国外急诊专科医师胜任力框架及其应用概述

目的 对国外急诊专科医师胜任力要求及其应用进行比较分析,为我国开展急诊专科医师胜任力研究提供参考。方法 以美国、欧洲、加拿大和澳大利亚为研究对象,运用文献研究法检索国外相关机构官方网站和外文数据库,收集和分析各国急诊专科医师胜任力相关文献。结果 经过检索,共获得相关资料和文献1 740余篇,初筛后纳入文献136篇,复筛后最终纳入文献24篇。结论 胜任力研究已逐渐成为各国开展急诊专科医师培养的基础和关键,研究对于规范我国急诊医师培养和考核具有较强的借鉴意义。     

国际临床路径研究热点与前沿的文献计量分析

目的 揭示国际临床路径的研究热点、研究前沿和主题结构，为国内学者及相关机构临床路径战略研究领域的选择与临床路径的制定提供决策依据。方法 采用高频主题词共词聚类分析方法，依据各类的内容分析当前研究热点，并通过主题战略坐标揭示研究前沿与主题结构。结果 2001—2010年，国际临床路径研究形成了13个主要的热点主题。结论 临床路径具有多学科特征，已经形成腹腔镜手术、肿瘤与临终关怀、精神疾病、循证医学和临床指南依从性研究等比较成熟和稳定的研究主题；老年病人健康服务成为该领域的研究中心，有着巨大的发展潜力；临床路径电子化、艾滋病和护士角色等主题可能成为未来研究的热点和新的发展方向。     

我国ICD-10疾病分类编码质量的系统评价

目的 基于文献,系统评价我国出院疾病诊断分类的编码质量。方法 计算机检索SINOMED(CBMdisc)、中国知网（CNKI）、维普数据库（VIP）、万方数据库,并辅以文献追溯的方法,收集2000-2014年间在国内公开发表的所有住院病历出院疾病编码错误率的文章。按纳入和排除标准筛选文献并评价其质量,采用描述性分析方法对编码质量进行定性系统评价。结果 纳入30篇文献中,19篇报道了总体编码错误率,研究对象为全部或大部分疾病10篇,仅针对特定种类或某专科疾病的文献9篇,编码错误率中位数分别是12.99%和20.41%,两者间差异无统计学意义,P＝0.121。编码错误率与时间无关但与研究样本量存在负相关关系,r_s＝-0.702,P＝0.001。16篇报道主要诊断编码错误率的文献中,8篇报道了主要诊断总错误率,11篇文献报道了主要诊断选择的错误率,错误率中位数分别为24.77%和5.17%。结论 我国编码质量水平总体上与现有标准仍存较大差距,政策制定者、医院管理者及病案编码人员应采取更有效措施来缩小差距,提高编码质量。

     

基于共词聚类分析法我国医改研究走向

目的 搜集近年来关于医药卫生体制改革的研究文献,分析研究热点。方法 以维普中文科技期刊数据库为数据来源,分别统计分析了在中文核心期刊上发表的2002—2005年、2006—2009年间研究医药卫生体制改革的文献中出现的关键词,统计词频,利用SPSS13.0统计软件对高频关键词进行系统聚类分析,得到研究热点。结果 共搜集到文献708篇,其中2002—2005年282篇,2006—2009年426篇,出现词频超过20次的关键词分别有15个和22个,共得到9个研究热点。结论 关于医药卫生体制改革的研究热点涉及公共卫生服务体系、医疗服务体系、医疗保障体系以及药品供应保障体系,社区卫生服务、医疗机构体制改革一直为研究热点,农村医疗保险改革成为新的热点,药品价格形成机制及改革、护理工作的流程改革及护理质量管理亦是研究热点。     

骨科3D打印技术临床研究的状况分析

目的 研究骨科3D打印技术临床研究状况。方法 通过文献检索,对纳入的107篇文献进行系统性综述,描述骨科3D打印技术临床研究的基本状况。结果 骨科3D打印技术临床研究对象以男性为主,主要集中在成人群体,并且研究时间主要在2007年~2012年。3D打印技术经常应用于骨科手术的复位内固定、畸形矫正、椎弓根钉置入、肿瘤切除、翻修重建、膝关节置换。结论 骨科3D打印技术仍处在初步临床发展阶段。     

