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Current state of medical device nomenclature and taxonomy systems in the UK: spotlight on GMDN and SNOMED CT. 英国医疗器械命名和分类系统的现状:聚焦于GMDN和SNOMED CT。
Pub Date : 2013-06-05 Print Date: 2013-07-01 DOI: 10.1177/2042533313483719
Judith White, Grace Carolan-Rees

A standardised terminology for describing medical devices can enable safe and unambiguous exchange of information. Proposed changes to EU-wide medical devices regulations mandate the use of such a system. This article reviews two important classification systems for medical devices in the UK. The Global Medical Device Nomenclature (GMDN) provides a classification system specifically for medical devices and diagnostics, and facilitates data exchange between manufacturers and regulators. SNOMED CT is the terminology of choice in the NHS for communicating, sharing and storing information about patients' healthcare episodes. Harmonisation of GMDN and SNOMED CT will encourage use of single terminology throughout the lifetime of a device; from regulatory approval through clinical use and post-marketing surveillance. Manufacturers will be required to register medical devices with a European device database (Eudamed) and to fit certain devices with a Unique Device Identifier; both are efforts to improve transparency and traceability of medical devices. Successful implementation of these elements depends on having a consistent nomenclature for medical devices.

用于描述医疗器械的标准化术语可以实现安全和明确的信息交换。欧盟范围内医疗器械法规的拟议变更要求使用这种系统。本文回顾了英国医疗器械的两个重要分类系统。全球医疗器械命名法(GMDN)提供了一个专门针对医疗器械和诊断的分类系统,并促进了制造商和监管机构之间的数据交换。SNOMED CT是NHS用于交流、共享和存储有关患者医疗保健事件信息的首选术语。GMDN和SNOMED CT的统一将鼓励在器械的整个生命周期内使用单一术语;从监管批准到临床使用和上市后监测。制造商将被要求向欧洲设备数据库(Eudamed)注册医疗设备,并为某些设备配备唯一设备标识符;两者都是为了提高医疗设备的透明度和可追溯性。这些要素的成功实施取决于医疗器械的一致命名法。
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引用次数: 6
Small bowel gastrointestinal tumour: An interesting case of presentation, diagnosis and treatment. 小肠胃肠道肿瘤:一个有趣的病例表现,诊断和治疗。
Pub Date : 2013-06-05 Print Date: 2013-07-01 DOI: 10.1177/2042533313481214
Stratos Sofos, Georgios Dimitrakakis, Paul Blake, Agamemnon Pericleous, David Stewart Jackson, Mohamed Salih
We report the diagnosis and surgical management of the interesting case of a patient with a gastrointestinal stromal tumour (GIST).
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引用次数: 9
Arterial embolization in the management of connective tissue tumours. 动脉栓塞治疗结缔组织肿瘤。
Pub Date : 2013-06-05 Print Date: 2013-07-01 DOI: 10.1177/2042533313476685
Oisin Jf Keenan, Buchir Arumilli, Finn Farquharson, Nicholas Chalmers, Ashok Paul
Arterial embolization may be used effectively for connective tissue tumours: to reduce bleeding during surgical excision, or for palliative treatment.
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引用次数: 10
Ankle osteomyelitis: an unusual presentation. 踝关节骨髓炎:一种不寻常的表现。
Pub Date : 2013-05-29 Print Date: 2013-06-01 DOI: 10.1177/2042533313476682
Shibby Robati, Kenneth Porter, Mohammad Shahid, Thomas Crompton, Nemandra Sandiford
Pain around the ankle occurs and is one of the most common complaints seen by medical practitioners treating patients with sporting injuries. Although there are many possible causes of ankle pain, common causes include injuries to the bony, ligamentous and tendinous structures around the joint. Injury to the cartilage leading to early arthritis can present as acute pain, swelling and instability. Acute osteomyelitis in this healthy, active population without any open injury is rare. We present a case of a traumatic cause of osteomyelitis affecting the hindfoot bones and resulting in significant bone injury and disability from a closed footballing injury.
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引用次数: 0
The use of individually wrapped presterilized small orthopaedic implants increase operating time: a prospective experimental study. 使用单独包装预消毒的小型骨科植入物增加手术时间:一项前瞻性实验研究。
Pub Date : 2013-05-29 Print Date: 2013-06-01 DOI: 10.1177/2042533313476413
Yasmeen Khan, Szymon Tokarczyk, Imran Khan, Kyriacos Eleftheriou, Christopher Pearce

Objective: There have been concerns about the potential increases in operating time associated with the use of individually wrapped presterilized small orthopaedic implants compared with our traditional method of screw banks. We set out to quantify this theory.

Design: Prospective experimental study.

Setting: Theatre.

Participants: Orthopaedic Surgical Trainees and Theatre Scrub team.

Main outcome measure: The time taken to complete the operation.

Results: The use of prepacked and sterilized implants added 2 min 56 s to the use of a bank with a full complement of normal screws that required tapping and 3 min 58 s if self-tapping screws were used (P < 0.001).

