Bland-Altman分析结果散点分布趋势与测量方法变异程度间的关联度分析

Bland-Altman(简称B-A)方法常用于评价两种测量方法的一致性,该方法通过绘制两种测量方法差值对均值图,并根据观察到的两种测量方法差值计算一致性界限,综合B-A图散布趋势和一致性界限的宽度,对两种方法的一致性程度进行评价.但在实际应用B-A方法的过程中,B-A图散布趋势与两种测量方法的标准差水平相关联,如果方法使用不当将错误的显示出实际并不存在的散布趋势,或者无法发现真实存在的散布趋势从而造成错判,本文将结合具体分析和随机模拟举例对上述问题加以讨论和证明.     

涉及病历记录及生物标本研究的伦理审查问题

介绍了针对涉及病历记录及生物标本研究的伦理审查的不同方式,并对相关定义进行了说明,对是否属于涉及人的研究进行了分析.在此基础上提出,为了合理地保护受试者的权益,同时又不给研究者和伦理委员会自身增加不必要的负担,根据国际上的相关做法,可以基于研究的风险大小,对涉及病历记录或生物标本的研究,采取免除伦理审查与快速审查不同的伦理审查与管理方式.     

新形势下医患沟通方式方法探究

医患沟通因具有辅助医疗诊断、增强患者信心、缓解医务人员心理压力等作用,在构建和谐医患关系的过程中发挥着无可替代的作用。完善医患沟通制度、建立第三方监督调解制度、积极转变思维模式、提高沟通技能、正确使用沟通方式方法、加强人文关怀与知识普及。真正做到在“以人为本”的医学模式下,缩小医患双方的距离,逐渐建立起互相尊重、互相信任、平等交流、精诚合作的新型和谐医患关系。     

膝关节多发韧带损伤关节镜下重建方法的临床应用

目的 探讨膝关节多发韧带损伤关节镜下重建方法的应用价值.方法 选取2011年5月～2013年3月收治的50例膝关节多发韧带损伤患者,依据随机数字表法将患者分为治疗组与对照组,每组25例.对照组患者给予保守治疗,治疗组患者给予关节镜下重建治疗,然后对两组患者的膝关节功能及不良反应发生情况进行统计分析.结果 两组患者治疗前后的Lysholm膝关节功能评分和主动关节活动范围之间的差异均具有统计学意义（P＜0.05）,治疗组患者的提升幅度较大;治疗前两组患者的Lysholm膝关节功能评分和主动关节活动范围之间的差异均不具有统计学意义（P＞0.05）,治疗后治疗组患者的Lysholm膝关节功能评分明显比对照组患者高,主动关节活动范围明显比对照组患者大,且术后不良反应发生率明显比对照组患者低,差异均具有统计学意义（均P＜0.05）.结论 膝关节多发韧带损伤关节镜下重建方法较保守治疗方法具有较好的应用效果,值得临床推广应用.     

Towards the inclusion of gender and sex in health research and funding: an institutional perspective

In this commentary, we reflect on the challenges of incorporating gender and sex into health research and funding and discuss some of the strategies we have employed in our efforts to overcome them. We write from our vantage point within Institute of Gender and Health, one of the 13 institutes that comprise the Canadian Institutes of Health Research, Canada's national health research funding agency.     

Marginalized identities,discrimination burden,and mental health: Empirical exploration of an interpersonal-level approach to modeling intersectionality

