General guidelines for evaluating and controlling the operating parameters of x-ray diagnostic equipment. Ministry of Health and Medical Industry of the Russian Federation

The International Electric Engineering Commission (IEEC) has published several guidelines for evaluating and controlling the operating parameters of X-ray diagnostic equipment at the units (rooms) of X-ray diagnosis. The first of these guidelines (IEEC 1223-1-93) having the subheading "General Requirements" is translated into Russian and adjusted to our conditions, approved by the Ministry of Health and Medical Industry of the Russian Federation and published as the guidelines P 42-501-95 to be introduced on July 1, 1995. The publication reflects the main contents of the national variant of the document, gives a scheme (an algorithm) for controlling the quality of X-ray diagnostic equipment.     

Ophthalmologic ultrasound diagnosis--current training programs in Germany, Austria, Switzerland

In these three countries the application of diagnostic ultrasound in ophthalmology is restricted, with few exceptions, only to institutions having access to in-patients. This situation is based on the organization of medical care and does not depend on the technical evolution of the equipment. Consequently the annual rate of trainees in ophthalmic ultrasound is relatively low, but a comprehensive training programme is needed in this field. The requisite training subjects are described. They include a technical and a clinical programme for both pulse-echo (A, B, M, D mode) and Doppler techniques as applied for biometry as well as for tissue and vascular examination. Some data are given regarding training facilities, aids and courses in the three countries. The concept and organization of a 5-day course (Bonn/Würzburg Course, Directors: W. Buschmann/H.G. Trier) is described in greater detail. For ophthalmic ultrasonography, testing and calibration of system parameters both for equipment and transducers is necessary for obtaining reliable and reproducible results. Examples are given for the organization of technical training in the practical course. The 1981 guidelines of the "Kassen?rztliche Bundesvereinigung", Cologne, are discussed. These regulations define minimum requirements for both ultrasonic training and equipment in the FRG. Finally, a few controversial aspects of the teaching (quality assurance, role of biometry) are mentioned.     

Intravenous contrast media: are they being administered safely in radiology departments?

A recent Royal College of Radiologists (RCR) publication is entitled Advice on The Management of Reactions to Intravenous Contrast Media. This study aims to determine whether radiology departments are adhering to the essential points, covered in the guidelines, regarding prevention, early recognition and prompt treatment of adverse reactions, and whether they are adequately equipped for the proposed contrast media reaction management protocols. A questionnaire was formulated and sent to the superintendent radiographers of 295 radiology departments in the United Kingdom of whom 233 (79%) replied. This was specifically directed at the use of intravenous contrast media in intravenous urography. In almost all departments there was provision for basic life support training, regular checking of equipment and drugs, and prompt access to emergency medical help. Certain "first line" drugs and monitoring equipment were not instantly accessible in the majority of institutions. Most departments did not adequately supervise post-injection patients and did not conform to the guidelines referring to the administration of intravenous contrast to children. Certain areas of the guidelines are being neglected by many radiology departments and there is still much to be done to improve the safety of intravenous contrast medium injection.     

Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology.

The purpose of these "Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology" is to provide a common framework for use in the development, evaluation, and review of education and training in consulting psychology/organizational consulting psychology (CP/OCP). The intent of these guidelines is to improve the quality of teaching and learning in the area of the practice of CP, especially OCP, within the scientific discipline and profession of psychology. Towards these ends, this document is intended as guidance for psychologists who teach or plan curricula for teaching CP/OCP at doctoral or postdoctoral levels of professional education and training in psychology. The guidelines are structured in the form of overarching principles, general competencies, and domain-specific competencies that are ideally obtained by persons receiving training at the doctoral or postdoctoral level in CP/OCP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and application of performance standards for Naval Petty Officers.

