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MeditConcept 5 User Manual

1. Look lor This dialogue allows you to specify insurance companies to filter only those patients whose health care expenditures are covered by them In order to search the applicable company there is a search string When you start typing seca CardioConcept tries to locate the insurance company that starts with the letters you type and moves selection indicator on the corresponding line You can select a single company or a number of them One or several insurance companies can be selected from the list using standard Windows technique Shift arrow keys ctrl mouse click A thick dot instead of cursor appears to the left of the selected company gt or OH lf no companies are marked as selected the current one blue bar is considered as selected Toolbar has two buttons OK button starts filtration x Cancel button closes the window without any filtration Filter by Examination Type dialogue Standard EL D exsmnalon Filth anskens This window can be used in order to view examinations of certain type only One or several examination types can be selected in the list box using standard Windows technique shift arrow keys shift ctrl mouse click Selected items are marked by blue selection bar Toolbar buttons Y OK button starts filtration x Cancel button closes the window without any filtration Specify filtered period dialogue x w Xx DE Cancel From Jeans ODM Y YY Tx ES WO DD MM Cer
2. 50 E Y Yi A d earned E 3 Y Y Aids Ea E e a A TE n Calibration cmim 1 Duration sec aA aL HR max bpm HR min ppm Conclusions Accelerated junctional rhythag Junctional escape rhythm alc RAR min fms RA msi Date Aire 02 08 2004 13 55 05 Conclusion by Sokolova Tatiana The name of current patient is shown in the window title bar The main parts of Rhythm ECG Viewer are Rhythm Viewer Menu and Toolbar Rhythm Viewer Menu and toolbar will be explained in detail in the corresponding section ECG Display Area ECG Display area is the largest part of the window It is clear that ECG Display is intended to show ECG recording Examination Toolbar Examination Toolbar with examination icons on it Current version of seca CardioConcept supports only standard A ECG record ER and rhythm analysis ECG record types You can click an appropriate icon to view examinations of the corresponding type only 8 Navigation Panel Quick Navigation Panel shows one lead of long ECG record with virtual paper speed 10 mm sec so that lager section of the whole recording is seen Left click on the Quick navigation panel relocates the specified part of ECG into the centre of Rhythm ECG viewer Diagnostic Conclusion Panel Diagnostic Conclusionpanel serves for browsing through available diagnostic conclusion and can be minimized in order to enlarge the ECG Display area ECG Features Panel ECG Features panel shows main d
3. Filtration buttons el next to each data field box You can use these buttons with the same effect as items in the Filtration menu Each filtration button remains pressed when the corresponding filtration is set To turn specific filtration off it is necessary to release the corresponding button Buttons Previous next reading and Filter By Diagnostic Statements buttons You can use these buttons E to scroll conclusions if there are some of them And this button Y is for filtering by diagnostic statements see Select filtered diagnostic statements window Special Indicator Field It shows the total number of examinations in the Examination List in accordance with filtration criteria currently in effect Assign examination to existing patient or enter new one Assign examination to existing patient or enter new one l x Patient Insurance company Search Filtration Help EN RH 2 a x Close Assign New patient Edit patient Delete patient Birth date dorar Black 4nna a E DEMO Emergency acquisition A DEMO Hooker Tomaz E DEMO Longman Andrew G Name DEMO Black Anna Remarks ID de ie Birth date fi 5 12 1967 i Y Unspecified i Policy number CH Insurance Company F This window is used for selecting a patient from database to reassign the examination to The window parts are ee Assign examination to chosen patient button allows to reassign the recording to appr
4. Manual Analysis menu e Conclusion command and toolbar button Ctrl W It calls Diagnostic Conclusion Wizard Automatic Analysis menu e Detect QRS positions command This is the only automatic analysis option for a rhythm analysis ECG record If you have the ECG acquired with Analyse option unchecked in the Smart Cardiograph you can get the QRS positions detected by seca CardioConcept The maximum minimum and mean heart rate together with maximum minimum and mean RR intervals are calculated automatically after that Tool menu e K Measurement command and button on the toolbar Ctrl M A Zoom command and button on the toolbar Ctrl Z Commands of this menu switch between measurement mode and zoom mode These modes control how ECG Display responds to mouse clicks ECG Callipers tool is active in measurement mode thus you can measure time intervals and amplitude differences directly on computer screen To the opposite left mouse click acts as zoom in command and right mouse click acts as zoom out command in zoom mode The point you click will be approximately in the centre of the window E Markers command and button on the toolbar Ctrl K This command turns on the user markers mode i e it turns on User Marker tool The User Marker tool is used only for rhythm analysis ECG record View menu e Scale command and toolbar combo box You can set precise zoom factor with this combo box Just select the scale from the list or
5. Patient data and Swedish Danish or Norwegian Social Security number are in conflict Check the data for errors and correct if necessary Cannot decompress ECG conclusion data Cannot decompress ECG data Examination not found These are internal DBMS errors Try to reboot If error persists call for technical service ECG analysis error messages RR interval not specified Representative complex not specified Fiducial points not specified Conclusion not specified One of these messages may appear when you are entering a new conclusion Conclusion consists of several parts and each of them should be present These parts are average RR interval representative cardiocycle fiducial points conclusion itself conclusion text Too many diagnostic statements for this mode This message may appear when you are trying to filter examinations by diagnostic statements contained in conclusions When you choose logical AND the number of statements is limited to 4 Fatal error in diagnostics This message may appear if internal error occurs while retrieving ECG information from database Restart seca CardioConcept and try again If error persists call technical support Invalid value In New Conclusion window of Standard ECG analysis you may enter RR HR QTd values manually rather than calculating them automatically Due to internal limitation of diagnostic algorithms these values must be within following limits RR gt 170 and RR lt 3000
6. To setup seca CardioConcept just place the installation CD into the drive and launch the setup exe programme that is located in X CardioPortable folder on the CD X stands for the drive letter of the CD ROM drive on your computer Follow the instructions on the screen after that The installation routine will create the local database copy the required files onto the hard disk and make necessary configuration changes The first synchronization needs to be carried out in order to start using seca CardioConcept functionality Launch seca CardioConcept and login to the database as usual Pleas note that Login Window is changed so make sure that On line radio button is checked in it it actually should by default The CardioPortable button is enabled in seca CardioConcept Control Centre now Click it with the mouse to open CardioPortable Control Window Click it as well to begin synchronization Now you will be able to watch the changing messages in the Log information area and elapsed estimated time in corresponding fields All required patients data and user accounts will be copied into the local database As soon as the first synchronization is completed you can safely switch to off line mode and unplug the laptop from the network Please consult your portable computer and network card manuals how to do it properly Programme windows and dialogues seca CardioConcept Control Centre Control Centre window MedIT Concept 5 5 Ioj xj Abo
7. e receiving ECG for interpretation analysing data and replying the requests e collecting and managing answered requests e importing received results of the consulting into seca CardioConcept database The main idea behind seca CardioConcept telemedical model is that every seca CardioConcept installation can function as both a client of remote consulting service and as a workstation for processing consulting requests Every seca CardioConcept message or ECG Envelope is an ordinary e mail message with seca CardioConcept Mail 5 5 line in the Subject field The body of the message contains the string seca CardioConcept 5 5 All information specific to electrocardiography is stored in an attachment file with cbm extension The size of the message depends on the number of ECGs in it and approximately amounts to 20 25 kilobytes per a standard ECG record The size of rhythm analysis ECG record depends on its length and can be calculated using the formula message size length of record sec X 2 5 kB The information in a message is equivalent to that stored in seca CardioConcept database Two additional text fields are included into messages The first one is called Request message and normally is filled in during preparation of the envelope for sending It can contain any supplementary clinical or organizational information The second one is called Answer message and is filled in by the consultant It may contain any comments that are not suit
8. sokolova3medit ru Examination for consultation 30 07 2004 14 41 30 Standard ECG examination Anonymous patient kW Urgent h Send immediately Request text dditional examinations 30 07 2004 14 43 34 Standard ECG examination 21 07 2004 16 01 09 Standard ECG examination E 21 07 2004 15 58 36 Standard ECG examination A 21 07 2004 15 57 05 Standard ECG examination The dialogue contains following parts Dialog Toolbar Dialogue toolbar with standard OK Y and Cancel x buttons OK button puts the created message into Outbox The entered data are checked before sealing the envelope And if there is an error an explanation will appear O Request Text Field Place here any additional information you think is valuable for ECG re reading by the consultant Time Mark The field shows the date and time of acquisition for the examination to be sent Y The List of Available Examinations It can be considered as previous relative to the examination to be sent Use the combo to choose desired examination type So you can add one or several previously recorded ECGs to the examinations to be sent for better comparison The List of Previous Examinations It is a list of examinations which are already added to the message The Arrow Buttons Use these arrows to add remove examinations to from the message The arrow buttons are enabled disabled depending on the availability of items in the left
9. A special fit scale is used to set such a scale when all twelve leads are seen simultaneously e IL gt Calibration command and button e ee Speed command and button They provide for virtual amplification and paper speed selection If you just click the button itself you change amplification or speed to its default value 1 cm mV and 50 mm sec correspondingly Please note that Calibration and Speed buttons have arrows on the right Use them to open lists with available amplification and paper speed values You can set 0 5 cm mV 1 0 cm mV and 2 0 cm mV amplification and 5 10 12 5 25 50 100 and 200 mm sec paper speed The amplification and paper speed you set with these commands are remembered by seca CardioConcept and used next time you open ECG Viewer You should remember that amplification and paper speed are virtual i e they set curve sizes relative to the paper grid Unlike a regular analogous ECG curve digitized ECG signal can be extended to any amplification and paper speed without distortion In the contrary zooming changes the visible size of the curves as well as the grid e Markers command turns on off small fiducial markers on median complexes e Parameters panel command turns on off ECG Features panel e Conclusion panel command turns on off Diagnostic Conclusion panel You can achieve the same effect by pressing I on the panels Choose Representative Complex Window You call this window if you want to select r
10. Repara L rra di Set the check boxes to specify which part of existing conclusion should be used as template for the new one You can specify measurements and conclusion measurements only or none This section acquaints you with New Rhythm Conclusion window layout and New Rhythm Conclusion window menu and toolbar New Rhythm Conclusion window layout Sew conclusion Manual analysis Automatic analysis Tool View Help e x Bs a 37 v IL OK Cancel Conclusion Measure oor Markers Calibration Speed EE lt i S E E T o SEH ECG presentation into EE O O O O O e a E o as E SE SE Calibration crm 1 30 SECH EE SE Duration sec e le Pee el ed eet len Pe er ed eee cd eed EFAS ey DE ET GE a an Ia ave The window has the following parts Menu and Toolbar Menu and Toolbar is fully described in the corresponding section ECG Display Area ECG Display area ECG Features Panel ECG Features panel Quick Navigation Panel Quick Navigation Panel shows one lead of long ECG record with virtual paper speed 10 mm sec so that lager section of the whole recording is seen Diagnostic Conclusion Panel Diagnostic Conclusion panel New Rhythm Conclusion window menu and toolbar Standard Y OK and x Cancel buttons on the toolbar OK stores the newly created conclusion into the database and Cancel discards any modifications made Both buttons close the window
11. Standard ECG examination 7 Number of examinations 10 Examination remarks Date 2 RR 21 07 2004 22 37 40 sel al 0 Hooker Tomas o d Y E saminator Med Concept Conclusion ae y Date time Conclusion buy MedIT Concept Window parts are Patient Sinus rhythm Normal ECG 21 07 20 22 38 40 Window Menu and Toolbar Window menu Refresh command and toolbar button Forces newly made examination records to appear in examination list This button is only needed in the network configuration as in the standalone configuration all the data in the list is refreshed automatically a Close command and toolbar button It closes the window and makes you return back to Control Centre Examination menu i Open command and corresponding button on the toolbar Use it to open the examination that is currently selected in the Examination List If Examination List has the focus i e one of the lines is highlighted in blue you can open it also by pressing ENTER or clicking this line twice A Delete examination button and corresponding command lt deletes the examination currently selected in the Examination List 5 Assign examination to patient button and corresponding command It evokes Assign examination to existing patient or enter new one where you can reassign the recording belonged to the Emergency Acquisition patient to appropriate patient Add remark command Use it to open Add
12. displayed on the corresponding ECG Features and Diagnostic Conclusion panels Compare ECG window layout Compare ECG window menu and toolbar Compare Rhythm window layout Compare ECGs Lead Tool View e Dr a O E View Measure 00m SS DK Calibration Speed Ml a 02 08 2004 14 19 29 Patient into Dex Male qe 4 ECG presentation info Speed rim sec 50 Calibration temm 1 Duration sec 02 08 2004 14 79 29 D HR max bpm HR min pm Conclusion RR min ms RR ms Date time 02 08 2004 Jl Conclusion bw CardioConcept O Menu and Toolbar Menu and Toolbar is explained in detail in the corresponding section ECG Labels Panel The sunken label indicates the currently selected ECG ECG Display Area ECG Display area shows selected lead of compared ECGs ECG Features Panel In addition to a standard ECG Features panel it contains a combo box with the list of ECGs being compared and shows features of the ECG selected in this combo Diagnostic Conclusion Panel Diagnostic Conclusion panel shows the diagnostic conclusion of the currently selected ECG Compare Rhythm window menu and toolbar Y Standard OK button closes the window and returns to ECG Viewer Lead menu I SE Current lead button and the corresponding command It is used to set the compared lead Tool menu Measurement command and button on the toolbar Ctrl M e
13. e E Answer command Ctrl A and toolbar button It opens ECG examination window with all the recordings of the current message in order to make ECG diagnostics i e to create an answer You can analyse ECG in the same way as if they are stored in seca CardioConcept database e Envelope command Ctrl E and toolbar button It opens Envelope dialogue for the currently selected message Tu e BR Open command Ctrl 0 and toolbar button opens the ECGs in the current message in the ECG examination window without generating an answer message You can reach the same effect double clicking the string with the message in the message list Delete command Ctrl 0 You can delete a message in most cases But you cannot delete the request sent to consulting if you haven t received the answer to it e Save into database command Ctrl Alt l and toolbar button allow to store a message into seca CardioConcept database Tools menu e Export command Clicking the arrow which is to the right of the menu you can open the format list where you are able to export ECG In this version of seca CardioConcept export is possible only in the specific format as file CBM Using this command you can save the mail message as a file at the hard disk or diskette In launching Export message as dialogue opens if you want to export a message which contains both a request and an answer but if you are exporting a message that contains only a request this command wil
14. examination type is already chosen and cannot be changed Recording length should be set for rhythm analysis record if you want a recording longer or shorter than the default 30 seconds Please use spin button arrows 170 1 to change the duration in ten second increments As soon as a patient is selected gt Play button gets available and you can press it in order to enter ECG monitoring mode The ECG leads should be properly mounted by that moment otherwise you will get a wild screen instead of ECG curves Just press the Pause button in this case actually in any case something is wrong and there is a need to fix leads and patient s cable Due to digital filtering a signal appears on the screen about 1 5 second later than it has actually been acquired from the electrodes In order to obtain a good quality recording ensure that the ECG signal is OK and no excessive noise and or artifacts are present Pause the acquisition and check the leads and patient cable if you are not satisfied with the signal The 10 second span of the ECG curves that is visible on the screen is to be acquired from the seca CardioConcept hardware if you press Record button and standard ECG record is selected as examination type The Y Record button becomes enabled after the 10 second time span passes and the required length of ECG signal is stored in the temporary buffer If you are acquiring a rhythm analysis record the Record button is enabled a
15. portrait Complexes landscape Complexes portrait Full disclosure with marks landscap al Full disclosure with marks portrait Full disclosure landscape Full disclosure portrait Name Complexes with marks landscape Examination ype Standard ECG examination Deke SO O Menu and Toolbar Printing Protocols Editor Menu and Toolbar List of Available Protocol Templates The list contains all protocol templates for the language selected in the Options dialogue Different templates can be available for different languages There is a search string When you start typing seca CardioConcept tries to locate the name of the template which starts with the letters you type and moves selection bar on the corresponding line O aries Attributes of the currently selected template e Name of the template e Examination type to which it is applied e Whether this is a default template or not The default template will be used for quick printing using toolbar Print button or printing from Smart Cardiograph e Any remarks concerning the protocol template Printing Protocols Editor menu and toolbar Window menu e Refresh command and toolbar button Forces newly entered protocols to appear in protocol list This button is needed only in the network configuration after creating a new protocol template as in the standalone configuration all the data is refreshed automatically E Close command and toolbar button Pressing ESC key ha
16. 64 65 66 67 68 70 71 72 73 78 79 80 Control Center Wmdow asasasanenenenennnonenenennnennnrrrnnnn 5 database examination data 13 pat nt data siii id 7 9 12 database integrity KENNEN 80 Diagnostic Conclusion Wizard 42 54 78 diagnostic Statement 84 85 86 ECG EXAMINATION WINGOW cccececceceseececeeeeceeeeceeneeenens 21 Cc A tT eRe ee 22 81 ECG COMPA inicia 32 Viet 33 menu and Ioolbar conan 33 ECG EIERE ri lo bara 15 ECG Features Table 75 ECGNewCGoncuson 39 78 Add Diagnostic Gtatement 43 Diagnostic Conclusion Wand 42 Viet 39 men and re e e TEE 40 Select Representative Cardiocycle 41 ECG VI We Ratas 27 29 calle pene eee ete cir te O eee eee ee tors 29 Diagnostic Conclusion pDanel 28 ECG Display area wasnt i cee ities 28 ECG Features panel 28 layout cassia ass 30 menurand toolbar dei ek eae are eet ee 31 Edit Patient Information WWmdow eeeeeeseeenennnn 9 Edit User Account Wmdow ese eee nee eee 64 Enter Average Values Dialogs nonnnnennnennenerenennn 78 Enter New Patient Information Window 9 Envelope Dial iii 98 error Messages sona 90 91 92 examination re e BEE 13 18 Examination Browser Window aeseseseseseenenereennennn 13 Tdci Si adn 74 75 MIMO a a dad 18 By Diagnostic Statements oocccoconccncccccnnccnoconnnnnno 21 By Examination Date aannnennneeneenenennenrneenee enne 20
17. Administration Administering user accounts This module is used to manage user accounts A user account is a special record in the database that contains user information and access rights It is referenced when ECG or conclusion is saved in the database to let you know who recorded an ECG or made a conclusion It is also used by seca CardioConcept to prevent unauthorized access to data or data modification User Administration main window User Administration menu and toolbar Edit User Account window Add New User and Edit User Information windows Administering user accounts User Administration layout MedIT Concept 5 5 Standalone user administ 5 mn Window User Help 8 Close Refresh a E New Edit Delete Look for _ User name D Med Concept cardiob a Sokolova Tatiana sokal Name Med Concept Remarks tel 47 23 37 84 00 Position fax 47 23 37 84 10 Speciality cardiology Address HediT AS Nydalsveren 33 0484 Oslo NORWAY Login name cardio gt Jh User can edit patient information IY User can delete examinations Jh User can delete patients Jh User can analyze examinations e User can assign patients to examinations e User has administrative rights W Account enabled O Menu and Toolbar Menu and Toolbar of User Administration p List of All Registered Users List of all registered users sorted by user name When you st
18. Analysis Workbench seca CardioConcept Rhythm Analysis Workbench consists of several window types that are used for viewing long ECG recordings comparing newly acquired ECGs with previous ones and creating new diagnostic conclusions This type of ECG record a rhythm analysis ECG record and these types of windows are particularly suitable for interpreting rhythm disturbances The Rhythm Viewer is a window of examination window type and contains Examination Toolbar to change the examination type to be viewed This is the main window of Rhythm Analysis Workbench through which you can access all the examinations of the patient currently selected i e the current patient Other types of windows you can see while processing ECG examinations are Compare ECGs rhythm analysis window and New Conclusion rhythm analysis window It is clear that there is no sense changing the patient or examination type while comparing ECGs or analysing a specific recording Thus these windows do not contain Examination Toolbar and do not have Examination menu and Close button El in the toolbar There are standard Y OK and x Cancel buttons on the toolbar of New Conclusion window instead The toolbar of Compare ECGs window has Y OK button only Common features of Rhythm Analysis Workbench windows ECG Display area Diagnostic Conclusion panel ECG Features panel Quick Navigation panel ECG Callipers tool QRS Marker tool and User Marker tool Specific windows of Rhythm Analys
19. By Examination Type 19 By elle EE ZU By Examined Patent 20 By Insurance Company s snesennsssnreesenreesnrnsennenn 19 By Patient Birth Date ccooncccconcnccocccnccnccnnonnnnnnos 20 BY PPS ND usted tddi inicia 18 By Patient RaCO EN 18 BY Faten EEN 18 BY Policy NUM e isa a 18 BY SIG UU und id 20 free text Conchusion 84 85 Hardware TAO tata tact oi eet aie 12 IR HE de EE 3 insurance company MANON BEE 12 LN EE 12 CO Mis 5 6 LOGIN PAVING iaa a cla 6 LOGIT telele UE 6 Mail Client VAY OU EE 96 menu and toolbar aasenonoseesnnnnnnnernrennnnonnrnenennnene 57 mall CONAGUA MON cepas 80 86 Malta sist iio prosa ocn 12 median Complexves 28 New Protocol WWmdow 66 OPUS EES 70 71 72 73 79 80 BASS WONG EE 6 patient 10 14 y 10 BE 9 o EE 7 18 NEWINTO Mal sica 9 o A tabaci ners sana 7 18 Patient Browser VWmdow T Presentation taD ea li 71 A A lssuateaieriuidetevag ia a 14 PUNUNG EE 74 82 Printing Protocol Editor LAY OU dida os 65 menu and toolbar aasesnnnoneennnenenennrnnnnnenrrnrnenerene 65 Protocol Layout Editor Osa oia 67 menu and toolbar urinaria 67 protocol layout elements 68 Protocol Preview WWmdow 70 protocol templates 64 65 66 67 68 70 79 ORS Marker TOO sia ol iaa A5 representative CardioCyCle oooccconncccocnccnccncnnoo 41 83 rhythm EE 22 81 Rhythm Compare eunapcaid 49 Vie EE 50 menu and toolbar ui 50 Rhythm ECG examination WINdOW cecce
20. Fill in three fields specifically user name organization and e mail address that identify you as a participant of electronic communication The name and organization will appear in the From field of the message The address you enter will be used for replying by the other communication parties Server information group This section allows you to set addresses of SMTP and POP3 servers that are used for sending and receiving e mail Contact your Internet Service Provider for information how to configure that Incoming Mail Server group It contains account name and password that is used to connect to the Internet mail servers Server timeout field sets the time period in seconds during which the programme will try to connect to e mail server before reporting a connection error see the section Understanding electronic mail basics if you are not familiar with the e mail configuration Screen Adjustment dialogue This window allows you to tune the scale of ECG presentation so that signal amplitude and duration on computer screen are the same size as on standard ECG paper The window contains vertical and horizontal scales with the resize buttons Q You should change the size of the scales so that the distance between graduations is exactly one centimetre Just put a ruler a transparent ECG ruler will suit the best to the computer screen next to the vertical grid first and adjust grid size with resize buttons you can also click somewhere on the scale and
21. Only users with edit patient rights can add patients and edit patients personal data All other users are only able to view patients information e The right to delete patients Assign this right very carefully as if a patient record is deleted from database this action cannot be undone and all examination data ECGs etc of a specified patient will be removed from database e The right to assign patients to examinations Only users with these rights can reassign recordings to appropriate patients e The right to delete examinations Only users with such rights can delete examinations e The right to analyse examinations Obviously not everybody should have such a right e Whether user s account is enabled or not It may be a problem for database management system the detailed description can be found in section Managing database if you just delete a user account of for example a person on leave or a retired person So just disable an account in order to prevent using it by mistake Screen adjustment Various computer monitors have different pixel size at various screen resolutions This makes visible amplitude and duration of signal curves unpredictable We recommend screen resolution 1024X768 or more if your computer video system allows it In this case ECG curves are displayed as close to print quality as it is possible with computer displays But you have to calibrate seca CardioConcept in order to make the size of screen ECG image corre
