浙江省临床医学硕士专业学位研究生与住院医师规范化培训并轨培养模式的质量分析和对策研究

目的 完善浙江省临床医学硕士专业学位研究生培养与住院医师规范化培训并轨的培训体系，以期提高医学研究生的职业素质。方法 通过文献法和专家访谈制定调查问卷，获得77名临床规培研究生资料，以柯氏评估的反映层、学习层、行为层、成果层为切入点，对规培效果进行评价。采用SPSS 20.0进行统计分析，柯氏评分采用均数±标准差，定性资料采用率或构成比；评分比较采用t检验，多组人群的评分比较采用方差分析。 结果 反应层规培态度值为9.26±1.08，规培内容值为29.29±4.36，规培师资带教教师积极性的值为11.13±2.17，规培感受值为17.38±3.10，说明住院医师对培训的总体满意度较高，但培训师资、考核及薪酬满意度较低。学习层规培前后，医学知识、临床思维及操作技能考试等成绩差异有统计学意义（P＜0.05）。行为层显示规培生行为前后均发生了明显的改变（P＜0.05），在查房、处理常见病等能力方面有较多提高。成果层显示77名规培生均无医疗事故和投诉，全部通过年度考核，100%参与课题研究。结论 规培研究生总体对培训的计划，内容，方式等感到比较满意，但存在信息反馈不及时、带教教师积极性不高、缺乏有效竞争机制等问题。柯氏评估模型从整体视角对研究生规培进行全面客观的评估，可以引入到研究生规培的效果评价中来。     

Quel « PRP » pour traiter les tendinopathies chroniques ?

Plasma rich platelets (PRP) consist of blood plasma with a high concentration of platelets autologous constituting a huge reservoir of growth factors. The clinical use of the PRP is widespread in various medical applications. Even it is very popular with athletes, the use of PRP in tendinopathies is still scientifically discussed, particularly related to a disparity in the products called PRP. In order to optimize employment, it should be interested in the different stages of obtaining of the PRP. In this literature review, we analyzed in particular 8 parameters that can influence the quality of the PRP: (1) anticoagulants used to preserve the best feature of platelet; (2) centrifuge speeds used in order to extract platelets; (3) platelet concentrations and the presence of leukocytes and erythrocytes in the PRP; (4) the platelet activators for the mast of platelets and thus the release of growth factors; (5) use of local anesthetics to achieve infiltration, in addition to these parameters, it might be interesting to analyze other variables like: (6) employment or not of buffer to neutralize the acidity caused by anticoagulants; (7) injection under US guidance or not; and (8) volume of PRP injected to determine their influence on the healing potential.     

Analysis of the factors which influence the measurement of synovial power Doppler signals with semi-quantitative and quantitative measures – a pilot multicenter exercise in Japan

Abstract

Objectives. This pilot multicenter exercise aimed to evaluate the inter-observer reproducibility of synovial power Doppler (PD) signals in rheumatoid arthritis (RA) patients and to determine the factors influencing the measurements.

Methods. Two representative RA patients were assessed by four independent experienced sonographers. The influence of machine difference, deterioration of the transducer and pulse repetition frequency (PRF) on the assessment of synovial PD signals was investigated.

Results. Intra-class correlation coefficient (ICC) for the scanner–reader reproducibility of semi-quantitative PD score was high (0.867). ICC for the inter-scanner reproducibility of synovial PD pixel count was higher than that of semi-quantitative PD score. The assessment of PD signals significantly differed between two machines with quantitative measurements but did not with semi-quantitative score. The assessment of PD signals with a deteriorated transducer was much less sensitive than that with an intact one. The semi-quantitative scores for PD signals were comparable between three different PRFs (500/800/1,300 Hz), whereas the pixel count was significantly lower with the highest one in the knee joint.

Conclusions. Measurement of PD signal can be substantially affected by deteriorated quality of the transducer, whereas the differences are relatively modest between machines with similar specifications and also between PRF settings within a low range.     

