Computational fluid dynamics as a method for assessing fume cupboard performance

A commercially available computational fluid dynamic (CFD) software program, specific for HVAC systems, was used to study the performance of an aerodynamic fume cupboard. The numerical results showed good qualitative agreement with physical measurements giving confidence in the CFD model to simulate and predict overall fume cupboard performance. However, there were some quantitative differences specifically around 'aerodynamic' features that could not be accurately simulated by the software code. The CFD model was clearly able to demonstrate differences in performance between good and bad cupboard designs, and show the importance of using rear baffles and lipfoils. It also showed the importance of good design features when a 'worker' was standing against the front edge or when there were draughts in front of the aperture. The computer model was used to simulate the gas tracer containment test method described in BS 7258 (1994) [Laboratory Fume Cupboards], and had a much greater sensitivity than the recommended physical measuring instruments. The results given in this paper demonstrate the potential for using a commercially available software package for the optimisation of fume cupboard design and testing. It also indicates the economy of using CFD compared with building a prototype and testing a model.     

Using data envelopment analysis for assessing the performance of pediatric emergency department physicians

In attempting to measure the performance of providers in a service industry such as health care, it is crucial that the measurement tool recognize both the efficiency and quality of service provided. We develop a Data Envelopment Analysis (DEA) model to help assess the performance of emergency department (ED) physicians at a partner hospital. The model incorporates efficiency measures as inputs and quality measures as outputs. We demonstrate the importance of a nuanced approach that recognizes the heterogeneity of patients that an ED physician encounters and the important role s/he plays as a mentor for physicians in training. In the study, patients were grouped according to their presenting complaint and ED physicians were assessed on each group separately. Performance variations were evident between physicians within each complaint group as well as between groups. A secondary grouping divided patients based on whether the attending physician was assisted by a trainee. Almost all ED physicians showed better performance scores when not assisted by trainees or ED fellows.     

An in-training assessment examination in family medicine: report of a pilot project

A family medicine in-training assessment examination was developed and piloted in 20 programs across the country. Core Content Review questions were used for the examination. Reporting of scores used both the traditional, normative-referenced approach, and a criterion-referenced approach. The latter permitted family medicine faculty to set passing standards for the examination. The pilot project was well received and the examination will be offered to all family medicine residency programs this year.     

Structured discharge letter in a department of geriatric medicine.

A discharge letter which has been introduced into the South and Central Birmingham Geriatric Service is described. This letter combines the features of a discharge notification and a discharge summary. For speed of communication, a handwritten version accompanies the patient on discharge from hospital and a typed copy is posted subsequently. The letter is structured and includes details of the medical assessment, medication, the recommended follow up, the need for support outside the hospital, the relatives involved and the unresolved problems. It has reduced the work of the hospital doctor and the secretaries, has speeded communication with general practitioners (GPs), and is acceptable to most GPs as a substitute for a conventional discharge summary.     

医学成像系统显示器性能评价方法

近几年PACS的普及促使医学影像诊断逐渐由传统胶片识读转为软读片,在这一趋势下医用显示器也逐步取代了胶片成为影像诊断的主要工具。针对此变化,介绍一种医学成像系统显示器性能的评价方法。     

A proposed method for assessing the performance of local public health functions and practices.

OBJECTIVES. One of the objectives for the nation for the year 2000 requires that 90% of the population be served by a local health department effectively carrying out the core functions of public health. This study proposes a method whereby determinations can be made of the extent to which a local public health jurisdiction is served by core public health functions, as well as the extent to which the functions are rendered by the health department. METHODS. Fourteen health departments under longitudinal study between 1979 and 1992 were studied. Respondents in each department completed a survey protocol using 81 indicators linked to standard public health functions and practices. Results are presented in graphic form, which provides a visual profile of public health performance for a local jurisdiction. RESULTS. The graphic profiles successfully differentiate one jurisdiction from another, and within each jurisdiction they differentiate the performance levels of different public health practices. The method enables identification of the full range of public health providers. CONCLUSIONS. Current definitions of public health practice have utility for evaluating public health performance. The validity of the proposed method deserves further study.     

An in-training examination for residents in family practice.

An in-training examination for family practice residents has been developed and used in a regional network residency program over the past three years. The most striking result has been the strong preference expressed by residents for question-specific feedback in order to facilitate learning after taking the examination. A well-designed in-training examination has the potential to meet both individual resident and program goals as an additional measure of resident performance and growth, as well as of the effectiveness of teaching in the various curricular areas. In-training examinations for residents are in use by 12 other specialties in medicine, and have been well-accepted by program directors and residents. A nationally-sponsored in-training examination for family practice residents is needed which includes maximal teaching capability through comprehensive and specific feedback.     

An audit of obstetric care in a university family medicine department and an obstetrics-gynecology department.

