腰椎棘间韧带退行性病变的磁共振成像分级研究

目的探讨磁共振成像(MRI)分级系统对腰椎棘间韧带退行性病变进行分级的可靠性。方法设计腰椎棘间韧带退行性病变的MRI分级系统,采用正中矢状位T1和T2加权像对100个腰椎棘间韧带退行性病变进行MRI分级,并对该分级系统的可靠性进行评估。结果 100个棘间韧带退行性病变的整体MRI分级:A级为43.0%～51.0%,B级为38.0%～46.0%,C级为3.0%～6.0%,D级为5.0%～9.0%。在所有阅片者中,观察者内一致性极好,kappa值为0.865～0.931;而观察者间一致性较低,kappa值为0.727～0.823。观察者内和观察者间A、B级之间的差异高于B、C级和C、D级之间的差异,观察者内和观察者间A、C级之间的分歧比例高于B、D级之间的分歧比例。结论该棘间韧带退行性病变MRI分级系统简单、可靠,重复性尚可。     

医学影像学实践考试系统的研究

介绍了应用计算机多媒体技术、图像处理技术和网络技术,解决医学影像学实践考试中因影像片准备、场地准备、考试组织、阅卷成绩管理等因素影响考试的一些做法。指出该系统不仅使实践考试更加自动化和科学化,而且该系统的研究也为其他学科的图像考试开辟了一条新的途径。     

医师共情能力自评问卷的编制

目的 编制一个适用于医师共情能力评测的问卷,并检验其信度和效度.方法 通过文献研究、访谈和专家咨询,编制医师共情能力自评问卷的初测版.按照便利取样的方法简单随机抽取某医院200名临床医师试测,并进行讨论分析,形成正式版的问卷.采用分层抽样的方法,抽取3所医院600名临床医师正式施测,并填答中文版人际反应指针量表.间隔4周抽取100人进行重测.对所得的586份有效问卷的数据进行验证性分析,并检验问卷的信度和效度.结果 探索性因素分析得到观点采择能力、情绪共享能力、积极关怀能力和共情表达技能4个因素,因素负荷值为0.516 ～ 0.828.问卷的内部一致性信度为0.840,重测信度为0.728,与中文版人际反应指针量表的相关系数为0.712.结论 所编制的医师共情能力自评问卷具有较好的信度和效度,可以用于临床医师共情能力的评测.     

Reliability of clinical tests of foot and ankle characteristics in older people

Lower-extremity problems are common in older people; however, the reliability of clinical tools used to assess foot and ankle characteristics has not been rigorously evaluated. This study evaluated the test-retest reliability of a battery of simple clinical tests of foot and ankle characteristics (tactile sensitivity of the first metatarsophalangeal joint, navicular height, foot length and width, hallux valgus severity, an overall foot problem score, ankle flexibility, ankle dorsiflexion strength, and foot pain) in 31 individuals (13 men and 18 women) aged 76 to 87 years recruited from the community. Three examiners performed the tests on two occasions approximately 2 weeks apart. Intraclass correlation coefficients and coefficients of variation were calculated for continuously scored tests, and the kappa statistic (kappa) was used to determine the reliability of hallux valgus severity grading. All of the continuously scored tests had acceptable reliability (intraclass correlation coefficients of 0.64 to 0.98; coefficients of variation of 0.6% to 15.0%), as did hallux valgus severity grading (kappa = 0.77; absolute percentage agreement, 84%). These simple clinical tests can now be used with confidence in clinical and research settings to provide reliable and functionally important information regarding foot and ankle characteristics in older people.     

Associations between clinical neck symptoms and various evaluations of cervical intervertebral disc degeneration by magnetic resonance imaging

