Canada's "disasters-R-us" medical platoon a hit in Honduras.
The Canadian Forces Disaster Assistance Response Team did not take long to adapt to the medical needs of 90,000 survivors of Hurricane Mitch last November. (+info
Sudden deaths among Finnish conscripts.
The epidemiology of sudden deaths was studied among conscripts in Finland in 1948-72 (660 000 man-years) and among Finnish men aged 15-24 years in 1969-70 (900 000 man-years). The incidence of sudden deaths among the conscripts was 6-8/100 000 man-years. The onset of acute symptoms occurred during strenuous exercise in a third of the conscripts but in only a few of the other young men. Cardiovascular diseases caused two-thirds of the deaths in both groups. Sudden death tended to be more common among conscripts than among other young men during the corresponding period, but overall non-violent deaths were less common among conscripts than among other young men. On the basis of health records an attempt was made to separate the sudden deaths among conscripts from those among the controls by multiple discriminant analysis. For all practical purposes, however, the separation power proved poor. (+info
Reengineering the picture archiving and communication system (PACS) process for digital imaging networks PACS.
Prior to June 1997, military picture archiving and communications systems (PACS) were planned, procured, and installed with key decisions on the system, equipment, and even funding sources made through a research and development office called Medical Diagnostic Imaging Systems (MDIS). Beginning in June 1997, the Joint Imaging Technology Project Office (JITPO) initiated a collaborative and consultative process for planning and implementing PACS into military treatment facilities through a new Department of Defense (DoD) contract vehicle called digital imaging networks (DIN)-PACS. The JITPO reengineered this process incorporating multiple organizations and politics. The reengineered PACS process administered through the JITPO transformed the decision process and accountability from a single office to a consultative method that increased end-user knowledge, responsibility, and ownership in PACS. The JITPO continues to provide information and services that assist multiple groups and users in rendering PACS planning and implementation decisions. Local site project managers are involved from the outset and this end-user collaboration has made the sometimes difficult transition to PACS an easier and more acceptable process for all involved. Corporately, this process saved DoD sites millions by having PACS plans developed within the government and proposed to vendors second, and then having vendors respond specifically to those plans. The integrity and efficiency of the process have reduced the opportunity for implementing nonstandard systems while sharing resources and reducing wasted government dollars. This presentation will describe the chronology of changes, encountered obstacles, and lessons learned within the reengineering of the PACS process for DIN-PACS. (+info
Meta-manager: a requirements analysis.
The digital imaging network-picture-archiving and communications system (DIN-PACS) will be implemented in ten sites within the Great Plains Regional Medical Command (GPRMC). This network of PACS and teleradiology technology over a shared T1 network has opened the door for round the clock radiology coverage of all sites. However, the concept of a virtual radiology environment poses new issues for military medicine. A new workflow management system must be developed. This workflow management system will allow us to efficiently resolve these issues including quality of care, availability, severe capitation, and quality of the workforce. The design process of this management system must employ existing technology, operate over various telecommunication networks and protocols, be independent of platform operating systems, be flexible and scaleable, and involve the end user at the outset in the design process for which it is developed. Using the unified modeling language (UML), the specifications for this new business management system were created in concert between the University of Arizona and the GPRMC. These specifications detail a management system operating through a common object request brokered architecture (CORBA) environment. In this presentation, we characterize the Meta-Manager management system including aspects of intelligence, interfacility routing, fail-safe operations, and expected improvements in patient care and efficiency. (+info
Benchmark testing the Digital Imaging Network-Picture Archiving and Communications System proposal of the Department of Defense.
The Department of Defense issued a Request for Proposal (RFP) for its next generation Picture Archiving and Communications System in January of 1997. The RFP was titled Digital Imaging Network-Picture Archiving and Communications System (DIN-PACS). Benchmark testing of the proposed vendors' systems occurred during the summer of 1997. This article highlights the methods for test material and test system organization, the major areas tested, and conduct of actual testing. Department of Defense and contract personnel wrote test procedures for benchmark testing based on the important features of the DIN-PACS Request for Proposal. Identical testing was performed with each vendor's system. The Digital Imaging and Communications in Medicine (DICOM) standard images used for the Benchmark Testing included all modalities. The images were verified as being DICOM standard compliant by the Mallinckrodt Institute of Radiology, Electronic Radiology Laboratory. The Johns Hopkins University Applied Physics Laboratory prepared the Unix-based server for the DICOM images and operated it during testing. The server was loaded with the images and shipped to each vendor's facility for on-site testing. The Defense Supply Center, Philadelphia (DSCP), the Department of Defense agency managing the DIN-PACS contract, provided representatives at each vendor site to ensure all tests were performed equitably and without bias. Each vendor's system was evaluated in the following nine major areas: DICOM Compliance; System Storage and Archive of Images; Network Performance; Workstation Performance; Radiology Information System Performance; Composite Health Care System/Health Level 7 communications standard Interface Performance; Teleradiology Performance; Quality Control; and Failover Functionality. These major sections were subdivided into workable test procedures and were then scored. A combined score for each section was compiled from this data. The names of the involved vendors and the scoring for each is contract sensitive and therefore can not be discussed. All of the vendors that underwent the benchmark testing did well. There was no one vendor that was markedly superior or inferior. There was a typical bell shaped curve of abilities. Each vendor had their own strong points and weaknesses. A standardized benchmark protocol and testing system for PACS architectures would be of great value to all agencies planning to purchase a PACS. This added information would assure the purchased system meets the needed functional requirements as outlined by the purchasers PACS Request for Proposal. (+info
Increased postwar symptoms and psychological morbidity among U.S. Navy Gulf War veterans.
To investigate reports on war-related morbidity, 527 active-duty Gulf War veterans and 970 nondeployed veterans from 14 Seabee commands were studied in 1994 with a questionnaire, sera collection, handgrip strength, and pulmonary function testing. The questionnaire assessed postwar symptoms, war exposures, and screened for chronic fatigue syndrome, post-traumatic stress disorder, and psychological symptoms suggesting neurosis (Hopkins Symptom Checklist). Sera were tested with four nonspecific reactant assays: C-reactive protein, transferrin, ferritin, and haptoglobin. Gulf War veterans reported a higher prevalence for 35 of 41 symptoms, scored higher on psychological symptom scales, were more likely to screen for post-traumatic stress disorder, had lower handgrip strength, and had higher serum ferritin assay results. Numerous comparisons of these morbidity outcomes with 30 self-reported exposures demonstrated many associations, but no unique exposure or group of exposures were implicated. Morbidity data are consistent with other postwar observations, but the etiology for morbidity findings remains uncertain. (+info
Entitlement to military healthcare--limitations of the NHS model.
The Defence Medical Services provide to a British population healthcare services that are funded from taxation and are free at the point of delivery. This paper reviews some principles for determining entitlement to healthcare for the population cared for by the Defence Medical Services. The starting point for entitlement uses the principles under which the National Health Service (NHS) was established. These are then extended to acknowledge the limitations of an NHS model when considering occupational health issues and geographical variations in healthcare provision. (+info
Osler usque ad mare: the SS William Osler.
William Osler's connections with the sea included a strong family history of seafaring, his own transatlantic crossings (of which there were at least 32) and the occasional use of nautical imagery in his inspirational writings. An unusual Oslerian connection with the sea emerged after his death in the form of a World War II Liberty ship. Through the SS William Osler and its sister ships, Osler was symbolically reunited with colleagues associated with the early days of the Johns Hopkins Hospital. The William Osler circumnavigated the globe in 1943 without engaging the enemy. She was then converted into an army hospital ship and renamed the USHS Wisteria. (+info