Prediction of the service life of surgical instruments from the surgical instrument management system log using radio frequency identification.

BACKGROUND: Bar code- or radio frequency identification (RFID)-based medical instrument management systems have gradually been introduced in the field of surgical medicine for the individual management and identification of instruments. We hypothesized that individual management of instruments using RFID tags can provide previously unavailable information, particularly the precise service life of an instrument. Such information can be used to prevent medical accidents caused by surgical instrument failure. This study aimed to predict the precise service life of instruments by analyzing the data available in instrument management systems. METHODS: We evaluated the repair history of instruments and the usage count until failure and then analyzed the data by the following three methods: the distribution of the instrument usage count was determined, an instrument failure probability model was generated through logistic regression analysis, and survival analysis was performed to predict instrument failure. RESULTS: The usage count followed a normal distribution. Analysis showed that instruments were not used uniformly during surgery. In addition, the Kaplan-Meier curves plotted for five types of instruments showed significant differences in the cumulative survival rate of different instruments. CONCLUSIONS: The usage history of instruments obtained with RFID tags or bar codes can be used to predict the probability of instrument failure. This prediction is significant for determining the service life of an instrument. Implementation of the developed model in instrument management systems can help prevent accidents due to instrument failure. Knowledge of the instrument service life will also help in developing a purchase plan for instruments to minimize wastage.

Kaempferia parviflora Ethanol Extract, a Peroxisome Proliferator-Activated Receptor γ Ligand-binding Agonist, Improves Glucose Tolerance and Suppresses Fat Accumulation in Diabetic NSY Mice.

This study assessed the effect of Kaempferia parviflora, also known as black ginger (BG), and its ethanol extract (BGE) on peroxisome proliferator-activated receptor (PPAR) γ agonistic activity, glucose tolerance, fat accumulation, and lipids-induced hypertriglyceridemia in mice. PPARγ ligand-binding capacity in vitro and polymethoxy flavone contents were highly observed in organic solvent extracts. In an animal experiment A, male diabetic Nagoya-Shibata-Yasuda mice were divided into five dietary groups and fed each diet for 8 weeks: AIN-93G diet (low-fat [LF] diet), high-fat (HF) diet, HF diet supplemented with 1% BG, HF diet supplemented with 0.19% BGE, and HF diet supplemented with pioglitazone (PPARγ agonist, 3 mg/kg/day) as a PPARγ agonistic positive control. As determined from glucose and insulin tolerance tests, plasma glucose levels were improved in the BG and BGE groups. The BGE extract suppressed fat accumulation in adipose tissues, liver, and muscles without changing the plasma adiponectin level. In an animal experiment B, in order to investigate the effect of BG and BGE on lipid-induced hypertriglyceridemia, male ddY mice were divided into three test groups: control, BG-administered group (500 mg/kg), and BGE-administered group (100 mg/kg). The plasma triacylglycerol level was not different among the groups during the lipids administration test. These results conclude that the BGE extract containing several kinds of polymethoxy flavones showed PPARγ ligand-binding capacity in vitro and prevented obesity and insulin resistance independent of adiponectin secretion in mice. PRACTICAL APPLICATION: Kaempferia parviflora, also known as black ginger (BG), is often used as a folk medicine and a functional food material to prevent metabolic syndrome mainly in Asian regions. Here, we have clarified that ethanol extract from BG (BGE) contains several kinds of polymethoxy flavones to show PPARγ ligand-binding capacity and is an active extract for the improvement of obesity and insulin resistance. The BGE is expected to be applied for functional food materials in health food markets. Also, polymethoxy flavones to show PPARγ ligand-binding capacity can be generally applied as a physiological active compound of functional food supplements.

Camellia japonica Seeds Extract SuppressesLipid-induced Hypertriglyceridemia and Fat Accumulation in Mice.

As the seed extract from Camellia japonica (CJ) contains saponins, inhibitory effects of pancreatic lipase activity and body fat accumulation are expected. To investigate the anti-obesity effect of CJ seed extract, ICR mice were fed with a high-fat diet that was either supplemented or not with 1% CJ seed extract for 53 days. Including CJ seed extract in the high-fat diets of mice increased fecal fat excretion and decreased the body weight gain and lipid parameters in plasma and in the liver. In addition, lipid-induced hypertriglyceridemia was delayed by a single administration of CJ in ddY mice. Small intestinal transit was increased in ddY mice that received the CJ seed extract, but gastric emptying remained unchanged. These data demonstrate that CJ seed extract can suppress excess fat absorption, which can lead to the prevention of diet-induced obesity.

