结直肠癌优化筛检方案在大肠癌高发区人群中的验证

本文根据“七五”期间在大肠癌高发区浙江省嘉善县进行的大肠癌人群序贯筛检资料，对原方案作进一步的修正，制订出优化方案并用两种筛检方案对该地区６４６４０人群进行回代验证。结果显示：在大肠新生物组，用序贯筛检方案检出新生物２７０例，敏感度为６６．３％，特异度９５．５％，正确指数０．６２，而用优化方案，可检出大肠新生物３５２例，敏感度为８６．５％，特异度为８６．０％，正确指数０．７３，经Ｘ＾２检验，二组具     

Excel在序贯试验分析中的应用

序贯试验(sequential analysis)是一种在临床上使用较多的实验方法,它可以由尽量少的病例得出结论。不仅可以节约时间和人力,而且可以避免用不够好的方法治疗过多的病例。一些常用的统计软件没有提供相应的分析方法,这为我们使用序贯试验带来了不便。其实,Excel是一种使用极为方便的电子表格软件,它具有强大的数据处理、图表绘制等功能。使用Excel就能较好地解决序贯试验设计数据分析的问题。本文以开放性单向计数资料的序贯试验为例,说明如何使用Excel对序贯实验设计的实验数据进行分析处理。     

在Excel中完成序贯检验的计算及其评价

目的在Excel中完成序贯检验程序的编制及其结果的评价。方法应用Excel中函数语句、计算和绘图功能,编写序贯检验的统计程序;结合实例比较和评价Excel程序的运算结果。结果在序贯检验的Excel程序中直接输入检验标准、检验水准和实验数据,即可提示统计结论和试验结束的样本例数,显示序贯检验图以及标准曲线的坐标方程;Excel程序的计算结果与文献的结果一致。结论在Excel中可准确、简便、直观地完成序贯检验的统计分析。     

尿HB检测试剂盒在人群肿瘤筛检中的应用

为了探讨一种新的尿肿瘤标志物ＨＢ检测试剂盒在人群肿瘤筛检及肿瘤辅助诊断中的应用价值，对广州市各种原发性恶性肿瘤病人尿样进行双对照研究。结果表明，该试剂盒对１０多种常见恶性肿瘤检测总阳性率为６９０１％，明显高于良性疾病对照组（１０１４％）和健康人群对照组（４６２％，Ｐ＜０００１），但不同肿瘤类型尿ＨＢ阳性率似乎不同。检测灵敏度和特异度分别为８３０５％和９４９２％，诊断准确度为８８９８％。提示该试剂盒对常见恶性肿瘤的检测有较高的灵敏度和特异性，良性疾病因素对检测结果的干扰较小，并具有广谱、简捷、采样无创伤性等优点，可作为癌症的检测指标，在高危人群或职业人群肿瘤的筛检方面，以及作为恶性肿瘤的辅助诊断方面均有较好的应用价值     

抗生素序贯疗法在肺炎中的应用价值

目的：研究抗生素序贯疗法在肺炎中的应用价值。方法选取我院2012年3月—2014年3月收治的肺炎患者160例，随机分为序贯疗法组和对照组，每组80例。两组患者均给予常规对症治疗退热，祛痰，平喘等，在此基础上，对照组根据经验性或采取药敏实验给予大环内酯类，喹诺酮类等抗菌药物持续静脉给药；序贯疗法组采用对照组相同方法采用同样的抗生素，治疗3-4天，待病人的病情得到明显改善后，改用同类药物口服剂。两组总疗程均为10-15天。结果对照组有效率91.25%（64/80）与序贯疗法组的有效率95.00%(65/80)，差异无统计学意义（P>0.05）；对照组发生药物不良反应率11.25%（9/80）高于序贯疗法组的药物不良反应率2.25%(2/80）。结论应用抗生素序贯疗法治疗肺炎，是一种经济可行，有效的减少了抗生素可能对人体造成危害的危险性的疗法，具有很高的临床应用价值，值得广泛推广应用。     

质反应开放型单向序贯检验在确定重点干预人群中的应用

20世纪50年代,序贯检验开始在药理研究、临床研究、药品检测、毒理研究及流行病学调查中广泛应用.通常适用于样本含量可随时增减,单一指标的急性动物实验或临床试验中,判断不同药物或治疗方法的疗效[1,2].不仅可以节约人力、物力、财力,而且能够使患者尽早得到有效、安全的治疗,最大程度地保障患者的权益.     

