中药生产过程质量控制关键技术研究进展

中医药发展已上升到国家战略层面,在医药行业贯彻实施"中国制造2025"战略的新形势下,中药生产过程质量控制是中药工业需要加快突破的关键领域之一。对中药生产过程质量控制领域在工艺设计、分析检测、过程建模、制造装备等方面的关键共性问题进行解析,综述了中药生产过程质量控制体系中工艺过程理解、生产过程实时分析方法开发、过程控制策略建立3个方面的研究进展;并结合企业研究实践,介绍了质量源于设计(quality by design,Qb D)、过程分析技术(process analytical technology,PAT)、实验设计(design of experiment,DOE)、多变量统计分析等关键技术在上述3个研究方向中的应用进展,分析了实际工业应用的难点问题并对其应用前景进行展望,旨在为中药企业应用和提升生产过程质量控制技术提供参考。     

VAC结合游离植皮治疗儿童大面积皮肤缺损疗效观察及对患儿生活质量的影响

目的:探讨负压创面治疗技术(Vacuum assisted closure,VAC)结合游离植皮治疗儿童大面积皮肤缺损疗效及对患儿生活质量的影响。方法:选取2015年2月-2019年2月笔者医院收治的60例大面积皮肤缺损患儿作为研究对象,按照随机数表法分为干预组和对照组,每组30例。对照组采用游离植皮术治疗,干预组在对照组的基础上结合VAC治疗,以皮片成活时间、皮片成活率、换药次数及住院天数评估疗效,以长海痛尺分级法评估患儿疼痛等级,以抑郁自评量表(Self-rating depression scale,SDS)、焦虑自评量表(Self-rating anxiety scale,SAS)评估患儿心理状态,以术后不良反应发生率评估患儿预后情况,以自制生活质量表评估患儿生活质量水平。结果:干预组患儿皮片成活时间、换药次数与住院天数均小于对照组,差异有统计学意义(P<0.05)。干预组患儿皮片成活率为93.33%高于对照组的76.67%,差异有统计学意义(P<0.05)。干预组治疗后疼痛感、SDS与SAS评分低于治疗前,且低于对照组,差异有统计学意义(P<0.05)。干预组患儿术后不良反应发生率为6.67%显著低于对照组23.33%,差异有统计学意义(P<0.05)。两组治疗前活动能力、心理健康及社交能力均低于治疗后,干预组治疗后活动能力、心理健康及社交能力均高于对照组(P<0.05)。结论:VAC结合游离植皮治疗儿童大面积皮肤缺损疗效显著,能有效降低患儿生理疼痛与心理焦虑,减少伤口感染等不良反应的发生,提高患儿生活质量,具有推广价值。     

探讨中西医护理改善老年高血压患者生活质量的效果

目的探讨中西医结合护理改善老年高血压患者心理状态及生活质量的效果。方法在医院2018年1月—2018年6月就诊的老年高血压患者中选出60例,按照随机数字法的原则,分成研究组(n=30)和参考组(n=30)。参考组采用单一西医护理,研究组在此之外联合中医护理,比较两组患者的临床疗效。结果入院时研究组与参考组SAS、SDS、SF-6评分差异不显著(P>0.05),护理后1月、3月与参考组相比,研究组SAS、SDS评分显著降低(P<0.05),SF-6评分显著升高(P<0.05);研究组患者对中西结合护理满意度为96.67%,参考组患者对西医护理满意度为73.33%,研究组满意度较参考组高,差异显著(P<0.05)。结论中西医结合护理能够有效改善老年高血压患者的心理状态,提高生活质量。     

The art of consent: visual materials help adult patients make informed choices about surgical care

Abstract

Supporting patients in making informed healthcare decisions is a cornerstone of ethical medical practice. Surgeons frequently draw for and show images to patients when consenting them for operations but the value of this practice in informed decision-making is unclear. An audit was conducted in a General Surgery Department. 244 patients completed questionnaires on the value of visual materials when giving consent for surgery. The complexity of the operations was classified into “simple”, “moderate” or “complex”. 100% of patients felt they had given informed consent to surgery. 62% of patients received at least one form of visual material during the consenting process. All patients who received a drawing, and 99% of those provided with other images, valued these resources. Visual materials were considered more useful to patients when giving consent for moderate or complex operations than simple ones. Approximately one third of patients who did not receive visual materials would have appreciated these when making an informed decision. This research highlights the value of surgeons drawing for, and providing other visual resources to, their patients as part of the consent process. There is a role for further research and training materials in drawing skills for surgeons.     

医养结合型养老机构卫生服务质量指标体系构建研究

目的:构建基于SERVQUAL模型的医养结合型养老机构卫生服务质量评价指标体系。方法:围绕医养结合型养老机构卫生服务的概念、特性、内涵、内容等,采用文献研究法、半结构式访谈法、Delphi—AHP法等定性与定量相结合的研究方法,构建指标体系并确定指标权重。结果:构建了具有7个一级指标,27个二级指标和77个三级指标的养老机构卫生服务质量评价指标体系。指标体系三轮咨询专家权威系数Cr均高于0.84,专家综合权威性系数均高于0.83;总体专家协调系数Kendall W第一、二轮为0.309,第三轮为0.706,且均通过显著性检验;内容效度指数I-CVI介于0.90~1.00之间,S-CVI为0.94,kappa值均高于0.74;信度系数Cronbachα总体为0.972,各维度Cronbachα系数在0.792~0.921之间。评价指标体系具有较好的稳定性、可靠性和一致性。结论:本研究建立的评价指标体系有利于医养结合型养老机构全面建立贴近老年人卫生服务需求的内设医疗机构,改善机构内卫生服务质量。在对指标体系进行应用时,可转化为机构中老年人对各指标项目的感受(P)与期望(E),以两者的差值(P-E)代表机构的卫生服务质量。根据专家赋权结果,应重点加强医养结合养老机构对可靠性、有效性、经济性等指标项目的建设。     

The relevance of Xenophon’s Anabasis and Plato’s Meno to nursing

The current situation in which the humanities are disparaged affects all university disciplines, including nursing, in whose historical evolution the humanities have always been present in one form or another. Looking beyond this disrepute, this study proposes that nursing renew its attention to classical philosophy. Specifically, it invites a close reading of Xenophon's Anabasis and Plato's Meno, to get three related goals: to show how the use of ancient texts are very valuable tools for the philosophical initiation of nursing students and can help them reflect on their choice of nursing as a practical activity; to reflect on the problem of virtue and the nature of the good life; and to show how the interaction with ancient texts allows students to reflect on questions and issues of life, theirs and others, that are not open to investigation through a purely scientific method. Consequently, both Anabasis and Meno readings strengthen the intellectual relationship between philosophy and nursing, enabling the latter to delve deeper into the key questions of its own thought as a discipline.