Pediatric lupus versus adult lupus role of the laboratory

Systemic lupus erythematosus (SLE) is the archetypical immunologic disease. Approximately 20% of patients present in the first two decades of life. This article highlights some of the differences between pediatric and adult onset lupus.Children are defined as different from adults on the basis of age. Lupus presents with different gender ratios based on hormonal or pubertal status with more significant skewing toward female patients in the childbearing years. Female patients in the childbearing years appear to have a higher relative risk for mortality. Despite this, children have greater disease severity at onset based on the number of patients who present with significant organ inflammation, the amount of corticosteroids required and the abnormalities in lupus serologies including autoantibodies and low complements. Children present frequently with congenital and acquired complement defects. Children have an increased risk of infections that can be confused with lupus. They have a higher risk of serious pneumococcal infection and may have less protection from vaccinations received at the time of disease onset.The clinical immunology laboratory is critical in the diagnosis and treatment of pediatric SLE. The rapid analysis and transfer of laboratory results can be life saving for the child with suspected new onset lupus. The laboratory is also helpful in determining disease activity through analysis of immunologic trends over time in pediatric lupus patients. This is especially important in the noncompliant adolescent patient who has a correlation between disease activity and lupus serologic tests. Finally, the clinical immunology laboratory is an important tool for better understanding of the immunologic phenomena associated with lupus and of disease pathophysiology.     

中西医联合治疗单纯疱疹性角膜炎的疗效观察

目的 :探讨单纯疱疹性角膜炎是中西医联合用药的治疗方法。方法 :本组 10 0例 ( 10 6只眼 )单纯疱疹性角膜炎患者应用抗病毒药物联合清热解毒中药的疗效观察。结果 :本组病例治疗后总有效率 82 .0 8%。结论 :中西医联合治疗措施是我们对单纯疱疹性角膜炎治疗的一项新的探讨。     

The development and evaluation of Student Training, Education and Practice for Dietetics CD-ROM: a computer-assisted instruction programme for dietetic students

The Student Training, Education and Practice for Dietetics (STEP‐DIET) CD‐ROM was developed at the University of Surrey to prepare dietetic students for the practical dietetic training component of their Nutrition/Dietetics degree. This study aimed to evaluate student response to the programme and its effectiveness as a teaching tool, based on the evaluation framework of D.L. Kirkpatrick (Evaluating a Course, 2nd edn. London, Kogan Page). Quantitative and qualitative methodologies were employed, with 41 dietetic students, separated by year group, completing questionnaires and taking part in six focus groups, at the University of Surrey. Student attitudes towards the instruction method and the STEP‐DIET programme itself were investigated, in conjunction with their perceived learning achievements. Students rated the programme highly in terms of design and content, however, there was a reluctance to accept computer‐assisted instruction (CAI) as a sole teaching method. A number of learning achievements relevant to dietetic practice were reported including a perceived increase in ability to conduct a dietetic interview and an increased understanding of the management of Type 2 diabetes. In general students reacted positively to the STEP‐DIET programme and it was perceived by students to be effective in preparing them for the practical component of their dietetic training.     

子宫颈癌226例临床病理分析

目的：探讨宫颈癌的临床、病理特点、诊治方法及预后因素。方法：收集1996年1月至2001年1月226例宫颈癌患者进行回顾性分析。结果：平均患病年龄为48．18岁。130例患者为阴道流血，70例为阴道流液，25例下腹疼痛，l例精神减退、贫血、浮肿。病理分期：Ⅰ期病例数为169例(75％)；Ⅱ期病例数为3l例(13．72％)；Ⅲ期病例数为23例(10．18％)；Ⅳ期病例数为3例(1．1％)。比较2l例宫颈鳞癌与宫颈腺癌的转移，显示后者的腹主动脉旁淋巴结转移、肾上腺转移、子宫转移、胸水形成明显高于前者。结论：重视宫颈癌发病相关因素及临床症状，争取早期诊断，严格手术病理分期，选择适当治疗方案。     

多站点综合性毕业考试的改革与实践

我校改革临床医学专业毕业考试模式与方法，在临床实习过程中组织多站点综合性考试，采用闭卷笔试方法考核临床理论知识，占70％；采用实践操作与现场口试方法考核临床技能及相关知识，占20％；采用开卷笔试方法考核医疗文书书写，占10％。实践证明，此项改革能促进医学生端正实习态度，调动实习的积极性与主动性，引导医学生在实习中重视理论学习与临床实践的密切结合，促进临床教学质量的提高。     

临床科室工作量评价方法及其应用

目的：探讨测量、评价临床科室工作量的指标和方法，加强医院科室管理，促进效益评价与核算。方法：应用医院病案和报表资料，每月计算科室工作强度指数并进行排位，用相对比方法初步分析科室临床工作量和排位变动的状况。结果：选取了实际占用床位数、危重病人抢救次数、门急诊人次数、出会诊人次数、出院病人数5项指标，计算出各科室工作强度指数和排位，并对各科室工作量排位变动进行了比较。结论：临床工作量评价指标和方法的代表性、灵敏性和可靠性较好，实际评价效果也较客观地反映了各临床科室的实际工作量大小。     

