Nowadays, the hospital managers are facing increasing financial difficulties, because of the global budget policy from the national health institute. Patient-oriented services, good manner of the care providers, and the rapid response of the hospital to the medical environment are among the important factors for hospital survival. Therefore, many medical care providers had designed the clinical pathway for standardized medical treatment to control the medical costs, but they also allowed some extra-services for attracting and recruiting more patients. In this study, by way of participating management and job enrichment, we try to improve the quality and the patient satisfaction of the pelvic sonography provided by Obs/Gyn department. The study was proceeded in 2 ways. First, we designed a standardized obstetrical and gynecological sonography service pathway, which include a standard flow chart, customer encounter, and a checklist. Second, we measured the total service time duration, including those of pre-service consultation, actual sonography performing, and the post-service consultation. The measurements were performed before and after the application of the standardized sonography pathway. The measurement results were used to analyze and evaluate the validity and efficiency of the originally designed pathway. The study results demonstrate that after application of the sonography pathway, the total service time duration is reduced in Gyn sonography, but increased in Obs sonography. For Gyn sonography, the duration of pre-service consultation and post-service consultation were significantly reduced after application of standardized pathway. Further analysis revealed that thorough pre-service consultation not only made our patients more comfortable, but also reduced the post-service consultation time. However, the actual sonography performing time was increased, because of the adding of the standardized conversation. For obstetrical sonography, the duration of the actual sonography performing time was decreased, possibly due to the adding of standardized conversation, which answered most of the questions that the pregnant patients want to know about. In conclusion, by way of establishment and repeated reassessment/correction of the standardized sonography pathway, the quality of the sonography services can be greatly improved, and the patient¡¦s satisfaction can be even greater. The same experience can be applied to other fields. The quality of medical care can be more stable by the application of standardized clinical pathway. Besides, through the efforts of quality control, the medical cost can be limited, and the financial burden of the hospital and medical care providers can be reduced, making a double-win medical environment. Key Word: service pathways,total service, Obs/Gyn sonography

Objective: The incidence rate and mortality of breast cancer are increasing in Taiwan during recent years. The incidence rate of breast cancer is ranked number one among top ten female cancers, and the mortality of breast cancer is ranked fourth among cause of death for female cancer sufferers. The most common age group for breast cancer is between 40 and 50 years old. Breast cancer causes huge disease burdens for individual, family and society. The breast sonography and fine needle aspiration cytology (FNAC) are common screening methods for breast cancer diagnosis. Nevertheless, little study has focused on the benefits of combing these two methods in clinical application. This study aims to fill such research gap. Method: This study conducted medical chart reviews and collected 2,776 observations that were under breast sonography and FNAC examination from a regional hospital locates in southern Taiwan. The diagnosis categories for sonography include: malignant, benign, and probably benign tumor. The diagnosis categories for FNAC include: malignant, benign, and suspicious for malignant. Results: Among 2,776 observations, there were 555 observations (20%) had operation in the studied hospital. The operation results indicated that 205 (36.9%) observations were with malignant status, and 350 (63.1%) observations were with benign status. The diagnosis categories of both sonography and FNAC were significantly associated with the operation results (p<0.001). The FNAC had specificity in 100%, false positive ratio in zero, and positive predictive value in 100%. The Odds ratios for sonography diagnosis categories, age groups, and tumor sizes were OR=4.132 (95%CI: 1.5¡V11.6), OR=31.957 (95% CI: 3.7¡V272.4), OR=0.457 (95% CI: 0.1¡V1.5), respectively. When combining sonography and FNAC in parallel tests, the diagnosis accuracy was 89.2%, sensitivity was 90.2%, specificity was 88.6%, positive predictive value was 82.2%, and negative predictive value was 93.9%. When combining sonography and FNAC in serial testing, the diagnosis accuracy was 88.1%, sensitivity was 67.8%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 84.1%. Conclusion: Combining sonography and FNAC in breast cancer diagnosis can increase the accuracy, decrease false positive ratio and false negative ratio. These two methods can be conducted during outpatient visit and are fast, accurate and cost-effective tools for breast cancer diagnosis. These two methods particularly appropriate for younger female patients for early screening, early intervention, and may increase the survival rates.

