SMILE角膜屈光手术专家共识的临床解读

飞秒激光小切口角膜基质透镜取出术（SMILE）是近年来单纯利用飞秒激光实施的全新的治疗理念和方式,不同于既往利用准分子激光治疗的表层和基质角膜屈光手术。如何合理应用该手术方式为广大的屈光不正患者提供满意舒适的视觉效果尤为重要。现结合临床SMILE角膜屈光手术专家共识进行解读,进一步深入阐述其实际应用的内涵和临床意义,以期为临床安全实施、稳步推广该手术提供参考。     

Standardization in Performing and Interpreting Electrocardiograms

Excellence in recording and interpretation of electrocardiogram (ECG) is a necessity for optimal electrocardiography. This includes data to properly interpret the ECG, including data on age, gender, cardiovascular diagnosis, medications, abnormal laboratory findings (eg, data on electrolytes), and the indications for the electrocardiogram. The ECG needs to be performed by a qualified technician and interpreted by an experienced physician.     

“挛三针”释义

本文主要介绍一组新的"靳三针"穴位——"挛三针"的方义、临床操作经验以及验案一则。这组穴位是由庄礼兴教授在其临床经验基础上总结,并经大样本临床病例观察验证有效后新提出的,主要用来治疗中风后痉挛性瘫痪。这组穴位分为:上肢挛三针——极泉、尺泽、内关;下肢挛三针——鼠鼷、阴陵泉、三阴交。     

Reducing image interpretation errors – Do communication strategies undermine this?

IntroductionErrors in the interpretation of diagnostic images in the emergency department are a persistent problem internationally. To address this issue, a number of risk reduction strategies have been suggested but only radiographer abnormality detection schemes (RADS) have been widely implemented in the UK. This study considers the variation in RADS operation and communication in light of technological advances and changes in service operation.MethodsA postal survey of all NHS hospitals operating either an Emergency Department or Minor Injury Unit and a diagnostic imaging (radiology) department (n = 510) was undertaken between July and August 2011. The questionnaire was designed to elicit information on emergency service provision and details of RADS.Results325 questionnaires were returned (n = 325/510; 63.7%). The majority of sites (n = 288/325; 88.6%) operated a RADS with the majority (n = 227/288; 78.8%) employing a visual ‘flagging’ system as the only method of communication although symbols used were inconsistent and contradictory across sites. 61 sites communicated radiographer findings through a written proforma (paper or electronic) but this was run in conjunction with a flagging system at 50 sites. The majority of sites did not have guidance on the scope or operation of the ‘flagging’ or written communication system in use.ConclusionsRADS is an established clinical intervention to reduce errors in diagnostic image interpretation within the emergency setting. The lack of standardisation in communication processes and practices alongside the rapid adoption of technology has increased the potential for error and miscommunication.     

解读《中国血糖监测临床应用指南》(2011年版)

血糖监测是糖尿病综合管理的重要组成部分,贯穿糖尿病治疗与疗效评估的全过程.自我血糖监测(SMBG)是血糖监测的基本形式,在不同的糖尿病阶段,因各自治疗措施和特点不同,需要相应的SMBG方案.糖化血红蛋白(Hb)A1c是反映长期血糖控制水平的金标准,但其检测方法需进行标准化.而动态血糖监测(CGM)可以提供连续、全面、可靠的全天血糖信息.糖化血清白蛋白(GA)反映短期内血糖变化比HbA1c敏感,是评价患者短期糖代谢控制情况的良好指标,二者有其自身的特点和优势,是上述监测方法的有效补充.     

Évaluation d’un support d’aide à l’analyse de l’électrocardiogramme par les internes des urgences

AimElectrocardiogram (ECG) is a routine examination in emergency medicine (EM), however the level of resident's interpretations is inhomogeneous and sometimes insufficient. We have developed a support to assist in the interpretation of ECG in emergency situations. Our main objective was to assess whether this new tool improved the rate of good interpretations by residents of EM departments (EMD). The secondary objectives were to assess whether it improved the rate of good triages, the level of certainty of residents, and to study its impact according to the seniority of the resident.Patients and methodMulti-center, before-and-after study, carried out with existing residents in the different EMD dependent of a single university hospital center. The evaluation was conducted in two stages: an initial analysis of 17 ECGs without tool and a new analysis using the tool.ResultsOut of a target population of 68 residents, 41 (60 %) were included. The tool significantly improved the correct reading rate from 46 % without the tool to 68 % (P < 0.001). The rate of correct triage (56 % vs. 64 %) and diagnostic certainty (54 vs. 66 on a scale of 0 to 100) were also significantly improved (P < 0.001). The more experienced residents were generally more efficient in pre-testing, but the tool improved results regardless of seniority.ConclusionThe development of a simple support to assist in the interpretation of ECGs improves the rate of good interpretations among residents in EMD.     

《中国结核病患者关怀手册》专家解读

为进一步减少结核病危害,全面提升各级结核病诊疗服务水平和质量,实施贯穿"防""诊""治""管""教"、全流程、全周期和全链条的患者关怀,中国疾病预防控制中心组织专家编写并出版印发了《中国结核病患者关怀手册》。该手册根据《国际结核病关怀标准》,并在结合近10年来我国结核病防治工作实践和相关政策、技术策略、新技术、新工具发展的基础上,进一步规范和细化了患者关怀的各项防控措施,具有较强的指导性和可操作性。笔者详细解读了其制定背景、主要内容和特点,以期促进各级各类医疗卫生机构规范结核病的诊断、治疗及管理,提高"以患者为中心"的服务质量和水平。     

Continuous or emergent EEG: can bedside caregivers recognize epileptiform discharges?

Objective When emergent or continuous EEG monitoring is carried out to detect subclinical seizures, expert interpretation of the results is usually not immediately available. We assessed the ability to recognize epileptiform discharges among various nonexpert bedside caregivers. A second objective was to determine whether such skill improves with a simple educational intervention.Design and setting A prospective cohort study with an educational intervention in a university-based tertiary medical center.Participants All 125 neurology and neurosurgery residents, intensive care fellows, critical care and neurological floor nurses, and EEG technicians were offered participation. Of these, 50 completed the study and provided 2,398 EEG responses.Interventions A computer-based PowerPoint lecture designed to teach recognition of epileptiform discharges.Measurements and results (a) Average number of correct responses in identifying epileptiform discharges in a computer-based pre-test consisting of 24 EEG questions. (b) Impact of the educational intervention as measured by change in the mean average score in a similar post-test. The rate of correct responses by group ranged from 46% for medical critical care nurses to 94% for EEG technicians. Overall mean correct response rate was 14.72 (61%) for the pre-test, and increased to 16.06 (67%) in for post-test (p=0.002).Conclusions Recognition of epileptifom discharges by bedside caregivers is disturbingly low. A simple educational intervention only modestly improved such ability. Therefore we should not rely on nontrained personnel to interpret emergent or continuous recordings. EEG technicians are an exception, and their skill could be utilized during emergent studies.