目的基于以资源为基础的相对价值比率(Resource Based Relative Value Scale,RBRVS)思想构建外科医师技术岗位等级分级指标体系。方法通过文献研究法和头脑风暴法,结合RBRVS思想初拟指标体系,采用德尔菲法进行两轮专家咨询,最终确立评...目的基于以资源为基础的相对价值比率(Resource Based Relative Value Scale,RBRVS)思想构建外科医师技术岗位等级分级指标体系。方法通过文献研究法和头脑风暴法,结合RBRVS思想初拟指标体系,采用德尔菲法进行两轮专家咨询,最终确立评价指标体系。结果两轮问卷回收率均为100%,两轮咨询的权威系数均为0.73,平均协调系数分别为0.30和0.51(两轮P<0.01),达到一致性检验要求。最终构建了包含2个维度、22个指标的外科医师技术岗位等级分级指标体系。结论指标体系的专家积极性、权威系数和协调系数较高,已筛选的指标的创新性、可靠性、实用性较好,需进一步测算指标权重、开展实践验证。展开更多
AIM To evaluate annual incidence of low grade dysplasia(LGD) progression to high grade dysplasia(HGD) and/or esophageal adenocarcinoma(EAC) when diagnosis was made by two or more expert pathologists.METHODS Studies ev...AIM To evaluate annual incidence of low grade dysplasia(LGD) progression to high grade dysplasia(HGD) and/or esophageal adenocarcinoma(EAC) when diagnosis was made by two or more expert pathologists.METHODS Studies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic. RESULTS Initial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies(n = 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate(AIR) of progression to HGD and or EAC was 10.35%(95%CI: 7.56-13.13) and progression to EAC was 5.18%(95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to No-dysplasia Barrett's esophagus, the AIR of progression to HGD and EAC was 0.65%(95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIR of progression to HGD and EAC was 1.42%(95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIR of progression to EAC was 28.63%(95%CI: 13.98-43.27). CONCLUSION When LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett's esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients.展开更多
文摘目的基于以资源为基础的相对价值比率(Resource Based Relative Value Scale,RBRVS)思想构建外科医师技术岗位等级分级指标体系。方法通过文献研究法和头脑风暴法,结合RBRVS思想初拟指标体系,采用德尔菲法进行两轮专家咨询,最终确立评价指标体系。结果两轮问卷回收率均为100%,两轮咨询的权威系数均为0.73,平均协调系数分别为0.30和0.51(两轮P<0.01),达到一致性检验要求。最终构建了包含2个维度、22个指标的外科医师技术岗位等级分级指标体系。结论指标体系的专家积极性、权威系数和协调系数较高,已筛选的指标的创新性、可靠性、实用性较好,需进一步测算指标权重、开展实践验证。
文摘AIM To evaluate annual incidence of low grade dysplasia(LGD) progression to high grade dysplasia(HGD) and/or esophageal adenocarcinoma(EAC) when diagnosis was made by two or more expert pathologists.METHODS Studies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic. RESULTS Initial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies(n = 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate(AIR) of progression to HGD and or EAC was 10.35%(95%CI: 7.56-13.13) and progression to EAC was 5.18%(95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to No-dysplasia Barrett's esophagus, the AIR of progression to HGD and EAC was 0.65%(95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIR of progression to HGD and EAC was 1.42%(95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIR of progression to EAC was 28.63%(95%CI: 13.98-43.27). CONCLUSION When LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett's esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients.
