#medinfo

[manifestashi]

Yogyakarta, 23 Februari 2023

Halo, Jiwa.

Pertama-tama, aku mau ngucapin terima kasih. Terima kasih sudah lahir ke dunia ini, ya. Sampaikan salam hormatku untuk mama papa kamu, berkat mereka anak lelakinya kini telah tumbuh jadi pria yang hebat.

Ji, kamu adalah lelaki yang sudah terbukti mengemban tumpukan tanggung jawab. Wakil Ketua Kesekjenan BEM, Kepala Bidang Eksternal Mapala Teknik, sampai Kormasit Tim KKN di Sumatra ... dengan seluruh beban itu, memang akhirnya banyak yang harus direlakan, ya? Dari waktumu bersosialisasi di luar organisasi, kesempatan magang di luar kota, prestasi serta nilai akademik, tertundanya periode kelulusan bahkan. Dan juga, aku.

Sesungguhnya, aku adalah bagian paling gak relevan dalam garis perjalananmu sebagai mahasiswa yang super-aktif dan serba-uhm-superior. Gak ada aku gak akan bikin kamu lengser atau tiba-tiba kehilangan jabatan.

Namun, melalui sudut pandangku, kamu adalah bagian signifikan yang menemani masa-masa paling krusial. Aku coba urutkan ya, dari masa kepengurusanku di Medinfo, hiruk-pikuk per-KKN-an, hingga gejolak penulisan skripsi yang nyata adanya.

Bagiku, cukup kamu satu-satunya—sayangnya, sepertinya, satu buat kamu itu gak cukup, ya?

Kalau dipikir-dipikir, seharusnya kita gak perlu berjalan sejauh ini kalau memang sebetulnya kamu gak mau. Seharusnya kita cukup melangkah sendiri-sendiri di jalur masing-masing. Kamu gak perlu pasang badan sebagai “teman” yang selalu ada, selalu bantu ini-itu, selalu berbagi cerita sampai tentang luka terdalam keluarga, selalu jadi teman baik yang terlalu baik—aku enggan mengatakan ini, tapi kali ini perlu kukatakan juga: kamu melakukan kebaikan yang sama dan setara porsinya untuk semua orang, Ji.

Seharusnya, kan, gak begitu.

Pertemuan di Artemy kalau bisa kita batalkan saja lah, ya.

Buat apa juga kamu tiba-tiba nge-DM mengomentari Instagram Story? Kamu dulu gak jelas, tapi entahlah kenapa waktu itu aku juga mau-mau saja menanggapi. Aku mestinya memberikan early warning kepada Yuna supaya gak usah upload status WA “reuni” atau lebih baik disembunyikan saja dari kontakmu ...

... gitu, Ji, kalau sebagian besar diriku terisi oleh emosi negatif. Tiba-tiba kesal, kecewa, ingin marah, dan parahnya sampai cemburu dengan perempuan-perempuanmu—padahal buat apa? Hahaha.

Jadi kali ini, lebih baik aku menuliskan kata-kata baik yang siapa tahu bisa menjadi doa pula. Sebab, poin-poin di atas sebenarnya mengerucutkan dirimu pada satu hal:

Kamu manusia biasa.

Banyak kurangnya, tapi juga masih ada sejuta alasan mengapa kamu patut hadir di dunia. Mungkin aku gak akan mampu menjabarkan semuanya, atau bahkan secuilnya, karena aku cuma bisa bilang:

Aku sangat senang dan bersyukur bisa kenal sama kamu, hidup dalam lintasan waktu yang sama dengan kamu.

Bersamamu, aku bisa jadi diriku sendiri. Aku bisa melepaskan segala identitas yang menempel selain diri sejati Rona Renjana yang, setidaknya, aku pahami dalam skala yang paling kecil.

Gak ada blush of lust yang tiap unggahannya dituntut FYP, bukan juga Roro di Kelas Filsafat Yunani yang gak pernah absen jadi tameng dosen, pun seluruh akun media sosial berjudul RR yang kurasa kerap dimata-matai seantero dunia maya, atau 'Rona biasa' kacung desain dan perkontenan di BEM.

