浅谈南非的基本药物政策

介绍南非的基本药物政策,包含NDP政策的制定与药物政策相关的立法和准则药物的定价、遴选、采购和分配,药物的合理利用以及主干政策。南非作为非洲经济最发达的国家,也是非洲唯一的工业化国家,与中国的政治体制非常相似,但是南非的基本药物政策制定先于中国十三年,对于刚刚出台了基本药物制度正在探索中的中国来说,具有极大的借鉴意义。     

宜昌市肺结核患者基层督导管理模式研究

目的探讨目前形式状态下基层结核病防治相关政策在实施过程中的问题及影响因素。方法选取宜昌市5个县市区不同工作层面的结核病防治人员开展焦点组访谈。结果有62%的村医采取家庭督导、电话督导与上门访视结合的督导管理模式;宜昌市中央级、省级、地方配套结核病防治经费人均不到0.8元,42%的病人在综合医疗机构住院后采取自费方式获得抗痨药品,接诊医生发现40%的接诊患者没有症状,体检发现疑似肺结核,给涂阴诊断带了难度。结论调整结核病防治经费投入方向,加强基层供方投入,增加人力资源建设,积极探索新模式是目前结核病防治工作迫切需要解决的问题。     

学用相长,造就中医人才（三）——学生医疗实践的保障问题及本科实践性课程体系的构建

讨论了我国医学教育临床实践的政策法规等现状、中医临床教学需求及学生医疗实践的保障问题,结合中医入门系列教程的初步教学实践,进一步探讨中医院校医学类本科实践性课程体系的构建。     

The structure and function of the stratum corneum

Over the past 150 years the skin's structure and function has been the subject of much investigation by scientists. The stratum corneum (SC), the skin's outermost layer and interface with the outside world is now well recognized as the barrier that prevents unwanted materials from entering, and excessive loss of water from exiting the body. This review summarizes the major advances in our understanding of this formidable membrane. The structure of the SC is outlined as well as techniques to visualize the barrier. The lipid organization and ionic gradients, as well as the metabolic responses and underlying cellular signalling that lead to barrier repair and homeostasis are discussed. Finally, a brief overview of the molecular and genetic factors that determine the development of a competent permeability barrier is provided.     

Multifunctional Cholinesterase and Amyloid Beta Fibrillization Modulators. Synthesis and Biological Investigation

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Screening for “Substance Abuse” Among School-Based Youth in Mexico Using the Problem Oriented Screening Instrument (POSIT) for Teenagers

Indices of classification accuracy of the Substance Use/Abuse scale of a Spanish-language version of the Problem Oriented Screening Instrument for Teenagers (POSIT) were evaluated among school-based youth in Mexico. Participants were 1203 youth attending one middle school (N = 619) and one high school (N = 584) in the third largest city of Coahuila, a northern border state in Mexico in May 1998. More than 94% of youth enrolled in the participating middle school and 89% of youth enrolled in the participating high school completed the International Longitudinal Survey of Adolescent Health. Indices of classification accuracy of the POSIT Substance Use/Abuse scale were evaluated against a “drug abuse” problem severity criterion that combined youth meeting DSM-IV criteria for alcohol abuse/dependence disorders with youth having used other illicit drugs five or more times in their lifetime. The present study findings suggest that using a cut score of one or two on the POSIT Substance Use/Abuse scale generally yields optimal classification accuracy indices that vary somewhat by gender and school subgroups. Further, classification accuracy indices of the POSIT Substance Use/Abuse scale are slightly better when used among high school males due, in part, to the higher base rate of serious involvement among this group compared to others.     

Secondary prevention and estimation of fracture risk

The key questions addressed in this chapter are:? How can individual risk of fracture be best estimated?? What is the best system to prevent a further fracture?? How to implement systems for preventing further fractures?Absolute fracture risk calculators (FRCs) provide a means to estimate an individual's future fracture risk. FRCs are widely available and provide clinicians and patients a platform to discuss the need for intervention to prevent fragility fractures.Despite availability of effective osteoporosis medicines for almost two decades, most patients presenting with new fragility fractures do not receive secondary preventive care. The Fracture Liaison Service (FLS) model has been shown in a number of countries to eliminate the care gap in a clinically and cost-effective manner.Leading international and national organisations have developed comprehensive resources and/or national strategy documents to provide guidance on implementation of FLS in local, regional and national health-care systems.     

