• 【GI内窥镜手术的 “适当性” 或 “优先级”?】 复制标题 收藏 收藏
    DOI:10.1016/j.gie.2005.11.024 复制DOI
    作者列表:Andriulli A,Annese V,Terruzzi V,Grossi E,Minoli G
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【在2型糖尿病自我管理应用程序中,适当的行动提示低血糖和高血糖。】 复制标题 收藏 收藏
    DOI:10.1002/dmrr.3235 复制DOI
    作者列表:Lum E,Jimenez G,Huang Z,Thai L,Car J
    BACKGROUND & AIMS: BACKGROUND:Control of blood glucose levels is needed not only to alleviate symptoms of hypoglycaemia and hyperglycaemia, but also to prevent or delay diabetes-related complications. Advice for glucose control is usually provided to patients by members of the health care team. However, many diabetes apps claim to enhance self-management of blood glucose by providing decision support to patients when an out-of-range blood glucose level is recorded. In this study, we investigated the appropriateness of action prompts provided by diabetes apps for hypoglycaemia and hyperglycaemia against evidence-based guidelines. METHODS:We used methods previously reported to identify and select diabetes apps, which were downloaded and assessed against the American Diabetes Association (ADA) guidelines. Screenshots of action prompts corresponding to low or high out-of-range blood glucose values were subjected to content analysis. RESULTS:Of 371 diabetes self-management apps evaluated, only 217 and 216 apps alerted patients about hypoglycaemia and hyperglycaemia, respectively. Of these, 20.7% (45/217) and 15.3% (33/216) also provided action prompts. We found 5.1% of apps (hypoglycaemia: 11/217; hyperglycaemia: 11/216) provided prompts that were either too general to be helpful or not aligned with ADA guidelines. Overall, only 17.9% (39/217) and 14.8% (32/216) provided appropriate action prompts for hypoglycaemia and hyperglycaemia, respectively. CONCLUSION:Less than one fifth of apps provided evidence-based steps to guide patients through hypoglycaemia and hyperglycaemia. The majority of apps failed to provide just-in-time diabetes self-management education to prevent frequent or severe episodes of hypoglycaemia and hyperglycaemia. Our findings emphasize the need for better design and quality assurance of diabetes apps.
    背景与目标:
  • 【ACR适当性标准®软组织肿块。】 复制标题 收藏 收藏
    DOI:10.1016/j.jacr.2018.03.012 复制DOI
    作者列表:Expert Panel on Musculoskeletal Imaging:.,Kransdorf MJ,Murphey MD,Wessell DE,Cassidy RC,Czuczman GJ,Demertzis JL,Lenchik L,Motamedi K,Pierce JL,Sharma A,Walker EA,Ying-Kou Yung E,Beaman FD
    BACKGROUND & AIMS: :Imaging is an integral component of the evaluation of patients with a suspected soft-tissue mass. Imaging can not only confirm the presence of a mass but can provide essential information necessary for diagnosis, local staging, and biopsy planning. Although the objectives of the evaluation have not changed, the choices available for imaging of musculoskeletal masses have evolved dramatically in recent years. The purpose of this document is to identify the most common clinical scenarios and the most appropriate imaging for their assessment on the basis of the current literature and to provide general guidance for those scenarios that are not specifically addressed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
    背景与目标: : 成像是对怀疑有软组织肿块的患者进行评估的一个组成部分。成像不仅可以确认肿块的存在,还可以提供诊断,局部分期和活检计划所需的基本信息。尽管评估的目标没有改变,但近年来,用于肌肉骨骼肿块成像的选择已发生了巨大变化。本文件的目的是在现有文献的基础上确定最常见的临床情景和最适合其评估的影像学,并为那些没有具体解决的情景提供一般指导。美国放射学学院的适当性标准是针对特定临床状况的循证指南,每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊中当前医学文献的广泛分析,以及对公认的方法 (RAND/UCLA适当性方法和建议评估,开发和评估或等级的分级) 的应用,以评估适当性特定临床场景的成像和治疗程序。在证据缺乏或模棱两可的情况下,专家意见可以补充现有证据以建议成像或治疗。
  • 【在巴布亚新几内亚选定的医疗机构开药的适当性。】 复制标题 收藏 收藏
    DOI:10.1093/heapol/czt012 复制DOI
    作者列表:Joshua IB,Passmore PR,Parsons R,Sunderland VB
