Six Sigma and Lean concepts, a case study: patient centered care model for a mammography center

Boca Raton Community Hospital in South Florida decided to increase return while enhancing patient experience and increasing staff morale. They implemented a program to pursue "enterprise excellence" through Six Sigma methodologies. In order to ensure the root causes to delays and rework were addressed, a multigenerational project plan with 3 major components was developed. Step 1: Stabilize; Step 2: Optimize; Step 3: Innovate. By including staff and process owners in the process, they are empowered to think differently about what they do and how they do it. A team that works collaboratively to identify problems and develop solutions can only be a positive to any organization.     

The relationship of managed care to business, professional, and organizational aspects of radiology practices

OBJECTIVE: We sought to determine the extent of managed care involvement among radiology practices of different types, locations, and sizes; the factors associated with differences in involvement; and the impact of managed care on professional, organizational, financial, and hospital-relations aspects of radiology practices. MATERIALS AND METHODS: A survey was mailed in 1999 to a sample of 970 radiology practices; completed, usable surveys were returned by 66% of the practices. Three indicators of managed care were used: a practice's percentage of managed care (HMOs plus preferred provider organizations), local area HMO penetration rate, and self-reported perceived effect of managed care. RESULTS: Percentage of managed care averaged 30% but was 40% for multispecialty groups. It was relatively high in large metropolitan areas, for practices with no hospital activity, and for practices with any owners who were not practice members. The three measures of managed care were only moderately correlated (correlation coefficient, 0.25-0.33). None of the managed care variables had a statistically significant effect on days provided for vacation and continuing medical education, promptness of payment, years required for practice ownership (partnership), and percentage of practice members who were owners. Higher percentage of managed care was associated with higher collection rates, whereas greater perceived impact of managed care had the opposite association. Two thirds of practices belonged to at least one managed care-related organization such as an independent practice association. Most radiology practices reported no involvement in the managed care negotiations of hospitals, which was true even when the hospital's negotiations included the radiologists' fees or when the practice determined its level of involvement. CONCLUSION: Many negative outcomes most feared by radiologists regarding the effect of managed care have not materialized. Perceptions of practices as to the effect of managed care seem to reflect negative aspects of their general situation, not only realities of managed care.     

Contamination and compensation: Gruinard as a 'menace to the mainland'

The decades-long contamination of Gruinard Island by anthrax is now a well-known part of the history of biological weapons (BW) development, as well as that of military encroachments in the Scottish Highlands and Islands (and the authorities' rather less persistent efforts at damage limitation). Some accounts have included the related episode, reportedly well-remembered by local people, of anthrax contamination on the mainland close to Gruinard. This occurred in 1942--43, when BW experiments were conducted on the island as part of the war effort by scientists from Porton Down under the auspices of the British government. After much top-level discussion, payments were made to the owners of animals that had died as a result of the contamination. The episode had a bearing on discussions about the future of the island and on subsequent policy with regard to the siting, conduct and secrecy of BW experiments.     

War and peace ‐ reconsidered

The decades-long contamination of Gruinard Island by anthrax is now a well-known part of the history of biological weapons (BW) development, as well as that of military encroachments in the Scottish Highlands and Islands (and the authorities' rather less persistent efforts at damage limitation). Some accounts have included the related episode, reportedly well-remembered by local people, of anthrax contamination on the mainland close to Gruinard. This occurred in 1942-43, when BW experiments were conducted on the island as part of the war effort by scientists from Porton Down under the auspices of the British government. After much top-level discussion, payments were made to the owners of animals that had died as a result of the contamination. The episode had a bearing on discussions about the future of the island and on subsequent policy with regard to the siting, conduct and secrecy of BW experiments.     

Women Radiologists in the United States: results from the American College of Radiology's 2003 Survey

