World Stroke Day 2011

29 th October 2011 is World Stroke Day

Point your smart phone with a qrcode reader application on to this cube to activate link. Feel free to download this design for stroke day campaigns at your hospital.

The World Stroke Organization (WSO) is calling for urgent action to address the silent stroke epidemic by launching the “1 in 6” campaign on World Stroke Day, 29 October 2010.

The “1 in 6” campaign celebrates the fact that not only can stroke be prevented, but that stroke survivors can fully recover and regain their quality of life with the appropriate long-term care and support. The two-year campaign aims to reduce the burden of stroke by acting on six easy challenges:

1. Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol.

2. Be physically active and exercise regularly.

3. Avoid obesity by keeping to a healthy diet.

4. Limit alcohol consumption.

5. Avoid cigarette smoke. If you smoke, seek help to stop now.

6. Learn to recognize the warning signs of a stroke and how to take action.

You can read further at http://www.worldstrokecampaign.org/2011/Pages/Home.aspx

The qr code was generated using http://qrcode.kaywa.com and then transforming the code using GIMP to create this cube design. Isn't it interesting that the qr code has a large error tolerance (redundancy of information or function) that it allows a custom design to be placed in it without loss of readability... much like the human brain!

If you don’t have PACS, take Alcohol! An effective way to archive your scans and retrieve them reliably and fast.

Hi!

So you don’t have picture archiving and communication system (PACS) in your hospital? It’s a shame, but don’t you despair. There is a cheap and effective mechanism to archive your patient’s images till PACS arrives.

I have seen than most of the departments are struggling and juggling with CDs of imaging data of patients – some of which do not open after sometime. You could always copy them as individual files to your computer but opening them is a hassle most of the time.

What you can do is use a CD drive emulator which makes a clone image of the CD and stores in your hard drive and mounts them as virtual CD drives whenever you want it. The advantages are many:

1. Hard drive access speed is many hundred times faster than a spinning CD. Scans open much faster. Trust me; you will save many hours of your life eventually.

2. You can run multiple scans simultaneously and compare them. (useful for teaching, reviewing old scans of a patient)

3. Archiving in hard drive allows all your scans to be in one place where you can search and find by patient details.

4. Backing up your hard drive is another layer of protection from the nuisance of corrupted / scratched CDs.

5. You can access your imaging data from anywhere in the hospital, if your hospital network is LAN connected. Just share the folder or drive where you have stashed away your alcohol barrels (mdf and mds alcohol image files) using the network places dialog boxes.(-poor man’s PACS costing around 0.00 $.)

This is what you got to do:

1. Download Alcohol 52% software from this link and install in your computer. (you can use other similar software too) (alcohol 120% is a paid software and one does not need this)

2. Whenever you need to see an MRI or CT, first ‘alcoholise’it –that is, make an image of it in the hard drive.

3. Once Alcohol dumps the image, the CD will be ejected. You can (and should immediately) give it back to the patient.

4. Mount the image as a virtual drive. (You can make many virtual CD drives as you want which will appear as multiple CD drives in ‘my computer’.

5. Click on the cd drive and watch scans as you normally do.

Departments that use a lot of scans like neurology, cardiology, RT, pediatrics, oncology etc might benefit.

A few tips:

1. Label the image file properly first time. This will make searches easier after a few years of accumulating scans.

Name age sex hospital number diagnosis or description date of scan

Or

Name_age_sex_hospital number_diagnosis_description of surgery_date of scan

(Do not use / < > ? etc)

Example:

Arnold 40 m Y353535 cyberdyne chip implant postopMRI 10Aug2025

2. Dedicate an entire partition (make it large, hard drives costs peanuts anyway nowadays)

3. Back it up regularly on a physically independent disk (and if you are the really paranoid/a-fixated types, back it up again on Bluray– I am not!)

4. Try not to see MRI or CTs first and then decide on copying. It’s faster to copy firstand then see it. You can always delete it if you don’t want it in the archive.

Hope this helps. Feel free to mail me if you run into turbulence. May be, if I have time, I’ll send you an instructional screen capture video. As of now you can take a look at the screen capture pics.

I had introduced Alcohol to my colleagues in my department four years back and I can assure you that they all are happily (and safely) addicted!

