住培基地管理人员线上培训学习与启示

介绍了北京市2020年8月住院医师规范化培训（住培）基地管理人员能力提升培训班线上授课的主要内容：包括住培制度建立的背景及重要性,住培相关政策介绍;基地评估的5个一级指标、16个二级指标、39个三级指标（住培工作重点）的具体评分标准,其中包括13项核心指标,是基地建设的关键,以及基地评审注意事项;住培招录相关文件政策简介,招录实施注意事项,招录工作中常见问题与解答,招录流程的规范要求;培训轮转安排的原则：依据培训细则的规定,尽量先安排必转科室的轮转,按照分层递进式轮转安排;住培考核分为过程考核和结业考核,过程考核是重点,主要包括：日常考核、出科考核、年度考核,简要介绍出科考核小组人员构成及考核流程等;以及住培医师入院入科教育、住院医师及住院师资日常管理等内容。通过培训,提升住培师资综合素质,为提高住培质量,培养合格的临床医师奠定基础。     

血清降钙素原清除率评估重型颅脑损伤肺部感染的价值

目的 对血清降钙素原清除率对于重型颅脑损伤患者肺部感染的治疗效果和预后评估价值进行分析。方法 选择2019年1月—2020年1月我院接诊的重型颅脑损伤患者80例作为本研究观察对象,所选80例重型颅脑损伤患者中包含恶化组患者40例、有效组患者40例,两组重型颅脑损伤患者全部接受血清降钙素原和血清降钙素原清除率检测,分析两组检测结果。结果 接受临床治疗前,两组重型颅脑损伤患者的血清降钙素原水平比较,差异无统计学意义（P> 0.05）,治疗后恶化组重型颅脑损伤患者的血清降钙素原水平显著高于有效组患者,差异有统计学意义（P <0.05）;治疗后1、3、7 d,恶化组40例重型颅脑损伤患者的血清降钙素原清除率水平显著高于有效组患者,差异有统计学意义（P <0.05）。结论 临床中采取动态观察重型颅脑损伤肺部感染患者的血清降钙素原水平和血清降钙素原清除率,能够良好地预测患者肺部感染的临床治疗效果和预后情况,应该给予大力推广与应用。     

Evaluation of a New Smartphone Powered Low-cost Pulse Oximeter Device

BackgroundMeasurement of blood oxygen saturation is a vital part of monitoring coronavirus 2019 (COVID-19) patients. Pulse oximetry is commonly used to measure blood oxygen saturation and pulse rate for appropriate clinical intervention. But the majority of direct-to-consumer grade pulse oximeters did not pass through in-vivo testing, which results in their accuracy being questionable. Besides this, the ongoing COVID-19 pandemic exposed the limitations of the device in resource limited areas since independent monitoring is needed for COVID-19 patients. The purpose of this study was to perform an in-vivo evaluation of a newly developed smartphone powered low-cost pulse oximeter.MethodsThe new prototype of a smartphone powered pulse oximeter was evaluated against the standard pulse oximeter by taking measurements from fifteen healthy volunteers. The accuracy of measurement was evaluated by calculating the percentage error and standard deviation. A repeatability and reproducibility test were carried out using the ANOVA method.ResultsThe average accuracy for measuring spot oxygen saturation (SPO2) and pulse rate (PR) was 99.18% with a standard deviation of 0.57 and 98.78% with a standard deviation of 0.61, respectively, when compared with the standard pulse oximeter device. The repeatability and reproducibility of SPO2 measurements were 0.28 and 0.86, respectively, which is in the acceptable range.ConclusionThe new prototype of smartphone powered pulse oximeter demonstrated better performance compared to the existing low-cost fingertip pulse oximeters. The device could be used for independent monitoring of COVID-19 patients at health institutions and also for home care.     

飞行员丙型肝炎病毒感染的临床诊治及航空医学鉴定

目的 通过5例飞行员丙型肝炎病毒感染的诊治过程,探讨飞行员丙型病毒性肝炎诊治及医学鉴定原则.方法 回顾性分析我院5例飞行员丙型肝炎病毒感染的诊治、随访过程及最终医学鉴定结果,并进行文献复习.结果 5例患者均系住院或改装体检时发现抗-HCV阳性,均无明显临床症状.肝功能轻度异常,HCV-RNA定量分析阳性;1例为基因1b型.3例患者发病前有手术外伤史,1例有牙科治疗史;4例患者接受聚乙二醇干扰素α-2a及利巴韦林抗病毒治疗,病毒阴转临床治愈,地面观察3～11个月后给予飞行合格,随访1～3年无复发,1例未接受抗病毒治疗,飞行不合格.结论 飞行员丙型肝炎病毒感染途径不清,可能与外伤手术及牙科治疗有关,发病隐匿,症状轻微.及时给予抗病毒治疗可以清除病毒临床治愈,飞行合格.     