Assessing the Minimally Clinically Significant Difference: Scientific Considerations,Challenges and Solutions

The scientific considerations surrounding the estimation of a minimally clinically important difference (MCID) are a myriad and challenging. There are a considerable number of hurdles to overcome. The good news is that there are solutions to virtually every one of the scientific hurdles. This paper intends to set out the issues, identify the challenges, and offer solutions so that the state of the science may move forward. The ultimate outcome of the paper may not be to provide a definitive answer for estimating the MCID in every situation, but it should provide a starting point and advice for a process or set of guidelines that may be followed toward achieving this goal. The paper begins with a brief synthesis of the literature and state of the science at the time of publication. The relationship between the process for determining MCIDs for other endpoints, such as tumor response or complete blood culture (CBC) variables, versus toxicity and QOL-related variables is described. The ultimate lessons to be learned from this exercise are:

1. There are many methods available to ascertaining an MCID. None are perfect, but all are useful.

2. All methods converge to similar answers. Supplementary information may refine answers from one or more of the methods.

3. Clinical opinion and patient subjective response should trump statistical theory.

4. A process of MCID estimation involving all approaches to produce a potential range with sensitivity analyses is the optimal solution to producing an MCID based on the most complete knowledge possible.

     

Nutritional assessment with different tools in leukemia patients after hematopoietic stem cell transplantation

Objective： Correct nutritional assessment is essential for leukemia patients after hematopoietic stem cell transplantation （HSCT）. This study aimed to investigate the best nutritional assessment method for leukemia patients after HSCT, and find the possible nutritional risk of the patients during the transplantation process in order to intervene in the patients with nutritional risks and undernourished patients timely, so that the entire transplantation process could be successfully completed. Methods： A prospective study was performed in 108 leukemia patients after HSCT, and different nutritional assessment methods, including nutritional risk screening 2002 （NRS2002）, mini nutritional assessment （MNA）, subjective globe assessment （SGA） and malnutritional universal screening tools （MUST）, were used. The associations between nutritional status of these patients and nutritional assessment methods were analyzed. Results： A total of 108 patients completed SGA, and 99 patients completed NRS2002, MNA and MUST. During the treatment process, 85.2% of the patients lost weight, wherein, 50% lost weight greater than 5%, and 42.6% had significantly reduced food intake. For nutritional risk assessment, the positive rates of NRS2002, MNA and MUST were 100%, 74.7% and 63.6%, respectively. There was a significant difference （P〈0.05） among the positive rates of NRS2002, MNA and MUST. In undernutrition assessment, the positive rate of SGA （83.3%） was significantly higher than that of MNA （17.2%） （P〈0.05）, and the incidence rate of nutritional risk among leukemia patients _〈30 years old was greater than that of patients 〉30 years old （P〈0.05）. Conclusions： Patients with leukemia were in poor nutritional status during and after HSCT. The leukemia patients 〈30 years old had a greater incidence rate of nutritional risk. As nutritional risk screening tool, the specificity of NRS2002 is not high, but it can be used for evaluating nutritional deficiencies. MNA is a good nutritional risk screening tool, but not an adequate tool for nutritional assessment. If assessment of undernutrition is necessary, the combination of all these screening tools and clinical laboratory indicators should he applied to improve accuracy.     

Diagnostic aids for detection of oral precancerous conditions

Oral cancer has a tendency to be detected at late stage which is detrimental to the patients because of its high mortality and morbidity rates. Early detection of oral cancer is therefore important to reduce the burden of this devastating disease. In this review article, the most common oral precancerous lesions are discussed and the importance of early diagnosis is emphasized. In addition, the most common non-invasive oral cancer devices that can aid the general practitioners in early diagnosis are also discussed.