脑血管病急诊规范化培训医师网络课程APP的应用研究

目的 研究脑血管病急诊规范化培训网络课程APP的教学效果。 方法 首都医科大学附属北京天坛医院急诊科规范化培训基地根据国家急诊医师规范培训的要求 制定、录制脑血管病相关教学课程，并呈现于网络课程APP。以急诊医师规范化培训基地培训的学员 24人为研究对象，在带教老师的指导和督导下，学员自行在线学习，学习前后均进行考核，比较学习前 后的考核成绩。 结果 经过一年的学习应用，学员考核成绩较入科成绩显著提高（91.13±3.51分 vs 66.04±2.79分， P =0.003）。 结论 网络课程APP的应用有效提高了急诊医师规范化培训学员的学习效果。     

Assessment of mass spectrometry-based pain management testing in clinical laboratories across North America

BackgroundUrine drug testing (UDT) is a useful tool in monitoring compliance to prescribed medication and can also help identify behaviors of drug misuse, abuse, and diversion. Mass spectrometry (MS)-based screening is recommended as the first-line of UDT for pain management patients; however, this testing comes with an inherent lack of standardization in methodologies and various analytical challenges. The objective of this study was to assess the current state of UDT for pain management in a cross-section of clinical laboratories in North America.Materials and methodsA total of 10 blinded urine samples were sent to 6 laboratories across the United States and Canada. Urine samples containing drugs and/or metabolites of interest were included to represent different clinical scenarios commonly seen in pain management settings. Assessment was based on the ability of the laboratories to correctly identify drugs and provide a meaningful interpretation of the findings (when offered by the performing laboratory).ResultsAcross the laboratories involved in the study, 85% of tests correctly identified and appropriately reported the drugs present in the urine samples. Similarly, 84% of samples were considered to have an accurate interpretation included in the UDT report. Out of the total number of drugs included in the samples, 11% were not offered on every test menu.ConclusionsThis study revealed the lack of standardization in pain management UDT performed in a limited cross-section of clinical laboratories across North America.     

Preparation allergenic pollen extracts; the points should be considered to make high-quality products

ABSTRACT

Atopic diseases have an increasing trend worldwide during the last two decades. Determining the main cause of allergic diseases, allergens, is the first step in managing and improving the issue, usually is done by Skin Prick tests (SPTs). Having allergenic extract in high quality is desired to perform a reliable SPT. Several parameters of extracts are considered including composition, stability, potency, preservation conditions, and unit definition. In this review, these factors have been explained pointing to factors might have profitable points or harmful drawback in the quality of allergen extracts.     

Tricalcium silicate cement sealers: Do the potential benefits of bioactivity justify the drawbacks?

BackgroundGrossman described the ideal properties of root canal sealers. The International Organization for Standardization and American National Standards Institute and American Dental Association have codified some of his requirements in ISO 6876 and ANSI/ADA 57, respectively. In this narrative review, the authors combined the ideal Grossman properties and requirements of these standards, emphasizing the newer tricalcium silicate cement sealers. This chemical matrix for such sealers was developed on the basis of the success of bioactive mineral trioxide aggregate–type (tricalcium silicate cement) materials for enhanced sealing and bioactivity.MethodsThe authors searched the internet and databases using Medical Subject Heading terms and then conducted a narrative review of those articles involving the tricalcium silicate cement endodontic sealers.ResultsNinety-four articles were identified that discussed tricalcium silicate cement sealers. Tricalcium silicate cement sealers are partially antimicrobial and have bioactivity, which may presage improved biological sealing of the root canal system. Most other properties of tricalcium silicate cement sealers are comparable with traditional root canal sealers.ConclusionsWithin the limitations of this review, tricalcium silicate cement endodontic sealers met many of the criteria for ideal properties, such as placement, antimicrobial properties, and bioactivity, but limitations were noted in solubility, dimensional stability (shrinkage and expansion), and retrievability.Practical ImplicationsTricalcium silicate–based cements have been commercialized as bioactive, bioceramic endodontic sealers. Warm, cold, and single-cone obturation techniques are usable, depending on the commercial product. Some sealers can cause discoloration and are not easily retrievable, particularly when used to completely obturate a canal.     

