An Overview of Some Technological/Health-Care System Implications of Seven Exploratory Broad-Band Communication Experiments

The utility of broad-band interactive two-way visual telecommunication has been assessed in a wide variety of healthcare delivery settings in seven exploratory projects funded by the Bureau of Health Services Research, Department of Health, Education, and Welfare. These projects are briefly summarized and communication events are classified into five exhaustive but not matually exclusive categories: consultation, supervision, direct patient care (telemedicine), administration and management, and education and training. Technical and human factors to be considered in the design of a visual telecommunication system are identified. Tradeoffs available among them are discussed, such as resolution for remote controls and frame rate. The impact of visual telecommunication on the often competitive performance goals of the health-care system is discussed, e.g., random video consultations may simultaneously decrease physician productivity and patient inconvenience. The paper concludes by suggesting directions for future research and by noting that broad-band video is but one among many technological, organizational, manpower, and other options available to those who seek solutions to the problems of health-care delivery.     

The Social Implications of Health Care Communication Systems

This paper discusses some of the changes that might take place in this nation's health care system with the advent of national health insurance. These changes include structural reforms, planning and regulation, and the introduction of quality assurance mechanisms. The paper argues that a health care system will evolve that is both aggregated and regulated; and it foresees that computer and communication technologies will play significant roles in this evolution. The paper concludes by discussing some potentially harmful social consequences of these developments.     

Subspecialty training in pediatric anesthesiology: what does it mean?

We evaluated the usefulness of the Duke criteria for diagnosing cases of active infective endocarditis (IE). Patients were identified prospectively over a 3-year period at 54 hospitals in the Philadelphia metropolitan area. Three of us independently reviewed abstracted hospital records and classified 410 patients as definite, probable, or possible cases of IE or as probable noncases. We then applied the Duke criteria to this sample to assess the degree of agreement between our diagnoses and the diagnoses based on these new criteria. Agreement was good to excellent, ranging from 72% to 90%, depending on the case definition used. The sensitivity of the Duke criteria was also good to excellent, varying from 71% to 99%, again depending on case definition used. Specificity was lower (0-89%). We conclude that use of the Duke criteria will result in little underdiagnosis of IE but that it may result in overdiagnosis of IE; therefore, these criteria should be applied prospectively to determine their clinical usefulness.     

A four-processor building block for SIMD processor arrays

A four-processor chip, for use in processor arrays for image computations, is described. The large degree of data parallelism available in image computations allows dense array implementations where all processors operate under the control of a single instruction stream. An instruction decoder shared by the four processors on the chip minimizes the pin count allocated for global control of the processors. The chip incorporates an interface to an external SRAM (static RAM) for memory expansion without glue chips. The full-custom 2-μm CMOS chip contains 56669 transistors and runs instructions at 10 MHz. Five hundred and twelve 16-b processors and 4 Mbyte of distributed external memory fit on two industry standard cards to yield 5-billion instructions per second peak throughout. As image I/O can overlap perfectly with pixel computation, an array containing 128 of these chips can provide more than 600 16-b operations per pixel on 512×512 images at 30 Hz     

Diagnosis of paraesophageal omental hiatal hernia by magnetic resonance imaging

We present a case of an enlarging retrocardiac mass lesion in which we observed the magnetic resonance imaging (MRI) finding of a fatty tumor with contiguous blood vessels extending from the abdominal portion into the thoracic portion of the tumor. These surgically verified findings provide an MRI indication of the presence of a paraesophageal omental hiatal hernia.