药物不良反应的监察系统与信息来源

据WHO统计 ,住院病人中药物不良反应发生率为 10 %～ 2 0 % ,有 5 %的住院病人因药物不良反应而入院 ,因药物不良反应而死亡者占住院死亡病人的 0 .2 4 %～ 2 .9%。因此 ,研究药物的不良反应 ,对药物不良反应信息进行及时的收集、整理、评价并加以报道 ,捉高医疗临床用药的合理性、安全性 ,具有重要的现实意义。1　药物不良反应概况按WHO国际药物监测合作中心的规定 ,药物不良反应 (adversereactions ,简称ADR)系指正常剂量的药物用于预防、诊断、治疗疾病或调节生理功能时出现的有害的和与用药目的无关的反应。该定义排除有意的或意外…     

浅谈细菌学快速检验

目的：探讨细菌学的快速检验方法及意义。方法：对直接涂片细菌形态学检验、微生物学快速检测进行分析。结果：细菌学信息传递越早、越快,对病人越有利。结论：及时通报病原学检验信息和微生物技术进展,接受临床的信息反馈,对促进医疗水平和微生物检验水平的提高都十分重要。     

病案管理中的医学伦理问题

病案管理中的医学伦理问题越来越受到人们的关注,正在我国进行的医疗体制和社会保障机制的改革,医疗法制尚不健全,医患纠纷日益增多。在现代医院管理中,随着医院技术设备的现代化,病案作为医疗活动信息的主要载体,不仅是医疗、教学、科研的第一手资料,而且也是医疗质量、技术水平、管理水平综合评价的依据。如何高效、准确、及时管理病案、及时反馈病人所有信息、及时了解医护人员对病人护理的历史记录,是医疗信息化建设的奋斗目标,因此,医院必须相应培养一支具有良好素质的病案管理队伍,以进一步加强病案管理工作,确保医院的宏观调控和科学管理的实施。     

浅谈细菌学快速检验

目的:探讨细菌学的快速检验方法及意义。方法:对直接涂片细菌形态学检验、微生物学快速检测进行分析。结果:细菌学信息传递越早、越快,对病人越有利。结论:及时通报病原学检验信息和微生物技术进展,接受临床的信息反馈,对促进医疗水平和微生物检验水平的提高都十分重要。     

建立后医疗管理信息反馈渠道对提高病人满意度的作用

目的建立后医疗管理信息反馈渠道,提高医务人员的服务质量,有效提升病人满意度。方法通过对全院出院病人电话随访,准确掌握出院病人的医疗服务满意程度;及时查找、分析随访信息;应用后医疗管理信息反馈渠道及时传递信息,为医院制定相应的管理、培训、约束机制提供可靠的依据。结果出院病人满意度调查结果综合满意度从95.23%上升到98.94%。结论及时了解病人需求,明确服务目标,有效规范医务人员服务行为,提高了服务质量和病人满意度,构建了和谐的医患关系,稳定医院客户群。     

从法律证据角度分析病案形成过程中的问题及对策

目的提高医务人员的法制意识,保证病案的证据学证明力。方法通过律师查房,从法律证据学角度对在院病人住院病历形成过程中存在的问题进行检查,现场进行讨论、反馈信息、及时改进。结果对病案形成过程中的客观、真实、及时、准确、完整性,主干医疗工作制度执行力度,知情告知,在院病人住院病历保管的问题及解决对策进行了剖析。结论医院及其医务人员只有严格执行法律法规,把握医疗文书形成各个环节,保证病历质量并妥善保管,才能提高医疗质量、堵塞漏洞、保证医疗安全。     

输液不良反应的观察及处理

目的探讨输液不良反应的原因及护理干预措施。方法对25例出现输液不良反应的病例进行总结,分析出现发热反应、过敏反应及其他不良反应的原因及护理干预措施。结果25例出现输液不良反应的患者经及时处置后均治愈,未留下后遗症。结论加强工作责任心、严格执行操作规程是减少输液不良反应的关键。输液过程中认真巡视观察,熟练掌握输液不良反应处理流程,及时发现输液不良反应及减少输液不良反应对病人的伤害,是提高医疗服务质量的有效措施。     

抽查分析门诊处方 配合临床合理用药

目的：减少药物不良反应，保证病人安全有效地使用药物．方法：抽查分析门诊处方，发现问题及时向医生提出，给与纠正．结果：抽查分析门诊处方4320张，纠正问题202例，结论：药师抽查分析门诊处方，配合临床合理用药，对病人安全有效地使用药物起到积极的促进作用，有效地防止了医疗差错事故的发生．     

浅谈护患沟通技巧的体会

目的护患沟通传递的每一个细微的信息,都要及时作出反应进行有效交流。沟通是一种与临床护理技能同样重要的人与人之间的交往技巧,通过沟通,护士可以收集病人健康方面的资料和信息,了解病人的需求,对病人实施有效的系统的护理,护患沟通的效果直接影响护理质量,讲究与病人的沟通技巧,建立良好的护患关系,使患者能够积极配合各项护理工作,从而提高护理操作成功率,促进康复的速度和质量,提高医疗服务水平具有重要意义。     

临床护士对心电图监测知识掌握情况的调查分析

近年来随着医疗设备的不断发展,抢救仪器的广泛使用,心电监护仪以其不可替代的优越性越来越受到临床护士的欢迎。在对病人实施连续心电图监测的过程中,临床护士正确观察和识别心电图波形变化,及时为医生提供病情变化的准确信息,对确立有效的治疗方案十分重要。为了解我院临床护     

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     

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…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

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.