Open Source Software in Healthcare: International Case Series from the IMIA Open Source Working Group.

In this case series, we demonstrate how open-source software has been widely adopted as the primary health information system in many low- and middle-income countries, and for government-developed applications in high-income settings. We discuss the concept of Digital Global Goods and how the general approach of releasing software developed through public funding under open-source licences could improve the delivery of healthcare in all settings through increased transparency and collaboration as well as financial efficiency.

Multicentre analysis of incidental findings on low-resolution CT attenuation correction images: an extended study.

OBJECTIVE: To review new incidental findings detected on low-resolution CT attenuation correction (CTAC) images acquired during single-photon emission CT-CT myocardial perfusion imaging as an extension to our initial study. METHODS: CTAC images acquired as part of myocardial perfusion imaging performed using single-photon emission CT at four UK nuclear medicine centres were evaluated as part of a multicentre study. New incidental findings that were considered to be clinically significant were evaluated further. Positive-predictive value (PPV) was determined at the time of definitive diagnosis. RESULTS: Out of 3485 patients, 962 (28%) patients had a positive finding on the CTAC image, of which 824 (24%) were new findings. 84 (2.4%) patients had findings that were considered clinically significant at the time of the CTAC report and which had not been previously diagnosed. However, only 10 (0.29%) of these had findings that were confirmed as clinically significant, with the potential to be detrimental to patient outcome, after follow-up and definitive diagnosis. CONCLUSION: The overall PPV from all centres over the 2-year period was 12%. Each centre achieved what we considered to be low PPVs with no significant difference between the present and initial studies. The additional data from the combined studies show that, statistically, there is no significant difference between the PPVs from any of the centres. We conclude that routine reporting of CTAC images is not beneficial. ADVANCES IN KNOWLEDGE: This study combined with the previous study offers a unique evaluation of new clinically significant incidental findings on low-resolution CT images in an attempt to determine the benefit of reporting the CTAC images.

Simplifying the setup for vacuum-outlet GC: using a restriction inside the injection port.

The application of vacuum GC has several advantages over pressurized GC. One of the key characteristics is that the optimal gas velocity is very high. Combined with short capillary columns of wide internal diameter, this results in short analysis times using standard GC-MS equipment. To make vacuum GC possible using a GC-MS system, a restriction must be positioned at the injection side of the column. This restriction is usually made of deactivated 0.1 mm i.d. fused-silica tubing which is coupled to the analytical column. Such restrictions will work, but practical challenges are found in coupling, reducing dead volume and robustness. A new way of making restrictions is by incorporating the restriction into the injection port. Using well-defined short pieces of fused silica with internal diameter of 0.025 mm, one can make a restriction using a Press-Tight type connector, and position this inside the injection port. By doing this, the restriction is very short and at high temperature all the time. Activity plays a minimal role, and also leaks will not be an issue as the coupling is in 100% inert gas. Data obtained using this concept is promising as vacuum GC becomes easier and more robust.

Health plan joins with physical therapy facility to manage back and neck pain.

Twenty-five billion dollars is spent each year on the medical care of back pain, and $50 billion is lost in productivity. Primary care physicians might have difficulty providing thorough counseling and treatment to their patients about the condition. In 2006, Capital Health Plan (CHP) partnered with Orthopedic and Sports Physical Therapy, which employed the mechanical diagnosis and therapy (MDT) technique. After undergoing this technique, members experienced a 79% improvement in pain scores and a 54% improvement in function scores, compared to when they started treatment.

Accuracy of ultrasonic detection of renal scarring in different centres using DMSA as the gold standard.

BACKGROUND: There is an ongoing debate over the radiological investigations of children with urinary tract infections (UTIs) with some authorities suggesting that ultrasound scan (USS) alone is an accurate tool to diagnose renal parenchymal scarring post-pyelonephritis. All studies on this subject have been performed at paediatric teaching centres whereas most children with UTIs are managed by General Paediatricians in District General Hospitals (DGHs) in the United Kingdom. We wished to identify whether results of scans in DGHs differed from those in teaching centres. METHODS: We looked at all children with a clinical history of UTIs having a DMSA and USS over a one year period in two DGHs and one teaching centre. A total of 476 children's results were reviewed, 297 from the DGHs and 179 from the teaching centre. RESULTS: The cohort had a total of 949 renal units. There were 79 scarred renal units (kidneys) on DMSA (8%) in 72 patients (15%). Just 18 renal units were detected as being scarred on USS (22.8%). Nine of 32 scarred renal units in the teaching centre were detected compared with nine of 47 in the DGHs (P = 0.40). Thirty-nine (49%) of the scarred renal units were in patients >5-years old. Of these 12 (30.7%) were detected on USS, nine of 17 within the teaching centre compared with just three of 22 at the DGHs (P = 0.01). CONCLUSION: Overall only a small percentage of scars are detected on USS. In the over 5-year old group, where USS alone might be preferred, DGHs were significantly worse at detecting scarred kidneys. We conclude that if the detection of renal scars is a prime reason for imaging in children with UTIs, ultrasonography alone is inappropriate at any age and DMSA ought to be the primary investigation.