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中国儿童川崎病诊疗循证指南(2023年)

中国当代儿科杂志 2023年第12期25卷 1198-1210页

作者：陕西省川崎病诊疗中心/陕西省人民医院儿童病院国家儿童医学中心/首都医科大学附属北京儿童医院上海交通大学医学院附属儿童医院国家区域医疗中心/中国医科大学附属盛京医院国家临床重点专科/上海市儿童医院重症医学科中国医师协会儿科医师分会普儿科学组中国妇幼健康研究会儿科能力建设专家委员会国家卫生健康委员会热带病防治重点实验室延安大学附属医院《中国当代儿科杂志》编辑焦富勇杜忠东黄玉娟李夙凌田园杨晓东王虹不详陕西省川崎病诊疗中心/陕西省人民医院儿童病院国家儿童医学中心/首都医科大学附属北京儿童医院上海交通大学医学院附属儿童医院急诊科延安大学附属医院儿科上海交通大学医学院附属儿童医院健康管理科上海交通大学医学院附属儿童医院心内科国家区域医疗中心/中国医科大学附属盛京医院小儿心脏病科

川崎病(Kawasaki disease,KD)是一种急性自限性血管炎性疾病,是引起5岁以下儿童后天获得性心脏病的最常见原因。国家卫生健康委员会发布的2023年儿科质控工作改进目标之一是降低KD患儿心脏事件的发生率及KD相关病死率。为规范我国KD的... 详细信息

川崎病(Kawasaki disease,KD)是一种急性自限性血管炎性疾病,是引起5岁以下儿童后天获得性心脏病的最常见原因。国家卫生健康委员会发布的2023年儿科质控工作改进目标之一是降低KD患儿心脏事件的发生率及KD相关病死率。为规范我国KD的诊断、治疗和长期管理实践,有效预防、减少冠状动脉病变的发生及远期不良影响,指南工作组遵循世界卫生组织指南制订的原则和方法,参照现有国内外证据和经验形成了《中国儿童川崎病诊疗循证指南(2023年)》。该指南针对KD的分类及定义、不同类型KD的诊断、KD急性期治疗、超声心动图在KD并发症识别中的应用和KD合并巨噬细胞活化综合征的处理等临床问题,基于最佳证据和专家共识形成了20条推荐意见,以期为广大医护人员在儿童KD的诊断与治疗方面提供指导与决策依据。

关键词：川崎病临床实践指南诊断治疗儿童

病毒性脑(膜)炎病原体诊断技术应用专家共识

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中华医学杂志 2023年第9期103卷 648-657页

作者：中国初级卫生保健基金会病原检测专业委员会中国医疗保健国际交流促进会分子诊断学分会中国研究型医院学会神经科学专委会脑炎协作组许松涛关鸿志谢正德范思远不详中国疾病预防控制中心病毒病预防控制所病毒性脑炎室北京102206 中国医学科学院北京协和医学院北京协和医院神经科北京100005 国家儿童医学中心(北京)首都医科大学附属北京儿童医院北京市儿科研究所感染与病毒研究室中国医学科学院儿童危重感染诊治创新单元北京100045 中国医学科学院北京协和医院神经科

病毒性脑(膜)炎是常见的中枢神经系统感染性疾病,是病毒侵袭脑实质与脑膜导致的炎症性疾病。病毒性脑(膜)炎呈世界性分布,临床以急症和重症常见,严重威胁人类健康。多种病毒可导致中枢神经系统感染,包括疱疹病毒、肠道病毒和虫媒病毒等... 详细信息

