北京市10个远郊区县新型农村合作医疗村级定点医疗机构布局探讨

目的 为了方便农村居民新型农村合作医疗村级报销,北京市10个远郊区、县需增设村级定点医疗机构.方法 利用主成分分析、规划软件LINDO 6.1实现对村级定点医疗机构的合理规划.结果 北京市10个远郊区、县需要在608个行政村中增设村级定点医疗机构才能满足未覆盖的1002个行政村村民的新型农村合作医疗报销需求.结论 布局模型的构建,为不同地理环境农村的村级定点医疗机构的规划提供了可借鉴的理论方法.     

Long-term effectiveness of an E-based survivorship care plan for breast cancer survivors: A quasi-experimental study

ObjectiveThe purpose of this study was to evaluate the effect of a web-based survivorship care plan (SCP) computerized application (APP): (SCP-A) on women’s unmet needs, fear of recurrence, symptom distress, anxiety, depression, and quality of life (QoL).MethodsWomen diagnosed with breast cancer, who had completed their primary treatment but less than 5 years without a sign of recurrence (N = 165) were randomized to a SCP-A or a control group. Self-reported questionnaires were completed by the both groups at baseline (T0), 5 weeks (T1), 3 months (T2), 6 months (T3), and 12 months (T4).ResultsControlling for relevant covariates, mixed effect model analyses revealed a significant decrease in women in the SCP-A group compared to the control group for total unmet needs since T3 (p < .004) and fear of recurrence since T4 (p = .02). Women in the SCP-A group also reported significant improvements in QoL at T4 (p < .001) relative to those in the control group.ConclusionProviding SCP using an information website application for women with breast cancer can decrease unmet needs, fear of recurrence, and improve quality of life during short-term and long-term use.Practice ImplicationsWeb-based information that provides survivorship care plans for breast cancer survivors are beneficial.     

最小子野宽度对肺癌容积调强弧形治疗计划质量的影响

目的:探讨肺癌容积调强弧形治疗（VMAT）计划中,最小子野宽度对放疗计划质量的影响。方法:选择病理证实为肺癌的患者12例,计划靶区处方剂量为60 Gy/30次。使用Monaco治疗计划系统设计全弧VMAT计划,计算网格为0.3 cm,采用6 MV X射线,每个弧的最大控制点数为200。计算不确定度为1%。最小子野宽度依次选取0.5、0.7、1.0、1.2和1.5 cm。以最小子野宽度为1.0 cm的计划为参考,与其他子野宽度下的计划相比较,分析各剂量学指标随最小子野宽度变化的情况。结果:随着最小子野宽度增大为1.2、1.5 cm时,靶区Dmean、D2变化明显（P?0.05）。相比参考最小子野宽度1.0 cm,最小子野宽度为1.5 cm时,适形度指数变化较大（Z=-2.694, P?0.05）;最小子野宽度为0.5、0.7、1.2和1.5 cm时,靶区覆盖率相差较明显（Z=-2.904、-3.061、-2.747、-2.941, P?0.05）。最小子野宽度1.0 cm时,VMAT计划平均机器跳数为684.4 MU;最小子野宽度为0.5、0.7、1.2、1.5 cm时,计划的平均机器跳数分别为为972.8、763.8、660.1、665.3 MU。控制点数随着最小子野宽度的增大呈降低趋势。结论:利用Monaco系统设计肺癌VMAT计划,最小子野宽度为1.0 cm时VMAT计划的质量更好。通过调整VMAT计划的最小子野宽度可大大降低机器跳数,提高射束的有效使用率,同时提高患者的治疗舒适度。     

