小剂量人血白细胞干扰素治疗乙型慢性迁延性肝炎20例近期疗效观察

小剂量人白细胞干扰素治疗乙型慢性迁延性肝炎20例近期疗效观察,20例慢迁肝(C.P.H)HBsAg阴转1例,阴转率为5％,滴度下降11例为55％,HBeAg阴转7例,阴转率为38.88％。DNA—P恢复正常7例,复常率为77.77％。HBV—DNA恢复2例,复常率为66.66％,抗—HBe阳转6例,阳转率为30％。治疗组效果优于对照组,总有效率治疗组为60％,对照组为30％。     

A simulation study of three sequential methods for the comparison of two treatment groups when the response criterion is censored

Three recent sequential methods, group sequential analysis (GSA), the sequential probability ratio test (SPRT) and the triangular test (TT) are well suited to randomized clinical trials with a censored response criterion, as they do not require matched pairs of patients. We undertook a simulation study to investigate their statistical properties and to compare these three methods with the fixed-sample design. Our results suggest that the three methods have the expected statistical properties for size and power; they allow an important reduction of the average number of events before stopping, except with GSA when there is no treatment difference; the triangular test (closed design) appears the optimal design, as the variance of the number of events is smaller than with the sequential probability ratio test (open design) and analysis after every twenty new events does not alter the statistical properties of these sequential methods and enhances their usefulness.     

Bayesian estimation of a random effects heteroscedastic probit model

Summary Bayesian analysis is given of a random effects binary probit model that allows for heteroscedasticity. Real and simulated examples illustrate the approach and show that ignoring heteroscedasticity when it exists may lead to biased estimates and poor prediction. The computation is carried out by an efficient Markov chain Monte Carlo sampling scheme that generates the parameters in blocks. We use the Bayes factor, cross‐validation of the predictive density, the deviance information criterion and Receiver Operating Characteristic (ROC) curves for model comparison.     

食品药品行政处罚裁量权内部约束机制的研究

目的从适用规则与适用程序两个方面对食品药品行政处罚裁量权的内部约束机制进行了有益的探索。方法采用理论研究与实证研究相结合的方法,通过法条梳理与实际调查,评价与分析目前处罚裁量权在规范与操作层面存在的问题及原因。结果与结论目前,行政执法裁量权内部约束机制的研究相对薄弱,在一定程度上造成了理论与实践的双重缺失。     

Working‐correlation‐structure identification in generalized estimating equations

Selecting an appropriate working correlation structure is pertinent to clustered data analysis using generalized estimating equations (GEE) because an inappropriate choice will lead to inefficient parameter estimation. We investigate the well‐known criterion of QIC for selecting a working correlation structure, and have found that performance of the QIC is deteriorated by a term that is theoretically independent of the correlation structures but has to be estimated with an error. This leads us to propose a correlation information criterion (CIC) that substantially improves the QIC performance. Extensive simulation studies indicate that the CIC has remarkable improvement in selecting the correct correlation structures. We also illustrate our findings using a data set from the Madras Longitudinal Schizophrenia Study. Copyright © 2008 John Wiley & Sons, Ltd.     

Generalized anxiety disorder with and without excessive worry in Hong Kong

Background: Two previous U.S. studies found that although generalized anxiety disorder (GAD) without self‐perceived excessive worry was milder than GAD with excessive worry, its persistence, impairment, and risk for subsequent onset of other mental disorders were still substantial. This study examined the implications of relaxing the “excessiveness” criterion on the prevalence and socio‐demographic profile of GAD in a Chinese population sample by considering both self and others' perception of excessive worry. Method: 2,005 respondents aged 15–65 years participated in a structured telephone interview that covered socio‐demographic profile, 12‐month DSM‐IV diagnosis of GAD, core depressive symptoms, longest duration of worry episode, number of domains of worry, impairment measured by the Sheehan Disability Scale, and treatment‐seeking. Excessive worry was assessed from the perception of both respondents and others as reported by respondents. Result: The 12‐month prevalence of GAD increased from 3.4 to 4% when the excessiveness requirement was relaxed. Excessive GAD and nonexcessive GAD had similar socio‐demographic, symptom, chronicity, impairment, depressive symptom, and treatment‐seeking profiles. Conclusion: GAD without excessive worry was less common than GAD with excessive worry but was likely to be a valid nosological entity. Future iterations of the DSM‐IV should clarify whether excessive worry should be retained and, if so, how individuals who only reported excessive worries perceived by others should be optimally assessed. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