22. Protocol layout elements for details concerning layout elements and their properties Protocol Layout Area A layout of currently selected page of a protocol template is shown here You can see the size and location of the layout elements Name of the element is written inside its bounding rectangle It does not fit the size of the rectangle in many cases so the full name of the element is shown in the status bar and in the tool tip that appears when you place the mouse cursor over the element See the section Customizing printed reports for more detailed information 4 Status Bar with Main Object Info Protocol Editor menu and toolbar Protocol menu e Save command and toolbar button Ctrl S It saves newly created protocol or modifications made to an existing one e Save As command It allows you to save a copy of the opened protocol template under a different name Before you save the new template Save protocol as dialogue appears After the copy of template is saved it is automatically loaded into the editor Thus you start to edit the new copy instead of the original template e Save to file command It allows to save protocol template to file in internal format Can be imported afterwards into another seca CardioConcept database E Preview command and toolbar button It calls Preview window Margins command Use it to set page margins It invokes Set margins dialogue E Close command and toolbar button It closes the wi
23. QRS position command in View menu User Marker Tool The ability to set series of marks on specific ECG components is very useful in arrhythmia detection If you turn on the User Marker tool with Markers command in Tool menu and ber button you will be able to set time marks anywhere on the ECG curves by clicking the left mouse button The time intervals between every mark pair are displayed in milliseconds automatically If you do not need a mark any more just remove it with right mouse click Rhythm Viewer Viewing Rhythm You will open this window from examination browser patient browser or smart cardiograph applications for examining a rhythm analysis ECG record Normally it appears as working area of an examination window Rhythm ECG Viewer Rhythm Viewer general layout Rhythm Viewer Menu and Toolbar Common features of ECG Analysis Workbench windows ECG Display area Quick Navigation panel Diagnostic Conclusion panel ECG Features panel ECG Callipers tool QRS Marker tool and User Marker tool Rhythm Viewer general layout 15 x Patient DEMO Hooker Tomas Examination ECG Conclusion Tool View Help o Je te a t Us Print Record Compare Conclusion easure oom Markers Calibration Speed EE in ii in EE E E HEP miii SE paca EE SC EEPE E E HE SA E o 30 07 2004 15 1 3 05 NEI mm T PoE o i Patientinto 1 S S SES le ECG presentation into E ee he ee SE SE EE Speed mm sec
24. Specify filtered period dialogue is used to enter dates when you want to filter patients with specific birth dates or select examinations made in certain period There are two edit boxes one for the oldest date and one for the newest one i e for starting and ending dates in the desired time span Only a valid date in correct format will be accepted by the dialogue according to a date mask At least one date must be entered either patients born after this date or examinations done later than this date are selected in this case If two dates are entered then the oldest date must go before the newest one Dialog has two buttons on the toolbar Y OK button starts filtration x Cancel button closes the window without any filtration Patient Group Selection dialogue This dialogue named Select patients allows to specify a group of patients in order to show examinations of selected patients only The patient list is sorted by name While you are entering the first letters of the surname seca CardioConcept tries to locate the patient whose name starts with the letters you type and moves selection indicator on the corresponding line One or several patients can be selected from the list using standard Windows technique shift arrow keys ctrl mouse click A thick dot or a cursor appears to the left of the selected patient Pl or If no patients are marked as selected the current one blue bar is considered as selected Toolb
25. User can start working with seca CardioConcept if they are correct otherwise an error message will appear x Cancel button Logging is cancelled user cannot work with the programme If user cancels logging or enters incorrect login name or password he will be returned to seca CardioConcept Control Centre Logging will be repeated again when the user tries to start any seca CardioConcept module as unauthorized users cannot work with the programme Change Password Window Charm parsen E FREE This window allows a seca CardioConcept user without administrative rights to change his her password for database connection It contains two fields one for entering new password and another for confirming it The password does not appear in the fields the symbol will replace all the password letters instead If the passwords in both fields are not exactly the same a special warning message will appear on the screen and the password will not be changed This protects the user from accidentally entering the password different from what he she intended to The window toolbar has two buttons in it Y OK button If you click it the new password will be saved if correctly confirmed x Cancel button It closes the window without changing password Patient Browser Patient Browser Main Window MedIT Concept 5 5 Browse patients Window Patient Insurance company Search Filtration Help E fH 2 E RN Close Refresh Open New Edt
26. and vice versa No filtration command Ctrl F It turns off all filters You can see all examinations in the Examination List stored in database and record indicator number renews gt Examination List This is a list of all examinations sorted by date in descending order If no filtration criteria are set all examinations are shown otherwise only those are displayed that match filtration criteria Each line in the list contains examination type date time and full name of the patient Selected examination can be opened by clicking Open Current Examination button E on the toolbar or by double clicking the chosen examination in the list or by pressing Enter button Data fields Data fields for the currently selected examination e Type of the examination Date and time when examination was made Patient s full name Full name of the medical professional who made the examination Examination remarks a free text field for any additional examination information Diagnostic conclusion More than one conclusion for examination may be available in some cases for example if automatic conclusion made by seca CardioConcept it can be re read by a human expert The last conclusion is shown by default It is possible to scroll through conclusions using buttons located to the left from the conclusion box e Date and time when the current conclusion was made e Full name of the physician who made the current conclusion Filtration buttons
27. any other type of unique identifier Birth date In Options dialogue the preferable date format can be selected Patient s sex Patient s race Patient s address Patient s medical insurance number e The name of insurance company covering the patient s health care expenditures e Remarks a free text field for any additional patient information you may need to save in the database You cannot modify the information directly in the patient browser window Instead you should open Edit Patient Information window for it Patient s List This is a list of all patients sorted by full name or a subset of patients matching filtration criteria if any filtration criteria are set There is a special field specified the number of patients which are in the list now One of the lines is highlighted in blue it contains a name of so called current patient When the user starts to type on the keyboard current selection moves to the patient whose starting name letters match the entered characters If you want to lessen the list of records among which you are looking for the appropriate one use Filtration menu commands or filtration buttons Search and filtering buttons are next to the corresponding data fields The following searching capabilities are available e By patient s ID e By patient s policy number The following filtration capabilities are available e By patients birth dates e By patients sex e By patients race e By insura
28. by using Representative complex command Manual analysis menu or the corresponding toolbar button Mi of New Conclusion window In this window choose P QRST complex recorded with best possible quality and then define its right and left boundaries with mouse clicks In interpreting the non analysed ECG it is possible to create a median cardiocycle automatically by using Representative complex command Automatic analysis menu The representative complex is selected Now seca CardioConcept can calculate average RR interval duration and heart rate Since that time the SS Automatic Fiducials and e Fiducial points buttons become available Then you can get fiducials to be found automatically by pressing SS Automatic Fiducials button Fiducial points command of Automatic analysis menu and correct them later if necessary Alternatively you need to define fiducials of your own in Set Fiducials window with ia Fiducial points command Manual analysis menu Set Fiducials window displays very enlarged representative cardiocycle with all twelve leads stacked one on another This specific display allows observing fiducial position in each lead simultaneously You should define P onset P offset QRS onset J point and T offset locations by mouse clicks on the corresponding points of one of the curves Drag the fiducial lines with the mouse to correct their position Ensure that fiducials are correctly placed for all leads It means that global J point J f
29. contains all leads Compare ECGs a x Tool view T wooo p A k 1 Oo m k u r OK Calibration Speed View Measure oom 21 07 2004 16 03 54 M lt j P Main Measurements Patient into GK ge ECG presentation info Speed mm sec DU l Calibration emie 1 Low pass Hz Heart rate HR bpm Conclusion D abe tire Conclusion buy limb leads Compare ECGs 3 E X Tool view Y ui K OQ feo iji As a Als Y T 2 r OF Calibration Speed View Measure oom 21 07 2004 16 03 54 ho Main Measurements Patient into See qe ECG presentation info speed mm sec DU D Calibration emie 1 Filters Notch Hz Low pass Hz Conclusion D abe tire Conclusion buy and chest lead modes El D S Tool view sox ET er View Wee PEA Speed 21 07 2004 16 03 54 Sz j 7 200 dek Or Main Measurements Patient into GK ge ECG presentation info Speed mm sec DU D Calibration emie 1 Conclusion D abe tire Conclusion by These modes allow to compare alongside any ECGs from the list of combo box You can compare all leads limb leads only or chest leads only The leads of the compared ECGs are shown in the corresponding fields of the two panel comparison window You can change the displayed ECGs with combo boxes which contain a list
30. correspondingly Set the radio button to specify what part of the message you want to save a request only an answer only or both a request and an answer CardioPortable Module New Login Window Ma iF Foch Te DH ee D CES Lee It is probably the first thing you note after installing CardioPortable It has Working mode radio button group for operating mode selection in addition to the Login and Password fields Two radio buttons correspond to ON line and OFF line mode respectively Please note that a login error can occur in two cases now First you can mistype you login name or password Second if network is not available and you trying to start the programme in on line mode it is impossible to connect to the master database see the section Error messages and troubleshooting CardioPortable Control Window ee OO This window contains the following controls Close menu El Standard Close button and Close command with obvious function Connect menu e The buttons and corresponding commands for switching between on line and off line modes Normally only one of the buttons is enabled e g the Switch On line button in off line mode and vice versa e Both buttons are active if seca CardioConcept application is not connected to any database e g if user entered a wrong password The programme is in kind of undefined mode in this case and may select any of them e a Synchronize button on the toolbar a
31. drag mouse cursor the size of the scale will change Repeat the procedure for the horizontal grid Now the size of ECG on the screen of your computer is exactly the same as you get accustomed to with your traditional ECG machine Screen adjustment i x vw X OF Cancel Make the size of the scales equal 10 cm using Up down and lett right Buttons See Screen adjustment section for details Miscellaneous windows and dialogues Print Dialogue This dialogue appears if you decide to make a hardcopy of the current ECG using Print command of the menu You can specify a printer change its settings and choose protocol template for ECG printout Cheoen porter are pointing Pedro e Xx Default system printer and default protocol template are chosen when this dialogue is open Pressing ENTER or clicking OK button prints the currently selected ECG with the conclusion seen on the screen There is Setup button next to the combo box with printers available in the system This button calls standard Windows Printer Setup dialogue Use the combo and Setup button to change the printer and its settings before obtaining ECG hardcopy Two buttons can be found in the toolbar OK button starts printing with selected settings e ZZ Cancel button abandon printing closes the window Add remark to examination This window appears both in Smart Cardiograph window as soon as ECG signal is acquired if Add remark check box is checked on t
32. hn EE hi rra Set the check boxes to specify which part of existing conclusion should be used as template for the new one You can specify measurements and conclusion measurements only or none New Conclusion window layout New Conclusion window menu and toolbar Choose Representative Complex window Diagnostic Conclusion Wizard Add Diagnostic Statement to your conclusion window New Conclusion window layout Mew conclusion Manual analysis Automatic analysis Tool View Help Y Xx alle a Ly 52 y l kb OF Cancel Features Recording Complexes Measure oom Calibration Speed ALIAS t TRR a ert RR 4 nn Se E a E re eee me Re ied CO AS De Wee E i ae Pte he Ab Main Measurements Patient inf AS N otch Hz DU 60 Low pass Hz 100 monlanninns fe TH F HCH E d El The window has the following parts Menu and Toolbar Menu and Toolbar is fully described in the corresponding section A ECG Display area ECG Display area ECG Features panel ECG Features panel Diagnostic Conclusion panel Diagnostic Conclusion panel New Conclusion window menu and toolbar Standard Y OK and x Cancel buttons on the toolbar OK stores the newly created conclusion into the database and Cancel discards any modifications made Both buttons close the window The internals of seca CardioConcept ECG analysis are organized in such a way that in order for a new conclusion to be saved an average
33. in the database only one user with specific login name The password was not correctly confirmed This message may appear when you are trying to add new user or changing your password To avoid typing errors you have to enter new password and confirm it Retype your password and confirm it again This user is referenced in database and cannot be deleted There are references to this user in the database and thus you cannot delete it User cannot delete himself This message may appear when you try to delete your own user record in User Administration window Ask another seca CardioConcept user with administrative rights to do this User seca CardioConcept cannot be deleted There is a predefined user account seca CardioConcept which is used internally to sign conclusions made by the programme This account cannot be edited except for password or deleted User with the same full name already exists This message may appear when you enter new user account You can have in the database only one user with specific full name User s last name and login must be set This message may appear when you are editing user information For each user the following information should be specified surname login name Cannot create unique ID for new record Something obscure and evil happened in seca CardioConcept database internals Call for clerical support Invalid ID number Inconsistency between ID and birth date Inconsistency between ID and sex
34. messages may appear when you are editing patient information For each patient the following information should be specified surname birth date and sex This insurance company is referenced in database and cannot be deleted There are references to this insurance company in the database and thus you cannot delete it Wrong date seca CardioConcept checks the validness of dates you enter This message appears when you try to enter an invalid date Message transfer related topics You must specify some recipient for the message This message appears if you try to place a message into Outbox without specifying recipient address seca CardioConceptPortable operation error messages Information messages Clear log file The programme asks the user to confirm log file deletion Purge all synchronized data This message appears after successful synchronization if Autodelete synchronized data option is off Yes No buttons allow you to select one of the alternatives Error messages Couldn t login to database This message appears if wrong login password is entered or network access to the master database is broken Cancelled by user This message appears after synchronization was cancelled by user command Couldn t create log file This message appears when seca CardioConcept fails to open lastsync log file The problem may occur if the disk is full or due to incorrectly set permissions in Windows NT Windows 2000 based systems Messages
35. mode while the main layout area is greyed and you cannot edit it See the section Customizing printed reports for more detailed information Protocol layout elements You can customize the feel and look of printed report template placing layout elements on the page Three types of layout elements exist These are e Text blocks These are rectangles containing an arbitrary text e Database fields They contain values from seca CardioConcept database fields e g PQ R duration or patient s name e ECG element lt can be an ECG lead block a median complexes block or a standard ECG record block a rhythm analysis ECG record block Each layout element has certain properties that determine its appearance and content Use Object property area to set or change the object properties Object property area shows the properties specific for the selected layout element and the set of displayed properties changes in accordance with the layout element selection The properties of different object types are described below A text block has the following properties e Font used for displaying the label text Font size used for displaying the label text Charset property specifies character set that is used for label text Font style property sets plain bold or italic font style Top and Left properties determine distance of the element left top corner from the page left top corner in mm Height and Width that determine the size of the element in mm e Text
36. order to manage user accounts On the other hand if somebody logs in using an account without administrative rights Change password text appears on the User Administration button because this is the only thing an ordinary user can perform on his her account A special Change Password dialogue appears in this case O Window status bar It shows the name of a person who currently uses seca CardioConcept CardioPortable and Mail client buttons can be inaccessible in this case the button is greyed It happens when the corresponding modules are not installed with your seca CardioConcept programme These modules are optional and should be licensed separately If you obtain such a licence then CardioPortable and Mail client modules will be activated and the corresponding buttons will be full coloured Logging Window x UK Cancel Login Password This window is used for logging in The user should specify his her login name and password in order to start working with the program To log for the very first time user account seca CardioConcept is used By default login name and password for this account are cardio5 Don t use this login for everyday work accounts for all users should be created instead A user with administrative rights should change password for this account or disable this account to prevent unauthorized access to the database Toolbar of this window has two buttons Y OK button Login and password are verified
37. pressing OK to save fiducials position and continue the ECG analysis If you want to resume the process press Cancel Now when the fiducial points are set main ECG features PR Q interval QRS duration QT Qty QTd QTdc P QRS and T axis will be calculated by the software and displayed in ECG Features Panel If you are not satisfied with calculated QTd QTdc you can manually correct it Other features cannot be changed as they depend on fiducial points position You have to change the fiducials to A athe correct these values The Automatic Conclusion and Manual Conclusion buttons are enabled as l E Now you can press Automatic Conclusion button or use Conclusion command of Automatic analysis menu to have seca CardioConcept generate new automatic conclusion in accordance with the fiducials you have just set If you want to add a couple of standard diagnostic statements to the conclusion just press E Add Diagnostic Statement button in order to evoke Add Diagnostic Statement to your conclusion window Alternatively you can create the conclusion from scratch Call the Conclusion Wizard with Manual Conclusion command Manual analysis menu or the corresponding button If you do not agree with some of the statements just remove them First of all remove the last statement that qualifies the ECG as normal borderline normal etc This statement is automatically generated by software because it is a requirement of the Common Standard
38. remark to examination window where you can write any comments on recordings Import command Allows user to import examinations stored as a file for example recorded in some other seca CardioConcept database There are two possible import export formats a cbe file examination in format produced by ActiveX ECGRecorderForm component This component is supposed to be used by third party companies in their own applications b com file seca CardioConcept mail format Conclusion menu It contains Previous and Next commands These commands allow you to browse through diagnostic conclusions saved together with current examination Scroll Conclusion buttons Ji serve the same purpose Filtration menu It contains commands related to various data filtration capabilities You can see selected examinations in the Examination List and the indicator field specifies the number of the actually selected examinations The following filtration modes are available through the corresponding commands By Type command It calls Select Filtered Examination Types dialogue to allow filtering examinations of certain types The corresponding Y button is located to the right from the box with examination type By Date time command Ctrl D It allows specifying a range of dates times to filter only examinations made during this period The corresponding Y button is located to the right from the box with the date and time the examination was made This filter is sa
39. same selection group After a group of elements is selected you can modify them simultaneously Le change properties move them around and place the whole group into clipboard There are two working modes for Protocol Layout area The first is the standard mode You can edit all elements on each page of protocol template The second one is header footer mode in which the main layout area is greyed and you cannot edit it To the opposite the header and footer common for all template pages are active and available for editing see the picture seca CardioConcept 5 5 is an obligatory label in the top right corner of each page See the section Protocol Editor menu and toolbar for more details about actions and commands available for editing protocol templates Configuring Internet Mail access In order to use seca CardioConcept for telemedical networking it is necessary to configure Internet access options Use Mail tab of Options dialogue for setting the dial up networking personal information that will identify you in the network and server information for connecting to Internet Mail servers of your Internet Service Provider Contact your Internet Service Provider in case any problems occurs Managing seca CardioConcept database Patient Database Management When a user a nurse for instance is going to acquire an ECG the programme asks her to choose a patient from the database A specific patient must be selected a new one can be created alte
40. that all data you have entered in Edit Patient Information window will be lost Overwrite patient information button If you click it the programme will replace the data of the currently selected patient in the Similar Patient List with newly entered data In this case patient information of the patient selected in the Similar Patient List will be lost and information from Edit Patient Information window will be written instead Patient exist window closes and you return to Patient browser window The patient picked out in Similar Patient List becomes the current patient R El Create New patient button This button forces the programme to create a new record in the database and fill it in with the data you have entered disregarding any existing discrepancies The window closes and you return to Patient Browser window The new patient becomes selected Cancel button closes the Patient Exists window without any modifications and returns to Edit Patient Information window Data Fields Data fields of a newly created patient record The specific fields that are in collision with information stored in the database are highlighted in red Data Fields Data fields of the patient currently selected in Similar Patient List Similar Patient List All patients whose personal data are in conflict with the newly entered data are listed here It can be a single patient or several patients depending on the data collision See section Patient Dat
41. the corresponding information The toolbar contains two buttons Wi OK button saves all changes or newly entered data Cancel button closes the window and discards all changes Printing Protocols Editor Editing protocol templates This module is used for managing templates for printing examination protocols In order to make hard copies of examination protocols you will need at least one protocol template for each examination type and each interface language At the same time it is possible to have several templates for examination of a certain type and seca CardioConcept comes with a set of protocol templates specifically tailored for various purposes With Printing Protocol Editor you can create new templates and modify existing ones if you wish For each examination type one of the templates is set as default template This default template will be used for quick printing using toolbar Print button or automatic printing from Smart Cardiograph Printing Protocols Editor Printing Protocols Editor menu and toolbar New Printing Protocol window Protocol Editor window Protocol Editor menu and toolbar Protocol Layout elements Preview window Save Protocol as Set Margins Dialogue Printing Protocols Editor layout MedIT Concept 5 5 Printing protocols editor Window Protocol Tools Help 8 El Close Refresh New E dit Delete Look for Complexes with marks landscape Complexes with marks
42. the width of median complexes part cannot exceed one third of ECG Display Area total width Use scroll bars to change the visible part of ECG record The drawing of ECG can be rather lengthy so nothing is changed on the screen while you drag the box on the scroll bar The visible part of the ECG will change as soon as you release the left mouse button Diagnostic Conclusion panel This panel allows browsing through all diagnostic conclusions attached to a specific ECG recording There is a special button l in the top left corner of the panel that can be used to switch the panel on off in order to enlarge ECG display area Normally there is at least one conclusion made automatically by seca CardioConcept If some re reading by one or more human experts occurred additional conclusions would be stored in the database The last one is shown by default Both the name of the expert who made the conclusion and the date time when it was created are displayed in the corresponding fields Two scroll conclusion buttons provide for browsing through available diagnostic conclusions Diagnostic Conclusion panel of New Conclusion window has an additional button This is Quick Statement button E This button evokes Add Diagnostic Statement to your conclusion window ECG Features panel This panel appears in all windows of ECG Analysis Workbench and contains most important patient information ECG acquisition parameters and main ECG features There is a specia
43. to add additional qualifier as rule out or probably old to the inserted statement Y Statement Organizing Buttons Using these buttons below preview panel you can change the order in which the statements follow each other in the conclusion Free Text Conclusion Area If standard statements are not sufficient to express your diagnostic opinion you can add arbitrary text conclusion into this edit box The free text part of the conclusion is added after the standard statement part Add Diagnostic Statement Window All dieta atera We rar peek This window is opened after you click Add Diagnostic Statement button of the Diagnostic Conclusion panel of New Conclusion window This window allows you to pick up a specific standard diagnostic statement and quickly add it into your diagnostic conclusion The window consists of toolbar and diagnostic statement tree area If you select a new statement in the tree view Set Statement Modifiers dialogues will appear before the new statement will be actually added to the conclusion After the statements is added you return to New Conclusion window Use Add new statement to your conclusion window just to add one or two statements If the order of the statements is incorrect you can change it in Diagnostic Conclusion Wizard There are two buttons in the window toolbar Cancel button It closes the window without adding any statement to the diagnostic conclusion e Collapse all button Use it
