Medical Division Research Articles

A Promising Generation: Future Academic Leadership of China.

With the world's largest population at 1.3 billion and a rising number of foreigners, China requires physicians and a healthcare system that meets the needs of a large and diverse population. Along with rapid economic and technological advancements, the Medical Administration Division of the National Health and Family Planning Commission remarked that medical services through online appointments and payments have improved its efficacy over the past 2 years. According to the official report from the National Health and Family Planning Commission of the People's Republic of China website, China has so far established a total of 25,000 hospitals and 981,000 community health centers, that includes 17,100 dermatologists and 190,000 residents in training.

Increasing Trend of Clinical Laboratory Testing at Gelephu Central Regional Referral Hospital, Bhutan

Bhutanese population have access to both traditional and modern medicine. The record published in Annual Health Bulletin (AHB), Ministry of Health (MoH) recorded the number of people seeking modern medicine has drastically escalated over the past few years. Gelephu based Central Regional Referral Hospital (CRRH), established in 1960’s, sees the second highest number of outpatient department OPD cases in the country. As a result the number of clinical laboratory testing has also increased over the time. The ratio of annual OPD attendance and annual laboratory test recorded at the medical record and AHB depicted at the ratio of 1:1 until 2013 and the ratio increased to 1:1.9 in 2017, significant at p<0.05. The annual total laboratory test increased from n=118567 in 2013 to n=234869 in 2017, with almost an increase by average of 2% annually. The increasing number of test order, increases the probabilities for error. Hence, laboratory quality system is of paramount importance. The introduction of automation in Biochemistry (2014) and Hematology (2015), has significantly reduced analytical errors and has generated reliable, and quality assured reports. No reports have been published until now from CRRH to indicate the increasing clinical laboratory tests. Therefore, the data analysis from this study will present the ever increasing annual laboratory testing conducted at CRRH and would also provide the national medical procurement and supply division with information critical for annual supply forecasting.

Incidental Thyroid Nodules: Race/Ethnicity Disparities and Outcomes

Black patients have a significantly lower incidence of well-differentiated thyroid cancer (WDTC) compared to all other race/ethnic groups, while white patients appear to be at greater risk. This study examines incidental thyroid nodules (ITNs) to assess whether racial disparities in WDTC arise from a differential discovery of ITNs-perhaps due to socioeconomic disparities-or reflect true differences in thyroid cancer rates. A retrospective review was performed of all patients who underwent fine-needle aspiration (FNA) of thyroid nodules by our academic medical center's endocrinology division between January 2006 and December 2010. Medical records were reviewed to identify whether the biopsied thyroid nodule was discovered incidentally through nonthyroid-related imaging or identified by palpation. FNAs were performed on 1,369 total thyroid nodules in 1,141 study patients; 547 (48%) were classified as white, and 593 (52%) were classified as nonwhite. Among this cohort, 36.6% of patients underwent biopsy for an ITN. White patients were 1.6 times more likely to have undergone a biopsy for a nodule that was incidentally identified compared to nonwhites ( P<.0001). Indicators of socioeconomic status (SES) did not have a significant association with ITNs. Within the ITN cohort, 4.9% of nonwhite patients were found to have a thyroid malignancy compared to 12.9% of white patients ( P<.01). The higher incidence of thyroid cancer in white patients appears to be not only due to diagnostic bias, but also to a true difference in cancer prevalence. FNA = fine-needle aspiration; ITN = incidental thyroid nodule; SEER = Surveillance Epidemiology and End Results; SES = socioeconomic status; WDTC = well-differentiated thyroid cancer.

Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital.

Reverse triage (RT) identifies patients eligible for discharge and have been proposed to cope with daily surge. Nevertheless, early discharge could increase the rate of readmission. Our aim is to test the effectiveness and safety of RT alone and with readmission screening tools (Identification Senior At Risk [ISAR], HOSPITAL, and Groeningen Frailty Index [GFI] scores) to predict appropriate discharge. We prospectively assessed every 4days (t0 ) inpatients of medical divisions (High Dependency Unit (HDU), Internal Medicine (IM), and Geriatrics (Ger)) of an Italian Hospital. RT score was calculated for each patient and an RT ≤3 identified those eligible for safe discharge. ISAR, HOSPITAL, and GFI were then applied. We assessed reinstituting of interventions and transferring to an increased level of care unit at 4days as an ethical proxy of consequential medical events following hypothetical discharge. Date of effective discharge, death, and readmission were measured at 4, 7, 15, and 30days after the first evaluation. Twenty-five (9.6%) out of 260 patients in our sample had an RT ≤3. Twenty-four (96%) of them compared with 205 (87%) of the RT >3 group (P=NS) were discharged. Patients with RT ≤3 were discharged significantly earlier (3.5 vs 8days after t0 [P=0.0002]). In the RT ≤3 group, all but one patient were alive and healthy at 7, 15, and 30days. The HOSPITAL score seemed to have the best concordance with RT (84%), in comparison with the ISAR (52%) and the GFI (48%) scores. RT showed a low sensitivity (22%) and high specificity (95%), which was even higher when using RT associated with readmission screening tools. Reverse triage proved to be a safe and conservative tool, with high specificity alone and with readmission screening tools. RT correctly identifies patients that will be discharged earlier.

