效果-实施双轨设计的分类和应用

将证据转化为卫生保健服务,需要经过3个转化过程“临床前研究-临床研究-实施性研究”,耗时漫长且常常出现转化不足。为加快证据转化为日常医疗实践和卫生政策的进程,融合了临床有效性研究和实施性研究的“效果-实施双轨设计”应运而生。本文介绍效果-实施双轨设计的概念、分类及其应用,为研究人员应用此方法开展研究提供参考。     

呼吸训练联合作业治疗对脑卒中患者上肢功能恢复的影响

目的:观察呼吸训练联合作业治疗对脑卒中患者上肢功能恢复的影响。方法:采用随机数字表法将50例脑卒中患者分为观察组及对照组,每组25例。对照组患者给予常规康复干预(包括偏瘫肢体良肢位摆放、物理因子治疗及运功功能训练等),观察组患者在此基础上辅以呼吸训练(包括渐进性吸气肌抗阻训练和呼吸控制训练)及作业治疗,每天训练2次。于...     

临床实习压力对医学生心理健康影响的调查

目的:调查临床实习压力对医学生心理健康的影响,为开展实习期医学生心理健康工作提供相关依据和支持。方法:采用Beck-Srivastava压力量表(BSSI)对586名处于临床实习期间医学生面临的压力源及压力强度情况进行初步检测,进一步结合症状自评量表(SCL-90)及状态-特质焦虑问卷(STAI)对其心理健康状况进行综合调查。结果:(1)临床实习期间,医学生的压力主要集中在学习压力、经济压力、临床实践和人际关系4个方面,其检出率普遍超过60%,且BSSI单因子得分均在3分以上。男生在学习压力及经济压力2个因子得分高于女生,在临床实践及人际关系2个因子得分低于女生,但差异均无统计学意义(P0.05);(2)临床实习期间医学生在SCL-90的9个因子得分均超过国内常模,且在人际关系、抑郁、焦虑及恐怖4个因子得分差异有统计学意义(t=8.5011,5.0781,27.5146,3.4907;P0.05)。男生在SCL-90的敌对性、偏执及精神病性3个因子得分高于女生,但差异均无统计学意义(P0.05);女生在SCL-90的躯体化、强迫、人际关系、抑郁、焦虑和恐怖6个因子得分高于男生,且在抑郁和焦虑2个因子得分差异有统计学意义(t=-4.2678,-3.7579;P0.05);(3)临床实习期间医学生在STAI的状态焦虑(S-AI)的得分高于标准常模,且差异有统计学意义(t=8.3293,P0.05),在STAI的特质焦虑(T-AI)的得分低于标准常模,但差异无统计学意义(P0.05);女生在S-AI及T-AI得分均高于男生,但差异均无统计学意义(t=-0.5390,-1.4026;P0.05)。结论:临床实习会对医学生造成较大的压力,进而导致一定的心理健康问题,尤其是会诱发较为严重的焦虑情绪。     

Additive Effect of Plasma Rich in Growth Factors With Guided Tissue Regeneration in Treatment of Intrabony Defects in Patients With Chronic Periodontitis: A Split‐Mouth Randomized Controlled Clinical Trial

Background: Periodontal regeneration can be defined as complete restoration of lost periodontal tissues to their original architecture and function. A variety of treatment modalities have been proposed to achieve it. Plasma rich in growth factors (PRGF) is a concentrated suspension of growth factors that promotes restoration of lost periodontal tissues. The objective of the present study is to assess the effect of PRGF associated with guided tissue regeneration (GTR) versus GTR only in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). Methods: Patients with CP (n = 14) with 42 contralateral 2‐ and 3‐walled defects were randomly assigned to test (PRGF+GTR) and control (GTR alone) treatment groups. Clinical and radiographic assessments performed at baseline and after 6 months were: 1) gingival index (GI), 2) probing depth (PD), 3) clinical attachment level (CAL), 4) radiologic defect depth, and 5) bone fill. Results: Comparison of parameters measured at baseline and after 6 months showed mean PD reduction of 3.37 ± 1.62 mm in the control group (P <0.001) and 4.13 ± 1.59 mm in the test group (P <0.001). There was a significant difference in mean change in CAL (P <0.001) in the control group (5.42 ± 1.99) and the test group (5.99 ± 1.77). Mean change in GI was 1.89 ± 0.32 and 1.68 ± 0.58 in the control group and test group, respectively, and the difference was statistically significant (P <0.001). When compared between groups, clinical parameters did not show any statistically significant variations. Mean radiographic bone fill was 1.06 ± 0.81 and 1.0 ± 0.97 in the control group and test group, respectively. However, the difference was not statistically significant. Conclusions: PRGF with GTR, as well as GTR alone, was effective in improving clinical and radiographic parameters of patients with CP at the 6‐month follow‐up. There was no additive effect of PRGF when used along with GTR in the treatment of IBDs in patients with CP in terms of both clinical and radiologic outcomes.     

Four-year clinical evaluation of Class II nano-hybrid resin composite restorations bonded with a one-step self-etch and a two-step etch-and-rinse adhesive

Objective

The objective of this prospective clinical trial was to evaluate the 4-year clinical performance of an ormocer-based nano-hybrid resin composite (Ceram X; Dentsply/DeTrey) in Class II restorations placed with a one-step self-etch (Xeno III; Dentsply/DeTrey) and two-step etch-and-rinse adhesive (Ivoclar Vivadent).