Eine Vielzahl von Faktoren können am Lebensanfang eine ausreichende Perfusion der Niere gefährden und ihre Funktion beeinträchtigen. Umgekehrt spiegelt eine suffiziente Nierendurchblutung meist auch eine stabile systemische Hämodynamik des Neugeborenen wieder. Laborwerte sind in diesem Alter wenig aussagefähig bezüglich der Nierenfunktion. Ziel dieser Studie war die Erstellung von dopplersonographischen Normalwerten der Blutflussparameter beim gesunden Neugeborenen am ersten und dritten Lebenstag. Es wurden Mittelwerte für die systolische, mittlere und diastolische arterielle Flussgeschwindigkeit in der A. renalis am ersten und dritten Lebenstag beim gesunden Neugeborenen durch dopplersonographische Messung bestimmt. Es konnten dopplersonographische Referenzparameter der Durchblutung der Niere ermittelt werden, die als unkompliziert messbare Parameter in der neonatologischen Praxis zur Einschätzung systemisch hämodynamischer Veränderungen sowie funktioneller Störungen der Niere bis zum akuten Nierenversagen benutzt werden können.

AN ABSTRACT OF THE DISSERTATION OF Valerie D. Newberry, for the Doctor of Philosophy degree in Workforce Education and Development, presented on June 2, 2009, at Southern Illinois University Carbondale. TITLE: EFFECTIVENESS OF A CLINICAL QUESTIONING ACTIVITY IN DEVELOPING CARDIAC SONOGRAPHY STUDENT LEARNING LEVELS MAJOR PROFESSOR: Dr. Marcia Anderson, Ph.D. The purpose of the study was to contribute to a better understanding of learning activities used in clinical education. In particular, this study aimed to investigate whether use of a question/answer (Q/A) activity in clinical learning promoted higher levels of learning. Results of this study will be beneficial to faculty in programs with a clinical component, clinical educators, employers, and to the students who participate in the programs. The two-fold problem addressed in this research study was (a) What is the level of student learning achieved with a Q/A clinical learning activity, as perceived by clinical instructors; and (b) is the students' perceived level of learning related to student characteristics? The study included students and clinical instructors from accredited cardiac sonography programs in the United States. Demographic data revealed the students were mostly female with a mean age of 30 and varying levels of education. Experts reviewed the Q/A activity for content validity and the level of Bloom's taxonomy. The instrument was revised based on their recommendations. Program directors in 53 programs were sent requests to participate in the study and nine programs had participants who agreed to be in the study. Participants were mailed the materials and asked to complete the Q/A assignment. Clinical instructors completed a teaching module prior to giving student scores for thinking levels. The demographic sheets, consents, and score sheets were mailed back and data analysis was completed. Findings of the study suggest the Q/A activity is successful at progressively increased means in the thinking scores of students. The teaching tutorial is adequate training for the clinical instructors on the levels of Bloom's taxonomy. The level of thinking score achieved is compared to the student's age, gender, and educational level with no statistically significant difference. Recommendations for practice, further research and instrumentation are discussed.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-12-05T18:23:14Z No. of bitstreams: 1 Marcos Gomes da Silva A ultra sonografia... 2005.pdf: 32482863 bytes, checksum: 577d11de768274646dcc96446a704746 (MD5) / Made available in DSpace on 2012-12-05T18:23:14Z (GMT). No. of bitstreams: 1 Marcos Gomes da Silva A ultra sonografia... 2005.pdf: 32482863 bytes, checksum: 577d11de768274646dcc96446a704746 (MD5) Previous issue date: 2005 / Escola Bahiana de Medicina e Saúde Pública / Centro de Pesquisas Gonçalo Moniz / Com objetivo de estudar os possíveis achados uitra-sonográficos na Síndrome do Ombro Doloroso (SOD), foram avallados 77 pacientes com diagnóstico clínico de ombro doloroso encaminhados para investigação através da ultra-sonografia (USG). Além dos achados de exame, procurou-se identificar variáveis clínicas e epidemiológicas, as quais, pudessem estar associadas à presença de alterações patológicas. Dos 77 pacientes incluidos no estudo foram encontradas alterações no exame de USG de 47(61%), destes 38 (80%) apresentaram algum tipo de lesão no manguito rotador (MR), classificadas de tendinose ou tendinopatia, ruptura parcial e ruptura completa. Dentre os outros nove (20%) pacientes, cinco (11%) apresentaram bursite e quatro (9%) derrame articular como diagnósticos isolados. Dentre as variáveis clínicas e epidemiológicas avaliadas, a idade acima de 51 anos e limitação funcional articular estiveram associadas a presença de alterações no exame ultra-sonográfico destes pacientes. A lesão do MR além de ter sido a alteração mais freqüente, esteve associada ao diagnóstico ultra-sonográfico de derrame articular e a necessidade de uso de drogas antiinflamatórias. Concluiu-se que a USG é um importante método de avaliação de pacientes com SOD e que fatores como idade, limitação funcional articular apresentam associação com a presença de lesão do manguito rotador. / Seventy-seven patients with clinical diagnostic of painful shoulder sent to ultrasonographic investigation were assessed in order to study the possible ultrasonographic findings of the painful shoulder syndrome (PSS). Besides the image findings, we tried to identify clinical and epidemiological variables which could be associated to the presence of pathological disorders. Among the 77 patients included in the study, we found ultrasonographic abnormalities in 47 patients (61%). The most common finding among the abnormal exams was the lesion of the rotator cuff in 38 patients (80%), classified as tendinopathy, partial rupture or complete rupture. Nine patients (20%) with abnormal exams presented other lesions, such as bursitis (5 cases) and joint effusion (4 cases), without other associated alterations. Among the clinical and epidemiologic variables assessed, age over 51 years and the presence of joint disability were associated to abnormal ultrasound results for these patients. The rotator cuff lesion was associated to the presence of joint effusion and the need of the use of anti-infiammatory drugs. We have reached the conclusion that sonography is an important method of assessing patients with PSS. In this study, factors such as age and joint disability were associated with the presence of the rotator cuff lesion

