影像技术在种植牙术前骨量评估临床应用的研究进展

种植牙手术能否获得完美效果与多方面因素有关,其中术前对受植区骨质及骨量的预判是关键,随着种植牙技术的提高为了配合种植手术影像技术也不断发展。从初期利用X线机获得少量信息到目前专业的牙科CT,为临床种植医生提供了更为精确的颌骨信息,大大提高了种植牙的成功率同时扩大了种植适应人群范围。     

Thyroid surgery

Diseases of the thyroid are common and surgical treatment is often the preferred option. Thyroid surgery is becoming subspecialised and falls within the repertoire of maxillofacial, and head and neck surgeons. Multidisciplinary management of most patients with diseases of the thyroid is key to providing the best care particularly for those with malignancies and retrosternal extension. To reduce postoperative complications a meticulous search for, and protection of the recurrent laryngeal nerve and parathyroid glands, with an incision along the skin crease in the lower neck, which can be extended for neck dissection, are paramount. Recent advances in thyroid surgery include ultrasound-guided cervical plexus block, use of the Harmonic Scalpel^® (Ethicon Endo-Surgery, Inc., USA), intraoperative nerve stimulation to monitor the recurrent laryngeal nerve, use of TissuePatch™ 3 (Tissuemed Ltd., Leeds, UK) adhesive sealant, and minimal access surgery.     

复杂性疾病遗传学研究进展

近十年,随着人类基因组计划的建立及不断完善、遗传学队列研究和基因分型技术的日趋成熟,复杂性疾病遗传背景的研究获得了突飞猛进的发展.迄今已发现数百个与复杂性疾病存在可靠关联的遗传变异,这为我们认识复杂性疾病发病机制提供了重要线索.该文将重点回顾近十年复杂性疾病遗传学研究的进展,主要包括:人类对基因组序列和结构认识的进步,复杂性疾病研究策略、队列的进步,基因分型技术的进展,最后简要概括这些进步对于复杂性疾病遗传学研究的新贡献.     

慢性肾功能不全对药动学影响研究进展

慢性肾功能不全是临床常见疾病之一,主要经肾消除及主要经非肾途径消除的药物,药代动力学及药效学均受慢性肾功能不全疾病的影响。肾功能不全尤其是终末期肾病不仅直接减少药物的排泄,还能影响药物吸收、药物转运及药物代谢,从而影响药物的非肾消除。肾功能不全可直接抑制药物代谢酶及转运体的活性并减少酶及转运体在胃肠道、肝脏等多个器官的mRNA及蛋白的表达。引起这种抑制作用的原因尚不明确,血液透析可以部分抵消或逆转这种抑制作用并存在透析消除。     

Consensus Statement No. 434: Simulation in Obstetrics and Gynaecology

ObjectiveTo provide a comprehensive and current overview of the evidence for the value of simulation for education, team training, patient safety, and quality improvement in obstetrics and gynaecology, to familiarize readers with principles to consider in developing a simulation program, and to provide tools and references for simulation advocates.Target populationProviders working to improve health care for Canadian women and their families; patients and their families.OutcomesSimulation has been validated in the literature as contributing to positive outcomes in achieving learning objectives, maintaining individual and team competence, and enhancing patient safety. Simulation is a well-developed modality with established principles to maximize its utility and create a safe environment for simulation participants. Simulation is most effective when it involves interprofessional collaboration, institutional support, and regular repetition.Benefits, Harms, and CostsThis modality improves teamwork skills, patient outcomes, and health care spending. Upholding prescribed principles of psychological safety when implementing a simulation program minimizes harm to participants. However, simulation can be an expensive tool requiring human resources, equipment, and time.EvidenceArticles published between 2003 and 2022 were retrieved through searches of Medline and PubMed using the keywords “simulation” and “simulator.” The search was limited to articles published in English and French. The articles were reviewed for their quality, relevance, and value by the SOGC Simulation Working Group. Expert opinion from relevant seminal books was also considered.Validation MethodsThe authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).Intended AudienceAll health care professionals working to improve Canadian women’s health, and relevant stakeholders, including granting agencies, physician/nursing/midwifery colleges, accreditation bodies, academic centres, hospitals, and training programs.Recommendations

• 1.Health care professionals in obstetrics and gynaecology should understand the value of both in situ and off-site simulation as a tool for education, patient safety, and quality improvement at both the team and individual levels (strong, moderate).
• 2.Health care professionals in obstetrics and gynaecology should be aware of the overall cost reduction associated with the use of simulation (strong, moderate).
• 3.Stakeholders at all levels must commit to an ongoing simulation program, including identifying, training, and supporting simulation advocates, as well as securing adequate funding. This approach leads not only to organizational readiness but also to quality improvement and positive culture change (strong, moderate).
• 4.Providers of obstetrical and gynaecological care should be familiar with key simulation modalities and principles of how to advance knowledge using simulation (conditional, low).
• 5.Purposeful simulation activities must be based on local needs assessments and knowledge gaps (conditional, low).
• 6.Interprofessional/interdisciplinary teams should participate in the design, implementation, and evaluation of team training and in situ simulation programs (strong, high).
• 7.Debriefing must be promoted as a fundamental component of the experiential learning process. Team debriefing/peer debriefing with a written guide can be as effective (as an alternative) as expert debriefing (strong, high).
• 8.Psychological safety must be established for all personnel within the simulation and the debriefing (strong, moderate).
• 9.Program evaluation, a system to measure the efficacy of a learning activity, must be included in the planning of simulation activities to assess whether the targeted outcomes of the program were achieved (strong, moderate).
• 10.Simulation-based activities should be designed in a culturally sensitive and socially responsible way, similar to all other aspects of health professionals’ education (strong, low).