肘关节三联征治疗方案的深入讨论

文题释义： 肘关节三联征：桡骨头骨折、冠突骨折伴肘关节后或后外侧脱位于1996年被Hotchkiss命名为“terrible triad of the elbow”,国内习惯称之为肘关节恐怖三联征,常合并外侧韧带复合体、内侧韧带复合体起止部位的撕脱损伤及冠突骨折周围前关节囊破裂。由于近年来在恐怖三联征损伤的诊断和治疗方面取得了迅速进展,预后也相应地比过去好很多,国内很多专家建议直接将其命名为肘关节三联征。 肘关节后外侧旋转不稳定：指由于外侧尺侧副韧带(外侧尺骨副韧带)损伤导致后侧半脱位或肱桡关节脱位,但不破坏近端尺桡关节,在1991由O’Driscoll等首次描述。目前对其的经典解释为：因摔倒致肘关节在轴向载荷下开始屈曲时,在身体在接近地面时肘关节受到外翻、旋后和轴向的应力综合作用,引起肘关节后脱位;同时导致的软组织损伤用“Horii环”解释：软组织破坏开始于外侧,并随着半脱位程度的增加向前后向内侧推进。 背景：近年来肘关节三联征损伤的诊断和治疗方面取得了迅速进展。 目的：简单介绍肘关节三联征的定义、相关基本解剖及稳定结构、损伤机制、分型,深入探讨其治疗方案。 方法：第一作者检索PubMed、CNKI及万方数据库建库至2019年9月的文献,以“terrible triad of the elbow,elbow joint,Fracture dislocation”为英文检索词,以“肘关节恐怖三联征,肘关节骨折脱位”为中文检索词,查阅大量近年肘关节三联征的相关文献,全面分析并总结其治疗策略。 结果与结论：对于肘关节三联征损伤患者,术前必须仔细检查,认真分析影像学检查结果及打印3D模型,准确判断肘部骨性结构和韧带损伤程度;术中通常先通过单独外侧入路或内外联合入路重建桡骨头的稳定性、修复冠突骨折及外侧韧带复合体损伤后,然后行肘关节稳定性检测,以决定是否需要进一步修复内侧韧带复合体或应用铰链式外固定器来恢复肘关节的稳定性;术后积极行早期康复功能锻。通过上述系统治疗可相对减少术后并发症,加速骨折愈合,改善肘关节功能和患者生活质量。 ORCID: 0000-0002-8244-4769(李宁鑫) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

医学影像信息系统辅助全膝置换前计划中的作用与意义

BACKGROUND: In clinical application, Picture Archiving and Communication System gradually replaces the traditional preoperative planning mode of acetate template measurement on film, which can accurately obtain the parameters needed in the operation of total knee arthroplasty.     

基于生物学优化肿瘤放射治疗计划的评估函数研究

目的：从生物学优化肿瘤放射治疗计划的角度来提出可用于评估放射治疗方案可行性的评估函数。方法：在以细胞受到照射后的再修复、再群体化、细胞周期的再分布、肿瘤内乏氧细胞的再氧合,即＂4R理论＂[1]的基础上,分析生物效应剂量函数BED的变种公式,最后得出3个用于评估肿瘤放疗计划好坏的评估函数。再利用评估函数试验性的分析文献报道过的肿瘤放射治疗方案,并与对应的方案结果进行比对,理论上评价评估函数的可行性。结果：综合分析已有治疗方案参数与评估函数理论参数基本一致。结论：基于生物学优化肿瘤放射治疗计划的评估函数在临床上用来预判治疗方案是可行的。     

Empowerment Through Mentorship and Leadership

Leadership is vital to future growth and change in the dental hygiene profession.Background and PurposeAs health care reform emerges, state practice acts expand and new models of dental hygiene practice are created and implemented, dental hygienists will assume leadership positions that may be quite different from the more traditional leadership roles they assume today. These dental hygienist leaders will envision, creatively design and implement oral health care programs to improve the oral health of the public. Mentoring, a vital component of leadership development, is critical for dental hygienists to acquire knowledge, guidance, and growth.MethodsThis paper provides a literature-supported overview of leadership and mentoring principles applicable to dental hygienists in their personal and professional lives. Opportunities for dental hygienists to assume leadership roles are also described.ConclusionsDental hygienists are poised to become leaders and vital members of the professional team promoting and integrating oral health care as a part of general health. Consequently, the dental hygienist's leadership roles are likely to expand and can be strengthened through mentoring relationships and mentoring teams. Ultimately, this can increase professional growth and career satisfaction for the dental hygienist as well as improve oral health care for the public.     

国际健康大数据研究计划发展及启示

对美国、欧盟等发达国家和地区的大数据研究计划中健康相关部分进行调研,分析其特色,最后提出我国医疗大数据建设发展建议,包括建立数据统一监管体系、统一数据标准与结构、开放共享数据资源以及开展多学科数据科学人才培训。