序贯排痰疗法在ICU的临床应用观察

目的评估序贯排痰疗法对ICU重症患者的排痰效果。方法选取30例ICU的重症患者为研究对象，随机分为两组，治疗组15例应用序贯排痰疗法，对照组15例应用传统排痰方法，比较治疗前后两组患者痰液量、血常规、C反应蛋白、血气分析等指标变化。结果治疗前两组患者所有指标差异均无统计学意义（P〉0．05）。治疗后两组痰液量均呈逐渐减少趋势，治疗组痰液量在治疗后第1天、第2天均大于对照组，在治疗后第4天、第5天均小于对照组，差异有统计学意义（P〈0．05）；治疗后两组血白细胞、CRP、PaCO2均降低，PaO2、氧合指数均升高，治疗组氧合指数大于对照组，差异有统计学意义（P〈0．05）。结论序贯排痰疗法的排痰效果优于传统排痰方法．值得进一步研究和推广。     

三联与序贯方案治疗Hp阳性慢性胃炎的临床研究

目的比较三联疗法与序贯方案治疗Hp阳性慢性胃炎的Hp根除效果及临床疗效。方法选取2010年7月—2014年12月确诊为Hp阳性慢性胃炎患者76例,简单数字随机法分为三联组和序贯组各38例,三联组采取标准三联疗法(埃索美拉唑20mg Bid+阿莫西林1.0 Bid+克拉霉素0.5 Bid,疗程10 d),序贯组给予序贯方案:前5 d埃索美拉唑(40mg Bid)+阿莫西林(1.0 Bid),后5 d埃索美拉唑(40mg Bid)+替硝唑(0.5 Bid);停药4周后,复查C14呼吸试验,记录Hp根除率,同时观察腹胀、恶心呕吐、腹部灼烧痛等症状消失时间,观察2组治疗效果及疗程间不良反应发生率。结果序贯组Hp根除率及治疗有效率均显著性高于三联组,差异均有统计学意义(P0.05),腹胀、恶心呕吐、腹部灼烧痛等症状消失时间均明显短于三联组,差异均有统计学意义(P0.05);两组治疗过程中均无明显不良反应。结论序贯方案治疗Hp阳性慢性胃炎疗效显著,不良反应少,Hp根除率高,值得临床推广应用。     

序贯器官衰竭评分在急性有机磷中毒病情评估中的应用

采用序贯器官衰竭评分(SOFA)系统对116例急性有机磷中毒(AOPP)患者病情进行评价。结果显示,轻、中、重度中毒患者SOFA评分差异有统计学意义(P0.05),高SOFA(评分2)组与低SOFA组呼吸衰竭、反跳、中间型综合征(IMS)、代谢性酸中毒等严重并发症发生率差异有统计学意义(P0.05)。提示SOFA对判定急性重度有机磷中毒的病情具有参考价值。     

首次Hp根治失败者应用序贯疗法的临床疗效评估

目的 评估首次幽门螺杆菌(Hp)根治失败者应用序贯疗法治疗的临床效果。方法 回顾性分析某医院2017年1月—2018年3月收治的、符合纳入标准的首次Hp根治失败患者120例。采用随机数字表法分为序贯组(n=60)和四联组(n=60)。序贯组采用序贯疗法,疗程10d;四联组采用标准四联疗法,疗程7d。收集并分析两组患者Hp根除情况、临床疗效及不良反应情况。结果 115例患者完成随访及进行14C-尿素呼气试验,随访成功率为95.83%(115/120);序贯组PP与ITT根除率均高于四联组,差异均具有统计学意义(χ2=7.29、7.07,P<0.05);序贯组总临床有效率高于四联组,差异具有统计学意义(χ2=4.13,P<0.05);两组不良反应发生率差异无统计学意义(χ2=0.14,P >0.05)。结论 序贯疗法与标准四联疗法均可作为首次Hp根治失败者的补救治疗方案,序贯疗法的临床效果更优于标准四联疗法。     

Behavioral mediators of colorectal cancer screening in a randomized controlled intervention trial

Background

Understanding mediators for behavioral change is important for the optimization of intervention strategies. This report examines mediators of change in the context of a randomized controlled intervention trial (Los Angeles, 2004-2009) that successfully increased colorectal cancer (CRC) screening among Filipino Americans.