Generation of narrowband elastic waves with a fiber laser and its application to the imaging of defects in a plate.

Pulsed laser equipment can be used to generate elastic waves through the instantaneous reaction of thermal expansion or ablation of the material; however, we cannot control the waveform generated by the laser in the same manner that we can when piezoelectric transducers are used as exciters. This study investigates the generation of narrowband tone-burst waves using a fiber laser of the type that is widely used in laser beam machining. Fiber lasers can emit laser pulses with a high repetition rate on the order of MHz, and the laser pulses can be modulated to a burst train by external signals. As a consequence of the burst laser emission, a narrowband tone-burst elastic wave is generated. We experimentally confirmed that the elastic waves agreed well with the modulation signals in time domain waveforms and their frequency spectra, and that waveforms can be controlled by the generation technique. We also apply the generation technique to defect imaging with a scanning laser source. In the experiments, with small laser emission energy, we were not able to obtain defect images from the signal amplitude due to low signal-to-noise ratio, whereas using frequency spectrum peaks of the tone-burst signals gave clear defect images, which indicates that the signal-to-noise ratio is improved in the frequency domain by using this technique for the generation of narrowband elastic waves. Moreover, even for defect imaging at a single receiving point, defect images were enhanced by taking an average of distributions of frequency spectrum peaks at different frequencies.

Evaluation of Efficiency Improvement in Vital Documentation Using RFID Devices.

We introduced medical devices with RFID tags and the terminal with RFID reader in our hospital. Time study was conducted in two phases. In phase I, nurses round as usual, and in phase II, the nurse round the ward with a terminal installed on a cart. This study concluded that RFID system shortens the time for vital sign documentation. However, deploying the terminals at every bedside did not contribute the more time reduction.

Internal domain-specific language based on Arden Syntax and FHIR.

We demonstrate the concept of Arden Syntax, which is like Domain Specific Language (DSL), for describing decision support rules that take advantage of modern programming language concepts. Using object relational mapper and meta programming enables the conceptualization of FHIR resources from various data sources, and reduces the complexity of knowledge retrieval in decision rules.

Virtual file system on NoSQL for processing high volumes of HL7 messages.

The Standardized Structured Medical Information Exchange (SS-MIX) is intended to be the standard repository for HL7 messages that depend on a local file system. However, its scalability is limited. We implemented a virtual file system using NoSQL to incorporate modern computing technology into SS-MIX and allow the system to integrate local patient IDs from different healthcare systems into a universal system. We discuss its implementation using the database MongoDB and describe its performance in a case study.

HTML5 microdata as a semantic container for medical information exchange.

Achieving interoperability between clinical electronic medical records (EMR) systems and cloud computing systems is challenging because of the lack of a universal reference method as a standard for information exchange with a secure connection. Here we describe an information exchange scheme using HTML5 microdata, where the standard semantic container is an HTML document. We embed HL7 messages describing laboratory test results in the microdata. We also annotate items in the clinical research report with the microdata. We mapped the laboratory test result data into the clinical research report using an HL7 selector specified in the microdata. This scheme can provide secure cooperation between the cloud-based service and the EMR system.

Verification system for postoperative autologous blood retransfusion.

Medical staff members should match blood products with patients using a barcode authentication system for blood transfusion to prevent medical accidents. However, our hospital only verifies the blood products of the Japanese Red Cross Society and the preserved autologous blood, not the autologous blood salvaged during the operation or from the oxygenator. In this study, we developed the barcode medication administration system and mobile device for verification. This system will prevent blood transfusion errors in the ward setting.

Archetype Model-Driven Development Framework for EHR Web System.

OBJECTIVES: This article describes the Web application framework for Electronic Health Records (EHRs) we have developed to reduce construction costs for EHR sytems. METHODS: The openEHR project has developed clinical model driven architecture for future-proof interoperable EHR systems. This project provides the specifications to standardize clinical domain model implementations, upon which the ISO/CEN 13606 standards are based. The reference implementation has been formally described in Eiffel. Moreover C# and Java implementations have been developed as reference. While scripting languages had been more popular because of their higher efficiency and faster development in recent years, they had not been involved in the openEHR implementations. From 2007, we have used the Ruby language and Ruby on Rails (RoR) as an agile development platform to implement EHR systems, which is in conformity with the openEHR specifications. RESULTS: We implemented almost all of the specifications, the Archetype Definition Language parser, and RoR scaffold generator from archetype. Although some problems have emerged, most of them have been resolved. CONCLUSIONS: We have provided an agile EHR Web framework, which can build up Web systems from archetype models using RoR. The feasibility of the archetype model to provide semantic interoperability of EHRs has been demonstrated and we have verified that that it is suitable for the construction of EHR systems.

