Diagnosis: toxic!--trying to apply approaches of clinical diagnostics and prevalence in toxicology considerations.

The assessment of relevance of toxicological testing was compared with approaches of diagnostic medicine, a discipline that faces a comparable situation. Considering the work of a toxicologist as setting a diagnosis for compounds, assessment tools for diagnostic tests were transferred to toxicological tests. In clinical diagnostics, test uncertainty is well accepted and incorporated in this assessment. Furthermore, prevalence information is considered to evaluate the gain in information resulting from the application of a test. Several common toxicological scenarios, in which test uncertainty and prevalence are combined, are discussed including the interdependence of test accuracy, prevalence and predictive values or the sequential application of a screening and a confirmatory test. In addition, real prevalences derived from prevalences determined by an imperfect test are presented. We conclude that information on prevalences of toxic health effects is required to allow a complete assessment of the relevance of toxicological test. In this process, lessons can be learned from evidence-based approaches in clinical diagnostics.     

Assessing the need to update prevention guidelines: a comparison of two methods.

BACKGROUND: An important concern for developers of clinical practice guidelines is how best to determine when guidelines require updating to ensure they remain current and evidence based. Because of the high costs associated with updating guidelines, recent attention has focused on approaches that can reliably assess the extent of updating required. Recently, Shekelle and colleagues proposed a model of limited literature searches with modest expert involvement as a way to reduce the cost and time requirements for assessing whether a guideline needs updating. METHODS: The main objective of this study was to compare the Shekelle et al. assessment model (review approach) and a conventional process using typical systematic review methods (traditional approach) in terms of comprehensiveness and effort. We modeled the review approach on that by Shekelle and colleagues but refined it iteratively over three phases to achieve greater efficiency. Using both methods independently, we assessed the need to update six topics from the 1996 Guide to Clinical Preventive Services from the US Preventive Services Task Force. Main outcomes included completeness of study identification, importance of missed studies and the effort involved. RESULTS: Although the review approach identified fewer eligible studies than the traditional approach, none of the studies missed was rated as important by task force members acting as liaisons to the project with respect to whether the topic required an update. On average, the review approach produced substantially fewer citations to review than the traditional approach. The effort involved and potential time saving depended largely on the scope of the topic. CONCLUSIONS: The revised review approach provides an efficient and acceptable method for judging whether a guideline requires updating.     

PROSPER Community–University Partnership Model for Public Education Systems: Capacity-Building for Evidence-Based,Competence-Building Prevention

This paper presents a model to guide capacity-building in state public education systems for delivery of evidence-based family and youth interventions-interventions that are designed to bolster youth competencies, learning, and positive development overall. Central to this effort is a linking capacity agents framework that builds upon longstanding state public education infrastructures, and a partnership model called PROSPER or PROmoting School-community-university Partnerships to Enhance Resilience. The paper presents an overview of the evolving partnership model and summarizes positive results of its implementation over a 12-year period in an ongoing project.     

医疗机构门诊药房社会化经营的补偿政策研究与探讨

通过对陕西省29所医院的资料调查与实证分析，就医院门诊药房社会化经营的有关补偿政策进行了实证研究与探讨。     

高等临床药学人才教育模式与培养课程设置的探讨

随着我国经济的迅速发展和医疗体制改革的深化，临床药师的需求将会不断增长。现阶段可采用培养药学博士、临床药学硕士和在职培训等多种方式来改善临床药师短缺的状况。长期来看，应在我国的主要医药高等院校建立完善的药学博士教育体系，建立安全合理用药的人才体系。药学博士的课程应包括生物医学、药学、临床医药学、中医药学和社会管理科学等几方面的内容，教学中应加强临床医药学、药物基因组学、药物经济学和医药信息检索知识的学习，并注重临床药学实践、与人沟通能力和获取新知识能力的培养，以使其能适应将来临床药师工作的需要。     

制定肠外肠内营养指南和规范的"指南":方法学、推荐意见分级与通过程序

中华医学会肠外肠内营养学分会自2004年12月成立，即开始了合理规范应用肠外肠内营养学的有关工作。在中华医学会正副会长的指导下，2005年4月启动了肠外肠内营养“指南”和“规范”的制定工作。参与“指南”和“规范”编写的52位专家来自多个学科，也包括部分基层医院医护人员；共组成8个编写组，分别完成“指南”（草案）相应部分和部分“规范”的内容。 2006年5—8月，有7个编写组先后召开了8次总论和各论的“共识”和“规范”会议，就本版的编撰结构、证据分级和推荐意见分级体系、文献检索策略等方法学问题展开讨论，确定了工作方案，各自召开“共识会议”进行讨论，完成相应的文件。 通过确定检索策略、入选标准和特定关键词，采用系统化的文献检索，收集指南推荐意见相关支持证据。按照证据级别，参照国际标准并结合本领域的国内情况，制定推荐意见分级体系。 分会的“指南”（草案）和“规范”（草案）由各个“共识工作组”相互配合完成。达成“共识”后和最终定稿前，按“议事规则”对“指南”（草案）和“规范”（草案）进行投票表决。“肠外肠内营养临床指南和操作规范”力图反映目前国内外肠外肠内营养支持的最新证据，为临床医师、护理工作者、营养师和患者在特定临床条件下制定和实行肠外肠内营养支持方案提供帮助，并为卫生政策的制定者提供决策依据。由于内容宽广，部分内容欠缺甚多，有待今后补充。     

浅谈环糊精包合技术

包合技术作为一种新的制剂工艺，在药荆中的应用越来越广。作者在阅读大量资料的基础上，对β-环糊精的结构性质、制备工艺以及药荆应用等方面进行综述。目的在于对环糊精的研究工作能起到促进作用。     

超滤技术在中药制剂中的应用

本文简要总结了超滤技术在中药制剂中的应用优势;重点对影响超滤技术广泛应用的三个方面问题做了分析,包括影响小分子有效成分损失的因素、影响超滤通量的因素以及超滤膜的清洗方法。     

药物戒烟的循证性临床指南综述

目的:了解和介绍循证性临床指南中药物戒烟的条款。方法:通过Medline、TRIPdatabase和NGC等9个数据库或指南类网站搜集有关指南。采用比较、归纳和罗列的方式介绍有关内容。结果:收集到HEA等6个循证性临床指南。(1)戒烟的一线药物有尼古丁制剂和安非拉酮,二线药物有可乐定和去甲替林;(2 )尼古丁替代疗法是有效的、安全的和主要的药物戒烟方法;(3)安非拉酮是有效的、安全的戒烟药物;(4)可乐定和去甲替林是有效的戒烟药物,应在一线药物无效或禁忌时在医生的监督下应用;(5 )没有足够的证据显示安定、普萘洛尔和美加明等药物的戒烟效果;(6 )尼古丁制剂对妊娠、心血管疾病患者基本上是安全的;(7)戒烟一般伴有体重的增加。结论:应该鼓励吸烟者戒烟;应该鼓励应用药物进行戒烟。     

中药学青年教师的培养

高校办学的生命在于质量，质量的高低主要取决于教师。青年教师是未来学术领域的接班人，是新世纪教学的主力军，青年教师的培养对教学水平的提高是至关重要的。中药学在祖国医学理论体系中占有相当重要的地位，它既是中医辨证施治、理法方药的重要环节，是中医的基础课程之一，也是从基础过渡到临床的桥梁课程。中药学课程教学质量直接影响其他学科如方剂学等临床课程的顺利进行。随着科技发展，新知识、新技术的应用，中药学还需要紧跟时代。