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The need for a balanced scorecard to monitor hospital performance 需要一个平衡计分卡来监控医院的表现
Pub Date : 2019-07-01 DOI: 10.4103/ami.ami_17_19
S. Shrivastava, P. Shrivastava
Hospitals or health-care establishments have been identified as one of the complex systems which have to simultaneously fulfill various roles to function effectively.[1] In general, apart from the equipment and infrastructure, any hospital comprises two major types of stakeholders, namely internal (doctors, nursing staff, and paramedical staff, etc.) and external (patients and their relatives).[1,2] In addition, the innovation/growth dimensions (provision of laparoscopic services or dialysis facilities) or financial/resources attribute (increasing hospital revenue, budgeting, staff training and retention, etc.) and also the internal processes (standard operating procedures for any task) should also be given due consideration.[1,2]
医院或保健机构已被确定为一个复杂的系统,必须同时履行各种角色才能有效运作一般来说,除了设备和基础设施外,任何医院都有两类主要的利益相关者,即内部(医生、护理人员和辅助医务人员等)和外部(病人及其亲属)。[1,2]此外,还应适当考虑创新/增长维度(提供腹腔镜服务或透析设施)或财务/资源属性(增加医院收入、预算编制、员工培训和保留等)以及内部流程(任何任务的标准操作程序)[1,2]。
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引用次数: 2
A comparative study of histopathological findings in psoriatic lesions with and without treatment 银屑病病变经治疗和未经治疗的组织病理学结果的比较研究
Pub Date : 2019-01-01 DOI: 10.4103/ami.ami_19_19
Deepti Arora, Faiyaz Ahmad, A. Mittal, Ashutosh Kumar, S. Awasthi, S. Dutta
Background: Psoriasis is a multifactorial chronic relapsing inflammatory dermatological disorder associated with significant comorbidities. It is characterized by sharply demarcated, erythematous papules, and plaques with abundant silvery-white scales. Due to its variable clinical presentation, histopathology remains the mainstay of diagnosis. However, these histologic features changes with treatment and may also guide in therapeutic decision-making. Aim: The aim is to evaluate and compare the histopathological features of psoriatic lesions before treatment with those receiving treatment for psoriasis. Patients and Methods: A total of 101 biopsies from selected consecutive patients of histopathologically confirmed psoriasis vulgaris were included in the study. These cases were then divided into two groups, Group A includes cases who never received treatment and Group B, those receiving treatment for psoriasis. These biopsies were histopathologically analyzed and compared for various morphological features. Results: Of 101 cases of psoriasis, 72 cases were included in Group A and 29 were included in Group B. Biopsies of Group A showed parakeratosis and acanthosis as a common feature in all of them with dilated or abnormal capillary pattern in dermal papillae in 93.1%. In Group B, in spite of uniform parakeratosis as noticed in Group A biopsies, focal parakeratosis was seen in 83.3%, acanthosis in 87.5%, and dilated/abnormal capillary pattern in dermis was observed to be a universal feature in biopsies of Group B. All other microscopic features of psoriasis also decreased in frequency in Group B. However, statistically significant difference is seen only in changes in morphological features of superficial epidermis that is, parakeratosis, acanthosis, and absent or decreased granular layer in both the groups. Conclusion: Treatment may lead to improvement in the histologic features in epidermis with significant difference in few of them. However, abnormal vasculature in the dermal papillae persists and does not show any improvement with therapy.
背景:银屑病是一种多因素慢性复发性炎症性皮肤病,具有明显的合并症。它的特征是界限分明的红斑丘疹和带有大量银白色鳞片的斑块。由于其多变的临床表现,组织病理学仍然是诊断的支柱。然而,这些组织学特征随着治疗而改变,也可能指导治疗决策。目的:目的是评价和比较银屑病治疗前和接受治疗的银屑病病变的组织病理学特征。患者和方法:选择连续的经组织病理学证实的寻常型银屑病患者,共101例活检纳入研究。然后将这些病例分为两组,A组包括从未接受治疗的病例,B组包括接受牛皮癣治疗的病例。这些活检组织病理分析和比较各种形态特征。结果:101例银屑病中,A组72例,b组29例。A组活检均以角化不全和棘层增生为共同特征,其中93.1%为真皮乳头毛细血管扩张或异常。在B组中,尽管A组活检中观察到统一的角化不全,但局灶性角化不全发生率为83.3%,棘层增生发生率为87.5%,真皮毛细血管扩张/异常模式是B组活检的普遍特征。B组银屑病的所有其他显微特征的发生频率也有所下降。两组均无颗粒层或颗粒层减少。结论:治疗可改善表皮的组织学特征,但少数组织学特征有显著性差异。然而,异常血管在真皮乳头持续存在,并没有显示任何改善治疗。
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引用次数: 1
Thyroid-stimulating hormone in hypothyroidism – How high is too high? 促甲状腺激素在甲状腺功能减退中的作用——多高才算过高?
