上海市社会办医信用监管结果在行政许可中应用问题及对策分析

本文以应用为导向,通过信用监管在社会办医疗机构行政许可中应用的现状调查分析,依托现有数据平台,从守信激励及失信受限两方面出发,制定信用监管在社会办医疗机构行政许可应用问题及对策分析,完善事前、事中、事后监管执法领域信用监管机制.     

咽喉反流与声带息肉之间的相关性研究

目的探讨咽喉反流与声带息肉之间的关系。方法选取2010年3月～2011年3月手术后经病理确诊的声带息肉患者15例,术后经患者同意行24 h双探头pH监测观察咽喉反流及胃食管反流与声带息肉的关系。结果 15例患者进行监测,咽喉部反流阳性6例(40%),食管反流阳性1 3例(8 6.6 7%),两者均阳性6例(4 0%)。在6例咽喉部反流阳性患者中,5例(8 3.3 3%)反流症状数量表阳性,4例(66.67%)反流检查计分阳性;13例食管反流阳性的患者中9例(69.23%)反流症状数量表阳性,11例(84.62%)反流检查计分阳性。结论上消化道及咽喉反流在声带息肉的发生、发展中可能起到一定的作用,胃反流物刺激可能是声带息肉发生的直接病因或是诱因之一。     

Helicobacter pylori infection and gastroesophageal reflux in children

Some studies suggest that Helicobacter pylori (H. pylori) infection would be a protective factor for the gastroesophageal reflux. The aim of this study was to explore this fact. A group of 72 children, admitted in a pediatric gastroenterology regional center in Northeast Romania, diagnosed with gastroesophageal reflux by 24‐hour continuous esophageal pH monitoring (results were interpreted using the Boix‐Ochoa score), underwent upper endoscopy with gastric biopsy to detect the presence of H. pylori by the rapid urease testing and for bacteriological and histologic examination. 19 children (26.39%) had H. pylori infection, while 53 (73.61%) did not. The grade of esophagitis was classified according to the Los Angeles classification system. Out of 47 children with esophagitis A, 16 (34.04%) had H. pylori infection, while out of the 25 children with esophagitis B, only 3 (12%) had H. pylori infection, with statistic significance (χ² = 54.69, P << 0.05, 95% confidence interval [CI]). Regarding the value of the Boix‐Ochoa score, it appears that the presence of the H. pylori determines lower pH‐metry scores (F = 8.13, P = 0.0015, 95% CI). The presence of the H. pylori was not an important factor in the gastroesophageal reflux. On the other hand its relationship with esophagitis appears to be inverse ratio. The fact that the H. pylori presence is statistically greater in the grade A esophagitis could confirm the hypothesis that the bacteria would slow down the development of the esophagitis.     

A clinical investigation of dental evacuation systems in reducing aerosols

BackgroundThe route of transmission of severe acute respiratory syndrome coronavirus 2 has challenged dentistry to improve the safety for patients and the dental team during various treatment procedures. The purpose of this study was to evaluate and compare the effectiveness of dental evacuation systems in reducing aerosols during oral prophylactic procedures in a large clinical setting.MethodsThis was a single-center, controlled clinical trial using a split-mouth design. A total of 93 student participants were recruited according to the inclusion and exclusion criteria. Aerosol samples were collected on blood agar plates that were placed around the clinic at 4 treatment periods: baseline, high-volume evacuation (HVE), combination (HVE and intraoral suction device), and posttreatment. Student operators were randomized to perform oral prophylaxis using ultrasonic scalers on 1 side of the mouth, using only HVE suction for the HVE treatment period and then with the addition of an intraoral suction device for the combination treatment period. Agar plates were collected after each period and incubated at 37 °C for 48 hours. Colony-forming unit (CFU) counts were determined using an automatic colony counter.ResultsThe use of a combination of devices resulted in significant reductions in CFUs compared with the use of the intraoral suction device alone (P < .001). The highest amounts of CFUs were found in the operating zone and on patients during both HVE and combination treatment periods.ConclusionsWithin limitations of this study, the authors found significant reductions in the amount of microbial aerosols when both HVE and an intraoral suction device were used.Practical ImplicationsThe combination of HVE and intraoral suction devices significantly decreases microbial aerosols during oral prophylaxis procedures.     

