GVC-Net: Global Vascular Context Network for Cerebrovascular Segmentation Using Sparse Labels

ObjectivesCerebrovascular disease is a serious threat to human health. Because of its high mortality and disability rate, early diagnosis and prevention are very important. The performance of existing cerebrovascular segmentation methods based on deep learning depends on the integrity of labels. However, manual labels are usually of low quality and poor connectivity at small blood vessels, which directly affects the cerebrovascular segmentation results.Material and methodIn this paper, we propose a new segmentation network to segment cerebral vessels from MRA images by using sparse labels. The long-distance dependence between vascular structures is captured by the global vascular context module, and the topology is constrained by the hybrid loss function to segment the cerebral vessels with good connectivity.ResultExperiments show that our method performed with a sensitivity, precision, dice similarity coefficient, intersection over union and centerline dice similarity coefficient of 61.24%, 75.58%, 67.66%, 51.13% and 83.79% respectively.ConclusionThe obtained results reveal that the proposed cerebrovascular segmentation network has better segmentation performance for cerebrovascular segmentation under sparse labels, and can suppress the noise of background to a certain extent.     

Enhancing Patient Literacy on Calcium Supplementation: A Quality Improvement Initiative

ObjectiveThis study aims to assess patients’ knowledge and identify barriers in interpreting calcium on supplement and nutrition labels and to determine whether education would be beneficial.MethodsPatients with conditions requiring calcium supplementation were included in this study. Participants were first given a 9-question pre-education survey. They were then taught how to read calcium on labels using the educational cards developed. This was followed by a 7-question posteducation survey. Endocrinologists were surveyed to assess their experience in treating patients who required calcium supplementation.ResultsBefore education, 31 (33%) and 37 (40%) of the participants felt that the supplement and nutrition labels, respectively, were confusing. After education, only 2 (2%) and 6 (6%) of the participants, respectively, still felt the same. There was a significant improvement in the interpretation of calcium citrate (Citracal) and calcium carbonate (TUMS) labels, with a trend of improvement in reading a milk label. Of the 47 endocrinologists surveyed, only 5 (11%) felt that their patients often or always knew the correct amount of calcium to be taken. Two-thirds 30 (64%) of the endocrinologists always or often explained to their patients how to interpret calcium labels. About half 23 (49%) of the endocrinologists always or often needed to take time to look up the calcium content of supplements. For most endocrinologists 29 (62%), this took at least 2 to 4 minutes.ConclusionOur patients had trouble interpreting calcium labels, and the use of educational cards was effective in improving calcium literacy.     

Patient Preferences Regarding Device Reuse and Potential of Devices for Reuse - A Study in a Veteran Population

BackgroundMany cardiac patients need and undergo device implants. Veterans’ preferences regarding post-mortem handling of devices are not known. Cardiac patients in low- and middle-income countries who need but cannot afford devices rely on donations. Charitable organizations have successfully provided devices for reuse to such patients.ObjectiveWe estimated the number of devices with potential for possible reuse in a veteran population.MethodsBetween January and December 2008, at a tertiary medical center, veterans with implanted cardiac devices were surveyed using a questionnaire for their preferences regarding post-mortem handling. One choice was donation to charity for reuse. Although altruistic, it is unclear what percent of such devices have reuse potential. Retrospective chart review of veterans who underwent device implants between 1992 and 2007 identified a cohort of patients with Implantable Cardiac Defibrillators (ICDs) who had died by April 31st 2009. In this cohort, ICDs implanted in the year preceding the patient’s death were counted as having reuse potential.Results94 of 97 veterans completed the survey. 56% were unaware of how devices are handled after death. The top three preferences for postmortem handling were: return to manufacturer, return to hospital and donation for reuse. 88% were willing to sign an advance device directive. Retrospective review identified 161 veterans who had received 301 ICDs. Of these, 77 ICDs (25%) had median reuse potential of 3.1 years.ConclusionIn a VA cohort of deceased patients a substantial proportion of devices had reuse potential. Further research is needed to direct health policy.     

