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Ensuring Primary Care Diagnostic Quality in the Era of Telemedicine. Am J Med 2021; 134:1101-1103. [PMID: 34051151 PMCID: PMC9746257 DOI: 10.1016/j.amjmed.2021.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 12/16/2022]
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Abstract
An outbreak of coronavirus disease 2019 (COVID-19) caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) began in Wuhan, Hubei, China, in December 2019 and spread rapidly worldwide. The response by the Alberta Precision Laboratories, Public Health Laboratory (ProvLab), AB, Canada, included the development and implementation of nucleic acid detection-based assays and dynamic changes in testing protocols for the identification of cases as the epidemic curve increased exponentially. This rapid response was essential to slow down and contain transmission and provide valuable time to the local health authorities to prepare appropriate response strategies. As of May 24, 2020, 236,077 specimens were tested, with 6,475 (2.74%) positives detected in the province of Alberta, Canada. Several commercial assays are now available; however, the response from commercial vendors to develop and market validated tests is a time-consuming process. In addition, the massive global demand made it difficult to secure a reliable commercial supply of testing kits and reagents. A public health laboratory serves a unique and important role in the delivery of health care. One of its functions is to anticipate and prepare for novel emerging pathogens with a plan for pandemic preparedness. Here, we outline the response that involved the development and deployment of testing methodologies that evolved as SARS-CoV-2 spread worldwide, the challenges encountered, and mitigation strategies. We also provide insight into the organizational structure of how a public health response is coordinated in Alberta, Canada, and its benefits.
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ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak: Endorsed by the American College of Cardiology. J Am Coll Cardiol 2020; 75:3078-3084. [PMID: 32272153 PMCID: PMC7194625 DOI: 10.1016/j.jacc.2020.04.002] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
•ASE guidance for patient and provider protection during echo exams in the COVID-19 pandemic. •Triaging approach for prioritizing echo exams during the COVID-19 pandemic. •Recommended imaging approach and appropriate PPE use during echo exams.
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An internet-based algorithm for diabetic foot infection during the COVID-19 pandemic. J Foot Ankle Res 2020; 13:37. [PMID: 32552797 PMCID: PMC7298919 DOI: 10.1186/s13047-020-00405-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
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The importance of intra- and inter-institutional networks for capacity building in severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction services: experience from an oncology centre in eastern India. Indian J Med Microbiol 2020; 38:9-17. [PMID: 32719203 PMCID: PMC7706412 DOI: 10.4103/ijmm.ijmm_20_255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022]
Abstract
High-throughput, accurate, cost-effective and rapid testing for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is the need of the hour in face of the global coronavirus disease pandemic. This target is achievable, within a relatively short time through capacity building of reverse transcription polymerase chain reaction (RT-PCR) tests by utilising the strengths of intra and inter institutional networks. These networks act as force multiplier for vital resources which are required for capacity building, namely, leadership, expertise, equipment, space, infection control inputs and human resources. In this article, we report the experience of capacity building for delivery of RT-PCR tests for SARS CoV-2 from a cancer hospital in Eastern India. The relevance, mode of operation and value addition of this essential public health service are discussed in the context of inter departmental collaboration and interaction with other institutes through the existing diagnostic, surveillance and infection control networks. This networking model for service development and delivery could be used by other centres.
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Access to Comprehensive Services for Advanced Liver Disease in the Veterans Health Administration. Dig Dis Sci 2019; 64:3471-3479. [PMID: 31432344 DOI: 10.1007/s10620-019-05785-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/07/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Veterans Health Administration (VHA) provides care to the one of the largest cohorts of patients with advanced liver disease (ALD) in the USA. AIMS We performed a national survey to assess system-wide strengths and barriers to care for Veterans with ALD in this national integrated healthcare setting. METHODS A 52-item survey was developed to assess access and barriers to care in Veterans with ALD. The survey was distributed to all VHA medical centers in 2015. Results were analyzed using descriptive statistics. RESULTS One hundred and fifty-three sites responded to this survey. Multidisciplinary services were available on-site at > 80% of sites. Ninety-five percent of sites had mental health and addictions treatment available, with 14% co-locating these services within the liver clinic. Few sites (< 25%) provided pharmacologic treatment for alcohol use disorder in primary care or hepatology settings. Seventy-two percent of sites reported at least one barrier to liver-related care. Of the sites reporting at least one barrier, 53% reported barriers to liver transplant referral, citing complex processes and lack of staff/resources to coordinate referrals. Palliative care was widely available, but 61% of sites reported referring < 25% of their patients with ALD for palliative services. CONCLUSION Multidisciplinary services for Veterans with ALD are widely available at VHA sites, though barriers to optimal care remain. Opportunities for improvement include the expansion of providers with hepatology expertise, integrating pharmacotherapy for alcohol use disorder into hepatology and primary care, streamlining the transplant referral process, and expanding palliative care referrals for patients with ALD.
