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排序方式: 共有9459条查询结果,搜索用时 15 毫秒
41.
Rianne Bindels Arie Hasman Mieke Derickx Jan W J Van Wersch Ron A G Winkens 《International journal for quality in health care》2003,15(6):501-508
OBJECTIVE: The GRIF automated feedback system produces real-time comments on the appropriateness of diagnostic tests ordered by general practitioners (GPs) based on recommendations from accepted national and regional practice guidelines. We investigated the experiences of GPs with this system and, more specifically, with the recommendations produced by the system as well as their views on using this system in daily practice. SETTING: We tested the GRIF system in an experiment in a laboratory setting and in a daily practice trial. STUDY PARTICIPANTS: General practitioners. INTERVENTION: In the laboratory experiment, GPs used the GRIF system to assess the appropriateness of 30 request forms. Each of the GPs was confronted with requests they had submitted to the diagnostic unit of the hospital in the past. In the field trial, the GRIF system was applied during patient consultations for 1 year. MAIN OUTCOME MEASURES: We measured GPs' satisfaction with the system using a questionnaire, and also conducted group discussions (in the laboratory experiment) and in-depth interviews (in the field trial) to elicit GPs' opinions of and experiences with the system. In addition, we explored GPs' reasons for not accepting the comments offered by the GRIF system. RESULTS: The results show that the GPs in the laboratory experiment had more positive attitudes towards the system compared with participants in the field trial. All discussion groups and most of the GPs in the field trial regarded receiving the immediate feedback during the test ordering process as an important advantage. The most frequently mentioned reason to reject the recommendation was disagreement with the content and/or the recommendations in the practice guidelines. CONCLUSION: Apart from securing agreement on guideline content, a prerequisite for using GRIF in daily practice on a large scale is that more attention is paid to promotion of the guidelines and their adoption, and stimulation of a positive attitude towards the practice guidelines among the users. 相似文献
42.
应用修正正交分段线性函数的时滞和反向特性,推导出求解时滞系统和卷积的公式。数字仿真表明,它具有计算简单,精度高的优点。 相似文献
43.
LISS钢板治疗股骨远端粉碎骨折的疗效分析 总被引:1,自引:0,他引:1
目的探讨应用微创固定系统LISS钢板治疗股骨远端粉碎骨折的临床疗效。方法采用LISS钢板治疗股骨远端粉碎骨折26例。结果所有患者获得10—28个月随访,切口Ⅰ期甲类愈合,骨折全部愈合,X线复查骨折对位、对线良好,未发生感染,无内固定钢板、螺钉脱出、断裂等发生。疗效评价采用Kolmert评定标准:优A3型10例,C2型3例;良A3型2例,C2型1例,C3型5例:可C2型2例,C3型2例;差C3型1例。结论采用微刨固定系统LISS钢板治疗股骨远端粉碎骨折,是一种有效的内固定方法,具有操作简便、创伤小、疗效肯定等优点,为术后早期功能锻炼提供保证。 相似文献
44.
Mahmut Koç Ömer Yoldaş Yusuf Alper Kılıç Erdal Göçmen Tamer Ertan Hayrettin Dizen Mesut Tez 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(5):581-585
Background and aims The aim of this study is to evaluate the predictive accuracy of different scoring systems on surgery for perforated peptic
ulcer referred to an academic department of general surgery in a tertiary reference center.
Patients and methods Seventy-five consecutive patients (Male/female ratio = 64:11; mean age, 44 years; range, 16–85) with perforated peptic ulcer
disease were investigated. Disease severity scores and mortality predictions were calculated using the collected data during
admission. Discrimination and calibration characteristics of each system, namely, the acute physiology and chronic health
evaluation II and III, the simplified acute physiology score II, and the mortality probability models (MPM) II, were determined
by using the area under receiver operating characteristics curve and the Hosmer–Lemeshow goodness-of-fit test, respectively.
Results Among the 75 patients included, there were eight (10.6%) mortalities. All systems had a reliable power of discrimination and
calibration. Among the systems tested, MPM II was the best performing as far as discrimination and calibration characteristics
were considered. The parameters of MPM II system that were related to systemic perfusion of the patient were significantly
positive in patients who died compared to those who survived.
Conclusions MPM II that predicted mortality at admission is better than the other systems in predicting mortality. Results also indicate
the importance of maintenance of systemic perfusion of the patient at the early phases of peptic ulcer perforation. 相似文献
45.
