颈静脉孔区的显微解剖及定位标志研究

目的:研究颈静脉孔区的显微外科解剖,探讨寰椎横突(TPA)、头侧直肌、二腹肌沟、颈静脉突等解剖标志在颈静脉孔区病变手术中的定位意义。方法:成人头颈标本15例,男13例,女2例,红色乳胶灌注颈总动脉和椎动脉。手术显微镜下(×3～×30)逐层显露颈静脉孔区结构,明确该区显微解剖特征、相关的解剖标志及其定位意义。结果:颈静脉孔区多数重要的解剖结构均可以TPA为参照标志予以明确。二腹肌后腹位于其浅层。TPA的后方为枕下三角,三角内有椎动脉、椎静脉丛和颈1神经通过。头侧直肌起始于TPA的外表面,止于枕骨颈静脉突的下表面,可作为确定颅外颈静脉孔的解剖标志。茎突位于TPA的前方,颈内静脉、迷走神经、副神经、舌下神经穿行于茎突与TPA之间,颈内动脉位于颈内静脉的前内侧。二腹肌、颈静脉突、颈动脉嵴对定位面神经、颈静脉孔及舌咽神经等结构具有重要意义。结论:颈静脉孔区解剖结构复杂,利用寰椎横突、头侧直肌、二腹肌沟、颈静脉突等解剖标志有助于明确此区域重要的解剖结构,避免术中不必要的损伤。     

中国激光杂志社期刊封面设计的实践与思考

【目的】 总结科技期刊封面设计流程管理模式并探讨其中的相关问题,为同行提供经验借鉴。【方法】 从版面、设计风格等方面对科技期刊封面图片的特征进行归纳。以中国激光杂志社期刊封面为例,总结封面设计流程管理模式,探讨封面设计过程中的相关问题。【结果】 期刊应对封面的主题策划、生产流程、版权保护等方面进行有效的流程管理。此外,就封面设置及风格、元素文化、版权意识、与设计公司合作等问题进行思考总结。【结论】 科技期刊可通过合理的封面设计流程,将科技与艺术融合,更准确地传播前沿科技成果,并弘扬中国传统文化。     

医院重大建设工程项目全过程跟踪审计成果转化探析

以湛江中心人民医院迁建工程项目为例,剖析项目全过程跟踪审计的各层级关系和作用。医院重大建设工程项目审计成果的生成和转化,要以国家审计为主导、社会审计为补充、内部审计为保障,齐抓共管,闭环整改,达到全过程跟踪审计的预期效果。     

Bayesian semiparametric joint modeling of longitudinal explanatory variables of mixed types and a binary outcome

Many prospective biomedical studies collect longitudinal clinical and lifestyle data that are both continuous and discrete. In some studies, there is interest in the association between a binary outcome and the values of these longitudinal measurements at a specific time point. A common problem in these studies is inconsistency in timing of measurements and missing follow-ups which can lead to few measurements at the time of interest. Some methods have been developed to address this problem, but are only applicable to continuous measurements. To address this limitation, we propose a new class of joint models for a binary outcome and longitudinal explanatory variables of mixed types. The longitudinal model uses a latent normal random variable construction with regression splines to model time-dependent trends in mean with a Dirichlet Process prior assigned to random effects to relax distribution assumptions. We also standardize timing of the explanatory variables by relating the binary outcome to imputed longitudinal values at a set time point. The proposed model is evaluated through simulation studies and applied to data from a cancer survivor study of participants in the Women's Health Initiative.     

补肾益智方治疗阿尔兹海默病的研究进展

阿尔茨海默病（AD）是最常见的痴呆形式,目前缺少疾病修饰性的治疗药物。中医理论认为肾精亏虚是AD发生发展的内在机制,补肾益精是中医治疗AD的基本原则,贯穿AD治疗的始终。补肾益智方是治疗AD的临床经验方。补肾益智方治疗AD已有大量文献报道,但补肾益智方缺乏临床应用安全性评价,同时其基础研究薄弱,有效成分不明、多靶点作用机制不清。为阐明补肾益智方多成分、多靶点、多途径治疗AD的作用机制,该文综述了补肾益智方治疗AD的研究进展。进一步收集了16个基于高效液相色谱指纹图谱的补肾益智方主要化学成分,并对其成药性与安全性进行评价。利用基于AD重要病理生理学过程的网络药理学与文献综述相结合的方法,深入分析了补肾益智方靶向胆碱能系统、AD神经病理学特征的有效成分及可能机制。该研究为AD对症治疗、疾病修饰性治疗的药物研发提供了一系列有潜力的先导化合物,并为深入拓展补肾益智方的临床应用提供了理论依据。     