44. two types of mail client applications First one is a general purpose mailer application that is capable of sending and receiving any types of e mail messages for general purpose communication seca CardioConcept Mail client is an example of specialized mail client that relies on Internet protocols for message transfer only The specific information is stored in proprietary format and can be utilized by seca CardioConcept only You can use either dial up networking or local area network LAN in order to reach your ISP Dial up networking allows you to connect through standard telephone lines and a modem while LAN access is configured by a network administrator to be shared all over the local network Both dial up connection through telephone lines or local network gateways can be used for access to the Internet remote networking These parts are integrated into the operating system of your computer As seca CardioConcept can be run on 32 bit Windows operating systems only it uses Windows RAS Remote Access Services for Internet connection Please see Windows manual or ask your system administrator for details how to configure Windows RAS Understanding seca CardioConcept telemedical model As it was mentioned above seca CardioConcept uses Internet Mail for transport purposes Being configured as mail client every computer with seca CardioConcept forms a node of telemedical network capable of e sending ECG recordings for rereading or second opinion
45. 0 msec before QRS onset if no P wave is present The same way click to set the right boundary a few milliseconds after the end of T wave Two vertical lines appear Drag them with the mouse to correct their positions if required Make sure the left line is situated before the P wave and that the right line is after the T wave end in all lead Press OK button to return to New Conclusion Window Now the representative cardiocycle is set The RR interval and average HR are calculated automatically at this point You can measure RR with Callipers Tool and enter right figures manually by double clicking on the corresponding field on ECG Features Panel if you are not satisfied with automatically calculated value In order to renew automatically calculated HR you should reenter Choose Representative complex window and quit it by pressing OK button Press Set Fiducial Points button is activated by now or use Fiducial points command Manual analysis menu in order to open the Set Fiducial Points window If you click on the window with the left mouse button a vertical line marked Pon appears The second click creates the line marked Poff the third Qon then J and at last Toff line is created These points correspond to P wave offset QRS onset J point and T wave offset You can move lines by dragging them with the mouse If you want to change the mark of the line i e the fiducial it represents you can click on the text label with the fiducial nam
46. 1 07 2004 15 57 37 Conclusion by CardioConcept In overlay mode each ECG is displayed in a colour of its own The labels on the leftward panel are shown in the same colours so that it is possible to specify which ECG each lead belongs to This mode allows identifying the most delicate changes in ST T part on several electrocardiograms Compare ECGs Ei Tool View UK View Measure oom AS A Zi IS ZT cyclin sty Calibration Zeep II III aVR al avr Vi V2 v3 pe KEE EE A ESE EES 21 07 2004 22 37 40 ae Age 40 D D D D D D D D D Mam Measurement 21 07 2004 SE SE Ee dE Sette agree ree ae E 16 03 34 JUN PEA AAA AA A Oo ECG presentation info Speed mm sec DU D Calibration emie 1 Filters Notch Hz Low pass Hz Conclusion Med Concept suggested conclusion Sinus rhythm Normal ECG Datetime 21 07 2004 22 38 40 Conclusion by CardioConcept New Conclusion window Creating new conclusion If you are not satisfied with diagnostic conclusion that seca CardioConceptgenerated for an ECG recording you can create a new one in ECG analysis window It looks very much similar to ECG Viewer but both window toolbar and behaviour are different and specifically tailored for diagnostic interpretation of ECG recordings Before New Conclusion window appears you will see Use In New Conclusion dialogue heras ra cr
47. A Zoom command and button on the toolbar Ctrl Z Commands of this menu switch between measurement mode and zoom mode These modes control how ECG Display responds to mouse clicks ECG Callipers tool is active in measurement mode thus you can measure time intervals and amplitude differences directly on computer screen To the opposite left mouse click acts as zoom in command and right mouse click acts as zoom out command in zoom mode The point you click while zooming in will be approximately in the centre of the window View menu e Scale command and toolbar combo box You can set precise zoom factor with this combo box Just select the scale from the list or enter the number into the box and press ENTER Menu command opens the Set Scale dialogue A special fit scale is used to set such a scale when all twelve leads are seen simultaneously e Calibration command and button e EE Speed command and button They provide for virtual amplification and paper speed selection If you just click the button itself you change amplification or speed to its default value 1 cm mV and 50 mm sec correspondingly Please note that Calibration and Speed buttons have arrows on the right Use them to open lists with available amplification and paper speed values You can set 0 5 cm mV 1 0 cm mV and 2 0 cm mV amplification and 5 10 12 5 25 50 100 and 200 mm sec paper speed The calibration and paper speed you set are remembered by seca CardioCon
48. ASUMA EEN 3 Installation of seca CardioConcept ON vour Conputer esasan E A E NA AA E E E a b 3 Installation and configuration of the programme for work with USB adanter 3 Configuring seca CardioConcept for shared access to database through the local network nannnnannnennnnnnnnnnnnennne 4 Configuring seca CardioConcept for using MS Access databaese 4 Configuring seca CardioConcept for working with Oracle sener 4 stalling Te Mee a ida 5 Programme Windows and dlalogUes EE 5 seca Cardio Concept Control Contencioso eiii 5 CONMOIG CHING WING OW o scada 5 KOOGING WV INGCOW rasai aidnvvnahdbaedndbeluwydeaed andeniaiaualacan shamed E 6 Change Password WIN CO Wet cota toa Dad a AaS 6 SE Ee EEN T Patent Browser Manr VINO Le T Edt Paten Amt OnmMavlOn WING OW aiie a a E e a a a A E E A cad 9 ele OM XIS a A Inte rei 10 Browse Insurance Companies and Choose Insurance Company VWumdows 11 Edit GOMmpany Intormatlon VV INC OW sind id inclinada ca hale ads 13 Examination BOWS CM ii o a e ls o lo 13 Examination Browser tee TEE 13 Assign examination to existing patient Or enter NEW one s sssssssrsesrresrrrstrrtrrrrsttrrtrrrsrtetrrrtrtrsrtrnrttennrr rtnn reenn eene 16 SGalcht and GA Eeer 18 Dialogues for search and filtration ooocccconncnconcncnncnonnoncnnonnncnnncnnononcnnnnnnnnnnnnnnrnnonnnnnnnonnnrnnnnnnrnnnrnnnnnnnnnrnnrnnarinennns 18 Search By Patient ID and by Insurance Policy dalogues 18 Choose filtered sex and Select filtered
49. Delete Patient name Birth date dorm T Name z pi ck Anna 15 12 1967 P DEMU Emergency acquisition 21 07 2004 DEMO Hooker Tomas 23 06 1957 DEMO Longman Andrew 12 09 7956 Name DEMO Black Anna Number of patients as ID de Remarks Binde psia sl ES Be made S o gt Pee Unspecified AP Insurance company il This window is used to manage patient records in database i e add delete patients and edit patient personal information The user can also select a subset of patients using different search and filtration criteria O Menu and Toolbar Window menu Refresh patient list command Forces newly entered patients to appear in patient list This button is needed only in the network configuration to make all changes done by other computer network users visible as in the standalone configuration all the data is refreshed automatically a Close window command It returns you to Control Centre Patient menu E New patient command and toolbar button Ctrl N Press this button to invoke Enter New Patient Information window and create a new patient record E Open patient window command and toolbar button It opens a Patient Examination window with all examinations available for selected patient You can do the same by double clicking the line on the patient list that contains desired patient s name or just by pressing ENTER key Edit patient data command and toolbar but
50. GlagnOSuG EE 83 Correcting representative Complex 83 Standard diagnostic statements cccccccseecccceeeeeeeceeeeeeeseeeeeeseeeeeeseeeeeesseeeeeeseeeeeeeeeeeeeseeeeesseeeeesseaeeessseeeeesseeeseneeees 84 How seca CardioConcept stores diagnostic conclusions s sssssnreesrrrrerrrrrsrnrrnsrrrrsrrrrsrrrrstrrrnsrrrrrnrrnrrrrennnrenne 84 Editing conclusion created by seca Cado oncent 84 Creating a conclusion from Scratch oooccccconncnccnoccnnononcnnonnnnnnnnnnncnnnnncnnnonnrnnnonnnrnnnnnnrnnnnnnrnnronnnrnnrnnnrnnnnnnnnrnnnnrnnnnnneos 85 Analysing Bo nun ECO TECO nina al li dr belt lcd os 86 Using telemedical functions of seca Cardiotopncent 86 General notes asma EE 86 Understanding electr nic Mall DASICS EE 86 Understanding seca CardioConcept telemedical model 87 Sending receiving and analysing seca CardioConcept messages 87 Cardlo Portable operation le 88 Cardlor Or able OD ela lO Ns A AE 88 Error MeSSages and trouble snAdo0IN di AA A AA A 90 Hardware and system error Messages cccccccccescecesececeueceneseeceseeceseecsaneesseeeneeceseuececagecesaseessaeeeseaeeenseeeneuesenseetens 90 Database CONNECTION error MESSAGES ccccsecccesececeseccseseecsesceceaececseceneuececseessaceeesaeceseecesegeeesgeessaeeeseeeeesaesenuesenaas 91 ECG analysis elror LEE 91 et aN a We GER ii ii 92 Database integrity error MESAS Aa 92 Message transfer related TOPICS a eed ease hea 92 seca CardioConceptPortable operati
51. MER New Edt Delete Look for Company name Address A emarks O Window Toolbar and Menu Y OK button If the user is choosing the company company name is saved in patient record being edited Pressing ENTER button on the keyboard produces the same effect Otherwise this button just closes the dialogue x Cancel button This button appears only in the Choose insurance company window toolbar It closes the window without any saving of the modifications Window Menu Refresh command and button It forces a newly entered insurance companies to appear in the Company List This action is only needed in the network configuration as the data is refreshed automatically in a standalone configuration Insurance Company Menu El New Insurance Company command and button Ctrl N opens a dialogue Add new company where you can enter information about a new insurance company e Edit Insurance Company command and button Ctrl E invokes a dialogue Edit company information You can do changes of the selected company information E Delete Insurance Company command and button Ctrl D The information relating to the current company is deleted after the user confirms the action The company data can be deleted only if there is no reference to it Company List This is a list of all companies sorted by name When the user starts typing in the Look for field the selection moves to a company with first characters in its n
52. Maker line ECG Compare Tab On the left there is a list of elements which you can set a colour e Background ECG curves Grid Measurement line ECG curves2 ECG curves3 ECG curves4 Marker line Rhythm Viewer Tab On the left side of the window the labels of possible colours are shown e Background ECG curves Grid Font Measurement line Marker line Rhythm Compare Tab On the left side of the window the labels of possible colours are shown Background ECG curves Grid Measurement line Within every tab there is a bar to the right from each of the above labels which has the colour of the corresponding element Double clicking on this bar invokes the standard Windows colour dialogue Schematic sample ECG screen allows previewing new colour settings Set Statement Modifiers Dialogues These dialogues allow you to add different statement modifiers like rule out or possibly old to standard diagnostic statements see Diagnostic Conclusion Wizard and Add Diagnostic Statement window for details D probada Zeg E carrol eschen D mbacuts D br uae C audience E conden i hr i borai een pabi old rada cul 7 peard cart i Gear sage CC pb i D piti econ D pii ac Enter Average Values Dialogues These three similar dialogues are used to enter manually average heart rate RR and QTd values correspondingly D Er Ei Erter best sta Lee Heri ge wooo Y All the dialogues have t
53. Notice that ESC button restore the previous value in any field until it has a focus Thus if you want to quit the window Edit patient information without saving the modifications you need to press ESC button twice if You use this button instead Cancel button Patient Exists Window Patient Exists Window When you create a new patient or edit data of an existing one the programme prevents you from typical errors that may destroy database integrity For example a user can mistype patient s name or try to enter a new patient with a similar name or the same ID as an existing patient A special window appears in this case see the picture Window title bar identifies the type of data collision Similar patients exist Y a E x UK New Edit Cancel Name DEMO Black Anna Remarks ID ES Birth date H 451967 Female Caucasian Policy number Insurance company N ame Black Anna ID Birth date E 5 12 1967 A emarks a The window consists of following parts ter There are the following buttons Choose patient button If you press it the programme reckons that you tried to create a new patient s record by mistake instead of choosing an existing one in database seca CardioConcept considers the data of the patient that is currently selected in Similar Patient List to be correct Therefore this patient s record will be chosen when you return to Patient browser window Please realize
54. QTd gt 200 or HR gt 20 and HR lt 350 Check the values you have entered and correct them if necessary Wrong representative complex This message appears if you set a wrong representative complex i e either you have set only one boundary or both boundaries are the same Printing ECG errors No default protocol found This message may appear when you try to print from the Smart Cardiograph window Print check box is set In this case default protocol template is used but none is specified Ask seca CardioConcept administrator to set default protocol template Protocol with the same name already exists This message may appear when you are trying to add new protocol template You can have in the database only one protocol with specific name Database integrity error messages Insurance company is specified but policy number is not specified Policy number is specified but insurance company is not specified These messages may appear when you edit patient information If you enter insurance information you should specify both the policy number and the name of the insurance company that issued it Insurance company name must be set Insurance company with the same name already exists One of these messages may appear when you enter new insurance company You can have in the database only one insurance company with specific name Patient birth date not specified Patient surname not specified Patient sex not specified One of these
55. RR interval must be specified representative cardiocycle must be selected fiducial points must be set and diagnostic conclusion conclusion text itself must not be empty Manual Analysis menu Representative Complex command and toolbar button Use it to call Choose Representative Complex window Here you can select a representative complex by hand ME Fiducial points command and toolbar button Ctrl F Use it to call Set Fiducial points window where you can set ECG fiducials manually e Manual Conclusion command and toolbar button Ctrl W It calls Diagnostic Conclusion Wizard that will help you to write a conclusion using a set of standard diagnostic statements Automatic Analysis menu SS Representative Complex command and toolbar button If you press it seca CardioConcept creates median representative cardiocycle automatically Fiducial points command and toolbar button If you press it seca CardioConcept detects the ECG fiducials automatically If representative cardiocycle is not selected either manually or automatically this button is disabled Automatic Conclusion command and toolbar button This button forces seca CardioConcept to generate diagnostic statements for the ECG based on available representative cardiocycle and the set of fiducial points If no representative cardiocycle and fiducial points are specified this button is disabled e de ECG feature table command and toolbar button Ctrl T It calls ECG F
56. Viewer application after acquisition This check box can be set only together with Save check box It is worth noting that if you uncheck Save check box then the programme set the check box Print automatically and make it untouchable it is greyed in this case Also notice that if you invoke ECG recorder window from Examination browser then check boxes Save and View are set and you cannot disable them In this case you can set only Preview ECG and Analyse check boxes Choose or Enter Patient window Choose or Enter Patient Ei Patient Insurance company Search Filtration Help RH o a Close Choose Emergency a x New patent Edit patent Delete patient Patient name Birth date ddrmirnyy DEMO Black Anna DEMO Emergency acquisition DEMO Hooker Tomas DEMO Longman Andrew A emarks a A a Bithdat bemonme P Race Unspecified Polceyrumber f AW Insurance compar 7 Pe This window appears in the course of Patient ECG recording command lt gives the possibility to select a patent immediately prior to ECG acquisition The button Choose selects the highlighted patient record and proceeds to Smart Cardiograph Pressing ENTER key produces the same effect The Emergency button starts Emergency ECG recording The Cancel recording buttons cancels the operation and returns to Control Centre Pressing ESC key produces the same effect In all other respects this window is similar to Patient B
57. Y OK and x Cancel buttons The text box for entering custom scale becomes selected as soon as you select Other scale Choose Colours for viewer Dialogue Choose Colours for viewer Dialogue This rather simple dialogue is used for tuning colours of ECG presentation in ECG Viewer Cheoer colors far viewer E x H ECG Pascoe ECG Vere ECG Compare Hiptie Views Frye Compare Basch peared EL cure Toolbar has three buttons e Y OK The colours are saved and the ECG curves are shown in the chosen colours e ZS Cancel Changes are lost and no actions are undertaken E Default Colours button restores seca CardioConcept default colours Colour settings are organized in groups corresponding to different windows for working with ECG and shown on five tabs ECG Recording ECG Viewer ECG Compare Rhythm Viewer Rhythm Compare ECG Recording Tab EH x D ECG Rendl ECG views EOS Compare Pieter Wire Etage Compare Bach god EUG cure Geet panal On the left side of the window the labels of possible colours are shown e Background e ECG curves e Current signal i e the colour of the line which shows the current signal in Smart cardiograph ECG Viewer Tab On the left part of the window those elements are shown whose colour can be changed Background ECG curves Grid of virtual ECG paper Font colour for lead labels etc Measurement line colour for callipers tool
58. abase integrity rules for detailed description How to adjust data conflict While you are adding a new patient record a data conflict takes place you can analyse the reason of the conflict in Patient Exist window Typically you should act in the following way e if you are sure that the new patient you are trying to enter is already present in database press Choose patient Y button If there are some variants in the Similar Patient List then be sure that you have chosen the appropriate patient e if you are sure that the new patient you are trying to enter is already present in database but the new data is more correct or more complete press Overwrite button If there are some variants in the Similar Patient List then be sure that you have chosen the appropriate patient e if you are sure that the new patient whose data you are trying to enter still it is a new one though being similar to some existing patients press Create New El button Please make sure that this new person doesn t really a mistakenly made alias to any other possible candidate Browse Insurance Companies and Choose Insurance Company Windows These windows appear in the following cases e The user wants to add view edit or delete information about insurance companies he she actually works with e The user wants to add or delete information about insurance company in patient record Browse insurance companies Window Insurance company Y a E Ok
59. able for ECG diagnostic conclusion The parties of telemedical network are called in the following way a client sends electrocardiogram and other diagnostic data to a consultant seeking for expertise or second opinion Message is called request in this case The consultant reviews the data sent and comes to a conclusion that is sent back to the client This reply message is called answer in this case The Mail client stores all messages in a special mail database sends the queued outgoing messages checks for incoming messages on the ISP server and manages the processing of the messages The typical route of an ECG record is like this e The message is prepared and put into Outbox folder of mail database and is marked as a request that is ready for delivering e As soon as you connect to the net the message is forwarded to the recipient The message is put into Sent folder e The recipient checks his her mailbox with his her Mail client All seca CardioConcept messages are retrieved from the server are put into Inbox folder and marked as pending requests A special delivery confirmation is generated for each received message and forwarded to the sender e As soon as the expert analyses the ECG creates new conclusion and fills in the Answer message field the message is marked as an answered request or just an answer that is ready for delivery and is put into Outbox folder e The queued answers are forwarded in accordance with their reply address
60. ace the object where you want Further you can change the location of the layout element dragging it with the mouse Or you can resize the element dragging the handles on its bounding rectangle e Delete command Ctrl Del It deletes the currently selected object E Cut command and toolbar button Ctrl X It places the currently selected object into Windows clipboard and removes it from the page layout Copy command and toolbar button Ctrl C It places the copy of the currently selected object into Windows clipboard e Paste command and toolbar button Ctrl V It inserts the object from the clipboard into the current page area at the same position relative to the upper left corner of the Protocol Layout area where it was at the moment of copying View menu e Zoom in command and toolbar button Ctrl I A Zoom out command and toolbar button Ctrl O Scale command calls Set Scale dialogue A combo box with current scale of protocol layout presentation You can set precise zoom factor with this combo box Just select the scale from the list or enter the number into the list box and press ENTER Header Footer command It switches between standard editing mode and header footer editing mode In standard editing mode you can edit all elements on each page of the protocol template except page headers and footers To the opposite the header and footer common for all pages are active and available for editing in header footer
61. ad height sets the vertical space for each ECG complex in mm e Speed Virtual paper speed used to display the curve e Calibration Virtual amplification used to display the curve e Markers property indicates whether vertical markers for ECG fiducials are shown ECG record block specific properties ColCount property sets the number of columns used for displaying the curves Lead height sets the vertical space for each ECG complex in mm Speed Virtual paper speed used to display the curve Calibration Virtual amplification used to display the curve Presentation property It can be short or full The property determines whether the lead block can expand in order to accommodate all curve length Protocol Preview Window The toolbar has following buttons ov OK button It closes the window e Combo box with presentation scale e Fit page button lt adjusts the presentation scale so that one page fits into window If protocol template has more than one page in it you can use Page Up Page Down buttons or scroll bar to navigate through pages Current page number and total number of pages are indicated in the status bar Save Protocol as Dialogue fr Cred Ferd Le ardid DOS ean This dialogue appears when you are going to save a copy of protocol template with a different name Enter new protocol template name into the Name field You can also indicate whether the new template should be used as default for the sel
62. additional records as you like Just remember that it increases the size of the message thus boosting requirements for storage capacity and transfer time Press Y OK button on the toolbar New seca CardioConcept message ECG Envelope is placed into Outbox folder of mail database by default If it is necessary to send the message immediately you should set the corresponding check box in Compose request window In this case after pressing OK button Mail client will try to set a remote connection and send a message If send immediately check box is not set you have to exit ECG Viewer and enter Mail client for sending messages While in Mail client you can edit the ECG Envelope using Envelope command of Message menu or the corresponding toolbar button Envelope dialogue will appear You can change recipient e mail address the text of request message and set urgency flag Use Send command of Connect menu or 7 Send Receive toolbar button to have all queued messages sent The connection status messages will appear on the status bar If you select Send Receive or Receive commands the program will check the messages available on server These can be requests from other seca CardioConcept nodes and answers on your earlier requests The answers will be merged with the corresponding requests in the Inbox folder together with received requests The Header and Message body panels show the content of the selected a La message Use Open command an
63. age Demonstration mode will appear at the window top right hand corner if you start Smart Cardiograph in simulation mode See the section Option dialogue hardware tab for details how to switch the simulation mode on and off The window has the following panels ECG monitoring screen ECG Display It occupies the major part of the window If monitoring is on and the leads are connected to a patient then the monitor screen shows ECG signal from all 12 leads There are labels to the left from the window which specify the names of the leads A vertical line moves on the screen from the left to the right and changes the signal New signal from the electrodes is to the left from the red line while the oldest signal can be seen to the right from the red line and is swept continuously Due to digital filtering a signal appears on the screen about 1 5 second later than it has been acquired from the electrodes Ten second signal span seen on the screen can be acquired for further processing saved to the database printed etc 2 Acquisition parameters panel Acquisition parameters panel There are control elements on this panel which regulate ECG recording conditions G Acquisition controls panel Acquisition controls panel On this panel there are elements which control the process of recording its type duration etc After Recording panel After Recording panel On this panel there are elements which control the process of recording The ch
64. agnostic Conclusion panel Diagnostic Conclusion Wizard Choose diagnostic statement D conclusion i x Conclusion preview OF Cancel Collapse I Heart axis ECG phenomena Myocardial lechemia Injury Myocardial Infarction Intraventricular cond Chamber hypertraph _ Non coronary ECG ch Other ORS Morphology or eneral Descriptive Statements Normal brormeal DANCES Free text conclusion O Windows Toolbar It contains the following buttons S OK button It closes the window and saves all changes made in diagnostic conclusion Cancel button It closes the window without saving any modifications in diagnostic conclusion EjJ ES Collapse all button Use it if you want to collapse all open branches of statement tree 2 Diagnostic Statement Tree It contains all diagnostic statements organized into a hierarchy by categories Conclusion Preview Area It contains selected standard diagnostic statements in order they will appear in the conclusion If you select a new statement in the tree view a check mark will be shown against it in the tree view and it will be added at the end of statement list in preview panel on the right Selecting statement in the preview panel will move the selection point in the tree view on the corresponding statement A Set Statement Modifiers dialogues will appear if appropriate when you insert new statements allowing you