病毒性脑(膜)炎是常见的中枢神经系统感染性疾病,是病毒侵袭脑实质与脑膜导致的炎症性疾病。病毒性脑(膜)炎呈世界性分布,临床以急症和重症常见,严重威胁人类健康。多种病毒可导致中枢神经系统感染,包括疱疹病毒、肠道病毒和虫媒病毒等,病原体鉴定仍是病毒性脑(膜)炎在临床上的主要难题。为规范、合理地应用病原体诊断技术开展脑脊液的病毒核酸检测与抗体检测,由国内病毒学、传染病学、临床医学及医学检验等领域的专家组成的专家组,经反复讨论达成本共识,主要从国内外病毒性脑(膜)炎病原种类、检测技术及检测策略等方面进行阐述,并提出针对我国病毒性脑(膜)炎病原体的检测策略和方案,以期为病毒性脑(膜)炎的临床诊断以及疾病预防控制提供参考。

关键词：病毒性脑炎病毒性脑膜炎病原体检测脑脊液专家共识

Effectiveness of quality of care for patients with type 2 diabetes in china:findings from the Shanghai Integration Model(SIM)

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Frontiers of Medicine 2022年第1期16卷 126-138页

作者： Chun Cai Yuexing Liu Yanyun Li Yan Shi Haidong Zou Yuqian Bao Yun Shen Xin Cui Chen Fu Weiping Jia the SIM Study group Shanghai Diabetes Institute Shanghai Jiao Tong University Affiliated Sixth People’s HospitalNational Office for Primary Diabetes CareShanghai Technical Center for Diabetes Prevention and Clinical CareShanghai Key Laboratory of Diabetes MellitusDepartment of Endocrinology and MetabolismShanghai Clinical Center for DiabetesShanghai Key Clinical Center for Metabolic DiseaseShanghai 200233China Shanghai Municipal center for Disease control&Prevention Shanghai 200336China Shanghai Eye Disease Prevention and Treatment center/Shanghai Eye Hospital Shanghai Key Laboratory of Ocular Fundus DiseasesShanghai General HospitalShanghai Engineering Center for Visual Science and PhotomedicineShanghai 200040China Shanghai Municipal Health Commission Information center Shanghai 200040China 不详

This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai,china.A total of 173235 patients with type 2 diabetes in 2017 were included in the *** of risk factors and intermediate outcomes were *** patients had a mean age of 66.43±8.12(standard deviation(SD))years and a mean diabetes duration of 7.95±5.53(SD)*** percentage of patients who achieved the target level for HbA_(1c)(<7.0%)was 48.6%.Patients who achieved the target levels for blood pressure(BP)<130/80 mmHg and low-density lipoprotein-cholesterol(LDL-c)<2.6 mmol/L reached 17.5%and 34.0%,respectively.A total of 3.8%achieved all three target levels,and the value increased to 6.8%with an adaptation of the BP target level(<140/90 mmHg)for those over 65 *** analysis identified the factors associated with a great likelihood of achieving all three target levels:male,young age,short diabetes duration,low body mass index,macrovascular complications,no microvascular complications,prescribed with lipid-lowering medication,and no prescription of antihypertensive *** conclusion,nearly 50%and one-third of the patients with diabetes met the target levels for HbA_(1c)and LDL-c,respectively,with a low percentage achieving the BP target *** percentage of patients who achieved all three target levels needs significant improvement.

关键词： type 2 diabetes quality of care macrovascular complication microvascular complication treatment pattern epidemiology

建立中国老年骨质疏松症三级防控体系专家共识

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中华内科杂志 2022年第6期61卷 617-630页

作者： “建立中国老年骨质疏松症三级防控体系专家共识”编写组中国老年保健医学研究会老年骨质疏松分会中国老年保健医学研究会老年内分泌代谢分会北京医学奖励基金会老年医学专业委员会国家老年疾病临床医学研究中心(解放军总医院) 李春霖纪立农潘琦不详解放军总医院第二医学中心内分泌科国家老年疾病临床医学研究中心(解放军总医院)北京100853 北京大学人民医院内分泌科北京100044 北京医院内分泌科国家老年医学中心北京100730

