ABSTRACT
Resumen El dolor torácico es un motivo de consulta muy frecuente en el servicio de urgencias. El abordaje adecuado del paciente en el que se incluye el diligenciamiento de la historia clínica, el examen físico y la toma de paraclínicos iniciales son cruciales para determinar cuáles son los posibles diagnósticos diferenciales. A continuación, presentamos el caso de un paciente de 71 años que ingresa al servicio de urgencias por un dolor retroesternal intenso posterior al consumo de alimentos, en quien, ante la persistencia del dolor, biomarcadores cardíacos negativos y patología aórtica descartada, se realiza una endoscopia que evidencia un hematoma disecante del esófago. En general, el pronóstico es bueno, pero es de gran importancia una buena historia clínica para su sospecha.
Abstract Chest pain is a very common reason for consultation in the emergency department. An adequate approach to the patient, including medical history, physical examination and initial laboratory tests, is crucial for determining possible differential diagnoses. The following is the case of a 71-year-old patient that visited the emergency room due to severe retrosternal pain after food consumption. In view of the persistence of pain and negative cardiac biomarkers, and after ruling out aortic disease, the patient underwent an endoscopy that showed dissecting hematoma of the esophagus. The prognosis is generally favorable, but a thorough medical history is required to suspect it.
Subject(s)
Humans , Male , Aged, 80 and over , Esophagus , Hernia, Hiatal , Pathology , Patients , Surgical Mesh , Eating , Emergencies , EndoscopyABSTRACT
OBJECTIVES: Increasing use of medical devices outside of healthcare facilities inevitably requires connectivity and interoperability between medical devices and healthcare information systems. To this end, standards have been developed and used to provide interoperability between personal health devices (PHDs) and external systems. ISO/IEEE 11073 standards and IHE PCD-01 standard messages have been used the most in the exchange of observation data of health devices. Recently, transmitting observation data using the HL7 FHIR standard has been devised in the name of DoF (Devices on FHIR) and adopted very fast. We compare and analyze these standards and suggest that which standard will work best at the different environments of device usage. METHODS: We generated each message/resource of the three standards for observed vital signs from blood pressure monitor and thermometer. Then, the size, the contents, and the exchange processes of these messages are compared and analyzed. RESULTS: ISO/IEEE 11073 standard message has the smallest data size, but it has no ability to contain the key information, patient information. On the other hand, PCD-01 messages and FHIR standards have the fields for patient information. HL7 DoF standards provide reusing of information unit known as resource, and it is relatively easy to parse DoF messages since it uses widely known XML and JSON. CONCLUSIONS: ISO/IEEE 11073 standards are suitable for devices having very small computing power. IHE PCD-01 and HL7 DoF messages can be used for the devices that need to be connected to hospital information systems that require patient information. When information reuse is frequent, DoF is advantageous over PCD-01.
Subject(s)
Humans , Blood Pressure Monitors , Delivery of Health Care , Hand , Hospital Information Systems , Information Systems , Thermometers , Vital SignsABSTRACT
OBJETIVO: Este artigo apresenta um modelo de integração de algoritmos de diagnóstico auxiliado por computador dentro do fluxo de trabalho dos sistemas de gerenciamento de imagens, desenvolvido com base em um conjunto de ferramentas computacionais de código aberto e uso livre chamado dcm4che2. MATERIAIS E MÉTODOS: O modelo de integração é composto por um servidor de processamento de imagens e por serviços de comunicação. O gerenciamento de dados segue o fluxo de trabalho definido pelo perfil de pós-processamento (PWF) do Integrating the Healthcare Enterprise (IHE) e utiliza a funcionalidade de captura secundária do DICOM. Uma aplicação para lesões difusas de pulmão foi utilizada para prova de conceito. RESULTADOS: O algoritmo de classificação de padrões apresentou acurácia de 78 por cento, com base em um método de teste de validação cruzada. A integração possibilita a visualização das imagens processadas como uma nova série dentro do estudo original. CONCLUSÃO: O modelo de integração proposto baseiase em perfis do IHE e permite o estabelecimento de procedimentos padronizados. Os princípios utilizados para integração do fluxo de trabalho são aplicáveis para qualquer tarefa não interativa de pós-processamento de imagens.
OBJECTIVE: This paper presents a model for integration of computer-aided diagnosis algorithms into the picture archiving and communication systems workflow that has been developed on the basis of the dcm4che2 open source toolkit. MATERIALS AND METHODS: The proposed integration model consists of an image processing server and communication services. The data management follows the workflow defined by the post-processing workflow profile (PWF) developed by Integrating the Healthcare Enterprise (IHE) and utilizes the DICOM secondary capture functionality. An application for diffuse lung disease has been utilized as proof of concept. RESULTS: Based on a cross validation method, the standard classification algorithm presented 78 percent accuracy. The integration enables the visualization of processed images as a new series in the original study. CONCLUSION: The proposed integration model is based on IHE profiles and allows the establishment of standardized procedures. The principles used to integrate the workflow are applicable to any non-interactive post-processing task.
Subject(s)
Humans , Diagnosis, Computer-Assisted , Information Management , Image Processing, Computer-Assisted , Lung Injury/diagnosis , Radiology Information Systems , Diagnostic Imaging , Radiography, Thoracic , Tomography, X-Ray ComputedABSTRACT
One important problem of regional information system in healthcare is the access to electronic patient records across healthcare institute boundaries. The Integrating Healthcare Enterprise initiatively proposes the integration profile of the retrieve information for display that enables a user to retrieve and display patients' related documents cross hospitals. The middleware is added to HIS to realize the cross-hospital data access to clinical information with access authorization and privacy regulations. Besides,the integration of cross-hospital patients' clinical information is achieved based on the realization of Patient ID protocol in different systems.
ABSTRACT
Objective To realize information sharing and medical resources integration in different medical enterprises.Methods In accordance with IHE XDS-I image data registration-distribution model,regional data exchange center was set up so that the medical images and report data could be exchanged and shared,and the regional medical network could be smoothly upgraded in interconnection.Results Exchange and sharing of medical images and reports were realized.Standard IHE data interface was prepared for future images exchange between different hospitals.XDS-I model in domestic hospitals were put into practice.Conclusion The structure design of data center is feasible,reliable and effective.