地震救援中实施远程医疗服务:把最好的医学专家送到灾区人民身边

目的和方法 总结解放军总医院远程医疗会诊系统在2013年“4·20”四川芦山地震救援中发挥其远程医疗服务的经验,探讨远程医疗会诊系统在灾难救援中的作用.结果和结论 在2013年4月20日四川芦山地震后,解放军总医院专家医疗队及时将无线便携式远程医疗会诊系统发送至地震灾区伤员集合点医院,第一时间组织开通面向灾区服务的远程医疗会诊系统,与位于地震灾区的多家医院及地震救援队救护车远程医疗系统联通,提供24h包括急诊和危重症救治、骨科、脑外科、肝胆外科、妇产科等相关专业的远程救援服务,对地震伤员的抢救提出了诊断和救治意见,形成了救灾现场专家与后方专家的良性互动,使灾区专家医疗队的救治能力倍增.解放军总医院在芦山地震中共进行远程医疗会诊110余例,在对灾难现场的受伤人员进行有效的紧急救治中实现了实时高清会诊和现场手术指导,并在业务层面实现了多媒体通信系统与医院医疗信息系统的对接,在功能层面实现了各联盟医院的视频、音频和数据以及医疗业务的互联互通,为我国在灾难救援中实施远程医疗抢救提供了可借鉴的经验.     

Probiotics in functional bowel disorders

Functional bowel disorders (FBDs) are the most common gastrointestinal (GI) disorders seen by gastroenterologists and primary care physicians. The disorders affect patients functioning and quality of life (QOL) and are associated with significant healthcare burden. The current theory regarding the development of FBDs suggests brain-gut axis dysfunctions associated abnormal GI motility and sensation. Recent data suggest that alterations in the intestinal microbiota may have a role in the pathogenesis of FBDs; or at least have the potential to affect intestinal functions that are thought to be relevant to the development of functional GI symptoms. This has led to growing interest of healthcare providers and patients in targeting the intestinal microbiota for the treatment of FBDs. In this article we discuss the potential role probiotic interventions in the treatment of FBDs. We review the evidence from pre-clinical and clinical studies and discuss the current recommendations for the use of probiotics for FBDs in clinical practice.     

国内外MOOC医学课程对比分析

目的：对比分析国内外MOOC医学课程现状,为中国学习者提供高效便捷的MOOC医学课程及远程医学教育。方法：对Coursera、edX、“中国大学MOOC”、“人卫慕课”4家平台的医学课程在数量、授课大学、授课语言、课程认证及中外MOOC医学课程的发展现状进行了对比分析。结果：中国的MOOC医学课程在数量、规模、认证方式等方面与国外还存在一定差距。结论：国内医学工作者应抓住机遇,为国内学习者提供更为便利高效的MOOC医学学习平台。     

Remote scanning support in magnetic resonance imaging: Friend or foe?

IntroductionRecent advances in technology have seen the introduction of remote scanning capabilities become a reality for departments, allowing staff to remotely access, observe and even scan without being by the scanner side. The COVID-19 pandemic has accelerated use of remote working which also aligns with the direction of travel for healthcare more widely. However for technology to succeed it needs to be acceptable for use by radiographers in clinical practice.MethodsFollowing trial of a remote scanning technology, a group of radiographers were surveyed for their views on its use in practice. The survey was based on the Technology Acceptance Model as well as providing opportunity for open feedback on views regarding the technology.ResultsPerceived ease of use was high but appears to have little influence over overall intention to use. Perceived usefulness was lower and demonstrated correlations with attitude towards and intended use of the remote technology, suggesting that this is a key area to address which would positively impact on acceptance. Other considerations that would help support effective implementation were highlighted with the majority stating the technology as friend rather than foe.ConclusionAs an early evaluation of practitioner views on remote scanning within MRI, the results highlight the areas that would benefit from further development before further roll out in practice. A clear vision of its use and robust governance is needed to effectively support its implementation and acceptance by radiographers.Implications for practiceIntroducing remote scanning technology has potential to support training and share skills of experienced radiographers across multiple locations. It has the potential to transform the way MRI departments work and increase safer supervision to enable wider utilization of the support workforce.     

Intensive supervised rehabilitation versus less supervised rehabilitation following anterior cruciate ligament reconstruction? A systematic review and meta-analysis

ObjectivesTo investigate whether intensive supervised rehabilitation following ACL reconstruction leads to superior self-reported function and sports participation compared to less supervised rehabilitation.DesignSystematic review and meta-analysis.MethodsWe included randomised controlled trials (RCTs) comparing supervised rehabilitation to rehabilitation with a similar protocol that used less supervised sessions for athletes following ACL reconstruction. Two reviewers independently screened studies and extracted data. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate methodological quality and GRADE to evaluate overall quality of evidence. Self-reported function and sports participation were the primary outcomes. Data were pooled using random effects meta-analyses.ResultsOur search retrieved 4075 articles. Seven articles reporting on six RCTs were included (n = 353). Very-low to low-certainty evidence suggests intensive supervised rehabilitation is not superior to less supervised rehabilitation following ACL reconstruction for improving self-reported function, sports participation, knee flexor and extensor strength, range of motion, sagittal plane knee laxity, single leg hop performance, or quality of life.ConclusionBased on uncertain evidence, intensive supervised rehabilitation is not superior to less supervised rehabilitation for athletes following ACL reconstruction. Although high-quality RCTs are needed to provide more certain evidence, clinicians should engage athletes in shared decision making to ensure athletes’ rehabilitation decisions align with current evidence on supervised rehabilitation as well as their preferences and values.