静配中心危害药品调配的环境建设与人员防护——《静脉用药调配中心建设与管理指南》系列解读(七)

本文从危害药品概念、负压调配环境、调配操作规范、防护着装要求、成品输液复核打包、废弃物处理、溢出应急预案等方面对《静脉用药调配中心建设与管理指南(试行)》中危害药品调配的相关内容进行全方位解读,深入探讨危害药品调配各环节的注意事项,以提高静配中心负责人对危害药品调配环境的重视程度,确保负压环境,强化调配人员的职业防护意识,严格着装和规范操作,最大程度地减少职业暴露,降低职业伤害。只要我们严格按照《指南》规定执行落实,遵守规章制度、规范操作流程、加强技能培训和监督管理,危害药品调配完全是可以安全运行的。     

河北省农村老年人医疗服务利用及影响因素

目的 了解河北省农村老年人医疗服务利用现状及影响因素。方法 于2021年8—9月采用随机分层法选取河北省1 395名农村老年人为研究对象,以安德森行为模型为分析框架,采用Logistic回归模型分析倾向因素、能力因素、利用因素对农村老年人医疗服务利用的影响。结果 农村老年人偶尔使用一般医疗服务1 029人(73.76%);1年内住院医疗服务利用654人(46.88%)。Logistic回归分析结果显示,年龄(70岁以上)、婚姻状况(单身)2个倾向因素,到医疗机构距离1 km及以上、到医疗机构所需时间10 min以内、商业保险、家庭功能、主观支持5个能力因素,健康状况及生理健康、共病指数2个利用因素,是农村老年人医疗服务的影响因素(P<0.05,P<0.01)。结论 河北省农村老年人的一般医疗服务利用较低,住院医疗服务利用处于中等水平,对医疗服务基本满意;倾向因素、能力因素和利用因素可影响医疗服务利用。     

广州市某区居民对社区卫生服务的需求利用和满意度分析

目的　了解广州市居民对社区卫生服务机构的利用情况、公共卫生基本项目的知晓情况和满意度情况,为改善广州市社区卫生服务质量提供方向和参考依据。方法　2020年12月,采取多阶段随机抽样的方法在广州市某区抽取1 050名居民进行问卷调查。单因素分析采用Pearson卡方检验,多因素分析采用二元logistic回归。结果　共发放问卷1 092份,收到有效问卷1 050份,有效率96.2%。受访居民过去一年在社区卫生服务中心看病或接受其他卫生服务的次数为（4.60±4.10）次;对公共卫生基本服务项目总知晓率为91.6%（962/1 050）,总知晓免费率为89.5%（940/1 050）;居民的社区卫生服务机构总体满意度得分为（4.61±0.75）分,其中得分最高为基本医疗服务情况,最低为机构设施、制度及基本情况。单因素分析发现,医保类型、就诊首选的医疗机构、步行到社区中心的时间和就诊服务时间等10个因素是居民总体满意度的影响因素;多因素分析发现机构设施、制度及基本情况,基本医疗服务情况,医疗费用情况,首诊医院4个因素为居民总体满意度的影响因素（OR值分别为21.294、109.013、18.203和20.989）。结论　广州市某区居民对社区卫生服务的利用情况较好,公共卫生服务项目的知晓率较高,但居民的社区卫生服务满意度仍有待提高,尤其是设施设备和医护人员服务效率等方面。     

新冠肺炎疫情防控期间急诊腹部多发伤一体化救治管理及对策

探讨新型冠状病毒肺炎（NCP）疫情期间急诊科接诊腹部多发伤的安全防护管理及高效救治流程及对策。制定规划急诊科安全防护管理方案及腹部多发伤一体化救治方案,制定急诊科疫情防控标准管理流程及腹部多发伤一体化救治管理流程,在把好预防NCP“四个安全防护管理环节”上,做到确保病区安全,避免院内交叉感染的发生;通过实施以上救治措施,提高了救治效果、降低了死亡率。按照全防护管理流程及腹部多发伤一体化救治管理流程保证了NCP疫情期间急诊科病区安全、医护人员安全、患者和陪护家属安全,无疫情不良事件发生,同时显著提高了腹部多发伤患者的抢救成功率。     

The impact of COVID-19 on the provision of cardiac surgical services

The global pandemic caused by COVID-19 has had a significant global impact on healthcare systems. One implication of this pandemic is the cancellation of elective cardiac surgeries and the centralization of services. As a result, hospitals in Europe, North America, and the United Kingdom have had to alter the services offered to patients to be able to cope with service provision for COVID infected patients. Data should be collected during this period to provide a good insight following the lockdown period to understand the implication of such service alteration. Future research should also focus on the effects on long-term mortality and morbidity as well as financial implications on hospitals as a result of these changes.     