Purpose: Magnetic resonance imaging (MRI) is widely used to evaluate intervertebral disc degeneration. Recently, various evaluations of cervical disc degeneration using MRI have been conducted, but there is no gold standard. The purpose of this study was to compare the reproducibilities of previously reported classifications for evaluating cervical disc degeneration by MRI and their associations with clinical symptoms. Participants and methods: A total of 582 subjects underwent conventional MRI of the cervical spine. Disc degeneration was assessed in each intervertebral disc from C2/3 to C7/T1 using five different classifications: Matsumoto’s grading system, Miyazaki’s grading system, Nakashima’s grading system, Jacobs’ grading system, and Suzuki’s grading system. MR images of 30 participants were used, and Cohen’s kappa coefficient of agreement of each classification was calculated for intra-observer and inter-observer reliabilities. These five classifications of disc degeneration and changes of vertebral endplates were measured, and associations with clinical symptoms were assessed. Results: Kappa (κ) values of intra-observer agreement were higher for Jacobs’ classification, whereas those of inter-observer agreement were higher for Nakashima’s and Jacobs’ classifications than for other classifications. The prevalences of neck pain and shoulder stiffness were 27.4% and 41.9%, respectively. There were no associations for any classifications of disc degeneration and Modic types with neck pain or shoulder stiffness. Only the presence of Schmorl’s nodes was associated with neck pain. Conclusion: At present, there is no specific classification for cervical disc degeneration associated with clinical symptoms. Vertebral endplate changes might be associated with clinical symptoms. It may be necessary to create a new classification for better reproducibility of the evaluation of cervical disc degeneration.     

Cross sectional survey of ultrasound use for central venous catheter insertion among resident physicians

BACKGROUND: Use of ultrasound guidance for Central Venous Catheter insertion has been associated with decreased complications and increased success rates. Previous reports show low rates of use among physicians. OBJECTIVES: Evaluation of the frequency of Ultrasound Guidance use for Central Venous Catheter insertion among residents at a teaching institution. METHODS: A cross sectional electronic survey of resident physicians at a tertiary care teaching hospital was conducted to evaluate use of Ultrasound Guidance for Central Venous Catheterization. Assessment included self reported frequency of ultrasound guidance use, and volume of central venous catheter placement. Attitudes toward the use of ultrasound were assessed using Likert scales. RESULTS: There is a high rate. over 90%, of ultrasound guidance use for Internal Jugular central venous catheters among residents. The majority of residents use sterile real-time imaging with a single operator with a reported success rate greater then 80%. CONCLUSIONS: Resident use of ultrasound guidance for Internal Jugular central venous catheter insertion can be much higher than previously reported in the literature.     

科学技术新兴技术主题识别研究

目的:挖掘科技文献中的新兴技术主题.方法:构建新兴技术主题识别研究框架.采用隐含狄利克雷分布(LDA)主题模型结合熵权法对新兴技术主题进行识别.结果:识别出了新型比色检测技术、新型荧光检测技术和生物检测技术3个新兴技术主题.结论:新兴技术主题识别研究框架可有效识别科技文献中的新兴技术主题.     

HIE磁共振多序列分度与临床分度的一致性研究

目的探讨新生儿缺氧缺血性脑病（HIE）患儿磁共振多序列分度与临床分度的一致性。方法将经临床确诊为HIE的新生儿95例进行包括DWI及ESWAN序列的MRI多序列扫描,分别比较不同序列组合的MRI分度与临床分度的一致性。结果T1WI组MRI分度与临床分度比较Kappa值为0．32（P〈0．05）,一致性较差;T1WI＋DWI组MRI分度与临床分度比较Kappa值为0．57（P〈0．05）,一致性上升;T1WI＋DWI＋ESWAN组MRI分度与临床分度比较Kappa值为0．79（P〈0．05）,一致性好。结论T1WI联合DWI及ESWAN序列后,明显提高了HIE MRI分度与临床分度的一致性。     

人工智能技术在医学影像中的应用讨论

深度神经网络是新一代人工智能技术,其在自然语言处理、学习能力、计算机视觉上将机器的认知能力推向了新的高度。目前,深度神经网络在医学影像中的应用主要集中在发现异常、量化测量和鉴别诊断3个方面,基于深度神经网络的医学影像研究已涉及放射影像、病理图像、超声影像、内镜影像等多个领域。深度神经网络在一些任务场景中已展现出与医师相当甚至超越医师的表现。在人工智能技术高速发展的大环境下,医师群体应客观冷静地看待技术、科学严谨地评价技术、积极开放地参与技术的提升与应用,成为技术的驾驭者,走向人工智能技术辅助下的医疗服务未来。     

