WTO成员国医药化妆品领域技术性贸易措施通报内容分析

目的:为完善我国医药政策和推动医药产业发展提供借鉴。方法:通过查询中国技术性贸易措施网数据库,对世界贸易组织(WTO)成员国2000年1月1日至2012年12月31日在医药化妆品领域技术性贸易措施(TBT)的通报情况进行统计,就主要通报国家、通报产品类型(药品、医疗器械、化妆品)和内容进行分析。结果:全球针对药品、医疗器械和化妆品的通报数量呈上升趋势,其中药品通报数量最多(511件),化妆品通报数量较少(155件);且各国差异较大,以阿根廷、巴西、韩国、加拿大、美国、欧盟、日本的通报数量占据绝对优势,美国、欧盟、加拿大、日本、韩国等的通报数量总体呈上升趋势,但2010年后通报数量趋于稳定,反映出这些国家的医药政策变化趋于稳定。结论:TBT已成为世界各国调整贸易利益的重要手段。我国应在积极发展医药产业的同时,合理利用TBT建立更加完善的医药政策。     

PiCCO临床应用的研究进展

本文介绍了脉搏指示连续心排量监测(pulse index continuous cardiac output,PiCCO)监测仪的基本原理和使用方法,简述了热稀释方法及分析动脉压力波形得到的两部分参数,分析了监测全心舒张末期容积(the monitoring end diastolic volume,GEDV)、胸内血容量(intrathoracic blood volume,ITBV)、血管外肺水(extravascular lung water,EVLW)、PVV、SVV等参数的临床意义,PiCCO的临床应用及注意事项,并得出PiCCO是一种可靠地有创血流动力学监测措施,可以准确的反映机体容量状况,指导液体治疗,且对肺水肿有很高的预测价值的结论。     

浅谈医务人员的绩效评价

在新的医改形势下,如何促进医务人员自身与医疗机构共同发展,是每个医疗机构管理者需要面对的问题。本文针对医院的特点,深入探讨了医院对医务人员实行绩效评价的可行性。通过分析提出了对医务人员进行绩效评价的方法和原则。对绩效评价制度的有效执行,可实现多劳多得、优劳优得,从而促使医务人员自觉提高业务能力与服务水平,同时也体现了收入分配的公平性。这样既有利于提高医务人员的工作积极性及人员质量,也有助于促进医院的发展,从而实现医院与医务人员的共同发展,有助于解决医疗机构医务人员不足的问题。     

Achieving vocational training goals during six months in an Italian general practice

Background: General practice training in Europe is still an unresolved issue. Italy has developed a formation course similar to specialty schools, awarding a certificate of attendance at the end of a 3-year period. Its training goals are defined mainly as work hours in medical facilities, including two semesters at two general practices.

Objectives: To evaluate if a registrar, during a semester in a general practice, has access to a case spectrum consistent enough to achieve the training goals, both ‘methodological’ (work organization targets) and ‘specific’ (targets of opportunity).

Methods: During a six-month period, every patient contact qualified for tutoring was recorded. For each visit, access mode and priority, patient name, age, patient reason for encounter (RFE), diagnosis, referrals, prescribed laboratory tests and treatment were recorded. Data was evaluated as in other Italian medical specialties; i.e. compared to target numbers.

Results: A total of 1 828 contacts and 2 437 RFE in 122 work days were recorded. There were 1 007 and 613 contacts with and without appointment respectively, 88 ‘family contacts,’ 44 scheduled check-ups, 11 phone contacts, and 65 nurse interventions. Of all contacts, 9.8% were indirect. In six months, we had at least one contact with 792 patients out of 1 500 (52.8%). Main RFE resulted from respiratory and musculoskeletal symptoms while most frequent diagnoses belonged to musculoskeletal, cardiovascular and respiratory fields.

Conclusions: A six months training period can be sufficient for representing a general practitioner's work organization and primary care epidemiology. However, deficiencies were observed.     

Take the HEAT: A pilot study on improving communication with angry families

ObjectiveOur objective was to evaluate the utility of an educational program consisting of a workshop based on the Take the HEAT communication strategy, designed specifically for addressing patients who are angry, using a novel tool to evaluate residents’ skills in employing this method.Methods33 first-year pediatric and internal medicine-pediatrics residents participated in the study. The workshop presented the Take the HEAT (Hear, Empathize, Apologize, Take action) strategy of communication. Communication skills were assessed through standardized patient encounters at baseline and post-workshop. Encounters were scored using a novel assessment tool.ResultsAfter the workshop, residents’ Take the HEAT communication improved from baseline total average score 23.15 to total average score 25.36 (Z = −3.428, p < 0.001). At baseline, empathy skills were the lowest. Intraclass Correlation Coefficient demonstrated substantial agreement (0.60 and 0.61) among raters using the tool.ConclusionFirst-year pediatric trainees’ communication with angry families improved with education focused on the Take the HEAT strategy. Poor performance by residents in demonstrating empathy should be explored further.Practice implicationsThis study demonstrates the utility of a brief communications curriculum aimed at improving pediatric residents' ability to communicate with angry families.     

中药口服并穴位贴敷联合腹腔、静脉双途径化疗治疗晚期卵巢癌合并腹水临床研究

目的:观察双途径化疗(以顺铂为主的PT方案静脉滴注配合腹腔顺铂灌注)联合中药穴位贴敷及口服自拟健脾生血汤治疗晚期卵巢癌并发腹水的临床疗效。方法:以62例晚期卵巢癌合并腹水的患者为研究对象,随机分为治疗组和对照组,各31例,治疗组予以双途径化疗+中药穴位贴敷+健脾生血汤口服,对照组单纯予以双途径化疗,连续治疗6个周期,观察两组患者腹水变化情况及血CA125、白细胞、血红蛋白、红细胞水平。结果:对照组有效率51.61%,治疗组有效率83.87%,两组比较,差异有统计学意义(P0.05);治疗后对照组血清CA125为(36.22±12.71)U·m L~(-1),治疗组血清CA125为(23.85±13.06)U·m L~(-1),两组比较,差异有统计学意义(P0.05);治疗后对照组白细胞为(3.65±1.12)×109L~(-1),血红蛋白为(88.62±7.63)g·L~(-1),红细胞为(3.23±0.44)×10~(12)L~(-1),治疗组白细胞为(6.83±1.70)×109L~(-1),血红蛋白为(115.15±10.39)g·L~(-1),红细胞为(5.63±1.42)×10~(12)L~(-1),两组比较,差异有统计学意义(P0.05)。结论:静脉、腹腔双途径化疗结合中药穴位贴敷及自拟健脾生血汤口服,可使晚期卵巢癌合并腹水患者的腹水明显减少,改善化疗引起的骨髓抑制,提高临床疗效。     

基于知识图谱和模型融合的医疗问答系统的构建

基于语义解析和规则匹配融合的模型，利用少量的语义训练语料，以中文医疗知识图谱为知识基础，构建中文医疗问答系统，解决医疗领域中文语料缺乏且标注难度大的问题。该系统由语义解析模块（SPM）和答案查询模块（AQM）组成。其中，SPM由意图识别和命名实体识别组成，它们分别以BERT-TextCNN和BiLSTM-CRF模型为基础，融合了规则校正，其准确率较非融合模型分别提升9%和11%。实验结果表明，该系统回答准确率达到82%，具有较强的问题解答能力和一定的实用价值。