The value of comparative research in major day surgery

Objective

To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain.

不同检测方法在MR急性脑梗诊断中的价值探究

目的:探究对急性脑梗死病灶可呈阳性显像MRI的DWI、FLAIR及常规SE序列T2WI的不同特点,并比较分析出这些不同检测方法对诊断急性脑梗死敏感度的高低.方法:对经MR检查的48例急性脑梗死患者进行分析.结果:在48例急性脑梗死中DWI序列测出48例,FLAIR序列测出42例,T2WI加权测出40例,其中有5个梗塞灶只在DWI序列测出.DWI序列的47个病灶信号的大小边缘及强弱均较FLAIR及T2WI加权像更为明显.结论:DWI序列能尽早显示病灶并准确诊断急性脑梗死,其灵敏度高于FLAIR、T2WI序列,为临床诊断提供必要依据.     

4种检测方法用于结核病诊断的临床价值

目的比较分析γ-干扰素释放试验(interferon gamma release assays,IGRAs)、结核菌素纯蛋白衍生物(purified protein derivative,PPD)试验、结核抗体以及液基夹层杯四种方法用于诊断结核病的临床价值。方法收集2017年5月-2019年4月于湖南中医药大学第一附属医院的住院病例,确诊为结核病246例,排除结核病的为216例。4种检测方法的敏感度和特异度的比较采用卡方检验;IGRAs斑点数量与PPD试验的强度之间的关系分析采用t检验;IGRAs在所有检测患者中的阳性率与患者年龄的关系分析采用趋势检验;IGRAs方法的斑点数用于诊断结核病的效能分析采用ROC曲线分析。结果 IGRAs、PPD试验、结核抗体及液基夹层杯这4种方法用于诊断结核病的灵敏度分别是90.7%、50.9%、12.1%及12.1%,特异度分别是63.1%、77.4%、94.0%、99.1%。在敏感度方面,除结核抗体和液基夹层杯之间无统计学差异,其他任意两种方法之间比较,均有统计学差异(均P<0.001)。在特异度方面,4种方法两两比较均具有统计学差异(均P<0.01)。IGRAs联合PPD试验的敏感度90.1%高于单独PPD试验的敏感度50.9%(P<0.001),IGRAs联合PPD试验的特异度80.2%高于单独的IGRAs的特异度63.1%(P=0.002)。PPD试验阴性(-)组的IGRAs斑点数低于PPD强阳性(+++)组的斑点数(P=0.031),PPD中度阳性(++)组和强阳性(+++)组的IGRAs斑点数均高于PPD弱阳性组(+)的斑点数(P<0.05)。IGRAs的阳性率与年龄呈递增关系(P<0.001)。ROC曲线分析显示IGRAs用于诊断结核病的曲线下面积为0.824,最佳斑点数为9.50,对应的灵敏度为81.6%,特异度为74.3%。结论在4种检测方法中,IGRAs诊断结核病的敏感度最高,液基夹层杯法诊断结核病的特异度最高。IGRAs斑点数量与PPD试验的强度具有相关性。在医院就诊的人群中,随着年龄的增高,IGRAs的阳性率有增高趋势。ROC曲线分析IGRAs诊断结核病的最佳斑点数为9.50。     

3种不同方法检测幽门螺杆菌的对比观察

目的对比观察3种不同方法检测幽门螺杆菌(Hp)的临床效果。方法对680例消化道科就诊的患者分别采用改良W-S银染法、快速尿素酶试验(RUT)、14 C-尿素呼气试验(14 C-UBT)检测Hp感染,比较其检测Hp感染的效果。结果改良W-S法的检出率为71.32%,显著高于RUT法和14 C-UBT法,差异有统计学意义(P<0.05);RUT法和14 C-UBT法的检出率比较,差异无统计学意义;改良W-S法的灵敏性、特异性和准确性分别为96.04%、100.00%和97.06%,均显著高于RUT法和14 C-UBT法,差异有统计学意义(P<0.05);而RUT法和14 C-UBT法之间比较差异无统计学意义。结论改良W-S法检测Hp感染具有很高的灵敏性、特异性以及准确性,而且操作方法简便,成本低廉,值得临床推广应用。     

The value of information technology in healthcare

Not only will healthcare investments in information technology (IT) continue, they are sure to increase. Just as other industries learned over time how to extract more value from IT investments, so too will the healthcare industry, and for the same reason: because they must. This article explores the types of business value IT has generated in other industries, what value it can generate in healthcare, and some of the barriers encountered in achieving that value. The article ends with management principles for IT investment.     

