癫痫康胶囊联合左乙拉西坦治疗癫痫的临床研究

目的研究癫痫康胶囊联合左乙拉西坦片治疗癫痫的临床疗效。方法选取2017年3月—2018年3月西宁市第一人民医院收治的112例癫痫患者为研究对象,利用双盲法将患者随机分为对照组和治疗组,每组各56例。对照组口服左乙拉西坦片,初始剂量5 mg/(kg·次),2次/d,之后每周增加10 mg/(kg·d),至25 mg/(kg·d)维持。治疗组在对照组治疗的基础上口服癫痫康胶囊,3粒/次,3次/d。两组患者持续治疗12周。观察两组的临床疗效,比较两组的癫痫发作频率、生活能力、智力水平和血清学指标。结果治疗后,对照组和治疗组的总有效率分别为80.36%、92.86%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者阵挛发作、强直发作、失神发作频率均显著下降,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组患者阵挛发作、强直发作、失神发作频率均明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者日常生活能力(ADL)评分明显降低,而韦氏智力量表(WISC-R)评分明显升高,同组治疗前后差异具有统计学意义(P0.05);且治疗后治疗组患者ADL评分明显低于对照组,WISC-R评分明显高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血清S-100β蛋白(S-100β)、超敏C-反应蛋白(hs-CRP)和丙二醛(MDA)水平均明显降低,同组治疗前后差异有统计学意义(P00.5),且治疗组患者血清S-100β、hs-CRP和MDA水平明显低于对照组,差异具有统计学意义(P0.05)。结论癫痫康胶囊联合左乙拉西坦片治疗癫痫具有较好的临床疗效,可改善临床症状,降低血清学指标,改善患者生活能力和智力水平,具有一定的临床推广应用价值。     

Monitoring reproductive health in Europe: what are the best indicators of reproductive health? A need for evidence-based quality indicators of reproductive health care

Monitoring reproductive health by the Reprostat indicators in Europe will facilitate the transparency of reproductive health as well as comparisons over time and between countries. However, for the monitoring and improvement of reproductive health care, we suggest the systematic development of evidence-based quality indicators, especially process and structure indicators.     

Comparison of increased overjet cases and controls: normative data for condylar positions

The aim was to compare normal overjet versus large overjet cases with clinically healthy temporomandibular joints (TMJ); to establish normative data regarding the difference between condylar positions in centric occlusion (CO) and maximum intercuspation (MI) and deflective CO contacts. Two study groups of normal overjet and large overjet cases consisted each of 33 subjects with no detectable clinical signs of temporomandibular disorder (TMD). CO-MI differences were recorded using the SAM Mandibular Position Indicator. Deflective contacts were examined on models mounted in CO. There was a significant difference between groups in the vertical (P = 0.030) and transverse (P = 0.008) range of movement from CO to MI, but not in the antero-posterior direction. There were no differences in the location of deflective contacts. Results of this study showed that patients with increased overjet show some differences compared with normal overjet patients, even in the non-patients. Further research on TMD patients is needed to find out about the role these features play in the aetiology and treatment of temporomandibular disorder (TMD). This study indicates that the clinician should be paying special attention to the TMJ status of patients with a large overjet.     

Quality indicators in colonoscopy: an evolving paradigm

The year 1969 marked a revolution in the diagnosis of colorectal cancer (CRC). It is when Dr Wolff developed the colonoscope and quickly realized its potential in both diagnosis and treatment of colonic neoplasms. Over the past 50 years there has been exponential increase in utilization of colonoscopy with over 1 million colonoscopies performed annually throughout Australasia. Endoscopic removal of pre‐malignant lesions has been proven to reduce the incidence and mortality of colorectal. Although timing and frequency of surveillance colonoscopy plays a crucial role in risk reduction of CRC, this is dependent upon the findings of the index colonoscopy. The goal of screening colonoscopy is to detect CRC and identify and remove pre‐malignant neoplasms that risk progression to CRC. With increasing uptake of bowel screening throughout Australasia, there is increasing pressure to ensure all endoscopists and endoscopy units perform at a universal high‐quality. All too often high demand and constant delays compromise colonoscopy quality. Without clear and concise quality indicators with transparent measurement and audit, these flaws can quickly jeopardize screening goals and patient outcomes. This review aims to explore six key quality indicators and explore the evidence behind the current recommended standards. These key indicators include; rate of adequate bowel preparation, caecal intubation rate, adenoma detection rate, withdrawal time, complication rates and surveillance intervals.     

