超声弹性成像联合BI-RADS分类在乳腺微小癌诊断中的临床价值

目的:探讨在乳腺微小癌诊断中联合应用超声弹性成像及数据系统(BI-RADS)分类的临床价值。方法:选择2018年3月~2019年3月本院接收的疑似乳腺微小癌的96例患者作为研究对象。均进行超声弹性成像检查、BI-RADS分类,以病理检查结果为诊断金标准,比较单项检查与联合检查的准确率、灵敏度、特异度。结果:数据显示,在96例疑似乳腺微小癌患者中,共80例患者经病理检查确诊为乳腺微小癌,同时乳腺钼靶联合超声检查的准确性、灵敏度均高于单项检测,数据之间的差异有统计学意义(P<0.05)。此外,单项与联合检测的特异度对比,差异无统计学意义(P>0.05)。结论:在乳腺微小癌诊断中联合应用超声弹性成像及BI-RADS分类检查,可有效提高诊断准确性及灵敏度,对早期疾病诊断、临床治疗具有重要意义。     

从在用医疗设备存在的电气安全风险谈其质量控制

根据四川省医疗器械检测中心从2015年~2019年对四川省内94家医院所使用的245台医疗设备进行抽验的结果,探讨目前在用医疗设备潜在的电气安全风险,并针对这些风险提出如何进行医疗设备质量控制的建议。     

Mortality,Health Care Use,and Costs of Clostridioides difficile Infections in Older Adults

ObjectivesEstimate mortality, cost, and health care resource utilization for Medicare beneficiaries aged ≥65 years who suffered a primary Clostridioides difficile infection (CDI) episode only or any recurrent CDI, and understand how outcomes covary with death.DesignRetrospective observational claims analysis.Setting and ParticipantsPatients aged ≥65 years who had an inpatient or outpatient CDI diagnosis claim to Medicare and continuous enrollment in Medicare parts A, B, and D during the 12-month pre- and post-index periods.MethodsUsing 100% Medicare Fee-for-Service claims data for 2009–2017, primary (pCDI, n = 345,893) and recurrent (rCDI: n = 151,596) CDI episodes were identified. Demographic and clinical characteristics, mortality, health care resource utilization, and costs (per patient per month) were summarized for 12 months before and up to 12 months after episode start. Regression models were estimated for hospitalization risk, hospital length of stay (LOS), and cost to adjust for comorbidities.ResultsCDI-associated deaths were almost 10 times higher after recurrent CDI (25.4%) than primary CDI (2.7%). Compared with survivors, decedents were older, had higher Charlson Comorbidity Index scores, and were more likely Black. Adjusting for comorbidities, during follow-up, decedents had higher hospitalization rates [pCDI: odds ratio (OR) = 1.83, P < .001; rCDI: OR = 2.58, P < .001], and recurrent CDI decedents had more intensive care unit use (OR = 2.34, P < .001) compared with survivors. Decedents also had a longer length of stay (pCDI: +3.2 days, P < .001; rCDI: +2.6 days, P < .001), and higher total cost (pCDI: +303%, P < .001; rCDI: +297%, P < .001).Conclusions and ImplicationsCDI is an important contributing diagnosis to all-cause mortality, particularly for recurrences. Prior to death, older Medicare beneficiaries who experienced CDI received longer, more intensive, and more costly care compared with survivors. Clinicians should be particularly attentive to prevention, identification, and appropriate treatment of CDI in older adults. Better treatments to reduce primary C difficile infection and recurrences in this vulnerable population can lower both mortality and economic burden.     

Formal and Informal Costs of Care for People With Dementia Who Experience a Transition to Hospital at the End of Life: A Secondary Data Analysis

ObjectivesTo explore formal and informal care costs in the last 3 months of life for people with dementia, and to evaluate the association between transitions to hospital and usual place of care with costs.DesignCross-sectional study using pooled data from 3 mortality follow-back surveys.Setting and ParticipantsPeople who died with dementia.MethodsThe Client Service Receipt Inventory survey was used to derive formal (health, social) and informal care costs in the last 3 months of life. Generalized linear models were used to explore the association between transitions to hospital and usual place of care with formal and informal care costs.ResultsA total of 146 people who died with dementia were included. The mean age was 88.1 years (SD 6.0), and 98 (67.1%) were female. The usual place of care was care home for 85 (58.2%). Sixty-five individuals (44.5%) died in a care home, and 85 (58.2%) experienced a transition to hospital in the last 3 months. The mean total costs of care in the last 3 months of life were £31,224.7 (SD 23,536.6). People with a transition to hospital had higher total costs (£33,239.2, 95% CI 28,301.8-39,037.8) than people without transition (£21,522.0, 95% CI 17,784.0-26,045.8), mainly explained by hospital costs. People whose usual place of care was care homes had lower total costs (£23,801.3, 95% CI 20,172.0-28,083.6) compared to home (£34,331.4, 95% CI 27,824.7-42,359.5), mainly explained by lower informal care costs.Conclusions and ImplicationsTotal care costs are high among people dying with dementia, and informal care costs represent an important component of end-of-life care costs. Transitions to hospital have a large impact on total costs; preventing these transitions might reduce costs from the health care perspective, but not from patients' and families' perspectives. Access to care homes could help reduce transitions to hospital as well as reduce formal and informal care costs.     