骨质疏松症患病率高、认知率低、诊断治疗率低,其严重并发症骨质疏松性骨折治疗费用高、致残率及病死率高,严重影响老年人的身心健康。建立老年骨质疏松症的三级防控体系,采取预防为主、防治结合、分层诊疗、全周期管理的策略,提高全社... 详细信息

骨质疏松症患病率高、认知率低、诊断治疗率低,其严重并发症骨质疏松性骨折治疗费用高、致残率及病死率高,严重影响老年人的身心健康。建立老年骨质疏松症的三级防控体系,采取预防为主、防治结合、分层诊疗、全周期管理的策略,提高全社会对骨骼健康知识的认知,明确各级医疗机构在骨质疏松防治中的定位,整合医疗资源,降低骨质疏松症及其骨折的危害,对实现健康中国战略具有重大意义。

关键词：骨质疏松老年人三级防控

重症血液净化血管通路的建立与应用中国专家共识(2023)

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中华医学杂志 2023年第17期103卷 1280-1295页

作者：中国重症血液净化协作组杨荣利赵举洪小杨陈伟明陈秀凯高恺韩世权李昌斌刘国梁刘松桥陆国平邱占军苏晓蕾田仁斌王义吴国志邢志群张宏民赵喆不详大连理工大学附属大连市中心医院重症医学科大连116089 首都医科大学附属安贞医院心脏危重病中心北京100029 解放军总医院第七医学中心儿童医学部重症医学科北京100010 复旦大学附属儿科医院重症医学科匹兹堡大学医学院心肺与血管研究所北京协和医院重症医学科山东第一医科大学附属省立医院重症医学三科上海市第十人民医院肾内科中南大学附属中大医院重症医学科山东中医药大学附属医院呼吸与危重症医学科遵义医学院附属医院心外科西安儿童医院重症医学科

重症患者在血液净化血管通路的建立与应用中存在其自身特点,为指导这一特殊人群的血液净化临床工作,中国重症血液净化协作组组织专家制定了重症患者血液净化血管通路建立与应用中国专家共识。协作组通过组织专家系统查阅文献资料并结合... 详细信息

重症患者在血液净化血管通路的建立与应用中存在其自身特点,为指导这一特殊人群的血液净化临床工作,中国重症血液净化协作组组织专家制定了重症患者血液净化血管通路建立与应用中国专家共识。协作组通过组织专家系统查阅文献资料并结合专家临床经验,列出重症患者血液净化过程中的血管通路问题,设计专家函询表,应用德尔菲专家函询法和专家会议法对各个条目进行修改、完善,最终在六个方面47个条目达成共识,为临床医护人员实施重症血液净化提供有价值的参考。

关键词：血液透析滤过重症血液净化血管通路专家共识

Enhancement of Synchronization in Brain during Acupuncture

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Enhancement of Synchronization in Brain during Acupuncture

重症心肺超声评估改变临床治疗的多因素分析——1913例患者的多中心、前瞻性研究

第二十九届中国控制会议

作者： LI Nuo1,WANG Jiang1,CHE Yan-Qiu1,WEI Xile1,DENG Bin1,GUO Yi2,WANG Chao2 1.School of Electrical Engineering and Automation,Tianjin University,Tianjin 300072,P.R.china2.center of Experimental Acupuncture and Moxibustion,Tianjin University of Traditional Chinese Medicine,Tianjin 300193,P.R.china

Synchronization which is the critical feature for the exchanging of information in brain is considered as the mecha-nism of brain function and regional *** this paper,a standard experiment has been designed in order to research the synchronization in brain when *** 6 healthy volunteers with an age group of 23-27 years old are subjects in the *** coherence estimation method and the mean phase synchronization method are used to measure the synchro-nization of electroencephalographic（EEG）signals when *** is found that the synchronization in brain is enhanced when acupuncture,which means that the electrical activity of different region in brain can be coordinated by *** can be supposed that the coordinating role may be one of the mechanisms of acupuncture.

