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Mountain View (mountain + view)
Selected AbstractsThe Pocket Echocardiograph: Validation and FeasibilityECHOCARDIOGRAPHY, Issue 7 2010Benjamin C. Culp M.D. Background: A new, miniaturized ultrasound device, the pocket echocardiograph (PE), is highly portable and can be carried inside a lab-coat pocket. Studies of this device are limited and have not examined the use by novice echocardiographers. We hypothesize that a novice echocardiographer can use PE to produce interpretable cardiac images, and that both novice and expert echocardiographers can use PE to accurately quantify ejection fraction. Methods: Unselected subjects (n = 40) in an echocardiography laboratory underwent blinded formal transthoracic echocardiography (TTE) and PE (Acuson P10, Siemens, Mountain View, CA, USA). A cardiology fellow with 2 months of echocardiography training acquired PE images. The fellow and an experienced echocardiographer interpreted the PE studies offline in a blinded fashion. To assess adequacy, studies were graded as technically adequate, limited, or inadequate. A visual estimation of ejection fraction was made. Comparisons were made to the formal reported TTE. Results: Subjects were heterogeneous, 43% male; age 64 ± 17 years, and ejection fraction 52.4%± 12.3%. All PE studies were interpretable, and the vast majority of PE and TTE images were considered technically adequate (77.5% and 85% respectively; P = 0.32). Ejection fraction showed a good correlation, bias, and limits of agreement for the fellow's interpretation (r = 0.78, ,5.9%, ±16.6%) with stronger association for the experienced echocardiographer (r = 0.88, ,0.8%, ±11.4%). Conclusion: Novice echocardiographers using the PE can produce adequate quality images. Both expert and novice echocardiographers can use PE to quantify ejection fraction over a broad range of patients. The device's low cost and portability may greatly expand the availability of bedside echocardiography for routine or urgent cardiovascular assessment. (Echocardiography 2010;27:759-764) [source] Computers, systems theory, and the making of a wired hospital: A history of Technicon Medical Information System, 1964,1987JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 6 2010Rachel Plotnick This paper investigates the controversy surrounding the systems approach in medicine, contributing to the body of literature on systems and information technology in civilian contexts. Specifically, the paper follows the design and implementation of a hospital information system at El Camino Hospital in Mountain View, California, in the 1960s and 1970s. The case study suggests that while many considered "people problems" like healthcare too complex for the systems approach, in fact it could have positive results if system engineers could translate social concerns about medicine into business and organizational strategies. This paper identifies the ways systems designers approached an organization characterized by autonomy rather than collaboration, craft rather than science, and charity rather than business, and helped to redefine that organization as one that emphasized rationality, efficiency, and the coexistence of man and machine. [source] Fractional deep dermal ablation induces tissue tightening,LASERS IN SURGERY AND MEDICINE, Issue 2 2009Zakia Rahman MD Abstract Background and Objective Due to the significant risk profile associated with traditional ablative resurfacing, a safer and less invasive treatment approach known as fractional deep dermal ablation (FDDAÔ) was recently developed. We report the results of the first clinical investigation of this modality for treatment of photodamaged skin. Study Design/Materials and Methods Twenty-four subjects received treatments on the inner forearm with a prototype fractional CO2 laser device (Reliant Technologies Inc., Mountain View, CA) at settings of 5,40 mJ/MTZ and 400 MTZ/cm2. Clinical and histological effects were assessed by study investigators 1 week, 1 month, and 3 months following treatment. Thirty subjects were then enrolled in a multi-center study for treatment of photodamage using the same device. Subjects received 1,2 treatments on the face and neck, with energies ranging from 10 to 40 mJ/MTZ and densities ranging from 400 to 1,200 MTZ/cm2. Study investigators assessed severity of post-treatment responses during follow-up visits 48 hours, 1 week, 1 month, and 3 months following treatment. Using a standard quartile improvement scale (0,4), subjects and investigators assessed improvement in rhytides, pigmentation, texture, laxity and overall appearance 1 and 3 months post-treatment. Results Clinical and histologic results demonstrated that fractional delivery of a 10,600 nm CO2 laser source offers an improved safety profile with respect to traditional ablative resurfacing, while still effectively resurfacing epidermal and dermal tissue. Forearm and facial treatments were well-tolerated with no serious adverse events observed. Eighty-three percent of subjects exhibited moderate or better overall improvement (50,100%), according to study investigator quartile scoring. Conclusions FDDAÔ treatment is a safe and promising new approach for resurfacing of epidermal and deep dermal tissue targets. Lasers Surg. Med. 41:78,86, 2009. © 2009 Wiley-Liss, Inc. [source] The effects of multiple passes on the epidermal thermal damage pattern in nonablative fractional resurfacing,LASERS IN SURGERY AND MEDICINE, Issue 2 2009Dieter Manstein MD Background and Objective Nonablative fractional resurfacing is a concept of cutaneous re-modeling whereby laser-induced microscopic treatment zones (MTZs) are surrounded by normal viable tissue. Such thermal damage pattern with a small diameter of individual lesions allows fast re-epithelialization with minimal side effects. The purpose of this in vitro study was to determine the fraction of thermal injury per unit surface area (fill factor) and lesion size in relation to pulse energy and number of passes. Methods Full thickness abdominal skin samples were exposed ex vivo to the Fraxel SR 750 laser (Reliant Technologies, Mountain View, CA). One set of exposures was performed for pulse energies in the range of 8 to 40 mJ for a single pass