基层医疗卫生机构发热哨点诊室设置标准：基于专家讨论的归纳总结

背景　国际范围内许多国家建立了基于传染病的哨点监测,在目前新型冠状病毒肺炎常态化防控背景下,国家卫生健康委基层健康司建议基层医疗卫生机构设置发热哨点诊室。目的　为了监测和防控秋冬季新型冠状病毒肺炎局部流行及可能发生的其他传染病,基于我国不同地区间的医疗水平及医疗资源差异,制定基层医疗卫生机构发热哨点诊室设置标准。方法　采用目的抽样的方法选取专家,并设计两轮专家讨论法。参考上海市基层医疗卫生机构发热哨点诊室建设,设计第一轮专家讨论会（15人）,会议时间为2020-06-30。在第一轮讨论提纲基础上,结合国家、各省市有关发热哨点诊室建设的政府政策文件,以及国内外有关哨点建设文献,设计《基层医疗卫生机构发热哨点诊室设置指导原则讨论稿》,邀请全国不同地区、不同单位基层医疗专家进行第二轮专家讨论（29人）,会议时间为2020-08-14。结果　基层医疗卫生机构发热哨点诊室设置标准主要包括6个方面：设置原则、功能设置、诊室设置、人员配备、工作路径及工作要求。二级指标包括：功能设置（日常功能、疫情期间功能要求）、诊室设置（房屋要求、设施设备配置及标志标识）、人员配备（医护、行政与工勤人员配置）、工作路径（预检、接诊、处置及健康宣教）、工作要求（接诊、防护、管理、培训、消毒、督导及保障）。结论　基层医疗卫生机构发热哨点诊室建设是基层医疗服务能力的体现,发热哨点诊室的功能应包括预检分诊、发热患者的接诊筛查、及时上报并协助安排转诊,同时可有效防止院内感染;发热哨点诊室的硬件与人员配置可根据基层医疗卫生机构自身条件按不同级别配置。     

安徽省城市社区糖尿病人健康教育与健康促进项目基线调查

目的了解安徽省城市社区糖尿病人相关知识、自我管理情况,为开展糖尿病人健康教育提供依据。方法采用整群抽样的方法对3个社区接受慢病管理的365名糖尿病人进行体格检查和问卷调查。结果调查对象除BMI(23.65±3.82 kg/m2)外,血压(134.62±15.03/82.65±9.09 mmHg)、WHR(男:0.92±0.53,女:0.86±0.10)、HbAlc(7.68±1.36)、空腹血糖(7.92±3.78 mol/L)、餐后血糖(11.61±3.88 mol/L)等指标均高于正常水平。调查对象的糖尿病基本知识知晓率为63.6%,胰岛素知识知晓率为19.0%。药物依从性较好者占80.7%,血糖监测行为较好者占6.0%。具有良好行为的调查对象中,糖尿病相关知识答对率较高者所占比例均高于答对率较低者。自我管理的态度、自我效能、社会支持按满分各45分调查,调查对象态度平均得分27.75±6.38分、自我效能35.30±4.70分、社会支持30.91±7.45分,具有不同行为的调查对象信念的差异有统计学意义(P<0.001)。结论调查对象血糖控制不良,相关指标高于正常控制值,糖尿病相关知识特别是胰岛素知识知晓率低,血糖监测行为较差。应加强社区糖尿病人的健康教育,提高他们自我管理水平。     

BMP-2与VEGF基因在同种异体骨修复骨缺损中的实验研究

目的 探讨“补肾壮骨合剂”(骨碎补、续断、自然铜、土鳖虫)在同种异体骨修复骨缺损中对骨形态形成蛋白-2(bone morphogenetic protein two,BMP-2)和血管内皮生长因子(vascular endothelial growth factor,VEGF)基因的表达及影响 方法 普通家兔48只,取其中36只随机分为实验组和对照组,实验组和对照组均为18只,实验组和对照组再继续分为6组,每组各为3只;实验组和对照组均按常规1术在无菌条件把左侧桡骨中下1/3处用骨磨钻制成10mm的骨缺损模型,取另外12只备用家兔处死后取髂骨植入以上骨缺损处;实验组用“补肾壮骨合剂”复合饲料喂养,对照组用普通饲料喂养,于术后3d及1、2、4、6、8周各处死实验组和对照组普通家兔3只,取骨缺损处标本进行BMP-2和VEGF基因的实时定量聚合酶链反应(real-time PCR).结果 对BMP-2和VEGF的目的基因校正结果后,以对照组1周拷贝数为基础,其他各组与其比值:对照组和实验组在3d及1、2、4、6、8周BMP-2基因分别为0.55、1.00、2.19、3.20、2.29、1.42和1.84,8.83、3.44、2.50、6.50、6.00;VEGF基因分别为2.08、1.00、0.88、3.40、1.71、1.17和6.5、2.25、1.86、3.13、3.33、3.31,实验组与对照组比较差异有统计学意义(P＜0.05) 结论 补肾壮骨合剂能明显缩短骨缺损的修复时间和提高骨组织的修复质量,在对BMP-2和VEGF的释放水平和诱导成骨进程及促进骨损伤区血管化方面有显著的影响,并可以看出在骨缺损的修复过程中各个时间段二者的增长不成比例关系.     

