9所大学附属医院职业化管理认知及培训需求分析

目的 调查并分析某医科大学9所附属医院职能部门工作人员对管理人员职业化的认知和培训需求。方法 采用整群抽样法,向9所附属医院的职能部门工作人员发放调查问卷,调查内容包括个人基本情况、工作情况、培训情况等五部分内容,共发放799份问卷,回收799份问卷,回收率100%。结果 9所附属医院职能部门工作人员中,有78.7%对未来职业发展有信心,21.0%认为目前的医院管理职业化建设不完善,57.5%认为医院中高层管理者应该来源于卫生管理专业人员,59.4%认为培训次数不够,60.4%认为迫切需要进行管理知识培训。结论 大多数医院管理人员对未来职业化发展有信心,但是目前医院管理知识培训存在不足,建议大学与附属医院合作开展系统的个性化的医院管理知识培训,提高医院管理水平,促进管理队伍职业化发展。     

Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial

ObjectiveTo evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care.DesignRandomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months.SettingPopulation of residential facility in Sydney living in self care units and hostels.Participants220 depressed residents aged ⩾65 without severe cognitive impairment.InterventionThe shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c) depression related health education and activity programmes for residents. The control group received routine care.ResultsIntention to treat analysis was used. There was significantly more movement to “less depressed” levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011).ConclusionsThe outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.

Key messages

• Large numbers of depressed elderly people live in residential care but few receive appropriate management
• A population based, multifaceted shared care intervention for late life depression was more effective than routine care in improving depression outcome
• The outcome of late life depression can be improved by enhancing the clinical skills of general practitioners and care staff and by providing depression related health education and activity programmes for residents
• The intervention needs further refining and evaluation to improve its effectiveness and to determine how best to implement it in other residential care settings

     

Strength of patient cohorts and biobanks for cardiomyopathy research

In 2011 the Netherlands Heart Foundation allocated funding (CVON, Cardiovasculair Onderzoek Nederland) to stimulate collaboration between clinical and preclinical researchers on specific areas of research. One of those areas involves genetic heart diseases, which are frequently caused by pathogenic variants in genes that encode sarcomere proteins. In 2014, the DOSIS (Determinants of susceptibility in inherited cardiomyopathy: towards novel therapeutic approaches) consortium was initiated, focusing their research on secondary disease hits involved in the onset and progression of cardiomyopathies. Here we highlight several recent observations from our consortium and collaborators which may ultimately be relevant for clinical practice.

     

Book Reviews

Teach Yourself Genetics R. J. BERRY pp. xi+164, 24 figs. London: The English Universities Press Ltd, 1965. 7s. 6d. Reviewed by G. Haskell

The Tissues of The Body (5th ed.). SIR W. E. LE GROS CLARK xi+423 pp. Oxford: Clarendon Press, 1965. 55s. Reviewed by P. C. Williams

Nuffield Biology Texts and Teachers' Guides I. Introducing Living Things II. Life and Living Processes HI. The Maintenance of Life IV. Living Things in Action Longmans/Penguin 1966. Volume V, to be published April 1967—not reviewed. Reviewed by John Mattocks and Peter Prosser

Animal Biology A. J. GROVE and G. E. NEWELL In collaboration with J. D. CARTHY and E. H. MERCER University Tutorial Press. 7th Edition. 38s. 6d. Reviewed by W. H. Freeman     

The coastal upwelling ecosystems analysis program as an experience in international cooperation

Abstract

The Coastal Upwelling Ecosystems Analysis CUEA) Project, the major effort in the Living Resources part of the United States Program for the International Decade of Ocean Exploration (IDOE), included a variety of approaches to international involvement. Escalating cost, expanded geographical scope, and increasing insistence on coastal state participation in research projects off foreign shores heighten the likelihood that similar large‐scale, long‐term research efforts will require particular attention to international cooperation and collaboration. A look at the international aspects of CUEA is timely and instructive. This discussion reviews the background to the upwelling project, the nature of international involvement, and closes with some observations about the requirements for similar projects in the future.     