Di sampingmu, Ji, aku merasa terlindungi. Kamu ruang amanku. Afeksimu, entah tujuan aslinya platonis atau murni romantis, selalu terdengar begitu lantang untukku. Kamu selalu percaya diri dalam mengungkapkan dan menyampaikannya, dan aku kelewat jatuh—tentu saja, siapa bisa tahan menerima luapan rasa sayang yang amat terang-terangan?

Ji, jujur saja, kalau dilahirkan lagi di masa depan, aku akan tetep pengin kenal sama kamu. Kita mulai dari awal, kita pertegas batas pertemanan. Gak perlu cemas, kita tetep bisa diskusi buku dan nyobain kuliner baru, kok. Malah dengan hati yang lebih lapang dan gembira.

Semoga dunia selalu jadi rumah yang paling ramah buat kamu ya, Ji. Dunia butuh lebih banyak orang seperti kamu—yang ringan tangan, penuh perhatian, mau mendengarkan, selalu menepati janji. Sesuai namamu pula, semoga kamu selalu memiliki jiwa yang besar.

Jangan pernah menyerah pada mimpimu—aku menghindari pembahasan ini, tapi izinkan aku meminjam kalimat Hegel, “Nothing great in the world was accomplished without passion.” karena sejatinya, “Education is the art of making man ethical.”

Jangan sampai sakit juga ya, Ji, nanti akan banyak yang khawatir. Kamu harus makan banyak dan tidur nyenyak. Aku tahu badanmu ekstra kuat, sudah menyerupai binaragawan. Namun percayalah, mengerjakan skripsi butuh energi penuh lebih dari sekadar ketahanan tubuh.

Dan satu lagi: bersetialah pada satu hal, dalam hal apa pun itu.

Akhir kata, selamat ulang tahun, Jiwa Hadinata. Selamat bertambah usia, selamat mendewasa.

Salam hangat, Rona Renjana

NB: Gue pake “aku” supaya kesannya lebih sopan, gue harap surat ini akan menemui lo dalam keadaan yang baik. Kalo udah dapet gebetan baru, kabarin gue ASAP!!

NBB: surat ini ditulis setelah gladi bersih wisuda, gue literally cari spot ternyaman di Perpusat. Penginnya sih, booking bilik belajar di TGCL yang mesti war jam 12 malem itu, sayangnya tampilan Simaster calon alumni udah berubah—lo cepetan nyusul ya~

[cirugiaoraleimplantologia]

#Repost @datosmedicos1 with @get_repost ・・・ ¿QUÉ DEBES HACER PARA INTENTAR SALVAR LA VIDA DE ALGUIEN QUE HA SUFRIDO UN PARO CARDIORRESPIRATORIO? El paro cardiorrespiratorio es la repentina detención de la respiración y del latido cardíaco en un individuo. Nunca sabemos cuando esto pueda suceder, es por eso que esta publicación tiene como objetivo que aprendas qué debes hacer inmediatamente esto ocurra. Lo primero que sucede es que la persona se desmaya (síncope), inmediatamente debes revisar el pulso y la respiración, si están ausentes debes empezar inmediatamente reanimación cardiopulmonar (RCP) y dirigirte al servicio de urgencias mas cercano. ¿CÓMO SE HACE RCP? Brazos estirados con manos entrelazadas en el sitio del corazón (hemitórax izquierdo) Se hacen 30 compresiones y 2 respiraciones boca a boca. Cada compresión debe ser rítmica y profunda para asegurar la contracción (sístole) y relajación (diástole) del corazón. Debes hacer esto hasta que llegues al servicio de urgencias mas cercano porque esto va a suplir de cierta forma la llegada de sangre a los tejidos (perfusión sanguinea) y evitará que ocurra tan rápidamente la disminución  de oxígeno hacia los tejidos (hipoxia) que se produce cuando el corazón se detiene. Hacer esto no asegura que la persona salga del paro cardiorrespiratorio en el que se encuentra, pero sí aumenta las posibilidades de que pueda salir una vez se realice el protocolo de reanimación en el servicio de urgencias. (el protocolo ya ha sido publicado en el perfil) Síguenos: @datosmedicos1 Etiqueta a todas las personas que quieras, esto es algo que debemos saber todos. #medicina #medicine #med #medtips #medinfo #medstudent #medlife #datosmedicos #health #salud #contenidoacademico #learn #medtopics #instafollow #pathology #picoftheday  #savesomeone  #primerosauxilios #studygram #RCP #reanimacióncardiopulmonar #PCR #parocardiorrespiratorio #heart #firstaid https://www.instagram.com/p/B2jaM0bH0fG/?igshid=jeqbewu1zvek

