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Data Communication with DICOM
Published in W. P. M. Mayles, A. E. Nahum, J.-C. Rosenwald, Handbook of Radiotherapy Physics, 2021
John Sage, John N.H. Brunt, W. P. M. Mayles
It may be necessary to migrate an organisation's archive of DICOM objects between two systems. Compliance with DICOM standards by the vendors involved substantially facilitates this process. Despite this, difficulties in PACS migrations encountered by organisations have encouraged the development and marketing of vendor neutral archives (VNA), in which the standardisation provided by DICOM allows vendor-neutral file access by other systems. For a VNA to be useful to an oncology centre, its capability to support all DICOM objects, including DICOM RT, would have to be verified.
HIV Healthcare Delivery and Managed Care: Applications and Implications from the Special Projects of National Significance Program
Published in David Alex Cherin, G. J. Huba, AIDS Capitation, 2021
Sandy Gamliel, Barney Singer, Katherine Marconi
The VNA project differs from the other capitated projects in that it focuses on home health services and home health hospice services, rather than on the capitation of primary and clinical care services. VNA’s model emphasizes a continuum of home care including a range of medical and hospice services. The Transprofessional Model of care uses the services of hospice-trained teams of nurses and social workers. Evaluation of this model of care compares it to a traditional home care model to evaluate differences in cost and quality of life. To date, VNA has found significant cost savings: for every $1 expended on its transprofessional continuum-of-care model, the amount expended for patients in the more traditional model is $1.59, or 59 percent more. Moreover, preliminary quality of life data indicate that the Transprofessional Model patients reported a higher level of emotional well-being and physicians caring for these patients indicated that patients had reported a high level of satisfaction with the care received.
The Psychiatric Provider in Home Care
Published in Danielle L. Terry, Michelle E. Mlinac, Pamela L. Steadman-Wood, Providing Home Care for Older Adults, 2020
To illustrate, I was asked to see an 80-year-old male patient with a recent stroke who was depressed and having passive suicidal ideation. The nurse seeing him on our home care team was planning to keep him long-term in the program, but because he eventually needed more services for his ADLs, he was discharged from our VA team to a Medicare visiting nurse association (VNA) (our local policy is that patients cannot concurrently receive both). I had started this patient on an antidepressant and a sleep medication, and because he was homebound I was not able to transfer him to the clinic or a community provider. Whereas I often relied on the VA HBPC nurse visiting him to update me on his status at weekly team meetings, I no longer had this reliable collaboration once the VNA took over. This naturally led to me needing to make more frequent home visits, taking time away from other patients. It is easy to see how this scenario could unfold for several patients concurrently, and lead to an accumulation of patients for psychiatric management who are no longer part of the original treatment team. Although there are times when these circumstances cannot be avoided, it is necessary for the psychiatrist to try and foresee all possible outcomes before committing to care for a patient in the home.
Modern biologics for rabies prophylaxis and the elimination of human cases mediated by dogs
Published in Expert Opinion on Biological Therapy, 2020
Terapong Tantawichien, Charles E. Rupprecht
Traditionally, attenuated modified-live or recombinant viruses and inactivated, adjuvanted vaccines used in veterinary medicine, for a variety of species, are highly effective in driving appropriate antigenic presentation and immune system stimulation, even after a single dose [36]. In contrast to those adjuvanted or self-replicative veterinary rabies products, all modern human vaccines for PrEP or PEP are un-adjuvanted and inactivated. These human rabies vaccines require several doses for elicitation of adequate innate and adaptive immunity, toward an effective, long-term response [46]. After administration, human rabies vaccines induce T cell responses that promote the induction of long-lived memory B cells and antibody-secreting plasma cells [46,47]. During a primary immune response, plasma cells are detected at ~day 7 and peak by ~day 10 [47]. Detectable VNA occur by ~ day 7, with nearly all patients responding appropriately by day 14 [46]. This delay in response during PEP necessitates the use of passive immunity via rabies immune globulin (RIG) or monoclonal antibody (MAb) infiltration into and around the lesions of exposed patients, to bridge the gap before the induction of active immunity [48]. The VNA from vaccination can persist for many years [49]. Memory B-cells may occur around day 10 until day 28. After a booster vaccination, natural killer cells are one of the first detectable cellular responses [47]. Even without the detection of VNA, an anamnestic response may occur even decades after primary vaccination [50].