Pub Date : 2019-01-01 DOI: 10.4103/ami.ami_76_18
R. Senthiappan, Smitha S. Bhat, S. Krishna
Background: The prevalence of hypothyroidism in the developed world is about 4-5% and in India is 10.9%. The goal of treating hypothyroidism is to maintain thyrotropin (TSH) levels within the normal reference range. Studies have shown that even within the normal range of TSH, patients with low normal TSH (LNT) have better outcomes when compared to patients with high normal TSH (HNT). Aims and Objectives: Our study aimed to find whether patients treated at a dose of levothyroxine resulting in an LNT had improved clinical outcomes and biochemical parameters, when compared to those on a levothyroxine dose resulting in an HNT. Materials and Methods: 180 patients with hypothyroidism on treatment, who had a TSH of 0.27-4.2mIU/L and had been on treatment with a stable dose of at least 50 micrograms of levothyroxine for at least 6 months were administered the Thyroid Symptom Questionnaire. TSH was assayed. Blood pressure and BMI were measured. Serum lipids were measured by spectrophotometry. Results: We found that patients with LNT and HNT did not differ with respect to cognitive symptoms , feelings of coldness, lethargy and fatigue. However, patients with LNT had a better lipid profile (mean LDL 132.24 in HNT and 115.39 in LNT p= 0.08) and lower BMI (1.045kg/m 2 lower in LNT compared to HNT) compared to HNT. Conclusion: Treating patients with a dose of thyroxine titrated to achieve LNT might decrease the cardiovascular risk by improving the lipid profile and BMI.
背景:发达国家甲状腺功能减退症的患病率约为4-5%,印度为10.9%。治疗甲状腺功能减退的目标是将促甲状腺激素(TSH)水平维持在正常参考范围内。研究表明,即使在正常TSH范围内,与高正常TSH (HNT)患者相比,低正常TSH (LNT)患者的预后更好。目的和目的:我们的研究旨在发现与左旋甲状腺素导致HNT的患者相比,左旋甲状腺素导致LNT的患者是否有改善的临床结果和生化参数。材料与方法:180例正在治疗的甲状腺功能减退患者,TSH为0.27 ~ 4.2 miu /L,且左旋甲状腺素稳定剂量≥50微克治疗至少6个月,填写甲状腺症状问卷。测定TSH。测量血压和身体质量指数。用分光光度法测定血脂。结果:我们发现LNT和HNT患者在认知症状、冷感、嗜睡和疲劳方面没有差异。然而,与HNT相比,LNT患者具有更好的脂质谱(HNT患者平均LDL为132.24,LNT患者平均LDL为115.39,p= 0.08)和更低的BMI(与HNT相比,LNT患者低1.045kg/ m2)。结论:通过甲状腺素滴定治疗达到LNT可能通过改善血脂和BMI来降低心血管风险。
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引用次数: 1
Treatment-emergent dhat syndrome in a young male with Obsessive–Compulsive disorder: An alarm for medication nonadherence 一名年轻男性强迫症患者在治疗中出现的症状:药物不依从的警报
Pub Date : 2019-01-01 DOI: 10.4103/ami.ami_82_18
S. Kar
Dhat syndrome refers to a culture-bound syndrome of Southeast Asia, where patients present with anxiety and depressive and somatic symptoms, which they attribute to semen loss. Common presentation of these patients is the passage of semen-like substance in urine. Retrograde ejaculation may cause spermaturia, and patients with firmly held cultural myths related to sexuality may develop features of Dhat syndrome. Here, a patient with obsessive–compulsive disorder on treatment with fluoxetine developed retrograde ejaculation and subsequently features of Dhat syndrome.
