On the Evaluation of the Hyperthermic Efficiency of Magnetic Scaffolds.

Goal: Deep-seated tumors (DST) can be treated using thermoseeds exposed to a radiofrequency magnetic field for performing local interstitial hyperthermia treatment (HT). Several research efforts were oriented to the manufacturing of novel biocompatible magnetic nanostructured thermo-seeds, called magnetic scaffolds (MagS). Several iron-doped bioceramics or magnetic polymers in various formulations are available. However, the crucial evaluation of their heating potential has been carried out with significantly different, lab specific, variable experimental conditions and protocols often ignoring the several error sources and inaccuracies estimation. Methods: This work comments and provides a perspective analysis of an experimental protocol for the estimation methodology of the specific absorption rate (SAR) of MagS for DST HT. Numerical multiphysics simultions have been performed to outline the theoretical framework. After the in silico analysis, an experimental case is considered and tested. Results: From the simulations, we found that large overestimation in the SAR values can be found, due to the axial misplacement in the radiofrequency coil, while the radial misplacement has a lower impact on the estimated SAR value. Conclusions: The averaging of multiple temperature records is needed to reliably and effectively estimate the SAR of MagS for DST HT.

Blinding assessment in clinical trials of traditional Chinese medicine: Exploratory principles and protocol.

As one of the key components of clinical trials, blinding, if successfully implemented, can help to mitigate the risks of implementation bias and measurement bias, consequently improving the validity and reliability of the trial results. However, successful blinding in clinical trials of traditional Chinese medicine (TCM) is hard to achieve, and the evaluation of blinding success through blinding assessment lacks established guidelines. Taking into account the challenges associated with blinding in the TCM field, here we present a framework for assessing blinding. Further, this study proposes a blinding assessment protocol for TCM clinical trials, building upon the framework and the existing methods. An assessment report checklist and an approach for evaluating the assessment results are presented based on the proposed protocol. It is anticipated that these improvements to blinding assessment will generate greater awareness among researchers, facilitate the standardization of blinding, and augment the blinding effectiveness. The use of this blinding assessment may further advance the quality and precision of TCM clinical trials and improve the accuracy of the trial results. The blinding assessment protocol will undergo continued optimization and refinement, drawing upon expert consensus and experience derived from clinical trials. Please cite this article as: Wang XC, Liu XY, Shi KL, Meng QG, Yu YF, Wang SY, Wang J, Qu C, Lei C, Yu XP. Blinding assessment in clinical trials of traditional Chinese medicine: Exploratory principles and protocol. J Integr Med. 2023; 21(6): 528-536.

Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China.

Objective: This study aims to investigate the changes in admission appropriateness after patients were admitted and provide a reference for physicians to make admission decisions and for the supervision of medical service behavior by the medical insurance regulatory department. Methods: Medical records of 4,343 inpatients were obtained based on the largest and most capable public comprehensive hospital in four counties in central and western China for this retrospective study. The binary logistic regression model was employed to examine the determinants of changes in admission appropriateness. Results: Nearly two-in-thirds (65.39%) of the 3,401 inappropriate admissions changed to appropriate at discharge. Age, type of medical insurance, medical service type, severity of the patient upon admission, and disease category were found to be associated with the changes in the appropriateness of admission. Older patients (OR = 3.658, 95% CI [2.462-5.435]; P < 0.001) were more likely to go from "inappropriate" to "appropriate" than younger counterparts. Compared with circulatory diseases, the case evaluated as "appropriate" at discharge was more frequent in the urinary diseases (OR = 1.709, 95% CI [1.019-2.865]; P = 0.042) and genital diseases (OR = 2.998, 95% CI [1.737-5.174]; P < 0.001), whereas the opposite finding was observed for patients with respiratory diseases (OR = 0.347, 95% CI [0.268-0.451]; P < 0.001) and skeletal and muscular diseases (OR = 0.556, 95% CI [0.355-0.873]; P = 0.011). Conclusions: Many disease characteristics gradually emerged after the patient was admitted, thus the appropriateness of admission changed. Physicians and regulators need to take a dynamic view of disease progression and inappropriate admission. Aside from referring to the appropriateness evaluation protocol (AEP), they both should pay attention to individual and disease characteristics to make a comprehensive judgment, and strict control and attention should be paid to the admission of respiratory, skeletal, and muscular diseases.

