Comparative Assessment of Forage Legume and Grass-legume Mixture Quality Ensiled with Biological and Chemical Preservatives

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - The paper presents research and production studies evaluating the forage legume ensiling quality treated with...     

Assessment of Image Quality and Dosimetric Performance of CT Simulators

BackgroundCT simulator for radiation therapy aims to produce high-quality images for dose calculation and delineation of target and organs at risk in the process of treatment planning. Selection of CT imaging protocols that achieve a desired image quality while minimizing patient dose depends on technical CT parameters and their relationship with image quality and radiation dose. For similar imaging protocols using comparable technical CT parameters, there are also variations in image quality metrics between different CT simulator models. Understanding the relationship and variation is important for selecting appropriate imaging protocol and standardizing QC process. Here, we proposed an automated method to determine the relationship between image quality and radiation dose for various CT technical parameters.Material and MethodThe impact of scan parameters on various aspects of image quality and volumetric CT dose index for a Philips Brilliance Big Bore and a Toshiba Aquilion One CT scanners were determined by using commercial phantom and automated image quality analysis software and cylindrical radiation dose phantom.Results and DiscussionBoth scanners had very similar and satisfactory performance based on the diagnostic acceptance criteria recommended by ACR, International Atomic Energy Agency, and American Association of Physicists in Medicine. However, our results showed a compromise between different image quality components such as low-contrast and spatial resolution with the change of scanning parameters and revealed variations between the two scanners on their image quality performance. Measurement using a generic phantom and analysis by automated software was unbiased and efficient.ConclusionThis method provides information that can be used as a baseline for CT scanner image quality and dosimetric QC for different CT scanner models in a given institution or across sites.     

Health Information Exchange and Ambulatory Quality of Care

Background

Health information exchange is a national priority, but there is limited evidence of its effectiveness.

Objective

We sought to determine the effect of health information exchange on ambulatory quality.

Methods

We conducted a retrospective cohort study over two years of 138 primary care physicians in small group practices in the Hudson Valley region of New York State. All physicians had access to an electronic portal, through which they could view clinical data (such as laboratory and radiology test results) for their patients over time, regardless of the ordering physician. We considered 15 quality measures that were being used by the community for a pay-for-performance program, as well as the subset of 8 measures expected to be affected by the portal. We adjusted for 11 physician characteristics (including health care quality at baseline).

Results

Nearly half (43%) of the physicians were portal users. Non-users performed at or above the regional benchmark on 48% of the measures at baseline and 49% of the measures at followup (p = 0.58). Users performed at or above the regional benchmark on 57% of the measures at baseline and 64% at follow-up (p<0.001). Use of the portal was independently associated with higher quality of care at follow-up for those measures expected to be affected by the portal (p = 0.01), but not for those not expected to be affected by the portal (p = 0.12).

Conclusions

Use of an electronic portal for viewing clinical data was associated with modest improvements in ambulatory quality.     

Learning Spinal Manipulation: Objective and Subjective Assessment of Performance

ObjectiveThe purpose of this study was to investigate associations between objective spinal manipulation therapy (SMT) biomechanical parameters and subjective assessments provided by patients, clinicians, and expert assessors.MethodsChiropractic students (N = 137) and expert instructors (N = 14) were recruited. Students were asked to perform a thoracic SMT alternately on each other on a force-sensing table while being observed by an expert instructor. Students who performed (clinicians) and received (patients) SMT, and expert instructors, independently scored each SMT performance using visual analog scales. Correlations between these subjective scores and SMT biomechanical parameters were calculated. The following parameters were evaluated: peak force, preload force, thrust duration, and drop in preload force. Spinal manipulation therapy comfort was also assessed by patients, clinicians, and expert instructors.ResultsResults of the study indicate that thrust duration assessed by instructors and patients was the only parameters significantly correlated with the table data (r = .37; P < .001 and r = .26; P = .002). Comfort assessed by clinicians was significantly correlated with their own assessments of thrust duration (r = .37; P < .001) and preload force (r = .23; P = .007), whereas comfort assessed by instructors was significantly correlated with their own assessment of thrust duration (r = .27; P = .002) and drop in preload force (r = -.34; P < .001). Objective biomechanical parameters of performance did not predict perceived comfort.ConclusionsOverall, the results from the subjective assessments of SMT performance are weakly correlated with objective measures of SMT performance. Only the thrust duration evaluated by expert instructors and patients was associated with scores obtained from the table. Perceived comfort of the procedure seems to be associated mostly with perceived thrust duration and preload characteristics.     

