There is still a care gap in osteoporosis management for patients with rheumatoid arthritis

ObjectivesTo assess compliance rates with the current Canadian osteoporosis guidelines and whether the Fracture Risk Assessment Tool score in patients with rheumatoid arthritis correlated with the likelihood of receiving osteoporosis treatment and having a bone mineral density test.MethodsCharts of serial outpatients with rheumatoid arthritis were reviewed to collect bone mineral density test data and patients’ use of calcium, vitamin D, and osteoporosis treatment. Odds ratios (OR) were calculated to determine if a higher Fracture Risk Assessment Tool score increased the likelihood of osteoporosis treatment or having a bone mineral density test.ResultsUsing the Fracture Risk Assessment Tool, the 10-year risk of major osteoporotic fracture was high in 92 (12.5%), moderate in 216 (29.3%), and low in 429 (58.2%) patients. Compared to those at low risk, patients identified as high risk were more likely to receive osteoporosis treatment (OR 16.31, 95% CI 9.45–28.13, P < 0.001); calcium (OR 3.89, 95% CI 2.43–6.25, P < 0.001); vitamin D (OR 3.46, 95% CI 2.12–5.64, P < 0.001); and to have had a bone mineral density test (OR 10.22, 95% CI 5.50–18.96, P < 0.001). Among 124 patients currently taking prednisone, half (46.8%) were prescribed a bisphosphonate.ConclusionsAlthough compliance with current osteoporosis guidelines remains low among all patients with rheumatoid arthritis, higher risk patients were more likely to have a bone mineral density test and receive treatment for osteoporosis, as indicated by the clear dose response seen along the 10-year fracture risk from low to high-risk groups.     

刍议军队医院内部审计

医院内部审计工作是现代医院管理的一项重要内容。本文从医院内部审计工作的必要性入手,探讨军队医院内部审计的基本原则,并对发挥军队医院内部审计作用提出建议。     

输血科不合格标本的原因探析及改进

目的:探讨分析临床输血不合格标本产生的原因,保证临床用血安全。方法:选取2012年1―12月期间西安市红会医院输血科接收临床输血样本9 211例,对不合格标本进行原因分析,并指定出改进方案。结果:统计分析2012年上半年和下半年拒收例数分别为107例和24例,同比下降63.34%。样本不合格因素包括:申请单信息有误、血型填写错误、医师未签字、血样信息有误、血量不足、样本溶血、血样无标识。各指标下半年较上半年下降率分别为:28.25%、8.16%、4.58%、14.50%、2.29%、2.29%、4.01%。结论:严格执行输血前样本审核制度,保证临床输血安全有效。     

医院内部审计信息化的发展现状与趋势

随着计算机技术的发展和应用,医院也进入信息性化时代,探讨内部审计怎样才能更好地适应信息技术的发展,实现内部审计信息化,确保医院信息的安全、完整和有效,做到为医院的信息化发展起到良好的促进作用。     

Putting an eye on cytological specimens: An audit of the clinical impact of thyroid fine‐needle aspiration in different health care settings

There is published evidence showing less cost‐benefit approaches in the evaluation of thyroid nodules. We performed an institutional audit of the cytologic diagnosis of thyroid fine‐needle aspiration (FNA) in an attempt to perceive the clinical impact of this technique on the management of thyroid nodules and to compare it in two different types of health care: Primary Care Medicine and Endocrinology. We performed a retrospective analysis to the electronic records of patients referred from General Practitioners (GP) and Endocrinologists (E) for thyroid FNA between 2010 and 2012. Request forms for cytological reports where retrieved for analysis of clinical and cytological data. The database search retrieved 1655 patients (female gender: 88.2%; GP references: 51.8%). Preprocedure clinical information was available from 157 out of 2005 nodules (7.8%). Significant differences in cytological diagnosis were seen in “Nondiagnostic” (GP: 11.6%; E: 7.5%, χ² = 0.002) and “Benign” categories (GP: 75%; E: 81.8%, χ² < 0.001). The main potential cause of “Nondiagnostic” samples was nodules smaller than one centimeter (total: 14 cases; GP: 7; E: 7). Reasons to request FNA for these nodules were provided in 6 out of 27 cases (GP: 0/16; E: 6/11, P < 0.001). The rate of insufficient samples was inversely correlated with nodule size (τ = ?0.242, P = 0.001). When evaluating thyroid nodules, clinicians should take into account the limitations of FNA, the international recommendations for better cost‐benefit approaches and the importance of a well‐informed cytopathologist for better cytological diagnostic results. Diagn. Cytopathol. 2014;42:1009–1012. © 2014 Wiley Periodicals, Inc.     

Exploring the Prescribing Behaviours and the Mind of Antibiotic Prescribers is Critical for a Successful Antibiotic Stewardship Programme: Results of a Survey from Eastern India

Quantitative and qualitative analysis were used to ascertain practices, perceptions and barriers about antibiotic stewardship program (ASP) in an oncology hospital in eastern India. In 2014 and 2017, 62% and 69.1% of the patients audited were found to be on anti infective medications respectively. Nearly 47% of patients in the study group (2014) who were on therapeutic antibiotics had an average cost of $46.48 per patient per day (inter-quartile range: $17.23–$94.76). Antibiotic related consultations from clinical microbiologists, was found to be in demand, and education of prescribers and policymakers was identified as critical to the success of ASP.     

基于“军卫一号”的结算审核系统的设计与实现

目的：解决医院业务及流程中存在的一些问题。方法：通过对业务流程的梳理分析,找出了问题产生的原因,由此对现有流程进行了改造优化,在此基础上开发了结算审核系统。结果：解决了医院业务及流程中存在的问题。结论：该系统的应用提高了审核员审核的效率和准确率,降低了收费问题的几率,落实了医嘱质量的监督工作,消除了患者长时间的等待环节,避免了在结算环节引起冲突或医疗纠纷的可能,解决了结算中心绩效考评时数据的准确性问题。