预防和控制流感在养老院暴发管理的最佳证据总结

背景　目前我国流感疫苗覆盖率较低，一旦暴发将加剧医疗压力。目的　总结预防和控制流感在养老院暴发的最佳证据，以强化养老院管理者以及工作人员对流感的重视。方法　计算机检索万方数据知识服务平台（Wanfang Data）、维普网（VIP）、中国知网（CNKI）、中国生物医学文献数据库（CBM）、中华人民共和国民政部官网、Cochrane Library、PubMed、Medline、Joanna Briggs Institute（JBI）循证卫生保健中心图书馆、Up to Date、Ovid数据库及美国疾病控制与预防中心（CDC）官网关于预防和控制养老院流感暴发的临床指南、系统评价、专家共识、队列研究、随机对照试验、横断面研究。检索时间为建库至2020-02-12。分别采用AGREE Ⅱ、AMSTAR、JBI循证卫生保健中心专家共识评价标准（2017年澳大利亚版本）、2016版JBI循证卫生保健中心队列研究评价标准、Jadad评分量表、2017版JBI循证卫生保健中心横断面研究质量评价工具进行质量评价。最后采用2014年澳大利亚版本JBI循证卫生保健中心证据分级及证据推荐级别系统进行证据汇总、评价和等级划分。结果　本研究最终纳入文献17篇，其中临床指南5篇、系统评价2篇、专家共识3篇、队列研究2篇、随机对照试验4篇、横断面研究1篇。5篇临床指南中各领域≥60%的数目为6的有3篇，推荐级别为A级的有5篇。2篇系统评价的质量评价结果均为准予纳入。3篇专家共识的质量评价结果均为准予纳入。2篇队列研究的质量评价结果显示文献质量均较高，允许纳入。4篇随机对照试验的质量评价结果均为准予纳入。1篇横断面研究的质量评价结果为文献属于高质量文献，允许纳入。证据汇总最终得出27条预防和控制养老院流感暴发的最佳证据，包含环境、人员管理、预防措施以及疫苗接种影响因素4个方面。结论　总结和分析国内外养老院流感暴发预防与控制的相关文献得出接种流感疫苗仍是目前控制流感的最佳方法，养老院管理者及工作人员应当提高对流感重视程度，优化流感预防管理模式。     

Consensus Statements on Driving in People with Parkinson's Disease

Parkinson's disease (PD) is a complex neurodegenerative disorder leading to motor and non-motor impairments, all of which can affect fitness to drive. The literature suggest that on-road and simulated driving performances are impaired in people with PD, as compared to healthy control drivers. Clear associations exist between impaired driving performance and contrast sensitivity, visual processing speed, and psychomotor speed. Prior to this review and expert panel process, no evidence-based guidelines have existed to help occupational therapy practitioners determining fitness to drive in those with PD. Three consensus statements are presented in this work to enable occupational therapy practitioners and other driver rehabilitation specialists to make fitness to drive determinations in people with PD.     

Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society – Part one

Neuropathic pain still present a major diagnostic and therapeutic challenge despite considerable progress in understanding of its mechanisms and publication of number of studies which assessed the efficacy and safety of drugs used in the symptomatic treatment. In practice, it is diagnosed less frequently than recognised in the epidemiological studies, and many patients do not achieve satisfactory outcomes of treatment. A multidisciplinary team of Polish experts, commissioned by the Polish Association for the Study of Pain and the Polish Neurological Society, has reviewed the literature on neuropathic pain, with special focus on the published international recommendations, and formulated recommendations on neuropathic pain diagnosis and treatment, in accordance with the principles of evidence-based medicine. The paper presents also background information on the neuropathic pain definition, epidemiology, pathomechanism and method of assessment. The diagnosis of neuropathic pain may be established based on medical history and physical examination including special assessment of the somatosensory system. First-line drugs used in pharmacological management of neuropathic pain are: tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin, opioids and lidocaine patches.     

