双歧杆菌三联活菌治疗飞行员慢性腹泻的效果观察

目的观察双歧杆菌三联活菌治疗空军飞行员慢性腹泻的临床效果。方法将慢性腹泻空军飞行员75例随机分为试验组(40例)和对照组(35例)。试验组予双歧杆菌三联活菌肠溶胶囊(4周)加蒙脱石散治疗(3~14 d),对照组予左氧氟沙星片(2周)加蒙脱石散治疗(3~14 d),疗程结束比较两组治疗效果,对治疗显效者1年后随访并统计比较复发率。结果治疗结束后显效率和总有效率试验组分别为82.5%、97.5%,对照组分别为42.9%、65.7%,两组比较差异均有统计学意义(P0.01)。治疗显效者1年后随访复发率试验组为24.2%,对照组为86.7%,两组比较差异亦有统计学意义(P0.01)。结论双歧杆菌三联活菌治疗空军飞行员慢性腹泻效果满意且复发率较低。     

A two-stage sample size recalculation procedure for placebo- and active-controlled non-inferiority trials

Many non-inferiority trials of a test treatment versus an active control may also, if ethical, incorporate a placebo arm. Inclusion of a placebo arm enables a direct assessment of assay sensitivity. It also allows construction of a non-inferiority test that avoids the problematic specification of an absolute non-inferiority margin, and instead evaluates whether the test treatment preserves a pre-specified proportion of the effect of the active control over placebo. We describe a two-stage procedure for sample size recalculation in such a setting that maintains the desired power more closely than a fixed sample approach when the magnitude of the effect of the active control differs from that anticipated. We derive an allocation rule for randomization under which the procedure preserves the type I error rate, and show that this coincides with that previously presented for optimal allocation of the sample size among the three treatment arms.     

Surgical nurses’ attitudes towards caring for patients dying of cancer – a pilot study of an educational intervention on existential issues

This is a randomised controlled pilot study using a mixed methods design. The overall aim was to test an educational intervention on existential issues and to describe surgical nurses’ perceived attitudes towards caring for patients dying of cancer. Specific aims were to examine whether the educational intervention consisting of lectures and reflective discussions, affects nurses’ perceived confidence in communication and to explore nurses’ experiences and reflections on existential issues after participating in the intervention. Forty‐two nurses from three surgical wards at one hospital were randomly assigned to an intervention or control group. Nurses in both groups completed a questionnaire at equivalent time intervals: at baseline before the educational intervention, directly after the intervention, and 3 and 6 months later. Eleven face‐to‐face interviews were conducted with nurses directly after the intervention and 6 months later. Significant short‐term and long‐term changes were reported. Main results concerned the significant long‐term effects regarding nurses’ increased confidence and decreased powerlessness in communication, and their increased feelings of value when caring for a dying patient. In addition, nurses described enhanced awareness and increased reflection. Results indicate that an understanding of the patient's situation, derived from enhanced awareness and increased reflection, precedes changes in attitudes towards communication.     

Pilot study of 6 weeks of chemoradiotherapy with 5 FU and hydroxyurea in malignant gliomas

Summary In an attempt to improve the primary treatment of malignant gliomas we used a concomitant 6-week course of chemoradiotherapy with 5 fluorouracil (5 FU) and hydroyxurea (HU) in 24 adults with anaplastic astrocytoma (AA) (7 cases) or glioblastomas (GLB) (17 cases). This patient population was characterised by a poor prognostic profile; 50% of cases had biopsic or subtotal surgery and 70% had GLB. Patients received 2 Gy/day 18 MV photons with 300m² of 5 FU in continuous infusion and 500 mg x 4/day per os of HU, five days per week during 6 weeks. Treatment was poorly tolerated in terms of toxicity and implied heavy logistics (hospitalization, central venous access) worsening the quality of life which is already bad in malignant gliomas. Unfortunately we did not improve median survival which does not exceed 26 weeks with 7 long survivors (> 49 weeks). This pilot study does not offer any benefits over current standard approaches. Aggressive locoregional approaches such as this should perhaps be attempted in patients with a better profile.     

我国临床药师工作现状与分析

本文分析探讨了临床药师制度试点工作开展两年以来我国临床药师的工作现状,以期对临床药学发展有所启示。本研究采用问卷调查的形式调研我国44所试点医院,深入访谈典型医院,并对结果进行统计分析。研究发现临床药师的临床药学工作较为充实,医生对其评价也很高,均为有帮助。但是,目前临床药师的临床药学工作还不能完全满足临床的需求。我国临床药学处于Hutchinson模型中回顾性评估药物治疗方法阶段,临床药师在数量和质量方面有待提高。     

空军航空兵场站卫勤信息管理系统的研制

目的：为了推动空军航空兵场站的卫勤保障信息化建设。方法：结合空军航空兵场站的保障特点及要求，设计了集飞行人员健康信息、场站卫勤保障、飞行人员生理心理检测为一体的综合数据库。结果：为空军各级卫生单位实时传递卫勤保障信息、动态掌握飞行人员健康状况提供自动化和智能化手段。结论：该系统的成功运用，有效提高了航空兵场站卫勤保障效率，对提高部队战斗力起到了积极的作用。     