Methods

The intervention, based on the Health Behavior Framework, targeted knowledge/awareness of CRC screening, communication with health care provider, health beliefs, social support and barriers to CRC screening. Health Behavior Framework variables were assessed at baseline and 6-month follow-up (N = 432). Variables targeted for change were tested as potential mediators of the primary outcome, self-reported receipt of CRC screening during the follow-up period, which was previously found to have increased significantly among intervention participants.

Results

Consistent with the Health Behavior Framework, knowledge/awareness of CRC screening and patient-provider communication mediated receipt of screening. Increase in knowledge/awareness of CRC screening accounted for 13% (95% confidence interval 2%-24%) of the total intervention effect size, while patient-provider communication accounted for 20% (5%-36%). Combined, these two variables accounted for 28% (10%-46%) of the total effect size.

Conclusion

Examining the roles of potential mediators in intervention trials may help identify constructs to target in order to enhance the effectiveness of interventions to increase screening.     

中国结直肠癌人群筛查方案的应用价值初探

目的 评价现行结直肠癌筛查方案的肿瘤检出率,探讨方案的应用价值.方法 筛查目标为2007-2009年杭州下城区和嘉善县40~74岁户籍人口,共43 713名.先进行由问卷调查与大便潜血检测组成的初筛,阳性者进行结肠镜诊断性复筛,发现息肉样病变即取活检或摘除,病理确诊.分析筛查数据,计算初筛阳性人群(高危人群)中不同年龄段和不同性别人群的肿瘤检出率.结果 初筛认定结直肠癌高危人群6489名,占14.85%.共有完成结肠镜检查4701名,检出结直肠肿瘤569例,检出率为12.10%(95%CI:11.17%～13.04%).其中结直肠癌52例,检出率1.11% (95%CI:0.81%～1.41%);进展期腺瘤(183 例)和非进展期腺瘤(334例)检出率分别为3.89%(95%CI:3.34%～4.45%)和7.10%(95%CI:6.37%～7.84%).70～74岁男性肿瘤检出率最高,为22.81%(95%CI:16.98%～28.70%);40～44岁女性中检出率最低,为2.49%(95%CI:0.79%～4.20%).结论 我国现行结直肠癌人群筛查方案的应用效果较好,但方案仍需进一步完善.

Abstract：

Objective To evaluate a colorectal cancer screening program by tumor detection rate and discussing its application values.Method In total,43 713 subjects were recruited in the screening program who were the registered people aged 40-74 in Xiacheng and Jiashan during year 2007-2009.The first screening involved questionnaire survey of colorectal cancer related risk factors and fecal occult blood test (FOBT),colonoscopy was performed when a positive result was observed in the first screening.If polyps were found during colonoscopy,biopsy and pathological diagnosis were carried out.The screening data were analyzed and the tumor detection rate was calculated according to age or sex.Results 6489 subjects (14.85%) belonged to the high risk group of colorectal cancer in the first screening,in which 4701 subjects finished complete colonoscopy.Finally,569 colorectal neoplasm were diagnosed,the detection rate was 12.10% (95%CI:11.17%-13.04%).It included 52 colorectal cancer (1.11%,95%CI:0.81%-1.41%),183 advanced adenoma(3.89%,95%CI: 3.34%-4.45%),334 non-advanced adenoma (7.10%,95%CI: 6.37%-7.84%).The highest detective rate was observed in male group that aged 70-74 (22.81%,95%CI: 16.98%-28.70%),the lowest detective rate was observed in female group aged 40-44 (2.49%,95%CI: 0.79%-4.20%).Conclusion The current colorectal cancer screening program in China works well,but the revision of the program is necessary.     

基于大数据的随机对照试验

我国医疗领域目前已积累了海量数据,如何利用大数据开展随机对照试验日益得到关注。本研究结合国外利用大数据实施随机对照试验的成功经验,从数据来源、研究对象和研究结局确定、干预措施、随机化方法、知情同意的实施等方面进行梳理总结,以期为国内未来开展相关研究提供借鉴。     

