Androgenic and oestrogenic influences on tyrosine hydroxylase-immunoreactive cells of the prairie vole medial amygdala and bed nucleus of the stria terminalis.

The posterodorsal medial amygdala (MeApd) and principal nucleus of the bed nucleus of the stria terminalis (pBST) are densely interconnected sites integrating steroid hormone and olfactory information necessary for sociosexual behaviours in many rodents. Our laboratory recently reported sexually dimorphic populations of cells containing tyrosine hydroxylase (TH) located in the MeApd and pBST of prairie voles (Microtus ochrogaster), with males having many more TH-immunoreactive (-ir) cells in these sites than do females. Gonadal hormones circulating during adulthood were showm to regulate this sex difference because it was eliminated by castrating adult males or implanting females with testosterone-filled capsules. In the present study, we demonstrate that many (25-65%) TH-ir cells in the MeApd and pBST of adult virgin male and female prairie voles also contain immunoreactivity for either the androgen receptor or oestrogen receptor alpha. Subcutaneous implants of oestradiol benzoate mimicked the effects of testosterone and maintained high numbers of TH-ir cells in these sites in castrated males. However, implants of dihydrotestosterone (DHT) did not, and these males had low numbers of TH-ir cells similar to castrated males given empty capsules. A similar effect was found in females, where testosterone or oestradiol benzoate greatly increased the number of TH-ir cells in these sites compared to intact or ovariectomised controls, but DHT did not. DHT implants did, however, maintain high seminal vesicle weights in males. Thus, many of the TH-ir cells in the prairie vole MeApd and pBST are potentially sensitive to androgens and oestrogens, although maintaining immunocytochemically detectable levels of TH in these cells may depend more on an oestrogen-mediated mechanism in both sexes. These data have implications for understanding how gonadal hormone release across the reproductive cycle modulates these species-specific groups of catecholaminergic cells and socially monogamous behaviours in prairie voles.

The web browser as a unifying agent for radiology and the health care enterprise.

A variety of information systems in the health care enterprise are used to store patient information. The hospital information system (HIS), the picture archiving and communications system (PACS), the radiology information systems (RIS), and patient records, for example, are often supported by separate and distinct systems. A referring physician reviewing a radiologist's report often does not have convenient access to the original radiologic images. A radiologist interpreting a radiologic examination may not have convenient access to clinical information generated outside of the radiology department. Clearly, convenient and quick access to all relevant patient information is the ideal in delivering quality patient care. Recently, the web browser has become increasingly well accepted as the "universal client" for viewing a wide variety of information. We believe that the web browser may provide the universal "window" to the variety of distinct information sources required by the physician, and may provide unification of these information sources through hypertext links. We specifically looked at the feasibility of using the web browser to view scanned patient charts. A total of 5,200 patient charts (131,000 pages) were scanned into a structured query language (SQL) database. Access to these records was made available on the hospital local area network (LAN), and on the Internet over the worldwide web. Comparison measurements were made of the time required to access patient records using a dedicated viewing application and using a web browser.

Upgrading legacy systems for the Integrating the Healthcare Enterprise (IHE) initiative.

As technology vendors have adopted standardized communication protocols, including Digital Imaging and Communications in Medicine (DICOM) and Health Level 7 (HL7), interconnectivity between various devices has been simplified. The recent Integrating the Healthcare Enterprise (IHE) initiative will further promote the use of standards for interconnectivity. Until these standards are universally accepted, we must live in a transitional world where some components will communicate without any modification, while others require upgrades to allow them to meet the new standards. In designing and implementing the network at University of California Los Angeles (UCLA) Medical Center, some integration problems were found that are common to the industry. Creating departmental workflow with only a limited number of acquisition devices supporting the DICOM worklist was the initial problem addressed. Although many manufacturers provide this function for their new scanners, upgrading existing equipment is often cost-prohibitive. To ensure the quality of the demographic information in the image data and the workflow of the system, third-party worklist components were required to upgrade the legacy acquisition devices. These worklist components provided a standards-compliant facade on top of the legacy equipment, allowing seamless integration with the remainder of the network. To support the distribution of worklist information and the feedback of procedure status, a bidirectional HL7/DICOM protocol bridge was required. Although many radiology information system (RIS) manufacturers will be providing native DICOM capabilities in future product releases, the majority of current RIS installations have no DICOM functionality. Similar to the legacy scanners, the HL7/DICOM bridge provided a DICOM-compliant facade to the non-DICOM RIS. The additional use of web-based technology for worklist display further extended flexibility of this facade. We have demonstrated standards-compliant facade technology allowing legacy components to operate seamlessly in an IHE environment at a fraction of the cost of upgrading to new equipment.

Interfacing the radiology information system to the modality: an integrated approach.