Real world evidence (RWE) - a disruptive innovation or the quiet evolution of medical evidence generation?

Stakeholders in healthcare are increasingly turning to real world evidence (RWE) to inform their decisions, alongside evidence from randomized controlled trials. RWE is generated by analysing data gathered from routine clinical practice, and can be used across the product lifecycle, providing insights into areas including disease epidemiology, treatment effectiveness and safety, and health economic value and impact. Recently, the US Food and Drug Administration and the European Medicines Agency have stated their ambition for greater use of RWE to support applications for new indications, and are now consulting with their stakeholders to formalize standards and expected methods for generating RWE. Pharmaceutical companies are responding to the increasing demands for RWE by developing standards and processes for each stage of the evidence generation pathway. Some conventions are already in place for assuring quality, whereas other processes are specific to the research question and data sources available. As evidence generation increasingly becomes a core role of medical affairs divisions in large pharmaceutical companies, standards of rigour will continue to evolve and improve. Senior pharmaceutical leaders can drive this change by making RWE a core element of their corporate strategy, providing top-level direction on how their respective companies should approach RWE for maximum quality. Here, we describe the current and future areas of RWE application within the pharmaceutical industry, necessary access to data to generate RWE, and the challenges in communicating RWE. Supporting and building on viewpoints from industry and publicly funded research, our perspective is that at each stage of RWE generation, quality will be critical to the impact that RWE has on healthcare decision-makers; not only where RWE is an established and evolving tool, but also in new areas that have the potential to disrupt and to improve drug development pathways.

What Is a Value Management Office? An Implementation Experience in Latin America

Value-based health care has been touted as the “strategy that will fix healthcare,” yet putting this value agenda to work in the real world is not an easy task. Robert Kaplan and colleagues first introduced the concept of a value management office (VMO) that may help to accelerate the dissemination and adoption of this value agenda. In this article, we describe the first known experience of the implementation of a VMO in a Latin American hospital and the main steps we have already taken to accelerate this value agenda at Hospital Israelita Albert Einstein. We faced a number of challenges in implementing the VMO at Einstein, including integration with existing clinical and financial information areas, transition to a standardized outcomes model, adaptation to our “open medical staff” model by connecting the VMO with the Medical Practice Division, and involvement with our physician-led multidisciplinary groups.

In vivo reflectance confocal microscopy combined with the ‘spaghetti technique’ for the identification of surgical margins of lentigo maligna: experience in 70 patients