肺结核专科护理质量评价指标体系的构建

目的：构建肺结核专科护理质量评价指标体系,为肺结核临床护理质量管理提供参考依据。方法：以Donabedian的“结构–过程–结果 ”三维质量评价模型为理论基础,通过文献检索、德尔菲专家函询法、层次分析法确立肺结核专科护理质量评价指标体系。结果：共有45名专家完成两轮函询,问卷有效回收率均为100%;专家权威系数（Cr）分别为0.822和0.859;两轮函询肯德尔协调系数（Kendall’s W）分别为0.140～0.379和0.107～0.665,P均<0.01。根据条目筛选标准、专家意见及院内外专家小组会议讨论结果,确立终版评价指标体系含一级指标3项,二级指标18项,三级指标73项。结论：肺结核专科护理质量评价指标体系结构合理,构建过程科学、可靠,可为肺结核专科护理质量管理及专业学科发展提供理论参考。     

Teacher Evaluation of an Experiential Vegetable Education Program for Australian Primary Schools: Does Face-to-Face Training Add Value above Digital Training?

The teacher-led implementation of healthy eating programs in schools is cost-effective and potentially impactful. Teacher acceptability is important for uptake; however, process evaluations are scarce. This study evaluated the effect of two intensities of teacher training on the evaluation of a vegetable education program for Australian primary schools by teachers. The teachers (n = 65) who implemented the program as part of a cluster RCT (25 schools in two states, New South Wales and South Australia) received either low- (provision with materials and online training) or high (additional face-to-face (F2F) training)-intensity training prior to implementing a 5-week vegetable education program. They evaluated the acceptability of a digital training module and program by indicating the level of agreement with 15 and 18 statements, respectively, using 5-point Likert scales. The average item scores ranged from 3.0 to 4.2. All but one item, including student engagement, alignment to the curriculum and intent for reuse of the program, had a rounded average or median score of 4. The level of training intensity did not impact the teacher acceptability ratings. In conclusion, the teacher acceptability was good, and additional F2F training does not add value above the solely digital training of the teachers.     

A Multidisciplinary,Community-Based Program to Reduce Unplanned Hospital Admissions

ObjectivesTo evaluate the effect of Hospital Admission Risk Program (HARP) on unplanned hospitalization, bed days, and mortality of enrolled individuals and to evaluate the cost-effectiveness of HARP.DesignA retrospective longitudinal analysis of hospital administrative data.InterventionIndividuals at risk of hospitalization were provided with multidisciplinary, community-based care support managed by care coordinators including integrated care planning, education, monitoring, service linkages, and general practitioner liaison over 6-9 months.Setting and ParticipantsIndividuals who were enrolled into 1 of 8 HARP chronic disease management programs between July 1, 2017, and June 30, 2018, at the Royal Melbourne Hospital, Australia.MethodsHospital admissions between 18 months before and 18 months after HARP enrollment were analyzed. Total hospital costs were compared between 18 months before and 12 months after HARP enrollment.ResultsA total of 1553 individuals with a median age of 71 years (interquartile range 60-81), 63.4% males, were admitted to HARP. Both unplanned hospitalizations and bed days were reduced during the HARP intervention compared to within 3 months before enrollment in each of the HARP management programs. After the HARP intervention, cardiac coach, cardiac heart failure, chronic respiratory, diabetes comanagement, and medication management programs had higher hospitalizations and bed days than individuals’ baseline of at least 3 months before HARP enrollment. Individuals in cardiac heart failure and chronic respiratory management programs had a higher mortality rate than other HARP chronic disease management programs. Individuals in cardiac coach, diabetes comanagement, and medication management programs had lower hospital costs during the HARP intervention compared to within 3 months before HARP enrollment.Conclusions and ImplicationsHARP reduced unplanned hospitalization and bed days but did not return individuals’ hospital use to baseline before the intervention. The variations in mortality between HARP chronic disease management programs implies that condition-specific goals between programs is preferable.     

基于德尔菲法的护理人员医院感染防控能力评价指标体系构建

 目的 构建护理人员医院感染防控能力评价指标体系,为培养及评价护理人员感染防控能力提供客观标准。方法 通过文献查阅和半结构式访谈法拟定护理人员医院感染防控能力评价指标草案,筛选并邀请全国20名感染防控、护理管理、感染性疾病等领域专家采用德尔菲法对草案进行修改,采取层次分析法确定最终指标权重。结果 两轮咨询专家积极系数均为100%,权威系数分别为0.874、0.882;肯德尔和谐系数在0.139~0.545,两轮专家咨询最终确定了包括一级指标3项、二级指标10项、三级指标28项的护理人员医院感染防控能力评价指标体系。结论 研究构建的护理人员医院感染防控能力评价指标体系,可为护理人员医院感染防控能力培训、评价提供依据。     

药用辅料在制剂中的应用概述

药用辅料是药物制剂的基础材料的重要的组成部分,在制剂型和生产中起着关键作用,它不仅赋予药物一定剂型,并且与提高药物的疗效,降低毒副作用有很大的关系,因此,研究开发,合理应用辅仅可提高药物制剂质量和生产技术水平,而且可取得较大的社会及经济效益。