Preliminary Assessment of Appropriateness of Emergency Care Service Use: Actions Taken and Consultations Obtained Before Emergency Care Presentation

Inappropriate use of emergency care services can increase hospital readmissions and related costs. This pilot, cross-sectional survey project determined whether home health care patients who receive emergency care services during a Medicare-approved home care episode sought consultation from health care professionals before they made the emergency care visit. The two research questions were: (a) What actions were taken by the patient before making an emergency care visit?; (b) If prior consultation was obtained, what were the suggestions? Preliminary data were obtained from a Michigan-based, Medicare-certified, not-for-profit home health agency affiliated with a university health system. A two-page questionnaire recorded up to three emergency care visits. Volunteer participants were Medicare patients who had no cognitive deficits and were able to communicate with home health care providers (HHCPs) by themselves. Thirty-five emergency care visits were reported; 31 (88.6%) Medicare patients participated and 4 (11.4%) of them had two emergency care visits. Before the patients made an emergency care visit, they most often called their primary care physicians (PCPs; N = 20, 57.1%), followed by the HHCPs (N = 10, 28.6%). All 20 patients who contacted their PCPs and 7 patients who contacted their HHCPs were advised to seek emergency care services. In 20 emergency care visits the patient was admitted for an acute hospital stay; the other 15 patients went home. Most patients contacted their PCPs or HHCPs before they went to an emergency department or urgent care facility. These results implied that PCPs and HHCPs seemed to perceive that the need for emergency care should be determined at an emergency room or urgent care facility. This study was unable to differentiate the need for emergency care services or the appropriateness of the advice given by PCPs or HHCPs when the home care patients were under the care of a medical team.     

中药饮片合理用药评价指标的构建研究

目的:建立上海市医疗机构中药饮片临床用药与管理评价指标体系。方法:采用德尔菲法,在文献研究的基础上制订《上海市医疗机构中药(饮片)临床用药与管理评价指标体系》调查问卷,向全市23位专家进行2次问卷调查,并对结果进行分析。结果:专家权威系数为0.8;2次调查问卷回收率均为100%;2轮问卷后,一、二、三级指标的协调系数分别为0.477,0.335,0.434;筛选出4个一级指标,10个二级指标和24个三级指标。结论:专家的集中程度和协调程度比较高,该框架设计的条目基本得到专家的认可。     

住院患者抗菌药物合理使用国际指标的调查干预研究

 目的探讨抗菌药物合理使用国际指标在我国医院的实用性,提高医院抗菌药物合理使用水平。方法按照抗菌药物合理使用国际指标对某一三甲医院住院患者进行现场调研,采用行政管理和宣传教育等多手段进行干预。医院整体情况数据通过管理部门和药库获得,处方行为和患者治疗情况通过系统抽样方法采集。用SPSS12.0软件进行统计分析。结果接受抗菌药物治疗的住院患者使用抗菌药物的平均品种数从干预前的2.07种降到干预后的1.79种,接受抗菌药物治疗的患者的平均费用从干预前的1597.61元降到干预后的1036.19元(P<0.05),单种抗菌药物的平均使用天数从干预前的5.21d下降到干预后的4.38d(P<0.05),接受抗菌药物治疗患者的平均住院日从干预前的14.41d下降到干预后的12.26d,其他多项指标均有改善。结论本研究所采用的抗菌药物合理使用国际指标调研具有实用性,干预措施有效,实施《抗菌药物临床应用指导原则》促进了抗菌药物的安全、经济、合理使用。     

血清甲状腺球蛋白在碘营养状况监测中的应用

对甲状腺球蛋白及血清甲状腺球蛋白在碘营养状况检测中的应用做了评述 ,包括甲状腺球蛋白的基本性质 ,在甲状腺内的代谢和碘供给对其的影响 ,同时着重对血清甲状腺球蛋白在碘缺乏病、高碘、特殊人群中的监测的优缺点进行了分析。血清甲状腺球蛋白对碘营养状况的敏感性优于血清促甲状腺素 ,是一个值得推荐的指标     

Mixed Sex Effects on the Second‐to‐Fourth Digit Ratio of Túngara Frogs (Engystomops pustulosus) and Cane Toads (Rhinella marina)

Sexual dimorphism in the ratio of digit lengths has been correlated to behavioral, physiological, and morphological traits in a variety of taxa. While sexual dimorphism in the second‐to‐fourth digit length ratio (2D:4D) is a well‐established indicator of prenatal androgen exposure in mammals, investigations into the patterns of 2D:4D and the drivers of such variation in other taxa are lacking. We used linear mixed effects models to gain a mechanistic understanding of the factors that drive variation in the scaling relationship between the lengths of the second and fourth digits in two species of anurans: túngara frogs (Engystomops pustulosus) and cane toads (Rhinella marina). We found evidence for sexual dimorphism of the 2D:4D scaling relationship on the front feet of túngara frogs, with female frogs having a larger ratio than males resulting from a relatively longer second digit on females. To our knowledge, this mammal‐like pattern of sex differences in digit ratio has not yet been reported for anurans. However, given the reduced number of digits on the front feet of anurans, and uncertainty about which digit was lost during evolutionary history, this apparent sexual dimorphism in the front feet of túngara frogs should be treated with caution. In contrast, we found no evidence of sexual dimorphism in 2D:4D on either the front or rear feet of cane toads. This study highlights ambiguities in 2D:4D across taxa and suggests that further research is needed to evaluate the effect of androgens on 2D:4D in animals other than placental mammals. Anat Rec, 299:421–427, 2016. © 2016 Wiley Periodicals, Inc.     

