A comparative study of a digital radiography system

The present study aimed to examine the efficiency of a new digital radiography system that was installed in the Royal Adelaide Hospital in September 1997, as compared to the existing conventional radiography system. A total of 55 examinations were observed over a 3-week period in January, and these consisted of 18 digital and 10 conventional chest examinations, and 27 conventional orthopaedic examinations. These were combined with 18 digital orthopaedic examinations recorded from a prior study. Total examination time was broken into several components, of which reporting time was of the most interest. The mean reporting times for digital and conventional chest examinations were 17 and 25 min, respectively, a significant (P < 0.1) 8-min difference. The orthopaedic examinations revealed mean reporting times of 8 and 26 min for digital and conventional systems, respectively; a significant (P < 0.001) 18-min difference. These results demonstrate that the digital system is a faster, more efficient system for the reporting of X-rays.     

针灸治疗原发性痛经优化方案评价及临床共性技术研究概述

"针灸治疗原发性痛经优化方案评价及临床共性技术研究"旨在前期临床和科研的基础上,以中医理论为指导,采用前瞻性、多中心、大样本、随机对照等研究方法,即运用规范化的临床研究及评价体系,开展针灸治疗原发性痛经的优化方案评价和临床共性技术研究。介绍了课题任务解决的主要技术难点和问题、研究内容及方案、课题创新及研究意义等。     

End-of-life care for older people in subacute care: A retrospective clinical audit

Background

With an ageing population and chronic illness the leading cause of death, challenges exist in meeting the healthcare needs of older people. For older people, care may be provided in subacute care services where, although the focus is on rehabilitation and optimisation of functioning, many older people will die.

The Canadian Heart Health Strategy and Action Plan: Cardiac rehabilitation as an exemplar of chronic disease management

BACKGROUND:

In October 2006, federal funding was announced for the development of a national strategy to fight cardiovascular disease (CVD) in Canada. The comprehensive, independent, stakeholder-driven Canadian Heart Health Strategy and Action Plan (CHHS-AP) was delivered to the Minister of Health on February 24, 2009.

OBJECTIVES:

The mandate of CHHS-AP Theme Working Group (TWG) 6 was to identify the optimal chronic disease management model that incorporated timely access to rehabilitation services and end-of-life planning and care. The purpose of the present paper was to provide an overview of worldwide approaches to CVD and cardiac rehabilitation (CR) strategies and recommendations for CR care in Canada, within the context of the well-known Chronic Care Model (CCM). A separate paper will address end-of-life issues in CVD.

METHODS:

TWG 6 was composed of content representatives, primary care representatives and patients. Input in the area of Aboriginal and indigenous cardiovascular health was obtained through individual expert consultation. Information germane to the present paper was gathered from international literature and best practice guidelines. The CCM principles were discussed and agreed on by all. Prioritization of recommendations and overall messaging was discussed and decided on within the entire TWG. The full TWG report was presented to the CHHS-AP Steering Committee and was used to inform the recommendations of the CHHS-AP.

RESULTS:

Specific actionable recommendations for CR are made in accordance with the key principles of the CCM.

CONCLUSIONS:

The present CR blueprint, as part of the CHHS-AP, will be a first step toward reducing the health care burden of CVD in Canada.     

临产后实施剖宫产和计划选择性剖宫产利弊分析

目的观察临产后实施剖宫产及计划选择性剖宫产对产妇及胎儿的影响。方法选择2008年9月～2009年6月产科收治的临产产妇160例。按照随机自愿的原则分为临产后实施剖宫产组72例,计划选择性剖宫产组88例。两组孕产妇一般情况具有可比性。临产后剖宫产组在孕产妇出现临产症状时,根据孕妇要求采用剖宫产。计划选择性剖宫产组采取阴道自然分娩,使分娩在计划时间内进行。观察两组孕产妇产后出血量及新生儿窒息、新生儿湿肺的发生情况。结果计划选择性剖宫产组产后出血者较多,出血量高于临产后剖宫产组;而新生儿Apgar评分计划选择性剖宫产组明显高于临产后剖宫产组;新生儿湿肺的发生率明显低于临产后剖宫产组。结论临床实践证明,临产后实施剖宫产优于计划性选择剖宫产。     