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A fetal alcohol spectrum disorder diagnostic service and beyond: Outcomes for families. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 93:103428. [PMID: 31357176 DOI: 10.1016/j.ridd.2019.103428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/09/2019] [Accepted: 06/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is of significant concern for Australians for many reasons, one being Australia's drinking culture which increases the potential for FASD to occur. AIMS The current study aimed to explore the lived experiences of Australian caregivers who received a FASD diagnosis for a child in their care, usingthe Australian Guide to the Diagnosis of FASD. METHODS AND PROCEDURES Semi-structured interviews were conducted with seven caregivers whose children were assessed for FASD by a multidisciplinary team. Interviews explored how families experienced the FASD diagnostic process, and sought insight into outcomes for families following diagnosis, particularly in relation to accessing supports and services. OUTCOMES AND RESULTS Through thematic analysis, five overarching themes were identified: (1) receiving a FASD diagnosis had a positive impact; (2) caregivers' evaluation of assessment process; (3) positive support services relative to FASD; (4) ongoing difficulties regardless of diagnosis; and (5) need for societal knowledge of FASD. CONCLUSIONS AND IMPLICATIONS Given the global need for standardised FASD diagnostic procedures and accurate reporting of prevalence rates, the current study provides a contribution to the emerging diagnostic FASD literature, and insight into families' experiences who have children diagnosed with FASD. WHAT THIS PAPER ADDS This study provides additional information to the developing pool of literature attempting to create a typical profile of FASD. Most importantly, this paper highlights the implementation of the Australian Guide to the Diagnosis of FASD, and evaluates caregivers' experiences of their child's FASD assessment process, within a public FASD diagnostic service, using the revised guidelines.
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Levels and predictors of TB-HIV Diagnostic service linkage and testing in government hospitals of Southern zone of Tigray, Northern Ethiopia. Afr Health Sci 2019; 19:2335-2346. [PMID: 32127802 PMCID: PMC7040298 DOI: 10.4314/ahs.v19i3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are global public health problems. TB and HIV diagnostic services linkage is imperative for the fight against the two diseases. OBJECTIVE To assess the diagnostic service linkage and testing of TB-HIV diagnostic services and identify predictors in Public hospitals of Northern Ethiopia. METHODS A cross-sectional study was conducted in five hospitals of Northern Ethiopia. Study subjects' socio-demographic, household and clinical variables were assessed. Data was analyzed using SPSS. Logistic regressions were used to determine the predictors of uptake of TB and HIV testing among HIV and TB patients, respectively. RESULT The level of HIV testing among TB patients was 94.4% and of TB screening among HIV patients was 90.5%. Factors that independently predict HIV testing among TB patients were Residence AOR=0.187(95% CI 0.05-0.76), being 9 grade and above AOR=13.17 (95%CI 2.67-65.03) and drinking alcohol AOR=0.03(95% CI 0.002-0.475). Likewise, being grade 9 and above AOR=6.92 (95% CI 1.75-27.4) and having chronic cough AOR=0.23 (95% CI 0.06-0.92) were predictor variables for having TB screening among HIV patients. CONCLUSION The levels of TB-HIV linkages and testing are high. Moreover, educational status is a strong predictor of TB screening among HIV patients and HIV testing among TB cases. The regional health bureau has to continue supporting its TB and HIV case teams in every health facility.
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What is needed now for successful scale-up of screening? PAPILLOMAVIRUS RESEARCH 2019; 7:173-175. [PMID: 31002883 PMCID: PMC6477512 DOI: 10.1016/j.pvr.2019.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 01/20/2023]
Abstract
Effective screening for pre-cancerous lesions of the cervix is the only protective intervention that can be offered to women that have not had the opportunity to be vaccinated. Elimination goals are being developed so that by 2030, 70% of women aged 35–45 years should have been screened at least once in a lifetime and 90% of all detected lesions should have been treated. These goals focus on a substantial reduction of cervical cancer burden in low- and middle-income countries (LMICs). Scaling-up screening in these settings may be substantially improved by using self-sampling (SS), human papillomavirus (HPV) testing, and managing screened-positive women with accessible treatment. The implementation of these tools requires minimal health information data for traceability, provider training, community education, operational management and quality control. Cost-effective algorithms tailored to country needs can greatly impact the burden of disease in a limited number of years.
