层次分析法在确定医疗设备维护优先级中的应用研究

目的:运用层次分析法(AHP)确定医疗设备维护中的优先级,增加医疗设备的可用性并降低维护成本。方法:采用AHP对医疗设备标准、子标准和等级进行评定获取其关键评分,基于多标准决策方法确定医疗设备维护的优先级,对选定设备进行评估,以准分子激光器和视力计为例,根据其标准权重、子标准权重和强度计算其总评分,确定维护优先级。结果:医疗设备维护的优先顺序由医疗设备评分的评估结果决定,医疗设备风险是医学技术人员在确定医疗设备维护优先级时的最重要标准。准分子激光器和视力计的关键评分权重分别为0.877和0.373,准分子激光器相比视力计在设备维护方面具有更高的优先级。结论:医疗设备维护优先级评估模型能确定医疗设备维护优先级,根据优先级规模规划医疗设备维护方案,以使资源更多地集中于具有高和中关键度的医疗设备。     

脑卒中肺部感染危险因素及血清免疫炎性因子的预测价值

目的基于主成分分析(PCA)-决策树模型分析脑卒中肺部感染的危险因素及血清免疫炎性因子的预测价值。方法回顾性分析2014年12月-2019年12月江西省上饶市人民医院确诊的176例脑卒中患者,根据是否发生肺部感染,分为感染组40例和未感染组136例。记录患者临床特征,检测血白细胞(WBC)计数、血清C-反应蛋白(CRP)、降钙素原(PCT)和可溶性白细胞介素-2受体(SIL-2R)水平。采用Logistic回归和卡方自动交叉检验(CHAID)模型分析影响脑卒中后肺部感染的危险因素;受试者工作特征曲线(ROC)分析血WBC、CRP、PCT、SIL-2R预测肺部感染的价值。结果脑卒中肺部感染与患者年龄、卒中类型、是否合并糖尿病、吸烟史、吞咽困难、意识障碍、侵入性操作有关(P<0.05);感染组患者血WBC、CRP、PCT和SIL-2R水平高于未感染组(P<0.05);糖尿病、侵入性操作、CRP和PCT均为影响脑卒中患者肺部感染的独立危险因素(P<0.05);PCA-ROC分析显示,血WBC、CRP、PCT、SIL-2R和联合预测主成分1(PC1)的曲线下面积(AUC)分别为0.670、0.816、0.854、0.686、0.918;PCA-卡方自动交互检测(CHAID)模型分析显示,WBC、CRP、PCT、SIL-2R和PC1预测肺部感染的准确率为77.33%、84.72%、86.90%、79.02%和89.24%。结论血清PCT水平可用于预测脑卒中患者肺部感染的发生,临床可重点关注合并糖尿病、意识障碍和侵入性操作的患者。     

Social tariffs and democratic choice—Do population‐based health state values reflect the will of the people?

In economic evaluations of health technologies, health outcomes are commonly measured in terms of quality‐adjusted life years (QALYs). QALYs are the product of time and health‐related quality of life. Health‐related quality of life, in turn, is determined by a social tariff, which is supposed to reflect the public's preference over health states. This study argues that, because of the tariff's role in the societal decision‐making process, it should not be understood as merely an operational (statistical) definition of health, but as a major instrument of democratic participation. I outline what implications this might have for both the method used to aggregate individual preferences, and the set of individuals whose preferences should count. Alternative tariff specifications and decision rules are explored, and future research directions are proposed.     

动态研究HBV和AFB1诱发树鼠句肝细胞癌过程中一些基因的表达

目的：探讨人乙肝病毒(HBV)和黄曲霉毒素B,(AFB1)致肝细胞癌(HCC)及协同致HCC作用的机制。方法：将树鼩分为4组：A组：感染HBV加摄入AFB,;B组：只感染HBV;C组：只摄入AFB1;D组：作空白对照。然后定期行肝活检,用免疫组化、分子生物学等技术动态观察一些癌基因(蛋白)和抑癌基因的表达。结果：①A组谷胱苷肽转移酶(GGT)阳性灶个数及面积明显多于、大于B、C组;②A组P21蛋白检出率明显高于B和C组,A组6只P21蛋白阳性的树鼩到120周时全部发生了HCC;③实验后期,A组HBxAg检出率及HBVDNA整合率明显高于B组;④在诱癌过程中,IGF-Ⅱ表达率呈波动形,带癌肝的表达率显著高于无癌肝;⑤105周时,A、B、C组P53蛋白表达率显著高于D组;在A,C组检出P53异常带;⑥第45及105周时,A组c-fos表达率分别为23．1％和20％;C组为38．5％和15．4％,B,D两组均未检出;⑦H-c-myc基因：直到120周,无癌肝组织均未见异常;在肝癌组织中,A组有4例扩增,c组无异常;@CDK4基因：只有A组在第75周有1例扩增,该树鼩在第106周时发生了HCC。在HCC中,A组有25％出现CDK。扩增,C组未见异常。结论：再次证实HBV和AFB。有协同致HCC作用;AFB、有利于HBxAg的表达和HBVDNA的整合;CDK4、Kiras和P53基因的变异参与了HCC的发生和演进;P21和c-fos蛋白的过表达与P^53蛋白的失活,促进了HCC的发生和演进;CDK4和c-myc基因的改变与HBV的感染有一定的关联。     

Can Machine Learning Methods Produce Accurate and Easy-to-Use Preoperative Prediction Models of One-Year Improvements in Pain and Functioning After Knee Arthroplasty?

