基础医学教师课堂教学质量评价

为了了解本科教师的教学质量和教学效果 ,教学专家和学生评价了 14 7位基础医学教师。结果显示 ,讲师以上职称教师的教学质量明显好于初级职称教师 (P<0 .0 5 ) ,高级职称教师教学的科学性、艺术性和思想性明显好于讲师和助教 (P<0 .0 5 )。文章还对教学中存在的问题和对策进行了讨论。     

医院综合效益评价中的权数（三）——估计权数

在医院综合效益评价中，估计权数由评价专家根据经验对评价指标的重要程度的一种评估，这类数据通常用的ＡＨＰ法进行处理。本文用ＡＨＰ的递推算法计算估计权数，这种算法不仅计算简单，而且易达到一致性的要求，其估计的剩余误差小于ＡＨＰ法。     

Worksite health promotion programs in the United States: progress, lessons and challenges

Worksite health promotion programs have become increasinglyprevalent in the United States, and one or more health promotionprograms are found in two-thirds of all private worksites with50 or more employees. Reasons for recent growth in program frequencyinclude increased concern for worker health, rapidly escalatingemployer payments for health care benefits to workers, and growingevidence of a strong linkage between employee health and productivity.Published results of evaluations to date suggest that worksitehealth promotion programs can have positive impacts on healthbehaviors and health status. In addition, economic analysesare suggesting that some programs can affect the slope of healthcare costs and have the potential of high cost-effectivenesscompared to some clinical interventions. A number of researchchallenges remain, particularly understanding the influencesof the worksite environment and how employee health promotionprograms affect individual and organizational productivity.     

成人肾上腺皮质癌的诊断和治疗(附16例报告)

目的：探讨成人肾上腺皮质癌的临床特点和治疗方法。方法：回顾性分析16例成人肾上腺皮质癌患者的临床资料，全部患者术前行B超、CT等影像学检查，10例接受内分泌激素检测，均首先行手术治疗，完整切除肿瘤13例，未能完整切除者3例。结果：术前13例明确诊断，3例末确诊。术后病理检查I期肿瘤3例，Ⅱ期9例，Ⅲ期4例。随访N一62个月，平均生存48个月；有5例至今生存，其中3例因术后转移而进展为Ⅳ期，行联合化疗(PDD加ADM加VN16)3—5周期，均末达到肿瘤缓解，术后平均生存17个月。3例末完全切除者术后放疗均末控，均因肿瘤扩散死亡，术后平均生存期为11个月。结论：成人肾上腺皮质癌恶性程度高，影像学检查是确诊的关键；早期发现并行根治性切除手术是目前提高其生存率的唯一有效方法。     

Automated lumen definition from 30 MHz intravascular ultrasound images

One prerequisite for standard clinical use of intravascular ultrasound imaging is rapid evaluation of the data. The main quantities to be extracted from the data are the size and the shape of the lumen. Until now, no accurate, robust and reproducible method to obtain the lumen boundaries from intravascular ultrasound images has been described. In this study, 21 different (semi-)automated binary-segmentation methods for determining the lumen are compared with manual segmentation to find an alternative for the laborious and subjective procedure of manual editing. After a preprocessing step in which the catheter area is filled with lumen-like grey values, all approaches consist of two steps: (i) smoothing the images with different filtering methods and (ii) extracting the lumen by an object definition method. The combination of different filtering methods and object definition methods results in a total of 21 methods and 80 experiments. The results are compared with a reference image, obtained from manual editing, by use of four different quality parameters—two based on squared distances and two based on Mahalanobis distances. The evaluation has been carried out on 15 images, of which seven are obtained before balloon dilation and eight after balloon dilation. While for the post-dilation images no definite conclusions can be drawn, an automated contour model applied to images smoothed with a large kernel appears to be a good alternative to manual contouring. For pre-dilation images a fully automated active contour model, initialized by thresholding, preceded by filtering with a small-scale median filter is the best alternative for manual delineation. The results of this method are even better than manual segmentation, i.e. they are consistently closer to the reference image than the average distance of all individual manual segmentations.     

