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Electronic Medical record in cardiac surgery
Asia Pacific
Heart J 1997;6(1)
Cardiothoracic
xenografts surviving beyond the phases of hyperacute and acute rejection rapidly develop intimal thickening characteristic of chronic rejection.
Abstracts
re-evaluated this issue using 3-D marker method which track the points fixed on the MA. Methods: 8 markers were sewn to the MA in 8 normal dogs under cardiopulmonary bypass; marker 1 was implanted on the midanterior MA, and 7 other markers followed in a clockwise direction with same interval (markers 1 and 8 were underneath aortic valve; marker 3 near posterior commissure, marker 5 on the midposterior MA, and marker 7 near anterior commissure). 1 week later the location of each marker and lengthening or shortening of each MA segment (seg) was measured with normal condition and then vena caval occlusion, using biplane cinefluoroscopy and computerised 3-D reconstruction method. In normal condition, seg l-2 and 2-3 (both on the anterior leaflet side) and seg 4-5, 5-6, and 6-7 (all on the posterior leaflet side) shortened significantly during systole. Seg 7-8 and 8-l (both under the aortic valve) lengthened (PdO.05). Results: With vena caval occlusion, all segments stopped shortening, but seg 7-8 and 8-l kept systolic lengthening. Conclusions: 1. MA had inhomogeneous systolic dynamics. 2. MA underneath the aortic valve showed systolic lengthening. 3. MA dynamics were influenced by preload. 4. MA on posterior leaflet side did not always shorten during systole. Further investigation will be necessary toward improvement of reparative technique including development of annuloplasty ring.
Electronic Medical Record In Cardiac Surgery L. Knight, A. Royse, J. Duncan Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia Aim: An electronic medical record (eMR) captures all clinical data and replaces the duplicate tasks of handwritten medical record and data sheetsfor database storage. Purposes: To develop and introduce a basic eMR into a cardiac surgery unit in order to: (1) make the eMR a secure repository of all clinical information; (2) fully integrate into the office environment (allowing data to be used easily by other programs) using ActiveX technology; (3) access remotely; (4) allow unparalleled quality of data for clinical research; (5) improve individual learning by linking data fields with related journal articles or other literature including unit protocols; (6) improve professional standards by enhanced comparative surgical audit locally and with international databases; and (7) introduce comprehensive coding methods. Materials and Methods: We employed Microsoft Visual Foxpro (VFP), a pioneer in a new generation of desktop object oriented databases. It has enhanced client-server capabilities and works in a 32-bit operating environment, It is derived from the widely used Xbase family of databases. Structured questions and answers (choices) with definitions and data validation rules form the basis for the eMR. These relate specifically to the specialty of cardiac surgery. Results: Extreme flexibility is present with all fields allowing addition to the choices whilst preserving data integrity by the techniques of selective display if field choices (and preventing field choice deletion) and tracking of changes made to patient data. However, this vastly improved capability and performance has been tempered with a steep learning curve for the new programing methods required and greater than expected instability in the program itself (unexpected outcome from programming changes). Delays have exceeded expectations. Conclusion: The development of a potentially more powerful method of clinical data storage and analysis (e.g. eMR) has been slowed down by the difficulties encountered in learning the new programing methods and initial instability of VFP. Further refinement of the program will be necessaryto make the eMR a useful tool.
A Comparison Of The Haemodynamic Effects Of Amiodarone, Sotalol And Digoxin When Used As Prophylaxis Against Supraventricular Tachycardias After Coronary Artery Bypass Graft Surgery David G. Lance, Carl T. Moller, David G. Hill, Mark M. Murton Tasmanian Cardiotboracic Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia Introduction: The use of antiarrhythmic agents to prevent postoperative supraventricular tachyarrhythmias (SVTs) is recognised. This prospective randomised control trial compared the efficacy of amiodarone, sotalol and digoxin in preventing these arrhythmias and quantified the haemodynamic effects of their administration. Method: 108 patients, scheduled for CABG surgery, who had no contraindications to the drugs, were randomised to receive intravenous amiodarone (5 mg/kg, n=24), sotalol (0.5 mg/kg, n=22), digoxin (500 pg, n=30) on the morning after surgery or to act as a control (n=32). Haemodynamic parameters were recorded at set intervals for the first 2 hours after drug administration. Maintenance doses of each drug were given orally and any subsequent dysrhythmias were recorded by telemetry over the following 7 days. The study protocol was approved by the hospital ethics committee and all subjects gave written informed consent.
Re-evaluating The Dynamics Of The Mitral Annulus M. Komeda, J.R. Glasson, D.C. Miller Austin and Repatriation Medical Centre, University of Melbourne, Victoria, Australia, and Stanford University, California, U.S.A. Introduction: Mitral annulus (MA) has been believed to be dynamic structure only on the posterior leaflet side. We
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Heart J 1997;6(1)
Cardiothoracic
xenografts surviving beyond the phases of hyperacute and acute rejection rapidly develop intimal thickening characteristic of chronic rejection.
