关于检验质量理论几个基本概念的思考和建议

检验结果的准确度（性）与可靠性是同一概念的两种说法，“精密度”是准确度的基础部分，而不应当说可靠包括了准确和精密两个方面。“精密度”概念在检验医学上的内涵与其在《汉语词典》中的词义有很大出入，且precision与accuracy这两个英文单词也有词义交叉。科学与文化从来就不割裂，故而作者建议在这个概念上停止使用“精密度”这一名词，改用稳定性（度）和（或）重复性之名。定义“正确度”这一概念来表示均值与真值的接近程度不合适，何况“偏倚”这个概念已能说明相关问题。严谨的表述应当为，室内质量控制反映检验结果的稳定性，室间质量评价则评估检验结果的准确性。由此建议，将室问质量评价又称作准确性验证．室内质量控制也可另称作稳定性监控。     

Rethinking Normal: Benefits and Risks of Not Reporting Harmless Incidental Findings

The authors explore the benefits and risks of not reporting imaging findings that do not have clinical relevance, with the goal of developing recommendations to reduce their reporting. The authors review the example of incidentally detected, simple renal cysts (Bosniak category I), including medicolegal conditions required for such a shift in reporting practices to be acceptable. The authors propose four potential criteria for not reporting clinically unimportant findings and recommend that these criteria be debated in other contexts, so that they can be refined and implemented.     

When Artificial Intelligence Models Surpass Physician Performance: Medical Malpractice Liability in an Era of Advanced Artificial Intelligence

It seems inevitable that diagnostic and recommender artificial intelligence models will ultimately reach a point when they outperform human clinicians. Just as antibiotics displaced a host of medicinals for treating infections, the superior performance of such models will force their adoption. This article contemplates certain ethical and legal implications bearing on that adoption, especially because they involve a clinician’s exposure to allegations of malpractice. The article discusses four relevant considerations: (1) the imperative of using explainable artificial intelligence models in clinical care, (2) specific strategies for diminishing liability when a clinician agrees or disagrees with a model’s findings or recommendations but the patient nevertheless experiences a poor outcome, (3) relieving liability through legislation or regulation, and (4) comprehending such models as “persons” and therefore as potential defendants in legal proceedings. We conclude with observations on clinician–vendor relationships and argue that, although advanced artificial intelligence models have not yet arrived, clinicians must begin considering their implications now.     

小儿厌食症治验举隅

举例介绍了治疗小儿厌食症的临床经验，并取得了满意的临床疗效。     

The impact of gross anatomy laboratory on first year medical students’ interest in a surgical career

This study sought to determine the impact of gross anatomy laboratory (GA) on first year medical students’ (M1) interest in a surgical career. Secondary objectives included identifying other influences in M1s’ career decision making. This prospective study included surveys before and after GA. All M1s enrolled in GA were invited to participate. Sixty students completed both the pre‐ and post‐test surveys. A 5‐point Likert‐type scale surveyed participants’ interests, specific personality traits, experience during the course of GA, and likelihood of pursuing a surgical career. Statistical analysis included Wilcoxon Signed Rank Test and (Polychotomous) Ordinal Logistic Regression Model. Students’ desire to work with their hands increased (50 vs. 33.3%) and enjoyment working with instruments and tools similarly increased (50 vs. 41.7%). Likelihood of pursuing a surgical career after gross anatomy increased in 31.7% of students, decreased in 16.7%, and was unchanged in 51.7%. Over 75% of students with a prior interest in surgery and 21% of those who previously felt neutral agreed that they were likely to pursue a career in surgery at the conclusion of the laboratory. Students with a surgeon family member were 0.1976 times as likely to exhibit a positive change in interest (P values 0.024). Gross anatomy may influence up to a third of the class to consider a surgical career, especially those with a prior interest in surgery and those previously feeling ambivalent. Students with a surgeon family member became less likely to enter a surgical career after gross anatomy. Clin. Anat. 29:691–695, 2016. © 2016 Wiley Periodicals, Inc.     

医用直线加速器的感生放射性研究

医用直线加速器在治疗过程中会产生对人体有害的感生放射性,且这种危害正逐渐引起人们的重视。本文介绍了感生放射性的概念、产生机制,总结感生放射性对患者、工作人员及公众所造成的危害,探讨了感生放射性水平的影响因素,并总结减少其水平的措施。