Regards,

MS Gopalakrishnan

Neurosurgery

23 Aug 2011

Can we EquiShare?: Equipment sharing rules in a Government hospital.

‘EquiShare”: Equipment sharing rules.

First things first: there are no rules and that’s why I am writing this. Second, not for a moment am I even pretending to suggest rules, rather, these are just thoughts on how best we can evolve a protocol of interdepartmental sharing of equipments based on a combination sound logic and pragmatism.

Logic base:

1.       Equipments in Government hospitals are bought with public money, and are not excusive property of a small number of individuals. It belongs to the patients who need it. ‘We’ just manage the life cycle of the equipment.

2.       More the number of users and larger the total duration of use, greater are the chances of malfunction and damage.

3.       Sub optimal utilization of costly equipment is often a hidden waste of money.

Obviously, there is apparent conflict between statements 2 and 3. (Damned if you share and damned if you don’t kind of paradox).  Since all equipments are bought with guarantees and pricy annual maintenance contracts, it is best to maximally use equipments as soon as it is installed. Optimal use is best assessed based on hours of active service rather than just the duration of potential availability of the device.

Time eats away everything:

Not being totally philosophical, but also taking natural entropy of chemical corrosion, out dating of technology and expiry of warranty contracts into consideration, the biggest error we tend to make is to securely keep equipment from its expected use. This probably stems from our desire to protect, preserve and perhaps hoard the valuable. Unfortunately, ultimately everything falls into disuse or decrepitude at the hands of time. (Same thing applies to virginity, cobalt-60 and cash under the pillow!)

So let’s just shift tactics and share stuff.

Divide and share!

I suggest that costly equipments be classified into three categories by the department which is managing its life cycle. (I am deliberately avoiding using phrases like “department which purchased it” to free ourselves from misplaced and over enthusiastic sense of possession that comes with the pain of chasing a purchase in a government set up)

Type A:

Equipment that is vital to every day functioning of the department’s clinical or research activity and for which there is neither standby nor spare. The clinical activity or procedure cannot be done without the use of this equipment

Type B:

Equipment that is vital to everyday functioning of the department‘s clinical or research activity and for which there is a standby or spare available. The procedure cannot be done without this equipment.

Type C:

Equipment that is only occasionally used OR something which is desirable for a clinical procedure but the procedure can also be done without it.

Sharing ‘rules’ may be as follows:

Equipment type	Cost	Share it?
Type A	Less than ten lakhs	No! Do not share.(except in an emergency)
Type A	More than ten lakhs to thirty lakhs	Yes, share it, but, at the discretion of the department managing it. Lean on sharing rather than denying.
Type A	More than thirty lakhs	Yes.
Type B	Any cost	Yes.
Type C	Any cost	Yes.

Note:

·         Departments may share stuff in a non-reciprocal manner too: Even if Department ‘X’ does not share equipment with Department ‘Y’, Department ‘Y’ can take a decision to keep sharing its resources with other departments including ‘X’, keeping in mind that it is patient’s need that is a priority rather than tit for tat games. (Although this is a violation of game theory, is it not!?).

·         ‘Discretion of the department’ means that the decision was arrived at a departmental meeting factoring in majority view of all individual consultants/users  involved rather than a single individual’s idiosyncrasy or apparent wisdom)

·         Costs mentioned are of course just my sense of value and considering speediness of various tender processes. You could think of a better way. I thought anything above thirty lakhs is just too costly to be lying underutilized. It has to be time shared by all valid users as a rule. Anything below ten lakhs can be acquired by any department fairly easily and is not worth taking a risk sharing if it shuts your own shop down

·         There may be other factors like high risk of damage on physical shifting of some heavy stuff to another building/level. But again, lean on the concept of sharing than denying, if reasonable efforts can be taken to avoid damage.

I would even take the liberty to suggest that departments be encouraged to give a monthly report of   costly equipments it successfully shared with others (and for what duration and purpose, and what it chose not to share, and why) to instill a sense of positive cooperation. Responsible and maximal use of resources is in every one’s interest. What do you say? Can we Equishare?

Regards,

MS Gopalakrishnan

Neurosurgery.