国家药典收载品种与其他标准品种在我院利用度比较分析

目的：对比分析《中国药典》（ChP）标准药物和非ChP标准药物在我院临床应用中其品规数、年消耗金额、年用药频次（DDDs）和日均费用（DDDc）4项药物利用指标的差异。方法：采用回顾性分析方法,收集我院2011~2013年4项药物利用研究数据,并依据其质量标准分别分为ChP药物和非ChP药物两个变量组,利用SPSS 18.0软件,采用对照t检验,分析组间各项指标差异性,显著差异水平P＜0.05。结果：与非ChP组比较,ChP组的品规数与DDDs没有显著差异（P>0.05）,但消耗金额前者显著低于后者（P＜0.05）;ChP药物组的DDDc十分显著低于非ChP药物（P＜0.01）。结论：ChP的药物利用研究指标在医院并不占主导地位,但其DDDc较低,提示应通过适宜政策逐步加强药典的权威性,以引导社会包括临床医生和患者对ChP药物的选择。     

miR-206与心血管疾病研究进展

微小RNA(microRNA,miRNA)是一大类短链非编码RNA,可以直接结合靶基因的3′非翻译区,进而影响基因表达,在心血管疾病中发挥关键作用。其中,microRNA-206(miR-206)是心脏发育和生理活动的关键调控因子,不仅可以作为诊断的标志分子,也可作为疾病治疗的定向作用点。本文综述了miR-206调节心肌细胞、内皮细胞、平滑肌细胞、自主神经细胞等细胞的基本功能,以及miR-206在冠状动脉疾病、心肌梗死、心力衰竭、心律失常、肺动脉高压等疾病发生发展中的具体作用和机制。     

超声引导锁骨下静脉置管对导管相关性血流感染控制研究

目的采用高频彩色多普勒超声实时引导锁骨下静脉精确置管对导管相关性血流感染发生率影响的临床研究,降低导管血流感染发生率。方法将实施锁骨下静脉精确置管的48例患者随机分为观察组和对照组,每组各24例,其中观察组采用高频彩色多普勒超声显像进行锁骨下静脉精确置管;而对照组则采用常规的方法进行置管,对所得的相关数据均采用SPSS13.0软件进行分析处理。结果两组患者临床资料比较差异无统计学意义;观察组锁骨下静脉精确置管一次成功23例占95.83%,对照组一次成功18例占75.00%;置管操作时间<2min者观察组21例、对照组9例;出现并发症观察组2例占8.33%、对照组7例占29.17%;置管一段时间后进行血液细菌检查,结果显示观察组感染1例占4.17%、对照组感染3例占12.50%;4个指标观察组与对照组对比差异均有统计学意义(P<0.05)。结论采用高频彩色多普勒超声引导锁骨下静脉精确置管和常规置管相比操作简便安全、异常成功率较高、并发症和感染率比较低,在临床上对于锁骨下静脉精确置管有一定的临床指导意义。     

基于知识图谱的城市生活垃圾研究前沿分析

从文献计量学的角度对城市生活垃圾研究进行分析。以Web of Science(SCI、SSCI)中1998—2013年收录的城市生活垃圾相关研究的论文及其引文数据为基础,分析相关文献的期刊分布特点,并利用信息可视化技术和工具(Cite Space),展开文献计量分析、聚类分析及共引分析,分析结果以知识图谱的形式展现了城市生活垃圾研究的知识结构特点,得出了该研究领域的研究前沿及其演变规律。     

抗肝纤维化药物治疗研究进展

肝纤维化（Liver fibrosis）是指各种损害因素导致的肝内结缔组织异常增生，汇管区和肝小叶内有大量纤维组织沉积，其中以Ⅰ、Ⅲ型胶原纤维为主，进一步发展可导致肝硬化。其病理机制主要在于肝星状细胞活化，细胞外基质代谢失衡。肝纤维化病理机制复杂，涉及因素较多，治疗上也就有广义与狭义的概念。     

Elective Percutaneous Coronary Intervention in Ambulatory Surgery Centers

ObjectivesThe aim of this study was to explore characteristics and outcomes of patients undergoing elective percutaneous coronary intervention (PCI) in ambulatory surgery centers (ASCs).BackgroundLittle is known about patients who underwent ASC PCI before Medicare reimbursement was instituted in 2020.MethodsUsing commercial insurance claims from MarketScan, adults who underwent hospital outpatient department (HOPD) or ASC PCI for stable ischemic heart disease from 2007 to 2016 were studied. Propensity score analysis was used to measure the association between treatment setting and the primary composite outcome of 30-day myocardial infarction, bleeding complications, and hospital admission.ResultsThe unmatched sample consisted of 95,492 HOPD and 849 ASC PCIs. Patients who underwent ASC PCI were more likely to be younger than 65 years, to live in the southern United States, and to have managed or consumer-driven health insurance. ASC PCI was also associated with decreased fractional flow reserve utilization (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.20 to 0.48; p < 0.001). In unmatched, multivariate analysis, ASC PCI was associated with increased odds of the primary outcome (OR: 1.25; 95% CI: 1.01 to 1.56; p = 0.039) and bleeding complications (OR: 1.80; 95% CI: 1.11 to 2.90; p = 0.016). In propensity-matched analysis, ASC PCI was not associated with the primary outcome (OR: 1.23; 95% CI: 0.94 to 1.60; p = 0.124) but was significantly associated with increased bleeding complications (OR: 2.49; 95% CI: 1.25 to 4.95; p = 0.009).ConclusionsCommercially insured patients undergoing ASC PCI were less likely to undergo fractional flow reserve testing and had higher odds of bleeding complications than HOPD-treated patients. Further study is warranted as Medicare ASC PCI volume increases.     