踝臂指数与心血管疾病

踝臂指数是指踝部动脉收缩压和肱动脉收缩压的比值。已经证实踝臂指数是诊断外周动脉疾病,评估其预后的简单有效的方法,同时其异常也反映了冠状动脉病变程度,是心、脑血管事件和死亡风险强有力的预测因子,应作为心血管疾病危险人群风险评估的重要组成部分。现就踝臂指数及其在心血管领域的主要研究进展做一综述。     

Years of good life is a well-being indicator designed to serve research on sustainability

Sustainable development (SD) as popularized by the Brundtland Commission and politically enshrined in the Sustainable Development Goals has been the explicit focus of sustainability science. While there is broad agreement that the trend of human well-being (W) over time should serve as a sustainability criterion, the literature so far has mostly addressed this in terms of its determinants rather than focusing on W itself. There is broad agreement that an indicator for W should have multiple constituents, clearly going beyond gross domestic product. Here, we propose a tailor-made indicator to serve precisely this purpose following a set of specified desiderata, including its applicability to flexibly defined subnational populations by gender, place of residence, ethnicity, and other relevant characteristics. The indicator, years of good life (YoGL), reflects the evident fact that in order to be able to enjoy any quality of life, one has to be alive and thus is primarily based on life expectancy. However, since mere survival is not considered good enough, life years are counted conditional on meeting minimum standards in two dimensions: the objective dimension of capable longevity (consisting of being out of absolute poverty and enjoying minimal levels of physical and cognitive health) and the subjective dimension of overall life satisfaction. We illustrate the calculation of this indicator for countries and subpopulations at different stages of development and with different degrees of data availability.

Sustainability science refers to the most comprehensive scholarly effort to understand the interactions between natural and social systems in order to assess whether certain developmental pathways can be considered sustainable. This should also include the possible negative effects of environmental changes, such as climate change and biodiversity loss, on future human well-being. In this paper, we propose a tailor-made indicator to assess long-term human well-being as the ultimate end of sustainable development. This indicator, called “years of good life” (YoGL), is designed in such a way that it can be both empirically measured—which is the focus of this paper—and modeled in its long-term future trends—which will be the focus of future work.When assessing changes over time in the well-being of certain human populations (or subpopulations, as defined, e.g., by gender, ethnicity, urban/rural place of residence, or other social groupings), one can focus on the determinants or the constituents of well-being. In sustainability science, thus far, empirical and theoretical research has placed more emphasis on studying the determinants, including environmental services (1), whereas specifying its constituents has received less systematic attention, often leaving us with nothing but the unspecific notion of “utility.” The focus on determinants has led to the concept of “inclusive wealth” (IW) which can be used to assess whether a society is on a sustainable development trajectory in terms of the productive base necessary to maintain a high standard of living in the future (2). However, empirically measuring the values and relative effects of the different capitals determining human well-being remains extremely challenging and “no current attempt to date can be said to be fully inclusive” (3).The idea behind YoGL, on the other hand, is to study sustainability by focusing explicitly on the constituents of well-being and its change over time. In doing so, YoGL avoids several of the pitfalls by which the IW approach is plagued (3, 4). For example, rather than making contestable quantitative assessments of the relative contributions of the different determinants of well-being, the demographic approach underlying YoGL provides numerical values of human well-being directly, expressed as the average number of years of good life a person can expect to live as part of a given subpopulation under the conditions of a specified point in time. Based on the assumed universal nature of its unit of measurement—YoGL lived today in one specific population has the same meaning as YoGL lived in the future or in another population—the indicator has a time-independent meaning. This also avoids the pitfalls of specifying a rate at which to discount future well-being, which have become apparent at least since the debates around the Stern report (5). YoGL allows us to directly compare human well-being across different subpopulations and generations. Moreover, while all estimates of the different determinants of future human well-being are highly sensitive to population growth, as a measure referring to per-person well-being the derivation of YoGL is not directly affected by assumptions about the future trajectory of population size. Finally, as stressed by Dasgupta (6), the nature of determinants can change over time and across places depending on different commodities and technological regimes, whereas the constituents of well-being—as used in YoGL—are arguably shared across space and time.In the following, we will first present the proposed design of the indicator. We will then provide a step-by-step user’s guide for empirically deriving YoGL based on the most appropriate available data source, before offering examples of how it can be calculated based on auxiliary information on populations for which the necessary data are not yet fully available. We will close with a discussion and brief outlook as to what is still needed to use this indicator for the assessment of sustainability.     

应用Delphi法构建“健康食堂”评价指标体系

[目的]探讨建立健康食堂评价指标体系,为开展健康食堂评定工作提供科学依据。[方法]选择32名专家进行两轮Delphi专家咨询,根据指标重要性赋值得分,确定健康食堂的评价指标及其权重。[结果]32名咨询专家的平均工龄为（18．41±8．03）年,两轮的应答率均为100％,权威系数分别为0．85±0．06、0．88±0．06,Kendall协调系数分别为0．708（χ^2=675．773,P〈0．01）、0．853（χ^2=818．902,P〈0．01）,经卡方检验均具有统计学意义;确定了健康食堂评价一级指标6项、二级指标25项,以及各项指标的权重,其中一级指标健全的组织管理、健康的环境、健康的膳食、健康的膳食服务和指导、健康的膳食安全保障、科学的效果评估的平均权重分别为1．55、1．56、2．05、1．91、1．08、1．86。[结论]Delphi专家咨询法是构建健康食堂评价指标体系的有效方法。     

基层医疗机构基本药物制度实施效果评价研究综述

回顾了国内外基本药物制度实施及评价方面的研究,简述了基本药物制度的产生与发展,对目前国内外基本药物制度实施的现状、相关评估方法和指标体系进行综述,分析了国内基本药物制度实施及评价中存在的问题并提出改进的思路。