九大病院におけるアジア遠隔医療システムの基盤整備

平成17年度大学病院情報マネジメント部門連絡会議 : 平成18年1月26日(木)～27日(金) : 静

Predictive factors of mortality of patients with fragility hip fractures at 1 year after discharge : A multicenter, retrospective study in the northern Kyushu district of Japan

Purpose: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. Methods: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. Results: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8–12.0%, n = 45). Log-rank test revealed that previous fractures (p = 0.003), Barthel index (BI) at discharge (p = 0.011), and place-to-discharge (p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking (p = 0.007), length of hospital stay (LOS; p = 0.009), and BI (p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI <30 (HR 5.42, p = 0.013) were the predictive variables of mortality for male patients. BMI <18.5 kg/m2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS <14 days (HR 13.9; p = 0.007), and BI <30 (HR 2.76; p = 0.049) were the counterparts for females. Conclusions: Previous vertebral fractures and BI <30 were the predictive variables of mortality for male patients, and BMI <18.5 kg/m2, TCCI ≥5, smoking history, LOS <14 days, and BI <30 were those for females. Decreased BI is one of the independent and preventable risk factors. A comprehensive therapeutic approach should be considered to prevent deterioration of activities of daily living and a higher risk of mortality

Emerging Technologies for Telemedicine

This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions

Live surgery from Japan to South Africa: High-quality image transmission over a high-speed academic network

Quality preservation during the transmission ofmedical moving images is challenging owing to image compression in thelimited bandwidth of the Internet. Satellite transmission does notsolve this problem because of the high cost involved, hindering theadvancement of practical telemedicine. We developed anew, affordable and usable system, and applied it to the livetransmission of surgery from Japan to South Africa. The digital videotransport system (DVTS), which is free software that transforms digitalvideo signals directly to Internet Protocol, and academic networksdedicated to research and education purposes were used with bandwidthof 30 Mbps. The cipher program IPsec was used to protect patientprivacy. Laparoscopic rectal surgery was transmitted live from KyushuUniversity Hospital in Japan, to the University of Cape Town in SouthAfrica, as well as Cho Ray Hospital in Vietnam, over a period of 2hours. Interactive discussion was held among the three sites with thetransmission of clear, high-resolution, and smooth surgical images.This project is an important milestone achieved in South Africaindicating its feasibility for developing nations with NationalResearch and Education Networks and provides a base for its domesticand international expansion

Asia-Pacific Telemedicine Project via High-Speed Internet

今年はドイツでワールドカップサッカーの熱戦が繰り広げられたが, 本プロジェクトの始まりはちょうど4年前に日韓共同で開催されたワールドカップサッカーの年に遡る. 通信情報分野の発達は目覚しく, 現在では一般家庭用にも100Mbpsという大容量のインターネット回線が提供され始めているが, 4年前までは日本・韓国間の国際回線容量は僅か8Mbpsであり, 今から考えると信じられないような状況であった. ちょうどその共同開催に合わせるように福岡と釜山の問に2Gpbs(ギガ)という大容量の海底光通信ケーブルが敷設されたが, ワールドカップ終了後もこの回線を利用して文・教育・研究・ビジネスなど多方面から日韓両国の交流推進に役立てようと, 「玄海プロジェクト」という事業が産官学で組織化されたのである. 九州大学病院は医療チームとして本プロジェクトに参加することとなった. 通信回線を使った医療, すなわち遠隔医療は, 場所の移動を伴うことなく容易に医療情報を交換できるという点で非常に有用な手段であるにも拘わらず, 従来は十分な回線容量が得られないために動画像としての画質が悪く, 利用は病理や放射線などの静止画や脈拍・心電図などの簡単な動画に限られており, 実際の臨床や医療教育の現場で積極的に利用されるには至っていないのが現状である. 我々はこの日韓高速ネットワークに注目し, 医療目的にも十分満足できる動画像配信システムの構築を目指すこととなった. これまでの活動を簡単に紹介したい

九大病院におけるアジア遠隔医療システムの基盤整備

平成17年度大学病院情報マネジメント部門連絡会議 : 平成18年1月26日(木)～27日(金) : 静