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Saisanjana Kalagara Adam E.M. Eltorai J. Mason DePasse Alan H. Daniels 《The spine journal》2019,19(1):182-185
BACKGROUND
Online physician rating websites are increasingly used by patients to evaluate their doctors. The purpose of this investigation was to evaluate factors associated with better spine surgeon ratings.METHODS
Orthopedic spine surgeons were randomly selected from the North American Spine Society directory utilizing a random number generator. Surgeon profiles on three physician rating websites, namely, www.HealthGrades.com, www.Vitals.com, and www.RateMDs.com, were analyzed to gather qualitative and quantitative data on patients’ perceptions of the surgeons. Independent variables from the websites were analyzed in relation to overall physician or patient satisfaction rating. Comments were coded by subject into following three categories: professional competence, bedside manner, and practice characteristics.RESULTS
A total of 250 surgeons were evaluated, and 92% (n=230) of these doctors had at least one rating among the three websites. The surgeons with a higher average rating had significantly better trust (p<.01), scheduling (p<.01), staff (p<.01), helpfulness (p<.01), and punctuality (p<.01) scores but significantly less experience (p<.05). A linear regression model for the average rating of each surgeon (R2 value=0.754) yielded only following three significant variables: trustworthiness (p<.01), experience match (p<.05), and the average number of negative comments on surgeon's professional competence (p<.05). Trustworthiness (β=0.749) was the strongest predictor variable of physician rating, followed by the number of negative professional competence comments (β=?0.132) and experience match (β=?0.112).CONCLUSIONS
This investigation assessed spine surgeon online patient ratings and categorized factors that patients associate with quality care. Trustworthiness was the most significant predictor of positive ratings, whereas ease of scheduling, quality of staff, helpfulness, and punctuality were also associated with higher patient ratings. Understanding what patients value may help optimize care of spine surgery patients. 相似文献3.
Philip Maier Jens Funk 《Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie》2006,244(9):1113-1118
Background The Retinal Thickness Analyser (RTA) is intended to detect glaucomatous changes as well as macular pathologies at the posterior pole. We determined the diagnostic accuracy for eyes with manifest glaucoma or macular diseases.Methods We examined 71 eyes with long-term, established eye conditions. Included were 28 eyes with glaucoma, 21 with different macular diseases and 22 normal eyes. All examinations were evaluated in a blind-test by RTA experts without any clinical information on the patients. After comparison of the RTA interpretation with the clinical diagnosis, we determined sensitivity, specificity, positive and negative predictive values.Results Of 71 examinations, 15 (21%) were not interpretable. If these results are excluded, the following diagnostic accuracy values were calculated for glaucoma and macular disorders respectively: sensitivity 75 and 59%, specificity 55 and 97%, positive predictive value 48 and 90% and negative predictive value 80 and 84%. These values were not significantly different when both eyes of each patient were included in the final analysis (n=133).Conclusion The diagnostic values of the RTA determined in this case control study were not satisfactory. However, no clinical information was used in the assessment. The extent to which additional clinical information increases the diagnostic value remains to be determined. 相似文献
4.
设计并试制了一种药用胶带纸层厚度在线检测系统.该系统将高精度电容传感器与计算机结合起来,同时配有丰富的外围器件,实现了多种实际生产中所需要的功能.它的出现,彻底解决了药用胶带纸胶层厚度在线检测这个难题,经过两年多的实际应用的检验,该系统实现了在线非接触测量,精度高,动态性能好,实现功能全面,价格合理,是药用胶带纸生产的必备检测仪器.由于该系统还可以很方便在纸张、塑料薄膜等其它生产线上进行推广,因而,其应用前景十分看好. 相似文献
5.
Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial 总被引:3,自引:0,他引:3
To compare pulmonary effects, postoperative pain and fatigue, morbidity, patient satisfaction, and cost of different anesthetic
techniques for inguinal hernia repair, 50 patients were randomized to local and general anesthesia groups (LA and GA). All
patients received the same premedications and the same postoperative analgesic regimen. The standardized postoperative analgesic,
intramuscular pyroxicam 20 mg, was given to all patients in the recovery room and an additional 20 mg on the same day was
given as requested by each patient. Pulmonary function studies and arterial blood gas analysis were performed 1 h prior to
the operation and at the postoperative 8th and 24th hours. All patients underwent Lichtenstein's tension-free hernioplasty.
Postoperative pain and fatigue were registered 8 h and 24 h after the operation. A questionnaire was filled out by the patients,
and they were asked to give grades for the general comfort of the anesthesia and the surgical procedure (1=worst, 10=best).
Postoperative pulmonary function tests were significantly poorer in the GA group both on 8th- and 24th-hour measurements (P<0.05). Patients who underwent LA had significantly lower PCO2 and higher PO2 at the postoperative 8th hour (P<0.05). Mean postoperative pain and fatigue scores revealed a significant difference in favor of local anesthesia at only
the 8th hour (P<0.05). There were two complications, one in each group (a hematoma in LA and a urinary retention in GA). Patient satisfaction
grades were not different in the two groups. We conclude that LA in inguinal hernia repair does not adversely affect pulmonary
functions, patients feel less pain, and patient satisfaction is comparable to that with GA.
Electronic Publication 相似文献
6.
