scholarly journals Can unsuccessful treatment in primary medical institutions influence patients’ choice? A retrospective cluster sample study from China

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022304 ◽  
Author(s):  
Yadong Niu ◽  
Liang Zhang ◽  
Ting Ye ◽  
Yan Yan ◽  
Yan Zhang
Keyword(s):  
Rural China ◽  
Exact Matching ◽  
Cluster Sample ◽  
Unsuccessful Treatment ◽  
Medical Institutions ◽  
Registration Number ◽  
Potential Risks ◽  
Township Hospitals ◽  
High Level ◽  
Study Setting

ObjectiveChina has been attempting to control the patients’ choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered poor. We aim to analyse whether unsuccessful treatment in primary medical institutions can lead to the patients’ choice of high-level medical institutions.DesignA retrospective cluster sample study.SettingThe study setting was in Macheng city, Hubei province.ParticipantsThe respondents are township–county (TC) patients (patients who first went to township hospitals and then county hospitals within 30 days for the same disease) who experienced unsuccessful treatment in primary medical institutions. A total of 2090 TC patients were screened out based on the New Rural Cooperative Medical System database in 2013.Main outcome measuresThe choice of patients between township hospitals (primary medical institutions) and county hospitals was observed. We compared TC patients’ ratio of choosing county hospitals (RoCC) before TC experience with after TC experience. Thereafter, we compared RoCC of TC patients and non-TC patients (patients who did not experience TC) based on coarsened exact matching.ResultsThe ratio of TC for outpatient in township hospitals is 0.68% and that of TC for inpatient in township hospitals is 3.37%. RoCC for TC disease increased from 20.8% to 35.5% (p<0.001), RoCC for other disease increased from 35% to 37.3% (p=0.01). TC patients had significantly higher RoCC than non-TC patients (p<0.001).ConclusionsPatients’ choice of high-level medical institutions is highly associated with the experience of unsuccessful treatment in primary medical institutions. Moreover, people likely select high-level medical institutions thereafter regardless of conditions in rural China. Unsuccessful treatment in primary medical institutions is inevitable for patients. Thus, additional measures should be considered in lowering the potential risks for patients when treatments fail.Trial registration numberChiCTR-OOR-14005563.

scholarly journals Comparison of Inpatient Distribution among Different Medical Alliances in County Region: a Longitudinal Study on a healthcare reform in Rural China

2020 ◽  
Author(s):  
Yifan Ran ◽  
Hongxia Gao ◽  
Dan Han ◽  
Guilin Hou ◽  
Yingchun Chen ◽  
...  
Keyword(s):  
Health Inequality ◽  
Rural Areas ◽  
Rural China ◽  
Interrupted Time Series ◽  
T Test ◽  
Interrupted Time Series Analysis ◽  
Medical Institutions ◽  
Reform Period ◽  
Different Types ◽  
Township Hospitals

Abstract Background: China has launched the medical alliances (MAs) reform to drive the development of primary medical institutions and decrease health inequality in rural areas. Three different types of MAs were built to promote township hospitals in Y County. This study aims to evaluate the actual effect of China’s MAs reform in rural areas on inpatient distribution especially amongst different types of MAs.Methods：We obtain 2008–2015 claims data from the New Cooperative Medical Scheme (NCMS) in Y County, Hubei Province of China. We consider January 2008–December 2010 as the pre-reform period and January 2011–December 2015 as the post-reform period. We use independent sample t-test and single-group interrupted time series analysis (ITSA) to compare the number of inpatients per month in the three MAs, including three county and 10 township hospitals before and after the reform. We use paired t-test and multiple-group ITSA between seven township hospitals within MAs and seven township hospitals outside MAs.Results：The MAs reform in Y County increased the number of inpatients in county and township hospitals within MAs. After the reform, the number of inpatients per month in county hospitals had an upward trend, with a slope of 31.01 person/month (P < 0.000). Approximately 19.99 new inpatients were admitted to township hospitals monthly after the reform (P < 0.000). Furthermore, township hospitals within MAs had a substantial increase in the number of inpatients (10.45 new inpatients monthly) compared with those outside MAs. Conclusion: The MAs reform in Y County significantly improved the capability of medical institutions within MAs. After the reform, township hospitals within MAs had greater development advantages than those outside MAs. However, it also caused further imbalance in the county region, which contained the new health inequality risk.