BackgroundApproximately 15%-20% of total knee arthroplasty (TKA) patients do not experience clinically meaningful improvements. We sought to compare the accuracy and parsimony of several machine learning strategies for developing predictive models of failing to experience minimal clinically important differences in patient-reported outcome measures (PROMs) 1 year after TKA.MethodsPatients (N = 587) in 3 large Veteran Health Administration facilities completed PROMs before and 1 year after TKA (92% follow-up). Preoperative PROMs and electronic health record data were used to develop and validate models to predict failing to experience at least a minimal clinically important difference in Knee Injury and Osteoarthritis Outcome Score (KOOS) Total, KOOS JR, and KOOS subscales (Pain, Symptoms, Activities of Daily Living, Quality of Life, and recreation). Several machine learning strategies were used for model development. Ten-fold cross-validation and bootstrapping were used to produce measures of overall accuracy (C-statistic, Brier Score). The sensitivity and specificity of various predicted probability cut-points were examined.ResultsThe most accurate models produced were for the Activities of Daily Living, Pain, Symptoms, and Quality of Life subscales of the KOOS (C-statistics 0.76, 0.72, 0.72, and 0.71, respectively). Strategies varied substantially in terms of the numbers of inputs required to achieve similar accuracy, with none being superior for all outcomes.ConclusionModels produced in this project provide estimates of patient-specific improvements in major outcomes 1 year after TKA. Integrating these models into clinical decision support, informed consent and shared decision making could improve patient selection, education, and satisfaction.Level of EvidenceLevel III, diagnostic study.     

功能锻炼决策辅助对单侧全膝关节置换恐动症患者的影响

目的探讨决策辅助对单侧全膝关节置换恐动症患者术后功能锻炼依从性的影响。方法按照住院时间将单侧全膝关节置换术后恐动症患者143例分为对照组72例和干预组71例。对照组给予常规治疗和护理,干预组在循证基础上,通过专家会议,构建并实施功能锻炼决策辅助方案。比较两组患者出院时、术后1个月和3个月功能锻炼依从性、恐动症和膝关节功能评分。结果干预后两组功能锻炼依从性、恐动症和膝关节功能评分的时间效应、组间效应和交互效应显著(P<0.05,P<0.01)。结论决策辅助有利于提高单侧全膝关节置换恐动症患者术后功能锻炼依从性,降低恐动水平,改善其膝关节功能。     

妇科肿瘤患者PICC知情同意移动医疗决策辅助程序的设计与实施

目的设计并实施PICC知情同意移动医疗决策辅助程序,增强患者决策参与意愿。方法将妇科肿瘤科行PICC化疗的86例患者随机分为观察组和对照组各43例,对照组采用常规PICC知情同意,观察组在对照组基础上,利用移动护理信息系统,构建并实施妇科肿瘤患者PICC知情同意移动医疗决策辅助程序。结果观察组焦虑抑郁状态评分显著低于对照组,患者的决策实际参与程度显著高于对照组,患者决策参与满意度总分及各维度得分显著高于对照组(P<0.05,P<0.01)。结论PICC知情同意移动医疗决策辅助程序为妇科肿瘤患者提供精准化的决策辅助,缓解了患者置管时的焦虑抑郁情绪,提高了患者决策实际参与程度及满意度。     

When is the right time to take an emergency surgery decision in Mechanical Intestinal Obstruction?

Background/Objective: Ischemia is a leading cause of morbidity in Mechanical Intestinal Obstruction (MIO) in which the timing of decisions of whether to proceed to surgical or conservative treatment is critical in emergency departments (ED). While advanced technological options are available, patients may be negatively affected by the application of contrast agents or radiation. The use of ultrasound is limited because of the air in the intestines does not allow a good field of vision. While biomarkers can be considered as a good alternative option at this point. In the present study we examine the effect of hemogram and blood gas parameters on early surgical decision-making in MIO patients.MethodInvolved in this observational prospective study were 264 patients diagnosed with MIO who presented to the Department of Emergency Medicine, Ataturk Research and Training Hospital, Katip Celebi University between February 2018 and February 2019. Contrast-enhanced tomography (CECT) and laboratory results of the patients were recorded. Pathology reports of the patients who underwent surgery were collected. Laboratory data were analyzed by comparing CECT and pathology reports.ResultsIn a ROC analysis of the laboratory values of the patients who were diagnosed with ileus, the sensitivity was calculated as 80% and the specificity was 57.7 in values above WBC>10.75 (10⁹/L), 96.6%, and the specificity was 31.1% in N/L > 2.9. For intestinal ischemia, the cut-off values were WBC> 12.6 and N/L > 3.2, Lactate >2.8 mmol/L and B.E < -3.6 mmol/L.ConclusionDiagnoses of ileus are based on the results examinations and imaging methods. More data are needed to support decisions on the timing of surgery in ED. WBC, N/L, Lactate and Base Excess indicate an ischemic segment. When the parameters are evaluated together, they strongly support early surgical decision-making regarding the treatment of intestinal ischemia.