《慢性胰腺炎外科治疗时机国际共识》评介

2020年2月国际胰腺病学会、欧洲胰腺俱乐部、美国胰腺学会和日本胰腺学会4家学术机构联合在线发表的《慢性胰腺炎外科治疗时机国际共识》,针对慢性胰腺炎的手术指征、外科干预时机、术式选择、沟槽状慢性胰腺炎及慢性胰腺炎恶变等5个方面问题展开讨论,以问题为基础,以循证为导向,提出20条推荐意见,体现出本领域现状及进展,具有实用性与权威性,非常值得学习借鉴。     

国际《胆囊切除术中预防胆管损伤多协会共识和实践指南（2020）》解读

医源性胆管损伤是腹腔镜胆囊切除术最常见的严重并发症,是医疗费用增加、病人生活质量下降和引起医疗纠纷的重要原因。优化胆囊切除术解剖辨识技术和手术技能、风险评估和控制、胆管损伤处理策略和提升医生经验等环节,有可能降低医源性胆管损伤的发生率。2018年10月美国胃肠与内镜外科医师协会（SAGES）联合美国肝胆胰协会、国际肝胆胰协会、消化道外科协会和欧洲内镜外科协会组成的国际小组,针对18个基于证据的问题和推荐意见进行投票决议,通过了其中17个推荐意见。该指南可为外科医生的临床实践提供指导,为相关医疗培训机构、医院管理和专业协会等提供合理有效的规范以降低胆管损伤发生率,从而改善病人的预后。     

胰腺体外震波碎石术专家共识意见

胰腺体外震波碎石术(pancreatic extracorporeal shock wave lithotripsy, P-ESWL)是治疗胰管结石的重要方法,其安全性和有效性已在临床实践中得到充分认可。但有关P-ESWL适应证、禁忌证、操作规范以及并发症防治等方面,国际与国内均尚未形成相关共识。为进一步规范我国P-ESWL的临床应用,由中国医师协会胰腺病学专业委员会及国家消化系统疾病临床医学研究中心(上海)牵头,在参考国内外P-ESWL相关研究基础上,结合国内临床应用经验,组织国内专家编写了本共识。该共识重点介绍了P-ESWL的设备、适应证、禁忌证、操作规范及并发症防治等,旨在提高相关专科医师对P-ESWL的认识,规范P-ESWL流程。     

Locust bean gum safety in neonates and young infants: An integrated review of the toxicological database and clinical evidence

Locust bean gum (LBG) is a galactomannan polysaccharide used as thickener in infant formulas with the therapeutic aim to treat uncomplicated gastroesophageal reflux (GER). Since its use in young infants below 12 weeks of age is not explicitly covered by the current scientific concept of the derivation of health based guidance values, the present integrated safety review aimed to compile all the relevant preclinical toxicological studies and to combine them with substantial evidence gathered from the clinical paediatric use as part of the weight of evidence supporting the safety in young infants below 12 weeks of age. LBG was demonstrated to have very low toxicity in preclinical studies mainly resulting from its indigestible nature leading to negligible systemic bioavailability and only possibly influencing tolerance. A standard therapeutic level of 0.5 g/100 mL in thickened infant formula is shown to confer a sufficiently protective Margin of Safety. LBG was not associated with any adverse toxic or nutritional effects in healthy term infants, while there are limited case-reports of possible adverse effects in preterms receiving the thickener inappropriately. Altogether, it can be concluded that LBG is safe for its intended therapeutic use in term-born infants to treat uncomplicated regurgitation from birth onwards.     

Challenges and Special Aspects of Pulmonary Hypertension in Middle- to Low-Income Regions: JACC State-of-the-Art Review

Challenges and special aspects related to the management and prognosis of pulmonary hypertension (PH) in middle- to low-income regions (MLIRs) range from late presentation to comorbidities, lack of resources and expertise, cost, and rare options of lung transplantation. Expert consensus recommendations addressing the specific challenges for prevention and therapy of PH in MLIRs with limited resources have been lacking. To date, 6 MLIR-PH registries containing mostly adult patients with PH exist. Importantly, the global prevalence of PH is much higher in MLIRs compared with high-income regions: group 2 PH (left heart disease), pulmonary arterial hypertension associated with unrepaired congenital heart disease, human immunodeficiency virus, or schistosomiasis are highly prevalent. This consensus statement provides selective, tailored modifications to the current PH guidelines to address the specific challenges faced in MLIRs, resulting in the first pragmatic and cost-effective consensus recommendations for PH care providers, patients, and their families.     

Quality standards for bone conduction implants

Conclusion: Bone conduction implants are useful in patients with conductive and mixed hearing loss for whom conventional surgery or hearing aids are no longer an option. They may also be used in patients affected by single-sided deafness. Objectives: To establish a consensus on the quality standards required for centers willing to create a bone conduction implant program. Method: To ensure a consistently high level of service and to provide patients with the best possible solution the members of the HEARRING network have established a set of quality standards for bone conduction implants. These standards constitute a realistic minimum attainable by all implant clinics and should be employed alongside current best practice guidelines. Results: Fifteen items are thoroughly analyzed. They include team structure, accommodation and clinical facilities, selection criteria, evaluation process, complete preoperative and surgical information, postoperative fitting and assessment, follow-up, device failure, clinical management, transfer of care and patient complaints.     

县级妇幼保健机构服务能力评价指标的权重研究

目的 为全面评价县级妇幼保健机构服务能力确定其评价体系各指标的权重。方法 运用专家评分法和CRITIC 法分别求出评价指标的主观权重系数和客观权重系数,再求出综合权重系数。结果 综合权重系数最小为0.0334,最大为0.0504,其中指标开放床位数（X6）、万元以上设备数（X7）、财政补助收入占总收入比例（X12）、年门急诊人次数（X21）和年住院人次数（X22）的综合权重系数较小;而指标次均住院天数（X9）、医疗支出占总支出的比例（X13）、孕产妇死亡率（X18）、出入院诊断符合率（X19）和次均门诊费用（X25）的综合权重系数较大。结论 本研究确立的服务能力评价指标权重系数,在通过医疗效益对县级妇幼保健机构进行评价的同时,也更加注重对其公共卫生服务的考核,符合当前医疗发展趋势。主观赋权法和客观赋权法相结合求指标权重系数,结果更加科学、合理。