基于DRGs的住院分娩单病种费用标准研究

目的 基于疾病诊断相关分组研究住院分娩费用标准,为医保按病种付费改革提供参考依据。方法 数据来源于2013—2016年60 954例住院分娩病例病案首页,利用非参数检验和多重线性回归分析住院分娩费用影响因素,通过CHAID决策树模型进行病例组合分组,计算标准费用和费用上限。结果 分娩方式、妊娠合并症与并发症、是否伴随其他妇科手术3个因素作为分组变量,形成12个住院分娩费用DRGs,标准费用对实际费用的解释比例达93.70%。结论 科学合理选择分组变量,构建更加符合实际的病例组合和费用标准,有助于推动医保按病种付费方式的完善与发展。     

Evaluating Sex and Gender Competencies in the Medical Curriculum: A Case Study

BackgroundSex and gender differences exist in the manifestation and prevalence of many conditions and diseases. Yet many clinician training programs neglect to integrate this information across their curricula.ObjectiveThis study aimed to measure the sex and gender medical knowledge of medical students enrolled in a program without an explicit directive to integrate sex and gender differences across a block system of core subjects.MethodsA forced-choice instrument consisting of 35 multiple-choice and true or false questions was adapted from an evaluation tool used in the European Curriculum in Gender Medicine held at Charité Hospital, Berlin, in September 2010.ResultsFourth-year (response rate 93%) and second-year (response rate 70%) students enrolled in Mayo Medical School completed the instrument. More than 50% of students in both classes indicated that topics related to sex and gender were covered in gynecology, cardiology, and pediatrics, and <20% of students indicated inclusion of such topics in nephrology, neurology, and orthopedics. More than twice as many second-year students indicated that topics dealing with sex and gender were included in immunology course material compared with fourth-year students. A consensus of written comments indicated that concepts of sex and gender-based medicine need to be embedded into existing curriculum, with an emphasis on clinically relevant information.ConclusionsAlthough this study represents only one medical school in the United States, information regarding sex and gender aspects of medicine is not consistently included in this curriculum without an explicit directive. These results can provide guidance for curriculum improvement to train future physicians.     

Comparison of the clinical application value of mo-targeted X-ray,color doppler ultrasound and MRI in preoperative comprehensive evaluation of breast cancer

ObjectiveTo investigate the clinical application value of the Mo-targeted X-ray examination, color Doppler ultrasound and magnetic resonance imaging (MRI) in the diagnosis and preoperative comprehensive evaluation of breast cancer.MethodsAmong 170 breast cancer patients, they underwent Mo-targeted X-ray examination, color Doppler ultrasound and MRI before surgery to evaluate the lesions in breast, axillary lymph nodes and the availability of breast-conserving surgery.ResultsThe detection rates using color Doppler ultrasound examination and MRI were higher than that in the Mo-targeted X-ray examination, which were 90%, 94% and 82%, respectively (P < 0.01 or 0.05). With the result of pathological examination as the golden criteria, we found that specificities of Mo-targeted X-ray examination, color Doppler ultrasound examination and MRI in evaluating the metastasis in axillary lymph nodes were similar (85.11%, 77.66% and 79.79%; P > 0.05). Before surgery, the sensitivities and accuracies of the color Doppler ultrasound examination and MRI were higher than those using the Mo-targeted X-ray examination, which were 73.21%, 82.14%, and 28.57%, 76.00%, 80.67% and 64.00% (P < 0.01 or 0.05). Before surgery, the accuracy rate of MRI in evaluating the breast-conserving surgery was higher than those of Mo-targeted X-ray examination and color Doppler ultrasound (92.00%, 83.33% and 84.67%; P < 0.05).ConclusionCombined application of Mo-targeted X-ray examination, color Doppler ultrasound and MRI shows a higher accuracy in diagnosis of breast cancer and evaluation of axillary lymph node metastasis, which is conducive to the selection of surgical methods.     

