我国主诊医师负责制的文献研究

主诊医师负责制近年来逐渐成为国内医院管理制度改革的热点。通过对主诊医师负责制进行文献计量学分析,探讨国内主诊医师负责制与国家卫生政策的关系,分析主诊医师负责制的特点及在我国医院的实施中遇到的困难和障碍,为该制度的进一步推广提供科学依据。     

主诊组——责任护士负责制在优质护理服务中的实践

目的 探讨主诊组-责任护士负责制在优质护理服务中的作用.方法 在临床护理工作中实施主诊组-责任护士负责制,通过医院-护理部-科室层层监控,对实施前后基础护理合格率、健康教育知晓率、病人及主诊组医生对护士满意度进行比较.结果 实施主诊组-责任护士负责工作制后基础护理合格率、健康教育知晓率、病人及主诊组医生对护士满意度均较实施前提高.结论 主诊组--责任护士负责工作模式的实施,使整体护理得到了升华,护理管理质量持续改进,基本达到了患者满意、医生满意及社会满意的总体目标.     

大型综合性医院主诊医师负责制应用效果评价

目的：探讨大型综合性医院主诊医师负责制的应用效果。方法：通过医院HIS系统、人员管理系统抽取评价用数据,并通过满意度问卷调查,运用SAS统计软件对数据资料进行描述、分析,对实验组和对照组医疗数质量、经济效益、医疗服务质量以及人力资源管理等三个方面的指标进行了综合评价。结果：通过对实施主诊组前后病区医疗数质量指标综合分析、患者满意度调查、高中初级医师比例等指标的综合对比,实行主诊医师负责制能够明显提高医疗质量和效率,改善医疗服务和医患关系。结论：主诊组的实施有助于实现能级管理、精细化管理和激励管理,强化医务人员竞争意识．提升人力资源管理水平,促进医疗技术创新和医院信息化建设。     

主诊医师负责制——主诊医师负责制管理模式及其应用

介绍了主诊医师负责制的概念,通过查阅文献、实地考察学习等手段了解了主诊医师负责制在国内外的应用现状及其在大型综合性医院中的应用特点,并阐述了其应用前景。     

大型综合性医院主诊医师负责制应用价值

探讨了大型综合性医院推行主诊医师负责制的应用价值,即明确了大型综合性医院推行主诊医师负责制的可行性、建立了其管理制度、形成了管理体系、为大型综合性医院评聘分开提供了有效的管理手段、为大型综合性医院咂专科管理提供了有效途径、为大型综合性医院推广和应用主诊医师负责制提供了依据。     

福建省：主诊医师负责制绑定诊疗全程

2008年年初,福建省肿瘤医院实施主诊医师负责制,主诊医师组一般由3人～4人组成,全面负责病人从门诊、住院、手术到出院后随访等工作。各主诊组仍归原专业病区,但给医院的管理者提出了更高的要求,包括：科室行政主任要协调好各主诊组之间的工作,实施好各组间的人员和技术支援等。主诊医师负责制给该院带来了变化：一是明确了责、权、利;二是对主诊组人员进行优化重组;三是推进了分配制度改革。     

主诊医师负责制实施后效果评价

目的分析主诊医师负责制实施前后医疗质量效率的改变趋势,评价实施后的社会和经济效益。方法采用某三甲医院2011年9月主诊医师负责制实施前后的神经内科、普通外科的统计指标：门急诊人次、出院人次、平均住院日、次均费用、死亡率、院感发生率、满意度等数据进行对比分析。结果门急诊诊疗人次增加、平均住院日减少、住院死亡率下降、医院感染发生率下降。结论主诊医师负责制能使诊疗工作量绩效增加,患者满意度、医疗投诉及纠纷发生率、科室工作效率及员工对医院的满意度朝着好的趋势发展。     

医院实行主诊医生负责制的实践与体会

为深化医疗制度改革,强化以＂病人为中心＂的理念,结合医院实践,对主诊医生负责制这种全新的医院经营管理模式从实施背景、具体的做法和实践后的体会进行了分析。     

大型综合性医院主诊医师负责制的组织实施方法

通过严密组织计划,拟定实施方案,试点科室运行及经验总结,逐步将主诊医师负责制推广到全院临床科室,形成一整套包括职责、资格、聘任、考评等内容的主诊医师负责制管理模式和监控机制,为其在大型综合性医院的实施提供具体方案。     

主诊医师负责制对医疗效率的影响研究

目的:评价中日友好医院主诊医师负责制实施前后对医疗效率的变化情况.方法:从医院HIS系统中提取平均住院日、入院患者数、床位使用率的相关数据,运用间断时间序列分析,剔除自然成长因素的影响后,比较各效率指标在主诊医师负责制实施前后的差异及变化趋势.结果:间断时间序列模型分析结果显示,实施主诊医师负责制后,医院平均住院日显著...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.