Análisis retrospectivo del diferimiento quirúrgico a un año de la pandemia COVID-19 / Retrospective analysis of the one-year surgical deferral of the COVID-19 pandemic

Resumen: Introducción: El diferimiento quirúrgico desde el inicio de la pandemia COVID-19 representa un riesgo para la salud de los pacientes y un reto para las instituciones sanitarias. La métrica de indicadores de productividad en quirófano, como la tasa de diferimiento quirúrgico, nos brindará información para planear estrategias basadas en evidencia científica que nos permitan mejorar la calidad de la atención. Objetivo: Determinar la tasa de diferimiento quirúrgico durante la pandemia COVID-19. Material y métodos: Se realizó un estudio, retrospectivo, descriptivo y transversal en el que se analizaron 297 pacientes cuyas cirugías fueron diferidas durante el período comprendido del 11 de marzo de 2020 al 10 de marzo de 2021. Para el análisis de variables se efectuó estadística descriptiva, utilizando medidas de tendencia central y dispersión, frecuencias simples y proporciones. Adicionalmente se realizó un diagrama de Pareto. La información fue procesada con SPSS v-25.0. Resultados: La proporción de diferimiento fue de 7.34%; 20.92% de las causas fueron atribuidas al paciente, 31.65% a causas médicas y 47.49% fueron logístico-administrativas. Conclusión: Las causas de diferimiento quirúrgico establecidas son evitables y revelan fracasos en los procesos logístico-administrativos que requieren planes de mejora continua.

Abstract: Introduction: Surgical deferral since the beginning of the COVID-19 pandemic represents a risk to the health of patients and a challenge for health institutions. The metric of productivity indicators in the operating room, such as the surgical deferral rate, will provide us with information to plan strategies based on scientific evidence that allow us to improve the quality of care. Objective: To determine the surgical deferral rate during the COVID-19 pandemic. Material and methods: A retrospective, descriptive and cross-sectional study was carried out in which 297 patients whose surgeries were deferred during the period from March 11, 2020 to March 10, 2021 were analyzed. Descriptive statistics were employed, using measures of central tendency and dispersion, simple frequencies and proportions. Additionally, a Pareto diagram was made. The information was processed with SPSS v-25.0. Results: The deferral rate was 7.34%. 20.92% of the causes were attributed to the patient, 31.65% to medical causes and 47.49% logistic-administrative. Conclusion: The established causes of surgical deferral are avoidable and reveal failures in the logistical-administrative processes that require continuous improvement plans.

Estimación de la eficiencia del uso de pabellones electivos en el sistema de salud público chileno entre 2018 y 2021 / Efficiency estimation on the use of elective surgical theaters in the Chilean public health system from 2018 to 2021

Objective The efficient use of wards intended for elective surgeries is essential to resolve cases on the surgical waiting list. This study aims to estimate the efficiency of ward use in the Chilean public health system between 2018 and 2021. Methods The design was an ecological study. Section A.21 of the database constructed by the monthly statistical summaries that each public health network facility reported to the Ministry of Health between 2018 and 2021 was analyzed. Data from subsections A, E and F were extracted: ward staffing, total elective surgeries by specialty, number and causes of suspension of elective surgeries. Then, the surgical performance during working hours and the percentage of hourly occupancy for a working day was estimated. Additionally, an analysis was made by region with data from 2021. Results The percentage of elective wards in use ranged from 81.1% to 94.1%, while those enabled for those staffing ranged from 70.5% to 90.4% during 2018 and 2021. The total number of surgeries was highest in 2019 (n = 416 339), but for 2018, 2020, and 2021 it ranged from 259 000 to 297 000. Suspensions varied between 10.8% (2019) and 6.9% (2021), with the leading cause being patient-related. When analyzing the number of cases canceled monthly by facility, we saw that the leading cause was trade union-related. The maximum throughput of a ward intended for elective surgery was reached in 2019 and was 2.5 surgeries; in 2018, 2020 and 2021, the throughput borders on two surgeries per ward enabled for elective surgery. The percentage of ward time occupied during working hours by contract day varies between 80.7% (2018) and 56.8% (2020). Conclusions All the parameters found and estimated in this study show that there is an inefficient utilization of operating rooms in Chilean public healthcare facilities.