Information following a Diagnosis of Congenital Heart Defect: Experiences among Parents to Prenatally Diagnosed Children

BackgroundPrenatal screening of pregnant women in Sweden has improved the detection of major congenital heart defects (CHD). The aim was to explore parental experiences and need for information following a prenatal diagnosis of CHD.MethodsSemi-structured interviews conducted with six fathers and five mothers to seven prenatally diagnosed children. Data were analyzed through content analysis.ResultsThree themes and 9 categories emerged. Theme 1, Grasping the facts today while reflecting on the future, containing five categories: Difficulties sorting out information when in emotional chaos; Respectful information regarding termination of pregnancy; Early information is crucial; Understanding the facts regarding the anomaly; Preparing for the future. Theme 2, Personal contact with medical specialists who give honest and trustworthy information is valued, containing two categories: Trust in information received from medical specialists and Truth and honesty is valued. Theme 3, An overwhelming amount of information on the Internet, containing two categories: Difficulties in finding relevant information and Easy to focus on cases with a poor outcome when searching the Internet.ConclusionEarly and honest information in line with individual preferences is crucial to support the decisional process regarding whether to continue or terminate the pregnancy. The use of illustrations is recommended, as a complement to oral information, as it increases comprehension and satisfaction with obtained information. Furthermore, the overwhelming amount of information on the Internet calls for compilation of easily accessible and reliable information sources via the Internet.     

视网膜周边视野人工成像研究

目的 对于中心视力受损的人群，新型人工视觉系统可以将简化后的图像投射到视网膜上黄斑区以外的区域，从而帮助他们利用周边视觉感知信息。本文探究周边视野的感知特征，为植入式光学人工视觉系统的图形编码设计提供依据。方法 设计了探索周边视野感知特征的实验环境，向被试施加符号、数字、汉字的图案刺激，并控制刺激的大小、颜色组合、偏离角度、运动情况。用图形化的方法分析感知能力与各变量的关系。结果 周边视野的感知能力随偏离角度增大而下降，其趋势分为两个阶段，且受颜色组合、大小的影响明显。结论 研究结果提供了感知识别率较高的变量组合，为人工视觉系统的光学投影、眼内光学植入装置、特殊通信彩色符号编码开发等“人机结合”新技术提供重要的实验依据。     

Exploratory evaluation of several teratogen warning symbols

BACKGROUND: Previous research has noted potential inadequacies in the warning labels and symbols used with some teratogenic medications. A clear teratogen warning symbol represents an important component of risk mitigation for accidental teratogen exposure. METHODS: Several teratogen warning symbols were developed through rapid prototyping and focus groups. A nationally distributed field trial (n = 300) examined the relative effectiveness of 6 candidate symbols, including the symbol in use at the time of the study. Measures included open-ended interpretation, closed-ended preference, and demographic surveys. Each participant was shown a single symbol and asked what it meant, to whom it applied, and what that person should do. Text statements were added to the symbol and participants were asked to reinterpret the warning. Participants were told the intended message of the warning, shown all 6 symbols, and asked to choose the most effective symbol. RESULTS: Four of 6 symbols achieved levels of correct interpretation close to or exceeding the American National Standards Institute (ANSI) benchmark of 85% and none exceeded the ANSI limit of 5% critical confusion. Symbols elicited varying conceptual responses. Respondents considered 1 symbol to be the most effective, by a 4 to 1 margin. Several outcomes varied by age and by ethnicity. CONCLUSIONS: Several symbols emerged as viable alternatives to the current symbol; however, no 1 symbol was clearly found to be the most effective. Instead, the symbol considered "best" depends on the messages that are considered most essential to the warning. Additionally, it appears a symbol without the addition of text can convey most, but possibly not all, of the meaning required of the warning label. Next steps should include further symbol refinement, closer examination of text additions to symbols, and validation of the candidate symbols and warnings through a large-scale field trial.     

