宫颈环形电刀切除术治疗212例宫颈上皮内瘤变价值探讨

目的:探讨宫颈环形电刀切除术(LEEP)治疗宫颈上皮内瘤变(CIN)的价值。方法:回顾分析2000年3月至2004年10月212例CIN患者在阴道镜辅助下行宫颈环形电切术的治疗情况。结果:阴道镜下宫颈异常结构处取活检病理结果为CIN者212例行宫颈环形电切术(LEEP),LEEP术后病理检查:宫颈粘膜慢性炎症13例(6.1%)、CINⅠ90例(42.5%)、CINⅡ77例(36.3%)、CINⅢ24例(11.3%),原位癌累及腺体伴早期浸润癌8例(3.8%)。术后195例(92.0%)宫颈标本边缘病理学检查未见CIN病变;术后降级者70例(33.0%),等级者122例(57.5%),升级者20例(9.4%);治愈率达89.2%。结论:LEEP治疗CIN安全有效、简单易行、并发症少、避免了二次手术和过度治疗,能保留患者的生育能力,在治疗的同时能进行诊断。但术后仍需定期和规范的随访以防止宫颈癌的发生和发展。     

医改与政府责任的伦理思考

在归纳医改失败原因的主流性意见和分析典型案例的基础上,揭示：医改失败的根本原因是趋利性临床决策和泛企业化卫生政策,形成机制是二者的共同作用,实质是医疗卫生服务与广大人民群众日益增长的健康需求和经济发展水平的不相适应,其中折射出政府责任伦理主要方面的缺位、不到位和不作为;医疗卫生服务的基本目标是社会公众利益的最大化,这是医疗卫生服务领域中始终应占主导地位的价值取向,当然也是医改中政府责任伦理的正确取向.     

基于对称边缘方向直方图自动提取主要道路

提出一种从航空影像中自动提取主要道路的方法。以对称边缘方向直方图作为主要道路特征矢量,先采用一种顾及数据空间分布特性的模糊C均值聚类算法分割提取主要道路种子段,然后利用Snakes算法跟踪提取完整主要道路网络。实验结果表明,所提方法能有效地从航空影像中自动提取主要道路网。     

利用EBSD技术分析高锰钢两相组织的结构与取向

利用EBSD取向成像技术初步分析了含锰15%的热锻态高锰钢和含锰20%的拉伸样品中的两相组织结构及取向特点。根据两相的取向及取向差分布分析了奥氏体与马氏体组织的织构特征;确定了含锰20%的高锰钢中大量的孪晶关系和形变时诱导出的马氏体有明显的取向选择性。     

支气管哮喘患者阶梯治疗的价值研究

目的:观察"全球哮喘防治创议(GINA)"--阶梯方案治疗哮喘患者的疗效及应用价值.方法:研究组64例哮喘患者按病情严重度分级,依照GINA方案制定相应的阶梯式治疗措施,对照62例哮喘患者按传统方法治疗,比较随访3年前后医疗费用及哮喘临床症状变化情况.结果:研究组治疗3年后的发作次数、咳嗽喘息天数、住院次数、FEV1及PEF值差异均有显著性差异(P＜0.01),与对照组比较也均有显著性差异(P＜0.05),研究组的医疗费用显著低于对照组(P＜0.05).结论:GINA方案防治哮喘比传统方法治疗效果显著,对于提高患者的生活质量,降低医疗费用具有重要意义.     

Avoidance of dental visits: the predictive validity of three dental anxiety scales

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corah's Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for nonattendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values (≤0.26), but high negative predictive values (≥0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point ≥13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was ≥15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level.     

Community orientation of general practitioners in 34 countries

General practitioners (GPs) are frontline health workers. They should be sensitive to the health needs of the community in addition to caring for patients that visit their practice. Due to changes in demography, epidemiology, ecology and healthcare policy, a community orientation becomes more important. Our research question is: to what extent does community orientation of GPs vary between countries and GPs and how can this variation be explained? We use cross-sectional survey data from the QUALICOPC study, conducted among over 7000 GPs in 34 countries. Community orientation was measured through a scale constructed from three survey questions on whether GPs would take action when confronted with: repeated accidents in an industrial setting, frequent respiratory problems in patients living near a certain industry, and repeated cases of food poisoning in the local community. Independent variables are at healthcare system level and GP or practice level. Data were analysed using linear multilevel regression analysis. Community orientation varies between GPs and countries. Community orientation is more frequent in healthcare systems with a list system, among self-employed GPs, those using medical records to make overviews, and those more active in prevention and multidisciplinary cooperation. GPs in rural areas and areas with more people from ethnic minorities are more community oriented. Based on the variation between countries and GPs, we would like to raise awareness and underline the importance of multidisciplinary cooperation.     

Drive-thru pharmacy services: A way forward to combat COVID-19 pandemic

Countries around the globe have responded to pandemic preparedness and developed strategies to cope with the COVID-19 crisis. In this context, the role of healthcare professionals is of paramount importance. Pharmacists are playing a vital role in dealing, preparedness, prevention, protection, promoting access to medicines and to improve health outcomes during this crisis. In this context, “Drive-thru” pharmacy services improve access to medicines while ensuring the preventive measures suggested by the World Health Organization. This commentary provides an overview of opportunities and challenges related to the implementation of “drive-thru pharmacy services” and their role in improving public health during this crisis.