茵柴护肝汤合甘利欣治疗慢性乙型肝炎患者疗效观察

目的观察茵柴护肝汤治疗肝功能异常慢性乙型肝炎患者的临床疗效。方法将143例患者分为3组，观察组和西药对照组均用甘利欣胶囊150mg口服，3次，d；观察组43例加用汤药茵柴护肝汤（茵陈，柴胡，车前子，茯苓，白术，垂盆草，蛇舌草，焦三仙，五味子等）。治疗；中药对照组单纯用汤药茵柴护肝汤，西药对照组加服肝泰乐、复合维生素B、C等，观察3组临床疗效及主要症状的改善。结果总有效率观察组为94.3％，西药对照组为61．9％，中药对照组为91．3％，两组均优于单用西药组p〈0．01（u=3．768，3．563）；临床疗效及主要症状的改善，观察组和中药对照组2组比较，差异无显著性p〉0．05。结论茵柴护肝汤治疗肝功能异常的慢性乙型肝炎患者疗效较好。     

经硬膜外、侧隐窝、骶管注药治疗腰椎间盘突出症的疗效比较

目的比较经硬膜外、侧隐窝、骶管3种方法注药治疗腰椎间盘突出症的疗效。方法将90例腰椎间盘突出症患者随机分为3组,每组30例,即硬膜外组、侧隐窝组与骶管组,3组均7日注药1次,2～4次为1个疗程。结果3组治疗效果的优良率分别为83.2%(25例),84.3(26例),83.3(25例),3组疗效比较差异无统计学意义(P>0.05)。结论经硬膜外、侧隐窝、骶管3种方法注药均是治疗腰椎间盘突出症的有效疗法,但侧隐窝组的不良反应少于硬膜外及骶管组。     

Evaluation of audit-based performance measures for dental care plans

OBJECTIVES: Although a set of clinical performance measures, i.e., a report card for dental plans, has been designed for use with administrative data, most plans do not have administrative data systems containing the data needed to calculate the measures. Therefore, we evaluated the use of a set of proxy clinical performance measures calculated from data obtained through chart audits. METHODS: Chart audits were conducted in seven dental programs--three public health clinics, two dental health maintenance organizations (DHMO), and two preferred provider organizations (PPO). In all instances audits were completed by clinical staff who had been trained using telephone consultation and a self-instructional audit manual. The performance measures were calculated for the seven programs, audit reliability was assessed in four programs, and for one program the audit-based proxy measures were compared to the measures calculated using administrative data. RESULTS: The audit-based measures were sensitive to known differences in program performance. The chart audit procedures yielded reasonably reliable data. However, missing data in patient charts rendered the calculation of some measures problematic--namely, caries and periodontal disease assessment and experience. Agreement between administrative and audit-based measures was good for most, but not all, measures in one program. CONCLUSIONS: The audit-based proxy measures represent a complex but feasible approach to the calculation of performance measures for those programs lacking robust administrative data systems. However, until charts contain more complete diagnostic information (i.e., periodontal charting and diagnostic codes or reason-for-treatment codes), accurate determination of these aspects of clinical performance will be difficult.     

疟疾疗法治疗晚期肿瘤的初步报告

［目的］通过初步的临床试验探索疟疗治癌的适应证及疗效,疟疗疗程与疗效的关系,其他抗癌疗法对疟疗的影响和观察疟疗治癌的副作用及并发症。〔方法〕共选择7例晚期肿瘤病人作治疗观察对象,其中乳腺癌1例,小细胞肺癌1例,肺腺癌1例,鼻咽癌1例,胰头癌1例,卡波氏肉瘤1例,直肠癌1例。诱发人工间日疟,疗程为10～17次疟疾阵发。〔结果〕乳腺癌和卡波氏肉瘤共2例部分缓解（PR）,其他5例无效。但值得注意的是2例有效者在疟疗前近期均无化疗史（或不超过一个疗程的化疗史）,而5例无效者均在疟疗前近期有一个疗程以上的化疗史或放射性同位素注射治疗史。未发现疟疗疗程与疗效之间有任何关系。并发症均不严重,1例在疟疗中并发支气管哮喘,另1例并血小板减少,经相应处理均迅速恢复。［结论］初步提示疟疗可能对无化疗史和放射性同位素注射治疗史的某些晚期肿瘤部分缓解,但需进一步研究。根据放疗的热增敏效应提议今后应探索疟疗与放疗相结合的联合疗法。     

