护理质量控制系统的设计与实现

目的研制先进、科学的工具客观高效控制护理质量.方法针对三级甲等医院的护理质量要求进行内涵要素分析,归纳出可操作性的具体内容,建立检查点库,通过先进实用的数学模型,按卫生部和卫生厅的有关标准和动态权值进行科学组合,生成护理质量检查评价表.录入检查表数据后能自动分析检查结果,对护理质量进行反馈控制,并根据实际检查情况不断修正护理质控模型.结果设计开发出护理质量检查综合评价管理系统.结论利用计算机技术和综合评价方法建立护理质量控制系统能科学有效的管理医院护理质量.     

On-Line Computer Scoring of the Auditory Brainstem Response for Estimation of Hearing Threshold

Auditory brainstem responses (ABRs) to click stimuli have become established as a useful indicator of hearing thresholds in infants and young children. Although the investigation is objective in so far as the patient is concerned, a subjective element remains in the decision by the operator as to whether or not an ABR is present in an averaged waveform. A simple on-line computer detection technique is described which removes some of the reliance placed upon the operator. The technique employs a scanning window for correlation and amplitude analysis of pairs of averaged ABR waveforms.

The reliability and accuracy of computer and operator scoring of 25 thresholds in normally hearing adults and 50 thresholds in infants and young children with suspected hearing impairment have been investigated. In the adult group, 96% of computer estimates of the threshold were within ± 10 dB of the subjective hearing threshold, compared with 92% for operator scoring. There were 92% of computer and operator scores within ± 10 dB of each other. In the patient group there was equally good agreement between computer and operator scoring with 90% of the thresholds within ± 10 dB of each other; the incidence of possible false-positive thresholds was also lower with computer scoring.

This on-line scoring technique, therefore, offers useful assistance to the operator; requires only limited computing power, and is suitable for use in a routine clinical environment.     

The Meaning of Embodiment

There is substantial disagreement among philosophers of embodied cognitive science about the meaning of embodiment. In what follows, I describe three different views that can be found in the current literature. I show how this debate centers around the question of whether the science of embodied cognition can retain the computer theory of mind. One view, which I will label body functionalism, takes the body to play the functional role of linking external resources for problem solving with internal biological machinery. Embodiment is thus understood in terms of the role the body plays in supporting the computational circuits that realize cognition. Body enactivism argues by contrast that no computational account of cognition can account for the role of commonsense knowledge in our everyday practical engagement with the world. I will attempt a reconciliation of these seemingly opposed views.     

Automated diagnosis of epilepsy using EEG power spectrum

Interictal electroencephalography (EEG) has clinically meaningful limitations in its sensitivity and specificity in the diagnosis of epilepsy because of its dependence on the occurrence of epileptiform discharges. We have developed a computer‐aided diagnostic (CAD) tool that operates on the absolute spectral energy of the routine EEG and has both substantially higher sensitivity and negative predictive value than the identification of interictal epileptiform discharges. Our approach used a multilayer perceptron to classify 156 patients admitted for video‐EEG monitoring. The patient population was diagnostically diverse; 87 were diagnosed with either generalized or focal seizures. The remainder of the patients were diagnosed with nonepileptic seizures. The sensitivity was 92% (95% confidence interval [CI] 85–97%) and the negative predictive value was 82% (95% CI 67–92%). We discuss how these findings suggest that this CAD can be used to supplement event‐based analysis by trained epileptologists.     

Accuracy of computer-assisted iliosacral screw placement using a hybrid operating room

IntroductionIn recent years hybrid operating rooms were established all over the world. In our setting we combined a 3D flat-panel c-arm (Artis zeego, Siemens) with a navigation system (BrainLab curve, BrainLab). This worldwide unique combination enables the surgeon to visualise an entire pelvis in CT-like image quality with a single 3D-scan. The aim of our study was to investigate, if utilisation of a hybrid operating room increases the accuracy of SI-screws in comparison to standard 3D-navigation.Material and methodsRetrospective, not randomised single centre case series at a level I trauma centre. Inclusion criterion was insertion of a percutaneous iliosacral screw using image-guidance in the hybrid operating room. 61 patients (35 female, 26 male) were included from June 2012 till October 2014. 65 iliosacral screws were inserted. Intraoperative 3D-scans and postoperative scans were examined to investigate screw placement. The results were compared to a preceding study performed in 2012 using conventional 3D-navigation. Statistical calculations were performed with Microsoft Excel 2011 and SPSS.Results65 iliosacral screws were implanted. Two different types of screws were implanted: 1. “Standard” iliosacral screws stabilizing one joint/a unilateral fracture. 2. Single SI-screws stabilizing both SI-joints and if present a bilateral fracture. Forty one patients were included in group 1 (screws n = 45). There was no perforation in 43 screws, grade 1 perforation in 2 screws. There was no grade 2 or 3 perforation in this group. Compared to the conventional 3D-navigated screws there was a highly significant difference (p < 0.001). Twenty patients could be included in group 2. Eleven screws showed a complete intraosseous position. There was grade 1 perforation in 2 screws, grade 2 perforation in 5 screws and grade 3 perforation in 2 screws.ConclusionImprovements in image quality and enlargement of the display window lead to better intraoperative visualisation of the entire dorsal pelvis. Thereby the accuracy of computer-assisted iliosacral screws could be increased using a hybrid operating room. Furthermore difficult tasks like a single screw for both joints can be accomplished.     

