Overview of some methodological problems in assessment of PACS

The purpose of technology assessment of picture archiving and communications systems (PACS) is to establish the need for the technology, provide a measure of functionality and to establish the costs and benefits associated with the introduction of the system. Given concerns about the clinical acceptability of PACS, it is unlikely that radiologists will change from existing film based systems until a clear demonstration of costs and benefits has been performed. The major need at present is to quantify the benefits which may flow from the introduction of PACS system in a standard manner which can be accepted by all parties involved.     

OSPACS: Ultrasound image management system

Background  

Ultrasound scanning uses the medical imaging format, DICOM, for electronically storing the images and data associated with a particular scan. Large health care facilities typically use a picture archiving and communication system (PACS) for storing and retrieving such images. However, these systems are usually not suitable for managing large collections of anonymized ultrasound images gathered during a clinical screening trial.     

PACS辅助教学在医学影像学实习教学中的应用探讨

尝试应用影像存储及传输系统(Picture Archiving and Communication System,PACS),对我院临床本科生进行影像学实习教学。首先应用PACS建立电子影像学图片库,学生在PACS联网的计算机上学习教学内容,通过定期随堂测验、期末考试和课后问卷调查评估PACS辅助教学的教学效果,对PACS辅助教学在医学影像学实习教学中的应用价值进行探讨。与以往传统医学影像学实习教学方法相比,PACS辅助教学在医学影像学实习教学中具有激发学生学习主动性、提高学习效率和学生读片能力的优越性,显著提高教学效果和教学质量,对促进医学影像学教学改革具有重要意义。     

Influence of health care systems on the market for picture archiving and communication systems

An analysis is given of the relation between health care systems and the PACS market. Two driving forces exist in the market: quality and price. It is argued that the quality driven market is mainly independent of the health care system and will be the force that drives the introduction of the health care system and will be the force that drives the introduction of PACS in the forthcoming years. Finally a change of focus is suggested from only archiving and communication to a more general concept of image networking, serving more goals than only the goal of working filmlessly.     

Evaluation of PACS-induced organizational change

Filmless digital imaging with a PACS will affect health care institutions by changing the handling of clinically relevant information, altering needed staffing levels, and possibly affecting both the quality and cost of care. Economic evaluation of PACS compares the costs and/or benefits of PACS with those of all other relevant alternatives. Other evaluations may focus on narrower research questions. This paper discusses methodological considerations in economic evaluation, methods of time measurement, and the methods and results of several applied assessments of PACS effects on the medical imaging department or the hospital.     

The impact of PACS on research and education

Picture Archiving and Communication Systems (PACS) are rapidly evolving and the total digital radiology department may be a reality within the next decade. PACS can have a major impact on the educational and research responsibilities of a medical institution. The possibility of correlating real patient data with existing radiological teaching files opens up numerous possibilities. Multi-institutional research can be strengthened by employing the PACS as the means to the end. This paper discusses the representative examples of how teaching and research can be enhanced with PACS and the technical requirements to achieve the inter-connectivity.     

Low-cost conversion of the Polaroid MD-4 land camera to a digital gel documentation system

A simple, inexpensive design is presented for the rapid conversion of the popular MD-4 Polaroid land camera to a high quality digital gel documentation system. Images of ethidium bromide stained DNA gels captured using the digital system were compared to images captured on Polaroid instant film. Resolution and sensitivity were enhanced using the digital system. In addition to the low cost and superior image quality of the digital system, there is also the added convenience of real-time image viewing through the swivel LCD of the digital camera, wide flexibility of gel sizes, accurate automatic focusing, variable image resolution, and consistent ease of use and quality. Images can be directly imported to a computer by using the USB port on the digital camera, further enhancing the potential of the digital system for documentation, analysis, and archiving. The system is appropriate for use as a start-up gel documentation system and for routine gel analysis.     

Protein Circular Dichroism Data Bank (PCDDB): data bank and website design

The Protein Circular Dichroism Data Bank (PCDDB) is a new deposition data bank for validated circular dichroism spectra of biomacromolecules. Its aim is to be a resource for the structural biology and bioinformatics communities, providing open access and archiving facilities for circular dichroism and synchrotron radiation circular dichroism spectra. It is named in parallel with the Protein Data Bank (PDB), a long-existing valuable reference data bank for protein crystal and NMR structures. In this article, we discuss the design of the data bank structure and the deposition website located at http://pcddb.cryst.bbk.ac.uk. Our aim is to produce a flexible and comprehensive archive, which enables user-friendly spectral deposition and searching. In the case of a protein whose crystal structure and sequence are known, the PCDDB entry will be linked to the appropriate PDB and sequence data bank files, respectively. It is anticipated that the PCDDB will provide a readily accessible biophysical catalogue of information on folded proteins that may be of value in structural genomics programs, for quality control and archiving in industrial and academic labs, as a resource for programs developing spectroscopic structural analysis methods, and in bioinformatics studies.     

