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.     

内镜下鼓室成形术治疗慢性中耳炎的效果观察

目的探讨内镜下鼓室成形术治疗慢性中耳炎的效果。方法选取于我院接受治疗的86例慢性中耳炎患者为研究对象,随机分为对照组与观察组。对照组采用常规治疗方法,观察组接受内镜下鼓室成形手术。对比两组患者的治愈效果。结果观察组治疗总有效率为97.92%,对照组的治疗总有效率为52.63%,观察组治疗有效率高于对照组,P0.05,差异具有统计学意义。结论内镜下鼓室成形术可提高中耳炎患者的治疗有效率、干耳率,可以改善患者听力,并降低中耳炎的复发率。     

加强医院实习生实习档案管理的分析

医学院的学生实习阶段是学生在教育中将理论与实践、基础知识与临床应用联系到一起的重要环节，是训练如何掌握专业的临床诊疗与各种医疗器械的操作技能不可缺少的阶段，是临床教育中重要的组成部分，同时也是医院选拔人才的一种重要的手段。因此许多医院在实习生参加实习的过程中都会建立实习档案对实习生进行系统的评价，档案不仅能反应一个学生的学习情况，增加考核临床带教的功能，还能够为用人单位提供一定参考价值的依据。     

McCune–Albright syndrome,natural history and multidisciplinary management in a series of 14 pediatric cases

BackgroundMcCune–Albright syndrome is a rare disorder characterized by endocrine disorders, café-au-lait spots and fibrous dysplasia of bone that occurs early in life.MethodsA series of 14 pediatric cases were followed between 1994 and 2013 by the competence center for rare endocrine diseases and constitutional bone diseases at CHU de Nancy (France). The diagnosis is based on the presence of at least two symptoms.ResultsThe mean follow-up was 6 years (1–17 years). The sex ratio was six girls per boy. The incidence was 0.28 cases/million population/year. Mean age at diagnosis was 6 years. A mutation in the GNAS gene was found in 33% of patients tested. Gonadal involvement (13/14 cases), including early peripheral puberty and ovarian cysts in girls (82%) occurred on average at 4 years of age. Bone involvement (10/14 cases) appeared on average at 5 years of age and was most often multiple (80%) with fracture risk, and the skull, with a neurosensory risk.ConclusionClinical definition and methods of screening and monitoring can be improved to allow for an earlier intervention. It must be multidisciplinary and take into account the disability and quality of life of the patient.     

精索静脉曲张手术后患者的管理策略

手术治疗精索静脉曲张在改善精液质量、提高配偶自然怀孕率和缓解局部疼痛症状中的作用已为多数医生所认同。随着手术方式的改进,越来越多的精索静脉曲张患者接受手术治疗,然而,临床对手术后患者的管理还重视不够。本文系统介绍了对精索静脉曲张手术后患者的疗效判断和后续治疗选择,包括观察随诊、非手术治疗方法和再手术。     

Que devient l’hôpital en régime néolibéral ? Entretien avec Stéphane Velut

ObjectivesThis interview with Professor Stéphane Velut, neurosurgeon and writer, is an occasion to reflect on the current challenges of transforming the functioning of public hospitals today. In recent years, he has made his voice heard in public debate by publishing several essays and tracts. This interview allows him to expand upon some of his theses, by giving voice to his experience. Professor Velut's lively and passionate speech is in constant dialogue with the human sciences and literature. His taste for words led him in particular to develop a sensitivity to and a critique of the rhetoric employed by contemporary hospital administrators.MethodsThis dialogue is based on open questioning. Professor Velut is asked about his own experience as head of department and surgeon. The interview makes it possible to explore the many influences, from Victor Klemperer to Régis Debray, which help him think about the era and the issues specific to it. The analysis of the social and political context of French medicine over the last forty years is widely discussed: from the emergence of health democracy with the AIDS epidemic to the most recent upheavals caused by the SARS-CoV-2 pandemic.ResultsThe new logics of care, evolving towards an ever greater requirement of technicality, systematicity, and evaluability, lead to a standardization of medical practice, which tends to eliminate any singularity, both that of the patient and the clinician.DiscussionToday, it is administrators, economists, and communicators who seem to hold the power to decide what is desirable for the hospital. The analysis of their “metalanguage” reveals a singular enterprise of watering down, which de-realizes the reality of the concrete objects of the caregiver: illness, care, death. This metalanguage contrasts with the language of clinicians, grappling with a reality other than that of evaluation and quantification, in their proximity to the suffering of each patient.ConclusionThe neoliberal management of the hospital, controlled by economic imperatives; modern forms of management, indexed against the principle of subsidiarity; finally, the new systematized and protocolized conceptions of care lead to a loss of autonomy for clinicians and caregivers who are no longer expected to be actors capable of thinking for themselves. In contrast, the concrete, even artisanal exercise of surgeon, in which the work of the surgeon's hand (like that of the craftsman) is irreplaceable, is a form of clinical practice that preserves the singularity of the encounter and the possibility of inventiveness. The practice of surgery allows the practitioner to take the singularity of each participant into account; in this, it can be compared to the practice of psychiatry.     

医院档案管理工作创新方法初探

档案管理是医院管理中一项重要的内容。医院传统档案管理已经不能满足现代化社会发展的要求,基于此需要加强对医院档案管理的创新,只有在加快医院档案管理创新的基础上才能提高档案管理的效率和水平,并推动社会的进一步发展,可见创新医院档案管理方法是时代发展的必然选择。该文主要针对现阶段创新医院档案管理工作方法的相关问题进行研究,目的是为医院档案管理纳入新的工作方法,提高医院管理水平。     

Outcomes of Prostatectomy versus Radiation Therapy in the Management of Clinically Localized Prostate Cancer Patients Within the PLCO Trial

Background

The objective of the study was to evaluate the outcomes of clinically localized prostate cancer treated with prostatectomy versus radiation therapy within the context of a prospective prostate cancer screening study.