Out of the boxes,out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain

In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.     

Importance of monitoring zones in the detection of arrhythmias in patients with implantable cardioverter-defibrillators under remote monitoring

Introduction

Implantable cardioverter-defibrillator (ICD) monitoring zones (MZ) provide passive features that do not interfere with the functioning of active treatment zones. However, it is not known for certain whether programming an MZ affects arrhythmia detection by the ICD. The aim of the present study is to assess the clinical relevance of MZ in a population of patients with ICDs.

中国医疗不良事件报告与质量改进的分析研究

文章分析了来自国家卫生健康委员会医政医管局收集的82万例不良事件报告中最常见的三项错误，该三项错误占82万例不良事件的53％；还介绍了抽样医院主动报告的五类不良事件，以及国家药品不良事件反应网络监测中心的药品与器械不良事件报告。介绍了北京中卫云医疗数据分析与应用研究院100万例误诊报告的简要内容，简要列举了6个典型误诊病例。介绍了中国政府主要的质量政策以及通过医院评审工作落实政策，改善医院管理的做法，引用《柳叶刀》杂志对中国医疗状况的评价，说明质量政策与医院评审对提升医疗服务安全质量是有效的。同时指出要警惕新发疾病，减少误诊，关注新技术、新材料、新药品应用时可能出现新的不安全事件，以实现高质量发展的目标。     

2016 - 2018年泰安市登革热媒介伊蚊监测结果分析

目的 了解泰安市登革热媒介伊蚊种类构成、密度、季节变化，为登革热风险评估提供科学依据。方法 利用布雷图指数(BI)、容器指数(CI)和房屋指数(HI)等指标评价伊蚊幼虫密度， 2016 - 2018年6 - 9月每月各监测1次，对监测结果进行统计学分析。结果 2016 - 2018年平均BI为27.64，CI为16.88%，HI为20.28%。2016 - 2018年3年间白纹伊蚊布雷图指数（BI）呈逐年下降趋势，容器指数（CI）、房屋指数（HI）在3年间呈波动趋势，2018年CI明显高于2016年和2017年，而HI也有上升趋势。2016年BI、CI在8月份最高（BI = 62.79，CI = 32.73%），HI在7月份最高（33.00%）。2017年BI、CI、HI密度高峰均集中在9月份（分别为48.00、24.24%和29.00%）。2018年BI、HI密度高峰在6月份（41.00和34.00%），CI在9月份最高（48.89%）。2016 - 2018年间容器指数差异有统计学意义（χ2 = 29.693，P = 0.000）。不同容器种类的CI差异有统计学意义(χ2 = 29.366，P = 0.000)，其中，废旧轮胎的CI最高（23.81%），其次是闲置容器（20.72%）。闲置容器（碗、瓶、缸、罐）的孳生地构成比最高为66.67%。结论 泰安市白纹伊蚊幼虫密度较高，有明显季节性。做好媒介生物防治知识宣传，加强密度监测，在活动高峰期持续清除孳生地和杀灭成蚊，可有效降低蚊虫密度水平。     

Guía de práctica clínica 2021 para la detección temprana,el diagnóstico,el tratamiento y el seguimiento de los pacientes con espondiloartritis axial. Asociación Colombiana de Reumatología

BackgroundAxial spondyloarthritis is a rheumatic condition affecting young patients with social and occupational consequences. Diagnosis delay is associated with functional impairment and impact on quality of life, requiring a multidisciplinary approach.ObjectiveTo develop a set of recommendations based on the best available evidence for the early detection, diagnosis, treatment, and monitoring of adult patients with axial spondyloarthritis.MethodsA working group was established, questions were developed, outcomes were graded, and a systematic search for evidence was conducted. A multidisciplinary panel of members was established (including patient representatives), minimizing bias in relation to conflicts of interest. The GRADE approach Grading of Recommendations Assessment, Development and Evaluation was used to assess the quality of the evidence as well as the direction and strength of recommendations. In total, 11 recommendations on diagnosis (n=2), pharmacological treatment (n=6), non-pharmacological treatment (n=2) and monitoring (n=1) are presented.ResultsSacroiliac joint radiography as the first diagnostic method, and the use of disease activity scales for patient monitoring (ASDAS or BASDAI), are recommended. Nonsteroidal anti-inflammatory drugs are the first treatment option; in case of intolerance or residual pain, acetaminophen or opioids are recommended. In patients with axial involvement, it is recommended not to use conventional disease-modifying antirheumatic drugs or systemic or local glucocorticoids. In patients with failure to non-steroidal anti-inflammatory drugs, anti-TNF or anti-IL17A is recommended. In those patients presenting with anti-TNF failure, starting an anti-IL17A is recommended. Exercise, physical and occupational therapy are recommended as part of treatment. It is recommended not to use unconventional therapies as the only treatment option.ConclusionsThis set of recommendations provides an updated guideline for the diagnosis, treatment, and monitoring of patients with axial spondyloarthritis.     