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Community based distribution of oral HIV self-testing kits in Zambia: a cluster-randomised trial nested in four HPTN 071 (PopART) intervention communities. Lancet HIV 2019; 6:e81-e92. [PMID: 30584047 PMCID: PMC6361868 DOI: 10.1016/s2352-3018(18)30258-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The HPTN 071 (PopART) cluster-randomised trial provided door-to-door HIV testing services to a large proportion of individuals residing in 21 intervention communities in Zambia and South Africa from 2014 to 2017 and reached the UNAIDS first 90 target among women in Zambia, yet gaps remained among men and young adults. This cluster-randomised study nested in the HPTN 071 (PopART) trial sought to increase knowledge of HIV status across all groups by offering the choice of oral HIV self-testing in addition to routine door-to-door HIV testing services. METHODS We nested this cluster-randomised trial in four HTPN 071 (PopART) intervention communities in northern Zambia. 66 zones (clusters) in these communities were randomly allocated (1:1) to either oral HIV self-testing plus routine door-to-door HIV testing services (HIV self-testing group) or the PopART standard of care of door-to-door HIV testing services alone (non- HIV self-testing group) over a 3-month period. All individuals aged 16 years or older were eligible for HIV testing. Randomisation was achieved by randomly selecting one allocation from a list of 10 000 possible allocations during a public ceremony. In HIV self-testing zones, trained lay-counsellors (known as community HIV care providers) visited households and offered eligible individuals the choice of HIV testing using HIV self-testing or routine door-to-door HIV testing services. For individuals aged 18 years or older whose partner was absent during the household visit, an HIV self-test kit could be left for secondary distribution to the absent partner. The primary outcome was knowledge of HIV status (defined as self-reporting HIV positive to the community HIV care providers or accepting an offer of HIV testing services). Outcomes were measured among households that were first visited, and individuals first enumerated as a household member during the HIV self-testing intervention period. We analysed data at the individual level using population-average logistic regression models, accounting for clustering of outcomes by zone, to estimate the effect of the intervention. This trial is registered with ClinicalTrials.gov, number NCT02994329. FINDINGS Between Feb 1, and April 30, 2017, the community HIV care providers enumerated 13 267 eligible individuals in the HIV self-testing group and 13 706 in the non-HIV self-testing group. After intervention implementation, 9027 (68%) of 13 267 in the HIV self-testing group had knowledge of HIV status compared with 8952 (65%) of 13 706 in the non-HIV self-testing group (adjusted odds ratio 1·30, 95% CI 1·03-1·65; p=0·03). The effect differed by sex (pinteraction=0·01). Among men, knowledge of HIV status was higher in the HIV self-testing group than in the non-HIV self-testing group (3843 [60%] of 6368 vs 3571 [55%] of 6486; adjusted odds ratio 1·31, 95% CI 1·07-1·60; p=0·01). There was no evidence of a between-group difference among female participants. INTERPRETATION Providing a choice of HIV self-testing during delivery of door-to-door HIV testing services increased knowledge of HIV status, driven by an effect among men. Lay counsellors have a vital role to play in adapting HIV self-testing interventions to local context. FUNDING The International Initiative for Impact Evaluation (3ie), the Bill & Melinda Gates Foundation, National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, National Institute of Mental Health, and the President's Emergency Plan for AIDS Relief.
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[The contribution of an asthma diagnostic consultation service in obtaining an accurate asthma diagnosis for primary care patients: results of a real-life study]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2018; 162:D2424. [PMID: 30040269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Previous studies showed that general practitioners (GPs) have problems in diagnosing asthma accurately, resulting in both under and overdiagnosis. To support GPs in their diagnostic process an asthma diagnostic consultation service (ADCS) was set up. DESIGN We evaluated the performance of this ADCS by analysing the (dis)concordance between the GPs working hypotheses and the ADCS diagnoses and possible consequences this had on the patients' pharmacotherapy. METHOD In total 659 patients were included in this study. At this service the patients' medical history was taken and a physical examination and a histamine challenge test were carried out. We compared the GPs working hypotheses with the ADCS diagnoses and the change in medication this incurred. RESULTS In 52% (n = 340) an asthma diagnosis was excluded. The diagnosis was confirmed in 42% (n = 275). Furthermore, chronic rhinitis was diagnosed in 40% (n = 261) of the patients whereas this was noted in 25% (n = 163) by their GP. The adjusted diagnosis resulted in a change of medication for more than half of all patients. In 10% (n = 63) medication was started because of a new asthma diagnosis. The 'one-stop-shop' principle was met with 53% of patients and 91% (n = 599) were referred back to their GP, mostly within 6 months. Only 6% (n = 41) remained under control of the ADCS because of severe unstable asthma. CONCLUSION In conclusion, the ADCS helped GPs significantly in setting accurate diagnoses for their patients with an asthma hypothesis. This may contribute to diminish the problem of over and underdiagnosis and may result in more appropriate treatment regimens.