Objetivo El uso eficiente de pabellones destinados a cirugías electivas es fundamental para resolver patologías en lista de espera quirúrgica. El objetivo general de este estudio es estimar la eficiencia del uso de pabellones en el sistema de salud público de Chile entre los años 2018 y 2021. Métodos El diseño fue un estudio ecológico. Se analizó la Sección A.21 de la base de datos construida por los resúmenes estadísticos mensuales que cada establecimiento de la red de salud pública reportó al Ministerio de Salud de Chile entre 2018 y 2021. Se extrajeron los datos de la subsección A, E y F: dotación de pabellones, total de cirugías electivas por especialidad, número y causas de suspensión de cirugías electivas. Luego se estimó el rendimiento quirúrgico en horario hábil y el porcentaje de ocupación horaria respecto de una jornada laboral. Adicionalmente, se hizo un análisis por región con datos de 2021. Resultados El porcentaje de pabellones electivos respecto de los en dotación varió entre 81,1 y 94,1%; mientras que los habilitados respecto de los en dotación varió entre 70,5 y 90,4% durante 2018 y 2021. El número total de cirugías fue más alto en 2019 (n = 416 339), pero en 2018, 2020 y 2021 variaron entre 259 y 297 mil cirugías. Las suspensiones varían entre 10,8 (2019) y 6,9%w(2021), siendo la principal causa de suspensión atribuida al "paciente". Al analizar la cantidad de pacientes suspendidos mensualmente por institución, se observa que la principal causa es "gremial". El rendimiento máximo de un pabellón destinado a cirugía electiva se alcanzó en 2019 y fue de 2,5 cirugías; mientras que en 2018, 2020 y 2021 el rendimiento bordea las dos cirugías por pabellón habilitado para cirugía electiva. El porcentaje de tiempo de pabellón ocupado en horario hábil respecto a una jornada de contrato varía entre 80,7 (2018) y 56,8% (2020). Conclusiones Todos los parámetros encontrados y estimados en este estudio muestran que el uso de pabellones en el sistema público de Chile es ineficiente.

Effect of preoperative telephone interview in the cancellation rate of daytime surgery in eye hospitals / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the role of preoperative telephone interview in the cancellation rate for ophthalmic daytime surgery. <p>METHODS: A prospective, single center study was conducted to compare and analyze the cancellation of daytime surgery in two time periods. The control group was from June 2018 to June 2019, only routine nursing and health education were implemented. The patient in the intervention group were from October 2019 to October 2020, add the telephone interview of the day before operation was added by the nurses in the ophthalmic operating room. <p>RESULTS: The main reasons for canceling the operation included upper respiratory tract infection, abnormal blood glucose, abnormal blood pressure and physiological period, abnormal preoperative examination results, and patients didn't follow the doctor's advice to use preoperative eye drops. In the control group, there were 16 974 cases scheduled for daytime operation, 16 332 cases actually operated, and the cancellation rate of operation was 3.78%(642 cases cancelled). In the intervention group, 17 694 cases were scheduled for daytime operation, and 17 296 cases were actually operated, with the cancellation rate of 2.25%(398 cases cancelled). The disease distribution and cancellation reasons of the two groups were statistically significant(<i>P</i><0.05).<p>CONCLUSION: Telephone interview can effectively reduce the cancellation rate of ophthalmic daytime operation, provide targeted and personalized pre-hospital guidance for patients, improve the compliance of patients and their families to complete preoperative preparation, reduce the psychological anxiety of patients before operation, and improve the medical experience of patients.

Bowel Sound Signal Identifcation of Whole Abdomen Based on Voice Endpoint Detection / 中国医疗器械杂志

Bowel sounds are one of the important physiological signals of the body,and different bowel sounds can reflect different gastrointestinal states.In this paper,long time bowel sound data is obtained with wearable full belly bowel sound recorder which is independent designed.After adaptive noise cancellation and wavelet threshold denoising,voice endpoint detection method based on short-time energy is used to identify effective bowel sounds.Experiments and results show that the sound recorder is simple and reliable.Through processing,analysis and endpoint detection algorithm,the recognition accuracy of effective bowel sounds is high,which has certain clinical practicality and research significance.

