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。     

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。     

Guidelines for infection control in dental health care settings--2003

BACKGROUND: The Centers for Disease Control and Prevention, or CDC, is the lead federal agency for disease prevention in the United States. It has been 10 years since CDC infection control guidelines for dental health care settings were last published. During those 10 years, new technologies and issues have emerged, and other CDC infection control guidelines for health care settings have been updated. RESULTS: In light of these developments, CDC collaborated with experts in infection control to revise its infection control recommendations for dental health care settings. Existing guidelines and published research pertinent to dental infection control principles and practices were reviewed. This article provides background information, describes the process used to create these guidelines, and lists the new recommendations. CLINICAL IMPLICATIONS: CDC believes that dental offices that follow these new recommendations will strengthen an already admirable record of safe dental practice. Patients and providers alike can be assured that oral health care can be delivered and received in a safe manner.     

Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management

A review of US poison center data for 2004 showed over 8,000 ingestions of methylphenidate. A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with suspected ingestions of methylphenidate by 1) describing the process by which a specialist in poison information should evaluate an exposure to methylphenidate, 2) identifying the key decision elements in managing cases of methylphenidate ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This review focuses on the ingestion of more than a single therapeutic dose of methylphenidate and the effects of an overdose and is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) All patients with suicidal intent, intentional abuse, or in cases in which a malicious intent is suspected (e.g., child abuse or neglect) should be referred to an emergency department (Grade D). 2) In patients without evidence of self-harm, abuse, or malicious intent, poison center personnel should elicit additional information including the time of the ingestion, the precise dose ingested, and the presence of coingestants (Grade D). 3) Patients who are chronically taking a monoamine oxidase inhibitor and who have ingested any amount of methylphenidate require referral to an emergency department (Grade D). 4) Patients experiencing any changes in behavior other than mild stimulation or agitation should be referred to an emergency department. Examples of moderate to severe symptoms that warrant referral include moderate-to-severe agitation, hallucinations, abnormal muscle movements, headache, chest pain, loss of consciousness, or convulsions (Grade D). 5) For patients referred to an emergency department, transportation via ambulance should be considered based on several factors including the condition of the patient and the length of time it will take for the patient to arrive at the emergency department (Grade D). 6) If the patient has no symptoms, and more than 3 hours have elapsed between the time of ingestion and the call to the poison center, referral to an emergency department is not recommended (Grade D). 7) Patients with acute or acute-on-chronic ingestions of less than a toxic dose (see recommendations 8, 9, and 10) or chronic exposures to methylphenidate with no or mild symptoms can be observed at home with instructions to call the poison center back if symptoms develop or worsen. For acute-on-chronic ingestions, the caller should be instructed not to administer methylphenidate to the patient for the next 24 hours. The poison center should consider making a follow-up call at approximately 3 hours after ingestion (Grade D). 8) Patients who ingest more than 2 mg/kg or 60 mg, whichever is less, of an immediate-release formulation (or the equivalent amount of a modified-release formulation that has been chewed) should be referred to an emergency department (Grade C). 9) If a patch has been swallowed, consider the entire contents of the patch (not just the labeled dose of the patch) to have been ingested. Patients who ingest more than 2 mg/kg or 60 mg, whichever is less should be referred to an emergency department. If it is known that the patch has been chewed only briefly, and the patch remains intact, significant toxicity is unlikely and emergency department referral is not necessary (Grade D). 10) Patients who ingest more than 4 mg/kg or 120 mg, whichever is less, of an intact modified-release formulation should be referred to an emergency department (Grade D). 11) For oral exposures, do not induce emesis (Grade D). 12) Pre-hospital activated charcoal administration, if available, should only be carried out by health professionals and only if no contraindications are present. Do not delay transportation in order to administer activate charcoal (Grade D). 13) Benzodiazepines can be administered by EMS personnel if agitation, dystonia, or convulsions are present and if authorized by EMS medical direction expressed by written treatment protocol or policy or direct medical oversight (Grade C). 14) Standard advanced cardiac life support (ACLS) measures should be administered by EMS personnel if respiratory arrest, cardiac dysrhythmias, or cardiac arrest are present and if authorized by EMS medical direction expressed by written treatment protocol or policy or direct medical oversight (Grade C).     

