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对黄斑分区标准化的建议

标准化病人在见习护理专业学生护患沟通能力培养中的应用

【摘要】　目的　了解标准化病人（standardized patients，SP）在见习护理专业学生护患沟通能力培养中的应用效果。　方法　对2009年1月—2010年12月186名护理专业学生按见习时间分为两组，2009年86名护理专业学生设为对照组，按常规方式进行见习；2010年100名护理专业学生设为试验组，在常规见习的基础上实施SP法。分别测评两组护理专业学生见习后的患者满意度和护患沟通能力。　结果　在患者满意度和沟通能力方面，两组护理专业学生的差异具有统计学意义（Plt;0.05）。　结论　SP在见习护理专业学生的护患沟通能力培养中具有明显作用与效果，值得推广应用。

阿昔洛韦治疗特发性周围性面瘫

目的　探讨阿昔洛韦抗病毒治疗对特发性周围性面瘫患者的治疗作用。 方法　通过病例对照研究对2010年1月－2012年6月入院的特发性面瘫患者78例，使用随机表法随机分为阿昔洛韦治疗组和对照组，每组39例。治疗2周，对两组患者治疗前、2周、4周及8周后使用House-Brackmann面神经分级标准进行评定面瘫恢复情况。 结果　两组患者面瘫2 周缓解率分别为51.3%和48.7%；8周后面瘫恢复率分别为84.6%和87.2%，差异均无统计学意义（P＞0.05）。 结论　特发性面瘫患者加用抗病毒治疗疗效未见明显提高，不推荐常规使用抗病毒治疗。

标准化患者在护理教学查房中的应用

【摘要】 目的 提高临床护士采集病史,护理查体和临床病历分析能力。方法 选择典型病历,要求护士阅读病历并了解病史；选择培养护士模拟标准化患者。结果 通过培养训练提高护士学习的积极性,培养护士患者至上的意识。结论 将标准化患者应用于护理教学查房中,锻炼了护士“护患”沟通能力,拓宽了教学资源,解决了病源问题。

An Analysis of 4109 Cases in Prehospital Care by ICD10

摘要:目的: 通过分析地市级急救中心院前急救资料,探讨ICD10疾病分类方法在院前急救中的实用性。 方法 :回顾性分析2007年1~12月份自贡市急救中心出诊的全部有效急救患者的急诊诊断以及随访诊断,使用ICD10编码进行归类,比较疾病性别构成比。 结果 :全年院前急救4109例,排5位的疾病分别为损伤、中毒和外因的某些其他后果(484%)、循环系统疾病(170%)、消化系统疾病(81%)、呼吸系统疾病(64%)、精神和行为障碍(52%),损伤、中毒和外因的某些其他后果、循环系统疾病以及消化系统疾病出诊量男性多于女性(P＜005),耳和乳突疾病以及妊娠、分娩和产褥期疾病出诊量女性多于男性(P＜005)。 结论 :采用ICD10标准对院前急救病谱分类有进一步探讨的价值。Abstract: Objective: To investigate the value of ICD10 in prehospital care by the analysis of cases in Zigong Urgent Rescue Center. Methods : All cases of prehospital care during the year of 2007 were studied, whose emergency Diagnoses and followup diagnoses were recorded, and they were classified by international classification of diseases 10th revision (ICD10). The gender composition ratio of diseases was analyzed. Results : Four thousand one hundred and nine cases of prehospital care in 2007 were included. Topfive diseases were injury, poisoning and certain other consequences of external causes (484%), diseases of the circulatory system (170%), diseases of the digestive system (81%), diseases of the respiratory system (64%), and mental and behavioral disorders (52%) respectively. The amout of the male prehospital cases was more that of than the female’s in the diseases of injury, poisoning and certain other consequences of external causes, diseases of the circulatory system, diseases of the digestive system (P＜005); the amount of the female prehospital cases was more than that of the male’s in the diseases of the ear and mastoid process, pregnancy, childbirth and the puerperium (P＜005). Conclusion : Further research on the spectrum of diseases classified by ICD10 is valuable.

High-dose Versus Moderate-dose Chemotherapy for Osteosarcoma: A Systematic Review

Objective　To assess the efficacy of high-dose chemotherapy versus moderate-dose chemotherapy in the treatment of osteosarcoma. Methods　We searched MEDLINE, EMbase, OVID database, CBMdisc, Cochrane CENTRAL Register of Controlled Trials in The Cochrane Library, and handsearched Journal of Chinese Oncology, Journal of Chinese Clinical Oncology and Tumor. The search time was updated to Feburary 2006.The quality of the included studies was evaluated by two reviewers and meta-analyses were performed on the results of homogenous studies. Results　Four studies involving 937 participants with primary, high-grade and non-metastatic extremity osteosarcoma were included. All the included studies were judged to be inadequate at reporting randomization and blinding, only one reported allocation concealment. All included studies reported the number of withdrawals and the reasons for these. The meta-analyses showed that there were no significant differences in 5-year event free survival (EFS) (RR 1.10, 95% CI 0.96 to1.25), 5-year overall survival (OS) (RR 1.08, 95% CI 0.97 to1.20), local recurrence rate (RR 0.92, 95% CI 0.54 to 1.57), proportion of good histological response (RR 0.93, 95% CI 0.81 to 1.07), proportion of limb salvage [RR 0.97, 95% CI 0.92 to 1.02) between the high-dose group and the moderate-dose group. The 5-year EFS of the good histological response group was significantly higher than in the poor histological response group [OR 2.45, 95% CI 1.76 to 3.39,Plt;0.00001 ). Conclusions　No advantage is shown for high-dose chemotherapy over moderate-dose chemotherapy in 5-year EFS, 5-year OS, local recurrence rate, proportion of good histological response and proportion of limb salvage. Histological response to preoperative chemotherapy is an independent prognosis factor for osteosarcoma. Due to the potential risk of selection bias, performance bias and publication bias, the evidence is not b enough to judge whether high-dose chemotherapy is better than moderate-dose chemotherapy in the treatment of osteosarcoma. Our conclusion suggests that large-scale randomized trials should be performed.