Analysis of the impacts of drug price markup reform on hospitalization expenses of tertiary public hospitals in Sichuan province / 中华医院管理杂志

Objective To analyze the impact of canceling drug price markup policy on hospitalization expenses of urban public hospitals in Sichuan province and provide decision-making basis. Methods Data of hospitalization expenses of the top 50 diseases among inpatients discharged in 2016 and 2017 were collected, totaling 2 732 022 inpatient cases. Based on hospitalization expenses, these disease were divided into seven categories ( A-G) using dynamic clustering analysis, which represent respectively dominant diseases of different expense makeups, to compare such indicators as hospitalization expenses and composition ratios of these diseases before (2016) and after the reform (2017). Results The study found drastic changes among the medical expenses of different categories of dominant diseases. For example, per-hospitalization cost of categories E ( featuring high drug and examination expenses ) and G ( featuring balanced expenses distribution) diseases decreased since the reform, while the other categories rose instead. The proportion of drugs of different disease categories decreased to various extents. For example, category A ( high drug ratio of 5.60% ) and category E (5.15% ) diseases of which were found with the sharpest drop. Proportion of service expenses, on the other hand, rose to different extents. For example, the proportion of service expenses of all disease categories increased to varying degrees, among which category E (3.46% ), category F (3.37% ) and category D (3.36% ) accounted for the largest share of increase.Conclusions The reform is moving the cost structure of dominant diseases in Sichuan towards a rational level, yet with significant differences among disease categories. The authorities should target various categories to adjust their reimbursement policies, minimize financial burden on patients, strengthen their supervision on drug use and medical behavior, prevent such misbehaviors as the inducing demands and transferring drug markups.

Enfrentando el dilema de las suspensiones: características e incidencia de las suspensiones quirúrgicas en un centro académico en Chile / Facing the dilemma of cancellations: incidence and characteristics of surgical cancellations in a Chilean academic hospital

Resumen Introducción: Las suspensiones quirúrgicas constituyen una problemática compleja en el ámbito de la administración de pabellones, que afecta tanto a pacientes como al personal de pabellón, y que compromete la eficiencia financiera de las instituciones de salud. Existe escasa información acerca de la incidencia y características de las suspensiones quirúrgicas en nuestro país. Objetivo: Caracterizar las suspensiones quirúrgicas en un centro académico chileno, describiendo su incidencia global y por especialidad. Materiales y Métodos: Se incluyó información recopilada de manera prospectiva acerca de la programación y actividad de pabellón, y de una cohorte de pacientes suspendidos de cirugía entre el 1 de enero de 2016 y el 20 de mayo de 2017. Para calcular el porcentaje de suspensiones se utilizaron 3 grupos en base a 6 períodos de 4 semanas. Se aplicó la transformación de doble arcoseno de Freeman-Turkey y el test-t de Student. Resultados: Durante el período del estudio se programaron 11.398 cirugías, de ellas 492 fueron suspendidas. La incidencia de suspensiones de los 3 períodos fue de 4,38% (IC 95% de 3,78% a 5,01%), 4,15% (IC 95% de 3,51% a 4,85%) y 4,10% (IC 95% de 3,50% a 4,74%) respectivamente. Al menos en un 57% de los casos la principal causa de suspensión se identificó como un cambio en la condición médica del paciente. Discusión y Conclusiones: Nuestros resultados muestran, de manera consistente, que las suspensiones se encuentran entre un 3% y un 5%, lo que está dentro de los estándares internacionales, y pueden ser utilizados como un "benchmarking" para comparaciones a nivel nacional.

Introduction: Surgical cancellations are a complex problem in the field of Operating Room Management, affecting patients, staff, including surgeons and anesthetists, and compromising the finances of health institutions. The available information about the incidence and characteristics of surgical cancellations in our country are scarce. Objective: The aim of this article is to characterize the surgical cancellations in a Chilean academic center, describing its global incidence and by specialty. Materials and Methods: Prospective information on surgical schedule and Operating Room activity was included in this cohort study of surgical case cancellations occurring from January 1, 2016 through May 20, 2017. To calculate the percentage of cancellations, 3 groups were used based on 6 periods of 4 weeks. The Freeman-Turkey double-arcsine transformation and Student's t-test were applied. Results: During the study period, 11,398 surgeries were programmed, of which 492 were cancelled. The incidence of cancellations for the 3 periods was 4.38% (95% CI 3.78% to 5.01%), 4.15% (95% CI 3.51% to 4.85%) and 4.10% (95% CI of 3.50% to 4.74%) respectively. In at least 57% of cases the main identifiable cause of cancellation was a change in the patient's medical condition. Discussion and Conclusions: Our results consistently show that the cancellation rates range between 3% and 5%, which is within international standards, and can be used as benchmarking for comparisons at a national level.

