Yao Y. Shieh

Mobile healthcare: the opportunities and challenges

The healthcare crisis in the US has caught national attention because of its high percentage of GDP spending. Healthcare reform has become a heated topic of discussion. Its key lies in quality of care, the foundation of which is information. Mobile- healthcare has the potential to greatly improve the quality of healthcare. It encompasses the realm of healthcare activities empowered by the whole spectrum of computer, communication and information technologies. The challenges of the current healthcare landscape and potential solutions offered by m-healthcare are presented in four distinct yet related domains: service, technology, finance and organization. This paper addresses healthcare as a whole, with special remarks directed exclusively to the radiology subspecialty due to its unique requirements of large bandwidth for transferring image data and exacting screen size for image display.

Intracerebral Hemorrhage after Thrombolytic Therapy in Acute Ischemic Stroke Patients with Renal Dysfunction

Purpose: One complication of thrombolysis is intracranial hemorrhage (ICH). We investigated whether treatment with tissue plasminogen activator (t-PA) for ischemic infarction results in a higher risk of ICH in patients with kidney dysfunction, who are predisposed to treatment complications due to their bleeding tendency. Methods: A total of 297 patients given thrombolytic therapy for ischemic stroke were classified into 2 groups on the basis of their estimated renal glomerular filtration rate (eGFR). The outcome measures included the incidence of ICH and modified Rankin scale scores at 1 month and 1 year. Results: ICH was more common in the renal dysfunction group (23 vs. 12.5%). Nevertheless, multivariate logistic regression showed that the odds of ICH were not high in the group with low eGFR. Also, eGFR values <60 ml/min/1.73 m2 did not predict the odds for functional dependence or death at 1 month and 1 year. Conclusion: After adjusting for confounding factors, the odds ratio for ICH was not higher in intravenous t-PA-treated stroke patients with renal dysfunction. A trend to the occurrence of ICH among these patients, however, was noted. Renal dysfunction does not predict the odds for functional dependence or death at 1 month and 1 year.

MRI/SPECT-based diagnosis and CT-guided high-intensity focused-ultrasound treatment system in MPTP mouse model of Parkinson's disease

Single-photon emission computed tomography (SPECT) of dopamine transporters with (99m)Tc-TRODAT-1 has recently been proposed to offer valuable information for the diagnosis of Parkinsons disease (PD). Furthermore, High-intensity focused ultrasound (HIFU) is a newly developed technique in which the energy of ultrasound wave is directed to a focused spot for the purpose treatment of PD. This study presents a diagnosis and image-guided system using HIFU to treat the mouse with PD under a designed stereotactic frame. The system comprises two key components: an automatic atlas-based SPECT/MRI image registration module for diagnosis and a stereotactic CT-guided module for HIFU treatment. The SPECT/MR image registration here is important in the non-invasive examination of the dopamine concentration in vivo. From the experimental results, the image registration module proves to have comparable performance to that derived from manual drawing by experts. In addition, the stereotactic CT-guided module achieved a positioning accuracy to within 2mm on the average, which is acceptable for the purpose of HIFU treatment.

The Impact of Intracranial Carotid Artery Calcification on the Development of Thrombolysis-Induced Intracerebral Hemorrhage

BACKGROUND We aimed to assess whether intracranial carotid artery calcification (ICAC) evident on head computed tomography is a risk factor for symptomatic intracerebral hemorrhage (sICH) following tissue plasminogen activator (tPA) treatment for acute stroke. METHODS We classified 297 consecutive patients into 2 groups (no to mild ICAC and moderate to severe ICAC) according to ICAC severity. Outcome measures included detection of intracerebral hemorrhage and assessment using a modified Rankin scale (mRS) at 1 month and 1 year after stroke. RESULTS ICH (any type) was significantly more common in patients with moderate to severe ICAC than in patients with no to mild ICAC (22.5% versus 12%; relative risk [RR], 1.67; 95% confidence interval [CI], 1.1-2.5; P<.05). The moderate to severe ICAC group tended to have a higher percentage of sICH, but this association was not statistically significant (RR, 1.57; 95% CI, .75-3.3, P>.05). Multivariate adjusted regression analysis revealed that moderate to severe ICAC was an independent risk factor for ICH following tPA treatment (odds ratio, 2.52; 95% CI, 1.07-5.94; P=.04). Dependent functional outcome (mRS score 3-6) at 1-month and 1-year follow-up was significantly associated with moderate to severe ICAC (RR, 1.56; 95% CI, 1.06-2.27; and RR, 1.56; 95% CI, 1.06-2.33; P<.05). However, ICAC was not an independent factor of functional dependency at 1-month and 1-year follow-up in the final multivariate regression model. CONCLUSION A significantly higher percentage of patients with moderate to severe ICAC developed ICH following tPA administration for stroke. ICAC severity is an independent risk factor for ICH events. ICAC severity can help predict short-term and long-term functional dependency in tPA-treated patients, although this can be confounded by other cardiovascular risk factors and stroke severity.

