2型糖尿病患者扫描式葡萄糖监测系统指标与尿白蛋白/肌酐比值的相关性研究

背景 随着血糖监测技术的发展，近些年来人们开始使用扫描式葡萄糖监测系统（FGMS）"全景式"地观察2型糖尿病（T2DM）患者的血糖水平，明确FGMS指标与T2DM并发症之间的关系有助于提高其临床应用价值，但目前相关研究较少。 目的 探究佩戴FGMS的T2DM患者葡萄糖在目标范围内时间（TIR）等指标与尿白蛋白/肌酐比值（UACR）的相关性。 方法 选取2019年1月至2021年10月于北京大学人民医院老年科就诊并佩戴FGMS的T2DM患者79例，以尿液检查中UACR是否<30 mg/g将患者分为无白蛋白尿组（n=50）和白蛋白尿组（n=29）。比较两组患者的临床特征、实验室检查指标及FGMS指标等。采用Pearson相关、Spearman秩相关分析探讨TIR、高血糖时间（TAR）与糖化血红蛋白（HbA1c）的相关性。分别采用Pearson相关、Spearman秩相关、偏相关分析探讨FGMS指标与lnUACR的相关性。使用多因素Logistic回归分析探究T2DM患者发生白蛋白尿的影响因素，采用受试者工作特征（ROC）曲线评估TIR对白蛋白尿的预测价值。 结果 白蛋白尿组T2DM病程长于无白蛋白尿组，三酰甘油（TG）、HbA1c、平均血糖（MBG）、TAR、平均血糖标准差（SDBG）、最大葡萄糖波动幅度（LAGE）、平均葡萄糖波动幅度（MAGE）、连续每隔2 h血糖净作用（CONGA2）高于无白蛋白尿组，TIR低于无白蛋白尿组（P<0.05）。Pearson相关、Spearman秩相关分析结果显示，TIR与HbA1c呈负相关（P<0.001），TAR与HbA1c呈正相关（P<0.001）。Pearson相关、Spearman秩相关、偏相关分析结果均表明，TIR与lnUACR呈负相关（P<0.001），MBG、TAR、SDBG、LAGE、MAGE、CONGA2与lnUACR呈正相关（P<0.001）。多因素Logistic回归分析结果显示，TIR>70%〔OR=0.038，95%CI（0.003，0.467）〕是T2DM患者出现白蛋白尿的保护因素（P<0.05），TAR升高〔OR=1.046，95%CI（1.000，1.094）〕是T2DM患者出现白蛋白尿的危险因素（P<0.05）。TIR预测T2DM患者出现白蛋白尿的ROC曲线下面积（AUC）为0.784〔95%CI（0.674，0.894）〕（P=0.003），灵敏度为78%，特异度为83%，最佳切点为69.71%。 结论 在FGMS指标中，TIR>70%是T2DM患者出现白蛋白尿的保护因素，TAR升高是T2DM患者出现白蛋白尿的危险因素。同时，SDBG、LAGE、MAGE、CONGA2等多种反映血糖波动的指标也与UACR密切相关。对TIR水平较低及TAR、SDBG、LAGE、MAGE、CONGA2水平较高的T2DM患者进行FGMS筛查有助于早期识别及预防白蛋白尿的发生、发展。     

Applications of geospatial analyses in health research among homeless people: A systematic scoping review of available evidence

BackgroundUnequal housing access resulted in more than 150 million homeless people worldwide, with millions more expected to be added every year due to the ongoing climate-related crises. Homeless population has a counterproductive effect on the social, psychological integration efforts by the community and exposure to other severe health-related issues. Geographic Information Systems (GIS) have long been applied in urban planning and policy, housing and homelessness, and health-related research.MethodsWe used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method to systematically review 24 articles collected from multiple databases (n = 10) that focused on health-related issues among homeless people and used geospatial analysis techniques in their research.ResultsOur findings indicated a geographic clustering of case study locations– 26 out of the 31 case study sites are from the USA and Canada. Studies used spatial analysis techniques to identify hotspots, clusters and patterns of patient location and population distribution. Studies also reported relationships among the location of homeless shelters and substance use, discarded needles, different infectious and non-infectious disease clusters.ConclusionMost studies were restricted in analyzing and visualizing the patterns and disease clusters; however, geospatial analyses techniques are useful and offer diverse techniques for a more sophisticated understanding of the spatial characteristics of the health issues among homeless people. Better integration of GIS in health research among the homeless would help formulate sensible policies to counter health inequities among this vulnerable population group.     