我国公立医院规制策略失效现况及影响因素因子分析

?????? 目的 探讨医院规制的主要失效关键节点及导致规制效果不佳的主要因素。方法 采用文献研究及专题小组讨论法,构建医院规制框架;通过调查研究分析医院规制失效主要内容;运用因子分析法分析规制效果不佳的主要因素。结果 确立了包括准入、价格等10项规制措施的医院整体规制框架,其失效程度最严重的为价格规制、行为规制及补偿规制,导致规制整体效果不佳的公因子为监管体制、条件等行政支持因子与监管执行的障碍因子2项。结论 构建医院规制体系,明确各措施的失效程度,提出导致规制效果不佳的公因子,为今后医院规制研究与政策制定提供参考依据。     

基于德尔菲法的外科手术风险因素评价指标构建

目的 构建外科手术风险因素评价指标体系,为有效监管外科手术质量与安全提供参考依据。方法 运用文献分析法、德尔菲法、层次分析法进行外科手术风险因素评价体系的构建和指标权重的确定。结果 建立了一个由手术固有风险、医疗机构风险、医务人员风险、患者风险4 个一级指标和手术本身风险、医务人员专业技术水平、患者个体差异、医务人员责任心、医学科学的局限性、医院诊疗流程、医务人员团队协作,医院诊疗服务水平、工作负荷等等20 个二级指标组成的手术风险因素评价指标体系。结论 建立一套完善的外科手术风险因素评价指标体系,对于保障手术患者安全、有效进行外科手术质量与安全监管具有重要意义。     

基于文献计量学的《中国医院管理》文献可视化分析

目的 通过文献计量学方法,探索《中国医院管理》的发展脉络及医院管理领域近年来的科研合作演进过程。方法 利用信息可视化分析软件CiteSpace,对近10年（2006—2015年）间刊发在《中国医院管理》的科学文献进行文献计量学分析（共有4 169篇文献纳入）。结果 其中高产作者有方鹏骞、薛迪、吴群红等,分别达到56篇、51篇、22篇。高产单位有华中科技大学同济医学院医药卫生管理学院、哈尔滨医科大学附属第一医院和首都医科大学卫生管理与教育学院,合作频次分别达到187次、96次和56次。其中“公立医院”“医院管理”“医疗质量”等关键词共现率较高均超过100次。2013年后“医药分开”“患者安全”“合理用药”和“县级公立医院等”等内容逐渐成为研究热点。结论 《中国医院管理》杂志是广大读者了解和学习医院管理领域研究热点和重大成果的重要平台。     

卫生知识产权人才培养机制与培训体系构建

目的 通过分析现有的知识产权人才培养相关文献了解现状,为构建卫生知识产权人才培养机制与培训体系提供参考意见。方法 制定检索词及检索策略,共检索相关文献90篇,根据已定文献纳入及排除标准,最终纳入文献7篇,最终纳入分析7篇。结果 我国知识产权人才培养取得了很大的进步,但卫生知识产权人才培养机制与培养体系仍不够完善,存在人才培养意识不够、人才结构不合理、师资力量不足等问题。结论 建立医学院校、医院、卫生专利代理机构共同合作的卫生知识产权人才培养体系,构建卫生知识产权人才库,设置高端卫生知识产权人才培养计划。     

基于患者体验的医疗服务质量关键指标体系构建

??????? 目的 初步构建基于“患者体验”的医疗服务质量关键指标体系。方法 通过检索国内外相关文献,构建指标体系框架和专家咨询表并进行2轮专家咨询,确定了基于“患者体验”的医疗服务质量关键指标体系。结果 构建基于“患者体验”的医疗服务质量关键指标体系,一级指标有有形性、可靠性、反应性、保证性、关怀性和连续性6个,二级指标28个,三级指标83个。结论 基于患者体验的医疗服务质量关键指标体系具有很强的实用性,为患者体验量表开发奠定基础。研究结果对于改进我国医疗服务质量评价手段和策略具有重要意义。     

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

Abstract

Purpose: It is suggested that tumour markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) could be used to predict the stage of pancreatic cancer. However, optimal cut-off values for CEA and CA19-9 are disputable. This study aimed to assess the value of CEA and CA19-9 serum levels at diagnosis of pancreatic ductal adenocarcinoma (PDAC) as predictors for the advanced stage of PDAC in patients discussed at pancreatic multidisciplinary team (MDT) meetings.