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The increase in available ultrasound technology has allowed healthcare professionals to begin learning the skills to use it starting early in their training and careers. The best methods of training to increase proficiency in its use have not been investigated, however. This study compares two different training methods of the Focused Assessment with Sonography in Trauma (FAST). First year medical students were randomized into two groups; one who trained using a conventional live human model and the other who trained using themselves as the model. Both groups were then assessed on a non-self live human model and scored based on time to completion of the FAST and the ability to identify pertinent anatomic landmarks. There was no significant difference in mean scores between both groups. The non-self training group was significantly faster than the self training group. This suggests that the conventional training model remains the best method for increasing proficiency in the FAST exam, although there are significant limitations and further investigations are needed.

Introduction: No protocol for assessing ultrasound imaging skill has been validated. We sought to develop and validate an assessment protocol for ultrasound imaging for the Focused Assessment with Sonography for Trauma. Methods: Our assessment tool consisted of task checklists, a global rating scale, and hand-motion analysis and was developed by a modified Delphi technique. Novice and expert cohorts were recruited to perform a FAST exam on a volunteer for assessment under the protocol. Results: Experts scored higher on static image acquisition (11.58 of 16 versus 6.63, p<0.0001), dynamic image acquisition (17.21 of 24 versus 11.08, p=0.0005), and our global rating scale (29.79 of 40 versus 18.42, p<0.0001); experts used fewer movements (263.0 movements versus 452.4, p=0.0216) and a shorter path length than novices (60.097 m versus 32.777 m, p=0.0041). Conclusion: Our protocol for assessing ultrasound imaging skill has criterion validity in assessing expertise and may lead to improvements to training and credentialing programs.

