大理学院2003级预防医学专业卫生统计学期末考试成绩分析

目的通过分析大理学院2003级预防医学专业卫生统计学的期末考试成绩,评价教学质量,为进一步教改提供依据。方法运用教学测量学的原理和方法对试卷的难度、区分度、信度和成绩进行分析。结果平均成绩为72.97,标准差为12.04,呈近似正态分布;信度系数在0.43-0.63之间;难度系数较高的是上机计算分析题(0.47)和综合分析题(0.52);难度系数较低的是单项选择题(0.80)和填空题(0.82);区分度系数较低的是填空题(0.15)和单项选择题(0.19),其余的区分度都>0.4;失分较高的是上机计算分析题(36.32%)、综合分析题(34.12%)和名词解释(23.33%)。结论试题难度适中、区分度和信度好。学生成绩比较好,教改效果明显,但统计学综合应用的能力、SPSS实习和专业英语学习等工作有待进一步提高。     

Induction of cervical compliance by balloon catheter in late pregnancy

Balloon catheter was used for pre-induction cervical priming and in order to enhance induction of labor in 51 patients. This procedure was found to be a safe and effective adjunct to induction of labor in patients with unripe cervices (mean Bishop score 3.4) with induction of labor to delivery time of 6.5 h.     

Utility of MTT assay in three-dimensional cultured human skin model as an alternative for draize skin irritation test: approach using diffusion law of irritant in skin and toxicokinetics-toxicodynamics correlation

Purpose. A cytotoxicity assay using a three-dimensional cultured human skin model, Living Skin Equivalent-high (LSE-high) was evaluated as an alternative to the Draize skin irritation tests using animals. A relation between the cytotoxicity and calculated concentration of an irritant in skin was also evaluated. Methods. Colorimetric thiazoyl blue (MTT) conversion assay and a surfactant, cetylpyridinium chloride (CPC), were selected as a cytotoxicity assay and a model irritant. The fraction of dead cell number in the MTT assay or the Draize irritation score (in vitro and in vivo irritation data, respectively) was treated as a function of CPC concentration in the viable skin of LSE-high and guinea pig. Separately, in vitro permeations of CPC through the LSE-high or excised guinea pig skin were determined to calculate the average concentration of CPC in the viable skin using the Fickian diffusion theory. The obtained relations between the irritation scores and CPC concentration were evaluated by the Emax model (Hill equation). Results. CPC concentration showing 50% irritation (IC ₅₀) was similar for the MTT assay (18.9%) and Draize test (12.3%), and a good relationship (r = 0.981) was observed between the fraction of dead cell number and the Draize score. In contrast, IC ₅₀, 1.32%, for the MTT assay in LSE-high was much lower than that using guinea pig skin. We then corrected the results for the MTT assay using a ratio of IC ₅₀ in guinea pig skin against LSE-high, resulting in a good relation between both MTT results in guinea pig skin and LSE-high. Conclusion. The present results suggest that the MTT assay using LSE-high may be utilized as an alternative for the Draize test in animals for evaluating skin irritation.     

Comparison of sleep/wake habits of university students with or without a habit of self-awakening

Several studies have reported that some people have the ability to awaken from sleep without using external means. This ability is called 'self-awakening'. The present study investigated the sleep/wake habits of university students with or without a habit of self-awakening. Of the 643 university students, 66 students (10.3%) habitually self-awakened in daily life. In comparison with those who did not self-awaken (n = 577, 89.7%), self-awakening students went to bed and woke up approximately 30 min earlier, felt better when they woke up in the morning, and dozed off less in the daytime. Moreover, self-awakening students showed a higher morningness score.     

Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment

Our objective was to compare the effectiveness of percutaneous cholecystostomy (PC) vs conservative treatment (CO) in high-risk patients with acute cholecystitis. The study was randomized and comprised 123 high-risk patients with acute cholecystitis. All patients fulfilled the ultrasonographic criteria of acute inflammation and had an APACHE II score > or =12. Percutaneous cholecystostomy guided by US or CT was successful in 60 of 63 patients (95.2%) who comprised the PC group. Sixty patients were conservatively treated (CO group). One patient died after unsuccessful PC (1.6%). Resolution of symptoms occurred in 54 of 63 patients (86%). Eleven patients (17.5%) died either of ongoing sepsis (n=6) or severe underlying disease (n=5) within 30 days. Seven patients (11%) were operated on because of persisting symptoms (n=3), catheter dislodgment (n=3), or unsuccessful PC (n=1). Cholecystolithotripsy was performed in 5 patients (8%). Elective surgery was performed in 9 cases (14%). No further treatment was needed in 32 patients (51%). In the CO group, 52 patients (87%) fully recovered and 8 patients (13%) died of ongoing sepsis within 30 days. All successfully treated patients showed clinical improvement during the first 3 days of treatment. Percutaneous cholecystostomy in high-risk patients with acute cholecystitis did not decrease mortality in relation to conservative treatment. Percutaneous cholecystostomy might be suggested to patients not presenting clinical improvement following 3 days of conservative treatment, to critically ill intensive care unit patients, or to candidates for percutaneous cholecystolithotripsy.     

