腹腔镜与开腹全胃切除术治疗Ⅰ期胃癌的近期疗效对比CSCD

目的探讨腹腔镜全胃切除术与传统开腹全胃切除术对Ⅰ期胃癌的近期疗效。方法回顾性分析89例肿瘤位于近端胃的Ⅰ期胃癌,并且行全胃切除术的患者。按照手术方式不同分为腹腔镜组(47例)和开腹组(42例)。通过观察两组患者手术时间、出血量、术后病理相关指标、术后并发症、术后首次进食流质饮食时间及术后住院天数,比较两种手术方式的近期疗效。结果两组患者基线资料对比差异无统计学意义,具有可比性。与开腹组相比,腹腔镜组患者手术时间更长,但术中出血量、术后首次进食流质饮食时间、术后住院天数、术后并发症发生率及并发症等级均低于开腹组(P<0.05)。结论腹腔镜全胃切除术能够在保证Ⅰ期的近端胃癌患者手术安全性的同时,降低患者术中出血量、进食流质饮食时间、术后住院时间及术后并发症。     

思想政治课教学对听障学生的教育作用和影响

要提高聋生班思想政治课教学的有效性，树立以人为本的教育理念是前提，提高思想政治课教师的素质是关键，联系聋生的认知特点和思想实际是根本要求，建立良好的师生关系，改进教学方法和教学形式是重要保证，构建真善美的校园文化环境，发挥环境育人的作用是有力的保障。     

Economic appraisal of laser applications in health care. Report of a project

This article reports on the results of a project evaluating effectiveness and cost-effectiveness of laser applications in health care. The literature was collected, emphasizing well-designed clinical trials and cost-effectiveness analyses. Few randomized clinical trials (RCTs) have been done outside the specialty of ophthalmology. Even fewer cost-effectiveness studies have been done, despite the frequent claims of cost-effectiveness in the medical literature. Review papers were commissioned, and a group of laser experts, economists, and policy-analysts met for 2 days to discuss the policy implications of lasers. The main conclusion from the conference is that inappropriate and unskilled use of lasers is presently the greatest problem with their application in health care.     

妇幼保健院医疗设备配置的思考和探讨

妇幼保健院运营的模式,服务的对象都有别于综合性医院。通过对设备使用效益的调查、分析,提出妇幼保健院医疗设备的配置,应符合本院的特点。配置应遵循:适用性、特色性、经济性、先进性,不可盲目求新、求全,避免设备使用的低效益。     

CT对肝内,外阻塞性黄疸的鉴别诊断价值

笔者通过对３５例阻塞怀黄疸的ＣＴ所见，指出了胆道扩张征象可作为鉴别肝内、阻阻塞性黄疸的可靠指标，再结合临床及ＣＴ的初期征象，可更加提高其鉴别诊断准确率。本文对这些指标的可靠性进行重点讨论。提出了该特点是特别胆道管囊肿的重要指征，即后者的胆道扩张为局部性或节段性。本文对良、恶性病变所致的胆道扩张形态亦进行了对照分析，发现二阻之间无明显性差异。     

Occupational stress management programmes: a practical overview of published effect studies

There are many occupational stress management programmes availablewhich are designed to prevent and cure the negative aspectsof job-stress. The focus of the programmes can be directed towardsthe individual worker, the working group, the organization ofthe work or the organization as a whole. Moreover, programmesshow a considerable variation with respect to the type of interventionsthey promote and their underlying assumptions, as well as theirduration and costs. In this paper, effect studies of occupationalstress programmes published between 1987 and 1994 are reviewed.The aim is to give a practical overview of the variety in occupationalstress programmes, their scope, applicability and the evidenceof their effectiveness. The paper updates the review by DeFrankand Cooper published in 1989.     

人本原理在医院管理中的应用价值

目的:研究人本原理在护理管理中的应用。方法:把人本原理的管理原则、动力原则、行为原则、能级原则应用于护士长的管理中,尊重、关心、帮助和激励护士,人人参与管理。选择2005年上半年住院病人180例作为改革组,应用人本原理管理。2004年下半年住院病人150例作为传统组,用传统方法管理。结果:通过人本原理管理原则的应用,提高了护理质量,各项指标应用后高于应用前(P<0.05或P<0.01),无投诉、无差错事故发生,病人满意度一直在95%以上,护士参与管理意识增强,团队精神加强,护士按期晋升。护士对病人实行人性化服务,为医院赢得了相应的社会效益和经济效益。结论:人本原理应用于护理管理行之有效,值得推广。     

A Group Randomized Trial Evaluating High School FLASH,a Comprehensive Sexual Health Curriculum