65. ame matching those you have typed Data Data related to the selected insurance company in the list The following information can be stored in database and displayed for each company in the list e Company name e Company address e Remarks a free text field for any additional information Edit Company Information Window Edit company information EE Y x UK Cancel Company name Address A emarks Depending on the situation whether New insurance company or Edit insurance company commands have been used Add new company or Edit company information will be displayed on the title bar of invoked window This dialogue contains data fields for insurance company record and Y OK and x Cancel buttons The name of the new company must be unique Examination Browser Examination Browser Window This window is used to browse examinations stored in seca CardioConcept database Examinations can be filtered by specified criteria if required MedIT Concept 5 5 Browse examinations Window Examination Conclusion Filtration Help BCB oe x Q Close Refresh Open Delete Assign oF ECG examination ER r Hooker Tomas H Standard ECG examination DEMO Longman Andrew P Standard ECG exarnination DEMO Longman Andrew Standard ECG examination DEMO Hooker Tomas E Standard ECG examination DEMO Black Anna Standard ECG examination el 07 2004 16 01 09 DEMO Black Anna i afl Type
66. and right lists and on which list has the focus Edit address entry dialogue Here you can edit consultant s name or address in the address book or create new one s data Standard Y OK and x Cancel buttons close the window saving or not modifications correspondingly You can change the consultant s record in the appropriate Name and Address fields Address book dialogue Address book OF Cancel New Edit This dialogue allows to enter new information about the consultant edit or delete it The dialogue consists of the following parts O Toolbar e Standard Y OK and 3 Cancel buttons close the window saving or not modifications correspondingly E This is New entry toolbar button This is Edit entry toolbar button Both these buttons open Edit address entry window which allow to enter new consultant data or to change the current selected one s data E This is Delete entry toolbar button It removes the consultant record and all the information about him Before the record is to be deleted a message asking for a confirmation of deleting appears The List of Existing Consultants Data This list is organized in two columns e The first column contains consultant s name e The second one shows consultant s address Export message as dialogue This dialogue allows you to export messages which contain both a request and an answer Standard Y OK and e Cancel buttons close the window exporting the message or not
67. ar has two buttons Y OK button starts filtration x Cancel button closes the window without any filtration Select examinators and Select users who signed conclusion dialogues These similar windows are used in order to find either examinations made by certain attending persons or examinations that have conclusions signed by specified users experts They differ from each other in window title bar This window is entitled either Select examinators or Select users who signed conclusion There is a list of users registered in seca CardioConcept in the window They have the right to make examinations or to write conclusions on examinations In special fields you can see the detailed information about the user selected in the list The examinator list is sorted by name While you are entering the first letters of the surname seca CardioConcept tries to locate the user whose name starts with the letters you type and moves selection indicator on the corresponding line One or several users can be selected from the list using standard Windows technique Shift arrow keys ctrl mouse click A thick dot appears to the left of the selected user 2 or E If no users are marked as selected the current one blue bar is considered as selected Toolbar has two buttons Y OK button starts filtration When you have pressed this button you will only see examinations made by certain attending persons or examinations that have conclusions sign
68. ardioPortable is particularly intended for When designing CardioPortable the developers took in mind two main scenarios The first one is aimed at selective ECG acquisition hospitals and large outpatient centres for the patients that cannot be brought to a fixed site cardiograph based on a desktop PC A nurse or a technician is a typical CardioPortable user in this case After all administered ECG recordings are performed CardioPortable notebook can be connected to the server through any available network socket and the acquired data are uploaded Since this moment new ECGs are accessible all over the network The access to patient records and ECGs on a portable computer in off line mode is controlled in the same way as it is in client server seca CardioConcept environment After successful synchronization uploaded data can be purged from the local database automatically in order to preserve privacy keep the local database small and do not tangle with further off line CardioPortable sessions Alternatively the synchronized data can be cleaned up manually from local database at any time at user discretion In the second scenario CardioPortable laptop serves as a mobile mirror of the master database A GP that needs to visit patient at their homes or work in a hospice is the proposed user The doctor a nurse or a doctor assistant performs the acquisitions and on screen ECG analysis if necessary right at the site using portable computer The data
69. ardware came with an installation CD 12 or floppy disk insert it now What do you want the wizard to do Install from a list or specific location Advanced Click Next to continue then Found New Hardware Wizard Please select the best match for your hardware from the list below Sa Sech MedIT IMI USB Device V2 Description Version Manufacturer Location Ku This driver is not digitally signed Tell me why driver signing is important and then Found New Hardware Wizard Completing the Found New Hardware Wizard The wizard has finished installing the software for Sul MedIT IMI USB Device V2 Click Finish to close the wizard Cancel In case of Windows 98 Me the driver is installed automatically Please note that you do not need to go through this procedure each time you plug CT110 into a different USB port Back Configuring seca CardioConcept for shared access to database through the local network Configuring seca CardioConcept for using MS Access database In order to share ECG database between several users it is necessary to choose MS Access database format during installation and specify the directory where database will be stored Such a directory can be either at one of the working stations of peer to peer network or at the file server All potential seca CardioConcept users need full network access to this directory You can provide this by specifyi
70. art typing seca CardioConcept tries to locate the user whose name starts with the letters you type and moves selection bar on the corresponding line E Data Fields User information data fields User name User position in the institution where he works User Medical specialty User Address Login name Remarks Flags User rights flags Administrative rights The user can administer user accounts and edit protocol templates The right to edit patient information The user can add new patient records and edit patient information in the database The right to delete patients The user can delete patients This action cannot be undone because all examination data ECGs etc of the specified patient will be removed from database if you delete a patient record The right to assign patients to examinations The right to delete examinations The right to analyse examinations Whether user account is enabled or not If a particular account is disabled it cannot be used to work with seca CardioConcept It is important to mention that user account cannot be deleted if there are any references to it for example any conclusions are signed by this user So if you don t need this user s database access then it is better to disable the user account than to delete User Administration menu and toolbar Window menu Refresh command and toolbar button Forces newly entered user records to appear in user list This button is needed o
71. at next synchronization See the corresponding section for detailed explanations of data integrity rules used in seca CardioConcept Synchronized patient XXX not found in master database Record will be appended This message is written to the log file if the patient record is in use in the local database is deleted from the master database prior the synchronization The record in the master database is restored in order to keep data integrity See the corresponding section for detailed explanations of data integrity rules used in seca CardioConcept Server record was accepted by user This message is written to the log file after the message Couldn t synchronize patient XXX Patient ID XXX Identical record exists in case the user takes decision in favour of the record in the master database See the corresponding section for detailed explanations of data integrity rules used in seca CardioConcept Server record was updated by user This message is written to the log file after the message Couldn t synchronize patient XXX Patient ID XXX Identical record exists in case the user takes decision in favour of the record in the local database See the corresponding section for detailed explanations of data integrity rules used in seca CardioConcept Record was added to server by user This message is written to the log file after the message Couldn t synchronize patient XXX Patient ID XXX Identical record exists in case the user decid
72. calculate maximum minimum and mean heart rate and RR interval of the long ECG record And the last but not the least you can use User Marker tool to set markers on any place of ECG curves Time intervals between them are calculated and displayed automatically This is particularly useful while discriminating between various arrhythmias and conduction disturbances For example you can decide if P wave candidates follow in the proper order Or check that coupling intervals of two premature complexes are the same These tools will make it possible to analyse the long ECG record directly on computer display Using telemedical functions of seca CardioConcept General notes seca CardioConcept has been designed with telemedical application in mind You can prepare a package of ECG recordings ECG Envelope to be sent to remote consulting An ECG expert on the other end of telemedical network can use seca CardioConcept for viewing and analysing this examination New conclusion and comments are added to the envelope Then it can be sent back to you so you can use the conclusion and recommendation of the consultant in patient management A special programme module Mail client is used for message exchange via the Internet Understanding electronic mail basics seca CardioConcept uses Internet Mail for organizing telemedical remote ECG consulting If you are an experienced user of the Net you can skip this section Electronic mail message is composed of a h
73. ce that if you drag out of ECG Display the cursor changes and no measurement will be performed O Pmr KC A 7 Pineal Le 3 i ECG sraaantance riki paed ine Eb i UL Colorao orin oS urns aac Ed F srg Hoc HE GE o Leeerosstz 100 Hear ram KN HA mac bpn a6 zl HAmnton EG pegpe T RA rural RE ma tre 00 PEt rran irrg U D PA rra KR The Callipers Tool will allow you to measure and compare time intervals determine ST segment shift determine Q wave amplitude and duration and perform lots of other traditional ECG measurements that are not performed automatically by seca CardioConcept It is particularly useful in rhythm analysis and in comparison of serial ECG recordings QRS Marker tool and User Marker tool Two tools specific for analysis of long ECG records and especially for rhythm analysis are available in seca CardioConcept These are QRS Marker tool and User Marker tool that can be used in Rhythm Viewer and New Conclusion windows of Rhythm Analysis Workbench QRS Marker Tool Blue vertical lines show location of QRS complexes that seca CardioConcept uses for calculation of heart rates and RR intervals If the markers you see are placed correctly the calculations are reliable You can also easily determine the interval between each two QRS complexes Turn the QRS marks on and off with
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75. cept They will be used next time you open Rhythm Viewer You should remember that amplification and paper speed are virtual i e they set curve sizes relative to the paper grid Unlike a regular analogous ECG curve digitized ECG signal can be extended to any amplification and paper speed without distortion In the contrary Zooming changes the visible size of the curves as well as the grid e Parameters panel command e Conclusion panel command These commands and panel buttons hide show the corresponding panels e Colours command evokes Choose colours for viewer dialogue It allows you to select colours for ECG representation elements ECG curves grid etc New Rhythm Conclusion window Creating new conclusions on rhythm ECG records You normally get a rhythm analysis ECG record acquired in case of severe arrhythmia bradicardia due to AV block or any other conditions in which the 10 second standard ECG record is not satisfactory The automatic diagnostic interpretation is limited to QRS detection and basic heart rate RR computations From the other hand seca CardioConcept provides you with useful tools to enhance your ability to cope with difficult cases of complex rhythm disturbances New Conclusion window for rhythm analysis is similar to New Conclusion window of Standard ECG Analysis Workbench Before New Conclusion window appears you will see Use In New Conclusion dialogue ibe mtb reg mekase O O Da D CE Cannel
76. ck a required statement to be added to the existing conclusion Some diagnostic information cannot be expressed with the built in set of statements Unfortunately it relates to comparison of present ECG with previous ones Type the necessary text into Free text conclusion area in the bottom of Conclusion Wizard window Creating a conclusion from scratch Click New Conclusion button of ECG Viewer or Rhythm Viewer or use New command of Conclusion menu and make sure that measurements and conclusion check boxes are unchecked in the New Conclusion dialogue The system discards the existing set of ECG features and diagnostic statements in this case and creates a new conclusion from scratch The following relates to Standard ECG Analysis Workbench As automatic ECG analysis is very rudimentary for rhythm analysis ECG record a new conclusions for it is always made from scratch Thus the process of creating new conclusion for this type of record is covered in special section of this manual Press SS Choose Representative Complex button or use Representative complex command Manual analysis menu in order to enter Choose Representative Complex window This is the only enabled button at the beginning of analysis Examine the ECG carefully and select the complex with least noise and artifacts Scale the view to see the details better Click with the mouse to set the left boundary line of the representative complex some milliseconds before the P wave or about 20
77. command closes Standard ECG Viewer and returns to Patient Browser or Examination Browser whichever Standard ECG Viewer window was evoked from Buttons for examination type selection with the corresponding icons on the Examination Toolbar Export command allows to export examinations in two possible formats with or without patient information i e as anonymous Mail client command If Mail Client is not installed on your computer this button is disabled ECG menu S Print command and Print button on the toolbar Ctrl P There is a difference between the action of menu command and toolbar button The menu command invokes Print ECG dialogue that allows you to select printing device and protocol template before actually start printing Thus it is much more flexible but it takes more time and mouse clicks in order to print an examination report Toolbar button just prints the report on the current examination using default protocol template on the printer set default printer name is shown in the tool tip of this button Record command and Record button on the toolbar Ctrl R This icon evokes Smart Cardiograph application in order to register new ECG for currently selected patient in standard ECG mode Ye Compare command and Compare button on the toolbar Ctrl O It invokes Compare ECG window You normally use it if you want to perform serial analysis of ECG records of the same patient ECG List command Ctrl L and ECG List combo box
78. conclusions and can be minimized in order to enlarge ECG display area ECG Features panel ECG Features panel shows main diagnostically relevant patient information and ECG features and can be minimized in order to enlarge ECG Display area The following ECG features are shown on ECG Features panel of Standard ECG Viewer Mean heart rate in bits per minute Average RR interval in milliseconds If you decide to analyse an ECG record from scratch i e without employing seca CardioConcept automatic interpretation features you have to enter average RR interval by hand While in New Conclusion window you can double click the Average RR field and enter the value in Enter average RR dialogue Representative cardiocycle P wave duration in milliseconds Representative cardiocycle PQ R interval duration in milliseconds Representative cardiocycle QRS duration Representative cardiocycle QT QTc duration in milliseconds Representative cardiocycle QTd QTdc in milliseconds If you are not going to utilize seca CardioConcept automatic diagnostic capabilities while creating a new conclusion you can enter the value in Enter QTd dialogue by double clicking the QTd QTdc field Representative cardiocycle QRS axis Representative cardiocycle P wave axis Representative cardiocycle T wave axis Sokolow Lyon index Cornell Voltage Criteria ECG Viewer Menu Toolbar Examination menu E Close command and Close button on Examination Toolbar ESC This
79. conclusions would be stored in the database The last one is showed by default The name of the expert who made the conclusion and the date time when it was created are displayed in the corresponding fields Two scroll conclusion buttons provide for browsing through available diagnostic conclusions Diagnostic Conclusion panel of New Conclusion rhythm analysis window has an additional button This is Add New Statement button l This button evokes Add Diagnostic Statement to Your Conclusion window ECG Features panel This panel appears in all windows of Rhythm Analysis Workbench and contains most important patient information ECG acquisition parameters and main ECG features The exact content of the panel varies depending on the window in which it is situated and on examination type that is loaded There is a special button I in the top left corner of the panel that can be used to switch the panel on off in order to enlarge ECG display area The following patient and ECG acquisition information is shown if has been specified Patient s sex Patient s age Virtual paper speed of ECG display Calibration Duration Notch filter frequency in effect at acquisition Low pass filter frequency in effect at acquisition Record duration in seconds If rhythm analysis ECG record is loaded the ECG Features panel contains the following ECG features e Maximum minimum and average heart rate in beats per minute e Maximum minimum and average RR i
80. ct See section Screen Adjustment Dialogue for detailed description Customizing printed reports seca CardioConcept is shipped with a number of predefined protocol templates that can satisfy most of the users If you want to create a specific type of printouts Protocol Template Manager allows you to prepare very elaborate templates for examination protocols Just drag a desired element of ECG printout for instance patient s name or representative cardiocycles block with the mouse from Object Menu and place it at the place you chose on the Protocol Layout area If necessary move or resize layout elements If you click on an element it becomes selected A bounding box with handles appears around the selected element Name of the element is written inside its bounding rectangle It does not fit the size of the rectangle in many cases so the full name of the element is shown on status bar or in the tool tip that appears when you place the cursor over the element You can move it around the layout area just dragging with the mouse Dragging of the handles of the currently selected element can be used to resize it Use Object property area in order to change properties e g text of a label of an element You can select several elements clicking them with the shift key pressed forming a selection group The selection group can contain either text elements labels and database fields or ECG elements It is impossible to mix those types of elements in the
81. d you can unplug the computer from network and use in any relevant environment in an ambulance vehicle during rounds in patients homes in a hospital ward etc while having all the functionality of networked seca CardioConcept software still at hand You can acquire new ECGs view them on the screen compare with those in the local database create new diagnostic conclusions and print examination reports The access to the information is governed by the same strict rules as in client server seca CardioConcept settings At the end you will have all the data collected in off line mode safely transferred to the sever database by the data synchronization utility as soon as the portable computer is connected to the network again Some understandable limitations are posed by data integrity considerations on work in off line mode though Users cannot edit or delete patient records and user accounts downloaded from the server It does not affect the programme main intent ECG acquisition and analysis Moreover no limitations at all apply in on line mode when CardioPortable computer is connected to the master database You will find CardioPortable equally useful in environments other than large hospitals and outpatient centres e g ina GP s office or in CICU Even if you use only two PCs a desktop and a portable one CardioPortable allows to benefit from mobility digital ECG archive and easy access to ECG recordings where and when a need occurs What C
82. d QTdc field Representative cardiocycle QRS axis Representative cardiocycle P wave axis Representative cardiocycle T wave axis Sokolow Lyon index Cornell Voltage Criteria ECG Callipers tool The Callipers tool can be used in all ECG Viewer Compare ECG and New Conclusion windows Just set Measurement button in the toolbar and then point somewhere on ECG curve click left mouse button and drag the cursor to another location at your choice A line connecting two selected points will appear on the screen together with a small window Time and amplitude difference between two selected points will be displayed in it The time difference is presented in two forms for your convenience as time interval in milliseconds and as the corresponding rate in bits per minute Please notice that if you drag out of ECG Display the cursor changes and no measurement will be performed Patient Di Sat Bashir Helen 15 x Erami BOG Condado Joo Wew Help The Callipers Tool will allow you to measure and compare the time intervals determine ST segment shift Q wave amplitude duration and perform many other traditional ECG measurements that are not performed automatically by seca CardioConcept It is particularly useful in rhythm analysis and in comparison of serial ECG recordings ECG Viewer Viewing ECG You will open this window from examination browser patient browser or smart cardiograph applications for exam
83. d diagnostic statements Combo box specifies whether all buttons are large or not Auto log out after May be not accurate In fact auto termination of the application after N minutes of user inactivity Two combo boxes with available date and time formats if you are not satisfied with one that is set by default The date format looks something like this YYYY MM DD where Y stands for year digits M stands for month digits and D for day digits The format string for time may look like HH MM SS where H stands for hour digits M for minute digits and S for second digits Seconds may not be indicated in some of the formats Patient ID is combo box specifies patient ID You can select arbitrary string the default that will allow you to enter patient ID in any format Three other options are Norwegian social security number Swedish social security number and Danish social security number Specify birth as combo box allows you to select whether a patient s birth date is entered as full date of birth or just year of birth This option is available only if you select arbitrary string as Patient ID type If Norwegian social security number Danish social security number or Swedish social security number option is selected only the full date of birth can be set as it is coded in a social security number The format of birth date affects the data entry only January 1 of the corresponding year will be displayed as birth date if this option is se
84. d network traffic in telemedical applications e The national language problem is eliminated because localized application displays the text representation of each statement in national language Of course you are not obliged to employ the standard statements seca CardioConcept allows you to create conclusions in free text format and fully ignore the standard diagnostic statement set The free text part of the conclusion is added after standard statements if any are present How seca CardioConcept stores diagnostic conclusions One cannot just modify a conclusion once created The conclusion might be used as a basis for an important clinical decision If somebody modifies it later the decision hangs without ground and there is no way to restore the history Thus a conclusion cannot be modified once it is signed On the other hand any conclusion made by seca CardioConcept or a human ECG reader can be wrong If you are not satisfied with a conclusion you can create a new one This process is called ECG re reading and the new conclusion overrides all previously made seca CardioConcept stores all conclusions ever entered together with the information about the user who signed them The conclusions automatically generated by software are signed by seca CardioConcept reader You can browse through all available conclusions with Previous and Next buttons on Diagnostic Conclusion Panel of examination window Editing conclusion created by seca Cardi
85. d on the hardcopy pages On the other hand seca CardioConcept automated module can do routine ECG measurements and write a draft diagnostic conclusion for you If it is necessary you can use tools for doing measurements comparing several ECGs and editing diagnostic conclusions manually You can do it just on the screen without printing because the capabilities of ECG curves presentation in seca CardioConcept give you the opportunity to see ECG layout as well as curve details on display with the same and sometimes even better quality as printed ECG ECG curves measurement results and diagnostic interpretation will be stored into database and at any time can be sent for second opinion to an expert via Internet Finally it is important to mention that seca CardioConcept supports two types of ECG examination specifically standard ECG record and rhythm analysis ECG record Algorithmic diagnostic interpretation can be done with a standard ECG record only The way to analyse a long ECG record with seca CardioConcept tools is discussed in a special section of this manual We begin with computer ECG diagnostic basics as it will help to explain the work of ECG diagnostic interpretation tools Steps of computer ECG diagnostic Computer analyses ECG curves in several stages shortly outlined below e After digitized ECG signal is acquired the programme looks for QRS complexes in order to prepare median cardiocycle for further analysis Such a median comple
86. d toolbar button to view the ECGs itself Use Answer command or corresponding button s for viewing ECG of a request message confirm the automatic conclusion or create a new one and place the answer into Outbox folder as it is ready Envelope command is available for editing the ready answer messages You have to use the Envelope command and set the Put into Outbox flag in order to place the answer into Outbox for delivery otherwise the message will stay where it is If there is no space for the message in Outbox folder you can drag the message there by using the mouse later Send command will allow you to send the answers back CardioPortable operation specifics CardioPortable operation Introduction The usefulness of multi user ECG databases is diminished by the need to acquire ECG at the site in a ward at a patient s home etc The task is easy to accomplish with a portable ECG machine but then the problem of storing the recordings in the database arises Diverse digital ECG equipment employs proprietary and incompatible data formats while traditional analogous devices lack this capability at all The main idea behind CardioPortable is to alleviate development of complex paperless solutions for health care institutions CardioPortable module allows the clinicians to combine the advantages of multi user ECG database on a network server with capabilities presented by a portable computer After CardioPortable is installed and configure
