Evaluation of Accuracy and Influencing Factors for Diagnosis of Two Chronic Diseases by Primary Healthcare Providers in Sichuan Rural Areas Based on Standardized Patients / 中国医学科学院学报

Objective We used standardized patients to evaluate the accuracy and explore the influencing factors of the diagnosis of unstable angina pectoris and type 2 diabetes by primary healthcare providers in Sichuan rural areas,aiming to provide a scientific basis for improving the diagnosis accuracy of primary healthcare providers for the two chronic diseases. Methods A multi-stage stratified random cluster sampling method was adopted to select 100 villages from 50 townships in 5 districts/counties in Zigong city,Sichuan province. General and internal medicine practioners who were on duty on the survey day were enrolled in the survey.Two rounds of data collection were conducted.In the first round,the basic information of providers from township health centers and village clinics was collected.One month after the the first survey,standardized patients were used to collect the information related to the diagnosis of unstable angina pectoris and type 2 diabetes by rural primary providers.Logistic regression was carried out to analyze the factors influencing the diagnosis accuracy. Results A total of 172 rural primary healthcare providers were enrolled in the survey,who completed 186 standardized patient visits and showed the correct diagnosis rate of 48.39%.Specifically,the correct diagnosis rates of unstable angina pectoris and type 2 diabetes were 18.68%(17/91) and 76.84%(73/95),respectively.The providers with medical practitioner qualifications were more likely to make correct diagnosis(OR=4.857,95%CI=1.076-21.933, P=0.040).The providers who involved more necessary consultation and examination items in the diagnosis process had higher probability of correct diagnosis(OR=1.627,95%CI=1.065-2.485, P=0.024).Additionally,the providers were more likely to make a correct diagnosis for type 2 diabetes than for unstable angina pectoris(OR=6.306,95%CI=3.611-11.013, P<0.001). Conclusions The overall diagnosis accuracy of unstable angina pectoris and type 2 diabetes was relatively low among primary healthcare providers in Sichuan rural areas.The training of diagnosis process can be taken as a key for improving providers' practice ability so as to increase the diagnosis accuracy of chronic diseases.

Diagnostic Value of Transbronchial Ultrasound-guided Needle Aspiration Biopsy in the Diagnosis of Small Cell Lung Cancer and Non-small Cell Lung Cancer / 中国肺癌杂志

BACKGROUND@#As a new technique developed in recent years, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has the advantages of simple operation, minimal invasive, high accuracy, safety and repeatability. It has become a new standard for lung cancer diagnosis and mediastinal staging. Because small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) have different biological characteristics and treatment methods, it is very important to diagnose and differentiate the types of lung cancer in the early stage of lung cancer for the staging, treatment and prognosis of lung cancer. This article evaluated the accuracy and sensitivity of EBUS-TBNA in the diagnosis of SCLC and NSCLC.@*METHODS@#From January 2012 to December 2018, the clinical data of 85 patients with SCLC and NSCLC who performed EBUS-TBNA in Xuan Wu Hospital CMU were retrospectively analyzed and the differences between the two groups were compared.@*RESULTS@#45 cases of SCLC were confirmed by immunohistochemistry and pathology. 42 cases of SCLC were diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 93.3% (42/45) and 100.0% (42/42), respectively. The positive rate of diagnosis was 48.9% (22/45) in 22 cases diagnosed by cytology, and 40 cases diagnosed by pathology, including 35 cases diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 87.5% (35/40) and 100.0% (35/35), respectively. The positive rate of diagnosis was 27.5% (11/40) in 11 cases diagnosed by cytology. The diagnostic sensitivity of EBUS-TBNA in SCLC group was significantly higher than that in NSCLC group (P<0.05).@*CONCLUSIONS@#EBUS-TBNA is more sensitive in the diagnosis of SCLC than NSCLC. As a minimally invasive technique, EBUS-TBNA can assist SCLC in early diagnosis and timely treatment.

Clinical application analysis and evaluation of 128-slice GEM CT technique / 医疗卫生装备

Objective To evaluate the clinical application of 128-slice GEM CT in order to analyze its advantages in clinical application.Methods The characteristics of ASiR technique were introduced,CT images of target area were obtained,and the clinical advantages of the technique were analyzed.Results The technique gained advantages in the imaging examination of heart,abdomen,soft tissues,vascular plaque and high resolutions in time,space and density,and image noise was decreased with no X-ray radiation dose increased.Conclusion The technique enhances CT examination in image quality,diagnosis accuracy,examination efficiency and high resolutions in time,space and density.