[info4writers]

Venomous Snake Bites

Venomous snake bites are often very deadly; it can kill a person within 15 minutes in the very early morning after a small bite. This is due to the venom build up in their fangs that occurs over the day, and lack of a kill where they would usually discharge some of the venom (they usually kill a prey early in the morning) so that allows the snake to fully inject venom in the victim. It is often a deadly, but it is also a very rare dose.

[hooman-lyfe]

#1 First Impression

Takdir Allah tu indah emang, kalo diinget inget lagi malah jadinya lucu wkwk. Banyak banget yang suka nanya, 'Hesti pake proposal yaa nikahnya?' atau 'kok bisa sih Dam, ketemu Hesti dimana?' jadii dari pada diulang-ulang mulu pertanyaannya jadi saya tulis aja disini biar kalo ada yang nanya langsung kirim link aja #eh 🤣

Awaaall banget tu sebenernya saya gatau sama beliau, tapi yang pasti saya tau sama organisasi kelimiahan Fakultas Teknik yaitu KST. Saya ngerasa amaze aja dengan pencapaian anggota-anggota KST dulu, karena saat itu FISIP belum punya organisasi kelimiahan, gitu.

Qadarullah di tahun berapa gituu mungkin 2016 akhir atau 2017 awal, U-Read (organisasi keilmiahan kampus) lagi ngadain open recruitment untuk reader 6 (betewe saya reader 5) tepatnya di depan musholah pertanian. Inget banget, waktu itu hampir pukul 6 sore kita lagi pada beberes buat pulang, tiba-tiba ada doi lagi sama temen-temennya lewat mau ke terminal, karena dirut uread saat itu dari FT alias anak KST jadi mereka mampir gitu sambil becanda-canda, kecuali satu orang. Yaa, itu beliau. Mukanya kek punya beban paling berat sedunia -,- terus kami dikenalin kan sama mereka, dan pas kakak dirut ureadnya bilang, 'kenalin ini Sadam, dirut KST.' Dalem hati langsung, 'ohh, ini dirutnya, sombong kali baru jadi dirut, senyum aja gamau.'

Yaa gituu wkwk. Emanglah yaa, dont judge the book by it's cover🤣 #maapyeeBang🐣

Lanjut pertemuan kedua, perantaranya masih uread dan kakak dirut uread wkwk. Ini kejadiannya waktu PK2 Unsri, kan dalam acara itu ada semacam pertunjukan yang dilakukan oleh organisasi-organisasi kampus ke maba, nah of kors dong Uread ikutan dan melibatkan semua organisasi keilmiahan fakultas. Jadi, konsep penampilan pada saat itu adalah para dirut organisasi keilmiahan fakultas pake jaket kebanggaan organisasinya masing-masing sambil bawa bendera organisasinya masing-masing jugak. Saya sebagai medinfo yang baiq tentu sajaa, asik dokumentasiin agenda dong yaaa. Lalu ...

TIBA-TIBAA! TIADA ANGIN TIADA HUJAN..

KONSEPNYA PUN BERUBAH.

Menjadi, semua dirut organisasi keilmiahan fakultas pake jaket uread, dan anak uread akan pake jaket organisasi keilmiahan fakultas sambil bawa bendera mereka. Tapi tapi itu bukan hal yang spesyel gezz, yang spesyel kek nasi goreng pake telor adalah ketikaa kakak dirut uread bersabda,

'Hesti, tukeran jaket sama Sadam!'

Whatt? Apa? Saya tak mau doong, tapi yaa gimanaaa -,-"

Long story short, udah kelar ni yaa acaranya, saya caricari doi dong yaaa buat tukeran balik jaketnya. Dan akhirnya kami pun bertemu lalu semuanya baik-baik saja sampai akhirnya kami meniqah.

OH TIDAK DOONGG, TENTU TYDAAACC!

Dan saya menemukan jaket saya di atas terpal, tergusur, terlempar, terdiam 🥲 dan semakin membara dong ketidak respect'an inii.

