Evidence-based Medicine

Summary:  Evidence-based medicine (EBM) has become a watchword for "the new" medical practice in the new century. Whether it represents a paradigm shift or simply a codification of the scientific method in medicine will be debated for years to come. Regardless of the place of EBM in medicine, this "movement" has served an important role in moving physician practice into the realm of becoming more scientific (albeit empirical) and transparent. There are still many problems to be addressed in the global application of the best evidence for medical practice. These include low-quality studies, delays in implementation of clear-cut improvements, outright fraud and deceit, and wariness on the part of physicians to change their practice. By working to understand the underpinnings of EBM (basic statistical concepts and critical thinking) we can advance the practice of medicine along the moral high road of science.     

WHAT KIND OF BENEFIT DO WE EXPECT FOR PERORAL PANCREATOSCOPY IN THE DIAGNOSIS OF INTRADUCTAL PAPILLARY MUCINOUS TUMOR OF THE PANCREAS?

Intraductal papillary mucinous tumor (IPMT) of the pancreas is characterized by slow growth and a relatively favorable prognosis, however, invasive cancer originating in an IPMT is associated with a poor prognosis. Although various parameters in imaging modalities have been advocated to differentiate between benign IPMN and malignant ones, it is not easy to obtain definite diagnosis based on these parameters. Peroral pancreatoscopy (POPS) allows a clear and direct visualization of the pancreatic duct, providing useful information regarding tumor nature in IPMT. The authors have studied the usefulness of POPS in the diagnosis of IPMT. Nevertheless, its usefulness is not necessarily widely accepted and the significance of POPS is still controversial. In this review, the authors intended to address the diagnostic value of POPS and to clarify its role in the diagnosis of IPMT. The authors think treatment of IPMT can be improved by introducing POPS because the determination of surgical procedure as well as the area of resection based on the preoperative diagnosis of the involvement of the main pancreatic duct and branch duct is inevitable.     

颈肩背轴型反流皮瓣修复儿童颏颈瘢痕挛缩

目的探讨修复儿童颏颈瘢痕挛缩一种实用而较理想的方法.方法以颈横动脉浅支为蒂,利用其与旋肩胛动脉皮支的丰富吻合,反流形成超长的轴型皮瓣,向前旋转修复瘢痕松解后的颈前创面.结果采用本皮瓣修复30例儿童颏颈瘢痕挛缩,其中18例随访2年,颈部活动自如,颌骨发育无明显异常,皮瓣色泽良好,效果令人满意.结论本皮瓣轴型血管恒定,反流灌注动脉压高有保证,供瓣面积充足,供区多可直接拉拢缝合,是修复儿童颏颈瘢痕挛缩的较理想方法.     

管理人员职业紧张常模及转换表研制

目的中高层管理人员、一般管理人员职业紧张常模、应用表、分级标准研究。方法采用职业紧张量表(OSI-R),对中高层管理人员263例、一般管理人员569例,共计832例常模样本进行研究。结果首先,采用OSI-R量表分别研制了中高层管理人员、一般管理人员职业紧张常模;其次,在常模的基础上,分别研制了常模样本粗分转换为T分表。职业紧张程度分级职业任务和紧张反应问卷中,T分≥70分者,为高度职业紧张、紧张反应;T分在60分至69分范围内者,为中度职业紧张、紧张反应;T分在40分至59分范围内者,为适度职业紧张和紧张反应;处于正常范围。T分低于40分者,为相对缺乏职业紧张和紧张反应。在应对资源问卷中,T分低于30分者,表明高度缺乏应对资源;T分在30分至39分范围内者,表明中度缺乏应对资源;T分在40分至59分范围之间者,具有适度的应对资源,属于正常范围;T分≥60分者,表明有很强的应对资源。结论将职业紧张的模式结合中高层管理人员、一般管理人员职业紧张常模及应用表,分别针对不同个体主要紧张源、紧张反应、应对资源,采取有针对性的干预(组织、个体)措施,以降低中高层管理人员、一般管理人员职业紧张程度,保护和促进工作能力是职业卫生领域面临的重要任务之一。     

消炎痛治疗宫内放环后出血

积极治疗节育手术并发症是搞好计划生育的一个重要环节。月经异常是宫内放置节育环的主要并发症，也是节育环停止使用的主要原因。近几年来本人采用消炎痛治疗官内放环后月经异常，取得了良好的效果。     

DTF降茶氟剂降茶氟初步研究

目的探讨DTF制剂降茶氟效果。方法在不同制茶方法程序中加入DTF制剂观察其降氟效果。结果在冲泡或煮沸(1.0g茶叶,200ml水量)沏茶中,0.2gDTF可使茶氟降低约60%,使茶水氟浓度由2.0～4.0mg/L降到1.0mg/L左右,茶液色、味、pH值无改变。结论DTF是1种有效的降茶氟剂。     

初次吸毒者与复吸者戒毒期间生活质量比较

目的:了解包头市初次吸毒者与复吸者戒毒期间的生活质量。方法:用QOL-DA2.0量表对戒毒人员的生活质量进行调查。结果:初次吸毒者与复吸者各纬度进行t检验显示躯体功能纬度(t=10.51)、心理功能纬度(t=5.94)、症状及毒副作用纬度(t=6.41)、社会功能纬度(t=10.47)和总分(t=10.48)均有统计学意义(P<0.001),表明戒毒期间初次吸毒者的生活质量高于复吸者。结论:在戒毒期间初次吸毒者的生活质量较复吸者易改善。     

Statistical analysis of pathologic risk factors for intramyometrial lymphvascular space involvement in myoinvasive endometrial carcinoma

In a retrospective study using univariate analysis, we identified tumor type (nonendometrioid vs endometrioid), depth of myoinvasion (MI), mode of MI (infiltrative vs cohesive), and direct anatomic invasion of the cervical wall from the isthmus as significant positive risk factors for intramyometrial lymphvascular space involvement (LVSI). On multivariate analysis, tumor grade, depth of MI, and mode of MI retained their significance. We created a grid for the relative risks of LVSI with respect to these variables individually or in combination. We suggest that our indirect estimate of the risk of LVSI can help in assessing prognosis and determining the need for adjuvant therapy whenever LVSI is important in clinical decision making, but its pathologic diagnosis is uncertain.     

六经气津互化论

气与津皆生于水谷,气生于水,水化于气,津即为水。由于气津互化的密切关系,故任何一方的改变,都会影响到另一方,即所谓水化于气,亦能病气;气生于水,亦能病水。因此,太阳经气可概括为两大功能,即卫外和气化,是由气津互化而体现的;阳明气津之间,表现为相互制约;少阳经的气津互化,关系到少阳气机的条达舒畅及三焦水道的通调运使;太阴脾气的健旺,可使津液化生有源;少阴心肾精血充沛,滋养有时,才可使心肾之气化生有源;而厥阴之气的条达顺畅,又可维持津液代谢的平衡状态。     

超市连锁店熟食卤味销售的HACCP研究

应用HACCP的原理和方法,对超市连锁店熟食卤味销售进行了危害因素分析,找出了关键控制点(CCP),提出了控制措施,并建议超市连锁店销售非包装熟食卤味时使用密封低温冷藏展示柜。