Conclusion: Using individually wrapped presterilized small orthopaedic implants increases operating time.

目的:与传统的螺钉架方法相比,使用单独包裹的预消毒的小型骨科植入物可能会增加手术时间。我们着手量化这一理论。设计:前瞻性实验研究。设置:剧院。参与者:骨科实习生和手术室擦洗团队。主要结果测量:完成手术所需的时间。结果:使用预包装和灭菌的植入物比使用一组需要攻牙的正常螺钉增加了2分钟56秒,如果使用自攻螺钉则增加了3分钟58秒(P < 0.001)。结论:单独包装预消毒的小型骨科种植体可增加手术时间。
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引用次数: 0
Foreign body airway obstruction causing a ball valve effect. 异物阻塞气道,造成球阀效应。
Pub Date : 2013-05-10 Print Date: 2013-06-01 DOI: 10.1177/2042533313482458
Johnny Kenth, Che Ng
Foreign body airway obstruction (FBAO) in adults is a rare but potentially fatal anaesthetic airway emergency.1
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引用次数: 6
Evaluation of a general practitioner-led urgent care centre in an urban setting: description of service model and plan of analysis. 城市环境中全科医生领导的紧急护理中心的评估:服务模式和分析计划的描述。
Pub Date : 2013-05-07 Print Date: 2013-06-01 DOI: 10.1177/2042533313486263
Shamini Gnani, Farzan Ramzan, Tim Ladbrooke, Hugh Millington, Saiful Islam, Josip Car, Azeem Majeed
Estimates of patients attending with conditions deemed non-urgent or inappropriate for accident and emergency services vary widely, from 6 to 80%. Previous research suggests that general practitioners (GPs) working in emergency departments can reduce referral rates, diagnostic testing, the proportion of patients who become emergency hospital admissions, and inappropriate attendances. However, little of this previous research is recent and new models of care for GPs working in emergency departments have now been developed, which remain to be evaluated. In this paper, we describe an integrated urgent care model, which was commissioned by NHS Hammersmith and Fulham in 2009 to manage the rising number of urgent attendances at local hospitals and its associated evaluation. The evaluation will include examining the effect of the system on outcomes such as utilization of diagnostic tests and effect on unplanned hospital admissions. If the new model of care is shown to be both clinically effective and cost-effective, the model and the proposed plan of evaluation will also be helpful to other areas that are considering the introduction of similar models of GP-led urgent care.
估计因非紧急或不适合事故和急救服务的情况就诊的患者差别很大,从6%到80%不等。先前的研究表明,在急诊科工作的全科医生(gp)可以降低转诊率、诊断测试、急诊住院患者的比例以及不适当的出勤率。然而,之前的研究很少是最近的,现在已经开发出了在急诊科工作的全科医生的新护理模式,这些模式仍有待评估。在本文中,我们描述了一个综合紧急护理模型,该模型是由NHS哈默史密斯和富勒姆于2009年委托管理当地医院急诊人数的增加及其相关评估。评估将包括审查该系统对结果的影响,如诊断测试的利用和对非计划住院的影响。如果新的护理模式被证明具有临床效果和成本效益,那么该模式和拟议的评估计划也将有助于其他正在考虑引入类似gp主导的急诊护理模式的地区。
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引用次数: 15
An underused opportunity to introduce ACE inhibitors and influence prognosis: observational study of patients undergoing aortic surgery. 引入ACE抑制剂和影响预后的未充分利用的机会:主动脉手术患者的观察性研究。
Pub Date : 2013-05-07 Print Date: 2013-06-01 DOI: 10.1177/2042533313484145
Kayria Muttardi, Ali Haydar, Chee Kiang Phua, Neil Chapman, Michael Jenkins, Nicholas Jw Cheshire, Colin D Bicknell
Objective To asses whether Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are underused in patients with aortic disease due to concerns regarding flow limiting (>70%) renal artery stenosis (RAS). Design A prospective analysis of patients admitted for aortic surgery was performed (January–July 2009). Co-morbidity, ACEI/ARB use and renal function were recorded. Computerised tomography (CT) angiograms were reviewed by a single blinded radiologist for the presence and severity of RAS. Setting St Mary's Hospital, Vascular Unit, Imperial College Healthcare NHS Trust, London, UK. Participants 75 randomly selected patients admitted to our vascular unit including elective and emergency admissions. Main outcome measures Indications for ACEI therapy were identified as determined by the National Institute of Health and Clinical Excellence (NICE) guidance. The ratio of the measurement distal to the stenosis and at the area of maximal stenosis on CT angiography were used to calculate the percentage RAS. Results 60 patients were identified (15 patients excluded due to previously modified renal vessels). The median age was 73 [interquartile range 68, 77]. Their underlying aortic disease included 52 (87%) aortic aneurysm, 6 (10%) with aortic dissection, 1 (1.7%) patient with occlusive disease and 1 (1.7%) patient with mycotic disease. Overall, 56/60 (93%) patients had at least one indication for ACEI therapy. 33/60 (55%) of patients were already receiving ACEI. CT angiogram examination demonstrated 17/60 (28%) patients have RAS of some degree, of which only 9/60 (15%) have flow limiting RAS. Conclusion A large proportion of aortic patients do not receive ACEI/ARB therapy despite definite indications and a low prevalence of flow-limiting RAS is low. After the exclusion of RAS at angiography, careful introduction of ACEI therapy with appropriate monitoring could be considered for many more patients.
目的:评估血管紧张素转换酶抑制剂(ACEIs)和血管紧张素受体阻滞剂(ARBs)在主动脉疾病患者中是否因血流受限(>70%)肾动脉狭窄(RAS)而使用不足。设计:对2009年1月至7月接受主动脉手术的患者进行前瞻性分析。记录合并症、ACEI/ARB使用情况及肾功能。计算机断层扫描(CT)血管造影由单盲放射科医生检查RAS的存在和严重程度。地点:英国伦敦帝国学院医疗保健NHS信托圣玛丽医院血管科。参与者:75名随机选择的患者入院我们的血管部门,包括选择性和急诊入院。主要结局指标:ACEI治疗的适应症由国家健康与临床卓越研究所(NICE)指南确定。采用CT血管造影测量狭窄远端与最大狭窄区域的比值计算RAS百分比。结果:60例患者被确定(15例患者因既往肾血管改变而被排除)。年龄中位数为73岁[四分位数范围68,77]。他们的潜在主动脉疾病包括52例(87%)主动脉瘤,6例(10%)主动脉夹层,1例(1.7%)闭塞性疾病和1例(1.7%)真菌性疾病。总体而言,56/60(93%)患者至少有一种ACEI治疗指征。33/60(55%)的患者已经接受了ACEI。CT血管造影检查显示17/60(28%)患者存在不同程度的RAS,其中仅有9/60(15%)患者存在限制性RAS。结论:尽管有明确的适应症,但很大一部分主动脉患者没有接受ACEI/ARB治疗,而且限流RAS的患病率很低。在血管造影中排除RAS后,可以考虑对更多的患者谨慎引入ACEI治疗并进行适当的监测。
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引用次数: 2
Using mixed methods in health research. 在卫生研究中使用混合方法。
Pub Date : 2013-05-07 Print Date: 2013-06-01 DOI: 10.1177/2042533313479197
Shema Tariq, Jenny Woodman