Reporting radiographer academy training model; an evaluation of the impact for trainees and clinical service

IntroductionDemand on imaging services continues to increase on a background of complex issues and barriers to care. Collaborative cross organisational working through the development of imaging networks is recommended to address these issues including managing reporting workloads. Standardisation of reporting practices and collaborative cross region reporting radiographer training has been recommended to be supported by a regional reporting radiographer academy model to achieve these aims. This research explores the perceptions of trainees and their managers/mentor who undertook radiographer academy training model with a view to integrated imaging network formalisation in the region.MethodsAn online questionnaire was designed to capture qualitative and quantitative data with three phases; 1) trainees perception of the academy model, 2) trainees perception of the differences in training models and 3) the perceptions of the managers/mentors related to the academy model.ResultsThere were overwhelmingly positive opinions of the academy training model from both cohorts in this study, with the two main benefits emerging being the protected study time away from clinical departments and minimal disruption to clinical services due to reduced onus on the local mentors. Peer support was also highlighted as a positive aspect of the model which would facilitate future integrated imaging network working.ConclusionThe academy model has been well received by both cohorts in this study with positive outcomes highlighted and the model being seen as promoting and facilitating integrated imaging network working between departments. The small sample size of the study requires consideration when extrapolating the results to wider academy models, however some themes may be applicable.Implications for practiceInvestment in the reporting radiographer academy model is justified and provides a practical alternative to the traditional model.     

放疗计划系统DeepPlan光子放疗剂量计算的临床可行性验证

目的:评估DeepPlan放疗计划系统患者计划剂量计算的准确性和临床应用的可行性。方法:剂量算法准确性评估主要是针对YY 0775号和YY/T 0889号报告中的例题内容进行测量验证。临床病例验证是基于Pinnacle计划系统设计的前列腺肿瘤患者9例、胸部肿瘤患者13例和头颈部肿瘤患者5例，试验将各病例原计划优化的子野等信息直接导入DeepPlan进行重新剂量计算，比较不同计划系统得到的靶区和危及器官剂量分布，并用PTW VeriSoft软件对两组计算结果进行全空间剂量γ分析。结果:DeepPlan光子剂量算法通过了剂量计算准确性验证，YY 0775号报告中所有测试例题误差均在2%以内。YY/T 0889号报告中所有患者计划的γ通过率均在96.8%以上，复合野的γ通过率平均值为98.1%。在病例验证中，前列腺肿瘤病例的等中心层面2D γ通过率平均值为97.6%，3D γ通过率平均值为96.9%。胸部肿瘤病例的等中心层面2D γ通过率平均值为98.7%，3D γ通过率平均值为98.3%。头颈部肿瘤病例的中间层面2D γ通过率为98.6%，3D γ通过率平均值为98.8%。结论:通过模体实际测量和临床病例测试，验证了DeepPlan光子放疗剂量计算的准确性和临床应用的可行性。     

Renal denervation prevents subclinical atrial fibrillation in patients with hypertensive heart disease: Randomized,sham-controlled trial

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Development of an evidence-based ESCALATION system for recognition and response to paediatric clinical deterioration

AimThe aim of this study was to develop an evidence-based paediatric early warning system for infants and children that takes into consideration a variety of paediatric healthcare contexts and addresses barriers to escalation of care.MethodsA three-stage intervention development framework consisted of Stage 1: evidence review, benchmarking, stakeholder (health professionals, decision-makers, and health consumers) engagement, and consultation; Stage 2: planning and coproduction by the researchers and stakeholders using action research cycles; and Stage 3: prototyping and testing.ResultsA prototype evidence-based system incorporated human factor principles, used a structured approach to patient assessment, promoted situational awareness, and included family as well as clinician concern. Family involvement in detecting changes in their child's condition was supported by posters and flyers codesigned with health consumers. Five age-specific observation and response charts included 10 weighted variables and one unweighted variable (temperature) to convey a composite early warning score. The escalation pathway was supported by a targeted communication framework (iSoBAR NOW).ConclusionThe development process resulted in an agreed uniform ESCALATION system incorporating a whole-system approach to promote critical thinking, situational awareness for the early recognition of paediatric clinical deterioration as well as timely and effective escalation of care. Incorporating family involvement was a novel component of the system.     

HIV相关淋巴瘤诊治进展

[摘要]　HIV相关淋巴瘤是常见的HIV相关肿瘤之一，在联合抗反转录病毒治疗（combination antiretroviral therapy, cART）出现之前，其治疗效果极差。在cART时代，HIV相关淋巴瘤的基础及临床研究取得了重大进展，这些为挖掘治疗新靶点提供了依据，使优化HIV相关淋巴瘤的诊治成为可能。本文对近年来HIV相关淋巴瘤的诊断和治疗进展进行综述。     

Innovating medication reviews through a technology-enabled process

Medication reviews are effective in improving the quality of medication use among older people. However, they are conducted to various standards resulting in a wide range of outcomes which limit generalisability of findings arising from research studies. There also appear to be funding and time constraints, lack of data storage for quality improvement purposes, and non-standardised reporting of outcomes, especially clinically relevant outcomes. Furthermore, the coronavirus disease-19 (COVID-19) pandemic has restricted many face-to-face activities, including medication reviews. This article introduces a technology-enabled approach to medication reviews that may overcome some limitations with current medication review processes, and also make it possible to conduct medication reviews during the COVID-19 pandemic by providing an alternate platform. The possible advantages of this technology-enabled approach, legislative considerations and possible implementation in practice are discussed.