肝癌转化治疗中国专家共识（2021版）

正国内许多研究中心已积累了肝癌转化治疗经验。初步研究结果显示,转化治疗是改善中晚期肝癌病人生存的重要途径。但转化治疗及其相关领域仍存在许多亟待解决的临床和科学问题。为了总结既往经验、梳理问题,由中国抗癌协会肝癌专业委员会转化治疗协作组发起,基于国内外该领域研究获得的初步经验和研究结果,结合符合我国国情的临床实践,制订《肝癌转化治疗中国专家共识(2021版)》。     

肌肉骨骼慢性疼痛诊治专家共识

肌肉骨骼系统慢性疼痛是临床最常见的慢性疼痛。随着人口老龄化,慢性肌肉骨骼疼痛的总体负担将继续加重,对安全有效的疼痛管理的需求也将日益增加。由于文化、经济和监管因素不同,国际指南可能不完全适合中国病人。可用的国内指南大多只针对于药物治疗,且没有阐述中医药在肌肉骨骼系统慢性疼痛诊治中的重要作用。为了制定慢性肌肉骨骼疼痛的中西医结合专家共识,我们召开会议回顾并讨论近期循证医学证据、临床经验和我们目前面临的实践挑战,为慢性肌肉骨骼疼痛的全面评估和管理提供了建议。这些共识建议不是指令性的,而是作为临床实践决策的指南,慢性肌肉骨骼疼痛的最佳治疗方案应该是个性化的。     

Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

PurposeThe purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method.MethodsThe panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached.ResultsConsensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade.ConclusionThis study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP.Level of evidenceV     

The development of guidelines for drug and alcohol dependence treatment: affecting policy and practice

The rationale and methodology behind the Australian Quality Assurance Project is described. The Project aimed to develop guidelines for treatment content based on three sources of information: research findings, current practice and expert opinion. The issue of the gap between research and practice is discussed, as well as the role of dissemination in altering clinician behaviour.     

An expert system to teach troubleshooting of common problems associated with the automated anesthesia recordkeeper

Automated anesthesia recordkeepers have been used to monitor patients during surgery in up to 90% of cases at The Ohio State University. The record-keeping devices are complex and can be difficult to troubleshoot. The 1st-CLASS Fusion Program, an expert system shell-program, has been programmed to allow the resident or nurse anesthetist to solve the two most common types of problems associated with the recordkeeper: printer problems and patient monitor problems. Use of this program allows the resident or nurse anesthetist to troubleshoot the recordkeeper quickly and accurately and promotes in the user a sense of competence and control over the technology.