放疗增敏剂甘氨双唑钠的Ⅱ期临床研究

目的 :按二期临床研究要求观察注射用甘氨双唑钠 (简称CMNa)的有效性和安全性。方法 :采用平行对照、随机分组的设计方法 ,将 2 8例经病理组织学确诊的需接受放射治疗的头颈部、食管和肺部肿瘤患者 ,按 2∶1的比例分设实验组(CMNa +常规放疗 )和对照组 (单纯常规放疗 ) ,观察其有效性和安全性的相关指标。结果 :治疗前后血常规、肝肾功能的实验室检查 ,治疗中和治疗后不良反应、严重程度的观察比较及不良反应率的结果比较。两组均无显著性差异。肿瘤原发灶和转移灶的CR率和CR +PR率两组未见显著性差异。但转移灶达PR时所需的照射剂量明显低于对照组 (P <0 0 5 )。结论 :安全性与前期研究结果相符 ,在临床推荐剂量内未观察到明显消化道和神经系统等的不良反应 ,有效率未见显著性差异可能与样本数较少有关。据后期汇总的大样本统计显示两组的显著性差异表现在CMNa可提高CR率和总有效率 ,并降低达到CR和PR时的照射剂量     

对社区人群进行性病/艾滋病健康教育的效果评价

目的 :探讨在社区人群中进行性病 /艾滋病健康教育的可行性。方法 :在南京市已开展社区卫生服务的某区内 ,整群抽取 4个居委会 ,170 0户居民 ,随机分成对照组与干预组。干预组以连续 5次发送“致居民信”的形式进行性病 /艾滋病的健康教育。结果 :对性病 /艾滋病有关知识的知晓率、态度正确率、相关行为正确率 ,干预组人群由干预前的 5 3.3%、4 5 .5 %、77.7%上升到干预后的6 9 .9%、5 8.4 %、82 .7% (P <0 .0 1)。对照组人群由干预前的 4 4 .6 %、37.5 %、6 9.2 %上升到干预后的6 4 .5 %、5 7.2 %、82 .8% (P <0 .0 1)。干预组与对照组均有不同程度的增高。结论 :利用社区卫生服务网络在居民中开展性病 /艾滋病健康教育是有意义的 ,但对不同人群应采取针对性内容。     

不同剂量和用药途径对早期妊娠药物流产效果影响的系统评价

目的:用循证医学的方法评价米非司酮配伍米索前列醇不同剂量、不同用药方法终止早孕药物流产的有效性。方法:计算机检索8个数据库、手工检索9种期刊,并追查参考文献,纳入国内外前瞻性临床对照试验,至少由两人独立评估文献质量和资料提取。数据分析采用软件Revman4.2完成。在异质性检验(P=0.05)后,无异质性者采用固定效应模型合并分析;有异质性者则分析异质性原因,并用敏感性分析、亚组分析或随机效应模型处理。结果:米非司酮<150mg组与150～200mg组的完全流产率、流产失败率和孕囊排除时间的差异均无统计学意义;米索前列醇口服组完全流产率低于阴道用药组,不完全流产率和流产失败率高于阴道用药组。结论:进一步减少米非司酮量(150mg)可能可行,需要深入研究米非司酮最低有效剂量。米索前列醇口服比阴道用药流产效果稍差,但口服用药更方便。     

南通市城乡居民恶性肿瘤健康教育效果评价

目的了解南通地区城乡居民恶性肿瘤健康教育干预效果。方法将恶性肿瘤发病率相似的海安县与如东县分别作为干预组和对照组,对两县(均衡抽取22个乡镇、53个行政村)常住居民中15岁以上的城乡居民恶性肿瘤知信行情况进行入户问卷调查。男性9750人,占48.4%,女性10389人,占51.6%,平均年龄(58.2±8.3)岁,两组间性别、年龄构成无显著差异,P>0.05。在基线调查的基础上,采用行政干预、社区干预、传媒干预、行为干预、心理干预、综合干预的方法对干预组实施为期3年的恶性肿瘤健康教育干预,干预后以与基线调查相同的方法再次进行入户问卷调查。结果除了对吸烟、饮酒这一行为改变效果不显著外,干预组对恶性肿瘤的知识、信念、行为的正确率与对照组相比,差异性非常显著,(P<0.01,相关知识知晓率由原来的64.3%上升到87.1%,信念态度正确率由原来的64.1%上升到84.3%,健康行为形成率由原来的63.5%上升到74.4%。结论对城乡居民开展恶性肿瘤知信行健康教育干预,可增加其预防恶性肿瘤的知识,建立良好的行为习惯和健康的生活方式,是降低恶性肿瘤发病最有效的途径之一。     

糖尿病教育对提高社区病人遵医行为效果的研究

目的评价社区糖尿病健康教育对提高糖尿病病人遵医行为的效果。方法以社区糖尿病病友联谊会的活动形式,对社区糖尿病病人进行系统的糖尿病教育和生活干预。一年半后,使用问卷调查、收集96例完整的社区糖尿病病人资料,调查分析病人接受教育前后对糖尿病基本知识、糖尿病饮食知识的认知变化,血糖的控制情况,生活干预后的遵医行为,结果经SPSS软件处理,进行比较。结果本组病人接受教育后,对糖尿病的认知水平显著提高(P<0.05),遵医嘱用药、控制饮食、自我监测血糖、定期复诊等方面的遵医率高于接受教育前(P<0.05)。血糖控制达标及尚好率>50%,远高于教育前统计资料25.4%(P<0.01)。结论社区医疗卫生服务机构以“病人联谊会活动”形式开展社区糖尿病病人教育,对提高病人遵医意识和行为是切实可行的,能提高糖尿病血糖良好控制达标率,达到糖尿病的二级防治的目的,是社区医疗的方向之一。     

