基于德尔菲法构建我国临床药师知识体系标准

目的：建立临床药师知识体系标准，为临床药师的培养和评估提供依据。方法：通过文献查阅，梳理出若干一级指标和二级指标；依据按Likert5级评分法设计咨询问卷；运用德尔菲法对35名专家进行两轮问卷咨询。结果：建立了包含5个一级指标，33个二级指标的临床药师知识体系标准。两轮咨询中，专家咨询积极系数分别为100%和92.9%，专家权威系数分别为0.904 3和0.907 7，专家协调系数分别为0.268和0.565。结论：专业核心知识是临床药师最应具备的知识，是临床药师培养的重中之重；临床药师的知识结构要由"以化学知识为主"转变为"以医学知识为主"；临床药师自身需要注重知识的再生，并树立终身学习的理念。本研究专家积极性和权威程度高，意见协调程度好，建立的知识体系标准能够对临床药师的培养与评估提供依据。     

Length change pattern of the ankle deltoid ligament during physiological ankle motion

BackgroundLength change pattern of the ankle deltoid ligament during physiological ankle motion is still confused currently and had not been studied in vivo.MethodsThe deltoid ligaments from 7 cadaveric specimens were dissected. Lengths of each band during 30° plantarflexion to 20° dorsiflexion were measured. A dual fluoroscopy imaging system was utilized to capture the images of hindfoot joint of 7 healthy subjects during the stance phase of walking. 3D bone models were reconstructed from CT images. Lengths of each band were calculated after model-image registration utilizing a solid modeling software. Percentage of length variation and poses when the bands were in maximum extension were documented among each band.ResultsThe anterior border of tibiocalcaneal ligament (TCL) had only 1.7% length variation in vitro and 5.7% length variation in vivo. The tibionavicular ligament, tibiospring ligament, and deep anterior tibiotalar ligament were in maximum extension at 30° plantarflexion, however, superficial posterior tibiotalar ligament, deep posterior tibiotalar ligament, and the posterior border of TCL were in maximum extension at 20° dorsiflexion. The tibionavicular ligament, tibiospring ligament, and deep anterior tibiotalar ligament were in maximum extension during foot flat. The TCL was in maximum extension during midstance. The superficial posterior tibiotalar ligament and deep posterior tibiotalar ligament were in maximum extension during heel off and toe off.ConclusionThe length of TCL did not change during ankle dorsiflexion and plantarflexion. The bands anterior to and posterior to the TCL showed different length change pattern during physiological ankle dorsiflexion and plantarflexion.     

From bedside to bench: an evaluation of expectations and challenges encountered by young surgeons facing basic science

Abstract

Background: The evolution of surgical practice may lead to increasing difficulties for surgeons to perform fundamental research. The aim of this study was to evaluate the expectations and the challenges encountered by young surgeons when starting basic science.

Methods: A qualitative study was conducted in France. A written questionnaire was anonymously filled by the participants attending to the Master Degree in surgical science.

Results: The study included 47 participants (median age: 28 years, 59.6% of men); 37 (78.7%) participants had applied for a grant for their salary and 32 (68.1%) had obtained it. Nine (19.1%) participants had planned to keep their usual clinical activity. The main motivations were the perspective to embark on an academic career (55.3%) and improvement of knowledge in science (38.3%). The main barriers encountered were the lack of time (70.2%), the lack of interest (27.7%), the lack of financial support (23.4%) and administrative difficulties (12.8%).

Conclusion: This study identified main barriers that young surgeons have to face when getting involved in basic science underlining the need to improve institutional and financial support to ensure involvement of new generations of surgeons in surgical research.     

门诊分诊叫号系统构建

以江苏省人民医院为例，介绍医院门诊分诊叫号系统设计。从软硬件实现两方面阐述系统整体架构、具体功能和应用实践，指出该系统有助于改善门诊就医环境、减轻医护人员工作压力、提升患者满意度。     

医联体基层医疗机构人才培养SWOT分析

医联体是指一定地域内不同类型层级的公立医疗机构组合起来,成立协作联盟或组建医疗集团,成为利益共同体和责任共同体,即实现金字塔格局的分层诊疗模式。本文以人才流动理论着手,以XX医院医联体"送下去、请上来"的基层单位临床骨干人才的培养方式为例,结合SWOT分析法,SWOT分析法是是一种能够较客观而准确地分析和研究一个组织或单位发展现状的研究方法 ,对该模式的内外部资源以及环境展开分析,探寻为院医联体基层单位临床人才培养的相关制度,为医联体人才培养提供依据,同时探讨该举措在培养医联体成员单位临床骨干人才的作用及需要改进的方面,从积极争取支持、设立集团内绩效制度、实现文化理念相结合、加速信息共享平台的建设等方面进行改善。     