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The strategic defense of physician autonomy: State public health agencies as countervailing powers. Soc Sci Med 2017; 186:113-121. [PMID: 28622609 PMCID: PMC5531602 DOI: 10.1016/j.socscimed.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
Advances in genetic testing and the aggressive marketing of genetic tests by commercial diagnostic laboratories have driven both consumer demand and the need for unbiased information about how tests should guide healthcare delivery. This paper uses the countervailing powers framework to explore the role of state public health agencies as arbiters of quality and safety, specifically through their efforts to encourage physicians to follow evidence-based recommendations for screening for hereditary cancers. Social scientists have often viewed actions by the state to regulate cost, quality, or safety as a threat to physician autonomy. This paper draws on case studies from two US states-Michigan and Connecticut-to better understand the specific role of state public health agencies, and especially whether their activities to encourage adherence to evidence-based recommendations bolster or subvert the interests of other parties in the healthcare arena. We find that lacking authority to compel provider to follow evidence-based recommendations, they improvised ways to foster compliance voluntarily, for example, by emphasizing the role of the physician as gatekeeper, thus affirming the importance of physician autonomy and clinical judgment. Both states also used public health surveillance data to make rare diseases visible and illustrate gaps between recommendations and practice. Finally, they both showed that following evidence-based recommendations could align the professional and market interests of healthcare stakeholders. Both states employed similar strategies with similar effects, despite substantial differences in the regulatory climate and organizational capacity. Taken as a whole, their activities orchestrated a countervailing response that checked the profit-seeking motives of commercial laboratories. Our findings demonstrate that rather than eroding physician autonomy, state action to monitor healthcare quality and encourage adherence to evidence-based recommendations can actually reinforce physician authority.
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A roadmap for the implementation of mHealth innovations for image-based diagnostic support in clinical and public-health settings: a focus on front-line health workers and health-system organizations. Glob Health Action 2017; 10:1340254. [PMID: 28838310 PMCID: PMC5645694 DOI: 10.1080/16549716.2017.1340254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/06/2017] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Diagnostic support for clinicians is a domain of application of mHealth technologies with a slow uptake despite promising opportunities, such as image-based clinical support. The absence of a roadmap for the adoption and implementation of these types of applications is a further obstacle. OBJECTIVES This article provides the groundwork for a roadmap to implement image-based support for clinicians, focusing on how to overcome potential barriers affecting front-line users, the health-care organization and the technical system. METHODS A consensual approach was used during a two-day roundtable meeting gathering a convenience sample of stakeholders (n = 50) from clinical, research, policymaking and business fields and from different countries. A series of sessions was held including small group discussions followed by reports to the plenary. Session moderators synthesized the reports in a number of theme-specific strategies that were presented to the participants again at the end of the meeting for them to determine their individual priority. RESULTS There were four to seven strategies derived from the thematic sessions. Once reviewed and prioritized by the participants some received greater priorities than others. As an example, of the seven strategies related to the front-line users, three received greater priority: the need for any system to significantly add value to the users; the usability of mHealth apps; and the goodness-of-fit into the work flow. Further, three aspects cut across the themes: ease of integration of the mHealth applications; solid ICT infrastructure and support network; and interoperability. CONCLUSIONS Research and development in image-based diagnostic pave the way to making health care more accessible and more equitable. The successful implementation of those solutions will necessitate a seamless introduction into routines, adequate technical support and significant added value.
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Abstract
We developed a teleradiology system linking a general hospital on Sado Island to tertiary care hospitals in Niigata City. The island is 40 km from Niigata City on the mainland and has only one diagnostic radiologist (for 72,000 islanders). Fibre optic cables between Sado Island and Niigata City were used for transmission. The introduction of the teleradiology system facilitated diagnostic and therapeutic consultation with specialists in Niigata City. The performance of the system was evaluated (on a scale of 0–6, with higher scores indicating better performance) by five diagnostic radiologists, who rated 32 features of the system twice, once in April 2002 and once in September 2003. The performance ratings improved from 1.38 to 2.86. While many of the initial problems with the software had been resolved, many still remained.