广西实施消灭脊髓灰质炎策略的成本效益分析

目的：评价广西消灭脊髓灰质炎实施策略的成本投入和产出的效益，为维护无脊髓类质炎状态以及控制、消除其它传染病和慢性非传染性疾病提供依据。方法：采用经济效益分析方法，对广西1991年实施消灭脊灰策略后所取得效果同之前进行对比，结果：广西消灭脊灰灰策略总共避免了脊灰发病19768例，避免死亡l955例，避免残疾21723例，产出效益44．43亿元，项目总投入2．153亿元，BCR为1：20．64，按照各年银行利率贴现后的BCR为1：22．38。结论：消灭脊灰策略所取得的经济效益显著，可以应用于控制麻疹等其它传染病和慢性非传染性疾病的控制。     

An assessment of the effectiveness of magnetic resonance imaging of the shoulder: literature review

Objective. To analyse and compare all papers published to date (August 2000) that quantify the effectiveness, defined as the impact of clinician’s diagnosis or management plans, or patient outcome, of MRI of the shoulder. Design. A computerised search of Index Medicus with a broad search strategy relating to shoulder MRI was performed. Manual assessment of all papers listed was undertaken with classification of each paper depending on whether it addressed questions of (1) technical performance, (2) diagnostic performance or (3) outcome. Results. Four of 265 qualifying papers addressed aspects of effectiveness and these were reviewed. The impact on the clinician’s diagnosis varied widely between papers: the primary diagnosis was altered in 23% to 68% of cases, and the management plans were subsequently changed in 15% to 61% of cases. Only one paper addressed the impact on patient health. Conclusions. The effectiveness of MRI of the shoulder depends on the clinical skills of the referring clinician and prevalence of disease in the study population. This will have implications when the effectiveness of an imaging technique between different institutions is compared, and this in turn will influence any comparisons of cost-effectiveness. Received: 22 October 1999 Revision requested: 31 January 2000 Revision received: 21 August 2000 Accepted: 24 August 2000     

Effectiveness and Tolerability of Carbamazepine vs. Oxcarbazepine as Mood Stabilizers

Abstract

Background.?Patients with bipolar illness or maniac-type schizoaffective disorder often present a variety of symptoms and mixed responses to treatment. Several anticonvulsants have been found effective in the treatment of mood disorders. In the early 70's, the clinical efficacy of carbamazepine in the treatment of acute mania was reported. Oxcarbazepine has been available in the United States since 2000. Both drugs display a different spectrum of properties and side effect profiles. Objective.?To compare the effectiveness and tolerability of carbamazepine and oxcarbazepine in a naturalistic setting. Methods.?A retrospective and concurrent chart review of all patients treated with carbamazepine or oxcarbazepine (n = 33) as mood stabilizers between 01 and 12 2002. The effectiveness was evaluated using the Positive And Negative Syndrome Scale (PANSS). Tolerability was assessed according to side effects recorded on charts. Patients with charts that were not complete were excluded from this study. Results.?There were no significant differences in efficacy between groups on positive (F = 3.575, P = 0.075), negative (F = 2.641, P = 0.121), or the general subscales (F = 1.111, P = 0.306) of the PANSS. Patients in both groups developed gastrointestinal upset and headache, but no significant differences in tolerability between the two therapies were found (χ² = 0.466, df = 1, P = 0.659) and (χ² = 0.195, df = 1, P = 0.367 respectively). Conclusion.?In summary, the patient charts reviewed demonstrated that carbamazepine, as well as, oxcarbazepine are equally effective and tolerable as mood stabilizers.     

Cognitive Behavioural Therapy for anorexia nervosa: A systematic review

Evidence for the effectiveness of psychological therapies for anorexia nervosa (AN) is inconsistent. There have been no systematic reviews solely on the effectiveness for Cognitive Behavioural Therapy (CBT) for AN. This review aimed to synthesise and appraise the recent evidence for CBT as a treatment for AN. Using specific search criteria, 16 relevant articles were identified which evaluated CBT alone or as part of a broader randomised/non-randomised trial. Various formats of CBT were utilised in the reviewed papers. Studies were evaluated using established quality criteria.     

健康教育干预对预防儿童维生素A缺乏的效果评价

目的:探讨在幼儿园开展儿童维生素A缺乏健康教育的效果。方法:随机抽取育才幼儿园181名儿童及其家长为研究对象对其实施健康教育,对比健康教育前后家长及儿童对相关知识的掌握程度。结果:通过对家长及儿童的健康教育,实施181名儿童及其家长对儿童维生素A营养缺乏及防治知识掌握程度比较干预前后差异有统计学意义(P<0.01)。结论:实施儿童维生素A缺乏的健康教育对家长及儿童对于维生素A摄入的知识、态度、行为有重要影响,健康教育是控制儿童维生素A缺乏的重要措施,健康教育技术适宜在社区及幼儿园推广应用并持续推进。