A process evaluation of implementing a vocational enablement protocol for employees with hearing difficulties in clinical practice

Objective: A multidisciplinary vocational rehabilitation programme, the Vocational Enablement Protocol (VEP) was developed to address the specific needs of employees with hearing difficulties. In the current study we evaluated the process of implementing the VEP in audiologic care among employees with hearing impairment. Design: In conjunction with a randomized controlled trial, we collected and analysed data on seven process parameters: recruitment, reach, fidelity, dose delivered, dose received and implemented, satisfaction, and perceived benefit. Study sample: Sixty-six employees with hearing impairment participated in the VEP. The multidisciplinary team providing the VEP comprised six professionals. Results: The professionals performed the VEP according to the protocol. Of the recommendations delivered by the professionals, 31% were perceived as implemented by the employees. Compliance rate was highest for hearing-aid uptake (51%). Both employees and professionals were highly satisfied with the VEP. Participants rated good perceived benefit from it. Conclusions: Our results indicate that the VEP could be a useful treatment for employees with hearing difficulties from a process evaluation perspective. Implementation research in the audiological setting should be encouraged in order to further provide insight into parameters facilitating or hindering successful implementation of an intervention and to improve its quality and efficacy.     

中西医结合要为妇女生殖健康创新页

45年来,复旦大学妇产科医院在中西医结合临床及科研方面取得了可喜的成就.针刺促排卵的研究,通过观察血雌激素和中枢β-内啡肽(β-EP)的关系,提出了针刺通过耗竭中枢β-EP而促排卵的新认识,认为针刺促排卵的主要适应症是青春期月经失调,并将针刺成功地应用于治疗神经性厌食;补肾化痰的俞氏温补方治疗多囊卵巢综合征(polycystic ovary syndrome, PCOS)被证实是通过提高血促卵泡激素(follicle stimulating hormone, FSH)并诱发排卵而起作用;益肾化瘀的天癸方是通过降低患者及动物模型的雄激素和胰岛素,引起以中枢阿片促黑激素皮质素原、神经肽Y和瘦素受体为主的神经-内分泌-代谢网络调节而发挥促排卵和减肥作用,对高胰岛素型PCOS有良效,并在研究中提出了对PCOS分类的新设想;益肾清火的更年春通过提高中枢与周围组织的雌激素受体及其mRNA表达来调节围绝经期妇女的神经-内分泌-免疫-代谢网络而获优越疗效.这些研究表明,疾病是外环境影响下患者生命网络的某些主脉失调所致,而且亚健康状态的妇女具有初步网络失控的现象,中西医结合将为女性生殖医学研究找到捷径,调控生命网络是防病治病的主要思路.     

复方麝香注射液联合脑血肿引流术治疗中老年高血压脑出血疗效观察及费用对比

目的:探讨复方麝香注射液联合微创手术治疗中老年高血压脑出血的临床疗效.方法:将78例接受微创治疗的患者随机分组,两组均采用内科综合治疗.手术对照组在综合治疗基础上加用微创手术进行脑血肿引流;中西医结合组在微创手术治疗后加用复方麝香注射液(10～20 ml/d)静脉滴注1周.结果:中西医结合组显效率(66.67%)、有效率(82.05%)均明显高于手术对照组(46.15%和69.23%,P均<0.05),存活患者日常生活能力也明显优于手术对照组(P<0.05),意识恢复时间明显短于手术对照组(P<0.05),并发症的发生率(15.38%)明显低于手术对照组(38.46%,P<0.01),病死率(5.13%)明显低于手术对照组(10.26%,P<0.01),平均住院天数[(18.29±4.93)d]明显少于手术对照组[(26.23±5.82)d,P<0.05],平均住院费用[(5 916.23±826.39)元]明显少于手术对照组[(8 168.35±1 021.21)元,P<0.05].结论:脑血肿引流术后加用复方麝香注射液治疗中老年高血压脑出血,可降低病死率,减少并发症,降低病残程度,提高生存患者的生活质量,缩短住院时间,降低治疗费用.     

集成电路芯片生产的职业病危害特点

目的 研究集成电路芯片制造中作业人员的操作特点、接触职业病危害种类以及事故类型。方法 对集成电路芯片制造的生产流程、职业病危害及接触状况的资料进行收集整理。结果 根据生产流程中使用的设备及芯片制造所用原辅材料，论述了生产过程中各设备和操作工序涉及的各类高度、中度毒性化学物质、工艺特殊气体以及电离辐射和非电离辐射等职业病危害因素、作业人员操作特点和易发事故种类。结论 集成电路芯片制造中职业病危害问题值得关注。     

Developing policy in the provision of parenting programmes: integrating a review of reviews with the perspectives of both parents and professionals

Background   Parenting programmes are a key component of the delivery of children's services, but evidence-based policy has often proved difficult to implement.
Methods   The present review addressed this issue by integrating a review of systematic reviews of parenting programmes and a series of focus groups with parents and professionals involved in parenting across three agencies in a regional area (health, education and social work). The review summarizes parenting interventions targeting infant mental health, emotional and behavioural difficulties, autism spectrum disorder and attention deficit hyperactivity disorder, abuse/neglect, alcohol/substance abuse and 'vulnerable' parents. The focus groups discussed topics such as the range of parenting services across the three agencies, accessibility, gaps in the service and future directions.
Results and conclusions   Twenty systematic reviews were summarized. These reviews demonstrated that there is a wide range of parenting programmes available that have the potential to benefit families who are affected by problems ranging from emotional and behavioural difficulties to adolescent substance abuse. However, the findings of the focus groups reveal that the success of these programmes will depend in part on how they can be tailored to meet the social context of the families targeted. These integrated findings are discussed in terms of their implications for policy and practice.     

