Nursing activities score

OBJECTIVES: The instruments used for measuring nursing workload in the intensive care unit (e.g., Therapeutic Intervention Scoring System-28) are based on therapeutic interventions related to severity of illness. Many nursing activities are not necessarily related to severity of illness, and cost-effectiveness studies require the accurate evaluation of nursing activities. The aim of the study was to determine the nursing activities that best describe workload in the intensive care unit and to attribute weights to these activities so that the score describes average time consumption instead of severity of illness. DESIGN: To define by consensus a list of nursing activities, to determine the average time consumption of these activities by use of a 1-wk observational cross-sectional study, and to compare these results with those of the Therapeutic Intervention Scoring System-28. SETTING: A total of 99 intensive care units in 15 countries. PATIENTS: Consecutive admissions to the intensive care units. INTERVENTION: Daily recording of nursing activities at a patient level and random multimoment recording of these activities. RESULTS: A total of five new items and 14 subitems describing nursing activities in the intensive care unit (e.g., monitoring, care of relatives, administrative tasks) were added to the list of therapeutic interventions in Therapeutic Intervention Scoring System-28. Data from 2,041 patients (6,451 nursing days and 127,951 multimoment recordings) were analyzed. The new activities accounted for 60% of the average nursing time; the new scoring system (Nursing Activities Score) explained 81% of the nursing time (vs. 43% in Therapeutic Intervention Scoring System-28). The weights in the Therapeutic Intervention Scoring System-28 are not derived from the use of nursing time. CONCLUSIONS: Our study suggests that the Nursing Activities Score measures the consumption of nursing time in the intensive care unit. These results should be validated in independent databases.     

Current status of the infrastructure and characteristics of radiation oncology in Korea

BACKGROUND: An analysis of radiotherapy infrastructure in Korea was performed in 2006 to collect data on treatment devices, the work force and new patients for future development plans. METHODS: The survey included radiotherapy centers, their major equipment and personnel. The centers were categorized into four levels: level 0 (stand-alone teletherapy units); level 1 (teletherapy, brachytherapy, treatment planning system, and at least the part-time service of a medical physicist); level 2 (level 1 plus individual customized radiotherapy block and full-time medical physicist); and level 3 [level 2 plus intensity-modulated radiation therapy (IMRT), intra-operative radiation therapy or stereotactic radiotherapy]. RESULTS: A total of 61 facilities delivered radiation therapy with 104 megavoltage devices, which included 96 linear accelerators, two cobalt 60 units, three Tomotherapy, two CyberKnife units and one proton accelerator. There were 28,789 new radiotherapy patients in 2004. Personnel included 132 radiation oncologists, 50 radiation oncology residents, 64 physicists, 130 nurses and 369 radiation therapy technologists. Thirty-two percent (20 facilities) used a CT-simulator, 66% (40) used a PET or PET-CT scanner, and 35% (22) had the capacity to implement IMRT. Centers were also divided into four levels: 41% were included in level 3, 31% in level 2, 25% in level 1 and 3% in level 0. CONCLUSIONS: There is a shortage of human resources. The distribution of megavoltage units per million inhabitants over the country was inadequate; geographic disparities were noted. Furthermore, the necessity of quality assurance for recent high-technology radiation therapy is increasing.     

准分子激光治疗近视近期临床效果观察

用准分子激光屈光性角膜切削术（ＰＲＫ）治疗近视，术后随访３￣５个月，４１眼中视力≥１．０者占２２％，视力≥０．５者占５１％。对ＰＲＫ的有效性、安全性以及合并症进行讨论。     

Chinese expert consensus on three-dimensional image guided brachytherapy for cervical cancer

In recent years, image-guided brachytherapy (IGBT) for cervical cancer has been rapidly developed in China. IGBT can improve local control and survival rates in patients with locally advanced cervical cancer compared with the two-dimensional technology. Dose volume histogram parameters for the high risk clinical target volume (HR-CTV), intermediate risk clinical target volume (IR-CTV) and organs at risk should be calculated, reported, and adopted to explore the relationship with local control rate and incidence of complications. The volume and topography of residual tumor at the initiation of IGBT is significantly correlated with local control rate. The residual tumor should be assessed by the combination of MRI, ultrasound images and gynecological examinations. The appropriate implant with intracavitary applicator supplemented with interstitial needles can improve the dose distribution in the target area. Target delineation, dose assessment and quality control should be conducted strictly according to the principles and consensus. To standardize its application, the Chinese expert consensus was jointly formulated by Brachytherapy Group of China Society for Radiation Oncology, the Gynecological Oncology Group of Chinese Association for Therapeutic Radiation Oncologists, and the Brachytherapy Special Committee of Chinese Anti-Cancer Association in light of the national conditions in China.     

宫颈癌图像引导三维近距离后装治疗中国专家共识

近年来宫颈癌三维近距离治疗(BT)技术在中国得到快速发展。与二维技术相比,宫颈癌图像引导的三维BT技术可以提高局控率、生存率。三维BT要求用体积剂量参数评价治疗靶区及危及器官受量,探索体积剂量参数与局控率、并发症发生率之间关系。BT开始时肿瘤残留体积及形状与局控率有明确相关性,应当结合MRI、超声、妇科检查结果,综合判断残留肿瘤体积。腔内联合组织间插植技术可以改善靶区剂量分布。严格遵守靶区勾画、体积剂量原则以及质控要求。为规范其应用,中华医学会放射治疗学分会近距离治疗学组、中国医师协会放射肿瘤分会妇科肿瘤学组、中国抗癌协会近距离治疗专委会结合中国国情联合制定此专家共识。