Short-term and long-term efficacy of artery-first approach versus standard approach pancreaticoduodenectomy: a meta-analysis

ObjectiveTo compare the short- and long-term efficacy of artery-first approach pancreatico-duodenectomy (AF-PD) and standard approach pancreaticoduodenectomy (S-PD).MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang, and CNKI databases were searched, relevant literatures were included, and relevant data were extracted for meta-analysis.ResultsA total of 30 articles were included, including 2 750 cases underwent pancreaticoduodenectomy. The results of meta-analysis showed that in terms of short-term efficacy when compared with S-PD group, the AF-PD group had less intraoperative blood loss (WMD=–175.87, P<0.001), lower intraoperative blood transfusion rate (OR=0.36, P=0.002), higher R0 resection rate (OR=1.83, P<0.001), lower postoperative pancreatic leakage rate (OR=0.71, P=0.005), and shorter postoperative hospital stay (WMD=–2.69, P=0.007). However, there were no statistically significant differences in the operation time and overall postoperative complication rate between the two groups (P>0.05). In terms of long-term efficacy when compared with S-PD group, the AF-PD group had lower tumor local recurrence rate (OR=0.43, P=0.004) and tumor liver metastasis rate (OR=0.60, P=0.010), but had higher 1-year (OR=1.95, P=0.007), 2-year (OR=2.04, P<0.001), 3-year (OR=2.09, P=0.001), and 5-year (OR=2.06, P=0.003) overall survival rates, and there were no significant differences in the rates of lung metastasis and peritoneal metastasis between the two groups (P>0.05).ConclusionsAF-PD is better than S-PD in some short-term and long-term outcome indicators such as R0 resection rate, pancreatic leakage rate, overall survival rate, and so on. However, due to the limited quality of the included literatures, more high-quality studies are still needed to verify in the future.

CLASSIFICATION AND TREATMENT OF WHOLE HAND DEGLOVING INJURY

Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.

PRODUCT STANDARD AND QUALITY CONTROL OF MEDICAL ALGINATES

Objective To compare product standards of drug and medical device made from sodium alginate and calcium alginate between domestic and abroad, and to emphases on the process parameters monitoring based on different standards. Methods Sodium alginate and calcium alginate standards of both domestic and foreign were analyzed and summarized, and the differences and commonalities of various product standards among each standard were compared. Results Differences exist in product standards of sodium alginate and calcium alginate between domestic and abroad, whether drug or medical device, but the fundamental control points are concordant. Conclusion Companies should focus on product quality control requirements combined with its own unique manufacturing process characteristics to develop reasonable and controllable quality standards, which can ensure safe and effective clinical use.

Quality Assessment of Clinical Studies on Compound Salvia Pellet (CSP) for Angina Pectoris

Objective　To investigate the current situation of randomized controlled trials (RCTs) on compound salvia pellet (CSP) for angina pectoris and assess whether there is adequate evidence for clinical practice. Methods　We collected all the published clinical studies on CSP for angina pectoris from 1994 to December 2005, and assessed each included report using the Jadad scale, the revised CONSORT statement and other self-edited items. Results　We finally identified 115 RCTs. Among which, 1 scored 3 points, 6 scored 2 points, 106 scored 1 points and 2 socred 0 points. No RCT performed allocation concealment according to the CONSORT criteria, only 4 RCTs (3.5%) described the generation of the randomization sequence, among which 2 were quasi-randomized. No RCT provided randomization implementation,1 RCT (0.9%) carried out placebo control, 1 RCT (0.9%) reported endpoint, 9 RCTs (7.8%) adopted single blinding, 4 RCTs (3.5%) reported double blinding, 11 RCTs (9.6%) calculated statistical values, 2 RCTs (1.7%) provided the record of follow-up, 1 RCT (0.9%) reported negative outcome, 25 RCTs (21.8%) described adverse events, no RCT described how the sample size was estimated, and how an intent-to-treat (ITT) analysis and correlation analysis were reported, 1 RCT (0.9%) was multi-center, no RCT completed ethical approval and informed consent, 27 RCTs (23.5%) described syndrome type of TCM. Conclusion　Currently, the methodology and reporting of studies on CSP for angina pectoris are not good enough to provide reliable evidence for clinical practice.