Aim: In prone breast treatments, a carbon fiber support device resides under the contralateral breast. Tangent beams are designed to encompass the treated breast and these often pass through the board at a shallow ang...Aim: In prone breast treatments, a carbon fiber support device resides under the contralateral breast. Tangent beams are designed to encompass the treated breast and these often pass through the board at a shallow angle, resulting in significant attenuation. Our planners account for this attenuation by adding field-in-field dose to the deep part of the breast, through the board. Concern was raised about how accurate the treatment delivery is when the inherent uncertainties of patients’ positions are accounted for. Furthermore, transmission measurements are usually carried out perpendicular to the board, a non-clinical situation. The goal of this study is to evaluate the dosimetric effect of the board and the robustness of the plan to positional uncertainty. Materials and Methods: Twenty-two breast patients treated on a commercial prone breast board between 2017 and 2020 were selected for this retrospective study. To evaluate the board’s attenuation, we compared the plans with the board removed from the dose calculation. To quantify the robustness of this technique, we moved the beam isocenter with respect to the patient and board. Results: Our results showed that when the breast board is removed from a plan which was designed to account for the board attenuation, the average point dose increases by 7.48%, with a maximum of 22%. Comparing results with a mixed Analysis of Variance (ANOVA) and a least-square means analysis, our robustness evaluation indicates that anterior shifts at every magnitude (1 mm through 5 mm) make a significant difference in all dose statistics (D95, max, 95% prescription coverage and homogeneity index) investigated. In/out and right/left shifts resulted in an insignificant change in dose statistics. Conclusion: Prone breast boards can add significant dosimetric uncertainty into the treatment delivery process. Accounting for plan robustness in the design of the plan is highly recommended. A prone breast board design with support moved away from the beam path is warranted.展开更多
Clinical decision support(CDS) systems with automated alerts integrated into electronic medical records demonstrate efficacy for detecting medication errors(ME) and adverse drug events(ADEs). Critically ill patients a...Clinical decision support(CDS) systems with automated alerts integrated into electronic medical records demonstrate efficacy for detecting medication errors(ME) and adverse drug events(ADEs). Critically ill patients are at increased risk for ME, ADEs and serious negative outcomes related to these events. Capitalizing on CDS to detect ME and prevent adverse drug related events has the potential to improve patient outcomes. The key to an effective medication safety surveillance system incorporating CDS is advancing the signals for alerts by using trajectory analyses to predict clinical events, instead of waiting for these events to occur. Additionally, incorporating cutting-edge biomarkers into alert knowledge in an effort to identify the need to adjust medication therapy portending harm will advance the current state of CDS. CDS can be taken a step further to identify drug related physiological events, which are less commonly included in surveillance systems. Predictive models for adverse events that combine patient factors with laboratory values and biomarkers are being established and these models can be the foundation for individualized CDS alerts to prevent impending ADEs.展开更多
Purpose: From a social and labor inclusion perspective, the article presents a digital prototype conceptualized to provide a “Diagnostic Page”, which delivers various prescribers and suppliers of support products th...Purpose: From a social and labor inclusion perspective, the article presents a digital prototype conceptualized to provide a “Diagnostic Page”, which delivers various prescribers and suppliers of support products that mitigate the problems of the respective patients. It also provides a “Patient Card Page”, where all the information about financing the respective products is placed, as well as all the documents likely to be needed for the commercial transactions to be