Estrategias para mejorar el flujo de ingresos y estancias hospitalarias: adaptación del cuestionario Appropriateness Evaluation Protocol (AEP): estudio Delphi / Strategies to improve the flow of admissions and hospital stays: A Delphi study of an adaptation of the Appropriateness Evaluation Protocol

Introducción y objetivo La herramienta Appropriateness Evaluation Protocol (AEP) analiza las estancias e ingresos hospitalarios inadecuados. El objetivo de este estudio fue adaptar el cuestionario AEP para analizar la adecuación de los ingresos y las estancias hospitalarias en nuestra realidad asistencial. Método Se desarrolló un estudio utilizando el método Delphi en el que participaron 15 expertos en gestión clínica y en asistencia hospitalaria. Los ítems del formulario inicial se conformaron a partir de la herramienta AEP tal y como fue definida en su primera versión. En la primera ronda los participantes aportaron nuevos ítems que consideraron relevantes en nuestra realidad actual. En las rondas 2 y 3 evaluaron 80 ítems según su relevancia mediante la utilización de una escala Likert del 1 al 4 (máxima utilidad). De acuerdo al diseño de nuestro estudio los ítems del AEP se consideraron adecuados si la media de la puntuación una vez evaluados por los expertos, era igual o superior a 3. Resultados Los participantes definieron un total de 19 nuevos ítems. Finalmente 47 ítems obtuvieron una puntuación media igual o superior a 3. El cuestionario resultante modificado consta de 17 ítems en «causas de admisiones adecuadas», 5 en «causas de admisiones inadecuadas», 15 en «causas de estancias adecuadas» y 10 en «causas de estancias inadecuadas». Conclusiones La identificación de ítems prioritarios para determinar la adecuación de los ingresos y las estancias prolongadas en nuestro medio y según la opinión de los expertos, podría definir un futuro instrumento para su utilización en nuestro entorno (AU)

Introduction and aim The Appropriateness Evaluation Protocol (AEP) tool analyzes inappropriate hospital stays and admissions. This study aimed to adapt the AEP questionnaire in order to analyze the appropriateness of hospital admissions and stays in our healthcare reality. Methods A study was conducted using the Delphi method in which 15 experts in clinical management and hospital care participated. The initial questionnaire items were taken from the first version of the AEP. In the first round, the participants contributed new items that they considered relevant in our current reality. In rounds 2 and 3, they evaluated 80 items according to their relevance using a Likert scale from 1 to 4 (maximum usefulness). Pursuant to the study's design, AEP items were considered adequate if the mean score according to the experts’ evaluation was greater than or equal to 3. Results The participants defined a total of 19 new items. In the end, 47 items earned a mean score greater than or equal to 3. The resulting modified questionnaire include 17 items in “Reasons for Appropriate Admissions”, 5 in “Reasons for Inappropriate Admissions”, 15 in “Reasons for Appropriate Hospital Stays”, and 10 in “Reasons for Inappropriate Hospital Stays”. Conclusions The identification according to expert opinion of priority items to determine the appropriateness of admissions and extended stays could be used in the future to help create an instrument to be used in our setting (AU)

Strategies to improve the flow of admissions and hospital stays: a Delphi study of an adaptation of the Appropriateness Evaluation Protocol (AEP).

INTRODUCTION AND AIM: The Appropriateness Evaluation Protocol (AEP) tool analyzes inappropriate hospital stays and admissions. This study aimed to adapt the AEP questionnaire in order to analyse the appropriateness of hospital admissions and stays in our healthcare reality. METHODS: A study was conducted using the Delphi method in which 15 experts in clinical management and hospital care participated. The initial questionnaire items were taken from the first version of the AEP. In the first round, the participants contributed new items that they considered relevant in our current reality. In rounds 2 and 3, they evaluated 80 items according to their relevance using a Likert scale from 1 to 4 (maximum usefulness). Pursuant to the study's design, AEP items were considered adequate if the mean score according to the experts' evaluation was greater than or equal to 3. RESULTS: The participants defined a total of 19 new items. In the end, 47 items earned a mean score greater than or equal to 3. The resulting modified questionnaire include 17 items in "Reasons for Appropriate Admissions," 5 in "Reasons for Inappropriate Admissions," 15 in "Reasons for Appropriate Hospital Stays," and 10 in "Reasons for Inappropriate Hospital Stays." CONCLUSIONS: The identification according to expert opinion of priority items to determine the appropriateness of admissions and extended stays could be used in the future to help create an instrument to be used in our setting.