胸腰段椎间盘突出症诊断的临床研究

目的探讨胸腰段椎间盘突出症临床表现的特点与规律，提高胸腰段椎间盘突出症的诊断水平。方法回顾性分析1995年9月～2004年1月我院经X线、CT、MRI及手术证实的胸腰段椎间盘突出症65例的临床资料，并将其分为低位胸椎组（T10-T12L1）43例，高位腰椎组（L1-2-L2-3）16例，多节段突出组6例。结果躯体感觉障碍89．2％（58／65）和下肢无力83．1％（54／65）是最多见的症状。9．2％（6／65）表现为上运动神经元损害，47．7％（31／65）表现为下运动神经元损害，43．1％（28／65）表现为上、下运动神经元混合性损害。仅3例为单根神经根损害，其余表现为多根神经或马尾神经的损害。腰背痛44．6％（29／65）和下肢无力40．0％（26／65）是最常见的首发症状。低位胸椎间盘突出以混合性运动神经元损害为主，占58．1％（25／43），易导致行走障碍、足下垂、下肢肌张力升高和病理征阳性；而高位腰椎间盘突出则以下运动神经元损害为主，占93．8％（15／16），易造成腰背、下肢疼痛及马尾神经损害。结论胸腰段椎间盘突出症的症状广泛、体征多样，当临床上存在以下情况时应高度怀疑胸腰段椎间盘突出症：①大腿前方、外侧或腹股沟部位出现感觉障碍者；②下肢无力，股四头肌，胫前肌肌力减退者（如足下垂）；③下肢运动或感觉障碍范围广泛、不规则，缺乏根性分布特征者；④上、下运动神经元损害同时存在，或虽表现为下运动神经元损害，但难以用低位腰椎间盘突出症解释者。     

网络模式下临床医师绩效评价指标体系研究

为了充分利用医院信息网络信息，更为全面、客观地对医生进行评价，阐述建立网络模式下临床医师绩效评价指标体系的原则、方法，并对的建立指标体系的可信度及合理性进行了分析。     

A comprehensive strategy for the evaluation and triage of the chest pain patient: A cost comparison study

BACKGROUND: Our objective was to determine the cost-effectiveness of a comprehensive, risk-based triage system, composed of multiple critical pathways, with the use of early myocardial perfusion imaging (MPI) in low-risk patients. We found previously that a chest pain evaluation system that uses MPI in low-risk patients was safe and effective, but the cost-effectiveness of this approach was not studied. METHODS AND RESULTS: We compared two groups. The Acute Cardiac Team (ACT) group (n = 874) was assigned prospectively to 1 of 4 risk levels by emergency department (ED) physicians. Level 1, 2, and 3 patients were admitted; level 4 patients were evaluated in the ED. Level 3 and 4 patients underwent ED MPI. The control group (n = 713) represented consecutive patients evaluated in the prior year according to standard care and assigned retrospectively to an ACT level based on the presenting electrocardiographic and clinical data. Record and hospital administrative data were assessed for clinical variables, outcomes, lengths of stay, and all expenses incurred within 30 days of the index visit. The baseline characteristics of the two groups were similar, including age, sex, myocardial infarction prevalence, and 30-day revascularization rates within each level or between the two groups. Mean costs per encounter were reduced for the ACT patients for each level, which was significant when all patients were compared ($5,030 +/- $7,081 vs $6,044 +/- $10,432, P =.02). Use of MPI in the low-risk patients was associated with reduced costs (level 3, $4,958 +/- $4,948 vs $5,051 +/- $7,036; level 4, $1,529 +/- $2,664 vs $1,794 +/- $6,854) and was associated with a significantly lower angiography rate and shorter length of stay. CONCLUSIONS: Implementation of a comprehensive strategy for chest pain evaluation and triage reduced overall costs for patients with chest pain on presentation. Acute MPI in the ED setting did not increase net cost.     

Scientific quality of clinical research an analysis of 40 research projects in pharmacology/pharmacotherapy

Objective: The scientific quality of research is an important ethical issue. To clarify the quality of research projects in pharmacotherapy/pharmacology, 40 randomly selected research projects in pharmacotherapy/pharmacology submitted to a research ethics committee were reviewed. Results: Eight of the projects would not have contributed new knowledge nor were they necessary as controls for the results of previous research. Fifteen of the research protocols were of good quality, 15 could be used after revisions, and 10 were unfit for use. Eleven of the research projects were not finished 5 years after they were started. A written report was produced from 26 of the projects. Nine were of good quality and could be accepted for publication in a medical journal, 10 of the reports were in need of revision before publication, and 7 should not be accepted for publication. Conclusion: Research in this field ought to be improved, and ways to improve the standard of clinical trials in pharmacotherapy are dicussed. Received: 1 April 1996 / Accepted in revised form: 28 June 1996