carried out by all the parties involved. It also aims to provide a digital medium to grow a community in this niche market. In the action research methodology approach, the prototype was taken to funding competitions and conferences, where interviews and surveys were carried out, and a number of suggestions were collected on the type of platform to consider in order to respond to the concerns and needs of end users, such as patients, prescribers, suppliers and associations. Methods: The digital platform where the system is hosted uses algorithms that, on the diagnostic page, consider keywords used by patients and return a series of prescribers and suppliers of support products, in which the corresponding percentage of attenuation is taken into account and the best solution found to overcome the level of difficulty presented by the respective patients is delivered. Results and Conclusions: It is hoped that, with this platform, people with motor problems will be able to obtain their diagnosis instantly, through the algorithm implemented, and that they will immediately be provided with a series of prescribers, suppliers and support products best suited to their needs, as well as all the information or conditions necessary to purchase or finance them. On the other hand, prescribers, suppliers and associations have an online platform where they can offer their consultations, products and other support as freelancers who are part of a community.展开更多
风险管理贯穿于医疗器械全生命周期以及各项活动,在医疗器械设计开发的过程中,除了在设计策划前期可用风险管理标准及产品适用的通用标准和专业标准进行风险识别、评价和管控外,在医疗器械全生命周期的风险管理过程中,各种风险管理工具...风险管理贯穿于医疗器械全生命周期以及各项活动,在医疗器械设计开发的过程中,除了在设计策划前期可用风险管理标准及产品适用的通用标准和专业标准进行风险识别、评价和管控外,在医疗器械全生命周期的风险管理过程中,各种风险管理工具的运用也能帮助人们更系统、全面地识别风险并进行风险控制,保证医疗器械的安全、有效。现以某放射治疗用患者支撑系统设计为例,利用风险管理工具故障树分析(fault tree analysis,FTA),对风险管理在医疗器械设计开发过程中的实施方法及作用进行研究。展开更多
目的研发实施基于CDSS(Clinical Decision Support System,CDSS)的护理信息系统,并评价该系统的临床应用效果。方法根据临床工作需要研发并运行基于CDSS的护理信息化系统,采用便利抽样法在该系统实施前、后各抽取300名患者,100名护理人...目的研发实施基于CDSS(Clinical Decision Support System,CDSS)的护理信息系统,并评价该系统的临床应用效果。方法根据临床工作需要研发并运行基于CDSS的护理信息化系统,采用便利抽样法在该系统实施前、后各抽取300名患者,100名护理人员,并对应用前后护士自我效能感、护士对工作的满意度、患者满意度、护理不良事件等指标进行调查分析,评价护理信息系统的使用效果。结果实施护理信息系统后护士自我效能感明显提高(P<0.05);患者对护理的满意度、护士对工作的满意度,均显著提高(均P<0.01)。实施前、后相关不良事件比较,差异有统计学意义(均P<0.05)。结论基于CDSS的护理信息系统的使用,能提高护士对工作热情与自我认同感,提高患者满意度,降低安全隐患,促进护理管理的系统化科学化。展开更多
文摘Aim: In prone breast treatments, a carbon fiber support device resides under the contralateral breast. Tangent beams are designed to encompass the treated breast and these often pass through the board at a shallow angle, resulting in significant attenuation. Our planners account for this attenuation by adding field-in-field dose to the deep part of the breast, through the board. Concern was raised about how accurate the treatment delivery is when the inherent uncertainties of patients’ positions are accounted for. Furthermore, transmission measurements are usually carried out perpendicular to the board, a non-clinical situation. The goal of this study is to evaluate the dosimetric effect of the board and the robustness of the plan to positional uncertainty. Materials and Methods: Twenty-two breast patients treated on a commercial prone breast board between 2017 and 2020 were selected for this retrospective study. To evaluate the board’s attenuation, we compared the plans with the board removed from the dose calculation. To quantify the robustness of this technique, we moved the beam isocenter with respect to the patient and board. Results: Our results showed that when the breast board is removed from a plan which was designed to account for the board attenuation, the average point dose increases by 7.48%, with a maximum of 22%. Comparing results with a mixed Analysis of Variance (ANOVA) and a least-square means analysis, our robustness evaluation indicates that anterior shifts at every magnitude (1 mm through 5 mm) make a significant difference in all dose statistics (D95, max, 95% prescription coverage and homogeneity index) investigated. In/out and right/left shifts resulted in an insignificant change in dose statistics. Conclusion: Prone breast boards can add significant dosimetric uncertainty into the treatment delivery process. Accounting for plan robustness in the design of the plan is highly recommended. A prone breast board design with support moved away from the beam path is warranted.