Clinique des dispositifs « aux limites ». Co-construction et subjectivation

ObjectivesThe author proposes to explore some of the characteristics of clinical practices and setting “at the limits.” Particular consideration is given to the underlying logics of co-construction and their implications for clinical work and the process of subjectivation.MethodClinical settings “at the limits” are defined as practices that are situated at the limits of psychological care or at the limits of the usually identified setting. They are specifically aimed at subjects with boundary problems and difficulties in subjectivation. Based on several types of setting, the dynamics of co-construction at work between patient(s) and therapist(s) and between setting and institution are studied, leading to the identification of some clinical benchmarks for the specificities of these treatments and the issues they raise from the point of view of the work of subjectivation.ResultsThe identification of the dynamic of co-construction specific to these clinical practices highlights the necessary congruence of these devices with the psychic needs of the subject, which implies a particular attention paid by the clinician to the effects produced in the therapeutic relationship by the setting. Three major characteristics of clinical settings “at the limits” are identified: unconditional welcome; appropriation of the setting; and sharing as a major organizer of the clinical encounter.DiscussionTaking into account the dimension of intersubjectivity and the singular use that the patient will make of the device makes it possible to underline the transitional virtues of the work of co-construction, notably in relation to the transference/counter-transference dynamic.ConclusionNowadays, clinical settings “at the limits” constitute a particularly heuristic and rapidly expanding field of research, contributing to refining and remodelling our clinical practices and theoretical models.     

GI-II型专用代型材料凝固时间和凝固膨胀率的测试

目的　测试了解GI II型粉浆涂塑铝瓷底层冠专用代型材料的凝固时间和凝固膨胀性能。方法　使用维氏针和万分表位移计分别测试代型材料的凝固时间和凝固膨胀率。结果　代型材料具有适当的凝固时间和凝膨胀率 ,其凝固膨胀可以较好地补偿GI II型铝瓷烧结后的体积收缩。     

Addition of fenofibrate to statins is associated with risk reduction of diabetic retinopathy progression in patients with type 2 diabetes and metabolic syndrome: A propensity-matched cohort study

AimThis study aimed to determine the association between fenofibrate added to statin therapy and diabetic retinopathy progression.MethodsIn this propensity-matched study using the Korean National Health Insurance Service cohort (2002–2019), patients with type 2 diabetes and metabolic syndrome (≥ 30 years) receiving statin therapy were matched 1:2 by propensity score into the statin plus fenofibrate group (n = 22,395) and statin-only group (n = 43,191). The primary outcome was a composite of diabetic retinopathy progression including vitreous hemorrhage, vitrectomy, laser photocoagulation, intravitreous injection therapy and retinal detachment.ResultsThe median (quartiles) follow-up duration was 44.0 (27.6–70.6) months. For the primary outcome, the incidence rate per 1,000 person-years was 9.66 in the statin-only group and 8.68 in the statin-plus-fenofibrate group. The risk of the primary outcome was significantly lower (hazard ratio [HR]=0.88; 95% confidence interval [0.81;0.96] P = 0.005) in the statin-plus-fenofibrate group than in the statin-only group. Only patients with pre-existing retinopathy showed benefits from fenofibrate treatment (HR=0.83 [0.73;0.95] P = 0.006). In addition, the statin plus fenofibrate group exhibited significantly lower risks of vitreous hemorrhage (HR= 0.86 [0.75;0.995] P = 0.042), laser photocoagulation (HR=0.86 [0.77;0.96] P = 0.009) and intravitreous injection therapy (HR=0.73 [0.59;0.90] P = 0.003) than those in the statin-only group. There was no significant interaction between the different characteristics at baseline and the treatment effect.ConclusionThe addition of fenofibrate to statins was associated with significantly lower risk of diabetic retinopathy progression than statin therapy alone in patients with type 2 diabetes and metabolic syndrome.