at 250 MTZ/cm2. A second set of exposures was performed at 10 mJ with number of passes from 1 to 30. The thermal damage pattern was assessed by incubation of epidermal sheets with NitroBlueTetrazoliumChloride (NBTC) stain. Size of individual MTZ and fill factor were determined by image analysis (ImageJ, NIH, Bethesda, MD) of digital micrographs. Results Width of the thermal injury zone was directly related to the pulse energy used. The fill factor did not have a uniform relationship with the number of passes. Due to the stochastic placement of individual MTZs, even for greater number of passes, some residual undamaged tissue was found. Due to formation of thermal damage clusters, defined as overlapping individual MTZs, the size of the resulting clustering lesions which we defined as microscopic treatment cluster (MTC) increased linearly as a function of the number of passes. Conclusion We have described the fill factor as it relates to the number of passes and have demonstrated that the average size of individual lesions depends on the number of passes. Clustering of MTZs lead to the development of MTC, the average size of which increased with the number of passes. The clinical implications of these findings are contingent on further studies. Lasers Surg. Med. 41:149,153, 2009. © 2009 Wiley-Liss, Inc. [source] Robotics in cardiac surgery: the Istanbul experienceTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2006Ertan Sagbas Abstract Background Robots are sensor-based tools capable of performing precise, accurate and versatile actions. Initially designed to spare humans from risky tasks, robots have progressed into revolutionary tools for surgeons. Tele-operated robots, such as the da VinciÔ (Intuitive Surgical, Mountain View, CA), have allowed cardiac procedures to start benefiting from robotics as an enhancement to traditional minimally invasive surgery. Methods The aim of this text was to discuss our experience with the da Vinci system during a 12 month period in which 61 cardiac patients were operated on. There were 59 coronary bypass patients (CABG) and two atrial septal defect (ASD) closures. Results Two patients (3.3%) had to be converted to median sternotomy because of pleural adhesions. There were no procedure- or device-related complications. Conclusion Our experience suggests that robotics can be integrated into routine cardiac surgical practice. Systematic training, team dedication and proper patient selection are important factors that determine the success of a robotic surgery programme. Copyright © 2006 John Wiley & Sons, Ltd. [source] Quantitative Analysis of Tympanic Membrane Disease Using Video-Otoscopy ,THE LARYNGOSCOPE, Issue 10 2000Vikram J. Jaisinghani MD Abstract Objective To perform quantitative analysis of pathological changes in the tympanic membrane using video-otoscopic images. Study Design Prospective case-control study. Methods Forty-two ears of children with chronic otitis media with effusion (OME) and 15 ears of normal children were included in this study. Tympanic membrane images were captured and digitized using a Welch-Allyn (Skaneatales Falls, NY) VDX-300 Illumination and Imaging system with S-VHS input to a MIRO DC 30 (Pinnacle Systems, Mountain View, CA) visual board in a Power PC,based computer. These images were visualized and recorded during static and pneumatic pressure changes. Quantitative analysis of tympanic membrane disease was performed using Image Pro Plus Imaging software (Media Cybernetics, Del Mar, CA). The measurements included area of the tympanic membrane and its quadrants, area of tympanic membrane involved by disease, angle formed at the umbo, and length of the malleus versus vertical length of the tympanic membrane. Results Tympanosclerosis was present in 57% of ears and occurred most frequently in the anteroinferior quadrant, but the ma-imum area of involvement was in the posteroinferior quadrant. The ratio of the angles formed at the umbo was significantly greater (P = .01) for the OME group compared with the control group. The ratio of the length of the umbo and the vertical length of the tympanic membrane was almost identical for the OME and the control groups (P = .4). Conclusions Video-otoscopic images can be used for quantitative analysis of tympanic membrane disease. The ratio of the posterior angle to the anterior angle formed at the umbo seems to be a more reliable indicator of post otitis media than is a reduced length of the long process of malleus. [source] Robot-assisted laparoscopic adrenalectomy: preliminary UK resultsBJU INTERNATIONAL, Issue 3 2004S. Undre Authors from London describe the early results from the UK in the use of robot-assisted laparoscopic adrenalectomy. In a small group of patients they found that patients could be treated early, with early discharge from hospital. The use of retrograde balloon dilatation of PUJ obstruction is revisited by authors from Plymouth, who review their 10 years of experience with this technique. They found that the procedure gave good symptomatic relief in 76% of their patients, but found no relationship between symptom relief and renographic improvement. In a few patients with a long-term follow-up there was symptomatic improvement and good maintenance of split renal function. OBJECTIVE To describe the results of our first two cases of laparoscopic adrenalectomy using the da VinciTM surgical system (Intuitive Surgical, Inc., Mountain View, CA, USA). PATIENTS AND METHODS Amongst 75 robot-assisted procedures performed at our institution, two patients underwent robot-assisted laparoscopic adrenalectomy. The set-up time, procedure time, hospital stay, complications and outcomes were recorded. RESULTS Both operations were completed successfully using the robot; the mean (range) set-up time was 31 (25,37) min and mean procedure time 118.5 (107,130) min. One patient had a postoperative pulmonary embolus and was discharged 5 days after surgery; the second patient was discharged after 3 days. There were no intraoperative complications; both patients were well at the 1-year follow-up CONCLUSIONS Robot-assisted laparoscopic adrenalectomy is technically feasible and can be conducted efficiently and safely with the da Vinci surgical system. [source] | ||||||||||