深圳市医疗服务整体管理与质量控制指标体系合理性分析

利用指标体系中的权数参加秩和比（Rank Sun,Ratio,RSR）综合评价,通过分析评价结果是否理想来探讨指标体系的合理性,为该指标体系的进一步完善提供科学依据。     

Preoperative elevation of serum C-reactive protein as an independent prognostic indicator of colorectal carcinoma

PURPOSE: The preoperative elevation of serum C-reactive protein (CRP) is thought to be a prognosticator of carcinomas of the digestive tract. We conducted this study to investigate the clinical importance of the preoperative elevation of serum CRP in patients with colorectal carcinoma (CRC). METHODS: We investigated the correlation between an elevated preoperative serum CRP level and the clinicopathologic factors, including prognosis, of 116 patients who underwent resection of CRC. RESULTS: Forty-seven (40.5%) patients had an elevated serum CRP value preoperatively (group H) and 69 (59.5%) did not (group L). There were significant differences in the tumor size, proportion of poorly differentiated tumors, depth of invasion, lymph node metastasis, lymphatic invasion, and tumor stage between the two groups. Survival was significantly lower in group H than in group L (P < 0.0001). Multivariate analysis showed that the preoperative elevation of serum CRP (P = 0.0007), as well as poor differentiation (P = 0.027) and advanced tumor stage (P = 0.007) were independent prognostic factors in patients with CRC. CONCLUSION: We found the preoperative elevation of serum CRP to be an independent prognostic indicator of CRC.     

Thyroid surgery in the tropics

In the tropics thyroid surgery is carried out either by general surgeons or ear, nose and throat surgeons and there are few places with a subspecialist endocrine or head and neck surgeon. The aim of this review is to determine the pattern of thyroid pathology, surgery and surgical outcomes in the tropics. A review of thyroid surgery in tropical regions was carried out based on published articles in English in Medline (1965-2004). The findings are also discussed in the light of the authors' own experience of thyroid disease and thyroid surgery in four continents. The pattern of thyroid pathology varies in the tropics, particularly in regions where endemic goitre is common. Endemic goitre usually regresses with iodine therapy. There is a rising incidence of thyroid autoimmune disease, particularly Graves' disease and Hashimoto's thyroiditis, probably related to an environmental immunological stimulus associated with development. Surgery is indicated for the same reasons as in the developed countries: thyrotoxicosis (more often in the absence of radioactive iodine therapy), solitary thyroid nodule and multinodular or malignant goitre. However, a preoperative cytological diagnosis will only be available in important centres where there is a pathologist. Malignancy appears more prevalent in nodules and goitres in the tropics than in the developed countries, perhaps because patients with malignancy are more likely to be referred to a surgeon. Nonetheless, the evidence suggests that thyroid surgery can be carried out safely with a minimum of complications even in remote mission hospitals with limited facilities for investigation. Standards can be set in terms of surgical outcomes; for example, mortality (0%), permanent recurrent laryngeal nerve (RLN) injury (<2%), re-exploration for haematoma(<2%), permanent hypocalcaemia (<5%) and wound infection (2.5%). The choice of operation depends on the local pathology and the likelihood of being able to obtain lifelong thyroxine. Total thyroidectomy should be avoided whenever possible if thyroxine supplies are unreliable. Advanced thyroid cancer presents a therapeutic challenge and some cases will be unresectable. The management options are limited by the resources available. Similar surgical outcomes should be able to be achieved no matter where the surgery is carried out.     

CysC、Hcy、HbAlc、hs-CRP在糖尿病早期肾损伤中的应用研究

目的探索筛选糖尿病早期肾损伤的最佳检验指标,并评价其应用价值。方法选取2010年5月至2012年5月接受治疗的200例糖尿病早期肾损伤患者为实验对象(实验组),选取健康人群100名为对照组,对实验组和对照组应用常规检验方法和胱抑素C、同型半胱氨酸、糖化血红蛋白、超敏C反应蛋白进行同步对比试验研究。结果肾功能正常组和早期肾损伤患者组的各项指标差异有统计学意义(P<0.05),且同时测定4项指标的阳性检出率为92.00%,远远高于单项检测指标的81.00%。结论同时测定胱抑素C、同型半胱氨酸、糖化血红蛋白、超敏C反应蛋白中筛选糖尿病早期肾损伤的检验方法准确率高。     

近7年中医药治疗特发性面神经麻痹随机对照试验结局指标的现状分析

目的：评价中医药治疗特发性面神经麻痹（IFP）随机对照试验（RCT）的结局指标应用现状。方法：全面检索7个数据库、2个临床试验注册中心，按预先制定的遴选标准筛选出相关的RCT，根据Cochrane风险偏倚评估工具对纳入文献进行偏倚风险评估，对结局指标、测量时间点、研究时间、结局指标等级情况进行统计描述。结果：初步检索出相关文献13 489篇，最终纳入45篇RCT（中文文献44篇，英文文献1篇），报告95个结局指标，使用频次233次。研究发现中医药治疗IFP的RCT总体偏倚不明确，临床研究中结局指标存在参考标准、命名、测量时间点杂乱，选用类别不均，主次不明确的问题。结论：中医药治疗IFP的RCT结局指标集研究尚处于起步阶段，参考国际经验，结合中医药特点制定实用的研究流程，仍需要精确的临床及统计工作来构建规范、统一、公认的核心指标集。     

脉波指示剂连续心排血量(PiCCO)中的胸内血容量(ITBV)测定

在新近推向临床的脉波指示剂连续心排血量(PiCCO)监测中,用单一温度稀释法所测定的胸内血容量(IT-BV),已被许多学者证明是一项可重复、又敏感,而且比肺动脉阻塞压(PAOP)、右心室舒张末期压(RVEDP)、中心静脉压(CVP)更能准确反映心脏前负荷变化的实用指标.本文从心脏生理学、病理生理学及临床应用等方面,系统阐述了前负荷的定义及其影响因素,列举了上述压力监测数据不能准确反映心脏前负荷的机理及临床报道.详细讲述了单一温度稀释法测定ITBV的原理、计算方法、修正公式、测定中注意事项、正常范围值.列举了ITBV作为心脏前负荷的具有代表性的实验与临床统计分析资料.有鉴于左心功能减退伴有中度容量不足病人.恒速补液过程中显示充盈压比ITBV更敏感的报道,笔者建议:临床工作者在应用PiCCO新技术、确认ITBV作为前负荷指标的同时,仍然不应该忽略相关心血管腔的传统压力监测.     

教研室评估指标体系的研究与实践

为了规范教研室的管理、促进教研室的建设和发展，我校根据教育部《普通高等学校本科教学工作水平评估方案》中的有关要求、教育部2005年《关于进一步加强高等学校本科教学工作若干意见》文件的精神，结合我校自身的情况，制定了《贵阳中医学院教研室评估指标体系》，并对全校50个教研室进行了评估。通过评估，教研室的管理水平得到明显提高，教师深化教学改革的意识得到加强，教学在学校的中心地位得到确认。