多指标综合加权评分法优选复方夏枯草洗剂提取工艺研究

[目的] 优选复方夏枯草洗剂的提取工艺。[方法] 采用L₉（3⁴）正交设计，以迷迭香酸、丹酚酸B的含量及出膏率的综合评分为指标，考察料液比、提取时间、提取次数对提取效果的影响，优选复方夏枯草洗剂的最佳提取工艺。[结果] 根据综合评分的结果，优选出最佳提取工艺为加8倍水，提取3次，每次0.5 h。[结论] 该工艺准确可靠，可行性好。     

超脉冲CO2点阵激光联合PRP治疗面部痤疮凹陷性瘢痕疗效分析

目的:探究超脉冲CO2点阵激光联合富血小板血浆(PRP)治疗面部痤疮凹陷性瘢痕的疗效。方法:72例面部痤疮凹陷性瘢痕患者,随机分为观察组(36例)和对照组(36例)。对照组采用超脉冲CO2点阵激光治疗,观察组采用超脉冲CO2点阵激光联合PRP治疗。比较两组患者的灰度差异、时间指标、瘢痕程度、疼痛、不良反应及视觉评估。结果:观察组的并发症发生率为11.11%,低于对照组的36.11%,差异具有统计学意义(P<0.05)。治疗后,两组患者的灰度差异率均减小,且观察组患者的灰度差异率显著低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的炎性渗出时间、红肿时间、愈合时间、停工时间及瘢痕程度评分均低于对照组,差异均具有统计学意义(P<0.05);但疼痛度评分组间比较,差异无统计学意义(P>0.05)。结论:超脉冲CO2点阵激光联合PRP治疗面部痤疮凹陷性瘢痕效果较好,可有效降低瘢痕程度,减少治疗时间及并发症的发生,帮助患者迅速回归正常工作与生活,值得临床推广使用。     

消化道恶性肿瘤住院患者的能量消耗研究

目的评估消化道恶性肿瘤患者的能量消耗，探讨最佳计算公式及能量消耗的影响因素。方法采用连续入组法，纳入2016年3月至2016年12月在陆军军医大学第一附属医院肿瘤科住院治疗患者，运用代谢车测定其静息代谢能量（REE），使用Harris-Benedict公式和30kcal/（kg·d） 公式预测患者的一日总能量消耗（TEE）。收集研究对象的相关指标如年龄、身高、体重、病程、原位癌部位、是否荷瘤等。结果共纳入26例患者，其中包括食管癌11例，胃癌8例，结直肠癌7例，73%的患者处于高代谢状态，约69%的患者处于肿瘤Ⅳ期；其中不同病程和原位癌位置与静息能量消耗有差异，差异具有统计学意义；用30kcal/（kg·d）×体重估算TEE可能并不适用于消瘦的消化道肿瘤患者。结论消化道恶性肿瘤患者大多存在营养不良且处于高代谢状态，在给消化道恶性肿瘤患者提供能量时应适当考虑病程长短、肿瘤分期以及肿瘤部位等因素。尽量使用代谢车估算恶性肿瘤患者的TEE，若没有代谢车条件时，对于能下床活动的消化道恶性肿瘤患者，体质指数（BMI）≥18.5kg/m2者推荐使用30kcal/（kg·d）×实际体重的方法估算TEE，BMI<18.5kg/m2者推荐使用30kcal/（kg·d）×标准体重的方法估算TEE。     

评教评学模式在肿瘤外科护理带教中的应用评价

目的探讨评教评学模式在肿瘤外科护理带教中的应用效果。方法选择2017年6月—2019年2月于该院肿瘤外科实习的88名护生作为该次研究对象,随机将护生分为对照组与观察组,两组分别有护生44名,对照组给予传统带教方法,观察组给予评教评学模式带教,比较两组护生的护理带教结果。结果观察组护生对带教老师综合能力评价优良率是92.0%,对照组评价优良率是76.0%,组间对比差异有统计学意义(χ^2=4.192,P=0.041<0.05)。观察组带教老师对护生综合能力评价优良率是90.9%,对照组评价优良率是72.7%,组间对比差异有统计学意义(χ^2=4.889,P=0.027<0.05)。观察组护生的理论知识与实操技能考核成绩均要显著比对照组高,差异有统计学意义(P<0.05)。结论评教评学模式在肿瘤外科护理带教中具有显著应用价值,可充分激发师生的教学积极性,改善护理教学质量。     

Cost of postoperative complications: How to avoid calculation errors

Postoperative complications(PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients' clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.     