PURPOSE: To retrospectively evaluate data from the 2003 American College of Radiology (ACR) survey of diagnostic radiologists with regard to characteristics of women radiologists, their professional activities, and the practices in which they work. MATERIALS AND METHODS: The authors analyzed nonindividually identified data from the ACR's 2003 Survey of Radiologists, a stratified random sample survey that guaranteed respondents confidentiality. A cover letter assured respondents that no individually identifiable information would be disseminated; to further enhance confidentiality, survey operations were conducted by a contractor rather than by the ACR itself. There was a 63% response rate, with a total of 1924 responses. Responses were weighted to make them representative of all radiologists in the United States. Two-tailed z tests of percentages and means and multiple regression analysis were used to compare information for women radiologists with that for men radiologists. RESULTS: Twenty-four percent of radiologists in training (residents and fellows) and 18% of posttraining, professionally active radiologists were women. Forty-one percent of posttraining, professionally active women were younger than 45 years in comparison with 29% of men (P = .004). Women radiologists were more likely to have fellowship training than men (69% vs 60%, P = .007), although they were less likely than men to have a subspecialty certificate (16% vs 27%, P < .001). Thirty-nine percent of women and 16% of men worked part-time (P < .001). Women were more concentrated in academia (22% vs 14%, P = .009) and breast imaging (27% vs 6%, P < .001) than their male peers but were underrepresented in interventional radiology (2% vs 13%, P < .001) and neuroradiology (3% vs 10%, P < .001). In situations where radiologists are likely to be practice owners, fewer women than men were owners (75% vs 91%) (P = .011). Women reported the same level of enjoyment of radiology as did men. CONCLUSION: Women radiologists differ from men in regard to age, fellowship training, full- versus part-time employment, academic versus nonacademic practice, subspecialty practice, and practice ownership.     

不同排龈时间修复楔状缺损的临床效果比较

目的比较三种排龈时间对修复楔状缺损的影响。方法选择颈部边缘平龈或位于龈下1mm内的楔状缺损患牙120颗,修复前使用排龈线于颊侧龈沟分别进行三种时间的排龈（Ⅰ组：5min;Ⅱ组：10min;Ⅲ组：15min）,光固化复合树脂修复,1年后随访,以改良USPHS临床评价修复体标准对各组修复材料进行疗效评估。结果三组修复材料均无脱落,排龈5min组修复材料边缘密合性、边缘着色情况、继发龋及牙龈炎症状况的不满意率均显著高于排龈10min组及排龈15min组（P〈0．05）。排龈10min组及排龈15min组修复材料的边缘密合性、边缘着色情况、继发龋及牙龈炎症状况的不满意率无统计学差异。结论排龈5min与排龈10min及15min的修复效果存在统计学差异（P〈0．05）,为了得到满意的修复效果,临床修复楔状缺损,应至少排龈10min。     

乌鲁木齐市无偿献血人群分布及献血动机调查分析

目的探讨乌鲁木齐市无偿献血者的人群分布及献血动机,为今后的无偿献血工作提供实践依据和宣传策略。方法采用问卷调查法,对乌鲁木齐市2 000名无偿献血者进行问卷调查,将调查结果进行统计学分析。结果学生、服务人员、私营业主、城镇户籍及常住本市的外来人口是乌鲁木齐市无偿献血的主力军;"奉献爱心"是公民献血的主要原因(87.2%),不同文化程度、不同职业的无偿献血人群献血动机有明显差异(χ2文化程度=59.780,P<0.05;χ2职业=102.339,P<0.05);"街头宣传"、"周围环境影响"、"大众媒体宣传"是献血人群了解献血知识的主要渠道。结论加强不同形式的宣传力度,挖掘不同人群的血源潜力,建立一支固定的无偿献血队伍。     

Team physician consensus statement

The objective of the Team Physician Consensus Statement is to provide physicians, school administrators, team owners, the general public, and individuals who are responsible for making decisions regarding the medical care of athletes and teams with guidelines for choosing a qualified team physician and an outline of the duties expected of a team physician. Ultimately, by educating decision makers about the need for a qualified team physician, the goal is to ensure that athletes and teams are provided the very best medical care. The Consensus Statement was developed by the collaboration of six major professional associations concerned about clinical sports medicine issues: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine. These organizations have committed to forming an ongoing project-based alliance to "bring together sports medicine organizations to best serve active people and athletes."     

Firearm suicides in Sweden

In a setting with restrictive firearm laws, prevention of firearm deaths is challenging. Around 100 firearm suicides occur annually in Sweden, representing the most common manner of death from firearm use. In order to explore a possible correlation between firearm suicides and firearm availability, legality of firearm possession, and demographic and geographical factors, all firearm suicides in Sweden among adults during the years 2016–2017 were studied. Data were collected from the National Board of Forensic Medicine and the Swedish Police. In total, 221 firearm suicides were found. Most victims were male (99%) and half (49%) were ≥65 years old. Firearm suicide rates were positively correlated with firearm ownership rates in Swedish counties. Legal firearms (80%) and long-barreled firearms (76%) predominated in the overall material, but illegal firearms were common among young suicide victims (18–29 years) and in urban areas. Prevention work needs to emphasize strategies to reach firearm owners at risk of suicide. Local health and healthcare-related factors, as well as geographic and demographic factors, should be considered in tailoring such strategies.     

