The implementation of telemedicine within a community cancer network.

Telemedicine is being used by physicians at the member hospitals of the Jefferson Cancer Network (JCN) for consultations regarding the diagnosis and management of cancer patients. The technology employed for this telemedicine system was chosen to meet three related specifications: low capital and operating cost, internal maintainability by community hospital data processing staffs, and compatibility with the existing technologic infrastructure. The solution selected is the ubiquitous desktop personal computer and associated software, and Integrated Services Digital Network (ISDN) communications links. The overall performance of this technology has been very satisfactory; ISDN communications has sufficient bandwidth for the transfer of patient data, including text reports, radiographs, and pathology slide images. The presence of the radiologist's interpretation along with the radiographic images allows the presentation of the images on these systems to be acceptable for review purposes. The video frame rates of these systems (12 to 15 frames per second) is adequate, particularly given the "talking heads" nature of the video presentations. Furthermore, the quality of the video image (resolution, size, frame rate) is secondary to the quality of the presentation of the medical information displayed and the capability for mutual annotation of the patient data during the consultation.

Integration of a European image processing component with an American HIS: the advantage of open standards.

This paper describes the integration of a European Image Processing System with an existing American Hospital Information System. Both systems were built independently (with no knowledge of each other), but on open systems standards. The easy integration of these systems demonstrates the major benefit of open standards-based software design.

Cost effective Internet access and video conferencing for a community cancer network.

Utilizing the ubiquitous personal computer as a platform, and Integrated Services Digital Network (ISDN) communications, cost effective medical information access and consultation can be provided for physicians at geographically remote sites. Two modes of access are provided: information retrieval via the Internet, and medical consultation video conferencing. Internet access provides general medical information such as current treatment options, literature citations, and active clinical trials. During video consultations, radiographic and pathology images, and medical text reports (e.g., history and physical, pathology, radiology, clinical laboratory reports), may be viewed and simultaneously annotated by either video conference participant. Both information access modes have been employed by physicians at community hospitals which are members of the Jefferson Cancer Network, and oncologists at Thomas Jefferson University Hospital. This project has demonstrated the potential cost effectiveness and benefits of this technology.

Integration of HIS components through open standards: an American HIS and a European Image Processing System.

This paper describes the integration of an existing American Hospital Information System with a European Image Processing System. Both systems were built independently (with no knowledge of each other), but on open systems standards. The easy integration of these systems demonstrates the major benefit of open standards-based software design.

Thin-film optical coating filter stability under different environmental conditions.

Experiments are conducted to determine the degree of moisture effects in optical thin-film coatings, to determine how to specify moisture stability of these films, and to ensure that performance levels are met after these films are exposed to all anticipated environmental conditions. Three testing techniques, an air oven, a vacuum oven, and water immersion, are evaluated to determine which techniques best characterize the moisture stability of these films. The filters tested fall into three categories, based on their degree of stability: type I, which are inherently stable, type II, which are basically stable except under extreme conditions, and type III, which are unstable.

A network scanner image management station.

Distributed computing can be applied to CT or MRI scanner image acquisition, printing, and archiving by interfacing the scanner with a computer network. Also on the network must be a computer workstation that has image management software to capture the images sent over the network by the scanner. This software must also allow the radiology staff to print and archive the images. Several benefits are realized by this network configuration. First, the scanner console is solely used for scanning patients; delays are not encountered because the console is being used for printing and archiving images. Also, the workstation printing software can be developed so that useful features not available at the scanner console can be incorporated. Finally, sophisticated archiving strategies can be implemented at the workstation. We have developed a network image management station at the Fox Chase Cancer Center using a reduced instruction set computer (RISC) workstation. Hardware and software is utilized to convert all scanner image data to the American College of Radiology-National Electrical Manufacturers Association format. All workstation software is developed using the open X-Windows standard. Digital audio tape is used for image archiving.

The use of X-terminals as clinical workstations.

The Medical Computer Facility at the Fox Chase Cancer Center has installed X-terminals in patient examination rooms and at nursing stations for clinical data access by physicians and nurses. The X-terminals are connected to UNIX operating system RISC processors via Ethernet. The RISC processors communicate with databases on a minicomputer cluster. Simultaneous presentation of textual (e.g., pathology and radiology reports) and graphical (e.g., clinical laboratory results) clinical data is provided under X-Windows. CT and MRI images can also be displayed in windows. Our experiences implementing X-terminal clinical workstations in a production environment will be discussed.

Penicillin prophylaxis for streptococcal infections in United States Navy and Marine Corps recruit camps, 1951-1985.

Benzathine penicillin G has been used in United States Navy and Marine Corps recruit camps since 1953 to reduce the incidence of streptococcal disease and its nonsuppurative complications-acute rheumatic fever and acute glomerulonephritis. This paper reviews the history of prophylactic penicillin use among U.S. Navy and Marine Corps recruits and discusses the rationale for continuing this practice today.

Lead absorption in children of employees in a lead-related industry.

Children can be exposed to lead from a variety of environmental sources. It has been repeatedly reported that children of employees in a lead-related industry are at increased risk of lead absorption because of the high levels of lead found in the household dust of these workers. A case-control study was done in Oklahoma in 1978 to determine whether children of employees in battery manufacturing plant had a higher prevalence of high levels of blood lead than children whose parents were not employed in a lead-related industry. The data obtained indicated that the blood lead levels of the study children were significantly greater than those of the control children. None of the control children had blood lead levels greater than 30 micrograms/dl, while 53% of the exposed children had blood lead levels of greater than 30 micrograms/dl. Trends indicated that the children whose fathers had higher lead exposure at work also had higher blood lead levels. However, the study children whose fathers had good personal hygiene had blood lead levels comparable to the control children. It appeared that only good personal hygiene, i.e., showering, shampooing and changing clothes and shoes before leaving work, was effective for lead containment. The mere changing of clothes and shoes appeared to be inadequate for lead containment.