    BACKGROUND & AIMS: OBJECTIVE:The objective of this study was to evaluate the level of appropriateness of prescribing to outpatients in selected healthcare facilities in Papua New Guinea (PNG), using health department guidelines as the benchmark. METHODS:A prospective study was carried out at Losuia Health Centre (LHC), Alotau Provincial Hospital (APH) and Port Moresby General Hospital (PMGH) in PNG. At each setting >300 consecutive prescriptions were evaluated in 2010. Diagnosis and prescribing data were collected from written prescription orders, patient health books and by patient interview. The appropriateness of prescribing was evaluated with respect to the relevant PNG Health Department guidelines. Differences in prescribing indices were evaluated using chi-squared tests as appropriate. RESULTS:There were 1090 patients (748 adults; 341 children) enrolled in the study with 356 at LHC, 318 at APH and 416 at PMGH. A total of 2495 medicines were prescribed. The most common were amoxicillins (355), paracetamol (344), artemether/artesunate (186) and chloroquine (162). The average number of drugs prescribed per patient was 2.3 (range: 1-7). The most common diseases treated were malaria (23.2%), acute soft tissue injuries (10.4%), anaemia (8.9%), respiratory problems (8.7%) and cough (5.9%). Overall, inappropriate prescribing was 33.4% in adults and 39.9% in children, the difference mainly arising from inappropriate drug dosage. There were statistically significant differences observed for the level of inappropriate prescribing by prescriber category on drug selection (P < 0.0001), drug dosage (P < 0.0001) and drug duration (P < 0.0001). CONCLUSION:The level of inappropriate prescribing was as high as 53.8% in the selected locations in PNG, which is of great concern with respect to the quality of PNG healthcare delivery. Appropriate interventions such as review/upgrade of the guidelines, supervision/oversight of compliance to guidelines and/or publication of ongoing supervision/audit oversight reports need to occur to address the underlying causes.
    背景与目标:
  • 【普通内科住院患者外周插入中心导管使用的适当性: 使用常规收集数据的观察性研究。】 复制标题 收藏 收藏
    DOI:10.1136/bmjqs-2019-010463 复制DOI
    作者列表:Verma AA,Kumachev A,Shah S,Guo Y,Jung HY,Rawal S,Lapointe-Shaw L,Kwan JL,Weinerman A,Tang T,Razak F
    BACKGROUND & AIMS: BACKGROUND:Peripherally inserted central catheters (PICC) are among the most commonly used medical devices in hospital. This study sought to determine the appropriateness of inpatient PICC use in general medicine at five academic hospitals in Toronto, Ontario, Canada, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). METHODS:This was a retrospective, cross-sectional study of general internal medicine patients discharged between 1 April 2010 and 31 March 2015 who received a PICC during hospitalisation. The primary outcomes were the proportions of appropriate and inappropriate inpatient PICC use based on MAGIC recommendations. Hospital administrative data and electronic clinical data were used to determine appropriateness of each PICC placement. Multivariable regression models were fit to explore patient predictors of inappropriate use. RESULTS:Among 3479 PICC placements, 1848 (53%, 95% CI 51% to 55%) were appropriate, 573 (16%, 95% CI 15% to 18%) were inappropriate and 1058 (30%, 95% CI 29% to 32%) were of uncertain appropriateness. The proportion of appropriate and inappropriate PICCs ranged from 44% to 61% (p<0.001) and 13% to 21% (p<0.001) across hospitals, respectively. The most common reasons for inappropriate PICC use were placement in patients with advanced chronic kidney disease (n=500, 14%) and use for fewer than 15 days in patients who are critically ill (n=53), which represented 14% of all PICC placements in the intensive care unit. Patients who were older, female, had a Charlson Comorbidity Index score greater than 0 and more severe illness based on the Laboratory-based Acute Physiology Score were more likely to receive an inappropriate PICC. CONCLUSIONS:Clinical practice recommendations can be operationalised into measurable domains to estimate the appropriateness of PICC insertions using routinely collected hospital data. Inappropriate PICC use was common and varied substantially across hospitals in this study, suggesting that there are important opportunities to improve care.