飞行员泌尿系结石与尿液成分关系的病例对照研究

目的 探讨飞行员泌尿系结石发生与尿液成分的关系。方法 采用1∶3病例对照研究,对2017年3—12月在某三级综合医院泌尿科住院的64例结石飞行员和同期192例健康飞行员的晨尿进行成分分析。结果 对2组飞行员的尿液成分进行多因素Logistic回归分析发现,尿钙、磷、钠是结石形成的危险因素,其OR值分别为4.31、1.20和1.04;尿氯、尿镁是结石的保护性因素,其OR值为0.96和0.95。结论 定期监测飞行员晨尿中钙、磷、钠、氯、镁,及早发现结石的危险因素,尽早对高危飞行员进行生活方式的干预,可能会降低结石的发生率。     

Field Testing Project to Pilot World Health Organization Eye Health Indicators in Latin America

Purpose: To develop and implement mechanisms to collect, report, and assess the World Health Organization (WHO) core eye health indicators in Chile, Honduras, Mexico, Peru, and Uruguay.

Methods: Simple templates for a situational analysis (of data collection and reporting processes), a national data collection strategy, and a national work plan to implement the core eye health indicators were developed. Public and private sector representatives from the ministries of health (MOHs), national vision committees, and national societies of ophthalmology of each country used these tools with 2013 baseline data to improve their data collection processes and collected 2015 data. Final analysis and cross-validation were performed using intraocular lens sales data and last observation carried forward imputation.

Results: Study tools were effectively implemented in all five countries and resulted in improved intersectoral stakeholder collaboration and communications, which improved the data collection and reporting processes. More complete and accurate data were reported by 2015 compared to the 2013 baseline.

Conclusions: Multisectoral stakeholders, including national professional societies and national vision committees, should collaborate with MOHs to improve the quality of data that are reported to WHO. This study involved these stakeholders in the data collection processes to better understand the realities of indicator implementation, better manage their expectations, and improve data quality. WHO Member States across the globe can feasibly adapt the study tools and methodologies to strengthen their data collection processes. Overall, the reliability and validity of the indicators is hampered with limitations that prevent fully accurate data from being collected.     

Self Management Pilot Study on Women with Breast Cancer: Lessons Learnt in Malaysia

Objective: With increasing survival rates, breast cancer is now considered a chronic condition necessitatinginnovative care to meet the long-term needs of survivors. This paper presents the findings of a pilot study onself-management for women diagnosed with breast cancer and their implications for Asian health care providers.Methods: A pre-test/ post-test pilot study was conducted to gain preliminary insights into program feasibilityand barriers to participation, and to provide justification for a larger trial. Results: The study found the 4 weekself management program feasible and acceptable, with a favourable trend in quality of life. The recruitmentbarriers ranged from competing medical appointments, uncollaborative health providers, linguistic barriersand social-household concerns. Supporting facilitators identified were family, health professionals and fellowparticipants (“buddies”). Lessons from the study are discussed with regard to Asian health providers. Conclusion:There is preliminary evidence that self management is a workable and potentially useful model even in an Asiansentrenched-hierarchical medical model of care. The initial challenge was breaking down barriers in acceptanceeof a collaborative stance. A clinical trial is now warranted to gather more evidence.     

Human papillomavirus self‐sampling for screening nonattenders: Opt‐in pilot implementation with electronic communication platforms

In organized cervical screening programs, typically 25% of the invited women do not attend. The Copenhagen Self‐sampling Initiative (CSi) aimed to gain experiences on participation among screening nonattenders in the Capital Region of Denmark. Here, we report on the effectiveness of different communication platforms used in the pilot with suggestions for strategies prior to a full‐implementation. Moreover, an innovative approach using self‐sampling brushes with unique radio frequency identification chips allowed for unprecedented levels patient identification safety. Nonattenders from the capital region of Denmark were identified via the organized national invitation module. Screening history was obtained via the nationwide pathology registry. Twenty‐four thousand women were invited, and as an alternative to the regular communication platforms (letter and phone), women could request a home test via a mobile‐friendly webpage. Instruction material and video‐animation in several languages were made available online. Chi‐square test was used to test differences. Out of all invited, 31.7% requested a home test, and 20% returned it to the laboratory. In addition, 10% were screened at the physician after receiving the invitation. Stratified by screening history, long‐term unscreened women were less likely to participate than intermittently screened women (28% vs. 16%, p < 0.001). Of all contacts received, 64% (63–65) came via letter, and 31% (95CI: 30–32%) via webpage/mobile‐app. Self‐sampling was well‐accepted among nonattenders. Adopting modern technology‐based platforms into the current organized screening program would serve as a convenient communication method between health authority and citizens, allowing easy access for the citizen and reducing the work load in administrating self‐sampling approaches.