超声引导穿刺活检在舌鳞癌术前颈部淋巴结转移诊断中的临床应用

目的探索一种确定术式和评估预后的方法，以提高舌鳞癌颈部淋巴结转移诊断准确率。方法利用自动弹射活检装置在超声引导下对37例舌鳞癌颈部淋巴结穿刺活检。以颈淋巴结清扫术或颈淋巴结探查术后对淋巴结检查的病理结果为标准，比较超声引导穿刺活检与临床触诊对淋巴结转移的诊断准确性。结果超声引导穿刺活检诊断符合率为94．59％，较临床触诊的59．46％高，假阴性率低，无假阳性，两种方法对诊断淋巴结转移的准确指数差异有统计学意义。结论超声引导穿刺活检可以提高舌鳞癌淋巴结转移诊断准确率，舌鳞癌术前可常规用超声检查颈部淋巴结，对可疑转移的淋巴结进行穿刺活检以确定病变性质。     

A comparison of traditional and Rasch cut points for assessing clinically important change in health-related quality of life among patients with asthma

Background Patient-perceived change in health-related quality of life (HRQoL) domains has often been classified using a 15-point patient transition rating scale. However, traditional change levels of trivial ( − 1, 0, or 1), minimal (2, 3 or − 2, − 3), moderate (4, 5 or − 4, − 5) and large (6, 7 or − 6, − 7) on this scale have been arbitrarily defined and originally assumed that change related to an improvement was the same as that for a decline. Objective To compare traditional and Rasch partial credit model-derived cut points and the mean changes for each change categorization when assessing clinically important change in asthma-specific HRQoL. Methods Our sample included 396 asthmatic outpatients who completed bimonthly telephone interviews on the Asthma Quality of Life Questionnaire and transition rating items over 1 year of participation. We employed item response theory in a novel approach to identify cut points on domain-specific HRQoL change data and transition ratings. After determining natural cut points for minimal, moderate, and large differences on the transition rating anchor, we calculated mean changes under change categorizations for both improvements and declines for the two transition rating classification approaches. Results Although traditional and Rasch categorizations for small, moderate, and large changes slightly differed and displayed a lack of symmetry between improvements and declines, nearly all mean changes between classification approaches were comparable. Conclusions In this study, traditional transition rating cut points remain suitable to assess HRQoL clinical significance in outpatients with asthma. An earlier version of this paper was presented at the International Society for Quality of Life Research Symposium, June 29, 2004, in Boston, MA and at the International Society for Quality of Life Annual Meeting, October 20, 2005, in San Francisco, CA.     

Graded response model-based item selection for behavior and symptom identification

In measuring outcomes of health care, information is obtained from subjects employing instruments that often use Likert scales. These instruments are typically designed using classical testing theory which assumes the errors around the true scores are normally distributed and constant. Advances in psychometric practices through the use of item response theory (IRT) models have led to more flexibility in scale development and in data analyses. In this paper, we introduce statisticians and health services researchers to IRT models through a case-study of data collected to measure subjective distress. The data consist of self-reports of symptom and problem difficulty obtained from a sample of 2,656 patients discharged with a psychiatric disorder from 13 hospitals in the United States between May 2001 and April 2002. Dimensionality of the trait is assessed using principal factor analysis. Model assessment is made using χ² statistics and residual analyses. We select items for the scale using the Fisher Information available at selected levels of the underlying trait.     

抑郁症患者焦虑、人格与应付方式变化及其反应时的研究

目的 探讨焦虑症状、人格、应付方式对抑郁症严重程度的影响，并考察抑郁症患者对负性情绪词的偏好。方法 对27例抑郁症患者及与之匹配的29名对照组进行SDS、SAS、EK2和应付方式问卷评定。测验完成后用E-Prime系统分别进行正、负性情绪词识别的实验。结果与对照组相比，抑郁症患者SDS、SAS、EPQ的N、P两个维度的得分与对照组间差异有显著性意义，EPQ的E维度、积极应什方式得分与对照组间差异有显著性意义。logistic回归分析表明抑郁症状的严重程度与SAS、EPQ的E维度有相关性。抑郁症患者对正、负情绪词的反应时与对照组间差异有显著性意义，在负性情绪词上的反应时与对正性情绪词的反应时间差异有显著性意义。结论抑郁症患者发病期有较高的N、P两个维度的得分，较低的E维度得分，较少采用积极的应付方式。抑郁症患者在情绪词上存在负性偏好。     

会员制医疗保健服务模式的理论与实践探讨(上)

介绍了会员制医疗保健服务的概念;分析了会员制医疗保健服务需求及会员制医疗保健服务的营销理论基础.认为医疗保健消费需求的发展变化趋势呼唤会员制服务;市场营销理论的变革有力地支持会员制服务;会员制是对医疗保健服务消费者不同需求的响应,对会员制医疗服务的部分典型案例营销特点进行分析,以南方医院惠侨楼贵宾会员制为例,探讨了会员制医疗服务的营销手法.     