Eficiencia del apoyo de Geriatría Transversal en el manejo de pacientes mayores de 80 años ingresados en el Servicio de Cirugía General. Resultados en la liberación de estancias y el coste asociado

ObjectiveTo determine the efficiency of «Cross-speciality Geriatrics» program in patients older than 80 years admitted to the Colorectal Pathology Unit of a General Surgery Department.Material and methodsA «before-after» study was conducted. The initial period (usual treatment for General Surgery) included patients admitted from 1^st January to 31^st August 2018, and the subsequent period (with support from geriatrics) from 1^st January to 31^st December 2019. Two types of patients were studied: Type 1, who were admitted to the Emergency Department, and Type 2, programmed admissions for colorectal cancer intervention. The Geriatrics intervention consisted of daily monitoring in the ward, collaboration in clinical management, and discharge planning. Furthermore, in Type 2 patients, a previous visit was made in the clinic, which included the detection and approach of frailty and pre-habilitation for surgery.ResultsA total of 175 patients were included, of whom 53 were treated by General Surgery and 122 with the co-management of geriatrics. The mean age was 84.9 years (SD 4.8). In the period with the Cross-speciality Geriatrics program, the mean stay was reduced by 10.6 days (39%), and 8.5 days (44%) in types 1 and 2, respectively (P < .01). This led to a decrease in bed occupancy (3.3 beds/day) and a cost reduction (1,215,970 € / year).ConclusionsThe support of Cross-speciality Geriatrics in patients older than 80 years admitted to General Surgery is an efficient care model. These data support its implementation in hospitals where this care line has not yet been developed     

Endocrine-Metabolic Pathophysiologic Conditions and Treatment Approaches After Kidney Transplantation

ObjectiveTo review pathophysiologic conditions and diagnostic and therapeutic approaches in the management of endocrine-metabolic disorders after kidney transplanta tion (KT).MethodsWe discuss the assessment of diabetes mel litus (DM), hyperlipidemia, hypertension, and disturbances of bone and mineral metabolism after KT.ResultsKT offers patients with end-stage kidney disease substantial improvement in life expectancy and quality of life. Despite amelioration of renal dysfunction, however, these patients are at risk for the deterioration of existing and the development of new endocrine pathologic conditions. Pretransplant DM and new-onset diabetes after transplantation are associated with worse patient and graft survival. Little is known about preventing new-onset dia betes after transplantation and managing DM shortly after KT. In addition to glycemic control in patients with dia betes, management of cardiovascular risk factors includes appropriate recognition and treatment of hypertension and dyslipidemia. After KT, patients are at considerable risk for derangements in calcium and vitamin D metabolism. Immunosuppressive medications may cause compromised glucose and lipid metabolism, which may, in turn, contrib ute to the progression of preexisting and the development of new posttransplant endocrinopathies.ConclusionClinical care of kidney transplant patients should include a comprehensive endocrine assessment before and after KT in close collaboration with transplant nephrology providers. A referral to an endocrinologist should be initiated early during the pretransplant stage, and collaborative management should be maintained in kidney transplant patients to improve clinical outcomes. (Endocr Pract. 2012;18:579-590)     

微生物与肺癌研究的知识图谱构建及可视化分析

【背景】微生物与肺癌的发生发展密切相关，该领域研究已成为国内外持续关注的焦点。【目的】对微生物与肺癌相关的文献进行文献计量分析，分析该领域的研究现状和发展趋势，为后续研究提供参考。【方法】收集Web of Science Core Collection （WOSCC）、中国知网（China National Knowledge Infrastructure，CNKI）、万方（Wanfang）与维普（VIP database for Chinese technical periodicals，VIP）等数据库的文献数据，并通过CiteSpace和VOSviewer对其年发文量、国家/地区、关键词进行可视化分析。【结果】共收录中文文献143篇，英文文献278篇。中国是发文量最多的国家。关键词分析显示，肺癌、肠道微生物、免疫治疗等关键词是该领域的研究热点。【结论】在过去20年中人们已关注到微生物在肺癌致病机制、诊断和治疗中的作用。通过对比这些数据库发现，国内外关注的热点话题基本一致。但该领域仍处于早期发展阶段，研究相对不成熟，缺乏广泛密切的国际合作，未来应进一步加强对该领域前沿热点的深入研究。本文结果有助于研究人员进一步了解该领域前沿热点及发展趋势，为后续研究的深入探索提供参考。     

Learning-by-doing: experience from 20 years of teaching LCA to future engineers

Purpose

In support of the sustainable development of our societies, future engineers should have elementary knowledge in sustainability assessment and use of life cycle assessment. Publications on pedagogical experience with teaching life cycle assessment (LCA) in high-level education are however scarce. Here, we describe and discuss 20 years of experience in teaching LCA at MSc level in an engineering university with the ambition to share our insights and inspire teaching of LCA as part of a university curriculum.

Methods

We detail the design of an LCA course taught at the Technical University of Denmark since 1997. The course structure relies on (i) a structured combination of theoretical teaching, practical assignments and hands-on practice on LCA case studies, and (ii) the conduct of real-life LCA case studies in collaboration with companies or other organisations. Through the semester-long duration of the course, students from different engineering backgrounds perform full-fledged LCA studies in groups, passing through two iterations—a screening LCA supporting a more targeted LCA.