多发伤的紧急伤情评估策略

多发伤诊断包括损伤诊断、损伤并发症诊断和并存疾病诊断,其中损伤诊断遗漏指入院24小时后发现并导致不良后果的损伤,发生率2%~40%[1]。导致漏诊的因素主要有医师缺乏整体观念、影像学误导、忽视隐蔽损伤、缺乏损伤机制认识,以及伤情危重、意识障碍、致伤机制和病史不详等因素。多发伤紧急伤情评估策略包括根据致伤机制评估,合理应用影像学技术精确评估,按照CRASH PLAN程序系统(C=circulation循环,R=respiratory呼吸,A=abdomen腹部,S=spine脊柱,H=head头颅,P=pelvis骨盆,L=limbs四肢,A=arteries and veins动静脉,N=nerves神经)评估,复苏无效时重点评估,以及动态、反复评估。     

重型颅脑损伤病人的临床评估

对６８例重型脑外伤患者的评分和预后评估进行分析，提出以重型脑外伤病人的血压、脉搏、呼吸、神智（ＧＣＳ）、瞳孔５项指标作为评估指数进行评分（简称重型脑外伤评估指数），总分为２５分，最低分５分。结果表明：评分在７分以下，持续２～４ｈ者，抢救意义不大；８～１３分，抢救４～６ｈ无效者，其死亡、残废率很高；计分在１４分以上者，有抢救意义，尤以１８分以上者，抢救意义明显增大     

针刺对照激素治疗贝尔麻痹急性期疗效比较系统评价

目的：比较针刺与激素治疗贝尔麻痹急性期临床疗效及安全性。方法：检索PubMed、Cochrane图书馆、CBM数据库、CNKI数据库等收集针灸治疗贝尔麻痹急性期的临床随机对照试验,以Cochrane系统评价手册4.26结合Jadad进行质量评价,统计学分析采用RevMan 4.2.6。结果：4篇文献符合纳入标准,共316例患者。Meta分析显示针刺治疗贝尔麻痹急性期对照激素为主治疗,组间比较差异无统计学意义。合并RR[随机效应模型]=1.11,95%CI（0.99,1.25）,Z=1.80,P=0.07。结论：针刺较激素予贝尔麻痹急性期治疗治愈率尚无差异,但可能有缩短疗程的趋势,需要高质量的证据进一步证明。     

Analytical and clinical evaluation of the light‐initiated chemiluminescent assays for measurement of human thyroid hormones

BackgroundLight‐initiated chemiluminescent assay (LiCA) is a new homogeneous immunoassay. The aim of this study was to evaluate the analytical and clinical performance of the assays for the detection of thyroid hormones based on the fully automated LiCA 800 analyzer.MethodsAnalytical validations of the LiCA thyroid assays (TSH, FT3, FT4, T3, and T4) included precision, linearity, analytical sensitivity, interference, and method comparison applying the protocols of the Clinical and Laboratory Standards Institute (CLSI). The diagnostic performance was assessed by the receiver operating characteristic (ROC) curve analysis with different assay schemes for the diagnosis of hyperthyroidism and hypothyroidism.ResultsWithin‐run and within‐lab precisions (%CV) of the five assays ranged from 1.06 to 6.40% at all concentrations evaluated. A satisfactory linearity was verified over the entire measuring range for TSH, T3, and T4 (R > 0.99, change in recovery <10%, p = 0.000 all). Paired‐comparison measurements presented a comparable assay for each of the five assays (R > 0.96, median bias <5%, p < 0.0001 all) between LiCA and Cobas across three institutes. The diagnostic accuracy of the LiCA assays for hyperthyroidism or hypothyroidism was quantified by the areas under curves (AUC) as 0.925 or 0.832 with the five‐assay panel (TSH, FT3, FT4, T3, and T4) and as 0.921 or 0.811 with the three‐assay panel (TSH, FT3, and FT4), respectively. No significant difference was found between the AUC of LiCA and that of DxI, Cobas, or Centaur (p > 0.3 all).ConclusionLiCA 800 provides a precise and high‐throughput immunoassay platform for detection of thyroid hormones. It is acceptable for clinical use.