医学研究生导师评价指标体系的构建

目的构建一套科学合理、切实可行的医学研究生导师评价指标体系。方法在文献分析的基础上,通过初拟评价指标体系框架,采取德尔菲（Delphi）法,进行了两轮问卷调查。运用描述性分析法、多独立样本的非参数检验法（Kruskal．Wallis检验）、专家可靠性分析、层次分析法等进行数据分析。结果两轮问卷调查的问卷回收率及合格率均在90％以上,总体专家权威系数为0．8957;二级指标咨询的协调系数为0．181,Х^2=27．148,P〈0．001;三级指标咨询的协调系数为0．157,Х^2=127．03,P〈0．001,专家意见协调性高度一致。结论构建了由3个一级指标、7个二级指标和28个三级指标组成的医学研究生导师评价指标体系。为研究生导师综合素质评价提供了直接参考,对加强导师队伍建设、保障研究生培养质量具有重要的现实意义。     

Physicians’ Views and Assessments on Picture Archiving and Communication Systems (PACS) in Two Turkish Public Hospitals

A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of and convenient access to images from multiple modalities (source machine types). PACS have been widely introduced as a credible alternative to the traditional film-based radiological service. This study was planned and conducted to determine the physicians' views and assessments on PACS in two public hospitals in Turkey. A questionnaire was prepared by viewing the literature related to PACS. The questionnaires were distributed several times to a total of 150 physicians two public hospitals in Ankara, Turkey. The overall response rate is 46%. Some questions required a graduated score in response and others an open ended response. The majority of physicians judged PACS to be a major advance for their hospitals with less frustration than using film high quality images and an improvement in their working lives and patient care. They reported that PACS gave them to radiology reports in short time. Also physicians believed that PACS has improved their consultations. Open ended questions were prepared with concerning the benefits and disadvantages of PACS. The assessments of the physicians demonstrated many more benefits than disadvantages of PACS in their hospitals. PACS has been accepted well by a wide percentage of hospital physicians. PACS evolves over time components are frequently replaced and so the users must expect continuous learning about new updates and improved functionality. The implementation of the PACS clearly contributes to an increase in the productivity of health professionals and physicians.     

基于德尔菲法构建临床医学专业本科生教学评估指标的研究

目的 本文旨在构建一套面向临床医学本科生教学,适应临床教学发展与需求,具有科学性、导向性、可行性的教学评估指标。方法 在文献研究、半结构式访谈和小组讨论的基础上拟定指标体系初稿,并编制函询问卷,采用德尔菲法对全国25名专家进行两轮函询。采用SPSS 27.0软件进行统计分析。结果 2轮专家函询问卷回收率均为100.0%,专家积极程度高;专家权威系数>0.84,可靠性强;各指标变异系数为0~0.22,第2轮协调系数高于第1轮,且P<0.001,专家意见的协调程度较高且专家意见一致性结果较为可信。最终形成了针对临床医学专业本科生理论授课、见实习带教和在线理论课程的质量评估指标,包括一级指标6~7项、二级指标12~14项。结论 通过科学、规范地应用德尔菲法,建立了一套较为全面、适应新时代发展、具有临床特色的本科生教学评估指标,全面提高了教学质量,促进了医学人才的培养。     

Classification of Procedures in the Domain of Thoracic Surgery—A Study of Reliability in Coding

This paper relates a study of reliability of coding of surgical procedures in the domain of thoracic surgery. The reliability measured is inter-coder variability in form of agreement. Four classifications were used by four physicians on 100 patient cases. The classifications, having differing granularity and structure, were analyzed using a statistical method (kappa). These results are discussed and related to the differences between the classifications. One of the topics for discussion is how the granularity affects the degree of agreement, coupled to the usefulness of the classification. Also the concept of using formal methods for representing classifications is discussed, how this will affect how classifications are designed and used.     