Results and discussion

The course design, which relies on a learning-by-doing principle, is transparently described to inspire LCA teachers among the readers. Historical evolution and statistics about the course, including its 192 case studies run in collaboration with 105 companies and institutions, are analysed and serve as basis to discuss the benefits and challenges of its different components, such as the theory acquisition, the assignment work, the LCA software learning, the conduct of case studies, the merits of industrial collaborations and grading approaches.

Conclusions

We demonstrate the win-win situation created by the setting of the course, in which the students are actively engaged and learn efficiently how to perform an LCA while the collaborating companies often get useful insights into their analysed case studies. The course can also be an eye opener for companies unfamiliar with LCA, who get introduced to life cycle thinking and the potential benefits of LCA. We have no hesitation in recommending industries and LCA teachers to engage into such collaborations even in the fundamental teaching of LCA techniques.

     

External Quality Assessment for Tuberculosis Diagnosis and Drug Resistance in the European Union: A Five Year Multicentre Implementation Study

BackgroundExternal quality assurance (EQA) systems are essential to ensure accurate diagnosis of TB and drug-resistant TB. The implementation of EQA through organising regular EQA rounds and identification of training needs is one of the key activities of the European TB reference laboratory network (ERLTB-Net). The aim of this study was to analyse the results of the EQA rounds in a systematic manner and to identify potential benefits as well as common problems encountered by the participants.MethodsThe ERLTB-Net developed seven EQA modules to test laboratories’ proficiency for TB detection and drug susceptibility testing using both conventional and rapid molecular tools. All National TB Reference laboratories in the European Union and European Economic Area (EU/EEA) Member States were invited to participate in the EQA scheme.ResultsA total of 32 National TB Reference laboratories participated in six EQA rounds conducted in 2010–2014. The participation rate ranged from 52.9% - 94.1% over different modules and rounds. Overall, laboratories demonstrated very good proficiency proving their ability to diagnose TB and drug-resistant TB with high accuracy in a timely manner. A small number of laboratories encountered problems with identification of specific Non-tuberculous Mycobacteria (NTMs) (N = 5) and drug susceptibility testing to Pyrazinamide, Amikacin, Capreomycin, and Ethambutol (N = 4).ConclusionsThe European TB Reference laboratories showed a steady and high level of performance in the six EQA rounds. A network such as ERLTB-Net can be instrumental in developing and implementing EQA and in establishing collaboration between laboratories to improve the diagnosis of TB in the EU/EEA.     

The TOPAS tool for particle simulation,a Monte Carlo simulation tool for physics,biology and clinical research

PurposeThis paper covers recent developments and applications of the TOPAS TOol for PArticle Simulation and presents the approaches used to disseminate TOPAS.Materials and methodsFundamental understanding of radiotherapy and imaging is greatly facilitated through accurate and detailed simulation of the passage of ionizing radiation through apparatus and into a patient using Monte Carlo (MC). TOPAS brings Geant4, a reliable, experimentally validated MC tool mainly developed for high energy physics, within easy reach of medical physicists, radiobiologists and clinicians. Requiring no programming knowledge, TOPAS provides all of the flexibility of Geant4.ResultsAfter 5 years of development followed by its initial release, TOPAS was subsequently expanded from its focus on proton therapy physics to incorporate radiobiology modeling. Next, in 2018, the developers expanded their user support and code maintenance as well as the scope of TOPAS towards supporting X-ray and electron therapy and medical imaging. Improvements have been achieved in user enhancement through software engineering and a graphical user interface, calculational efficiency, validation through experimental benchmarks and QA measurements, and either newly available or recently published applications. A large and rapidly increasing user base demonstrates success in our approach to dissemination of this uniquely accessible and flexible MC research tool.ConclusionsThe TOPAS developers continue to make strides in addressing the needs of the medical community in applications of ionizing radiation to medicine, creating the only fully integrated platform for four-dimensional simulation of all forms of radiotherapy and imaging with ionizing radiation, with a design that promotes inter-institutional collaboration.     