Influence of Zinc Yeast Supplementation on Growth Performance,Antioxidant, and Immune Status of Growing Sahiwal Calves

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - This experiment was conducted to evaluate the effect of zinc (Zn)-yeast supplementation on growth...     

Praecordial Accelerometry: An Indirect Assessment of Left Ventricular Performance

Abstract. 1. Praecordial acceleration was measured by a "pixie" strain gauge transducer in 14 dogs in whom an electromagnetic flow probe and pacing electrodes had been implanted. Peak acceleration of blood from the left ventricle (aortic max. dv/dt) was derived from the flow signal by differentiation. – 2. The amplitude of the major systolic complex (DE) of the praecordial accelerogram and aortic max. dv/dt were measured during stimulation of the heart with calcium gluconate and isoprenaline and depression of the heart with propranolol and halothane inhalation. – 3. Close linear correlations were found between the percentage change in the DE complex and the percentage change in aortic max. dv/dt during stimulation and depression of the heart. – 4. The amplitude of the DE complex was found to be sensitive to changes in left ventricular end-diastolic pressure, systemic vascular resistance and increase in heart rate up to 150 beats per minute. – 5. It is concluded that changes in the amplitude of the DE complex of the praecordial accelerogram may be a useful index for non-invasive assessment of changes in left ventricular function in the dog.     

The Quality of Assessment of Learning (Qual) Score: Validity Evidence for a Scoring System Aimed at Rating Short,Workplace-Based Comments on Trainee Performance

Abstract

Construct: This study seeks to determine validity evidence for the Quality of Assessment for Learning score (QuAL score), which was created to evaluate short qualitative comments that are related to specific scores entered into a workplace-based assessment, common within the competency-based medical education (CBME) context. Background: In the age of CBME, qualitative comments play an important role in clarifying the quantitative scores rendered by observers at the bedside. Currently there are few practical tools that evaluate mixed data (e.g. associated score-and-comment data), other than the comprehensive Completed Clinical Evaluation Report Rating tool (CCERR) that was originally derived to rate end-of-rotation reports. Approach: A multi-center, randomized cohort-based rating exercise was conducted to evaluate the rating properties of the QuAL score as compared to the CCERR. One group rated comments using the QuAL score, and the other group rated comments using the CCERR. A generalizability study (G-Study) and a decision study (D-study) were conducted to determine the number of meta-raters for a reliable rating (phi-coefficient target of >0.80). Both scores were correlated against rater’s gestalt perceptions of utility for both faculty and residents reading the scores. Results: Twenty-five meta-raters from 20 sites participated in this rating exercise. The G-study revealed that the CCERR group (n?=?13) rated the comments with a very high reliability (Phi = 0.97). Meanwhile, the QuAL group (n?=?12) rated the comments with a similarly high reliability (Phi = 0.97). The QuAL score required only two raters to reach an acceptable target reliability of >0.80, while the CCERR required three. The QuAL score correlated with perceptions of utility (Meta-rater usefulness, Pearson’s r?=?0.69, p?<?0.001; Perceived usefulness for trainee, r?=?0.74, p?<?0.001). The CCERR performed similarly, correlating with perceived faculty (r?=?0.67, <0.001) and resident utility (0.79, <0.001). Conclusions: The QuAL score is reliable rating score that correlates well with perceptions of utility. The QuAL score may be useful for rating shorter comments generated by workplace-based assessments.     

公立医院护理人员绩效考核与分配体系的实施与体会

目的将公立医院护理人员绩效考核结果与分配体系挂钩,充分体现同工同酬、按劳取酬、多劳多得的分配原则。方法设计包括护理工作数量与质量、护理工作风险与责任、护理技术难度、护理人员编配等诸多因素在内的绩效考核方案,并建立以此为依据的分配体系。结果绩效考核与分配体系的建立与实施大大激发了护理人员工作的积极性和主动性,增强了集体凝聚力,提高了护理质量,稳定了护理队伍。结论建立和护理人员的薪酬、职称晋升直接相关的绩效考核与分配体系,是调动护理人员工作主观能动性的关键因素。     

Preoperative Management of Endocrine,Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources utilize the recommendations derived from individual studies and do not include a multidisciplinary focus or formal consensus. The Society for Perioperative Assessment and Quality Improvement (SPAQI) identified a lack of authoritative clinical guidance as an opportunity to utilize its multidisciplinary membership to improve evidence-based perioperative care. SPAQI seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this Consensus Statement is to provide practical guidance on the preoperative management of endocrine, hormonal, and urologic medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then utilized a modified Delphi approach to critically review the literature and generate consensus recommendations.