To help accomplish its assigned mission for the Navy, the Bureau of Naval Personnel must fulfill its functions of "Procurement" of kinds and numbers of personnel, "Training" them to the necessary skill level, the "Distribution" of the right men to the right jobs at the right time, and "Promotion." Essential in all aspects of personnel operations are performance standards. These standards must be continuously adjusted to meet and conform to the changing conditions facing the bureau and the Fleet: changes in weapons and equipment, changes in Fleet operations, changes in quality of personnel input, and time-factor changes. The bureau has an integrated system in operation for establishing, maintaining, and applying up-to-date performance standards for enlisted personnel. Starting with field analysis of the weapons and equipment during their developmental and test phases, the occupational analysis data generated are used to phase equipment into the existing occupational classification system of the Navy. The specific performance requirements, after being codified, are then used as a basis for the preparation of study and training materials. The attainment of the requisite performance standards is then given official recognition by the promotion process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reappraisal of lateral cervical cysts in neonates: pyriform sinus cysts as an anatomy-based nomenclature

Anticoccidial drugs undergo a vigorous series of test during development in order to demonstrate their efficacy and safety. Evaluation of efficacy may also be necessary after a drug is utilised in the field in order to establish whether resistance has developed. The principles and procedures used to evaluate anticoccidial efficacy were reviewed in a series of papers presented at a symposium held at the University of Georgia in May 1969. It is a testimony to the quality of this symposium that much of the information presented remains valid today. In the USA, general procedures that should be followed in new drug investigations are given in various guidelines and memoranda issued by the Food and Drug Administration. Specific guidelines relate to anticoccidial investigations. Although not a legal requirement, they provide a standard for those investigators seeking approval of a new anticoccidial drug. These guidelines are periodically revised, and investigators should consult the FDA for advice on specific protocols. Many of these procedures are also appropriate for the determination of drug resistance.     

Work organisation, work environment and the use of medical equipment: a survey study of the impact on quality and safety

In a study of hospital staff's perceived quality of care and worry, related to the use of medical equipment, a systems approach was used. This included training and user aspects on the equipment, environmental ergonomics, work organisation and psychosocial work conditions. In a survey study, 543 hospital staff members from seven departments with various degrees of equipment utilisation participated. By means of factor analysis, factors which were important to perceived quality of care and worry were determined. Adaptation of equipment and environment and training on the use of equipment were shown to be important. However, several organisational and psychosocial factors turned out to have a still greater impact. In the assessment of healthcare technologies which include medical equipment a holistic systems approach is therefore advocated.     

Quality management in medical specialties: the use of channels and dikes in improving health care in The Netherlands

BACKGROUND: In 1989 a Dutch national policy was instituted to ensure that quality management is the responsibility of both health care professionals and management, with input from insurers and patients. In turn, quality management of medical specialists remained to a large extent self-regulatory, with accountability toward third-party payers and patients. Three programs for quality management-peer review, guidelines, and visitation-have sufficiently persuaded patient organizations and care insurers about medical specialists' ability to ensure the quality of the care they provide. PEER REVIEW: Operational since 1976, the national program for peer review in hospitals has stressed the need for explicit evaluative mechanisms. This program led to the foundation of the National Organization for Quality Assurance in Hospitals (CBO), which conducts peer review activities but also support efforts aimed at quality assurance in hospitals. Once it is linked with the other two quality management programs, peer review will realize its full potential as a profession-based method for standardizing and rationalizing medical specialty practice. PRACTICE GUIDELINES: Since 1982, more than 60 consensus guidelines have been developed for and by medical professionals, with input from patient organizations and third-party payers. Medical specialty associations have also created their own guidelines. Although the guidelines' impact has not been evaluated systematically, studies have shown effects on behavioral change and health outcomes. Solid, credible guidelines continue to be developed, although the successful implementation of these guidelines needs to be studied. VISITATION PROGRAM: Visitation, or onsite assessment of specialty practice sites (in training and non-training hospitals), has been a hot issue in Dutch medical quality assurance. All 28 scientific societies have visitation programs, focusing on areas for improvement such as process management, use of guidelines, and evaluation of patient satisfaction and treatment outcomes. Closely linked to other medical quality assurance activities, visitation programs also incorporate clinical guidelines into evaluations. CONCLUSIONS: Profession-driven peer review, practice guidelines, and visitation programs have been effective support tools for quality management in The Netherlands. Future challenges involve creating more synergy among these programs and between the profession-based quality management approaches and recently introduced hospital-based quality systems and maintaining the trust between third-party payers and patients.     

Pharmacy benefit management, cost-effectiveness analysis and drug formulary decisions

Ten years ago, a review of U.S. center-based infant and toddler care found that not even one state met federally recommended standards of quality with regard to group composition, staff training, and program of care. The present analysis indicates that little progress has been made since then. While most states currently require centers to follow appropriate practice guidelines, standards for staff training were rated as unacceptable in almost all states. Findings are discussed in terms of the interrelation of quality dimensions and the ongoing importance of improved state-level infant and toddler child-care regulation.     

