儿童CT检查诊断参考水平研究进展

CT检查具有较高的辐射剂量,如何降低儿童CT检查的辐射剂量越来越重要,诊断参考水平(diagnostic reference level, DRL)是一个可以实现防护最优化、降低儿童CT辐射剂量的实用工具。本文通过对儿童CT检查中诊断参考水平的概念、制定方法、各国现状及问题进行简要总结,为我国儿童CT检查防护最优化提供参考。     

美国2005年膳食指南和膳食参考摄入量

膳食指南和膳食参考摄入量是公众最直接的营养参考标准.具有不同生活方式和饮食习惯的人群,对营养素的需要各不相同,对食物的选择也不同.为指导不同人群的健康饮食,本文介绍了美国2005年发布的膳食指南、金字塔和膳食参考摄入量,供相应人群选择食物和确定食物摄入量作参考.     

美国和欧洲的职业病诊断标准体系

美国和欧洲均将职业病的诊断纳入工伤赔偿或保险系统,如1970年,美国国会成立州劳动者赔偿法国家委员会(National Commissionon State Workmen's CompensationLaws),并于1972年向国会提交了一份报告,列举了现代工人赔偿规划的目标,提出将所有的工伤和职业病纳入赔偿系统。欧洲丹麦也设立国家工伤委员会(National Boardof Industrial Injuries),负责工伤和职业病的诊断与赔偿。     

关于亚健康诊断参考标准的讨论

一、健康标准WHO于1947年提出了健康的新概念:"健康不仅仅是没有疾病和不虚弱,而且是身体上、心理上和社会适应能力上三方面的完善状态。"1989年又增加了"道德健康"。其健康的标准应该包括:1、精力充沛,能从容不迫地应付日常生活和工作;2.处世乐观,态度积极,乐于承担任务而不挑     

2012年欧洲酒精性肝病处理指南介绍

本文介绍2012年欧洲肝病学会制定的欧洲酒精性肝病处理指南。     

儿科诊断质量控制初探

从儿科诊断环节质量管理入手,针对儿内科疾病特点,在深入分析影响诊断质量因素的前提下,总结出一套儿科诊断环节质量管理办法,医疗质量与患者及家属的满意度都得到了大幅度提高。     

美国儿科学会预防佝偻病和维生素D缺乏2008年指南简介

2008年美国儿科学会重新修订的临床指南推荐所有的婴儿（包括全母乳喂养婴儿）、儿童和青少年自出生后不久起每日至少补充维生素D400IU。本文简单介绍该指南,并与2008年中华医学会儿科学分会等的建议比较,提议中华医学会儿科学分会,参照2008年美国儿科学会指南,修订其2008年3月的建议。     

超声诊断在儿科急腹症临床诊断中的应用研究

目的:研究超声诊断在儿科急腹症临床诊断中的应用价值.方法:选择我院儿科收治的184例急腹症患儿作为研究对象,所有的研究对象均采用多普勒超声进行诊断,同时结合手术、病理及内镜检查进行最终的诊断.结果:超声诊断的总体相符率为89.7％.结论:将超声诊断应用于儿科急腹症诊断的过程中,可以显著提高临床的准确性,降低误诊及漏诊率.     

肺结核诊断和治疗指南

文章介绍肺结核诊断和治疗指南.     

中国高龄老年人血压水平适宜范围指南

本标准按照GB/T 1.1-2009给出的规则起草。本标准由中华预防医学会归口。本标准起草单位:中国疾病预防控制中心环境与健康相关产品安全所、北京医院/国家卫生健康委北京老年医学研究所、南方医科大学。本标准主要起草人:施小明、杨泽、毛琛、吕跃斌、陈沛良、孙亮、王政和。     