    背景与目标:
  • 【经验性抗生素的适当性: ICU成年脓毒症患者的危险因素。】 复制标题 收藏 收藏
    DOI:10.1007/s11096-020-01005-4 复制DOI
    作者列表:Al-Sunaidar KA,Prof Abd Aziz N,Prof Hassan Y
    BACKGROUND & AIMS: :Background The appropriateness of antibiotics is the basis for improving the survival of patients with sepsis. Objective This study aimed to determine the appropriateness of empirical antibiotics, reasons for non-appropriate empirical antibiotics, risk factors of mortality, length of stay in intensive care unit (ICU-LOS) and Acute Physiology And Chronic Health Evaluation II (APACHE II) score predictors in adult patients with sepsis. Setting An adult ICU of a tertiary hospital in  Malaysia. Methods A retrospective cohort study was conducted amongst patients with sepsis. Data were retrieved from the patients' files and computer system. Each case was reviewed for the appropriateness of empirical antibiotics based on ICU local guidelines, bacterial sensitivity, dose, frequency, creatinine clearance and time of administration of empirical antibiotics. Multivariable logistic and Cox regression modelling were performed to compute the adjusted association of receiving appropriate or inappropriate empirical antibiotics with ICU mortality. Multivariable linear regression modelling was performed using ICU-LOS and APACHE II scores. Main outcome measures were ICU mortality, severity score (APACHE II scores) and ICU-LOS. Results The total mortality rate amongst the 228 adult ICU patients was 84.6%. Males showed a higher mortality rate (119 [52.2%]) than females (74 [32.5%]). Inappropriate empirical antibiotics were significantly associated with mortality and ICU-LOS (P < 0.005). Results from multivariable logistic regression showed that the appropriateness of empirical antibiotics model was a potential predictor for survival (OR 0.395, 95% CI 0.184-0.850, P < 0.005). Results from simple linear regression indicated that the appropriateness of empirical antibiotics model was a remarkable predictor of decreasing ICU-LOS (R2 = 0.055, 95% CI - 7.184 to - 2.114, P < 0.001). Results from simple Cox regression suggested that the appropriateness of empirical antibiotics was a protective factor for ICU mortality (HR 0.610, 95% CI 0.433-0.858, P = 0.005). Multivariable Cox regression revealed that the administration of antibiotics exceeding the recommended dose based on creatinine clearance was a protective factor (HR 0.186, 95% CI 0.040-0.868, P = 0.032). Conclusion The appropriateness of empirical antibiotics is a good predictor for improving survival and decreasing ICU-LOS. Effective appropriateness of empirical antibiotics use and close adherence to the recommended dose can prevent the early mortality of patients with sepsis and acute renal failure.
