口腔修复中高熔铸件浇铸不全的原因浅析及预防

目的:探讨高熔铸件浇铸不全的可能原因。方法:通过对临床85件可摘铸件缺损的初浅分析,总结出浇铸不全的可能原因。结果:高熔铸件浇铸不全的原因有以下7个方面:①铸金量不足;②熔金温度过低;③离心力不够;④铸道布局不当;⑤铸件过薄;⑥高温包埋料透气性差;⑦铸圈温度下降。结论:通过查找原因,总结出预防的方法,对提高高熔铸件修复体的质量有一定的作用。     

一步法排龈技术临床应用评价

目的探讨一次法牙龈压排技术在临床使用的可行性.方法采用同一病人不同牙位对照,对589例双端烤瓷固定桥,一端基牙使用一次压排法,另一端基牙(对照组)采用二次压排法,通过戴牙时和修复后一年、三年、五年的复查,比较两种方法修复后牙龈炎症和牙龈退缩发生率.结果采用一次法备牙较二次法牙龈炎症发生率明显减少,牙龈萎缩发生率无明显差别.结论采用一次法牙龈压排技术备牙时牙龈损伤少,视野清晰,印模也更清晰准确,制作的修复边缘形态更精密,日后牙龈炎症发生率少,同时备牙时间内的牙龈压迫,并不会造成牙龈退缩发生率提高.     

经内镜胆管内支架术在恶性梗阻性黄疸治疗中的应用

目的:探讨经内镜胆管内支架置入术在各种恶性梗阻性黄疸治疗中的临床应用价值.方法:对13例各种恶性梗阻性黄疸患者采用经内镜胆道内支架置入术行胆汁引流,其中胆道塑料支架引流术(ERBD)8次、胆道金属支架置放术(EMBE)6次,双支架1次.结果:13例恶性梗阻性黄疸患者术后黄疸逐渐消退,皮肤瘙痒等症状减轻或消失;放置胆道内支架1周后,患者的相关指标TBIL,ALT、AST、AKP及r-GT明显下降,黄疸和肝功能状况较术前明显改善(P＜0.05).3例患者术后出现高淀粉酶血症,3天后基本降至正常.全部患者无感染、出血、穿孔等并发症发生.结论:经内镜胆道支架放置术是治疗恶性梗阻性黄疸的一种有效、安全的方法,有很好的临床应用价值.     

一次法和多次法在急性根尖周炎根管治疗术的效果比较

目的:比较一次法和多次法在急性根尖周炎根管治疗术上的治疗效果.方法:对我院2007年1月～2009年12月因急性根尖周炎来就诊的患者随机分为二组,单数位次就诊的患者为观察组,共113例患者113颗牙,采用一次法进行治疗,双数位次就诊的患者为对照组,共113例患者113颗牙,采用多次法进行治疗;术后随访1周～12个月,根据患者自觉症状、临床与X线片对治疗效果进行评判.结果:二组患者治疗效果相比差异不明显,无统计学意义P＞0.05.结论:采用一次法对急性根尖周炎进行根管治疗术后效果满意,具有患者就诊次数少、疗程短、避免继发感染等优点,在临床上值得推广应用.     

环境水体中霍乱弧菌的二次PCR检测方法

目的建立环境水体中霍乱弧菌的二次PCR检测方法。方法对霍乱弧菌的外环境水监测样本进行PCR检测;确定弱电泳条带或无电泳条带的稀释度,将第一次PCR的产物梯度稀释后进行二次PCR。采用琼脂凝胶糖电泳进行分析。结果对378件环境水样分别进行一次、二次PCR检测,有4件水样经两种方法检测均为阳性,有6件水样二次PCR检测为阳性。一次PCR检测霍乱弧菌的阳性率[1.06%(4/378)]低于二次PCR[2.65%(10/378)],差异有统计学意义(P<0.05)。结论二次PCR操作简便快速、检出率高、费用低廉,适用于环境水样中霍乱弧菌的快速监测。     

包埋固定化EM菌的氨氮去除特性研究

采用PVA-硼酸包埋固定化EM菌,在好氧、批式运行条件下,系统考察不同的工艺参数对固定化EM菌的氨氮去除性能的影响.结果表明:用PVA-硼酸包埋法固定EM的小球对氨氮的去除是EM生物降解、包埋小球自身吸附的共同结果;以贝壳粉末作为添加剂、包埋离心后的EM有利于提高包埋小球的强度及脱氨效果.经过6个运行周期,氨氮的去除率...     

