上海某二级医院实行委托管理的探索

医院托管是将医院委托给有一定知名度及一定实力与经验的（医疗）管理有限公司或三级医院,根据＂政事分开、管办分开＂的精神,进行大胆改革的一种管理模式。本文将简要阐述目前医院托管的背景,通过以一家（非中心）二级医院为例,总结其托管后采取的举措和取得的成果,分析医院托管的成功和不足的相关因素,并得出结论：委托管理符合新医改的方向,是医疗资源整合的一种模式,也是二级医院生存发展的优选途径之一。     

Improved sensitivity in caries clinical trials by selection on the basis of baseline caries experience

As caries prevalence in some countries declines, and panel sizes for discriminating anti-caries clinical trials inevitably increase, the need for participant pre-selection grows to avoid escalating cost and manpower problems. Hence, retrospective analyses of data were undertaken, from a 3-yr double-blind caries clinical trial where a linear fluoride dose-response had been obtained. As a result, it was demonstrated that the eruption status of permanent second molars, in 3005 participants aged 11-12 yr at outset, when coupled with their baseline clinical DMFT values, provided a sound basis for panellist size prediction without loss of sensitivity. Thus, had only those subjects with DMFT greater than 4, with at least three of their permanent second molars erupted been selected following clinical baseline examination, the same sensitivity would have been achieved with 52% fewer subjects. Furthermore, using these criteria, selection can be made on site, in real time, and a child informed whether its immediate participation in a trial is possible.     

Activity pattern of swallowing-related muscles, food properties and body position in normal humans

Summary  Activity patterns of the swallowing-related muscles were examined in normal subjects at different four body positions during swallowing of foods with different textural properties. Surface electromyograms were recorded from two muscle groups, the anterior tongue and suprahyoid muscles. The T _P technique we developed was applied to the electromyograms for quantitative analysis of the activity patterns. Three test foods were prepared by dissolving 2·0% (low), 5·7% (middle) and 9·1% (high concentration) of a thickening agent into distilled water. Each subject was delivered randomly, one of the test foods to swallow at one of the four body positions i.e. horizontal supine, 30° inclined, 60° inclined and upright. In this study, T ₅₀ values were calculated in activity data of the two muscle groups, and the T ₅₀ values were statistically examined analysis of variance with a linear model including four fixed effects of 'concentrations', 'body positions', 'subjects' and 'sessions'. Three major findings obtained were that (i) the activity pattern of the anterior tongue was altered from a decrementing discharge pattern to an incrementing discharge pattern by shifting from the upright to the horizontal supine position, (ii) the activity pattern of the suprahyoid muscles was altered from a decrementing discharge pattern to an incrementing discharge pattern by shifting from the low concentration food to the higher ones and (iii) two subgroups were detected in subjects with the significant effects of 'concentrations' and 'body positions'. These findings lead a conclusion that activity patterns of the swallowing-related muscles are affected by food properties and body positions.     

Effectiveness of using a computer to improve attention to visual analysis activities of five preschool children with disabilities

This study used a single‐subject reversal research design to examine the effectiveness of using a computer to improve attention to visual analysis activities in five preschool children with disabilities in a special education programme. Baseline levels of attention to task behaviours were measured during the performance of fine motor tabletop visual analysis activities of matching, requiring shape recognition, counting, free drawing, and size and colour discrimination. During the intervention phase, computer‐based visual analysis activities were introduced. Results suggest that each child's attention to task performance improved during the computer‐based activities, when measured by the number of distractions, although sitting tolerance and visual attention to the task did not change. The findings of this study, although limited to five participants with developmental disabilities, suggest that the students were interested and motivated to engage in computer‐based activities. More research is needed to examine a longer intervention phase and the effectiveness of computer‐based intervention in natural settings such as a classroom. Copyright © 2000 Whurr Publishers Ltd.     

Extrapulmonary Infections Associated with Nontuberculous Mycobacteria in Immunocompetent Persons

Over the past several years, the prevalence of human disease caused by nontuberculous mycobacteria (NTM) has increased. Whether the increase in cases is real or whether more cases are being recognized remains unclear. Despite a considerable increase in knowledge about NTM infections, they still represent a diagnostic and therapeutic challenge for several reasons: 1) pathogenic isolates may be indistinguishable from contaminant or saprophytic isolates; 2) timely and reliable identification of isolates may depend on proper communication between clinicians and laboratory staff; 3) lack of standardized susceptibility testing makes adoption of tailored therapies unrealistic; and 4) lack of treatment guidelines exposes patients to toxic drugs and disappointing outcomes. Laboratory research and multicenter controlled trials are needed to improve diagnosis and treatment of these infections.     

Family Status and Dilemma of HIV Positive Subjects

Objective To understand the family status and dilemma of HIV positive subjects and provide some related suggestions. Methods Constructured questionnaire and in-depth interview were used to survey their psychological needs of the 111 HIV positive subjects and AIDS patients from 4 provinces in China. Results HIV positive subjects and AIDS patients had strong mental stress. All of them hope to get support from their families; the most difficulty the subjects faced was economic poor. Conclusion It is a highlight to promote AIDS education to establish a good social environment in which HIV positive subjects and AIDS patients can live quietly and happily. And psychological support from their families and the society is very important to HIV positive subjects and AIDS patients.     

提高高校思想政治理论课实效性的必要性

当代大学生的思想政治教育工作倍受党中央、国务院的高度重视和社会各界的广泛关注。作为主渠道的思想政治理论课只有从教学观念、教学内容、教学方式、教学手段等四个方面加以改进和创新,才能不断增强授课的针对性和实效性。     

2002年循证医学研究热点的文献计量分析

目的分析2002年国外循证医学研究热点,为我国开展循证医学研究与实践提供借鉴.方法检索MEDLINE数据库中收录的2002年"Evidence-based medicine"论文;遵循文献计量学原理、利用作者所在系编制的文献计量分析软件确定循证医学研究高频主题词;对高频主题词进行同篇聚类分析、并描绘聚类关系图.结果共检出循证医学研究论文545篇;相关主题词1 554个;高频主题词35个,其中包括循证医学、循证医学标准、方法及教育、实践指南及其标准、决策等;聚类分析显示高频主题词主要聚于循证实践指南及其推广、循证医学方法学等9个类别.结论2002年循证医学研究热点主要包括实践指南及其推广、循证医学方法学、医学伦理、循证临床决策及其应用等,可为我国的循证医学研究提供参考.     

建设乳腺癌专题学习网站的依据

随着我国网络建设的迅速发展,特别是校园网的广泛建立,以计算机网络为基础的现代教育手段得到广泛的应用,Internet多媒体教学资源的开发已迫在眉睫。Internet学习网站的建设是信息技术与课程整合的新视点,是信息技术与学科整合的重要切入点。乳腺癌专题学习网站为学生对专题内容开展深入地学习、研究提供必要的支持、引导、管理和帮助。