Implementation of guidelines for preoperative laboratory investigations in patients scheduled to undergo elective surgery

OBJECTIVE: To assess the impact on preoperative laboratory investigations in elective surgery after the implementation of guidelines for ordering such tests. DESIGN: A retrospective chart audit. SETTING: A university teaching hospital. PATIENTS: The charts of 903 patients who underwent an elective surgical procedure from each surgical specialty except cardiovascular and thoracic. INTERVENTIONS: Implementation of guidelines for preoperative laboratory investigations. MAIN OUTCOME MEASURES: Impact on the preoperative use of laboratory investigations after implementation of the guidelines as well as patient morbidity and mortality. RESULTS: The mean number of preoperative laboratory investigations done per patient decreased from 4.65 before implementation of the guidelines to 4.18 after (p < 0.001). There was no apparent adverse impact on patient morbidity or mortality. CONCLUSION: Implementation of guidelines for preoperative laboratory investigations for elective surgery resulted in a reduction in the number of tests without adverse impact on patient morbidity or mortality.     

论连铸设备在连铸生产中的地位和作用

本文对连铸设备对提高连铸生产效率、质量和效益的作用，连铸设备组成与连铸设备管理中几个主要问题，连铸装备水平的优化与提高，连铸工艺与设备的结合，抓好连铸设备人员培训等问题进行了论述。     

Photosensitization of experimental hepatocellular carcinoma with protoporphyrin synthesized from administered delta-aminolevulinic acid: studies with cultured cells and implanted tumors

The use of ultrasonography, traditionally performed by radiologists, is becoming increasingly widespread in emergency medicine. Consequently, much debate has evolved over whether emergency medicine physicians are qualified to provide this service, and the criteria by which training and credentialing can be achieved. This article discusses training and credentialing guidelines, paths to becoming credentialed in emergency sonography, and quality assurance issues. Also, strategies are proposed for emergency departments seeking to perform emergency sonography.     

End-of-life algorithms.

Tools and strategies for eliciting patient preferences for end-of-life care are often absent, of poor quality, or ignored. The American Medical Association's Council on Ethical and Judicial Affairs has proposed new guidelines for the "optimal use" of advance directives. The guidelines urge the use of detailed work sheets in "tailoring end-of-life care to patients' preferences" and suggest a process to be followed by physicians in educating patients about death and dying. However, these well-intentioned guidelines face 3 key obstacles: the negative consequences of "ritualizing" end-of-life planning, physicians' inclination to disdain and to delegate to others communication about end-of-life preferences, and the tardiness of medical pedagogy in emphasizing end-of-life care and communication as crucial for the success of future physicians. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Acute eosinophilic pneumonia with diffuse fine nodular shadows

Precision features of image analyser "Videotest" and possibilities of its applications for cytophotometric investigations have been analysed. It has been shown that a photometric feature is linear at least to optical density 1.1. Cytophotometry of the Feulgen stained rat hepatocyte nuclei has been performed. Coefficients of variation of DNA for 2c, 4c and 8c nuclei are 7.72, 7.65 and 6.50%, respectively, and ratios between average values of these nuclei are 1.00:2.06:4.12. Possible causes of errors of digital television equipment for cytophotometry are discussed.     

Quality assurance in roentgen mammography. Comparison of recommended EUREF guidelines with relevant German regulations

The Program "Europe against Cancer" published the 2nd edition of quality assurance guidelines for breast cancer screening in June 1996. For the enforcement of these guidelines, a European network of reference centres (EUREF) is being established. Although the EUREF protocol contains guidelines for all disciplines involved in breast cancer screening, this article concentrates on the physical and technical aspect. The comparison with the German regulations (DIN Norms) demonstrates the high requirements requested by the EUREF guidelines with its tighter limits and more extensive and more frequent tests.     

Workshop "Radio-oncology and the Law"

From 25 to 27 Sept 1997, a workshop was organized at the Essen Medical School (Universit?tsklinikum Essen), at which radiooncologists and jurists from universities and courts as well as lawyers contributed their views on mutual problems. The following topics were discussed by papers and in round table meetings: "Requirements on the patient's information", "definition of therapeutic guidelines-limits of clinical research and standard treatments", "treatment documentation", "liability of the physician for treatment faults" and "technical standard and preserve of quality". The consensual guidelines to the topics "patient's information", "therapeutic guidelines" and "liability" are presented here.     

