Antifungal susceptibility testing practices in mycology laboratories in France, 2018

A survey of mycology laboratories for antifungal susceptibility testing (AFST) was undertaken in France in 2018, to better understand the difference in practices between the participating centers and to identify the difficulties they may encounter as well as eventual gaps with published standards and guidelines. The survey captured information from 45 mycology laboratories in France on how they perform AFST (number of strains tested, preferred method, technical and quality aspects, interpretation of the MIC values, reading and interpretation difficulties). Results indicated that 86% of respondents used Etest as AFST method, with a combination of one to seven antifungal agents tested. Most of the participating laboratories used similar technical parameters to perform their AFST method and a large majority used, as recommended, internal and external quality assessments. Almost all the participating mycology laboratories (98%) reported difficulties to interpret the MIC values, especially when no clinical breakpoints are available. The survey highlighted that the current AFST practices in France need homogenization, particularly for MIC reading and interpretation.     

Electrocardiogram Interpretation Training and Competency Assessment in Emergency Medicine Residency Programs

OBJECTIVES: To determine the type of electrocardiogram (ECG) interpretation instruction in emergency medicine (EM) residency programs, the use and perceived value of teaching modalities and resources, and the methods used to assess competency of ECG interpretation. METHODS: An interactive survey instrument was posted on the Internet using SurveySuite, Inc., software and e-mailed to program directors (PDs) of all 125 Accreditation Council for Graduate Medical Education-approved U.S. EM residency programs. Responses are reported in total numbers and percentages. RESULTS: Ninety-nine of 125 PDs completed the online survey (response rate, 79.2%). Emergency department instruction (99%), case-based lectures (98%), and didactic lectures (98%) were most commonly used to teach interpretation of ECGs, followed by computer-based instruction (34%) and ECG laboratory (12%). The majority of programs (53%) spent more than eight hours on formal ECG lectures per year, while 11% spent less than three hours. Observation during clinical time (99%), lecture time (76%), and hypothetical cases (57%) were the most common ways to determine competency in reading ECGs, while clinical observation and hypothetical cases were perceived as the most valuable. The most commonly used resource was personal or departmental ECG files (91%), and this had the highest perceived value. The majority of PDs were comfortable with residents' abilities to read ECGs by the third year (96%) and fourth year (91%) of residency. CONCLUSIONS: These data suggest that EM PDs believe that EM residency is adequately preparing graduates to interpret ECGs. This goal is achieved through a variety of methods.     

Interpretation of functional series expansions

While much research has been devoted to the implementation and application of Volterra and Wiener functional series expansions in the identification and characterization of biological systems, little effort has been focused on the fundamental problem of interpreting the resulting kernels. This paper describes the application of the series to the components of a known model of the human pupil control system. As more complicated elements are put together, insight into kernel interpretation is built up incrementally until the total system is identified. Practical limitations and methods are also discussed.     

Benefits of the DICOM Structured Report

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change. Biography Rita Noumeir is a professor at the Department of Electrical Engineering of the University of Quebec, école de Technologie Superieure in Montreal. A founding member of the Imaging, Vision, and Artificial Intelligence Laboratory (LIVIA), her main research interest is the Healthcare Information Technology, specifically, Interoperability, Electronic Patient Record, Security, Information Confidentiality, and Image Processing. As a member of both Technical and Planning International IHE Radiology Committees, Dr. Noumeir took part over the last 5 years in developing many Integrating the Healthcare Enterprise (IHE) Integration Profiles in Radiology and in organizing several Integration Demonstrations. She is a cofounder of IHE Canada. Dr. Noumeir contributed to many research and development projects in collaboration with several Canadian and international companies in medical imaging and healthcare information. Currently, she collaborates with the Diagnostic Imaging Team of Canada Health Infoway to define the principles and architecture for sharing imaging information between multiple healthcare institutions. She plays a leading role in the development of this solution that is published as an IHE Integration Profile for which she is the editor. Rita Noumeir holds a Ph.D. and a Masters degree in Biomedical Engineering from école Polytechnique of Montreal specializing in Medical Imaging. She is a professional engineer, and a member of the Ordre des ingénieurs du Québec.     

