高密度脂蛋白胆固醇两种直接测定法试剂性能的评价

目的对比评价高密度脂蛋白胆固醇免疫分离法和化学修饰法试剂性能。方法对两种方法进行精密度、线性、干扰评价,并对二者进行相关性分析。结果两种方法精密度,线性,抗干扰都符合要求,且具有较好的相关性,免疫分离法抗干扰优于化学修饰法。结论两种测定方法皆适用于临床自动化检测。     

Do Standardized Patients Have Concerns About Students Not Captured by Traditional Assessment Forms?

Construct: Traditionally, standardized patients (SPs) assess students' clinical skills principally through numerical rating forms—an approach that may not fully capture SPs' concerns. SPs are students' closest approximation to real patients. To maximally benefit students' clinical training and evaluation it is important to find ways to give voice to the totality of SPs' perspectives. Background: SPs have been shown to be a reliable and valid means to assess medical students' clinical skills in clinical skills examinations. We noticed, however, that SPs often express “off the record” concerns about students, which they do not include on traditional assessment forms. Approach: To explore these “off the record” concerns, we designed a Concerns item and added it to the traditional assessment form for an end-of-3rd-year clinical skills examination shared by three medical schools. We asked SPs to use this Concerns item to identify students about whom they had any “gut-level” concerns and provided them with a narrative opportunity to explain why. SPs were informed that the purpose of the item was to help students with difficulties and was not part of the student's grade. Results: We analyzed the concerns data using quantitative and qualitative methods. Of 551 students at three schools, 223 (～40%) had concerns recorded. Seventy students received two or more concerns. Qualitative analysis of SPs' comments revealed 3 major categories of concern: communication and interpersonal skills, history taking, and physical exam. Grouped under each were several subcategories. More than half of the written comments from the SPs related to the communication/interpersonal skills category and included subcategories commonly addressed in communications courses: lack of empathy, good listening skills, and lack of connection to the patient. They also included subcategories that in our experience are less commonly addressed: odd or off-putting mannerisms, lack of confidence, unprofessional behavior, domineering behavior, and biased behavior. Another 47% of concerns identified deficiencies in history taking and physical examination. Of the students with concerns noted by two or more SPs, SPs' narrative comments on 84%, 42%, and 48% of the students in the domains of communications, history, and physical exam respectively indicated potential problems not identified by scores on the traditional assessment form. Conclusion: The Concerns item is a narrative assessment method that may add value to traditional quantitative scoring by identifying and characterizing problematic student performance not captured by the traditional assessment form. It may thus contribute to giving fuller voice to the totality of SPs' perspective.     

MRTA在三叉神经痛病因学诊断中的应用研究

目的探讨三又神经痛患者血管压迫的MRTA（磁共振断层血管成像）表现及其病因诊断价值。方法对216例临床上诊断为三叉神经痛的患者术前行MRTA检查，均行微血管减压术，MRTA表现并与手术结果进行对照。结果216例三叉神经痛患者MRTA显示有208例在患侧有血管接触后压迫：小脑上动脉80例（37．04％），小脑前下动脉36例（16．67％），小脑后下动脉17例（7．87％），基底动脉39例（18．05％），多根血管32例（14．81％），未发现血管12例（5．56％）；手术所见216例均有血管接触或压迫：小脑上动脉75例（34．72％），小脑前下动脉33例（15．28％），小脑后下动脉15例（6．95％），基底动脉38例（17．59％），多根血管34例（15．74％），动脉＋静脉14例（6．48％），静脉7例（3．24％）。结论MRTA能清晰显示三叉神经脑池段与毗邻血管之间的关系，对三叉神经痛患者是否有血管接触或压迫的判断具有较高的敏感度和准确度，为手术医生提供术前评估和指导术中治疗有重要价值。     

超声测量颏舌骨肌长度对女性患者困难插管预测作用的初步研究

目的 研究超声测量颏舌骨肌长度对女性困难插管的预测作用.方法 选取择期手术需行气管插管的女性患者30例,手术麻醉前使用超声测量患者颏舌骨肌长度.所有患者采用相同麻醉诱导方案及相同的插管流程.气管插管后,记录气管插管困难评分(intubation difficult scale,IDS).结果 30例患者中有3例IDS评分＞5分,认为有插管困难.以颏舌骨肌长度为检验变量,绘制ROC曲线,曲线下面积为0.852,P=0.049.以约登指数最大值3.88 cm为临界值,评估困难气管插管,敏感度、特异度、阳性预测值、阴性预测值均大于Mallampati分级,但差异无统计学意义.结论 超声下测量颏舌骨肌长度对女性患者困难插管具有一定的预测作用.     

