La dermatología y sus aspectos médico-legales: seguridad clínica y dermatología

Clinical safety and medical liability are first-order concerns in today's medical practice. It is important to understand the circumstances under which medical acts fail to live up to the accepted standard of care and to recognize the impact that malpractice claims have on physicians. Practitioners must also grasp the concept of medical error, studying malpractice claims in order to identify the areas where improvement is needed. The risk of accusations of malpractice in dermatology is comparatively low, both in Spain and worldwide. However, a great variety of clinical scenarios in dermatology can potentially give rise to a claim, and malignant melanoma is most susceptible to risk. Dermatologists should know which actions during clinical consultation merit particular attention and care. Clinical practice carries inherent risk of malpractice claims, but taking certain recommended precautions can prevent them.     

Machine learning identifies unaffected first‐degree relatives with functional network patterns and cognitive impairment similar to those of schizophrenia patients

Schizophrenia (SCZ) patients and their unaffected first‐degree relatives (FDRs) share similar functional neuroanatomy. However, it remains largely unknown to what extent unaffected FDRs with functional neuroanatomy patterns similar to patients can be identified at an individual level. In this study, we used a multivariate pattern classification method to learn informative large‐scale functional networks (FNs) and build classifiers to distinguish 32 patients from 30 healthy controls and to classify 34 FDRs as with or without FNs similar to patients. Four informative FNs—the cerebellum, default mode network (DMN), ventral frontotemporal network, and posterior DMN with parahippocampal gyrus—were identified based on a training cohort and pattern classifiers built upon these FNs achieved a correct classification rate of 83.9% (sensitivity 87.5%, specificity 80.0%, and area under the receiver operating characteristic curve [AUC] 0.914) estimated based on leave‐one‐out cross‐validation for the training cohort and a correct classification rate of 77.5% (sensitivity 72.5%, specificity 82.5%, and AUC 0.811) for an independent validation cohort. The classification scores of the FDRs and patients were negatively correlated with their measures of cognitive function. FDRs identified by the classifiers as having SCZ patterns were similar to the patients, but significantly different from the controls and FDRs with normal patterns in terms of their cognitive measures. These results demonstrate that the pattern classifiers built upon the informative FNs can serve as biomarkers for quantifying brain alterations in SCZ and help to identify FDRs with FN patterns and cognitive impairment similar to those of SCZ patients.     

不同学历护生职业认同和学习动机的相关性研究

目的:调查分析不同学历护生职业认同和学习动机的相关性.方法:采用护生职业认同问卷、学习动机问卷对山东省某高校1537名护生进行调查.结果:不同学历护生职业认同评分比较,差异有统计学意义(P ＜0.001),专科＞专升本＞本科;不同学历护生学习动机评分比较,差异有统计学意义(P＜0.001),专升本＞专科＞本科;护生职业...     

基于集聚度的广西卫生人力资源公平性分析

目的 对2010-2017年广西卫生人力资源公平性进行分析,为制订科学合理的卫生人力发展计划和政策提供参考;方法 横向上将广西14个地级市按经济发展水平由高到低分为3类城市,运用集聚度方法对不同经济发展水平城市卫生人力配置的公平性进行评价;纵向上对2010-2017年广西不同类别卫生人力资源的公平性进行集聚度分析;结果 从横向上看,无论是按地理配置还是按人口配置的卫生人力资源,Ⅰ类地区公平性＞Ⅱ类地区公平性＞Ⅲ类地区公平性;从纵向上看,2010-2017年广西各类卫生人力资源的集聚度呈上升势态,其中注册护士集聚度最高,执业(助理)医师集聚度最低;结论 广西不同经济发展水平地区间公平性分化严重,低人口密度地区按地理配置的卫生人力资源公平性较差,少数民族人口聚居地区卫生人力资源公平性欠佳,按人口配置的医师公平性较低。     

2013 - 2017年北京市非职业性一氧化碳中毒事件的流行病学特征分析

目的 分析北京市非职业性一氧化碳中毒事件的流行病学分布特征,为针对性开展防控工作提供信息支持。方法 收集2013 - 2017年《突发公共卫生事件管理信息系统》中北京市非职业性一氧化碳中毒事件监测数据,运用率、构成比、集中度与圆形分布法等方法对其流行病学分布特征进行分析。结果 2013 - 2017 年北京市共报告非职业性一氧化碳中毒事件6 990起,发病9 377人,死亡100人,年均发病率8.78/10万。非职业性一氧化碳中毒事件94.01%发生在居民家,99.93%为未分级事件。非职业性一氧化碳中毒事件发生高峰日为1月20日,流行期为11月29日 - 次年3月13日。结论 北京非职业性一氧化碳中毒的发病及死亡较为严重,冬春季为高发季节,应采取综合措施加强防控工作。     

