378例教师嗓音疾病分析

目的：了解中学和大学教师嗓音疾病状况。方法：采用间接喉镜或电子喉镜观察，结合问诊和嗓音的客观检测。结果：患嗓音疾病的中学教师比率（78．31％）明显高于大学教师（21．69％）。其中，中学教师最常见的嗓音疾病是慢性喉炎（66％）和声带小结（28％）。中学教师与大学教师比较，嗓音检测参数声门噪声（NNE）差异有统计学意义。结论：中学教师的嗓音保健直接关系到教学质量，防治教师嗓音疾病，应引起教育主管部门及全社会的关注。     

中美高等医学教育比较及启示

美国高等医学教育是特色鲜明和比较成功医学教育模式之一，与之相比，我国高等医学教育存诸多方面存存着较大的差距。借鉴美国医学教育的经验，对我国新的历史时期建设一流高等医学院校将大有裨益。     

影响高校教师亚健康状态的成因分析

目的了解高校教师亚健康状态的存在现状，探索引起高校教师亚健康发生的相关危险因素，为进一步提出相应的预防措施提供依据。方法采用统一调查表，以单位统一发放，当场填写收回，亚健康状态的确定采用康乃尔医学指数（CMI）。结果高校教师亚健康状态发生率为55．11％，男性62．61％，高于女性42．96％，二者差异有统计学意义（P〈0．01）；不同年龄、职称组间教师亚健康状态发生率总的差异有统计学意义（P〈0．01），年龄越大、职称越高者亚健康状态发生率也较高；吸烟、酗酒和缺乏体育锻炼会增高亚健康状态发生率，回归分析显示，影响教师亚健康状态的主要因素有年龄、锻炼态度、睡眠质量、吸烟酗酒、心理环境、疼痛、人际关系、压力、自我保健等。结论高校教师亚健康状态发生率较高，随着年龄、职称的变化发生率逐渐增高，同时个人生活行为与心理因素对亚健康发生影响较大，应采取针对性干预措施，对高校教师健康水平具有重要意义。     

A Comparison between Two Methods for Assessing Heartbeat Perception

In this study two methods assessing heartbeat perception ability were compared. Subjects (N = 64) completed Schandry's (1981) mental tracking task and Störmer's (1988) heartbeat discrimination procedure (based on Whitehead, Drescher, Heiman, & Blackwell, 1977). In addition, subjects were tested on their ability to estimate the duration of time intervals. A high degree of correspondence was found between the two heartbeat perception tasks for the extreme groups of very good and very poor perceivers, but a low degree of correspondence emerged for the middle range of performance (overall r= .59, p<.001). Time estimation did not correlate significantly with either heartbeat detection procedure. Blood pressure measurements taken after the Schandry task and between Störmer test blocks showed that blood pressure amplitude was elevated among good perceivers on both heartbeat detection tasks.     

First results of the introduction of DRGs in Germany and overview of experience from other DRG countries

In spite of numerous discussions and programs aimed at reducing public health care costs in Germany, the country has seen a massive increase in health care costs at an annual average rate of 7% since 1972. When German policymakers decided to reform the health care system by passing legislative measures on 22 December 1999, one of the key elements was to oblige hospitals and health insurance providers to replace the existing retrospective and procedural reimbursement system with a new prospective and diagnostic system based on diagnosis-related groups (DRGs). German policymakers are hoping to accomplish two feats with the introduction of DRGs: firstly, to improve the profitability of the health care system, and secondly, to improve the quality of health care services because DRGs require documentation and coding, which leads to increased transparency and allows for an external comparison of rendered services (benchmarking), as well as for an analysis and assessment of how appropriate and how successful the rendered services were in each particular case. Although the intentions underlying the introduction of DRGs are unquestionable, it remains to be determined whether the introduction has negative effects as well, and to which extent these negative effects have shown up so far. Hence the purpose of our survey will be to provide an extensive and systematic overview of results from other countries, along with preliminary results from Germany. In order to judge the trade-off between the desired and negative effects in a DRG system, we will define the set of parameters that determine the incentives of health care agents in such a system before surveying the economic and medical literature in light of these parameters in Section 3 and summarizing the results in Section 4. In view of the literature analysed, we find that the introduction of DRGs hasstarted a tendency towards a reduction in costs and towards a focus on profitability. If the legislator takes the necessary actions to reduce possible negative effects like manipulation and upcoding, the introduction of G-DRGs will lead to an increase in economic effectiveness and efficiency, while bringing more transparency into the quality of medical services at the same time.