Yaa, setelah kami menjadi teman #eyyaa saya konfirmasi dong tentang apa yang telah terjadi, dan yaa semua hanya kesalah pahaman semata😌 Emaang gaboleh gasuka banget tu sama orang, entar bucin #eh wkwkk. Bucinnya pas udah nikah aja, biar bucinnya jadi ladang pahala #eyyaaa.

Lanjutannya nanti ajalah yaa, biasa bawaan umur suka sakit pinggang😌

[schoolsformedicalbilling]

Combining and integrating cross-institutional data remains a challenge for both researchers and those involved in patient care. Patient-generated data can contribute precious information to healthcare professionals by enabling monitoring under normal life conditions and also helping patients play a more active role in their own care. This book presents the proceedings of MEDINFO 2019, the…

[nafisahrh]

Setiap pertemuan pasti ada perpisahan. Kemarin malem, adalah pertemuan virtual terakhir aku dan temen-temen medinfo aspal.idn, sedih rasanya harus berpisah dan berbeda tempat berjuang. Bersyukur karena Allah telah pertemukan aku dengan mereka semua. Setiap orang yang datang dalam kehidupan kita selalu memberikan hikmah dan juga pelajaran untuk kita. Tinggal kitanya aja mau menerima atau malah mengacuhkannya. Untuk mas irfan, mas kholik, mbak suri. Terima kasih ya sudah berjuang bareng di medinfo, berkarya untuk palestina. Semoga selalu diberi kemudahan untuk segala urusannya. See you in Quds the capital of palestine.

Ini adalah kata-kata perpisahan sekaligus pesan yang mereka sampaikan :

Semangat teman2 medinfo, kalian di masa2 kek gini, jadi ujung tombak dakwahnya aspal nih 💪🏿✨

Namanya berdakwah lah ya, karena ga digaji, kalian bergerak atas motivasi dari dalam diri kalian, jdi tanggungjawab bener2 dipertaruhkan di sini.

Peluang bagi kalian sebelum bertanggungjawab ke urusan2 yang lebih besar (mengurus keluarga contohnya)

Intinya, kalo kalian bener2 bersatu karena visi yang sama (membebaskan al-quds), maka kalian harus bertanggung jawab atas visi itu dengan semaksimalnya menjalankan apapun yang ada di ASPAL.

Kalo kalian bener2 ingin mendapatkan ridho Allah karena itu, pasti ga ada rasa cemburu diantara kalian, yg ada rasa saling support dan kasih sayang ✨

Seperti jaman para sahabat nabi dulu, mereka sangat mencintai sesamanya karena sama2 memiliki visi yang sama,

Kuharap kalian juga begitu 💪🏿✨

Semoga kita dapat bertemu kelak di hadapan Allah, karena telah menjadi bagian dari umat yang menjalankan perbaikan di muka bumi ✨✨

Barakallah wa innalillah ✨

#semogabermanfaat

[fullperfectionwerewolf]

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The Medinfo program covered all aspects of health informatics from traditional areas, such as hospital information systems, patient registries, nursing informatics, data integration, standards, interoperability issues and decision support, to innovative topics, such as translational bioinformatics, text mining, intelligent data analysis, emerging technologies, quality, social networking prom ball gowns, workflow and organizational issues. The outgoing President of the IMIA, Professor Reinhold Haux, presented on health informatics challenges into the future, reinforcing that today and in the future, health care has to be considered as part of a continuous and coordinated life-time journey and not just as episodes of disease. Medical informatics has a key role to play in this paradigm shift. The new IMIA President, Professor Antoine Geissbuhler, was announced at the closing ceremony. Now in spite of the fact that you have a wonderful wedding photographer, it is not unheard of that someone might just swoop down and steal your thunder. And god forbid but we do have a few relatives like that in our midst don’t we? But do not let politeness get in the way of you fulfilling your dream of the perfect shot with the perfect dress at the perfect lighting. As far as cheap Epson inks is concerned sequin homecoming dress, you will have some better options of choosing the best one from genuine to compatible one. From black to a variety of other inks, you will have some better options to choose the best one. When you purchase a new cartridge, it comes with ink; while refilling it again and again is the right way of saving some good amount of money and at cheapyjsojcje-khs the same time keeping your printing requirements fulfilled all the times. Having ink in stock is also important for those who need more printouts every day. However, before placing your order for ink, it is also important to keep some important points in mind. First of all, always choose the best quality to ensure durable and unique printouts. Related recommendations: im so excited to talk about the black bridesmaid dresses today from lalamira Why is the wedding dress white? Have you ever thought about this problem? how does a round faced bride choose a wedding dress dont wear a high collar in the lalamira online store you can find your dream summer prom dresses