心脏ECT展开图评价异舒吉和硝酸甘油抗心肌缺血作用

目的　评价比较 ２ 种药物异舒吉和硝酸甘油抗心肌缺血作用。方法　利用９９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ灌注断层显象展开图比较药物治疗前后左室缺血面积的改善情况，用面积的改善反映药物的抗心肌缺血作用。结果　异舒吉治疗前后缺血心肌面积分别为３２５９７± ６２９５ ｃｍ ２ 、２８６７３ ±３１３１ ｃｍ ２， 治 疗前 后缺血 面积 与左 室面 积的 百分 比分别 为 １７２５４％ ±５６１４％ 、１５４０１％ ±２７８０％ ；硝酸甘油治疗前后缺血面积分别为 ３２１２６ ±５４７８ ｃｍ ２ 、２９７０２±２９８２ ｃｍ ２， 缺血面积与左室面积 的百分比分别为１６９８９％ ±５６１４％ 、１５９２３％ ±２７８０％ （ Ｐ＜ ００５）。治疗前后，异舒吉组的缺血面积改善程度与硝酸甘油组相比无差异（ Ｐ ＞００５）。结论　异舒吉和硝酸甘油均有抗心肌缺血作用，临床医生需要注意“成本效果分析     

Complementary and alternative medicine for lowering blood lipid levels: A systematic review of systematic reviews

BackgroundThe aim of this article is to summarize and critically evaluate the evidence from systematic reviews (SRs) of complementary and alternative medicine (CAM) for lowering blood lipid levels (BLL).MethodsEight electronic databases were searched until March 2016. Additionally, all the retrieved references were inspected manually for further relevant papers. Systematic reviews were considered eligible, if they included patients of any age and/or gender with elevated blood lipid levels using any type of CAM. We used the Oxman and AMSTAR criteria to critically appraise the methodological quality of the included SRs.ResultsTwenty-seven SRs were included in the analyses. The majority of the SRs were of high methodological quality (mean Oxman score = 4.81, SD = 4.88; and the mean AMSTAR score = 7.22, SD = 3.38). The majority of SRs (56%) arrived at equivocal conclusions (of these 8 were of high quality); 7 SRs (37%) arrived at positive conclusions (of these 6 were of high quality), and 2 (7%) arrived at negative conclusions (both were of high quality). There was conflicting evidence regarding the effectiveness of garlic; and promising evidence for yoga.ConclusionsTo conclude, the evidence from SRs evaluating the effectiveness of CAM in lowering BLL is predominantly equivocal and confusing. Several limitations exist, such as variety of doses and preparations, confounding effects of diets and lifestyle factors, or heterogeneity of the primary trials among others.     

黄山地区农民吸烟行为干预及其效果评价

目的　探讨黄山地区农民吸烟特征和农村控烟教育工作方式及其效果。方法　采用综合控烟教育干预措施 ,对黄山地区 1 8个自然村 3万农民进行控烟干预研究。首先进行 6个月的干预前基线调查 ,然后按项目设计进行干预 ,结束后比较干预前和干预后的控烟效果。结果　基线调查表明 ,黄山地区农民的吸烟率为35 1 % ,低于 1 996年全国农民吸烟率 39 2 %。干预后的戒烟率为 2 2 9% ,高于干预前的 1 7 8% ,亦高于 1 996年全国的调查结果 7 0 %。结论　项目区农民控烟教育的效果明显。     

Prevention of Behavior Problems for Children in Foster Care: Outcomes and Mediation Effects

Parent training for foster parents is mandated by federal law and supported by state statues in nearly all states; however, little is known about the efficacy of that training, and recent reviews underscore that the most widely used curricula in the child welfare system (CWS) have virtually no empirical support (Grimm, Youth Law News, April-June:3-29, 2003). On the other hand, numerous theoretically based, developmentally sensitive parent training interventions have been found to be effective in experimental clinical and prevention intervention trials (e.g., Kazdin and Wassell, Journal of the American Academy of Child and Adolescent Psychiatry, 39:414-420, 2000; McMahon and Forehand, Helping the noncompliant child, Guilford Press, New York, USA, 2003; Patterson and Forgatch, Parents and adolescents: I. Living together, Castalia Publishing, Eugene, OR, USA, 1987; Webster-Stratton et al., Journal of Clinical Child Pyschology Psychiatry, 42:943-952, 2001). One of these, Multidimensional Treatment Foster Care (MTFC; Chamberlain, Treating chronic juvenile offenders: Advances made through the Oregon Multidimensional Treatment Foster Care model, American Psychological Association, Washington, DC, USA, 2003), has been used with foster parents of youth referred from juvenile justice. The effectiveness of a universal intervention, KEEP (Keeping Foster Parents Trained and Supported) based on MTFC (but less intensive) was tested in a universal randomized trial with 700 foster and kinship parents in the San Diego County CWS. The goal of the intervention was to reduce child problem behaviors through strengthening foster parents' skills. The trial was designed to examine effects on both child behavior and parenting practices, allowing for specific assessment of the extent to which improvements in child behavior were mediated by the parenting practices targeted in the intervention. Child behavior problems were reduced significantly more in the intervention condition than in the control condition, and specific parenting practices were found to mediate these reductions, especially for high-risk children in foster families reporting more than six behavior problems per day at baseline.