两种指标计算住院病人抗菌药物使用强度的适用性比较

目的：比较采用实际占用总床日数和收治病人人数天数计算住院病人抗菌药物使用强度（antibacterial use density, AUD）的准确性,以确定一个适用性更高的AUD计算方法。方法：分别使用实际占用总床日数和收治病人人数天数（即抽样时间段内出院人数×平均住院天数）计算上海市公共卫生临床中心2009-2011年每年,以及2012年1-3月每月住院病人的AUD,记为AUD1和AUD2,比较月度AUD1和AUD2、年度AUD1和AUD2的离散度。结果：月度AUD1的离散度显著小于月度AUD2离散度,年度AUD1和年度AUD2的离散度相差不大。结论：与收治病人人数天数相比,使用实际占用总床日数计算AUD适用性更佳,更能真实反映住院病人抗菌药物使用水平。     

关于临床药师角色的几点体会

目的:探讨临床药师在临床药物治疗团队中的角色。方法:结合重症监护病房临床工作经历谈谈角色体会。结果与结论:临床药师在临床药物治疗团队中是学习者、协助者和沟通者。     

工作流程梳理在门诊药房应用的体会

目的总结门诊药房工作流程梳理及应用体会。方法从建立和应用的角度,介绍工作流程制订的方法和使用的意义。结果建立工作流程可避免传统带教弊端,提高工作效率,减少工作差错,便于药房统一管理。结论合理的工作流程是高质高效完成各项工作的有力保障。     

银屑病的蛋白组学与中医相关研究探析

蛋白组学作为近年来一门较为新型的学科和研究手段,已被应用于生命学科的各领域。笔者主要从中医证候与辨证分型、中医药治疗与蛋白组学研究在银屑病发病机制和治疗等方面的研究及应用进行综述,以期找出传统医学和现代医学在研究中相互渗透的切入点,并希望能为银屑病的诊断与治疗研究提供一些参考资料和依据,进一步为银屑病患者提供更好的辨证施治。     

中西医结合治疗肿块期肉芽肿性乳腺炎临床观察

目的:观察疏肝消痈汤治疗肉芽肿性乳腺炎的临床疗效。方法:选取符合纳入标准的肉芽肿性乳腺炎患者60例,分为两组各30例,对照组予抗生素治疗,治疗组在此基础上加用顾老经验方疏肝消痈汤口服,1周后评价两组疗效。结果:治疗后,三个症状积分比较、WBC、hs-CRP及IL-2、IL-4实验室检查结果比较,有统计学差异(P<0.05)。治疗后治疗组总有效率90.0%,对照组总有效率40.0%,具有统计学差异(P<0.05),治疗组明显优于对照组。结论:疏肝消痈汤对肉芽肿性乳腺炎临床治疗有效。     

Integrated testing and management in fetal growth restriction

Growth-restricted fetuses are at higher risk for poor perinatal and long-term outcome than those who are appropriately grown. Multiple antenatal testing modalities can help document the sequence of fetal deterioration. The full extent of this compromise is best identified by a combination of fetal biometry, biophysical profile scoring, and arterial and venous Doppler. In the preterm growth-restricted fetus, timing of delivery is critically determined by the balance of fetal versus neonatal risks. In the near-term fetus, accurate diagnosis continues to be a challenge as unrecognized growth restriction contributes to a significant proportion of unexplained stillbirths. In this review, we present an integrated diagnostic and surveillance approach that accounts for these factors.     

Integration of Hot Isostatic Pressing and Heat Treatment for Advanced Modified γ-TiAl TNM Alloys

The conventional processing route of TNM (Ti-Nb-Mo) alloys combines casting and Hot Isostatic Pressing (HIP) followed by forging and multiple heat treatments to establish optimum properties. This is a time-consuming and costly process. In this study we present an advanced alternative TNM alloy processing route combining HIP and heat treatments into a single process, which we refer to as IHT (integrated HIP heat treatment), applied to a modified TNM alloy with 1.5B. A Quintus HIP lab unit with a quenching module was used, achieving fast and controlled cooling, which differs from the slow cooling rates of conventional HIP units. A Ti-42.5Al-3.5Nb-1Mo-1.5B (at.%) was subjected to an integrated two HIP steps at 200 MPa, one at 1250 °C for 3 h and another at 1260 °C for 1 h, both under a protective Ar atmosphere and followed by cooling at 30 K/min down to room temperature. The results were compared against the Ti-43.5Al-3.5Nb-1Mo-0.8B (at.%) thermomechanically processed in a conventional way. Applying IHT processing to the 1.5B alloy does indeed achieve good creep strength, and the secondary creep rate of the IHT processed materials is similar to that of conventionally forged TNM alloys. Thus, the proposed advanced IHT processing route could manufacture more cost-effective TiAl components.     

Individual Response to Botulinum Toxin Therapy in Movement Disorders: A Time Series Analysis Approach

On a group level, satisfaction with botulinum neurotoxin (BoNT) treatment in neurological indications is high. However, it is well known that a relevant amount of patients may not respond as expected. The aim of this study is to evaluate the BoNT treatment outcome on an individual level using a statistical single-case analysis as an adjunct to traditional group statistics. The course of the daily perceived severity of symptoms across a BoNT cycle was analyzed in 20 cervical dystonia (CD) and 15 hemifacial spasm (HFS) patients. A parametric single-case autoregressive integrated moving average (ARIMA) time series analysis was used to detect individual responsiveness to BoNT treatment. Overall, both CD and HFS patients significantly responded to BoNT treatment with a gradual worsening of symptom intensities towards BoNT reinjection. However, only 8/20 CD patients (40%) and 5/15 HFS patients (33.3%) displayed the expected U-shaped curve of BoNT efficacy across a single treatment cycle. CD (but not HFS) patients who followed the expected outcome course had longer BoNT injection intervals, showed a better match to objective symptom assessments, and were characterized by a stronger certainty to control their somatic symptoms (i.e., internal medical locus of control). In addition to standard evaluation procedures, patients should be identified who do not follow the mean course-of-treatment effect. Thus, the ARIMA single-case time series analysis seems to be an appropriate addition to clinical treatment studies in order to detect individual courses of subjective symptom intensities.     

对接大健康产业发展的康复治疗学人才培养体系的构建

在大健康产业发展背景下,康复服务产业发展模式和服务理念逐步转变。康复人力资源是康复服务产业发展的基石,文章基于《国际功能、残疾和健康分类》(international classification of functioning,disability and health,ICF)康复科学理论体系,切合康复服务产业化和专业化需求,重构康复治疗学专业人才培养的课程体系,强化实践教学,探讨构建康复治疗学专业人才培养新模式。