A survey of hospital toilet facilities.

OBJECTIVE--To assess the quality of toilet facilities available for disabled people in a large provincial teaching hospital. DESIGN--Survey of toilet facilities for patients on the wards and in the outpatient department. SETTING--Teaching hospital in Leeds. RESULTS--Although the quality of toilet facilities varied, none met the standards recommended by the British Standards Institution. The worst facilities were found on a ward accommodating elderly patients, where the toilets were unsuitable for use by disabled people and bedside commodes had to be used instead. CONCLUSION--Toilet provision within a major hospital failed to meet standards required for disabled people. Admission to hospital may therefore result in loss of independence and dignity. If hospitals are to be centres of excellence, greater consideration must be given to the requirements of disabled people in the design of new wards, and current inadequate facilities should be upgraded.     

二级及以上公立医疗机构公共卫生相关科室设置分析

目的 摸底二级以上医疗机构公共卫生工作的组织方式,并对其设置公共卫生职能科室的必要性进行讨论。方法 检索北大法律信息数据库查找相关政府文件,梳理医疗机构设置公共卫生相关科室的要求。对发文要求设立公共卫生科室的省份和对比省份的163家医疗机构进行问卷调查。结果 原卫生部要求500张床位以上的医疗机构设立预防保健科,2003年以后部分省份发文要求二级以上医疗机构设立疾病预防控制或公共卫生科。72.5%的发文地区医疗机构和39.8%的未发文地区医疗机构设立了公共卫生相关科室,二级以上公立医疗机构设置公共卫生科室对公共卫生职责的承担有促进作用。结论 二级以上医疗机构应当设置公共卫生职能科室,以促进公共卫生职责的落实。     

Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes

Background

More than 761 million people rely on shared sanitation facilities. These have historically been excluded from international sanitation targets, regardless of the service level, due to concerns about acceptability, hygiene and access. In connection with a proposed change in such policy, we undertook this review to identify and summarize existing evidence that compares health outcomes associated with shared sanitation versus individual household latrines.

Methods and Findings

Shared sanitation included any type of facilities intended for the containment of human faeces and used by more than one household, but excluded public facilities. Health outcomes included diarrhoea, helminth infections, enteric fevers, other faecal-oral diseases, trachoma and adverse maternal or birth outcomes. Studies were included regardless of design, location, language or publication status. Studies were assessed for methodological quality using the STROBE guidelines.Twenty-two studies conducted in 21 countries met the inclusion criteria. Studies show a pattern of increased risk of adverse health outcomes associated with shared sanitation compared to individual household latrines. A meta-analysis of 12 studies reporting on diarrhoea found increased odds of disease associated with reliance on shared sanitation (odds ratio (OR) 1.44, 95% CI: 1.18–1.76).

Conclusion

Evidence to date does not support a change of existing policy of excluding shared sanitation from the definition of improved sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines.     

Genetically modified mouse health reporting: a need for global standardization

The distribution of GM mice between facilities has raised new problems because of variable microbiological quality. One of the most important management issues concerns the methods of reporting laboratory animal health surveillance results. The authors evaluated the format and content of 380 health reports of mice received from 55 institutions in Europe and North America. Their results suggest that a standardized rodent health form would facilitate the management of laboratory mouse distribution and infection control.     

Recommendations for utilizing and reporting population genetic analyses: the reproducibility of genetic clustering using the program structure

Reproducibility is the benchmark for results and conclusions drawn from scientific studies, but systematic studies on the reproducibility of scientific results are surprisingly rare. Moreover, many modern statistical methods make use of ‘random walk’ model fitting procedures, and these are inherently stochastic in their output. Does the combination of these statistical procedures and current standards of data archiving and method reporting permit the reproduction of the authors' results? To test this, we reanalysed data sets gathered from papers using the software package structure to identify genetically similar clusters of individuals. We find that reproducing structure results can be difficult despite the straightforward requirements of the program. Our results indicate that 30% of analyses were unable to reproduce the same number of population clusters. To improve this, we make recommendations for future use of the software and for reporting structure analyses and results in published works.     

GLP机构档案室的建立和管理与科研档案管理之比较

档案的建立和管理在药物非临床安全性评价和科学研究中都起到非常重要的作用。我们通过查阅文献发现,关于GLP机构档案管理的文献综述极少,涉及到将它与科研档案管理作系统全面的比较的文章是没有的。现从资料档案保存机构的硬件设施、档案管理规范和应注意的问题3个方面详细介绍了资料档案管理的相关规定和经验,并将GLP档案管理规范与科研档案管理规范作比较,我们根据国家档案局发布的《科学技术研究档案管理暂行规定》和7年GLP档案管理经验以及多次国家食品药品监督管理局（SFDA）认证现场检查的经历,总结出两者在功能实现、硬件设施、温湿度要求、档案防护、制定SOP、档案管理人员资质、各方人员职责、归档范围、归档形式、资料档案的接收与审查、归档时间、保管期限、借阅返还规定、资料的书写规范性、进出记录和电子文件的保存这16个方面的异同之处,突出GLP档案管理规范的特点和重点。通过这一深入全面的比较分析,得出GLP档案管理更加明确、具体、细致和可操作。     