87. des The first one is represented by single lead mode Compare ECGs i i X Lead Tool view Y Mi y oo Jl elle 1 100 S 5 z OF View Measure Zoom Calibration Speed Lead GE al 21 OF 2004 22 37 40 Main Measurements 21 07 2004 22 ar 40 21 07 2004 g 107200 In a He SG ee in S EE oe Ee pe i KS s H S i S 1557 37 i BF cr erer ER eebe Se EE a ik sieges e ee en my S Al Patient into See qe ECG presentation into speed mm sec 50 D Calibration crm raw 1 Filters Motch Hz Low pass Hz Conclusion Med Concept suggested conclusion Sinus rhythm Normal ECG Datestime 21 07 2004 22 38 40 Conclusion by CardioConcept A lead of each compared ECGs is shown one under another You can change the displayed lead with the buttons on the toolbar A vertical panel on the left side of the application window contains label boxes with date and time of ECGs being compared One of the boxes looks sunken which indicates the currently selected ECG record The conclusion and ECG featuresof the selected ECG are displayed on the corresponding ECG Features and Diagnostic Conclusion panels This type of ECG comparison can be used for virtually any purpose but is particularly helpful in detecting subtle rhythm disturbances P wave changes etc Comparing ECG in all leads limb leads and chest leads modes This group of compare modes
88. e The first group contains single lead mode The second one is represented by all leads limb leads and chest leads modes And the last one contains complexes and overlay modes Compare ECG window layout Compare ECG window menu and toolbar Comparing ECG in single lead mode Comparing ECG in all leads limb leads and chest leads modes Comparing ECG in complex and overlay modes Compare ECG window layout Compare ECGs X ae Self A e Measure Lead oom Calibration Speed Lead Tool View e i OF JS la OF 2004 22 37 40 Main Measurements Patient into Sex Male Age q7 ECG presentation info Speed mm sec DU D Calibration emmy 1 Filters Notch Hz Low pass Hz 21 07 2004 22 37 40 21072004 16 03 54 Conclusion Med Concept suggested conclusion Sinus rhythm Normal ECG Datetime 21 07 2004 22 38 40 Conclusion by CardioConcept 5 O Menu and Toolbar It is explained in the corresponding section ECG Labels panel The sunken label indicates the currently selected ECG ECG Display area ECG Display area ECG Features panel ECG Features panel shows features of the currently selected electrocardiogram In addition to a standard ECG Features panel it contains a combo box with the list of ECGs being compared Diagnostic Conclusion panel Diagnostic Conclusion panel shows the diagnostic conclusion of the currently selected electrocardiogram Co
89. e The mark will be changed in series with each click from Pon through Toff i e Pon to Poff Poff to Qon Qon to J J to Toff So click the P wave onset then P wave offset and so on If there is no P wave just set the mark of the leftmost fiducial to be Qon Click on the mark with right mouse button to remove the fiducial point represented with the corresponding line Obviously nothing will happen if you click to the left of Pon or to the right of Toff positions Representative complexes of all twelve leads are very enlarged in Set fiducial points window thus you can see ECG fiducials of all leads in detail It is very important that fiducial points position is correct in all leads It means that global J point J fiducial should correspond to QRS end in a lead in which it has the longest duration i e to the rightmost J point position among all leads The opposite is true while selecting QRS onset point that should correspond to the earliest sign of ventricular activation Thus global QRS onset Qon fiducial must be set to the leftmost QRS onset among all leads Positions of other fiducials should be set in similar way i e P wave onset Pon fiducial corresponds to the earliest atria activation P wave offset Poff fiducial to the latest P wave termination and T wave end Toff fiducial should fall on the end of the longest T wave but not on the U wave among all twelve leads When all ECG fiducials are set correctly close the window by
90. eader with information about sender and recipient a text message body and possibly one or more attached binary files In order to use electronic mail a user has to obtain an e mail address from his her Internet Service Provider ISP ISP creates a mail account and a temporary message storage a so called mailbox for the user within its host computer Since this moment the user is able to send and receive messages via the Internet Message exchange in the Internet is based on two main protocols of data transmission First SMTP protocol is used to send messages to other e mail users POP3 protocol is used to receive messages from your mailbox Actually two programmes SMTP server and POP3 server run on ISP host computer and process request from mail client applications accepting and storing new messages to and from the user automatically creating special types of messages used as confirmation of delivery and forwarding all the messages appropriately Thus a mail client application is required for a user to connect to SMTP and POP3 servers and send receive messages In order to work properly this mail client must be configured First the user address is required for your messages to be replied Second you must set the names a special Internet addresses like smpt provider com of your provider s SMTP and POP3 servers Third the name of your mail account and password is required for your mail client to authorized connection to your provider There are
91. eatures Table dialogue This command is only available if seca CardioConcept has performed programmatic ECG feature extraction The idea behind coexistence of manual and automatic analysis is to invoke seca CardioConcept automatic diagnostic facilities after performing some crucial steps manually It helps to make best quality ECG diagnosis right on the display screen Tool menu o gt Measurement command and button on the toolbar Ctrl M e A Zoom command and button on the toolbar Ctrl Z The commands of this menu switch ECG Display between measurement mode and zoom mode These modes control how ECG Display responds to mouse clicks ECG Callipers tool is active in measurement mode thus you can measure time intervals and amplitude differences directly on computer screen To the opposite left mouse click acts as zoom in command and right mouse click acts as zoom out command in zoom mode The point you click while zooming in will be approximately in the centre of the window View menu ECG command and toolbar button Ctrl E e Representative complex command and toolbar button Ctrl C These commands turn on off full curve and median complex ECG representation You can see both if you wish see ECG Display section e Scale command and toolbar combo box You can set precise Zoom factor with this combo box Just select the scale from the list or enter the number into the box and press ENTER Menu command opens the Set Scale dialogue
92. eck boxes on it specify actions which will be undertaken after an ECG record is acquired ECG acquisition parameters panel HE EEN The panel contains the following controls demonstrated the ECG recording mode in the monitoring process e Average heart rate of monitored ECG e A check box that turns QRS beeper on off e A box that shows amplification of the signal value with a spin button to change it This is important that this value changes only the size of signal representation on the computer screen during monitoring and DOES NOT AFFECT acquired signal itself By default level 3 is set ECG acquisition controls Standard ECG examination sl Recording time sec 10 G Main Acquisition control buttons gt Start monitoring Ctrl S The button looks pressed while monitoring is active Choose or Enter Patient window appears when you press this button if the patient is not selected Record Ctrl R This button activates acquisition and processing of ECG signal from the patient If standard ECG signal is set as examination type the Record button becomes enabled after 10 seconds of monitoring when the required length of signal curves are stored in the buffer If you are acquiring a rhythm analysis record the Record button is enabled as soon as monitoring begins The progress bar appears on Acquisition Controls panel during the rhythm analysis record acquisition process showing the percentage of long ECG that has already been sa
93. ected examination type The new name must be unique for the current language and examination type Any additional information concerning the new protocol template can be saved in Remarks field Set Margins Dialogue Eu Rs Use this dialogue to set top bottom left and right page margins correspondingly It is worth noting that some layout elements can overlap after the margins are changed so you will have to adjust their property specifies character set that The toolbar contains standard Y OK and x Cancel buttons to save or dispose changes you made Options dialogue Changing seca CardioConcept options This dialogue is used when a user wants to change preferences of seca CardioConcept programme It consists of four pages Presentation tab Hardware tab Mail tab Screen Adjustment dialogue Presentation tab MedIT Concept 5 5 Options Ioj x e XK OF Cancel Presentation Hardware Language English e Large buttons Auto logout after min 1 D ate format DO MM wir e Time format HH MM SS Patient ID is arbitrary string E pecity birth as date of birth Lead sequence Ce Standard f Cabrera Size adjustment Change colours Using this tab you can change the programme form and data layout format This page contains controls that define some properties of seca CardioConcept user interface Combo box for choosing the language for user interface and standar
94. ed by specified users x Cancel button closes the window without any filtration Select filtered diagnostic statements dialogue This dialogue window opens when the user wants to view examinations containing certain diagnostic statements in their conclusion parts Select tered diagnettic atements y x x ik AD OK Cancel Hest geen 7 l ELG peevegneoa z Mpocendial echengaieegm 3 1 Mpocardia inisin z L niyii oracion A Cri huperisophy 2 _ Horen EDG chez Othe DRS Not sdkaeg ct Geer Destiplrs Saee 7 J Noreen A statement list is arranged as a tree by category You can choose separate leaves with specific statements as well as several statements or the whole category branches Toolbar has the following buttons Y OK button After this button is pressed only examinations containing specified diagnostic statements in their conclusion parts are displayed If no statements are selected no actions are undertaken x Cancel button Window is closed and no actions are undertaken UR Set logical OR operation for selected statements It means that an examination appears in the filtered list if any of the selected statements is present in conclusion d Set logical AND operation for selected statements It means that an examination appears in the filtered list if all of the selected statements are present in its conclusion part No more than four statements can be selected for this kind of a que
95. efault value 1 cm mV and 50 mm sec correspondingly Please note that Calibration and Speed buttons have arrows on the right Use them to open lists with available amplification and paper speed values You can set 0 5 cm mV 1 0 cm mV and 2 0 cm mV amplification and 5 10 12 5 25 50 100 and 200 mm per second paper speed The amplification and paper speed you set with these commands are remembered by seca CardioConcept and used next time you open ECG Viewer You should remember that amplification and paper speed are virtual i e they set curve sizes relative to the paper grid Unlike a regular analogous ECG curve digitized ECG signal can be extended to any amplification and paper speed without distortion In the contrary zooming changes the visible size of both the curves and the grid e Markers command turns on off small fiducial markers on median complexes e Parameters panel command turns on off ECG Features panel e Conclusion panel command turns on off Diagnostic Conclusion panel You can achieve the same effect by pressing el minimizing buttons on the tool bars e Colours command evokes Choose Colours for Viewer dialogue It allows you to select colours for ECG representation elements ECG curves grid etc Compare ECG window Comparing ECG This window is intended to help in serial analysis of standard ECG records The programme shows the current recording and up to three previous ones Three groups of compare modes are availabl
96. emia Injury Myocardial Infarction Intraventricular conduct ancez Chamber hypertrophy _ Non coronary ECG ch Other ORS Morphology al Descriptive Statements C Normal 4bnormal Accelerated ventricular rhythm High QRS voltages in the frontal leads Free text conclusory O Windows Toolbar It contains the following buttons e S OK button It closes the window and saves all changes made in diagnostic conclusion Cancel button It closes the window without saving any modifications in diagnostic conclusion EjJ e ES Collapse all button Use it if you want to collapse all open branches of statement tree 2 Diagnostic Statement Tree It contains all diagnostic statements organized into a hierarchy by categories Conclusion Preview Area It contains selected standard diagnostic statements in the order they will appear in the conclusion If you select a new statement in the tree view a check mark will be shown against it in the tree view and it will be added at the end of the statement list in preview panel on the right Selecting statement in the preview panel will move the selection point in the tree view to the corresponding statement A Set Statement Modifiers dialogues may appear if appropriate when you insert new statements allowing you to add additional qualifiers as rule out or probably old to the inserted statement Statement Organizing buttons Using these buttons below previ
97. enter the number into the box and press ENTER Menu command opens the Set Scale dialogue A special fit scale is used to set such a scale when all twelve leads are seen simultaneously e Calibration command and button e BE Speed command and button They provide for virtual amplification and paper speed selection If you just click the button itself you change amplification or speed to its default value 1 cm mV and 50 mm sec correspondingly Please note that Calibration and Speed buttons have arrows on the right Use them to open lists with available amplification and paper speed values You can set 0 5 cm mV 1 0 cm mV and 2 0 cm mV amplification and 5 10 12 5 25 50 100 and 200 mm sec paper speed The calibration and paper speed you set are remembered by seca CardioConcept They will be used next time you open Rhythm Viewer You should remember that amplification and paper speed are virtual i e they set curve sizes relative to the paper grid Unlike a regular analogous ECG curve digitized ECG signal can be extended to any amplification and paper speed without distortion In the contrary Zooming changes the visible size of the curves as well as the grid e QRS positions command turns on off blue lines that shows location of QRS complexes as detected by seca CardioConcept software See section QRS Marker tool for details e Parameters panel command turns on off ECG Features panel e Conclusion panel command turns on off Di
98. epresentative cardiocycle manually This window has large ECG display area and a simple toolbar y A as HR pa E Ls R WE A e oe dl Wl i do The toolbar has following buttons e B OK button It saves the selected representative cardiocycle and closes the window e ZE Cancel button It closes the window without saving the selected cardiocycle a Zoom In and A Zoom Out buttons for changing the presentation scale interactively e Presentation Scale combo box If the ECG has not been analysed the window displays just ECG curves and nothing more As soon as you click the window a vertical line appears The second vertical line appears if you click the window again at another location These two vertical lines show the borders of representative cardiocycle You should position the lines so that first one immediately precedes the beginning of the cardiocycle i e right before P wave onset or QRS onset if P wave is not present and the second should be immediately past the T wave offset You should choose the cardiocycle of dominant rhythm as free of noise and artifacts as possible and a representative complex to ensure accurate measurements You can adjust lines positions dragging them with the mouse Diagnostic Conclusion Wizard Choose diagnostic statements br conclusion EjJ Lei Or Cancel Collapse E Diwtben Conclusion preview Heart asis SEEC phenomena JI Myocardial lech
99. er the connection to corresponding database is established If you provide wrong login data or the master database is not accessible due to network failure in case you try to switch on line error message will appear and you will have to repeat the procedure It is useful to Know that the mode of operation is indicated on the title bar of Control Centre Data synchronization and synchronization log Make sure that seca CardioConcept is in on line mode and network is up and running prior synchronization and switch into on line mode if necessary In order to initiate the process open CardioPortable Control Window and mouse click Synchronize button Log information area and time indicators show the course of the process Patient records added in off line mode would be checked against those in the master database If data collision is revealed a Similar patients exist window will appear Please see the corresponding section for detailed description of data integrity rules and means of resolving data collisions in seca CardioConcept database In the case synchronization is cancelled by the operator the process will not be terminated immediately The programme will wait for completion of current record transfer and stop synchronization after that Therefore you have to be patient if the network connection is slow We suggest you use D Stop button only in case of emergency ECG acquisition or similar reason occur during synchronization If Autodelete sy
100. es both records correspond different people though they bear similarities The local patient record is added to the master database See the corresponding section for detailed explanations of data integrity rules used in seca CardioConcept User XXX not found in master database Couldn t append a record The account of the user attending synchronization was deleted from the server for some reason Synchronization is aborted and all data left in the local database Synchronization process completed This message is written into the log after successful synchronization Errors occurred during synchronization This message is written into the log if synchronization was incomplete due to some errors Cancelled by user This message is written into the log if incomplete synchronization was cancelled by user Add Diagnostic Statement Window 43 55 78 Adjust Screen Metrics Tool 73 analyze ECG 27 28 29 39 40 41 42 43 82 83 84 85 analyze rhythm 43 44 45 51 52 54 55 82 83 86 browse EXAMINATIONS ococcococoncnconcncnconcncnnonanannnnnonanos 82 Browse Insurance Companies Window 12 Change Password Wumdow nssannensnrnsenneesnreesennne 6 Check the Quality of ECG Window ccccoccccooon 26 Choose EGG Dial siii 74 combate E EE 2 28 29 32 33 Compare rhythm c cccceeeeee sees eens 43 44 45 49 50 Compose Request Dialog 58 configuration 62 63
101. es during next Internet session e The client receives the message with answer and puts it into Inbox Mail client matches the arrived answer with the corresponding request in the Sent folder and merge them At the same time it generates the confirmation of delivery and forwards it to the consultant e You can view the answer with standard seca CardioConcept tools Thus your seca CardioConcept workstation can be used both for sending receiving requests and receiving sending answers This makes seca CardioConcept suitable not only for simple star topology telemedical networks that means a central consulting station with several clients connected but for more complex distributed telemedical solutions as well At the same time seca CardioConcept can be used for general purpose ECG data exchange between medical professionals or for sending examination data from one medical institution to another sending receiving and analysing seca CardioConcept messages We assume that you use ECG Viewer for sending a standard ECG record The usage of Rhythm Viewer is absolutely analogous lf you decide to send an ECG to remote consulting service just select the Send to consultation command of ECG menu Compose request dialogue will appear You have to specify the recipient address and fill in the request text There is a possibility to mark the outgoing message as an urgent one Add some previous examinations if they are required for comparison You can add as many
102. essage request The icon shows the messages e The last column shows the patient name Clicking the column header sorts the message by data in this column Subsequent clicks change the sorting order from ascending to descending and vice versa Double clicking the selected message opens the ECG attached to the message in the examination window Y The Header Panel It contains the following fields for currently selected message e Processing status field Status of the message can be one of the following e Request prepared request has been prepared and is ready for sending e Request sent request has been sent e Request sent confirmation received request has been sent and confirmation has been received from the addressee about delivery of the message Request received request has just been received e Request received confirmation sent request has just been received and confirmation has been sent to the addresser about delivery of the message Answer prepared answer has been prepared and is ready for sending Answer sent answer has been sent e Answer sent confirmation received answer has been sent and delivery confirmation has been received from the addressee e Answer received answer has just been received e Answer received confirmation sent answer has just been received and delivery confirmation has been sent to the consultant e Request achieved processing cycle of the request is
103. ew panel you can change the order in which the statements follow each other in the conclusion Free Text Conclusion Arealf standard statements are not sufficient to express your diagnostic opinion you can add arbitrary text conclusion into this edit box The free text part of the conclusion is added after the standard statement part Add Diagnostic Statement to your Conclusion window All diene be shat arene We rar peek x This window is opened after you click Add Diagnostic Statement button of the Diagnostic Conclusion panel of New Conclusion window This window allows you to pick up a specific standard diagnostic statement and quickly add it to your diagnostic conclusion The window consists of toolbar and diagnostic statement tree area If you select a new statement in the tree view Set Statement Modifiers dialogues will appear before the new statement will be actually added to the conclusion After the statement is added you return to New Conclusion window Use Add new statement to your conclusion window just to add one or two statements If the order of the statements is incorrect you can change it in Diagnostic Conclusion Wizard There are two buttons in the window toolbar 2 Cancel button It closes the window without adding any statement to the diagnostic conclusion EjJ ES Collapse all button Use it if you want to collapse all open branches of statement tree Rhythm Analysis Workbench Examination window of Rhythm
104. filtration with the same parameters No filtration command turns all filtration off Ctrl F All patients in database appear in the list of available patients Search strings When you start typing in the Patient name field seca CardioConcept tries to locate the patient whose name starts with the letters you type and moves selection indicator on the corresponding line It is not started immediately but after a 1 sec delay allowing user to enter full search string Sometimes search can take considerable time You can also search a patient by entering his her birth date in Birth date field The date format looks something like this ddmmyy where d stands for day digits m stands for month digits and y for year digits In order to return to the full patient s list you can turn this filtration off by using By birth date command in Filtration menu or the corresponding button LG Patient s List This is a list of all patients sorted by full name or a subset of patients matching filtration criteria if any filtration criteria are set One of the lines is highlighted in blue it contains a name of so called current patient When the user starts to type on the keyboard current selection moves to the patient whose starting name letters match the entered characters If you want to lessen the list of records among which you are looking for the appropriate one use Filtration menu commands or filtration buttons Search and filtering buttons are ne
105. fo window So you can decide to link the ECG just recorded to a new existing patient or leave it assigned to an artificial Emergency Acquisition patient 4 You return to Control Centre window Recording ECG from Smart Cardiograph seca CardioConcept supports two additional scenarios for ECG recording They can be named serial ECG acquisition and individual ECG acquisition Serial ECG acquisition This scenario is tailored for serial ECG registration in a specialized environment like an emergency room or other workplace specifically assigned for ECG acquisition A nurse is a typical seca CardioConcept user in this case In order to operate the programme in this mode you should start Smart Cardiograph application from Control Centre with Patient ECG command Just leave in Smart Cardiograph after you acquire the first ECG As it was said above a patient must be specified before ECG acquisition lt can be done in three ways First you can select an existing patient from database or create a new one in Choose patient window which automatically appears if you launch Smart Cardiograph from Control Centre Secondly you can select a patient with Choose Patient button which evokes Choose Patient window as well And at last you can choose a patient you have just recorded ECG for to be the current patient with H Choose Previous Patient button The latter is possible only if you have already acquired ECG just before but you are not satisfied with t
106. for Quantitative Electrocardiography It is clear that this type of statement is redundant in a human made conclusion Add all statements you need and arrange them in proper order as described in the previous section You are free to add some additional text into Free text conclusion area If you do not want to use standard diagnostic statement set you can type the whole conclusion into Free text conclusion area in free text format Press Y OK to save newly created conclusion and return to New Conclusion Window This is the end of diagnostic interpretation Press Y OK button on New Conclusion Window toolbar The conclusion together with new representative complex and all ECG features are now stored in the database and signed by you Analysing rhythm ECG record You can create diagnostic conclusion in New Rhythm Conclusion window This type of recording is mostly used for documenting rhythm disturbances thus serving as an add on to a standard ECG record As automatic QRS detection is the only type of automatic analysis available for rhythm analysis ECG record diagnostic interpretation is performed in more traditional way than that of a standard ECG record seca CardioConcept provides you with following tools for alleviating analysis and increasing your performance First you can use Conclusion wizard to create a diagnostic conclusion quickly Second you can measure ECG parameters with the ECG Callipers QRS Marker tool will allow you to easily
107. he After Recording panel and in Examination Browser if you use Add remark command There you can write any comments on this recording They will be saved into database and can be later viewed from Examination Browser Choose ECG Dialogue This dialogue contains a list of all ECGs available for the current patient with acquisition date and time The dialogue has standard Y OK and a Cancel buttons View Fiducial Points Window Computer assisted ECG analysis depends very much on correct placement of ECG fiducials within representative cardiocycle lt is a good idea to check the fiducials if you are not satisfied with automatic diagnosis or are in doubt if ECG intervals are measured correctly This window allows achieving the goal quickly The window shows magnified representative cardiocycles of all twelve leads placed in such a way that fiducial points can be seen in all twelve leads simultaneously Five vertical lines point at the positions of ECG fiducials thus characterizing cardiocycle as a whole rather than single leads only Each line is marked in the following way Pon stands for P wave onset Poff for P wave offset Qon for QRS onset J for J point and Toff for T wave offset See section Creating a conclusion from scratch for more detailed information Set Fiducial Points Window This window is used to set fiducial points on representative cardiocycle manually It looks similar to View Fiducial Points wind
