中西医结合治疗消化性溃疡的疗效观察

目的观察自拟清胃散联合泮托拉唑、克拉霉素和铝碳酸镁片治疗消化性溃疡的临床疗效。方法 108例患者随机分为两组,对照组给予西药泮托拉唑、克拉霉素和铝碳酸镁片治疗。治疗组在对照组治疗基础上加用清胃散治疗,观察两组的临床疗效和复发情况。结果治疗组总有效率与对照组比较无显著性差异(P0.05);治疗组2年后复发率明显低于对照组(P0.05)。结论自拟清胃散联合泮托拉唑、克拉霉素和铝碳酸镁片治疗消化性溃疡,疗效与单用西药治疗无显著性差异,但2年后复发率明显优于对照组。     

中西医联合治疗糖尿病肾病

中医认为,糖尿病肾病(消渴肾病)以本虚为主,虚和瘀贯穿了疾病的始终.治疗上不能一味追求西药强化治疗,应当中西医结合攻补兼施,增强疗效,减轻不良反应.从中西医角度分析糖尿病肾病的发病机制及其治疗进展,发现糖尿病肾病的发病机制从中医及西医的角度解释是相通互补的,并且中医联合西医治疗糖尿病肾病有着相辅相成的作用.中医联合西医治疗糖尿病肾病可延缓糖尿病肾病的进展,并且可以减少低血糖的风险和西药带来的毒副作用.     

大数据思维框架下医院“质量数据管理中心”的集成构建

目的：应用大数据思维集成构建医院“质量数据管理中心”,实现医院质量管理从数据化运营到运营大数据的适应性变革。方法：将医院医保科、质量管理科、病案室、统计室、计算机中心等数据管理密集的职能科室集成构建为医院“质量数据管理中心”。对其职能重新整合分工,逐步建立对医疗、护理、行政管理等全方位质量考核评价的独立机构,定期向医院党委及机关各部门提供一致、准确的决策数据分析报告,用于宏观决策。结果：集成构建的“质量数据管理中心”其原有职能作用可实现1+1＞2,且由于数据信息集中采集、应用、分析、释放,医院决策速度加快、问题管理到位、效益扩增显著。结论：大数据思维框架下集成构建的医院“质量数据管理中心”可重新整合职能分工,高效利用信息资源,减少跨部门管理、控制信息衰减及流失,可为现代医院管理者借鉴应用。     

Kinematic Analysis of a Drinking Task in Chronic Hemiparetic Patients Using Features Analysis and Statistical Parametric Mapping

Objective

To compare sitting posture and movement strategies between chronic hemiparetic and healthy subjects while performing a drinking task, using statistical parametric mapping (SPM) and feature analysis.

Analysis of Clinical Evaluation of Response to Treatment of Parkinson’s Disease with Integrated Chinese and Western Medicine Therapy

Objective:To analyze the clinical evaluation of Parkinson's disease(PD) patients receiving integrated Chinese and Western medicine therapy.Methods:One hundred and twenty patients were enrolled and randomly allocated to a control group or treatment group.Patients in the two groups received placebo and Bushen Huoxue Granule(补肾活血颗粒,BHG),respectively.Both groups received baseline levodopa and benserazide(Madopar).The effects of treatment were assessed monthly during the 9-month treatment.Means of evaluation included Unified PD Rating Scale(UPDRS) scores(Ⅱ and Ⅲ),sleep scale score,10 m turn back test(getting up time,10 m×2 times,and turning time),timing motor test(TMT)-left and TMT-right,which were treated as the dependent variables;and age,sex,duration of PD,Hoehn and Yahr(H-Y) stage and Madopar dosage of admitted PD patients were as the independent variables.Multiple linear regression was used to analyze these factors.Results:H-Y stage significantly affected UPDRS Ⅱ score,UPDRS Ⅲ score,and getting up time(P0.01).Madopar dosage and H-Y stage significantly affected the 10 m×2 times(P0.05 or P0.01).Madopar dosage significantly affected the sleep scale score(P0.05).There were also significant correlations between age and TMT-left or TMT-right(P0.01),and duration of PD and TMT-right(P0.05).Conclusions:The six assessed means of clinical evaluation(including UPDRS Ⅱ and UPDRS Ⅲ scores,sleep scale score,getting up time,10 m×2 times,and turning time) are sensitive indexes in all PD patients.H-Y stage and Madopar dosage are the major factors influencing means of clinical assessment of PD treatment.     

Cost-Effective Isolation of a Process Impurity of Pregabalin

Cost-effective isolation methods were developed on preparative HPLC, flash LC, and simulated moving bed (SMB) to prepare the process impurity, 3-(aminomethyl)-5-methylhex-4-enoic acid (4-ene impurity), of pregabalin. By a thorough experimental study on the different isolation techniques available, it was concluded that SMB was the most cost-effective. Hence, it was a continuous chromatography that utilized the advantage of SMB so that a high quantity of the impurity was generated in a short period of time. SMB was equipped with eight reversed-phased columns and was used to separate the process impurity of pregabalin. The effects of flow rate in zone 2 (Q2) and 3 (Q3), as well as switching time, on the operating performance parameters like purity, productivity, and desorbent consumption were studied. Operating conditions leading to more than 90% purity in the raffinate outlet stream were identified, together with those achieving optimal performance. All of these developed methods are novel, cost-effective, and can be applied to the isolation of other process- and stability-related impurities of pregabalin.     