The application of ECG cancellation in diaphragmatic electromyographic by using stationary wavelet transform

In this paper, we present and investigate a special kind of stationary wavelet algorithm using “inverse” hard threshold to eliminate the electrocardiogram (ECG) interference included in diaphragmatic electromyographic (EMGdi). Differing from traditional wavelet hard threshold, “inverse” hard threshold is used to shrink strong coefficients of ECG interference and reserve weak coefficients of EMGdi signal. Meanwhile, a novel QRS location algorithm is proposed for the position detection of R wave by using low frequency coefficients in this paper. With the proposed method, raw EMGdi is decomposed by wavelet at fifth scale. Then, each ECG interference threshold is calculated by mean square, which is estimated by wavelet coefficients in the ECG cycle at each level. Finally, ECG interference wavelet coefficients are removed by “inverse” hard threshold, and then the de-noised signal is reconstructed by wavelet coefficients. The simulation and clinical EMGdi de-noising results show that the “inverse” hard threshold investigated in this paper removes the ECG interference in EMGdi availably and reserves its signal characteristics effectively, as compared to wavelet threshold.

Causas de cancelación del turno quirúrgico, en un servicio de cirugía general / Causes of cancellation of the surgical turn, in a general surgery service

La cancelación de procedimientos quirúrgicos en una sala de cirugía, afecta la productividad de la misma y ocasiona un impacto emocional en el paciente. Objetivo: determinar las principales causas de cancelación del turno quirúrgico, en el Servicio de Cirugía General del Hospital Dr. Francisco Antonio Rísquez, en el periodo 2006-2015. Métodos: se revisaron las planillas del plan quirúrgico diario de cirugía, en el área de quirófano y los libros de cancelación de acto quirúrgico del departamento de Cirugía del hospital. Resultados: en el Hospital "Dr. Francisco Antonio Risquez", se planificaron para acto quirúrgico del Servicio de Cirugía desde el 2006 al 2015; 2.872 pacientes, de los cuales se suspendieron 1.082 (37,67 %). Las causas específicas de las cancelaciones del turno quirúrgico fueron: ausencia de anestesiólogos: 613 pacientes (56,65%), prolongación del turno quirúrgico: 132 (12,20%), crisis hipertensiva: 81 (7,49%), aire acondicionado dañado: 47 (4,34%), ascensor averiado: 38 (3,51%), "otros": 36 (3,33%), falta de material quirúrgico: 33 (3,05%), ausencia delespecialista en cirugía: 31 (2,87%), maquina anestésica dañada: 27 ( 2,50%), enfermedad aguda del paciente: 20 (1,85%), área quirúrgica contaminada: 14 (1,29%) y exámenes preoperatorios incompletos: 10 (0,92%). Por causas atribuidas al personal médico 666 (61,55 %) casos, seguidas por las inherentes a la institución 306 (28,28 %) personas y 110 (10,17 %) suspensiones atribuibles al paciente. Conclusiones: el índice de suspensión de cirugías en el período evaluado en nuestro centro fue muy alto. Las principales causas de cancelación del turno quirúrgico fueron atribuibles al personal médico(AU)

the cancellation of surgical procedures in a surgery room affects the productivity of the same and causes an emotional impact on the patient. Objective: to determine the main causes of cancellation of surgical interventions in the department of General Surgery of "Dr. Francisco Antonio Rísquez" Hospital, during the period comprised between 2006 and 2015. Methods: the daily surgical schedule formats were revised, located on the fourth floor in the operating room area, as well as the books detailing the cancellation of interventions by the department of Surgery, located in the hospital's office of medical records. Results: in "Dr. Francisco Antonio Rísquez" Hospital, 2.872 patients were scheduled for intervention by the department of surgery between the years 2006 and 2015, of which 1.082 (37, 67%) The specific causes behind the cancellation of the interventions were: absence of anesthesiologist: 613 (56,65%), prolonged surgery times: 132 (12,20%), hypertensive crisis: 81 (7,49%), malfunctioning air conditioning: 47 (4,34%), elevator out of order: 38 (3,51%), others: 36 (3,33%), lack of surgical equipment: 33 (3,05%), absence of attending surgeon: 31 (2,87%), patient with acute illness: 27 (2,50%), non-operative anesthesia machinery: 20 (1,85%), contaminated operating room: 14 (1,29%) and incomplete preoperatory exams: 10 (0,92%). Causes attributed to medical staff predominated by 666 (61, 55%) cases, followed by causes attributed to the hospital in 306 (28, 28%) people, and 110 (10, 17%) suspensions attributed to the patient. Conclusions: the rate of suspension of surgeries in our center was very high and therefore worrisome for all health personnel. The main causes of cancellation of the surgical shift were attributable to medical personnel(AU)

Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement

PURPOSE: To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. METHODS: Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. RESULTS: During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). CONCLUSION: This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

Usability of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) “Cancellation” from the Perspective of Executive Function / The Japanese Journal of Rehabilitation Medicine