Intersectionality is a term used to describe the intersecting effects of race, class, gender, and other marginalizing characteristics that contribute to social identity and affect health. Adverse health effects are thought to occur via social processes including discrimination and structural inequalities (i.e., reduced opportunities for education and income). Although intersectionality has been well-described conceptually, approaches to modeling it in quantitative studies of health outcomes are still emerging. Strategies to date have focused on modeling demographic characteristics as proxies for structural inequality. Our objective was to extend these methodological efforts by modeling intersectionality across three levels: structural, contextual, and interpersonal, consistent with a social–ecological framework. We conducted a secondary analysis of a database that included two components of a widely used survey instrument, the Everyday Discrimination Scale. We operationalized a meso- or interpersonal-level of intersectionality using two variables, the frequency score of discrimination experiences and the sum of characteristics listed as reasons for these (i.e., the person's race, ethnicity, gender, sexual orientation, nationality, religion, disability or pregnancy status, or physical appearance). We controlled for two structural inequality factors (low education, poverty) and three contextual factors (high crime neighborhood, racial minority status, and trauma exposures). The outcome variables we modeled were posttraumatic stress disorder symptoms and a quality of life index score. We used data from 619 women who completed the Everyday Discrimination Scale for a perinatal study in the U.S. state of Michigan. Statistical results indicated that the two interpersonal-level variables (i.e., number of marginalized identities, frequency of discrimination) explained 15% of variance in posttraumatic stress symptoms and 13% of variance in quality of life scores, improving the predictive value of the models over those using structural inequality and contextual factors alone. This study's results point to instrument development ideas to improve the statistical modeling of intersectionality in health and social science research.     

The mesenterially perfused rat small intestine: A versatile approach for pharmacological testings

Pharmaceutical compounds enter the body via several major natural gateways; i.e. the lung, the skin and the gastrointestinal tract. Drug application during surgical operations can lead to severe impairment of gastrointestinal motility, which can contribute to a paralytic ileus. Here we investigated an ex vivo perfused small intestine model that allows us to ascertain the influence of pharmaceuticals upon the gut.Corresponding segments from the proximal jejunum of adult rats were used. Their mesenteric arteries and veins were cannulated and the jejunal segment excised. The individual segments were placed in a custom designed perfusion chamber and perfusion performed through the intestinal lumen as well as the mesenteric superior artery. Three test drugs, which are commonly used in anesthesiology; i.e. pentobarbital, propofol and ketamine were administered via the blood vessels. Their effects upon gastrointestinal motility patterns were evaluated by optical measurements. Longitudinal and pendular movements were distinguishable and separately analyzed.Pharmacological effects of the individual substances could be investigated. Propofol (50–200 μg/ml) was found to decrease intestinal motility, especially longitudinal movements in a dose dependent manner. Pentobarbital decreased intestinal motility only at high concentrations, above 2.5 mg/ml. A dose of 2.5 mg/ml lead to an increase in longitudinal- and pendular movements in comparison to control, while ketamine (2.5–10 mg/ml) did not alter intestinal motility at all. Histological examination of the perfused segments revealed only minor changes in tissue morphology after perfusion.The perfusion approach shown here allows for the identification of compounds which interfere with gut motility in a highly sophisticated way. It is suitable for characterization of drug and dose specific changes in motility patterns and can be used in drug development and preclinical studies.     

How should a scientific team be effectively formed and managed

In the research process, hypotheses, observations and raw data are systematically transformed into new knowledge and scientific rules. People and human input are essential features of the research; the intellectual process performed by the individual scientists and their team. Unplanned administration and human conflicts are the major causes of unsuccessful research. In this article, some essential organizational and psychological aspects of the scientific team are described and discussed. In addition, practical guidelines on forming, working and managing a research team are presented.     

连续臂丛阻滞下手法松解联合超激光治疗肩周炎的临床应用

目的观察连续臂丛阻滞下手法松解联合超激光治疗肩周炎的疗效。方法选取四川省乐山市老年病专科医院2011年2月～2012年11月确诊并收治的肩周炎患者72例,行连续臂丛阻滞下手法松解联合超激光治疗,观察疼痛及肩功能改善情况。结果治愈27例,显效34例,有效7例,无效4例,总有效率94.44％。结论连续臂丛阻滞下手法松解联合超激光治疗肩周炎疗效确切。     

妊娠高血压重度子痫前期及子痫患者终止妊娠时机及方式的探讨

目的：探讨妊娠高血压重度子痫前期、子痫患者终止妊娠的时机和方式对母婴的影响。方法：回顾性分析55例妊娠高血压重度子痫前期、子痫患者在不同孕周及采取不同方法终止妊娠对母婴结局的影响。结果：妊娠高血压重度子痫前期、子痫患者55例入院后经药物治疗分别选择适当时机及分娩方式终止妊娠,无1例孕产妇死亡,新生儿窒息率33．87％。结论：治疗妊娠高血压重度子痫前期、子痫患者适时终止妊娠是极重要的手段,剖宫产已成为主要措施。