Determinants of Abuse of the Bodies of the Dead

2019 ◽  
pp. 71-77
Author(s):  
Margarita Khomyakova
Keyword(s):  
Low Income ◽  
Criminal Code ◽  
Value Judgments ◽  
Legal Norms ◽  
Low Level ◽  
Medical Institutions ◽  
Specific Object ◽  
The Subject ◽  
The Dead ◽  
High Level

The author analyzes definitions of the concepts of determinants of crime given by various scientists and offers her definition. In this study, determinants of crime are understood as a set of its causes, the circumstances that contribute committing them, as well as the dynamics of crime. It is noted that the Russian legislator in Article 244 of the Criminal Code defines the object of this criminal assault as public morality. Despite the use of evaluative concepts both in the disposition of this norm and in determining the specific object of a given crime, the position of criminologists is unequivocal: crimes of this kind are immoral and are in irreconcilable conflict with generally accepted moral and legal norms. In the paper, some views are considered with regard to making value judgments which could hardly apply to legal norms. According to the author, the reasons for abuse of the bodies of the dead include economic problems of the subject of a crime, a low level of culture and legal awareness; this list is not exhaustive. The main circumstances that contribute committing abuse of the bodies of the dead and their burial places are the following: low income and unemployment, low level of criminological prevention, poor maintenance and protection of medical institutions and cemeteries due to underperformance of state and municipal bodies. The list of circumstances is also open-ended. Due to some factors, including a high level of latency, it is not possible to reflect the dynamics of such crimes objectively. At the same time, identification of the determinants of abuse of the bodies of the dead will reduce the number of such crimes.

O-202 Usage of laser during trophectoderm biopsy and its affect on PGT-A results and moscaism

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
H K Yelke ◽  
Y. Kumtepe Colakoglu ◽  
B Yuksel ◽  
M Cetinkaya ◽  
S Kahraman
Keyword(s):  
Cell Damage ◽  
Laser Pulses ◽  
Cell Junctions ◽  
Chromosomal Mosaicism ◽  
Trophectoderm Biopsy ◽  
Excessive Heat ◽  
Contact Points ◽  
Registration Number ◽  
Minimum Number ◽  
High Level

Abstract Study question Does laser use during trophectoderm biopsy affect biopsy results on prehatching embryos with regard to mosaicism ? Summary answer According to our findings laser usage during trophectoderm biopsy increases mosaic results on next generation sequencing (NGS) irrespective of embryo quality. What is known already Chromosomal mosaicism, which is a result of mitotic errors after fertilization, is defined as the presence of karyotypically distinct cell lines within an embryo. The introduction of NGS made it possible to detect chromosomal mosaicism at levels as low as 20%. The incidence of mosaicism is highly variable between clinics which reported the incidences between 4-32%. Apart from the biological reasons, there are also various technical factors that may impact the incidence of mosaicism. One of the most emphasized factors is the trophoectoderm biopsy technique. Laser usage and number of laser pulses may cause excessive heat during the procedure Study design, size, duration The mosaicism ratio in embryos in which trophectoderm biopsy was performed with or without laser, between January 2017 December 2020 in Istanbul Memorial Hospital (IMH) were examined retrospectively. A total of 13002 embryos were analyzed. A subgroup analysis was also performed regarding mosaicism ratios in different embryo qualities. Blastocysts were classified according to Gardner’s classification and classified as follows: top quality-TQ (4AA,5AA,6AA), good quality-GQ (3AA, 4,5,6AB,BA) and moderate quality-MQ (3,4,5 BB). Participants/materials, setting, methods The biopsy samples of the cases who had PGT-A in IMH between 2017-2020 were evaluated by NGS method. This method enables the identification of embryos with 20% to 80% mosaicism. The study assessed whether there was an increase in the embryos with mosaic results due to the use of laser during biopsy. The effects of laser use among the TQ (4AA,5AA,6AA), GQ (3AA, 4,5,6AB,BA) and MQ (3,4,5 BB) groups according to Garder classification were analyzed. Main results and the role of chance Trophectoderm biopsy was applied on 13002 embryos within the specified period. During biopsy in 5088 embryos laser was used and in 7843 embryos laser was not used, and biopsy was performed mechanically (flicking method). After observing the biopsy results, 945/5088 (18.5%) of the laser applied embryos; and 1087/7914 (13.7%) of laser not applied embryos were defined as mosaic(p &lt; 0.0001). When mosaicism rates were examined according to embryo qualities, the rate of mosaicism was 19.3%(469/2430), 18.2%(290/1591) and 13.2%( 380/2875), 13.5 (426/3141) respectively in embryos with and without laser in TQ and GQ groups. A statistically high level of significance (p &lt; 0.0001) was observed between the embryos evaluated as top quality and good quality before biopsy. Regarding the evaluation in the moderate group embryos, although the mosaicism rates tended to increase on the laser applied group side 40/248(16.1%), no statistical difference was observed when compared to non-laser group 103/670(15,4%). (P &gt; 0.05) Limitations, reasons for caution The retrospective nature of the data is the main limitation of the study. On the other hand, the large number of NGS based PGT-A tested TQ and GQ embryos from a single center and resuts from single laboratory. However, further studies are required to corroborate our findings. Wider implications of the findings Laser dependent heat effect may increase mosaicism. To reduce the cell damage, teasing of cells should be avoided and a minimum number of laser pulses should be used in order to avoid excessive heat and contact points should be preferably confined to cell junctions Trial registration number None