Protocol in Evaluating Capacity of Zn-Mn Aqueous Batteries: A Clue of pH.

In the literature, Zn-Mn aqueous batteries (ZMABs) confront abnormal capacity behavior, such as capacity fluctuation and diverse "unprecedented performances." Because of the electrolyte additive-induced complexes, various charge/discharge behaviors associated with different mechanisms are being reported. However, the current performance assessment remains unregulated, and only the electrode or the electrolyte is considered. The lack of a comprehensive and impartial performance evaluation protocol for ZMABs hinders forward research and commercialization. Here, a pH clue (proton-coupled reaction) to understand different mechanisms is proposed and the capacity contribution is normalized. Then, a series of performance metrics, including rated capacity (Cr ) and electrolyte contribution ratio from Mn2+ (CfM), are systematically discussed based on diverse energy storage mechanisms. The relationship between Mn (II) ↔ Mn (III) ↔ Mn (IV) conversion chemistry and protons consumption/production is well-established. Finally, the concrete design concepts of a tunable H+ /Zn2+ /Mn2+ storage system for customized application scenarios, opening the door for the next-generation high-safety and reliable energy storage system, are proposed.

Evaluation Protocol for Analogue Intelligent Medical Radars: Towards a Systematic Approach Based on Theory and a State of the Art.

We propose the basis for a systematised approach to the performance evaluation of analogue intelligent medical radars. In the first part, we review the literature on the evaluation of medical radars and compare the provided experimental elements with models from radar theory in order to identify the key physical parameters that will be useful to develop a comprehensive protocol. In the second part, we present our experimental equipment, protocol and metrics to carry out such an evaluation.

Motion Analysis of Balance Pre and Post Sensorimotor Exercises to Enhance Elderly Mobility: A Case Study.

Quantitative assessment of movement using motion capture provides insights on mobility which are not evident from clinical evaluation. Here, in older individuals that were healthy or had suffered a stroke, we aimed to investigate their balance in terms of changes in body kinematics and muscle activity. Our research question involved determining the effects on post- compared to pre-sensorimotor training exercises on maintaining or improving balance. Our research hypothesis was that training would improve the gait and balance by increasing joint angles and extensor muscle activities in lower extremities and spatiotemporal measures of stroke and elderly people. This manuscript describes a motion capture-based evaluation protocol to assess joint angles and spatiotemporal parameters (cadence, step length and walking speed), as well as major extensor and flexor muscle activities. We also conducted a case study on a healthy older participant (male, age, 65) and an older participant with chronic stroke (female, age, 55). Both participants performed a walking task along a path with a rectangular shape which included tandem walking forward, right side stepping, tandem walking backward, left side stepping to the starting location. For the stroke participant, the training improved the task completion time by 19 s. Her impaired left leg had improved step length (by 0.197 m) and cadence (by 10 steps/min) when walking forward, and cadence (by 12 steps/min) when walking backward. The non-impaired right leg improved cadence when walking forward (by 15 steps/min) and backward (by 27 steps/min). The joint range of motion (ROM) did not change in most cases. However, the ROM of the hip joint increased significantly by 5.8 degrees (p = 0.019) on the left leg side whereas the ROMs of hip joint and knee joint increased significantly by 4.1 degrees (p = 0.046) and 8.1 degrees (p = 0.007) on the right leg side during backward walking. For the healthy participant, the significant changes were only found in his right knee joint ROM having increased by 4.2 degrees (p = 0.031) and in his left ankle joint ROM having increased by 5.5 degrees (p = 0.006) during the left side stepping.

Understanding the Impact of a New Approach to the Safeguarding of Children at Risk: An Evaluation Protocol.