PurposeTo evaluate the effectiveness of a school-based comprehensive sexual health curriculum (FLASH) on high-school students’ sexual behavior and related outcomes.MethodsA cohort of 1,597 9th and 10th grade students representing 20 schools from two regions in the U.S. (Midwest and South) were enrolled and completed the baseline survey. Following baseline, the 20 schools were randomly assigned to receive FLASH (n = 10 schools, five per region) or a knowledge-based sexual health curriculum (n = 10 schools, five per region). Follow-up surveys were administered at 3 months and 12 months after the instruction period.ResultsThere were no statistically significant differences between conditions for the overall sample on rates of vaginal sex in the past 3 months or the rates of vaginal sex without a condom or other birth control. In supplementary subgroup analyses of students who were not sexually experienced at baseline, FLASH showed a statistically significant protective impact at the 3-month follow-up on vaginal sex without a condom or birth control (p = .04). FLASH also showed statistically significant gains in psychosocial outcomes, such as refusal and condom use self-efficacy, attitudes toward birth control and condoms, and perceived norms.ConclusionsFLASH demonstrated consistent short-term and long-term impacts on key behavioral determinants. It also showed a significant impact on vaginal sex without a condom or other birth control for the subgroup of students who were not sexually experienced at baseline. Behavioral impacts were not evident for the entire study population.     

针灸对卵巢低反应患者妊娠结局和卵巢功能有效性的系统评价

目的:系统评价行体外受精-胚胎移植过程中针灸对卵巢低反应（POR）患者妊娠结局和卵巢功能有效性的疗效。方法:计算机检索国家知识基础设施数据库(CNKI)、中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、中国学术期刊数据库(CSPD)、PubMed、Cochrane Library数据库,检索针灸治疗POR的随机对照试验（RCT）,检索时限为建库至2021年8月31日。采用RevMan 5.4软件对纳入研究进行偏倚风险评价和数据分析,并进行GRADE证据质量评价。结果:共纳入8个RCT,包括537例患者。Meta分析结果显示：与体外受精-胚胎移植(IVF-ET)组比较,针灸+IVF-ET组可提高POR患者临床妊娠率（RR=1.58,95%CI为1.03～2.42,P=0.04）,增加获卵数（MD=1.16,95%CI为0.47～1.85,P=0.001）和窦卵泡数（MD=0.93,95%CI为0.06～1.8,P=0.04）,降低促卵泡素（FSH）水平（SMD=-0.29,95%CI为-0.50~-0.08,P=0.007）,但2组在提高受精率、优胚率、降低促黄体素（LH）水平、提高抗米勒管激素（AMH）水平、降低促性腺激素（Gn）用量上差异均无统计学意义。结论:现有证据表明,针灸可提高接受IVF-ET助孕的POR患者临床妊娠率,增加获卵数和窦卵泡数,降低POR患者的FSH水平。由于纳入研究数量较少且存在一定的偏倚风险,本研究结论后续仍需要高质量研究进行验证。     

Effectiveness of typhoid conjugate vaccine in Zimbabwe used in response to an outbreak among children and young adults: A matched case control study

BackgroundZimbabwe suffers from regular outbreaks of typhoid fever (TF), worse since 2017. Most cases were in Harare and a vaccination campaign with Typhoid Conjugate Vaccine (TCV) was conducted in March 2019. The vaccine effectiveness (VE) was assessed against culture-confirmed S. Typhi in children six months to 15 years and in individuals six months to 45 years in Harare.MethodsA matched case-control study was conducted in three urban suburbs of Harare targeted by the TCV vaccination campaign. Suspected TF cases were enrolled prospectively in four health facilities and were matched to facility (1:1) and community (1:5) controls.FindingsOf 504 suspected cases from July 2019 to March 2020, 148 laboratory-confirmed TF cases and 153 controls confirmed-negative were identified. One hundred and five (47 aged six months to 15 years) cases were age, sex, and residence matched with 105 facility-based controls while 96 cases were matched 1:5 by age, sex, and immediate-neighbour with 229 community controls.The adjusted VE against confirmed TF was 75% (95%CI: 1–94, p = 0.049) compared to facility controls, and 84% (95%CI: 57–94, p < 0.001) compared to community controls in individuals six months to 15 years. The adjusted VE against confirmed TF was 46% (95%CI: 26–77, p = 0.153) compared to facility controls, and 67% (95%CI: 35–83, p = 0.002) compared to community controls six months to 45 years old.InterpretationThis study confirms that one vaccine dose of TCV is effective to control TF in children between six months and 15 years old in an African setting.