Benefits of positron emission tomography scans for the evaluation of radiotherapy

The assessment of tumour response during and after radiotherapy determines the subsequent management of patients (adaptation of treatment plan, monitoring, adjuvant treatment, rescue treatment or palliative care). In addition to its role in extension assessment and therapeutic planning, positron emission tomography combined with computed tomography provides useful functional information for the evaluation of tumour response. The objective of this article is to review published data on positron emission tomography combined with computed tomography as a tool for evaluating external radiotherapy for cancers. Data on positron emission tomography combined with computed tomography scans acquired at different times (during, after initial and after definitive [chemo-]radiotherapy, during post-treatment follow-up) in solid tumours (lung, head and neck, cervix, oesophagus, prostate and rectum) were collected and analysed. Recent recommendations of the National Comprehensive Cancer Network are also reported. Positron emission tomography combined with computed tomography with (¹⁸F)-labelled fluorodeoxyglucose has a well-established role in clinical routine after chemoradiotherapy for locally advanced head and neck cancers, particularly to limit the number of neck lymph node dissection. This imaging modality also has a place for the evaluation of initial chemoradiotherapy of oesophageal cancer, including the detection of distant metastases, and for the post-therapeutic evaluation of cervical cancer. Several radiotracers for positron emission tomography combined with computed tomography, such as choline, are also recommended for patients with prostate cancer with biochemical failure. (¹⁸F)-fluorodeoxyglucose positron emission tomography combined with computed tomography is optional in many other circumstances and its clinical benefits, possibly in combination with MRI, to assess response to radiotherapy remain a very active area of research.     

Circuitos postoperatorios en los pacientes sometidos a craneotomía programada. Revisión narrativa

In 2017, the Neurosciences section of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy published a national survey on postoperative care and treatment circuits in neurosurgery. The survey showed that practices vary widely, depending on the centre, the anaesthesiologist and the pathology of the patient. There is currently no standard postoperative circuit for cranial neurosurgical procedures in Spanish hospitals, and there is sufficient evidence to show that not all patients undergoing elective craniotomy should be routinely admitted to a postsurgical critical care unit. The aim of this study is to perform a narrative review of postoperative circuits in elective craniotomy in order to standardise clinical practice in the light of published studies. For this purpose, we searched MEDLINE (PubMed) to retrieve studies published in the last ten years, up to November 2019, using the keywords neurosurgery and postoperative care, craniotomy and postoperative care.     

宁夏2019参加全国个人剂量监测能力考核结果分析

目的 通过分析2019年参加全国放射工作人员个人剂量监测能力考核结果，了解本省实验室个人剂量监测系统运行状况，进一步提高监测能力和水平。方法 参加2019年全国放射工作人员个人剂量监测能力考核，并对考核结果进行分析总结。结果 本次能力考核检测报告获得满分10分，且单组性能偏差在-0.04～0.01（均符合|P_i| ≤ 0.10），同时综合性能偏差B² + S² ≤ 0.10（B为综合判定指标，S为综合标准偏差），故而实验得70满分，总分达到80分可参加评定优秀的要求，经评定质控分为17.3分，Q值为97.3（Q值 ≥ 95为优秀），故本实验室个人剂量监测能力考核结果为优秀。结论 宁夏个人剂量监测实验室系统运行良好，检测结果准确、误差范围较小，可满足国家职业性外照射个人剂量监测相关标准要求。     

AERMOD在核设施辐射环境影响评价中的应用研究

目的 基于AERMOD模型机理，研究其在核设施辐射环境影响评价中的应用。方法 根据给定的释放源项和厂址气象数据，模拟获取核设施常规运行时气态放射性核素浓度分布，并进一步定性分析气态流出物浓度峰值落地点和时间分布，研究AERMOD模型在核设施辐射环境影响评价中的适用性和应用前景。结果 通过AERMOD模型适用性和应用前景分析，得出该模型总体满足核设施气态流出物浓度分布计算需求，可应用于核设施气态流出物扩散趋势和敏感点分析，并可为核设施常规运行的监测计划提供数据支撑。结论 本研究可为今后深入开展AERMOD模型在核设施辐射环境影响评价中的应用提供参考。