疾病预防控制 卫生执法监督 综合业务信息管理系统应用效果分析

目的分析疾病预防控制、卫生执法监督综合业务信息管理系统应用效果。方法将各业务管理模式作需求分析,并进行适应性修改。结果系统全程记录检测、质控、评价过程,减少和消除了系统误差和随机误差;系统设置统计查询模块和检索功能,提高了基础资料的使用效率;系统自动生成各类检验报告单和监督文书,格式统一、标志齐全。结论应用系统提高了工作质量、效率、准确性和可靠性,使出具文书的科学性和权威性明显提高。     

Investigation of ultrasound screening efficiency for neural tube defects during pregnancy in rural areas of China

Objectives

To understand the uptake and efficacy of ultrasound screening for neural tube defects (NTDs) during pregnancy, and the outcomes when NTDs were detected in rural areas of China.

Study design

Prevalence study.

Methods

Four hundred and twenty-four women who delivered or gestated babies/fetuses with NTDs were selected at random in 20 counties of two provinces of China from March 2008 to January 2009. The uptake of ultrasound screening, NTD detection rate and termination of pregnancy (TOP) rate were calculated and analyzed. Generalized estimating equations were employed to control for potential confounding factors.

Results

The uptake of ultrasound screening was 98.8%. Among the study subjects, 361 (85.1%) NTDs were detected and 63 (14.9%) were not detected by prenatal ultrasound screening. The total detection rate was 43.3% (15.6%, 49.6% and 52.2% in the first, second and third trimesters, respectively; P < 0.05). Taking the possibility of NTD detection in the first trimester as 1.0, the possibilities in the second and third trimesters were 10.9 [95% confidence interval (CI) 6.5–18.3] and 25.2 (95% CI 13.3–47.6), respectively. The detection rate at the township health centres (THCs), family planning centres (FPCs), maternal and child care service centres (MCSCs) and hospitals was 24.5%, 29.1%, 53.6% and 78.1%, respectively (P < 0.05). Taking the possibility of NTD detection at THCs as 1.0, the possibilities at FPCs, MCSCs and hospitals were 0.9 (95% CI 0.5–1.6), 3.4 (95% CI 1.9–6.1) and 2.1 (95% CI 1.3–3.4), respectively. Three hundred and fifty-five (98.3%) of the 361 NTDs detected at prenatal ultrasound screening ended in TOP.

Conclusions

The uptake of ultrasound screening was satisfactory, but the NTD detection rate was low. Ultrasound screening did not play its full role in the secondary prevention of NTDs in the study areas. Medical institutions in rural areas in China need to improve their ultrasound screening skills in order to increase the efficacy of NTD control.     

Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation

Purpose

To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, or repeated sooner than recommended due to preparation (prep) quality; prep quality; colonoscopy duration; and patient satisfaction with and tolerance of the preparation.

Methods

We used 4 alternating 4-week periods to compare the decision tool with usual care for outpatient colonoscopy. All decision tool decisions were reviewed in real-time by gastroenterology nurses and/or physicians. Patients completed a survey about the prep process. Endoscopists blindly rated prep quality. Colonoscopy duration and findings were recorded.

Results

Of 354 persons in the decision tool group, 4 prep decisions were overridden because of patient preference or prior prep failure, but none for medical reasons. Sodium phosphate was used more frequently in the decision tool group (73% vs. 41%; P < 0.01). There was no difference between the decision tool and usual care groups in the composite outcome (26% vs. 30%, respectively; P = 0.29), acceptable prep quality (62% vs. 56%; P = 0.22), colonoscopy duration (28 vs. 30 min; P = 0.17), patient satisfaction (P = 0.38), or preparation tolerance (P = 0.37).

Conclusions

An electronic medical record-based decision tool can safely and effectively tailor the prep for colonoscopy and may improve colonoscopy efficiency and patient satisfaction.

Limitations

This study was performed at a single VA medical center and endoscopy unit, relies on the presence of relevant medical conditions and laboratory data in the electronic medical record, and had a higher than expected use of sodium phosphate during usual care.     

