Innovation in Orthopaedics: Part 2—How to Translate Ideas and Research into Clinical Practice

Purpose of ReviewThis paper presents some approaches and techniques for translating an idea or research into clinical practice, considering the innovation development process.Recent FindingsInnovative tools have been a key solution for healthcare problems, such as musculoskeletal disorders, which represent a great economic burden and are among the leading causes of disability. There has been an increase in publications on this topic, but there has been no analysis of the process of innovation development. This review describes the innovation phases for translating an idea or research into clinical practice, considering the stages of discovering the opportunity, innovation creation, project specification, technology development, and innovation launch.SummaryAn analysis of the innovation development process to translate an idea or research into clinical practice, including concepts, approaches, and techniques that shows the “why”, “how”, and “what” of innovation.     

儿童膳食营养知-信-行问卷的编制及信效度评价

目的编制适用于我国儿童的膳食营养知-信-行调查问卷。方法以Pearson相关分析法分析重测信度;采用Cronbach'sα系数评价内部一致性信度;采用单项与总和相关分析评价内容效度;采用因子分析评价结构效度。结果知识、态度、行为各维度和总问卷的重测信度系数分别为0.684、0.792、0.752、0.705,Cronbach'sα系数分别为0.816、0.889、0.981、0.943。内容效度中,除态度2、行为2、行为8、行为10条目外,其他各条目与问卷总分的相关系数均大于0.200;除知识7、行为2、行为8、行为10条目外,其他各条目与所属维度总分的相关系数均大于0.300。因子分析提取了3个公因子,累积方差贡献率为51.21%,56%的条目提取公因子后的共同度超过0.5。结论该问卷具有较好的效度和信度,可为同类研究提供参考。     

案例教学法在普通外科实习医师教学中的应用

普通外科是所有外科实习科室中最重要的科室之一,如何在较短的实习时间内将普通外科常见病和多发病的诊疗知识掌握好,这是普通外科实习教学教师必须面对的问题.采用案例教学法与传统教学法进行教学效果比较研究,发现前者能明显提高普通外科实习质量.     

Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence

Due to its excellent diagnostic performance, CT is the mainstay of diagnostic test in adults with suspected acute appendicitis in many countries. Although debatable, extensive epidemiological studies have suggested that CT radiation is carcinogenic, at least in children and adolescents. Setting aside the debate over the carcinogenic risk of CT radiation, the value of judicious use of CT radiation cannot be overstated for the diagnosis of appendicitis, considering that appendicitis is a very common disease, and that the vast majority of patients with suspected acute appendicitis are adolescents and young adults with average life expectancies. Given the accumulated evidence justifying the use of low-dose CT (LDCT) of only 2 mSv, there is no reasonable basis to insist on using radiation dose of multi-purpose abdominal CT for the diagnosis of appendicitis, particularly in adolescents and young adults. Published data strongly suggest that LDCT is comparable to conventional dose CT in terms of clinical outcomes and diagnostic performance. In this narrative review, we will discuss such evidence for reducing CT radiation in adolescents and young adults with suspected appendicitis.     

Diagnosing pancreatic cancer in general practice: a cross-sectional study on associations between suspicion of cancer,urgent referral and time to diagnosis

ObjectiveThis study aimed to investigate the first point of contact in patients diagnosed with pancreatic cancer, and to study factors associated with the GP’s suspicion of cancer, Cancer Patient Pathway (CPP) referral and long diagnostic interval.DesignCross-sectional study combining register and survey data.PatientsPatients with incident pancreatic cancer recorded in the Danish National Patient Register (n = 303).Main outcome measuresThe patient’s first point of symptoms presentation, GP’s cancer suspicion, CPP referral and diagnostic interval.ResultsGeneral practice was the first point of contact for 85.5% of the population. At the first consultation, cancer was suspected in 32.7% and 22.9% were referred to a CPP. The GPs were more likely to suspect cancer or serious illness in patients aged >70 years (prevalence rate ratio (PRR) 1.34, 95% CI 1.09–1.66) and among patients with high comorbidity (PRR 1.23, 95% CI 1.04–1.47). A CPP referral was less likely among patients with low education. The median diagnostic interval was 39 days (interquartile range: 15–72). When the GP initially did not suspect cancer, the likelihood of longer diagnostic interval increased.ConclusionThe majority of patients with pancreatic cancer began their diagnostic route in general practice. Diagnosing pancreatic cancer swiftly in general practice was challenging; the GP did often not initially suspect cancer or refer to a CPP and several of the patient characteristics were associated with the GPs initial suspicion of cancer or CPP referral. Thus, there may be room for improvements in the diagnostics of pancreatic cancer in general practice.

Key points

• Patients with pancreatic cancer have a poor prognosis, as pancreatic cancer is often diagnosed in late stage.
• The majority of patients with pancreatic cancer began their diagnostic process in general practice.
• General practitioners (GPs) suspected cancer at the first consultation in one out of three patients with pancreatic cancer; more often in older and comorbid patients.
• The GPs suspicion of cancer was associated with urgent referral and shorter time to diagnosis.

     

1950 — 2001年我国疟疾发病趋势分析

  目的  了解我国居民疟疾防治知识、态度、行为（KAP）相互影响程度。  方法  采取多级分层抽样,于2016年9月 — 2017年3月在广西、安徽、湖北、重庆4个疟疾多发地进行调查。根据疟疾流行的分类标准,将4个省（市）所有疟疾流行县分为1、2、3类县,每一类县抽取3个县共9个县作为样本县;每个样本县随机抽取3个乡镇,共抽取27个乡镇作为样本乡镇;在每个乡镇随机抽取3个村,共81个村作为样本村,随机抽取1358位居民进行入户调查,回收有效问卷1 321,有效率97.3%。问卷内容包括居民家庭条件,个人特征,疟疾防治知识,态度,行为等相关问题,对结果采用KAP量化和多组结构方程模型（SEM）分析。  结果  KAP量化得分上,行为得分最高（0.63 ± 0.25）分,态度（0.61 ± 0.32）分,知识得分最低（0.47 ± 0.22）分;结构方程模型潜在因子之间的总效应上,疟疾知识对行为的总效应为0.4439,疟疾态度对行为的影响效应为0.19,呈“知而趋于行”的特征;不同类别县的知识态度行为相互作用参数差异有统计学意义（P < 0.05）。  结论  我国消除疟疾行动已进入防治疟疾复发阶段,应当加大对偏远地区疟疾防治的卫生宣教,形成良好的态度和行为习惯。     

CLINICAL CONTRIBUTIONS TO ADMINISTRATIVE PRACTICE

No abstract available for this article.     

Creating Experimental Analogs with Available Clinical Information

SUMMARY

Comparison of the implementation and findings of a “gold standard” evaluation of social work intervention and its experimental analog based on available clinical information illustrates the strengths and weaknesses of each. From a practice-research integration perspective, however, “clinical data-mining” may be a credible alternative to randomized controlled experiments.     

FROM THE EDITOR'S DESK

No abstract available for this article.