结直肠癌内镜检出率及筛查研究

目的 探讨结直肠癌内镜检出率及直肠指检、粪便隐血试验、肿瘤标志物与无痛结肠镜在结直肠癌筛查中的价值.方法 回顾性分析2010年1月至2013年12月2 167例结肠镜检查患者,所有病例在行结肠镜检查前均行直肠指检、粪便隐血试验、肿瘤标志物检查,并与病理、手术结果等资料进行比较分析.结果 2010-2013年男、女所占比例比较差异无统计学意义（x2=3.640 5,P＞0.05）.2010-2013年结直肠腺瘤检出率分别为4.762％ （25/525）,8.180％ （40/489）,8.276％（48/580）,8.028％（46/573）,四者比较差异无统计学意义（x2=6.785 7,P＞ 0.05）.2010-2013年结直肠癌的检出率分别为12.571％ （66/525）,11.656％ （57/489）,13.448％（78/580）,10.820％（62/573）,四者比较差异无统计学意义（x2=2.065 7,P＞ 0.05）.2010-2013年结直肠癌占结肠镜检查阳性结果百分率分别为72.527％ （66/91）,58.763％ （57/97）,61.905％（78/126）,57.407％ （62/108）,四者比较差异无统计学意义（x2=5.679 8,P＞ 0.05）.结论 2010-2013年结直肠癌检出率较为稳定;联合直肠指检、粪便隐血试验及肿瘤标志物检查在结直肠癌筛查中的价值在于筛选结肠镜检查人群,提高针对性,从而提高结直肠癌的早诊断和早治疗水平.     

Neighborhood effects in a behavioral randomized controlled trial

Randomized controlled trials (RCTs) of interventions intended to modify health behaviors may be influenced by neighborhood effects which can impede unbiased estimation of intervention effects. Examining a RCT designed to increase colorectal cancer (CRC) screening (N=5628), we found statistically significant neighborhood effects: average CRC test use among neighboring study participants was significantly and positively associated with individual patient’s CRC test use. This potentially important spatially-varying covariate has not previously been considered in a RCT. Our results suggest that future RCTs of health behavior interventions should assess potential social interactions between participants, which may cause intervention arm contamination and may bias effect size estimation.     

耳穴贴压疗法治疗失眠症的随机对照研究

目的 探讨耳穴贴压疗法及特定穴位治疗失眠症的有效性.方法 选择符合纳入标准的失眠症患者125例,随机分为真穴治疗组63例和伪穴对照组62例.真穴组选取神门、皮质下、心、肾、肝、脾、枕等穴位,伪穴组选上述穴位旁开2～3mm处,疗程1个月.每组治疗前后均采用匹兹堡睡眠质量指数量表(PSQI)评价疗效.结果 (1)两组治疗前后PSQI各因子评分差及总分差均有统计学意义(P＜0.01);(2)两组间治疗后各因子评分及总分的比较显示,两组在睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍和日间功能障碍6项的差异有统计学意义(P＜0.01);两组治疗前后其评分差值的比较也有统计学意义;(3)对两组各因子治疗前后的等级差值进行秩次分析,其差异均有统计学意义(P＜0.01).结论 耳穴贴压疗法近期内能有效改善睡眠质量,缩短入睡时间,延长睡眠时间,提高睡眠效率.     

由2450例大肠癌临床资料探讨伺机性筛查策略

目的回顾性分析已知大肠癌临床资料,为伺机性筛查策略及方案制定提供依据。方法收集2001年10月至2011年9月间华北地区五家医院收治的、具有完整记录并经组织学检查确诊的2450例大肠癌患者资料,分析年龄、性别、肿瘤发生部位和组织学类型与大肠癌发病的相关性。结果大肠癌患者中男性1377例,女性1073例;男：女为1．28：1;50岁以下占所有大肠癌病例的18．14％,50岁以上呈明显上升趋势;直乙结肠癌占73．00％,其他部位占27．00％（降结肠、横结肠、升结肠癌分别为6．12％,6．98％和13．9％）;中分化腺癌占50．33％,高分化腺癌占40．35％,低分化腺癌占9．32％;分化程度与诊断年龄无明显相关性分化程度与诊断年龄、性别无明显相关性（P〉0．05）。结论50岁以下大肠癌所占比例上升,年轻化趋势,伺机性筛查不宜做年龄限制;推荐全结肠镜检查作为伺机性筛查精查手段;伺机性筛查不考虑性别差异。     