Organisation and management of the first clinical trial of BNCT in Europe (EORTC Protocol 11961)

Boron Neutron Capture Therapy is based on the ability of the isotope¹⁰B to capture thermal neutrons and to disintegrate instantaneously producing high LET particles. The only neutron beam available in Europe for such a treatment is based at the European High Flux Reactor HFR at Petten (The Netherlands). The European Commission, owners of the reactor, decided that the potential benefit of the facility should be opened to all European citizens and therfore insisted on a multinational approach to perform the first clinical trial in Europe on BNCT. This precondition had to be respected as well as the national laws and regulations. Together with the Dutch authorities actions were undertaken to overcome the obvious legal problems. Furthermore, the clinical trial at Petten takes place in a nuclear research reactor, which apart from being conducted in a non-hospital environment, is per se known to be dangerous. It was therefore of the utmost importance that special attention is given to safety, beyond normal rules, and to the training of staff. In itself, the trial is an unusual Phase I study, introducing a new drug with a new irradiation modality, with really an unknown dose-effect relationship. This trial must follow optimal procedures, which underscore the quality and qualified manner of performance.

     

Basic characteristics of radiology practices: results from the American College of Radiology's 1999 survey

OBJECTIVE: The basic characteristics of radiology practices in the United States are described. We defined radiology practices as diagnostic-radiology-only practices, either solo or multiradiologist practices. Findings were compared with those from other data sources. MATERIALS AND METHODS: In May 1999, the American College of Radiology surveyed 970 practices by mail using a 65-item questionnaire. A final response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States. RESULTS: Approximately 4400 radiology practices existed in the country; 39% were located in nonmetropolitan or rural areas. The greatest percentage of practices (85%) was private nonacademic radiology practices. The greatest percentage of practices (43%) served only hospitals. However, solo practices were particularly likely (p < or = 0.01) to serve only nonhospital sites. Of all multiradiologist practices, 87% were completely owned by their members, but approximately two thirds of academic multiradiologist practices had outside owners. Seventy percent of multiradiologist practices interpreted images from outside clinics or groups; these averaged 3.2 outside clinics or groups for which they interpreted images. CONCLUSION: The basic characteristics of radiology practices in 1999 are described. Good agreement was seen with findings obtained from other data sources.     

An epidemiological survey of Clostridium perfringens-associated enterotoxemia at an army veterinary treatment facility

The purpose of this study was to determine the incidence of Clostridium perfringens-associated vomiting and diarrhea in canine and feline patients at the Okinawa Branch Veterinary Service and to establish a relationship between dietary indiscretion and the presence of clostridial enterotoxemia. Stool samples were obtained from 38 control animals and 44 animals with vomiting and diarrhea during a 3-month period. For each sample, fecal cytology were examined for the presence of C. perfringens, white blood cells, and red blood cells. A survey was also completed by the animal's owner, which provided the researcher with information on the owner's pet feeding practices. After the data were analyzed, 27% of animals with vomiting and diarrhea were found to have C. perfringens upon examination of their fecal samples (p < 0.05), compared with 11% for control animals. Results of our survey revealed that when owners were questioned regarding their feeding practices, 45% of the animals with C. perfringens-positive fecal samples and with clinical signs of vomiting and/or diarrhea had an episode of dietary indiscretion soon before the illness (p < 0.05). Therefore, we conclude that C. perfringens is an important cause of vomiting and diarrhea in our patient population and that a causal relationship may exist between dietary indiscretion and C. perfringens-associated intestinal disease.     

Estimates of regional cerebral blood flow and 5-HT2A receptor density in impulsive, aggressive dogs with 99mTc-ECD and 123I-5-I-R91150