Probabilistic hazard assessment for skin sensitization potency by dose–response modeling using feature elimination instead of quantitative structure–activity relationships

Supervised learning methods promise to improve integrated testing strategies (ITS), but must be adjusted to handle high dimensionality and dose–response data. ITS approaches are currently fueled by the increasing mechanistic understanding of adverse outcome pathways (AOP) and the development of tests reflecting these mechanisms. Simple approaches to combine skin sensitization data sets, such as weight of evidence, fail due to problems in information redundancy and high dimensionality. The problem is further amplified when potency information (dose/response) of hazards would be estimated. Skin sensitization currently serves as the foster child for AOP and ITS development, as legislative pressures combined with a very good mechanistic understanding of contact dermatitis have led to test development and relatively large high‐quality data sets. We curated such a data set and combined a recursive variable selection algorithm to evaluate the information available through in silico, in chemico and in vitro assays. Chemical similarity alone could not cluster chemicals' potency, and in vitro models consistently ranked high in recursive feature elimination. This allows reducing the number of tests included in an ITS. Next, we analyzed with a hidden Markov model that takes advantage of an intrinsic inter‐relationship among the local lymph node assay classes, i.e. the monotonous connection between local lymph node assay and dose. The dose‐informed random forest/hidden Markov model was superior to the dose‐naive random forest model on all data sets. Although balanced accuracy improvement may seem small, this obscures the actual improvement in misclassifications as the dose‐informed hidden Markov model strongly reduced " false‐negatives" (i.e. extreme sensitizers as non‐sensitizer) on all data sets. Copyright © 2015 John Wiley & Sons, Ltd.     

超长住院日病例对平均住院日的影响分析

目的：通过对本院超长住院日病例分析,了解超长住院日形成原因,为医疗管理部门有效缩短平均住院日提供依据。方法从2010—2013年出院患者病案首页获取资料,对其性别、年龄、费别、疾病分类进行统计分析。结果超长住院日病例以医保患者、男性患者居多,主要病种为损伤和中毒,其次是循环系统疾病。结论医疗管理部门应加强管理,合理配置资源,完善住院诊治流程,缩短平均住院日,提高医院床位利用率,减轻患者和医保部门负担,从而实现医疗资源可持续发展。     

Evaluating Quality in Adult Cardiac Surgery

National and institutional quality initiatives provide benchmarks for evaluating the effectiveness of medical care. However, the dramatic growth in the number and type of medical and organizational quality-improvement standards creates a challenge to identify and understand those that most accurately determine quality in cardiac surgery. It is important that surgeons have knowledge and insight into valid, useful indicators for comparison and improvement. We therefore reviewed the medical literature and have identified improvement initiatives focused on cardiac surgery. We discuss the benefits and drawbacks of existing methodologies, such as comprehensive regional and national databases that aid self-evaluation and feedback, volume-based standards as structural indicators, process measurements arising from evidence-based research, and risk-adjusted outcomes. In addition, we discuss the potential of newer methods, such as patient-reported outcomes and composite measurements that combine data from multiple sources.     

Prevalence of pulmonary embolism in patients with obstructive sleep apnea and chronic obstructive pulmonary disease: The overlap syndrome

ObjectiveGrowing evidence indicates that both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) may be closely associated with the prevalence of pulmonary embolism (PE). However, the relationship of overlap syndrome (OS) (coexistence of OSA and COPD) with PE is unclear. The purpose of this study was to investigate whether OS were associated with increased PE prevalence.MethodsWe performed a retrospective chart review of patients who underwent sleep study at Beijing An Zhen Hospital from 2011 to 2014. The association of OS with PE prevalence was estimated by using logistic regression models.ResultsIn contrast to control patients (neither OSA nor COPD), those subjects with OS had higher odds of PE (OR9.61; 95%CI 4.02–21.31, p < 0.001) with significance persisting after adjusting for covariates (OR 5.66; 95%CI 1.80–16.18, p = 0.004). Meanwhile, patients with OS compared with those with isolated OSA also had significantly higher odds of PE in univariate (OR 4.79; 95%CI 2.04–10.33, p = 0.0007) and adjusted models (OR 3.89; 95%CI 1.27–10.68, p = 0.019). In subgroup analysis, patients with OS had higher odds of PE than control group among male subjects (OR 8.12, 95%CI1.86–31.87, p = 0.007) and patients ≥ 58years (OR 5.50, 95%CI 1.51–18.14, p = 0.012) in multivariable models. Percentage of total sleep time with saturation lower than 90% (T90) ≥ 2.6% was significantly associated with prevalence of PE (OR 4.72, 95%CI1.34–19.83, p = 0.015) in subgroup of patients older than 58.ConclusionsOS is independently associated with PE prevalence. Longitudinal studies are needed to better understand the relationship with incident PE.