中国人群结直肠癌疾病负担分析

目的 了解中国人群结直肠癌的发病与死亡情况。方法 从GLOBOCAN 2012、《2012中国肿瘤登记年报》、《五大洲癌症发病率》(CI5)、全国三次死因回顾调查和WHO Mortality Database 5个数据源中摘录中国结直肠癌的发病和/或死亡数据,分析中国人群结直肠癌的发病、死亡及其趋势。结果 GLOBOCAN 2012估计2012年中国男、女性结直肠癌发病率(世标率)分别为16.9/10万和11.6/10万,死亡率(世标率)分别为9.0/10万和6.1/10万。GLOBOCAN 2012对不同人类发展指数与结直肠癌疾病负担分析显示,人类发展指数越高,结直肠癌发病率与死亡率也越高,中国目前属高等发展水平,提示随着中国经济卫生的发展,未来结直肠癌负担可能越来越严重。CI5第4卷和GLOBOCAN 2012显示,中国人群结直肠癌发病率从50岁开始上升明显。《2012中国肿瘤登记年报》显示,2009年城市地区的结直肠癌发病率(世标率)(22.2/10万)和死亡率(世标率)(9.9/10万)约为农村地区发病率(世标率)(11.8/10万)和死亡率(世标率)(5.7/10万)的2倍。2009年结肠癌占全部结直肠肛门癌的构成比,男、女性分别为49.0%和54.2%,城市和农村地区分别为53.4%和41.7%。CI5第4~10卷数据显示:1973－2007年上海男性和女性结肠癌和直肠肛门癌均呈上升趋势,与1973－1977年相比,2003－2007年男性发病率分别增加138.8%和31.1%,女性则分别增加146.7%和49.1%。全国三次死因回顾调查显示,从1973－1975年至2004－2005年间结直肠癌死亡粗率上升77.9%。基于WHO Mortality Database数据的Joinpoint分析显示:1987－2000年中国结直肠癌死亡率平均年度变化百分比升高0.7%(P<0.05)。结论 中国人群结直肠癌疾病负担提示城市地区和男性人群应为防控重点。中国结直肠癌发病与死亡模式趋向发达国家,呈增长趋势,应尽早开展筛查等人群层面的防控工作。     

A community-based randomized trial of a faith-placed intervention to reduce cervical cancer burden in Appalachia

Objective

Faith Moves Mountains assessed the effectiveness of a faith-placed lay health advisor (LHA) intervention to increase Papanicolaou (Pap) test use among middle-aged and older women in a region disproportionately affected by cervical cancer and low screening rates (regionally, only 68% screened in prior 3 years).

Method

This community-based RCT was conducted in four Appalachian Kentucky counties (December 2005-June 2008). Women aged 40-64 and overdue for screening were recruited from churches and individually randomized to treatment (n = 176) or wait-list control (n = 169). The intervention provided LHA home visits and newsletters addressing barriers to screening. Self-reported Pap test receipt was the primary outcome.

Results

Intention-to-treat analyses revealed that treatment group participants (17.6% screened) had over twice the odds of wait-list controls (11.2% screened) of reporting Pap test receipt post-intervention, OR = 2.56, 95% CI: 1.03-6.38, p = 0.04. Independent of group, recently screened participants (last Pap > 1 but < 5 years ago) had significantly higher odds of obtaining screening during the study than rarely or never screened participants (last Pap ≥ 5 years ago), OR = 2.50, 95% CI: 1.48-4.25, p = 0.001.

Conclusions

The intervention was associated with increased cervical cancer screening. The faith-placed LHA addressing barriers comprises a novel approach to reducing cervical cancer disparities among Appalachian women.     

Randomized controlled trial of a patient decision aid for colorectal cancer screening.

PURPOSE: To conduct a pilot test of a decision aid designed to help patients choose among currently recommended colorectal cancer screening programs. METHODS: Randomized controlled trial comparing a patient decision aid based on multicriteria decision-making theory with a simple educational intervention. PATIENT POPULATION: 96 patients at average risk for colorectal cancer seen in an Internal Medicine practice in Rochester, New York. OUTCOME MEASURES: The two primary outcome measures were patient decision process and the decision outcome. Patient decision process was assessed using the decisional conflict scale. Decision outcome was defined as the proportion of colorectal cancer screening plans carried out. RESULTS: After controlling for the effects of the physicians in a factorial analysis of variance, patients who used the decision aid had lower decisional conflict regarding colorectal cancer screening decisions (F ratio 6.47, P = 0.01) due to increased knowledge, better clarity of values, and higher ratings of the quality of the decisions they made. There was no difference between the groups in decision outcomes: 52% of patients in the control group and 49% in the experimental group completed planned screening tests (P = 1.0). CONCLUSIONS: In a pilot study, a multicriteria-based patient decision aid for colorectal cancer screening improved patients' decision-making processes but had no effect on the implementation of screening plans.