108. he currently selected patient i e the current patient The windows of other types you can see while processing ECG examinations are Compare ECG window and New Conclusion window It is clear that there is no sense changing the patient or examination type while comparing ECGs or analysing a specific recording Thus these windows do not contain Examination Toolbar They do not have Examination menu and Close button E in the toolbar There are standard r OK and x Cancel buttons in the toolbar of New Conclusion window instead The toolbar of Compare ECGs window has only ok button Common features of standard ECG Analysis Workbench windows ECG Display area Diagnostic Conclusion panel ECG Features panel ECG Callipers tool Specific windows of standard ECG Analysis Workbench ECG Viewer Compare ECG window New Conclusion window ECG Display area ECG display of Standard ECG Viewer consists of three parts The leftmost part contains lead names and standard reference one millivolt signals for each lead displayed You cannot change the size of this part or remove it from the screen Two other parts are removable and you have a splitter so you can change the portion of ECG Display occupied by each part One part displays full ECG curves and the second the rightmost one shows median complexes Standard ECG paper grid is present as window s background to make it easier to analyse the curves visually If you want to make ECG Display as large as possible ju
109. he quality of the record or you can decide to make a long rhythm analysis record after an acquired standard record proved to be insufficient for complete diagnostic interpretation In all cases a patient is selected as the current patient and any ECG recording is stored in database as belonging to the current patient Individual ECG acquisition The second scenario can be useful in more individualized settings like GP general practitioner office In this case Smart Cardiograph window is activated either from Patient Browser or Examination Browser The current patient is already specified and there is no reason to reselect it in such a case So there are no DH Choose Patient and H Choose Previous Patient buttons on Acquisition control panel of Smart Cardiograph Another significant difference between the two scenarios is that you can stay using Smart Cardiograph in case of serial acquisition if of course the check box View is not set on After recording panel This is convenient if the user typically a nurse is just to acquire ECG without analysing them The second scenario supposes ECG diagnostic interpretation immediately after its registration that s why the check box Preview is set automatically and you cannot disable it After you have set the current patient you have to select the required examination type with the combo box in Acquisition Controls of Smart Cardiograph In the second scenario when you enter this window from examination window
110. his mode will have prefix DEMO The sets of these patients and patients created in the mode of real signal will not across each other The emulation mode can be used when there is no digital signal processor e No device This option allows you to work with seca CardioConcept properly when there is no ECG acquisition device This configuration is needed when computer is to be used as a workbench usually in local network for interpretation of ECGs acquired in another place on another workstation or with CardioPortable and stored in net database or sent via e mail In this configuration there is no possibility to evoke Smart cardiograph window and acquire ECG accordingly But you can view ECG from database create a new conclusion for it and save it ECG or a selection of ECGs sent through e mail can be stored into database as well Mail tab This tab allows you to configure Internet connection parameters in order to use telemedical functionality It contains the following groups of controls Dial up service combo box This combo allows you to select the dial up connection if you have several of them configured on your computer for dial up networking You can also select None for Dial up service In this case seca CardioConcept will try to connect to the Internet through local computer network If this is not possible the access in not configured properly or absent the telemedical functionality will be disabled User information group
111. hooting Hardware and system error messages CBMMD DLL not found or corrupt One of the files needed to run seca CardioConcept is missing Ask seca CardioConcept administrator to reinstall the programme COMPRESS DLL not found or corrupt Some internal error occurred during the work of DSP board If the error persists apply to technical support Emulation file not found or corrupt You are working in emulation mode but the emulation file which contains ECG data was deleted or corrupted Open Options dialogue choose hardware tab and look at the list of emulation files Check that all of them are present Choose different files using Browse button normally emulation files are located in EMU subdirectory of the seca CardioConcept working folder Patient adapter not connected seca CardioConcept cannot detect the presence of patient adapter Check the connection of patient adapter to DSP board If the error persists apply to technical support Time out when starting driver This error may appear when seca CardioConcept was unable to initialise DSP board and patient adapter during nominal time Wait 10 seconds and try to start recording again If the error persists apply to technical support Cannot open pipe for CT110 USB device CT110 device not found Please ensure that CT110 recorder is connected and turned on USB version of patient adapter or CT110 ECG recorder does not functioning properly First thing try to unplug the USB connector a
112. iagnostically relevant patient information and ECG features can be minimized in order to enlarge the ECG Display area The ECG Features panel of Rhythm Viewer contains the following ECG features Maximum minimum and average heart rate in beats per minute Maximum minimum and average RR interval in milliseconds Rhythm Viewer menu and toolbar Examination menu a Close command and Close button on Examination Toolbar ESC This command closes Rhythm ECG Viewer and returns to Patient Browser or Examination Browser whichever has evoked Rhythm ECG Viewer window Items to select examination type with the corresponding icons on the Examination Toolbar Export command allows to save examination with patient information or to save examination with anonymous patient Mail client command If Mail Client is not installed on your computer this button is disabled ECG menu Print command and Print button on the toolbar Ctrl P There is a difference between menu command and toolbar button The menu command invokes Print ECG dialogue that allows you to select printing device and protocol template before actually start printing Thus it is much more flexible but it takes more time and mouse clicks in order to print an examination report Toolbar button just prints the report on the current examination using default protocol template on the printer set as system default default printer name is shown in the tool tip of this button Record com
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114. iducial should correspond to QRS end in a lead in which it has the longest duration i e to the rightmost J point position among all leads The opposite is true while selecting QRS onset point that should correspond to the earliest sign of ventricular activation Thus global QRS onset Qon fiducial must be set to the leftmost QRS onset among all leads Positions of other fiducials should be set in similar way i e P wave onset Pon fiducial corresponds to the earliest atria activation P wave offset Poff fiducial to the latest P wave termination and T wave end Toff fiducial should fall on the end of the longest T wave but not on the U wave among all twelve leads Press Y OK when finished Now you have got basic ECG features properly set and basic ECG intervals calculated and they appear on ECG features panel Standard diagnostic statements seca CardioConcept uses ECG interpretive statements harmonized with SCP ECG proposals SCP ECG presents a set of standardized clinically significant diagnostic statements each of them mapped to a short code The proposed set is a result of broad international consensus among many cardiology experts and major manufacturers of ECG equipment The advantages of standardized statements are e Clinical relevance and meaning of each statement are both strictly defined and tested worldwide e Standard diagnostic codes are much shorter than their text representation That saves storage space of ECG databases an
115. if you want to collapse all open branches of statement tree Telemedical Workbench seca CardioConcept telemedical functionality seca CardioConcept can be used to exchange ECG recordings and diagnostic conclusions via the Internet as a special type e mail messages A special module is used for this purpose This module is called Mail client If you are not aware of electronic mail first see the section Understanding electronic mail basics and Understanding telemedical model This section will explain the use of Mail client layout menu commands and dialogues that are needed for telemedical ECG exchange Mail client window layout Mail client menu and toolbar Envelope dialogue Compose request dialogue Edit address entry dialogue Address book dialogue Mail Client layout ll x MedIT Concept 5 5 Mail client Exit Connect Message Tools Help LI Close pen Anewer WE Import Envelope Send rec Address 7 Received Patient Message status Recelved Examination type Patient Total 0 unread O O Menu and toolbar Mail Client menu and toolbar The Tree of Directories It is for storing different message types These are K Inbox folder contains just received messages Es Outbox folder contains messages prepared for sending Sent folder contains messages just sent and Archive folder contains messages passed through the complete processing i e these are either sent requests wi
116. in synchronization log Insurance company XXX created in off line mode exists in master database Local record discarded This message is written to the log file if the insurance company record transferred from the local database collides with that in the master database and the user attending synchronization discards the local record in favour of the one in the master database See the corresponding section for detailed explanations of data integrity rules used in seca CardioConcept Synchronized insurance company XXX not found in master database Record will be appended This message is written to the log file if the insurance company record in use in the local database is deleted from the master database prior the synchronization The record in the master database is restored in order to keep data integrity See the corresponding section for detailed explanations of data integrity rules used in seca CardioConcept Couldn t synchronize patient XXX Patient ID XXX Identical record exists This message is written to the log file if the patient record transferred from the local database collides with that in the master database If no one of the messages below follows the user attending synchronization takes no action Otherwise the following message provides description of user decision No changes are made in the master database and all relevant data is left in the local database After the problem is investigated it is possible to resolve it
117. ining a standard ECG record Normally it appears as working area of an examination window Standard ECG Viewer ECG Viewer general layout ECG Viewer Menu and Toolbar Common features of ECG Analysis Workbench windows ECG Display area Diagnostic Conclusion panel ECG Features panel ECG Callipers tool ECG Viewer general layout Patient DEMO Longman Andrew ie EZ e a e Record Compare Speed a ee 272000 1607 z me Mam Measurements Notch Hz dare EEE AR ee eee eee ee eee z ate P E it Low pass Hz Conclusions aa Date time Conclusion by The name of current patient is shown in the window title bar The main parts of Standard ECG Viewer are D Standard ECG Viewer Menu Standard ECG Viewer Menu will be explained in detail in the corresponding section Standard ECG Viewer Toolbar Standard ECG Viewer toolbar will be explained in detail in the corresponding section ECG Display area ECG Display area is the largest part of the window It is clear that ECG Display is intended to show ECG recording Examination Toolbar Examination Toolbar with examination icons on it Current version of seca CardioConcept supports only standard AA ECG record a and rhythm analysis ECG record types You can click an appropriate icon to view examinations of the corresponding type only Diagnostic Conclusion panel Diagnostic Conclusionpanel serves for browsing through available diagnostic
118. is Workbench Rhythm Viewer Compare ECGs rhythm analysis window New Conclusion rhythm analysis window ECG Display area ECG display of Rhythm Viewer consists of two parts The leftmost part contains lead names and reference millivolt signals for each displayed lead You cannot change the size of this part or remove it from the screen The other part displays full ECG curve Standard ECG paper grid is present as window s background to make it easier to analyse the curves visually If you want to make ECG Display as large as possible just hide ECG Features and Diagnostic Conclusion panels ita E e 4 LELLI E HH inam COC e SE You can scale the ECG curves with zoom tool Use scroll bars to change the visible part of ECG record The drawing of ECG can be rather lengthy so nothing is changed on the screen while you drag the box on the scroll bar The visible part of the ECG will change as soon as you release the left mouse button Use Quick Navigation panel for navigating lengthy rhythm recordings Diagnostic Conclusion panel This panel allows browsing through all diagnostic conclusions attached to a specific ECG recording There is a special button l in the top left corner of the panel that can be used to switch the panel on off in order to enlarge ECG display area There is no automatic conclusion for rhythm analysis ECG record If some re reading by one or more human experts occurred created
119. is transferred to an office desktop or to a server with seca CardioConcept installed after the rounds for permanent storage Recordings of the patients that require frequent electrocardiographic assessment are accumulated in the course of day to day work so it is practical to compare a newly recorded ECG with the relevant previous ones directly at the site of examination rather than postpone the final judgment until return to the office A full set of data is still available at the office at any time Switching between operation modes First the mode of operation can be chosen while launching seca CardioConcept application Just select the corresponding radio button in the Login Window Make sure the computer is properly connected to the network if you are intended to work in on line mode Otherwise an error message will appear and you will have to login again If you use Windows NT operating system you may need to restart seca CardioConcept or even reboot the laptop to enable network access The second procedure can be used if seca CardioConcept is already running Normally it is used for switching CardioPortable off line after synchronization but this is not obligatory Use the CardioPortable Control Window button for turning on the mode alternative to that the programme currently is If you click it with the mouse Login Window appears and prompts you to enter your user name and password The programme will switch to the required mode of operation aft
120. ked window Bwincow Toolbar Standard Y OK and x Cancel buttons OK button saves the modifications you made to the database Cancel button allows you to close the window without saving modifications Certain rules are applied to the data before it is saved into database These checks are necessary for database integrity See the section Patient Database Management for detailed explanations QD pata Fields You can specify the following patient information e Last name The field is marked by an asterisk It means that this field is required The Last names of the patients who were created in demonstration mode have prefix DEMO See section Hardware tab for more detailed explanations e First name e Middle names e Patient s unique ID It can be case history number social security number or whatever you use in your institution in order to uniquely identify patients ID number must be either absent or unique You can use an arbitrary string of signs as an ID number Norwegian Swedish and Danish policy numbers can be used in addition In this case birth date and sex are set automatically when the focus moves to another field It also happens when you enter sex or birth date Before the windows with these data are closed there will be another comparison of policy number with birth date and sex If there is any disagreement a warning will appear on the screen and the window remains open Birth date It is entered using a mask for the curre
121. l ECGs of Ms You should know her will be still linked to Mrs You should know him as well after she marries and consecutively changes her name It may seem unnecessary to look up patient name each time you are going to register a single ECG but it can save you a lot of time when the number of ECGs grows The database management system helps you to keep all your examinations in proper order practically it forces you to do so and you never loose or shuffle any patient or examination record See next section Patient database integrity rules for detailed explanations of rules applied to patient records Patient Database Integrity Rules The following rules are applied whenever a patient record is created or modified e f patient s first name or middle name consists of a single letter the programme considers the letter to be an initial and adds a period to it e For each patient the following information should be specified e Last name e Birth date Birth date should be a correct date after January 1 1900 and before the current date e Patient s sex e Patient Exists window appears to help you identify and correct the problem if the following is the case e If patient s ID is not unique e f patient s insurance policy number is not unique e f a patient exists with the same full name sex race and birth date If similar patients exist i e patients with the same surname sex birth year and at least one initial they are listed in Patient E
122. l button 1 in the top left corner of the panel that can be used to switch the panel on off in order to enlarge ECG display area The following patient and ECG acquisition information is shown if specified Patient s sex Patient s age Virtual paper speed of ECG display Virtual calibration Notch filter frequency in effect at acquisition Low pass filter frequency in effect at acquisition Mean heart rate in bits per minute In New Conclusion window you can double click the HR field and enter the value manually in Enter heart rate dialogue The following ECG features are shown if standard ECG record is being viewed or analysed e Average RR interval in milliseconds If you decide to analyse an ECG record from scratch i e without employing seca CardioConcept automatic interpretation features you have to enter average RR interval by hand While in New Conclusion window you can double click the RR field and enter the value manually in Enter average RR dialogue Representative cardiocycle P wave duration in milliseconds Representative cardiocycle PQ R interval duration in milliseconds Representative cardiocycle QRS duration Representative cardiocycle QT QTc duration in milliseconds Representative cardiocycle QTd QTdc in milliseconds If you are not going to utilize seca CardioConcept automatic diagnostic capabilities while creating a new conclusion you can enter the value manually in Enter QTd dialogue by double clicking the QT
123. l invoke a standard Windows dialogue Save mail message as file e Import command allows to import ECG from mail message file into database It opens a standard Windows dialogue where you can choose a file from importing Add to address book command and e Address book button open Edit address entry and Address book windows These windows are used for entering saving and editing the recipients e mail addresses Envelope Dialogue This dialogue is used for editing message envelope within the Mail client Standard Y OK and x Cancel buttons close the dialogue saving or discarding changes correspondingly You can change recipient s e mail address and the message text for request or answer depending on the message type The Urgent check box marks the message as an urgent one The check box Put into Outbox marks the message as ready for delivery and places it into Outbox only for requests received by consultant with answer already prepared If you do not check this box the message will remain in its folder and will not be sent Afterwards you can drag it into the Outbox folder using the mouse This check box becomes inaccessible when you are editing the message which is already in the Outbox folder Compose Request Dialogue This dialogue allows you to prepare an examination possibly accompanied by several examinations of the same or another type to be send to remote consulting service Compose request x OF Cancel Address e E end to
124. lected Standard I Il Ill aVR aVL aVF or Cabrera aVL I aVR II aVF Ill ECG leads presentation scheme can be set with Lead sequence radio buttons A special size adjustment button can be used for calling Screen Adjustment window Hardware tab MedIT Concept 5 5 Options Ioj x UK Cancel Simulation Files EMU 019 emu EMU 020 emu EMU 0217 er EMU O22 emu EMU 023 emu EMU O24 emu EMU 025 emu EMU 026 emu E MUSO emu MUNO emu EMU 0Z29 emu EMU O30 emu EMUNMLT emu EMILIO emu EMUO emu EMU O34 emu EMU O35 emu EMU O36 emu EMU Os emu Chal lita meaa Browse Device type CardioBase 5A f CardioBaze USB MedlT Sense USB Ce Simulation f No device On this page the user can specify seca CardioConcept hardware settings A group of device types is shown to the left e CT110 USB device type delivered by MedIT as e Simulation This check box set emulation mode By choosing it a list of emulation files appears to the right Using Browse button you are able to choose one or several files with beforehand recorded ECGs These ECGs will be used instead of real signal The ECG files emu are copied to the hard drive during the seca CardioConcept installation Please note that emulation mode should be used for demo purposes only By choosing this device type the programme is switched off to the demonstration mode All the names of the patients created in t
125. lection dialogue e Select examinators and select users who signed conclusion dialogues e Select filtered diagnostic statements dialogue search By Patient ID and by Insurance Policy dialogues These are two dialogues you can use to enter patient ID or policy number in order to quickly locate a patient with specific ID or insurance policy number Both dialogues are similar and look like this here you can see Enter searched ID dialogue The window has one edit box to enter patient ID or policy number Toolbar has two buttons with functions i OK starts search X Cancel closes the dialogue without searching Choose filtered sex and Select filtered races dialogues One of these dialogues opens when the user wants to filter patients by their sex or by their race The dialogues are similar and contain check boxes for selecting filtration parameters x w N DE Cancel M JUnspecihed F x T Coucasan KE kee C Black Es Male FT Drena Female The windows have check boxes for each possible sex or race values User can choose one of the sexes and only patients of this sex will be shown User can check any of the boxes in Select filtered races dialogue Patients belonged to any of the selected races will be shown Toolbar has two buttons with apparent functions Y OK start filtration x Cancel no filtration select filtered insurance companies dialogue Select filtered insurance companies 8 xj XK OK Cancel
126. mand and Record button on the toolbar Ctrl R This icon evokes Smart Cardiograph application in order to register new ECG for currently selected patient in rhythm analysis mode Ye Compare command and Compare button on the toolbar Ctrl O It invokes Compare ECG window You normally use it if you want to perform serial analysis of ECG records of the same patient ECG List command Ctrl L and ECG List combo box on the toolbar You can use it to walk through examinations of currently selected type that are available for the current patient The difference is that ECG List menu command opens Choose ECG dialogue Send to consultation command This command opens Compose request dialogue that is used for sending currently viewed ECG for consultation via the Internet Mail If Mail Client is not installed on your computer this button is disabled Conclusion menu New command and Write New conclusion button on the toolbar Ctrl N This command invokes New Conclusion window if you want to make a new diagnostic conclusion Ji Previous Next command and buttons on Diagnostic Conclusion panel Use it to browse through diagnostic conclusions stored in database Tool menu gt Measurement command and button on the toolbar Ctrl M A Zoom command and button on the toolbar Ctrl Z Commands of this menu switch between measurement mode and zoom mode These modes control how ECG Display responds to mouse clicks ECG Callipers tool is active in meas
127. mpare ECG window menu and toolbar Y Standard OK button closes the window and returns to ECG Viewer Lead menu I Ge Current lead button and the corresponding command It is used to set the compared lead in per lead mode Tool menu e K Measurement command and button on the toolbar Ctrl M e A Zoom command and button on the toolbar Ctrl Z These commands switch ECG Display between measurement mode and zoom mode These modes control how ECG Display responds to mouse clicks ECG Callipers tool is active in measurement mode thus you can measure time intervals and amplitude differences directly on computer screen To the opposite left mouse click acts as zoom in command and right mouse click acts as zoom out command in zoom mode The point you click while you are zooming in will be approximately in the centre of the window View menu o ECG command and toolbar button Ctrl E It switches ECG Display into per lead mode Representative Complex command and toolbar button Ctrl C It switches ECG Display into median complexes mode Complex superimposition command and toolbar button Ctrl 0 It switches ECG Display into superimposed complexes mode e Scale command and toolbar combo box You can set precise zoom factor with this combo box Just select the scale from the list or enter the number into the box and press ENTER Menu command opens the Set Scale dialogue e Calibration command and button SE Speed command a
128. nce company Search strings When you start typing in the Patient name field seca CardioConcept tries to locate the patient whose name starts with the letters you type and moves selection indicator on the corresponding line It is not started immediately but after a 1 sec delay allowing user to enter full search string Sometimes search can take considerable time You can also search a patient by entering his her birth date in Birth date field The date format looks something like this ddmmyy where d stands for day digits m stands for month digits and y for year digits In order to return to the full patient s list you can turn this filtration off by using By birth date command in Filtration menu or the corresponding button Y Number of patients Field It displays the Number of patients in the patients list If you apply some search or filtration criteria the field changes in accordance with the number of patients actually selected Edit Patient information Window Edit patient information Yo UK Cance Last name First name Middle hamez ID A emarks a Birth date 15 12 1967 DO Mi Y Policy number Insurance company x This window is used to edit information in the patient record Depending on the situation whether New patient or Edit patient commands have been used Enter new patient information or Edit patient information will be displayed on the title bar of invo
129. nchronized data option is on all data that have been successfully uploaded is deleted from the local database Otherwise the operator is prompted to delete it Removal of synchronized records from local databases can be primarily stipulated by privacy considerations It is useful to keep the local database small for performance reasons as well The log of the messages generated during the last synchronization is shown in Log information area of the CardioPortable Control Window Alternatively you can view the file lastsync log that resides in seca CardioConcept installation folder C Program Files Cardio Concept by default in any text editor As information describing all errors and exceptions that took place during synchronization are written in this file you can use it to backtrack the problem If some synchronization errors persist it is a good idea to send a copy of lastsync log file to seca CardioConcept technical support Off line operation mode specifics What you can do in off line mode The following functionality is available in off line mode e Adding new patient records e Adding information of insurance companies e You can edit or delete patient and insurance company records until they are synchronized e ECG can be acquired for the newly entered patients as well as for those whose records were downloaded from the server synchronized e New diagnostic conclusions can be created for any ECG recording stored in local database It is w