磁共振扩散张量成像在胶质瘤分级中的应用

目的评价扩散张量成像（Dif-fusion tensor imaging,DTI）在颅内胶质瘤分级上的价值。方法经手术及病理证实的30例颅内胶质瘤（低级别16例,WHOⅠ～Ⅱ级,高级别14例,WHOⅢ～Ⅳ级）,使用Philips Achieva1.5T超导型磁共振扫描仪在术前进行常规扫描及DTI数据采集。使用PhilipsEWS工作站的Release2.6.3,Fibertrak软件,对比分析FA（fractionalanisotropy,部分各向异性）、RA（relative anisotropy,相对各向异性）和ADC（apparent diffusionco efficient,表观扩散系数）三个参数在胶质瘤不同级别中的表现。结果高级别胶质瘤肿瘤实质部分（包括强化区及未强化区）的FA值及RA值均高于低级别组（P〈0.01）,ADC值低于低级别组（P〈0.01）。结论 DTI能够为鉴别胶质瘤分级提供一定信息。     

Validation and clinical application of the Arabic rhinoplasty outcomes evaluation questionnaire

Objectives:To carry out translation, cross-cultural adaptation, and validation of the rhinoplasty outcome evaluation (ROE) into Arabic.Methods:This non-randomized, prospective study included 50 patients from the Otorhinolaryngology Department, King Saud University, Riyadh, Saudi Arabia who underwent primary rhinoplasty from January to October 2020 and a control group of 89 healthy individuals. The reliability of the Arabic (ROE) was tested using Cronbach’s alpha. The test-retest reliability was assessed by estimating the intra-class correlation coefficient for the total Arabic (ROE) score and individual items. Discriminant validity was used to examine the validity of the Arabic (ROE) by comparing the scores of the patients and the control group. The Friedman test was used to measure differences in Arabic (ROE) ratings within the study patients’ group, including preoperative, and 2 weeks, and 3 months postoperative ratings.Results:The internal consistency and reliability of the Arabic (ROE) were good. There was a significant difference in ratings between rhinoplasty patients and the control group regarding both the individual questions and total scores. Significant improvement was observed in the patient group ratings at 2 weeks and 3 months postoperatively compared to the preoperative rating (p<0.0001).Conclusions:The Arabic version of the (ROE) showed good reliability and validity and can be used in the assessment of rhinoplasty outcomes in the Arabic population.     

医院科研目标管理量化考核的设计与实施探讨

目的 加强科研绩效考核管理,调动科研积极性,从而提高医院科研水平.方法 设计了科研目标管理考核指标、考核内容、评分细则等方案来进行考核.结果 通过制定考核目标实现了科研量化考核管理.结论 本目标量化考核管理方案切实可行,可以有效地对科研工作实施质量控制.     

“中医生存质量自评量表”的评价

目的:构建并验证“中医生存质量自评量表”的可行性、信度、效度、反应度。方法:在整体观念指导下,体现中医临床信息和辨证的特点,基于整体症状、五脏和气血阴阳的功能异常等10个维度,构建“中医生存质量自评量表”,收集临床信息,借用SAS 6.12统计分析。结果:信度系数R>0.70,克朗巴赫α系数均大于0.7,标准关联效度系数均大于0.5(P<0.0001),单因素方差分析P<0.0001。结论:量表的可行性、结构稳定性、内部一致性较好,能够区分正常人群和患病人群。但因子分析结果不理想。     

体素内不相干运动成像判断肝细胞癌的病理分级

目的评估核磁共振成像（MRI）中运用体素内不相干运动成像（IVIM）判断Wistar大鼠肝细胞癌（HCC）的病理分级。方法采用饮水中加入二乙基亚硝胺（DEN）制备大鼠HCC模型,运用IVIM扫描大鼠肝组织病灶,获得表观扩散系数(apparent diffusion coefficient, ADC)值和IVIM参数值〔包括真性扩散系数（D）、假性扩散系数（D*）及灌注分数（f)〕,扫描完成后处死大鼠,取肝组织病灶行HE染色,对判断建模成功的HCC病灶行Edmondson-Steiner病理分级,按病理分级分为低级别组（Ⅰ+Ⅱ级）和高级别组（Ⅲ+Ⅳ级）HCC,比较两组ADC和IVIM参数值,应用ROC曲线分析上述参数的诊断效能。结果48只大鼠成功建立HCC模型,共获取50个HCC病灶,其中28个低级别HCC和22个高级别HCC。高级别组HCC的ADC值、D值均低于低级别组（P=0.009,0.005）,高级别组HCC的D*值、f值高于低级别组（P=0.032,0.044）,提示ADC及IVIM参数均能鉴别高、低级别HCC。ROC曲线分析显示,ADC、D、D*及f值为0.907 8×10-3 mm2/s、0.817 6×10-3 mm2/s、24.31×10-3 mm2/s、14.4%时,约登指数最大,但各参数值ROC曲线下面积（AUC）两两比较,差异均无统计学意义（P＞0.05）,其AUC均＞0.5,且＜0.9,说明ADC、D、D*及f判断HCC病理分级的诊断效能无明显差异,诊断效能为中等。结论ADC及IVIM参数均能单独鉴别高、低级别HCC,有助于术前评估HCC的病理分级。     