Objectives : In Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), full scale intelligence quotient (FSIQ) and the index scores are thought to be solely important and supplemental subtests are not taken into account in the score.However, in assessment by intelligent tests it is required that we analyze the result from many directions. Accordingly, the factor of “Cancellation” was taken up and the importance of adding a focus on the qualitative side of the test results was examined. Methods : Some 412 children who received WISC-IV in our developmental evaluation center were divided into three groups according to their intellectual level, and of these, 30 persons were assigned to each group [total of 90] selected at random to comprise the sample. By comparing the index scores and the scaled scores for each group,we have classified the procedures of deletion into six types. Results : The more the intellectual level increases, the lower the “Cancellation” scaled score becomes compared to the other subtests. Further, the scaled score was lower in the type of deletion procedure such as systematic linear strategy. Conclusion : In the high intellect level group, the scaled “Cancellation” score was lower than the other subtests, it was thought to be because there were many “order type” subjects using a systematic linear strategy. It was also considered that attention to the qualitative aspects as well as quantitative is important in “Cancellation”. Therefore, when assessing high intellect children with developmental disabilities in the future, a clinical examination that incorporates “Cancellation” to detect executive function disabilities such as persistence or poor planning ability is desirable.

Development of the Forgiveness Schema in Adolescence / Desarrollo del esquema de perdón en la adolescencia

The study aims to chart the development of the willingness to forgive among adolescents, as a function of seven situational factors: Possibility of revenge, cancellation of harmful consequences, encouragement to forgive from parents and/or from close friends, social proximity with the offender, intent to harm, and presence of apologies. The participants were presented with 16 stories in which an adolescent committed a harmful act against another one. Each participant was asked to rate the degree of personal willingness to forgive in each case on a continuous scale. The effect of the cancellation of consequences factor was the strongest one, and it was stronger among younger adolescents than among older adolescents. The effect of the intent factor was the second strongest factor, and it was stronger among older adolescents than among younger adolescents. The effect of the encouragement factors was moderate (encouragement by friends), or small (encouragement by parents), and no age difference was observed. The effects of the revenge, apologies, and social proximity factors were always weak. An additive-type combination process was observed in each age group.

El objetivo del estudio fue describir el desarrollo de la voluntad para perdonar en adolescentes, como función de siete factores situacionales: posibilidad de venganza, anulación de consecuencias perjudiciales, disposición a perdonar a los padres o amigos cercanos, proximidad social con el delincuente, intención de daño y ofrecimiento de excusas. A los participantes se les presentaron 16 historias donde un adolescente había cometido un acto perjudicial contra otro. Caso por caso, se pidió a cada participante valorar en una escala continua el grado de voluntad para olvidar. El efecto de la anulación del factor de consecuencias fue el más fuerte, y mayor entre adolescentes jóvenes en comparación con los de más edad. El efecto del factor intención se ubicó en segundo lugar, siendo más fuerte entre los adolescentes mayores que entre los más jóvenes. El efecto de los factores de disposición a perdonar fue moderado (amigos) o pequeño (padres), y no se encontró diferencia en cuanto a la edad. En todos los casos, los efectos de la venganza, las disculpas y los factores sociales de proximidad fueron débiles. En cada grupo de edad, se observó un proceso de combinación de tipo aditivo.

Dados normativos do teste de atenção por cancelamento (tac) em estudantes do ensino fundamental / Normative date of attention by cancelling test (act) among fundamental level students / Datos normativos del test de atención por cancelación (tac) en estudiantes de la escuela primaria

O presente artigo traz dados de normatização do Teste de Atenção por Cancelamento (TAC). Participaram do estudo 524 sujeitos, com idades entre sete e 16 anos, estudantes do ensino fundamental das redes pública e privada da cidade de Natal/RN. Foram analisadas as diferenças de desempenho dos estudantes em função do tipo de escola, sexo e faixa etária. Verificou-se que as variáveis: nível de escolaridade e tipo de escola mostraram-se estatisticamente significativas (p < 0,05), enquanto a variável sexo não apresentou relevância para diferenciação de desempenho dos estudantes. Em termos de acurácia e velocidade em tarefas que avaliam a seletividade e alternância, constatou-se aumento significativo no desempenho dos estudantes nas três primeiras séries do ensino fundamental e estabilização dos resultados nos três últimos anos, o que aponta para estabelecimento de platô no desenvolvimento atencional. O TAC apresentou sensibilidade para a detecção de aspectos neurodesenvolvimentais e características socioculturais do funcionamento cognitivo humano.