Impulsive aggression in dogs has an important impact on human public health. Better insight into the pathophysiology of this phenomenon could lead to more adequate diagnosis and treatment. Indirect in vivo research on peripheral body fluids and post-mortem studies in impulsive animals and humans indicate a deficient serotonergic system in general and disturbances in the serotonin-2A (5-HT2A) receptor in particular. In this study, brain perfusion and the 5-HT2A receptors were examined in impulsive, aggressive dogs, in comparison with a group of normally behaving animals. In order to decide which dogs to include in this study, owners were asked to describe the general behaviour of the dogs, the circumstances in which aggression occurred and their conduct during aggressive acts. Finally, 19 dogs were retained for this study, showing, according to different behavioural specialists, disinhibited dominance aggression. Functional imaging studies were performed on all these dogs. Single-photon emission tomography (SPET) was used to measure regional brain perfusion using technetium-99m labelled ethyl cysteinate dimer (ECD). The 5-HT2A receptor binding properties were investigated using the selective radioligand iodine-123 labelled 5-I-R91150. A significant increase in uptake of the 5-HT2A radioligand was noted in all cortical areas. No significant alterations were found in regional cortical perfusion, indicating that the increased binding index was not a consequence of increased tracer delivery. This study supports a role for the serotonergic system in canine impulsive aggression.     

Pesticide use and related health problems among greenhouse workers in Batinah Coastal Region of Oman

Pesticide practices and the health problems associated with pesticide exposure among 74 greenhouse workers in the Batinah Coastal Region of Oman were investigated. The workers were mostly migrant workers from India (37.8%), Bangladesh (28.4%), Nepal (14.9%), Sri Lanka (8.1%) and Pakistan (5.4%). Majority of the workers (44%) had some primary education, were between 31 and 40 years of age (50%), were married (85.1%) and had been applying pesticides for over 10 years (32.4%). Occupational and phytosanitary practices among the pesticide workers were poor, as most of the workers (59.5%) did not wash their hands after pesticide application, many (43.2%) did not shower and some (20.3%) did not change their clothes. Their methods of handling of partly used pesticides were questionable, with 81.1% storing them in other rooms in the house and 14.9% storing them in their bedrooms. Personal protective equipment (PPE) such as nose mask, overall and eye goggles were hardly used during pesticide application. Some of the reported health symptoms due to pesticide exposure were skin irritation (70.3%), burning sensation (39.2%), headache (33.8%), vomiting (29.7%) and salivation (21.6%). It was suggested that a provision be included in the Pesticide Laws of Oman that makes it mandatory for greenhouse owners to provide their workers with PPE. Also, regular training programs should be organized for the greenhouse pesticide workers to improve their ability to handle hazardous chemicals.     

Racing problems in the U.S.A.

The major problems of racing in the United States at the present time are caused by too much racing. This has led to too few horses and small fields. Consequently many owners and trainers are trying to enter their horses too frequently and to race them when they are not really fit to run. The desire to race horses as frequently as possible has led to constant pressure from horsemen through their organizations for so called "permissive medication". Started in the state of Colorado approximately ten years ago this has grown until finally there are only a few states, notably New York and New Jersey that have resisted the pressure. The drug that gave the opening wedge to permissive medication was phenylbutazone, but this in many states has led to the inclusion of other drugs including analgesics and drugs that veterinarians claim are needed for therapeutic purposes. Some states have endeavoured to control phenylbutazone medication by quantitation and while lower limits cause little difficulty, maximum allowable limits have caused problems and are not practical. While there has been no publicity to my knowledge about frusemide (furosemide, lasix) the abuse of this drug for so called "bleeders" is an example that may seriously interfere with drug detection in urine and its use should be confined to proven "bleeders" (i.e. horses suffering from epistaxis). Pre-race blood testing began roughly ten years ago at the harness tracks and has been resisted by our flat tracks rather successfully up to the present time. The blood testing methods and those used by the same laboratories in post-race urine testing is inadequate and will not detect many illegal drugs.     

