急诊危重症患者院内转运流程的建立和应用评价

目的构建急诊危重症患者院内转运流程,降低院内转运过程中不良事件发生率。方法组建项目团队,根据医疗失效模式与效应分析(HFMEA)方法,列出转运过程中每个流程步骤及子流程,进行危急值计算及决策树分析,拟定行动计划与结果评价,对流程执行者进行培训与考核,考核合格后实施转运。比较流程方案实施前与实施后转运过程中不良事件的发生率。结果实施后患者转运过程中输液管滑脱或堵塞、血压下降、意外拔管、氧气供给不足、氧饱和度下降发生率显著低于实施前(均P0.01)。结论运用HFMEA构建急诊危重症患者院内转运流程,可以提高急诊危重症患者院内转运的安全性。     

Contemporary Epidemiology of and Risk Factors Associated with Removal of a Pathologically Normal Appendix in Children with Suspected Appendicitis

BackgroundThe goal of this study was to characterize contemporary performance benchmarks and risk factors associated with negative appendectomy (NA) in children with suspected appendicitis.MethodsA multicenter retrospective cohort analysis of children undergoing appendectomy for suspected appendicitis was performed using data from the 2016–2021 NSQIP-Pediatric Appendectomy Targeted Public Use Files. Multivariable regression was used to evaluate the influence of year, age, sex, and WBC count on NA rate, and to generate rate estimates for NA based on different combinations of demographic characteristics and WBC profiles.Results100,322 patients were included from 140 hospitals. The overall NA rate was 2.4%, and rates decreased significantly during the study period (2016: 3.1% vs. 2021: 2.3%, p < 0.001). In adjusted analyses, the highest risk for NA was associated with a normal WBC (<9000/mm³; OR 5.31 [95% CI: 4.87–5.80]), followed by female sex (OR 1.55 [95% CI: 1.42–1.68]) and age <5 years (OR 1.64 [95% CI 1.39, 1.94]). Model-estimated risk for NA varied significantly across demographic and WBC strata, with a 14.4-fold range in rates between subgroups with the lowest and highest predicted risk (males 13–17 years with elevated WBC [1.1%] vs. females 3–4 years with normal WBC [15.8%]).ConclusionsContemporary NA rates have decreased over time, however NA risk remains high in children without a leukocytosis, particularly for girls and children <5 years of age. These data provide contemporary performance benchmarks for NA in children with suspected appendicitis and identify high-risk populations where further efforts to mitigate NA risk should be targeted.Level of EvidenceIII.     

依托大学附属医院培养医学影像技术专业的问题与思考

我国医学影像技术专业开设时间短,办学依托模式在各高校间存在较大差异,其中基于大学附属医院培养医学影像技术专业的模式存在课程体系逻辑不合理、教研机构设置不健全、学生创新研究引导不足等弊端,同时本文提出缓解上述不利教育因素的方案,旨在进一步完善高校附属医院主导医学影像技术专业建设的模式,输出更优质的人才。     

小分子ERK抑制剂的研究进展

细胞外信号调节激酶(ERK)是一种丝/苏氨酸蛋白激酶。作为RAS-RAF-MEK-ERK信号通路中关键的下游蛋白,其异常活化在肿瘤的发生发展中起着重要作用。选择性ERK1/2抑制剂能够阻断ERK信号通路,同时克服上游靶点突变而导致的耐药性。本文概述了MAPK信号通路的组成、ERK的结构与功能以及ERK信号通路在肿瘤发生发展中的作用,并重点介绍一些具有代表性的处于临床和临床前研究阶段的ERK抑制剂。     

青岛市围绝经期妇女保健需求现状

目的 了解青岛市围绝经期妇女对围绝经期的认识程度和保健需求，为制定保健措施提供依据。方法 采用整群随机抽样方法，选取青岛市区及城郊的各400名共1600名35—59岁的妇女作为调查对象，进行围绝经期妇女保健需求调查。结果保健需求排在前五位的有：定期全面查体（54．56％）、围绝经期咨询（50．88％）、预防骨质疏松（42．56％）、预防老年痴呆症（39．19％）、保护关节功能（38．25％）；只有16．56％的妇女了解围绝经期保健知识；知识主要来源于媒体（38．60％）、同事朋友（35．92％）、医疗机构（25．48％）；围绝经期妇女HT的使用率4．13％，青岛市区的HT使用率明显高于城郊（χ^2=22．73，P〈0．01）。结论围绝经期妇女对保健需求较迫切，保健知识贫乏，应深入开展健康教育，普及推广HT的相关知识。     