Influence of follow-up methodology and completeness on apparent clinical outcome of fundoplication

BACKGROUND: Outcomes after surgery can be determined by face-to-face interview, interviewing patients by telephone, or by mailing out questionnaires. For reasons of convenience, many clinical research studies use mail survey methods. Mail-out responses, however, are rarely complete, and patients returning mail-out questionnaires might be different from patients who do not return questionnaires. METHODS: We identified a group of 75 patients who were all sent a mail-out questionnaire 5 or more years after a laparoscopic fundoplication. Some of these patients returned questionnaires and some did not. All patients were subsequently interviewed by telephone. The responses to the two different data collection methods were compared as well as the interview responses of patients who returned questionnaires with those of patients who did not to determine the influence of follow-up methodology on apparent clinical outcome. RESULTS: Of the 75 patients interviewed, 49 patients (65%) had previously returned a mail-out questionnaire and 26 patients had not. The mean time difference between mail-out response and telephone interview was 1 month. When mail-out responses were compared with interview responses of the patients who had returned questionnaires, equivalent answers were obtained for all symptoms except for dysphagia, for which a higher incidence and greater scores were reported by patients in their mail-out questionnaire responses. When mail-out nonresponders were compared with responders, the nonresponders had a lower level of overall satisfaction with the outcome of surgery, a higher incidence of dysphagia, and greater levels of heartburn. CONCLUSIONS: The measurement of surgical outcomes using a mail-out questionnaire may not be an accurate method of assessing patient symptoms and satisfaction after surgery, particularly if follow-up is incomplete. In this study, patients not responding to mail-out questionnaires were more likely to have adverse symptoms and a lower level of satisfaction than patients returning questionnaires. This dissatisfaction could make patients less likely to return mail-out questionnaires, and for this reason studies with incomplete follow-up that rely on mail-out questionnaire responses may report erroneously higher surgical success rates.     

三种不同空气消毒方法在手术室的应用效果比较

目的：观察三种不同的空气消毒方法在手术室空气消毒中的应用效果，寻求手术室的最佳空气消毒方法。方法：对我院一间普通手术室采用三种不同的空气消毒方法进行消毒，并对二三种方法的消毒效果、不同物体表面细菌监测结果及各细菌检出率与构成比进行比较。结果：手术室空气消毒30min后，动态消毒机法空气培养监测无菌率为61．11％，显著高于紫外线灯照射法的无菌率（32．43％）和醋酸氯己定喷雾法无菌率（36．84％），P〈0．05；动态消毒机法消毒后不同物体表面细菌监测合格率为100．00％，高于紫外线灯照射法和醋酸氯己定喷雾法（P〉0．05）：各种细菌检出率和构成比也均低于紫外线灯照射法和醋酸氯己定喷雾法。结论：动态消毒机法克服了传统静态消毒方式的缺点，杀菌作用强，效果好，优于其他传统消毒方法，适合基层医院手术室推广。     

间接喉镜下刮除术和鼻内镜下切吸术治疗腺样体肥大的手术效果比较

目的比较间接喉镜下腺样体刮除术和鼻内镜直视下腺样体切吸术治疗腺样体肥大的效果。方法118例患者分为A组(64例)和B组(54例),全身麻醉,用导尿管悬吊软腭,分别行间接喉镜下腺样体刮除术或鼻内镜直视下腺样体切吸术。结果所有患者术后打鼾症状明显改善,显效率分别为A组93.8%(60/64),B组94.4%(51/54);78例伴有渗出性中耳炎或复发性中耳炎,术后A、B组平均听阈提高分别为16±4.2dB和15±5.8dB;伴有鼻窦炎的患者,术后症状改善率分别为A组78.3%(18/23),B组88.9%(24/27)。术中平均出血量分别为A组20m1,B组25m1;平均手术时间分别为A组9分钟,B组7分钟。所有患者均无术后并发症发生。A组的手术费用明显低于B组。结论间接喉镜下腺样体刮除术和鼻内镜直视下腺样体切吸术均为安全、有效术式,但间接喉镜下腺样体刮除术简单易行、经济实惠。     

美国加州大学洛杉矶分校牙学院课程设置对我国长学制口腔医学教育的借鉴意义

本文介绍并分析了美国加州大学洛杉矶分校(以下简称UCLA)牙学院课程设置的特点,建议在我国长学制口腔医学教育中借鉴这种课程体系,将口腔医学基础课程和部分口腔医学临床课程前置;基础课程与临床课程穿插设置;加大实验室操作训练的课时投入,安排学生早期接受临床训练;将口腔医学临床课程进行分级递进设置。     

胃镜检查中插镜的两种方法比较

在胃镜检查中，如何插镜是关系到检查是否成功的重要要因素。我们通常用的方法是在检查前15min-30min肌肉注射阿托品等药物，术前10min咽喉部局部麻醉，患者取好体位，插镜时当胃镜通过咽喉部时，嘱患者以鼻深呼吸，同时做吞咽动作，将胃镜镜头端徐徐插入食管。但此法操作时患者难于配合，出现“进镜”与“吞咽”不同步，增加了患者的痛苦，且咽喉黏膜损伤较多。自1999年以来，我们将胃镜检查前常规肌注用药免用，插镜时免做吞咽动作快速插镜法，经临床实践观察，此法操作准确，快捷、顺利、安全，避免用药引起的副作用，患者痛苦少，效果满意，现介绍如下。