吐温-80增敏光度法测定卷烟纸中磷酸盐含量

高档卷烟纸通常通过填加磷酸盐(磷酸氢二钠或磷酸二氢铵)来改善烟支燃烧状态.目前测定磷酸盐的方法主要是磷钼蓝法和钒一钼酸铵法.本文尝试采用吐温-80增敏光度法来定量测定卷烟纸中的磷酸盐,现报告如下.     

弹性义齿与铸造支架联合修复双侧游离端缺失方法的临床探讨

目的:探讨弹性义齿与铸造支架联合修复双侧游离端缺失的临床效果。方法:采用弹性树脂做基托和唇(颊)侧固位体,缺失区和基托采用铸造支架,制作修复体27件,患者戴用一年后进行临床观察。结果:弹性义齿与铸造支架联合义齿较传统修复方法在美观舒适度、咀嚼效率、基牙情况等均有明显改善。结论:弹性义齿与铸造支架联合修复双侧游离端缺失是一种较好的方法。     

恒磨牙牙髓炎一次根管充填法与两次根管治疗法临床疗效对照

目的评价恒磨牙牙髓炎根管治疗一次法和二次法的临床疗效。方法选择符合适应症的病例204例,恒磨牙急性牙髓炎和慢性牙髓炎随机分成2组,研究组采用根管治疗二次法,对照组采用根管治疗一次法。比较2组间术后急性反应及远期疗效的差异。结果根管治疗一次法的术后急性反应较二次法明显,但远期疗效无明显差异。结论对于恒磨牙牙髓炎,二次根管治疗法术后反应均较佳,远期效果完善。     

上海市闵行区住宿场所二次供水的卫生状况

目的 了解上海市闵行区住宿场所二次供水设施和卫生管理状况.方法 对闵行区使用二次供水的全部住宿场所进行二次供水设施及卫生管理状况的问卷调查,并采集二次供水水样进行实验室检测.结果 33家使用二次供水的住宿场所中,水箱材质主要为不锈钢及水泥瓷砖贴面.2家住宿场所二次供水设施选址不符合卫生要求,18家住宿场所二次供水设施设计存在溢水管无防护网罩、水箱入口未加锁等问题.住宿场所二次供水设施每年开展清洗消毒的占75.76％,每年开展水质检测的占51.52％,住宿场所二次供水设施清洗消毒、水质检测等卫生管理情况明显不如居民小区,差异有统计学意义(P＜0.01).共检测住宿场所二次供水水样45件,合格38件,合格率84.44％,二次供水水质合格率显著低于居民小区,差异有统计学意义(P＜0.01).结论 闵行区住宿场所二次供水水质明显不如居民小区二次供水,建议从许可审核环节改善二次供水设施设计、加强外部监、督促进其卫生管理水平、加强负责人培训以提高内部管理水平等方面提高住宿场所二次供水卫生状况.     

A new privacy framework for the management of chronic diseases via mHealth in a post-Covid-19 world

Aim

New challenges are being faced by global healthcare systems such as an increase in the elderly population, budget cuts as well as the ongoing Covid-19 pandemic. As pressures mount on healthcare systems to provide treatment to patients, mHealth is seen as one of the possible solutions to addressing these challenges. Given the sensitivity of health data, the rapid development of the mHealth sector raises privacy concerns. The aims of this research were to investigate privacy threats/concerns in the context of mHealth and the management of chronic diseases and to propose a novel privacy framework to address these concerns.

Subject and method

The study adopted a modified version of the engineering design process. After defining the problem, information was gathered through literature reviews, and analyses of existing regulatory (privacy) frameworks and past research on privacy threats/concerns. Requirements for a new framework were then specified leading to its development and comparison with existing frameworks.