    背景与目标: 背景: 抗生素的适当性是改善脓毒症患者生存的基础。目的本研究旨在确定成人脓毒症患者经验性抗生素的适当性,不适当的经验性抗生素的原因,死亡的危险因素,重症监护病房 (ICU-LOS) 的住院时间以及急性生理与慢性健康评估II (APACHE II) 评分的预测因素。在马来西亚设置三级医院的成人ICU。方法对脓毒症患者进行回顾性队列研究。从患者的文件和计算机系统中检索数据。根据ICU局部指南,细菌敏感性,剂量,频率,肌酐清除率和经验性抗生素给药时间,对每个病例进行了经验性抗生素的适用性审查。进行了多变量logistic和Cox回归模型,以计算接受适当或不适当的经验性抗生素与ICU死亡率的校正相关性。使用ICU-LOS和APACHE II评分进行多变量线性回归建模。主要结局指标为ICU死亡率,严重程度评分 (APACHE II评分) 和ICU-LOS。结果228例成人ICU患者的总死亡率为84.6% 例。男性的死亡率 (119 [52.2%]) 高于女性 (74 [32.5%])。不适当的经验性抗生素与死亡率和ICU-LOS显著相关 (p  <  0.005)。多变量logistic回归结果表明,经验性抗生素模型的适当性是生存的潜在预测因素 (OR 0.395,95% CI 0.184-0.850,p  <  0.005)。简单线性回归结果表明,经验性抗生素模型的适用性是降低ICU-LOS的显著预测指标 (R2   =   0.055,95% CI -  7.184为-  2.114,p  <  0.001)。简单的Cox回归结果表明,经验性抗生素的适用性是ICU死亡率的保护因素 (HR 0.610,95% CI 0.433-0.858,p   =   0.005)。多变量Cox回归显示,超过基于肌酐清除率的推荐剂量的抗生素给药是一个保护因素 (HR 0.186,95% CI 0.040-0.868,p   =   0.032)。结论经验性抗生素的适用性是提高生存率和降低ICU-LOS的良好预测指标。经验性抗生素使用的有效适当性和对推荐剂量的严格遵守可以预防败血症和急性肾功能衰竭患者的早期死亡。
  • 【颈部疼痛驱动指数: 评级量表的适当性和战略、战术和作战水平的单维度。】 复制标题 收藏 收藏
    DOI:10.1016/j.apmr.2013.02.017 复制DOI
    作者列表:Takasaki H,Johnston V,Treleaven J,Jull G
    BACKGROUND & AIMS: OBJECTIVE:To establish an appropriate scoring system using Rasch scores for the strategic, tactical, and operational levels of the Neck Pain Driving Index (NPDI) and to refine the NPDI by testing the unidimensionality of each driving performance level using Rasch analysis. DESIGN:Cross-sectional. SETTING:Tertiary institution. PARTICIPANTS:Individuals with chronic whiplash-associated disorders (WAD) (N=123). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURE:The NPDI, which was developed to evaluate self-reported driving difficulty in people with chronic WAD. RESULTS:On the basis of Rasch analyses, modifications were made to the response format, changing it from a 0 to 4 scale (0=no difficulty, 1=slight difficulty, 2=moderate difficulty, 3=great difficulty, 4=unable to drive because of the injury) to a 0 to 3 scale (0=no difficulty, 1=slight difficulty, 2=moderate difficulty, 3=great difficulty and unable to drive because of the injury). Unidimensionality of the strategic and operational levels was confirmed. Modification of the tactical level was necessary to ensure its unidimensionality. After removing the tasks "driving near (your) collision site," "driving in a bad weather condition," and "driving at night," unidimensionality of the 4-item tactical level was confirmed. A 9-item NPDI was established. A table converting raw total scores into Rasch scores was created for each level. CONCLUSIONS:This study established the 9-item NPDI, and its 3 subsections (strategic, tactical, and operational levels) are unidimensional. The magnitude of self-reported driving difficulty at each of the 3 subsections can be assessed with the use of a 0 to 3 scale and Rasch scores.
