ABC分类与信息管理法在医院药库管理中的工作效率分析

目的比较医院药库管理中采用ABC分类和信息管理法的工作效率。方法利用我院药库计算机管理系统对我院2012年1月至2013年12月的药品销售及库存数据信息进行分析,采用两种物流分类管理方法,即ABC分类法、信息管理法,分析每种分类管理方法所占资金、库存量等指标。结果两种方法年药品采购种类、采购周期、安全库存周期、年采购金额和年采购次数比较差异均有统计学意义(P<0.05)。信息管理法的年采购药品种类多于ABC分类法,其安全库存周期和年采购金额短于ABC分类法,年采购次数少于ABC分类法。两种方法的库存周转率、平均库存值、断货率、药品资金占用率、采购周期和盘点工作量比较差异均有统计学意义(P<0.05),信息管理法库存周转率大于ABC分类法,平均库存值、断货率和药品资金占用率低于ABC分类法,药品采购周期和盘点工作量短于ABC分类法。通过分析每月Q1(流入累计)与Q2(流出累计)所包围的面积,ABC分类法每月库存周转量低于信息管理法。结论应综合考虑影响药品合理库存的因素,以科学性和实用性为原则,在减少药品和资金浪费的基础上满足患者和临床治疗的需求,制定合理的医院药库管理方法。     

重庆市肺结核患者直接医疗费用及其影响因素分析

目的 调查重庆市活动性肺结核患者的直接医疗费用情况,并分析其影响因素。方法 从《中国疾病预防控制信息系统》的子系统《结核病信息管理系统》中搜集重庆市41家区(县)级结核病定点医院2019年1—12月登记的新诊断为活动性肺结核患者(排除单纯肺外结核和利福平耐药肺结核患者)的病案信息,并与2019年1月1日至2020年5月31日重庆市46家市级和区(县)级结核病定点医疗机构的门诊和住院诊疗记录、收费和报销等诊疗信息和费用结算信息进行匹配,最终纳入已治愈或已完成疗程的11745例患者。采用单因素分析和多因素广义线性模型分析调查对象的直接医疗费用及相关影响因素。结果 11745例调查对象的直接医疗费用共计8385.6万元,其中,药品费用为3400.9万元(40.56%),检查费用为3205.3万元(38.22%),其他费用为1779.4万元(21.22%);每例调查对象的直接医疗费用中位数(四分位数)为4517.0(2144.0,8903.0)元。多因素广义线性模型分析显示,二级医院、三级医院、城镇医保职工、有并发症和住院治疗是增加普通活动性肺结核患者直接医疗费用的影响因素[直接医疗费用中位数(四分位数)分别为:4701.0(2262.0,9165.0)、5258.0(2198.0,11197.5)、6158.0(2960.0,11619.0)、6289.0(2658.0,11417.0)和10858.0(7544.0,16390.0)元;OR(95%CI)值分别为:1.299(1.062~1.437)、1.123(1.020~1.366)、1.240(1.114~1.379)、1.149(1.096~1.205)和3.115(3.012~3.226)]。结论 重庆市普通活动性肺结核患者直接医疗费用较高,高级别医疗机构、城镇医保职工、有并发症和住院治疗是影响费用增高的因素。应积极开展实行单病种付费医保政策,并规范二、三级结核病定点医院和对医保职工的诊疗行为。     

山东省泰安市2015—2019年输入性疟疾病例实验室诊断与复核结果分析

省、市、县三级实验室分别采用镜检法、胶体金法及巢式PCR法对泰安市2015-2019年输入性疟疾进行诊断与复核。共诊断与复核输入性疟疾病例122例,其中镜检法和胶体金法的符合率分别为94.3%(115/122)和95.9%(117/122),镜检阴性率为5.7%(7/122),均为恶性疟;胶体金法阴性率为4.1%(5/122),3例非恶性疟和2例恶性疟阴性,3种检验方法符合率差异有统计学意义(P <0.05)。其中恶性疟和间日疟诊断符合率最高,均达100%,对卵形疟诊断符合率最低,仅为12/18,对4种疟原虫实验室诊断符合率差异有统计学意义(P <0.01)。医疗机构中初诊合格率为94.3%(115/122),市、县级疾病预防控制机构复核合格率分别为97.5%(119/122)和95.1%(116/122),差异无统计学意义(P> 0.05)。今后应继续加强市、县级疟疾实验室镜检人员技能培训,积极开展疟疾核酸检测,以进一步提升医疗及疾病预防控制机构的疟疾诊断水平。     

