规范创伤救治模式促进严重创伤救治质量的作用研究

目的 探讨规范创伤救治模式对严重创伤救治质量的促进作用. 方法 以2006年1月1日本院建立创伤中心为界,将新损伤严重度评分(NISS)≥16分的严重创伤患者分为研究组(创伤中心建立后2006 - 2008年)和对照组(创伤中心建立前2001-2005年),采用创伤数据库记录创伤患者伤情、救治与结局信息,比较严重创伤救治效率和质量的变化. 结果 研究组66例,对照组260例.研究组与对照组NISS值分别为(20.59±4.63)分和(20.57±5.38)分(P＞0.05);研究组急诊处理时间为(0.33±0.03)h,对照组为(0.57±0.35)h (P ＜0.01);研究组住院时间为(27.64±29.01)d,对照组为(30.84±32.87) d(P ＞0.05);研究组ICU治疗时间为(2.98±5.77)d,较对照组为(2.65±7.00) d(P ＞0.05);研究组治愈率为87.9％,对照组为76.5％(P＜0.05);研究组死亡率为9.1％,对照组为20.8％ (P ＜0.05). 结论 规范的创伤救治显著地提高了严重创伤的救治质量和水平.     

部队医院医疗设备质量控制的标准化管理体系的建立

 本文结合武警部队医院的实际情况,探讨了加强医疗设备质量控制的标准化管理体系建设的必要性和措施,旨在强调加强医疗设备质量控制重要性认识,确保医疗设备使用安全和应用质量.     

安全性药理学试验的质量保证

安全性药理学（safety pharmacology）试验是最晚列入良好实验室规范（good laboratory practice,GLP）管理的毒理学试验。安全性药理学试验为多个小型试验的组合,涉及到多组生理功能的检测,在药品非临床研究质量管理规范和质量保证方面有其特殊性。该文从安全性药理学的定义和范围、研究内容、执行GLP的要求、实验室资质的确认、试验关键阶段的检查、原始资料和报告的审核等方面分析了安全性药理学试验质量保证的程序、要求和注意事项。     

Implementing an Electronic Event-Reporting System in a Radiation Oncology Department: The Effect on Safety Culture and Near-Miss Prevention

PurposeWe implemented an electronic event-reporting system to investigate its effect on quality improvement in our department.MethodsWe developed an event-reporting program that launched in October 2012; data analysis was performed in January 2014. Events were logged by the radiation oncology staff and reviewed by our quality and safety committee on a biweekly basis. To measure the efficacy of the new program, and change in safety culture, a Likert-scale survey was administered before, and three months after, implementation of the event-reporting system.ResultsA total of 194 events were logged into the new system during a 15-month period (approximately 13 events per month), compared with 93 events in an 18-month period (approximately five events per month) before the program was launched. The average number of events reported by radiation therapists increased from 0.9 per month to 8.6 per month. The survey results showed a shift toward stronger agreement by staff members, in postimplementation versus preimplementation responses, when they were asked if they knew how to report an event in the department (P = .042), and if the current event-reporting system would reduce the incidence of future events (P = .032). Results showed a trend toward stronger agreement by staff members when they were asked if they felt more comfortable reporting events that they had observed (P = .093). Multiple safety action plans were implemented as a result of analysis of these events.ConclusionsAn electronic event-reporting system streamlines quality and safety in a radiation oncology department by increasing reported events and promoting a safety culture. A program that is widely accessible, easy to use, and can analyze data meaningfully will be the most successful.     

CareDose 4D联合Care kV对CT肺部磨玻璃密度结节图像质量影响的体模研究

目的 探讨CareDose 4D联合Care kV对CT肺部磨玻璃密度结节（ground glass nodule,GGN）图像质量和辐射剂量的影响。方法 采用7种低剂量方案对含有6个GGN的胸部仿真体模行CT扫描。方案1采用CareDose 4D+Care kV。方案2、3、4管电压120 kV,管电流分别为30、20、10 mAs。方案5、6、7管电压100 kV,管电流分别为30、20、10 mAs。比较不同方案的图像质量[CT值、对比噪声比（CNR）、噪声值（SD）和主观评分]和有效剂量（E）。结果 各方案GGN的CT值差异无统计学意义（P>0.05）。方案1的SD高于方案2、3、5,低于方案7,而CNR低于方案2、3、5,高于方案7,差异均有统计学意义（t=13.020、9.560、8.120、-5.720、-7.849、-5.192、-4.130、1.361,P<0.05）。方案1的SD、CNR与方案4、6差异均无统计学意义（P>0.05）。方案1、2、3、5、6各GGN的主观评分均≥ 3分,方案4、7各有1个GGN的主观评分<3分。方案1的E较方案2、3、5、6分别降低了63.0%、44.4%、38.8%、9.1%。结论 CareDose 4D联合Care kV在低剂量肺部CT扫描中,可保证GGN的图像质量,有效降低辐射剂量。     