Clinical application analysis and evaluation of 128-slice GEM CT technique / 医疗卫生装备

Objective To evaluate the clinical application of 128-slice GEM CT in order to analyze its advantages in clinical application.Methods The characteristics of ASiR technique were introduced,CT images of target area were obtained,and the clinical advantages of the technique were analyzed.Results The technique gained advantages in the imaging examination of heart,abdomen,soft tissues,vascular plaque and high resolutions in time,space and density,and image noise was decreased with no X-ray radiation dose increased.Conclusion The technique enhances CT examination in image quality,diagnosis accuracy,examination efficiency and high resolutions in time,space and density.

Eficacia de la tinción de Gram de muestras respiratorias para la predicción de la neumonía asociada al respirador y su utilidad en la selección de la terapéutica antibiótica empírica / Efficacy of the Gram stain in respiratory samples for the prediction of ventilation associated pneumonia and its utility in the selection of the initial empiric antibiotic therapy

Introducción: La neumonía asociada a la ventilación (NAV) es una complicación frecuente de la ventilación mecánica (VM) y se asocia a alta mortalidad. Su adecuado manejo se basa en detección precoz y terapia con antibióticos (ATB) empírica eficaz, siendo esenciales los métodos que permitan predecir la NAV y ayuden a seleccionar los ATB. Objetivo: valorar la eficacia del examen directo por tinción de Gram de muestras obtenidas del tracto respiratorio en la detección de NAV y como ayuda a la selección de ATB. Materiales y Métodos: Se incluyeron prospectivamente 95 episodios de sospecha de NAV en 69 pacientes, considerando sólo los casos sin modificación de los ATB por más de 48 hs o sin ATB. Las muestras fueron obtenidas por medio de Lavado bronquioloalveolar a través de Fibro- broncoscopia (BAL) o minibal por catéter envainado a ciegas (miniBal). La confirmación se efectuó por el análisis bacteriológico cuantitativo (> 10 elevado a la cuarta y > 10³ para el BAL y minibal respectivamente). Se calculó la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y negativo (VPN) de la técnica de tinción directa de Gram, considerando como referencia el resultado microbiológico del cultivo del BAL o mini-BAL. Se comparó además la concordancia entre el tipo de germen observado en la tinción directa de Gram, bacilo Gram negativo (BGN) o coco Gram positivo (CGP) y el tipo de bacteria aislada en el cultivo. Se analizaron también las variables predictivas específicas o cualitativas, esto es la eficacia del Gram en predecir VAP por CGP o por BGN. Resultados: Se diagnosticó NAV en 52 casos. La S de la tinción de Gram fue de 60%, E: 100%, VPP Positivo: 100%, VPN: 67%. En cuanto a la eficacia para predecir VAP por BGN se observó: S: 52%, E: 100%, VPP: 100%, VPN: 72%. Para CGP: s: 91 %, E: 100%, VPP 100% y VPN: 99%. Conclusión: Si bien un examen bacteriológico directo por tinción de Gram predice presencia de VAP, su VPN es bajo por lo que un directo negativo...

Introduction: Ventilator Associated Pneumonia (VAP) is a frequent complication in mechanically ventilated patients, and is associated with a high mortality. Early diagnosis and appropriate use of empiric antibiotic therapy (ATB) is essential to its treatment. Tests that help to make an early diagnosis and select the initial ATB are useful. Objective: to evaluate the accuracy of the Gram stain examination of respiratory tract samples in the prediction of VAP and its potential role in the selection of empiric ATB. Materials and methods: prospective evaluation of 95 episodes in 69 patients with clinical suspicion of VAP who had not had any changes in the ATB for more than 48 hours or had not been treated with ATB. Samples were taken by bronchoalveolar lavage (BAL) through flexible bronchoscopy or blind mini bronchoalveolar lavage with protected catheter. VAP was confirmed when the quantitative cultures showed =10 to the fourth ufc/ml for BAL and =10³ ufc/ml for mini BAL. A comparison was made between the type of bacteria observed by the direct Gram staining (Gram negative bacteria or Gram positive bacteria) and the type of bacteria isolated by culture. Specific or qualitative predictive variables were analyzed to determine the value of Gram staining to predict a Gram-negative VAP or Gram-positive VAP. Results: VAP was confirmed in 52 cases. The sensitivity of the Gram stain for VAP was 60%, specificity 100%; positive predictive value: 100% and negative predictive value: 67%. The sensitivity of Gram negative bacteria for VAP was: 52%; specificity: 100%; positive predictive value: 100%; negative predictive value: 72%. The sensitivity of Gram positive bacteria for VAP was: 91 %; specificity: 100%; positive predictive value: 100%; negative predictive value: 99%. Conclusions: A positive finding in the Gram staining examination of respiratory tract samples was highly predictive of VAP but a negative result did not mean absence of VAP, because the negative...