核化生洗消装备选型与评估

目的：为市购核化生洗消装备建立可行的指标体系和选型评估模型。方法：采用集成赋权法建立核化生洗消装备选型评估模型。结果：通过选用6种核化生洗消装备对建立的模型进行了评估测试。结论：集成选型模型可以在一定程度上纠正单纯采用主观或客观权重法计算得到的指标权重的偏差,测试结果与装备实际性能基本一致。     

生物侦检装备选型模型研究

目的：为市购生物侦检装备建立适合的选型模型。方法：采用集成赋权法建立生物侦检装备选型模型,集成赋权法是由层次分析法和变异系数法结合而成。结果：通过选型模型对10种手持式生物侦检装备的数据测试,表明集成选型模型的权重值和综合值排序结果介于主观选型模型和客观选型模型的排序结果之间,与预期结果相近。结论：集成选型模型既反映了主观需求,也兼顾了客观性,初步验证了集成选型模型的合理性。     

Delphi法建立输卵管性不孕患者输卵管功能评价指标体系

目的：建立输卵管性不孕患者生殖手术中输卵管功能的评价指标体系,为预后及术后指导受孕提供科学依据。方法：经查阅国内外文献并结合临床实际,采用自行设计的专家咨询表,通过三轮专家Delphi法和层次分析法确定生殖手术后输卵管功能评价的指标体系及权重。结果：三轮专家咨询的协调系数均为0.426,有统计学意义（P＜0.05）。一级至五级指标的专家权威系数分别在0.625～0.630、0.600～0.640、0.595～0.630、0.585～0.655和0.595～0.650之间。经过三轮专家咨询确定的指标体系包括2个一级指标、6个二级指标、19个三级指标、31个四级指标和33个五级指标。其中,输卵管通畅度在输卵管性不孕患者生殖手术预后的权重最高（0.673）,双侧通畅高于单侧通畅,本身通畅高于手术复通,经手术复通者输卵管远端造口的权重高于近端导丝介入者,而两端均阻塞者最低。对于输卵管的形态判断,双侧通畅、本身形态正常的权重较高。经手术恢复形态者,伞端形态与结构较输卵管与卵巢相对位置更为重要,伞端狭窄的权重高于积水造口后,输卵管周围膜样粘连者高于输卵管扭曲上举者。术后输卵管形态仍异常者,权重由高到低依次为伞端无自由度、造口后无正常伞端、积水输卵管内部结构异常。结论：用Delphi法构建的输卵管不孕患者生殖手术后输卵管功能评价的指标体系可信度、可靠性高,可为输卵管性不孕患者生殖手术预后及术后指导受孕提供参考。     

危重病医学领域主要技术装备功能定位及其功能配置

危重病医学是一个备受关注的临床学科,相关卫生技术装备发展迅速,呈逐年递增趋势,成为卫生资源配置研究不可忽视的领域.文章从危重病医学技术装备功能定位入手,采用技术功能需求与装备功能双向分解评估方法,探讨主要技术装备管理的功能配置问题.     

我国健康人社会功能衰老测量量表构建研究

目的 探讨并构建我国健康人社会功能性衰老评估指标体系,制作人体社会功能性衰老量表。方法 采用文献搜集、改良Delphi法和层次分析法（analytic hierarchy process,AHP）筛选并确立社会功能性衰老评估指标体系及权重系数;通过信度、相关性和探索性因子分析等评价量表的信度、效度并提取指标。结果 确定社会维度衰老指标体系,其中二级指标3项（即个人能力、社会参与、组织交往）,三级指标13项（生活自理能力、人际关系等）;量表信度克朗巴哈α系数为0.873,重测信度系数r为0.848（P<0.001）,内容效度指数（content validity index,CVI）为0.836;结构效度经因子分析共提取3个公因子,能解释总变异量的53.69%,各原始指标公共度介于0.573~0.776之间。结论 建立的社会功能性衰老指标体系,指标代表性好、认可度较高;量表的内容和结构效度较理想,指标分值及离散度与总分的相关系数大部分达到统计学标准,具有较好的应用价值和实用价值。     

嵌入式临床路径管理软件功能标准研究

目的：确定嵌入式临床路径电子化系统功能标准,满足临床电子病历系统应用的相关要求。方法：对病区医生进行访谈,从纸张临床路径应用中得到电子化临床路径的基本功能,从临床路径电子化软件切换应用中得到其附加功能,比较相关软件得到适合大型医院使用的能嵌入电子病历系统的临床路径软件的功能标准。结果：嵌入式临床路径的功能标准,其重要功能是患者临床处置列表、变异管理、评估与统计分析。结论：该研究对嵌入电子病历系统的临床路径电子化开发具有帮助作用。     

建立心血管疾病住院病人病情评估指标体系的研究

目的：构建心血管疾病住院病人病情评估指标体系,实现心血管疾病病情变化的即时评估,以期指导临床护理。方法：采用文献查询和资料收集方法构建初步模型,运用Delphi专家咨询法和层次分析法,进行各级指标的论证并确立指标的权重。结果：专家积极系数为100%,对各项指标的权威系数分别为0.92～0.93,协调系数分别为0.22、0.372,χ2检验P〈0.001,认为专家协调程度较好。根据专家意见的集中度,确定4项一级指标,15项二级指标。结论：本次咨询专家的积极性高,权威性、协调性较好,显示评价指标体系的代表性和可信度高。     