学生饮用奶质量安全关键控制技术研究进展

启动和推广学生饮用奶计划,主要目的是为了改善中小学生营养健康状况,因此做好学生饮用奶质量安全控制是保障中小学生饮奶安全的基础和前提工作。学生饮用奶质量安全控制是一项系统工程,涉及奶牛饲料品质、饲养管理、疫病防治、环境卫生以及学生饮用奶加工、储藏运输等关键环节。从各环节的实践来看,重点关注饲料原料的品质提升、奶牛日粮配方精准执行、奶牛营养均衡供给、奶厅卫生和奶牛乳房炎健康改善,冷链运输及送达时间精准把控等环节的关键控制技术,对提升学生饮用奶品质,保障饮奶安全有重要意义。本文对目前学生饮用奶质量安全有关问题和关键控制技术进行了梳理分析,并对各环节质量安全控制技术的发展趋势进行了展望。     

Impact of increased cell loss on the repopulation rate during fractionated irradiation in human FaDu squamous cell carcinoma growing in nude mice

Purpose: To determine the impact of increased necrotic cell loss on the repopulation rate of clonogenic cells during fractionated irradiation in human FaDu squamous cell carcinoma in nude mice.

Materials and methods: FaDu tumours were transplanted into pre‐irradiated subcutaneous tissues. This manoeuvre has previously been shown to result in a clear‐cut tumour bed effect, i.e. tumours grow at a slower rate compared with control tumours. This tumour bed effect was caused by an increased necrotic cell loss with a constant cell production rate. After increasing numbers of 3‐Gy fractions (time intervals 24 or 48?h), graded top‐up doses were given to determine the dose required to control 50% of the tumours (TCD₅₀). All irradiations were given under clamp hypoxia.

Results: With increasing numbers of daily fractions, the top‐up TCD₅₀ decreased from 37.9?Gy (95% CI: 31; 45) after single dose irradiation to 14.1?Gy (8; 20) after irradiation with 15 fractions in 15 days. Irradiation with 18 daily 3‐Gy fractions controlled more than 50% of the tumours without a top‐up dose. After irradiation with six fractions every second day, the top‐up TCD₅₀ decreased to 26.9?Gy (22; 32). No further decrease of the TCD₅₀ was observed after 12 and 18 irradiations every second day. Assuming a constant increase of TCD₅₀ with time, the calculated doubling time of the clonogenic tumour cells (T_clon) was 7.8 days (4.4; 11.3). The T_clon calculated for FaDu tumours growing in pre‐irradiated tissues was significantly longer (p=0.0004) than the T_clon of 5.1 days (3.7; 6.5) determined under the same assumptions in a previous study for FaDu tumours growing in normal subcutaneous tissues.

Conclusions: Increased necrotic cell loss by pre‐irradiation of the tumour bed resulted in longer clonogen doubling times during fractionated radiotherapy of human FaDu squamous cell carcinoma. This implies that a decreased necrotic cell loss might be the link between reoxygenation and repopulation demonstrated previously in the same tumour model.     

A Retrospective Evaluation of Time to Obtain an MRI for English- Versus Non–English-Speaking Patients

Purpose

Americans with limited English proficiency (LEP) face significant barriers to health care that result in health disparities in the LEP population. LEP could delay an MRI, potentially increasing morbidity and mortality in the LEP population. This study compares the time to obtain a neurological MRI in English versus non-English language preference patients.