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An evaluation of primary care led dementia diagnostic services in Bristol. BMC Health Serv Res 2014; 14:592. [PMID: 25432385 PMCID: PMC4264325 DOI: 10.1186/s12913-014-0592-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/10/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Typically people who go to see their GP with a memory problem will be initially assessed and those patients who seem to be at risk will be referred onto a memory clinic. The demographic forces mean that memory services will need to expand to meet demand. An alternative may be to expand the role of primary care in dementia diagnosis and care. The aim of this study was to contrast patient, family member and professional experience of primary and secondary (usual) care led memory services. METHODS A qualitative, participatory study. A topic guide was developed by the peer and professional panels. Data were collected through peer led interviews of people with dementia, their family members and health professionals. RESULTS Eleven (21%) of the 53 GP practices in Bristol offered primary care led dementia services. Three professional panels were held and were attended by 9 professionals; nine carers but no patients were involved in the three peer panels. These panels identified four main themes: GPs rarely make independent dementia diagnosis; GPs and memory nurses work together; patients and carers generally experience a high quality diagnostic service; an absence of post diagnostic support. Evidence relating to these themes was collected through a total of 46 participants took part; 23 (50%) in primary care and 23 (50%) in the memory service. CONCLUSIONS Patients and carers were generally satisfied with either primary or secondary care led approaches to dementia diagnosis. Their major concern, shared with many health care professionals, was a lack of post diagnostic support.
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New blood. FORTUNE 2014; 169:64-72. [PMID: 25181811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Innovation and efficiency. Diagnostic services: the bigger picture. THE HEALTH SERVICE JOURNAL 2014; 124:19-21. [PMID: 25029785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Standards changes for organizations providing diagnostic imaging services. JOINT COMMISSION PERSPECTIVES. JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS 2014; 34:5-19. [PMID: 24716325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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[The methodic approaches to calculation of potential relevance of clinical diagnostic technologies]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2013:39-42. [PMID: 24432580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The article presents the calculation of potential relevance of clinical diagnostic technologies for population of Novosibirsk oblast relating to leading nosology forms of diseases on the basis of the results of diagnostic of population pathology using different techniques in the regional diagnostic center.
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[The development of activity of supporting curative diagnostic service]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2013:37-39. [PMID: 24027846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The article presents the role and significance of retrospective analysis of volumes of consumption of various types of diagnostic services to develop the activity of supportive curative diagnostic service.
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Where have young men been screened for STIs? Sex Transm Infect 2012; 89:107. [PMID: 23241966 DOI: 10.1136/sextrans-2012-050902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Undetected rheumatic heart disease revealed using portable echocardiography in a population of school students in Tairawhiti, New Zealand. THE NEW ZEALAND MEDICAL JOURNAL 2012; 125:53-64. [PMID: 23159902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this programme was to find undetected rheumatic heart disease (RHD) in students from selected schools in the Tairawhiti region (eastern part of the North Island) of New Zealand. METHOD Portable echocardiography was used to scan students in 5 urban and rural schools in Tairawhiti where the population is predominantly Maori. The age range of students in the urban schools was 10-13 years and in the rural schools 5-17 years. Those with abnormal echocardiograms were referred for a paediatric consultation, with hospital-based echocardiography if required for the clarification of diagnoses and further management. RESULTS A total of 685 students, representing over 95% of the schools' students, consented to having echocardiographic scanning. After repeat hospital based echocardiography for 11 students, a total of 52 scans were regarded as abnormal. In this population definite (n=4) or probable (n=7) RHD was found in 11 students a prevalence of 1.61% (95%CIs 0.80-2.85). Possible RHD was found in 19 students. Previously undetected confirmed (n=1) or probable (n=7) RHD was found in 8 students a prevalence of 1.17% (95%CIs 0.51-2.29). Congenital heart defects (CHD) were found in 22 students a prevalence of 3.21% (95%CIs 2.02-4.83). CONCLUSION Echocardiography was a popular modality and detected a significant burden of previously unknown RHD in this young Maori population who are now receiving penicillin. However, echocardiography detected a greater prevalence of possible RHD for which optimum management is at present uncertain. Echocardiography also detected students with a range of severity of CHD. Screening with echocardiography for RHD would involve a significant use of public health, paediatric and cardiac resources with 7.6% of students and their families requiring clinical consultations and ongoing management of the abnormal echocardiographic results.
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Profile: NIH's disease detectives. Lancet 2012; 380:718. [PMID: 22928189 DOI: 10.1016/s0140-6736(12)61392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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[The reserves for development of counseling diagnostic care in public health system]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2012:32-37. [PMID: 22880248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article analyses the social aspects and reserves for development of counseling diagnostic care in public health system exemplified by the state Novosibirsk oblast clinical diagnostic center. The ultimate result of the ocganization of system of diagnostic centers is to establish conditions for early, including preclinical diagnostic of wide-spread social hazardous diseases, in particular those which result in early disability of population. Yet another result is an effective overcoming of deficiency of qualitative highly informative counseling diagnostic care on the level of national public health systemn. It is demonstrated that the modernization within the framework of profitable activities is one of the most significant organizational technological reserves to increase the accessibility, timeliness and effectiveness of counseling diagnostic care (exemplified by oncologic pathology) and to optimize functionimg of regional counseling diagnostic centers. The results of analysis of patients' sociologic survey objectively testify the positive dynamics in patients' satisfaction of medical care.