Journal of the European Academy of Dermatology and VenereologyVolume 32, Issue 9 p. e366-e368 Letter to the Editor In vivo reflectance confocal microscopy combined with the ‘spaghetti technique’ for the identification of surgical margins of lentigo maligna: experience in 70 patients E. Couty, E. Couty Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceThe first two authors equally contributed to this work.Search for more papers by this authorL. Tognetti, Corresponding Author L. Tognetti l.tognetti@student.unisi.it Department of Dermatology – Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy Department of Medical Biotechnologies, University of Siena, Siena, ItalyThe first two authors equally contributed to this work.Correspondence: L. Tognetti. E-mail: l.tognetti@student.unisi.itSearch for more papers by this authorB. Labeille, B. Labeille Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorC. Douchet, C. Douchet Department of Pathology, University Hospital of Saint Etienne, Saint-Etienne, FranceSearch for more papers by this authorC. Habougit, C. Habougit Department of Pathology, University Hospital of Saint Etienne, Saint-Etienne, FranceSearch for more papers by this authorC. Couzan, C. Couzan Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorA.C. Biron-Schneider, A.C. Biron-Schneider Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorF. Cambazard, F. Cambazard Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorV. Prade, V. Prade Department of Maxillofacial and Plastic Surgery, University Hospital of Saint Etienne, Saint-Etienne, FranceSearch for more papers by this authorP. Rubegni, P. Rubegni Department of Dermatology – Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, ItalySearch for more papers by this authorE. Cinotti, E. Cinotti Department of Dermatology – Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, ItalySearch for more papers by this authorJ.L. Perrot, J.L. Perrot Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this author E. Couty, E. Couty Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceThe first two authors equally contributed to this work.Search for more papers by this authorL. Tognetti, Corresponding Author L. Tognetti l.tognetti@student.unisi.it Department of Dermatology – Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy Department of Medical Biotechnologies, University of Siena, Siena, ItalyThe first two authors equally contributed to this work.Correspondence: L. Tognetti. E-mail: l.tognetti@student.unisi.itSearch for more papers by this authorB. Labeille, B. Labeille Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorC. Douchet, C. Douchet Department of Pathology, University Hospital of Saint Etienne, Saint-Etienne, FranceSearch for more papers by this authorC. Habougit, C. Habougit Department of Pathology, University Hospital of Saint Etienne, Saint-Etienne, FranceSearch for more papers by this authorC. Couzan, C. Couzan Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorA.C. Biron-Schneider, A.C. Biron-Schneider Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorF. Cambazard, F. Cambazard Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this authorV. Prade, V. Prade Department of Maxillofacial and Plastic Surgery, University Hospital of Saint Etienne, Saint-Etienne, FranceSearch for more papers by this authorP. Rubegni, P. Rubegni Department of Dermatology – Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, ItalySearch for more papers by this authorE. Cinotti, E. Cinotti Department of Dermatology – Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, ItalySearch for more papers by this authorJ.L. Perrot, J.L. Perrot Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, FranceSearch for more papers by this author First published: 24 March 2018 https://doi.org/10.1111/jdv.14947Citations: 19 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume32, Issue9September 2018Pages e366-e368 RelatedInformation

CHARACTERIZATION OF MEDICAL EVACUATION PROCEDURES FOR MILITARY PERSONNEL HAVING SEVERE NON-NOSOCOMIAL PNEUMONIA IN THE ARCTIC PART OF KOLA PENINSULAR

Medical evacuation procedures for drafted military personnel having severe non-nosocomial pneumonia (SNNP) are characterized and the causes of evacuation are delineated. The system of healthcare for military contingent dislocated in Kola Peninsular is described, including the organization of medical divisions and the speci fi c features of disease prevalence and treatment with emphasis on emergency care and aviation evacuation upon SNNP. Procedures for emergency evacuation of SNNP patients are suggested. The study is focused on the causes and speci fi c features of SNNP in patients evacuated to the head military medical facility of the Northern Fleet, i.e. Navy Hospital № 1469. The retrospective statistical study is based on 46 case histories of draftees aged 18 to 25 who were hospitalized for SNNP.

「生命倫理」の研究や教育の在り方を考える : 医療系学生等に実施した調査経験を踏まえて

「生命倫理」の研究や教育の在り方を考える : 医療系学生等に実施した調査経験を踏まえて

Real world evidence (RWE) – a disruptive innovation or the quiet evolution of medical evidence generation?

Stakeholders in healthcare are increasingly turning to real world evidence (RWE) to inform their decisions, alongside evidence from randomized controlled trials. RWE is generated by analysing data gathered from routine clinical practice, and can be used across the product lifecycle, providing insights into areas including disease epidemiology, treatment effectiveness and safety, and health economic value and impact. Recently, the US Food and Drug Administration and the European Medicines Agency have stated their ambition for greater use of RWE to support applications for new indications, and are now consulting with their stakeholders to formalize standards and expected methods for generating RWE. Pharmaceutical companies are responding to the increasing demands for RWE by developing standards and processes for each stage of the evidence generation pathway. Some conventions are already in place for assuring quality, whereas other processes are specific to the research question and data sources available. As evidence generation increasingly becomes a core role of medical affairs divisions in large pharmaceutical companies, standards of rigour will continue to evolve and improve. Senior pharmaceutical leaders can drive this change by making RWE a core element of their corporate strategy, providing top-level direction on how their respective companies should approach RWE for maximum quality. Here, we describe the current and future areas of RWE application within the pharmaceutical industry, necessary access to data to generate RWE, and the challenges in communicating RWE. Supporting and building on viewpoints from industry and publicly funded research, our perspective is that at each stage of RWE generation, quality will be critical to the impact that RWE has on healthcare decision-makers; not only where RWE is an established and evolving tool, but also in new areas that have the potential to disrupt and to improve drug development pathways.

Real world evidence (RWE) - a disruptive innovation or the quiet evolution of medical evidence generation?

