Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

Background  

The main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options.     

3款荧光定量PCR仪检测甲型H1N1流感结果比较

[目的]比较3款荧光PCR仪对甲型H1N1流感样品检测结果的差异,为结果解释和仪器选择提供参考。[方法]对2009年8～12月间256份流感样标本同时采用3款荧光定量PCR仪(A、B、C)按照国家监测方案检测,定性结果进行卡方分析,定量结果采用方差分析及配对t检验。[结果]3款荧光定量PCR仪定性检测结果存在差异(χ2=19.554,P﹤0.001),其中仪器A、B检测结果无统计学意义(χ2=0.711,P=0.399﹥0.05),仪器A与C、仪器B与C检测结果差异有统计学意义(χ2=10.949,P=0.001,χ2=17.134,P﹤0.001)。定量检测结果与此类似。[结论]不同仪器对于甲型H1N1流感样品检测结果存在差异,在实际工作中应根据需要进行选择。     

贵州省职工医疗保险省级统筹的适配性待遇水平研究*

目的：提高职工医疗保险省级统筹的科学性和稳定性，为医保管理部门提供逻辑思路、实证资料和政策参考，解决省级统筹的待遇测算问题。方法：本研究以前期运用ILO保险成本模型计算得出的贵州省省级统筹筹资标准6.20%为基准， 基于2020年贵州省职工医疗保险运行报告中的数据，根据“以收定支、收支平衡”的测算原则，利用粗估测算法中的平衡系数法，分析统收统支省级统筹模式的职工医疗保险适配性待遇方案。结果：以2020年医疗费为基数计算出的6.20%的筹资水平进行统筹，政策选择下限为住院报销80.00%，门诊报销50.00%，上限为住院报销82.00%，门诊报销55.00%，可选方案为8个； 以各统筹地区单位缴费均值6.60%的筹资水平进行统筹，政策选择下限为住院报销80.00%，门诊报销55.00%，上限提高至住院报销85.00%，门诊报销58.00%；可选方案增加至12个。结论：粗估法中的平衡系数法适合运用在省级统筹待遇水平的测算和甄选工作上，且随着统筹费率的提高，政策选择余地增大，适配性待遇水平也会相应提高。该研究可为医保管理部门制定职工医保省级统筹待遇方案提供可靠的理论依据和政策参考。     

Overview of the Program to Strengthen Primary Care Health Centers: a profile of the grant-making process, the recipients, and their activities

The Program to Strengthen Primary Care Health Centers supported improvements in operating systems and the development of good business practices at participant centers. This article provides an overview of the Program. Participant centers were small, community-based organizations that served high-need populations and offered a sliding fee scale for uninsured patients. Grants supported activities to increase patient revenues, serve more patients, promote general stability of center operations, expand the kinds of services provided, and enhance nonpatient revenues. Successful organizations needed to take a step back and analyze their options and also to have a good management team.     

球后麻醉致青光眼术中一过性视力丧失2例分析及文献回顾

目的探讨球后麻醉导致青光眼术中一过性视力丧失的临床特征及治疗。方法分析舟山市妇幼保健院2例青光眼患者手术前球后麻醉中出现一过性视力丧失的临床资料,回顾相关文献。结果球后麻醉并发一过性视力丧失较少见,与局麻药物对神经的视觉传导影响及循环障碍引起局部缺血等因素有关。经过处理患者已恢复术前视力。主要治疗措施是:术前含服硝苯地平、尼莫地平等血管扩张剂,选择麻醉方式及局麻药等可减少一过性视力丧失时的发生。结论球后麻醉导致青光眼术中一过性视力丧失应早期发现,积极吸氧扩血管等处理可及时恢复视力。     

Decision models for capital investment and financing decisions in hospitals.

The literature on capital investment and financing decisions for hospitals has suggested several approaches to analyzing sets of options. In this paper, I present a taxonomy of the different approaches; analyze and compare the different elements of the taxonomy; and illustrate and discuss the information that can be gained by using each approach. I view these different analytic methods as complementary rather than competing methods of providing information to decision makers, and argue that the complex nature of hospital objectives demands the use of more than one approach. Failure to do this may lead to biased evaluations and poor decision making.     