Computer assisted detection of abnormal airway variation in CT scans related to paediatric tuberculosis

Airway deformation and stenosis can be key signs of pathology such as lymphadenopathy. This study presents a local airway point distribution model (LA-PDM) to automatically analyse regions of the airway tree in CT scans and identify abnormal airway deformation. In our method, the airway tree is segmented and the centreline identified from each chest CT scan. Thin-plate splines, along with a local mesh alignment method for tubular meshes, are used to register the airways and develop point distribution models (PDM). Each PDM is then used to analyse and classify local regions of the airway. This LA-PDM method was developed using 89 training cases and evaluated on a 90 CT test set, where each set includes paediatric tuberculosis (TB) cases (with airway involvement) and non-TB cases (without airway involvement). The LA-PDM was able to accurately distinguish cases with airway involvement with an AUC of the ROC classification (and 95% confidence interval) of 0.87 (0.77–0.94) for the Trachea–LMB–RMB region and 0.81 (0.68–0.90) for the RMB–RUL–BI region – outperforming a comparison method based on airway cross-sectional features. This has the potential to assist and improve airway analysis from CT scans by detecting involved airways and visualising affected airway regions.     

Planning for Alcohol-Problem Prevention through Complex Systems Modeling: Results from SimCom

This article describes a computer-based model of alcohol use and misuse intervention called SimCom. This generic model, based on the best available scientific knowledge, incorporates eight interaction subsystems. When loaded with actual data from a locality, the model has the ability to “act like” this location and can be used to forecast the future effects of alternative prevention strategies. The article descibes benchmark testing of a model for the state of California, including projected prevention strategies for that state.     

Dyna CT与Embolization Guidance技术在前列腺动脉栓塞中的应用

目的探讨Dyna CT与Embolization Guidance技术在前列腺动脉栓塞中的应用。方法收集我科使用SIEMENS Artis Zeego数字减影血管造影机检查和图像采集进行前列腺动脉栓塞的38例患者,用Dyna CT技术明确前列腺癌供血动脉与其他侧支的情况,Embolization Guidance技术指导进行安全性的前列腺癌供血动脉栓塞。结果 38例患者经两名高年资主任医师指导分别进行前列腺癌动脉栓塞术。Dyna CT联合DSA确认前列腺动脉65侧,比例达85.5%(65/76),其中24例患者显示双侧前列腺动脉,10例确认单侧前列腺动脉;前列腺动脉开口起源于髂内动脉38条,起源于闭孔动脉11条,起源于膀胱下动脉9条,起源于阴部内动脉5条,起源于直肠下动脉2条。利用Embolization Guidance技术完成前列腺动脉栓塞89.2%(58/65),其中24例患者完成双侧栓塞,10例完成单侧栓塞,4例因血管迂曲不能进行超选择栓塞。结论 Dyna CT联合Embolization Guidance技术能够准确地显示前列腺优势供血动脉,在前列腺动脉栓塞治疗中具有重要的应用价值。     

CalcDose: A Software for Drug Dosage Conversion Using Metabolically Active Mass of Animals

Abstract

This Visual Basic computer program has been developed for drug dosage conversions using metabolically active mass (MAM) of the animals. The two body weights (one with known dosage and the other, for which the dosage has to be calculated) and the known dosage are entered in the respective input boxes and the appropriate units are selected using the option buttons. The program displays the report in the form of both the animals’ body weights and the respective dosages in milligram per kilogram body weight as well as the total actual doses in milligrams. The object oriented layout, flexible data entry and comprehensive report format render the CalcDose software a convenient and handy tool for dosage conversions.