关键词： EEG Acupuncture Synchronization Coherence Estimation Mean Phase Synchronization

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中华超声影像学杂志 2021年第12期30卷 1018-1025页

作者：李莉刘丽霞王小亭张宏民朱英尹万红何伟晁彦公张丽娜中国重症超声研究组中南大学湘雅医院重症医学科国家老年疾病临床医学研究中心(湘雅医院)长沙410008 河北医科大学第四医院重症医学科石家庄050011 中国医学科学院北京协和医学院北京协和医院重症医学科100730 浙江大学医学院附属杭州市第一人民医院重症医学科 310006 四川大学华西医院重症医学科成都610041 首都医科大学附属北京同仁医院重症医学科 100730 清华大学附属华信医院重症医学科北京100016 不详

目的阐述重症患者的心肺超声特征,并分析其影响临床治疗的相关因素。方法2018年1-12月纳入13家医院重症医学科收治的重症患者,进入重症医学科后24 h内完成重症心肺超声评估,包括有无显著的心脏结构异常、呼吸末下腔静脉宽度、右心室收... 详细信息

目的阐述重症患者的心肺超声特征,并分析其影响临床治疗的相关因素。方法2018年1-12月纳入13家医院重症医学科收治的重症患者,进入重症医学科后24 h内完成重症心肺超声评估,包括有无显著的心脏结构异常、呼吸末下腔静脉宽度、右心室收缩功能、左心室收缩和舒张功能、肺部超声评分。根据评估后治疗计划清单上的选项是否改变分为治疗改变组和治疗未改变组,通过Logistic回归模型分析影响治疗改变的相关因素,包括患者、操作者及心肺超声指标3个方面。结果共纳入1913例重症患者,1204例(62.9%)患者的治疗发生改变,其中867例(72.0%)涉及液体管理策略。组间比较表明,患者的一般情况、操作者特征和重症心肺超声指标差异有统计学意义(均P1,P6分(对比≤6分)的患者在重症心肺超声评估后,治疗改变的可能性下降(均OR值<1,P<0.05)。结论重症心肺超声评估后,重症患者治疗措施改变的发生率为62.9%,其中72.0%的治疗改变涉及液体管理方面。呼气末下腔静脉宽度、左心室收缩功能和肺部超声评分是影响重症超声评估后治疗改变的重症心肺超声指标。

关键词：重症超声液体管理回归分析重症患者多中心研究

Evaluation of ICUs and weight of quality control indicators:an exploratory study based on Chinese ICU quality data from 2015 to 2020

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Frontiers of Medicine 2023年第4期17卷 675-684页

作者： Longxiang Su Xudong Ma Sifa Gao Zhi Yin Yujie Chen Wenhu Wang Huaiwu He Wei Du Yaoda Hu Dandan Ma Feng Zhang Wen Zhu Xiaoyang Meng Guoqiang Sun Lian Ma Huizhen Jiang Guangliang Shan Dawei Liu Xiang Zhou china-NCCQC Department of critical care Medicine State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijing 100730China Department of Medical Administration National Health Commission of the People’s Republic of ChinaBeijing 100044China Intensive care Unit The People’s Hospital of ZizhongNeijiang 641000China Department of Epidemiology and Biostatistics Institute of Basic Medicine SciencesChinese Academy of Medical Sciences&School of Basic MedicinePeking Union Medical CollegeBeijing 100730China Information center State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China 不详