基金Supported by The Agency for Healthcare Research and Quality,No.R18HS02420-01
文摘Clinical decision support(CDS) systems with automated alerts integrated into electronic medical records demonstrate efficacy for detecting medication errors(ME) and adverse drug events(ADEs). Critically ill patients are at increased risk for ME, ADEs and serious negative outcomes related to these events. Capitalizing on CDS to detect ME and prevent adverse drug related events has the potential to improve patient outcomes. The key to an effective medication safety surveillance system incorporating CDS is advancing the signals for alerts by using trajectory analyses to predict clinical events, instead of waiting for these events to occur. Additionally, incorporating cutting-edge biomarkers into alert knowledge in an effort to identify the need to adjust medication therapy portending harm will advance the current state of CDS. CDS can be taken a step further to identify drug related physiological events, which are less commonly included in surveillance systems. Predictive models for adverse events that combine patient factors with laboratory values and biomarkers are being established and these models can be the foundation for individualized CDS alerts to prevent impending ADEs.
文摘Purpose: From a social and labor inclusion perspective, the article presents a digital prototype conceptualized to provide a “Diagnostic Page”, which delivers various prescribers and suppliers of support products that mitigate the problems of the respective patients. It also provides a “Patient Card Page”, where all the information about financing the respective products is placed, as well as all the documents likely to be needed for the commercial transactions to be carried out by all the parties involved. It also aims to provide a digital medium to grow a community in this niche market. In the action research methodology approach, the prototype was taken to funding competitions and conferences, where interviews and surveys were carried out, and a number of suggestions were collected on the type of platform to consider in order to respond to the concerns and needs of end users, such as patients, prescribers, suppliers and associations. Methods: The digital platform where the system is hosted uses algorithms that, on the diagnostic page, consider keywords used by patients and return a series of prescribers and suppliers of support products, in which the corresponding percentage of attenuation is taken into account and the best solution found to overcome the level of difficulty presented by the respective patients is delivered. Results and Conclusions: It is hoped that, with this platform, people with motor problems will be able to obtain their diagnosis instantly, through the algorithm implemented, and that they will immediately be provided with a series of prescribers, suppliers and support products best suited to their needs, as well as all the information or conditions necessary to purchase or finance them. On the other hand, prescribers, suppliers and associations have an online platform where they can offer their consultations, products and other support as freelancers who are part of a community.
文摘风险管理贯穿于医疗器械全生命周期以及各项活动,在医疗器械设计开发的过程中,除了在设计策划前期可用风险管理标准及产品适用的通用标准和专业标准进行风险识别、评价和管控外,在医疗器械全生命周期的风险管理过程中,各种风险管理工具的运用也能帮助人们更系统、全面地识别风险并进行风险控制,保证医疗器械的安全、有效。现以某放射治疗用患者支撑系统设计为例,利用风险管理工具故障树分析(fault tree analysis,FTA),对风险管理在医疗器械设计开发过程中的实施方法及作用进行研究。
文摘目的研发实施基于CDSS(Clinical Decision Support System,CDSS)的护理信息系统,并评价该系统的临床应用效果。方法根据临床工作需要研发并运行基于CDSS的护理信息化系统,采用便利抽样法在该系统实施前、后各抽取300名患者,100名护理人员,并对应用前后护士自我效能感、护士对工作的满意度、患者满意度、护理不良事件等指标进行调查分析,评价护理信息系统的使用效果。结果实施护理信息系统后护士自我效能感明显提高(P<0.05);患者对护理的满意度、护士对工作的满意度,均显著提高(均P<0.01)。实施前、后相关不良事件比较,差异有统计学意义(均P<0.05)。结论基于CDSS的护理信息系统的使用,能提高护士对工作热情与自我认同感,提高患者满意度,降低安全隐患,促进护理管理的系统化科学化。