Delphi法确立宫内节育器综合评价指标体系

目的:采用德尔菲(Delphi)法对通过数理方法初步建立的IUD综合评价指标体系进行调整确立。方法:在数理方法初步建立的IUD综合评价指标体系基础上,按照Delphi法原理,选择副高级以上职称、对生殖健康领域研究感兴趣且在各自领域具有权威性的计划生育、妇产科和公共卫生学专家进行两轮咨询评分,总结归纳反馈意见,计算相关参数,调整确立IUD的综合评价体系,采用直接评分法和Satty's赋权法确定各指标权重。结果:调整确立了由3个一级指标、6个二级指标和20个三级指标及其权重构成的IUD综合评价体系。调整后的IUD综合评价体系与调整前相比,在指标数目上没有增减,但在二级指标项、三级指标项及其维度的划分、各指标权重方面均有较明显的变化。结论:Delphi法的结果及建立的IUD综合评价体系具有科学性、合理性和可靠性,可以应用其对IUD进行综合评价。     

凝血酶生成动力学检查方法实验初探

目的：探讨凝血酶生成动力学检测方法在血栓与止血研究领域的意义，在传统检查方法的基础上，通过动力学图形的标准化处理获得更为直观，丰富的实验参数。方法：利用分光光度计连接微机对弟因过程进行扫描，并绘制动力学图形，然后人工测量动力学图形自设参数。结果；研究资料显示，在一定条件下分析动力学图形中的主要分析参数与凝血酶的形成速度与量成正，负相关，并有满意的精确度[CV=(1.2%-6.6%)]与敏感性（可能最低因子含量0．325％。结论：凝血酶生成动力学检查方法可行实用，有望成为评价人体凝血功能检查方法的一种新趋势。     

A simple and rapid DNA extraction method for the detection of Wuchereria bancrofti infection in the vector mosquito,Culex quinquefasciatus by Ssp I PCR assay

A simple, rapid and inexpensive method for the extraction of DNA from filarial vector, Culex quinquefasciatus, useful in Ssp I PCR assay for xenomonitoring of infection with Wuchereria bancrofti is presented. The DNA extracted by this method was found suitable for PCR detection of W. bancrofti infection in pools of 10-30 mosquitoes. The PCR assay employing the simplified DNA extraction method was evaluated for its sensitivity on field caught Cx. quinquefasciatus, in comparison with the conventional dissection and microscopy technique. When assayed on dissection washings of vector mosquitoes the PCR assay detected 45 pools out of 49 dissection positive pools as positive for infection and hence found to be less sensitive than the conventional technique. The reason for detecting four dissection positive pools as negatives by the PCR assay may be due to the loss of a few numbers of parasites (1-3) present in these pools during the transfer of washings of dissected mosquitoes. The PCR assay detected ten out of 72 dissection negative pools as positives, while it did not detect any of the 62 known negative (laboratory reared, uninfected) mosquito pools as positives. When 38 pools (10 mosquitoes/pool) of intact mosquitoes were assessed for infection by each method, the infection rates obtained by the two methods were almost similar (3.35 and 3.01%, respectively, for conventional method and PCR assay). The results thus show that the DNA extraction method, which is simple, rapid, safe and inexpensive, is efficient to generate DNA from vector mosquitoes useful in PCR assay and hence has potential application in xenomonitoring.     