Introduction: Child Safeguarding Services intervene in situations where a child is at risk of serious emotional or physical harm. The response will vary according to the level of risk, but in serious cases, a child may need to be removed from danger and cared for by foster parents either temporarily or permanently. The number of children being taken into care has increased markedly in recent years in the United Kingdom. Oxfordshire County Council (OCC) is implementing a new approach to the welfare of children (Family Solutions Plus; FSP) in which the focus is to support the whole family and ideally reduce the need for foster care.In this paper, we describe a proposed programme of evaluation to examine the impact of FSP on the time children are in contact with services, the nature of the support provided, experience of children and families, the experience of staff, and longer term outcomes for children, particularly whether they remain within the family or need to be cared for outside the home. Methods and analysis: A mixed methods approach will be taken in an observational retrospective study of children's social care services. Quantitative research will include descriptive analysis on data routinely collected by OCC, examining the effect on time spent in services, outcomes for children and how these outcomes are mediated by family characteristics and circumstances. Qualitative research will be carried out using individual interviews and focus groups with children, families and staff in the teams providing family safeguarding services to capture their experiences with the new model. Ethics and dissemination: This project has been registered with the OCC as a service evaluation. The qualitative studies will seek ethical approval from Oxford University Ethics Committee. A local data sharing agreement will govern the transfer of quantitative data. Results will be disseminated through newsletters, community forums, professional publications and conference presentations to national and international audiences.

Appropriateness of hospital admissions in a university hospital in Egypt: Analyzing a preintervention phase.

Background: Identifying the magnitude of this improper use and applying interventions to eliminate unnecessary hospitalization will reduce health-care expenditure, improve the quality of care for patients, and increase the accessibility to care for actual patients in need on waiting lists. Aim of Work To measures the rate of inappropriate admissions at the Ain Shams University Hospital. Methods: This research is the preintervention phase of a study conducted to improve the appropriateness of patient admission at this hospital. The appropriateness evaluation protocol (AEP) was used to review the appropriateness of 576 hospital admissions over 100 days. The patients' medical records were stratified according to the admission route into two groups, namely emergency and outpatient admission. Next, the systematic random samples were taken from each stratum based on the admission list of the previous day. Results: The results showed that 20.5% of the sampled cases were inappropriately admitted. Furthermore, a statistically significant difference was observed between appropriately and inappropriately admitted cases regarding gender and shifts during which admission occurred in addition to body systems affected; inappropriate admissions were more among females, and admissions occurred most frequently during the morning shifts (8:00 am-2:00 pm). The remaining other factors that were studied also proved insignificant. Conclusion: It can be concluded that a considerable proportion of hospital admissions is inappropriate, especially in the elective surgery department, and these admissions vary according to patient's gender, shifts during which admission occurred, and the affected body systems. Recommendations: Adopting hospital admission policies based on the AEP criteria in addition to training of physicians on these criteria would help prevent inappropriate admission and ensure optimization during use of hospital facilities.

Towards socialVR: evaluating a novel technology for watching videos together.

Social VR enables people to interact over distance with others in real-time. It allows remote people, typically represented as avatars, to communicate and perform activities together in a shared virtual environment, extending the capabilities of traditional social platforms like Facebook and Netflix. This paper explores the benefits and drawbacks provided by a lightweight and low-cost Social VR platform (SocialVR), in which users are captured by several cameras and reconstructed in real-time. In particular, the paper contributes with (1) the design and evaluation of an experimental protocol for Social VR experiences; (2) the report of a production workflow for this new type of media experiences; and (3) the results of experiments with both end-users (N = 15 pairs) and professionals (N = 22 companies) to evaluate the potential of the SocialVR platform. Results from the questionnaires and semi-structured interviews show that end-users rated positively towards the experiences provided by the SocialVR platform, which enabled them to sense emotions and communicate effortlessly. End-users perceived the photo-realistic experience of SocialVR similar to face-to-face scenarios and appreciated this new creative medium. From a commercial perspective, professionals confirmed the potential of this communication medium and encourage further research for the adoption of the platform in the commercial landscape. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-022-00651-5.

Protocol for the Implementation and Evaluation of a Mindfulness-Based Intervention for Caregivers of Children with Mental Disorders in a Clinical Setting.