scholarly journals An Optimization Algorithm for Computer-Aided Diagnosis of Breast Cancer Based on Support Vector Machine

2021 ◽  
Vol 9 ◽  
Author(s):  
Yifeng Dou ◽  
Wentao Meng
Keyword(s):  
Breast Cancer ◽  
Support Vector Machine ◽  
Optimization Algorithm ◽  
Breast Cancer Diagnosis ◽  
Support Vector ◽  
Medical Institutions ◽  
High Level ◽  
Aided Diagnosis ◽  
Very High ◽  
Important Branch

As one of the most vulnerable cancers of women, the incidence rate of breast cancer in China is increasing at an annual rate of 3%, and the incidence is younger. Therefore, it is necessary to conduct research on the risk of breast cancer, including the cause of disease and the prediction of breast cancer risk based on historical data. Data based statistical learning is an important branch of modern computational intelligence technology. Using machine learning method to predict and judge unknown data provides a new idea for breast cancer diagnosis. In this paper, an improved optimization algorithm (GSP_SVM) is proposed by combining genetic algorithm, particle swarm optimization and simulated annealing with support vector machine algorithm. The results show that the classification accuracy, MCC, AUC and other indicators have reached a very high level. By comparing with other optimization algorithms, it can be seen that this method can provide effective support for decision-making of breast cancer auxiliary diagnosis, thus significantly improving the diagnosis efficiency of medical institutions. Finally, this paper also preliminarily explores the effect of applying this algorithm in detecting and classifying breast cancer in different periods, and discusses the application of this algorithm to multiple classifications by comparing it with other algorithms.

Organizational culture and socio-psychological age of female personnel of medical institutions

2020 ◽  
Author(s):  
I. S. Leonova ◽  
L. N. Zakharova ◽  
A. I. Makhalin
Keyword(s):  
Organizational Culture ◽  
Empirical Study ◽  
Hierarchical Model ◽  
Gender Stereotypes ◽  
Market Development ◽  
Chronological Age ◽  
Work Process ◽  
Successful Management ◽  
Medical Institutions ◽  
High Level

The results of an empirical study of the socio-psychological age of female doctors of clinics that have successfully entered into the innovative format of development and clinics experiencing many years of difficulty in introducing innovations are presented. It is shown that the organizational culture of innovative clinics is characterized by a pronounced adhocratic component, and a clan-hierarchical model dominates in problematic clinics, therefore, the introduction of innovations is carried out by inconsistent administrative methods typical of this model. As a result, the personnel experiences a high level of stress, which makes them feel unwell, tired, it rejects innovations and strives to maximize the clan component of the organizational culture as a means of protection against the stress of innovative changes. The results are an «older» socio-psychological age and a low level of labour involvement, which, in general, shows the correspondence of the characteristics of the female personnel of problematic clinics to gender stereotypes. In innovative clinics, female personnel feel more alert, healthy and younger, shares, regardless of the chronological age, innovative values traditionally associated with younger ages, is personally involved in the work process and does not fall under the characteristics of gender stereotypes. It is shown that the socio-psychological age of female personnel and the value of readiness for innovation depend on the type of organizational culture. In the future, female doctors are oriented towards an innovative way of market development of their clinics, but not in the managerial paradigm that is currently being implemented by management. Successful management of the socio-psychological age and the introduction of innovation involve the abandonment of administrative methods, the prevention of the stress of organizational change and the establishment of innovative values as the basis of a new organizational culture.