Estimating the expected value of partial perfect information: a review of methods

BACKGROUND: Value of information analysis provides a framework for the analysis of uncertainty within economic analysis by focussing on the value of obtaining further information to reduce uncertainty. The mathematical definition of the expected value of perfect information (EVPI) is fixed, though there are different methods in the literature for its estimation. In this paper these methods are explored and compared. METHODS: Analysis was conducted using a disease model for Parkinson's disease. Five methods for estimating partial EVPIs (EVPPIs) were used: a single Monte Carlo simulation (MCS) method, the unit normal loss integral (UNLI) method, a two-stage method using MCS, a two-stage method using MCS and quadrature and a difference method requiring two MCS. EVPPI was estimated for each individual parameter in the model as well as for three groups of parameters (transition probabilities, costs and utilities). RESULTS: Using 5,000 replications, four methods returned similar results for EVPPIs. With 5 million replications, results were near identical. However, the difference method repeatedly gave estimates substantially different to the other methods. CONCLUSIONS: The difference method is not rooted in the mathematical definition of EVPI and is clearly an inappropriate method for estimating EVPPI. The single MCS and UNLI methods were the least complex methods to use, but are restricted in their appropriateness. The two-stage MCS and quadrature-based methods are complex and time consuming. Thus, where appropriate, EVPPI should be estimated using either the single MCS or UNLI method. However, where neither of these methods is appropriate, either of the two-stage MCS and quadrature methods should be used.     

两种HBV DNA定量检测方法的临床对比研究

目的比较某国产实时荧光定量PCR试剂(后称国产试剂)与某进口(后称进口试剂检测乙型肝炎病毒(HBV)DNA的定量的结果。方法根据进口试剂检测结果抽取514份慢性乙型肝炎的血浆标本,采用国产全自动核酸提取仪和PCR高敏试剂进行HBV DNA定量平行检测,以分析国产试剂的检测情况和与进口试剂的结果差异和相关性。结果进口试剂和国产试剂的阳性检出率分别为77.2%和78.5%,不符合率分别为7.2%和8.6%,两者无明显差异;Spearman相关分析显示,两种试剂检测的HBV DNA在20～1.7×10~8IU/mL区间内检测结果的相关系数(r=0.966,P<0.000 1),表明二者具有较强的相关性;Bland-Altman分析2种方法检测病毒载量的差异分析显示结果具有较高的一致性。结论国产高敏试剂和进口试剂,检测血浆HBVDNA在20～1.7×10~8IU/mL的病毒载量结果具有较好的相关性和一致性。     

Social aspects in the activities of radiodiagnostic services

Results of sociological investigation of the staff members and patients of radiodiagnosis departments of treatment and prophylaxis institutions of St. Petersburg are analyzed. Anonymous questionnaires were distributed in 50 institutions of different profiles among 200 staff members (physicians--roentgenologists and radiologists, and x-ray laboratory assistants) and 300 patients (from x-ray rooms and radiodiagnosis departments). The study showed an objective picture of the state of radiological care rendered to the population viewed from two sides, by those rendering this care and those rendered it. The results helped develop recommendations for public health organization.     

The value of current nutrition information

To prevent or delay the occurrence of chronic diseases, scientific bodies from the cardiologic and oncologic disciplines have made recommendations regarding the daily dietary intake of certain macro- and micronutrients. This study assessed the knowledge of a random population of 2,305 individuals comprising members of the public, health care workers, university graduate students, and health club attendees. Segments of this population might be expected to have a greater understanding and ability to implement these dietary recommendations. We found that over 90% of the participants were unaware of the recommendations for calcium, salt, vitamin A, and fiber, and the fiber content in a high fiber cereal. Approximately 80% of the participants were unaware of the recommendations regarding fat intake and could not calculate the fat content of a food product. Almost half of the study population took a vitamin pill daily. Of the subjects who were aware of the correct unit measurement for vitamin A (IU), almost 25% of gave a response that exceeded the recommended daily intake. A majority of this study population were unaware of the dietary recommendations regarding the prevention of cardiovascular events and cancer. Subgroups of this study population that might be expected to have more information regarding these recommendations (i.e., having higher education or being a health care professional) did not display a satisfactory level of knowledge. To further compound the problems of adhering to the recommended guidelines, the labeling of many food products is misleading. The recommendations on dietary intake and the information on food product content must be transmitted to the public in a form that allows for ready application when purchasing and consuming food.     