    背景与目标:
  • 【肾清除和连续肾脏替代治疗对危重病患者推荐美罗培南给药方案的适当性的影响易感威胁生命的感染。】 复制标题 收藏 收藏
    DOI:10.1093/jac/dky370 复制DOI
    作者列表:Burger R,Guidi M,Calpini V,Lamoth F,Decosterd L,Robatel C,Buclin T,Csajka C,Marchetti O
    BACKGROUND & AIMS: Background:Meropenem plasma concentration above a pathogen's MIC over the whole dosing interval (100% ƒT>MIC) is a determinant of outcome in severe infections. Significant variability of meropenem pharmacokinetics is reported in ICU patients. Objectives:To characterize meropenem pharmacokinetics in variable CLCR or renal replacement therapy and assess the appropriateness of recommended regimens for MIC coverage. Methods:A pharmacokinetic analysis (NONMEM) was conducted with external model validation. Patient characteristics were tested on meropenem clearance estimates, differentiated according to the presence/absence of continuous renal replacement therapy (CRRT, CLCRRT or CLno-CRRT). Simulations evaluated the appropriateness of recommended dosing for achieving 100% fT>MIC in 90% of patients. Results:A total of 101 patients were studied: median 63 years (range 49-70), 56% male, SAPS II 38 (27-48). 32% had a CLCR >60 mL/min, 49% underwent CRRT and 32% presented severe sepsis or septic shock. A total of 127 pathogens were documented: 76% Gram-negatives, 24% Gram-positives (meropenem MIC90 2 mg/L, corresponding to EUCAST susceptibility breakpoint). Three hundred and eighty plasma and 129 filtrate-dialysate meropenem concentrations were analysed: two-compartment modelling best described the data. Predicted meropenem CLno-CRRT was 59% lower in impaired (CLCR 30 mL/min) compared to normal (CLCR 100 mL/min) renal function. Simulations showed that recommended regimens appropriately cover MIC90 in patients with CLCR <60 mL/min. Patients with CLCR of 60 to <90 mL/min need 6 g/day to achieve appropriate coverage. In patients with CLCR ≥90 mL/min, appropriate exposure is achieved with increased dose, frequency of administration and infusion duration, or continuous infusion. Conclusions:Recommended meropenem regimens are suboptimal in ICU patients with normal or augmented renal clearance. Modified dosing or infusion modalities achieve appropriate MIC coverage for optimized antibacterial efficacy in meropenem-susceptible life-threatening infections.
    背景与目标:
  • 【多种慢性病患者药物治疗适当性问卷的可靠性。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejim.2013.01.020 复制DOI
    作者列表:Galván-Banqueri M,de la Higuera-Vila L,Vega-Coca MD,Nieto Martín MD,Pérez-Guerrero C,Santos-Ramos B
    BACKGROUND & AIMS: BACKGROUND:The original Medication Appropriateness Index was validated for elderly and polymedicated patients, both in hospital and outpatient contexts. However, no studies have applied this questionnaire in patients with multiple chronic conditions. The objective of this study is to assess the reliability of a modified Medication Appropriateness Index questionnaire in a population of patients with multiple chronic conditions. METHODS:We selected patients with multiple chronic conditions who were included in an integrated care project conducted at the Hospital Universitario Virgen del Rocío. To determine inter-observer reliability, each professional (internist or hospital pharmacy specialist) applied the questionnaire under the same conditions and with the same resources. To determine intra-observer reliability, each physician applied the tool at baseline and two months later. We measured inter- and intra-observer reliability using the kappa coefficient. The proportion of overall agreement was also determined. RESULTS:We obtained a weak overall kappa (k=0.38) for inter-observer reliability and moderate (k=0.52) and very good (k=0.84) values for intra-observer reliability of the internist and specialist in hospital pharmacy, respectively. The proportion of overall agreement is very high in all three situations: 96%, 98%, and 99%, respectively. CONCLUSIONS:Despite its limitations, the Medication Appropriateness Index questionnaire modified by our group can be used, as a reliable method, to assess the appropriateness of pharmacotherapy in patients with multiple chronic conditions.