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[On the issues of functioning of the clinic of research institute of balneology]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2012:37-40. [PMID: 22880249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article presents the results of analysis of effectiveness of application of main resources in organizing and quality supporting of medical diagnostic care to patients in the clinic of research institute of balneology profile. The result data points out the insufficient effectiveness of application of these resources; the defects in organization and quality of curative diagnostic and rehabilitation care. They determine the priority directions of enhancement of functioning of the institution being a clinical base of research institute of balneology.
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27
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[An external respiratory failure classification: scientific rationale for its clinical use]. TERAPEVT ARKH 2012; 84:115-119. [PMID: 23480002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The paper presents an external respiratory failure (ERF) classification, a scientific rationale for its use in the clinical practice of departments of different profiles. The setting up of interclinical functional diagnostic laboratories and preventive health care facilities for the preclinical diagnosis of ERF is substantiated. The introduction of the classification of ERF into wide clinical practice is intended to form a social order for the design and purchase of diagnostic equipment for therapeutic-and-prophylactic institutions and to stimulate researches in clinical respiratory physiology, and to improve physicians' knowledge of this section of clinical science.
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28
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PACS re-envisioned. HEALTH MANAGEMENT TECHNOLOGY 2011; 32:26. [PMID: 22141246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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29
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Seven ways to streamline radiology. HEALTH DATA MANAGEMENT 2011; 19:33-38. [PMID: 22145262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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30
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Abstract
The acceptability of couples-based voluntary HIV counseling and testing (CVCT) has not been previously investigated among men who have sex with men (MSM) in South Africa. Using online advertisements, data were collected from 486 MSM, who were 18 years of age or older with a current residence in South Africa and had at least one male sex partner in the previous 12 months. The analysis examined associations between individual characteristics and willingness to utilize CVCT services. The willingness to utilize CVCT services was compellingly high (89%) among this sample of mostly White/European African (89%) and HIV-negative (83%) men. MSM who reported higher numbers of completed school years were less likely to report willingness to use CVCT. Willingness did not vary significantly across other individual demographic or behavioral characteristics. Our results show an overwhelmingly high acceptance of CVCT services. Future studies should survey a more heterogeneous population of MSM, explore the complex nature of same-sex male relationships, and why respondents would or would not use these HIV testing services.
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31
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[The actual issues of regional diagnostic service and main directions of its development]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2011:29-30. [PMID: 22279809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The article deals with main issues of regional diagnostic service functioning in actual conditions. The focus is made on the need of development of forms of organization of diagnostic service. The strategy of its reorganization on the regional level is proposed. The positive outcomes achieved in some regions after these proposal were applied is discussed.
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32
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[The social hygienic significance of the consultative diagnostic care]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2011:3-5. [PMID: 22279799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
To determine the potential need in medical technologies based on Novosibirsk regional clinical diagnostic center data, the social hygienic evaluation of the population pathology detection during medical consulting care was organized. It is established that the detection of diseases of thyroid gland, bronchial asthma, hypertension, urolithiasis, duodenal ulcer chronic hepatitis, hepatocirrhosis, and allergic rhinitis is the most important issue in the social hygienic evaluation of prevalence of pathologic affection.
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[The effectiveness of implementation of medical equipment and labor efficiency as major criteria in the assessment of functioning of curative preventive institution]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2011:49-53. [PMID: 22279817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The analysis of functioning of Novosibirsk regional clinical diagnostic center demonstrated that the development and enhancement of labor efficiency, accessibility and quality of consulting diagnostic process and total medical care to oblast population needs to follow several directions. These are adequate organizational managerial activities, integral methodological approach to modernization of structural units functioning, rationale planning, standardization and control of quality, modernization and optimization of actual material technique base and resources implementation, elaboration of optimal model of interaction with regional curative preventive organizations. On the basis of evidential operative data it is proved that the integral evaluation of the activities of curative preventive organizations, polyclinics for instance, has to include such overall criteria of consulting diagnostic process as effectiveness of using medical equipment and labor efficiency of personnel.