医药分开改革下医务人员工作态度及影响因素分析

目的 对北京市医改实施一年后医务人员工作态度及影响因素进行调查分析。方法 从样本医院中随机抽取1/3医务人员进行问卷调查,对基本信息情况、工作态度、医药分开相关情况、医务人员工作状态、绩效考核情况、收入情况等方面进行调查。以工作态度为因变量,以其他可能影响因素指标为自变量分别进行卡方分析和多元Logistic回归分析。结果 医务人员工作积极性较高,工作态度的影响因素包括岗位、医药分开支持度、岗位适合度、才能发挥程度、绩效考核的激励作用5项指标。结论 实施公立医院医药分开改革,得到了绝大大多数医务人员的支持和拥护。     

基于闭环医嘱的患者临床安全信息保障研究与实践

目的 对医院临床信息系统进行改造和完善,进行患者临床安全信息保障体系理论研究。方法 结合医院信息化实际,针对药品、护理、手术、检查、检验、输血六大类医嘱,分析其流转环节关键节点,进行信息闭环,研究护理执行文档、手术医疗器械以及消毒供应包管理追溯、医技报告危急值报警等信息标准化,建立数据集,实现病人临床安全的信息化支撑。结果 实现了护理文档数据标准化和移动护理数据采集的全面应用,探索了医嘱闭环信息的工程化建设方法,研发了移动护理软件,形成了护理工作绩效评价的新模式。结论 通过项目研究,在国内率先进行了护理文档标准化研究,形成了医嘱闭环执行与护士工作量评价新方法,并在患者临床安全的一系列关键环节进行了信息保障的全面应用。     

Randomised trial of personalised computer based information for cancer patients

ObjectiveTo compare the use and effect of a computer based information system for cancer patients that is personalised using each patient''s medical record with a system providing only general information and with information provided in booklets.DesignRandomised trial with three groups. Data collected at start of radiotherapy, one week later (when information provided), three weeks later, and three months later.Participants525 patients started radical radiotherapy; 438 completed follow up.InterventionsTwo groups were offered information via computer (personalised or general information, or both) with open access to computer thereafter; the third group was offered a selection of information booklets.OutcomesPatients'' views and preferences, use of computer and information, and psychological status; doctors'' perceptions; cost of interventions.ResultsMore patients offered the personalised information said that they had learnt something new, thought the information was relevant, used the computer again, and showed their computer printouts to others. There were no major differences in doctors'' perceptions of patients. More of the general computer group were anxious at three months. With an electronic patient record system, in the long run the personalised information system would cost no more than the general system. Full access to booklets cost twice as much as the general system.ConclusionsPatients preferred computer systems that provided information from their medical records to systems that just provided general information. This has implications for the design and implementation of electronic patient record systems and reliance on general sources of patient information.     

Communicating accuracy of tests to general practitioners: a controlled study

ObjectiveTo assess the extent to which different forms of summarising diagnostic test information influence general practitioners'' ability to estimate disease probabilities.DesignControlled questionnaire study.SettingThree Swiss conferences in continuous medical education.Participants263 general practitioners.InterventionQuestionnaire with multiple choice questions about terms of test accuracy and a clinical vignette with the results of a diagnostic test described in three different ways (test result only, test result plus test sensitivity and specificity, test result plus the positive likelihood ratio presented in plain language).ResultsThe correct definitions for sensitivity and predictive value were chosen by 76% and 61% of the doctors respectively, but only 22% chose the correct answer for the post-test probability of a positive screening test. In the clinical vignette doctors given the test result only overestimated its diagnostic value (median attributed likelihood ratio (aLR)=9.0, against 2.54 reported in the literature). Providing the scan''s sensitivity and specificity reduced the overestimation (median aLR=6.0) but to a lesser extent than simple wording of the likelihood ratio (median aLR=3.0).ConclusionMost general practitioners recognised the correct definitions for sensitivity and positive predictive value but did not apply them correctly. Conveying test accuracy information in simple, non-technical language improved their ability to estimate disease probabilities accurately.

What is already known on this topic

Many doctors confuse the sensitivity of clinical tests and their positive predictive valueDoctors tend to overestimate information derived from such tests and underestimate information from a patient''s clinical historyMost primary research on diagnostic accuracy is reported using sensitivity and specificity or likelihood ratios

What this study adds

In a cohort of experienced Swiss general practitioners most were unable to interpret correctly numerical information on the diagnostic accuracy of a screening testWhen presented with a positive result alone they grossly overestimated its valueAdding information on the test''s sensitivity and specificity moderated these overestimates, and expressing the same numerical information as a positive likelihood ratio in simple, non-technical language brought the estimates still closer to their true values     