Dhat综合征是指东南亚的一种文化结合综合征,患者表现为焦虑、抑郁和躯体症状,他们将其归因于精液丢失。这些患者的常见表现是尿中有精液样物质。逆行射精可能会导致精尿,而与性有关的文化神话根深蒂固的患者可能会发展出哈特综合征的特征。本例中,一名接受氟西汀治疗的强迫症患者出现了逆行性射精,随后出现了Dhat综合征的特征。
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引用次数: 1
Validating biological research: Role of statistics 验证生物学研究:统计学的作用
Pub Date : 2019-01-01 DOI: 10.4103/AMI.AMI_43_19
S. Jain, Umme Afifa, Sanya Jain, Sonika Sharma
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引用次数: 0
Cerebral vein thrombosis due to meningococcal meningitis 由脑膜炎球菌性脑膜炎引起的脑静脉血栓
Pub Date : 2019-01-01 DOI: 10.4103/ami.ami_67_18
A. Hakamifard, H. Hemasian
Bacterial meningitis is a life-threatening condition and Neisseria meningitidis is a major cause. Cerebrovascular complications can occur. Cerebral venous and sinus thrombosis (CVST) is an uncommon type of these complications, especially in meningococcal meningitis. The initiation of anticoagulant in septic thrombosis is controversial. A 35-year-old man was admitted to a hospital with fever and confusion. The diagnosis of N. meningitidis meningitis was established. Antimicrobial regimen (ceftriaxone) was continued. On the 3rd day, the patient's consciousness was improved; however, according to the patient's headache on day 7, brain imaging was performed which revealed a cerebral thrombosis in transverse and sigmoid sinuses. Although initiation of anticoagulant is controversial in septic thrombosis, the anticoagulant treatment also was started. Control brain magnetic resonance venogram done revealed complete resolution of cerebral CVST after 2 weeks. CVST as a complication of meningococcal meningitis should be considered. Anticoagulant treatment may be considered in the management of septic cerebral thrombosis if there are no contraindications. The use of anticoagulant needs further studies.
细菌性脑膜炎是一种危及生命的疾病,而脑膜炎奈瑟菌是主要病因。可发生脑血管并发症。脑静脉和窦血栓形成(CVST)是一种罕见的并发症类型,特别是在脑膜炎球菌性脑膜炎。在脓毒性血栓形成中抗凝剂的起始治疗是有争议的。一名35岁男子因发烧和神志不清而入院。确定脑膜炎奈瑟菌脑膜炎的诊断。继续使用头孢曲松抗菌方案。第3天,患者意识有所改善;然而,根据患者第7天的头痛,进行脑成像显示横窦和乙状窦脑血栓形成。虽然抗凝治疗在脓毒性血栓形成中存在争议,但抗凝治疗也开始了。对照脑磁共振血管造影显示,2周后脑CVST完全消退。CVST作为脑膜炎球菌性脑膜炎的并发症应予以考虑。如果没有禁忌症,抗凝治疗可以考虑在脓毒性脑血栓的管理。抗凝剂的使用还需进一步研究。
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引用次数: 0
Personality traits of young men with different diplotypes 不同二倍型青年男性的人格特征
Pub Date : 2019-01-01 DOI: 10.4103/ami.ami_49_18
P. Ermakov, E. Vorobyeva, E. Kovsh, I. Abakumova, O. Fedotova, M. Aralova, Wladimir W Latun, L. Horonko
Background: Historically in psychogenetic research the attention has been paid to describing personality traits of the carriers of some sole genotypes; but in this work the characteristic traits of carriers of catecholaminergic system MAOA and COMT genes' genotypes different combinations are presented. Methods: A psychodiagnostic toolkit included 7 types of inventories. Genotyping was conducted with the help of DNA extraction from the buccal epithelium cells with subsequent PCR diagnostics and 3 types of statistical processing. Results: It was shown that carriers of a highly active diplotype have the lowest level of aggressiveness and are inclined to cooperate in the conflict; carriers of the highly active genotype MAOA in combination with the heterozygous genotype COMT have an average level of aggressiveness and high rates of emotional lability; carriers of low-level MAOA in combination with heterozygous genotype COMT have the highest rates of motivation to achieve success and verbal aggression; carriers of low-level MAOA and highly active COMT are emotionally labile and non-aggressive. Conclusion: We conclude that male carriers of a low-active diplotype have the highest level of aggressiveness and disposition to addictive behavior, which may indicate the association of this diplotype in a sample of young Russian men with social disadaptation.
