Elevated plasma total homocysteine in preeclampsia

OBJECTIVES: To investigate the possible association between hyperhomocysteinemia and preeclampsia. METHODS: A case-control study was carried out in the Departments of Obstetrics and Gynecology of the Ghaem Hospitals in Mashhad University of Medical Sciences, Mashhad, Iran from May 2004 to August 2006 and included 75 preeclamptic patients, 37 women with mild preeclampsia, and 38 women with severe preeclampsia, in addition we included 40 controls without pregnancy complications. Plasma total homocysteine was determined in all subjects by enzyme linked immunosorbent assay. RESULTS: The 3 groups were similar in age and body. Patients with severe preeclampsia had significantly higher mean plasma levels (13.8+/-7 mg/l) than normal pregnant women (8.8+/-2.8 mg/l) and mild pre-eclamptic women (10.4+/-2.3 mg/l) (p<0.05). CONCLUSION: Women who developed severe preeclampsia have higher plasma homocysteine levels than women who remain normotensive throughout pregnancy.     

对新版《病历书写基本规范》病程记录部分的几点商榷

认为新版《病历书写基本规范》在病程记录这一部分的不足之处有：对病程记录的界定欠妥;只要求＂重要的＂辅助检查结果才在病程记录中反映欠妥;对上级医师查房记录、死亡记录及死亡讨论记录在格式上的要求不如七版《诊断学》;实际工作中出院记录应在病人出院前完成,并有＂一式两份＂出院记录科室加盖印章的办法更好。建议今后在发布更新版的《病历书写基本规范》之前,先充分征求意见,尤其应征求最新版《诊断学》编写组的意见,避免二者不统一。     

用层次分析与加权秩和比法综合评价病案首页质量

目的探讨用层次分析法与加权秩和比法评价病案首页监控质量。方法采用层次分析与加权秩和比法对某院30个科室2010年病案首页监控质量进行综合评价。结果 30个科室被划分成4个等级：肿瘤科等4个科室的病案首页监控质量为差;骨外科等10个科室病案首页监控质量为中;神经内科等11个科室病案首页监控质量为良;中医科等5个科室病案首页监控质量为优。1月份病案首页监控质量为差;11、12月份为病案首页监控质量为优。结论综合应用层次分析法与加权秩和比法能对病案首页监控质量做出客观全面评价,可有效监控首页质量。     

Contributing death factors in very low-birth-weight infants by path method analysis

Background:

Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. Therefore, efforts to achieve the UN Millennium Development Goal 4 of reducing childhood mortality by two-thirds by 2015 are focused on reducing neonatal deaths in high-mortality countries. The aim of present study was to determine death factors among very low-birth-weight infants by path method analysis.

Materials and Methods:

In this study, medical records of 2,135 infants admitted between years 2008 and 2010 in neonatal intense care unit of Alzahra Educational-Medical centre (Tabriz, Iran) were analysed by path method using statistical software SPSS 18.

Results:

Variables such as duration of hospitalisation, birth weight, gestational age have negative effect on infant mortality, and gestational blood pressure has positive direct effect on infant mortality that at whole represented 66.5% of infant mortality variance (F = 1018, P < 0.001). Gestational age termination in the positive form through birth weight, and also gestational blood pressure in negative form through hospitalisation period had indirect effect on infant mortality.

Conclusion:

The results of the study indicated that the duration of low-birth-weight infant''s hospitalisation is also associated with infant''s mortality (coefficient -0.7; P < 0.001). This study revealed that among the maternal factors only gestational blood pressure was in relationship with infants’ mortality.     

新版病案首页填写存在的问题及改进措施

根据卫医政发〔2011〕84号《住院病案首页部分项目填写说明》及《住院病案首页项目修订说明》,对我院病案首页填写质量进行分析,发现首页填写缺陷较多,涵盖了患者基本信息及医疗信息,如患者基本信息中出生地、电话、邮编、身份证号等漏填或用＂不详＂代替,工作单位及地址、户口地址等填写缺陷;医疗信息中医护人员漏签名问题较严重。另外损伤、中毒的外部原因及病理诊断常填写不规范,影响疾病编码的准确性。新版病案首页新增项目也存在较多问题,如未死亡的患者＂死亡患者尸检＂处仍填写为2（否）,新生儿年龄与出生体重、手术级别、病理号等漏填现象时有发生。为提高病案首页填写质量,需加强培训,强化质量控制,充分利用信息化管理技术,以进一步完善病案管理,为预付费制改革做好铺垫工作。     