    背景与目标:
  • 【车载信息系统警报: 烦恼、紧急和适当性。】 复制标题 收藏 收藏
    DOI:10.1518/001872007779598145 复制DOI
    作者列表:Marshall DC,Lee JD,Austria RA
    BACKGROUND & AIMS: OBJECTIVE:This study assesses the influence of the auditory characteristics of alerts on perceived urgency and annoyance and whether these perceptions depend on the context in which the alert is received. BACKGROUND:Alert parameters systematically affect perceived urgency, and mapping the urgency of a situation to the perceived urgency of an alert is a useful design consideration. Annoyance associated with environmental noise has been thoroughly studied, but little research has addressed whether alert parameters differentially affect annoyance and urgency. METHOD:Three 2(3) x 3 mixed within/between factorial experiments, with a total of 72 participants, investigated nine alert parameters in three driving contexts. These parameters were formant (similar to harmonic series), pulse duration, interpulse interval, alert onset and offset, burst duty cycle, alert duty cycle, interburst period, and sound type. Imagined collision warning, navigation alert, and E-mail notification scenarios defined the driving context. RESULTS:All parameters influenced both perceived urgency and annoyance (p < .05), with pulse duration, interpulse interval, alert duty cycle, and sound type influencing urgency substantially more than annoyance. There was strong relationship between perceived urgency and rated appropriateness for high-urgency driving scenarios and a strong relationship between annoyance and rated appropriateness for low-urgency driving scenarios. CONCLUSION:Sound parameters differentially affect annoyance and urgency. Also, urgency and annoyance differentially affect perceived appropriateness of warnings. APPLICATION:Annoyance may merit as much attention as urgency in the design of auditory warnings, particularly in systems that alert drivers to relatively low-urgency situations.
    背景与目标:
  • 【根据目前的建议,氯吡格雷使用的适当性。】 复制标题 收藏 收藏
    DOI:10.1093/fampra/cmu039 复制DOI
    作者列表:Fornós-Garrigós A,Orozco-Beltrán D,Gil-Guillén VF,Puig-Barberà J,Fluixa C,Fernández A
    BACKGROUND & AIMS: BACKGROUND:Clopidogrel is widely used in cardiovascular prevention. However, the prescription of clopidogrel in clinical practice does not match the recommendations concerning its indication and treatment duration. OBJECTIVE:To assess the appropriateness of clopidogrel prescription according to the accepted indications. METHODS:We undertook a retrospective observational analytical audit of the electronic clinical records in the region of Valencia, Spain (5 million inhabitants), selecting those patients on treatment with clopidogrel between 2007 and 2010. The primary outcome measure was the duration of the treatment. RESULTS:A total of 45721 patients started clopidogrel treatment during the study period. Treatment was for cardiologic disorders (CD) in 56.85% of the patients, neurologic disorders (ND) in 37.06% and peripheral arterial disease in 6.08%. Treatment duration was longer than that expected from clinical recommendations in 38.8% of the CD patients and 87.8% of the ND patients. The estimated avoidable cost ranged from 2 to 4.4 million Euros per year, according to whether a cheaper generic clopidogrel or a more expensive version was considered. CONCLUSIONS:Almost 40% of the cardiologic patients and 90% of the neurologic patients received excess treatment. Adjustment of treatment duration to international recommendations would result in savings of between 80.1 and 176.3 Euros per year and per patient treated.
    背景与目标:
  • 【ACR适当性标准®运动障碍和神经退行性疾病。】 复制标题 收藏 收藏
    DOI:10.1016/j.jacr.2020.01.042 复制DOI