The radiology information system (RIS) provides patient and examination information that is used in setting up and performing a radiologic procedure. In a digital imaging environment, information from the RIS can also be used to populate fields in the Digital Imaging and Communications in Medicine (DICOM) image header. Ideally, information from the RIS should be available at the modality at the time of the examination, and automatically be attached to the image in the appropriate DICOM fields before storage in the picture archiving and communications system (PACS). We have designed a highly integrated RIS interface for a digital radiography (DR) system. This interface employs browser technology to make RIS information conveniently available at the modality, and DICOM modality performed procedure step (MPPS) for RIS/DR information exchange. A novel feature of our approach is that a single display screen at the modality is used to alternatively display either the modality control window or the RIS window. Full access to RIS capabilities is available at the modality, including worklists and prior reports.

Ovid's evidence-based medicine reviews: a review of a clinical information product.

Evidence-Based Medicine Reviews (EBMR) is a new full-text product from Ovid Technologies. EBMR supports the practice of evidence-based medicine (EBM) by providing access to two premiere EBM resources: the Cochrane Database of Systematic Reviews from the international Cochrane Collaboration, and Best Evidence from the American College of Physicians-American Society of Internal Medicine. Both resources alert health care professionals, researchers, and librarians to clinically relevant and methodologically sound studies by providing access to full-text reviews and meta-analyses of clinical literature. Value-added features include links to EBMR from MEDLINE, alerting MEDLINE users to available reviews. An "EBM Reviews" limit within MEDLINE facilitates access to the EBMR database contents.

Measuring the ability to meet family needs in an intensive care unit.

OBJECTIVE: To measure the ability to meet family needs in an intensive care unit (ICU). DESIGN: Descriptive survey. SETTING: University hospital ICU. SUBJECTS: Ninety-nine next of kin respondents and 16 secondary family respondents were recruited. INTERVENTIONS: A modified Society of Critical Care Medicine Family Needs Assessment instrument was used. MEASUREMENTS AND MAIN RESULTS: Demographic variables included patient age, gender, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission, Therapeutic Intervention Scoring System (TISS) score on the date of interview, cumulative TISS of the ICU on the day of interview, number of patients in the ICU at time of interview, nurse/patient ratio for the patient, average nurse/patient ratio of the entire unit, day of the week of the interview, timing of the interview, number of ICU attending physicians who cared for this patient (scheduled for a period of seven consecutive days), number of nurses who cared for the patient, if a nurse was assigned the same patient on two consecutive days worked, length of stay in the ICU, and length of hospital stay. Demographic information concerning the family member included gender, age, commuting time to the hospital, visiting time in the hospital per day, number in family group, relationship to the patient, ethnic background, and education level. The additive score of all questions in the needs assessment instrument was calculated and used as the dependent variable. The independent variables were demographic information concerning patients, ICU, and respondents. The model coefficient of determination (R2adj) was 0.20 with a p = .0079. Greater family dissatisfaction (i.e., higher score) was present if there were more than two ICU attendings per patient (p = .048), or if the same nurse was not assigned on two consecutive days (p = .044). Family satisfaction increased if the respondent was female (p = .006), if the patient had a higher APACHE II score (p = .007), and if the patient's relationship with the most significant family member was brother/sister (p = .012). The family needs instrument was reliable and demonstrated a high degree of concordance with a second respondent in the same family surveyed. CONCLUSIONS: Communication by the same provider was important when measuring the ability of an ICU to meet family needs. Instrument scores and the ability to meet family needs differed depending on the gender and the relationship to the patient of the most significant family member. We speculate that this instrument may be a useful adjunct in assessing quality of critical care services provided.

The hypertrophied antral-pyloric fold.

In 3.25% of 400 consecutive double-contrast upper gastrointestinal examinations, a prominent fold in the prepyloric gastric antrum that extends through the pylorus into the base of the duodenal bulb has been identified. Although the clinical significance of this fold is undetermined, endoscopic evaluation suggests it is a manifestation of chronic gastritis. This fold may simulate other entities, but can be distinguished by its characteristic features. Proper recognition may prevent unnecessary procedures such as endoscopy and biopsy.

The anterior bronchus sign: a new clue to hilar abnormality.

One hundred normal posteroanterior chest radiographs were reviewed to determine the frequency of appearance and characteristics of the anterior segmental bronchi of the upper lobes. The bronchus was visible as a sharp circle on the right in 45% of normals, and on the left in 50%. In 90% of normals, there is less than 3 mm of tissue lateral to the bronchus. In 10% of normals, pulmonary vessels may cause 3-5 mm of tissue lateral to the bronchus. Four cases of bronchogenic carcinoma were found to have more than 5 mm of tissue lateral to the bronchus. The presence of more than 5 mm of tissue lateral to the anterior segmental bronchus is termed the "anterior bronchus sign" and is a helpful clue to recognizing hilar region abnormality.