Occupational stress management programmes: a practical overview of published effect studies

There are many occupational stress management programmes availablewhich are designed to prevent and cure the negative aspectsof job-stress. The focus of the programmes can be directed towardsthe individual worker, the working group, the organization ofthe work or the organization as a whole. Moreover, programmesshow a considerable variation with respect to the type of interventionsthey promote and their underlying assumptions, as well as theirduration and costs. In this paper, effect studies of occupationalstress programmes published between 1987 and 1994 are reviewed.The aim is to give a practical overview of the variety in occupationalstress programmes, their scope, applicability and the evidenceof their effectiveness. The paper updates the review by DeFrankand Cooper published in 1989.     

Obstructive sleep apnoea: The role of the oral and maxillofacial surgeon

Obstructive sleep apnoea is a relatively common sleep disorder that is popularly associated with snoring and excessive daytime sleepiness. It is a disorder with serious implications that has only in the last two decades received the attention of clinical specialists. The aim of this article is to review the role of the dental profession in the recognition and management of this disorder.     

Using switching detection and variational equations for the shooting method

We study in this paper the resolution by single shooting of an optimal control problem with a bang‐bang control involving a large number of commutations. We focus on the handling of these commutations regarding the precise computation of the shooting function and its Jacobian. We first observe the impact of a switching detection algorithm on the shooting method results. Then, we study the computation of the Jacobian of the shooting function, by comparing classical finite differences to a formulation using the variational equations. We consider as an application a low thrust orbital transfer with payload maximization. This kind of problem presents a discontinuous optimal control, and involves up to 1800 commutations for the lowest thrust. Copyright © 2007 John Wiley & Sons, Ltd.     

Evaluating projects funded by the Western Australian Health Promotion Foundation: first results

The paper describes output measures of performance of the WesternAustralian Health Promotion Foundation (Healthway), using asystem known as graduated project evaluation (GPE). Resultsare reported at the basic and process levels of evaluation on588 health and sponsorship projects, and at the impact levelbased on surveys of 5710 spectators and participants at 53 sport,arts and racing events sponsored by Healthway funds. At thebasic and process levels the average Healthway project reached7449 people directly and generated media coverage of healthmessages on 27.3 occasions. It secured, on average, 0.99 healthystructural reforms in recreational or cultural venues, involvedthe participation of local community members in project administrationin 38% of instances, and provided 1596 person-hours of healtheducation. Non-smoking, safe drinking, nutrition, exercise,sun protection, safe sex and injury prevention health messageswere promoted using 24 different types of sponsor benefits.Of the 5710 respondents surveyed post-event, 67% were awareof the promoted health message and 82% of these understood whatthe message meant. Four per cent of all respondents intendedto take action ranging from seeking information to adoptingthe health behaviour. A comparison of the cost-effectivenessof small and large sponsorship projects is given to illustratethe use of GPE to inform funding decisions. Smaller projectsoutperformed larger projects on all available indicators. Wediscuss the peculiar features of the health promotion foundationconcept, methods to improve its performance and implicationsfor future research.     

Digital subtraction arthrography in preoperative evaluation of painful total hip arthroplasty

 Objective. The objective of this clinical study was to define the diagnostic value of plain radiography, digital subtraction arthrography and two-phase bone scintigraphy in patients with clinically loose or infected hip prostheses. Design. Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard. Results. Digital subtraction arthrography was best (P<0.001) for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs (P=0.24) and scintigraphy (P=0.27). Digital subtraction arthrography was also the most important modality for predicting a loose femoral component (P=0.001), while the plain radiograph was of significant (P=0.04) additional value and scintigraphy was of no additional value (P=0.13) on multivariate analysis. Conclusion. Digital subtraction arthrography gives the best results in the prediction of loosening of acetabular and femoral components. Plain radiographs give additional information on loosening of the femoral component, but scintigraphy offers no additional advantage.