Abstracts
re-evaluated this issue using 3-D marker method which track the points fixed on the MA. Methods: 8 markers were sewn to the MA in 8 normal dogs under cardiopulmonary bypass; marker 1 was implanted on the midanterior MA, and 7 other markers followed in a clockwise direction with same interval (markers 1 and 8 were underneath aortic valve; marker 3 near posterior commissure, marker 5 on the midposterior MA, and marker 7 near anterior commissure). 1 week later the location of each marker and lengthening or shortening of each MA segment (seg) was measured with normal condition and then vena caval occlusion, using biplane cinefluoroscopy and computerised 3-D reconstruction method. In normal condition, seg l-2 and 2-3 (both on the anterior leaflet side) and seg 4-5, 5-6, and 6-7 (all on the posterior leaflet side) shortened significantly during systole. Seg 7-8 and 8-l (both under the aortic valve) lengthened (PdO.05). Results: With vena caval occlusion, all segments stopped shortening, but seg 7-8 and 8-l kept systolic lengthening. Conclusions: 1. MA had inhomogeneous systolic dynamics. 2. MA underneath the aortic valve showed systolic lengthening. 3. MA dynamics were influenced by preload. 4. MA on posterior leaflet side did not always shorten during systole. Further investigation will be necessary toward improvement of reparative technique including development of annuloplasty ring.
Electronic Medical Record In Cardiac Surgery L. Knight, A. Royse, J. Duncan Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia Aim: An electronic medical record (eMR) captures all clinical data and replaces the duplicate tasks of handwritten medical record and data sheetsfor database storage. Purposes: To develop and introduce a basic eMR into a cardiac surgery unit in order to: (1) make the eMR a secure repository of all clinical information; (2) fully integrate into the office environment (allowing data to be used easily by other programs) using ActiveX technology; (3) access remotely; (4) allow unparalleled quality of data for clinical research; (5) improve individual learning by linking data fields with related journal articles or other literature including unit protocols; (6) improve professional standards by enhanced comparative surgical audit locally and with international databases; and (7) introduce comprehensive coding methods. Materials and Methods: We employed Microsoft Visual Foxpro (VFP), a pioneer in a new generation of desktop object oriented databases. It has enhanced client-server capabilities and works in a 32-bit operating environment, It is derived from the widely used Xbase family of databases. Structured questions and answers (choices) with definitions and data validation rules form the basis for the eMR. These relate specifically to the specialty of cardiac surgery. Results: Extreme flexibility is present with all fields allowing addition to the choices whilst preserving data integrity by the techniques of selective display if field choices (and preventing field choice deletion) and tracking of changes made to patient data. However, this vastly improved capability and performance has been tempered with a steep learning curve for the new programing methods required and greater than expected instability in the program itself (unexpected outcome from programming changes). Delays have exceeded expectations. Conclusion: The development of a potentially more powerful method of clinical data storage and analysis (e.g. eMR) has been slowed down by the difficulties encountered in learning the new programing methods and initial instability of VFP. Further refinement of the program will be necessaryto make the eMR a useful tool.
A Comparison Of The Haemodynamic Effects Of Amiodarone, Sotalol And Digoxin When Used As Prophylaxis Against Supraventricular Tachycardias After Coronary Artery Bypass Graft Surgery David G. Lance, Carl T. Moller, David G. Hill, Mark M. Murton Tasmanian Cardiotboracic Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia Introduction: The use of antiarrhythmic agents to prevent postoperative supraventricular tachyarrhythmias (SVTs) is recognised. This prospective randomised control trial compared the efficacy of amiodarone, sotalol and digoxin in preventing these arrhythmias and quantified the haemodynamic effects of their administration. Method: 108 patients, scheduled for CABG surgery, who had no contraindications to the drugs, were randomised to receive intravenous amiodarone (5 mg/kg, n=24), sotalol (0.5 mg/kg, n=22), digoxin (500 pg, n=30) on the morning after surgery or to act as a control (n=32). Haemodynamic parameters were recorded at set intervals for the first 2 hours after drug administration. Maintenance doses of each drug were given orally and any subsequent dysrhythmias were recorded by telemetry over the following 7 days. The study protocol was approved by the hospital ethics committee and all subjects gave written informed consent.
Re-evaluating The Dynamics Of The Mitral Annulus M. Komeda, J.R. Glasson, D.C. Miller Austin and Repatriation Medical Centre, University of Melbourne, Victoria, Australia, and Stanford University, California, U.S.A. Introduction: Mitral annulus (MA) has been believed to be dynamic structure only on the posterior leaflet side. We
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