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[Detection of temporomandibular joint diseases in elderly and senile age in ambulatory medicoprophylactic institutions]. ADVANCES IN GERONTOLOGY = USPEKHI GERONTOLOGII 2011; 24:692-696. [PMID: 22550881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The research analyzes diagnostic TMJ's disease's identification work of stomalogists owned to different types of day care properties (municipal, departmental, private). This research based on examination of primary medical records of 1906 patients aged 61 to 89 years, including 2978 prescribing lists made by stomatologists - orthopedists to dental outpatient's card. This research shows that in case of outpatient conditions in the primary examination of patients of elderly and senile age stomatologists pay attention to joint pathology in the presence of acute patients' complaints, caused by TMJ's displacement, arthritis, painful TMJ's dysfunction or pronounced sound phenomena of TMJ. Stomatologists examine TMJ's pathology more particularly. The TMJ's pathology complicates the tooth replacement made to patients contrary to absence of indications of disease presence in primary medical records. The prepared conclusion and recommendations allow improving the outpatient diagnosis of TMJ's pathology.
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Esposito leads Phadia's allergy-testing team. MLO: MEDICAL LABORATORY OBSERVER 2010; 42:52. [PMID: 21090059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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36
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[The issues of organization of consultative diagnostic care to population in the subject of the Russian Federation]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2010:39-42. [PMID: 20973128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The article deals with the basic issues of state of regional health system. The issues of resource supply of diagnostic service in the regions and technical conditions of diagnostic technologies are discussed. The attention is focused on the need to develop the organization of diagnostic care to population. The essential approaches to its organization on the regional level are proposed.
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37
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[The provision of quality and security of medical care on the basis of standardization of medical nurse activities in counseling diagnostic center]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2010:32-34. [PMID: 20967968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The enhancement of curative diagnostic process and the increase of its quality depend not only on the management, but on the reasonable implementation of high-tech new technologies. Nowadays, the evidence-based medical nursing practice represents an actively developing direction of medical nurse business. The State Novosibirsk oblast diagnostic center has developed the standards of nurse activities targeted to decrease the duplication in work, the provision of personnel and patient security. The audit of implementation of standards and the monitoring of nursing process permit to timely input the adjustments to the provision of quality of medical nurse care.
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38
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Evaluating innovations in the delivery and organization of endoscopy services in England and Wales. QUALITATIVE HEALTH RESEARCH 2010; 20:922-930. [PMID: 19959823 DOI: 10.1177/1049732309354282] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article presents four focus groups conducted with health professionals, part of a mixed-method evaluation of modernization of endoscopy services in England catalyzed by the UK National Health Service Modernisation Agency. Transcripts were analyzed adapting van Manen's "sententious" or "wholistic" approach to thematic analysis. Seven analysts worked to distil lengthy transcripts into summative paragraphs to capture the essentiality of text. Five major themes emerged: lack of senior management understanding and appropriate management systems, inadequate resources, loss of personal autonomy and erosion of professionalism, barriers and facilitators to change, and differences between English and Welsh units-the Welsh perspective. Achieving long-lasting, positive effects of modernization within complex systems demands senior management to actively support innovations, consider staff morale, and provide appropriate levels of funding. However, although professional morale was low, ambition to improve services was strong. The methodological framework offered a comprehensive and applicable approach to data analysis, and our analysis approach was inclusive and collaborative, with far-reaching possibilities for experimental studies and large-scale, mixed-method studies, including trials.
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Abstract
BACKGROUND The low uptake of HIV voluntary counseling and testing (VCT), an effective HIV prevention intervention, has hindered global attempts to prevent new HIV infections, as well as limiting the scale-up of HIV care and treatment for the estimated 38 million infected persons. According to UNAIDS, only 10% of HIV-infected individuals worldwide are aware of their HIV status. At this point in the HIV epidemic, a renewed focus has shifted to prevention, and with it, a focus on methods to increase the uptake of HIV VCT. This review discusses home-based HIV VCT delivery models, which, given the low uptake of facility-based testing models, may be an effective avenue to get more patients on treatment and prevent new infections. OBJECTIVES (1) To identify and critically appraise studies addressing the implementation of home-based HIV voluntary counseling and testing in developing countries. (2) To determine whether home-based HIV voluntary counseling and testing (HBVCT) is associated with improvement in HIV testing outcomes compared to facility-based models. SEARCH STRATEGY We searched online for published and unpublished studies in MEDLINE (February 2007), EMBASE (February 2007), CENTRAL (February 2007). We also searched databases listing conference proceedings and abstracts; AIDSearch (February 2007), The Cochrane Library (Issue 2, 2007), LILACS, CINAHL and Sociofile. We also contacted authors who have published on the subject of review. SELECTION CRITERIA We searched for randomized controlled trials (RCTs) and non-randomized trials (e.g., cohort, pre/post-intervention and other observational