    作者列表:Expert Panel on Neurological Imaging.,Harvey HB,Watson LC,Subramaniam RM,Burns J,Bykowski J,Chakraborty S,Ledbetter LN,Lee RK,Pannell JS,Pollock JM,Powers WJ,Rosenow JM,Shih RY,Slavin K,Utukuri PS,Corey AS
    BACKGROUND & AIMS: :Movement disorders and neurodegenerative diseases are a variety of conditions that involve progressive neuronal degeneration, injury, or death. Establishing the correct diagnosis of a movement disorder or neurodegenerative process can be difficult due to the variable features of these conditions, unusual clinical presentations, and overlapping symptoms and characteristics. MRI has an important role in the initial assessment of these patients, although a combination of imaging and laboratory and genetic tests is often needed for complete evaluation and management. This document summarizes the imaging appropriateness data for rapidly progressive dementia, chorea, Parkinsonian syndromes, suspected neurodegeneration with brain iron accumulation, and suspected motor neuron disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
    背景与目标: : 运动障碍和神经退行性疾病是涉及进行性神经元变性,损伤或死亡的各种疾病。由于这些疾病的可变特征,异常的临床表现以及重叠的症状和特征,很难建立运动障碍或神经变性过程的正确诊断。MRI在这些患者的初步评估中具有重要作用,尽管通常需要结合影像学,实验室和基因测试来进行完整的评估和管理。本文总结了快速进行性痴呆,舞蹈病,帕金森综合征,疑似脑铁蓄积的神经退行性变和疑似运动神经元疾病的影像学适当性数据。美国放射学学院的适当性标准是针对特定临床状况的循证指南,每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊中当前医学文献的广泛分析,以及对公认的方法 (RAND/UCLA适当性方法和建议评估,开发和评估或等级的分级) 的应用,以评估适当性特定临床场景的成像和治疗程序。在证据缺乏或模棱两可的情况下,专家意见可以补充现有证据以建议成像或治疗。
  • 【ACR适当性标准®婴儿呕吐。】 复制标题 收藏 收藏
    DOI:10.1016/j.jacr.2020.09.002 复制DOI
    作者列表:Expert Panel on Pediatric Imaging.,Alazraki AL,Rigsby CK,Iyer RS,Bardo DME,Brown BP,Chan SS,Chandra T,Dietrich A,Falcone RA Jr,Garber MD,Gill AE,Levin TL,Moore MM,Nguyen JC,Shet NS,Squires JH,Trout AT,Karmazyn B
    BACKGROUND & AIMS: :Vomiting in infants under the age of 3 months is one of the most common reasons for parents to seek care from their doctor or present to an emergency room. The imaging workup that ensues is dependent on several factors: age at onset, days versus weeks after birth, quality of emesis, bilious or nonbilious vomiting, and the initial findings on plain radiograph, suspected proximal versus distal bowel obstruction. The purpose of these guidelines is to inform the clinician, based on current evidence, what is the next highest yield and most appropriate imaging study to pursue a diagnosis. The goal is rapid and accurate arrival at a plan for treatment, whether surgical or nonsurgical. The following modalities are discussed for each variant of the symptom: plain radiography, fluoroscopic upper gastrointestinal series, fluoroscopic contrast enema, ultrasound of the abdomen, nuclear medicine gastroesophageal reflux scan. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
    背景与目标: : 3个月以下的婴儿呕吐是父母向医生寻求护理或前往急诊室的最常见原因之一。随后进行的影像学检查取决于以下几个因素: 发病年龄,出生后的天数与数周,呕吐的质量,胆汁性或非胆汁性呕吐,以及x线平片的初步发现,怀疑是近端和远端肠梗阻。这些指南的目的是根据目前的证据,告知临床医生下一个最高产量和最合适的影像学研究来进行诊断。目标是快速,准确地达成治疗计划,无论是手术还是非手术。针对症状的每种变体讨论了以下方式: x线平片,透视上消化道系列,透视对比灌肠,腹部超声,核医学胃食管反流扫描。美国放射学学院的适当性标准是针对特定临床状况的循证指南,每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊中当前医学文献的广泛分析,以及对公认的方法 (RAND/UCLA适当性方法和建议评估,开发和评估或等级的分级) 的应用,以评估适当性特定临床场景的成像和治疗程序。在证据缺乏或模棱两可的情况下,专家意见可以补充现有证据以建议成像或治疗。
  • 14 ACR Appropriateness Criteria® Hematospermia. 复制标题 收藏 收藏

    【ACR适当性标准®血精。】 复制标题 收藏 收藏
    DOI:10.1016/j.jacr.2017.02.023 复制DOI
    作者列表:Expert Panel on Urologic Imaging:.,Hosseinzadeh K,Oto A,Allen BC,Coakley FV,Friedman B,Fulgham PF,Hartman MS,Heller MT,Porter C,Sahni VA,Sudakoff GS,Verma S,Wang CL,Yoo DC,Remer EM,Eberhardt SC