Being a parent is complicated in typical circumstances, with a great psychological impact as well as feelings and experiences of great intensity. This impact is greater in families in vulnerable situations, such as those with children with mental health problems, receiving treatment in a clinical setting. Due to these challenges, parenting in these circumstances is often accompanied by experiences of stress. An approach that has shown evidence of effectiveness in mitigating the negative impact of stress is mindfulness-based interventions, including the Mindfulness-Based Stress Reduction intervention program. The Mindfulness-Based Stress Reduction intervention program is designed as a psychoeducational, instructional, multimodal, and structured program whose main objective is to provide strategies for the management, coping, and awareness of stress in order to reduce it. In this paper, a protocol for the implementation and evaluation of the original Mindfulness-Based Stress Reduction intervention program with the added positive parenting component is presented, in order to systematize the incorporation of a parenting component in the Mindfulness-Based Stress Reduction intervention program, analyze its effectiveness for parents whose children have mental health problems (in terms of stress, mindfulness, emotional intelligence, general health, and parental role), explore the mechanisms of change operating in this intervention as perceived by the participants, and examine the application of acquired strategies to daily life.

User Experience and Potential Health Effects of a Conversational Agent-Based Electronic Health Intervention: Protocol for an Observational Cohort Study.

BACKGROUND: While the average human life expectancy has increased remarkably, the length of life with chronic conditions has also increased. To limit the occurrence of chronic conditions and comorbidities, it is important to adopt a healthy lifestyle. Within the European project "Council of Coaches," a personalized coaching platform was developed that supports developing and maintaining a healthy lifestyle. OBJECTIVE: The primary aim of this study is to assess the user experience with and the use and potential health effects of a fully working Council of Coaches system implemented in a real-world setting among the target population, specifically older adults or adults with type 2 diabetes mellitus or chronic pain. METHODS: An observational cohort study with a pretest-posttest design will be conducted. The study population will be a dynamic cohort consisting of older adults, aged ≥55 years, as well as adults aged ≥18 years with type 2 diabetes mellitus or chronic pain. Each participant will interact in a fully automated manner with Council of Coaches for 5 to 9 weeks. The primary outcomes are user experience, use of the program, and potential effects (health-related factors). Secondary outcomes include demographics, applicability of the virtual coaches, and user interaction with the virtual coaches. RESULTS: Recruitment started in December 2019 and is conducted through mass mailing, snowball sampling, and advertisements in newspapers and social media. This study is expected to conclude in August 2020. CONCLUSIONS: The results of this study will either confirm or reject the hypothesis that a group of virtual embodied conversational coaches can keep users engaged over several weeks of interaction and contribute to positive health outcomes. TRIAL REGISTRATION: The Netherlands Trial Register: NL7911; https://www.trialregister.nl/trial/7911. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/16641.

Bem-estar dos cães de abrigos municipais no estado do Paraná, Brasil, segundo o protocolo Shelter Quality / The welfare of dogs from municipal shelters in the state of Paraná, Brazil, under the Shelter Quality protocol

O bem-estar dos animais, além dos aspectos individuais, depende do entendimento e dedicação dos responsáveis pelo abrigo. O objetivo do presente trabalho foi avaliar o bem-estar dos cães mantidos em abrigos municipais do estado do Paraná, mediante a aplicação do protocolo Shelter Quality. Foram avaliados 16 abrigos, 439 cães e 165 recintos, na estação do outono de 2017. A maioria dos abrigos apresentou cães com condição corporal adequada e pelagem limpa, em recintos seguros, com metragem e suprimento de água adequados e conforto térmico. Além disso, a maioria dos cães eram mantidos em recintos coletivos e em ambientes abertos, com baixo nível de ruído e demonstravam mais emoções positivas, desejáveis na adoção. Como aspectos negativos, 58% (96/165) dos recintos avaliados tinham camas inadequadas ou inexistentes e 30% (50/165) dos recintos mantinham cães individualmente, sendo indicadores de baixo grau de bem-estar para os cães envolvidos. Além disso, nenhum abrigo disponibilizava ração para cães idosos e 81% (13/16) dos abrigos negligenciavam o diagnóstico e tratamento da dor. Apesar de a maioria dos abrigos apresentarem mais pontos positivos que negativos em sua avaliação, a gestão dos abrigos deve sempre visar à correção dos pontos críticos que comprometam o bem-estar dos animais.(AU)

Animal welfare, in addition to individual aspects, depends on the understanding and dedication of those responsible for the shelter. The objective of this study was to evaluate the welfare of dogs kept in municipal shelters in the state of Paraná, using the Shelter Quality protocol. A total of 16 shelters, 439 dogs and 165 enclosures were evaluated in the fall season of 2017. Most shelters presented dogs with adequate body condition and clean coat, in secure enclosures with adequate water supply and thermal comfort. In addition, most dogs were kept in collective enclosures and in open environments, with low noise levels and showing more positive, desirable emotions in adoption. As negative aspects, 58% (96/165) of the precincts evaluated had inadequate or inexistent beds and 30% (50/165) of the enclosures kept dogs individually, being indicators of a low degree of well-being for the dogs involved. In addition, no shelter provided elderly dog rations and 81% (13/16) of the shelters neglected the diagnosis and treatment of pain. Although most shelters present more positive than negative points in their evaluation, shelter management should always aim at correcting critical points that compromise animal welfare.(AU)

Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and findings.