This paper presents normative data concerning Attention by Cancelling Test (ACT). A group of 524 subjects aged between seven and 16 years and registered in elementary private and public schools in Natal/RN/Brazil took part in this research. Simultaneously differences were analyzed in students performance according to the type of school, gender and age. It was found that educational level and school type were statistically significant for students performance (p < 0.05), while gender did not show relevant effect. A statistically significant improvement in accuracy and speed in selectivity and alternance tasks was verified in students of 1st to 3rd primary school years. On the other hand, performance of students during the last three primary school years showed a clear stabilization, which leads to think in a developmental plateau in attention processes. Data issued from ACT showed sensibility in order to evaluate both neurodevelopmental and sociocultural aspects of human cognitive functioning.

En este artículo se presentan los datos normativos para el Test de Atención por Cancelación (TAC). El estudio incluyó a 524 sujetos, con edades comprendidas entre los siete y dieciséis años, estudiantes de escuelas primarias pública y privadas de la ciudad de Natal/RN. Se analizaron las diferencias del desempeño de los estudiantes en función del tipo de escuela, el género y la edad. Se verificó que las siguientes variables: nivel de educación y tipo de escuela fueron estadísticamente significativas (p < 0,05), mientras que la variable de género no presentó importancia a la diferenciación del desempeño de los estudiantes. En términos de precisión y velocidad en las tareas que evalúan la selectividad y la alternativa, se produjo un aumento significativo en el rendimiento de los estudiantes en los tres primeros grados de la escuela primaria y estabilización de los resultados en los últimos tres años, lo que apunta a establecer meseta en el desarrollo atencional. El TAC presentó sensibilidad para la detección de los aspectos de neurodesarrollo y en las características socio-culturales del funcionamiento cognitivo humano.

Teste de cancelamento dos sinos: comparação entre duas versões / Bells test: comparison between two versions

Os testes de cancelamento são classicamente utilizados em avaliações neuropsicológicas de atenção e velocidade psicomotora, com a tarefa tradicional de riscar alvos entre distratores. O Teste de Cancelamento dos Sinos, reconhecido internacionalmente por sua contribuição diagnóstica de heminegligência visual, foi desenvolvido com a tarefa de circular todos os sinos o mais rápido possível. Buscou-se verificar se há diferenças de desempenho entre duas versões de aplicação - sinos círculo e traço - em uma mesma amostra de 88 adultos neurologicamente saudáveis, de 19 a 75 anos, com no mínimo cinco anos de escolaridade. Eles foram avaliados na mesma sessão com as duas versões alternadamente. Os escores de acurácia e tempo foram comparados pelo teste Wilcoxon. O tempo da tarefa de riscar foi menor que o tempo da tarefa de circular. Assim, as duas versões não parecem ser totalmente equivalentes. Sugerem-se estudos para padronizar a versão sinos traço, assim como para caracterizar amostras clínicas, principalmente aquelas com ocorrência de heminegligência como sequela.

Cancellation tests are traditionally used in neuropsychological assessment of attention and psychomotor speed, with the traditional task of marking targets. The Bells Test, internationally acknowledged for its contribution to the diagnosis of visual hemineglect, was developed with the task of circling all the bells as quick as possible. This paper aimed at verifying whether there are differences in performance between two versions of application - bells with circles and bells with straight lines - in the same sample consisting of 88 neurologically healthy adults from 19 to 75 years of age, with at least 5 years of formal education. The sample was evaluated in the same session with the two versions in an alternative manner. Accuracy and time scores were compared by the Wilcoxon test. The performance time of the marking task was lower than in the circular version. Thus, the two versions do not seem to be totally equivalent. Studies are suggested to standardize the bells with straight lines version, as well as to describe clinical samples, especially those with hemineglect as a sequelae.

Case-control study on cognitive function of 87 children with behavior problems / 中华行为医学与脑科学杂志

