人文关怀改善医患关系的探讨

目的 为了提升服务内涵,增加人性化服务,构建和谐的医患关系,完善医院的服务环节,促进医院可持续发展.方法 对治疗后的患者用打电话的方式进行跟踪服务.结果 通过电话随访不仅可以协助患者减轻病痛,维持和促进个体的健康,还可以广泛征求患者的意见和建议,调查患者对医院的满意程度,从中发现自身的问题与缺陷,及时采取整改措施.结论 诊后电话随访受到广大患者的欢迎,通过这个交流平台,医患之间的关系得以改善,人文关怀得以体现,患者提出的合理化建议与意见也得到采纳.这既拓展了医院的服务范围和领域,又扩大了科室的影响,促进了医院的建设.     

电话随访出院10000例结果分析

目的：探讨电话随访对出院患者和医院的意义。方法：采取对出院后1个月的生存患者10 000例,由患者回访中心进行电话随访,了解治疗、护理效果,患者的生活质量,再就医需求。患者对医院的环境,医护人员的服务态度及治疗效果的满意程度,并收集患者提出的合理化意见和建议。结果：通过随访拉近了医院、社会和患者三者之间的距离,将为患者的服务延续至家庭,为提高医院的医疗、服务质量提供了信息资源,取得了良好的社会效益。结论：随访是提高医院医护质量和服务态度,促进医患关系的和谐、不断拓展医疗市场,促进患者康复的有效措施之一。     

电话随访出院患者满意度8597人次调查分析

目的:通过电话随访调查分析出院患者对医疗护理服务的满意度。方法:由专职人员对出院患者进行电话随访,征求患者住院期间对医疗护理服务的意见及建议,将患者的有效随访信息进行汇总分析。结果:电话随访8 597人次,收集各方面意见385件;影响患者满意度的首要因素为服务态度问题,第二位为护士技能操作及疗效和医护服务的及时性。结论:服务态度是影响医院满意度的主要因素,过硬的技术和高度的服务效率是患者对医护人员的期望,与患者多沟通建立良好医患关系是提高满意度的有力措施。     

3469例门诊患者电话回访程序及效果分析

门诊是医院的最前沿，就诊患者集中，是向社会展示医院形象、技术水平的窗口。为真正做到“以患者需求为导向”，进一步提高门诊服务水平和整体效率，我院自2006年1月开始对门诊就诊患者进行电话回访，通过为患者提供连续性服务．在医院和患者之间建立有目的的互动，延长对患者的医疗服务时间。充分征求患者在就诊环节中的意见和建议,在促进医患关系和谐发展、     

护理电话随访在临床中的应用体会

随着社会和经济的不断发展,促进了医疗护理服务市场的迅速发展,而现代化通信技术的普及为实现护理服务的延伸提供了很好的平台。对出院患者进行电话随访正是新形势下的一种开放式、延伸式的健康教育形式[1]。为进一步改善医患关系,延伸医疗服务,我院从2010-10以来,开展了对出院患者的电话随访,成立了客户服务中心,受到了患者及社会的好评,找出了影响医院发展的瓶颈问题,取得了满意的效果。我科积极响应,在科内建立医疗组随访和护理组随访登记本。通过随访,大大缩短了医患间的距离,增强了医疗机构与患者的信任     

出院患者回访工作对医患关系管理的启示

通过信件和电话两种方式对某院2006—2007年32 037人次出院患者进行回访,共有25 459例病人反馈了意见,其中满意者25 171例,288例不满意者反馈意见或建议311条,涉及服务态度、服务效率、服务水平、就医环境、服务流程、医患沟通、医疗收费、医德医风共8个方面。分析回访数据,掌握服务现状,揭示了医患关系管理的重点,包括医院软环境建设;改善医院服务态度、提高服务效率;不断构建全程医患沟通渠道。笔者认为：出院患者回访工作对构建和谐医患关系,提升管理水平有积极的促进作用,但仍需科学化;医患关系紧张甚至形成冲突成因复杂,需要行业性、全方位的解决方案。     

电话随访在优质护理过程中的应用体会

目的　总结电话随访在优质护理延伸服务中的经验体会。方法　2012年1月－2013年6月实行优质护理后,对我院普外科出院患者进行电话随访。结果　增加了医患之间的信任,拉近护患之间的距离,提高社会的满意度及治疗依从性,改变了服务意识。结论　电话随访是护理优质服务的延伸,是护理工作的必要补充,是建立护患、医患良好关系的纽带,提升了医院的社会形象。     

慢性阻塞性肺疾病出院患者的电话随访式教育

总结了对慢性阻塞性肺疾病出院患者进行电话随访式教育的方法,包括建立出院患者电话随访制度及随访登记本,随访方式和随访内容。认为电话随访式健康教育是一种简便、高效的医疗服务措施,能更好地促进患者的遵医行为,提高患者的身心独立能力,不但完善了出院指导,更进一步地促进了医患和护患关系的和谐,提高了医院信誉及患者满意度。     

病区助理在院后随访工作中的做法与体会

目的：体现医院人性化服务,为出院患者提供疾病的后续治疗。方法：成立院后服务办公室,各病区设立病区助理,院后服务办公室负责指导病区助理开展出院患者电话随访,为患者提供院前-院中-院后一体化服务。结果：患者满意度明显提高,同时也增加了患者就诊率。结论：提升了医院知名度,和谐了医患关系,是提高医疗服务质量的有效方法。     

实施医疗后满意度调查 提升护理工作质量

目的 通过实行医疗后满意度调查更加全面地了解患者对医院医疗、护理、后勤等方面的意见,提高医院服务质量,实现工作目标--医患零距离、服务零投诉.方法 成立医疗后办公室,设立专职护士,于患者出院后第1天通过电话和邮寄调查其在整个就医过程中接受的服务质量.结果 随访成功5425位患者,反映意见共219条,占4.04%,涉及护理工作共79条,占36.1%.经统计得出影响患者对护理工作满意度的首要因素为护患沟通问题(27.8%),第二位为服务态度问题(13.9%).结论 实施医疗后满意度调查可以获得更加真实、全面的患者意见,激励广大护理人员提高工作积极性,不断提高护理服务质量.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

妊娠合并血小板减少症与心、肝、肾脏器损伤

目的探讨妊娠合并血小板减少症伴随重要脏器的损伤情况。方法前瞻性研究我院及北华大学附属医院2004年10月至2005年5月妊娠合并血小板减少症的临床资料，对41例妊娠合并血小板减少症者尿素氮（BUN）、肌酐（CREA）、谷丙转氨酶（ALT）、乳酸脱氢酶（LDH）的测定及妊娠期高血压疾病与血小板计数（PLT），血小板平均体积（MPV）和血小板体积分布宽度（PDW）参数的测定进行对比分析。结果妊娠合并血小板减少症患者心、肝、肾等重要脏器均有不同程度的改变，且随着血小板计数降低，损害程度加剧，差异具有显著性（P〈0．01）。妊娠期高血压疾病，随着疾病程度的加重，血小板计数较正常孕妇明显减少，MPV、PDW明显升高，有显著性差异（P〈0．01）。结论血小板参数是判断疾病的重要参考指标，肝、肾、心脏器损伤程度与血小板计数具有相关性。