The Botany Array Resource: e-Northerns, Expression Angling, and promoter analyses

The Botany Array Resource provides the means for obtaining and archiving microarray data for Arabidopsis thaliana as well as biologist-friendly tools for viewing and mining both our own and other's data, for example, from the AtGenExpress Consortium. All the data produced are publicly available through the web interface of the database at http://bbc.botany.utoronto.ca. The database has been designed in accordance with the Minimum Information About a Microarray Experiment convention -- all expression data are associated with the corresponding experimental details. The database is searchable and it also provides a set of useful and easy-to-use web-based data-mining tools for researchers with sophisticated yet understandable output graphics. These include Expression Browser for performing 'electronic Northerns', Expression Angler for identifying genes that are co-regulated with a gene of interest, and Promomer for identifying potential cis-elements in the promoters of individual or co-regulated genes.     

The profile inter-unit reliability

To assess the quality of health care, patient outcomes associated with medical providers (eg, dialysis facilities) are routinely monitored in order to identify poor (or excellent) provider performance. Given the high stakes of such evaluations for payment as well as public reporting of quality, it is important to assess the reliability of quality measures. A commonly used metric is the inter-unit reliability (IUR), which is the proportion of variation in the measure that comes from inter-provider differences. Despite its wide use, however, the size of the IUR has little to do with the usefulness of the measure for profiling extreme outcomes. A large IUR can signal the need for further risk adjustment to account for differences between patients treated by different providers, while even measures with an IUR close to zero can be useful for identifying extreme providers. To address these limitations, we propose an alternative measure of reliability, which assesses more directly the value of a quality measure in identifying (or profiling) providers with extreme outcomes. The resulting metric reflects the extent to which the profiling status is consistent over repeated measurements. We use national dialysis data to examine this approach on various measures of dialysis facilities.     

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

Objectives

Efforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship.

Methods

We undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence.

Findings

Methodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions.

Conclusion

Existing evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.     

Cervical cancer screening from the public health perspective

Many state health departments have a significant role in cervical cancer screening. Given that role, a group of public health personnel from eight southeastern states drafted a set of questions and quality assurance issues to be discussed with a laboratory under consideration as a contract provider of cytology services. The major points of concern included: (1) quality of laboratory services (accreditation, personnel, facilities and operational and quality control procedures); (2) quality of sampling (including techniques used and the training and monitoring of sample takers); (3) terminology for cytology reporting; and (4) protocols used for diagnostic evaluation of abnormal Papanicolaou smears.     

GLP机构档案室的建立和管理与科研档案管理之比较

档案的建立和管理在药物非临床安全性评价和科学研究中都起到非常重要的作用。我们通过查阅文献发现,关于GLP机构档案管理的文献综述极少,涉及到将它与科研档案管理作系统全面的比较的文章是没有的。现从资料档案保存机构的硬件设施、档案管理规范和应注意的问题3个方面详细介绍了资料档案管理的相关规定和经验,并将GLP档案管理规范与科研档案管理规范作比较,我们根据国家档案局发布的《科学技术研究档案管理暂行规定》和7年GLP档案管理经验以及多次国家食品药品监督管理局(SFDA)认证现场检查的经历,总结出两者在功能实现、硬件设施、温湿度要求、档案防护、制定SOP、档案管理人员资质、各方人员职责、归档范围、归档形式、资料档案的接收与审查、归档时间、保管期限、借阅返还规定、资料的书写规范性、进出记录和电子文件的保存这16个方面的异同之处,突出GLP档案管理规范的特点和重点。通过这一深入全面的比较分析,得出GLP档案管理更加明确、具体、细致和可操作。     

River Restoration in Victoria, Australia: Change is in the Wind, and None too Soon

Stream restoration has become a multibillion dollar industry worldwide, yet there are few clear success stories and the scientific basis for effective stream restoration remains uncertain. We compiled data on completed river restoration projects from four management authorities in Victoria, Australia, to examine how the available data could inform the science of restoration ecology in rivers, and thus improve future restoration efforts. We found that existing data sources are limited and much historical information has been lost through industry restructuring and poor data archiving. Examining records for 2,247 restoration projects, we found that riparian management projects were the most common, followed by bank stabilization and in‐stream habitat improvement. Only 14% of the project records indicated that some form of monitoring was carried out. It is evident that overall there is little scientific guidance and little or no monitoring and evaluation of the projects for which we had information. However, recent advances with mandatory, statewide reporting and an increased emphasis on project design and monitoring strongly suggest that the design, implementation, monitoring, and reporting of stream restoration projects have improved in recent years and will continue to do so.