卫生人力资源管理及其中西方的比较

对卫生人力资源管理进行了简要介绍，并对中西方的异同进行比较，旨在引起我国卫生管理部门或有关人员的重视，从而借鉴西方的理论和经验，探索中国卫生人力资源管理的方法和模式。     

A phase 3 study of tezacaftor in combination with ivacaftor in children aged 6 through 11 years with cystic fibrosis

BackgroundTezacaftor/ivacaftor is a new treatment option in many regions for patients aged ≥12 years who are homozygous (F/F) or heterozygous for the F508del-CFTR mutation and a residual function (F/RF) mutation. This Phase 3, 2-part, open-label study evaluated the pharmacokinetics (PK), safety, tolerability, and efficacy of tezacaftor/ivacaftor in children aged 6 through 11 years with these mutations.MethodsPart A informed weight-based tezacaftor/ivacaftor dosages for part B. The primary objective of part B was to evaluate the safety and tolerability of tezacaftor/ivacaftor through 24 weeks; the secondary objective was to evaluate efficacy based on changes from baseline in percentage predicted forced expiratory volume in 1 s (ppFEV₁), growth parameters, sweat chloride, and the Cystic Fibrosis Questionnaire–Revised (CFQ-R) respiratory domain score.ResultsAfter PK analysis in part A, 70 children received ≥1 dose of tezacaftor/ivacaftor in part B; 67 children completed treatment. Exposures in children aged 6 through 11 years were within the target range for those observed in patients aged ≥12 years. The safety profile of tezacaftor/ivacaftor was generally similar to prior studies in patients aged ≥12 years. One child discontinued treatment for a serious adverse event of constipation. Tezacaftor/ivacaftor treatment improved sweat chloride levels and CFQ-R respiratory domain scores, mean ppFEV₁ remained stable in the normal range, and growth parameters remained stable over 24 weeks.ConclusionsTezacaftor/ivacaftor was generally safe and well tolerated, and improved CFTR function in children aged 6 through 11 years with CF with F/F and F/RF genotypes, supporting tezacaftor/ivacaftor use in this age group. NCT02953314.     

Peer Reviewed: Prevalence of Diabetes and Impaired Fasting Glucose in Chinese Adults,China National Nutrition and Health Survey, 2002

Introduction

As a result of rapid economic development in China, the lifestyles and dietary habits of its people have been changing, and the rates of obesity, diabetes, and other chronic conditions have increased substantially. We report the prevalence of type 2 diabetes and impaired fasting glucose (IFG) and the association between diabetes and overweight and obesity in Chinese adults. We also compare the results with those from the US National Health and Nutrition Examination Survey, 1999-2002.

Methods

Data were from adults aged 20 years or older who participated in the China National Nutrition and Health Survey, 2002 (n = 47,729). Diabetes and IFG were defined by the American Diabetes Association 2009 criteria. We assessed the prevalence of diabetes, IFG, and overweight and obesity by sex, age, region of residence, and ethnicity.

Results

The prevalence of diabetes and IFG in Chinese adults was 2.7% and 4.9%, respectively. The prevalence of diabetes increased with age and body mass index. Men and women had a similar prevalence of diabetes, but men had a significantly higher prevalence of IFG. The prevalence of diabetes among Chinese who lived in urban areas was 2 to 3 times higher than the prevalence among those who lived in rural areas (3.9% for urban areas and 6.1% for large cities vs 1.9% for rural areas), and the prevalence of IFG was 1.5 to 2 times higher (6.1% and 8.1% vs 4.2%, respectively). The prevalence of diabetes among Chinese women and young (20-39 y) and middle-aged (40-59 y) adults who lived in large cities was similar to the prevalence of diabetes in the US population.

Conclusion

The prevalence of diabetes and IFG was much higher in urban than rural areas, particularly in the large cities of China. Prevention must be emphasized among adults to reduce the future social and economic burden of diabetes in China.     

椎体成型术治疗老年压缩性骨折的临床研究

目的探讨椎体成型术治疗老年压缩性骨折的临床疗效。方法选取本院2008年1月～2011年6月收治的老年压缩性骨折患者39例,在双C型臂X线机的透视下,经皮向患者椎体内穿刺并注入骨水泥,对其术后的止痛效果和椎体恢复情况进行评估。结果患者椎体平均骨水泥注入量为（3.4±1.7）mL,平均手术时间为（52.4±6.1）min/椎体,患者平均住院时间为（11.2±3.8）d。患者治疗前VAS评分为（7.2±1.8）分,治疗后VAS评分为（2.4±1.0）分,差异有统计学意义（P〈0.05）。所有患者椎体操作手术全部成功,均未出现脊髓压迫、神经损伤、感染、肺栓塞等严重并发症。患者术后伤椎前缘高度和伤椎后缘高度均明显大于术前,患者术后Cobb角明显小于术前,差异有统计学意义（P〈0.05）。结论采用经皮穿刺椎体成型术治疗老年压缩性骨折具有显著的临床疗效,手术操作简便且安全,患者术后止痛效果明显,能较好恢复患者的椎体高度,是一种安全有效的治疗方法,值得临床推广使用。     

Development and validation of the simplified Chinese version of EORTC QLQ-H&N35 for patients with head and neck cancer

Goals

A simplified Chinese version of EORTC QLQ-H&N35 was developed using strict translation procedures according to EORTC translation guidelines. Psychometric properties were evaluated.