《皮肤科学（非肿瘤性皮肤病）中皮肤镜术语和基本参数的标准化：国际皮肤镜协会专家共识》解读

【摘要】 为规范非肿瘤性皮肤病的皮肤镜检查标准，国际皮肤镜协会组织专家制定了《皮肤科学（非肿瘤性皮肤病）中皮肤镜术语和基本参数的标准化：国际皮肤镜协会专家共识》，该共识确定了5个标准化基本参数及31个子项，包括血管（形态和分布）、鳞屑（颜色和分布）、毛囊改变、其他结构（颜色和形态）、特异线索，并总结了它们的曾用名、组织病理学对应关系和主要涉及的疾病。本文通过介绍该共识，为未来相关中文皮肤镜术语及参数规范的制定提供参考，以期更好地规范皮肤镜在皮肤科学中的应用。     

关于规范器官获取组织流程的思考

近年来,中国的器官移植事业发展较快,但由于缺乏系统规范的管理体系,衍生出了一系列社会、伦理、法律等方面的问题。通过分析我国器官捐献与获取现状以及所存在的问题,提示应采取及时发现潜在案例、判定生命状态、规范报批捐献手续、维护脏器功能、获取捐献器官、安抚供者家属、分配捐献器官等一系列措施来完善器官获取组织流程,以推进我国器官移植事业的健康长久发展。     

江苏省卫生地方标准工作现状分析

目的分析江苏省卫生地方标准发展现状，提出优化建议。方法采用数据库检索方式进行分析。结果江苏省卫生地方标准制定主体以卫生行政部门为主，技术标准数量较多。75.00%的标准标龄较短，标准更新较少。江苏省卫生地方标准以职业健康领域标准为主，存在总体标准数量较少、分类依据不清晰、缺乏系统性及全面性指导、第三方主体作用不突出、标准重制定而轻执行等问题。结论江苏省卫生地方标准在促进江苏省卫生领域发展，完善卫生健康管理体系方面发挥着重要作用。建议建立健全标准化工作政策法规，强化标准实施，建立标准专业化队伍，推动行业标准化工作发展。     

Calibration of ionization chamber for 18F and 68Ga

In order to maintain the results of primary activity standardizations carried out in 2011 the LNMRI has determined the calibration factors for a pressurized 4π-ionization chamber for the nuclides ¹⁸F and ⁶⁸Ga. This ionization chamber is coupled to a 6517A Keithley electrometer which is controlled by a homemade LabVIEW program. This paper will describe the main issues related to the calibration of an ionization chamber system for positron emitters and short half-life radionuclides such as timing, current measurement, background, decay, and ²²⁶Ra check source measurements.     

开展实验室认证认可全面提升实验室规范化管理水平

从实验室认证认可的起源与发展、异同、基本内容及其在实验室管理体系中的地位与作用,阐明了通过积极开展实验室认证认可对实验室规范化管理的作用与意义.     

The European I-MOVE Multicentre 2013–2014 Case-Control Study. Homogeneous moderate influenza vaccine effectiveness against A(H1N1)pdm09 and heterogenous results by country against A(H3N2)

BackgroundIn the first five I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe) influenza seasons vaccine effectiveness (VE) results were relatively homogenous among participating study sites. In 2013–2014, we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in six European Union (EU) countries to measure 2013–2014 influenza VE against medically-attended influenza-like illness (ILI) laboratory-confirmed as influenza. Influenza A(H3N2) and A(H1N1)pdm09 viruses co-circulated during the season.MethodsPractitioners systematically selected ILI patients to swab within eight days of symptom onset.We compared cases (ILI positive to influenza A(H3N2) or A(H1N1)pdm09) to influenza negative patients. We calculated VE for the two influenza A subtypes and adjusted for potential confounders. We calculated heterogeneity between sites using the I² index and Cochrane's Q test. If the I² was <50%, we estimated pooled VE as (1 minus the OR) × 100 using a one-stage model with study site as a fixed effect. If the I² was >49% we used a two-stage random effects model.ResultsWe included in the A(H1N1)pdm09 analysis 531 cases and 1712 controls and in the A(H3N2) analysis 623 cases and 1920 controls. For A(H1N1)pdm09, the Q test (p = 0.695) and the I² index (0%) suggested no heterogeneity of adjusted VE between study sites. Using a one-stage model, the overall pooled adjusted VE against influenza A(H1N1)pdm2009 was 47.5% (95% CI: 16.4–67.0).For A(H3N2), the I² was 51.5% (p = 0.067). Using a two-stage model for the pooled analysis, the adjusted VE against A(H3N2) was 29.7 (95% CI: −34.4–63.2).ConclusionsThe results suggest a moderate 2013–2014 influenza VE against A(H1N1)pdm09 and a low VE against A(H3N2). The A(H3N2) estimates were heterogeneous among study sites. Larger sample sizes by study site are needed to prevent statistical heterogeneity, decrease variability and allow for two-stage pooled VE for all subgroup analyses.