Stakeholders in healthcare are increasingly turning to real world evidence (RWE) to inform their decisions, alongside evidence from randomized controlled trials. RWE is generated by analysing data gathered from routine clinical practice, and can be used across the product lifecycle, providing insights into areas including disease epidemiology, treatment effectiveness and safety, and health economic value and impact. Recently, the US Food and Drug Administration and the European Medicines Agency have stated their ambition for greater use of RWE to support applications for new indications, and are now consulting with their stakeholders to formalize standards and expected methods for generating RWE. Pharmaceutical companies are responding to the increasing demands for RWE by developing standards and processes for each stage of the evidence generation pathway. Some conventions are already in place for assuring quality, whereas other processes are specific to the research question and data sources available. As evidence generation increasingly becomes a core role of medical affairs divisions in large pharmaceutical companies, standards of rigour will continue to evolve and improve. Senior pharmaceutical leaders can drive this change by making RWE a core element of their corporate strategy, providing top-level direction on how their respective companies should approach RWE for maximum quality. Here, we describe the current and future areas of RWE application within the pharmaceutical industry, necessary access to data to generate RWE, and the challenges in communicating RWE. Supporting and building on viewpoints from industry and publicly funded research, our perspective is that at each stage of RWE generation, quality will be critical to the impact that RWE has on healthcare decision-makers; not only where RWE is an established and evolving tool, but also in new areas that have the potential to disrupt and to improve drug development pathways.

Efficacy and outcome of 0.7mg sustained release dexamethasone implant in a Tertiary Eye Care Hospital over a period of one year-A retrospective study

The present article retrospectively elaborates the indication and the final visual acuity at 1 year in a cohort of 28 patients administered with 1 or more doses of 0.7 mg intravitrealozurdex over a period of 1 year. Data of 28 eyes of 28 patients was retrived from the medical record division. Majority of the patients were in the age group of 50–60 years. The most common indication was vascular occlusion (n=15) followed by post cataract extraction (n=7), diabetic macular edema (n=6). 5 patients had raised IOP one-two months following injection. 19 pts had prior intravitrealantiVEGF injection. 2 patients repeatedozurdex injection at 6 months. There was a difference of 173 +/-90.5 (p<0.0001)in the 1 year CRT value.

Discussion on the construction of "typical case teaching" in the standardized training of resident doctors

The teaching of typical case analysis for standardized resident training has been con-structed in our hospital, which is organized by medical and teaching administration division. Intractable cases are carefully chosen from the current year representative cases in our hospital. In the class specialists share their diagnosis and treatment processes in the cases, introduce the knowledge relevant to the diseases and set questions for the training students in the key node of the diagnosis and treatment processes. This teaching method introduces PBL elements on the basis of improving CBL. Teaching content extends to new medical technology and new methods. It is expected to open up students' vision, stimulate their interest in learning and standardize their clinical thinking. Key words: Resident; Standardized training; Clinical thinking; Typical case analysis

Alfred Lewis Hodgson

Born in St Helens in 1931, Alfred Lewis Hodgson qualified from the University of Liverpool in 1956. After national service as a flying officer in the Royal Air Force’s medical...

Antibiotic Use by Pediatric Residents: Identifying Opportunities and Strategies for Antimicrobial Stewardship

To determine the antibiotic prescribing practices of pediatric residents and assess how they acquire knowledge leading to prescribing behaviors. We performed a cross-sectional electronic survey of all pediatric residents at the Children's National Medical Center and Nicklaus Children's Hospital, assessing antibiotic prescribing patterns for common pediatric infections, use of antibiograms, and factors influencing antibiotic choice. Eighty-five surveys (45%) were returned complete and included in the analysis. Increased deviations from clinical guideline recommendations were observed for antibiotic treatments of sinusitis and community-acquired pneumonia as compared with otitis media and group A streptococcal pharyngitis. Only 57% of residents reported having used antibiograms. General pediatric inpatient attending physicians were identified as the most influential source for house staff antibiotic knowledge. Results illustrate the need for better promotion and integration of clinical guidelines with antibiograms when developing antibiotic education programs for residents in training. In addition, pediatric hospitalists should play an active role in the implementation of these programs and can provide valuable insight into the development of educational programs in conjunction with graduate medical education divisions.