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit(ICU)patients in Chinese mainland over six years(2015–2020).The data for this study were from 31 provincial and municipal hospitals(3425 hospital ICUs)and included 2110685 ICU patients,for a total of 27607376 ICU hospitalization *** found that 15 initially established quality control indicators were good predictors of patient prognosis,including percentage of ICU patients out of all inpatients(%),percentage of ICU bed occupancy of total inpatient bed occupancy(%),percentage of all ICU inpatients with an APACHE II score≥15(%),three-hour(surviving sepsis campaign)SSC bundle compliance(%),six-hour SSC bundle compliance(%),rate of microbe detection before antibiotics(%),percentage of drug deep venous thrombosis(DVT)prophylaxis(%),percentage of unplanned endotracheal extubations(%),percentage of patients reintubated within 48 hours(%),unplanned transfers to the ICU(%),48-h ICU readmission rate(%),ventilator associated pneumonia(VAP)(per 1000 ventilator days),catheter related blood stream infection(CRBSI)(per 1000 catheter days),catheter-associated urinary tract infections(CAUTI)(per 1000 catheter days),in-hospital mortality(%).When exploratory factor analysis was applied,the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation:nosocomial infection management(21.35%),compliance with the Surviving Sepsis Campaign guidelines(17.97%),ICU resources(17.46%),airway management(15.53%),prevention of deep-vein thrombosis(14.07%),and severity of patient condition(13.61%).Based on the different weights of the core elements associated with the 15 indicators,we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management+17.97%xcompliance with SSC guidelines+17.46%×ICU resources+15.53%×airway management+14.07%×DVT prevention+13.61%×severity of patient *** evidence-based quality

关键词： critical care medicine quality control evaluation exploratory factor analysis(EFA)model

quality metrics and outcomes among critically ill patients in china:results of the national clinical quality control indicators for critical care medicine survey 2015-2019

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Chinese Medical Journal 2022年第9期135卷 1064-1075页

作者： Xi Rui Fen Dong Xudong Ma Longxiang Su Guangliang Shan Yanhong Guo Yun Long Dawei Liu Xiang Zhou Department of critical care Medicine Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijing 100029China Institute of Clinical Medical Sciences China-Japan Friendship HospitalBeijing 100029China Department of Medical Administration National Health Commission of the People's Republic of ChinaBeijing 100044China Department of Epidemiology and Biostatistics Institute of Basic Medicine SciencesChinese Academy of Medical Sciences(CAMS)&School of Basic MedicinePeking Union Medical CollegeBeijing 100005China

Background:It is crucial to improve the quality of care provided to ICU patient,therefore a national survey of the medical quality of intensive care units(ICUs)was conducted to analyze adherence to quality metrics and outcomes among critically ill patients in china from 2015 to ***:This was an ICU-level study based on a 15-indicator online survey conducted in *** that ICU care quality may vary between secondary and tertiary hospitals,direct standardization was adopted to compare the rates of ICU quality indicators among provinces/*** analysis was performed to identify potential factors for in-hospital mortality and factors related to ventilator-associated pneumonia(VAP),catheter-related bloodstream infections(CRBSIs),and catheter-associated urinary tract infections(CAUTIs).Results:From the survey,the proportions of structural indicators were 1.83%for the number of ICU inpatients relative to the total number of inpatients,1.44%for ICU bed occupancy relative to the total inpatient bed occupancy,and 51.08%for inpatients with Acute Physiology and Chronic Health Evaluation II scores≥*** proportions of procedural indicators were 74.37%and 76.60%for 3-hour and 6-hour surviving sepsis campaign bundle compliance,respectively,62.93%for microbiology detection,58.24%for deep vein thrombosis prophylaxis,1.49%for unplanned endotracheal extubations,1.99%for extubated inpatients reintubated within 48 hours,6.38%for unplanned transfer to the ICU,and 1.20%for 48-hour ICU *** proportions of outcome indicators were 1.28‰for VAP,3.06‰for CRBSI,3.65‰for CAUTI,and 10.19%for in-hospital *** the indicators varied greatly across provinces and regions,the treatment level of ICUs in china has been stable and improved based on various quality control indicators in the past 5 *** overall mortality rate has dropped from 10.19%to approximately 8%.Conclusions:The quality indicators of medical care in china’s ICUs are hetero

关键词： Medical quality ICU china Epidemiological survey