2004—2008年浙江省台州市麻疹报告病例流行特征

目的了解台州市2004-2008年的麻疹流行特征，为制定更科学的防控措施提供依据。方法 采用描述性流行病学方法描述麻疹流行状况。结果2004-2008年，该市麻疹报告病例数分别为426例、1 734例、189例、677例、2 121例，年报告发病率分别为8.27/10万、33.65/10万、3.67/10万、13.14/10万、41.16/10万，无死亡病例报告；流动人口麻疹病例数分别为208例、484例、75例、278例、607例。2005年开展“消除麻疹专项强化免疫活动”，2006年麻疹发病率最低，为3.67/10万。发病高峰月份为每年的3～5月份。在麻疹高发的2008年，病例年龄集中在2岁以下儿童和10～40岁人群；无免疫史和免疫史不详者占84.82％（1 799/2 121）。结论开展强化免疫活动,可明显控制麻疹发病率；应继续加强<2岁和10～40岁人群的常规免疫及其查漏补种工作。     

Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: A randomized controlled study

Objectives: The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. Methods: A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. Results: 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2–0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06–0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5). Conclusions: Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.     

中国门诊2型糖尿病患者口服药降糖达标状况调查及格列齐特缓释片优化治疗效果分析

Objective To evaluate the current state of glycemie control in Chinese patients with type 2 diabetes mellitus who have received oral antidiabetic agents in the out-patient clinic,and the efficacy and safety of optimized regiments of gliclazide modified-release tablets (Diamicron MR, SERVIER, Tianjin) in patients with failed glycemic control (HbA1c 6.5%). Methods The patients with type 2 diabetes were enrolled from 54 hospitals in more than 20 cities and received long-term (more than 3 months) oral antidiabetic agents. HbA1c was measured and the success rate of HbA1c reduction was evaluated. The patients who failed to achieve glycemic control (HbA1c 6. 5%) and received daily multiple-dosing insulin secretagogues were provided with the optimized treatment regimen, consisting of replacing daily multiple-dosing insulin secretagogues with single-dosing gliclazide sustained-release tablets. Clinical efficacy and safety were evaluated after three months treatment. Results The survey of glycemic control revealed that the mean HbA1c of 5 586 patients with diabetes mellitus was (7.97±2.89)% ,and the success rate (HbA1c≤6.5%) was 14. 1%. Further more, HbA1c decreased from (8.23±4.00)% before optimization to (6.86±2.24)% after optimization with the average decrement of 1.37% (P<0. 001) and the success rate was raised to 34. 1%. The gliclazide modified-release tablets were well tolerated by most patients, only 2.6% of whom were reported to experience unconfirmed hypoglycemia. Conclusion The success rate of glycemic control was low in Chinese out-patients with type 2 diabetes mellitus receiving oral antidiabetic agents in the clinic. The optimized regimen of gliclazide modified-release tablets taken once daily can down-regulate glycemic levels and increase the success rate of HbA1c reduction,and thus plays efficiently and safely a key role in the optimized management of type 2 diabetes mellitus.     

论医科院校准确定位与科学发展——以蚌埠医学院为例

对大学准确的目标定位是办好大学的基础，定位决定了大学的规格和模式，也决定了大学发展的方向和目标。大学在选择目标定位时既要根据经济和社会发展的需求，又要根据自身的历史和现实条件；既要量力而行，实事求是，又应寻找特色，大胆突破。文章以蚌埠医学院为例，讨论了医学院校准确定位与科学发展的关系。     

计划管理在双向执行反馈体系中的应用

作为双向执行反馈体系的基础,计划管理通过建立"计划—分解—执行—督办—考核—反馈"的持续循环机制,有效地将领导决策层层分解落实,为绩效管理提供了考核依据,保证了双向执行反馈体系的运作到位。     

基于中西医结合治疗方案的冠心病心绞痛的卫生经济学研究

目的：探讨中西医结合治疗和单纯西医治疗冠心病心绞痛的治疗效果和经济效果。方法：运用卫生经济学中的成本—效果分析方法对中西医结合治疗和单纯西医治疗冠心病心绞痛两种治疗方案并进行评价。结果：中西医结合治疗冠心病心绞痛的方案优于单纯西医治疗方案。结论：对于冠心病心绞痛的临床治疗,中西医结合治疗方案较单纯西医治疗方案有明显的经济学优势,是值得临床推广的有效、经济、合理的治疗方案。同时还提示卫生经济学方法在优化治疗方案,帮助临床决策过程中选择最佳治疗方案,以期用最小成本获得最大效益上会发挥重要指导作用。     

基于校园网的多媒体电子教案在生理教学中的应用探讨

随着医学教学改革的全面深化,形成以学生为主体的自主学习机制是非常重要的。将多媒体电子教案融入生理学教学,有利于培养学生自主学习能力,改革旧的教学模式。文章探讨了基于校园网的多媒体电子教案在生理学教学中的优势、具体设计及存在的问题,力求为生理学课程的教学提供一种有益尝试。     

中西药物优化组合治疗退行性腰椎管狭窄症的疗效观察

目的:观察中西药物优化组合治疗退行性腰椎管狭窄症的疗效。方法:166例患者随机分为A组(氨糖美辛口服)40例,B组(腰痹汤口服)40例,C组(优化组1:氨糖美辛 腰痹汤)44例和D组(优化组2:C组治疗 灯盏花素注射液静脉注射)42例。疗程2周,共2个疗程。结果:用JOA标准评价。A组和B组的有效率和优良率相近,C组的有效率和优良率均高于A组和B组,但未见统计学差异。D组的有效率和优良率分别高达100%和83.3%,高于其它任何1组,与A组比较,差异有显著性(P<0.01)。1年后随访,D组和C组却保持了较高的有效率(77.50%、87.80%)和优良率(45.00%和56.09%),C组和D组与A组比较,差异有显著性(U=2.776,P<0.01;U=2.252,P<0.05)。结论:中西药物优化组合治疗退行性腰椎管狭窄症优于单一药物,并能保持较好远期效果。     

医院中草药销售的季节性变化研究

目的:了解我院中草药销售与季节变化的关系。方法:统计医院2005年及2006年两年各种中草药的销售情况并加以分析。结果:中药的总体销售情况随销售月份变化影响较大,主要影响因素有春节、五一长假、十一长假及夏季销售淡季。具体中药销售统计应采用相对销售数量及相对使用次数来统计,不适宜绝对销售数量及绝对使用次数统计。补虚药在医院的销售数量及使用次数上占有很大的比例;发散风热药、止咳平喘药及化痰药显示明显的销售旺季与销售淡季。结论:了解中药的销售规律,可以科学合理地制订医院的采购计划。