[speedytreefart]

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Matt McCullar has been playing music for several years, and owns his own self-created business. Firmly following the belief that clothes make the man, he decided to change his life by getting diamond gold watches and it has been a great addition to his life. Get your own diamond gold watches here: www.diamondgoldwatches.org There seems little need to consider ideas with regards to a bachelorette party. vedlalaormaihs_iah The wedding ceremony is close available and discussions concerning the dress, the honeymoon as well as the 'lucky' groom is going to be very popular. But that doesn't mean you can't invent something great for your event. Here are a few suggestions to consider when planning your bachelorette party. The Medinfo program covered all aspects of health informatics from traditional areas, such as hospital information systems, patient registries, nursing informatics, data integration, standards, interoperability issues and decision support, to innovative topics, such as translational bioinformatics, text mining, intelligent data analysis, emerging technologies, quality, social networking, workflow and organizational issues. The outgoing President of the IMIA, Professor Reinhold Haux, presented on health informatics challenges into the future champagne dresses under 100, reinforcing that today and in the future, health care has to be considered as part of a continuous and coordinated life-time journey and not just as episodes of disease evening gowns under 200. Medical informatics has a key role to play in this paradigm shift. The new IMIA President, Professor Antoine Geissbuhler, was announced at the closing ceremony.

Now in spite of the fact that you have a wonderful wedding photographer, it is not unheard of that someone might just swoop down and steal your thunder. And god forbid but we do have a few relatives like that in our midst don’t we? But do not let politeness get in the way of you fulfilling your dream of the perfect shot with the perfect dress at the perfect lighting burgundy evening dress. As far as cheap Epson inks is concerned, you will have some better options of choosing the best one from genuine to compatible one. From black to a variety of other inks, you will have some better options to choose the best one. When you purchase a new cartridge, it comes with ink; while refilling it again and again is the right way of saving some good amount of money and at the same time keeping your printing requirements fulfilled all the times yellow prom dresses. Having ink in stock is also important for those who need more printouts every day. However, before placing your order for ink, it is also important to keep some important points in mind. First of all, always choose the best quality to ensure durable and unique printouts. Related recommendations: IUYGFP）&……rfghThe branded saree retailers also are in great demand during the marriage season plus size prom dresses under 200 the interiors along with incorporated textures as well mermaid prom dresses under 200*&^RUItfgs you could possibly buy yourself – if you had the money? Fine mermaid wedding dresses under 200.HGFO7ifkytrdfg' you have to be sure that the online wedding shop can present superb services beaded prom dresses under 200(*Uougs

[mossjp]

OsiriX MDの国内医療機器認証取得について

0. まずはおめでとうございます

まずは、FLOSS由来のソフトウェアが初めて国内で医療機器認証を取得できたことを喜びたい。

http://www.newton-graphics.co.jp/archives/2636

取得がいかに大変だったかについては、ニュートングラフィクス社の菅野社長からお伺いしていた。取得までのご健闘に敬意を評するとともにその成果を心から賞賛し祝福する。

残念ながら、すでにOsiriX MDはFLOSSとは呼べないものではあるが、FLOSSが元になったことは経過から明らかである��OsiriXがFLOSS版の更新をほぼ中止したこと、そしてPACS（薬機法での届出は画像診断用ワークステーションプログラム）がクラス２の管理医療機器として認証をうけなければならないものであるのかという点について論考する。

1. 薬機法改正の背景

医薬品および医療機器の許認可のために制定されていた「薬事法」が、2013年に「薬機法」に改正され、ソフトウェアも管理対象とされた。この背景にはアメリカFDAが2010年にPACSを510(k)で管理対象のクラス２医療機器として分類したことにある。この動きにはPACSをCTなどの画像撮影装置に付属するおまけのようなものではなく、画像処理をするきちんとした製品として、ソフトウェアとして独立した存在として高めていくべきだという考えがあったとその働きかけをした人物からきいたことがある。