scholarly journals Use of head camera-cued recall and debrief to externalise expertise: a systematic review of literature from multiple fields of practice

2018 ◽  
Vol 5 (3) ◽  
pp. 121-129
Author(s):  
Vivienne Isabella Blackhall ◽  
Kenneth Grant Walker ◽  
Iya Whiteley ◽  
Philip Wilson
Keyword(s):  
Decision Making ◽  
Visual Cues ◽  
Video Recording ◽  
Cognitive Activity ◽  
Cued Recall ◽  
Point Of View ◽  
Current Evidence ◽  
Training Tool ◽  
Registration Number ◽  
High Level

BackgroundThe study of decision making in complex naturalistic environments poses several challenges. In response to these, video-stimulated cued-recall-debrief was developed. It involves an individual wearing a head-mounted camera which records a task from their point of view. Afterwards, footage captured is reviewed along with a facilitated debrief to help externalise cognitive processes. In theory, motion, audio and visual cues generate a high level of experiential immersion which helps the expert to articulate previously hidden thoughts and actions.ObjectiveTo examine the current evidence for video-stimulated cued-recall-debrief as a means of explicating expert thoughts and feelings in complex tasks in a range of environments.Study selectionMEDLINE, EMBASE, Education Resources Information Center, SPORTDiscus, PsycINFO and Google Scholar were searched for articles containing the key terms ‘cued-recall (debrief)’, ‘decision making’, ‘skills’ and ‘video recording’. Studies were included if they examined the following outcomes: (1) feasibility, (2) extent of experiential immersion, (3) ability to generate unique insight into decision-making processes and (4) current applications. 1831 articles were identified initially, and 9 studies were included in the final review.FindingsVideo-stimulated cued-recall-debrief is associated with a high level of experiential immersion and generates between two and four times the number of recollections compared with free recall. It can be used to build models of cognitive activity and to characterise the way in which more and less skilled individuals tend to think and feel.ConclusionsThe technique could be used to explicate expertise within medicine: these insights into performance could be used as a training tool for other practitioners.Trial registration numberCRD42017057484.

scholarly journals A systematic review identifying common data items in neonatal trials and assessing their completeness in routinely recorded United Kingdom national neonatal data

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Sena Jawad ◽  
Neena Modi ◽  
A. Toby Prevost ◽  
Chris Gale
Keyword(s):  
Clinical Trials ◽  
United Kingdom ◽  
High Impact ◽  
Research Database ◽  
Electronic Patient Records ◽  
Registration Number ◽  
Recorded Data ◽  
Using Data ◽  
Common Items ◽  
High Level

Abstract Background We aimed to test whether a common set of key data items reported across high-impact neonatal clinical trials could be identified, and to quantify their completeness in routinely recorded United Kingdom neonatal data held in the National Neonatal Research Database (NNRD). Methods We systematically reviewed neonatal clinical trials published in four high-impact medical journals over 10 years (2006–2015) and extracted baseline characteristics, stratification items and potential confounders used to adjust primary outcomes. Completeness was examined using data held in the NNRD for identified data items, for infants admitted to neonatal units in 2015. The NNRD is a repository of routinely recorded data extracted from neonatal Electronic Patient Records (EPR) of all admissions to National Health Service (NHS) Neonatal Units in England, Wales and Scotland. We defined missing data as an empty field or an implausible value. We reported common data items as frequencies and percentages alongside percentages of completeness. Results We identified 44 studies involving 32,095 infants and 126 data items. Fourteen data items were reported by more than 20% of studies. Gestational age (95%), sex (93%) and birth weight (91%) were the most common baseline data items. The completeness of data in the NNRD was high for these data with greater than 90% completeness found for 9 of the 14 most common items. Conclusion High-impact neonatal clinical trials share common data items. In the United Kingdom, these items can be obtained at a high level of completeness from routinely recorded data held in the NNRD. The feasibility and efficiency using routinely recorded EPR data, such as that held in the NNRD, for clinical trials, rather than collecting these items anew, should be examined. Trial registration PROSPERO registration number CRD42016046138. Registered prospectively on 17 August 2016.