延迟增强MRI评估基质诱导自体膝关节软骨移植术效果

目的 探讨延迟增强MRI对基质诱导自体膝关节软骨移植术的临床评估效果.方法 随机选取我院2012年1月至2014年2月期间收治的行自体膝关节软骨移植术患者45例作为实验组,另选取同期软骨损伤患者45例作为对照组,对两组患者进行MRI扫描,对扫描结果进行对比分析.结果 实验组患者术后CR值(0.92±0.08)较术前(1.33±0.15)明显降低,且随着患者病情分级的不断升高,其CR也随之增高(P＜0.05);各部位的MRI增强扫描结果明显优于平扫,差异具有统计学意义(P＜0.05).结论 对基质诱导自体膝关节软骨移植术患者进行MRI增强扫描,能够为临床诊断提供高质量的膝关节软骨检查图像,同时通过对手术前后软骨强化率进行分析,有助于对手术效果进行有效评估.     

大型综合公立医院效率特征及变动研究

目的:从静态与动态两个层次分析大型综合公立医院的效率特征及变动趋势。方法:采用数据包络分析的C~2R-DEA和BC~2-DEA模型与Malmquist指数模型,利用50家大型公立医院2006—2012年的人员、设备、资产、医疗服务等投入—产出指标,构建适宜分析模型。结果:约10%~12%样本医院处在相对有效运行状态,其配置效率均值与规模效率均值分别为0.956与0.943,接近效率前沿,其效率表现相对较好;而纯技术效率均值、技术效率均值、成本效率均值与整体效率均值分别为0.796,0.784,0.714和0.714,与效率前沿差距较大,其效率表现相对较差。同时,样本医院处于规模报酬递减状态的医院由7.69%增加到26.31%,而处于规模报酬递增状态的医院由80.77%下降到58.34%;其技术进步与Malmquist生产率指数、技术效率指数、纯技术效率指数与规模效率指数的变化保持比较稳定的一致性,并呈现持续改善与稳步发展的趋势。结论:大型公立医院正面临着发展动力与激励机制的转换,不仅需要转变医院管理理念与发展模式,也需要构建有关结构、过程和结果的最佳效率评价标准,以促进包括政府职能在内的医院治理与发展模式的转变。     

国外医院绩效评价对我国的启示

绩效评价是促进公立医院公益性、引导其医疗服务质量持续改进的有效方法。然而目前国内尚无一套统一、科学、合理的公立医院绩效考核制度, 对医改背景下的公立医院绩效进行考核, 已成为困扰我国卫生事业发展的重要问题。本文在借鉴国外医院绩效评价先进经验措施的基础上, 结合我国现状, 对医院绩效评价提出了一些针对性的建议和意见。     

缬沙坦氨氯地平片治疗高血压有效性和安全性的系统评价

目的 系统评价缬沙坦氨氯地平片(倍博特)治疗高血压的有效性和安全性.方法 采用循证医学的方法,将国内外符合纳入标准的12项(共计2 796例患者)关于倍博特治疗高血压的随机对照试验进行Meta分析.采用收缩压、舒张压、24 h平均血压、临床疗效以及不良反应率作为结局指标判定治疗效果.运用RevMan 5.0软件进行Meta分析.结果 Meta分析结果显示倍博特的临床疗效优于氨氯地平组(OR=3.36,95％ CI:2.17～5.19,P＜0.001)、缬沙坦80 mg组(OR =3.19,95％ CI:2.40 ～4.24,P＜0.001)和缬沙坦160 mg组(OR=1.61,95％ CI:1.12 ～2.32,P=0.010);倍博特组患者不良反应的发生率低于氨氯地平组(OR=0.45,95％ CI:0.27～0.74,P＜0.001),而倍博特组与缬沙坦80 mg组及160 mg组不良反应的发生率差异无统计学意义.结论 倍博特治疗高血压的效果优于对照组,且具有较好的安全性.