中医护理路径在人工髋关节置换患者护理质量管理的应用研究

目的探究中医护理路径对于人工髋关节置换前后患者护理碛量的作用,为提高护理质量提供循证参考。方法选择行人工髋关节置换病伤患者53例,分为中医护理路径实验S组和常规对照D组,比较2组的患者留医满意度、并发症发生率以及患者舒适指数。结果采用中医护理路径,患者满意率明显提高,与对照组比较,差异有显著性意义（P〈0．001）;并发症发生率以及患者舒适指数比较,差异有显著性意义（P〈0．05）。结论中医护理路径在HR术患者中的应用,取得了良好的效果,具有很高的临床应用价值,是一种有效可行的护理质量管理方法。     

Aberrant voxel-based degree centrality and functional connectivity in Parkinson's disease patients with fatigue

Aims

The study aimed to investigate alterations in the inherent connectivity pattern of global functional networks in Parkinson's disease (PD) patients with fatigue.

Methods

Eighteen PD patients with fatigue (PD-F), 20 PD patients without fatigue (PD-NF), and 23 healthy controls (HCs) were recruited and analyzed by the voxel-wise degree centrality (DC) and the seed-based functional connectivity (FC) analysis. Meanwhile, the surface-based morphometry (SBM) analysis was also commanded to explore the structural alternations among groups.

Results

PD-F patients displayed reduced DC values in the left postcentral gyrus relative to PD-NF and HCs groups, while increased DC values in the bilateral precuneus compared to HCs. Simultaneously, altered DC value in the left postcentral gyrus negatively corresponded to the mean fatigue severity scale (FSS) in PD-F patients. Additionally, the receiver operating characteristic (ROC) curves uncovered that the reduced DC value of the left postcentral gyrus could discriminate PD-F from PD-NF and HCs groups. Our FC analysis further revealed that altered FC was located predominantly in the sensorimotor network in the PD-F group. Moreover, we discovered no statistically significant differences between the three groups concerning cortical thickness.

Conclusion

Our findings indicated that the altered functional connectivity in the sensorimotor network centering on the left postcentral gyrus and the bilateral precuneus might be the potential pathogenesis of PD with fatigue.     

2型糖尿病家系一级亲属血脂分析

目的 研究2型糖尿病家系一级亲属血脂的变化规律.方法 以37个2型糖尿病家系中的一级亲属（n=98）为受试者,按照OGTT结果分为3组：糖耐量正常（NGT）组（n=61）、糖调节受损（IGR）组（n=22）和糖尿病（DM）组（n=15）,并以正常体检者为对照组（n=39）.分别检测及比较各组血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平.结果 3个受试组TG水平均高于对照组（NGT组、IGR组与对照组比较,均P〈0.05;DM组与对照组比较,P〈0.01）,而TC、LDL-C及HDL-C水平的差异均无统计学意义.结论 2型糖尿病家系一级亲属血脂代谢紊乱,主要表现为TG升高.     

The Prevalence and Characteristics of Dual PharmD/MPH Programs Offered at US Colleges and Schools of Pharmacy

Objective. To assess the prevalence and characteristics of curriculum in dual doctor of pharmacy (PharmD)/master of public health (MPH) degree programs offered by US pharmacy programs.Methods. An 18-item survey instrument was developed and distributed online to faculty members at US colleges and schools of pharmacy.Results. Of the 110 colleges and schools that responded, 23 (21%) offered a PharmD/MPH degree. Common characteristics of these 23 programs included current PharmD program structure (3 + 1 year), early curricular recruitment, small enrollment, and interdisciplinary coursework occurring online and in the classroom. The impact of the dual degree on the curriculum and longevity of the dual-degree programs varied. About 55% of responding programs without a formal dual-degree program reported that additional public health training was available.Conclusion. Twenty-one percent of colleges and schools of pharmacy offer a combined PharmD/MPH dual degree. Most programs required an additional 1 or 2 semesters to complete both degrees.