目的 比较喀什地区和广州地区健康体检儿童维生素D3水平和缺乏率。方法 纳入2019年1月—2020年12月喀什地区第一人民医院、广州市番禺区中心医院健康体检儿童,比较汉族儿童不同地区间以及比较喀什儿童不同民族间的维生素D3水平和缺乏率,分析了性别、年龄和季节对血清维生素D3水平的影响。结果 喀什汉族儿童维生素D3低于广州汉族儿童,缺乏率更高（均P<0.05）。喀什维族儿童的维生素D3水平低于喀什汉族儿童,缺乏率更高（均P<0.05）。同一地区、同一民族不同年龄段儿童间维生素D3缺乏率和水平比较差异均有统计学意义（均P<0.05）,维生素D3缺乏率随年龄增加而升高,水平则显著下降。同一地区、同一民族儿童不同季节间维生素D3缺乏率和水平比较差异均有统计学意义（均P<0.05）,冬季的缺乏率最高、水平最低。同一地区、同一民族儿童不同性别间维生素D3缺乏率和水平比较差异均无统计学意义（P>0.05）。结论 健康体检儿童血清维生素D3水平,喀什维族低于喀什汉族,喀什汉族低于广州汉族,缺乏率间差异明显。健康体检儿童血清维生素D3水平和缺乏率与年龄、季节有关,与性别无关。

目的 探讨理论授课后续以问题为基础的学习（PBL）的阶梯教学法在临床技能混合教学中的效果。方法 选择福建医科大学附属南平第一医院2019级临床医学专业58名见习生为研究对象,将其通过单双号抽签的方式分为两组,即研究组与对照组各29例,研究组基于理论授课后续PBL的阶梯教学法,以“一对一”方式进行线上线下混合教学,对照组开展常规线下教学,对两组见习生教学效果进行比较。结果 研究组见习生参与消毒铺巾、气管插管、胸腔穿刺、腰椎穿刺及小儿腰椎穿刺等5项临床技能考核分别为（95.23±3.18）（95.19±3.26）（95.15±3.35）（95.28±3.17）（95.11±3.45）分,优于对照组（88.23±4.01）（87.89±4.59）（86.23±3.78）（87.22±3.89）（86.23±3.67）分（t=7.366、6.983、9.510、8.650、9.494,P<0.05）;研究组见习生综合能力提升情况优于对照组（χ²=6.444,5.497、5.497、6.444、7.733,P<0.05）;从教师培训态度（7项）、培训方法（15项）、培训时间（3项）、培训效果（11项）等方面进行评价,研究组临床技能培训教学效果各项评分及总分分别为（6.67±0.35）（12.23±2.23）（2.44±0.29）（9.23±2.56）（30.34±4.45）分,高于对照组的（4.12±1.45）（10.12±2.17）（9.23±2.56）（1.68±0.56）（7.23±2.12）分（24.34±3.45）分,（t=9.206、3.652、6.490、3.240、5.738,P<0.05）。结论 基于理论授课后续PBL的阶梯教学法,以“一对一”线上线下混合教学建立医学生临床技能的培训方法,见习生的综合能力明显提升,教学效果更好。

Objective To explore the effect of Problen-Based Learning（PBL）step-by-step teaching method in the online and offline mixed teaching of clinical skills for medical students. Methods Fifty-eight interns majoring in clinical medicine of grade 2019 in Nanping First Hospital affiliated to Fujian Medical University were selected as the research object,they were divided into two groups by drawing lots with even and odd numbers,namely,the study group and the control group,with 29 cases in each group．The study group conducted online and offline mixed teaching in a “one-on-one” way based on the step-by-step PBL teaching method after theoretical teaching,while the control group received regular offline teaching,and the teaching effects of the two groups were compared. Results The students of the study group participated in 5 clinical skills assessment,including disinfection towel（95.23±3.18）,tracheal intubation（95.19±3.26）,chest puncture（95.15±3.35）,lumbar puncture（95.28±3.17）and pediatric lumbar puncture（95.11±3.45）,were significantly better than those of control group（88.23±4.01）,（87.89±4.59）,（86.23±3.78）,（87.22±3.89）,（86.23±3.67）（t=7.366,6.983,9.510,8.650,9.494,P<0.05）．The comprehensive ability improvement of students in study group was better than that in control group（χ²=6.444,5.497,5.497,6.444,7.733,P<0.05）．The evaluation was made from the aspects of teacher training attitude（7 items）,training method（15 items）,training time（3 items）and training effect（11 items）．The clinical skill training teaching effect scores of study group（6.67±0.35）,（12.23±2.23）,（2.44±0.29）,（9.23±2.56）,（30.34±4.45）were significantly higher than those of control group（4.12±1.45）,（10.12±2.17）,（9.23±2.56）,（1.68±0.56）,（7.23±2.12）,（24.34±3.45）（t=9.206,3.652,6.490,3.240,5.738,P<0.05）. Conclusions Based on PBL step-by-step teaching method after theoretical teaching,the training method of clinical skills for medical students is established by “one-to-one” online and offline mixed teaching,can improve the clinical skills and comprehensive ability of interns and get high evaluation from students．