重症急性呼吸综合征患者中重症者早期预警指标研究

目的　探讨重症急性呼吸综合征 (SARS)患者中与重症发生相关的危险因素 ,寻找发生重症的早期预警指标。方法　对北京市SARS临床诊断病例数据库中转院资料完整 ,且在 2周内发生重症的 35 5例和始终未发生重症的 84 1例SARS患者进行单因素和多因素分析。结果　高龄、有基础病的患者发生重症的危险性明显增加。重症患者发生重症前表现出以下特点 :体温下降缓慢、脉搏加快、淋巴细胞计数持续 <0 9× 10 9/L、中性粒细胞高于 7 1× 10 9/L(80 % )、X线胸片异常进展较快等。采用Cox多元逐步回归发现 ,具有统计学显著性的早期预警重症发生的独立因素包括 :年龄偏大、有基础疾病、住院 2d后体温仍不能降至正常、住院 3d后中性粒细胞比值持续在 80 %以上、住院 4d后淋巴细胞计数仍持续 <0 9× 10 9/L和病程中出现脉搏持续加快达到 10 0次 /min。结论　根据SARS患者的年龄和基础病情况 ,结合临床对体温、脉搏、淋巴细胞绝对值以及中性粒细胞绝对值 (百分比 )的密切观察能够对重症SARS的发生进行早期预警。     

对一步夹心法轮状病毒单克隆抗体酶标试剂盒的评价

以一步夹心法轮状病毒单克隆抗体酶标试剂盒及聚丙烯酰胺凝胶电泳对253份粪样进行检测,结果显示试剂盒敏感度和特异度分别为96.36％和96.28％;阳性预示值和阴性预示值分别为98.15％和92.45％;试剂盒批内和批间变异系数分别为4.65％和8.06％。表明本试剂盒敏感性和特异性均好,且较稳定,适用于临床快速诊断。     

Accuracy of the London Atlas,Haavikko’s Method and Cameriere’s European Formula of dental age estimation in Turkish children

Age estimation is a mandatory procedure when the chronological age is unknown or uncertain. Dental development is the preferred characteristic for estimating a child's age. There are many methods for dental age estimation, but their reliability can differ between populations. This study compared the accuracy of three of these methods—the London Atlas (LA), Haavikko's method (HM), and Cameriere's European formula (CF)—in Turkish children living in northwestern Turkey. Panoramic radiographs of 980 children from northwestern Turkey aged between 6.00 and 14.99 years were examined for the whole study group and separately for different ages and sexes by all three methods. Statistical differences between chronological age and dental age were tested using the paired sample t-test and the Wilcoxon signed-rank test. The LA, HM, and CF accuracies were determined based on the mean absolute error. Spearman's rank correlation coefficient showed that the correlation between chronological age and dental age for both sexes was linear for all methods. The LA overestimated the chronological age by 0.09 years, while HM and CF underestimated it by 0.49 and 0.11 years, respectively. The difference between dental age and chronological age was significant in all samples, for all methods, except for the LA in boys. When boys, girls, and the total sample were evaluated, values with the lowest mean absolute error were obtained by HM and were statistically significant in all three groups. Therefore, HM is more accurate than the LA and CF for dental age estimation in Turkish children living in northwestern Turkey.     

CTLA-4单核苷酸多态性与中国汉族人类风湿关节炎的关联分析

目的在中国汉族类风湿关节炎（RA）患者中，检测细胞毒T淋巴细胞相关抗原4（CTLA-4）基因中的单核苷酸多态性（SNPs）并进行关联分析。方法用变性梯度凝胶电泳法（DGGE）在326例RA患者和250名健康志愿者提供的血样中检测CTLA-4基因的SNPs（MH30，＋49，CT60和J031）．分析单个位点的等位基因和基因型频率是否与RA相关。结果在RA患者中，CTLA-4的＋49和CT60的等位基因频率及它们的基因型频率显著高于健康对照组（P=0.028和0．007）；此两种SNPs构成的4种单倍体的分布状态两组间差异有统计学意义（x^2=10．58，d．f=3，P=-0．014）。结论CTLA-4基因上2个SNPs及单倍体型与中国汉族RA之间存在显著的相关性。