Molecular imaging: an overview and clinical applications

Molecular imaging is a new medical discipline that integrates cell biology, molecular biology and diagnostic imaging. Clinical applications of molecular imaging include the use of nuclear medicine, magnetic resonance imaging (MRI) and ultrasound (US). The nuclear medicine applications utilize devices such as single photon emission computerized tomography (SPECT) and positron emission tomography (PET). Molecular imaging has two basic applications. The first is diagnostic imaging, which is used to determine the location and extent of targeted molecules specific to the disease being assessed. The second is therapy, which is used to treat specific disease-targeted molecules. The basic principle of the diagnostic imaging application is derived from the ability of cell and molecular biologists to identify specific receptor sites associated with target molecules that characterize the disease process to be studied. The biology teams then develop molecular imaging agents, which will bind specifically to the target molecules of interest. The principle for using molecular targeting therapy is based on an extension of the diagnostic imaging principle. Basically, it is assumed that if the molecular probe does target the specific disease molecules of interest, the same molecular agent can be loaded with an agent that will deliver therapy to the targeted cells. Patients and physicians have the clinical expectation that molecular imaging, when used for diagnostic purposes, will significantly improve the time-liness as well as the accuracy of detecting the presence and extent of disease. When applied to therapy, the expectation is that FDA-approved agents will have been shown in clinical trials to provide a significant improvement in clinical outcomes over traditional therapy methods. The eventual clinical owners of molecular imaging may be a specialty group that is a hybrid by conventional measures. For example, the clinical owner should have fundamental knowledge in basic cellular and molecular biology but must also be certified as well as competent in the specific diagnostic imaging specialty applied (i.e. nuclear, MR or ultrasound). If the owner is also to be involved with therapy, experience and appropriate certification will also be required. Another issue relates specifically to the therapy applications in oncology. It is conceivable that traditional chemotherapy and radiotherapy may be replaced in part with molecular imaging therapy that utilizes target-specific agents to treat cancer on a non-toxic, outpatient basis. The issue to be addressed by the radiology administrator is whether this new discipline will be performed in the radiology department or oncology and radiotherapy departments. Clearly, radiology and its associated diagnostic imaging subspecialties are the most logical owner of molecular imaging. However, to make this ownership a reality will require major shifts in training requirements, as well as exertion of political influence from the radiology administrators against other specialties that have much to lose in terms of patient populations and revenue to their practice.     

侧脑室肿瘤的MRI诊断及鉴别诊断

目的 探讨侧脑室肿瘤的MRI表现特点. 资料与方法 回顾性分析25例经手术病理证实的侧脑室肿瘤的MRI表现. 结果 25例侧脑室肿瘤中,星形细胞瘤9例,其中3例(3/9)位于侧脑室三角区,3例(3/9)位于侧脑室体部;脑膜瘤6例,其中4例(4/6)位于侧脑室三角区,6例增强扫描均呈明显均匀强化;室管膜下瘤3例,2例位于侧脑室前角和室间孔区,增强扫描不强化或轻度强化;中枢神经细胞瘤2例, 1例位于侧脑室前角,1例位于侧脑室体部;脉络丛乳头状瘤2例;室管膜瘤2例;转移瘤1例. 结论 侧脑室肿瘤MRI表现有一定特点.     

慢性血吸虫病腹部CT及病理对照研究

目的 回顾分析慢性血吸虫病腹部CT表现与病理结果，以求进一步提高对其的诊断准确性。方法 103例患者进行腹部CT平扫，81例行CT增强扫描；全部病例均获得手术标本及作病理切片，并注意切片方向与CT扫描层面相近的平面进行。结果 CT显示肝硬化84例，以肝脏右叶改变最重；肝内不同形态钙化71例，以分隔状钙化最多；肝癌12例；脾脏增大78例，脾脏钙化13例；结肠壁增厚27例，以降、乙状结肠及直肠增厚居多；结肠壁钙化31例，其中全结肠弥漫性钙化5例；结肠癌9例。病理观察肝内不同程度纤维化并形成假小叶，纤维增生间隔及假小叶内均可见虫卵及钙化；结肠黏膜下及区域淋巴结内可见虫卵及钙化。结肠壁纤维组织及黏膜组织增生明显；脾内可见纤维增生及钙化，但未见虫卵。结论 慢性血吸虫病对腹部脏器的损伤以肝脏及结肠为重，CT的病理性改变也相对明显，而脾脏改变大多是肝硬化的伴随变化。CT腹部扫描检查是慢性血吸虫病脏器病理损害和程度的重要影像诊断方法。     

颅底脊索瘤的CT和MRI影像诊断与鉴别诊断

目的探讨颅底脊索瘤CT与MR影像学诊断与鉴别诊断。方法回顾性分析13例经病理证实的颅底脊索瘤的CT与MR影像学资料。结果13例脊索瘤中,发生在斜坡5例,鞍区4例,颅中凹2例,鼻咽部1例,蝶窦1例。肿瘤的形态以不规则形最多8例,圆形3例,椭圆形2例。病灶边界清楚9例,边缘模糊4例。MR表现为T1WI呈低、等、高混杂信号,T2WI则以高、低混杂信号为主。增强后病灶呈轻到中度强化,强化信号不均匀。CT见病灶呈不均匀等或稍高密度肿块,7例可见不同程度的骨质破坏。结论颅底脊索瘤的CT和MR表现有一定的特征性,结合临床大多可以确诊,但需与脑膜瘤、垂体瘤、鼻咽癌、软骨类肿瘤等鉴别。