睾丸精原细胞瘤的疗效及预后因素分析

作者分析了５０例睾丸精原细胞瘤的疗效及预后因素。术后单纯放疗２４例，放疗加化疗１３例，两组的５年、１０年生存率分别为９１．７％及８４．３％，Ｐ＞０．０５，单纯化疗１３例，５年生存率为９０．９％，与放疗、化疗组相比，Ｐ＞０．０５。年龄＜４０岁和≥４０岁的病例的５年、１０年生存率分别为９５．７％和６８．８％，Ｐ＜０．０５。结果表明，Ⅰ期睾丸精原细胞瘤病例手术后宜行单纯放疗，若复发，可行放疗加化疗；年龄较轻的病例生存率较高；β－绒毛膜促性腺激素水平、隐睾及隐睾部位与生存率关系不大。     

成人高等护理教育中“教师课堂教学质量评价表”的设计与应用

目的:设计成人高等教育中学生对“教师课堂教学质量评价表,”并应用于成人护理课堂教学中以提高学生的满意率,促进教师教学质量的提高。方法:分析成人教育的实际情况,设计教学质量评价表,对教师的课堂教学进行初次评价,统计评价分数与学生的满意率,并将评价结果反馈给授课教师,再授课一段时间内,该门课程未结束前,进行第二次评价,统计学生对教师课堂教学的评价分数与满意率。结果:学生对教师的课堂教学评价分数、满意率、出勤率均有提高。结论:通过教学评价表的设计与应用,加快成人教育教师队伍建设,促进成人教学质量的全面提高。     

在校医学生艾滋病/性病健康教育近期效果评价

目的了解在校医学生对艾滋病/性病相关知识的知晓情况、相关态度及行为,评价在大学生开展艾滋病/性病健康教育的近期效果。方法采用整体抽样方法,对4000名大学生在健康教育前和健康教育后3个月分别下发同一调查问卷进行相关问题调查。结果被调查对象健康教育后比健康教育前艾滋病/性病知识知晓率有明显提高;可以接受和艾滋病病毒感染者或患者一起学习、生活的学生由健康教育前的41.32%上升到健康教育后的68.09%(P<0.05);可以接受和性病患者握手、共用餐具、与性病患者一起学习的学生分别由健康教育前的72.44%、64.38%、74.66%上升到健康教育后的92.47%、87.32%、91.41%(P<0.05)。结论通过专题教育、宣传栏、小册子等多种形式,在大学生中开展艾滋病/性病健康教育可起到良好的效果。     

Does the magnetic anal sphincter device compare favourably with sacral nerve stimulation in the management of faecal incontinence?

Aim The magnetic anal sphincter (MAS) is a recent surgical innovation for severe faecal incontinence (FI). With its place in the treatment algorithm of FI yet to be defined, we report a nonrandomized comparison between MAS and sacral nerve stimulation (SNS) in a single‐centre cohort of patients with FI. Method Data were reviewed from prospective databases. From December 2008 to December 2010, 12 women [median age 65 (42–76) years], having FI for a median of 6.5 years, were implanted with a MAS. Sixteen women, of similar age, preoperative function scores, aetiology and duration of incontinence, and implanted with a permanent SNS pulse generator during the same period, served as a reference group. The duration of hospital stay, complications, change in incontinence and quality of life scores and anal physiology were compared between the two groups. Results The duration of follow up was similar [MAS = 18 (8–30) months vs SNS = 22 (10–28) months; P = 0.318]. Four patients with MAS experienced a 30‐day complication, and the device was removed from one patient in each group. A significant improvement in incontinence (P < 0.001) and quality‐of‐life scores (P < 0.04) occurred in both groups. Mean anal resting pressure increased significantly in patients implanted with a MAS (P = 0.027). Conclusion In this single‐centre nonrandomized cohort of FI patients, MAS was as effective as SNS in improving continence and quality of life, with similar morbidity. These results can now serve as a prelude to a randomized trial comparing the procedures.     

