新型冠状病毒肺炎疫情下死亡病例报告分析的现状、思考与建议

医生在日常临床工作中,死亡病例讨论是必不可少的工作内容之一,而在突发公共卫生事件中,对死亡病例的报告与分析则有更深远的意义。新型冠状病毒肺炎疫情为我国带来巨大损失,医疗系统承受巨大压力,而战胜疫情的有利武器便是医疗数据及相关科学研究,死亡病例的系统分析与高效利用是关键一步。该文基于疫情下死亡病例报告记录不完善、人文视角与患者报告缺乏等现状,针对各部门机构面临巨大的数据管理压力,相关制度有待完善,规范化报告和临床科研一体化工作尚不成熟等问题提出方法学思考与建议:①建立国家医药健康数据中心,完善相关法律法规;②加大医药数据管理投入,疫情期间尽早开始数据收集与分析;③完善死亡病例报告相关内容,促进规范化报告形成;④重视死亡病例报告,回顾总结分析,强调疫情过后继续建立并完善相关平台与方案,开展相关科学研究,提升健康卫生数据管理效率,提高医疗系统抗风险能力,促进健康中国战略稳步前进。     

儿童普通感冒药物治疗中的问题及规范

普通感冒是儿童最常见上呼吸道感染性疾病，也是儿科最容易滥用药物的疾病。该文阐述了普通感冒在治疗上存在滥用抗生素、抗病毒药、感冒药、中药、中成药及不规范的治疗方法等问题，从而提出规范治疗的重要性，并引导如何进行普通感冒药物规范治疗。医生、药师、家长需正确认识普通感冒，选择普通感冒药时应避免诊治误区，减少药物滥用。     

Effect of Day Optimizing Throughput (Dot) Knee Software Implementation on Magnetic Resonance Imaging Workflow Efficiency

PurposeAttempts by magnetic resonance (MR) manufacturers to help imaging centres improve patient throughput has led to the development of more automated acquisition. This software is capable of customizing individual scan alignment; potentially improving imaging efficiency and standardizing protocols. However, substantial investments are required to introduce such systems, potentially deterring their widespread application. This study assessed the implementation costs and reduction in examination durations for automated knee MR imaging (MRI) software.Materials and MethodsResearch activities were performed at a community-based academic centre on a 3-Tesla (3-T) system using Siemens' Day Optimizing Throughput (Dot) knee software. Examination acquisition times were extracted from the system before and after software implementation. Fiscal year 2012/13 finances were used to determine the average hourly cost of MRI utilization. Costs associated with automated software implementation were also calculated. Finally, the number of knee scans required to achieve a positive return on investment using the software was established.Results and DiscussionThe mean (standard deviation, sample size) pre- and post-Dot software scan times were 23.20 (4.18, n = 266) and 21.94 (4.51, n = 59) minutes, respectively, for a routine knee scan and 11.88 (1.60, n = 74) and 11.24 (1.51, n = 27) minutes, respectively, for a fast knee scan. The overall weighted average resulted in a 64-second time savings per automated knee examination. This negligible time savings would be extremely difficult to make use of clinically. Dot simplified 29 unique knee protocols to two, improving the consistency of knee examinations. Current Dot software is not compatible with all patients and therefore has limitations that are a concern among MR technologists.ConclusionAdoption of automated knee systems could assist in standardizing protocols; however, the cost of implementation and difficulty in modifying patient scheduling to reflect the minimal time savings would make a financial return unlikely to occur at small- and medium-sized institutions.     

中医皮肤病住院医师规范化培训存在的问题与改革

目的研究云南中医药大学皮肤病科住院医师规范化培训存在的问题,找到改革的关键。方法结合实际教学及规培现状进行分析:规培学员不够重视;规培内容多,规培时间短;规培学员水平参差不齐,轮转方案不够个性化等问题。近年来,皮肤科根据自身特点注重住院医师规范化培训工作的开展。通过对规培学员临床诊疗能力、学习能力、中医思维、师生沟通情况及规培满意度进行打分。结果对156位出科规培医师进行满意度调查及考核,大部分住院医师对所在科室科培训工作满意度较高,中医临床能力得到增强。在本科规培人员2月以上组80分以上的人数高于2月以下组(P<0.05)。结论通过加强考勤管理、制定适合的规培方案、改革教学内容及开展内容丰富的教学活动、加强业务学习,突出中医特色,不断促使学员进行学习皮肤病相关知识,皮肤科规培工作取得了一定成效。     

互联互通标准化成熟度测评对医院信息平台建设的指导和规范作用

针对目前国内医院信息平台建设的难点,探讨如何应用国家卫生标准委员会颁布的《医院信息互联互通成熟度测评方案》,指导医院信息平台建设。按照医院信息互联互通成熟度测评方案中四级甲等的标准,从数据集标准化、共享文档规范化、技术架构、互联互通服务、运行性能、基础设施6个方面,指引和规范医院信息平台建设的规划、实施和验收。     

重视角膜屈光手术操作规范及并发症防治

当今各种治疗近视眼技术的手段很多,激光角膜屈光手术是矫正屈光不正的重要方式之一。屈光手术中任何环节的质量控制对手术成功与否、减少并发症至关重要。严格的手术适应证把控、个性化的手术方式选择、规范的围手术期处方用药等等都有助于手术质量提高,保证整体手术安全。     

两套中医译名标准化方案中译名用词问题的探讨

从用词角度探讨两套中医译名标准化方案中译名用词方面的情况,总结出两套方案在译名用词方面的继承和创新,指出存在的问题,旨在促进译名标准化方案的修订和推广。     

渐进式规范化岗前培训提升入职护士临床技能的研究

针对新入职护士规范化岗前培训对快速提升临床技能的研究状况、进展以及影响新入职护士规范化岗前培训的因素进行综述,以期为新入职护士的渐进式规范化培训的进一步研究提供参考。     

Examiner training and reliability in two randomized clinical trials of adult dental caries

Objectives: This report describes the training of dental examiners participating in two dental caries clinical trials and reports the inter‐ and intra‐examiner reliability scores from the initial standardization sessions. Methods: Study examiners were trained to use a modified International Caries Detection and Assessment System II system to detect the visual signs of non‐cavitated and cavitated dental caries in adult subjects. Dental caries was classified as no caries (S), non‐cavitated caries (D1), enamel caries (D2), and dentine caries (D3). Three standardization sessions involving 60 subjects and 3,604 tooth surface calls were used to calculate several measures of examiner reliability. Results: The prevalence of dental caries observed in the standardization sessions ranged from 1.4 percent to 13.5 percent of the coronal tooth surfaces examined. Overall agreement between pairs of examiners ranged from 0.88 to 0.99. An intra‐class coefficient threshold of 0.60 was surpassed for all but one examiner. Inter‐examiner unweighted kappa values were low (0.23‐0.35), but weighted kappas and the ratio of observed to maximum kappas were more encouraging (0.42‐0.83). The highest kappa values occurred for the S/D1 versus D2/D3 two‐level classification of dental caries, for which seven of the eight examiners achieved observed to maximum kappa values over 0.90. Intra‐examiner reliability was notably higher than inter‐examiner reliability for all measures and dental caries classifications employed. Conclusion: The methods and results for the initial examiner training and standardization sessions for two large clinical trials are reported. Recommendations for others planning examiner training and standardization sessions are offered.