高校学生常见心理疾病及干预措施浅析

高校学生的心理正处于迅速走向成熟的阶段，是心理疾病高发群体，常见的心理疾病主要为神经症、精神分裂症、心身疾病、人格障碍及性行为异常。针对日趋严重的大学生心理问题，高校相关部门应重视加强大学生心理方面的健康教育，以预防大学生心理疾病的发生。     

Subchondroplasty in the treatment of bone Marrow lesion in early Knee Osteoarthritis: A systematic review of clinical and radiological outcomes

BackgroundKnee osteoarthritis (KOA) is increasingly prevalent in North American society. The significant societal burden it represents makes it essential to promote and target new treatments in earlier phases of the disease. Among others, subchondroplasty is a newly documented technique using calcium phosphate injection targeting the osteochondral lesions preceding KOA, also known as Bone Marrow Lesions (BMLs). This article aimed to review the existing literature on clinical and radiological outcomes of subchondroplasty in the treatment of BMLs in KOA.MethodA systematic review was performed using PubMed, Embase, Medline and Cochrane Database of Systematic Reviews. Studies on calcium phosphate injections into BMLs for KOA and its clinical and radiological outcomes were screened and reviewed by independent evaluators.ResultsAfter screening, ten articles were included, totaling 540 patients. Follow-up ranged from 6 months to 7 years. Overall, the procedure showed significant functional and quality of life improvement, as well as pain relief, as shown by Patients-Reported Outcomes Measures (PROMs). There were very few complications reported, the most important being leakage of calcium phosphate outside the targeted site. Conversion rate to total knee arthroplasty (TKA) ranged from 14 % to 30 % at 2 years post-procedure. Long term radiological outcomes have been poorly documented.ConclusionsSubchondroplasty is a promising avenue for the treatment of KOA. However, quality evidence is still required before any real conclusions and practical management guidelines can be drawn. Prospective, randomized studies with a control group and a rigorous assessment of long-term clinical and radiological outcomes are recommended.     

CR-lipped bearing is an adequate functional solution to patients with perioperative excessive laxity in cruciate retaining total knee arthroplasty

BackgroundThe cruciate retaining lipped (CR-lipped) bearing is designed to provide more anterior-posterior (AP) stability and could be employed to resolve excessive intraoperative laxity during the cruciate retaining TKA (CR-TKA). The aim of the study was to determine whether the CR-lipped bearing in CR-TKAs with a perioperative excessive laxity allows equivalent functional results as compared to the standard CR articulation.MethodsA cohort of 111 TKAs with CR-lipped bearings was matched to a cohort of conventional CR bearings regarding age and sex. The CR-lipped bearing was used in patients with excessive knee AP laxity and the regular CR bearing was used in patients without excessive AP laxity during TKA. Various PROMs (WOMAC, KSS, SF-36) were assessed preoperatively and at 5-years postoperative in combination with revision rate and Range of Motion (ROM).ResultsPROMs did not differ significantly between both groups 5-years postoperatively. Mean ROM (flexion) 5-years postoperatively was not significantly different. The implant survivorship was 100% for both cohorts with revision for any reason as end point.ConclusionBased on these results, the CR-lipped bearing is a safe and effective solution for mild interoperatively assessed PCL laxity during CR-TKA without loss of function or decreased survivorship at 5 years. Peroperative conversion to a PS-TKA in order to obtain satisfactory functional scores might therefore not be necessary when mild PCL laxity is observed during surgery. Further research should focus on verifying this approach and longer follow-up is needed to generate data on long term survivorship.Level of evidenceLevel IV therapeutic, retrospective, cohort study.     

医疗机构面临的问题和对策

文章就宁波市医疗机构目前情况作了论述,指出目前存在问题主要是卫生资源配置不合理,其原因有体制和政策方面;各级医院的功能错位,导致医疗费用急剧增加;医疗费用构成不舍理,药费比例偏高：医疗机构管理体制和运营机制不能适应市场经济形势;针对上述问题,文章提出的对策为实施区域卫生规划,优化卫生资源配置;加快社区卫生服务建设,增强社区基层卫生服务力量,调整医疗收费价格体系,实行医药分开核算;推进干部人事制度改革,引进竞争机制。     

A UK multi‐centre pilot study of speech and swallowing outcomes following head and neck cancer

Speech and swallowing are important components of health‐related quality of life following head and neck cancer treatment. The aim of this study was to demonstrate the value of prospective multi‐centre evaluation by Speech and Language Therapists and to compare health‐related quality of life with speech and swallowing impairments. The University of Washington Head and Neck questionnaire version 4 (UW‐QOL) and Therapy Outcome Measures (TOM) were rated before and 6 months after cancer treatment in 95 patients from 12 centres. There was deterioration in TOM scores at 6 months. Pretreatment UW‐QOL swallowing was ranked equal first, with speech fourth. At 6 months speech was first and swallowing second. There were positive correlations between UW‐QOL swallowing and TOM dysphagia and between UW‐QOL speech and TOM laryngectomy, voice, phonology and dysarthria disorders. Both outcome measures are suitable for routine practice. Adaptation of TOM scales for use with head and neck cancer patients may improve sensitivity, validity and therapist compliance.     

56例临床输血不良反应原因分析

目的:分析临床输血过程中发生输血不良反应的原因,探讨有效的预防措施。方法:回顾2012—2014年输注由我站提供的血液制品后发生输血不良反应患者56例,分析输血不良反应发生的原因。结果:21615人次输血中,发生不良反应56例,发生率为0.3%,其中非溶血性发热反应为32例,占57.1%,过敏反应为24例,占42.9%,未发现其他输血不良反应。结论:临床上应加强对输血全过程的监管,遵循合理科学用血原则,采用新的输血技术,大力提倡自身输血,确保临床输血的安全性。     

一起尿源性脓毒血症死亡案例的解析与改进*

对一起尿源性脓毒血症患者死亡案例进行解析，从明确诊断标准、制定规范举措、畅通绿色通道、促进患方参与等方面进行改进。改进后，尿源性脓毒血症患者诊断率提高，就诊至处理时间（DTN）从88.9min缩短至55.6min（P＜0.001），患者住院时间由7.9天缩短至4.9天，人均住院总费用减少8 105元，差异均有统计学意义（P＜0.05）。运用精益管理方法，优化专科急危重症诊治流程，能够缩短治疗时间，促进患者康复，节约住院费用，改善患者愈后     

临床医生对医学信息的认知情况分析

对四川省三级医院、二级医院、基层医疗卫生机构610名临床医生进行问卷调查,结果显示四川省临床医生对医学信息的认知不足、学习时间较少、学习途径仍以教科书为主、不同职称医生对医学信息掌握有差异。对此需加强信息素质教育,增强其主动获取医学信息的意识。