The Utilization and National Variation of Plain X-Ray Services by Australian Residents of Long-Term Care Facilities

ObjectivesTo (1) estimate incidence, trends, and determinants of government-subsidized diagnostic radiography (ie, plain x-ray) services utilization by Australian long-term care facility (LTCF) residents between 2009 and 2016; (2) examine national variation in services used.DesignA repeated cross-sectional study.Setting and ParticipantsAustralian LTCF residents who were ≥65 years old.MethodsMedicare Benefits Schedule subsidized plain x-rays employed for diagnosing fall-related injuries, pneumonia, heart failure, and acute abdomen or bowel obstruction were identified. Yearly sex- and age-standardized utilization rates were calculated. Poisson and negative binomial regression models were employed. Facility-level variation was examined graphically. Overall and examination site–specific analyses were conducted.ResultsA total of 521,497 LTCF episodes for 453,996 individuals living in 3018 LTCFs were examined. The median age was 84 years (interquartile range 79-88), 65% (n = 339,116) were women, and 53.9% (n = 281,297) had dementia. In addition, 34.5% (n = 179,811) of episodes had at least one x-ray service. Overall, there was a 12% increase in utilization between 2009 and 2016 (from 535/1000 in 2009 to 602/1000 person-years in 2016, incidence rate ratio=1.02, 95% confidence interval 1.02-1.02). Factors associated with x-ray use included being 80-89 years old, being a man, not having dementia, having multiple health conditions (4-6 or ≥7 compared to 0-3), being at a smaller facility (0-24 bed compared to 50-74), facility located in the Australian state of New South Wales, or in major cities (compared to regional areas). National variation in x-ray service use, with largest differences observed by state, was detected.Conclusions and ImplicationsPlain x-ray service utilization by LTCF residents increased 12% between 2009 and 2016. Sex, age, dementia status, having multiple health conditions as well as facility size, and location were associated with plain x-ray use in LTCFs and use varied geographically. Differences in x-ray service utilization by residents highlight lack of consistent access and potential over- or underutilization.     

中文医学术语标准开发管理体系框架研究

中文医学术语标准对卫生健康信息共享和业务协同具有重要意义,中文医学术语标准的开发需要完善的组织管理机制和模式支撑。本研究通过分析国外典型医学术语标准开发和应用的管理模式,结合国内医学术语标准发展现状,提出了中文医学术语标准开发的管理体系框架,探讨了中文医学术语标准的制定、维护和推广过程中应关注的管理要素,对我国医学术语标准的发展具有指导意义。     

肝脏局灶性小占位的磁共振信号强度比与病灶性质的相关性

目的 计算肝细胞癌、肝转移瘤、肝脏海绵状血管瘤和肝囊肿的病灶／肝脏磁共振信号强度比（SIR）,并评价其与病灶性质的关系。方法 随机选择经确诊的肝细胞癌、肝转移瘤、肝海绵状血管瘤和肝囊肿病例共92例（148个病灶）行前瞻性磁共振成像（0．5T）研究。计算4种病灶的SIR,并进行统计学分析。结果 在T1W图像上,肝海绵状血管瘤与恶性肿瘤的SIR值间差异无显著性（t=1.799,P=0.075);质子加权像上,良恶性肿瘤的SIR之间无统计学意义（t=0.691,P=0.491);T2WI上,良性病变的SIR显著高于恶性肿瘤（P＜0．01）,且4种病变的SIR值与回波时间（TE）之间均存在线性正向相关关系。结论 在T2WI个测得的SIR可用于区分肝脏占位性病灶的性质。     

21世纪老年医学伦理学之探讨

21世纪人类全面进入人口老龄化,我国也进入了人口老年型国家的行列。文章叙述了21世纪我国老年人的特点,制定了衡量老年人生活质量的指标,并对提高老年人生活质量的对策,实现健康老龄化进行了医学伦理学方面的探讨。     

高技术条件下战场救治的特点及医德要求

高技术条件下战争的特殊性给战场救治带来了新的挑战。通过分析高技术条件下的战场救治的特点,提出了要圆满完成战场救治任务,军队医务人员必须承担的医德责任和应具备的身心素质。     

99Tcm-MIBI心肌断层显像对病毒性心肌炎的诊断价值

目的：探讨^99Tc^m-甲氧基异丁基异腈（^99Tc^m-methoxyisobutyl isonitrile,^99Tc^m-MIBI)心肌断层显像对病毒性心肌炎的诊断价值。方法对29例病毒性心肌炎患者及15例健康对照者进行负荷、静息^99Tc^m-MIBI心肌断层显像。结果13例（44．8％）表现为弥漫性放射性核素分布稀疏,15例（51．7％）表现为局灶性放射性核素分布稀疏。结论^99Tc^m-MIBI心肌断层显像对诊断病毒性心肌炎有临床实用价值。.