Methods: Patients with suspected PDAC discussed at MDT meetings from 2013 to 2017 were reviewed, in order to determine optimal cut-off values of both CEA and CA19-9.

Results: In total, 375 patients were included. Optimal cut-off values for predicting advanced PDAC were 7.0?ng/ml for CEA and 305.0?U/ml for CA19-9, resulting in positive predictive values of 83.3%, 73.6%, and 91.4% for CEA, CA19-9 and combined, respectively. Both tumour markers were independent predictors of advanced PDAC, demonstrated by an odds ratio of 4.21 (95% CI:1.85–9.56; p?=?0.001) for CEA and 2.58 for CA19-9 (95% CI:1.30–5.14; p?=?0.007).

Conclusions: CEA appears to be a more robust predictor of advanced PDAC than CA19-9. Implementing CEA and CA19-9 serum levels during MDT meetings as an additional tool for establishing tumour resectability is worthwhile for tailored diagnostics.     

多学科协作诊疗模式在青年医师培养中的运用

通过对多学科协作(Multidisciplinary Team,MDT)诊疗模式应用于青年医师培养的效果观察,结果表明,基于临床路径的MDT管理集合了临床规范性、资源整合性、患者中心性、专业互补性等特性,通过形式和内容的改进,将原以患者诊治为目的的管理手段赋予教学性质,以其为平台与抓手,并作为青年医师培养的一项重要手段,可切实提升医师综合能力。

     

Decadal heat and drought drive body size of North American bison (Bison bison) along the Great Plains

Large grazers are visible and valuable indicators of the effects of projected changes in temperature and drought on grasslands. The grasslands of the Great Plains have supported the greatest number of bison (Bison bison; Linnaeus, 1758) since prehistoric times. We tested the hypothesis that body mass (BM, kg) and asymptotic body mass (ABM, kg) of Bison decline with rising temperature and increasing drought over both temporal and spatial scales along the Great Plains. Temporally, we modeled the relationship of annual measures of BM and height (H, m) of 5,781 Bison at Wind Cave National Park (WICA) from 1966 to 2015. We used Gompertz equations of BM against age to estimate ABM in decadal cohorts; both females and males decreased from the 1960s to the 2010s. Male ABM was variable but consistently larger (699 vs. 441 kg) than female ABM. We used local mean decadal temperature (MDT) and local mean decadal Palmer Drought Severity Index (dPDSI) to model the effects of climate on ABM. Drought decreased ABM temporally (?16 kg/local dPDSI) at WICA. Spatially, we used photogrammetry to measure body height (H_E) of 773 Bison to estimate BM_E in 19 herds from Saskatchewan to Texas, including WICA. Drought also decreased ABM spatially (?16 kg/local dPDSI) along the Great Plains. Temperature decreased ABM both temporally at WICA (?115 kg/°C local MDT) and spatially (?1 kg/°C local MDT) along the Great Plains. Our data indicate that temperature and drought drive Bison ABM presumably by affecting seasonal mass gain. Bison body size is likely to decline over the next five decades throughout the Great Plains due to projected increases in temperatures and both the frequency and intensity of drought.     