双定位像结合Care Dose 4D和Care kV技术在降低肺部CT辐射剂量的临床应用价值

目的 探讨双定位像结合Care Dose 4D和Care kV技术在肺部CT检查中的可行性及其临床应用价值。方法 连续纳入临床确诊为肺部肿瘤行肺部CT扫描的患者60例,按随机数表法分为对照组和试验组,每组各30例,对照组行单定位像（AP）结合Care Dose 4D和Care kV技术扫描,试验组行双定位像（AP和lat）结合Care Dose 4D和Care kV技术扫描。由2位高年资医师采用双盲法对两组图像和病变组织的信噪比（SNR）、对比噪声比（CNR）,及整体图像质量进行综合分析和评价,同时计算有效辐射剂量。结果 60例患者均成功完成肺部CT检查,试验组整体图像质量评分为4.57±0.45,与对照组的4.73±0.45相比差异无统计学意义（P>0.05）。对照组图像SNR、CNR、病变组织SNR、CNR与试验组相比差异均无统计学意义（P>0.05）。试验组和对照组的容积CT剂量指数CTDI_vol、剂量长度乘积（DLP）、有效剂量（E）,差异有统计学意义（t=8.514、8.464、8.464,P<0.001）。与对照组相比,试验组有效剂量降低了33.3%。结论 较单定位像（AP）肺部CT检查,双定位像（AP和lat）结合Care Dose 4D和Care kV技术肺部CT检查可获得满足诊断及临床需求图像,同时明显降低辐射剂量,可成为肺部CT常规检查方式。     

The future quality and safety of medical imaging: proceedings of the third annual ACR FORUM

The ACR annually engages in a long-range planning activity called the FORUM on a specific issue deemed important to the specialty of radiology over a horizon of 5 to 10 years. The FORUM brings together experts from multiple disciplines to discuss the topic, develop scenarios, and make recommendations to the ACR and the specialty on what courses to take to improve the development of radiology. The Third Annual FORUM, held May 21 to 23, 2003, was on the subject of improving quality and safety. The sessions ended with numerous recommendations as to how the specialty of radiology could promote safer, higher quality imaging that would also engage the interest and participation of the public, employers, insurers, and government. These fell into the following categories: (1) how to measure the performance of radiologists, (2) how to use measurements of performance to improve quality and safety, (3) means of working with employers and insurers to improve care and reduce waste, (4) the development of new ACR programs intended to foster change, and (5) disseminating information about ACR efforts on behalf of improving quality and safety.     

Radiologist Peer Review by Group Consensus

PurposeThe objective of this study was to evaluate the feasibility of the consensus-oriented group review (COGR) method of radiologist peer review within a large subspecialty imaging department.MethodsThis study was institutional review board approved and HIPAA compliant. Radiologist interpretations of CT, MRI, and ultrasound examinations at a large academic radiology department were subject to peer review using the COGR method from October 2011 through September 2013. Discordance rates and sources of discordance were evaluated on the basis of modality and division, with group differences compared using a χ² test. Potential associations between peer review outcomes and the time after the initiation of peer review or the number of radiologists participating in peer review were tested by linear regression analysis and the t test, respectively.ResultsA total of 11,222 studies reported by 83 radiologists were peer reviewed using COGR during the two-year study period. The average radiologist participated in 112 peer review conferences and had 3.3% of his or her available CT, MRI and ultrasound studies peer reviewed. The rate of discordance was 2.7% (95% confidence interval [CI], 2.4%-3.0%), with significant differences in discordance rates on the basis of division and modality. Discordance rates were highest for MR (3.4%; 95% CI, 2.8%-4.1%), followed by ultrasound (2.7%; 95% CI, 2.0%-3.4%) and CT (2.4%; 95% CI, 2.0%-2.8%). Missed findings were the most common overall cause for discordance (43.8%; 95% CI, 38.2%-49.4%), followed by interpretive errors (23.5%; 95% CI, 18.8%-28.3%), dictation errors (19.0%; 95% CI, 14.6%-23.4%), and recommendation (10.8%; 95% CI, 7.3%-14.3%). Discordant cases, compared with concordant cases, were associated with a significantly greater number of radiologists participating in the peer review process (5.9 vs 4.7 participating radiologists, P < .001) and were significantly more likely to lead to an addendum (62.9% vs 2.7%, P < .0001).ConclusionsCOGR permits departments to collect highly contextualized peer review data to better elucidate sources of error in diagnostic imaging reports, while reviewing a sufficient case volume to comply with external standards for ongoing performance review.