Two-dimensional coronary MRA: limitations and artifacts

Our purpose was to assess image quality and interpretation problems of two-dimensional (2D) coronary MR angiograms. The coronary arteries of 27 subjects (12 normal volunteers and 15 patients) were evaluated with 2D coronary MR angiography (MRA). Coronary MRA was performed with a fat-suppressed electrocardiographically gated breath-hold gradient-echo sequence with k-space segmentation using a 1.5-T imager. Image quality throughout the study was occasionally degraded by: image ghosting (22%), ringing (19%), and/or blurring (22%) and incomplete fat-suppression (19%). Intermittent difficulties with breathholding were encountered in 44% of subjects. When limiting the analysis to those images with optimal image quality, interpretative difficulties were sometimes found: misregistration due to inconsistent breathholding (37%); difficulty in distinguishing veins from arteries (37%); obscured anatomy due to overlapping structures (26%); and poor visualization of portions of the left main coronary artery (59%). Two-dimensional coronary MRA studies have image quality and interpretive problems which need to be understood and addressed before routine clinical scanning is initiated.Correspondence to: A. J. Duerinckx     

Strategies for understanding. A case study of occupational therapists' communication behaviour

This study focuses on the communication strategies of occupational therapists. Many recent studies in occupational therapy emphasize the importance of having a client-oriented perspective; the needs and wishes of the patient should form the basis for treatment. Such a perspective brings to the fore the capacity of the therapist to enter into the life-world of the patient. Communication, dialogue between patient and therapist, is the basic source of such knowledge. In this paper, understanding verbal acts is seen as fundamentally problematic. The purpose is to analyse what strategies and tactics occupational therapists use to create a basis for their interpretation of patients' messages. What kinds of questions and other forms of verbal behaviour are utilized to check and verify these interpretations? A case-study of communication behaviour during five meetings between patients and therapists in the homes of the patients was undertaken. Seven types of tactics were observed and categorized as belonging to two different strategic dimensions: active-passive and abstract-concrete. Although active strategies were predominant, only one therapist consistently used a combination of ‘asking open questions’ and ‘verifying’ interpretations, the two most active tactics. Most therapists also asked the patients to concretely ‘show in action’ what they meant, but to a varying degree. A consistent use of active-concrete strategies is arguably an ideal way of seeking knowledge and understanding. Empirically, therapists differ in how closely they fit this ideal. This may be a result of training and experience, but also of degree of empathy. This study points to the importance of carefully developing communication strategies in order to fully understand the problems of the patients. Copyright © 1997 Whurr Publishers Ltd.     

颈痛患者手法治疗：最佳实践指南解读

颈痛在临床上常由颈椎退行性疾病引起,易对患者颈部功能及生活质量造成不良影响。为提供最佳、有效的诊断及治疗方案,2019年美国国家健康科学大学发表了《最佳实践建议：颈痛患者的整脊治疗管理》。课题组在充分研读最新版指南诊治内容的基础上,从诊断、治疗、注意事项3个方面进行解读,同时检索相关文献,纵向对比多个高质量颈痛相关指南,从生物力学及神经生物学方面分析手法治疗颈痛的科学性,并结合中国诊疗现状分析认为其推荐的手法治疗及诊疗流程在中国具有可行性,基于此认为将国内外现有的循证医学证据结合中国传统医学能指导临床实践。     

Unique demographic situation in the United Arab Emirates

A method which optimizes on global properties of sample recordings is proposed for the definition of and the discrimination between electroencephalogram (EEG) classes. The sample was drawn from students at the University of Heidelberg from 1974 to 1978 and consists of 15 healthy index cases clinically ascertained as belonging to the low voltage EEG group. In addition, the three clinically defined groups: diffuse β (18 index cases), borderline α (12 index cases) and monomorphous α (18 index cases) have been included in the study, as well as the first degree relatives of the index cases, thus providing a clinical classification into four groups. The proposed method provides an automatic and reliable classification algorithm using discriminant and cluster analysis. The relation between such an automatized classification and clinical classification schemes is investigated. In particular, the inheritance of the low voltage, EEG, the question on sex differences and the question of a simple Mendelian mechanism had been examined. The method of random splittings had been applied for discriminant and cluster analysis. Our findings can be summarized as follows: (1) except for the monomorphous α EEG group, the clinical classification shows rather marginal separation (discriminating performance 60% to 75%), while a new and more reliable grouping scheme improves the discriminating performance up to 87% to 91%. The latter scheme leads to the concept of personal channel pattern (PCP) and was compared to the clinical classification scheme by means of contingency tables; (2) only a weak correlation between the clinically and PCP-based groups could be found (Cramér Index: 0.27). Accordingly, we continued to investigate the extent to which the proposed EEG classification scheme can nevertheless explain the genetic mechanisms apparently involved in the low voltage EEG. We thus considered the role of sex differences manifest in our proposed new grouping scheme; (3) males occurred more frequently in the new group 3 and females more frequently in the new group 1. In this regard, a much better correlation of the new groups between mothers and children than between fathers and children was observed; and (4) with help of our new PCP scheme, we have been able to reproduce a simple two gene Mendelian scheme to explain inheritance of the clinical low voltage EEG group. In this PCP-based scheme, the low voltage property does not occur when dominance of a certain gene (called gene A) is absent. © 1996 Wiley-Liss, Inc.