Seasonal variation in the incidence of congenital hypothyroidism in Isfahan, Iran

OBJECTIVE: To evaluate the seasonal variations in the incidence of congenital hypothyroidism (CH) in the screening program of CH in Isfahan, Iran. METHODS: In this study, we compiled the data obtained retrospectively from CH screening results of 113282 neonates from 17 maternity hospitals in Isfahan, Iran from June 2002 to December 2005. The seasonal variation in the incidence of CH, as well as its monthly incidence was analyzed using all the diagnosed cases of CH. RESULTS: From the 113282 neonates referred for CH screening, 358 neonates were diagnosed with CH, showing an overall incidence of 3.1/1000 live birth. There was no significant difference in the seasonal variation of CH (p=0.5). According to the monthly distribution analysis, the incidence of CH was higher in the second month of summer (Mordad) and lower in the last month of autumn (Azar)(p=0.04). CONCLUSION: The high incidence of CH in Mordad, the second month of summer, supports the hypothesis that certain environmental factors such as intrauterine viral infections (which commonly exhibit seasonal variations in incidence), exposure to chemical compounds, differences in climate and so forth, may play a role in the etiology of this disorder. Awareness of the monthly distribution of CH incidence could help us identify associated environmental factors and aid in the development of preventative strategies. Further, it would for the appropriate allocation of resources within the screening programs.     

病案管理信息系统上线准备与维护

目的在不影响病案科日常工作的前提下,平稳完成病案信息系统的上线工作。方法对旧系统进行调研和历史数据准备,设计新的病案管理信息系统,按计划认真培训了人员,制定完善操作规程和管理制度。结果新信息系统运行平稳顺利,达到预期目的。结论在综合性大医院更新病案管理信息系统是一件复杂的问题。因此,做好规划与准备是实现病案管理信息系统的重要基础;对工作人员的培训,对信息系的维护,严格规范操作和规章制度是实现新的病案管理信息系统平稳运行的重要保障。     

18370份电子病案的缺陷分析

目的通过对电子病案质量的影响因素的分析,探讨提高病案质量的有效方法。方法参照卫生部《病案书写基本规范》和《住院病案质量评价标准》进行评分,对使用电子病案系统后6个月的终末病案进行病案质量监控及统计分析。结果在18,370份终末电子病案中,甲级病案18,003份,乙级病案367份,无丙级病案;手术科室的缺陷率明显高于非手术科室;病案缺陷中病程记录、复制粘贴及错字别字缺陷出现率占比例大。结论建立健全的电子病案管理制度及分明的奖惩制度,加强电子病案规范培训及医师法律意识,提高医院的病案管理水平。     

A randomized, double-blind, placebo-controlled trial of metformin treatment for weight gain associated with initiation of risperidone in children and adolescents

OBJECTIVE: To evaluate the effect of metformin treatment on the risperidone-induced body weight gain in patients. METHODS: In a 12-weeks, double-blind, placebo controlled, randomized trial between October 2006 and October 2007 which was conducted in the Child and Adolescent Psychiatric Consultation Center of Isfahan University of Medical Sciences, 49 patients were entered the study with schizophrenia diagnosis. Then metformin (500 mg bid) or placebo was administrated with risperidone (6 mg) for the patients. Weight, height, and body mass index BMI were measured at the beginning, at 4 weeks, and at 12 weeks of the study. Changes in weight and BMI were evaluated by using repeated measures analysis of variance. RESULTS: Seventeen patients were excluded from the study. Repeated measure analysis of variances showed a significant difference between weight and BMI in both metformin (p<0.001, p<0.015) and placebo group (p<0.013, p<0.005). CONCLUSION: Metformin treatment did not show a significant effect to control the body weight of patients after 12 weeks.     

《名医类案》《续名医类案》脉诊特色研究

《名医类案》《续名医类案》是资料空前丰富的中医全科医案专著,是历代著名医家临床经验的总结。脉诊是中医诊断的最基本要素之一,古人由于条件的限制,对其具体内容尚未清晰明了并统一规范。现希望通过对《名医类案》《续名医类案》中脉诊相关病案的研究,探析《名医类案》《续名医类案》病案中脉诊与病症治则之间的关联规律,作为辨证论治的参考依据,推动中医诊断学的发展和提高。     

HIMSS电子病历应用模型分析

介绍美国医疗信息与管理系统协会(Healthcare Information and Management System Society,HIMSS)电子病历应用模型的基本情况,从电子病历基本概念、发展方向、评价范围及评价方式等方面对该模型进行深度分析,旨在为国内电子病历系统建设及评价体系形成提供参考.     

