生脉注射液治疗对兔严重心肌挫伤后血流动力学的影响

目的:探讨兔严重心肌挫伤(Sever Myocardiac Contusion,SMC)早期血流动力学的改变及生脉注射液的治疗作用.方法:新西兰大白兔24只,随机分为对照组、严重心肌挫伤组及牛脉注射液治疗组各8只.BIM-Ⅱ型水平式生物撞击机制备兔SMC模型,制模后10 min静滴生理盐水或生脉注射液.各组分别监测伤前及伤后各时间点血流动力学参数变化.结果:对照组各时点血流动力学无明显变化.SMC组伤后LVEDP、-dp/dtmax、CVP增高而LVESP、+dp/dtmax下降.SIT组伤后LVEDP、CVP、-dp/dtmax增高而LVESP、+dp/dtmax下降,但均较SMC组显著减轻.结论:兔严重心肌挫伤后血流动力学发生明显改变,生脉注射液具有有效的治疗作用.     

新时代卫生资源分配决策的价值理性及规范价值探讨

卫生资源的短缺和浪费现象较为普遍，医疗控费及其管控措施也会不断被强化。卫生资源分配不单是需要借助经济学方法提供决策证据，更应重视价值判断讨论资源分配决策的"应然"问题，不同价值观的偏好深刻影响宏观卫生资源分配制度的设计。在健康中国的国家战略执行新时期，有必要探讨影响卫生分配决策的主流价值观及其决策伦理价值规范，发展适合本土卫生发展的价值观，重视基于价值的卫生服务体系设计，有助于展开负责任的决策行为和政策执行。     

2018版国家基本药物在某三甲中医院的使用现状分析

目的了解某三甲中医院国家基本药物的使用现状，为三级医疗机构推进实施国家基本药物提供理论数据和依据。方法通过安徽省药品集中采购平台导出某三甲中医院 2019―2020年的药品目录，梳理出该院在用基本药物的药品目录，采用 Excel表对数据进行统计处理和分析。结果该院 2019―2020年在用国家基本药物品种数分别为 324种、 322种，基本药物配备率分别为 47.30%、47.01%。在用基本药物采购金额分别为 12 820.33万元、 10 494.15万元，采购金额占全院药品采购总金额的比例分别为 26.07%、25.50%。在用化学药品和生物制品类国家基本药物 2019年为 246种， 2020年为 244种，其中心血管系统用药和激素及内分泌药连续两年稳居金额排序第一、二；中成药在用品种数没有变化，连续两年都是 78种，内科用药 55种，占品种数的 71%。结论该院国家基本药物的品种配备率符合有关文件要求，但离《国务院办公厅关于进一步做好短缺药品保供稳价工作的意见》的目标还有差距。建议该院根据 2018版国家基本药物目录要求继续适当增加品种，临床应优先使用国家基本药物，进一步重视和强化基本药物的合理使用。     

JAK-STAT信号通路在创伤性深静脉血栓形成中作用的实验研究

目的:探讨Jak蛋白酪氨酸激酶-信号转导子和转录激活子信号通路在创伤性深静脉血栓形成中的作用。方法:将150只SD大鼠随机分为正常对照(A组)和模型组。模型组根据造模后的不同生物学状态再分为7组:创伤即刻(B组)、血栓形成前期(C组)、高峰期血栓形成(D组)、高峰期血栓不形成(H组)、血栓消退期(E组)、血栓不消退(F组)和血栓不形成(G组),在相应时相点无创切取股静脉血管组织,随后抽取各组大鼠总RNA,用Genechip Rat Genome430 2.0芯片测定股静脉RNA表达,并分析Jak蛋白酪氨酸激酶-信号转导子和转录激活子信号通路基因表达变化情况。结果:Jak蛋白酪氨酸激酶-信号转导子和转录激活子信号通路中Cytokine R、STAT、PI3K、AKT、SOCS、CycD等关键基因均呈下调,调控着细胞凋亡、细胞周期等。结论:Jak蛋白酪氨酸激酶-信号转导子和转录激活子信号通路可能是调控血栓的生物学状态的重要信号通路之一。     

Block urn design - a new randomization algorithm for sequential trials with two or more treatments and balanced or unbalanced allocation

