“Helper:” A critical events prompter for unexpected emergencies

Objective. The medical practitioner is faced with an increasing list of protocols and algorithms related to patient care. These recommendations are often difficult to recall, particularly in stressful emergency situations. Using advanced cardiac life support (ACLS) protocols, we built a computer-based system to exhibit precompiled response plans for medical emergencies. To validate the usefulness of this prompting device, we tested application of two of the nine ACLS algorithms, pulseless ventricular fibrillation/ventricular tachycardia (Vfib/Vtach) and bradycardia, in a simulated operating room (OR) environment.Methods. The system utilized the software authoring system IconAuthor (Aimtec Inc., Nashua, NH) and a touch-screen monitor (DiamondScan, Microtouch, Methuen, MA). Prior to testing our system, all 39 subjects were given time to familiarize themselves with its operation. Subsequently, all subjects were videotaped while managing a standard simulated anesthetic. During the anesthetic, the subjects were presented with two emergency scenarios, not viewed during the familiarization period. The electrocardiographic (EKG) signals for normal sinus rhythm, ventricular fibrillation, and second-degree heart block were presented. By random selection, the prompter was available to half of the subjects for help with arrhythmia management (experimental group), while to half it was not (control group).Results. A total of 39 subjects completed the exercise. Use of the prompter enabled significantly more subjects to administer correct drugs and dosages during ventricular fibrillation. The correct lidocaine dose was chosen more often by the experimental group than by the control (p=0.015); similarly MgSO₄ was appropriately ordered more often in the experimental group (p=0.003). During second-degree heart block, atropine was correctly followed with a dopamine infusion (p=0.004), and epinephrine infusion was ordered for refractory bradycardia (p=0.002) more often in the experimental than the control group.Conclusions. These data demonstrate the value of a prompting device at the anesthesia workstation. We foresee the use of such prompters in many areas of medicine.This study was made possible by a grant from the Anesthesia Patient Safety Foundation. Results were presented, in part, at the meeting of the STA/SEA Orlando, Florida, January 1994.     

肺内小病灶CT表现及其病理基础的研究：附76例分析

本文对７６例肺内小病灶（直径≤３ｃｍ）病例进行了ＣＴ－病理对照研究。结果表明，短毛刺征，深分叶征、棘状突起征、空泡征、血管集束征，胸膜凹陷征等对于诊断周围型小肺癌有重要临床价值；而尖角征、局限性胸膜肥厚粘连对诊断良性病灶有意义。本文重点讨论了血管集束征的定义，ＣＴ表现及病理基础；并就有争议的胸膜凹陷征提出一些粗浅的看法。旨在提高肺内小病灶良恶性诊断的准确率     

Perimetric variability: Importance of criterion level

Perimetry suffers from considerable variability of results. A new technique for estimating individual criterion levels in normal subjects exposes the important role of psychological variables. The analysis depends on features peculiar to acuity perimetry. It can be accommodated in the regular examination. The results can be used to compensate for practice effects in serial examinations and to tighten the range of normal limits. The reduction in variation between normal subjects amounted to 57 per cent.     

国人鼻泪管冠状位CT扫描基线的定位

目的　探讨国人鼻泪管冠状位CT扫描的最佳基线。②方法　随机选取 2 8例 (男 2 0例 ,女 8例 )正中矢状位切开的尸头 ,解剖鼻泪管 ,观察鼻泪管的走向并测量鼻泪管在矢状面上的投影与额最高点至前鼻棘连线的夹角 ,并根据此角度对随机选取的 5例完整尸头进行冠状位CT扫描 ,同一角度对扫描后的尸头进行冠状位切片 ,并比较两种方法所测鼻泪管是否吻合。③结果　鼻泪管在矢状面上的投影与额最高点至前鼻棘连线的夹角为8.74°± 1 .39° ,两种方法所测鼻泪管结果一致。④结论　依此角度进行冠状位CT扫描 ,可以完整地显现出鼻泪管全貌     

Comparing hand-held computers and paper diaries for haemophilia home therapy: a randomized trial

Treatment of severe haemophilia with factor concentrates is by self-infusion in the home. Adherence to record keeping on paper diaries is poor. A randomized-controlled trial compared adherence with record keeping of paper diaries with hand-held computers. Forty-one individuals with severe haemophilia, were randomized to hand-held computers (n = 22) or paper diaries (n = 19) and followed for 6 months. About 86.2% (679 of 788) of infusions by patients in the computer group were in compliance with the data submission schedule compared with only 48.3% (358 of 741) of infusions by patients using paper diaries (P < 0.0001). The time intervals between infusions and the receipt of data were shorter in the computer group (median 0.25 vs. 25 days respectively, P < 0.0001). Reminder phone calls by the clinic were made less frequently to users of hand-held computers than to users of paper diaries (median one vs. five times, P < 0.0001). Accuracy of data was similar for both methods. Compliance with hand-held computers was superior to paper diaries. The clinic received data from hand-held computers mostly on the same day, and nurses could thereby provide clinical advice more effectively. Although hand-held computers did not result in increased accuracy, errors could be detected and corrected more rapidly. Electronic data can more easily be verified, analysed and summarized than that from paper diaries.     

