Assessment of Lung Tumour Motion and Volume Size Dependencies Using Various Evaluation Measures

The purpose of the study was to assess internal target volume changes through the breathing cycle and associated tumour motion for lung patients and to establish possible correlations between different parameters. Respiration-induced volume changes with breathing cycle and the associated tumour motion were analyzed for 11 patients. Selected phases were the maximum and average intensity projections and the 10 phases of equal duration and separation obtained through the respiratory cycle. Tumour centre of mass (COM) motion planes were generated using least square fitting, and their angles and orientations were then compared between the cases studied. Trajectories that are composed by the points of COM location in different phases were identified, and their interrelation was assessed through different similarity measures. The results were used to determine if there is any correlation between parameters chosen and if the margins conventionally used for the planning target volume creation successfully encompassed lung tumour motion and volume change. The results show that the extent of tumour motion was related to its volume and location. The tumour displacement was predominantly left and inferior. Planar fitting to COM motion data through respiratory phases demonstrated some correlation in best fit motion plane positions between different data sets. In the plane fit comparison, for each patient, the lower root mean square error values showed that a good planar fit can be achieved for the COM motion path. The evaluation of the inhale and exhale trajectories may allow, for certain tumour locations and size, contouring on only inhalation or exhalation phases, knowing that tumour motion will be adequately covered on the other phases. Taking all the data into account and knowing the tumour size and location, a good estimate can be made of the motion plane position in the three-dimensional space and the required dosimetric margins.     

Effects of tonal language background on tests of temporal sequencing in children

Objective: The aims of the present study were to determine the effects of language background on the performance of the pitch pattern sequence test (PPST) and duration pattern sequence test (DPST). As temporal order sequencing may be affected by age and working memory, these factors were also studied. Design: Performance of tonal and non-tonal language speakers on PPST and DPST were compared. Study sample: Twenty-eight native Mandarin (tonal language) speakers and twenty-nine native Malay (non-tonal language) speakers between seven to nine years old participated in this study. Results: The results revealed that relative to native Malay speakers, native Mandarin speakers demonstrated better scores on the PPST in both humming and verbal labeling responses. However, a similar language effect was not apparent in the DPST. An age effect was only significant in the PPST (verbal labeling). Finally, no significant effect of working memory was found on the PPST and the DPST. Conclusion: These findings suggest that the PPST is affected by tonal language background, and highlight the importance of developing different normative values for tonal and non-tonal language speakers.     

Patient reported outcome measures in ankle replacement versus ankle arthrodesis – A systematic review

ObjectivesCompare the functional outcomes of comparative studies of ankle arthrodesis (AA) and total ankle replacements (TAR).DesignSystematic review using PRISMA guidelines.Data SourcesMedline, Cochrane and EMBASE databases in July 2020.Eligibility CriteriaStudies that directly compared TAR and AA which reported patient reported outcomes measures (PROMs) of pain, function and quality of life.Data Extraction and SynthesisTwo authors independently reviewed all papers. PROMs were allocated into pain, function or quality of life domains. Two summary statistics were created to allow for analysis of the PROMs. These statistics were the mean difference in post-operative score and the mean difference in the change of score.Results1323 papers were assessed of which 20 papers were included. 898 ankle arthrodesis and 1638 ankle replacements were evaluated. The mean follow up was 3.3 years (range 0.5–13.0 years). AA patients had a mean age of 55.7 (range 20–82) and TAR 62.5 (range 21–89).There was major heterogeneity in outcomes used. We were unable to find a significant difference between the reported change in PROMs following TAR and AA. 29.3% of PROMs and their subscores showed TAR had better outcomes, 68.7% showed no significant difference and only 2.0% showed AA to have better outcomes.ConclusionsThe majority of published studies found equality in patient reported outcomes following TAR and AA although the quality of the studies was of low-level evidence. There is an urgent need for randomised controlled studies to definitively answer this important clinical question.     

血液标本采集中护理缺陷原因分析及改进措施研究

目的：探讨血液标本采集中存在的护理缺陷的原因并提出有效的改进措施。方法回顾性分析该站2016年1一5月的33215例血液标本，分析血液标本采集中57例存在护理缺陷的原因，结合原因提出有效的改进方法。结果对该次33215例血液标本进行分析，在57例有护理缺陷的血液标本中信息不准确或不完整30例(52.6％）是该次采血护理缺陷的主要原因，标本质量缺陷15例(26.3％）是该次采血护理缺陷的次要原因。结论强化采血护士对标准操作规程及实践培训是改进血液标本采集护理的重要措施，优化调整排班，建立缺陷标本沟通和反馈途径，并持续改进，是保证标本质量，降低缺陷发生率的重要途径。     

2020 中国心力衰竭医疗质量控制报告

心力衰竭(心衰)是各种心脏疾病的严重和终末阶段,已经成为影响我国居民健康的重要公共卫生问题。针对目前我国心衰规范化诊治方面存在的问题,积极开展心衰医疗质量评价和改进,提高心衰诊治的规范性,具有重要的意义。自从2018年3月成立国家心血管病中心心力衰竭专病医联体(HFMU-NCCD),加入医院已超过1000家。国家心血管病医疗质量控制中心专家委员会心力衰竭专家工作组(NCCQI-HF)纳入2017~2020年期间在医联体单位住院的心衰患者,开展全国心衰医疗质量评价,包括心衰的诊断与评估、指南指导的药物治疗及器械治疗、临床结局等,并依据该研究结果和我们的思考,撰写成本报告。此外,通过与China-HF注册研究(2012~2015年)结果及美国心脏学会(AHA)的“跟着指南走——心力衰竭(GWTG-HF)”项目结果做比较,发现当前我国在心衰诊疗规范化方面较以前有明显改善,但仍存在诊疗不足、治疗不当及治疗过度等现象,不同等级医院之间也存在差异,而且与美国比较仍有一定差距,也体现出心衰患者特点以及国情的不同。未来需要提高数据填报数量和质量,持续开展医疗质量控制和改进,以便从整体上提高我国心衰的诊治水平。