    BACKGROUND & AIMS: :Most men with hematospermia or hemospermia (HS) are young (<40 years of age), presenting with transient or episodic HS without other signs or symptoms of disease. The condition is self-limiting in most cases and idiopathic in nature. When a cause can be identified, infections of the urogenital tract are the most common. Imaging does not play a role in this patient population. In older men (>40 years of age), clinical screening for prostate cancer is advised. Furthermore, when HS is persistent or has symptoms, causes include obstruction or stricture at the level of the verumontanum, calcifications or calculi in the prostate, ejaculatory ducts or seminal vesicles, and cysts arising within these structures. Noninvasive imaging, predominantly transrectal ultrasound (TRUS) and MRI, can be used in men of any age with persistent or refractory HS, or other associated symptoms or signs. TRUS is considered as the first-line imaging with MRI used when TRUS is inconclusive or negative. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
    背景与目标: : 大多数患有血精或血精 (HS) 的男性都是年轻的 (<40岁),表现出短暂或发作性HS,没有其他疾病迹象或症状。在大多数情况下,这种情况是自限性的,本质上是特发性的。如果可以确定病因,则最常见的是泌尿生殖道感染。成像在该患者人群中不起作用。对于年龄较大的男性 (>40岁),建议临床筛查前列腺癌。此外,当HS持续存在或有症状时,原因包括在疣水平的阻塞或狭窄,前列腺,射精管或精囊中的钙化或结石,以及这些结构内出现的囊肿。非侵入性成像,主要是经直肠超声 (TRUS) 和MRI,可用于患有持续性或难治性HS或其他相关症状或体征的任何年龄的男性。当TRUS不确定或阴性时,TRUS被认为是MRI的一线成像。美国放射学学院的适当性标准是针对特定临床状况的循证指南,每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊中当前医学文献的广泛分析,以及对公认的方法 (RAND/UCLA适当性方法和建议评估,开发和评估或等级的分级) 的应用,以评估适当性特定临床情况下的成像和治疗程序。在证据缺乏或模棱两可的情况下,专家意见可以补充现有证据以建议成像或治疗。
  • 【寻求庇护者的医疗护理: 在门卫系统中,与传统的基于医生的护理相比,护士从业者护理的适当性的描述性研究。】 复制标题 收藏 收藏
    DOI:10.1186/1471-2458-7-310 复制DOI
    作者列表:Bodenmann P,Althaus F,Burnand B,Vaucher P,Pécoud A,Genton B
    BACKGROUND & AIMS: BACKGROUND:Medical care for asylum seekers is a complex and critical issue worldwide. It is influenced by social, political, and economic pressures, as well as premigration conditions, the process of migration, and postmigration conditions in the host country. Increasing needs and healthcare costs have led public health authorities to put nurse practitioners in charge of the management of a gatekeeping system for asylum seekers. The quality of this system has never been evaluated. We assessed the competencies of nurses and physicians in identifying the medical needs of asylum seekers and providing them with appropriate treatment that reflects good clinical practice. METHODS:This cross-sectional descriptive study evaluated the appropriateness of care provided to asylum seekers by trained nurse practitioners in nursing healthcare centers and by physicians in private practices, an academic medical outpatient clinic, and the emergency unit of the university hospital in Lausanne, Switzerland. From 1687 asylum seeking patients who had consulted each setting between June and December 2003, 450 were randomly selected to participate. A panel of experts reviewed their medical records and assessed the appropriateness of medical care received according to three parameters: 1) use of appropriate procedures to identify medical needs (medical history, clinical examination, complementary investigations, and referral), 2) provision of access to treatment meeting medical needs, and 3) absence of unnecessary medical procedures. RESULTS:In the nurse practitioner group, the procedures used to identify medical needs were less often appropriate (79% of reports vs. 92.4% of reports; p < 0.001). Nevertheless, access to treatment was judged satisfactory and was similar (p = 0.264) between nurse practitioners and physicians (99% and 97.6% of patients, respectively, received adequate care). Excessive care was observed in only 2 physician reports (0.8%) and 3 nurse reports (1.5%) (p = 0.481). CONCLUSION:Although the nursing gatekeeping system provides appropriate treatment to asylum seekers, it might be improved with further training in recording medical history and performing targeted clinical examination.
    背景与目标:

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