直丝弓与方丝弓矫治器的疗效比较

目的：应用PAR指数评价直丝弓矫治器与方丝弓矫治器的治疗效果。方法：回顾性分析本院2004年6月～2010年8月收治入院的80例采用直丝弓或方丝弓双颌固定矫治器完成治疗错胎畸形患者临床资料,随机分为直丝弓组和方丝弓组,每组40例,对两组患者的测量数据进行统计学检验。对治疗前后模型进行PAR指数测量,记录治疗前后PAR分值及其差值,以治疗前相同的PAR总分值者进行临床分析。结果：治疗后直丝弓组后牙排列的PAR分值低于方丝弓组（P〈0.05）,后牙排列效果较方丝弓组好。两组患者治疗后其余各项PAR分值及治疗前后PAR差值均无统计学差异（P〉0.05）。直丝弓组平均疗程缩短5.7个月。结论：直丝弓矫治器对牙齿排列尤其是后牙的定位较准确,在较短的时间内可取得与方丝弓矫治器相同的治疗效果,矫治效率较方丝弓矫治器高。     

Influence of muscle fibre type and pedal rate on the V̇O2-work rate slope during ramp exercise

We hypothesised that the ratio between the increase in oxygen uptake and the increase in work rate (O₂/WR) during ramp cycle exercise would be significantly related to the percentage type II muscle fibres at work rates above the gas exchange threshold (GET) where type II fibres are presumed to be active. We further hypothesised that ramp exercise at higher pedal rates, which would be expected to increase the proportional contribution of type II fibres to the total power delivered, would increase the O₂/WR slope at work rates above the GET. Fourteen healthy subjects [four female; mean (SD): age 25 (3) years, body mass 74.3 (15.1) kg] performed a ramp exercise test to exhaustion (25 W min^–1) at a pedal rate of 75 rev min^–1, and consented to a muscle biopsy of the vastus lateralis. Eleven of the subjects also performed two further ramp tests at pedal rates of 35 and 115 rev min^–1. The O₂/WR slope for exercise <GET (S ₁) was significantly correlated with O₂ peak in ml kg^–1 min^–1 (r=0.60; P<0.05), whereas the O₂/WR slope for exercise >GET (S ₂) was significantly correlated to percentage type II fibres (r=0.54; P=0.05). The ratio between the O₂/WR slopes for exercise above and below the GET (S ₂/S ₁) was significantly greater at the pedal rate of 115 rev min^–1 [1.22 (0.09)] compared to pedal rates of 35 rev min^–1 [0.96 (0.02)] and 75 rev min^–1 [1.09 (0.05), (P<0.05)]. The greater increase in S ₂ relative to S ₁ in subjects (1) with a high percentage type II fibres, and (2) at a high pedal rate, suggests that a greater recruitment of type II fibres contributes in some manner to the xs O₂ observed during ramp exercise.     

A high blood lactate induced by heavy exercise does not affect the increase in submaximal \dot V{\text{O}}_2 with hyperoxia

Few studies evidenced an enhancement in oxygen uptake during submaximal exercise in hyperoxia. This O₂ overconsumption seems to increase above the lactate threshold. The aim of this study was to determine whether the hyperoxia-induced enhancement in may be related to a higher metabolism of lactate. Nine healthy males (aged 23.1 years, mean = 53.8 ml min^–1 kg^–1) were randomized to two series of exercise in either normoxia or hyperoxia corresponding to an inspired O₂ fraction (F_IO₂) of 30%. Each series consisted of 6 min cycling at 50% (Moderate1), 5 min cycling at 95% (Near Max) and then 6 min at 50% (Moderate2). In both series Near Max was performed in normoxia. was significantly greater under hyperoxia than in normoxia during Moderate1 (2192±189 vs. 2025±172 ml min^–1) and during Moderate2 (2352±173 vs. 2180±193 ml min^–1). However, the effect of the high F_IO₂ was not significantly different on (+172±137 ml min^–1 with [La] ~ 6 mmol l^–1) compared to (+166±133 ml min^–1 with [La] ~ 2.4 mmol l^–1). [La] at the onset of Moderate2 was not different between normoxia and hyperoxia (10.1±2.2 vs. 10.9±1.6 mmol l^–1). The results show that is significantly increased during moderate exercise in hyperoxia. But this O₂ overconsumption was not modified by a high [La] induced by a prior heavy exercise. It could be concluded that lactate accumulation is not directly responsible for the increase in O₂ overconsumption with intensity during exercise in hyperoxia.The authors declare that the experiments comply with the current French laws.     

