多模式整合教学法在医学影像学教学中的影响

目的 探讨多模式整合教学法在医学影像学教学中的应用效果.方法 选取我院2017年7月～2019年7月放射科50例住培医师作为观察对象,采用计算机随机数字表法将其分为对照组和试验组,分别给予传统教学法及多模式整合教学法,比较两组住培医师培训后的考核成绩及综合能力.结果 培训后,试验组理论成绩与读片技能得分均高于对照组,其...     

Clinical mycology in Latin America and the Caribbean: A snapshot of diagnostic and therapeutic capabilities

Despite the existence of endemic mycoses in Latin America and the Caribbean, in addition to a large population of patients at risk for invasive mycoses, the capability of medical centres to perform a proper diagnosis in mycology has not been studied in the region. Moreover, availability of antifungal drugs in the region is unknown. Here, we report the results of a survey involving 129 centres in 24 countries. Only 9% of centres would have the potential to apply for the minimum standards in mycology, as determined by the European Confederation of Medical Mycology. There is an urgent need to improve diagnostic conditions in Latin America and the Caribbean, as well as providing access to safer and more efficacious antifungal drugs.     

Is ignorance bliss,or is knowledge power? When cancer healthcare professionals become cancer patients

Cancer healthcare professionals who are diagnosed with cancer enter the patient journey with considerable illness‐specific and healthcare expertise, which may influence the nature of their experience. Insights gained from having personal cancer experience may also lead to changes in professionals' subsequent clinical practice. This study explored cancer professional‐patients' experiences of their own cancer diagnosis, changes in practice, and recommendations for cancer care improvements. Participants were current or former cancer healthcare professionals who had ever received a cancer diagnosis. Semi‐structured interviews were conducted with 26 participants. Thematic analysis with an inductive approach was used for data analysis. Cancer professional‐patients faced unique needs, benefits and disadvantages due to their professional background, which both aided and marred their personal cancer experience. Individuals reported subjective practical and emotional‐related improvements in their clinical practice, although adverse emotional consequences upon returning to work were also prevalent. Care recommendations highlighted the importance of communication skills training for professionals, integrating psychological support, and providing patient‐centred care. In order to provide optimal care for cancer professional‐patients, providers must acknowledge their distinct challenges. Findings may help to foster improvements in cancer care practices through developing guidelines for treating cancer professional‐patients, and as part of narrative‐based medicine.     

原发性肝癌营养不良三级诊断的营养筛查手段和评价工具

为合理选择营养筛查方法和评价工具,准确测定原发性肝癌患者的营养状态,本资料以中国抗癌协会确立的营养 不良三级诊断为依据,查阅国内外文献,就适用于原发性肝癌患者的一级诊断（营养筛查）、二级诊断（营养评估）和三级 诊断（综合测定）的方法和评价工具进行归纳分析。一级诊断包括NRS 2002、MUST 和BMI。NRS 2002 适用于原发性肝癌 患者的营养筛查,MUST 敏感性差,BMI 是最直接、最简单的营养筛查指标,因易受体成分影响不宜作为独立筛查手段用于 原发性肝癌患者。二级诊断包括主观全面评估工具SGA、PG-SGA 和MNA。PG-SGA 是原发性肝癌患者营养不良的敏感评估 工具,SGA、MNA 敏感性差。三级诊断除病史采集、体格和体能检查外,人体学测量上臂围、肱三头肌皮褶厚度和手握力, 因直接、客观,对测定原发性肝癌患者营养不良有较高的准确性,实验室检查外周血淋巴细胞总数、白蛋白、前白蛋白欠敏感, 生物电阻抗分析和L3骨骼肌指数能够精确反映原发性肝癌患者营养状况,但易受设备、条件的影响,不利于临床大范围使用。 综合显示 NRS 2002、PG-SGA 是原发性肝癌患者首选的营养筛查手段和评价工具,结合上臂围、肱三头肌皮褶厚度、手握力、 生物电阻抗分析、L3 骨骼肌指数等指标综合测定,可以准确评定原发性肝癌患者的营养状态。     