闭合复位经皮内固定治疗肱骨近端骨折的中期疗效

[目的]考察肱骨近端骨折患者采用经皮复位固定治疗的中期临床效果.[方法]回顾分析2005～2008年因肱骨近端骨折接受经皮复位内固定治疗的39例患者资料,其中27例患者获得至少3年的临床及影像学随访,平均随访时间为60个月(36～84个月).在随访时,通过X线片对患者的创伤性肱盂关节炎及肱骨头坏死情况进行评估；采用美国肩肘外科医师(American Shoulder and Elbow Surgeons,ASES)评分评估患者的临床效果.[结果]随访中发现,共有7例患者(26％)发生肱骨头坏死,肱骨头坏死出现的平均时间为内固定术后45个月(18～72个月).所有10例NeerⅣ型患者中5例发生肱骨头坏死,发生率为50％；而12例NeerⅢ型患者中2例出现肱骨头坏死,发生率为17％；5例NeerⅡ型患者均未出现术后肱骨头坏死.所有27例患者中10例(37％)出现创伤性肱盂关节炎的影像学改变,NeerⅣ型患者的发生率为60％(6例)；NeerⅢ型为33％(4例)；5例NeerⅡ型患者均未发生创伤性肱盂关节炎.肱骨头坏死与无肱骨头坏死病例的平均ASES评分分别为(77.9±6.9)分和(83.6±7.1)分,未发生肱骨头坏死的病例其ASES评分较高,但差异无统计学意义(t=1.840,P=0.078).创伤性肱盂关节炎与无创伤性关节炎病例的平均ASES评分分别为(79.6±7.2)分和(84.1±6.8)分,未发生创伤性肱盂关节炎患者的ASES评分较高,但差异无统计学意义(t=1.625,P=0.117).[结论]肱骨近端骨折采用闭合复位经皮固定治疗后患者发生中期肱骨头坏死和创伤性关节炎的概率较高,但肱骨头坏死和创伤性关节炎的出现不会显著影响患者的临床评分结果.     

Attentional Difficulties and the Effectiveness of a Visual Representation Strategy for Counseling Drug-Addicted Clients

Three hundred thirty-one opioid-addicted clients in methadone treatment were randomly assigned to counselors who used either mappingenhanced or standard counseling. Those counseled with mapping had lower percentages of during-treatment urine specimens that were positive for either cocaine or opiates, and they were rated by their counselors as having higher rapport, motivation, and self-confidence. Clients were further classified into those exhibiting either good or poor attention during an intake interview. The results suggest that clients with poor attention are more likely to have positive urines, but that this tendency appears to be reduced under mapping-enhanced counseling.     

目标性培训在消毒供应中心培训中的应用

目的 探讨目标性培训方法在消毒供应中心岗位人员器械培训中的应用效果。方法 本研究为随机对照试验。选取2021年4月至7月在揭阳市人民医院消毒供应中心从事手术组工作的 20名 33～45岁女性岗位人员作为培训对象，采用随机数字表法将其分为对照组和观察组，各 10名。 对照组应用传统的培训方法，观察组应用目标性培训方法。培训后比较两组人员操作技能考核成绩、 培训满意度、负责清洗包装腹腔镜基础器械包的清洗质量和包装质量合格率。符合正态分布的计量资料采用均数±标准差（xˉ ± s）表示，组间比较采用独立样本t检验；计数资料采用例数或率（%）表示， 组间比较采用卡方检验；P＜0.05为差异有统计学意义。结果 观察组考核成绩、培训满意度及其负责清洗包装的腹腔镜基础器械包清洗质量、包装质量合格率明显高于对照组［（90.2±6.1）分比（77.0± 7.5）分、（90.0±6.0）分比（72.1±9.8）分、487（97.4%）比453（90.6%）、492（98.4%）比472（94.4%）］，差异有统计学意义（均P＜0.05）。结论 在消毒供应中心岗位人员器械培训时应用目标性培训方法，可有效提高岗位人员考核成绩及培训满意度及其负责清洗包装的腹腔镜基础器械包清洗质量、包装质量合 格率，保障患者安全。     

Impact of Guidelines for Antihypertensive Treatment on Clinical Practice

Many Guidelines and Consensus Statements were published in 1993 and 1994. The pressure to produce these guidelines comes from clinicians faced with rapid change, from a wish to provide an independent authoritative view rather than rely on commercial promotion of particular treatments, and from governments seeking assistance with the allocation of scarce resources.

Evaluation of the impact that guidelines exert on clinical practice is notoriously difficult, but has been attempted using the self-report questionnaire, or the more reliable but expensive analysis of actual practice data, before and after publication of the guidelines.