法医物证学实验室运行机制的探讨

法医物证学实验室运行机制的改革包括实验室管理体制的改革和实验教学的改革．笔者对高校法医物证学实验室的运行机制和管理体制模式做了一些探索和研究，提出了自己的观点和看法．     

A system of diagnostic codes for dental health care

OBJECTIVES: We set out to develop and implement a system of diagnostic codes for use in the computerized management information system of the Community Dental Services of the North York Public Health Department. METHODS: We received staff input on common diagnoses, reviewed other diagnostic systems and established criteria for an ideal coding system. The codes are consistent with the format of other classification systems used in dental management information in Canada. They were implemented in 1997-98. RESULTS: We developed a system of four-digit, numeric codes for dental diagnoses. The diagnostic codes are specific at the level of the patient, consistent with current evidence on the natural history and classification of diseases, consistent with conventional measures of oral conditions, and fit the paradigm of the Canadian system of treatment codes. In the first year, 91 percent of 6,740 patients had at least one diagnosis, with a mean of 2.5 per patient. The five most common diagnoses were smooth surface caries, pit and fissure caries, calculus, teeth with deep fissures, and gingivitis. CONCLUSIONS: We have developed a coding system for dental diagnoses that has achieved high use and provided more accessible information on the conditions seen by staff dentists.     

Solid-State Characteristics of Amorphous Sodium Indomethacin Relative to Its Free Acid

Purpose. Having previously studied the amorphous properties of indomethacin (IN) as a model compound for drugs rendered amorphous during processing, we report on the formation and characterization of its sodium salt in the amorphous state and a comparison between the two systems. Methods. Sodium indomethacin (SI) was subjected to lyophilization from aqueous solution, rapid precipitation from methanol solution, and dehydration followed by grinding to produce, in each case, a completely amorphous form. The amorphous form of SI was analyzed using DSC, XRD, thermomicroscopy and FTIR. The method of scanning rate dependence of the glass transition temperature, Tg, was used to estimate the fragility of the SI system. Enthalpy relaxation experiments were carried out to probe the molecular mobility of the SI system below Tg. Results. The amorphous form of SI formed by different methods had a Tg equal to 121°C at a scanning rate of 20°C/min. This compares with a Tgfor indomethacin of 45°C. Estimation of fragility by the scanning rate dependence of Tg indicates no significant differences in fragility between ionized and unionized forms. Enthalpy relaxation measurements reveal very similar relaxation patterns between the two systems at the same degree of supercooling relative to their respective Tg values. Conclusions. The amorphous form of SI made by various methods has a Tg that is about 75°C greater than that of IN, most likely because of the greater density and hence lower free volume of SI. Yet, the change of molecular mobility as a function of temperature relative to Tgis not very different between the ionized and unionized systems.     

Stepwise development of a clinical expert system in rheumatology

Summary The evaluation of computer expert systems, a promising diagnostic tool for future application in clinical medicine, is of great importance. We present here the evaluation of our expert system, RHEUMA. It is stressed, that repeated retrospective testing and updating of an expert system and its subsequent repeated assessment in clinical use and surroundings is mandatory. This increases the diagnostic accuracy of the system. For our system this is demonstrated under three separate conditions. In the first study the information available for the computer system (mainframe) came from medical histories only. Here an error rate of about 25% — similar to that of physicians themselves using the same information — was observed in 358 outpatients, compared to the final diagnoses of physicians also relying solely on information from medical histories. In a second step a completely new system on a personal computer was developed with all relevant diagnostic information. The error rate of this system (0.4%) was much too optimistic because the knowledge base was changed during the study, affecting about 30% of the 282 prospectively recruited outpatients. In a third step the efficacy of the expert system was tested in an additional hospital without the diagnostic involvement of the first testing clinic. The error rate of the system without changing the knowledge base reached 11% in 51 outpatients in this rheumatology clinic. This result reflects the diagnostic accuracy of the system today. Its ability to specify the same diagnoses which clinical experts reached approached 90%. Considerable time is needed for such prospective testing, with repeated updating of the knowledge base — in our case for both the two systems and field studies of 2 years each. Further prospective field testing with physicians not specialized in rheumatology and with a larger number of patients is necessary before the system can be used in clinical routine.Dedicated to Prof. Dr. N. Zöllner on the occasion of his 70th birthday     

临床合理用药监测系统平台建设意义及价值

本文就合理用药监测管理系统平台的应用背景和合理用药监测系统的价值和方式进行了总结概述,并阐述了通过实践就应用系统平台监测的主要效果。     

全自动细菌分析系统检测耐甲氧西林葡萄球菌的初步评价

采用琼脂筛选法、纸片扩散法和仪器法平行进行葡萄球菌苯唑西林敏感性的测定 ,同时进行微生物敏感性试验。结果显示 :MRS的分离率为 5 4.4% ,琼脂筛选法和仪器法两法对MRS检测的符合率为 96 .7%。MRS对万古霉素最敏感 ,敏感率 10 0 % ;呋喃妥因次之 (耐药率 0 .0 2 4% )。VITEK32型细菌分析系统可准确检测MRS。认为MRS以万古霉素治疗效果最佳 ,其次为呋喃妥因     

Indicators without a cause. Reflections on the development and use of indicators in health care from a public health perspective.

Indicators have a long history in public health. Since the end of the 18th century information on the health of communities has been gathered on a health system level and public health indicators have become more sophisticated over the vears. However, in many modern health care systems there is a separation between public health and health services. This paper discusses the need for integration and promotes a stronger public health orientation of health services. This has consequences for the nature of indicators on the health services level. The methodological problems of turning epidemiological data into management information for health services are discussed. The key message is that the health of the community should be the ultimate cause of all indicators.     

系统生物学与针灸学

目的探讨系统生物学在针灸学研究中的应用。方法概述系统生物学的概念、内涵和发展历史,分析系统生物学与针灸学研究的关系。结果系统生物学在针灸学研究中的应用可以包括针灸在靶器官及相关器官产生效应的构成成分及其相互关系研究,针灸穴效、时效、量效关系的研究,针灸效应生物模式分析,基于针灸研究的科学发现等。结论将系统生物学与针灸学研究相结合,不仅是针灸学研究新的切入点,也是系统生物学研究新的出发点,对当代针灸学和生命科学的发展都将产生深远的科学影响。     

Accommodative stimulus/response function in human amblyopia

Three parameters are essential to describe static accommodative behavior in a comprehensive, quantitative manner: the slope of the stimulus/response curve, the depth of focus, and the tonic response. These parameters were obtained in amblyopes, former amblyopes, strabismics without amblyopia, and normals. Results showed that the accommodative response in the amblyopic eye was characterized by a reduction in the slope of the stimulus/response curve and increased depth of focus. Similar abnormalities but of lesser magnitude were found in the non-dominant eye of some former amblyopes and some strabismics without amblyopia. Orthoptic therapy always increased the slope of the stimulus/response curve in the amblyopic eye. We believe that the reduced accommodative responses found in amblyopic eyes reflect a primary sensory loss over the central retinal region that occurs as a result of prolonged, early, abnormal visual experience associated with the presence of strabismus and/or anisometropia.