七年制考试改革成果分析

传统的一次性闭卷考试存在不少的弊端,我院在七年制中医学专业(中西医结合方向)两门临床课程中,试行了以多种形式相结合的考试改革,以综合考试形式取代传统的一次性期末考试.实践证明,考试改革的试行,大大提高了学生分析问题和解决问题的能力,激发了学生学习的兴趣,取得了较好的效果.     

正态分布定量指标统计分析报表的SAS宏程序

为规范临床试验数据管理，简化程序并减少数据统计分析过程中的错误来源，我们编制了一些特定的SAS宏程序，可以直接输出临床试验正态分布的定量指标统计分析报表。     

用药代动力学软件预测氨基糖苷类抗生素血浓度的准确性

目的 评价药代动力学软件(PKS)预测氨基糖苷类抗生素血浓度的准确性。方法 严重感染病人53例,静脉点滴氨基糖苷类抗生素q 6 h共3天。血药浓度测定用偏振荧光免疫测定法。用PKS软件Bayesian模式,以首次给药后峰和低浓度为反馈值,对以后每剂量的峰和谷浓度作预测。预测准确性和精确性用平均预测误差(ME)、均方预测误差(MSE)、均方预测误差平方根(RMSE)及其95％可信限表示。将24,48,72h峰、谷浓度实测值与预测值做配对t检验。结果 303次血药浓度实测值供预测。ME,MSE,RMSE及其95％可信限均在临床可接受范围内。24和48h峰浓度预测值和观察值间无显著差异(P>0.05),72 h组问差异有显著性(P<0.05)。上述3个时间点的谷浓度预测值和观察值间均有显著性差异(P<0.01)。结论 用PKS可准确预测氨基糖苷类静脉给药后4 8 h内每一剂量的峰浓度,但谷浓度预测受限。     

靶向联合化疗与常规化疗治疗表皮生长因子受体基因突变肺腺癌患者的临床效果

目的探讨靶向联合化疗治疗表皮生长因子受体(EGFR)基因突变晚期肺腺癌患者的临床疗效及靶向联合化疗对EGFR基因不同突变位点患者的疗效差别。方法选择安徽省胸科医院2016年1～12月收治确诊的64例EGFR基因检测阳性的Ⅲb/Ⅳ期肺腺癌患者,使用随机数字表方法分为靶向联合化疗组(33例)与常规化疗组(31例),同时对靶向联合化疗组患者按照其基因突变位点不同分为3个亚组(19外显子突变组、21外显子突变组、20外显子突变组)。靶向联合化疗组患者采用EGFR受体酪氨酸抑制剂靶向治疗联合培美曲塞+卡铂/顺铂治疗,常规化疗组患者采用培美曲塞+卡铂/顺铂治疗。比较两治疗组患者的近期及远期疗效,并对靶向联合化疗组不同位点远期疗效进行数据分析。结果靶向联合化疗组的中位无进展生存期高于常规化疗组,两组差异有统计学意义(P <0. 05),两组患者总体疗效和不良反应总发生率相似,差异无统计学意义(P> 0. 05)。靶向联合化疗组中,不同外显子突变的肺腺癌患者之间靶向联合化疗的生存期相似,差异无统计学意义(P> 0. 05)。结论 EGFR基因突变晚期肺腺癌患者接受靶向联合化疗能延长无进展生存时间,且不良反应未见增加。不同位点基因突变患者接受靶向联合化疗的临床效果无明显差别。     

Technologies for localization and diagnosis of prostate cancer

The gold standard for detecting prostate cancer (PCa), systematic biopsy, lacks sensitivity as well as grading accuracy. PSA screening leads to over-treatment of many men, and it is unclear whether screening reduces PCa mortality. This review provides an understanding of the difficulties of localizing and diagnosing PCa. It summarizes recent developments of ultrasound (including elastography) and MRI, and discusses some alternative experimental techniques, such as resonance sensor technology and vibrational spectroscopy. A comparison between the different methods is presented. It is concluded that new ultrasound techniques are promising for targeted biopsy procedures, in order to detect more clinically significant cancers while reducing the number of cores. MRI advances are very promising, but MRI remains expensive and MR-guided biopsy is complex. Resonance sensor technology and vibrational spectroscopy have shown promising results in?vitro. There is a need for large prospective multicentre trials that unambiguously prove the clinical benefits of these new techniques.     

The universal newborn hearing screening program in a public hospital: The importance of the day of examination

ObjectivesNewborn hearing screening programs are already implemented in many countries worldwide. Nonetheless there is still no consensus about the most proper post-birth day of examination. The purpose of this study was to assess the most appropriate day of universal hearing screening program in a public hospital.Material and methodsA prospective cohort study was conducted in “Attiko University National Health System Hospital” and included 2494 newborns. They were examined before discharge from the hospital, using transient evoked otoacoustic emissions (TEOAEs).ResultsFrom 2494 neonates included in the study, 2129 (85.4%) bilaterally passed the screening examination, while 365 (14.6%) failed the test. Higher levels of “pass” result per day of life were presented the third (90%) and fourth (94%) day of life. These days the referral scores were lower, reaching 6% the 4th post-birth day.ConclusionAll infants should be screened for their hearing in the first days of life as otoacoustic emissions can be recorded from the first 24 h of life. If the babies stay in the maternity unit for more that 1–2 days for any reason (protocol of the maternity unit, parents leave in remote areas, etc.) we recommend the 4th day of life as the most appropriate day of examination in order to minimize the false positive (“refer”) results at the initial examination.     

Impact of the sustained control of cardiovascular risk factors on first episode heart failure: The relevant role of primary care

Background: The role of cardiovascular risk factor control in the development of heart failure (HF) has not yet been clearly established.

Objective: To determine the effect of cardiovascular risk factor control on the occurrence of a first episode of hospital admission for HF.

Methods: A case-control study using propensity score-matching was carried out to analyse the occurrence of first hospital admission for HF taking into account the degree of cardiovascular risk factor control over the previous 24 months. All patients admitted to the cardiology unit of the Hospital del Mar between 2008 and 2011 because of a first episode of HF were considered cases. Controls were selected from the population in the hospital catchment area who were using primary care services. Cardiovascular risk factor measurements in the primary healthcare electronic medical records prior to the first HF episode were analysed.

Results: After the matching process, 645 participants were analysed (129 HF cases and 516 controls). Patients suffering a first HF episode had modest increments in body mass index and blood pressure levels during the previous two years. Adjusted odds ratio for experiencing a first HF hospital admission episode according to systolic blood pressure levels and body mass index was (OR: 1.031, 95% CI: 1.001–1.04), and (OR: 1.09, 95% CI: 1.03–1.15), respectively.

Conclusion: Increased levels of body mass index and systolic blood pressure during the previous 24 months may determine a higher risk of having a first HF hospital admission episode.