Results

A novel future-proof privacy framework was developed and illustrated. Using existing regulatory frameworks for privacy and privacy threats/concerns from research studies, privacy principles and their resulting requirements were identified. Furthermore, mechanisms and associated technologies needed to implement the privacy principles/requirements into a functional prototype were also identified. A comparison of the proposed framework with existing frameworks, showed that it addressed privacy threats/concerns in a more comprehensive manner.

Conclusion

This research makes a valuable contribution to protecting privacy in mHealth. The novel framework developed is an improvement on existing frameworks. It is also future-proof since its foundations are built on regulatory frameworks and privacy threats/concerns existing at the time of its deployment/revision.

     

Identifying optimal dosage regimes under safety constraints: An application to long term opioid treatment of chronic pain

There is growing interest and investment in precision medicine as a means to provide the best possible health care. A treatment regime formalizes precision medicine as a sequence of decision rules, one per clinical intervention period, that specify if, when and how current treatment should be adjusted in response to a patient's evolving health status. It is standard to define a regime as optimal if, when applied to a population of interest, it maximizes the mean of some desirable clinical outcome, such as efficacy. However, in many clinical settings, a high‐quality treatment regime must balance multiple competing outcomes; eg, when a high dose is associated with substantial symptom reduction but a greater risk of an adverse event. We consider the problem of estimating the most efficacious treatment regime subject to constraints on the risk of adverse events. We combine nonparametric Q‐learning with policy‐search to estimate a high‐quality yet parsimonious treatment regime. This estimator applies to both observational and randomized data, as well as settings with variable, outcome‐dependent follow‐up, mixed treatment types, and multiple time points. This work is motivated by and framed in the context of dosing for chronic pain; however, the proposed framework can be applied generally to estimate a treatment regime which maximizes the mean of one primary outcome subject to constraints on one or more secondary outcomes. We illustrate the proposed method using data pooled from 5 open‐label flexible dosing clinical trials for chronic pain.     

精准医学技术优选评估方法支持医保决策探索

采用国际经验比较、专家咨询和案例研究等方法,并基于优先领域确定(priority-setting)理论,提出适宜于我国的精准医学技术早期识别和优选方法框架,明确技术识别和优选的目的、实施主体、服务对象、识别范围和流程方法。其中,优选方法框架可为及时发现具有应用前景的优先精准医学技术提供技术支持。通过系统地早期识别并对初筛技术的健康需求、安全性、有效性、经济性、创新性和社会公平伦理等维度开展快速卫生技术评估,重点关注技术的成本-效果和应用对于医保预算的潜在影响,最后确定优先支持的精准医学技术名单,为医保目录调整提供优先考虑的技术清单,助力精准医学技术的及时转化和应用。在具体实施时需要组织、信息和资金等保障措施并通过实际应用不断完善方法。     

2008年北京奥运会对人群健康影响的定性研究

目的通过定性访谈了解奥运会对居民和社区层面上的影响,验证本课题所提出的指标的合理性。方法对51名访谈对象开展了专题组访谈和个人深入访谈,并用主题框架法进行分析。结果访谈的结果可以被归纳形成为包括环境、健康理念、生活方式、健康状况四个总主题和相应分主题的主题框架,这一主题框架与本研究前期建立的指标体系结构基本一致。结论研究结果在一定程度上验证了本研究所建立的二级指标和部分三级指标的合理性与代表性。     

THE COST‐EFFECTIVENESS OF USING FINANCIAL INCENTIVES TO IMPROVE PROVIDER QUALITY: A FRAMEWORK AND APPLICATION

Despite growing adoption of pay‐for‐performance (P4P) programmes in health care, there is remarkably little evidence on the cost‐effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered, before proposing a new more comprehensive framework, which we apply to the first P4P scheme introduced for hospitals in England. We emphasise that evaluations of cost‐effectiveness need to consider who the residual claimant is on any cost savings, the possibility of positive and negative spillovers, and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the £13m total programme costs. By generating approximately 5200 quality‐adjusted life years and £4.4m of savings in reduced length of stay, we find that the programme was a cost‐effective use of resources in its first 18 months. Copyright © 2013 John Wiley & Sons, Ltd.     

