放射治疗记录与验证系统质量控制指南

放疗记录与验证系统(RVS)是一套用于防止医用电子加速器等放疗设备治疗参数设置错误,并且记录所有放疗阶段执行参数的医用计算机软件控制系统。为确保患者的治疗安全,必须对记录与验证系统采取必要的质量控制措施。本指南内容涉及:RVS安装和参数设定过程中的质量控制;RVS的验收测试;RVS在临床使用过程中的持续质量控制;使用RVS过程中的典型错误类型;执行RVS验收测试的具体测试例。     

Twelve tips for developing,implementing, and sustaining medical education fellowship programs: Building on new trends and solid foundations

Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization’s educational mission and participants’ career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a team of committed individuals who provide expertise, guidance, and mentoring. Qualified MEFP directors should utilize instructional methods that promote individual and institutional short and long term growth. Directors must balance the use of traditional design, implementation, and evaluation methodologies with advancing trends that may support or threaten the acceptability and sustainability of the program. Drawing on the expertise of 28 MEFP directors, we provide twelve tips as a guide to those implementing, sustaining, and/or growing a successful MEFP whose value is demonstrated by its impacts on participants, learners, patients, teaching faculty, institutions, the greater medical education community, and the population’s health.     

Pathophysiology and management of sensitive skin: position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch (IFSI)

The special interest group on sensitive skin of the International Forum for the Study of Itch previously defined sensitive skin as a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus and tingling sensations) in response to stimuli that normally should not provoke such sensations. This additional paper focuses on the pathophysiology and the management of sensitive skin. Sensitive skin is not an immunological disorder but is related to alterations of the skin nervous system. Skin barrier abnormalities are frequently associated, but there is no cause and direct relationship. Further studies are needed to better understand the pathophysiology of sensitive skin – as well as the inducing factors. Avoidance of possible triggering factors and the use of well-tolerated cosmetics, especially those containing inhibitors of unpleasant sensations, might be suggested for patients with sensitive skin. The role of psychosocial factors, such as stress or negative expectations, might be relevant for subgroups of patients. To date, there is no clinical trial supporting the use of topical or systemic drugs in sensitive skin. The published data are not sufficient to reach a consensus on sensitive skin management. In general, patients with sensitive skin require a personalized approach, taking into account various biomedical, neural and psychosocial factors affecting sensitive skin.     

Quality of decision aids developed for women at average risk of breast cancer eligible for mammographic screening: Systematic review and assessment according to the International Patient Decision Aid Standards instrument

Mammographic screening contributes to a reduction in specific mortality, but it has disadvantages. Decision aids are tools designed to support people's decisions. Because these aids influence patient choice, their quality is crucial. The objective of the current study was to conduct a systematic review of decision aids developed for women eligible for mammographic screening who have an average breast cancer risk and to assess the quality of these aids. The systematic review included articles published between January 1, 1997, and August 1, 2019, in the PubMed, Embase, Cochrane, and PsycInfo databases. The studies were reviewed independently by 2 reviewers. Any study containing a decision aid for women eligible for mammographic screening with an average breast cancer risk was included. Two double-blind reviewers assessed the quality of the selected decision aids using the International Patient Decision Aid Standards instrument, version 3 (IPDASi). Twenty-three decision aids were extracted. Classification of decision aid quality using the IPDASi demonstrated large variations among the decision aids (maximum IPDASi score, 188; mean ± SD score, 132.6 ± 23.8; range, 85-172). Three decision aids had high overall scores. The 3 best-rated dimensions were disclosure (maximum score, 8; mean score, 6.8), focusing on transparency; information (maximum score, 32; mean score, 26.1), focusing on the provision of sufficient details; and probabilities (maximum score, 32; mean score 25), focusing on the presentation of probabilities. The 3 lowest-rated dimensions were decision support technology evaluation (maximum score, 8; mean score, 4.3), focusing on the effectiveness of the decision aid; development (maximum score, 24; mean score, 12.6), evaluating the development process; and plain language (maximum score, 4; mean score, 1.9), assessing appropriateness for patients with low literacy. The results of this review identified 3 high-quality decision aids for breast cancer screening.     

螺旋断层治疗系统的质量保证

螺旋断层治疗系统(HT)是一种集调强放射治疗和影像引导放射治疗于一体的放射治疗系统,是目前最先进的放疗设备之一。考虑其与常规直线加速器质量保证的差异,由国家癌症中心/国家肿瘤质控中心提出,多家医疗单位共同参与制定了本指南。指南包括国内医疗机构HT用于临床工作的验收项目、操作制度、应急预案等内容,明确了质量控制的测试方法、评价标准、检测频率。指南结合国内医疗单位实际情况给出了推荐性检测项目,主要包括机械精度、剂量输出与分布、激光定位系统、治疗床运动精度、MVCT影像系统质控检测、临床治疗计划验证等具体实施方法步骤,使得指南具有很强的可操作性。本指南能给临床工作人员提供质量保证技术指导,使HT质量保证工作有章可循,可提高放射治疗的准确性和精度。对国内各医疗机构建立规范HT质量保证体系具有指导意义。     