Using Cost-Effectiveness Analysis to Address Health Equity Concerns

This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health—the objective underpinning conventional CEA—and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and—crucially—who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.     

宫腔积脓31例临床分析

目的探讨绝经后老年妇女宫腔积脓的临床特点。方法回顾性分析2009年11月—2013年11月收治该院的宫腔积脓患者31例,总结其临床特点及诊治方法。结果 31例宫腔积脓患者中,子宫内膜炎26例,占83.9%（26/31）;子宫内膜癌5例,占16.1%（5/31）。31例宫腔积脓患者中,比较子宫内膜炎与子宫内膜癌的临床特点,子宫内膜炎患者阴道流血的发生率（4/26,15.4%）低于子宫内膜癌患者（4/5,80%）,差异有统计学意义（P〈0.01）;子宫内膜炎患者中子宫内膜増厚发生率（1/26,3.8%）低于子宫内膜癌患者（5/5,100%）,差异有统计学意义（P〈0.01）。结论宫腔积脓患者中,合并阴道流血及子宫内膜增厚,警惕子宫内膜癌的发生。     

How choices in exchange design for states could affect insurance premiums and levels of coverage

The Affordable Care Act gives states the option to create health insurance exchanges from which individuals and small employers can purchase health insurance. States have considerable flexibility in how they design and implement these exchanges. We analyze several key design options being considered, using the Urban Institute's Health Insurance Policy Simulation Model: creating separate versus merged small-group and nongroup markets, eliminating age rating in these markets, removing the small-employer credit, and setting the maximum number of employees for firms in the small-group market at 50 versus 100 workers. Among our findings are that merging the small-group and nongroup markets would result in 1.7 million more people nationwide participating in the exchanges and, because of greater affordability of nongroup coverage, approximately 1.0 million more people being insured than if the risk pools were not merged. The various options generate relatively small differences in overall coverage and cost, although some, such as reducing age rating bands, would result in higher costs for some people while lowering costs for others. These cost effects would be most apparent among people who purchase coverage without federal subsidies. On the whole, we conclude that states can make these design choices based on local support and preferences without dramatic repercussions for overall coverage and cost outcomes.     

Access to care and use of health services by low-income women

Data from the 1997 National Survey of America's Families (NSAF) are used to analyze access to care and use of health care services for low-income women. Three groups of women are examined: those with Medicaid coverage, those with private coverage, and those with no insurance. Findings show that uninsured women faced larger access barriers and utilized fewer services, particularly preventive care services, than women with either public or private coverage. Access and use did not differ greatly between Medicaid and privately covered women. The results suggest that expansions in coverage, either through Medicaid or through private options, could improve access to care for uninsured women.     

多重应答资料统计分析及其SAS软件实现过程

目的 探讨现场调查中多重应答资料的统计推断方法.方法 根据多重应答资料不同选项间既存在关联,又不可互换的特点,将其视为多因变量的多元logistic回归问题,采用广义估计方程建模分析,并通过实例及其SAS编程的实现过程进行阐述.结果 广义估计方程可以很好地分析自变量对于多重应答资料各项的影响,并能进一步回答各选项的基线应答概率、作业相关矩阵信息;在此模型下,还可以进一步分析各影响因素对于每一选项的具体影响,或各自变量的分层比较具体差异的信息.结论 广义估计方程可以作为现场调查中多重应答资料的推断分析.     

高频彩超对乳腺肿块的诊断价值

目的探讨高频彩色多谱勒超声对乳腺肿块的诊断价值。方法将126例经手术及病理证实为乳腺肿块的彩色多谱勒超声声像图进行回顾分析,重点分析肿块形态、边界、内部回声、有无钙化及钙化形态、纵横比、血流分级、阻力指数等超声声像图特征。结果126例患者共174个乳腺肿块中,超声检出163个,检出率为93．7％,良性肿块108个,超声诊断正确99个,准确率为91．7％,恶性肿块66个,超声诊断正确57个,准确率为86．4％。结论应用高频彩色多谱勒超声检查,能提高乳腺肿块诊断准确率,并对良恶性肿块进行鉴别诊断,为临床治疗方式的选择提供确切依据。     