Screening for type 2 diabetes and prediabetes in obese youth: evaluating alternate markers of glycemia – 1,5‐anhydroglucitol,fructosamine, and glycated albumin

Hemoglobin A1c (HbA1c) is increasingly performed over the oral glucose tolerance test (OGTT) as the initial screening test for type 2 diabetes in youth. However, the optimal strategy for identifying type 2 diabetes in youth remains controversial. Alternate glycemic markers have been proposed as potentially useful tools for diabetes screening. We examined the relationships among fructosamine (FA), glycated albumin (GA), and 1,5‐anhydroglucitol (1,5‐AG) with traditional screening tests, HbA1c and OGTT. Youth 10–18 yrs, BMI ≥85th‰, and HbA1c <7.5% had a single visit with measurement of HbA1c, 1,5‐AG, FA, GA, and a standard OGTT. Distributions of FA, GA, and 1,5‐AG by HbA1c and 2‐hour glucose (2hG) categories were compared. Receiver operating characteristic (ROC)‐curves were generated to determine the cut points at which alternate markers maximized sensitivity and specificity for predicting prediabetes and diabetes. One hundred and seventeen, 62% female, 59% Hispanic, 22% White, 17% black, median 14.1 yr, and body mass index (BMI) z‐score 2.3 participated. Median values of each alternate marker differed significantly between prediabetes and diabetes HbA1c and 2hG categories (p < 0.017). Only GA medians differed (p = 0.006) between normal and prediabetes HbA1c. Area under the receiver operating characteristic curves (ROC‐AUCs) for alternate markers as predictors of prediabetes (0.5–0.66) were low; however, alternate marker ROC‐AUCs for identifying diabetes (0.82–0.98) were excellent. Although the alternate markers were poor predictors of prediabetes, they all performed well predicting diabetes by 2hG and HbA1c. Whereas the usefulness of these markers for identifying prediabetes is limited, they may be useful in certain scenarios as second line screening tools for diabetes in overweight/obese youth.     

Of duty hour violations and shift work: changing the educational paradigm

Background

Successful surgical education balances learning opportunities with Accreditation Council on Graduate Medical Education (ACGME) duty hour requirements. We instituted a night shift system and hypothesized that implementation would decrease duty hour violations while maintaining quality education.

Methods

A system of alternating teams working 12-hour shifts was instituted and was assessed via an electronic survey distributed at 2, 6, and 12 months after implementation. Resident duty hour violations and resident case volume were evaluated for 1 year before and 2 years after implementation of the night shift system.

Results

Survey data revealed a decrease in the perception that residents had problems meeting duty hour restrictions from 44% to 14% at 12 months (P = .012). Total violations increased 26% in the 1st year, subsequently decreasing by 62%, with shift length violations decreasing by 90%. Resident availability for didactics was improved, and average operative cases per academic year increased by 65%.

Conclusions

Night shift systems are feasible and help meet duty hour requirements. Our program decreased violations while increasing operative volume and didactic time.     

血脂、血糖与脑血流联合分析在惊恐障碍中的应用

目的探讨惊恐障碍患者的血脂、空腹及餐后2h血糖水平、脑血流的变化。方法将首诊于综合性医院急诊科惊恐障碍患者60例分成有自杀意念和没有自杀意念两组,并和30名正常对照进行上述四组指标比较。结果单因素方差分析显示惊恐障碍伴自杀意念者血浆总胆固醇（TCh）、低密度脂蛋白胆固醇（LDL）明显低于惊恐障碍不伴自杀意念者及正常对照组（P〈0．05）,前者餐后2h血糖（2hBS）明显高于后者及正常对照组（P〈0．05）。经颅多普勒（TCD）检查发现：惊恐障碍伴自杀意念者左大脑中动脉（LMCA）平均峰、左大脑前动脉（LACA）平均峰、右大脑中动脉（RMCA）平均峰明显低于惊恐障碍不伴自杀意念者和健康对照（P〈0．05）。将上述检查结果中有统计学意义的TCh、LDL、餐后2hBS、LMCA平均峰、LAcA平均峰、RMCA平均峰进行多分类Logistic回归分析,结果显示LDL、LMCA平均峰、RMCA平均峰惊恐障碍伴自杀意念者明显低于惊恐障碍不伴自杀意念者（P〈0．05）,TCh、餐后2hBS、LACA平均峰两组无统计学意义（P〉0．05）。结论低LDL、脑血流量改变可能是惊恐障碍的神经生物学指标之一。