超声引导下辅助诊断和治疗冻结肩的研究进展

冻结肩是常见的肩部疾病,传统非可视化治疗冻结肩效果欠佳。近年来,超声引导具有动态实时定位、无辐射、便携性、低成本等优点在辅助诊断和治疗冻结肩患者中得到成功应用,不仅能提供精确的诊断,也提高了患者中长期的疗效。本文就超声引导辅助诊断和治疗冻结肩的研究进展进行综述。     

Ultrasound-guided Brachytherapy for Cervix Cancer

Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. The use of soft-tissue imaging, particularly magnetic resonance imaging, has enhanced their effectiveness and improved clinical outcomes. However, the use of magnetic resonance imaging is largely restricted to well-resourced centres in both the first and developing world and remains elusive to many less advantaged centres, particularly those in areas with a high burden of cervix cancer. Ultrasound is an accessible, affordable and accurate imaging modality that can be used throughout the brachytherapy procedure. Ultrasound is primarily used to ensure safe insertion of the applicator but can also be used to guide planning. The methods used to utilise ultrasound images for planning are described. Ultrasound is particularly useful as a verification aid to confirm applicator placement after patients are moved and transferred around the radiotherapy department. It can also be used to verify the dimensions of treatment volumes over the course of brachytherapy. There is a crucial unmet need for an accessible economical soft-tissue imaging modality in cervical brachytherapy. Ultrasound has the potential to meet this need.     

手部多发掌骨骨折术后的功能康复指导疗效评价

目的探讨手部多发掌骨骨折患者术后进行功能康复指导的临床疗效。方法 92例手部多发掌骨骨折患者依据是否早期行康复治疗分成康复组(50例)与普通组(42例)。普通组采取常规治疗,康复组在普通组治疗基础上进行功能康复指导。对比两组治疗效果及并发症发生情况。结果康复组治疗总有效率为92.0%高于普通组的76.2%,差异有统计学意义(P<0.05)。康复组并发症发生率为8.0%低于普通组的23.8%,差异有统计学意义(P<0.05)。结论手部多发掌骨骨折患者术后尽早进行康复锻炼,可有效减少并发症发生,可最大程度的恢复手部功能,对提升患者生活质量,恢复正常生活作用显著,建议临床应用。     

Designing and Implementing Deliberative Processes for Health Technology Assessment: A Good Practices Report of a Joint HTAi/ISPOR Task Force

ObjectivesDeliberative processes for health technology assessment (HTA) are intended to facilitate participatory decision making, using discussion and open dialogue between stakeholders. Increasing attention is being given to deliberative processes, but guidance is lacking for those who wish to design or use them. Health Technology Assessment International (HTAi) and ISPOR—The Professional Society for Health Economics and Outcomes Research initiated a joint Task Force to address this gap.MethodsThe joint Task Force consisted of 15 members with different backgrounds, perspectives, and expertise relevant to the field. It developed guidance and a checklist for deliberative processes for HTA. The guidance builds upon the few, existing initiatives in the field, as well as input from the HTA community following an established consultation plan. In addition, the guidance was subject to 2 rounds of peer review.ResultsA deliberative process for HTA consists of procedures, activities, and events that support the informed and critical examination of an issue and the weighing of arguments and evidence to guide a subsequent decision. Guidance and an accompanying checklist are provided for (i) developing the governance and structure of an HTA program and (ii) informing how the various stages of an HTA process might be managed using deliberation.ConclusionsThe guidance and the checklist contain a series of questions, grouped by 6 phases of a model deliberative process. They are offered as practical tools for those wishing to establish or improve deliberative processes for HTA that are fit for local contexts. The tools can also be used for independent scrutiny of deliberative processes.     

FDA“治疗等效性评价供企业用指导原则”（草案）介绍

美国食品药品管理局（FDA）于2022年7月发布了"治疗等效性评价供企业用指导原则"（草案）。该指导原则阐明了FDA治疗等效性的标准以及治疗等效性编码系统，目的是准确评价仿制药与参比制剂的治疗等效性并通过治疗等效性代码，在"橙皮书"中迅速检索到治疗等效的仿制药。而中国目前尚无类似的指导原则，详细介绍FDA该指导原则主要内容，期望对中国加强仿制药的治疗等效性评价和加速完善和实施符合国情的治疗等效性编码系统有所帮助。     