Methods of reducing the financial risk of physicians under capitation

In today's rapidly changing medical marketplace, managed care plans are not the only entities assuming risk for the care of enrollees through capitation. Increasingly, managed care plans are transferring this risk to their primary care and specialty physicians by paying them on a fully or partially capitated basis. Although capitation provides a strong incentive for physicians to provide cost-effective care, there are concerns that capitation may place some physicians at considerable financial risk. Our purpose is to familiarize physicians with issues they will want to consider when they evaluate capitation options and methods that are available to reduce their financial risk. Specifically, we analyze 3 issues: the range of services that are capitated, who accepts the risk, and size of patient panel. We conclude with a discussion of 3 methods for reducing or limiting risk--reinsurance, "carve outs," and risk adjustment.     

上颈部非腺源性包块临床诊疗分析

目的分析上颈部非腺源性包块的临床治疗效果,探讨其分布类型及最佳治疗方案。方法回顾性分析76例上颈部非腺源性包块患者的临床资料,分析其治疗效果。结果76例上颈部非腺源性包块中,良性肿瘤25例,恶性肿瘤19例,非肿瘤性疾病32例。良性肿瘤和恶性肿瘤以手术切除为主。非肿瘤性疾病则根据病变性质采取手术切除或药物对症治疗。结论上颈部非腺源性包块涵盖的疾病较为复杂,治疗应根据病变性质、位置及范围综合考虑,选择最佳治疗方案。     

Real options reasoning in healthcare: an integrative approach and synopsis

For the past 40 years, practitioners and researchers alike have been grappling with the natural shortcomings associated with the net present value approach to strategic decision making and capital budgeting. Work by scholars in option pricing theory has evolved into an alternative perspective on strategic capital investments, called "real options." Proponents of real options argue that this is a superior way of approaching decision making and capital budgeting, compared with other approaches, as it allows for greater strategic flexibility and encourages exploration, experimentation, and innovation. Within the healthcare literature, articles on real options have focused on pricing these options. This article is unique to the healthcare literature as it emphasizes the cognitive or strategic aspects of real options. Additionally, this article integrates two techniques for applying the real options approach for interested practitioners using a hospital's imaging department as an example, while providing scholars with additional applications and questions for future research. For practitioners, the implications are that thinking of and planning for capital investments as real options may create greater strategic and operating flexibility than other, more traditional approaches.     

Demand-based water options for arsenic mitigation: an experience from rural Bangladesh

A supply of safe drinking water is a recognized global concern. The arsenic contamination of groundwater in Bangladesh and other countries has furthered this concern. Lack of appropriate water options is one of the main barriers to the supply of safe drinking water for 30-60 million people who are exposed to the risk of drinking arsenic-contaminated water in Bangladesh. This paper describes the experience from a water supply programme for arsenic mitigation based on demand and participation of 30,000 rural people in Srinagar, a subdistrict of Bangladesh. About 85% of the 912 tubewell water samples tested had an arsenic content higher than 0.05 mg/l. The project promoted 11 options including groundwater, surface-water and rainwater-harvesting household-based options as well as community managed technologies. Most people, particularly women, wanted piped water, and hand-operated deep tubewells were also requested. Four cluster-based motorized piped water systems, 20 home-based arsenic-removal options (two types) and an arsenic-removal filter plant were installed. The public contributed about 49, 25 and 20% of the installation costs of piped water, home-based options and filter options, respectively, and 100% of all operation and maintenance costs. The household options and filter plant were abandoned within a few weeks. Reportedly, those options required too much attention, discharged small volumes of water at low rates, were difficult to maintain, and discharged poor-quality water. The proportion of families (54%) that drank arsenic-contaminated water during the final survey was significantly lower than in the baseline survey (87%). For arsenic-affected areas, it is recommended that a cluster-based piped water system be given proper consideration when selecting appropriate water options rather than household-based options or the development of new low-cost options.     