Guidelines for Psychological Practice With Older Adults.

Presents the American Psychological Association Guidelines for psychological practice with older adults. The present document is intended to assist psychologists in evaluating their own readiness for working clinically with older adults and in seeking and using appropriate education and training to increase their knowledge, skills, and experience relevant to this area of practice, when desired and appropriate. The specific goals of these guidelines are to provide practitioners with (a) a frame of reference for engaging in clinical work with older adults and (b) basic information and further references in the areas of attitudes, general aspects of aging, clinical issues, assessment, intervention, consultation, and continuing education and training relative to work with older adults. These guidelines build on, and are intended to be entirely consistent with, the APA's (2002a) "Ethical Principles of Psychologists and Code of Conduct" and other APA policies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the Agency for Health Care Policy and Research (AHCPR) in improving outcomes of care

This article describes the various outcomes programs supported by the Agency for Health Care Policy and Research (AHCPR). The mission of the agency is to generate and disseminate information that improves the delivery and quality of health care. The agency is charged with helping consumers, providers, purchasers, health plans, and policy makers meet the challenge of improving the quality of health care services while reducing spending. AHCPR has been recognized as funding the development of "gold standard" clinical practice guidelines and the source of unbiased, science-based information on what works and does not work in health care.     

Wasp venom immunotherapy changes IgG antibody specificity

OBJECTIVE: To evaluate the quality of studies seeking to establish measurement properties (reliability and validity) of ultrasonic estimation of urinary bladder volume. DESIGN: Online searching of the MEDLINE database between 1966 and 1995, and scanning of bibliography of known studies on ultrasonic bladder volume estimation. Study selection and study quality assessment were performed independently by two reviewers. Each article was evaluated for suitability of the reference standard, adequacy of reported blinding of the observers and appropriateness of the statistical index of concordance. The last two of these guidelines were applied to reliability studies (evaluating the relation among observed ultrasonic estimations), and all three guidelines were applied to validity studies (evaluating the relation of ultrasonic estimation with a definitive measurement). POPULATION: One hundred and twenty-five participants enrolled in the five reliability studies and 769 participants in the 27 validity studies selected for appraisal of their quality. MAIN OUTCOME MEASURE: Rate of study compliance with preset criteria for high quality. RESULTS: None of the studies complied with all of the criteria for high methodologic quality. In the five reliability studies, investigators did not report adequate blinding of observers in three (60%) and an appropriate index of reliability was not used in any. Among the 27 validity studies, there was a lack of a suitable reference standard in 6 (22%), an inadequate blinding in 25 (93%), and an inappropriate index of validity in all (100%). CONCLUSION: Based on our guidelines for quality assessment, a large proportion of studies on measurement properties was found to have inadequate methods, raising concern about the credibility of the reliability and validity estimates reported. These deficiencies highlight the lack of rigour employed in the design, conduct and analysis of reliability and validity studies, which has the potential for leading to patient mismanagement due to biases in the assessment of measurement variability in clinical investigations.     

Guidelines for the diagnosis and treatment of chronic obstructive lung disease--effective and necessary

The independent practice of the art of medicine which doctors took for granted in the past has ended. With almost revolutionary speed, insurers, administrators and politicians have distributed the unique relationship between doctors and their patients. Treatment and diagnostic guidelines in different clinical entities have been based on the pillars of medicine - controlled studies and/or a common consensus among specialists and practitioners. These dynamic activities have enriched our knowledge and practice of medicine. However, only the continuing direct collaboration of physicians at all levels and constant adjustment to changing conditions make these guidelines applicable to the ever changing world of medicine. Chronic obstructive lung disease is one such clinical entity that requires uniform guidelines. Issues that have to be addressed are not only who belongs in this category but also what interventions, such as lateral chest radiographs, CT scans and sleep lab investigations, should be performed as well as the indications for costly therapies such as long-term home oxygen, alpha-1-protease inhibitor augmentation therapy and lung transplantations. Instead of looking at guidelines at straitjackets that limit excellence in the practice of medicine, medical associations should treat them as an opportunity to define their own quality standards. By doing so, the medical community would eliminate the influence of administrative directions or gatekeeper decisions, while patients and the whole population would greatly benefit.