Objective To compare the cognitive function of children with behavior problems and normal children. Methods 87 children with behavior problems were choosed as study group,according to Rutter' s Children Behaviour Qestionnaire. And 87 normal children were choosed randomly as normal control. Chinese Wechsler Intelligence Scale for Children (C-WISC) ,Clinical Memory Scale (CMS) ,Number Cancellation Test (NCT) and the Forth Exceptional Test (FET) were adopted to assess the cognitive function of children in two groups. Results Compared with normal control, arithmetic scale ( ( 10.40 ± 3.02 ) vs ( 12. 13 ± 3.26 ) ), verbal IQ ( ( 121.55 ±12.54) vs ( 129.40 ± 13.98) ), object assembly scale ( ( 9.98 ± 2.79 ) vs ( 11.70 ± 2.78 ) ), performance IQ((97.40±10.84) vs ( 103.93 ±14.22)),full IQ ((112.28±11.14) vs (119.03 ± 12.57)),verbal comprehension IQ ( ( 110.48 ± 11.23 ) vs ( 115.80 ± 12.31 ) ), memory/concentration IQ ( ( 101.25 ± 11.66 ) vs ( 109.40 ± 15.45 ) ),the net scale ( (67.05 ± 33.85 ) vs ( 88.72 ± 22.51 ) ) and error rate( ( 32.27 ± 35.77 ) %vs ( 15.41 ± 10.35 ) % ) were lower in children with behavior problems ( all P ＜ 0.05 ). In study group, the total scale of Rutter' s Children Behaviour Qestionnaire was negatively correlated with memory/concentration IQ, and with net scale(r = - 0. 335, - 0. 367, P ＜ 0.05 );but it was positively correlated with error rate (r = 0. 333, P ＜ 0.05 ). Conclusion Cognitive defects may exist in children with behavior problems.

Study and Analysis of Method for Extracting SEP / 中国医学物理学杂志

Objective: To study the method of extracting somatosensory evoked potential better. Methods: This article com-pares an auto-reference, auto-correlative and adaptive interference cancellation theories and techniques (AAA-ICT) used to the single trial of somatosensory evoked potential (SEP) with the traditional superposition averaging. Results: By the intensive study and analysis of the somatosensory evoked potentials from the 80 human subjects whose nervous systems are normal, We can find that the traditional superposition averaging method has its reasonable connotation on the extraction of SEP except the inevitable defects. Conclusions: Meanwhile the AAA-ICT avoids its defects. R implements another jump for the SEP extrac-tion method and has a good clinical application value.

Analysis of the clinical assessment of unilateral neglect after stroke / 中华物理医学与康复杂志

Objective To investigate the performances in line bisection(LB)and line cancellation(LC)tasks of patients with unilateral neglect.Methods The unilateral neglect patients,performances in LB and LC tasks before and after rehabilitation treatment were retrospectively analyzed.Results Before treatment,statistical analyses revealed the patients,performances in LC and LB tasks did not differ from each other(P =0.902).After treatment,statistical analyses revealed a significant difference between the two tasks(P =0.007).With LB only,29/30(97%)patients with neglect were detected;with LC only,22/30(73%)patients with neglect were detected.Conclusions As the performances of unilateral neglect patients improved,patients revealed difference between the performances in LB and in LC tasks.One test alone would miss some subjects with neglect.Combinative use of the two tests was more sensitive than either of the 2 tests alone.

Analysis of Cause for Cancellation of Elective Operation / 대한마취과학회지

BACKGROUND: Cancellations of elective operations are due to various reasons, which can be categorized into those initiated by patients or their guardians and those initiated by hospital staff. Cancellations of elective operations result not only in time and economic loss but also in negative psychological effects for patients and guardians and operational inefficiency for hospitals among other problems. As such, by studying and analyzing the causes of such cancellations, one may categorize them into involuntary ones and preventable ones, with the aim to reduce the occurrence of the latter that will lead to reduction in cancellation of elective operations. METHODS: 11,082 cases of elective operation were reviewed and analyzed retrospectively from January 2002 to December 2006. Total number, department, anesthetic type and cause of cancellation were recorded daily. Emergency operation and operation under local anesthesia were excluded. RESULTS: Total number of cancellation was 762 cases and mean cancellation rate was 6.9%. The most common cause of cancellation was co-existing disease or abnormal laboratory finding (25.3%). Especially in urology the most common cause of cancellation was the relief from diseases or symptoms. Plastic surgery showed the highest cancellation rate among all at 12%. CONCLUSIONS: Setting up standards that help determine the driving factors behind cancellations of elective operations within anesthesiology departments and utilizing a patient evaluation system, after categorizing the causes of cancellations into involuntary and preventable ones and analyzing them, will lead to reduction in cancellation of operations and solve problems faced by patients and guardians, and hospitals and their staff.