studies) comparing home-based HIV VCT against other testing models. DATA COLLECTION AND ANALYSIS We independently selected studies, assessed study quality and extracted data. We expressed findings as odds ratios (OR), and relative Risk (RR) together with their 95% confidence intervals (CI). MAIN RESULTS We identified one cluster-randomized trial and one pre/post-intervention (cohort) study, which were included in the review. An additional two ongoing RCTs were identified. All identified studies were conducted in developing countries. The two included studies comprised one cluster-randomized trial conducted in an urban area in Lusaka, Zambia and one pre/post-intervention (cohort) study, part of a rural community cohort in Southwestern Uganda. The two studies, while differing in methodology, found very high acceptability and uptake of VCT when testing and or results were offered at home, compared to the standard (facility-based testing and results). In the cluster-randomized trial (n=849), subjects randomized to an optional testing location (including home-based testing) were 4.6 times more likely to accept VCT than those in the facility arm (RR 4.6, 95% CI 3.6-6.2). Similarly, in the pre/post study (n=1868) offering participants the option of home delivery of results increased VCT uptake. In the intervention year (home delivery) participants were 5.23 times more likely to receive their results than during the year when results were available only at the facility. (OR 5.23 95% CI 4.02-6.8). AUTHORS' CONCLUSIONS Home-based testing and/or delivery of HIV test results at home, rather than in clinics, appears to lead to higher uptake in testing. However, given the limited extant literature and the limitations in the included existing studies, there is not sufficient evidence to recommend large-scale implementation of the home-based testing model.
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[The functional methods of examination and consultative care at diagnostic centers]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2010:45-47. [PMID: 20499695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
On the basis of working materials of the Novosibirsk regional consultative and diagnostic center, the prognostic significance of functional diagnosis methods and consultative care was demonstrated. It was found that methods of echocardiography are important in forecasting the prevalence of ischemic heart disease, arterial hypertension, congenital and acquired valvular disease. The consultative care acquires significance in detecting diseases of the thyroid gland, bronchial asthma, hypertonic disease, urolithic disease, duodenal ulcer, chronic hepatitis and cirrhosis of the liver, allergic rhinitis.
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41
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[The diagnostic services in the Omsk medical health care institutions]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2009:51-53. [PMID: 19385082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The analysis of the medical diagnostic services status in the city of Omsk is presented based on the study of the opinions of the medical specialists from various municipal medical health care institutions. The research results validity is proved by the implementation of the fitting criterion conjointly with its reliability evaluation.
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42
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[Assessment of the operation of local branches of radiodiagnosis of breast diseases in Russia (2002-2008)]. VOPROSY ONKOLOGII 2009; 55:501-511. [PMID: 19947381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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44
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45
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[The experience of monitoring of the implementation of the priority national project "health" in municipal polyclinic]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2008:25-28. [PMID: 19004218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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46
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Patient satisfaction. Hospitals tap into a niche market: executive health. HOSPITALS & HEALTH NETWORKS 2008; 82:10. [PMID: 18714691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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47
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Moving pictures: case history. A Minnesota imaging company upgrades its RIS and PACS for streamlined workflows that facilitate sustained growth. HEALTH MANAGEMENT TECHNOLOGY 2008; 29:18-20. [PMID: 18524161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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48
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Fully functional MR-compatible flexible operating table resolves the neurosurgeon's dilemma over use of intraoperative MRI. THE TOKAI JOURNAL OF EXPERIMENTAL AND CLINICAL MEDICINE 2008; 33:57-60. [PMID: 21318967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 02/27/2008] [Indexed: 05/30/2023]
Abstract
In February 2006, our hospital officially opened the Magnetic Resonance / X-ray / operation (MRXO) suite, which is the first hybrid neurosurgical procedure suite to combine magnetic resonance imaging (MRI), computed tomography and angiography with a neurosurgical operating room. For this suite, we have developed a specially designed fully functional magnetic resonance (MR)-compatible flexible operating table. Here, we describe the details of this operating table and discuss its advantages. Its MR-compatible tabletop can be bent during surgery. The specially designed MR-compatible flexible operating table for the MRXO suite reduces limitations on neurosurgeons during standard neurosurgical procedures. Also, it does not give rise to imaging artifacts on MRI. The specially designed MR-compatible flexible operating table resolves the neurosurgeon's dilemma over use of intraoperative MRI.
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Collection, banking and diagnostic archiving of tissues. Pathologica 2008; 100:49-54. [PMID: 18792520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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50
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Creating a mutually beneficial approach to CBD project. MLO: MEDICAL LABORATORY OBSERVER 2008; 40:63. [PMID: 18429555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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