建立中药材盲样检验机制 有效预防以权谋私

从建立管理制度、完善工作程序、编制作业文件、加强运行监督等方面介绍了药品检验机构新近运行的中药材盲样检验机制,详细介绍了中药材盲样检验工作流程,对中药材盲样检验机制在药品检验机构廉政建设中有效预防以权谋私的作用进行了简要论述。     

How the war on drugs impacts social determinants of health beyond the criminal legal system

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the “war on drugs” in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that “drug war logic” has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts.

KEY MESSAGES

• A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.
• The U.S. drug war’s frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.
• Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.

     

听障儿童声母音位对比识别康复训练内容的编制研究

目的 设计一套科学、系统、可操作的声母音位对比康复训练内容.方法 本实验选取26名听障儿童进行测试,筛选符合听障儿童声母音位对比识别发展规律的康复内容.结果 研究将康复训练内容分为强化内容和拓展内容.经筛选,各强化内容难度适中,通过率均高于90%.结论 本研究制订的康复训练内容共包括87对音位对,312对强化内容,单音节词语316个,拓展短句106句.其中,强化内容占常用声韵组合的62%,韵母的出现频率与<声学手册>中所统计的汉语语音韵母的出现频率基本一致.     

One-stage vs. two-stage adjustable sutures for the correction of esotropia

BACKGROUND The aim of this study was to evaluate the stability and the level of postoperative consciousness, nausea and vomiting, ocular pain, starting oral intake and activity, and cost-effectiveness in patients undergoing medial rectus recession surgery using an adjustable suture technique that was performed by two different methods. METHOD In this prospective study, we evaluated 78 patients undergoing medial rectus recession surgery. Thirty-eight patients were operated by a one-stage technique in which the whole operation was done under topical anesthesia and adjustment was done on the operating table, while 40 patients were operated by a two-stage technique in which the operation was done under general anesthesia and adjustment was done the following day at the patient’s bedside. The results were recorded and compared according to the parameters given above. A scoring system was used to assess all these parameters except for stability. The stability of the procedures was evaluated according to the degrees of squint immediately after the adjustment and at least three months thereafter. RESULTS There was no significant difference between the procedures with regard to stability and ocular pain. During the early postoperative period, the level of consciousness was better and nausea and vomiting occurred less frequently in the patients operated by the one-stage procedure. Postoperative activity and oral intake returned to normal status more quickly in the one-stage group and the one-stage procedure was cost-effective. CONCLUSION We conclude that although both procedures provide satisfactory and stable results, the one-stage procedure has significant advantages over the two-stage procedure for medial rectus recession surgery in suitable cases.     

Cardiac catheterization in children with pulmonary arterial hypertension

Cardiac catheterization of childhood pulmonary arterial hypertension (PAH) is used to assess the severity of the disease as well as prognosis, selection of the most adequate pulmonary vasodilators, and evaluation of effectiveness. Sudden deterioration of cardiovascular hemodynamics, however, can be easily induced by pain, patient agitation, catheter manipulation, and by vasodilator provocation tests; these could trigger a pulmonary hypertension crisis, vagotony, respiratory distress, and hemoptysis resulting in critical complications, including death. Those patients with New York Heart Association functional class IV are at an especially high risk. It is noteworthy that pulmonary arteriography is a contraindication in patients with PAH. In a review of 7218 adult patients, 76 (1.1%) serious complications, including four deaths, were reported; with regard to the pediatric patients, 29 (10.7%) out of 270 patients with complications, including one with cardiogenic shock requiring cardiopulmonary resuscitation in addition to minor complications, were reported. To prevent serious complications, basic and routine precautions, such as oxygen and concomitant transcutaneous oxygen saturation and electrocardiogram monitoring during transportation to and from the catheter laboratory, are mandatory. Furthermore, the cooperation of experienced physicians and well informed medical staff in addition to meticulous preparation, for example, calculation of prior doses of catecholamine and confirmation of the presence of emergency equipment, is required.     

血浆置换术后联合小剂量激素治疗溶血尿毒综合征

目的探讨血浆置换术后联合小剂量激素治疗溶血尿毒综合征(HUS)的疗效。方法回顾性分析近5 a来本院肾内科11例HUS患儿临床资料。男6例,女5例;年龄2～9岁,平均年龄5.2岁。重症10例,轻症1例。其中8例进行血浆置换治疗,每例2、3次,术后应用泼尼松(1.0～1.5 mg.kg-1)或甲泼尼龙(1 mg.kg-1)维持;其中1例联合血液透析治疗,1例联合连续性血液滤过治疗。轻症1例采用大剂量丙种球蛋白(丙球)治疗。1例重症HUS外院进行血液透析1个月余转本院继续血液透析治疗。1例重症HUS外院采用大剂量丙球冲击联合甲泼尼龙治疗后继续甲泼尼龙1 mg.kg-1治疗和肠道透析。结果 19例次血浆置换治疗均顺利实施,无明显并发症;8例血浆置换后联合小剂量激素治疗者中7例肝酶、心肌酶、肾功能恢复正常,尿常规镜下血尿或并轻中度蛋白尿出院,追踪观察2～26个月,复查肾功能均正常,尿蛋白阴性,5例镜下轻微血尿[RBC(9～36)×106L-1],1例感染后轻微镜下血尿,1例尿常规正常。轻症1例出院时尿常规和肾功能均正常,门诊随诊38个月尿常规正常。2例外院治疗的重症HUS患儿转入本科时病程1周～1个月,血小板已恢复正常,Hb无继续下降,尿常规示肉眼血尿和中量蛋白尿,处于肾衰竭期。其中1例血液透析6次,肾功能稍好转、肉眼血尿并中量蛋白尿,放弃治疗出院。1例经肠道透析和口服激素等措施后放弃治疗出院。结论重症HUS患儿宜早期应用血浆置换治疗,血浆置换治疗后联合小剂量激素治疗可改善重症HUS患儿预后,减少后遗症。     

儿童肺血管栓塞性疾病

近年来,儿童肺血管栓塞性疾病在临床的发生率有所增长。儿童肺栓塞跟成人不同,其临床表现无明显特异性,血流动力学不稳定少见,容易误诊漏诊,病死率较高。治疗上大部分经验来自于成人,儿科医生对本病的药物使用经验不足。该文对儿童肺栓塞的流行病学、风险因素、临床表现、诊断、治疗、预防及预后等方面的诊治进展进行综述,以提高临床医生对本病的认识,做到早诊断、早治疗,降低病死率。