The central-peripheral transitional zones of rat dorsolateral vagal rootlets are highly complex. Peripheral nervous tissue extends centrally for up to several hundred micrometers deep to the brainstem surface along these rootlets. In some instances this peripheral nervous tissue lacks continuity with the peripheral nervous system (PNS) and so forms an island within the central nervous system (CNS). In conformity with the resulting complexity of the CNS-PNS interface, segments of vagal axons lying deep to the brainstem surface are myelinated by one or more intercalated Schwann cells, contained in peripheral tissue insertions or islands, at either end of which they traverse an astroglial barrier. Intercalated Schwann cells are thus isolated from contact or contiguity with the Schwann cells of the PNS generally. They are short, having a mean internodal length of around 60% of that of the most proximal Schwann cells of the PNS proper, which lie immediately distal to the CNS-PNS interface and which are termed transitional Schwann cells. The thickness of the myelin sheaths produced by intercalated Schwann cells is intermediate between that of transitional Schwann cells and that of oligodendrocytes myelinating vagal axons of the same calibre distribution. This is not due to limited blood supply or to insufficient numbers of intercalated Schwann cells, the density of which is greater than that of transitional Schwann cells. These factors are unlikely to restrict expression of their myelinogenic potential. Nevertheless, the regression data show that the setting of the myelin-axon relationship differs significantly between the two categories of Schwann cell. Thus, the myelinogenic response of Schwann cells to stimuli emanating from the same axons may differ between levels along one and the same nerve bundle. Mean myelin periodicity was found to differ between sheaths produced by intercalated and by transitional Schwann cells. 相似文献
7.
The systolic hump in the aortic blood pressure wave is defined as the aorticresistance component proportional to the aortic
blood flow superimposed on the windkessel component. An electrical analogue comprising a series resistance (aortic resistance)
plus a resistance (peripheral resistance) and capacitance (aortic compliance) in parallel (i.e. windkessel component) is used
for analysis. Curve fitting using the leastsquares method is performed on calculated and measured blood pressure waves from
dogs under haemodynamical conditions induced by infusion of three drugs (noradrenaline, isoproterenol and acetylcholine).
The curve fitting RMS (root mean square) errors are <3% for blood pressure waves and <30% for blood flow waves, with good
agreement between measured and calculated blood flow waveforms. Infusion of noradrenaline and acetylcholine is found to induce
a significant decrease and increase in the aortic resistance, respectively. Although only a small fraction of the blood pressure
wave, the systolic hump has a marked effect on the systolic pressure waveform. 相似文献
8.
Klaus Rauber Kathrin S. Heidinger Bettina Kemkes-Matthes 《Cardiovascular and interventional radiology》1997,20(3):169-173
Purpose To determine the systemic effects of local fibrinolytic therapy with low-dose recombinant tissue-type plasminogen activator
(rt-PA).
Methods Ten patients received intrathrombal infusion of 20 mg rt-PA and heparin for local thrombolysis and had subsequent percutaneous
transluminal angioplasty (PTA). Eight controls underwent PTA and received heparin alone. We measured t-PA, D-Dimer, and fibrinogen
levels before, directly after, and 20, 40, and 60 min and 24 hr after therapy.
Results In the thrombolysis group the t-PA level peaked immediately after infusion and then declined within 1 hr. D-Dimer increased
and remained elevated, whereas in the control group only t-PA levels increased, and only after 24 hr. Fibrinogen remained
within the normal range in both groups. Eight of ten patients in the thrombolysis group and seven of eight with PTA had clinical
improvement after the procedure.
Conclusions The increase in D-Dimer in the rt-PA group indicates a good local fibrinolytic effect. The fact that fibrinogen levels remained
unchanged indicates that there is a lack of systemic fibrinogenolysis. 相似文献
9.
我院治疗66例心间隔缺损的病例中,有4例合并哑性动脉导管未闭(简称PDA),发生率6%。全组病例术前均无PDA临床体征,1例术前再次复查心脏彩超时发现,其余3例均漏诊。1例先处理PDA,3例在纠正心内畸形同时处理PDA。心间隔缺损合并哑性PDA容易漏诊,但有其临床特点,手术可先处理PDA,或在体外循环下处理PDA。 相似文献
10.
Non-ionic contrast media (CM) are proven to be significantly safer than the high osmolar ionic contrast media (HOCM). Nevertheless deaths are reported after administration of non-ionic agents. The aim of the study was to investigate the rate of adverse reactions to non-ionic CM with special regard to high-risk patients and the effects of premedication with H1-and H2-receptor antagonists.In a prospective study conducted over about 2 years 12 995 examinations with intravenous or intra-arterial non-ionic CM were evaluated. Premedication with H1-and H2-antagonists was used in 1276 high-risk patients with known adverse reaction to CM, history of allergy or severe cardiac or pulmonary disease. 229 patients received no premedication inspite of known risk factors. In total, there were 143 (1.10%) adverse reactions (mild in 0.58%, moderate in 0.41% and severe in 0.05%). In high-risk patients there were adverse reactions in 4.37% without and in 1.57% with premedication. There were no severe adverse reactions in the high-risk patients after premedication. The age of the patient, CM dosage and CM concentration were not shown to be risk factors in the present study. In conclusion, the additional premedication with H1- and H2-antagonists could be an effective agent to reduce the risk of mild and moderate adverse reactions and to avoid severe adverse reactions in high-risk patients.
Correspondence to: U. Fink 相似文献