No description available.

In der Veterinärmedizin existieren nur wenige Veröffentlichungen zur, in der Humanmedizin weitgehend etablierten, Sonographie des Oropharynx. Da vor allem bei brachyzephalen Hunden das Ausmaß der Hyperplasie der oropharyngalen Weichteile, insbesondere des weichen Gaumens, von großem diagnostischen Interesse ist, wird nach Möglichkeiten zur wenig invasiven Untersuchung dieser Region am wachen Patienten gesucht. So war es Ziel dieser kumulativen Dissertation die Grundlagen der sonographischen Untersuchungs- und Messmethode am weichen Gaumen zu erarbeiten. Die Darstellung der sonographischen Anatomie des weichen Gaumens und der Umgebung erfolgte in der ersten Studie an sieben Tierkörpern normozephaler Hunderassen. Die transkutane Untersuchung erfolgte bei submentaler Schallkopfauflage. Zudem kamen speziell geformte Schallköpfe zur direkten Auflage auf den weichen Gaumen in einer intraoralen Untersuchung zum Einsatz. Zur Erleichterung der Identifizierung der anatomischen Strukturen wurden Wasserbad- und sequentielle Ultraschalluntersuchungen im Anschluss an submentale Weichteilpräparationen des Maulhöhlenbodens durchgeführt. Unter Herstellung des Gewebekontaktes zwischen Zunge und weichem Gaumens bei submentaler Schallkopfauflage, gelang die transkutane sonographische Darstellung des weichen Gaumens im kranialen und mittleren Bereich. Der weiche Gaumen wies eine mondsichelähnliche Form und eine geringe Echogenität auf. Als charakteristisch zeigte sich der Übergang von hartem zu weichem Gaumen, die Darstellung des kaudalen Anteils des Gaumensegels ist aufgrund der umgebenen Luft und Überlagerung mit dem Zungenbein nur eingeschränkt möglich. Die intraorale Untersuchung erlaubte die Darstellung der gaumenspezifischen Echotextur. In der zweiten Studie wurde an 15 normozephalen Hunden in Allgemeinanästhesie die Dicke der Gaumensegel sowohl sonographisch als auch computertomographisch an zwei definierten Messpunkten bestimmt. Die Übereinstimmung der Ergebnisse von wiederholten Messungen mit der jeweiligen Messmethode wurde geprüft. Die wiederholten Messungen erzielten sehr gute Übereinstimmungen (Mean absolute deviation von 0), so dass davon ausgegangen werden kann, dass sowohl die Sonographie als auch die CT reproduzierbare Messungen ermöglicht. Im Messmethodenvergleich wurden die Messergebnisse, die mit den unterschiedlichen Messverfahren (Ultraschall und CT) gewonnen wurden, in der Bland-Altman Auswertung miteinander verglichen. Es waren Abweichungen für beide Messpunkte zu verzeichnen, wobei der Mittelwert der Abweichung vor allem für den zweiten Messpunkt mit 0,31 cm als hoch anzusehen ist. Der Mittelwert der Abweichung fällt am ersten Messpunkt mit 0,08 cm geringer aus. Die klinisch relevanten Abweichungen wurden als Folge der zwischen beiden Messmethoden variierenden Untersuchungsbedingungen, insbesondere der abweichenden Patientenlagerung, interpretiert. Sonographie und CT sind damit, trotz guter Reliabilität des einzelnen Verfahrens, als nicht austauschbare Methoden zur Gaumensegeldickenmessung anzusehen. Die transkutane Sonographie ermöglichte, unter den geschilderten Untersuchungs-bedingungen, erstmals eine Darstellung des kranialen und mittleren Anteils des weichen Gaumens. Der kaudale Anteil des Gaumensegels konnte nicht identifiziert werden. Die Sonographie birgt, nach Ermittlung entsprechender Referenzbereiche, das Potential einer nichtinvasiven, schnellen Untersuchungsmethode zur Vermessung der Gaumensegeldicke am wachen Hund.

No description available.