现代中医药发展战略思考

建国几十年来，由于党和政府的大力提倡和扶持，中医药得到了很大发展，但相对于西医的发展势头仍显不足。尤其是近10多年来，由于现代科技及现代管理学的有力推动，西医获得了突飞猛进的发展，然而，中医却由于种种原因发展相对缓慢。在这各行各业竞相发展的现代社会，中医要生存，就蓝须发展，中医要发展，就妊须总揽全局，从战略高度克服中医药发展的各种不利因素，充分发挥各方面的有利条件。     

Establishing the Cost-Effectiveness of New Pharmaceuticals under Conditions of Uncertainty—When Is There Sufficient Evidence?

Decisions about which health-care interventions represent adequate value to collectively funded health-care systems are as widespread as they are unavoidable. In the case of new pharmaceuticals, many countries now require formal cost-effectiveness analysis to inform this decision-making process. This requires evidence on parameters associated with health-related utilities, treatment effects, resource use, and costs, for which data from available regulatory trials are invariably absent or highly uncertain. This uncertainty results from a number of factors including the predominance of intermediate end points in the clinical evidence-base and the limited period of follow-up of patients in clinical studies. Despite these imperfections in the evidence base, decisions about whether new pharmaceuticals are sufficiently cost-effective for reimbursement cannot be side-stepped. Data limitations do, however, require the use of rigorous analytical methods to support decision making. Probabilistic decision models and value of information analysis offer a means of structuring decision problems, synthesizing all available data, characterizing the uncertainty in the decision, quantifying the cost of uncertainty, and establishing the expected value of perfect information. This analytical framework is important because it addresses two fundamental questions about new pharmaceuticals. First, is the product expected to be cost-effective on the basis of existing evidence? Second, is additional research concerning the product itself cost-effective? In addressing these questions, the analytical framework can establish when sufficient evidence exists to sustain a claim for a new pharmaceutical to be cost-effective.     

Development of the Qualeffo–31, an osteoporosis-specific quality-of-life questionnaire

Introduction Vertebral deformities are a common consequence of osteoporosis and are known to decrease quality of life. The Qualeffo–41 is a quality-of-life questionnaire especially developed for measuring quality of life in patients with vertebral deformities. It consists of 41 questions arranged in five domains: pain, physical function, social function, general health perception, and mental function. The objectives of this study were: (1) to develop a shorter version of the Qualeffo–41 by removing redundant questions; and (2) to investigate the scale characteristics, reliability, and validity of this shorter version. Methods The study was performed using data from the Qualeffo validation study and the Multiple Outcomes of Raloxifene Evaluation (MORE) study. The analyses were performed in patients with vertebral deformities (n=579). Factor analysis on polychoric correlations and an item response theory (IRT) model, i.e., the generalized partial credit model (GPCM), were used to create a shorter version of Qualeffo–41. Using GPCM, scoring weights were computed for all items. Results Three items were removed from the data set because of too many missing values. Factor analysis identified three instead of five domains: (1) pain, (2) physical function, and (3) mental function. Five items had factor loadings <0.4 and were not included in the GPCM. After excluding several items, the domains pain (four items), physical function (18 items), and mental function (nine items) showed a good, reasonable, and excellent fit, respectively. This indicates that the mental function domain and the pain domain are more unidimensional than the physical function domain. All three domains showed a very high correlation (r ≥0.95) with the corresponding domains of the Qualeffo–41. Conclusions Qualeffo–31 was developed, consisting of three domains with a reasonable to excellent fit to the GPCM. Although the fit to the GPCM supports the construct validity of the Qualeffo–31, validation in a new study should be performed before using it in practice.     

溃疡散预防消化性溃疡复发临床观察

目的 :观察溃疡散对消化性溃疡的抗复发治疗的临床效果。方法 :随机将 80例患者分成溃疡散治疗组 (4 2例 )和雷尼替丁对照组 (38例 )并同时观察两组患者治疗前后溃疡复发情况。结果 :治疗后治疗组溃疡复发率明显低于对照组 ,P <0 .0 1,两组对比有非常显著性差异。结论 :治疗组能明显的改善患者临床症状和降低消化性溃疡复发率。     

清咽雾化液治疗咽喉炎的临床研究

清咽雾化液为紫红色澄明灭菌溶液，经９５例急慢性咽喉炎临床治疗观察，其临床痊愈率与显效率为８１．０４％，与对照组比较有显著差异。药效研究具有抗炎消肿、镇咳祛痰、改善微循环、增强免疫功能等作用。其可以提高患者唾液中ＩｇＧ水平，且具有统计学差异。     

我对子午流注阴阳盛衰转换的认识

阐述了时相与阴阳的关系，阴阳昼夜的盛衰转换与经脉循行、气血流注密切相关；对传统流注说和任督为主的阴阳循环说进行了分析，认为子午流注阴阳盛衰转换在妇科学中有重要意义，子午流注所指出的4个较重要的时期与月经周期中的4期(行经期、经后期、经间排卵期、经前期)相关。重视研究日相阴阳太极钟的变化，将能更加深入地认识月经周期中阴阳消长转化的规律变化，从而推动中医妇科学向前发展。     

股骨颈骨折几种闭合复位方法的评价(译文)

在股骨颈移位骨折的治疗中,试用了7种不同的闭合复位方法。其中Whitman's法在骨折床台上进行,正常肢体外展,患肢由屈曲牵引至完全伸直位后,维持牵引并外展到与对侧肢体相称位,单髋人字石膏外固定(1914年)。 Leadbetter's法也在骨折床台上进行。将患肢髋部屈曲90°,沿大腿轴线行手法牵引。同时股骨干稍内收,患肢缓慢行环形活动至外展、内旋位,患肢向下降至骨折床台面时,行跟掌试验以验证是否完全复位(1933年)。 Bozan's法利用骨折床台使双下肢维持在伸直位,大绷带放置在患肢髂嵴部位,小绷带放置在患肢腹股沟皱襞最高点处实施牵引。然后整个患肢极度内旋,在维持侧方牵引的同时,患肢外展并轻度过牵(1934年)。     

三个统一:21世纪中医学发展取向的思考

21世纪中医学的发展，面临着理顺民族性表述方式与国际性科学内涵关系的问题，因此必须辩证地把握结构与机能、实证科学手段与人文精神、过程与结果之间的谐调统一，这样既符合中医学术体系特征，又能与当代生命科学研究保持一致。     

原发性肝癌中医单证证型专家观点文献分析

目的整理原发性肝癌辨证分型文献中的专家观点,分析原发性肝癌各中医单证证型在专家观点中的出现状况,初步明确其主要的单证证型.方法对建国以来国内公开报道的有关原发性肝癌中医辨证分型的文献进行整理,运用χ2检验对文献中的专家观点进行统计分析.结果气滞(肝气郁结)型、血瘀型、脾气虚型、肝阴虚型、肾阴虚型、肝胆湿热型在专家观点中出现频率较高(均超过50%),它们之间没有显著性意义,但与其它出现频率较低的各单证证型相比,均有显著性差异(P<0.00091).结论原发性肝癌常见的中医单证证型依次为①气滞(肝气郁结)型;②血瘀型;③脾气虚型;④肝阴虚型;⑤肾阴虚型;⑥肝胆湿热型.