广东省X射线诊断医疗照射频率与剂量水平

目的 掌握目前广东省X射线诊断医疗照射频率与剂量水平，加强放射卫生防护管理。方法 参照全国医疗照射调查方案，采用面上普查、典型调查和现场监测相结合方式，全省统一开展调查、统一控制质量。结果 广东省X射线诊断的应用频率为每千人口224．81人次；受检者与患者在各种类型X射线诊断中的平均受照剂量水平在0．23-18．67mGy范围，其中，X线电子计算机断层扫描(CT)检查病人的头部受照剂量平均达18．67mGy，颈椎摄影、腰椎侧住和正位平均分别为15．90、12．40和7．34mGy；牙科口内片、胃肠造影和骨盆摄影的平均受照剂量分别为6．97、6．95和6．87mGy；胸片正位和四肢摄影的平均受照剂量分别为0．54和0．23mGy.调查还显示医用X射线诊断设备没有系统地开展质量控制和质量保证工作。结论 广东省X射线诊断的平均受照剂量低于GBl8871—2002推荐的指导水平，但应用频率高于联合国原子辐射效应科学委员会(UNSCEAR)统计的Ⅱ级医疗保健水平，应该加强受检者和患者的防护。     

Derivation of Australian diagnostic reference levels for paediatric multi detector computed tomography

Australian National Diagnostic Reference Levels for paediatric multi detector computed tomography were established for three protocols, Head, Chest and AbdoPelvis, across two age groups, Baby/Infant 0–4 years and Child 5–14 years by the Australian Radiation Protection and Nuclear Safety Agency in 2012. The establishment of Australian paediatric DRLs is an important step towards lowering patient CT doses on a national scale. While Adult DRLs were calculated with data collected from the web based Australian National Diagnostic Reference Level Service, no paediatric data was submitted in the first year of service operation. Data from an independent Royal Australian and New Zealand College of Radiologists Quality Use of Diagnostic Imaging paediatric optimisation survey was used. The paediatric DRLs were defined for CTDI_vol (mGy) and DLP (mGy·cm) values that referenced the 16 cm PMMA phantom for the Head protocol and the 32 cm PMMA phantom for body protocols for both paediatric age groups. The Australian paediatric DRLs for multi detector computed tomography are for the Head, Chest and AbdoPelvis protocols respectively, 470, 60 and 170 mGy·cm for the Baby/Infant age group, and 600, 110 and 390 mGy·cm for the Child age group. A comparison with published international paediatric DRLs for computed tomography reveal the Australian paediatric DRLs to be lower on average. However, the comparison is complicated by misalignment of defined age ranges. It is the intention of ARPANSA to review the paediatric DRLs in conjunction with a review of the adult DRLs, which should occur within 5 years of their publication.     

生物类似物政策监管指南原则与要求研究综述——基于欧盟版生物类似物指南

本文通过文献综述,在明确界定生物类似物概念的基础上,阐述了生物药的特点及其研发生产过程.基于欧盟版生物类似物指南,介绍了其政策框架,并系统梳理了生物类似物政策监管指南原则与要求,包括生物相似性、安全性和免疫原性、适应症外推法、标签与命名、数据保护以及药物互换性与药物警戒等内容,旨在为促进我国生物类似物与生物制药产业的进一步发展提供政策参考与建议.     

医学影像学诊断报告质量控制的应用研究

目的:通过有效的途径对医学影像诊断报告进行质量控制。方法:选出有代表性的数据,利用统计学处理,对各项控制内容作出对比评估。结果:根据影像诊断报告书写要求及相关规章制度,制定并完善一系列的核心制度及控制方法。结论:对影像诊断报告科学的质量控制可以有效的提高诊断质量及工作效率,为提高影像学诊断质量评价与管理研究提供理论指导。     

A human IgG anti-Vi reference for Salmonella typhi with weight-based antibody units assigned