通用实验室离心机及其功能配置

离心是一项广泛应用于医学实验室的重要技术。本文在讨论通用实验室离心机技术的进展、常规离心技术方法的选择、离心技术相关的生物安全事项等内容的同时,从卫生技术装备功能配置管理角度研究了装备离心机应考虑的若干问题,对不同应用领域离心技术需求的功能定位、功能配置双向评估原则以及实验室间资源共享等方面进行了较系统分析。     

临床护理路径应用于脑梗塞患者康复功能锻炼效果分析

目的：研究并分析采用临床护理路径对脑梗塞患者康复功能锻炼的应用效果.方法：选取的72例脑梗塞患者作为研究对象. 将其均分为观察、对照两组并分别对其进行临床护理路径措施与普通常规护理措施手段,对比观察行临床护理路径的措施在脑梗塞患者康复功能锻炼中的效果.结果：采用临床护理路径措施的观察组的康复功能锻炼效果与采用常规护理措施的对照组比较,观察组明显优于对照组.结论：采用临床护理路径应用在脑梗塞患者康复功能锻炼中,其疗效较好,且能提高满意度,满足患者的需求,值得在临床上应用.     

卫生技术装备之功能配置管理

功能是卫生技术装备由静态(物资)向动态(技术)转化过程中的表达方式,是衔接使用需求与装备配置两者的界面,卫生技术装备作为重要的卫生资源,其合理配置和有效利用实质上也可以认为是技术功能的配置及其利用效果、效益的体现.文章提出技术装备要重视功能配置管理的观点,强调应当以卫生单位的技术定位为基础,以装备领域对技术功能的应用需求及其技术发展目标为出发点,以卫生器材的技术指标及功能为研究对象,评价应用需求与器材技术功能配置之间的相互关系,探讨最佳的硬、软件技术功能配置方案.     

A systematic assessment of the concept and practice of public-private mix for tuberculosis care and control

Introduction  

The STOP TB Partnership aims to improve global tuberculosis (TB) control through expanding access to the directly observed treatment short course (DOTS) strategy. One approach to this is 'Engaging all Care Providers', which evolved from 'Public-Private Mix (PPM) DOTS'. The overall aim of this study was to systematically assess whether and to what degree the STOP TB Partnership's four global objectives of engaging all care providers are met through existing PPM interventions. These four objectives are; 1) Increase TB case detection; 2) Improve TB treatment outcomes; 3) Enhance access and equity; 4) Reduce financial burden on patients. The specific objectives of this assessment were to 1) Understand what PPM means to the STOP TB Partnership's PPM Subgroup and to National Tuberculosis Programme managers; 2) Scope the nature of existing country-level PPM interventions and 3) Review PPM practice against the global PPM objectives.     

Ordinal outcomes: A cumulative probability model with the log link and an assumption of proportionality

We present here a study of ordinal outcomes with a cumulative probability model. In particular, we consider the log link with the assumption of proportionality. The logit link is currently the most widely used link with ordinal outcomes in the health research literature. With the logit link, one obtains regression coefficients that are functions of odds. When the log link is used, one obtains regression coefficients that are functions of probabilities. While odds might be preferred with certain studies that are retrospective, many health researchers may prefer to have direct statements about probabilities. There are two classes of models with the log link analogous to those with the logit link. We will call these two classes the Proportional Probability Model (PPM) and the Log Cumulative Probability Model (LCPM). These models introduce a challenge not seen with the logit link models. The log link models have constraints on the parameter space. We must insist that the maximum likelihood estimate (MLE) satisfy these constraints. We present conditions for the uniqueness of the MLE and we present other features of the MLE. Several examples and several closed form expressions for the MLE are presented. While this paper is primarily about the PPM, our R package lcpm contains functions to fit both the PPM and the LCPM.     

Growth and development in the rat during sub-chronic exposure to low levels of hydrogen sulfide

The effects of low levels of hydrogen sulfide (H2S) on mammalian growth and development are unknown although it has long been postulated that H2S can inhibit critical developmental functions through the cleavage of disulfide bonds and chelation of essential metal ions. Gravid rat dams exposed to H2S (less than or equal to 75 PPM) from day 6 of gestation until day 21 postpartum (PP) demonstrated normal reproductive parameters until parturition. At parturition, however, delivery time was extended in a dose dependent manner with a maximum increase of 42% at 75 PPM. Maternal liver cholesterol content was elevated significantly on day 21 postpartum following exposure to 75 PPM H2S each day for 6 weeks. Pups which were exposed in utero and neonatally to day 21 postpartum developed with a subtle decrease in time of ear detachment and hair development and with no other observed change in growth and development through day 21 postpartum.     