背景:在心理遗传学的历史研究中,人们一直关注于描述某些单一基因型携带者的人格特征;本文介绍了儿茶酚胺能系统MAOA和COMT基因不同基因型组合的携带者的特征特征。方法:心理诊断工具包括7种量表。通过提取口腔上皮细胞DNA,进行PCR诊断和3种统计处理,进行基因分型。结果:高活性外交型携带者的攻击性水平最低,在冲突中倾向于合作;高活性基因型MAOA和杂合基因型COMT的携带者具有平均水平的攻击性和较高的情绪不稳定率;低水平MAOA与杂合子基因型COMT的携带者具有最高的成功动机和言语攻击率;低水平MAOA和高活性COMT的携带者情绪不稳定,无攻击性。结论:低活性二倍型男性携带者具有最高水平的攻击性和成瘾行为倾向,这可能表明这种二倍型与俄罗斯年轻男性的社会适应障碍有关。
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引用次数: 0
Lymph node biopsies: Evaluation of disease pattern and role of surgery – Our experience from South Punjab, Pakistan 淋巴结活检:评估疾病类型和手术的作用-我们在巴基斯坦旁遮普南部的经验
Pub Date : 2019-01-01 DOI: 10.4103/ami.ami_62_18
M. Hussain, M. Bukhari, Muhammad Aftab
Objective: The objective of the study was to determine the frequency of different pathologies presenting with lymphadenopathy in patients from South Punjab and to evaluate the role of surgery in reaching the diagnosis. Materials and Methods: It was a cross-sectional study done at Recep Tayyip Erdogan Hospital, Muzaffargarh (managed by The Indus Health Network), from August 2014 to October 2017. Those being biopsied at some other hospital and the lymph node dissection biopsy done for a known primary cancer were excluded. Results: Lymph node biopsy was done on a total of 71 patients (56.3% n = 40 males, 43.7% n = 31 females). The mean (standard deviation) age of the patients was 27.30 ± 17.07 years. Open biopsy was performed on 70 cases (98.6%), whereas laparoscopic biopsy was performed on one case (1.4%). The most common pathology found on histopathology report was Tuberclosis (TB) lymphadenitis (49.3%, n = 35), followed by lymphoma (25.4% – Hodgkin's disease [HD] 15.5% and non-Hodgkin's lymphoma [NHL] 9.9%). Conclusion: TB is the most common pathology, followed by lymphoma. HD is more common than NHL. Surgical biopsy is the gold standard. Laparoscopy and other minimally invasive techniques are very safe and useful for excision biopsy of the central lymph nodes.
目的:本研究的目的是确定在旁遮普南部患者中出现淋巴结病的不同病理的频率,并评估手术在达到诊断中的作用。材料和方法:这是一项横断面研究,于2014年8月至2017年10月在Muzaffargarh的雷杰普·塔伊普·埃尔多安医院(由印度河卫生网络管理)进行。那些在其他医院做过活组织检查和为已知原发癌症做过淋巴结清扫活检的患者被排除在外。结果:71例患者行淋巴结活检,其中男性40例占56.3%,女性31例占43.7%。患者平均(标准差)年龄为27.30±17.07岁。开放活检70例(98.6%),腹腔镜活检1例(1.4%)。组织病理学报告中最常见的病理是结核性(TB)淋巴结炎(49.3%,n = 35),其次是淋巴瘤(25.4% -霍奇金病[HD] 15.5%和非霍奇金淋巴瘤[NHL] 9.9%)。结论:结核是最常见的病理,其次是淋巴瘤。HD比NHL更常见。手术活检是金标准。腹腔镜和其他微创技术对于中央淋巴结的切除活检是非常安全和有用的。
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引用次数: 1
Acceptance of immunization by caregivers of children attending a tertiary health facility in Northwestern Nigeria 在尼日利亚西北部的三级卫生设施就诊的儿童的照料者接受免疫接种
Pub Date : 2019-01-01 DOI: 10.4103/ami.ami_3_19
I. Aliyu, A. Mohammed, H. Ibrahim, Yohanna Ghidazuka
Introduction: Immunization against childhood diseases is well received in most developed countries; also, countries in the Caribbean and Latin America have attained over 90% immunization coverage unlike the most sub-Saharan African countries, such as Nigeria, which have a dismally low coverage. Our objective is, therefore, to determine the acceptance and willingness to complete immunization of children by caregivers seen in our health facility. Materials and Methods: This study was cross sectional involving caregivers attending the pediatric outpatient clinic of Aminu Kano Teaching Hospital, Kano, Nigeria, during the month of December 2017. This was questionnaire based and was administered by the researchers and trained assistants. It contained 20 questions consisting of both open- and close-ended questions. Results: All respondents were aware of the childhood immunization program and were willing to accept all vaccines for their children. They all believed that immunization was beneficial to their children; 126 (79.7%) respondents could correctly state the advantages of childhood immunization. However, only 18 (11.4%) of the respondents could correctly list the names of the childhood vaccines in the National Programme of Immunization. About 33.5% of respondents reported six visits as the total number of visits for childhood immunization; higher proportion of health workers and those with tertiary educational qualification could correctly list the names of the vaccines given to their children, and these observations were statistically significant (Chi-squared test = 27.786, df = 1, P = 0.000; Fisher's exact test = 12.421, P = 0.004). Conclusion: This study showed that most respondents were willing to accept and complete the immunization schedule; however, there was a significant knowledge gap, especially in listing the names of the vaccines and the expected number of immunization visits.
