耳鸣评价量表（TEQ）的耳鸣疗效评定新标准探索

目的通过对比耳鸣评价量表(TEQ)治疗前后得分变化和等级变化计算的疗效,并与耳鸣残疾评估量表(THI)的疗效相对比,为TEQ评估耳鸣疗效的评定标准提供参考。方法 TEQ得分疗效是根据国际上使用的标准差/2原则,即治疗前后得分变化≥TEQ初诊得分标准差/2视为治疗有效;TEQ等级疗效是TEQ等级变化≥1级视为治疗有效。THI得分疗效标准分为文献推荐的变化≥7分和变化≥20分,及标准差/2计算的变化≥12分分别视为有效。结果本次调查的165例患者中,按TEQ得分原则(SD/2原则)、TEQ等级原则、THI7分原则、THI12分原则(SD/2原则)及THI20分原则计算的疗效分别为60.00%、49.09%、61.82%、52.73%、及32.73%。通过卡方检验,TEQ得分疗效及TEQ等级疗效与THI7分及THI12分疗效比较均无统计学差异(P>0.005),均明显高于THI20分疗效(P<0.005)。结论使用耳鸣评价量表(TEQ)进行耳鸣疗效评定时,除了通过等级变化外,还可以采用以治疗前后得分变化为基础的疗效评定标准。     

中文版糖尿病压力评价量表的信效度研究

目的 翻译并评价糖尿病压力评价量表（Appraisal of Diabetes Scale,ADS）的信效度,提供一种有效评估糖尿病患者压力的中文版问卷.方法 翻译、修订形成中文版ADS,请10名专家对量表的文化相关性和内容效度进行评定;对243例2型糖尿病患者进行调查,评定该工具的内部一致性、结构效度、效标关联效度、区分效度.间隔2周后对25名患者进行重测,计算重测信度.结果 中文版ADS所有条目均具有较好的文化相关性.中文版ADS内容效度指数为0.96;以糖尿病授权量表和糖化血红蛋白值为效标,其效标关联效度分别为-0.626、0.634;因子分析共提取出3个公因子：对糖尿病的控制、糖尿病对患者的心理影响、糖尿病症状管理的认知和态度,累计方差贡献率为76.44％.中文版ADS的Cronbach＇s α系数为0.731,重测信度为0.926.结论 中文版ADS具有较高的信度和效度,可作为2型糖尿病患者压力的评价工具.     

APEC 医院认证工作会议(CHICAGO)综述

从建立国家医疗质量评估项目的优先发展战略;APEC成员国在医疗质量评估上的经验及合作状况;如何建立与完善质量评估标准;评估对执业机构与人员的价值与影响;建立评估体系的跨地域协作等方面介绍了亚太经济合作组织医院认证工作大会的概况。     

县级疾控机构综合效益评价指标的筛选及其应用研究

目的构建反映"预防为主"功能的县级疾控机构综合效益评价的指标体系。方法运用Delphi法、变异系数法和聚类分析法等3种方法从初选的43个指标中筛选出反映县级疾控机构综合效益的评价指标,采用筛选后的指标,运用加权TOPSIS法对杭州地区13家县级疾控机构2004年各自的综合效益进行模拟评价,并与杭州市疾控中心对上述单位进行评价的实际结果相比较,论证其一致性。结果根据Delphi法、变异系数法和聚类分析法筛选出17个评价指标,用其对13家县级疾控机构进行模拟评价的结果与杭州市疾控中心自身评价的实际结果之间存在正相关性(rs=0.825,P<0.05)。结论本研究建立的整套评价指标能够较好地体现"预防为主"的功能,具有良好的政策导向作用,筛选后的17个指标有一定的代表性,能够比较全面地对县级疾控机构的综合效益进行评价,且容易操作,具有一定的实际应用价值。     

全科医师临床沟通能力的培养模式与评估机制

临床沟通能力成为全球医学教育七大最低基本要求之一。本文强调了沟通能力在全科医疗服务中的重要性,指出全科教育的薄弱环节,并探讨了临床沟通能力的培养模式及考评机制。     

Pre-operative appraisal of cochlear implant results by means of electrical promontory stimulation: Preliminary report

Summary A test procedure based on the patient's understanding of acoustic material is presented. The score obtained in this test showed a highly significant correlation with the postoperative score evaluated by independent examiners 4 weeks after stimulator adjustment.     

Stress, appraisal, and coping: a comparison of HIV-infected women in the pre-HAART and HAART eras

BACKGROUND: It has been widely suggested that highly active antiretroviral therapy (HAART) has improved the psychosocial aspects of living with HIV/AIDS. METHOD: A sample of 79 women living with HIV/AIDS in the pre-HAART era (1994-1996) were compared with a matched sample of 79 women with HIV/AIDS from the HAART era (2000-2003) on measures of stress, illness appraisals, and coping strategies. RESULTS: Contrary to expectations, HIV-infected women in the HAART era were significantly more likely than women in the pre-HAART era to report health-related stress, to report stress from stigma and disclosure, to view HIV as having caused them harm, to report that their health is due to chance, and to report more use of maladaptive forms of coping (e.g., escape-avoidant coping). CONCLUSION: Although HAART may have extended survival for many HIV-infected individuals, they have not resulted in equivalent psychosocial improvements. Thus, efforts are needed to address the psychosocial difficulties that HIV-infected women in the HAART era continue to experience.     

Argument-based medical ethics: a formal tool for critically appraising the normative medical ethics literature

Although there are critical appraisal tools for other genres of the medical literature, there currently is no formal tool for physicians to use in their critical appraisal of the normative medical ethics literature. We present a formal assessment tool for the critical appraisal of the normative medical ethics literature that incorporates the intellectual standards of argument-based medical ethics and evidence-based medicine. We draw on the intellectual standards of argument-based ethics, ethical analysis and argument, and the literature on evidence-based medicine. The tool involves 4 questions about normative medical ethics papers: (1) Does the article address a focused ethics question? (2) Are the arguments that support the results of the article valid? (3) What are the results? (4) Will the results help me in clinical practice? Obstetrician-gynecologists can use this tool to appraise the normative literature of ethics in obstetrics and gynecology formally.     

现行医疗事故鉴定机制存在的问题及对策

医疗事故鉴定涉及到千家万户的切身利益，应有其相应的客观标准。现行的医疗事故鉴定办法与社会客观要求存在着不少差距，公平性、公正性及独立性受到社会的广泛关注。制定新的医疗事故鉴定办法时，要引入民法归责原则并推广社会化保险，建立一个适合中国国情的医疗事故鉴定和处理机制，造福广大国民。