经颅多普勒超声量化诊断白兔颈内动脉狭窄的研究

目的探讨血流信号的最大Lyapunov指数在诊断白兔颈内动脉不同程度狭窄中的价值,以期达到利用经颅多普勒超声(TCD)量化诊断血管狭窄的目的.方法通过TCD诊断仪及自行设计的多普勒超声信号采集系统 ,提取白兔颈内动脉正常时及不同程度狭窄时血流信号,并使用小波包分析去噪,得到血流信号的时间序列数据,计算其最大Lyapunov指数,对白兔颈内动脉血流情况的动态活动状态进行对比研究.结果白兔颈内动脉正常时,血流信号的最大Lyapunov指数均为负值,血液流动呈非混沌状态;白兔颈内动脉狭窄时,血流信号的最大Lyapunov指数均为正值,血液流动呈混沌状态,且值越大,狭窄程度越高.结论可利用Lyapunov指数无创诊断白兔颈内动脉狭窄疾病.     

Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA)

These evidence-based guidelines have been produced after a literature review of the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). We have considered the detection of MRSA in screening samples and the detection of reduced susceptibility to glycopeptides in S. aureus. Recommendations are given for the identification of S. aureus and for suitable methods of susceptibility testing and screening for MRSA and for S. aureus with reduced susceptibility to glycopeptides. These guidelines indicate what tests should be used but not when the tests are applicable, as aspects of this are dealt with in guidelines on control of MRSA. There are currently several developments in screening media and molecular methods. It is likely that some of our recommendations will require modification as the new methods become available.     

从SARS防治绩效对比研究各国公共卫生应急反应体系

目的选择SARS危机中公共卫生应急反应体系完善、应急迅速的有代表性的国家,对其公共卫生应急反应体系的机构机制与绩效进行对比分析,为我国建立和完善公共卫生应急反应体系提供依据.方法采用循证科学的原理和方法,通过系统查阅、收集和评价中国、美国、英国、澳大利亚和新加坡官方网站的信息,比较其SARS防治绩效及公共卫生应急反应体系的机构设置和运作机制,分析原因,总结问题,提出对策.结果美国、英国和澳大利亚的SARS防治绩效最好;新加坡的应急反应措施受到WHO高度评价.我国公共卫生应急反应体系的结构与发达国家相似,但投入不足、管理落后、运作机制不成熟导致效率低下.结论我国公共卫生体系改革应以加强机制建设为突破口.我国幅员辽阔,不同地区宜采用适合本地区条件的公共卫生防御体系和机制.上述国家的经验有助于我们建立和完善有中国特色的公共卫生预警应急体系.     

中国各省法定传染病疫情动态摘抄(200707期)

疟疾安徽:2007年8月安徽省共报告疟疾病例6328例,比上月(6564例)下降3.60%,比去年同月(6459例)下降2.03%。2007年累计报告疟疾病例17671例,与去年同期相比上升60.66%。病例主要分布在毫州市、宿州市、淮北市、蚌埠市、阜阳市、淮南市和滁州市。2007年1～8月疟疾报告病例数均高于前2     

2002年全国地方性氟中毒监测

目的 掌握全国地方性氟中毒(地氟病)防治措施落实进度、防治效果及病情变化动态，为制定地氟病防治策略提供科学依据。方法 按全国地氟病监测方案规定的方法和要求进行。结果 ①无论饮水型病区还是燃煤型病区的防治措施完成率和合格率，仍有一些省份处于较低水平。②全国大部分监测点的病情不是很重，但仍然有黑龙江、新疆、贵州、四川等病情严重的地区。结论 地氟病防治工作是长期的，必须有打持久战的思想准备和技术储备。     

家畜粪便污染江滩在血吸虫病流行中的作用及对策研究

本文报道了江滩型地区各类传染源血吸虫感染及污染情况和对策实施结果。人和牛的克粪毛蚴数(有效EPG)分别为1.82为9.5。按EPD公式推算,宿主每天排出的有效虫卵数牛占99.6％,人仅占0.4％,滩地实际污染结果与推算基本相符。经2年防制后,牛感染率为6.67％(3/45),居民感染率仅0.96％(11/1144),分别下降了81.42％和77.9％,野粪阳性率与人畜感染源下降水平亦基本相符。提示,针对耕牛为主要传染源而采取的防制对策效果是显著的。