两种HCV RNA定量检测方法的临床对比研究

目的对比分析某国产的丙型肝炎病毒(HCV)核酸定量检测试剂(简国产试剂)和某进口试剂(简称进口试剂),检测其对HCV血清病毒载量的相关性和一致性。方法收集2019年1月至5月期间在深圳市第三人民医院就诊的慢丙肝患者临床检测剩余血清标本132份,采用进口试剂和国产试剂,平行检测HCV感染者血清病毒载量,采用t检验、线性回归和Bland-Altman等方法进行统计分析,评价2种检测试剂检测结果的相关性和一致性。结果国产试剂和进口试剂检测结果均高于或低于检测下限的样本分别为114例和6例,检测结果一致性较高,达到90.91%(120/132)。进口试剂和国产试剂检测结果均高于检测下限的114例样本中,国产和进口试剂检测结果的平均HCV血清病毒载量分别为((2.38×10~4～5.6×10~6)IU/mL,(5.47×10~6～1.39×10~7)IU/mL,差异具有统计学意义(t=-3.32,P=0.001)。2种检测方法在病毒载量>1 000 IU/mL时差异有统计学意义(t=-2.45,P=0.02),在病毒载量<1 000 IU/mL时差异也具有统计学意义(t=-2.30,P=0.03)。相关分析显示,2种方法检测结果具有很强的相关性(r=0.98,P<0.001)。差异性分析显示,进口试剂与国产试剂的2者定量值差异的平均值为-0.33 log10 IU/mL,其95%可信区间为(-0.91～0.25)log10 IU/mL。96%(109/114)的样本检测值在95%的可信区间内。结论进口试剂与国产试剂2种试剂具有较高的相关性和一致性。     

阴道镜在诊断宫颈病变中的临床价值

目的 探讨阴道镜检查在诊断宫颈病变中的实用价值.方法 对我院妇产科1999年10月-2005年4月的351例宫颈病变患者的阴道镜检查及病理学检查结果进行回顾性分析.结果 阴道镜检查的351例患者中,全部进行病理学检查,阴道镜下诊断为慢性宫颈炎217例,宫颈癌前病变109例,宫颈原位癌及浸润癌25例.病理诊断慢性宫颈炎226例,宫颈癌前病变101例,宫颈原位癌及浸润癌24例.两者相比,诊断符合率在90%以上.结论 阴道镜检查对提早发现宫颈癌前病变及早期宫颈癌具有重要价值.     

Improvement of the information value of multifrequency impedancometry for detection of small tumor arrays

Use of multifrequency impedancometry makes it possible to considerably increase the information value of electroimpedancometry for malignant tumor diagnosis. Integral characteristics of the tissue electrical impedance vs. frequency curves Z(f) in normal and pathological states are used to obtain additional diagnostic information about the type and physiological state of biological tissues on the basis of calculation of quotients K(P). The number of these quotients depends on the number of diagnostically significant frequencies and integral characteristics Z(S). Ratios of quotients K(P) for the same frequency domains and ratios (and differences) of areas under the curves Z(f) for normal and pathological biological tissues can be used as diagnostically significant correlation parameters.     

螺旋CT对肾上腺囊性病变的诊断价值

目的分析肾上腺囊性病变的CT特征,以提高其CT诊断的准确性。方法收集笔者所在医院2001～2008年间经手术和病理证实的13例肾上腺囊性病变的病例的CT及临床、病理资料。结果13例经手术证实的肾上腺囊性病变中,上皮样囊肿6例,嗜铬细胞瘤囊变2例,陈旧性出血形成假囊肿2例,原发性肾上腺癌囊变2例,肾上腺转移瘤囊变1例。结论根据肾上腺囊性病变的CT特征,有助于明确诊断。     

Optimal clinical trial design using value of information methods with imperfect implementation

Traditional sample size calculations for randomized clinical trials are based on the tests of hypotheses and depend on somewhat arbitrarily chosen factors, such as type I and II errors rates and the smallest clinically important difference. In response to this, many authors have proposed the use of methods based on the value of information as an alternative. Previous attempts have assumed perfect implementation, i.e. if current evidence favors the new intervention and no new information is sought or expected, all future patients will receive it. A framework is proposed to allow for this assumption to be relaxed. The profound effect that this can have on the optimal sample size and expected net gain is illustrated on two recent examples. In addition, a model for assessing the value of implementation strategies is proposed and illustrated. Copyright © 2009 John Wiley & Sons, Ltd.