Studies in health technology and informatics
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Stud Health Technol Inform · Jan 2003
Federal initiatives in information technology to improve patient safety and quality of care.
In November 1999, the Institute of Medicine (IOM) released a report that focused on patient safety in the United States (U. S.), in which it estimated that up to 98,000 people die in U. S. hospitals each year from medical errors. ⋯ The crux of these initiatives was a series of solicitations that form an integrated set of research and demonstration projects for reducing medical errors in multiple health care settings. This chapter will discuss some of these initiatives, focusing on the role of clinical informatics in the Agency's efforts to improve the safety and quality of health care in the U. S.
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Some recent developments around the organisation of ICT applications in healthcare in the Netherlands are discussed, in relation with the installation of a new National ICT Institute for Healthcare (NICTIZ). Some examples are given, especially from the field of Quality Assurance and Information Security.
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Stud Health Technol Inform · Jan 2002
Sagittal and transversal plane deformity in thoracic scoliosis.
The aim of the study was to assess the sagittal and transversal plane deformity of the spine in thoracic scoliosis by the mean of 3-D radiographic analysis. 46 patients admitted for surgery for thoracic idiopathic scoliosis underwent preoperative radiographic assessment. All patients presented the same pattern of the coronal plane deformity: single right thoracic curve (Lenke 1, King 3). Neither lumbar nor proximal thoracic structural curve were present. The Cobb angle varied from 41gamma to 77 gamma (mean 55,4 gamma +/- 8,6 gamma). Long cassette standing antero-posterior and lateral radiographs were analysed. Three-dimensional reconstruction with Rachis 91TM software was performed for each pair of radiographs. The following parameters were assessed: sagittal thoracic Cobb angle (Th4-Th12), upper thoracic kyphosis angle (Th5-Th8), lower thoracic kyphosis angle (Th9-Th12), superior and inferior hemi-curve sagittal angles, lumbar lordosis, sacral slope, sacral incidence, vertebral plate index, segmental vertebral axial rotation throughout the thoracic and lumbar spine. Results showed great variability of parameters assessed. The non-harmonious distribution of kyphosis was demonstrated in the thoracic spine. Local Th9-Th12 hypokyphosis and adjacent local Th5-Th8 hyperkyphosis constitute the most typical sagittal pathologies. So called normokyphotic curves were composed of one hyperkyphotic and one hypokyphotic zone. Th1-Th4 segment revealed two patterns of segmental rotation distribution: a purely compensatory curve with no vertebral axial rotation or a rotated curve presenting the morphology intermediate between Lenke 1 and Lenke 2 types (or King 3 and King 5). ⋯ curves presenting the same coronal plane deformity differ in their morphology assessed in the two other planes; global thoracic kyphosis angle is a misleading parameter because it covers hypo- and hyperkyphotic zones; local distal thoracic (Th9-Th12) hypokyphosis is present in idiopathic thoracic scoliosis.
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Stud Health Technol Inform · Jan 2002
Randomized Controlled Trial Comparative Study Clinical TrialThe role of rigid vs. dynamic instrumentation for stabilization of the degenerative lumbosacral spine.
This is a prospective comparative randomised study to compare the immediately postoperative effects of a rigid versus dynamic instrumentation for degenerative spine disease and stenosis on the standing sagittal lumbar spine alignment and to investigate if a dynamic spine system can replace the commonly used rigid systems in order to avoid the above mentioned disadvantages of rigid fixation. ⋯ Both rigid and dynamic instrumentations restored lumbar lordosis, sacral tilt, distal lordosis and increased the foraminal diameter at the level L4-L5 resulting in an indirect decompression of the nerve roots at this level . Both rigid and dynamic instrumentations applied in the lumbosacral spine to treat degenerative disease secured L3 to S1 sagittal spine profile close to preoperative levels, that should theoretically guarantee a pain-free postoperative course. This study supports the belief that the dynamic system can be used with the same indications with the rigid in degenerative lumbar spine because it can offer equally good short-term results regarding sagittal spine alignment while simultaneously it has the previously mentioned advantages (avoidance stress shielding etc).
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This chapter focused on some of the key issues of Health and Nursing Informatics Education. First an historical overview of Health and Nursing Informatics Education is presented. ⋯ Because of the variety of educational systems, the International Medical Informatics Association (IMIA) felt the need to develop international recommendations in health and medical informatics education. From a nursing informatics perspective, the IMIA recommendations in Nursing Informatics Education are discussed.