Révéler des violences sexuelles subies dans l’enfance à un professionnel de santé : une métasynthèse

ObjectiveChild sexual abuse is a major public health issue, and disclosure of such abuse to a healthcare professional could mitigate its impact on the survivor's life. Qualitative studies are relevant in this context, focusing as they do on the lived experience of the stakeholders, victims and professionals. We aimed to conduct a metasynthesis, i.e. a systematic review and analysis of qualitative studies, exploring the qualitative literature about the lived experience of child's sexual abuse disclosure.Method and data sourcesFour databases and two journals were screened (Medline, PsycINFO, EMBASE, SSCI, Journal of Sexual Abuse and Child Abuse and Neglect) so as to identify studies concerning the lived experience of child sexual abuse disclosure from the point of view of survivors or healthcare professionals or both. We used the “Critical Appraisal Skills Program” to assess the methodological quality of each article and performed a thematic analysis of the data extracted to identify key themes and synthesize them.ResultsTwenty-six articles were included, covering data from 673 participants (333 survivors, adult at the time of the study; 122 survivors still minor at the time of the study and 218 health professionals). Data analysis produced three themes: (1) to reveal or not to reveal, (2) the narrative of the disclosure by the participants, (3) positive and negative outcomes of the disclosure. Our results show that, on the one hand, health professionals and minor survivors both have a negative experience of disclosure that could impede the process. On the other hand, some adult survivors underlined the importance and the positive impact of such disclosure to a healthcare professional.ConclusionWe identified a gap in the literature regarding disclosure of such abuse within child and adolescent psychiatry services and drew research perspectives. Concrete clinical implications can also be drawn from our results, especially the involvement of adult survivors within the training of concerned healthcare professionals so as to raise awareness among them and help them better cope with the disclosure process.     

Research: Ageing,social capital and the Internet: Findings from an exploratory study of Australian ‘silver surfers’

Objective: To document the sociodemographic characteristics and online use patterns of older Australian Internet users as part of an exploratory study of the relationship between Internet communication and access to social capital in later life. Methods: A purposive sample of 154 Internet users aged 55 years or older and not employed full time completed an electronic survey about their social characteristics and patterns of Internet use. A subsample of 30 participated in follow‐up in‐depth interviews. Results: The majority of participants comprised married, home‐owning, English‐speaking women and men in good health. They made extensive use of the communication and information functions of the Internet to supplement and enhance their connections with friends and family and their engagement with wider social networks. Conclusion: Policy development should be informed by better understanding of the potential and limitations of the Internet as a tool for generating and sustaining social capital in old age.     

Lessons Learned about Implementing Research Evidence into Clinical Practice

The mission of the Veterans Health Administration's (VHA) quality enhancement research initiative (QUERI) is to enhance the quality of VHA health care by implementing clinical research findings into routine care. This paper presents lessons that QUERI investigators have learned through their initial attempts to pursue the QUERI mission. The lessons in this paper represent those that were common across multiple QUERI projects and were mutually agreed on as having substantial impact on the success of implementation. While the lessons are consistent with commonly recognized ingredients of successful implementation efforts, the examples highlight the fact that, even with a thorough knowledge of the literature and thoughtful planning, unexpected circumstances arise during implementation efforts that require flexibility and adaptability. The findings stress the importance of utilizing formative evaluation techniques to identify barriers to successful implementation and strategies to address these barriers.     

桉柠蒎肠溶软胶囊联合糠酸莫米松治疗慢性鼻炎的疗效观察

目的探讨桉柠蒎肠溶软胶囊联合糠酸莫米松治疗慢性鼻炎的临床效果。方法选取2017年1月—2018年8月西安医学院第二附属医院收治的134例慢性鼻炎患者,随机分成对照组(n=67)和治疗组(n=67)。对照组给予糠酸莫米松鼻喷雾剂,鼻腔给药,每侧鼻孔2揿/次,1次/d。治疗组患者在对照组基础上口服桉柠蒎肠溶软胶囊,1粒/次,2次/d,于餐前0.5 h用凉开水整粒吞服。两组均连续治疗4周。比较两组临床疗效、治疗前后鼻部主要症状评分、鼻腔鼻窦结局测试-20(SNOT-20)评分、DIP内镜评分、总鼻阻力(TNR)值、鼻声反射参数[鼻腔最小横截面积(NMCA)、0～5 cm鼻腔容积(0～5cmNCV)]值及鼻灌洗液炎症细胞计数变化及随访复发率。结果治疗组总有效率为95.5%显著高于对照组83.6%(P0.05)。两组治疗后鼻塞评分、鼻涕评分及SNOT-20总分均显著低于治疗前(P0.05),且治疗组下降更显著(P0.05)。与治疗前对比,两组治疗后DIP内镜评分系统中各项(炎症、分泌物、息肉/水肿)评分及其总分均显著降低(P0.05);但治疗后,治疗组以上DIP内镜评分均较对照组同期显著更低(P0.05)。两组治疗后TNR较治疗前均显著减小(P0.05),NMCA和0～5cmNCV则均显著增大(P0.05);且治疗组上述参数的改善效果均更显著(P0.05)。两组治疗后鼻灌洗液EOS和LYM计数均显著低于治疗前(P0.05),而治疗组鼻灌洗液以上炎症细胞计数均显著更少(P0.05)。随访6个月,治疗组复发率3.0%显著低于对照组14.9%(P0.05)。结论桉柠蒎肠溶软胶囊联合糠酸莫米松治疗慢性鼻炎的整体疗效显著,能明显缓解患者鼻部症状和体征,改善鼻腔通气功能,减轻鼻腔炎症反应,降低复发风险,具有一定的临床推广应用价值。