叶桂诊治情志致脾胃病

清代叶桂所著《临证指南医案》,治疗情志失调导致的脾胃病时,叶氏汲取李东垣、刘河间、张仲景等著名医家治疗脾胃病的学术经验,创立归纳治疗情志所致脾胃病的3条基本法则:肝胃阴未虚,肝阳犯胃,立法用刚远柔;肝胃阴俱虚,风阳扰胃,立法忌刚用柔;平治肝胃,立法刚柔寒热并用。叶氏重视脾胃,善用人参补中养虚,半夏、枳实、厚朴、姜汁通降胃气,茯苓、陈皮健脾和胃,白芍、乌梅倡养胃阴,壮脾土以制肝木,形成了理法方药一线贯穿的理论体系。     

晕厥的临床诊疗进展

晕厥是门诊常见症状,有三个主要病因：反射性（神经介导性）晕厥、直立性低血压和心源性晕厥。反射性晕厥预后良好,而心源性晕厥有心脏猝死的高危风险。短暂意识丧失发作后,首先应根据现行晕厥的定义,与其他形式的短暂意识丧失进行鉴别后完成对晕厥的诊断,并对晕厥患者进行仔细的评估。如果初始评估明确了晕厥的病因,应行相应治疗;如果病因不明,应根据心血管事件及猝死风险进行分级及进一步评估。本综述根据晕厥的最新指南,较系统全面地对晕厥的定义、诊断检查和治疗进展进行一小结,以提高对指南的理解及实施。     

社区获得性肺炎指南对社区获得性肺炎治疗成功率的影响

目的分析社区获得性肺炎（CAP）诊治指南对治疗成功率的影响.方法回顾性分析2006年1月至2010年12月收治的417例CAP患者遵循指南选择首剂抗生素情况以及指南对治疗的成功率的影响.结果本资料首剂抗生素使用遵循指南的占68.8%,5 a间首剂抗生素的遵循率之间无统计学差异（P〉0.05）;2.5 a间遵循指南选择抗生素治疗与未遵循指南选择抗生素治疗失败率之间有明显的统计差异（χ2=20.458,P〈0.001）.结论遵循CAP指南能够降低首选抗生素的失败率.     

Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed

Objective

Results of reliability and agreement studies are intended to provide information about the amount of error inherent in any diagnosis, score, or measurement. The level of reliability and agreement among users of scales, instruments, or classifications is widely unknown. Therefore, there is a need for rigorously conducted interrater and intrarater reliability and agreement studies. Information about sample selection, study design, and statistical analysis is often incomplete. Because of inadequate reporting, interpretation and synthesis of study results are often difficult. Widely accepted criteria, standards, or guidelines for reporting reliability and agreement in the health care and medical field are lacking. The objective was to develop guidelines for reporting reliability and agreement studies.

Study Design and Setting

Eight experts in reliability and agreement investigation developed guidelines for reporting.

Results

Fifteen issues that should be addressed when reliability and agreement are reported are proposed. The issues correspond to the headings usually used in publications.

Conclusion

The proposed guidelines intend to improve the quality of reporting.     

慢性乙型肝炎防治指南(2010年版)

为规范慢性乙型肝炎的预防、诊断和治疗,中华医学会肝病学分会和感染病学分会于2005年组织国内有关专家制订了<慢性乙型肝炎防治指南>[1].近5年来,国内外有关慢性乙型肝炎的基础和临床研究取得很大进展,为此我们对本指南进行更新. 本指南旨在帮助医生在慢性乙型肝炎诊疗和预防工作中做出合理决策,但不是强制性标准,也不可能包括或解决慢性乙型肝炎诊治中的所有问题.     

National compliance to an evidence-based multidisciplinary guideline on pancreatic and periampullary carcinoma

BackgroundWe evaluated national compliance to selected quality indicators from the Dutch multidisciplinary evidence-based guideline on pancreatic and periampullary carcinoma and identified areas for improvement.MethodsCompliance to 3 selected quality indicators from the guideline was evaluated before and after implementation of the guideline in 2011: 1) adjuvant chemotherapy after tumor resection for pancreatic carcinoma, 2) discussion of the patient within a multidisciplinary team (MDT) meeting and 3) a maximum 3-week interval between final MDT meeting and start of treatment.ResultsIn total 5086 patients with pancreatic or periampullary carcinoma were included. In 2010, 2522 patients were included and in 2012, 2564 patients. 1) Use of adjuvant chemotherapy following resection for pancreatic carcinoma increased significantly from 45% (120 out of 268) in 2010 to 54% (182 out of 336) in 2012 which was mainly caused by an increase in patients aged <75 years. 2) In 2012, 64% (896 of 1396) of patients suspected of a pancreatic or periampullary carcinoma was discussed within a MDT meeting which was higher in patients aged <75 years and patients starting treatment with curative intent. 3) In 2012, the recommended 3 weeks between final MDT meeting and start of treatment was met in 39% (141 of 363) of patients which was not influenced by patient and tumor characteristics.ConclusionCompliance to three selected quality indicators in pancreatic cancer care was low in 2012. Areas for improvement were identified. Future compliance will be investigated through structured audit and feedback from the Dutch Pancreatic Cancer Audit.     

How to implement guidelines and models of care

In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory examination contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermittent, and sequential therapy. Implementation of guidelines requires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reimbursement of assessment and therapy.     

2020新生儿机械通气时气道内吸引操作指南

气道内吸引是患儿接受机械通气时常用且必要的侵入性操作，整个过程包括病人的准备、吸引及后续护理，可能伴随不良事件的发生。现基于国内外相关研究，采用证据推荐分级的评估、制订与评价方法（GRADE），制定新生儿机械通气时气道内吸引的操作指南，旨在促进这一操作规范化实施，保证病人安全。