Patients and methods

Three instruments (QLQ-H&N35, QLICP-HN, and FACT-H&N) were used in a sample of 133 patients with head and neck cancer at the time of their admission to the hospital. Each patient was assessed for the second time 1–2 days after hospitalization so that the test–retest reliability could be calculated. A sub-sample of patients was sampled and measured for the third time at discharge in order to evaluate the responsiveness.

Results

Correlation analysis among domains and items of the three instruments showed good construct validity and criterion-related validity. Comparisons of QLQ-H&N35 between treatment groups and age groups supported clinical validity. The internal consistency reliability measured by Cronbach’s coefficient α was greater than 0.70 for all multi-item domains, and test–retest reliability coefficients for all domains were greater than 0.80, ranging from 0.88 to 0.95. Score changes between pre- and post-treatment were observed in 6 out of 18 domains, with effect size SRM ranging from 0.27 to 0.87.

Conclusions

The simplified Chinese version of QLQ-H&N35 demonstrates good validity, reliability, and responsiveness and can be used to measure QOL for Chinese patients with head and neck cancer.     

不同剂量淫羊藿苷对冒公藤多苷模型小鼠睾丸病理损伤的影响

目的 探讨淫羊藿苷拮抗雷公藤多苷小鼠睾丸病理损伤的量效关系.方法 应用雷公藤多苷所致的睾丸生精障碍小鼠模型,观察不同剂量淫羊藿苷对小鼠睾丸病理形态学的影响.结果 模型组小鼠睾丸组织可见明显的病理损伤;3份淫羊藿苷/1份雷公藤多苷治疗组小鼠睾丸生精小管管壁较厚,细胞层次较宽,各级生精细胞排列较规则,基底面至腔面可见精原细胞、初级精母细胞、精子细胞等各个发育阶段的细胞,细胞增殖旺盛,可见较多分裂期细胞,腔内可见成熟精子,间质稀少,血管丰富,间质细胞发育良好.1份淫羊藿苷/1份雷公藤多苷治疗组和9份淫羊藿苷/1份雷公藤多苷治疗组小鼠睾丸病理表现相似,好于模型组,但差于3份淫羊藿苷/1份雷公藤多苷治疗组.结论 在淫羊藿苷/雷公藤多苷的1∶1、3∶1、9∶1三种剂量配比中,3∶1配比具有最好的拮抗雷公藤多苷睾丸病理损伤的作用.     

北京市医疗机构继续教育现状分析

目的:通过对400名基层医师整体知识水平的了解,分析北京城乡基层医疗机构继续教育对医师医技知识获知的情况,为北京城乡基层医疗机构的继续教育寻求适合的方式。方法:以《中国高血压防治指南》及相关继续教育课程为指导设计调查问卷,采用多层随机抽样,建立数据库对北京市城乡基层医疗机构400名医师问卷调查结果进行分析。结果:北京城乡基层医疗机构有定期业务培训的占66.5%,城乡继续教育渠道不一致,参加继续教育计划课程的占79.3%、阅读专业书刊文献占82.5%,这是城区医师继续教育的主要渠道。乡镇医师的知识渠道比例排序前2位为继续教育课程(45.8%)和报刊及广告(37.5%)。通过继续教育课程获知《中国高血压指南》相关知识的比例为29.3%,城乡差异有统计学意义(34.8%vs.12.6%,P<0.01),考核及格率为44%,参加过培训与未培训者分别为(56.9%vs.38.7%,P<0.01)。结论:北京基层继续教育计划课程不是北京基层医疗机构医师、医技知识获知主渠道,其现状影响基层医生医疗水平的提高。     

利用双能X射线吸收法测量体成分

目的：应用双能Ｘ射线吸收法（ＤＸＡ）直接测量评定体成分的分布及其与年龄、性别的关系。方法：随机选取２０３名２０岁～５０岁的成人，用ＤＰＸＬ型双能Ｘ射线骨密度仪测量分析体成分及其分布。结果：ＤＸＡ测量的体重与体重计所测体重呈显著线性相关（ｒ＝０９９，Ｐ＜００１）。体重、全身体脂百分比随年龄增长而增加，３０岁以后，体脂分布的向心化趋势加快，女性体脂百分比大于男性，性别间差异显著（Ｐ＜００１）。结论：ＤＸＡ能直接测量体成分，具有简单、快速、安全等优点。本研究为国内首次应用ＤＸＡ直接证实：全身体脂百分比随年龄增长而增加、且越加向心化分布，女性的体脂百分比大于男性。     

骨折外固定架测力装置

本文介绍一种骨拆外固定架测力装置。该装置通过电阻应变式传感器测得固定架受力状态，并用ＥＣＤ数码管显示测量结果。在０～１００Ｎ范围内，其线性度和重复性优于１％，精度可达１Ｎ。