A Statistical Analysis of the Causes of Cancellation of Elective Operation / 대한마취과학회지

BACKGROUND: An elective operation is cancelled by many causes. Cancellation of the operation bothers patients physically and emotionally; also it affects the patient's family emotionally. If we know the causes of cancellation, we can prevent them. In addition we can provide better quality medical service. METHOD: We examined all patients scheduled for an operation in An - am Hospital, Korea University from August 3rd, 1999 to September 19th, 1999 and from September 16th, 1999 to December 6th, 1999. We counted the number of operations which were cancelled on the day of operation and put together the causes of cancellation after asking surgical employees. RESULTS: The total numbers of scheduled patients was 2,494 and cancelled patients was 512. The overall cancellation rate was 20.5%. The most common cause was departmental, 48.4%; abnormal laboratory results, 24.8%; patients denial, 9.6%; inadequate preparation, 7.0%; overtime, 5.5%; or a change to local anesthesia, 4.7%. In the departmental causes, 52% was due to an excessive schedule (129/248); 32.3% to delayed admission (80/248); 8.9% to clerical error (22/248); 4.4% to operator problems (11/248); and 1.6% to delayed transfer (4/248). In the abnormal laboratory results, 27.6% were due to the medical causes (35/127); 23.6% to LFT (30/127); 23% to an EKG (23/127); 18% to a chest roentgenogram (18/127); 8.7% to a URI (11/127); and 5.5% to hypertension (7/127). CONCLUSIONS: Overall the cancellation rate of elective surgery was 20.5%. The most common cause was departmental (48.7%), and abnormal laboratory results (24.8%) was next.

Etiology of the Cancellation in the Elective and Emergency Surgery / 대한마취과학회지

BACKGROUND: All population had been taken the medical insurance period. Because the most patients like the third medical institute, the many problems of the side effects in the admission, bed lacks, etc were occurred. The aim of the study was analysed several factors to decrease the etiology of the cancellation in the elective and emergency surgery occurred in the admitted patients for operation. METHODS: We examined the etiology and cancellation in the elective and emergency surgical patients from July 1st to December 31th, 1997. Total number, department, anesthetic type, etiology and cancellation of the elective and emergency surgical patients were recorded daily. Total number, the important etiologies and department of the cancelled cases were also recorded daily. RESULTS: The total and cancel number of the operative patients were 5,415 and 578 cases. The cancel rate of the total operative, elective and emergency surgical patients was 10.7%, 10.7% and 10.6%. In general anesthesia, the cancel rate of the total operative, elective and emergency surgical patients was 10.6%, 10.4% and 11.1%. In regional anesthesia, the cancel rate of the total operative, elective and emergency surgical patients was 11.9%, 14.9% and 4.9%. By monthly, the peak and the lowest cancel rate of the total operative patients was August as 18.5% and October as 4.8%. The single most frequent etiology was affairs of operator or operating department. The second was no admission. The peak cancal rate of department was pediatric surgery. CONCLUSIONS: We found that there were several factors to decrease the etiology of the cancellation in the elective and emergency surgery performed in the operation room. These were a careful preopertive evaluation of patient's physical status and results of the laboratory examination before hospitalization, removal of affairs of the operator and operating department, removal of no admission, appropriate schedule of elective surgery, consultation with anesthesiologist, prevention of the inappropriate operative schedule, etc.

A Study of Cancellation Cases of the Elective Operations / 대한마취과학회지

BACKGROUND: Unexpected cancellation of the elective operation on scheduled day is stressful event to both of patients and doctors, especially when there is little explanation and understanding. Above all, it is against cost-saving policies in hospital management. Thus the author investigated the rate, distribution and causes of cancelled cases to get help to make plans to reduce the cancellation rates. METHODS: From March 1st in 1996 to February 28th in 1997, all operation schedules were reviewed and cancelled cases on scheduled day were analyzed. All the elective operations except emergency operations under general, regional or local anesthesia were included in this analysis. Total cancellation rate was analyzed according to surgical departments, month, week day, age and causes. In statistical analysis, SAS program was used. RESULTS: Total number of cancellation was 424 cases and mean cancellation rate was 8.47%. In analysis of cancellation rate by months, it was highest in October and lowest in November. In August, October and December the cancellation rates were higher than the other months. It was higher on Tuesday and Thursday. Most common causes of cancellation was the problems related patient's condition, especially related to coexisting diseases. Among these, cardiac disease was predominant. Non-medical causes were predominant than medical causes in most cancelled cases. CONCLUSION: Trying to reduce the cancellation rates is suggested as one of methods that will make the quality and quantity of medical services better. Careful preoperative evaluation of patient and consultation of abnormal findings or laboratory data before hospitalization, appropriate scheduling of operation, complete preparation of operation apparatus, through all these, firm establishment of doctor-patient rapport are core element of reducing of cancellation rate. So, attention and support by not only anesthesiologist but surgeons and hospital managers are needed to achieve these goals of reducing of cancellation rate.