Telemedicine: New technology = new questions = new exposures

Cyberspace, telemetry, and virtual reality all refer to mankind's evolving ability to be in two places at once, without ever leaving one location. Now this ability has expanded into the world of medicine, with increased awareness of risk management concerns, and questions about where we go from here.     

135名学龄前生长痛儿童压痛阈研究

目的研究学龄前生长痛患儿与非生长痛儿童下肢痛阈是否存在差异,为明确生长痛的发生机制提供参考依据。方法采用痛觉传感器,测量135名生长痛患儿和133名非生长痛儿童下肢相关部位的压痛阈,采用非参数秩和检验与χ2检验比较两组儿童痛阈值和压痛点人数。结果生长痛儿童股骨外上髁、胫骨内侧髁、胫骨外侧髁与髌骨中间处痛阈值与对照组差异具有统计学意义(P<0.05);压力水平<3kg/cm2时,生长痛组胫骨内侧髁、胫骨外侧髁与髌骨中间处压痛点数目与对照组差异具有统计学意义(P<0.05)。结论生长痛患儿更容易产生膝关节周围疼痛并出现相应体征。     

The growing pains of integrated health care for the elderly: lessons from the expansion of PACE

The early success of the demonstration Program of All-Inclusive Care for the Elderly (PACE) led to its designation as a permanent Medicare program in 1997. But the growth in the number of programs and enrollment has lagged and does not meet expectations. This article offers insights into the mechanisms influencing the expansion of PACE, from information obtained in interviews and surveys of administrators, medical directors, and financial officers in 27 PACE programs. Sixteen barriers to expansion were found, including competition, PACE model characteristics, poor understanding of the program among referral sources, and a lack of financing for expansion. This experience offers important lessons for providing integrated health care to the frail elderly.