统计信息在医院管理中的作用

医院统计信息是效果评价、制定政策和计划的重要依据,也是管理、监测医院各项医疗活动的重要手段。通过对诸多统计信息的分析,来确定和调整医院发展,可增强医院的竞争能力,使医院在竞争大潮中立于不败之地。医院统计信息是效果评价、工作总结、发现问题、制定政策和计划的重要依据,也是管理、监测医院各项医疗活动的重要手段。随着医院信息化建设的不断发展,以及医疗卫生体制改革逐步深入,医保、新农合的普及和深化,对医院统计信息提出了更多、更新、更深的要求,如何正确分析和利用统计数据信息,这给统计工作带来了许多新的课题和新的发展机遇。     

病案回收迟缓的调查分析

目的探讨病案回收管理工作,提高病案管理质量。方法通过回顾本院近几年病案回收情况,分析病案回收迟缓的具体原因,提出管理对策。结果近几年我院病案回收迟缓发生率有逐年升高趋势,手术科室与非手术科室病案回收迟缓发生率无显著差异,儿科和妇产科病案回收迟缓发生率低于其他科室,病案回收迟缓的原因是多方面。结论病案及时回收归档是病案管理的保证之一,须采取有效措施,以保证病案管理质量。     

Factors associated with incomplete colonoscopy: a population-based study

BACKGROUND & AIMS: The U.S. Multi-Society Task Force on Colorectal Cancer sets a target of cecal intubation in at least 90% of colonoscopies. We conducted a population-based study to determine the colonoscopy completion rate and to identify factors associated with incomplete procedures. METHODS: Men and women 50 to 74 years of age who underwent a colonoscopy in Ontario between January 1, 1999, and December 31, 2003, were identified. The first (index) colonoscopy was classified as complete or incomplete. A generalized estimating equations model was used to evaluate the association between patient, endoscopist (specialty, colonoscopy volume), and setting (academic hospital, community hospital, private office) factors and incomplete colonoscopy. RESULTS: A total of 331,608 individuals had an index colonoscopy, of which 43,483 (13.1%) were incomplete. Patients with an incomplete colonoscopy were older (odds ratio [OR] 1.20 per 10-year increment; 95% confidence interval [CI]=1.18-1.22), more likely to be female (OR 1.35; 95% CI: 1.30-1.39), have a history of prior abdominal surgery (OR 1.07; 95% CI: 1.05-1.09) or prior pelvic surgery (OR 1.04; 95% CI: 1.01-1.06). For colonoscopies done in a private office, the odds of an incomplete procedure were more than 3-fold greater than for procedures done in an academic hospital (OR 3.57; 95% CI: 2.55-4.98). CONCLUSIONS: In usual clinical practice in Ontario, 13.1% of colonoscopies are incomplete. The factors most strongly associated with incomplete colonoscopy were increased patient age, female sex, and having the procedure in a private office. Quality improvement programs are needed to improve colonoscopy completion rates.     

Monte Carlo dose calculation on deforming anatomy

This article presents the implementation and validation of a dose calculation approach for deforming anatomical objects. Deformation is represented by deformation vector fields leading to deformed voxel grids representing the different deformation scenarios. Particle transport in the resulting deformed voxels is handled through the approximation of voxel surfaces by triangles in the geometry implementation of the Swiss Monte Carlo Plan framework. The focus lies on the validation methodology which uses computational phantoms representing the same physical object through regular and irregular voxel grids. These phantoms are chosen such that the new implementation for a deformed voxel grid can be compared directly with an established dose calculation algorithm for regular grids. Furthermore, separate validation of the aspects voxel geometry and the density changes resulting from deformation is achieved through suitable design of the validation phantom. We show that equivalent results are obtained with the proposed method and that no statistically significant errors are introduced through the implementation for irregular voxel geometries. This enables the use of the presented and validated implementation for further investigations of dose calculation on deforming anatomy.