Methods

Seventy-eight participants received at random at least two, as similar as possible, Class II restorations of the nano-hybrid resin composite bonded with either a single step self-etch adhesive or a control 2-step etch-and-rinse adhesive. The 165 restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 4 years.

Results

162 restorations were evaluated at 4 years. Postoperative sensitivity was observed in 6 patients (3 Xeno III, 3 Exite) between 1 and 3 weeks. Eleven failed restorations (6.8%) were observed during the follow up. Seven in the one-step self-etch adhesive group (7.7%) and four in the 2-step etch-and-rinse group (5.6%). This resulted in non-significant different annual failure rates of 1.9% and 1.4%, respectively. Fracture of restoration was the main reason for failure.

Conclusion

The ormocer-based nano-hybrid resin composite showed a good clinical performance in Class II cavities during the 4 year evaluation. No significant difference was seen in overall clinical effectiveness between the two adhesives.     

Modified Split‐Cast Technique: A New,Timesaving Clinical Remount Technique

Interocclusal discrepancies can be eliminated by a clinical remount procedure, but most practitioners avoid it because of the time involved. This article introduces a new timesaving method, the modified split‐cast technique. It uses a semi‐adjustable articulator, tin foil as plaster separator, and an addition‐type, silicone bite‐registration material. The technician does most of the remounting procedures before the denture delivery appointment, so the dentist spends very little time chairside to complete the clinical remount procedure. Compared with the conventional and two other remounting techniques, the new technique is faster and easier to manipulate.     

牙龈卟啉单胞菌临床菌株的毒力分析

目的:利用啮齿动物模型,比较分析中国人群口腔中牙龈卟啉单胞菌(Porphyromonas gingivalis,P.gingivalis)临床菌株的毒力。方法:采用小鼠脓肿形成实验,将6株从牙周炎患者牙周袋中分离获得的P.gingivalis临床菌株L2、L3、L4、L5、L11和L12分别注射至小鼠后背中央,观察其临床症状,并与国际标准菌株ATCC33277和W83进行比较,分析临床菌株的毒力特性。采用SPSS11.5软件包对数据进行统计学分析。结果:L3、ATCC33277和W83诱发小鼠产生原发性脓肿和轻微的全身反应,L2、L5、L11、L12则诱发小鼠产生远处转移性病变和严重的全身反应。结论:中国牙周炎患者口腔中的P.gingivalis临床菌株与国际标准菌株相比,在诱发实验鼠发生局部脓肿方面,具有一定程度的相似性,但临床菌株间的毒力特征具有较大差异。     

A pattern of association between clinical form of vitiligo and disease-related variables in a Brazilian population

Background

Vitiligo classification systems are often based exclusively on the number and distribution of the white patches. To what extend these classification protocols reflect possible different pathophysiological basis for vitiligo or carry any prognostic value is currently unknown.

Objective

To investigate patterns of association between type of vitiligo and common disease-related variables, in order to advance on the understanding of the exact nature of different clinical forms of disease, as well as to identify features with prognostic value for clinical progression of early diagnosed vitiligo.

Materials and methods

This is a cross-sectional study of a population sample from south of Brazil composed of 586 independent vitiligo-affected individuals. Different strategies of case-control analysis were employed to test for association between the three most common vitiligo clinical types and age of onset, family history of vitiligo, occurrence of Köebner phenomenon (KP) and presence of autoimmune co-morbidity.

Results

Individuals affected by segmental vitiligo showed lower average age of onset (16 years) when compared with vulgaris (23.9 years) and acrofacial cases (29 years) (p < 0.001). The distribution of occurrence of KP, family history of vitiligo and co-occurrence of autoimmune disease followed a gradient pattern, with high, intermediate and low chance of occurrence of all three variables observed for vulgaris, acrofacial and segmental vitiligo, respectively (p < 0.001 for overall distribution).

Conclusion

Results indicate a uniform pattern of association between vitiligo clinical forms and KP, positive vitiligo family history and occurrence of co-morbidity autoimmune. The impact of the observed pattern of association over disease prognosis and classification is discussed.     

无创性皮肤测试在黄褐斑临床分型中的应用及意义

目的探讨黄褐斑不同临床类型及其皮肤生理功能,以指导疾病治疗。方法采用无创性皮肤测试仪分析黄褐斑不同临床类型的皮肤生理功能。用伍氏灯及玻片压诊法对84例黄褐斑患者进行分型;采用德国CK公司的无创性皮肤测试仪检测84例患者皮损部位及40例正常对照的油份、水分、经表皮水分流失、血色素及黑色素,并两两比较各型黄褐斑的血色素及黑色素水平。结果根据伍氏灯及玻片压诊法初步将84例黄褐斑分为四型:单纯色素型(M)23例,单纯血管型(V)17例、M>V型24例及V>M型20例。84例患者与对照组相比,面颊部皮肤水分显著降低(p<0.01),经表皮水流失(TEWL)、血色素、黑色素水平显著增高(p<0.01),皮脂含量无显著性改变(p>0.05);V型与V>M型之间血色素水平无明显差异(p>0.05),但均高于其他两型(p<0.01);M型及M>V型的黑色素水平之间无显著差异(p>0.05),但高于其他两型(p<0.05)。结论黄褐斑在临床上存在四种不同类型,即M型、V型、M>V型及V>M型;四型均存在皮肤屏障功能受损,保湿是四型黄褐斑治疗的基础;M型及M>V型以黑色素值增高为主,V型及V>M型以血红蛋白增高为主,提示黄褐斑的治疗应以其类型为依据。