ERCP术与腹腔镜手术治疗胆总管结石的疗效对比及对血清AST、ALT、ALP的影响

目的:探讨内镜逆行胰胆管造影术(ERCP)与腹腔镜手术治疗胆总管结石的疗效对比及对血清门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)的影响。方法:选择2017年4月到2018年4月我院接诊的胆总管结石患者50例作为研究对象,以随机数表法分为观察组(n=26)和对照组(n=24),对照组使用腹腔镜手术治疗,观察组采用ERCP取石术治疗。比较两组手术时间、术中出血量、术后下床时间、住院时间、血清AST、ALT、ALP水平变化情况、术后胃肠道恢复时间及术后不良反应发生情况。结果:观察组患者手术时间高于对照组,(P0.05),术中出血量、术后下床时间及住院时间均显著低于对照组(P0.05);手术前,两组患者血清AST、ALT、ALP水平无明显差异;治疗后,两组患者血清AST、ALT、ALP水平均明显上升(P0.05),且观察组患者血清AST、ALT、ALP水平显著低于对照组(P0.05);观察组患者肠鸣音恢复时间、排气时间、排便时间均明显低于对照组(P0.05);治疗期间,观察组患者不良反应总发生率为7.69%,显著低于对照组的29.17%(P0.05)。结论:在胆总管结石患者中应用ERCP取石术效果显著,对患者血清血清AST、ALT、ALP影响较小,值得推广与运用。     

Implementation of automatic plan optimization in Italy: Status and perspectives

PurposeTo investigate and report on the diffusion and clinical use of automated radiotherapy planning systems in Italy and to assess the perspectives of the community of Italian medical physicists involved in radiotherapy on the use of these tools.Materials and MethodsA survey of medical physicists (one per Institute) of 175 radiotherapy centers in Italy was conducted between February 21st and April 1st, 2021. The information collected included the institute’s characteristics, plan activity, availability/use of automatic tools and related issues regarding satisfaction, criticisms, expectations, and perceived professional modifications. Responses were analysed, including the impact of a few variables such as the institute type and experience.Results125 of the centers (71%) answered the survey, with regional variability (range: 47%–100%); among these, 49% have a TPS with some automatic option. Clinical use of automatic planning is present in 33% of the centers, with 13% applying it in >50% of their plans.Among the 125 responding centres the most used systems are Pinnacle (16%), Raystation (9%) and Eclipse (4%). The majority of participants consider the use of automated techniques to be beneficial, while only 1% do not see any advantage; 83% of respondents see the possibility of enriching their professional role as a potential benefit, while 3% see potential threats.ConclusionsOur survey shows that 49% of the responding centres have an automatic planning solution although clinically used in only 33% of the cases. Most physicists consider the use of automated techniques to be beneficial and show a prevalently positive attitude.     

A preliminary study for identification of candidate AFLP markers under artificial selection for shell color in pearl oyster Pinctada fucata

Pearl oyster Pinctada fucata is widely cultured to produce seawater pearl in South China, and the quality of pearl is significantly affected by its shell color. Thus the Pearl Oyster Selective Breeding Program (POSBP) was carried out for the shell color and growth traits. The black (B), gold (G), red (R) and white (W) shell strains with fast growth trait were achieved after five successive generation selection. In this study, AFLP technique was used to scan genome of four strains with different shell colors to identify the candidate markers under artificial selection. Eight AFLP primer combinations were screened and yielded 688 loci, 676 (98.26%) of which were polymorphic. In black, gold, red and white strains, the percentage of polymorphic loci was 90.41%, 87.79%, 93.60% and 93.31%, respectively, Nei's gene diversity was 0.3225, 0.2829, 0.3221 and 0.3292, Shannon's information index was 0.4801, 0.4271, 0.4825 and 0.4923, and the value of F_ST was 0.1805. These results suggested that the four different shell color strains had high genetic diversity and great genetic differentiation among strains, which had been subjected to the continuous selective pressures during the artificial selective breeding. Furthermore, six outlier loci were considered as the candidate markers under artificial selection for shell color. This study provides a molecular evidence for the inheritance of shell color of P. fucata.