Statistical disclosure limitation of health data based on Pk-anonymity.

The Act for the Protection of Personal Information in Japan considers as personal information any quasi-identifier that may be used to obtain information that identifies individuals through comparisons with datasets. Studies using health records are not widely conducted because of the concern regarding the safety of anonymized health records. To increase the safety of such records, we used the Pk-anonymity method. In this method, attributes are probabilistically randomized and then reconstructions are performed on the basis of statistical information from perturbed data. Hence, it is expected to provide more precise statistics and more reliably preserve privacy than the traditional "k-anonymity" method. We anonymized health records, performed cross tabulation, and assessed the error rate using original data. This study shows that the Pk-anonymity method can be used to perform safety statistical disclosures with low error rates, even in small cases.

Effect of green tea extract on reactive oxygen species produced by neutrophils from cancer patients.

BACKGROUND/AIM: Oxidative stress in cancer patients has been demonstrated to be partly mediated by neutrophils. Although it is reported that natural antioxidants, such as green tea extract, reduce oxidative stress, there is limited evidence of their effects in cancer patients. This study aimed to determine the effect of green tea extract on reactive oxygen species produced by neutrophils from cancer patients. MATERIALS AND METHODS: Peripheral blood samples were obtained from eighteen patients with advanced cancer. Green tea extract was added to the blood samples with luminol on Mebiol gel, and luminol-dependent chemiluminescence was measured to monitor the production of reactive oxygen species from migrated neutrophils into the gel, at 37°C. RESULTS: Luminol-dependent chemiluminescence was significantly down-regulated in the presence of green tea extract in a concentration-dependent manner. CONCLUSION: These results indicate the antioxidant effect of green tea extract on reactive oxygen species produced by neutrophils, which may be effective in reducing oxidative stress in cancer patients.

Developing an electronic health record for intractable diseases in Japan.

Because intractable diseases result from unidentifiable causes and are very difficult to treat, they require a lifelong epidemiology database. Japan does not use global unique identifiers, such as social security numbers, so we conducted a feasibility study regarding an electronic health record (EHR). An EHR can be used as a lifelong database and reduce conventional administrative work. However, it will be necessary to develop additional tools to overcome issues specific to Japan before an EHR can be implemented.

Development of nursing care system with web service.

In this study, we have developed nursing care support using Personal Digital Assistants (PDA) with web service architecture. With the survey of the log nursing care support system, we have found out the nurse use the emergency to bypass the authentication and to access the operation quickly. We have concluded the compression of response time is the key of correct these abuse. We have developed rich-client with web service to cut down the response time. We can achieve to shorten it into 80% of total operation time.

Development MFER (Medical waveform Format Encoding Rules) parser.

The union of the diagnosis and treatment document and the accompanied inspection data is indispensable for the success of community health cooperation. Especially in the perinatal medicine we require the standardization of diagnosis document and the fetal cardiotocograph data. For diagnosis document, HL7CDA will be the leading solution, but for the fetal cardiotocograph, it does not show enough activity in the standardization. Moreover, the development of the tools and the application utilizes the standard is the key component to expand use of the standard. We have the idea that we describe the CTG data with MFER (Medical wave form Format Encoding Rule). MFER is the specialized in the description of medical waveform and it's generic design enables to apply to any medical wave pattern. There is a degree of freedom in the composition and the interpretation of the data structure in MFER. So we have developed MFER parser to ease the handling with MFER. In this paper, we introduce the implementation of the MFER parser and application to the CTG description with MFER format.

Development of a tele-echography system by using an echographic diagnosis robot.

We have developed a tele-diagnosis system of echography (tele-echography system) using an Echographic Diagnosis Robot. The examiner moves the robot by using a control device at a distance from the patient and obtaining the echogram and the situation around the patient. The examiner and the patient locations are connected by a wireless local area network. Remote control is realized by the Object Request Broker (ORB) technique. We experimentally verified possibility of our system for clinical use. The robot was safe and stable even when there was slight movement of the patient and an adult patient never felt any discomfort due to the robot weight. Remote diagnosis of echograms was proved to be possible with sufficient image quality after a skilled examiner got used to controlling the robot. Since the required bandwidth of this system was at most 1Mbps, we confirmed the ability of this system for mobile robotic telemedicine.