Observer Variability in ECG Interpretation for Thrombolysis Eligibility: Experience and Context Matter

BACKGROUND: Despite the known benefit of thrombolysis it remains underutilized among eligible patients with acute myocardial infarction. We sought to determine whether potential errors in ECG interpretation might be a contributing factor and to what extent clinical history, a checklist outlining recognized inclusion criteria and a computerized interpretation would influence reliability and accuracy. METHODS: Seventy-five ECGs were interpreted on 8 separate occasions by 9 clinicians (3 cardiologists, 3 cardiology fellows, 3 medical residents) according to a 2 x 2 x 2 factorial design. RESULTS: The overall level of agreement among all raters was substantial with a kappa (kappa) of 70.4%. Intra-observer ECG reading reliability was stronger among cardiologists (CC) as compared with cardiology fellows (CF) and medical residents (MR). Similarly, inter-observer reliability was substantial to very good and a gradient was seen with greater reliability among CC, followed by CF, then MR ( P = 0.0013). CC recommended thrombolysis significantly more frequently ( p < 0.001) than either CF or MR. Trainees were biased by the presence of a computerized ECG interpretation resulting in a decision to recommend thrombolysis administration less often. CONCLUSION: The reliability of ECG interpretation for deciding to administer thrombolysis was substantial; there was a gradient from lowest to highest commensurate with training and experience. Errors in thrombolysis eligibility are influenced by clinical history and the presence of a computerized ECG interpretation among less experienced clinicians.     

Interpreting trauma radiographs

BACKGROUND: Many accident and emergency clinicians regard the radiographic image as an extension of the clinical examination, as a provisional diagnosis, based on clinical signs and symptoms, can be confirmed or refuted by inspection of X-rays. However, the value of radiography in this context is not determined by the actual presence of trauma or pathology on the radiograph, but is dependent on the ability of a clinician to identify any trauma or pathology present. Traditionally, the responsibility for interpreting radiographic images within the accident and emergency environment in the United Kingdom (UK) has been with medical clinicians. However, expansion of the nursing role has begun to change the boundaries of professional practice and now many nurses are both requesting and interpreting trauma radiographs. AIM: To ascertain the ability of accident and emergency doctors and nurses to interpret trauma radiographs, and identify whether there is a consistent standard of interpretive accuracy that could be used as a measure of competence. METHODS: A literature review was conducted using the Cochrane Library, Medline and CINAHL databases and the keywords radiographic interpretation, radiographic reporting, accident and emergency and emergency/nurse practitioner. FINDINGS: The ability of accident and nursing doctors and nurses to interpret trauma radiographs accurately varies markedly, and no identified published study has established an appropriate level of accuracy that should be achieved in order to demonstrate satisfactory competence in the interpretation of radiographic images. CONCLUSIONS: Determining a measure of interpretive accuracy that can be used to assess ability to interpret radiographic trauma images is fraught with difficulties. Consequently, nurses may attempt to prove their skills by directly comparing their abilities to those of their medical colleagues. However, as a result of marked variation in the ability of senior house officers to interpret trauma radiographs, a similar ability does not automatically imply that a satisfactory level of ability has been achieved.     

Lessons for surveillance in the 21st century: a historical perspective from the past five millennia

This paper reviews some major epidemics in the past 5,000 years in human history and derives 12 lessons in the context of epidemiologic surveillance. The corresponding 12 challenges proposed in this paper could be used to guide us in building a better and more comprehensive surveillance system in the 21st century. This will be achieved by: continuing the evolvement and improvement of surveillance; maintaining on an ongoing basis; being systematic; being population-based; including risk and intervention indicators in the data base; more efficient data analysis; stimulating etiologic research; improving forecasting capability; linking to development of intervention; evaluating the intervention; better ways of information dissemination; and dissemination without prejudice.     

山西省10年间医药卫生获奖科技成果分析

对山西省1996-2005年度卫生厅直属医药卫生获奖科技成果进行分析研究，旨在了解山西省医疗卫生发展状况，并为制定科研规划提供参考数据。研究结果显示获奖项目总数298项，其中山西医科大学第一医院、山西医科大学第二医院、山西省人民医院、山西省肿瘤医院、山西省中医研究所及山西省眼科医院所承担的项目，占到了研究成果总数的绝大部分。获奖成果第一负责人中40-49岁年龄人员成为山西省医学科技方面的主力军。获奖成果第一负责人学历中博士学历人员明显增加；获奖成果第一负责人技术职称逐步以正高人员为主。说明获奖成果第一负责人素质明显提升，日趋合理化。提示科研立项要围绕重点单位、优势学科及优秀人才进行。     

Update on blood cultures: how to obtain,process, report,and interpret

The detection and identification of microorganisms circulating in the bloodstream of patients is arguably one of the most important functions of the clinical microbiology laboratory. Effective implementation of this function requires careful consideration of specimen collection and processing, culture techniques, result reporting, and, perhaps most importantly, result interpretation by the physician. The purpose of this review is to provide a synopsis of the current state of the art for each of these areas, with the intention of providing adequate information to enable clinical laboratory personnel and physicians to critically evaluate and, if required, improve their current blood culture practices.     

A hermeneutic textual analysis of suffering and caring in the peri-operative context

Hermeneutic text interpretation is discussed in this paper as a possible way of releasing nurses' knowledge, in order to develop a deeper understanding of professional caring. The text is a nurse's story, which has been gathered by means of the critical incident technique. The intention is to elicit the knowledge of professional caring in the stories and the language of caring science, which is concealed in a nurse's reality. Hermeneutic text interpretation through reading a text and having a dialogue with the nurse's reality will give a voice and a language to silent knowledge.     

Ricoeur’s hermeneutic phenomenology: an implication for nursing research

Researchers and educators are increasingly implementing qualitative research methods to investigate issues of concern and interest. Hermeneutics has risen as an option for the qualitative research paradigm particularly after the 1970s. The precedence of the sciences that have applied hermeneutics as their approach to investigation is provided with special reference to nursing. In the nursing science, hermeneutics have been used extensively as a qualitative research method to investigate a variety of issues, through the lived experiences of the participants. In this paper, we introduce important aspects of the philosophy of Paul Ricoeur and we discuss the reasons why we have applied this approach in our study titled ‘Quality Nursing Care: perspectives of patients with cancer and the nursing response’. The arguments that are presented here can be generalised to fit other areas of Nursing Science. Through this paper our aim is not only to familiarise the reader with Ricoeur’s work, but also to arrive at an appreciation of his philosophy as a methodological approach for future nursing research.     

《天问》要籍解题

清·林云铭云：“一部（楚辞最难解者，莫如《天问》一篇”。《天问》之奇，复有柳宗元《天对》，耗费历代学者几多心血。楚辞研究史，有《楚辞》著作七百种，其中《天问》专著二十五种，专题探求，庶成专学。然歧义纷纭，至今莫辩。本文择其十二种，“解题”评说，以作诠释之助。