上海市社区药学服务需求现状

背景 随着患者就诊下沉明显，联合家庭医生团队开展社区药学服务日益重要，但如何发挥家庭医生团队作用以满足患者社区药学服务需求仍有待进一步探索。 目的 了解上海市社区药学服务需求现状，为改进社区药学人员参与家庭医生团队开展服务的方式提供参考建议。 方法 于2020年9—12月，采用多阶段抽样法抽取349例老年慢性病患者和855例家庭医生团队主要成员〔全科医生（n=481）、护士（n=234）、公共卫生医生（n=140）〕进行问卷调查。针对老年慢性病患者的调查问卷主要内容包括基本情况、患病情况、用药情况、社区药学服务需求情况和社区药学服务利用情况。针对家庭医生团队成员的调查问卷主要内容包括基本情况、社区药学服务认知情况和社区药学服务需求情况。 结果 349例老年慢性病患者中，125例（35.8%）同时患有≥3种慢性病，305例（87.4%）每日需多次用药。用药管理类药学服务方面，"用药重整及随访"需求人数最多，为52例（14.9%），"用药随访"利用人数最多，为49例（14.0%）。用药教育类药学服务方面，"慢性病用药特殊性的普及教育"需求人数最多，为247例（70.8%），"宣传健康生活方式"利用人数最多，为33例（9.4%）。家庭医生团队成员中，全科医生、护士、公共卫生医生对药学服务的了解程度方面，分别有440例（91.5%）、202例（86.3%）、112例（80.0%）表示了解；对药师的信任程度方面，分别有302例（62.8%）、183例（78.2%）、103例（73.6%）表示非常信任；"协同医师做好药物使用遴选"服务项目的需求人数分别有359例（74.6%）、112例（47.9%）、81例（57.8%）；"指导护士使用与管理药品"服务项目的需求人数分别有190例（39.5%）、153例（65.4%）、57例（40.7%）。 结论 一方面患者实际迫切需要用药管理类药学服务，另一方面患者的用药教育类药学服务需求远未得到满足。鉴于社区药学人员队伍薄弱及家庭医生团队对社区药学服务认知局限的现状，社区药学人员应通过培训团队成员，提升团队的社区药学服务认知水平及服务能力，借助团队力量及成员特性，更广泛高效地开展社区药学服务。     

Quality indicators for breast cancer care: A systematic review

ObjectivesWe evaluated breast cancer (BC) care quality indicators (QIs) in clinical pathways and integrated health care processes.MethodsFollowing protocol registration (Prospero n^o: CRD42021228867), relevant documents were identified, without language restrictions, through a systematic search of bibliographic databases (EMBASE, Scopus, Web of Science, MEDLINE), health care valuable representatives and the World Wide Web in April 2021. Data concerning QIs, measurement tools and compliance standards were extracted from European and North American sources in duplicate with 98% reviewer agreement.ResultsThere were 89 QIs found from 22 selected documents (QI per document mean 13.5 with standard deviation 11.9). The Belgian (38 QIs) and the EUSOMA (European Society of Breast Cancer Specialists) (34 QIs) documents were the ones that best reported the QIs. No identical QI was identified in all the documents analysed. There were 67/89 QIs covering processes (75.3%) and 11/89 (12.4%) for each structure and outcomes QIs. There were 21/89 QIs for diagnosis (30.3%), 43/89 for treatment (48.3%), and 19/89 for staging, counselling, follow-up and rehabilitation (21.4%). Of 67 process QIs and 11 outcome QIs, 20/78 (26%) did not report a minimum standard of care. Shared decision making was only included as a QI in the Italian document.ConclusionMore than half of countries have not established a national clinical pathway or integrated breast cancer care process to achieve the excellence of BC care. There was heterogeneity in QIs for the evaluation of BC care quality. Over two-thirds of the clinical pathways and integrated health care processes did not provide a minimum auditable standard of care for compliance, leaving open the definition of best practice. There is a need for harmonisation of BC care QIs.     