计算机X线摄影适宜照射线量的探讨

目的以噪声的频率特性评价计算机X线摄影系统(computed radiography, CR)的适宜曝光量.方法在相同摄影条件下获得中速 CaWO4屏-Fuji片组合照片和CR照片,以此为基础,改变mAs,获得不同照射剂量下的CR影像,经相同的后处理条件输出它们的CR照片.用显微密度计依次对这些照片进行扫描,每张获得10万个密度值,作为离散随机信号来处理,用快速傅立叶变换计算威纳频谱(Wiener spectrum, WS),测试CR照片噪声的WS与中速CaWO4屏-Fuji片组合的照片噪声WS值相等的曝光量值.结果 (1)在照射剂量均为5.61μGy、照片密度均为1.0的情况下,在空间频率(ω)=0.1 LP/mm处,CR系统的WS值为 23.1×10 -6 mm2,屏-片系统的为20.1×10 -6 mm2;在ω=0.5 LP/mm处,CR系统的WS值为 9.73×10 -6 mm2,屏-片系统的为8.41×10 -6 mm2 .(2)当ω=0.1 LP/mm时,照射剂量为5.61μGy的CR照片的WS值分别是照射剂量为1.40、2.80、8.76、13.67、21.11μGy CR片的0.53、0.75、1.14、1.44、1.80倍;当空间频率为0.5 LP/mm时,照射剂量为5.61μGy的CR片的WS值分别是照射剂量为1.40、2.80、8.76、13.67、21.11μGy CR片的0.40、0.58、1.26、1.47、2.16倍.(3)在ω=0.5 LP/mm时,与照射剂量为5.61μGy的屏-片组合有相当的噪声水平的CR照片照射剂量大致为7.70 μGy左右.结论相同摄影条件下CR照片的噪声要比中速 CaWO4屏-Fuji片组合的大;随着照射量的增加CR系统总WS将减小,噪声下降;如想获得和屏-片相同噪声的影像,应适当增大CR系统的照射量.     

翼腭窝的CT三维成像

目的：探讨CT三维成像评价翼腭窝解剖结构的价值。材料和方法：使用Philips Mx8000型多层CT检查仪对5个成人头颅标本进行准直1mm或0．5mm的容积采集，并将数据输入配套Mxview工作站（SGI02）进行三维重建处理，包括容积显示（VR）和三维正交多平面重建（MPR）。鼻腔内侧壁相关结构进行测量并与标本测量进行对比。结果：CT三维正交多平面重建图像可以十分清楚地显示翼腭窝结构及其6个通路结构，VR可以清楚、准确地显示鼻腔内侧壁结构，并均可以获得准确测量。结论：CT容积采集结合合理的三维重建可以直观、立体地显示翼腭窝解剖及其相关通连结构。     

中国汉族人群腓骨肌萎缩症Cx32基因突变分析

Charcot Marie Tooth (CMT)diseaseisthemostcommoninheritedperipheralneuropathywithapreva lenceof 1in 2 5 0 0 .Distalmuscleweaknessandatro phy ,sensorylossandreducedorabsenttendonreflex es ,pescavus ,hammertoes ,steppagegaitareamongthemainsymptoms .Thereares…     

16层螺旋CT冠状动脉造影伪影分析

目的：探讨16层螺旋CT冠状动脉造影伪影表现和成因，提高冠状动脉CT血管造影质量和诊断准确性。材料和方法：回顾性分析400例16层螺旋CT冠状动脉造影中失败及假狭窄诊断的38例图像，以DSA冠状动脉造影为金标准，分析上述病例中的伪影及假狭窄的CT表现。结果：伪影分为呼吸伪影、心律不齐伪影、冠状动脉搏动伪影、上腔静脉高浓度造影剂产生假斑块伪影、冠状动脉重度钙化产生的伪影，上述各种伪影均具有独特的影像特征。结论：准确分析CT冠状动脉成像伪影的影像表现及成因，对提高CT成像质量，减少诊断失误有很大的临床意义。