基于德尔菲法的自身免疫性甲状腺炎中医辨证分型研究

目的运用德尔菲法对自身免疫性甲状腺炎辨证分型及各证型诊断标准进行专家调研分析,制定自身免疫性甲状腺炎中医诊断标准。方法共对全国46位专家进行两轮问卷调查,利用SPSS软件分析问卷反馈的数据,评价专家意见的集中和协调程度、问卷信度情况。结果第一轮专家咨询共22名,专家积极系数为95.45%;第二轮专家咨询共24名,专家积极系数为87.5%。第一轮专家调查的内部一致信度值0.353,第二轮信度值0.613。结论符合临床实际的自身免疫性甲状腺炎中医辨证分型:肝郁痰凝证、脾肾阳虚证、痰瘀互结证、气滞痰凝证、气阴两虚证、阳虚痰凝证。     

基于肠内营养小组运作规范化护理路径在神经重症患者中的应用价值

目的 总结基于肠内营养小组运作下,规范化肠内营养护理路径在神经重症患者中的临床实践经验,探讨其应用价值。方法 选取2017 年10 月至2018 年7 月收治的762 例营养支持患者为对照组,对照组实施肠内营养常规护理;2018 年10 月至2019 年7 月收治的783 例营养支持患者为观察组,观察组肠内营养实施过程中,成立肠内营养护理小组,开展专业化营养支持与管理路径,规范肠内营养护理措施,患者按照护理小组制定的护理路径开展喂养。观察两组患者喂养7 d、14 d 后血红蛋白、血清清蛋白、血清前清蛋白和喂养前的差异,比较两组患者喂养相关并发症的发生率,评价肠内营养小组运作后,对护士在护理流程、并发症处理、应急预案三方面知识的提高效果。结果 对照组喂养7 d 及14 d 后血红蛋白、血清清蛋白及前清蛋白、观察组喂养7 d 及14 d 后的血红蛋白、喂养7 d 的血清清蛋白、前清蛋白较喂养前变化,差异无统计学意义（P＞0.05）,观察组喂养14 d 后的血清清蛋白和前清蛋白水平与喂养前比较,差异有统计学意义（P＜0.05）;观察组神经重症肠内营养患者胃肠道并发症,包括腹胀、腹泻、呕吐,感染并发症误吸发生率低于对照组（P＜0.05）;观察组机械性并发症,包括堵管、脱管及压疮的发生率低于对照组（P＜0.05）;肠内营养护理小组成立后护士的护理流程为（89.23±6.87）分、并发症处理为（89.18±6.21）分、应急预案为（93.45±5.88）分,掌握度高于小组成立前的（86.15±5.06）分、（84.18±4.21）分、（89.23±3.41）分（P＜0.05）。结论 基于肠内营养护理小组的运作,采用规范化营养支持路径管理,可减少营养支持过程中相关并发症的发生,保证喂养质量,使肠内营养支持的护理和管理得到改善。     

混合方法研究制定中医药临床实践指南及实例解读

中医药临床实践指南的制定是实现中医药标准化的重要工作内容。中医药指南对临床的指导意义极大,但目前仍存在临床实际使用情况不佳的现状,这可能与指南的内容有关。由于高质量的中医药临床研究数量较少,以循证医学证据,即定量研究结果为主导的指南,在指南推荐干预措施的确定上存在一定的局限性。而混合方法研究重视实用主义,其将定量研究与定性研究的结果相结合,在中医药指南的制定中存在一定优势。本文初步探讨混合方法研究在指南制定过程中的思路及作用,并以《中医药治疗流感临床实践指南》为例,探讨以定量研究为主导制定指南时遇到的问题及混合方法研究在指南制定中的具体应用。结果发现,混合方法研究可以弥补单纯依赖定量研究或定性研究结果的不足,有可能成为未来指南制定的主要方法之一,但仍存在一定的局限性,需进一步研究。     

The clinical use of cerebrospinal fluid biomarker testing for Alzheimer's disease diagnosis: A consensus paper from the Alzheimer's Biomarkers Standardization Initiative

BackgroundCerebrospinal fluid (CSF) biomarkers β-amyloid 1-42 (Aβ_1-42), also expressed as Aβ_1-42:Aβ_1-40 ratio, T-tau, and P-tau_181P, have proven diagnostic accuracy for mild cognitive impairment and Alzheimer's disease (AD). How to use, interpret, and disclose biomarker results drives the need for standardization.MethodsPrevious Alzheimer's Biomarkers Standardization Initiative meetings discussed preanalytical issues affecting Aβ_1-42 and tau in CSF. This second round of consensus meetings focused on issues related to clinical use of AD CSF biomarkers.ResultsConsensus was reached that lumbar puncture for AD CSF biomarker analysis be considered as a routine clinical test in patients with early-onset dementia, at the prodromal stage or with atypical AD. Moreover, consensus was reached on which biomarkers to use, how results should be interpreted, and potential confounding factors.ConclusionsChanges in Aβ_1-42, T-tau, and P-tau_181P allow diagnosis of AD in its prodromal stage. Conversely, having all three biomarkers in the normal range rules out AD. Intermediate conditions require further patient follow-up.