人工智能在医疗领域的应用现状和思考

人工智能在医疗领域有着广泛的应用前景和发展空间,已成为影响医疗健康产业发展的重要科技手段。本文首先分析人工智能在医疗领域的应用现状,其次讨论目前人工智能技术在各医疗领域应用中存在的问题,并提出应对措施和建议,为人工智能技术在我国医疗领域的应用发展提供参考,使人工智能技术更好地助力于医疗领域。     

程式训练在精神分裂症患者社区护理中的应用研究

目的：探讨程式训练对社区精神分裂症患者防残，康复的作用。方法：对社区精神分裂症患者随机分成训练组和对照组各50例，在药物治疗的同时，对训练组患者进行程式训练，对照组患者予以传统的精神康复干预，对两组患者随访1年，用BPRS量表评价病人病情的严重程度，用SDSS量表评价病人的社会功能缺陷情况，并比较两组病人出院后的服药依从性，复发情况及（再）就业情况。结果：出院6个月、12个月训练组病人BPRS评分明显低于对照组，服药依从性训练组明显好于对照组，训练组的病情复发率和再住院率低于对照组，训练组的再就业率高于对照组，1年后两组间SDSS第1、5、6、9、10项及总分比较差异有显著性意义。结论：程式训练对社区精神分裂症患者维持疗效，减少复发，有效延缓社会功能缺陷，尽早重返社会有良好的促进作用。     

Cardiovascular risk and prevalence of metabolic syndrome by differing criteria

Background The prevalence of metabolic syndrome （MetS） in hypertensive population in Chinese countryside is unknown. Firstly, this study compared the prevalence of MetS according to National Cholesterol Education Program （NCEP） ATPIII, revised NCEP and International Diabetes Federation （IDF） definitions. Secondly, it investigated the association between MetS, coronary heart disease （CHD） and stroke in patients with hypertension. Methods In this cross sectional study, the cluster sampling method was used. Three MetS definitions were applied to 1418 normal subjects and 5348 hypertensive patients aged 40-75 years in rural areas in China. The agreement between different MetS definitions was estimated by K statistics. Logistic regression analyses determined the association between MetS defined by the three MetS definitions and CHD and stroke. Results In subjects without hypertension, the prevalence of Mets was 4.1% by NCEP definition, 8.3% revised NCEP definition and 7.8% IDF definition. In hypertensive individuals, the prevalence was 14.0%, 32.9%, and 27.4% in men; 35.6%, 53.1%, and 50.2% in women by the same definitions, respectively. In hypertensive individuals, the agreement was 94.4% in men and 97.0% in women between revised NCEP and IDF definitions. The IDF defined MetS was more strongly associated with CHD than the NCEP or revised NCEP defined MetS （adjusted odds ratio： 1.92 compared with 1.85 and 1.69 in men; 1.64 compared with 1.48 and 1.60 in women）. Conclusions In the patients with hypertension, the revised NCEP and IDF definitions identified more individuals than NCEP definition and their agreement is very high. The IDF defined MetS is more strongly associated with CHD than the NCEP or revised NCEP defined MetS, but weakly or not associated with stroke.     

乡镇卫生院产权制度改革中的政府职能

从十七大报告中看出，在现有国情下，为达到“为群众提供安全、有效、方便、价廉的医疗卫生服务”，“鼓励社会参与”仍然必要。乡镇卫生院产权制度改革就是“社会参与”的一种体现，但“参与”过程中存在的问题要求政府在实现其职能过程中紧掌公平之舵：乡镇卫生院产权制度改革的目标是实现人人享有卫生服务的公平；过程要确保参与各主体的公平得利。     

深化医疗卫生事业改革的伦理底蕴探析

过去医疗改革中所暴露出的一系列突出问题和矛盾凸显出我国医疗卫生事业改革伦理底蕴的缺失。全面深化医疗卫生事业改革应当坚持正确的伦理价值取向和伦理原则；明确界定政府、医疗单位和医务工作者、患者及其家属各自应负的伦理责任；走中国特色社会主义医疗卫生事业改革道路，推动和保障医疗卫生事业健康持续发展。