抗埃博拉期间利比里亚护理人员标准隔离防护相关知识、态度与行为调查

目的 了解利比里亚护理人员对标准隔离防护知识、态度和行为水平。方法 采用基于国际标准隔离防护指南设计的《医护人员标准隔离防护知信行》英文量表,通过涵盖一般情况,标准隔离防护知识、态度及行为等32个条目的问卷对中国解放军援利医疗队所在的埃博拉诊疗中心的护理人员进行调查。结果 问卷由80名护理人员填写,有效回收率71.25%。其标准隔离防护知识、态度和行为的平均得分分别是(7.4±1.1)分、(36.4±4.6)分、(6.6±1.9)分。经Spearman相关系数检验,护理人员标准隔离防护的知识与态度、态度与行为间存在正向线性相关关系,而知识与行为间相关关系不显著。结论 在经济落后、医疗卫生保健体系岌岌可危的利比里亚,世界卫生援助机构对当地护理人员的埃博拉病毒病相关隔离防护实践培训一定程度上提升了其隔离防护的行为水准。但由于缺乏系统的标准隔离防护理论培训,以及政府不能提供充足的隔离防护用品,利比里亚护理人员对标准隔离防护的态度仍存在一定的提升空间,这将影响国际援助撤离后利比里亚护理人员标准隔离防护的行为水平。     

高职院校食品安全检测课程教学实践改革探索

食品安全检测课程的教学改革具有重要意义,在教学中既要强化学生的食品安全意识和社会责任感,也要培养学生与社会需求对接的实际操作能力.食品安全检测课程的教学改革主要采取将理论教学与实验教学相结合的手段,改革以学校和课堂为中心的传统人才培养模式,设计与实施各实践教学环节,实施理实一体化的教学方式.以高职医学院校食品安全检测实践课程为探索对象,以职业能力培养为重点,阐述食品安全检测课程对实践教学及过程进行控制,减少教学过程中教与学的随机性,极大提升学生的学习和研究兴趣.     

Argentinian clinical practice guideline for surveillance,diagnosis, staging and treatment of hepatocellular carcinoma

The A.A.E.E.H has developed this guideline for the best care of patients with hepatocellular carcinoma (HCC) from Argentina. It was done from May 2018 to March 2020. Specific clinical research questions were systematically searched. The quality of evidence and level of recommendations were organized according to GRADE. HCC surveillance is strongly recommended with abdominal ultrasound (US) every six months in the population at risk for HCC (cirrhosis, hepatitis B or hepatitis C); it is suggested to add alpha-feto protein (AFP) levels in case of inexeperienced sonographers. Imaging diagnosis in patients at risk for HCC has high specificity and tumor biopsy is not mandatory. The Barcelona Clinic Liver Cancer algorithm is strongly recommended for HCC staging and treatment-decision processes. Liver resection is strongly recommended for patients without portal hypertension and preserved liver function. Composite models are suggested for liver transplant selection criteria. Therapies for HCC with robust clinical evidence include transarterial chemoembolization (TACE) and first to second line systemic treatment options (sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). Immunotherapy with nivolumab and pembrolizumab has failed to show statistical benefit but the novel combination of atezolizumab plus bevacizumab has recently shown survival benefit over sorafenib in frontline.     

Biomarkers in Cardiology – Part 1 – In Heart Failure and Specific Cardiomyopathies

Cardiovascular diseases are the leading causes of mortality and morbidity in Brazil. The primary and secondary preventions of those diseases are a priority for the health system and require multiple approaches to increase their effectiveness. Biomarkers are tools used to more accurately identify high-risk individuals, to speed the diagnosis, and to aid in treatment and prognosis determination. This review aims to highlight the importance of biomarkers in clinical cardiology practice, and to raise relevant points of their use and the promises for the coming years. This document was divided into two parts, and this first one discusses the use of biomarkers in specific cardiomyopathies and heart failure.     

