失代偿期肝硬化患者的社区管理建议

本文结合2018年欧洲肝脏研究学会发布的《失代偿期肝硬化患者的管理临床实践指南》中关于失代偿期肝硬化相关并发症的诊疗，引发对失代偿期肝硬化患者诊疗环节中社区管理的讨论，以期全科医生在诊疗和预防工作中做出合理决策，提高该类患者的预后、生活质量等。     

北京市核医学科辐射安全管理现状与对策研究

通过对核医学科辐射安全管理现状的调研，结合辐射安全日常监督检查情况，基于北京市的实际，通过研究、分析、归纳、概括，理清了北京市核医学科辐射安全管理中存在的突出问题，针对问题依据现有法律、法规对北京市核医学科辐射安全规范化管理提出对策，以确保辐射安全、促进行业健康发展。     

Manejo y factores de riesgo de gravedad asociados a lesiones no intencionadas en urgencias de pediatría en España

IntroductionThirty-eight million patients with injuries are treated in Emergency Departments every year, 90% of them being in the form of unintentional injuries (UIs). There are currently no global records of its management in Spain, or the risk factors that may be associated with them. The objective of this study is to describe the management of UIs in Spanish paediatric emergency departments, and to analyse factors related to the presence of serious injuries.Material and methodsA sub-study of a prospective multicentre observational study conducted over 12 months in 11 hospitals of the Spanish Paediatric Emergency Research Group (RiSEUP-SPERG), including children from 0 to 16 years of age consulting for UIs. Epidemiological data, circumstances of the injury, and data on emergency care and discharge destination were recorded on the 13th day of each month.ResultsA total of 10,175 episodes were recorded, of which 1,941 were UIs (19.1%), including 1,673, of which 257 (15.4%) were severe. The most frequent complementary test was simple radiography (60.0%), and the most frequent procedure was limb immobilisation (38.6%). A significant relationship was found between presenting with a severe UI and age > 5 years (OR 2.24; 95% CI: 1.61-3.16), history of fracture (OR 2.05; 95% CI: 1.22-3.43), or sports activity as a mechanism of injury (OR 1.76; 95% CI: 1.29-2.38), among others.ConclusionIn Spain, most UIs are not serious. X-rays and immobilisation of extremities are the most frequently performed tests and procedures. Severe UIs were associated with individual factors, such as age > 5 years or history of fracture, and with sports activity as a mechanism associated with severity. It is vital to implement measures to improve the prevention of these injuries and to support the training of caregivers through educational programmes.     

基于校医院视角的医院感染管理方法

该文立足于校医院,探讨控制医院感染的管理方法。管理方法包括建立健全的医院感染管理体系,制定并完善医院感染管理制度,严格规范医院感染监测,加强细节管理力度,保障医疗安全。严格执行以上管理方法可以提高校医院医务人员对医院感染管理的认识,实施各项医院感染管理制度,控制医院感染的发生。要做好校医院的医院感染的管理工作,必须加强组织领导,加强监测,各部门明确职责,共同协作,严格遵守管理制度。     

Looking for opportunities to co-enroll: The DISCOVERY study experience

BackgroundConducting high-quality stroke trials is complex and costly. Often these trials compete for the attention of researchers and the availability of patients. Enrolling patients in more than one study concurrently has the potential to accelerate recruitment into individual studies. DISCOVERY is a multicenter, inception cohort study of cognitive impairment and dementia following ischemic or hemorrhagic stroke. At the request of site investigators, a DISCOVERY committee reviews individual studies for approval of possible concurrent co-enrollment into DISCOVERY. The purpose of this report is to summarize the characteristics and outcomes of studies reviewed by committee for possible co-enrollment.MethodsThis analysis covers studies reviewed from 07/01/2020 to 04/26/2022 by the Site Management Committee (SMC) of the DISCOVERY Recruitment and Retention Core. Characterization of each study included study type, number and length of follow-up visits, and whether there were protocol-required blood draws, brain imaging studies, or cognitive tests. Studies were scored for patient burden and scientific overlap with Discovery. The primary outcome was SMC approval to co-enroll.Results59 studies were reviewed, and 69.5% (n = 41, 21 clinical trials; 20 observational studies) were found by the SMC to be appropriate for co-enrollment. Higher patient burden and greater scientific overlap with DISCOVERY reduced the rates of approval for co-enrollment.ConclusionA large number of diverse stroke studies are being run concurrently across the DISCOVERY study network, however, about two-thirds of the studies were considered appropriate for consideration of co-enrollment. Future studies should study how co-enrollment might improve trial network efficiency.     

Impact of new technologies on diabetes care

Technologies for diabetes management, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems, have improved remarkably over the last decades. These developments are impacting the capacity to achieve recommended hemoglobin A1c levels and assisting in preventing the development and progression of micro- and macro vascular complications. While improvements in metabolic control and decreases in risk of severe and moderate hypoglycemia have been described with use of these technologies, large epidemiological international studies show that many patients are still unable to meet their glycemic goals, even when these technologies are used. This editorial will review the impact of technology on glycemic control, hypoglycemia and quality of life in children and youth with type 1 diabetes. Technologies reviewed include CSII, CGM systems and sensor-augmented insulin pumps. In addition, the usefulness of advanced functions such as bolus profiles, bolus calculators and threshold-suspend features will be also discussed. Moreover, the current editorial will explore the challenges of using these technologies. Indeed, despite the evidence currently available of the potential benefits of using advanced technologies in diabetes management, many patients still report barriers to using them. Finally this article will highlight the importance of future studies tailored toward overcome these barriers to optimizing glycemic control and avoiding severe hypoglycemia.