Time to diagnosis of retinoblastoma in Latin America: A systematic review

Retinoblastoma (RB) is the most common intraocular tumor of childhood. In low income countries, Time to diagnosis (TTD: interval between first symptom and diagnosis) has been associated with extraocular disease, metastasis and mortality. However, the relationship between TTD and prognosis is complex and not simply a linear correlation, particularly if TTD is <6?months. This systematic review aims to identify studies reporting TTD of retinoblastoma in Latin America, highlighting factors affecting TTD, alongside proposals and initiatives to obtain shorter intervals. The review also aims to discuss the methodology linked to cancer pathways studies. The study respected PRISMA recommendations, was registered on Prospero, an international database for systematic review registries under number CRD42017076777. MEDLINE/PUBMED, LILACS and SCIELO databases were searched. Studies from Latin America and the Caribbean, published between 1997 and 2017, reporting TTD and age at diagnosis of patients with retinoblastoma were selected. Nine studies were selected, concerning 1560 patients from Argentina, Brazil, Chile, Honduras, Mexico and Peru. The median TTD ranged from 3 to 5?months and the median age at diagnosis ranged from 16.5 to 22.2?months. A prolonged TTD was observed and was associated to damaging results on retinoblastoma outcomes, particularly increasing extraocular disease, and mortality rates. Methodological heterogeneity was observed and reiterates the importance of standardization of TTD studies, allowing more reliable comparisons and greater knowledge about retinoblastoma pathways before diagnosis. Reports on successful initiatives against delayed diagnosis were scarce, emphasizing a need for further studies.     

Diagnosing and managing allergic conjunctivitis in childhood: The allergist’s perspective

Allergic conjunctivitis in childhood often poses problems of diagnosis and management for the allergist. We present the salient points concerning the diagnosis and treatment of ocular allergy emerging from a large cohort survey conducted jointly in the departments of ophthalmology and paediatric allergy in a French teaching hospital. Seasonal acute conjunctivitis is a common disorder and not overly difficult to diagnose and treat when associated with rhinitis leading to allergic rhinoconjunctivitis. An ophthalmologist should be consulted when conjunctivitis occurs alone and if another form of conjunctivitis is suspected, such as perennial allergic conjunctivitis, vernal keratoconjunctivitis or atopic keratoconjunctivitis. When IgE‐mediated hypersensitivity assessment does not establish aetiological diagnosis, a conjunctival allergen provocation test can be performed. The principal non‐IgE‐mediated allergy is chronic blepharoconjunctivitis. The main problem for differential diagnosis is the presence of signs suggestive of dry eye. Management includes non‐pharmacological treatments, such as lacrimal substitutes, avoidance measures and protection of the ocular surface. Second‐line treatment consists of eye drops, preferably single dose or without additives and with dual local action, mast cell stabilizer action and antihistaminic action. Third‐line treatment is reserved for severe forms. Short‐lasting local steroid therapy can control flare‐ups of allergic keratoconjunctivitis, which should have specialized follow‐up. Cyclosporine is a disease‐modifying treatment, which is both effective and well tolerated.     

Beverage Specific Drinking Contexts

The contextual differentiation of beverage specific consumption is examined in a metropolitan area household survey of current drinkers. The findings indicate that beverage specific consumption is related to such structural proportions as presence/absence of food, drinking location, type of companion, and duration. Wine, for example, is frequently associated with mealtimes, at home, and with relatives.     

肾结核的影像诊断

目的探讨X线、B超和CT对肾结核的诊断价值。方法对我院2007年1月～2012年1月临床手术病理证实肾结核的28例病历从发生机理及病理基础上进行分析，结合其病理基础讨论。肾结核的X线、B超和CT表现及其鉴别诊断。结果中晚期肾结核病例，不宜做膀胱镜或输尿管插管，诊断不明确，可选CT扫描。多层螺旋CT（MSCT）能清晰地显示病变部位、累及范围、腔内外改变以及肾功能情况，是诊断肾结核的一种很好的影像方法。结论X线、B超和CT对肾结核检查有明显的诊断价值。曲面重建（CPR）对病变的显示及诊断很实用。     

Applause sign: screening utility for dementia and cognitive impairment

Objective: To examine the diagnostic utility of applause sign scores for the diagnosis of dementia and mild cognitive impairment. Methods: Consecutive unselected new outpatient referrals to a dedicated cognitive disorders clinic over a 12-month period were administered the clapping test. Criterion diagnosis was by usual clinic assessment using standard diagnostic criteria, blind to applause sign score. Results: Applause sign scores differed significantly (p < 0.001) between diagnostic groups (dementia, mild cognitive impairment, subjective memory complaint) and did not correlate with other cognitive screening instrument scores. Nearly three-quarters of those with an abnormal score had cognitive impairment. Applause sign score was specific but not sensitive for a diagnosis of cognitive impairment. Conclusion: The applause sign supports a diagnosis of dementia or cognitive impairment in high prevalence settings and may be useful in conjunction with other cognitive screening tests.