Effects of Multidisciplinary Team Care on the Survival of Patients with Different Stages of Non-Small Cell Lung Cancer: A National Cohort Study

In Taiwan, cancer is the top cause of death, and the mortality rate of lung cancer is the highest of all cancers. Some studies have demonstrated that multidisciplinary team (MDT) care can improve survival rates of non-small cell lung cancer (NSCLC) patients. However, no study has discussed the effect of MDT care on different stages of NSCLC. The target population for this study consisted of patients with NSCLC newly diagnosed in the 2005–2010 Cancer Registry. The data was linked with the 2002–2011 National Health Insurance Research Database and the 2005–2011 Cause of Death Statistics Database. The multivariate Cox proportional hazards model was used to explore whether the involvement of MDT care had an effect on survival. This study applied the propensity score as a control variable to reduce selection bias between patients with and without involvement of MDT care. The adjusted hazard ratio (HR) of death of MDT participants with stage III & IV NSCLC was significantly lower than that of MDT non-participants (adjusted HR = 0.87, 95% confidence interval = 0.84-0.90). This study revealed that MDT care are significantly associated with higher survival rate of patients with stage III and IV NSCLC, and thus MDT care should be used in the treatment of these patients.     

小柱芥属植物分类及地理分布研究

小柱芥属(Microstigma Trautv.)为十字花科(Brassicaceae)一寡种属,目前由于缺乏系统研究,存在属内物种划分不明确,地理分布不确定等问题。该文通过在甘肃、内蒙古的标本采集,以及GBIF的标本记载和相关文献的查阅,对小柱芥属植物的形态特征和地理分布进行了详细描述,确定了小柱芥属内的物种数目并编制了属内物种检索表,绘制了地理分布图。结果表明:支持尤那托夫小柱芥(Microstigma junatovii)为一个独立的种,同时该种为中国新分布记录种;确定小柱芥属为蒙古高原近特有属,含4个种。该研究不仅丰富了中国小柱芥属的物种多样性,为小柱芥属的植物鉴定提供了理论依据,也为蒙古高原植物区系、植被等相关研究积累了新资料。     

A systematic review and meta-analysis of the association of transforming growth factor β receptor I 6A/9A gene polymorphism with ovarian cancer risk

Abstract

Ovarian cancer is the leading cause of cancer-related death in women. This meta-analysis was conducted to evaluate the association of transforming growth factor β receptor I (TβR-I) 6A/9A gene polymorphism with ovarian cancer risk. The association literatures were identified from PubMed and Cochrane Library on 1 October 2013, and eligible reports were recruited and synthesized. Four reports were recruited into this meta-analysis for the association of TβR-I 6A/9A gene polymorphism with ovarian cancer risk. 6A allele and 6A/6A genotype of TβR-I were associated with the ovarian cancer risk (6A: OR?=?1.24, 95% CI: 1.02–1.51, p?=?0.03; 6A/6A: OR?=?2.30, 95% CI: 1.01–5.22, p?=?0.05). However, TβR-I 9A/9A genotype was not associated with the risk of ovarian cancer (OR?=?0.82, 95% CI: 0.66–1.02, p?=?0.08). In conclusion, TβR-I 6A allele and 6A/6A genotype are associated with the ovarian cancer risk. However, more studies should be performed to confirm this relationship in the future.     

Anticancer Potential of the Plant-Derived Saponin Gracillin: A Comprehensive Review of Mechanistic Approaches

With the increasing prevalence of cancer and the toxic side effects of synthetic drugs, natural products are being developed as promising therapeutic approaches. Gracillin is a naturally occurring triterpenoid steroidal saponin with several therapeutic activities. It is obtained as a major compound from different Dioscorea species. This review was designated to summarize the research progress on the anti-cancer activities of gracillin focusing on the underlying cellular and molecular mechanisms, as well as its pharmacokinetic features. The data were collected (up to date as of May 1, 2023) from various reliable and authentic literatures comprising PubMed, Springer Link, Scopus, Wiley Online, Web of Science, ScienceDirect, and Google Scholar. The findings demonstrated that gracillin displays promising anticancer effects through various molecular mechanisms, including anti-inflammatory effects, apoptotic cell death, induction of oxidative stress, cytotoxicity, induction of genotoxicity, cell cycle arrest, anti-proliferative effect, autophagy, inhibition of glycolysis, and blocking of cancer cell migration. Additionally, this review highlighted the pharmacokinetic features of gracillin, indicating its lower oral bioavailability. As a conclusion, it can be proposed that gracillin could serve as a hopeful chemotherapeutic agent. However, further extensive clinical research is recommended to establish its safety, efficacy, and therapeutic potential in cancer treatment.