Recent data showing the high incidence of typhoid fever in young children, the demonstration of safety and efficacy of a Vi conjugate for this age group, the safety and similar immunogenicity in infants when administrated concurrently with EPI vaccines, together with the interests of manufacturers and investigators in studying such conjugate vaccines prompted us to prepare a human IgG anti-Vi standard to facilitate this work. Volunteers were injected with an investigational Vi-recombinant Pseudomonas aeruginosa exoprotein A (Vi-rEPA) conjugate vaccine. Plasmas with the highest levels of IgG anti-Vi were pooled. The IgG anti-Vi content of this preparation, assayed by precipitin analysis with purified Vi, was 33 μg/ml. Accordingly, the estimated IgG anti-Vi protective level of 3.5 ELISA unit/ml, derived from our efficacy trial of Vi-rEPA in 2–5 years old children, is equivalent to 4.3 μg/ml. This reagent is suitable for comparison of immune response of Vi conjugate vaccines or for other purposes requiring anti-Vi measurement.     

Microneedle technology for immunisation: Perception,acceptability and suitability for paediatric use

ObjectiveTo examine published research which explores the perception and acceptability of microneedle technology for immunisation and to investigate the suitability of this technology for paediatric use.MethodsA series of keywords and their synonyms were combined in various combinations and permutations using Boolean operators to sequentially search four databases (PubMed, Web of Science, Embase and CINAHL). Following removal of duplications and irrelevant results, 12 research articles were included in the final literature review.ResultsThe opinions of patients, parents, children and healthcare professionals (HCP) were collated. A positive perception and a high level of acceptability predominated.ConclusionMicroneedle technology research has been focussed on demonstrating efficacy with minimal focus on determining HCP/public perception and acceptability for paediatric use, exemplified by the paucity of studies presented in this review. Commercial viability will depend on HCP/public acceptability of microneedle technology. An effort must be made to identify the barriers to acceptance and to overcome them by increasing awareness and education in stakeholder groups pertaining to the paediatric population.     

欧盟跨境就医管理模式对中国跨省异地就医的经验借鉴

随着欧洲一体化进程的深入,如何有序管理公民在各成员国之间跨境就医成为欧盟一项重要议题。多年来欧盟社会医疗保险在保障患者跨境就医上已建立一套较为完善的管理模式并受到全世界关注,其社会保障的实践对我国跨省异地就医管理具有借鉴意义。本研究通过系统梳理欧盟跨境就医管理模式,并着重比较欧盟与中国在异地就医对象、异地就医授权、服务机构、就医服务类型、异地医保报销五个方面的异同,为进一步完善我国跨省异地就医管理提供经验借鉴。本研究建议,各省应同步推进跨省就医政策,加快相关工作的落实;增强参保地医保管理机构的审核权限和能力以构建有序就医秩序;同时,在严格审核下拓宽更加合理的跨省就医服务机构网络;最后,鉴于医保对异地就医机构行为缺乏了解,应通过国家异地就医网络,加强医疗机构提供异地就医服务中的监管。     

Local diagnostic reference levels for angiographic and fluoroscopic procedures: Australian practice

Although diagnostic and interventional fluoroscopic procedures are amongst the highest dose examinations performed in radiology, these procedures currently lack established national diagnostic reference levels (DRLs) in Australia. In this absence, local diagnostic reference levels (LDRLs) are proposed for a wide range of diagnostic and interventional angiographic and fluoroscopic procedures based upon data collected from 11,000 examinations, performed over a 2.5 year period at a major Australian public, teaching hospital. Each procedure type assessed included a minimum of 50 cases. LDRLs were defined for each procedure in terms of the 75th percentile of the dose area product and median fluoroscopic times have also been provided. The detailed categories of procedures used in this study may inform the Australian Radiation Protection and Nuclear Safety Agency when establishing national DRLs for angiographic and fluoroscopic procedures. Until national DRLs for these complex procedures are available, these LDRLs may provide guidance to other institutions on achievable dose levels.     

Treatment compliance with European guidelines and prognosis of Clostridium difficile infection according to age

Objective

Age > 65 years is associated with the recurrence and poor prognosis of Clostridium difficile infection (CDI). Data on elderly patients (≥ 75 years) is scarce, and little is known about compliance with European guidelines in terms of specific treatment. We aimed to analyze the treatment and prognosis of CDI in two groups of patients aged < and ≥ 75 years.