永磁减载耐久性叶轮血泵的研制

为了延长血泵使用寿命 ,目前除了电磁磁浮还没有更好的解决办法 ,但是电磁磁浮需要位置检测和反馈控制 ,而且增加能耗、可靠性差 ,因此提出了永磁减载的新方法。介绍了一种新颖的永磁轴承 ,它具有径向支承和轴向弹簧的双重作用。在血泵驱动电机的两端安装两个永磁轴承 ,既可以为转子提供径向减载 ,又可以使转子轴向悬浮。为了减小定子与转子之间的摩擦 ,除了提高轴承的径向支承力以外 ,还要减小定子铁心对转子磁钢的径向吸引力 ,解决的办法是适当减小铁心和转子磁钢的用量 ,同时增大定子与转子间的气隙。通过实验研究转子磁钢参数和气隙的变化对电机效率的影响 ,可以确定转子磁钢的尺寸和气隙值 ,从而使电机保持高效率运转 ,同时又实现了永磁减载。通过永磁减载方法设计的耐久性叶轮血泵已连续稳定运转八个月 ,振动小 ,噪音低 ,进一步深入研究正在进行之中     

Muscle strength and electromyogram in boys and girls followed through puberty

The main purpose of this study was to investigate the changes in anthropometric measures and muscle strength that occur during puberty in children from the age of 11 to 16 years. Special attention was paid to possible gender- and muscle action-type-specific alterations in torque/velocity and EMG/velocity characteristics. Sixteen children participated in the study (9 boys and 7 girls). Eccentric and concentric muscle strength was measured on an isokinetic dynamometer at angular velocities of 45, 90 and 180° · s⁻¹. Simultaneously, a surface electromyogram (EMG) was recorded from the quadriceps muscle. At the age of 11, the boys and girls exhibited equal anthropometric measures and strength performance. In both genders, body measures and muscle strength increased significantly during the 5-year period, with larger increases being recorded for the boys. In addition, the boys increased selectively their eccentric torque per body mass, indicating an action-type-specific change in muscle quality. The general shape of the torque/velocity relationship exhibited an adult-like pattern both before and after puberty, and did not differ between genders. Both pre- and postpuberty, myoelectric activity was generally lower during eccentric than concentric actions, the highest values occurring for both genders in the concentric 180° · s⁻¹ test. Ratios of eccentric to concentric torque per EMG, which reflect electromechanical efficiency, showed no significant changes with age. A significant velocity- and gender-specific change in electromechanical efficiency was observed at the highest speed at postpuberty, where the ratio for the girls was higher than for the boys. Accepted: 13 June 1999     

基于数据包络法的中医类医院卫生资源配置效率分析与研究＊

目的 对全国中医类医院卫生资源配置效率进行分析与研究,为进一步优化中医类医院卫生资源配置提出参考建议。方法 采用因子分析方法选取投入和产出指标,使用DEAP2.1软件,利用数据包络分析方法,运用CCR-BCC模型对2017年全国31个省市的中医类医院卫生资源相关数据进行分析。结果 数据分析研究,2017年31个省市中医类医院卫生资源配置综合效率、纯技术效率和规模效率均值分别为0.949、0.973、0.975,其中达到DEA有效省市14个（占45.16%）,DEA弱有效省市7个（占22.58%）,非DEA有效省市10个（占32.26%）。结论 我国2017年中医类医院卫生资源配置效率总体水平较高,但有效配置省市占比较低且各省份差异较大,部分省市出现卫生资源冗余情况,需优化投入规模与结构,进一步提高中医药医疗服务效率。     

内镜黏膜下剥离术治疗十二指肠病变的临床疗效分析

目的评价内镜黏膜下剥离术(ESD)治疗十二指肠病变的临床疗效及安全性。方法回顾性分析2011年1月至2019年5月在中南大学湘雅二医院消化内科行ESD治疗的45例十二指肠病变患者(共46个病变)的临床资料,对病变特点、整块切除率、完整切除率、手术并发症、术后病理和复发情况进行统计分析。结果45例患者中男20例、女25例,年龄(52.0±11.8)岁。46个病变中位于十二指肠球部31个(67.4%),降部12个(26.1%),球降交界部3个(6.5%)。病变直径(2.4±1.9)cm。病变起源于黏膜层14个(30.4%),黏膜下层29个(63.1%),固有肌层3个(6.5%)。术后病理:Brunner腺瘤11个(23.9%),神经内分泌肿瘤9个(19.6%),异位胰腺5个(10.9%),脂肪瘤5个(10.9%),其他16个(34.8%)。45例患者46个病变均顺利完成ESD,病变整块切除率100.0%(46/46),完整切除率为91.3%(42/46)。术中出血1例(2.2%),内镜下成功止血;迟发性穿孔1例(2.2%),行急诊外科手术治疗;电凝综合征1例(2.2%),内科保守治疗好转。术后2例患者追加外科手术治疗。患者平均住院时间6.2 d(2~21 d),无一例死亡。随访41例,平均随访时间30个月(1~78个月),随访期间1例(2.4%)复发。结论ESD治疗十二指肠病变安全、有效,具有较好的临床应用价值。