Challenges in the implementation of picture archiving and communication system in a high volume public sector hospital of a developing country

Objectives: To highlight the challenges faced in implementation of Picture Archiving and Communication System [PACS] in a high volume public sector hospital of a developing country after conducting a survey among health professionals related to PACS

Method: This descriptive observational study was conducted out in the Department of Radiology, Medical Teaching Institute, Lady Reading Hospital, Peshawar from March 2017 to August 2017. Standardized Performa was designed for data collection and distributed among radiologists, emergency physicians and radiology technicians working on PACS and results were analyzed

Results: 92.8% radiologists were more comfortable with reporting on PACS than on films. 100% technicians agreed that PACS has decreased the time taken for the images to reach the referring physicians. 70.8% physicians said that waiting time for radiology reports has reduced by the use of PACS and 62.5% physicians thought that their efficiency has improved by getting reports quickly. 42.8% radiologists and 70% technicians have experienced frequent system errors

Conclusion: Medical imaging implementation in a developing country is an expensive and complex undertaking. Its success is multifactorial and multidisciplinary involving radiologists, physicians and radiology technicians with full backup and support of IT department for training and troubleshooting. In addition, a continuous financial support for up-gradation and maintenance of the technology is a major challenge for government sector hospitals

Determinants of success of decortication

Background: To find out different factors which lead to failed decortication and to evaluate their management and outcome

Study Design: Retrospective observational descriptive study

Place of Study: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2003 to Sep 2006

Materials and Methods: Clinical record of 300 patients who underwent decortication tor chronic empyema during the last 3.9 years was retrospectively analyzed and their results evaluated. Detailed scrutiny of the computerized clinical record was carried out to analyze the aetiology of failure of the operation. The variables studied were persistent broncho- pleural fistula, poor postoperative efforts by the patients, wound infection, old chest drain site infection, technical failure and nutritional state of the patient

Results: Of the 300 deoortications performed over the period of 3.9 years, 260 patients had a successful outcome in terms of lung expansion and improved pulmonary functions. In thirty patients [19 males, 11 females with age range of 12 to 70 years] decortications failed to achieve the desired results. These patients had to undergo space obliteration procedures for persistent infected space. Twenty three patients had history of tuberculosis and seven patients had nontuberculous empyema. All patients had chronic empyema with duration of more then 12 weeks before the first operation. All patients were nutritionally compromised. Thoracoplasty [compete or partial] was performed in 25 patients to obliterate the persistent infected space. Five patients with recurrent broncho-pleural fistula had an additional procedure of intercostal muscle reinforcement over the fistulae, in addition to thoracoplasty. All patients had successful obliteration of the persistent space with no mortality and minor wound infection in only three patients

Conclusion: Early referral, old drain site infection control, meticulous closure of broncho pleural fistula and space obliteration procedure in combination primarily instead of secondarily, lead to a successful outcome