Intensive Metabolic Support : Evolution and Revolution

ObjectiveTo describe a new aspect of critical care termed intensive metabolic support.MethodsWe performed a MEDLINE search of the English-language literature published between 1995 and 2008 for studies regarding the metabolic stages of critical illness, intensive insulin treatment, and intensive metabolic support in the intensive care unit, and we summarize the clinical data.ResultsIntensive metabolic support is a 3-component model involving metabolic control and intensive insulin therapy, early nutrition support, and nutritional pharmacology aimed at preventing allostatic overload and the development of chronic critical illness. To improve clinical outcome and prevent mortality, intensive metabolic support should start on arrival to the intensive care unit and should end only when patients are in the recovery phase of their illness.ConclusionsIntensive metabolic support should be an essential part of the daily treatment strategy in critical care medicine. This will involve a newfound and extensive collaboration between the endocrinologist and the intensivist. We call for well-designed future studies involving implementation of this protocol to decrease the burden of chronic critical illness. (Endocr Pract. 2008;14:1047-1054)     

Occupational low-level exposure to hard metals: cobalt and tungsten biomonitoring as an effective tool to evaluate the effectiveness of industrial hygiene interventions for risk management

Abstract

Purpose: The aim of the study was to assess the exposure to Cobalt (Co) and Tungsten (W) in a group of hard metal tool sharpeners through a combined approach of air and biological monitoring, and to evaluate the effectiveness of a control and improvement intervention carried out in collaboration with the medical officers of the local Health Protection Agency, by biomonitoring.

Methods: We enrolled 132 workers from 17 companies of the province of Brescia, northern Italy. The study was performed in two phases: (1) an environmental and biomonitoring survey to assess the workers’ exposure to Co and W at their usual working conditions; (2) a further biomonitoring survey 3?months after the enforcement of a control and improvement intervention, to assess its effectiveness.

Results: Workers were found to be exposed to low concentration of airborne dust containing Co and W but after the intervention we recorded a significant decrease of the urinary concentrations of both Co and W. The extent of the decrease was correlated to the number of preventive industrial hygiene interventions that were carried out.

Conclusions: Biological monitoring of Co and W in the hard metal tools manufacturing industry is a sensitive and effective method to evaluate the effectiveness of prevention practices.     

Treatment planning systems dosimetry auditing project in Portugal

Background and purposeThe Medical Physics Division of the Portuguese Physics Society (DFM_SPF) in collaboration with the IAEA, carried out a national auditing project in radiotherapy, between September 2011 and April 2012. The objective of this audit was to ensure the optimal usage of treatment planning systems. The national results are presented in this paper.Material and methodsThe audit methodology simulated all steps of external beam radiotherapy workflow, from image acquisition to treatment planning and dose delivery. A thorax CIRS phantom lend by IAEA was used in 8 planning test-cases for photon beams corresponding to 15 measuring points (33 point dose results, including individual fields in multi-field test cases and 5 sum results) in different phantom materials covering a set of typical clinical delivery techniques in 3D Conformal Radiotherapy.ResultsAll 24 radiotherapy centers in Portugal have participated. 50 photon beams with energies 4–18 MV have been audited using 25 linear accelerators and 32 calculation algorithms.In general a very good consistency was observed for the same type of algorithm in all centres and for each beam quality.ConclusionsThe overall results confirmed that the national status of TPS calculations and dose delivery for 3D conformal radiotherapy is generally acceptable with no major causes for concern. This project contributed to the strengthening of the cooperation between the centres and professionals, paving the way to further national collaborations.     

Metabolic Associated Fatty Liver Disease Increases the Risk of Systemic Complications and Mortality. A Meta-Analysis and Systematic Review of 12 620 736 Individuals

ObjectiveThe recent introduction of the term metabolic associated fatty liver disease (MAFLD) sought to reclassify nonalcoholic fatty liver disease (NAFLD). MAFLD is thought to improve the encapsulation of metabolic dysregulation. However, recent evidence has found significant differences between MAFLD and NAFLD, and prevailing knowledge has largely arisen from studies on NAFLD. Hence, we conducted a meta-analysis and systematic review of the outcomes associated with MAFLD.MethodsMEDLINE and Embase databases were searched for articles relating to outcomes in MAFLD. Analysis was conducted in random effects with hazard ratios (HRs) to account for longitudinal risk assessment of mortality and systemic complications.ResultsA total of 554 articles were identified, of which 17 articles were included. MAFLD resulted in an increase in the overall mortality (HR, 1.24; confidence interval [CI], 1.13-1.34), cancer-related mortality (HR, 1.27; CI, 1.01-1.54), and cardiovascular disease mortality (HR, 1.28, 1.03-1.53; P = .04) compared with non-MAFLD. MAFLD also increases the risk of cardiovascular events (HR, 1.49; CI, 1.34-1.64; P < .01), stroke (HR, 1.55; CI, 1.37-1.73; P < .01), and chronic kidney disease (HR, 1.53; CI, 1.38-1.68). The presence of MAFLD was also associated with an increased risk of heart failure, obstructive sleep apnea, and malignancy.ConclusionMAFLD can significantly elevate the risk of systemic diseases and mortality. The care of MAFLD thus requires interdisciplinary collaboration, and future clinical trials conducted on MAFLD should aim to reduce the incidence of end-organ damage aside from improving liver histology.     