The impact of globalisation on teleradiology practice

Some advocates of globalisation argue that a free market with little regulation is the best approach for achieving cost-effective healthcare. Healthcare, however, is different from other business activities in that it is typically less profit-driven; instead, it often involves the goal of providing equitable care to the underprivileged. Traditionally, the government has subsidised the expenses of delivering affordable healthcare to underserved communities. Because of the many recent advances in telecommunications technology, telemedicine has gained increasing attention. Teleradiology, in particular, is by far the maturest of all telemedicine disciplines and, thus, it may serve as a pivotal indicator of whether telemedicine on a global scale is feasible or not. In this paper, a prediction of the future landscape of globalised teleradiology operations is attempted based on the extrapolation of the historical trends in teleradiology practice as well as the growing pressure on federal and local governments to reduce their regulatory power under the General Agreement on Trade in Services (GATS).

Novel electronic medical record-based stroke registry system

This paper presents the innovative electronic medical record based stroke registry system (SRS) that has been designed and developed at Chang Gung Memorial Hospital (CGMH). A prototype which was introduced in 2006, akin to a consumer electronics commodity, has been adopted by other vascular disease-associated specialties such as cardiology, endocrinology, nephrology and oncology. Furthermore, the SRS has proliferated to three other hospitals within the CGMH chain and promises to provide longitudinal association between pathophysiology and clinical outcomes of vascular diseases in the Taiwanese population.

Automated ASPECTS scoring system as a clinical support system for acute stroke care

The recombinant tissue plasminogen activator (tPA) has shown effective in improving the outcome of early acute ischemic if less than one third of the territory of the middle cerebral artery (MCA) was involved. The Alberta Stroke Program Early CT Score (ASPECTS) method has been adopted to assess the MCA involvement by many institutions. However, ASPECTS scoring is still a challenge to clinicians in the stroke center. The purpose of this study is the development of an automated ASPECTS scoring system which provides objective assessment as well as decision making support. The very-high-accuracy-rate test results of such a system on 36 subjects as well as its fast response have demonstrated its potential of providing clinical support in acute stroke care.

Static magnetotherapy for the treatment of insomnia

Magnets have been used for centuries to treat a number of physical disorders. The vast majority of research, however, on static magnet therapy for insomnia has been confined to the auricular type of therapy, with publications limited to Chinese journals. Most of these studies have depended on the subjective self-assessment of participants rather than objective scientific measurements. In this study, the authors report the positive preliminary results of insomnia treatment using pillows with embedded magnets, magnetic insoles and TriPhase bracelets. The analysis is based on objective actigraphic and polysomnographic data. A theory of accelerated transition from wakefulness to sleep is proposed to explain the process of insomnia relief through low-strength static magnetic fields. Analysis by functional Magnetic Resonance Imaging (fMRI) is used to further investigate the theory.

Consumer electronics-based intelligent alert system for unattended elderly residents

In this paper, we propose an intelligent alert system that continuously monitors the living quarters of an unattended elderly resident and can automatically issue alerts to family members or helpers when it detects potential accident patterns or suspicious signs in the monitored persons body dynamics. The systems works with absolutely no disturbance to the elderly persons everyday life and no burden of carrying or wearing any portable devices on the body. The front-end of the proposed system consists of multiple closed circuit TV (CCTV) cameras, which are equipped with infrared LED lighting capability. The image processing software carries out the following functions: extraction of the elderly residents body silhouette, estimation of the upper body posture, and detection of body motion dynamics. The preliminary results from simulations have shown that a number of accident patterns that are regarded as high risk and high occurrence can be detected with 100% accuracy. Such an intelligent system provides a novel and cost effective option for elderly people who desire to age with maximum independence and at the same time desire to free their adult children from worrying about their emergency hazards.

The increasing role of portable electronics in the emergency department

Portable electronics have played an increasing role in the emergency department. In this paper, we will review the current status and future prospective of portable electronics applications in the emergency department.