Improving secure messaging: A framework for support,partnership & information-giving communicating electronically (SPICE)

BackgroundPatient-centered communication benefits patients and is widely endorsed. However, it is primarily associated with face-to-face contexts, although patients are increasingly using electronic platforms, such as secure messaging in patient portals, to communicate with providers.PurposeGiven the popularity of secure messaging and its ability to impact the patient-provider relationship, this study aimed to determine which attributes of patient-centered communication are most desired by cancer patients using secure messaging.MethodsA 2⁶ balanced incomplete block design discrete choice experiment was conducted using the best-worst scaling technique. Respondents were asked to select their most and least preferred attributes of two simulated patient-provider exchanges within each of eight choice sets.Results210 respondents indicated that either level of partnership (high and low) and either level of information-giving (high and low) were most preferred, while response times greater than 24 hours and low levels of support were least favored.ConclusionsSimilar to face-to-face communication, patients value aspects of patient-centered communication in the secure messaging setting and desire them to be included in provider replies.Practice ImplicationsPatient-centered communication is important to patients using secure messaging. Providers should incorporate SPICE (Support, Partnership, and Information-giving while Communicating Electronically).     

Preferences for pharmacist services to enhance medication management among people with diabetes in Indonesia: A discrete choice experiment

ObjectivesTo elicit patients’ preferences for pharmacist services that can enhance medication management among people with diabetes in Indonesia.MethodsA discrete choice experiment (DCE) among 833 respondents with diabetes in 57 community health centers (CHCs) and three hospitals in Surabaya, Indonesia. Consultation was the baseline service. Four attributes of consultation and two attributes of additional services were used in the DCE profiles based on literature and expert opinion. The DCE choice sets generated were partially balanced and partially without overlap. Random effect logistic regression was used in the analysis.ResultsRespondents preferred a shorter duration of consultation and flexible access to the pharmacist offering the consultation. A private consultation room and lower copayment (fee) for services were also preferred. Respondents with experience in getting medication information from pharmacists, preferred to make an appointment for the consultation. Total monthly income and experience with pharmacist services influenced preferences for copayments.ConclusionDifferences in patients’ preferences identified in the study provide information on pharmacist services that meet patients’ expectations and contribute to improve medication management among people with diabetes.Practice implicationThis study provides insight into evaluating and designing pharmacist services in accordance with the preferences of people with diabetes in Indonesia.     

Identifying Areas for Operational Improvement and Growth in IR Workflow Using Workflow Modeling,Simulation, and Optimization Techniques

Identifying areas for workflow improvement and growth is essential for an interventional radiology (IR) department to stay competitive. Deployment of traditional methods such as Lean and Six Sigma helped in reducing the waste in workflows at a strategic level. However, achieving efficient workflow needs both strategic and tactical approaches. Uncertainties about patient arrivals, staff availability, and variability in procedure durations pose hindrances to efficient workflow and lead to delayed patient care and staff overtime. We present an alternative approach to address both tactical and strategic needs using discrete event simulation (DES) and simulation based optimization methods. A comprehensive digital model of the patient workflow in a hospital-based IR department was modeled based on expert interviews with the incumbent personnel and analysis of 192 days’ worth of electronic medical record (EMR) data. Patient arrival patterns and process times were derived from 4393 individual patient appointments. Exactly 196 unique procedures were modeled, each with its own process time distribution and rule-based procedure-room mapping. Dynamic staff schedules for interventional radiologists, technologists, and nurses were incorporated in the model. Stochastic model simulation runs revealed the resource “computed tomography (CT) suite” as the major workflow bottleneck during the morning hours. This insight compelled the radiology department leadership to re-assign time blocks on a diagnostic CT scanner to the IR group. Moreover, this approach helped identify opportunities for additional appointments at times of lower diagnostic scanner utilization. Demand for interventional service from Outpatients during late hours of the day required the facility to extend hours of operations. Simulation-based optimization methods were used to model a new staff schedule, stretching the existing pool of resources to support the additional 2.5 h of daily operation. In conclusion, this study illustrates that the combination of workflow modeling, stochastic simulations, and optimization techniques is a viable and effective approach for identifying workflow inefficiencies and discovering and validating improvement options through what-if scenario testing.     