6σ标准在临床生化质量管理中的应用

目的应用6σ标准分析临床生化检验质控数据,评价常规检验项目的方法性能,改进检验质量。方法收集2012年度临床生化检验项目室内质量控制及室间质量评价数据;按照美国临床实验室改进修正法案中允许总误差（TEa）标准,采用公式σ=（TEa-Bias）/CV%,计算各检验项目的总分析性能σ值,联合方法性能决定图,评价分析性能,设计最佳室内质量控制方案,提出并实施改进措施。结果全部22个常规生化检测项目平均西格玛值2.83,其中12个质量水平大于3σ,其余10个项目均小于3σ,存在较严重的质量缺陷,采取质量改进措施后σ值明显提高。结论 6σ质量标准的应用,有助于了解和提高临床生化检验质量水平,是一项有效的实验室质量管理工具。     

27家医院《医院中药房基本标准》达标情况调查分析

卫生部、国家中医药管理局于2009年3月16日发布了《医院中药房基本标准》(以下简称《标准》),要求各中医医院、中西医结合医院、综合医院均照此标准遵照执行。2009年5～6月,按照《标准》的要求,笔者调查了本地区27家医院,包括8家三级综合医院、4家三级中医医院、10家二级综合医院、5家二级中医医院,并就各医院的中药房存在的问题作了比较分析,希望能为新标准的执行工作提供参考。1各类医院的达标情况将《标准》内容分解成9个项目,对上述医院中药房符合情况分别调查,汇总调查结果见表1。表127家医院达标情况统计(家)项目医院数(n=27)类别中医院(n=9)综合医院(n=18)等级三级(n=12)二级(n=15)中成药调剂106473饮片煎煮229131210饮片数量279181215技术人员比例229131210任职资格136776调剂室面积87153调剂设备19910118规章制度238151211从表1可以看出两点:第一,中医医院符合标准情况优于综合医院,这与中医医院领导重视中医药文化建设、专项配置中医药经费、设备购置有财政资金扶持有关。第二,三级医院优于二级医院,这与等级医院评审、考核时,三级医院药剂科的考核...     

职业性接触粉尘工人不同结局的肺通气功能比较

目的比较职业性接触粉尘导致的不同结局工人肺通气功能及小气道损伤状况,为早期诊断职业性呼吸疾患提供依据。方法选取某矿煤工尘肺患者80例,尘肺合并结核33例,以及无尘肺矿工177例为接触粉尘后的三种不同结局。分别测定各结局对象的肺功能,指标包括FVC、FEV1、FEV1/FVC、V50、V25、MMEF,以实测值占预计值百分比进行比较分析。结果比较各组肺功能各指标实测值占预计值的百分比,尘肺合并结核组各指标显著低于其他两组（P〈0.01）,单纯尘肺组在FVC%、FEV1%和FEV1/FVC%上损伤分级均属正常（〉80%）;各组肺通气功能损伤级别构成差异有统计学意义（P〈0.01）,其中尘肺合并结核组肺功能在中重度损伤的比例显著高于其他组,而无尘肺组正常的肺功能级别比例显著高于其余两组（P〈0.01）。小气道指标（V50%,V25%）在尘肺合并结核组和尘肺组显著减低。结论职业性接触粉尘导致的尘肺及尘肺合并结核肺通气功能显著减低;小气道功能对职业性接触粉尘肺功能损伤较敏感,对职业性接触粉尘工人有早期预警作用。     

血管重建术后冠心病相关证型辨证标准的研究

目的通过专家问卷调查,总结血管重建术后冠心病患者中医证候分布规律,建立辨证标准,分析其实用性和可行性。方法根据以往研究结果,制订专家咨询问卷,对全国17个省市45家医院的105位相关专家进行问卷调查,建立Epidata3.1数据库,采用SPSS13.0对数据进行统计分析,总结血管重建术后冠心病患者的常见证型,并建立辨证标准,分析其实用性和可行性。结果本次调查共发放专家问卷105份,回收105份,回收率为100%,其中103份问卷有效,有效率98.10%。根据证型常见度,将累积百分率≥80%且变异系数≤0.45者作为血管重建术后的主要证型(血瘀证、气虚证、痰浊证);将累积百分率≥80%且变异系数≤0.45者的症状作为支持该证型诊断的要素;以百分比反映专家对该问卷的认可度。结论通过对103名心血管病专业中医专家的经验总结,为血管重建术后主要证型的辨证标准提供了依据。