This study uses the Taiwan Healthcare Indicator Series (THIS) system as an example to examine which determinants would improve
performance by sharing indicators from a management perspective. This study population included all 227 hospitals participating
in the THIS system in 2006. A structured questionnaire was sent to the director who was responsible for the THIS system via
electronic mail. A total of 111 responses were returned by February 10, 2006. Questions included current implementation and
impacts of the system. Hierarchical regression models were performed to identify which variables were significantly associated
with performance improvement, adjusted for hospital characteristics. Four variables significantly associated with implementing
the THIS system to improve performance were ‘senior management support,’ ‘benchmarking,’ ‘making departments improve the underperforming
indicators and report the improvement results in performance management meetings,’ and ‘integration with the National Health
Insurance payment regulations’. This study contributes substantially to the evidence base about what works to improve performance
by information sharing. Although information sharing is the basis of efforts to improve performance, senior management support
and how to effectively apply the information are the most important determinants of performance enhancement. 相似文献
46.
Paolo R. Salvalaggio Katie Neighbors Susan Kelly Karan M. Emerick Kishore Iyer Riccardo A. Superina Peter F. Whitington Estella M. Alonso 《American journal of transplantation》2005,5(8):1868-1874
The Pediatric End-Stage Liver Disease (PELD) score was designed to reduce subjectivity in liver allocation and to advantage patients with a higher probability of waiting list mortality. The aims of this study were to determine the impact of PELD implementation for children with chronic liver disease and to assess whether PELD met its goal of standardization of liver allocation for children. This study used data reported to the United Network for Organ Sharing (UNOS) registry for children with chronic liver disease receiving primary cadaveric liver transplant between January 2000 and December 2001 (pre-PELD) and March 2002 and July 2003 (PELD). PELD reduced the percentage of children transplanted while in an intensive care unit and as status 1. A calculated PELD score was used for allocation in only 52% of recipients. Thirty percent were status 1 at transplant and PELD scores granted by exception were used for allocation in 18% of patients. There was regional variation in PELD score at allocation and use of exception scores with a significant relationship between PELD score and percentage of exception cases. Regional variation suggests that PELD has not resulted in standardization of listing practices in pediatric liver transplantation. 相似文献
47.
Van Buskirk Glenn A. González Mario A. Shah Vinod P. Barnhardt Scott Barrett Colin Berge Stephen Cleary Gary Chan Keith Flynn Gordon Foster Thomas Gale Robert Garrison Raymond Gochnour Scott Gotto Amanda Govil Sharad Gray Vivian A. Hammar James Harder Samuel Hoiberg Charles Hussain Ajaz Karp Carol Llanos Hector Mantelle Juan Noonan Patrick Swanson David Zerbe Horst 《Pharmaceutical research》1997,14(7):848-852
Pharmaceutical Research - 相似文献
48.
The ripple-free deadbeat control problem for SISO plants subjected to arbitrary reference signals is considered. The trade-off between the settling time and the integral square error between the system output and reference signal is investigated. Given a specific order of the controller, it is shown how to design an optimal ripple-free deadbeat controller. An illustrative example is presented to show the feasibility of the proposed algorithm. 相似文献
49.
This paper considers a pole assignment problem to cluster all poles of a closed-loop system into some specified regions by introducing the complex state for systems having an isotropic property and by using the Riccati equation. The algebraic relations for the distribution of the eigenvalues of a complex matrix are used in order to cluster the poles into specified regions, which guarantees the relative stability margin, e.g. uniform damping or uniform damping ratio. The proposed scheme is essentially a combination of the pole assignment approach and linear quadratic design, taking the advantages of both. A block modal control method—an extension of recursive pole assignment—is also developed for the vibration control of rotating systems by clustering the forward and backward modes in order. Vibration control simulations with an isotropic rotor—bearing system, a magnetic bearing system and a rotating circular disc are treated in order to demonstrate the advantages of the proposed method. 相似文献
50.
基于Lyapnuov泛函方法,研究了满足匹配条件的不确定性时滞系统的鲁棒稳定性及具有稳定度β〉0鲁棒稳定性,给出了已有结果不能推出的新判据。这些新判据对已有结果难以使用的情况下也可有是有效的,或有时减少了已有结果的保守性。 相似文献