Review of hemoglobin A(1c) in the management of diabetes

Hemoglobin HbA(1c) (A(1c)) has been used clinically since the 1980s as a test of glycemic control in individuals with diabetes. The Diabetes Control and Complications Trial (DCCT) demonstrated that tight glycemic control, quantified by lower blood glucose and A(1c) levels, reduced the risk of the development of complications from diabetes. Subsequently, standardization of A(1c) measurement was introduced in different countries to ensure accuracy in A(1c) results. Recently, the International Federation of Clinical Chemists (IFCC) introduced a more precise measurement of A(1c) , which has gained international acceptance. However, if the IFCC A(1c) result is expressed as a percentage, it is lower than the current DCCT-aligned A(1c) result, which may lead to confusion and deterioration in diabetic control. Alternative methods of reporting have been proposed, including A(1c) -derived average glucose (ADAG), which derives an average glucose from the A(1c) result. Herein, we review A(1c) , the components involved in A(1c) formation, and the interindividual and assay variations that can lead to differences in A(1c) results, despite comparable glycemic control. We discuss the proposed introduction of ADAG as a surrogate for A(1c) reporting, review imprecisions that may result, and suggest alternative clinical approaches.     

Quantification of immunohistochemistry--issues concerning methods, utility and semiquantitative assessment II

Immunohistochemistry is entering its fourth decade of use on formalin‐fixed paraffin‐embedded tissues. Over this period the method has evolved to become a major part of the practice of diagnostic surgical pathology worldwide. From the beginning immunohistochemistry has been adapted to provide a range of markers of cell lineage and tissue type, with particular application to the diagnosis and classification of tumours. In this modality immunohistochemical methods were employed simply as ‘special stains’, the results of which were evaluated qualitatively by the pathologist, as for any other stain. More recently, attention has shifted to the demonstration of prognostic markers in tumour cells, driven by the advent of molecular biology and the discovery of numerous regulatory molecules, coupled with manufacture of the corresponding specific antibodies. Immunohistochemistry has rapidly adapted to this new use, but in so doing the demand for quantification has become paramount; it is no longer enough that the ‘stain’ is there; rather it is a question of ‘How much is there?’. This review explores the limitations of immunohistochemistry when employed in a semiquantitative mode, and explores the possibility of fulfilling the full potential of immunohistochemistry, as a true quantitative immunoassay applied in a tissue section environment.     

建立中药注射剂综合标准化质量控制体系的思考

目的综合控制中药注射剂的产品质量,降低临床安全风险,探索在药品生产企业中建立中药注射剂综合标准化质量控制体系。方法应用药品质量风险管理的主要工具HACCP原理,对中药注射剂原料、生产、运输、临床使用过程中的各个环节进行危害分析,确定关键控制技术标准。结果与结论建立中药注射剂综合标准化质量控制体系,将极大地加强药品生产企业对中药注射剂产品质量的控制。     

急诊管理标准化的解读和应用框架

推行急诊科管理标准化,为急诊科工作提供了全面有效的改进方法。从以患者为中心,维护患者权利和安全;以急诊医疗护理技术质量和服务质量为关键点;遵循系统原理,改进急诊工作流程;以人为本,规范急诊人力资源管理等方面介绍了急诊管理标准化的原则,指出建立健全急诊规章制度、设定急诊质量监控点是急诊管理标准化的关键要点,认为推行急诊管理标准化,可以建立健全工作程序,取得最佳疗效,可以提高人员适应度,尽快进入工作角色。     

中医药标准化建设与教学

近年来国内外对中医药标准化的需求,已经成为中医药传承、推广和发展的重要问题。因此,培养中医药标准化人才,具有长远、重要的意义。该文建议把中医药标准化建设与教学结合起来,从根本上做起,把今后的每一个中医药从业者,都培养成为中医药标准化建设的实践者,以更好的促进中医药标准化的建设与发展。     

美国药品风险评估与减低计划的简介与启示

目的为发展我国药品风险减低的相关举措提供参考。方法通过对美国药品风险评估与减低计划文献资料的查阅,对文献研究的方法进行研究。结果美国药品风险评估与减低计划的发展已较完善,并逐步标准化、系统化。结论美国药品风险评估与减低计划的运用及标准化措施可为我国药品风险减低相关举措的发展提供参考。     

一例与华法林多药联用致使INR增高的病例分析

1例74岁男性患者因既往有房颤、左房血栓,长期服用华法林0.625mgqd治疗,国际标准化比值(INR)稳定在1.22～2.01。本次因"反复咳嗽咳痰气喘六年,加重三天"入院。后使用哌拉西林钠他唑巴坦钠4.5gbid联合阿奇霉素500mgqd抗感染治疗,入院第5天因恶心呕吐加用注射用奥美拉唑钠40mgqd治疗,入院第10天查INR为5.09,停华法林,加维生素K110mg肌注,第11天INR为4.56,继续予维生素K110mg肌注,第12天开始INR稳定在1.15～1.31,第18天开始恢复使用华法林0.625gqd。     

基于UPOINTS的中西医结合治疗慢性前列腺炎的规范化思考

根据慢性前列腺炎的发病机制与治疗现状,分析UPOINTS分类系统及其临床价值,结合中医学对慢性前列腺炎的认识与辨治特点,探讨UPOINTS与中医辨证论治结合的具体方法和意义。认为根据前列腺炎UPOINTS的分类体系,将现有的中医辨证分型和方剂归类,有利于促进中西医结合治疗慢性前列腺炎的规范化,达到有序治疗的目的。     

小儿哮喘中医辨证分型

小儿哮喘辨证分型结果表明,目前小儿哮喘的分型标准可分为现行标准、名老中医经验和古今文献3类。现行标准及名家经验将本病分为发作期和缓解期,并根据患儿的具体临床表现辨证分型。古代文献则多以哮喘的病因、病位、病理产物分型论治。现代文献在此基础上融入体质学说,更有学者参照上述分型方法综合辨证,进一步补充了小儿哮喘的辨证分型方式。但目前本病缺乏统一的辨证分型标准,为中医临床规范治疗带来了极大的不便,有待专家继续研究,达成共识。     

护理本科生规范化课间见习管理模式的实施与效果评价

对辽宁省两所教学医院护理本科课间见习教学的带教教师严格遴选、规范培训,实施聘任制、动态管理及新模式课间见习管理等措施。实施后带教教师教学能力、教学态度、对学生的管理能力及学生的学习成绩均有所改善或提升（P〈0.05）。规范化课间见习教学管理模式对师资队伍建设具有重要意义,为临床教学质量提供了有力保障。