山东省医疗机构医疗不良事件内部报告制度建立现况调查

[目的]了解山东省医疗机构建立和实施内部不良事件报告制度的情况。[方法]采用分层随机抽样方法,调查山东省6个样本市30家二、三级医院内部不良事件报告制度建立情况。[结果]82.76%的医疗机构建立了医疗不良事件内部报告制度,建立内部报告制度的医院数逐年增加,报告数量也逐年增多。[结论]山东省医疗不良事件内部报告制度建立呈普及趋势,但报告环境有待改善。     

非接触式医疗监测雷达研究进展

介绍了非接触式医疗监测雷达相比于传统的呼吸和心电监护仪的优势,从3种不同雷达体制的角度总结回顾了近10 a来医用生命监测雷达系统的研究现状,概括比较了呼吸和心跳信号的提取、分离、杂波抑制等算法,并指出了各种算法的优缺点,最后对非接触式生命监测雷达的发展趋势进行了探讨和展望.     

热解式医疗废弃物处理车的研制

目的:研制一种热解处理医疗废弃物的车辆,用于野战医院、偏远分散乡镇医院以及突发事件产生医疗废弃物的及时无害化、减量化处置.方法:综合运用结构设计、热力学原理,人机工程、自动控制技术设计试制敞开式车厢、车载热解炉及烟气控制系统、热解炉控制和监测系统.结果:热解式医疗废弃物处理车通过了7 000 km可靠性试验、高低温试验、烟气排放监测和部队试用等试验.结论:热解式医疗废弃物处理车是一种先进实用、排放达标、经济和社会效益显著、应用前景广泛的新型卫生技术车辆.     

浅谈医院医疗设备购置关键环节的管控

介绍了医院医疗设备购置管理的现状,阐述了购置管理的关键环节及存在问题,并在此基础上从计划编制、预算控制、采购实施、质量验收4个环节提出了具体的管控措施,并指出对医疗设备购置的关键环节进行管控可以规范医院医疗设备购置程序,提高设备购置的质量和效益,对医疗设备购置管理工作起到积极的促进作用.     

Clinical decision support in the neonatal ICU

Clinical Decision Support (CDS) tools help the healthcare team diagnose, monitor, and treat patients more efficiently and consistently by executing clinical practice guidelines and recommendations. As a result, CDS has a direct impact on the delivery and healthcare outcomes. This review covers the fundamental concepts, as well as the infrastructure needed to create a CDS tool and examples of its use in the neonatal setting. This article also serves as a primer on what to think about when proposing the development of a new CDS tool, or when upgrading an existing one. We also highlight important elements that influence CDS development, such as informatics methodologies, data and device interoperability, and regulation.     

Assessment of US Radiology Residency Program Websites in the COVID-19 Era

ObjectiveTo provide an updated evaluation of radiology residency program websites in light of virtual interviewing during the COVID-19 pandemic and encourage programs to improve the quality of their online website presence.MethodsWe evaluated the websites of 197 US radiology residency programs between November and December 2021 for the presence or absence of 30 metrics. The metrics chosen are those considered important by applicants when choosing a program and have been used in other similar papers.ResultsOf the 197 programs, 192 (97.5%) had working websites. The average radiology residency website had 16 of 30 (54%) metrics listed on their websites. Five programs did not have accessible websites and were not included in the analysis. The most comprehensive website had 29 of 30 (97%) of metrics listed and the least comprehensive website had 2 of 30 (7%). There is a statistically significant difference in website comprehensiveness between top 20 and non–top 20 radiology program websites.ConclusionAlthough radiology residency program websites have generally become more comprehensive over time, there is still room for improvement, especially in times of virtual interviews when residency applicants are becoming more and more reliant on program websites to gain essential information about a program. Some key areas to include are diversity and inclusion initiatives, resident wellness, applicant information, program benefits, and showcase of people in the program.     

Usability of Hospital Price Estimators for Lumbar Spine MRI

PurposeThe aim of this study was to evaluate the usability of online hospital price estimators for a common imaging examination using surrogate patients.MethodsUsing the Amazon Mechanical Turk platform, the authors recruited adult English-speaking US residents as surrogate patients to find the cash price for a noncontrast lumbar spine MRI examination for a self-pay patient using price estimator tools at four hospitals. All were asked to view a 3-min tutorial video and report their experiences with the task, including the System Usability Scale (SUS) for the estimator, through a paid survey. Participants were queried about demographics, insurance, prior imaging exposure, and assessed health literacy and health insurance literacy using validated measures. Multivariable analysis for correct price identification and price estimator SUS were performed.ResultsOf 660 respondents, 476 met eligibility criteria (72.7% <45 years of age, 41.7% female, 86.1% white); 76.9% found all four estimators, and 9.2% were unable to locate any. Only 27.7% found the correct price at all four hospitals, with 67.4% being able to find at least one correct cash price. Average SUS score for the hospitals’ estimators ranged between 62.4 and 77.5. The hospital with a similar estimator to that used in the tutorial video had the highest SUS score. Accuracy of price identification improved with later tasks. Higher health insurance literacy was associated with higher identification of at least one correct price (odds ratio, 1.21; 95% confidence interval, 1.02-1.44) and higher SUS score (B = 1.68; 95% confidence interval, 1.07-2.29).ConclusionsSurrogate patients were able to locate hospital price estimators but unable to effectively use them to obtain correct prices. Tutorial videos improved SUS score, but correct price identification improved with practice.     