基于生物活性与效应基准的中药质量 评价技术发展现状与展望

中药质量的评控问题是制约中药现代化发展的瓶颈,因此有必要在现有检测方法的基础上结合生物评价,继而更为全面地保证中药质量。生物评价是完善中药质量标准、保证临床功效和安全性评价的重要方法,已成为中药质量标准化发展趋势之一。在此处主要论述了近年来基于生物活性与效应基准的中药质量评价技术和已取得的部分研究进展,同时对目前中药质量生物评价研究与应用中存在的主要问题进行探讨,进一步对其未来应用做出展望,从而更好的对中药质量进行控制。     

手术室细节护理管理在医院感染控制中的应用评价

目的探讨手术室细节护理管理在医院感染控制中的应用效果。方法选定2017年1月-2018年3月该院收诊的160例手术室患者,按照管理方法的不同分为观察组(细节护理管理)80例与对照组(传统护理管理)80例,比较两组手术室患者的护理质量、并发症发生率、感染发生率、护理满意度、收缩压。结果观察组护理管理后的护理安全(82.23±6.14)分、体征监测(93.46±6.23)分、体位协助(87.32±4.65)分、器械准备(91.57±6.21)分、文书记录(90.24±4.92)分、护理满意率(98.75%)均高于对照组(P<0.05);观察组护理管理后的并发症发生率(2.50%)、感染发生率(1.25%)、收缩压(121.37±6.26)mmHg均低于对照组(P<0.05)。结论细节护理管理方法可有效提高手术室患者的护理满意度,减少其感染情况,值得推广使用。     

Economic Evaluation of Factorial Trials: Cost-Utility Analysis of the Atorvastatin in Factorial With Omega EE90 Risk Reduction in Diabetes 2 × 2 × 2 Factorial Trial of Atorvastatin,Omega-3 Fish Oil,and Action Planning

ObjectivesWe applied principles for conducting economic evaluations of factorial trials to a trial-based economic evaluation of a cluster-randomized 2 × 2 × 2 factorial trial. We assessed the cost-effectiveness of atorvastatin, omega-3 fish oil, and an action-planning leaflet, alone and in combination, from a UK National Health Service perspective.MethodsThe Atorvastatin in Factorial With Omega EE90 Risk Reduction in Diabetes (AFORRD) Trial randomized 800 patients with type 2 diabetes to atorvastatin, omega-3, or their respective placebos and randomized general practices to receive a leaflet-based action-planning intervention designed to improve compliance or standard care. The trial was conducted at 59 UK general practices. Sixteen-week outcomes for each trial participant were extrapolated for 70 years using the United Kingdom Prospective Diabetes Study Outcomes Model v2.01. We analyzed the trial as a 2 × 2 factorial trial (ignoring interactions between action-planning leaflet and medication), as a 2 × 2 × 2 factorial trial (considering all interactions), and ignoring all interactions.ResultsWe observed several qualitative interactions for costs and quality-adjusted life-years (QALYs) that changed treatment rankings. However, different approaches to analyzing the factorial design did not change the conclusions. There was a ≥99% chance that atorvastatin is cost-effective and omega-3 is not, at a £20 000/QALY threshold.ConclusionsAtorvastatin monotherapy was the most cost-effective combination of the 3 trial interventions at a £20 000/QALY threshold. Omega-3 fish oil was not cost-effective, while there was insufficient evidence to draw firm conclusions about action planning. Recently-developed methods for analyzing factorial trials and combining parameter and sampling uncertainty were extended to estimate cost-effectiveness acceptability curves within a 2x2x2 factorial design with model-based extrapolation.