经皮肾镜气压弹道超声碎石在肾结石中的效果

目的 B超引导经皮肾镜气压弹道超声联合碎石治疗肾结石的临床效果。方法选择2017年9月-2018年9月医院收治的肾结石患者82例,按照抽签法的要求将其平均分成对照组(41例:B超引导经皮肾镜气压弹道超声治疗)与试验组(41例:输尿管软镜治疗),分析手术时间、住院时间、出血量、结石清除率、结石的残留率。结果试验组的手术时间、住院时间、出血量。优于对照组,数据比较有差异性,P<0.05。对照组的结石清除率高于试验组、结石的残留率低于试验组,相互比较有差异性,P<0.05。结论在肾结石实际治疗期,使用输尿管软镜钬激光碎石治疗方式。     

« S’attacher pour bien grandir » : résultats préliminaires d’un groupe thérapeutique de guidance parentale et de mise en situation centré sur l’attachement

BackgroundPreventive and therapeutic settings are very common in perinatal and early childhood mental health services. However, their theoretical basis, their methods and their efficacy are rarely described.AimsIn this paper, we present and describe the first feedback from parents about a new group therapeutic setting model that relies on parental guidance and practical experiences designed to prevent and to treat attachment-related parent–infant/child problematic issues.MethodThe group is designed to enhance the quality of parent-child attachment by promoting parents’ awareness of the nature and the importance of attachment bonds for child development and parent–child relationship, and by bringing parents and child to experience new interactions that promote child attachment security. The group is led by two psychologists, a pediatric nurse and a childcare assistant. It is designed to receive up to five families referred by a child psychiatrist after a consultation. Children are aged 1 to 3 years old. Parents and children are received for an assessment interview prior and after they complete their participation to the group, including measures of parental stress (PSI-SF), infant relational withdrawal (ADBB), parent-child relationship (PIRGAS), and child social and emotional competences and problems (BITSEA). Families attend six thematic sessions each of which addresses one of the main attachment pillars: sensitivity, reciprocity, engagement, proximity, emotional regulation and support network. Contents are delivered via slides, video clips, group discussions, practical situations and home tasks. Both parents are encouraged to participate. The feedback from the first families (n = 17) who attended the group are presented.ResultsPreliminary results on the first families who participated in this group show that all of them were satisfied about the group contents and setting. Most parents reported they have acquired new insights on their child's attachment needs and behaviors, felt more comfortable with regulating their own and their child's emotional needs and expression, and became more able to manage problematic behaviors, separation and conflict situations. Slides, video clips and experiencing practical situations and home tasks were also greatly appreciated.PerspectivesThe preliminary positive feedback from the parents supports the relevance of this new intervention model targeted on attachment issues. The group setting, the concrete materials and the active participation of parents and children promote the awareness of attachment needs and the experience of new and safer parent–child interactions.     

Créativité numérique et innovation thérapeutique : recréer un lieu de soin sur Minecraft

ObjectivesToday, video games are recognized as an excellent tool for therapeutic mediation with young children with Autism Spectrum Disorder (ASD), playing the role of a malleable medium facilitating the evolution of group dynamics and creating a play area between the child and the adult, a space of creativity and shared pleasure allowing them to “be together,” to communicate, and to enter into a secure and holding-type intersubjective relationship. This is why we wanted to maintain this type of treatment during the general lockdown imposed in France in March 2020.MethodWe set up a virtual activity based on the use of the video game Minecraft, after having reconstituted our outpatient clinic for children and adolescents on a private server. Following the end of the lockdown, we were able to experiment with two workshops: one face-to-face; and the other in video therapy.ResultsWe were able to observe similarities and differences in the use of this medium by our young ASD patients, but also in the way in which this treatment allowed us to “put a little institution” back into the daily lives of youth during lockdown. Thus, we were able to see that the content of the Minecraft game, and more specifically the reconstructed clinic, functioned as a space of holding for the adolescents. The comparison between the digital institution and the real institution was present throughout the session in the adolescents’ exploratory actions. However, they were never “tricked” by this virtual reality, each one considering this digital clinic as a simple simulation of the institution where they go for treatment.DiscussionIt should be noted, however, that this type of mediation is not the easiest to set up for a team of professionals. Indeed, we were confronted with certain difficulties, notably the amount of time required to recreate the clinic in the game, problems with the private servers, the quality of the hardware, and the extraordinary public health situation.ConclusionThis therapeutic workshop with digital mediation allowed the very early establishment of a group dynamic and of a group psychic envelope. Therapy sessions conducted in Minecraft allowed us to work on group dynamics, on the real and digital representations of a place of care, on the children's identity references (therapeutic groups, home, etc.), and on their capacity to play in a group. The adolescents enrolled were able to individually search for their own identity markers, according to their place in the institution. Finally, the Minecraft project allowed for the emergence of many interactions and shared emotions between the members of the therapeutic group (children and adults).