中西医结合治疗寻常性痤疮的临床观察

目的 :探讨中西医结合治疗寻常性痤疮的临床疗效。方法 :将 10 5例寻常性痤疮患者随机分为中西医结合治疗组和西药治疗对照组 ,分别应用中西药结合治疗和西药治疗 ,治疗后观察两组的临床疗效及皮损变化情况。结果 :中西医结合治疗组痊愈率、显效率及皮损消退情况显著高于西药治疗对照组 (P <0 .0 5 ,P <0 .0 1)。结论 :中西医结合治疗寻常性痤疮有较好的临床效果。     

肾综合征出血热特异性抗体的检测与中西医结合治疗的研究

目的探索一种更为简便、快速、特异、灵敏的肾综合征出血热(hemorrhagic fever with renal syndrome, HFRS)抗体的检测方法及更为有效的中西医结合治疗手段.方法559例HFRS患者血清同时采用免疫滴金法(colloidal gold immuno-dot assay,CGIDA)与酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)对比检测特异性免疫球蛋白M抗体(抗HFRS-IgM),间接免疫荧光法(indirect fluorescent antibody test,IFAT)对比检测特异性免疫球蛋白G抗体(抗HFRS-IgG).101例HFRS患者分组进行中西医结合治疗,治疗组50例用苦黄注射液、参麦注射液联合黄芪口服液,对照组51例用利巴韦林注射液联合甘利欣注射液,针对老年患者的临床特点,及早采用综合性防治措施.结果559例HFRS患者血清,以CGIDA法检测抗HFRS-IgM,阳性396例(70.8%);以CGIDA法检测抗HFRS-IgG,阳性489例(87.5%).治疗组与对照组用药后退热天数、主要症状和体征缓解天数相似(P＞0.05);肾功能恢复天数,对照组优于治疗组(P<0.01);在越期方面,治疗组越休克期数明显高于对照组(P<0.01). 结论CGIDA法检测HFRS特异性抗体分别与ELISA法及IFAT法对照,均有简便、快速、特异、灵敏之优点,检测抗HFRS-IgM,CGIDA法敏感性差于ELISA法,但是无假阳性;检测抗HFRS-IgG,CGIDA法的灵敏度高于IFAT法.苦黄注射液、参麦注射液联合黄芪口服液与利巴韦林注射液联合甘利欣注射液相比较,疗效无明显差别,但前者优于改善休克情况,后者强于改善肾功能.     

有机结合 共同发展——从血清脂蛋白谱研究谈中西医结合体会

在整体观和平衡观的基础上 ,创立双梯度聚丙烯酰胺凝胶电泳法 ,应用于同步分离血清脂蛋白及其亚组分 ,检测血清脂蛋白谱 (SLPG) ,以及“内脾虚”的基础和临床研究 ,并逐步建立了新的理论体系。SLPG较理想地表达了血清脂蛋白动态平衡的状态 ,是中西医结合认识血脂代谢和“脾气散精”功能的新指标。实践提示 ,有机结合和共同发展应是现代中西医结合研究面临的主要任务之一。     

脑转移瘤同期加量混合调强放疗与调强放疗的剂量学比较

目的:探讨同时运用三维适形与调强的混合调强放疗（Hybrid-IMRT）与调强放疗（IMRT）用于脑转移瘤同期加量的剂量学差异。方法:选取20例进行头颅放疗的患者，分别设计Hybrid-IMRT计划和IMRT计划。Hybrid-IMRT计划包括全脑行三维适形（两野对穿）3 600 cGy/20 F、脑转移灶行IMRT同期加量至5 000 cGy/20 F；IMRT计划全程运用IMRT给予全脑照射3 600 cGy/20 F、脑转移灶5 000 cGy/20 F。在满足临床要求的前提下，比较两组计划靶区的均匀性指数、适形度指数、平均剂量和机器跳数，危及器官脑干、视神经、晶体、视交叉、眼球的最大剂量和平均剂量。结果:两种计划均能满足临床要求。Hybrid-IMRT计划的PGTV均匀性优于IMRT计划（P<0.001）；Hybrid-IMRT计划的脑干、视交叉、左右晶体的最大剂量与平均剂量，左右眼球的平均剂量以及左右视神经的最大剂量均低于IMRT计划（P<0.05）；Hybrid-IMRT计划的机器跳数比IMRT计划减少了约70%（P<0.001）。结论:两种计划均能满足临床要求，Hybrid-IMRT计划相较IMRT计划靶区剂量更加均匀，治疗时间缩短，也能更好地保护危及器官。     

Epidemiological link between obesity,type 2 diabetes mellitus and cancer

There exists a complex interaction between obesity, type 2 diabetes mellitus (T2DM) and cancer, and an increase in the incidence of cancer is expected with the growing obesity-diabetes pandemic. The association of cancer with diabetes mellitus and obesity appears to be site-specific, the highest risk being for post-menopausal breast cancer, endometrial cancer, and colorectal cancer. Moreover, there is worsening of hyperglycaemia with the onset of cancer, evidencing a bi-directional link between cancer and diabetes mellitus and the need for monitoring for diabetes in cancer survivors. In this review, we look at the epidemiological evidence from observational studies and Mendelian randomization studies linking obesity, diabetes, and cancer, as well as the complex pathophysiological mechanisms involved, including insulin resistance with associated hyperinsulinaemia, the effect of chronic low-grade inflammation, and the effect of various adipokines that are associated with obesity and T2DM. Additionally, we describe the novel therapeutic strategies, based on their role on the discrete pathophysiological mechanisms involved in the tumourigenesis.