Organisational innovation and control practices: the case of public–private mix in tuberculosis control in India

Partnerships between public and private healthcare providers are often seen as an important way to improve health care in resource‐constrained settings. Despite the reconfirmed policy support for including private providers into public tuberculosis control in India, the public–private mix (PPM) activities continue to face apprehension at local implementation sites. This article investigates the causes for those difficulties by examining PPM initiatives as cases of organisational innovation. It examines findings from semi‐structured interviews, observations and document analyses in India around three different PPM models and the attempts of innovating and scaling up. The results reveal that in PPM initiatives underlying problem definitions and different control practices, including supervision, standardisation and culture, continue to clash and ultimately hinder the scaling up of PPM. Successful PPM initiatives require organisational control practices which are rooted in different professions to be bridged. This entails difficult balancing acts between innovation and control. The innovators handle those differently, based on their own ideas of the problem that PPM should address and their own control practices. We offer new perspectives on why collaboration is so difficult and show a possible way to mitigate the established apprehensions between professions in order to make organisational innovations, such as PPM, sustainable and scalable.     

聚氧乙烯醚碘伏对HBV灭活效果观察

本文对以聚氧乙烯醚为载体的碘伏消毒剂进行了 HBV 灭活实验观察,有效碘含量为0.645％(W/V)。消毒剂贮存20±1℃条件下168h后,性能无变化。100ppm以上碘伏消毒剂灭活 HBV活性,5min 以上即有效;电镜下观察典型的乙型肝炎病毒3种颗粒全部灭活。     

Influence of water quality on cholesterol induced systemic pathology

Reduced systemic pathology was identified in cholesterol-fed rabbits administered distilled water compared to animals drinking local tap water; this included pathology of the liver and spleen. Studies directed at determining the effect of the trace metals aluminum, copper and zinc on cholesterol-induced systemic pathology were undertaken. As previously reported copper added to distilled drinking water (0.12 PPM) increased Alzheimer-like pathology in the brain, but did not augment pathology of the spleen or liver. Aluminum added to distilled water (0.36 PPM) administered to drink exacerbated cholesterol-induced hepatic pathology but not splenic pathology, and addition of 0.36 PPM zinc to the distilled drinking water failed to affect pathology of either the liver or spleen. The overall increase in both central and systemic pathology observed among cholesterol-fed rabbits administered tap water seems to be due to different trace metal contaminants occurring in tap water.     

Nitrate and fluoride levels in ground waters of Davanagere Taluka in Karnataka

The quality of ground water supplies in Davanagere Taluk, situated in central part of Karnataka has been investigated with respect to pH, dissolved solids, chlorides, nitrates and fluorides. The levels of pH, dissolved solids and chlorides were found within the safe limits as prescribed by BIS, for more than 95% of the samples. Out of the 61 different borewell samples analysed, selected from different areas of Davanagere taluk, 26% of the samples are found to contain fluorides less than 0.50 PPM (lower safe limit prescribed by BIS) and 11.5% of the samples are found to contain more than 1.5 PPM of fluorides (higher safe limit prescribed by BIS). Further, it was also found during study that, 16.00% of the borewell samples analyzed, were found to contain more than 100.00 PPM of nitrates (measured as NO3 mg/L, safe limit prescribed by BIS). The values of fluorides and nitrates observed in different samples were in the range of 0.19 - 2.06 PPM and 0.08 - 308 PPM, respectively.     

县域医共体背景下浙江省县级妇幼保健机构功能实现状况分析

从妇幼健康服务功能、辖区业务管理和技术指导功能、承接基层转诊功能3个维度调研浙江省东阳市、桐乡市、德清县三地县级妇幼保健机构在县域医共体背景下功能实现的状况。调研发现,县级妇幼保健机构无论是否参与或以何种方式参与县域医共体,与基层医疗卫生机构建立稳定联系以及坚持临床与保健相结合是其功能实现的重要基础。政府应充分考虑县级妇幼保健机构与医共体的协调发展,县级妇幼保健机构应加强保健与临床的结合,同时构建医共体下妇幼健康统一指导考核机制。     

Can public-private collaboration promote tuberculosis case detection among the poor and vulnerable?

Private-public mix (PPM) DOTS is widely advocated as a DOTS adaptation for promoting progress towards the international tuberculosis (TB) control targets of detecting 70% of TB cases and successfully treating 85% of these. Private health care plays a central role in health-care provision in many developing countries that have a high burden of TB. It is therefore encouraging that PPM projects are being set up in various countries around the world to explore possible interaction between the national TB programmes and other partners in the fight against TB. The objective of this review was to use the published literature to assess the range of providers included in PPMs for their ability to provide case-detection services for the vulnerable. From a case-detection perspective, we identify the essential elements of a pro-poor PPM model, namely, cost-effectiveness from a patient perspective, accessibility, acceptability and quality. The review revealed that a very large part of the total spectrum of potential PPM-participating partners has not yet been explored; current models focus on private-for-profit health-care providers and non-governmental organizations. We conclude that it is important to think critically about the type of private providers who are best suited to meeting the needs of the poor, and that more should be done to document the socioeconomic status of patients accessing services through PPM pilots.