“医信融合”视域下复合型医学人才培养目标及效果评价

培养“医信融合”复合型医学人才是医学高等教育在新时代信息技术发展背景下的历史使命。在引入“医信融合”教育理念的基础上，提出“医信融合”教育的人才培养目标及其内容体系，并据此构建了“医信融合”人才培养质量评价指标，提出了培养效果评价方法。介绍“医信融合”教育人才培养效果的评价方法，对山西医科大学“医信融合”教学效果进行实证分析，从而为“医信融合”教育实践提供借鉴。     

我国三级医疗机构营养科专业人才队伍情况调查

目的调查分析我国三级医疗机构营养科专业人才队伍情况，提出针对性建议。方法从国家医疗质量管理与控制信息网选取1 283家三级医疗机构调研临床营养专业技术人员数据，应用频数、构成比等进行描述性统计分析。 结果三级医疗机构营养科专业技术人员数量不足且分布不均衡，高层次人才比例偏低。医床比1:556.91，技床比1:841.30，医技比1.51:1，护床比1:1 031.31，均未达到文件标准，营养科医师严重缺编。结论应加强营养科专业人员教育和高层次人才培养，建立规范化培养体系，明确营养科职称评定和岗位技能考核制度，不断扩增专业人才数量，提升临床营养诊疗能力。     

China special issue on gastrointestinal tumors-Improved survival after multidisciplinary team decision for patients with advanced gastrointestinal cancer: A multicenter,noninterventional, controlled study

Formal multidisciplinary team (MDT) discussions in clinical practice require time and space but have unclear survival benefits for advanced gastrointestinal cancer patients. Our study aimed to investigate the long-term survival of patients with advanced gastrointestinal cancer after MDT decision. From June 2017 to June 2019, continuous MDT discussions on advanced gastrointestinal cancer were conducted in 13 medical centers in China. MDT decisions and actual treatment received by patients were prospectively recorded. The primary endpoint was the difference in overall survival (OS) between patients in the MDT decision implementation and nonimplementation groups. The secondary endpoints included the implementation rate of MDT decisions and subgroup survival analysis. A total of 461 MDT decisions of 455 patients were included in our study. The implementation rate of MDT decisions was 85.7%. Previous treatment had an impact on MDT decision-making. The OS was 24.0 months and 17.0 months in the implementation and nonimplementation groups, respectively. The implementation of MDT decisions significantly reduced the risk of death in multivariate analyses (hazard ratio = 0.518; 95% confidence interval: 0.304-0.884, P = .016). Subgroup analysis showed a significant difference in survival of patients with colorectal cancer, but not in survival of patients with gastric cancer. The rate of secondary MDT discussion was only 5.6% among patients who the MDT decisions were discontinued due to changes in their condition. MDT discussion can prolong the OS of patients with advanced gastrointestinal cancer, especially those with colorectal cancer. Timely scheduling of the subsequent MDT discussion is necessary when the disease condition changes.     

“人工智能+X”背景下医学信息管理专业研究生培养模式

阐述当前“人工智能+X”背景下市场对医学信息管理专业人才能力的需求，分析医学信息管理专业人才培养现状，提出从重塑学科人才培养目标、优化课程内容与课程设置、建设“双师型”导师队伍、搭建多方协同共建共享在线平台及设立“政用产学研”联合培养基地等方面探索医学信息管理专业研究生培养模式，以期培养适应人工智能时代发展，具备学科优势特色的高层次、高水平、高质量的复合型、应用型、创新型人才。     

重视甲状腺癌多学科综合治疗

甲状腺癌是最常见的内分泌肿瘤之一，其发病率逐年上升。对于复杂疑难的甲状腺癌，其诊断过程涉及超声、CT、放射性核素检查、喉镜检查、血液学检查［甲状腺功能、血清甲状腺球蛋白（Tg）］、病理学检查。其治疗是以外科为主的综合治疗，诊疗过程涉及甲状腺外科、耳鼻喉科、胸外科、麻醉科、内分泌科、核医学科、放疗科、肿瘤内科、ICU、超声科、病理科、影像科等。采用多学科综合治疗协作组（MDT）模式可以发挥多学科优势，为病人提供最佳的诊疗方案，实现个体化、精准化治疗，有助于降低手术并发症发生率，改善病人预后和生活质量，提高综合疗效，最终使甲状腺癌病人获益。     

甲状腺髓样癌诊治难点及对策

甲状腺髓样癌预后较差，早期易发生转移。遗传性和散发性髓样癌具有不同临床特征和预后。超声、CT、MRI、骨显像具有特定的诊断价值。降钙素具有诊断特异性，而癌胚抗原有助于评估病情进展。无论遗传性还是散发性髓样癌，均应重视后续的基因检测。遗传性和散发性髓样癌需制定不同的手术策略。颈部局部复发转移的病人应积极手术治疗。晚期进展性髓样癌可进行姑息性手术、外放射治疗或采用酪氨酸激酶抑制剂的全身性治疗。术后监测降钙素和癌胚抗原的倍增时间评估复发和转移。