优选膝关节炎贴最佳提取工艺

目的优选膝关节炎贴的最佳提取工艺。方法采用出膏率及阿魏酸的含量为评价指标,以正交试验法L9(34)优选提取工艺参数。结果乙醇浓度为工艺提取主要影响因素,其余均为次要因素。确定最佳工艺为:加70%乙醇4倍量,提取2次,每次1 h。结论在所选因素水平范围内,乙醇浓度对本方法提取效果影响最大。所选条件提取工艺稳定,可行。     

Key elements in assessing the educational environment: where is the theory?

The educational environment has been increasingly acknowledged as vital for high-quality medical education. As a result, several instruments have been developed to measure medical educational environment quality. However, there appears to be no consensus about which concepts should be measured. The absence of a theoretical framework may explain this lack of consensus. Therefore, we aimed to (1) find a comprehensive theoretical framework defining the essential concepts, and (2) test its applicability. An initial review of the medical educational environment literature indicated that such frameworks are lacking. Therefore, we chose an alternative approach to lead us to relevant frameworks from outside the medical educational field; that is, we applied a snowballing technique to find educational environment instruments used to build the contents of the medical ones and investigated their theoretical underpinnings (Study 1). We found two frameworks, one of which was described as incomplete and one of which defines three domains as the key elements of human environments (personal development/goal direction, relationships, and system maintenance and system change) and has been validated in different contexts. To test its applicability, we investigated whether the items of nine medical educational environment instruments could be mapped unto the framework (Study 2). Of 374 items, 94% could: 256 (68%) pertained to a single domain, 94 (25%) to more than one domain. In our context, these domains were found to concern goal orientation, relationships and organization/regulation. We conclude that this framework is applicable and comprehensive, and recommend using it as theoretical underpinning for medical educational environment measures.     

High strength Co-Cr-Mo alloy by hot isostatic pressing of powder.

Currently available cobalt alloy prostheses for total hip applications are fabricated by investment casting techniques. Instances of stem fracture have been reported due to metal fatigue secondary to stem loosening or cement breakdown. A new process has been developed which includes the preparation of ultraclean powder and subsequent consolidation of the powder by hot isostatic pressing. The resultant solid material is characterized by 100 percent density and ultrafine grain size. Prostheses prepared by the new process have the same biocompatibility and corrsion resistance as the conventional cast alloy but higher strength and fatgue resistance.     

Incorporating Ethics in Priority Setting: A Case Study of a Regional Health Board in Canada

The authors were involved in developing an ethical framework to assist the Queens Region Board (Prince Edward Island, Canada) set priorities in health and health care. Two and one half years after the adoption of this framework, the authors undertook an evaluation of the framework. This paper will discuss: a) the historical background of regionalization in Canada, and in particular the circumstances leading up to the institution of regional boards in Prince Edward Island; b) the sorts of ethical issues facing the Queens Regional Board; c) issues arising in connection with the use and development of ethics frameworks for managing ethical issues in priority setting; d) the framework adopted by the Queens Board and the process that led to its development; e) issues arising as concerns implementation of the framework; f) questions and issues pertinent to other boards and bodies considering similar initiatives. This revised version was published online in August 2006 with corrections to the Cover Date.     

Globalization, international trade, and health equity]

Globalization and international trade are having an increasingly evident impact on the day-to-day duties of the health sector, and the phenomenon has aroused a great deal of interest among governments, nongovernmental organizations, international organizations, and the mass media. Up to this point the heated and polemical debate on the subject has seriously hindered objective discourse on the health implications of globalization and international trade. This piece examines the possible impact of the two processes on health in the Region of the Americas, in order to foster policies for equity that are adopted within the framework of public health in the Americas. The piece considers the relationships among globalization, trade, and health in general and then focuses on the special case of trade in health goods and services. The piece looks at the possible impact on health equity of the agreements for integration and free trade that are being negotiated in the Americas. The piece concludes with a summary of the activities that the Pan American Health Organization has been carrying out in this area.