OBJECTIVES: This article reviews the applicability of a customised version of the Appropriateness Evaluation Protocol (AEP) to evaluate the magnitude of inappropriate hospitalisations in two regions of Ukraine. DATA AND METHODS: The original AEP was modified to develop a customised tool, which included criteria for the appropriateness of hospitalisation and duration of inpatient stay. The customisation of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalisations. We used descriptive and analytical statistics, receiver operating characteristic curve analysis and Cohen's kappa to check the consistency between the findings of primary reviewers and experts. RESULT: We observed high levels of agreement in conclusions of primary reviewers (reference standard) and experts during testing of the reliability and validity of the method. The external validity check showed that the use of the tool by different experts provided high accuracy: 95.1 sensitivity, 76.6 specificity and area under ROC-curve (AUC)=0.948 (р<0.001) for analysis of the appropriateness of admissions; 95.3 sensitivity, 84.7 specificity and AUC=0.900 (р=0.001) for the duration of hospitalisations. Cohen's kappa coefficient (κ) indicated agreement in expert evaluations of 0.915 (95% СІ 0.799 to 1.000) and 0.812 (95% СІ 0.749 to 0.875), respectively.We found that over one-third of admissions (38.1%; 95% СІ 33.9 to 43.5) and over half of total bed-days were unnecessary (57.4%; 95% СІ 56.4 to 58.5). The highest levels of stay were observed in hospitals' general medicine departments (64.6%; 95% СІ 63.0 to 66.3)compared with other departments included in the analysis. CONCLUSION: The proposed method is robust in assessing the appropriateness of hospitalisations and duration of inpatient stays. The quantified levels of unnecessary hospital care indicate the need for improving efficiency and quality of care and optimising the excessive hospital capacities in Ukraine.

Electrochemical Analysis for Demonstrating CO Tolerance of Catalysts in Polymer Electrolyte Membrane Fuel Cells.

Since trace amounts of CO in H2 gas produced by steam reforming of methane causes severe poisoning of Pt-based catalysts in polymer electrolyte membrane fuel cells (PEMFCs), research has been mainly devoted to exploring CO-tolerant catalysts. To test the electrochemical property of CO-tolerant catalysts, chronoamperometry is widely used under a CO/H2 mixture gas atmosphere as an essential method. However, in most cases of catalysts with high CO tolerance, the conventional chronoamperometry has difficulty in showing the apparent performance difference. In this study, we propose a facile and precise test protocol to evaluate the CO tolerance via a combination of short-term chronoamperometry and a hydrogen oxidation reaction (HOR) test. The degree of CO poisoning is systematically controlled by changing the CO adsorption time. The HOR polarization curve is then measured and compared with that measured without CO adsorption. When the electrochemical properties of PtRu alloy catalysts with different atomic ratios of Pt to Ru are investigated, contrary to conventional chronoamperometry, these catalysts exhibit significant differences in their CO tolerance at certain CO adsorption times. The present work will facilitate the development of catalysts with extremely high CO tolerance and provide insights into the improvement of electrochemical methods.

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea.