New framework (GRADE) for development of evidence-based recommendations by the Advisory Committee on Immunization Practices

The Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee that provides expert advice to the Director of CDC and the Secretary of the U.S. Department of Health and Human Services. This advice comprises recommendations on the use of vaccines and related agents for control of vaccine-preventable diseases in the U.S. civilian population. To develop its recommendations, ACIP forms work groups that gather, analyze, and prepare scientific information and present it at public meetings. The work groups also present options for recommendations based on the scientific evidence they have assessed. Recommendations that are approved by a majority of ACIP's voting members are then reviewed by the Director of CDC. If approved by the Director, recommendations are published in MMWR. This report briefly summarizes the new framework for developing evidence-based recommendations that ACIP adopted at its October 2010 meeting.     

Patients' perceptions of pain management and use of coping strategies

As a result of the Joint Commission on Accreditation of Healthcare Organizations accreditation standards for 2001, pain management for hospitalized patients has become a top priority of healthcare facilities. In addition to using the traditional pharmacological approach to pain management, many patients also use complementary or alternative medicine (CAM) treatments. However, CAM treatments may not be discussed or offered to patients by healthcare providers who lack awareness about these alternatives. The purpose of this study was to assess patients' perceptions of pain, their beliefs about the use of pharmacological and CAM pain management techniques, and their satisfaction with pain management. Researchers verbally administered a survey to patients by using a combination of open-ended questions and a 0-10 rating scale, and they recorded their responses. This study was conducted in a not-for-profit teaching hospital in the southeast United States. Convenience sampling was used to select the 137 patients who completed the surveys. No treatment intervention was provided. Pharmacological treatment was the primary method expected and used by the majority of patients for pain management. Chi-squared statistics were used to analyze nonparametric data. An analysis of variance was used to analyze parametric data. The frequency with which nonpharmacological CAM options were used ranged from 6 to 34 percent. The most commonly used CAM method was distraction, such as watching television or reading.     

Fruit and vegetables consumption and gastric cancer: a systematic review and meta-analysis of cohort studies

Fruit and vegetable intake is widely recognized as protective for gastric cancer occurrence but prospective research challenged this belief. To evaluate the influence of design options in such results we did a meta-analysis of relevant published cohort studies identified from inception to 2004 in PubMed, EMBASE, and LILACS. Random-effects meta-analysis, stratification, and meta-regression were used to pool effects and to analyze the association with type of outcome event and length of follow-up independent of other study characteristics. An inverse association was observed between fruit intake and gastric cancer incidence (relative risk, RR = 0.82; 95% confidence interval, CI = 0.73-0.93) and stronger for follow-up periods of > or = 10 yr (RR = 0.66; 95% CI = 0.52-0.83) but not when the study outcome was death (RR = 1.08; 95% CI = 0.86-1.35). For vegetables, the RR was 0.88 (95% CI = 0.69-1.13) using all incidence studies and 0.71 (95% CI = 0.53-0.94) when considering only those with the longer follow-up. The association observed between vegetable intake and gastric cancer mortality was 1.05 (95% CI = 0.89-1.25). Other study characteristics assessed added no significant contribution to explain heterogeneity. This meta-analysis showed that design options might play a key role in the observed magnitude or the direction of the association between fruit and vegetable intake and gastric cancer.     

Gluten-Free Pasta: Replacing Wheat with Chickpea

Chickpeas were already implemented as an ingredient in the making of gluten-free pasta; however, structural agents such as hydrocolloids and different flours were used in order to achieve satisfactory characteristics. Therefore, the aim of this study is to develop pasta dough utilizing only chickpeas as a flour source and to analyze its chemical, technological, and sensory characteristics. The development of gluten-free chickpea pasta used chickpeas (65.7%), egg whites (34.3%) and the control wheat pasta contained wheat flour (61.9%) and whole eggs (39.1%) for comparison. The chickpea pasta presented 37.3% less fat, 53.8% more protein, and 166.5% more dietary fiber. Chickpea pasta also presented good acceptance for every criterion, including texture and taste. In this manner, this study suggests that chickpeas can be used as a satisfactory substitute for wheat, without the use of any structure agents, increasing the amount of healthy options for individuals with gluten-related disorders.