Mixed methods research is the use of quantitative and qualitative methods in a single study or series of studies. It is an emergent methodology which is increasingly used by health researchers, especially within health services research. There is a growing literature on the theory, design and critical appraisal of mixed methods research. However, there are few papers that summarize this methodological approach for health practitioners who wish to conduct or critically engage with mixed methods studies. The objective of this paper is to provide an accessible introduction to mixed methods for clinicians and researchers unfamiliar with this approach. We present a synthesis of key methodological literature on mixed methods research, with examples from our own work and that of others, to illustrate the practical applications of this approach within health research. We summarize definitions of mixed methods research, the value of this approach, key aspects of study design and analysis, and discuss the potential challenges of combining quantitative and qualitative methods and data. One of the key challenges within mixed methods research is the successful integration of quantitative and qualitative data during analysis and interpretation. However, the integration of different types of data can generate insights into a research question, resulting in enriched understanding of complex health research problems.

混合方法研究是在一项研究或一系列研究中使用定量和定性方法。这是一种新兴的方法,越来越多地被卫生研究人员使用,特别是在卫生服务研究中。关于混合方法研究的理论、设计和批判性评价的文献越来越多。然而,很少有论文为希望进行或批判性地参与混合方法研究的卫生从业人员总结这种方法学方法。本文的目的是为临床医生和不熟悉这种方法的研究人员提供一个可访问的混合方法介绍。我们综合介绍了关于混合方法研究的主要方法学文献,并举例说明了我们自己的工作和其他人的工作,以说明这种方法在卫生研究中的实际应用。我们总结了混合方法研究的定义、这种方法的价值、研究设计和分析的关键方面,并讨论了将定量和定性方法和数据结合起来的潜在挑战。混合方法研究的关键挑战之一是在分析和解释过程中成功地整合定量和定性数据。然而,整合不同类型的数据可以产生对研究问题的见解,从而丰富对复杂卫生研究问题的理解。
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引用次数: 315
Growing interest in use of geographic information systems in health and healthcare research: a review of PubMed from 2003 to 2011. 地理信息系统在健康和医疗保健研究中的应用日益增长的兴趣:PubMed 2003年至2011年的综述。
Pub Date : 2013-05-03 Print Date: 2013-06-01 DOI: 10.1177/2042533313478810
Negin A Sanati, Mehri Sanati
Abstract in UndeterminedThere has been an increasing interest in applyingGIS into health and healthcare research in recentyears.4,5 However, this increasing interest has notyet been gauged. In order to address this, the currentstudy was performed to examine the crudenumber and the annual rate of papers with‘Geographic Information Systems’ among theirMeSH Terms in PubMed (a free database which ismaintained by US National Library of Medicine).
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引用次数: 4
期刊
JRSM short reports
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