医薬品や医療機器は国際的に流通するものであり、その管理や取締は国際的な協力のもとで行われている。PACSもまた、ほかの医薬品や医療機器と同様に国際的に販売されるものであるため、日本でもFDA 510(k)同様の規制を設ける必要があり、薬機法の改正につながっている。

同様の規制はヨーロッパ、カナダなどの先進国を中心に波及し、PACSの販売にはそれぞれの地域で機器認定を取ることが必要となっている。

2. FLOSSへの影響

2004年からOsman RatibらによりFLOSSとして開発されていたOsiriXは市販されている高額なPACSに負けないような性能があったことから、高く評価されていた。日本でも杉本真樹医師が積極的に普及活動を行っていた。しかし、前述の通り2010年にFDAによる認証を受けなければアメリカでPACSを流通させることができなくなったため、pixmeo社を設立しOsiriX MDの販売を行うこととなり、無料でダウンロードして使うこともできていたOsiriX liteは医療用途には使わないという前提での公開となった。公開されているソースコードはLGPL3に準拠しているが、その時点を持って、Version 5.8のままほぼ更新されることがなくなっている。

OsiriX MDはソースコードが非公開となった上で、10万円以上もすることからユーザーの��発を招いたが米国FDAでの認証を取るためにかかるコストが数百万円単位でかかること、そしてヨーロッパや各国で認定を取るために同様の経費がかかることを考えれば、ボランティア主体のFLOSSコミュニティで負担する金額とは言い難く、妥当な路線変更と言わざるを得ない。

OsiriXのsource codeを利用して、FLOSSでの開発継続のためforkしたHoros projectは100,000USDを目標に寄付を集めており、2019年3月8日時点で69,110USDを集めている。今後の発展に期待したい。

3. PACSのクラス2機器分類は妥当か

薬機法が定める医療機器は「人若しくは動物の疾病の診断、治療若しくは予防に使用されること、又は人若しくは動物の身体の構造若しくは機能に影響を及ぼすことが目的とされている機械器具等（再生医療等製品を除く。）であって、政令で定めるものをいう。」である。さらに、人体に与える影響をもとに医療機器をクラス1から4までに分類している。製造販売に認証が必要となるのはクラス2以上の管理医療機器である。PACSはクラス2に分類されている。薬機法は289条からなり、さらに施行令と施行規則からなる膨大な法体系である。なかなか素人には理解しづらいものではあるが、人命を左右する医薬品、医療機器は適正に公的機関により管理される必要があるという趣旨は否定のしようがない。心室細動で作動しないようなAEDなど市場に流通してもらっては害悪でしかないし、インチキ医薬品や危険薬物の流通も取り締まる必要がある。

PACSが単独で医療機器認定されたことでよいこともある。CTなどの画像機器の付属品であった時代は、PACSが動作しているOSに脆弱性が見つかってOSをアップデートしようにも、そのためにCTの機器認証を更新する必要があるため、更新がなかなか進まないといった問題があった。それがPACSが独立したことで、比較的容易にアップデートをすることが可能となった。

しかしながら、なぜ、PACSがクラス2の管理医療機器と分類されているのかについては疑問が残る。PACSは画像を表示することで、診断や治療計画に使用されることは間違いがなくその点で言えば、確かに医療機器である。しかし、その理屈から言えば電子カルテもまた医療機器であるが、クラス２には分類されていない。

それならば電子カルテも薬機法で規制しようとなるような動きが出るような、藪蛇をつついてしまうことにもなりかねないのが怖くてこれまで言及を避けてきたが、画像を表示するPACSがクラス２であれば文書を表示する電子カルテもまたクラス２ではないかと思われる。

いずれにしても、PACSや電子カルテが診断���ために使われるとしても、それを判断するのは医師であり、直接患者に害を及ぼすことはあまりない。今の所、電子カルテまで規制する動きはないが、規制が増えることは良いことばかりでもない。

自分の診療や院内業務を円滑に進めるため、医療従事者がちょっとしたソフトウェアを作って使うということもあり、そうしたソフトウェアがFLOSSとして広まることもある。どこまでが薬機法の対象となるのかならないのかが、分かりづらいのは大きな問題点である。

医療分野へのAI応用が期待される中、どこまでが研究開発として許されるのか、どこからが薬機法の対象となるのか不明である現状では、たとえそれが自分の個人的な診療のために使うものであっても研究開発にたいして抑制的な態度をとらざるをえない。医療分野でのソフトウェア開発と流通が、許認可についてのコストがまかなえる資本を持つ大企業だけに独占されることに健全な未来を展望することはできない。

Tivoization?

