increasing social acceptance. Improvements in technique and technology have rendered it a safe, effective, and cost-efficient outpatient procedure. This makes tubal sterilization a particularly attractive choice in the managed care setting and in developing countries, where access to medical care occurs most frequently in rural clinic settings.

关键词：健康态度咨询电凝术/仪器和设备妇科学/教育子宫切除术实习医师和住院医师职务腹腔镜检查/副作用腹腔镜检查/方法病人满意度妊娠异位/诊断显像妊娠异位/病因学妊娠异位/预防和控制绝育输卵管/副作用绝育输卵管/仪器和设备绝育输卵管/方法治疗失败超声检查成年人女(雌)性人类妊娠

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Faculty and resident opinions regarding the role of morbidity and mortality conference

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AMERICAN JOURNAL OF SURGERY 1999年第2期177卷 136-139页

作者： Harbison, SP Regehr, G Allegheny Univ Hlth Sci Grad Div Dept Surg Allegheny Univ Hosp Philadelphia PA 19146 USA

BACKGROUND: The role of the surgical morbidity and mortality (M&M) conference as a forum for examination of surgical failure may remain unclear. This paper reports the results of a national survey of surgical faculty and trainees regarding the role and effectiveness of the M&M conference. METHODS: Based on focus groups and pilot studies from multiple institutions in one geographic area, a questionnaire addressing critical issues in attitudes toward the M&M conference was sent to 1,100 randomly chosen subjects nationwide: 500 residents and 600 staff. The survey includes individual and institutional demographic information, 15 statements answered using a Likert scale, and 2 open-ended questions. RESULTS: Faculty response rate was 501 of 600 (83%) and resident response rate was 166 of 500 (33%). Responses were generally positive in both groups, with staff showing small but significantly more positive attitudes than residents. A higher proportion of residents characterize the M&M conference as too defensive. CONCLUSION: The M&M conference is fulfilling its potential as a teaching tool but there may be room for improvement as residents view the experience slightly less positively than faculty. This questionnaire provides a perspective of expectations for the M&M conference, allowing educators to optimize its effectiveness. (C) 1999 by Excerpta Medica, Inc.

关键词：态度全体教工医学院校卫生保健调查实习医师和住院医师职务手术后并发症/流行病学问卷调查美国人类

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Transmission of live laparoscopic surgery over the Internet2

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AMERICAN JOURNAL OF SURGERY 1999年第5期178卷 415-417页

作者： Damore, LJ Johnson, JA Dixon, RS Iverson, MA Ellison, EC Melvin, WS Ohio State Univ Med Ctr Dept Surg Columbus OH 43210 USA Ohio State Univ Med Ctr Tech Serv Columbus OH 43210 USA

BACKGROUND: Video broadcasting of surgical procedures is an important tool for education, training, and consultation. Current video conferencing systems are expensive and time-consuming and require preplanning. Real-time Internet video is known for its poor quality and relies on the equipment and the speed of the connection, The Internet2, a new high-speed (up to 2,048 Mbps), large bandwidth data network presently connects more than 100 universities and corporations. We have successfully used the Internet2 to broadcast the first real-time, high-quality audio/video program from a live laparoscopic operation to distant points. METHODS: Video output of the iaparoscopic camera and audio from a wireless microphone were broadcast to distant sites using a proprietary, PC-based implementation of H.320 video conferencing over a TCP/IP network connected to the Internet2. The receiving sites participated in two-way, real-time video and audio communications and graded the quality of the signal they received. RESULTS: On August 25, 1998, a laparoscopic Nissen fundoplication was transmitted to Internet2 stations in Colorado, Pennsylvania, and to an Internet station in New York, On September 28 and 29, 1998, we broadcast laparoscopic operations throughout both days to the Internet2 Fall Conference in San Francisco, California. Most recently, on February 24, 1999, we transmitted a laparoscopic Heller myotomy to the Abilene Network Launch Event in Washington, DC. CONCLUSIONS: The Internet2 is currently able to provide the bandwidth needed for a turn-key video conferencing system with high-resolution, real-time transmission. The system could be used for a variety of teaching and educational programs for experienced surgeons, residents, and medical students.

关键词：因特网实习医师和住院医师职务腹腔镜检查/方法外科学/教育远程医学录像人类

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State-of-the-art phacoemulsification performed by residents in Buenos Aires, Argentina

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JOURNAL OF CATARACT AND REFRACTIVE SURGERY 1999年第12期25卷 1651-1655页

作者： Badoza, DA Jure, T Zunino, LA Argento, CJ Univ Buenos Aires Hosp Clin Jose de San Martin Sch Med Dept Ophthalmol Buenos Aires DF Argentina

Purpose: To analyze the learning curve for state-of-the-art phacoemulsification performed by residents. Setting: Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, University of Buenos Aires, Buenos Aires, Argentina. Methods: The records of patients having phacoemulsification performed by residents from June 1996 to January 1998 were reviewed for preoperative and postoperative best corrected visual acuities and the occurrence of complications. The phacoemulsification technique used for the first 35 surgeries of each resident was compared with that of their last 35 surgeries. Results: The records showed 249 cases of phacoemulsification by residents. Mean preoperative best corrected visual acuity was 0.19 +/- 0.19 (SD). One month postoperatively, it wa 0.86 +/- 0.2. Nuclear fracture was performed in a mean of 28.33 +/- 5.0 of the first 35 surgeries by each resident, whereas chopping techniques were used in a man of 23.33 +/- 1.5 of the last 35 cases. Vitreous loss occurred in 2.8% of cases. Conclusion: Residents learned cracking and chopping phacoemulsification techniques safely with satisfactory outcomes. J Cataract Refract Surg 1999;25:1651-1655 (C) 1999 ASCRS and ESCRS.

关键词： Clinical Competence Internship and Residency Ophthalmology Phacoemulsification 临床工作能力实习医师和住院医师职务眼科学超声乳化白内障吸除术 Residency Surgery Ophthalmology Phacoemulsification Clinical Competence Internship and Residency

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