The COVID‐19 pandemic: considerations for resuming normal colorectal services

This European Society of Coloproctology guidance focuses on a proposed conceptual framework to resume standard service in colorectal surgery. The proposed conceptual framework is a schematic and stepwise approach including: in‐depth assessment of damage to non‐COVID‐19‐related colorectal service; the return of service (integration with the COVID‐19‐specific service and the existing operational continuity planning); safety arrangements in parallel with minimizing downtime; the required support for staff and patients; the aftermath of the pandemic and continued strategic planning. This will be dynamic guidance with ongoing updates using critical appraisal of emerging evidence. We will welcome input from all stakeholders (statutory organizations, healthcare professionals, public and patients). Any new questions, new data and discussion are welcome via https://www.escp.eu.com/guidelines .     

MSeqDR mvTool: A mitochondrial DNA Web and API resource for comprehensive variant annotation,universal nomenclature collation,and reference genome conversion

Accurate mitochondrial DNA (mtDNA) variant annotation is essential for the clinical diagnosis of diverse human diseases. Substantial challenges to this process include the inconsistency in mtDNA nomenclatures, the existence of multiple reference genomes, and a lack of reference population frequency data. Clinicians need a simple bioinformatics tool that is user‐friendly, and bioinformaticians need a powerful informatics resource for programmatic usage. Here, we report the development and functionality of the MSeqDR mtDNA Variant Tool set (mvTool), a one‐stop mtDNA variant annotation and analysis Web service. mvTool is built upon the MSeqDR infrastructure ( https://mseqdr.org ), with contributions of expert curated data from MITOMAP ( https://www.mitomap.org ) and HmtDB ( https://www.hmtdb.uniba.it/hmdb ). mvTool supports all mtDNA nomenclatures, converts variants to standard rCRS‐ and HGVS‐based nomenclatures, and annotates novel mtDNA variants. Besides generic annotations from dbNSFP and Variant Effect Predictor (VEP), mvTool provides allele frequencies in more than 47,000 germline mitogenomes, and disease and pathogenicity classifications from MSeqDR, Mitomap, HmtDB and ClinVar (Landrum et al., 2013). mvTools also provides mtDNA somatic variants annotations. “mvTool API” is implemented for programmatic access using inputs in VCF, HGVS, or classical mtDNA variant nomenclatures. The results are reported as hyperlinked html tables, JSON, Excel, and VCF formats. MSeqDR mvTool is freely accessible at https://mseqdr.org/mvtool.php .     

The past,present and future of service delivery in genetic counseling: Keeping up in the era of precision medicine

Precision medicine aims to approach disease treatment and prevention with consideration of the variability in genes, environment, and lifestyle for each person. This focus on the individual is also key to the practice of genetic counseling, whereby foundational professional values prioritize informed and autonomous patient decisions regarding their genetic health. Genetic counselors are ideally suited to help realize the goals of the precision medicine. However, a limited genetic counseling workforce at a time in which there is a rapidly growing need for services is challenging the balance of supply and demand. This article provides historical context to better understand what has informed traditional models of genetic counseling and considers some of the current forces that require genetic counselors to adapt their practice. New service delivery models can improve access to genetic healthcare by overcoming geographical barriers, allowing genetic counselors to see a higher volume of patients and supporting other healthcare providers to better provide genetic services to meet the needs of their patients. Approaches to genetic counseling service delivery are considered with a forward focus to the challenges and opportunities that lie ahead for genetic counselors in this age of precision health.     

颌骨大型牙源性囊性病变的微创治疗

目的探讨袋成形术联合应用阻塞器治疗颌骨大型牙源性囊性病变的临床效果。方法颌骨大型牙源性囊性病变患者36例,采用袋成形术联合应用阻塞器治疗,术后3、6、12个月复诊,行临床检查及拍摄X线曲面断层片,记录囊腔影像面积变化,术后6~12个月对仍存留的囊肿行Ⅱ期囊肿刮切术。结果 36例患者术后3~6个月面部膨隆畸形均基本消失或完全消失,无1例患者出现伤口感染;10例患者囊腔体积缩小大于90%,24例囊腔体积缩小率达到80%~90%,2例囊腔体积缩小在60%以上;Ⅱ期囊肿刮切术后继续随访1年囊肿无复发,形态功能均恢复良好。结论袋成形术联合应用阻塞器治疗颌骨大型囊性病变,可改善患者颌骨膨隆畸形,最大程度保留颌骨解剖结构及生理功能,疗效肯定。