中国5~18岁人群遗尿症患病率的横断面调查

目的 了解中国儿童和青少年遗尿症的患病情况。方法 横断面调查，以中国医师协会肾脏专委会中国儿童遗尿疾病管理协作组（简称：协作组）成员与所在省、自治区和直辖市有工作联系的区县为抽样单位。遗尿症诊断标准为年龄≥5岁，3个月内出现尿床事件≥1次；尿床指夜间睡眠中排尿于床上或尿湿衣裤。调查时间为2017年4月20日至2017年5月12日；调查人群为中国5~18岁儿童及青少年，分为幼儿园（5~6岁）、小学（~12岁），初中（~15岁）和高中（~18岁）。每个区县样本量需＞3 073人。自行设计遗尿症调查问卷，本文主要分析基本人口学信息和尿床事件。由儿童或青少年的家长或照护者在手机或其他安装有微信应用终端设备上填写问卷。结果 24个协作组成员所在省、自治区和直辖市中的34个区县中的225所幼儿园和学校参与了调查，其中幼儿园82所，小学61所，初中49所，高中33所。调查目标样本人群129 952人，进入本文分析的调查问卷100 071份（77.0%）。男52 074份，平均年龄（11.0±3.4）岁，汉族占92.5%，幼儿园、小学、初中、高中人数比例约为1∶5∶2∶1。中国儿童和青少年遗尿症患病率为4.8%（4 821/100 071）；幼儿园、小学、初中、高中遗尿患病率分别为12.1%、5.1%、1.1%和1.4%；各年龄男孩遗尿症患病率均高于同年龄的女孩；中国境内6大行政区（华北、东北、华东、中南、西南、西北）以样本人群年龄构成比进行标准化后，其患病率分别为4.2%，3.7%、4.6%、5.8%、5.1%和4.9%；4 821名遗尿症患儿中，轻、中、重度遗尿症患儿分别占81.4%、13.5%和5.1%；重度遗尿症幼儿园、小学、初中和高中组比例为6.9%、3.7%、5.3%和10.0%。结论 中国幼儿园、小学、初中、高中人群遗尿患病率分别为12.1%、5.1%、1.1%和1.4%，儿童遗尿症患病率总体为4.8%。幼儿园及高中组重度遗尿症的比例较高。     

Ligustrazine inhibits high voltage-gated Ca~(2+) and TTX-resistant Na~+ channels of primary sensory neuron and thermal nociception in the rat:a study on peripheral mechanism

Objective Ligustrazine, also named as tetramethylpyrazine, is a compound purified from Ligusticum chuanxiong hort and has ever been testified to be a calcium antagonist. The present investigation was to determine the antinoci-ceptive effect of ligustrazine and, if any, the peripheral ionic mechanism involved. Methods Paw withdrawal Latency ( PWL) to noxious heating was measured in vivo and whole-cell patch recording was performed on small dorsal root ganglion (DRG) neurons. Results Intraplantar injection of ligustrazine (0.5 mg in 25μl) significantly prolonged the withdrawal latency of ipsilateral hindpaw to noxious heating in the rat. Ligustrazine not only reversibly inhibited high-voltage gated calcium current of dorsal root ganglion (DRG) neuron in dose-dependent manner with IC50 of 1.89 mmol/L, but also decreased tetrodotoxin (TTX) -resistant sodium current in relatively selective and dose-dependent manner with IC50 of 2.49 mmol/L. Conclusion The results suggested that ligustrazine could elevate the threshold of thermal nociception through inhibiting the high-voltage gated calcium current and TTX-resistant sodium current of DRG neuron in the rat.     

含左氧氟沙星及卷曲霉素方案治疗耐多药肺结核近期疗效分析

目的　观察和评价含左氧氟沙星和卷曲霉素联合化疗方案在耐多药肺结核 (MDR PTB)治疗中的疗效。方法　将 177例MDR PTB患者分为治疗组 88例和对照组 89例。化疗方案 :治疗组以左氧氟沙星和卷曲霉素为主 ,联合利福喷汀、异烟肼、对氨基水杨酸钠、吡嗪酰胺 ;对照组用链霉素、乙胺丁醇 ,联用药物同治疗组 ,疗程均为 2 1个月。结果　共有 16 1例患者完成化疗疗程 ,治疗组 82例 ,痰菌阴转率 83% ;对照组 79例 ,痰菌阴转率 5 8% ;痰菌阴转率治疗组明显高于对照组 (P <0 0 1) ;治疗组病灶显效率 5 0 % ,空洞闭合率 6 3% ,治疗组优于对照组 (P <0 0 1) ;治疗组的药物不良反应率为 31% ,对照组为 35 % ,两组比较差异无显著性 (P >0 0 5 )。结论　含左氧氟沙星和卷曲霉素的方案治疗MDR PTB ,有助于痰菌阴转和病变吸收好转 ,药物不良反应低 ,值得在临床上推广应用