中药临床应用的适当性探索

目的 探讨和阐述中药临床应用的适当性原则，提高临床中药师运用适当性原则指导临床用药的技能，促进临床合理用药。方法 通过文献梳理及理论分析，结合中医药理论基础以及中药临床应用的复杂性，探讨中药临床应用的适当性原则，明确中药临床应用"适当性"的学术内涵。结果 中药临床应用的适当性表现在用药过程的各个环节，是合理用药的基本要求之一。中药临床应用适当性的基本内容应充分考虑用药对象、适当的药物、适当的剂量及疗程、适当的给药途径和煎煮方式、适当的服药方法、适当的治疗目标等各个用药环节。结论 中药临床应用的适当性是合理用药的基本要求，将适当的药品，以适合的剂量，在合适的时间内经适当的用药途径给相应的患者使用，以达到预期的治疗目的。     

Evaluation of antioxidant capacity and reproductive toxicity of aqueous extract of Thai Mucuna pruriens seeds

ObjectiveIn traditional medicine, the seeds of Thai Mucuna pruriens (T-MP) are used to treat male dysuria and are believed to enhance fertility. However, information pertaining to the toxicity of T-MP and its interaction with other properties is limited. This study was thus conducted to evaluate the antioxidant capacity and subacute toxicity of T-MP in the reproductive system.MethodsTotal phenolic content and antioxidant capacity of T-MP seed extract were determined using total phenolic content, 2,2-diphenyl-1-picrylhydrazyl and ferric reducing antioxidant power assays. Male and female adult rats were treated orally with T-MP at a dosage of 150 or 300 mg/kg body weight for 14 consecutive days. Sex hormones and functional parameters in the liver and kidney were evaluated. Histopathology of all tissue was conducted using Masson’s trichrome staining. Sperm parameters, including concentration, morphology, acrosome reaction status and DNA damage, were also examined. Expression of tyrosine phosphorylated protein (TyrPho), androgen receptor and A-kinase-anchoring protein 4 (AKAP4) were investigated using the Western blot technique.ResultsT-MP seed extract contained phenolic compounds and exhibited high antioxidant capacity with no toxicity at the tested doses. It did not affect liver or kidney function parameters in the male rats, but increased estradiol, aspartate aminotransferase and alanine aminotransferase levels in the females. Additionally, it decreased serum progesterone and alkaline phosphatase levels in female rats. Serum and intratesticular testosterone levels were significantly lower in male rats that received a high dosage of T-MP. Histopathological changes were not observed in any tissue treated with T-MP. T-MP also significantly increased sperm concentration (but did not affect sperm parameters), and enhanced testicular TyrPho protein and androgen receptor and expression of AKAP4 in sperms.ConclusionT-MP seed extract exhibited antioxidant capacity and was not harmful to reproductive tissues. It also had a phytoestrogenic effect on females and increased the expression of testicular and sperm markers of male fertility.     

β-blocker therapy for infantile hemangioma

ABSTRACT

Introduction

Fifteen percent of proliferating infantile hemangioma (IH) require intervention because of the threat to function or life, ulceration, or tissue distortion. Propranolol is the mainstay treatment for problematic proliferating IH. Other β-blockers and angiotensin-converting enzyme (ACE) inhibitors have been explored as alternative treatments.     

Validation of the post-neoadjuvant staging system of the American joint committee on cancer, 8th edition,in patients treated with neoadjuvant chemoradiotherapy followed by curative esophagectomy for localized esophageal squamous cell carcinoma

ObjectiveThe American Joint Committee on Cancer 8th edition staging system presents separate classifications for pTNM and post-neoadjuvant ypTNM (ypTNM-8th) to enhance prognostic prediction after neoadjuvant therapy and surgery. We aimed to validate the ypTNM-8th staging system and to compare the prognostication performance of ypTNM-8th with that of pTNM-7th and pTNM-8th in esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (nCRT).MethodsWe reviewed 207 ESCC patients treated with nCRT between January 2007 and December 2014 and compared the Akaike information criterion (AIC) and Harrell's C-index to determine the prognostic performance of each TNM system.ResultsSurvival curve analysis of pTNM-7th and -8th showed a stepwise drop in survival from ypT0N0 to advanced stages, whereas the survival outcome of ypStage III showed a better prognosis than that of ypStage II according to ypTNM-8th. Lymphovascular invasion, perineural invasion, and tumor regression grade were significantly associated with overall survival on univariate analysis. Each TNM system showed significant p-values for trend (p < 0.0001 each), but after adjusting for prognostic factors, ypTNM-8th did not significantly predict survival (p = 0.15), whereas pTNM-7th remained significant (p < 0.001). pTNM-7th incorporating ypT0N0M0 and ypT0 (is)N + M0 as separate groups was superior in prognostication as its AIC was smaller and its C-index was higher than those of pTNM-8th and ypTNM-8th, respectively.ConclusionsBecause ypTNM-8th did not provide sufficient prognostication for patients with ESCC treated with nCRT followed by esophagectomy, more sophisticated prognostic classification should be developed for the ypTNM staging system in these patients.