心脏介入药物涂层球囊临床使用合理性评价及干预研究

目的对某三级医院心脏介入药物涂层球囊的临床使用情况进行分析，评价其临床使用合理性。方法参考HB-HTA评价维度，从安全性、有效性、经济性3个方面制定评价指标体系，通过与药物洗脱支架进行对比，评价药物涂层球囊临床使用合理性，并将评价结果应用于管理决策。结果该药物涂层球囊临床使用有效性与药物洗脱支架基本一致，经济性具有一定优势，但在安全性方面有71.1％的病例存在未按说明书使用情况。制定改进措施并实施后，药物涂层球囊未按说明书使用病例比例由69%降为0%，同时患者人均药物涂层球囊费用由23 203.1元降至20 350.0元。结论医院开展医用耗材临床合理使用管理工作时，可参考HB-HTA模式，建立临床使用合理性评价指标体系，并进行定期评价，为管理决策提供依据，以提升医院耗材管理水平。     

Modelling assistive technology adoption for people with dementia

PurposeAssistive technologies have been identified as a potential solution for the provision of elderly care. Such technologies have in general the capacity to enhance the quality of life and increase the level of independence among their users. Nevertheless, the acceptance of these technologies is crucial to their success. Generally speaking, the elderly are not well-disposed to technologies and have limited experience; these factors contribute towards limiting the widespread acceptance of technology. It is therefore important to evaluate the potential success of technologies prior to their deployment.Materials and methodsThe research described in this paper builds upon our previous work on modelling adoption of assistive technology, in the form of cognitive prosthetics such as reminder apps and aims at identifying a refined sub-set of features which offer improved accuracy in predicting technology adoption. Consequently, in this paper, an adoption model is built using a set of features extracted from a user’s background to minimise the likelihood of non-adoption. The work is based on analysis of data from the Cache County Study on Memory and Aging (CCSMA) with 31 features covering a range of age, gender, education and details of health condition. In the process of modelling adoption, feature selection and feature reduction is carried out followed by identifying the best classification models.FindingsWith the reduced set of labelled features the technology adoption model built achieved an average prediction accuracy of 92.48% when tested on 173 participants.ConclusionsWe conclude that modelling user adoption from a range of parameters such as physical, environmental and social perspectives is beneficial in recommending a technology to a particular user based on their profile.     

基于晶闸管导通角控制的脉宽调制旋转阳极控制技术的设计与实验

针对X线检查大型医疗设备整机价格昂贵、维保费用高、生命周期短、场地要求严苛等问题,研究一种能够应用于教学示教及技能培训、故障演练测试的教学器具,结合旋转阳极电路的基本功能要素,涵盖高压启动、低压维持、延时保护、运转检测等基本流程,结果表明,该装置能够准确地演练实际工作环境,起到培育医疗设备维修人员检修旋转阳极时所需要的实际技能的作用,降低了实际教学成本,满足了工位数需求,增加了实践动手训练机会,提升了技能培训效果。     

The association of nurses' assessment and certainty to pain management and outcomes for nursing home residents in Jordan

Despite advances in dementia care, pain in people with dementia is still undertreated due to poor assessment, poor treatment, and factors relating to nurses' critical thinking and decision-making skills. The purpose of the study is to examine temporally based relationships between change in behavior, the nurses' level of certainty regarding pain, assessment scope, and outcomes of pain. The findings of the study were consistent with the Response to Certainty of Pain model. This study found high percentage of variances accounted for by nurses' level of certainty due to potential unexpected confounding variables. This study may provide a new understanding of the relationship between nurses' certainty, assessment scope, and patient outcomes for people with dementia. Improved understanding of this relationship and how it relates to the problem of unrelieved pain in people with dementia is crucial.