Cancer in the Solomon Islands

IntroductionThe Solomon Islands, with a population of 550,000, has significant challenges in addressing non-communicable diseases, including cancer, in the face of significant economic, cultural, general awareness and health system challenges.ObjectivesTo summarise the existing knowledge regarding cancer in the Solomon Islands, to gather new data and make recommendations.MethodsA literature review was undertaken and cancer data from the National Referral Hospital, Honiara were analysed and are presented. Key stakeholders were interviewed for their perspectives including areas to target for ongoing, incremental improvements. Last, a health services audit for cancer using the WHO SARA tool was undertaken.ResultsBreast and cervical cancer remain the first and second most commonly identified cancers in the Solomon Islands. The Solomons cancer registry is hospital based and suffers from incomplete data collection due to its passive nature, lack of resources for data entry and processing resulting in weak data which is rarely used for decision-making. The health system audit revealed system and individual reasons for delayed diagnosis or lack of cancer treatment or palliation in the Solomon Islands. Reasons included lack of patient knowledge regarding symptoms, late referrals to the National Referral Hospital and inability of health care workers to detect cancers either due to lack of skills to do so, or lack of diagnostic capabilities, and an overall lack of access to any health care, due to geographical barriers and overall national economic fragility.ConclusionThe Solomon Islands is challenged in preventing, diagnosing, treating and palliating cancer. Stakeholders recommend establishing specialty expertise (in the form of a cancer unit), improved registry processes and increased collaboration between the sole tertiary hospital nationwide and other Solomon health services as important targets for incremental improvement.     

Working to Improve Care of Hospital Hyperglycemia Through Statewide Collaboration: The Georgia Hospital Association Diabetes Special Interest Group

ObjectiveTo review the efforts of the Georgia Hospital Association Diabetes Special Interest Group (DSIG) to develop and disseminate sample clinical guidelines on management of inpatient hyperglycemia.MethodsBeginning in February 2003, a consortium of physicians and allied health professionals from throughout the state of Georgia began meeting on a frequent basis to formulate a plan to enhance the care of hospitalized patients with hyperglycemia. The immediate goals of the DSIG were the identification and organization of interested stakeholders, the development of consensus sample clinical guidelines, and the dissemination of information.ResultsSince its inception, the DSIG has accomplished the following: development of 7 consensus sample clinical guidelines, construction of a Web site that posts these clinical guidelines and other useful related information and educational materials, and sponsorship of workshops throughout the state of Georgia.ConclusionAs the importance of glucose control in the hospital setting has become increasingly recognized, institutions must find ways of applying results of clinical trials to “real-world” hospital environments. The DSIG is an example of a successful collaboration that could serve as a model for other state hospital organizations that wish to develop programs to enhance the care of inpatients with hyperglycemia. (Endocr Pract. 2007;13:45-50)     

基于CiteSpace的磷转化微生物研究文献计量和可视化分析

【背景】磷转化微生物对于自然环境中的磷循环具有重要作用。此类微生物通过对环境中磷素的溶解矿化和吸收转运等作用促进资源高效利用,减少环境污染,对粮食安全和生态系统稳定也具有积极的影响。【目的】探究近年来国内外关于磷转化微生物的发展热点及趋势,展示该领域的知识结构和知识演化过程,为后续研究提供可行性的参考和启示。【方法】应用Cite Space可视化软件对2002-2022年发表在中国知网(CNKI)和WebofScience(WOS)数据库中的文献通过关键词共现分析、关键词聚类分析、关键词突现分析、发文数量分析、国家分布、作者合作共现及机构合作共现等方式对磷转化微生物的研究现状及新兴趋势进行分析。【结果】最终共筛选出887篇有效文献。磷转化微生物研究在2016年后开始蓬勃发展,近几年增速加快;中国和美国学者是此领域重要的研究力量;中国是发文量最多的国家,中国科学院是发文量最多的机构;热门的研究领域为菌株的分类与筛选、代谢途径、营养元素循环以及环境污染与生态保护。【结论】磷转化微生物具有广阔的发展前景。目前,生物炭及磷转化微生物的响应机制正在成为新的研究热点。此类技术在未来的广泛应用是必然...