Multidisciplinary Tinnitus Care

Tinnitus (ringing in the ears) is highly prevalent, and yet standards of clinical care for tinnitus do not exist. Consequently, tinnitus clinical care is haphazard, leaving individuals seeking help for their tinnitus at a disadvantage. These individuals need accurate information about the realities of tinnitus management, which should be made available by health care providers. This report reviews the key concerns related to clinical care for tinnitus and provides recommendations for all health care practitioners to provide their patients with useful and cost-effective information. A toolkit of resources is provided to facilitate the process of dispensing this information.     

糖尿病肾病相关生物学标志物的研究进展

糖尿病肾病(diabetic nephropathy,DN)是引起糖尿病相关性死亡的主要原因之一。尿微量白蛋白是目前诊断DN最常用的临床指标,然而部分DN患者虽然已经有了晚期肾组织病理上的改变,但尿微量白蛋白仍然处于正常范围内。因此,寻找新的灵敏、特异的生物学指标对于DN的诊断及判断疾病进程有重要意义。近年来,肾损伤相关标志物、与DN发病机制相关的生物标志物等已经逐渐成为临床研究的热点,而蛋白质组学技术的发展也为寻找DN相关的生物标志物提供了新的指导方向。     

La gestión de la asistencia neurológica en tiempos de la pandemia de Covid-19

IntroductionThe COVID-19 epidemic has led to the need for unprecedented decisions to be made to maintain the provision of neurological care. This article addresses operational decision-making during the epidemic.DevelopmentWe report the measures taken, including the preparation of a functional reorganisation plan, strategies for hospitalisation and emergency management, the use of telephone consultations to maintain neurological care, provision of care at a unit outside the hospital for priority patients, decisions about complementary testing and periodic in-hospital treatments, and the use of a specific telephone service to prioritise patients with epileptic seizures.ConclusionDespite the situation of confinement, neurology departments must continue to provide patient care through different means of operation. Like all elements of management, these must be evaluated.     

Reducing the probability of falsely elevated HbA1c results in diabetic patients by applying automated and educative HbA1c re-testing intervals

IntroductionToo frequent HbA1c measurements may lead to unnecessary treatment modifications of diabetic patients. The aim of this study was to estimate the percentage of falsely elevated HbA1c results in two hospitals, Landeskrankenhaus/Uniklinikum Salzburg (LKH) and Landesklinik St. Veit (STV), as well as to retrospectively investigate the effect of an automated and an educative 60-day re-testing interval (RTI).MethodsThe amount of estimated falsely elevated results (eFER), based on odds calculated using the baseline and the follow-up values and the time between these measurements, the number of HbA1c re-testings within 60 days as well as the overall number of ordered and performed HbA1c analyses were calculated. In LKH, an automated algorithm cancelling inappropriate HbA1c testing was applied, and in STV, educational actions were taken.ResultsBefore RTI-implementation, eFER were 0.9% and 2.1% and within-60-days-re-testing were 15.0% and 7.4% of cases in LKH and STV, respectively. After RTI-implementation, these numbers decreased to 0.2% (p < .001) and 1.8% (p = .869) and within-60-days-re-testing decreased to 1.1% (p < .001) and 3.6% (p = .003) in LKH and STV, respectively. Median monthly HbA1c measurements decreased by 15.8% (p < .001) and 21.1% (p = .002) in LKH and STV, respectively.ConclusionBoth the educational and the automated 60-day-RTI were proven to be efficient in reducing overall HbA1c measurements, re-testing within 60 days and eFER.     

利用数据挖掘对某医院零加成后慢病门诊费用分析

目的： 通过分析该院药品零加成后慢病门诊费用变化，为后续医保费用管控及合理用药提供参考意见。方法： 使用数据挖掘方法，分别利用费用消耗占比、月度次均费用变化情况以及皮尔逊相关系数（Pearson Correlation Coefficient）分析各类费用变化情况及药品费用对其他费用的影响。结果： 次均总费用、次均西成药费用、次均中草药费用整体呈现下降的趋势，次均检查费用、次均检验费用、次均挂号费用、次均手术费用、次均麻醉费用、次均治疗费用呈现上升趋势。结论： 次均总费用下降主要是由于次均西成药费的下降所产生的，但是次均西成药费下降与次均麻醉费用、次均检验费用、次均检查费用上升是呈现相关性的，这也揭示了次均总费用下降速度慢于次均西成药费下降速度的原因。     

Preoperative Prophylactic Antibiotics in Total Hip and Knee Arthroplasty: What,When, and How

Although there are numerous nonpatient-related factors that may help reduce infection risk, the proper use of prophylactic antibiotics is most responsible for reducing infection. The role of prophylactic antibiotics is to reduce early periprosthetic joint replacement, which is accomplished by having adequate antibiotic tissue levels at the time of skin incision. The goal of this section of the symposium is to review current antibiotic recommendations, how to manage patients with a self-reported penicillin allergy, review the use of dual antibiotics, discuss the use of antibiotics in the outpatient total joint setting, as well as very briefly discuss the administration of intraosseous antibiotics in knee arthroplasty.     

妊娠合并肺动脉高压的管理

妊娠合并肺动脉高压为严重的妊娠合并症，文章从肺动脉高压的诊断、临床分类、妊娠风险评估、妊娠常见类型的孕期管理等方面对该疾病进行了综合介绍。在相应级别的医疗机构进行规范评估及治疗，有助于改善妊娠合并肺动脉高压患者的母儿预后。