Permuted block design is the most popular randomization method used in clinical trials, especially for trials with more than two treatments and unbalanced allocation, because of its consistent imbalance control and simplicity in implementation. However, the risk of selection biases caused by high proportion of deterministic assignments is a cause of concern. Efron's biased coin design and Wei's urn design provide better allocation randomness without deterministic assignments, but they do not consistently control treatment imbalances. Alternative randomization designs with improved performances have been proposed over the past few decades, including Soares and Wu's big stick design, which has high allocation randomness, but is limited to two-treatment balanced allocation scenarios only, and Berger's maximal procedure design which has a high allocation randomness and a potential for more general trial scenarios, but lacks the explicit function for the conditional allocation probability and is more complex to implement than most other designs. The block urn design proposed in this paper combines the advantages of existing randomization designs while overcoming their limitations. Statistical properties of the new algorithm are assessed and compared to currently available designs via analytical and computer simulation approaches. The results suggest that the block urn design simultaneously provides consistent imbalance control and high allocation randomness. It can be easily implemented for sequential clinical trials with two or more treatments and balanced or unbalanced allocation.     

北京市乡镇卫生机构人力配置的主要问题和对策研究

目的：通过现场调查,分析北京乡镇卫生机构人员配置结构的现状和主要问题,为调整和完善卫技人员配置提出政策建议。方法采用分层随机抽样的方法抽取调查对象,以填写机构调查表的形式收集调查地区乡镇卫技人员的配置情况,对卫生人员总量和结构进行分析。结果乡镇卫生机构在岗职工数超出编制总量10．27％,且超编比例逐年增大。卫技人员中医护比1∶0．7,医师和预防保健人员比例1∶0．2。有80％的卫技人员是大专及以下学历、初级及以下职称。卫技人员以25～36岁为主,45岁以上人员有所下降,引进人才存在流失的问题。结论适度增加编制总量,补充护理、预防保健等紧缺人才;完善人才培养,有计划地逐步提升基层卫生队伍的专业素质;深化人事制度改革,形成农村基层人员的激励机制。     

重庆市卫生资源配置现状与公平性研究

目的 分析重庆市卫生资源配置现状,为卫生行政部门优化卫生资源配置提供依据.方法 对反映重庆市卫生资源的多项指标进行描述性分析和对比分析,并用基尼系数评价卫生资源配置公平性.结果 至2009年底,重庆市共有卫生机构6 512个,病床92 689张,每千人口卫生技术人员、执业(助理)医师、注册护士数分别是3.05、1.36和0.97.卫生资源按人口分布基尼系数小于按地理分布.结论 重庆市卫生资源总量不足,卫生资源按人口配置公平性优于按地理配置,护理人员严重不足且配置公平性差.     

天津市病床资源总量预测及分析

目的:分别从供给与需求角度研究到2015年我市床位发展水平,为确定我市2015年的床位资源配置目标提供参考。方法:应用常规GM(1,1)模型和新陈代谢模型预测2015年天津市医院床位供需水平。结果:新陈代谢模型预测精度更高,预计到2015年天津市供给床位数将达到54132张,需求床位数达到64096张,预测平均相对误差为0.37%和0.25%,供需比为0.84。结论:与《天津市"十二五"卫生资源调整规划意见》比较验证模型预测的合理性,提出"十二五"期间天津市病床资源总量建设的政策建议。     

The implications of metapopulation dynamics on the design of vaccination campaigns

Control programmes for vaccine preventable diseases typically operate under logistic constraints such as limited resources and in spatially structured populations where the assumption of homogeneous mixing is invalid. It is unclear, therefore, how to maximise the effectiveness of campaigns in such populations. We investigate how to deploy vaccine in metapopulations by comparing the effectiveness of alternative vaccination strategies on reducing disease occurrence (presence/absence), using canine rabies as a model system, and a domestic dog population within a Tanzanian district divided into sub-populations corresponding to villages. We use patch-occupancy models to quantify the contribution of sub-populations to disease occurrence (“risk”) and model allocation strategies for a limited number of vaccine doses that prioritize villages based on their size, risk, or the reduction in risk for the entire population that would result from vaccination. We assume that a maximum of 70% of susceptible individuals in a village could be vaccinated, and that only susceptible dogs are vaccinated. The most effective strategy maximised the reduction in risk of the entire population, and was up to 62% more effective than the other strategies. Large, single-pulse campaigns provided the greatest short-term protection, but higher frequencies of smaller pulses were more effective at reducing long-term disease occurrence. Vaccine allocation on a per-dose basis was substantially more effective than a per-village strategy, indicating that operational constraints can reduce control effectiveness. The spatial distribution and abundance of hosts have an important influence on disease dynamics and these results demonstrate that metapopulation models can be used to substantially improve the effectiveness of vaccination campaigns and optimize the allocation of limited control resources.