导言:儿童疾病免疫接种在大多数发达国家得到广泛接受;此外,加勒比和拉丁美洲国家已达到90%以上的免疫覆盖率,而大多数撒哈拉以南非洲国家,如尼日利亚,其覆盖率低得令人沮丧。因此,我们的目标是确定在我们保健设施中看到的护理人员是否接受并愿意完成儿童免疫接种。材料与方法:本研究是横断面研究,涉及2017年12月在尼日利亚卡诺Aminu Kano教学医院儿科门诊就诊的护理人员。这是以问卷为基础的,由研究人员和训练有素的助手进行管理。它包含20个问题,包括开放式和封闭式问题。结果:所有受访者都了解儿童免疫规划,并愿意接受所有疫苗为他们的孩子。他们都相信接种疫苗对他们的孩子有益;126名(79.7%)应答者能够正确陈述儿童免疫接种的好处。然而,只有18个(11.4%)答复者能够正确列出国家免疫规划中的儿童疫苗名称。约33.5%的答复者报告儿童免疫接种总次数为6次;较高比例的卫生工作者和具有高等教育资格的人能够正确列出给子女接种的疫苗名称,这些观察结果具有统计学意义(卡方检验= 27.786,df = 1, P = 0.000;费雪确切检验= 12.421,P = 0.004)。结论:本研究显示,大多数应答者愿意接受并完成免疫接种计划;但是,在知识方面存在很大的差距,特别是在列出疫苗名称和预期免疫接种次数方面。
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引用次数: 2
The jefferson scale of physician empathy: A preliminary study of validity and reliability among physicians in Nigerian tertiary hospital 杰弗逊医师共情量表:尼日利亚三级医院医师效度与信度之初步研究
Pub Date : 2019-01-01 DOI: 10.4103/ami.ami_70_18
J. Osim, E. Essien, Joseph Okegbe, O. Udofia
Introduction: Physician empathy has been shown to have a substantial effect on doctor–patient relationship, therapeutic adherence, and overall treatment outcome. Despite its important role, physician empathy is under-researched in Nigeria. Aims: This study aims to investigate the validity and reliability of the Jefferson Scale of Physician Empathy (JSPE) (Health Professional version) among Nigerian physicians in the University of Uyo teaching hospital, Uyo, Nigeria. Participants and Methods: In this cross-sectional study, a brief sociodemographic questionnaire, the Emotional intelligence scale (EIS), and the JSPE were administered to 120 doctors in the University of Uyo teaching hospital. Data were analyzed using SPSS version 22. Results: Cronbach's and split half coefficients were 0.73 and 0.66, respectively. Correlation coefficient with the EIS was 0.49 (P < 0.05). Exploratory factor analysis yielded three factors that were not quite consistent with previous reports. We found empathy to be significantly higher among older physicians, those who were involved in administrative duties and those with a higher rank (P < 0.05). After regression analysis, age, sex, and administrative role emerged as significant predictors of physician empathy (P < 0.05). Conclusions: The JSPE had fairly strong reliability coefficients and an acceptable convergent validity with the EIS which measures a related construct. It can serve as a useful measure of patient-related empathy among Nigerian doctors.
医师共情已被证明对医患关系、治疗依从性和整体治疗结果有实质性影响。尽管医生的同理心扮演着重要的角色,但在尼日利亚还没有得到充分的研究。目的:本研究旨在探讨尼日利亚乌约大学教学医院尼日利亚医生使用杰弗逊医生共情量表(JSPE)的效度和信度。对象与方法:本研究采用社会人口学问卷、情绪智力量表(EIS)和JSPE量表对禹约大学教学医院的120名医生进行问卷调查。数据分析采用SPSS version 22。结果:Cronbach’s系数为0.73,split half系数为0.66。与EIS的相关系数为0.49 (P < 0.05)。探索性因素分析产生的三个因素与以前的报告不太一致。我们发现,年龄较大的医生、参与行政职责的医生和级别较高的医生的共情能力显著高于其他医生(P < 0.05)。经回归分析,年龄、性别、行政职务是医生共情的显著预测因子(P < 0.05)。结论:JSPE具有相当强的信度系数,与测量相关构念的EIS具有可接受的收敛效度。它可以作为衡量尼日利亚医生与病人相关的同理心的有用指标。
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引用次数: 4
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Acta Medica International
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