新生儿缺氧缺血性脑病及脑室扩大的随访

目的探对影响新生儿缺氧缺血性脑病(HIE)及脑室扩大患儿预后的因素 方法 对我院2002年1-12月收治的足月新生儿HIE 76例出院后进行3-19个月随访,其中26例在"SARS"期间改用电话随访 结果 住院HIE患儿88例,随访76例(86.4％),健康存活73例(96.1％),死亡2例(2.6％),脑瘫1例(1.3％) 轻度HIE 39例无后遗症;中度35例中脑瘫、死亡各1例(各2.9％),重度2例中死亡1例(50％),另1例无后遗症 有阿氏评分记录者71例,其中1 mm 8-10分30例中脑瘫1例(3％),1mm≤7分、5mm8-10分者17例均无后遗症;1mm、5mm均≤7分者24例中死亡2例(8％) 预后不良与胎儿发育迟缓、重度窒息、治疗不当等有关 头颅B超随访49例,脑室扩大12例(24.5％),其中出生时即有、随访中出现各6例,后者脑瘫1例,余在12-19个月恢复正常 结论 影响HIE预后不良的因素与胎儿发育迟缓、重度窒息、治疗不当等有关随访中可见一过性脑室扩大,预后良好     

医改尚未成功,路在何方?

由于医改的特殊性和空前性，难免出现一些问题，但应该认真总结经验教训：（1）医改的日的腹明确，当时提出医改的目标需要反思。（2）卫生系统的性质应明确，是公益事业，还是服务企业？（3）把卫生系统全面推向市场带来一系列弊端：过度医疗，医患关系恶化，医务人员的社会形象受到严重贬损，把医疗卫生系统推到非常被动的位置。对于这一系列不良后果反应迟钝，未能及时采取果断措施加以改造。（4）医改尚未成功，路在何方？医改成功的标准是国家满意、人民满意、卫生工作者满意。根据以上4个方面，有6点不成熟的建议供诸位参考。     

湘蕾金银花最佳采收时间和干燥方法的研究

目的 确定湘蕾金银花最佳采收时间和干燥方法。方法 采用高效液相色谱法测定湘蕾金银花花蕾的绿原酸含量。结果 不同时间采收的湘蕾金银花花蕾绿原酸的含量，随着花蕾增长而下降；一天中不同时间采收的花蕾绿原酸含量以清晨为高；不同干燥方法湘蕾金银花花蕾绿原酸的舍量，手工炒干最高，直接烘干法最低。结论 湘蕾金银花最佳采收时问宜在6月27日左右；一天中不同采收时间以清晨采收为佳；最佳干燥方法为杀青烘干法。     

Recovery from a recurrent major depressive episode

Episode-related factors and antidepressant treatment adequacy may be important determinants of recovery from a major depressive episode (MDE). We compared recovered and nonrecovered patients on baseline sociodemographic, clinical and episode-related measurements. Twenty-five inpatients with recurrent major depressive disorder diagnosed by SADS-L participated in this naturalistic, prospective, longitudinal study. Recovery, which was defined as a sustained return to non-depressed status lasting > or = 8 consecutive weeks, was assessed at 6- and 12-month follow-up with the Streamlined Longitudinal Interval Continuation Evaluation (SLICE). Thirteen (52%) patients met recovery criteria. The cumulative proportion remaining depressed for at least 52 weeks was 42.5%. Recovered patients had shorter episodes preceding the index hospitalization (P = .01). Despite adequate antidepressant pharmacotherapy, the length of the current episode remains the most important correlate of recovery from MDE recurrence. Our small sample size and the uncontrolled nature of treatment may limit the generalizability of these findings.     

Development and pretesting of “Becoming Breastfeeding Friendly”: Empowering governments for global scaling up of breastfeeding programmes

Scaling up breastfeeding programmes has not been highly prioritized despite overwhelming evidence that breastfeeding benefits the health of mothers and children. Lack of evidence‐based tools for scaling up may deter countries from prioritizing breastfeeding. To fill this gap, Becoming Breastfeeding Friendly (BBF) was developed to guide countries in effectively scaling up programmes to protect, promote, and support breastfeeding. BBF includes an evidence‐based toolbox that consists of a BBF Index, case studies, and a 5‐meeting process. These three interrelated components enable countries to assess their breastfeeding scaling up environment, identify gaps, propose policy recommendations, develop a scaling up plan, and track progress. The toolbox was developed based on current evidence and expert guidance from a Technical Advisory Group, which was composed of global breastfeeding and metric experts with experience in the scaling up of health and nutrition programmes in low‐, middle‐, and high‐income countries. The BBF toolbox required a step‐by‐step iterative approach to describe and systematize each component, thus an operational manual was developed. The BBF toolbox and BBF operational manual underwent intensive pretesting in two countries, Ghana and Mexico, resulting in the modification of each component plus the operational manual. Pretesting continues in six additional countries demonstrating that BBF is a robust and dynamic multi‐sectoral process that, with relatively minor adaptations, can be successfully implemented in countries across world regions.     

口腔溃疡分布与脏腑辨证的关系探析

【目的】探讨口腔溃疡分布与脏腑辨证的关系。【方法】收集2015年1月~2016年6月口腔溃疡患者65例,比较发生于舌及唇颊部位溃疡患者的情绪、饮食、睡眠、消化道病史和家族史,以及唇颊溃疡、舌尖溃疡及舌后缘溃疡的分布与脏腑辨证的相关性,并用统计软件SAS 9.2进行统计分析。【结果】(1)舌溃疡组焦虑患者的比例比唇颊溃疡组高(P0.01),有消化道病史的比例也比唇颊溃疡组高(P0.05)。(2)唇颊溃疡多与脾虚有湿或胃肠积热有关,舌尖溃疡多以心火上炎为主,舌后缘溃疡多以肝郁化火为主,3组间比较,差异均有统计学意义(P0.01)。【结论】口腔溃疡的分布与脏腑辨证有关。     

Improving the quality of transition and transfer of care in young adults with congenital heart disease

The transition and transfer from pediatric to adult care is becoming increasingly important as improvements in the diagnosis and management of congenital heart disease allow patients to live longer. Transition is a complex and continuous process that requires careful planning. Inadequate transition has adverse effects on patients, their families and healthcare delivery systems. Currently, significant gaps exist in patient care as adolescents transfer to adult care and there are little data to drive the informed management of transition and transfer of care in adolescent congenital heart disease patients. Appropriate congenital heart disease care has been shown to decrease mortality in the adult population. This paper reviews the transition and transfer of care processes and outlines current congenital heart disease specific guidelines in the United States and compares these recommendations to Canadian and European guidelines. It then reviews perceived and real barriers to successful transition and identifies predictors of success during transfer to adult congenital heart disease care. Lastly, it explores how disease‐specific markers of outcomes and quality indicators are being utilized to guide transition and transfer of care in other chronic childhood illnesses, and identifies existing knowledge gaps and structural impediments to improving the management of transition and transfer among congenital heart disease patients.