Biological monitoring of cobalt exposure,based on cobalt concentrations in blood and urine

Summary Cobalt exposure level and its concentrations in blood and urine were determined for 175 hard metal workers. For control data, the cobalt concentrations in blood and urine were measured for 20 office workers. The exposed workers had significantly higher cobalt concentrations in both blood and urine. The relationships between exposure level and cobalt concentrations in blood and urine were linear and positive. The results clearly showed that the cobalt concentration in the blood or urine can be used as an exposure indicator. With cobalt exposure of 100 g/m³, the cobalt concentration was 0.57 to 0.79 g/dl in blood and 59 to 78 g/l in urine with 95% confidence limits. In workers using respirators, the cobalt concentrations in the blood and urine decreased to 2/5 and 1/8, respectively, of those not using respirators.     

In vivo diagnostic assessment of dentinal caries by junior and senior students using red acid dye

The aim of this study was firstly to determine and compare the ability of inexperienced junior dental students (Fourth-year) and senior students (Fifth-year) versus a dental school instructor to identify demineralized dentine with the aid of a caries-disclosing solution and secondly to evaluate an eventual improvement of the caries diagnosis accuracy of junior (Fourth-year) and senior (Fifth-year) dental students. Three successive stages were used to check the ability of the dental students to diagnose and excavate the de-mineralized dentine. This study pointed out that 96% of junior dental students versus a teacher failed to remove all of the demineralized dentine without the use of a caries detector at the first stage and 79% at the second stage in the same condition. 100% of senior students versus a teacher, also failed to diagnose dental caries without a caries detector, but only at the first stage. However, at the second stage, unlike the junior students, all of the senior students were able to remove all of the demineralized dentine. Without the use of a caries detector dye, the risks of the dental students leaving demineralized dentine are high. This technique may be particularly helpful for the fourth-year students who are performing their first restorative treatment.     

Imaging of calcineurin activated by long-term depression-inducing synaptic inputs in living neurons of rat visual cortex

Long-term depression (LTD) of synaptic transmission is induced by low-frequency stimulation (LFS) of afferents lasting for a long time, typically for 10-15 min, in neocortical and hippocampal slices. It is suggested that calcineurin, Ca2+/calmodulin-dependent protein phosphatase, plays a role in the induction of LTD, based on the results that pharmacological or genetic manipulation of calcineurin activity interfered in its induction. However, questions as to why it takes so long to induce LTD and in which compartment of neurons calcineurin is activated remain unanswered. With a fluorescent indicator for calcineurin activity, we visualized the spatiotemporal pattern of its activation in living neurons in layer II/III of visual cortical slices of rats during the LFS of layer IV that induced LTD of synaptic responses. During LFS, the fluorescence intensity gradually increased with a latency of a few minutes in dendrites and soma of neurons, and remained increased during the whole observation period (10-25 min) after LFS. The onset latency of the increase in the soma was slower than that in the distal dendritic region. The LFS-induced rise in fluorescence was not observed in neurons which were loaded with inhibitors of calcineurin, indicating that the intensity of fluorescence reflects calcineurin activity. Control stimulation at 0.05 Hz and theta-burst stimulation did not significantly change the intensity of fluorescence. Only LFS-type inputs effectively activate calcineurin in postsynaptic neurons in an augmenting manner, and such a time-consuming activation of calcineurin may be a reason why long-lasting LFS is necessary for the induction of LTD.     

Establishing a balanced scorecard measurement system for integrated care organizations in China

To address, among other issues, the regional and international challenges of the heavy health care burden caused by an aging population, integrated care organizations (ICOs) were proposed at the end of the 20th century for health care delivery. However, the implementation of ICOs has not progressed smoothly, and the current results have not eliminated the imbalance of medical service capabilities among hospitals of different levels. To make up for the deficiency in the current evaluation system at ICOs and offer suggestions for improved sustainable health planning and management, this study establishes a balanced scorecard based on a comprehensive measurement system valid for a Chinese ICO by surveying the staff at the West China Hospital ICO. This study collected valid responses from 216 professional staff members at the ICO via questionnaires. K‐means clustering and the coefficient of variation method were used to evaluate the weights of the first‐ and second‐level indicators. The results show the importance ranking of the core perspectives of the ICO balanced scorecard in the following order: patient, internal process, learning and growth, and financial. The weight‐based analysis identified the importance ranking of all indicators and pointed to the areas that require close attention in future ICO planning and management.