介导癌症发病及肿瘤靶向治疗中TLR4的作用

目的:评估TLR4与肿瘤发病的关系,并探讨其在肿瘤治疗中的作用。方法:以"TLR4、肿瘤(tumor)"为关键词,使用PubMed和CNKI数据库对2005-01-2010-12发表的文章进行分别和联合检索。纳入标准:1)TLR4的基本资料介绍;2)TLR4在肿瘤组织中的表达研究;3)TLR4在肿瘤治疗中的作用。根据纳入标准分析43篇文献。结果:TLR4的在胃癌、B细胞淋巴瘤、肝细胞癌、结肠癌、膀胱癌和前列腺癌等多种恶性肿瘤组织及细胞中阳性表达。TLR4是把双刃剑,一方面促进肿瘤的发展,另一方面对某些肿瘤的生长起抑制作用。结论:TLR4及TLR4的寡核苷酸基因多态性与肿瘤发生发展密切相关。TLR4有望成为肿瘤治疗的新靶点。     

剖宫产麻醉的注意事项及麻醉选择

目的为了提高麻醉质量,保证胎儿和母体的安全。方法回顾分析我院2009年1月120例割宫产临床资料。结果有30例血压下降,超过基础血压25％,一半晨仰卧位低血压综合征;5倒术中呕吐;全麻病人新生儿Apgar评分偏低,椎管内麻醉有2例导管误入血管,3例麻醉平面过高。结论剖宫产麻醉术前要充分准备,既要考虑产妇特有的生理变化,又要顾及麻醉药物和麻醉方法对新生儿及母体的影响。     

医学动植物实验用热电偶测温装置的设计*☆

背景：目前温度测量多为环境测量,无法准确测量胚胎发育温度和幼体发育温度。 目的：研究基于AD595芯片的医学动植物实验用热电偶测温装置的设计方案。 方法：实验设计包括信号的输入模块,信号的放大模块和信号的显示模块。信号由接插件端口送至AD595进行电阻电容网络去噪后送给AD620进行放大。放大后的信号经数模转换后送给单片机,最后通过3位8段码LED进行显示。 结果与结论：缝入动物体内的K型热电偶可以精确测量出胚胎发育温度和幼体发育温度。实验发现大明虾孵化温度为20~ 22 ℃有利于雌性化。采用AD595芯片设计的热电偶测温电路方案切实可行,效果稳定。同时可以有效降低电磁干扰和误差,便于软件的升级和改进。     

含有离散变量和连续变量的判别分析方法

本文研究了含有离散变量和连续变量的多组分层的判别分析问题,并提出了判别难则。对判别式进行了参数估计,并应用此判别准则对“七.五”攻关课题“胃癌筛选和诊断方法的研究”中的部分资料进行了实际应用。     

Controlling for overdispersion in grouped conditional logit models: A computationally simple application of Dirichlet‐multinomial regression

Summary In this article, we provide a random utility‐based derivation of the Dirichlet‐multinomial regression and propose it as a convenient alternative for dealing with overdispersed multinomial data. We show that this model is a natural extension of McFadden's conditional logit for grouped data and discuss its relationship with count models. Finally, we use a data set on patient choice of hospitals to illustrate an application of the Dirichlet‐multinomial regression.     

胰腺假性囊肿治疗方法的选择

该文报告２３例胰腺假性囊肿,根据病期、囊肿大小、部位选择治疗方法,其中非手术治疗５例,外引流１例,内引流１４例,囊肿切除术３例。结果：无手术死亡,非手术治愈５例,外引流术后胰瘘１例,囊肿切除术后复发１例,内引流术后无严重并发症出现。我们认为急性囊肿应观察６周,有些病例有自行消散的可能,慢性囊肿一经确诊即可行内引流治疗,内引流是目前较理想的有效手术方式