OBJECTIVES: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. METHODS: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. RESULTS: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. CONCLUSIONS: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Systematic approach for benign liver lesions in non - cirrhotic livers

Introduction: Focal liver lesions are increasingly diagnosed in non-cirrhotic livers with widespread use of imaging. Arriving at an accurate diagnosis is challenging. Management of indeterminate lesions is not clearly defined. This paper looks at 101 non - malignant cases on the initial assessment and the outcome after three years of follow up. Objectives: To assess the outcome of 101 benign liver lesions on initial assessment. Methods: 136 lesions in non-cirrhotic patients underwent triphasic CT(Computed Tomography )scan in all, MRI in 56 cases, biopsy in 5 patients and all discussed in multidisciplinary meeting. After initial evaluation 101/136 were benign or likely to be benign. These were divided as having benign asymptomatic lesions (n = 59), benign symptomatic lesions (n = 9), benign but indeterminate lesions (n = 33). Surgery was offered for symptomatic and potentially progressive lesions. Collective decision was taken in indeterminate lesions for surgery or follow up for three years. Results: Overall, 37% had haemangiomas, 24% had liver cysts, 8% had focal nodular hyperplasia (FNH), 5% had adenomas. 25% underwent surgery. These included 7/59 diagnosed lesions, nine symptomatic lesions and 8/33 indeterminate lesions. Of the 33 indeterminate lesions six turned out to be FNH after surgery. 24 lesions, which were followed up for three years, did not increase in size. None of the 101 benign lesions turned out to be malignant after surgery or follow- up. Conclusion: Benign lesions can be diagnosed safely with currant imaging. Strong recommendation for follow up appears to be a safe strategy for indeterminate lesions.

Effect of inappropriate admissions on hospitalization performance in county hospitals: a cross-sectional study in rural China.

BACKGROUND: Inappropriate admissions cause excessive utilization of health services compared with outpatient services. However, it is still unclear whether inappropriate admissions cause excessive use of health services compared with appropriate admissions. This study aims to clarify the differences in the hospitalization performances between appropriately admitted inpatients and inappropriately admitted inpatients. METHODS: A total of 2575 medical records were obtained after cluster sampling in three counties. Admission appropriateness was assessed by appropriateness evaluation protocol (AEP). The propensity score matching (PSM) was computed to match patients in treatment and control group with similar characteristics, and to examine the differences in the utilization of hospitalization services between the two groups. The samples were matched in two major steps in this study. In the first step, total samples were matched to examine the differences in the utilization of hospital services between the two groups using 15 individual covariates. In the second step, PSM was computed to analyze the differences between the two groups in different disease systems using 14 individual covariates. RESULTS: For the whole sample, the inappropriate group has lower expenditure of hospitalization (EOH) (difference = - 0.12, p = 0.003) and shorter length of stay (LOS) (difference = - 0.73, p = 0.016) than the appropriate group. For number of clinical inspection (NCI), it has no statistically significant difference (difference = - 0.39, p = 0.082) between the two groups. Among different disease systems, no significant differences were observed between the two groups among EOH, LOS and NCI, except that the EOH was lower in the inappropriate group than that in the appropriate group for surgical disease (difference = - 0.169, p = 0.043). CONCLUSION: Inappropriate admissions have generated excessive health service utilization compared with appropriate admissions, especially for internal diseases. The departments in charge of medical services and hospital managers should pay high attention to the health service utilization of the inappropriately admitted inpatients. Relevant medical policies should be designed or optimized to increase the appropriateness in health care service delivery and precision in clinical pathway management.

High-precision evaluation of electromagnetic tracking.

PURPOSE: Navigation in high-precision minimally invasive surgery (HP-MIS) demands high tracking accuracy in the absence of line of sight (LOS). Currently, no tracking technology can satisfy this requirement. Electromagnetic tracking (EMT) is the best tracking paradigm in the absence of LOS despite limited accuracy and robustness. Novel evaluation protocols are needed to ensure high-precision and robust EMT for navigation in HP-MIS. METHODS: We introduce a novel protocol for EMT measurement evaluation featuring a high-accuracy phantom based on LEGO[Formula: see text], which is calibrated by a coordinate measuring machine to ensure accuracy. Our protocol includes relative sequential positions and an uncertainty estimation of positioning. We show effects on distortion compensation using a learned interpolation model. RESULTS: Our high-precision protocol clarifies properties of errors and uncertainties of EMT for high-precision use cases. For EMT errors reaching clinically relevant 0.2 mm, our design is 5-10 times more accurate than previous protocols with 95% confidence margins of 0.02 mm. This high-precision protocol ensures the performance improvement in compensated EMT by 0.05 mm. CONCLUSION: Our protocol improves the reliability of EMT evaluations because of significantly lower protocol-inherent uncertainties. To reduce patient risk in HP-MIS and to evaluate magnetic field distortion compensation, more high-accuracy protocols such as the one proposed here are required.