门诊呼吸科抗菌药物处方点评分析及干预前后对比

目的：了解某三甲医院门诊呼吸科抗菌药物处方规范性、用药适宜性、超常行为及干预后效果， 评估干预措施，探索不合理处方的干预模式。方法：采用回顾性分析方法，随机抽取干预前、干预后门诊呼吸科抗菌药物处方每月200张，按照《处方管理办法》《医院处方点评管理规范(试行)》《北京市医疗机构处方专项点评指南(试行)》《抗菌药物临床应用指导原则》《中国医师药师临床用药指南》 《新编药物学》《临床用药须知》以及药品说明书进行处方点评，对点评结果进行统计分析，并对比干预前后的处方合理性的改进。结果：干预前(1~6月)及干预后7~12月、13~18月、19~24月：不合理处方占总处方比例分别是10.00%，12.41%，8.50%和5.67%；不规范处方占总处方比例分别是7.67%， 8.00%，6.00%，2.75%；用药不适宜处方占总处方比例分别是4.33%，5.33%，2.92%，3.75%；干预后的 19~24月，不合理处方和不规范处方的数量与干预前(1~6月)比较具有显著性差异(P＜0.01)。干预前后抗菌药物处方比例为29.68%、27.69%、26.56%、26.64%。结论：本院门诊呼吸科抗菌药物处方存在不规范、用药不适宜现象，但干预后不合理处方数、不规范处方数、不规范及用药不适宜项目、不规范和用药不适宜处方占总处方比例、抗菌药物处方比例均有所下降，处方合理率上升至94.33%，接近卫计委的要求，医师处方行为和药师调剂行为呈持续改进之势，干预措施有效，干预模式可行。     

非心脏病患者住院发生急性心肌梗死的现状综述

急性心肌梗死(acute myocardial infarction, AMI)是严重威胁人类生命健康的心血管不良事件，然而非心脏病患者住院期间发生AMI是一种独特的心脏疾病，其临床特征、治疗和预后均不同于院外AMI。这种疾病仅在10年内才开始受到越来越多的关注和研究，本文就住院患者发生AMI的相关研究及进展进行综述。     

贵州省中学生心理健康素养现状及影响因素分析

目的 通过问卷调查探索分析贵州省中学生的心理健康素养及影响因素，为提升中学生心理健康素养水平提供参考依据。方法 使用多阶段分层整群随机抽样法，采用一般资料调查表、国民心理健康素养问卷，于2021年5—6月对贵州省3 001名中学生进行问卷调查。运用t检验、方差分析、多元线性回归进行统计分析。结果 贵州省中学生心理健康素养水平总体偏低，均分为（31.89 ± 8.36），回答正确率为53.12%。多元线性回归分析结果显示，性别（β = 0.099，t = 5.625，P＜0.001）、年级（β = 0.059，t = 2.931，P = 0.003）、户籍（β = - 0.052，t = - 2.582，P = 0.010）、学校所在地（β = - 0.060，t = - 2.237，P = 0.025）、父亲文化程度（β = 0.082，t = 3.614，P＜0.001）、家庭平均月收入（β = 0.053，t = 2.066，P = 0.039）、是否有心理健康老师（β = - 0.057，t = - 2.132，P = 0.033）、是否使用过心理健康服务（β = - 0.037 ，t = - 2.092，P = 0.036）、了解心理健康知识有必要吗（β = - 0.136，t = - 7.478，P＜0.001）、老师重视学生的心理健康吗（β = 0.149，t = 3.093，P = 0.002）对中学生心理健康素养产生影响。结论 贵州省中学生心理健康素养水平较低，并且不同类别的中学生心理健康素养水平存在差异，尤其应对女生、低年级学生、农村户籍、农村学校、心理健康教育服务水平较差地区的学生开展针对性干预，以提高中学生心理健康素养水平。     

Comparative clinical outcomes between stock vs custom temporomandibular total joint replacement systems

With the evolution of temporomandibular (TMJ) prosthetic total joint replacement, there has been much debate around the advantages of custom over stock prostheses. The aim of this study is to compare the clinical outcomes of a TMJ stock prosthesis (Zimmer-Biomet) to a custom prosthesis (OMX).Clinical data from 139 prosthetic joints placed in 117 patients was retrospectively collected and analysed. All patients were diagnosed with end-stage joint osteoarthritis and were treated by a single surgeon. Minimum follow up was 2 years post-surgery.The cohort was divided into 2 groups, 60 stock prosthetic joints in 54 patients and 79 custom prosthetic joints in 63 patients. This comprised of 110 males and 7 females. The average age at the time of surgery was 53.4yr ± 12.7yr. There was no statistical difference in pre-operative MIO and pain scores between the two groups. Post-operatively, patients fitted with a custom prosthesis showed statistically significant (P = 0.013) improvement in Maximum Interincisal Opening (MIO) (+6.33 mm vs +2.53 mm) and fewer complications. Following surgery, no difference noted in pain scores and patient satisfaction between the two groups.In experienced hands, both stock and custom TMJ implants work well. However, the added advantages of custom prostheses together with growing access to digital technology is likely to result in custom devices dominating the market in TMJ total joint replacement systems.     

Nasoalveolar molding and skeletal development in patients with bilateral cleft lip and palate: A retrospective cephalometric study at the completion of growth

The aim of this retrospective long-term study was to assess the influence of primary columella lengthening and presurgical nasoalveolar molding (NAM) on the skeletal development at the completion of growth in patients with bilateral cleft lip and palate (BCLP).Lateral cephalometric radiographs at the completion of growth of consecutively treated patients BCLP patients, operated by the same surgeon, who had undergone NAM were compared with a second group of BCLP patients who were not treated with NAM. The groups were matched for sex and age. Independent samples t tests were carried out.23 Lateral cephalometric radiographs of BCLP patients (mean age 18.2 ± 1.3 years) who had undergone NAM were compared with a second group of 23 BCLP patients (mean age 18.4 ± 1.3 years) who were not treated with NAM. The only two significant differences were observed in Ans-Me/N–Me (control group = 0.6 ± 0.02; sample group = 0.57 ± 0.05; p = 0.019) and ILs^AnsPns (control group = 105.5 ± 7.9; sample group = 112.4 ± 8.6; p = 0.007). No other significant differences were observed in terms of facial skeletal development between the two groups.Presurgical NAM performed during infancy in BCLP patients does not seem to have negative effects on the skeletal development at the completion of craniofacial growth compared to the group of patients treated without NAM.