《名医类案》《续名医类案》脉诊特色研究

《名医类案》《续名医类案》是资料空前丰富的中医全科医案专著,是历代著名医家临床经验的总结。脉诊是中医诊断的最基本要素之一,古人由于条件的限制,对其具体内容尚未清晰明了并统一规范。现希望通过对《名医类案》《续名医类案》中脉诊相关病案的研究,探析《名医类案》《续名医类案》病案中脉诊与病症治则之间的关联规律,作为辨证论治的参考依据,推动中医诊断学的发展和提高。     

民营医院折桂JCI

民营医院如果想做行业标杆,自己做很难获得同行认同,如果借助于一个强大的第三方力量,情况会大有不同。 2010年12月17日,南京。 一群来自大洋彼岸的美国JCI评审专家一改往届评审的矜持,当场就宣布受审医院通过了JCI的评审,现场的沸腾经久不息。在宣告声中,     

Pure red cell Aplasia in Zaria. A 10- year review

Pure red cell Aplasia (PRCA) is a transfusion dependent condition characterised by anaemia, reticulocytopaenia and a paucity of erythroid precursors in the bone marrow. Records of patients with PRCA seen in Ahmadu Bello University Teaching Hospitals between 1991 and 2001 were reviewed and the outcome of their management was assessed. Fifty per cent of the ten patients had high dose methyl Prednisolone (HDMP) therapy. Seven patients recovered, 2 died and one was lost to follow up. All patients had red cell concentrate transfusion.     

论《临证指南医案》中辛润开肺思想在便秘治疗中的运用

探讨《临证指南医案》中辛润开肺思想在便秘中的运用。叶天士治疗便秘时主张腑病治脏、下病上取,特立辛润开肺一法,其立法严谨、用药灵活、配伍精当。然其所著《临证指南医案》一书案语甚为简括,其诊治之法甚难掌握,以《临证指南医案》为蓝本,节选肠痹、肺痹及其他散在各门中典型医案,并结合其他古籍加以分析探讨其学术思想。     

2009年《中国病案》载文及引文分析

目的对2009年出版的《中国病案》共计12期进行分析,归纳该刊的特点;方法采用文献计量学方法 ,分析2009年出版的《中国病案》共计348篇文献,分别统计其载文量、栏目设置、合著情况、作者分布、引文情况等指标;结果作者地区分布很广,覆盖了29个省、自治区和直辖市,论文作者合作度为2.51人/篇,合作率为69.83%,篇均引文量为4.87,主要为中文和英文,分别占总引文量的90.02%和9.98%。结论该刊文稿来源广泛,合著程度较高,引文丰富,对本专业读者群具有很高的利用价值。     

《名医类案》、《续名医类案》判断死亡时间方法探析

对《名医类案》、《续名医类案》中判断死亡时间的医案及含有患者死亡时间的医案进行研究,以探讨古代医家判断死亡时间的方法。结果表明,两部医案中判断死亡时间的准确率为83.3%。脉法是古代医家判断死亡时间最常用的诊法,五行生克理论是最常用的推断死亡时间的理论工具。对于正气盛衰的把握应贯穿于始终,因为它是决定死期远近的关键,也决定了以理论工具推断及参考经验死期判断死亡时间的步骤先后。     

8470份手术病案的质量分析与对策

目的通过分析8470份手术病案中的质量情况,分析手术病案中的书写缺陷,提出相应对策,狠抓病案书写质量。方法根据《病历书写基本规范》和《江苏省住院病历质量判定标准》,对8470份手术病案逐份检查。结果发现病案缺陷的构成为13.20%,其中重度缺陷占总缺陷的13.51%;主要以住院病案首页填写有缺项、实验室及器械检查漏缺和缺传染病疫情报告记录等缺陷因素构成。结论加强医师规范化培训的学习,提高医务人员对病案重视程度,逐级加强病案质控力度,保证病案书写质量。     

《临证指南医案》“方合岁气体质调理”理论运用探析

《临证指南医案》中"方合岁气体质调理"理论与《黄帝内经》中"天人相应"的思想一脉相承,依据患者个体因素,并结合四时岁气的变化立法遣方,将其运用至临床实践,在《临证指南医案》中记载的诸多验案中得以体现。分析叶天士《临证指南医案》中相关医案,对其中"方合岁气体质调理"理论在临床辨证、用药施治、指导养生防病等方面的运用进行探讨,以为现代临证提供指导与借鉴。