130. nd Synchronize command It is clear that these button and command can be used for launching synchronization e Info fields that show date and time of the last synchronization and the name of the user that performed the action Y Stop button and the corresponding command It terminates synchronization process as soon as the current record is transferred This function can be useful in case an urgent need for ECG machine occurs right in the course of data transmission Tools menu m Purge synchronized data button and the corresponding command e Info fields that show the time of the last deletion and the name of the user that performed the action D Clear log button and the corresponding command You can delete all messages from the log by clicking this button e Log information area that shows the messages in synchronization log file If some messages are hidden you can use scroll bar to make them visible e Work time indicators the fields Elapsed time and Estimated time During synchronization these fields show actual time elapsed from the start of the process and full time estimation calculated on the data transferred rate so far e Check box Autodelete synchronized data If this option is on all the data successfully transferred to the master database is deleted from the local base Otherwise the programme prompts for purging the local database every time synchronization completes seca CardioConcept configuration utilities User
131. nd button They provide for selection of virtual amplification and paper speed If you just click the button itself you change amplification or speed to its default value 1 cm mV and 50 mm sec correspondingly Please note that Calibration and Speed buttons have arrows on the right Use them to open lists with available amplification and paper speed values You can set 0 5 cm mV 1 0 cm mV and 2 0 cm mV amplification and 5 10 12 5 25 50 100 and 200 mm per second paper speed The amplification and paper speed you set with these commands are remembered by seca CardioConcept and used next time you open ECG Viewer You should remember that amplification and paper speed are virtual i e they set curve sizes relative to the paper grid Unlike a regular analogous ECG curve digitized ECG signal can be extended to any amplification and paper speed without distortion In the contrary zooming changes the visible size of both the curves and the grid e Markers command turns on off the ECG fiducial markers on median complexes in median complexes mode e Parameters panel command e Conclusion panel command These commands and panel buttons hide show the corresponding panels e Colours command evokes Choose colours for viewer dialogue It allows you to select colours for ECG representation elements ECG curves grid etc ECG Compare modes Comparing ECG in single lead mode As it was told the Compare ECG window has three groups of display mo
132. nd plug it in again If this does not work you have to reinstall USB driver If this fails as well call technical support Device not working properly Something is wrong with seca CardioConcept ECG acquisition hardware Shutdown and restart the computer If the error persists call technical assistance Not enough memory to run diagnostics This error may occur if too many Windows applications are loaded at the same time and thus too little is rest to seca CardioConcept Close unused application and repeat the operation that was interrupted by the message This language is not supported by the system You are trying to set seca CardioConcept interface language in conflict with Window international settings Install National language support you need and try to reconfigure seca CardioConcept again Error opening device driver An error occurs while loading seca CardioConcept ECG acquisition driver Reboot the computer If the error persists call technical service Database connection error messages Access verification failure Check login and password When seca CardioConcept is started you have to enter login name and password seca CardioConcept was either unable to find login name in the list of user accounts or the password is incorrect Try to enter login and password again If error persists apply to seca CardioConcept administrator Login is not unique This message may appear when you add new user or edit user information You can have
133. ndow User is prompted to save changes if any modifications have been made Page menu E Add page command and toolbar button It adds new page to the end of protocol template 5 Delete current page command and toolbar button It removes the selected page from the protocol template A combo box for changing current page of the edited protocol M First page command and toolbar button sets the first page of the template as the current page e Previous page command and toolbar button sets the previous page of the template as the current page If the first page is shown the command and button are disabled Next page command and toolbar button sets the next page of the template as the current page If the last page is shown the command and button are disabled e Last page command and toolbar button sets the last page of the template as the current page Object menu Insert command and Objects toolbar button A hierarchical menu opens if you choose it It contains objects layout elements of three categories e Elements of patient data record e Elements of ECG data record The set of available elements depends on the type of the ECG record for what the protocol template is designed either standard ECG record or rhythm ECG record e Text blocks i e labels containing an arbitrary text Just select with the mouse an object you want to see in the protocol page Mouse cursor will turn into a cross Click on the layout area to pl
134. nds switch ECG Display between measurement mode and zoom mode These modes control how ECG Display responds to mouse clicks ECG Callipers tool is active in measurement mode thus you can measure time intervals and amplitude differences directly on computer screen To the opposite left mouse click acts as zoom in command and right mouse click acts as zoom out command in zoom mode The point you click while you are zooming in will be approximately in the centre of the window for your convenience View menu e ECG curves command and toolbar button Ctrl B J Representative complex command and toolbar button Ctrl C These commands turn on off full curve and median complex ECG representation You can see both if you wish ECG Display area is divided into two unequal parts The left larger area contains full curve ECG representation and the narrow right one contains median cardiocycles e Scale command and toolbar combo box allow you to zoom the ECG curves You can set precise zoom factor with this combo box Just select the scale from the list or enter the number into the box and press ENTER Menu command opens the Set Scale dialogue A special fit scale is used to set such a scale when all twelve leads are seen simultaneously D Calibration command and button iadi Speed command and button They provide for virtual amplification and paper speed selection If you just click the button itself you change amplification or speed to its d
135. ng new ECGs with previously acquired ones and creating new diagnostic conclusions One of them is the main one For example you start viewing standard ECG recordings and get access to other windows and tools for ECG analysis in a window of this type The name of the current patient is shown in the window title bar Depending on examination type either ECG Viewer or Rhythm Viewer fills the window client area The current examination type is represented by the pressed button on the Examination Toolbar see the picture below ze e nm ht if wie HR gt ei 014 44 Ar B r s ln A Jl gt MA ml alll Li l TL b Ariel Sr 1 4 e dd tad E i You can click on icons in order to browse through examinations of required type Please see sections Standard ECG Analysis Workbench and Rhythm Analysis Workbench for detailed description of examination windows and other components of ECG Analysis Workbench standard ECG Analysis Workbench Examination window of Standard ECG Analysis Workbench seca CardioConcept Standard ECG Analysis Workbench consists of several window types that are used for viewing ECG recordings comparing newly acquired ECGs with previous ones and creating new diagnostic conclusions The ECG Viewer is of examination window type and contains Examination Toolbar to change the examination type to be viewed This is the main window of Standard ECG Analysis Workbench through which you can access all the examinations of t
136. ng this directory as a shared network resource Consult with network administrator before making any changes in some organizations these changes can be done only by network administrator Please note that the workstation can slow down under these conditions thus the variant with file server is preferable Configuring seca CardioConcept for working with Oracle server If you choose the variant of installation with using of Oracle database then Oracle sub directory will be created in the installed seca CardioConcept directory by default C Program Files Cardio Concept Files CB5 sq OracleDM exe n readme txt can be found in this directory In the last one there are instructions for creating ECG database at the Oracle server The administrator of your Oracle database server can use these instructions to create a seca CardioConcept database this should be done only once At every workstation Oracle client software should be installed Installing CardioPortable Installation of seca CardioConcept in client server configuration is a prerequisite for CardioPortable setup on a portable computer Please read corresponding sections for the detailed description of seca CardioConcept installation procedure It is not necessary to connect the laptop to the network before the install On the other hand a newly created local database must be synchronized with the master database before use and this definitely requires network access to be up and running
137. nly when editing or deleting a user account in the network configuration as in the standalone configuration all the data is refreshed automatically El Close command and toolbar button User menu E New User command and toolbar button Ctrl N It evokes Add New User window where you can create a new account Edit User command and toolbar button Ctrl B If you want to edit any user account you can open Edit User Information window using this command or button a Delete User command and toolbar button Ctrl D Use it when you want to delete a user account It is worthwhile to notice that it is impossible to delete a user if he she is referenced in the database user reference is stored with every examination and or conclusion If a user does not work with seca CardioConcept any more just disable his her account to prevent unauthorized access to the database Edit User Account Window The dialogue has either Add New User or Edit User Information title bar it depends on what it is used for The window has the same data fields as User Administration main window except that you can enter new values in any of them Data fields are blank if you create a new account The new user name you enter must be unique It is impossible to create two accounts to the same user If you decide to change something in an existing account for example after change in address or if you want to disable the account of a retired person the window will contain
138. nnecessary conclusions in the tree panel on the left side of the wizard s window You cannot delete a statement directly from the list Instead you have to use a tree panel for that The Wizard behaves in the following way in order to make it easier for you If a statement is selected in the statement list on the right the tree view automatically moves focus and selects the same statement in the tree structure on the left Just uncheck the statement in the tree and it disappears from the list The tree view organizes all the statements in several categories which represent parts of standard ECG conclusion You can expand or collapse the branches of conclusion tree in order to navigate through the tree structure easily When you add a statement dialogue with additional attributes like probable or acute appears if appropriate for the statement s semantics When you add a statement from the tree it appears in the statement list on the right After you add and delete some statements in an arbitrary order the sequence they appear in the conclusion may be wrong Use Up and Down buttons below the statement list to change the position of selected statement within the conclusion You do not need to open the Conclusion Wizard in order to add a single standard diagnostic statement to the conclusion If you press E Add Diagnostic Statement button on the Diagnostic Conclusion panel the Add Diagnostic Statement to your conclusion window appears You can easily pi
139. nt date format Date format can be changed in Options dialogue Please notice that the date format is shown according to parameters set currently rather than at the moment the record was created If you set year of birth as date presentation format in Options dialogue then you need to enter the year of birth only In this case January 1st of corresponding year is automatically recorded as the day of birth Notice that ESC or Cancel buttons restore the previous value This field is required Sex It can be selected from a combo box with a fixed list Unspecified Male Female This field is required and only male or female can be entered as a new patient s sex Race It can be selected from a combo box with a fixed list Unspecified Caucasian Black and Oriental Patient s address Remarks a free text field for any additional patient information Insurance policy number This field must be either empty or unique e there mustn t be any other patient with the same policy number Otherwise a warning appears that the patient with the same policy number exists e Insurance company name It can only be chosen from a list of companies that are already stored in the database by pressing a button 7 Choose company This button invokes a window Choose insurance company Both the company and the policy number must be present or absent You can press Delete button A in order to delete insurance company information from the patient s database record
140. nterval in milliseconds Quick Navigation panel e a toieder deie deh aia gem aiis aia iaia aa om il F TE De E ps pn zi d J t ER Te This panel shows one lead of long ECG record with virtual paper speed 10 mm sec so that a lager section of the whole recording is seen Two blue vertical lines with arrows aimed towards the visible part of ECG show the limits of the record part currently displayed in the ECG Display area Clicking the left mouse button on Quick Navigation Panel moves the curves in ECG Display area thus alleviating navigation within the long recording Sometimes the lead used in Quick Navigation Panel is not good enough for navigating a specific ECG You can easily change it by choosing another tab of Quick Navigation Panel ECG Callipers tool The Callipers tool can be used in all Rhythm Viewer Compare ECGs rhythm analysis and New Conclusion rhythm analysis windows Just press Measurement button on the toolbar or use Measurement command of Tool menu and then point somewhere on ECG curve click left mouse button and drag the cursor to another location at your choice A line connecting two selected points will appear on the screen together with a small window Time and amplitude difference between two selected points will be displayed in it The time difference is presented in two forms for your convenience as time interval in milliseconds and as the corresponding rate in beats per minute Please noti
141. oConcept The process of changing conclusion for rhythm analysis ECG record is covered in Analysing rhythm ECG records section This section explains the editing conclusions for standard ECG records Click New Conclusion button if you want to tune the existing software or user generated conclusion A dialogue appears This dialogue allows you to specify which parts of present conclusion measurements diagnostic statements or both you want to use as starting point for modification If measurement and conclusion check boxes are turned on seca CardioConcept will use existing data Otherwise you will have to create all conclusion components from scratch The programme switches to New Conclusion Window If you have not selected measurements check box at the previous step just press consecutively pa Automatic Representative Complex and st Automatic Fiducials buttons to allow seca CardioConcept determine median cardiocycle and fiducials Correct the fiducial position if required see the more detailed description in the next section Now you are ready to create a diagnostic conclusion and Automatic Conclusion button is enabled Just press it and the programme will select statements in accordance with new set of ECG features You should open the Conclusion Wizard in order to edit a ready conclusion The previous conclusion is displayed as a template if you have selected conclusion check box at the beginning Check any additional or uncheck u
142. of ECGs being compared ECG features and Diagnostic Conclusion panels show data related to the currently selected ECG the currently selected ECG is framed in blue box and pressed Arrow button points at its combo box When you change the displayed ECG the corresponding panel is chosen automatically Comparing ECG in complex and overlay modes The last one group is represented by complexes and overlay modes Median complexes are organized in rows in ECG display area If one of ECGs has not been analysed and thus median complexes are absent the corresponding row is empty The ECG features panel and Diagnostic Conclusion panel show the data related to the currently selected ECG Lead Select buttons are disabled This type of ECG comparison is very useful if you need to observe myocardial infarction evolution transient depolarization changes ina ventricular hypertrophy patient etc Compare ECGs f X Tool view AS A oe e an st OK View Measure oom Calibration Sneed Il III aA aL ENN Vi We Vi Tal E a 21 07 2004 15 57 37 Main Measurements Patient into DEK ge 223740 E de PE Less AN db TER ECG presentation info speed mm sec DU D Calibration emie 1 Filters Notch Hz Low pass Hz 21 07 2004 16 03 54 21 07 2004 IA Conclusion Med Concept suggested conclusion Sinus rhythm ASr type in Vl or V2 Borderline ECG Datetime 2
143. of the element Database field contains text representation of its value and has the properties similar to a text block e Font Font size Charset property specifies character set that is used for field text Font style property sets plain bold or italic font style Top and Left properties determine distance of the element left top corner from the page left top corner in mm e Height and Width that determine the size of the element in mm ECG element properties vary depending on the element subtype The following are the common ECG element properties e Font used for displaying lead names etc e Font size e Charset property specifies character set that is used for text e Font style property sets plain bold or italic font style e Top and Left properties determine distance of the element left top corner from the page left top corner in mm Single ECG lead block specific properties e Lead name Use the combo box to change the lead to be displayed e Lead height It determines the vertical space used for displaying the curve in mm Speed Virtual paper speed used to display the curve Calibration Virtual amplification used to display the curve Presentation property It can be short or full The property determines whether the lead block can expand in order to accommodate all curve length Median complexes block specific properties e ColCount property sets the number of columns used for displaying the representative cardiocycles of all leads e Le
144. on error MESSAGES cccooccccoccncccccnccnncnononononnnnnnonnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnonencnnnos 92 Jean le in un E Let 92 n or LEE 93 Messages IMi NEIEN ENEE 93 Installation Installation of seca CardioConcept on your conputer To install seca CardioConcept 5 5 programme on your computer run SETUP EXE from the SETUP directory of the installation CD The setup programme will do the rest for you just follow its instructions In order to acquire ECG you need to attach patient s adapter to USB computer port via a special USB adapter In order to use USB adapter first you should set up seca CardioConcept and then install a driver for this adapter see the corresponding section You should have administrative rights for installation of seca CardioConcept in Windows NT and Windows 2000 See section Configuring for further details on tuning up seca CardioConcept system Installation and configuration of the programme for work with USB adapter The drivers for CT110 device are normally installed during program setup When you plug CT110 device after driver installation and reboot the hardware will be recognized automatically and Windows New Hardware Wizard will lead you through driver installation on a specific USB port In case of Windows XP it looks like this cartoon Found New Hardware Wizard Welcome to the Found New Hardware Wizard This wizard helps you install software for MedIT IMI USB Device V2 H your h
145. on the toolbar You can use it to walk through examinations of currently selected type that are available for the current patient The difference is that ECG List menu command opens Choose ECG dialogue Send for consultation command This command opens Compose request dialogue that is used for sending currently viewed ECG for consultation via the Internet Mail Mail Client application that allows you using Internet Mail for remote ECG consulting is an optional application and is licensed separately If Mail Client is not installed on your computer this button is disabled Conclusion menu e 7 New command and Write New Conclusion button on the toolbar Ctrl N This command invokes New Conclusion window if you want make a new diagnostic conclusion bas View Fiducials command and View Fiducials button on the toolbar Ctrl F This icon invokes Viewer Fiducial points window You normally use it for checking how seca CardioConcept set fiducial points on representative cardiocycle a ECG features table command and ECG features toolbar button Ctrl T It calls View ECG Features Table dialogue where you can find out all the features calculated by the programme e Previous Next command and buttons on Diagnostic Conclusion panel Use it to browse through diagnostic conclusion history stored in database Tool menu e K Measurement command and button on the toolbar Ctrl M e A Zoom command and button on the toolbar Ctrl Z These comma
146. opriate patient Emale Standard Cancel button allows you to close the window without modifications Menu and toolbar Patient menu El New patient command and toolbar button Ctrl N Press this button to invoke Enter New Patient Information window and create a new patient record Edit patient data command and toolbar button Ctrl E Press this button to invoke Edit Patient Information window and edit selected patient s record A Delete patient command and toolbar button Ctrl D This button deletes patient s data and all his her examinations Insurance company menu Browse command lt opens Browse insurance companies window The latter can be used to modify information about insurance companies Search menu Search by ID command Ctrl l opens Search By ID dialogue You can also use search button EI next to ID field box Search by policy number command opens Search by policy number dialogue You can also use search button EI next to Policy number field box Filtration menu It contains commands to filter by birth date Ctrl B by sex Ctrl S by race Ctrl R and by insurance company You can also use filtration buttons Y next to the corresponding field box Filtration buttons remain pressed when the corresponding filtration is set It is necessary to release the button in order to turn a specific filtration off These filters are saved after you turn them off until you close the window So you can easily repeat the
147. or printing Examination type to which it is applied Whether this is a default protocol or not e Paper orientation portrait or landscape e Margins When necessary information for the new protocol is specified or when the user chooses to edit a protocol Protocol Editor window is opened x OK button opens Protocol Editor window Only users with administrative rights can edit protocol templates e Cancel button closes the window without creating a new protocol template Protocol Editor window 21501 x Protocol Full disclosure with marks landscape Protocol Page Object View Help a oa al Add page Delete page AL Close Save Object E al Font size Standard ECG examination ECS features Charset ANSI_LCHARSET Font style E old l 17 Top Height Lett Width Text ECG Features Table oom i oom out Preview lee oo Font Page 414 Object Label O Menu and Toolbar Protocol Editor Menu and Toolbar The title bar of the wndow shows the name of the loaded protocol template Object Property Area Properties of selected layout element object like font size and dimensions are shown in this area You can enter property value directly into the corresponding text box e g label text choose the value from combo boxes e g paper speed for displaying ECG curves or call standard Windows dialogue for setting font typeface and size etc See section
148. orthwhile to notice though that the ECGs and diagnostic conclusions made in on line mode are not uploaded at synchronization Print examination reports on a printer connected to the portable computer Edit protocol templates in the local database These templates will be accessible in off line mode only Change the programme settings The changes will affect both modes send the electrocardiograms in the local database to a remote consultant and receive the answers of the consultant through e mail e Receive ECGs for reviewing and send the conclusions back through e mail The received recordings can be imported to the local database Things that cannot be done while off line Two types of activities are not allowed while in off line mode even for user with administrative privileges e Although you can modify or delete non synchronized patient records any patient related data e g patient records or insurance company records that are downloaded from or successfully uploaded to the master database cannot be changed or deleted while seca CardioConcept application is in off line mode e User accounts cannot be modified created or deleted in off line mode In order to correct create or delete patient records insurance company records or user accounts you have to switch the seca CardioConcept application to on line mode You also need to carry out synchronization for the changes become available in off line mode Error messages and troubles
149. over answered request is stored in archive e Answer achieved processing cycle of the answer is over answered request is forwarded to archive e Time stamp It indicates the date and time the message has reached the processing status as indicated in the previous field e Examination type of the main examination in the envelope e Patient s name Messages Body Panel It contains two text fields that are associated with every message The request message is filled in while preparing the outcoming envelope and normally contains the information that explains the consultation goal and patient s conditions The answer message contains the recommendation of the expert that cannot be expressed in standard ECG diagnostic conclusion These fields can be filled by using Envelope dialogue see Envelope dialogue Mail Client menu and toolbar Connect menu e Send Ctrl S and Receive Ctrl V commands and Send Receive messages combo button on the toolbar Use these commands to connect with your Internet Service Provider and send receive messages via the e mail server Small down arrow on Send Receive messages combo button opens a list with Send and Receive items that stands for the corresponding menu commands If you click the Send Receive messages combo button itself a combined delivery will be initiated i e seca CardioConcept will connect to the server and receive the available messages first and send queued messages afterwards Message menu
150. ow If you select a new representative cardiocycle before opening this window only enlarged ECG curves will be seen Otherwise you will see vertical lines each marked with fiducial point name These lines show positions of fiducial points on representative cardiocycle You can change the position of a line by dragging it with the mouse Right clicking on a fiducial line removes it Left clicking on fiducial name changes this name from Pon through Toff If required fiducial is absent just click on the place where it should be and then set proper name and adjust the position of newly created fiducial It is clear that nothing will happen if you click to the left of Pon line or to the right of Toff line For more detailed information see section Creating a conclusion from scratch View ECG Features Table i par par g s 4 12 Ka AE S AE E Seuil ERES enanss wi This dialogue shows all ECG features extracted by seca CardioConcept diagnostic algorithms for each lead PQ R duration amplitude of R and Rr and etc You can examine this table in order to save the work of calculating these ECG features manually Another application is finding out why seca CardioConcept generated diagnostic statement you are interested in set Scale Dialogue This dialogue contains radio buttons to select fixed scales of ECG presentation and a text box to enter numeric value of magnification factor The dialogue has standard