目的 对喀什地区和广州地区过敏性疾病儿童血清过敏原特异性IgE进行检测并比较检测结果。方法 选择喀什地区第一人民医院(喀什地区)和广东省妇幼保健院、广州市番禺区中心医院(广州地区)过敏性疾病儿童,血清标本采用国产欧博克试剂盒(酶联免疫法)检测过敏原特异性IgE。结果 两地区过敏性疾病儿童的过敏原IgE总阳性率均随年龄增长逐渐升高。广州地区过敏性疾病儿童对牛奶的IgE阳性率随年龄增长逐渐降低,对屋尘螨/粉尘螨则逐渐升高,组间比较均有统计学意义差异(P均<0.05)。喀什地区过敏性疾病儿童对花生/榛子/开心果、葎草/艾蒿/豚草、猫/狗毛皮屑的血清IgE阳性率明显高于广州地区,而对牛奶、屋尘螨/粉尘螨的血清IgE阳性率明显低于广州地区(P均<0.05)。结论 喀什地区和广州地区过敏性疾病儿童过敏原特异性IgE结果存在显著差异,过敏性疾病需要做好不同地区过敏原的监测。

目的 分析比较总额控制下的病种分值付费和单病种付费支付方式的应用效果。方法 回顾性分析2015年—2018年总额控制下病种分值付费和单病种付费模式下的平均住院费用、医保基金支出以及医保基金收入等基本情况,比对分析总额控制下单病种付费模式下与病种分值付费模式的总体运行效率。结果 2015年—2018年总额控制下病种分值付费情况存在轻微波动,但不出现明显上涨现象,稳定于9 000元左右的水平,并且总额控制下病种分值付费的医保基金结余率处于17%的水平,同时具有稳定的医保基金支出与医保基金收入水平。相比较总额控制下病种分值付费,单病种付费模式下的平均住院费用更高,且呈现出逐年增加的发展趋势;相比较2015年的平均住院费用,2018年平均住院费用高出500元。2015年—2018年总额控制下单病种付费的医保基金结余率具有较大波动,表示医保基金支出与医保基金收入水平不稳定。结论 总额控制下的病种分值付费模式具有明显的医疗费用以及医保基金费用支出控制效果,但同时也具有较大的基础投入水平以及较高管理成本等缺陷端,总额控制下的单病种付费模式具有方便管理的优势,但是在费用控制、病种涵盖等方面不如病种分值付费,总额控制下的单病种付费与病种分值付费各具优势和不足,需要依据区域情况,取长补短,因地制宜以及择优而用,确保健全医保支付方式。

Objective To analyze the application effect of the payment of disease type and the payment of single disease payment under the control of total amount. Methods A retrospective analysis of the basic hospitalization expenses, medical insurance fund expenditures and medical insurance fund income under the control of the total value of the disease and the single-income payment model under the total control from 2015 to 2018 were taken, and to have comparative analysis of the total control of the single disease overall operational efficiency of the payment model with the payment model. Results There was a slight fluctuation in the payment of disease value under the control of total amount from 2015 to 2018, but there was no obvious increase, which was stable at around 9 000 yuan, and the balance of medical insurance fund paid for the disease value under the total control was at 17% level and has both stable medical insurance fund expenditure and medical insurance fund income level. Compared with the total score control under the total amount control, the average hospitalization cost under the single disease payment mode was higher, and showed a trend of increasing year by year; compared with the average hospitalization cost in 2015, the average hospitalization cost in 2018 was higher, out of 500 yuan. From 2015 to 2018, the balance of the medical insurance fund paid for the control of the single disease had a large fluctuation, indicating that the medical insurance fund expenditure and the medical insurance fund income level were unstable. Conclusion The disease-based payment model under total control has obvious control effect of medical expenses and medical insurance fund expenses, but it also has a large basic input level and high management cost and other defects. The payment model has the advantage of convenient management, but it is not as good as the cost control and disease coverage, and the single disease payment and the disease value payment under the total control have their own advantages and disadvantages, which need to be based on the regional situation. We need to make use of the strengths and weaknesses, adapt to local conditions and choose the best, to ensure a sound medical insurance payment method.

目的 探讨臭氧水在外科手消毒中的消毒效果和医护人员的舒适度。方法 将参加手术的医务人员80例按时间段分为对照组、低浓度组、高浓度组,于消毒后分别进行手采样培养,并进行分析。结果 消毒后三组在菌落数比较差异有统计学意义(P<0.01);消毒后三组皮肤在发痒、脱屑、干燥评分比较差异有统计学意义(P<0.05);在气味、粘腻感、干燥速度比较差异有统计学意义(P<0.05)。结论 臭氧水用于外科手消毒效果可靠,无刺激气味和粘腻感,医护人员感觉更舒适。

Objective The aim of this study was to explore the disinfection effect of ozone water in surgical hand disinfection and the comfort of medical staffs. Methods 80 medical staffs who participated in surgeries were divided into control group, low-concentration group and high-concentration group according to the time period. After disinfection, hand samples were cultured and analyzed. Results After disinfection, there were statistically significance in colony number (P<0.01), itching, scaling and drying scores (P<0.05), odor, stickiness and drying speed (P<0.05). Conclusion Ozone water for surgical hand disinfection is reliable, no irritating odor and stickiness, and makes medical staffs feel more comfortable.