Assessment of ECG interpretation skills among Polish medical students, nursing, emergency medicine and English Division medical students

Assessment of ECG interpretation skills among Polish medical students, nursing, emergency medicine and English Division medical students

Evaluasi Sistem Informasi Pelayanan Rekam Medis di RSJ Prof. Dr. V.L. Ratumbuysang Provinsi Sulawesi Utara dengan Pendekatan Hot Fit Model

Medical Record Information System Service at Prof. Dr. V.L. Ratumbuysang Mental Hospital North Sulawesi Province had not run as expected. Indicated by the differences in patient data in the recording and the medical records. Factors that allegedly affect are human, organization and technology. This study aims to evaluate medical record service information system with the HOT FIT Model approach and its benefits. This was a qualitative study. Data collected through in depth interviews and analyzed by content analysis method. Research subjects were 1 admin officer and 3 archival officers as main informants and the chief of medical record service, the head medical services division and an assistant director of medical services and nursing as the triangulation informants. The results showed that the medical record service information system had facilitated the work but the knowledge and skills of the officers were still lacking. Organizational factors were supported but the budget was still lacking in system development. Technological factors had not run optimally because the LAN network did not work. The quality of the information had not been met because the data of the visits should be checked again before used for decision making. Quality of service was not maximal yet, because the connectivity between medical record and polyclinic was impaired, then the officer used manual form. It can be concluded that the hospital need to increase the staff knowledge and allocate funds for improvement and development of information systems or cooperate with other parties in system maintenance.

Are Australian Regional Hospitals Doing Enough for Coeliac Disease Testing in 2012-2013? A Pilot Study

Coeliac disease diagnosis requires adequate testing, and insufficient testing may increase complications. This pilot study determined the prevalence of appropriate testing for coeliac disease among eligible in-patients admitted in a regional Australian hospital. A retrospective review of all admissions were conducted between August 2012 and January 2013 in the medical, surgical and geriatric divisions for the patients diagnosed with haematinic-deficiency anaemia due to unspecified causes, protein-energy malnutrition due to unspecified causes and irritable Bowel Syndrome. Secondarily an extended review between February 2012 and February 2013 was also conducted to review all serology test requests for coeliac disease to identify the positive serology testing. We observed that, except for Iron Deficiency Anemia (IDA) and Irritable Bowel Syndrome (IBS), a very small proportion of unspecified anaemia and Protein Energy Malnutrition (PEM) patients were investigated (15.6% and 11%, respectively) for celiac disease. Invasive testing such as histopathology was requested only for about 52% of serology positive cases. Low diagnostic test requests for coeliac disease warrants the demand for availability of specialist gastroenterologist services and telemedicine support in regional Australia. Training for practicing doctors and continuing medical education around this may help adequate testing and diagnosis.

Commentry on "The Changing Medical Division of Labor".

Commentry on "The Changing Medical Division of Labor".

Performance study of an amplification-based NGS test on clinical FFPE specimens in China’s first multi-center study.

e13112 Background: Next Generation Sequencing (NGS) assays provide a comprehensive view of clinically actionable variations in patients. The increasing application of NGS holds new promise towards accurate diagnosis, personalized treatment and precision medicine. Formalin-fixed Paraffin-embedded (FFPE) treatment remains to be the most popular format of tissue preservation. To further standardize the whole process of the application of NGS assays on FFPE tissues, the Chinese Medical Association Pathology Division organized a multi-center performance study of a NGS assay on more than 1,000 clinical FFPE specimens by inviting top pathology departments in the country. Methods: OncoAim Tumor Mutation and PharmGx Detection Kit (Singlera Genomics, Shanghai) was used for this study. Reference samples with known mutations and allele frequencies together with 1045 clinical FFPE specimens from 11 participating hospitals were tested. Among them, 615 Colorectal Cancer (CRC) and 430 Non-Small Cell Lung Cancer (NSCLC) FFPE samples were processed and sequenced on Illumina Miseq platform and Thermo ion torrent PGM platform, respectively. Results: The results on reference materials show 100% (Confidence interval = 100%) analytical sensitivity for mutations with MAF ≥ 10% when median coverage is ≥ 500X.Positive predictive value of &gt; 99% was observed for mutations with MAF at 5% (data not shown). The median depth for CRC and NSCLC samples were 977Xand 828X, respectively. Among all CRC samples, 564 (91.7%) samples were found containing at least 1 clinical hotspot alteration. The top mutated genes were TP53, KRAS, APC, PIK3CA, SMAD4, BRAF, FBXW7, NRAS, PTEN, and ERBB2. For all the NSCLC samples, 304 (70.69%) were detected containing at least 1 clinical hotspot mutation. The top 10 mutated genes were EGFR, TP53, KRAS, PIK3CA PTEN, VHL, ERBB2, SMAD4, NFE2L2 and CTNNB1. Conclusions: In this study, we showed that the amplification-based NGS assay can achieve very high sensitivity and specificity for samples with median depth over 500X. The samples containing at least 1 clinical hotspot mutation were about 83% on average, suggesting NGS could be of great use for further characterization of the tissues.