GPL2はソフトウェアの改変と再配布をライセンスの範囲内で認めている。しかし、ほかの制約により改変したソフトウェアが利用できなくなる事例が報告され、Tivoization と呼ばれている。薬機法によりFLOSSの流通に制約がかかるのは、Tivoizationとも考えられるが、適正な手続きを踏めばFLOSSであっても薬機法を遵守して利用することも可能ではある。したがって、薬機法での規制はTivoizationとまではいえない。認証にかかる手間とお金があればだが。

GPLは配布に関するコストを適正な価格で徴収することは否定していないが、それはソフトウェアを配布するためのメディア代程度であるとされている。配布のためのコストとして、ソフトウェアの認定に関するコストを転嫁することが許されるのかということについてはFSFとも議論が必要だろう。FLOSSであっても保守などのサービスの対価を求めることも同様に認めている。しかし、すべての利用者と保守契約を結ぶことはFLOSSとして配布の形態上困難である。

OsiriXのようにFLOSS版と商用版の2つのライセンスを用意して、商用版の利用には料金を徴収するソフトウェアはMySQLなど多くある。すべての著作権者の同意があれば、この形態をとって許認可にかかるコストを転嫁することも可能ではある。OsiriXの場合であれば、pixmeo社から商用版の再配布の許諾を得てライセンス費用を払えば、Newton Graphics社のように薬機法の認定を取った上で商用ライセンスでOsiriXを配布することも可能である。ただし、現在公開されているLGPL3版のOsiriXのコードを利用する場合、再配布にはLGPL3の規定に従わなければならず、OsiriXのLGPL3版から派生したHorosも同様にLGPL3の規定に従う必要がある。したがって、商用版であってもソースコードを動作する形で設定ファイルを含めて提供する義務があり、改変や再配布もLGPL3の規定通りに認める必要がある。

公正で安全な医療ソフトウェアの流通のために

何よりも重視しなければいけないのは、質の高いソフトウェアにより人体の安全を確��することである。人体への影響は時に不可逆的な転帰をたどることがあるため、人体に害を及ぼすようなソフトウェアの流通は予防的に阻止する必要がある。しかし、その区分についてどこまでが妥当なのかについては、臨床現場での利用方法を含めて議論を重ねる必要がある。

FLOSSはライセンス上、その動作については開発者に一切の保証を認めていない。したがって、その使用はユーザーが自己責任で行うものであるが、だからといって薬機法を無視していい訳でもない。薬機法での認証にコストがかかるのはFLOSSだからというわけでもなく、FLOSSだからといって薬機法の認証を受けないで良い理由とはならない。法律として定められたルールがある以上、それに従うのは当然のことであり公正な競争なくしてソフトウェアの発展もまた見込めない。

公正なルールのもとでソフトウェアを開発し、流通させていくことは医療の進歩のために欠くことができないものである。そのためには妥当なルール設定と明確な基準が必要となる。PACSが規制の対象となることが妥当であるかどうか、医療分野でのFLOSSと規制については今後も国際的な議論を深めていく必要がある。

今年8月に開催されるMEDINFO2019では、医療分野でのFLOSSが直面する課題として、FLOSSと規制に関するワークショップを提案した。そろそろ採択されるかどうかの結果が出る。乞うご期待。