动态密度泛函理论在嵌段共聚物介观结构模拟中的应用

采用动态密度泛函理论(DDFT)方法对两嵌段和三嵌段共聚物熔体微相分离后的三维介观结构进行了模拟研究，考察了共聚物链长．N—12下组分A、B不同配比的11种两嵌段共聚物和10种三嵌段共聚物，通过等密度面图很好地表述了微相分离后的三维介观结构。通过比较序参数户、自由能F和熵S随时间的变化，发现当组分A与组分B的链节数之比．NA／NB和模拟参数均相同时，两嵌段共聚物熔体比三嵌段共聚物熔体容易发生微相分离，而三嵌段共聚物越不对称，微相分离越容易。     

基于双变量控制原理的变压变频新方法

阐述了在变频调速系统中运用变压变频技术的必要性，分析了使用传统余弦交点法进行在线变压变频存在的缺陷，进而提出了基于双变量控制原理、自然无环流控制和对称余弦法的变压变频新方法，给出了在保持输出频率不变条件下闭环调压的具体实现方法。对变压变频新方法的实验结果进行了仿真、分析和比较，验证了新方法具有良好的控制效果。     

新生儿游泳与抚触的临床观察及护理

目的:探讨新生儿游泳与抚触对婴儿体格发育及胎便初排、转黄时间的影响。方法:选择368例足月分娩的正常新生儿,将其分为观察组179例,住院期间每日给予新生儿游泳及抚触;对照组189例,每日给予新生儿沐浴,分别记录,比较两组新生儿体重增长情况及胎便初排至转黄时间。结果:新生儿出院时体重与出生体重的平均差值,两组比较有显著性差异(P<0.01)。胎便初排至转黄时间<24h者,两组比较有显著性差异(P<0.01)。结论:新生儿游泳与抚触可促进婴儿体重增长,缩短胎便初排至转黄时间。     

妊娠期饮食控制对胎儿体重及分娩方式的影响

目的通过妊娠期母体饮食的合理搭配及对摄入热量的控制,从而控制孕妇的体重增加及胎儿出生时体重、减少糖耐量异常及妊娠期糖尿病的发生率、减少巨大儿的发生率及相对头盆不称的发生率,最终达到降低剖宫产率的目的。方法选择2001年1月至2004年3月在我院门诊行系统产前检查的无任何内外科合并症及遗传病史的孕妇2300名,根据年龄、孕前体重、孕产次进行配对分组。观察组(A组)1100例;对照组(B组)1200例。观察组孕妇在医生的指导下对其饮食进行合理搭配,控制孕妇每日饮食热量的摄入,对照组孕妇的饮食未作任何控制。对比2组间孕妇平均体重增加值,糖耐量异常(IGT)及妊娠期糖尿病(GDM)发生率,胎儿出生时的平均体重,巨大儿发生率及剖宫产率的差异。结果观察组与对照组之间在孕妇平均体重增加值,糖耐量异常(IGT)发生率,妊娠期糖尿病(GDM)发生率,胎儿出生时的平均体重,巨大儿发生率,剖宫产率方面统计学差异显著(P<0.01)。结论通过对孕妇进行营养指导及饮食控制,可有效地控制孕妇体重增加,减少IGT及GDM的发生率,有效地控制胎儿出生时的体重,有效地减少因胎儿体重过大所致的头盆不称、产程延长等,有效降低剖宫产率。     

经络与方位对应现象探讨

本文从“脏经对应”的古典理论和“循经取穴”的临床基本原则着手,探讨“方位对应”现象与“脏经对应”之间的关系。结果发现,“脏经对应”理论存在许多疑点,其合理成分具有“方位对应”的现象,而其疑点之处恰恰不具有“方位对应”的特点。“方位对应”并具复杂性。认为“方位对应”概念使我们从复杂的古典经络理论和临床经验中抽出一条主线,有利于简化研究对象。