151. pin button for setting length of rhythm analysis ECG record in seconds You can change the length of record from 20 seconds to 5 minutes 300 seconds by 10 second increments Use arrows on the spin button for this purpose because you cannot enter the length of the record directly Notice that monitoring is paused as soon as you change recording time This control is disabled if standard ECG record is selected After Recording panel lt TEET rreran AE Sere eae So rn HHFH H i Alter recording Preview ECG vw Save Add remark IY Analyse Frit a View The following check boxes are available Preview ECG if this check box is on Check the Quality of ECG window will appear as soon as ECG signal is acquired and before it is saved into the database You can repeat the recording immediately if the quality of the signal is unsatisfactory e Save save signal to database after acquisition e Add remark if this check box is checked Add remark to examination window will appear as soon as ECG signal is acquired There you can write any comments on this recording They will be saved into database and can be later viewed from Examination Browser Analyse turns on automated generation of the conclusion This check box can be set only together with check box Save or Print e Print immediately print the acquired ECG on default system printer using the default protocol template View switches to ECG
152. races dalogues 18 Select filtered insurance COMPANIES dialogue occcccconcnccconccnconoconcononcnnnonarononnnnnnononcnnnnnnrnnnonnnrnnnnnnrnnnnnarnnnonanennnnneos 19 Filter by Examination Type dalogue EEA EEEAEEES AEEA EEn Eren tEn enren Enn 19 Specify filtered period dalogue AE 20 Patient Group Selection dialogue E 20 Select examinators and Select users who signed conclusion dialogues ooccccccoocncnccnoccncononcnnonnncnncnnarononanennononons 20 Select filtered diagnostic statements dalogue 21 ECG recording module Smart Cardiograph E 22 Smart Cardalographi la e usar id lis ibas 22 ECG acquisition parameters Cu EE 23 ES a GU MON CONOS ars rd asuntos 23 EE 24 Choose or Enter Patient WING OW stas dai dt iaa 25 Assign ECG to existing patient or Enter New Patient Info 26 Check the SEIT Ee ele EE 26 ECG Analysis en en NEE 27 Examination ln elle EE 2 Standard EGG Analysis Workbench EE 27 PREV CEN ATELY SIS KEE eegene eegene 43 Rule Reg ele EE 55 seca CardioConcept telemedical functionality ccoooocncnccconnnnconoccnnnnonnnnnnncnnnonancnnononcnnnnnnnnnnnnancnnnnnnrnnnonanennnnnns 55 Mail CIEE IA YOUN ekaa EE 56 Mail Cle nt Mme nur and too ba a a E ds ef EnVelope ER ee UE 58 Compose Request RE e EE 58 E GIt lee ere E ee EE 59 Address DOOK UA ica adds 60 Exportmessagesas GIAO GUC i siren aan sud aw ds eii eri 60 F210 Portable leie EE 61 Klee We ele EE 61 CardioPorable Contor WINdOWs cti do o ae leat sense cas
153. rnatively before ECG is actually recorded Two main types of records patient records and examination records are stored in seca CardioConcept ECG database Patient records contain data about patients i e patients surname address date of birth etc Examination date ECG signal curves averaged cardiocycles conclusions etc are kept in examination records Each examination record is internally linked to a certain patient record Saving ECGs into database means that each examination record is linked only to one patient record In order not to break this rule the programme demands to choose a patient record or to create a new one before ECG is recorded Database management system prevents creation of an examination record without the link to an existing patient being specified Thus no examination can be lost or hanged This is an example of data integrity Why is it important to support data integrity In traditional record systems it is always possible to mistype for example a patient s name Mr Smith and Mr Smiht become different persons since then and there is no way to look up all Mr Smith s ECGs except for careful browsing through all database in order to find all erroneous entries manually This type of mistakes cannot occur if you use database management system instead a simple traditional record system Another advantage is that if some data like address or family name is changed you have to enter changes in one place only so al
154. rowser window Assign ECG to existing patient or Enter New Patient Info This window appears immediately prior the completion of Emergency ECG Recording command and allows to assign an anonymous ECG to an existing patient or create a new patient record The button Assign links the ECG to selected patient Pressing ENTER key produces the same effect Close button leaves the ECG anonymous Le assigned to a virtual Emergency Acquisition patient Pressing ESC key produces the same effect In all other respects this window is similar to Patient Browser window Check the Quality of ECG Window This window displays the ECG just acquired giving you an opportunity to examine its quality etc Left clicking on the screen will zoom in the curves so you can peruse the details The point of the image you click with the mouse will be approximately in the centre of the window after zooming Right clicking will Zoom out the ECG image allowing you to see the general properties of the acquired record If you are satisfied with the curve quality e Y OK button and the recordings will be processed further i e saved analysed printed etc Otherwise click 2 Cancel button You will return to Smart Cardiograph and can repeat the acquisition process in order to obtain the ECG of proper quality ECG Analysis Workbench Examination windows Various windows of seca CardioConcept ECG Analysis Workbench are used for viewing ECG recordings compari
155. ry ECG recording module Smart Cardiograph smart Cardiograph layout Patient Emergency acquisition Oo xj Demonstration mode Sound Amplitude H y cu SR aM CS aM Standard ECG examination Recording time sec 10 E Alter recording JL TT TTT O e Preview ECG PPT TPT TASS O Add remark ETT I Print View AUT T KA BE EE E V E Ka aa aa aah E 5 This window is used to record ECGs in the manner similar to the work with a modern ECG chart The window occupies full area of the Windows desktop If you start ECG recording module from Control Centre window there are two ways to evoke Smart Cardiograph application whether you use Patient ECG button or Emergency ECG If you use Patient ECG button when Smart Cardiograph appears Choose or enter patient window will be invoked automatically You have to select a patient from database before monitoring if possible or use Emergency examination button Emergency ECG button serves for urgent ECG acquisition without prior registering the patient in the database Smart Cardiograph window appears and you can start acquisition process That is done so you can easily identify such recordings later and reassign them to appropriate patients in Assign examination to existing patient or enter new one window If you launch activate another application monitoring is paused automatically A special mess
156. s soon as monitoring begins The progress bar appears on Acquisition Controls panel during the rhythm analysis record acquisition process showing the percentage of long ECG that has already been saved to hard drive Long ECG recordings occupy much storage space so make sure that enough free room is available at the drive where temporary directory is located by default temporary directory is C WINDOWS TEMP Printing ECG You can print an ECG protocol either during the acquisition process or from ECG Viewer In order to print the protocol immediately after it is recorded just turn on the Print check box on After Recording panel of Smart Cardiograph window The ECG will be forwarded directly to the printer Make sure the printer is ready if you turn this option on The ECG is sent to the default system printer and default protocol template is used Another possibility is clicking the S Print toolbar button to quickly print the ECG you are currently viewing in examination window No dialogue will appear and the examination report will be printed using default protocol template on system default printer Use Print menu command if you need to change protocol template or use a different printing device Print ECG dialogue will appear so you can change the printer device if there are several of them available printer settings and protocol template to be used Browsing ECG examinations You can find the ECG recording in two ways First you can look up
157. s the same effect Protocol menu o E New command and toolbar button Ctrl N Use it to create a new protocol template e Edit command and toolbar button Ctrl E Use it to change currently selected protocol template New and Edit commands open Protocol Editor window where you can create or modify protocol layout If you create a new protocol New Printing Protocol windowappears first E Delete command and toolbar button Ctrl D Use it to delete a currently selected template A message box asking you to confirm the deletion appears before the template is actually deleted If a default template is deleted the first template on the list for the current language will be the new default e Make Default command Makes currently selected protocol a default printing protocol The template that has been set as default previously looses its default status Only users with administrative rights can create edit or delete protocol templates Tools menu Import command Ctrl l Allows user to import protocol template stored as prt file New Printing Protocol Window This window appears if you create a new protocol template You can specify the following information SS erota i wv N D Ceeg me RS Fe a Lt irii EOL gegeubeen Chat all Bees fee ees scer E Eesen T Laws Wee Ess ron ez e Name of the protocol should be unique for selected language Remarks concerning the protocol Size of the paper used f
158. st hide ECG Features and Diagnostic Conclusion panels and median complexes part of the display area see below ECG Viewer of a standard ECG record Patient DIA Buste Heleri x Fearon BOG Concdii n Tos Wew Help Ex A E ES Mg a ee fee at Eh nan BEL ri A Becke Compress Mesue Zoom Speed P E EE SEET Clg CU Le EAT ERs ech ern a h l ae EE SE GK ooo Aa AHH AH vt tee Piet a CERLE ahe Sec acces ELLA See LA EL T ETETE Sp EEEE pb PEF GRITE H KE a crt EFFET H CH ARTES EE a CET KC LEIA a mu nau Sg kri an DELLA EE LLL MAZA ETE TIA IAE EEN en EE Teel SS KE at Nah r Era hal Dk GEES Enan HE KEE LKCLEI E Hy HHHH CO DRSESsben TH an Sooo seuss Ane rb EHEHEHEH on 4 SHSSR RES HEEE e sua MT BAA PS BAPANA EEA A E TEMEM att Pa BREA De OR SLALI Mi Edade wu Spa End ral p Cee eg a oh LA titit T a a TTT a ET a Hitit POH KR ae erte e oe E SRSER A LL ar ee E a IN Ff HEN E HE KH E 1 En Sta TRI SE CET kort SR a L SR mr sa pana a You can scale the ECG curves with zoom tool The size of both full leads and median complexes changes simultaneously and as a result median complexes may not fit into the corresponding window Double click on the splitter bar between the ECG Display Area parts will change the width of median complexes area so as to make the whole length of complexes visible At the same time
159. th received answers or received requests with sent answers These messages include ECGs which were requested and texts of requests and answers If you select a folder on the tree you can work with ECG messages contained in that folder 2 The List of Messages The messages are stored in the currently selected folder The list is organized in columns e First column marked with exclamation sign contains the icon bg if the message is marked as an urgent one e The second column shows the type of the message and its processing status The processing status shows the stage of consulting cycle sending to consulting examining by the consultant receiving the consultant s answer and etc Several icon types are used for it The icon 5 indicates the outbox or inbox message contains a a is used for sent requests with delivery confirmation and the icon E contain consulting results And this icon indicates the outbox message includes the answer to the request Achieved messages are not marked graphically The confirmed answers at the consultant s side become achieved automatically The received answers at being consulted side become achieved manually only after the browsing e The third column contains the sender s or the receiver s address It depends on message status e The forth column indicates the date and time a message has reached the corresponding processing status e The fifth column contains the examination type of ECG attached to the m
160. the patient in Patient Browser and then activate examination window with all ECGs available for the patient Use ECG List combo box or ECG list command of examination wndow ECG menu in order to look for the specific ECG record you need Alternatively you can locate the ECG record you are interested in using Examination Browser Then activate the examination window from within Examination Browser and the required examination data appears in it in this case ECG diagnostic interpretation with seca CardioConcept Introduction As it was already discussed seca CardioConcept has a module for algorithmic ECG analysis With this module diagnostic conclusion can be created automatically Such an automated conclusion cannot substitute a cardiologist but can help a physician inexperienced in electrocardiography However the most important aim of automated diagnosis is to help the specialist in quick and perfect ECG interpretation directly on the screen without preliminary printing the electrocardiogram The point is that seca CardioConcept is primarily referred to integration into medical information systems and work in telemedical environments Under such conditions preliminary printing can considerably slow down the work and even put it into trouble It is not necessary to use automated diagnosis though and seca CardioConcept provides tools ECG interpretation in more traditional way Sure you can just print ECGs out and then write your diagnostic conclusion by han
161. ton Ctrl E Press this button to invoke Edit Patient Information window and edit selected patient s record A Delete patient command and toolbar button Ctrl D This button deletes patient s data and all his her examinations Insurance Company menu Browse command and button lt opens Browse insurance companies window The latter can be used to modify information about insurance companies Search menu Search by ID command Ctrl 1 opens Enter searched ID dialogue You can also use search button EI next to ID field box Search by policy number command opens Enter searched policy number dialogue You can also use search button EI next to Policy number field box Filtration It contains commands to filter by birth date Ctrl B by sex Ctrl S by race Ctrl R and by insurance company You can also use filtration buttons Y next to the corresponding fields Filtration buttons remain pressed when the corresponding filtration is set lt is necessary to release the button in order to turn a specific filtration off These filters are saved after you turn them off until you close the window So you can easily repeat the filtration with the same parameters No filtration command turns all filtration off Ctrl F All patients in database appear in the list of available patients Patient Information The following information is shown for the selected patient e Full name ID number It can be case history number social security number or
162. ual 61 seca CardioConcept Configuration UNMIS Soi A vee a elioe 62 SI A nee 62 MNO I FOLOCOIS EMO adas 64 8 9 6 acs A 70 Miscellaneous windows and dialogues oocccconcnconcccconccnnoncnononcnnnnncnnoncnnonnnnnnnnnn nn rn r rn rnr ron rn nnnnnnrrnnnrrnnrnrrnrnrrnnrnrrnaninnos 14 EARI MANOS cha cit A AE testers escrito AA 14 o ieee a tet ian anes ence neern nenne 14 Enoose ECOG Dal OO pala atrasado devil ee ee eee ee eee 74 VIEW Tell UC lel OMS e lo do pl ll 14 set Fidu ial Ta Cu e e EE 15 VIEW EOC Features TA O ce baat ede tess a a e e o e een uated 15 SEL Scale DIGIO GUC sian oto tens ads 76 Choose Colours for viewer Dialogue EE 76 Set Statement Modifiers RTE el EE 78 Enter Average Valles DIAS una A A A A AA a 78 Operating Instracions fleet aad do oirlo 78 Contiqufing seca CardloConce platas 78 E Eet Un Leg 78 Aral He Ee Re el in EE 78 Serena US TITS IN ct laa 79 CUSTOMIZING PHIMLEO ee e EE EE 19 Contiguring Internet Mall ACCCSS added acia 80 Managing seca CardioConcept database AAA 80 Patent Database Manage Men EE 80 Patent Database Integrity RUS us condal ti ideada 80 Recording looki g Ub and prnl ECOS sai a ad ias 81 Direc ECG Recording EE 81 Recording ECG from Smart Cardi ograph EE 81 PANUNG EE 82 Browsing ECG ln le te 82 ECG diagnostic interpretation with seca CardiOCOnCe pt oocccccccnccccnnccccnnccncnnonnnnnnnncnononnnonnnnnnnnnnnnnnnnnnnnnnnnnnnonnnnncnnncnns 82 lao re Le EE 82 Steps of computer ECG
163. urement mode thus you can measure time intervals and amplitude differences directly on computer screen To the opposite left mouse click acts as zoom in command and right mouse click acts as zoom out command in zoom mode The point you click will be approximately in the centre of the window Markers command and button on the toolbar Ctrl K This command turns on the user markers mode e itturns on User Marker tool The User Marker tool is used only for rhythm ECG record View menu e Scale command and toolbar combo box allow you to zoom the ECG You can set precise Zoom factor with this combo box Just select the scale from the list or enter the number into the box and press ENTER Menu command opens the Set Scale dialogue A special fit scale is used to set such a scale when all twelve leads are seen simultaneously E Calibration command and button K Speed command and button They provide for virtual amplification and paper speed selection If you just click the button itself you change amplification or speed to its default value 1 cm mV and 50 mm sec correspondingly Please note that Calibration and Speed buttons have arrows on the right Use them to open lists with available amplification and paper speed values You can set 0 5 cm mV 1 0 cm mV and 2 0 cm mV amplification and 5 10 12 5 25 50 100 and 200 mm sec paper speed The calibration and paper speed you set are remembered by seca CardioConcept They will be
164. used next time you open Rhythm Viewer You should remember that amplification and paper speed are virtual i e they set curve sizes relative to the paper grid Unlike a regular analogous ECG curve digitized ECG signal can be extended to any amplification and paper speed without distortion In the contrary Zooming changes the visible size of the curves as well as the grid e Navigation lead submenu allows you to select the lead used in Quick Navigation panel e QRS positions command turns on off blue lines that show location of QRS complexes as detected by seca CardioConcept software See section QRS Marker tool for details e Parameters panel command turns on off ECG Features panel e Conclusion panel command turns on off Diagnostic Conclusion panel You can reach the same effect using 29 l buttons on the panels e Colours command evokes Choose Colours for Viewer dialogue It allows you to select colours for ECG representation elements ECG curves grid etc Compare Rhythm window Comparing Rhythm This window is intended to help in analysing a series of up to four long ECGs i e rhythm analysis ECG records The programme shows the current recording and up to three previous ones A vertical panel on the left side of the application window contains label boxes with date and time of ECGs being compared One of the boxes looks sunken which indicates the currently selected ECG record The conclusion and ECG featuresof the selected ECG are
165. ut User administration e E G Patient ECG Emergency 3 be browser Examination browser Lal pS Ex CardioPortable Mail cher 4 Print editor Options Current user Sokolova Tatiana This is a starting window of seca CardioConcept programme It is used for logging into seca CardioConcept database and launching various seca CardioConcept applications and utilities Window title bar It shows the programme name and the mode in which the programme will work if CardioPortable module is installed Logging window appears when seca CardioConcept is started If you refuse to log or enter incorrect login or password database access will be closed and Logging window will appear again when you try to activate any seca CardioConcept module Window toolbar It contains some buttons e Exit button is used to quit seca CardioConcept e About button shows window with information about the program e User Administration button invokes User Administrator application G Buttons They are used to start specific seca CardioConcept modules Two left buttons i e Patient ECG and Emergency ECG are very special ones They serve for direct ECG acquisition It is worth attention that the text on the User Administration button differs depending on the access rights of the current user If the current user has administrative rights then it is labelled User Administration This means that the user can invoke User Administrator application in
166. ved after you turn it off until you close the window So you can easily repeat the filtration with the same or similar parameters By Patient command Ctrl P It allows selecting a group of patients to show only examinations belonged to the selected patient The corresponding Y button is next to patient field By Examinator command Ctrl B It filters examinations that were performed by a specified attending person s examinators The corresponding Y button is located to the right from the box with attending person s name By Signature command Ctrl G It filters examinations that have conclusion signed by a specific person s The corresponding E button is located to the right from the box with specialist name By Diagnostic Statements command Ctrl S It filters examinations by diagnostic statements contained in conclusions The corresponding W button is located to the left from the box with the conclusion This filter is saved after you turn it off until you close the window So you can easily repeat the filtration with the same or similar parameters Ki Non analysed examination command and button It filters examinations that have been made today and still doesn t have any diagnostic conclusion confirmed by a human reader This button is located to the right from the box with the date and time when the examination was made and has an exclamation mark on it It is worthwhile to notice that this filter cancels all other filters in effect
167. ved to hard drive ll Pause monitoring Ctrl P The button looks pressed while monitoring of ECG signal is paused Release this button in order to resume monitoring The programme always assumes that the patient remains the same after resuming a Stop monitoring Ctrl T Monitoring of the current patient is stopped The current patient is disposed and you have to reselect current patient in order to resume work E Exit button This button closes the smart cardiograph window and returns to Control Centre Pressing ESC button has the same effect i e it stops monitoring and closes the window Additional buttons e D Choose patient Ctrl C This button opens patient browser to select a patient as the current patient Full name of the current patient is shown in the smart cardiograph title bar a Reselect previous patient Ctrl V seca CardioConcept memorizes the patient for which the last ECG was recorded If this ECG is not satisfactory or if there are some pathologic findings you want to document with another ECG recording then you should reselect the patient Pressing this button reselects the previous patient automatically Examination type controls e The combo box for selecting examination type Two types are available in the current version of seca CardioConcept The first one is standard ECG record The second one is rhythm analysis ECG record Notice that monitoring is paused as soon as you change examination type e EKE The s
168. wo buttons in toolbar Standard OK button saves the entered value in the database while Cancel button 3 abandons the changes Operating instructions Configuring seca CardioConcept General notes This section describes how to configure seca CardioConcept and adjust it to your needs The basic configuration parameters are described in the following sections e Administering user accounts e Screen adjustment e Customizing printed reports e Configuring Internet Mail access Administering user accounts For more detailed description see section User Administration Here we just explain some basic ideas of network database administration in conjunction with seca CardioConcept User administration is used in order to prevent unauthorized data access Special database records named user accounts are maintained in database for this purpose A user login name password and data access rights are kept in this account together with some additional user information The following data access rights are used in seca CardioConcept database e Administrative rights Assign this right very carefully since these rights give full control over seca CardioConcept A user with administrative rights can add edit or delete user accounts and edit protocol templates The idea behind is to prevent these crucial data from being unintentionally damaged Another point is to keep them in proper order by dedicated person s e The right to edit patient information
169. x is more suitable for precise measurements due to better signal noise ratio e After that the programme tries to define global ECG fiducial points Global means that all leads are taken into account rather than determining fiducial position in a single lead e ECG features PQ interval etc are determined at the next step e Logic production probability or other artificial intelligence techniques are used to derive diagnostic statements from the set of ECG features obtained at the previous stage e The standard diagnostic statements are formatted into text diagnostic conclusion Computer diagnosis cannot be perfect in all cases Understanding the workflow of programme analysis allows you to correct the erroneously performed stages and let the software do the rest This is the easiest and most productive way to analyse the ECG on the computer screen without printing it Let us consider the process of creating new diagnostic conclusion in detail First press New Conclusion button of ECG Viewer and or menu command to activate New Conclusion window Correcting representative complex If you are not satisfied with the median cardiocycle generated by the programme it is quite possible when a patient has a rhythm disturbances with polymorph QRS complexes or if you are analysing an ECG which was not analysed automatically you can manually select a representative complex in Choose Representative Cardiocycle window You can invoke this window
170. xists window All these situations are identified as data collision The rules explained above may seem to be too complicated and make data entry more difficult at the beginning But you will certainly appreciate their value after a large number of patients are entered into database Recording looking up and printing ECGs Direct ECG Recording seca CardioConcept gives the user two ways to record ECG immediately after application start i e from Control Centre The first one is Patient ECG Recording and the second one is Emergency ECG Recording Patient ECG Recording 1 While in Control Centre press Patient ECG button 2 Select the patient in Choose or Enter Patient Window You can easily switch to emergency acquisition mode if there is no time to enter patient information 3 You are in Smart Cardiograph now with ECG monitoring on Record the ECG See more details on working with Smart Cardiograph in Recording ECG from Smart Cardiograph section 4 Leaving Smart Cardiograph returns you to Control Centre Emergency ECG Recording 1 While in Control Centre press Emergency ECG button 2 You are in Smart Cardiograph now with ECG monitoring on Record the ECG See more details on working with Smart Cardiograph in Recording ECG from Smart Cardiograph section 3 After all actions possibly set at After Recording panel are done you get to ECG Viewer and then while closing this window to Assign ECG to existing patient or Enter New Patient In
171. xt to the corresponding data fields The following searching capabilities are available e By patient s ID e By patient s policy number The following filtration capabilities are available e By patients birth dates e By patients sex e By patients race e By insurance company ration Information The following information is shown for the selected patient Full name ID number It can be case history number social security number or any other type of unique identifier Birth date In Options dialogue the preferable date format can be selected Patient s sex Patient s race Patient s address Patient s medical insurance number The name of insurance company covering the patient s health care expenditures Remarks a free text field for any additional patient information you may need to save in the database Search and Filtration dialogues Dialogues for search and filtration When the user presses one of search EI or filtration Y buttons or selects items in Search or Filtration menus it invokes one of search filtration dialogues They allow the user to enter values to search for in the database or filtration criteria There is a list of these dialogues e Search by patient ID and search by insurance policy dialogues e Choose filtered sex and Select filtered races dialogues e Select filtered Insurance Companies dialogue Filter by Examination Type dialogue e Specify filtered period dialogue e Patient Group Se

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