小林慎治 医療オープンソースソフトウェア協議会代表 IMIA Open Source Working Group, Chair

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¿QUÉ DEBES HACER PARA INTENTAR SALVAR LA VIDA DE ALGUIEN QUE HA SUFRIDO UN PARO CARDIORRESPIRATORIO? El paro cardiorrespiratorio es la repentina detención de la respiración y del latido cardíaco en un individuo. Nunca sabemos cuando esto pueda suceder, es por eso que esta publicación tiene como objetivo que aprendas qué debes hacer inmediatamente esto ocurra. Lo primero que sucede es que la persona se desmaya (síncope), inmediatamente debes revisar el pulso y la respiración, si están ausentes debes empezar inmediatamente reanimación cardiopulmonar (RCP) y dirigirte al servicio de urgencias mas cercano. ¿CÓMO SE HACE RCP? Brazos estirados con manos entrelazadas en el sitio del corazón (hemitórax izquierdo) Se hacen 30 compresiones y 2 respiraciones boca a boca. Cada compresión debe ser rítmica y profunda para asegurar la contracción (sístole) y relajación (diástole) del corazón. Debes hacer esto hasta que llegues al servicio de urgencias mas cercano porque esto va a suplir de cierta forma la llegada de sangre a los tejidos (perfusión sanguinea) y evitará que ocurra tan rápidamente la disminución de oxígeno hacia los tejidos (hipoxia) que se produce cuando el corazón se detiene. Hacer esto no asegura que la persona salga del paro cardiorrespiratorio en el que se encuentra, pero sí aumenta las posibilidades de que pueda salir una vez se realice el protocolo de reanimación en el servicio de urgencias. #medicina #medicine #med #medtips #medinfo #medstudent #medlife #datosmedicos #health #salud #contenidoacademico #learn #medtopics #instafollow #pathology #picoftheday #savesomeone #primerosauxilios #studygram #RCP #reanimacióncardiopulmonar #PCR #parocardiorrespiratorio #heart #firstaid https://www.instagram.com/p/Bu41xwjHq1a/?utm_source=ig_tumblr_share&igshid=1eqabqyjalp9o

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Basic First Aid #1: Head & Spinal Injuries

Lets face it, most action scenes that are written often result in injuries to the head and spine. This is due to most people knowing that these injuries are traumatic with dire results, but the issue is people sometimes write it wrong. Every injury is different, so each victim with have different results, injury level, and aid. 

What can cause these types of injuries: motor vehicle crashes, whiplash (can be direct or indirect to any impact to head), falling from a height that’s more than a few feet, skiing/sports, and diving. These blows to the head/spine do not always cause external (superficial/skin) wounds or bruising.

Risk factors: elderly, children, crashes, falls, intoxication/not alert, painful back/neck/head injuries

General Signs and Symptoms: lump/deformity in head/back/neck, unequal pupils (one will react to light (dilate and constrict) while the other remains the same through light stimulus), headache, clear & bloody fluid from nose/ears, inability to move any body part (specifically the arms and legs), tingling/numbness in feet/hands, and changing responsiveness (drowsiness, confusion, dizziness)

Assessing Head/Spinal Injuries: consider the cause of the injury, assess observations from bystanders of the scene, observe sign of any head/spinal injury. 

-Feel for bumps/depressions (dips) in the skull gently (do not press on the skull if suspected injury), check ears/nose for blood/clear fluid, check pupils, check neck for swelling/deformity/bleeding/pain, observe breathing pattern and/or loss of bladder/bowel control (urinating/bowel movements unconsciously (severe lower spinal cord/nerve injury))

The Assessment: check the head, check the neck, touch toes and ask if there is sensation, ask them to move toes and push, do the same for hands as for feet

*Do not move victim unless it is necessary. This can cause injuries to worsen. An injury to the spine can shift and permanently damage the spinal cord, which can kill the victim if the injury is in the upper portion of the spine (in the C-spine) or paralyze permanently. A skull/brain injury can also kill the victim if they’re moved harshly. Only move the victim to prevent the choking on vomit (which can occur from shock and traumatic injury), blood, and other fluids. 

Call 911. Your story may be about a doctor, or a superhero, or something of a fantasy nature, but these types of injuries needs a team of professionals. The injuries are quick to do damage, and the wrong action can cause a loss. Don’t assume that the victim is going to lack a specific assessment and can still go on without a limp.

Disclaimer: the information above can be applied to real life, but only a trained first aid-er should apply them and should not rely on this information if they were trained differently. You can do some of this in real life in an emergency. The information above is for writers. It has come from several references, but do realize a hospital, EMS, first aid-er, and medical professionals will not follow these because they usually have their own guidelines. 

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