Repeatability and validity of an upper limb and neck discomfort questionnaire: the utility of the standardized Nordic questionnaire

The repeatability and validity of a questionnaire for upper limb and neck complaints were assessed in a population of 105 hospital outpatients with a range of upper limb and neck disorders (including cervical spondylosis, adhesive capsulitis, lateral epicondylitis, carpal tunnel syndrome and Raynaud's phenomenon). Subjects were asked to complete a modified Nordic-style upper limb and neck discomfort questionnaire on two occasions closely spaced in time. The repeatability of their responses was assessed by calculating a kappa coefficient (kappa), and the sensitivity and specificity of component items in the questionnaire were determined for specific diagnostic categories of upper limb and neck disorder. Symptom reports for pain in the upper limb and neck, pain interfering with physical activities, neurological symptoms and blanching were all found to be highly repeatable (kappa = 0.63-0.90). A number of regional pain reports proved to be very sensitive in relation to specific upper limb disorders, but, with the exception of reported finger blanching in patients with Raynaud's phenomenon, none proved to have a good specificity (range = 0.33-0.38). We conclude that a modified Nordic-style questionnaire is repeatable and sensitive, and is likely to have a high utility in screening and surveillance. However a complementary examination schedule of adequate specificity and repeatability is essential to establish a clinical diagnosis.     

临床分离菌的耐药性测定与分析

目的：分析本地区临床分离菌耐药趋势，为合理选择抗生素提供参考。方法：用Kirbv-Bauer琼脂扩散法测定285株革兰阴性菌和133株革兰阳性菌对18种抗菌药物的敏感性，计算各菌种对不同抗生素的耐药率。结果：多数革兰阴性菌对第三代头孢菌素耐药率明显增加。74株金黄色葡萄球菌中甲氧西林耐药的金黄色葡萄球菌检出率为28．4％；所有金葡菌对万古霉素均敏感，耐万古霉素的肠球菌检出率为3．4％。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶阳性率分别是34．0％和29．7％。结论：本地区常见致病茵耐药情况较严重，提示用药前的药敏试验是非常必要。     

1999至2001年广州地区临床常见肠杆菌科细菌耐药性监测结果分析

目的 了解临床分离常见肠杆菌科细菌的耐药性。方法 统一采用纸片扩散法进行实验，以美国NCCLS文件为判断标准，每次监测均有质控数据。结果 共有11家广州市三级甲等医院实验室参加耐药性监测，三年共统计临床常见肠杆菌科细菌3147株。结论 对肠杆菌科细菌，亚胺培南的耐药率最低，可考虑为临床首选药物，阿米卡星、头孢他啶耐药率相对较低，可选择用药。庆大霉素的耐药率有逐年下降的趋势，将来可能成为临床一线药。而磺胺甲噁唑／甲氧苄啶、四环素、萘啶酸等耐药率相对较高，应慎用。氨节西林的耐药率很高，应避免使用。     

The Role of Therapeutic Alliance in Network Therapy: A Family and Peer Support-Based Treatment for Cocaine Abuse

The therapeutic alliance is a well-studied construct factor that is important to outcome in many forms of individual therapy. Therapeutic alliance has been rarely studied in group therapy and results in addiction treatment have been mixed. In this paper, we studied the presence of a therapeutic alliance in Network Therapy: an approach that uses peer and family support in addiction treatment. Twenty-one participants undergoing Network Therapy for cocaine addiction were observed on videotape, and were rated on therapeutic alliance using the Working Alliance Inventory and the Penn Helping Alliance Rating Scale. Results showed a significant positive correlation between therapeutic alliance and outcome as measured by the percentage of cocaine-free urine toxicology screens and by eight consecutive cocaine-free urines.     

前哨淋巴结活检对乳腺癌外科导航的临床分析

目的 探讨前哨淋巴结活检(SLNB)对乳腺癌手术导航的临床价值及可靠性。方法 用染料法(1％亚甲蓝)对30例乳腺癌病人进行腋窝前哨淋巴结(SLN)染色切除。术中冰冻切片，术后石蜡切片，并常规行腋窝淋巴结清除术(ALND)。结果 SLN染色成功率96．7％(29／30)，失败1例。SLN阳性10例，后站淋巴结有癌转移6例(60％)，无癌转移4例（40％)。SLN阴性19例，其中假阴性1例，后站淋巴结均无癌转移。SLNB评价：检出率96．7％、准确率93．3％、敏感度90．9％、假阴性率9．1％、假阳性率0。结论 只要提高技术水平，SLN染料着色和检出率都相对较高，对外科术式选择有实际指导意义。相信SLNB取代传统的ALND已为时不远。     

乳腺癌前哨淋巴结活检意义初探

目的：探讨开展乳腺癌前哨淋巴结活检(Sentinel lymph node biopsy，SLNB)的必要性、可行性、准确性及临床应用价值。方法：对45例临床、B超及钼靶检测腋窝LN阴性的原发乳腺癌患者，术中在原发肿瘤周围注射专利蓝进行腋窝淋巴结切除(SLNB)，随后行腋窝淋巴结清扫(ALND)。术中对部分SLN、术后对全部LN行常规病理检查。结果：45例患者中41例检测到SLN，成功率91．1％；假阴性率为6．66％，SLNB总的敏感性是93．3％，特异性是96．1％；总的阳性和阴性预测值分别是93．3％和96．1％。结论：乳腺癌SLNB是一项有实用价值的新技术，目前国内外仍在研究阶段，随着研究的扩大与深入将有可能取代常规的ALND。     

Tamoxifen and the female genital tract

Ugwumadu AHN, Carmichael P, Neven P. Tamoxifen and the female genital tract. Int J Gynecol Cancer 1998; 8 : 6–15.
Tamoxifen was originally developed by Imperial Chemical Industries (England) (ICI) in 1966 as an anti-estrogenic contraceptive. Ironically, it found a role in the treatment of anovulatory infertility, but its most important application to date is in adjuvant hormonotherapy for breast cancer. Tamoxifen has a complex and poorly understood mix of estrogenic and anti-estrogenic properties with variable and contrasting effects on hormone-sensitive target tissues, such as the endometrium. This article reviews the gynecologic lesions associated with tamoxifen therapy and discusses the merits and acceptability of endometrial surveillance tests and the role of progestogens.     

黑龙江省医疗机构突发事件监测能力的影响因素分析

采用定性与定量相结合的方法对黑龙江省部分医疗机构突发公共卫生事件监测情况调查研究.结果显示:现阶段影响医院应急预警信息收集与上报能力的主要因素为:人员、资金、政策支持、培训演练;其中影响人员信息收集与上报能力的因素为:预案知晓情况、传染病的知晓情况、传染病报告时限的了解情况、医院类别.