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Background

The Duke Activity Status Index (DASI) assesses the functional capacity of patients with cardiovascular disease (CVD), but there is no Portuguese version validated for CVD.

Objectives

To translate and adapt cross-culturally the DASI for the Portuguese-Brazil language, and to verify its psychometric properties in the assessment of functional capacity of patients with CVD.

Methods

The DASI was translated into Portuguese, then checked by back-translation into English and evaluated by an expert committee. The pre-test version was first evaluated in 30 subjects. The psychometric properties and correlation with exercise testing was performed in a second group of 67 subjects. An exploratory factor analyses was performed in all 97 subjects to verify the construct validity of the DASI.

Results

The intraclass correlation coefficient for test-retest reliability was 0.87 and for the inter-rater reliability was 0.84. Cronbach''s α for internal consistency was 0.93. The concurrent validity was verified by significant positive correlations of DASI scores with the VO₂max (r = 0.51, p < 0.001). The factor analysis yielded two factors, which explained 54% of the total variance, with factor 1 accounting for 40% of the variance. Application of the DASI required between one and three and a half minutes per patient.

Conclusions

The Brazilian version of the DASI appears to be a valid, reliable, fast and easy to administer tool to assess functional capacity among patients with CVD.     

新型冠状病毒肺炎疫情下结核病专科医院运行与患者治疗管理举措

如何在新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情下做好结核病的治疗管理是我们面临的新的课题和挑战。西安市胸科医院作为COVID-19的省市定点收治医疗机构,通过七大综合举措较好地完成了疫情期间结核病患者的治疗任务,为广大结核病防治机构提供了管理思路。     

Practice Effects and Longitudinal Cognitive Change in Normal Aging vs. Incident Mild Cognitive Impairment and Dementia in The Mayo Clinic Study of Aging

The objective of this study was to examine practice effects and longitudinal cognitive change in a population-based cohort classified as clinically normal at their initial evaluation. We examined 1390 individuals with a median age of 78.1 years and re-evaluated them up to four times at approximate 15-month intervals, with an average follow-up time of 5 years. Of the 1390 participants, 947 (69%) individuals remained cognitively normal, 397 (29%) progressed to mild cognitive impairment (MCI), and 46 (3%) to dementia. The stable normal group showed an initial practice effect in all domains which was sustained in memory and visuospatial reasoning. There was only a slight decline in attention and language after visit 3. We combined individuals with incident MCI and dementia to form one group representing those who declined. The incident MCI/dementia group showed an unexpected practice effect in memory from baseline to visit 2, with a significant decline thereafter. This group did not demonstrate practice effects in any other domain and showed a downward trajectory in all domains at each evaluation. Modeling cognitive change in an epidemiologic sample may serve as a useful benchmark for evaluating cognitive change in future intervention studies.     

Benchmarking: applications to transfusion medicine

Benchmarking is ‘a structured, continuous, collaborative process in which comparisons for selected indicators are used to identify factors which when implemented will improve transfusion practices’. In the Transfusion Medicine literature, there are only a few published articles that meet the criteria for benchmarking: (1) using comparisons between institutions to identify practice variation; (2) using a communication and/or evaluation process to identify factors associated with best practices; (3) introduce best practice factors into one's own setting; and (4) re-evaluate performance. Three models for benchmarking have been proposed: (1) a regional benchmarking programme that collects and links relevant data from existing electronic sources; (2) a sentinel site model where data from a limited number of sites are collected; and (3) an institutional-initiated model where a site identifies indicators of interest and approach other institutions as comparators. Finland has the most well-developed benchmarking model where hospital data are collected electronically from multiple sources and analysed centrally with web-based reports available for participants. Areas of practice variation are explored in annual benchmarking workshops, interventions are identified and implemented, and the impact of the interventions are evaluated at a later date. A provincial model used in Canada will also be described showing the impact on red cell outdating when hospitals were challenged to meet evidence based targets. Limitations of benchmarking and future research will be discussed.