Cost-effectiveness of the Danish smoking cessation interventions

The cost-effectiveness of smoking cessation interventions is well documented. However, most studies are based on randomized controlled trials (RCTs) and provide little information on the differences between subgroups. This study assessed the relative cost-effectiveness of smoking cessation interventions offered to various subgroups of smokers, based on real-life data. Regression analyses provided information on the factors determining abstinence and costs and led to the formation of relevant subgroups of smokers. Probabilistic Markov modeling was then used to estimate the relative cost-effectiveness of smoking cessation interventions for the entire database population and for the subgroups compared to a no-intervention case. The ICER for the base case population was estimated at €1,358. This is consistent with results from the existing literature. Group simulations showed lower ICERs for men, hospitals, and light smokers and falling ICERs with increasing age. Despite differences in the cost-effectiveness ratios between subgroups our results do not justify any kind of subgroup differentiation in a smoking prevention policy.     

The New Injury Severity Score: Better Prediction of Functional Recovery after Musculoskeletal Injury

OBJECTIVES: Injury Severity Score (ISS) is the most widely used method of assessing severity of injury in blunt trauma. It has been recognized that, by only allowing the score to consider the worst injury for each body system, ISS underestimates the problems of multiple musculoskeletal injuries. The New ISS (NISS) allows the three most severe injuries to be scored, irrespective of region affected, and may give better prediction of functional recovery in these patients. METHODS: A prospective cohort study of 200 patients with musculoskeletal injuries, examining the predictive value of ISS and NISS on functional recovery as measured by patient-derived outcome measures (Short Form-36, Sickness Impact Profile, and Musculoskeletal Function Assessment). RESULTS: NISS was greater than ISS in 34 patients (17%). NISS showed closer correlation with total scores and subscores of the outcomes measures than did ISS (Spearman's rho ranked test, P < 0.05). CONCLUSIONS: NISS, a simple modification from ISS, better predicts functional outcomes in survivors of musculoskeletal trauma, and offers an improvement in the assessment of effectiveness of trauma care delivery.     

大脑皮层电刺激对偏瘫患者肢体功能活动的影响

目的探讨大脑皮层电刺激对偏瘫患者肢体功能的影响。方法脑血管后遗症患者随机分为3组,分别进行大脑皮层电刺激、周围神经和肌肉电刺激治疗和脑保护治疗,应用偏瘫后神经功能障碍评分比较三者的疗效。结果皮层刺激组上肢运动障碍、下肢运动障碍、肌张力增强和肢体疼痛的改善得分分别为:0.66±0.37、0.87±0.36、0.66±0.51和1.20±0.44,与内科治疗组比较P<0.01,与周围刺激组比较P<0.05。结论大脑皮层电磁激治疗在运动障碍、肌张力增强、肢体疼痛方面均具有非常显著的疗效。     

PCT水平、APACHE III及MODS评分对SIRS患者预后预测性的临床比较

目的比较PCT(前降钙素)水平、APACHEIII评分和MODS评分对SIRS(系统性炎症反应综合征)患者预后的预测能力。方法将1998年11月～2004年11月间入住我院ICU,满足SIRS标准的95例患者纳入此次研究。PCT在动脉血样本中检测,记录患者入院第1个24h后APACHEIII和MODS评分,连续2周每天记录1次或直到患者出院或死亡。将患者按预后分成两组,生存者(n=71)和非生存者(n=24)。按照PCT水平的变化结果又分为3组下降组、升高组、无变化组。结果在整个研究期间APACHEIII和MODS评分在生存者和非生存者之间都有显著区别,但是PCT在生存者和非生存者之间区别仅表现在第1到第7天,入院当天按PCT的水平所分的三组中生存者和非生存者PCT的值无显著性区别。PCT、APACHEIII评分和MODS评分第1天预测死亡率的ROC曲线下面积分别为0.690,0.915,0.913。结论PCT可以作为SIRS患者死亡率的预测因子,但是可靠性低于APACHEIII和MODS评分。     

Likely variations in perioperative mortality associated with cardiac surgery: when does high mortality reflect bad practice?

OBJECTIVE—Several methods exist for estimating the risk of perioperative mortality based on preoperative risk factors; graphical methods such as the variable life adjusted display (VLAD) can be used to examine how an individual surgeon's performance for a series of operations fares against what would be expected, given the case mix. This study aimed to devise a method for assessing the natural variation in outcome in order to assist with making judgements about individual performance, in particular whether seemingly poor performance could have occurred by chance.
METHOD—The risk scoring system has been derived and validated locally for cardiac surgery. A method is described for calculating the probability that an observed number of deaths occurs within a sequence of operations if perioperative mortality is regarded as a chance event with an expected value derived from the risk score. To illustrate this method, nested prediction intervals are superimposed onto VLAD plots for a series of 393 isolated coronary artery bypass and isolated valve operations performed by a single surgeon.
RESULTS—Using the locally derived risk score, the VLAD plot for the individual surgeon shows a net life gain of about 6 over the predicted number of survivors, which is observed to be within the 90% prediction interval. If the Parsonnet scoring system is used instead of the locally derived risk score, the net life gain is considerably overestimated.
CONCLUSIONS—The nested prediction intervals are straightforward to generate and can be integrated into a visually informative display. As an indication of the inherent variability in outcome, they have a valuable role in the monitoring of surgical performance.


Keywords: perioperative mortality; variable life adjusted display; locally derived risk score; Parsonnet score