Physician complicity in human rights violations: Involuntary sterilization among women from Mexico and Central America seeking asylum in the United States

Involuntary sterilization is a violation of human rights and grounds for asylum in the United States. Forensic medical evaluations can be useful in documenting this form of persecution and supporting asylees’ claims for immigration relief. We conducted a retrospective case analysis of the personal and medical affidavits of 14 asylum-seeking women from four Latin America countries who all reported they had been involuntarily sterilized. Sixty-four percent said that “consent” was coerced; the remainder were unaware of having been sterilized at the time of the procedure. In all cases, findings on hysterosalpingogram were consistent with sterilization, revealing that all 14 had undergone a tubal ligation. Eighty-six percent of the women had been sterilized at the time of childbirth. The healthcare providers involved in the 14 cases failed to obtain informed consent, misled patients about sterilization, engaged in discriminatory behavior, and/or breached patient confidentiality regarding their HIV-status. All 14 asylum cases were defensive; of the 7 cases (50%) that have been decided to date, 100% have been granted asylum.     

Feasibility and Timing of Prehospital Administration of Reteplase in Patients with Acute Myocardial Infarction

Background: In myocardial infarction patients undergoing thrombolysis, treatment delays negatively impact outcomes. This pilot study was conducted to determine the feasibility and timing of field administration of intravenous double bolus reteplase in patients with ST-elevation myocardial infarction. Methods: Sixty three patients with symptoms and EKG changes consistent with acute myocardial infarction of less than six hours duration received the first bolus of reteplase before arriving at the emergency department. A second bolus of reteplase was given in the emergency department. Subsequent resolution of ST-segment elevation was measured. Mean time from symptom onset to paramedic dispatch, and paramedic arrivals to first bolus of reteplase were measured. The mean time from the first bolus of reteplase to heparin bolus in an emergency department was also measured. All patients with evidence of ST-elevation and suspected acute myocardial infarction gave consent for the thrombolytic therapy. There were no refusals of therapy among those candidates eligible for thrombolysis. Results: The mean times from the first bolus of reteplase to heparin bolus in the emergency department was substantially longer than the in-field times. Resolution of ST-segment elevation was recorded in 52 of the 63 patients and the times of resolution ranged from five minutes after the first bolus dose to 190 minutes after the second bolus of reteplase. Resolution of ST-segment elevation and relief of pain occurred almost simultaneously. Conclusions: These results demonstrated that in-field administration of thrombolytic therapy is a viable option to reduce the delay from symptom onset to initiation of thrombolysis. They demonstrated that satisfactory resolution of ST-segment elevation can be recorded in the field. The reduction in mortality observed in this study is comparable to previously published studies on inpatients. Abbreviated Abstract. This open-label pilot study was conducted to determine the feasibility and timing of field administration of intravenous double-bolus reteplase and to measure subsequent resolution of ST elevation in 63 patients with symptoms and ECG changes consistent with acute myocardial infarction for less than 6 hours. These results demonstrated that in-field administration of thrombolytic therapy is a viable option to reduce the delay from symptom onset to initiation of thrombolytic therapy.     

Lipoprotein(a) and aortic valve stenosis: A casual or causal association?

AimsThis review aims to provide an update of available methods for imaging calcification activity and potential therapeutic options.Data SynthesisAortic valve calcification represents the most common heart valve condition requiring treatment among adults in Western societies. No medical therapies are proven to be effective in treating symptoms or reducing disease progression. Therefore, surgical or transcatheter aortic valve replacement remains the only available treatment option. Elevated circulating concentrations of lipoprotein(a) is strongly associated with degenerative aortic stenosis. This relationship was first observed in prospective observational studies, and the causal relationship was confirmed in genetic studies.ConclusionsNew therapeutic targets have been identified and new imaging techniques could be used to test the effectiveness of new agents and further clarify the pathophysiology of AVS. No therapy that specifically lowers Lp (a) levels has been approved for clinical use.