scholarly journals Can Primary Medical Institutions Lead to Worse Health Status for Patients with Noncommunicable Diseases Compared with High-Level Hospitals? A Follow-Up Observation Study in China

2019 ◽  
Vol 16 (8) ◽  
pp. 1336 ◽  
Author(s):  
Yadong Niu ◽  
Ting Ye ◽  
Yan Zhang ◽  
Liang Zhang
Keyword(s):  
Health Status ◽  
Healthcare System ◽  
Growth Curve ◽  
Primary Healthcare ◽  
Utility Score ◽  
Growth Curve Model ◽  
Observation Study ◽  
Medical Institutions ◽  
Curve Model ◽  
High Level

The weak primary healthcare system in China brings challenges to the national strategy of primary medical institutions providing general health needs for patients with non-communicable diseases (NCDs). It is necessary to explore the potential discrepancies in health status for patients with NCDs if they go to primary medical institutions rather than high-level hospitals. Data was obtained from Surveillance of Health-seeking Behavior in Hubei Province. Respondents were investigated six times to collect information on health service utilization and health-related quality of life (HRQoL). Ninety-two hypertension patients who went to medical institutions of the same level were included. HRQoL was measured by the Chinese version of EQ-5D-3L. A multilevel growth curve model was applied to analyze whether provider level could influence HRQoL. The utility score and visual analogue scale (VAS) of patients varied insignificantly over six months (p > 0.05). A growth curve model showed that comorbidity was the only factor significantly influencing utility score (p = 0.019). Time and comorbidity were the only influencing factors of VAS (p < 0.05). Our findings indicated that the level of healthcare provider had no significant impact on the health status of patients with NCDs. As such, this study concludes that the primary healthcare system in China is qualified to be the health gatekeeper for NCDs patients.

scholarly journals Canadian Urological Association position statement on the use of transvaginal mesh

2017 ◽  
Vol 11 (6S2) ◽  
pp. 105 ◽  
Author(s):  
Blayne Welk ◽  
Kevin V. Carlson ◽  
Richard J. Baverstock ◽  
Stephen S. Steele ◽  
Gregory G. Bailly ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Stress Incontinence ◽  
Position Statement ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Current Evidence ◽  
Prolapse Repair ◽  
Potential Risks ◽  
High Level

Stress incontinence (SUI) and pelvic organ prolapse (POP) are common conditions. There is high-level evidence that midurethral mesh slings for stress incontinence are effective and safe; however, the rare but serious potential risks of this surgery must be discussed with the patient. The use of transvaginal mesh for prolapse repair does not appear to be supported by the current evidence, and its use should be restricted to specialized pelvic floor surgeons and specific clinical situations.

scholarly journals A Neural Network Based Artificial Vision System for Licence Plate Recognition

1997 ◽  
Vol 08 (01) ◽  
pp. 113-126 ◽  
Author(s):  
Sorin Draghici
Keyword(s):  
Neural Network ◽  
Character Recognition ◽  
Vision System ◽  
High Reliability ◽  
Artificial Vision ◽  
Training Algorithms ◽  
Real World Data ◽  
Registration Number ◽  
Plate Location ◽  
High Level

This paper presents a neural network based artificial vision system able to analyze the image of a car given by a camera, locate the registration plate and recognize the registration number of the car. The paper describes in detail various practical problems encountered in implementing this particular application and the solution used to solve them. The main features of the system presented are: controlled stability-plasticity behavior, controlled reliability threshold, both off-line and on-line learning, self assessment of the output reliability and high reliability based on high level multiple feedback. The system has been designed using a modular approach. Sub-modules can be upgraded and/or substituted independently, thus making the system potentially suitable in a large variety of vision applications. The OCR engine was designed as an interchangeable plug-in module. This allows the user to choose an OCR engine which is suited to the particular application and to upgrade it easily in the future. At present, there are several versions of this OCR engine. One of them is based on a fully connected feedforward artificial neural network with sigmoidal activation functions. This network can be trained with various training algorithms such as error backpropagation. An alternative OCR engine is based on the constraint based decomposition (CBD) training architecture. The system has showed the following performances (on average) on real-world data: successful plate location and segmentation about 99%, successful character recognition about 98% and successful recognition of complete registration plates about 80%

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