Direct measurement of the signal intensity of diffusion-weighted magnetic resonance imaging for preoperative grading and treatment guidance for brain gliomas

BackgroundMagnetic resonance diffusion-weighted imaging (DWI) has been widely used clinically in imaging diagnosis of intracranial disorders. The purpose of current study was to present a quantitative method of direct measuring the DWI signal intensity of brain gliomas on the monitors of hospital picture archiving and communicating system (PACS) for grading gliomas.MethodsThis study recruited 135 patients with treatment-naïve brain gliomas. Direct measurement of the signal intensity of selected tumoral regions of interest (ROIs) by DWI on the monitors of the hospital PACS was performed for all patients. From the measurements, we obtained three values, defined as DWI_T (tumor), DWI_N (the homologous normal-appearing area of the tumor ROI in the contralateral hemisphere), and DWI_WM (normal-appearing white matter) in the contralateral frontal lobe. Two ratios, DWI_T/WM and DWI_T/N, were obtained for each tumoral ROI. The same method was used for apparent diffusion coefficient (ADC) ratios of the tumoral ROI. Fractional polynomial regression and the Mann–Whitney U test were applied to determine the correlation between tumor grading, MIB-1 labeling index, and DWI and ADC ratios. Logistic regression models and receiver operating characteristic curve analysis were used to establish diagnostic models. Measurements of intraobserver and interobserver agreement were also made at 1-month interval.ResultsThe DWI ratios correlated positively with tumor grade and MIB-1 value (p < 0.01). Cut-off ratios of 1.62 for DWI_T/WM and 1.47 for DWI_T/N generated the optimal combination of sensitivity (0.82, 0.80), specificity (0.79, 0.86), and sound discriminating power, with an area under the curve of 0.87 and 0.84, respectively, to differentiate low-grade from high-grade gliomas. ADC ratios showed relatively worse sensitivity, specificity, and discriminating power than DWI ratios. Almost all intraobserver and interobserver measurements were within 95% agreement.ConclusionThe proposed method – direct measuring of tumor signal intensity of DWI on PACS monitors – is feasible for grading gliomas in clinical neuro-oncology imaging services and has a high level of reliability and reproducibility.     

Views regarding the training of ethics consultants: a survey of physicians caring for patients in ICU

BACKGROUND: Despite the expansion of ethics consultation services, questions remain about the aims of clinical ethics consultation, its methods and the expertise of those who provide such services. OBJECTIVE: To describe physicians' expectations regarding the training and skills necessary for ethics consultants to contribute effectively to the care of patients in intensive care unit (ICU). DESIGN: Mailed survey. PARTICIPANTS: Physicians responsible for the care of at least 10 patients in ICU over a 6-month period at a 921-bed private teaching hospital with an established ethics consultation service. 69 of 92 (75%) eligible physicians responded. Measurements: Importance of specialised knowledge and skills for ethics consultants contributing to the care of patients in ICU; need for advanced disciplinary training; expectations regarding formal-training programmes for ethics consultants. RESULTS: Expertise in ethics was described most often as important for ethics consultants taking part in the care of patients in ICU, compared with expertise in law (p<0.03), religious traditions (p<0.001), medicine (p<0.001) and conflict-mediation techniques (p<0.001). When asked about the formal training consultants should possess, however, physicians involved in the care of patients in ICU most often identified advanced medical training as important. CONCLUSIONS: Although many physicians caring for patients in ICU believe ethics consultants must possess non-medical expertise in ethics and law if they are to contribute effectively to patient care, these physicians place a very high value on medical training as well, suggesting a "medicine plus one" view of the training of an ideal ethics consultant. As ethics consultation services expand, clear expectations regarding the training of ethics consultants should be established.