The Effect of Short-term Bed-rest on Radial Pulse in Healthy Subjects

The objective of this study is to investigate the effects of short-term bed rest on the radial pulse in healthy subjects. Twenty-one healthy volunteers participated in this study. Their radial pulse was measured at different measuring positions using a multi-step tonometry system. The participants took 30 minutes of bed rest and their radial pulse was measured before and after the bed rest. The effects of bed rest on the radial pulse were analyzed. The pulse area, the amplitudes of h4 and h5, the pulse period, and the diastolic pulse proportion increased with short-term bed rest, whereas the proportions of systolic and hightension pulse and the fundamental frequency of the pulse wave decreased with short-term bed rest. All the changes were in the same direction in both male and female participants at all measuring positions; however, some parameters changed more in women than in men, and some changed more at the distal position than at the proximal position. In shortly, Short-term bed rest induces significant changes in the radial pulse of healthy subjects. The results of this study could be used as a control reference for clinical acupuncture studies with participants lying on a bed for acupuncture treatment.     

Establishing diagnostic reference levels for interventional procedures in Kenya

PurposeTo quantify ionizing radiation exposure to patients during interventional procedures and establish national diagnostic reference levels (NDRLs) for clinical radiation exposure management.MethodsThe cumulative reference point air kerma, kerma area product, fluoroscopy time and other operational parameters were monitored for 50 children and 261 adult patient procedures in five catheterization medical laboratories in Kenya. To estimate the risk associated with the exposure, effective doses were derived from the kerma area product using conversion factors from Monte Carlo models.ResultsAbout 3% of the measured cumulative reference point air kerma for the interventional procedures approached the threshold dose limit with the potential to cause deterministic effects such as skin injuries. In interventional cardiology, the results obtained for both children and adults indicated 33% were below the diagnostic reference levels (DRLs). In adult interventional radiology, 29% for cumulative reference point air kerma, and 43% for kerma area product and fluoroscopy time respectively were below the diagnostic reference levels. NDRLs were proposed for routine use in the procedures considered and for the non-existent DRLs situations in paediatric interventional cardiology.ConclusionThe measured patient doses were above the DRLs available in the literature indicating a need for radiation optimization through, continuous monitoring and recording of patient dose. To promote radiation safety, facilities performing interventional procedures need to establish a radiation monitoring notification threshold for possible deterministic effects, in addition to the use of the newly established national diagnostic reference levels, as a quality assurance measure.     

The Application of Non-Default Uncertainty Factors in the U.S. EPA's Integrated Risk Information System (IRIS). Part I: UF L,UF S,and “Other Uncertainty Factors”

The United States Environmental Protection Agency's Integrated Risk Information System (IRIS) includes hazard identification and dose-response assessment values developed by Agency scientists. Uncertainty factors (UFs) are used in the development of IRIS values to address the lack of information in five main areas. The standard UFs account for interspecies uncertainty (UF_A) and intraspecies variability (UF_H). The UF_A addresses uncertainty related to the extrapolation of data from animals to humans, whereas the UF_H addresses variability amongst individuals (i.e., intrahuman). Additional UFs have been employed to account for database incompleteness, extrapolations from a lowest-observed-adverse-effect level in the absence of a no-observed-adverse-effect level (UF_L), and subchronic-to-chronic extrapolation (UF_S). A sixth UF designated as “other uncertainty factors” (UF_O) has also been applied in place of the UF_L to account for uncertainty with the adversity of points of departure obtained using benchmark dose modeling. This review will discuss how UF_L, UF_S, and UF_O have been applied in IRIS assessments, along with the rationale used to describe the choice of UF values that deviate from the standard default of 10.     

北京地区健康女性跟骨超声速率的正常参考值及其分析

目的建立北京地区健康成年女性的跟骨骨超声速率(speed of sound,SOS)的正常参考值。方法用日本吉野电器公司生产的CM-100型跟骨骨超声测定仪对912名北京地区健康女性志愿者进行跟骨SOS测定,并对其中110名志愿者用双能X线骨密度仪(DXA)进行腰椎I_(2-4)和髋部的骨密度测定。结果健康女性跟骨SOS在26～30岁年龄组达到峰值[(1 533.4±34.2)m/s],达峰值后开始下降,46～50岁后下降速度加快。绝经期前、后跟骨SOS差异有统计学意义。跟骨SOS下降分为快速下降期、稳定下降期和再下降期。经DXA测定的骨密度值与跟骨SOS值相关(r=0.323～0.506,P0.01)。结论本研究建立了北京地区健康妇女跟骨SOS正常值,跟骨SOS和DEXA测定骨密度之间存在良好的相关性。