The care of obstetric patients in a university family medicine department was compared with that in the obstetrics-gynecology department of the same university. The obstetric service patients tended to be at higher risk due to a higher black population (24.2 percent vs 6.3 percent), greater prepregnancy weight (mean 154.0 lbs vs 113.9 lbs), and a greater number of patients referred from the community because of prenatal complications. However, the family medicine patients had a higher incidence of premature rupture of membranes (26 percent vs 11 percent), and were therefore at risk for several complications. Family medicine nulliparas had first stages of labor which lasted an average of 12.2 hours as opposed to obstetric service nulliparas whose first stages averaged only 9.2 hours. There were more family medicine than obstetric service patients who received no anesthesia (18.0 percent vs 10.2 percent). Elective low forceps were used more often by obstetric service physicians than by family physicians (28.2 percent vs 15.3 percent). Mothers on the family medicine service had more puerperal complications than those on the obstetric service (16.0 percent vs 5.6 percent). No serious discrepancies in quality of care could be found between the two services.     

洁净手术部工程综合性能全面评定检测方法

对洁净手术部工程综合性能全面评定必检项目及探索其检测方法，为评定洁净工程质量提供准确检测数据。     

A nomograph method for assessing body weight.

The ratio of weight/height emerges from varied epidemiological studies as the most generally useful index of relative body mass in adults. The authors present a nomograph to facilitate use of this relationship in clinical situations. While showing the range of weight given as desirable in life insurance studies, the scale expresses relative weight as a continuous variable. This method encourages use of clinical judgment in interpreting "overweight" and "underweight" and in accounting for muscular and skeletal contributions to measured mass.     

A method for assessing drug therapy appropriateness.

This study evaluated the reliability of a new medication appropriateness index. Using the index, independent assessments were made of chronic medications taken by 10 ambulatory, elderly male patients by a clinical pharmacist and an internist-geriatrician. Their overall inter-rater agreement for medication appropriateness (ppos) was 0.88, and for medication inappropriateness (pneg) was 0.95; the overall kappa was 0.83. Their intra-rater agreement for ppos was 0.94 overall, for pneg was 0.98 overall while the overall kappa was 0.92. The chronic medications taken by 10 different ambulatory elderly male patients were independently evaluated by two different clinical pharmacists. Their overall inter-rater agreement for ppos was 0.76, and for pneg was 0.93, while the overall kappa was 0.59. This new index provides a reliable method to assess drug therapy appropriateness. Its use may be applicable as a quality of care outcome measure in health services research and in institutional quality assurance programs.     

Daily text messages used as a method for assessing low back pain among workers

ObjectivesTo evaluate a method for collecting data concerning low back pain (LBP) using daily text messages and to characterize the reported LBP in terms of intensity, variability, and episodes.Study Design and SettingWe conducted a cohort study of LBP among workers used by a mining company. The participants were asked to answer the question “How much pain have you had in your lower back in the last 24 hours on a scale from 0 to 10, where 0 = no pain and 10 = the worst pain imaginable” once a day for 5 weeks, with this process being repeated 6 months later.ResultsA total of 121 workers participated in the first period of data collection, and 108 participated in the second period. The daily response rate was 93% for both periods, and cluster analysis was shown to be a feasible statistical method for clustering LBP into subgroups of low, medium, and high pain. The daily text messages method also worked well for assessing the episodic nature of LBP.ConclusionWe have demonstrated a method for repeatedly measuring of LBP using daily text messages. The data permitted clustering into subgroups and could be used to define episodes of LBP.     

Problems in assessing the technology of critical care medicine.

Technology assessment is becoming increasingly important in the area of critical care due both to the explosion of technology associated with this discipline and to the realization that future demand for these health care resources will undoubtedly exceed the ability to pay. Technology assessment remains both confusing and controversial to many physicians. This review tries to address some of the confusion by reviewing the basic strategies involved in this process. From there, problems and prospects for the evaluation of critical care as a program are presented, followed by the assessment of components within the area of critical care. Finally, recommendations are made on how technology assessment could proceed in the future to best achieve the efficient provision of this service.     

A statistical method for assessing a threshold in epidemiological studies

I describe a method for estimating and testing a threshold value in epidemiological studies. A threshold effect indicates an association between a risk factor and a defined outcome above the threshold value but none below it. An important field of application is occupational medicine where, for a lot of chemical compounds and other agents which are non-carcinogenic health hazards, so-called threshold limit values or TLVs are specified. The method is presented within the framework of the logistic regression model, which is widely used in the analysis of the relationship between some explanatory variables and a dependent dichotomous outcome. In most available programs for this and also for other models the concept of a threshold is disregarded. The method for assessing a threshold consists of an estimation procedure using the maximum-likelihood technique and a test procedure based on the likelihood-ratio statistic R, following under the null hypothesis (no threshold) a quasi one-sided chi 2 distribution with one degree of freedom. This use of this distribution is supported by a simulation study. The method is applied to data from an epidemiological study of the relationship between occupational dust exposure and chronic bronchitic reactions. The results are confirmed by bootstrap resampling.