社区卫生服务机构与医院双向转诊现状分析

【摘要】 本研究通过对社区卫生服务机构双向转诊情况的调查，从卫生服务机构，社区居民及二三级医院三方面进行分析，并根据分析结果提出解决措施。     

缬沙坦预处理对乳鼠心肌细胞缺氧/复氧损伤的保护作用

目的:探讨缬沙坦预处理对乳鼠心肌细胞缺氧/复氧损伤的保护作用及其机制.方法:常规方法培养心肌细胞,培养72小时后,分为三组:正常对照组、心肌细胞缺氧/复氧损伤组、缬沙坦预处理后心肌细胞缺氧/复氧损伤组.分别观察心肌细胞结构,测定心肌细胞存活率、乳酸脱氢酶(LDH)、丙二醛(MDA)及超氧化物歧化酶(SOD)水平.结果:与对照组比心肌细胞缺氧/复氧损伤组细胞存活率明显下降、培养液中LDH、MDA含量明显增高,SOD含量明显下降；与心肌细胞缺氧/复氧损伤组比,缬沙坦预处理组心肌细胞存活率明显提高,培养液中LDH、MDA含量明显下降、S0D含量明显上升.结论缬沙坦通过抗氧化、抗脂质过氧化反应,清除氧自由基对乳鼠心肌细胞缺氧/复氧损伤有保护作用.     

Assessment of cerebral oxygenation during prolonged simulated driving using near infrared spectroscopy: its implications for fatigue development

Information on cerebral oxygenation during prolonged driving in healthy humans may help to explain the cause and development of central fatigue and its effects on cortex activities. The objective of this study is to investigate the time course of cerebral oxygenation during a prolonged driving task. Forty healthy male subjects were randomly divided into two groups: task group (Task) and control group (CNL). All subjects were required to rest well prior to the experiment. For the task group, subjects were required to perform the simulated driving task for 3 h. Cerebral oxygenation signal was monitored from the left frontal lobe using near infrared spectroscopy throughout the entire experiment. Significant increases in the concentrations of HbO₂ (ΔCHbO₂) and HbT (ΔCHbT) were recorded at the start of driving task compared with the resting value (p < 0.01). The cerebral oxygen saturation in the Task group was found to be significantly lower following three hours of driving compared with that in the CNL (F = 16.95, p < 0.001). In addition, a significant difference in selective reaction time was observed between the Task group and CNL during the post-task period (p = 0.023). The results demonstrated that the cerebral oxygenation is closely related to the mental stress. The decrease in the cerebral oxygen saturation may indicate reduced cerebral oxygen delivery, and this may be an important factor affecting central fatigue development during prolonged driving.     

A refined surgical treatment modality for bromhidrosis: Subcutaneous scissor with micropore

Axillary bromhidrosis has a strong negative effect on one's social life. A high success rate and few complications are criteria for a surgical treatment. The objective of this study was to evaluate a new surgical treatment modality for bromhidrosis: subcutaneous scissor with micropore. Twenty patients with bromhidrosis were treated. Patients were placed in a supine position with their treated arms abducted to 110°. After injection of 60 mL of tumescent solution into each axilla, one small incision was made at the middle axillary of the hair‐bearing area. The whole hair‐bearing skin was undermined at the level of the superficial fat to obtain adequate skin eversion. The flaps were everted to offer full exposure of the apocrine glands, and meticulous excision of each gland was performed. Both sides were punctured with scalpel. The micropore was used for drainage, and whose width was just 3 mm. Finally, the incisions were re‐approximated, and bulky compressive dressings were applied to the area for 72 hours. Of the 40 axillae (20 patients), 34 (85.0%) showed excellent results, and six (15.0%) had good results. Malodor was significantly decreased. There were no serious complications. This technique can produce excellent results with a lower complication rate than most other surgical modalities and can be performed without costly equipment.     

Professional Commitment, Patient Safety, and Patient-Perceived Care Quality

Purpose: To examine how professional commitment influences patient safety and patient-perceived care quality.
Design: Investigators for this study used a cross-sectional design with questionnaires. A total of 348 pairs of nurses and inpatients were contacted at two medical centers in Taiwan during the period from August 2007 to January 2008, yielding 284 pairs of completed questionnaires.
Methods: Frequencies of six adverse patient events were used to measure patient safety; and the Service Quality Scale was used to measure patient-perceived care quality. Four items of the Professional Commitment Questionnaire were used to measure professional commitment. Regressions were used for the analyses.
Findings: Professional commitment positively influenced overall patient safety (ß=.19, p =.00) and overall patient-perceived care quality (ß=.13, p =.03). Furthermore, professional commitment positively influenced all patient safety indicators (ß≥.12, p ≤.04), except frequency of nosocomial infections, the coefficient of which reached borderline significance (ß=.11, p =.07). Professional commitment also positively influenced care quality in terms of responsiveness (ß=.16, p =.01) and empathy (ß=.14, p =.03).
Conclusions: Professional commitment may enhance patient safety and patient-perceived care quality.
Clinical Relevance: This study indicates that nurse professional commitment can enhance patient safety and patient-perceived care quality.     

AcrySof IQ人工晶状体植入术的临床效果观察

目的:探讨白内障超声乳化联合蓝光滤过型非球面人工晶状体植入术的临床效果。方法:年龄相关性白内障患者80例(80眼),术中植入AcrySof IQ人工晶状体为观察组,植入AcrySof Natural人工晶状体为对照组。观察术后1wk不同视标对比度的视力;使用主观像差仪检查实验组术后1mo的像差,依35项Zernike系数计算总像差及4阶像差的均方值(root means quare,RMS),比较实验组与对照组间的差异。结果:术后1wk,视标对比度为100%时,两组间差异无统计学意义(P<0.05)。对比度为25%时,两组间差异有统计学意义(P>0.05)。术后1mo,实验组与对照组总体像差的RMS均值分别为0.84±0.21μm及1.44±0.42μm,两者之间的差异有统计学意义。实验组、对照组4阶像差(球差)的RMS均值为0.58±0.18μm、1.14±0.37μm,两者之间的差异有统计学意义。结论:非球面人工晶状体可以减少术眼光学像差(尤其是球差),获得更好的低对比度视力,从而提高术后的视觉质量。     

大黄在小儿重症肺炎治疗中肠道保护的作用

目的：探讨大黄在小儿重症肺炎治疗中的肠道保护作用。方法：选择小儿重症肺炎60例，随机分成治疗组和对照组，均采用综合治疗，对照组按西药常规治疗，治疗纽内服大黄。结果-治疗组有效率为77％（23／30），对照组有效率为50％（15／30），有统计学差异（P〈0．05）。多器官功能障碍（MODS）的发生率治疗组（8／30）占27％；对照组（16／30）占57％，有统计学差异（P〈0．05）。治疗组存活26例，生存率86．7％，对照组存活20例，生存率66．7％（P〉0．05）。结论：大黄对肠道屏障保护在治疗小儿重症肺炎是行之有效的，可以防止病情向MODS演变及降低病死率。     

凹凸棒对中药中连翘苷吸附作用考察

目的：考察凹凸棒作为吸附澄清剂，对连翘药材、银翘解毒颗粒水煎提取液中连翘苷的吸附作用和对无效成分的吸附清除作用。方法：以水煎提取液中浸出物含量和连翘苷的含量作为评价指标，分别用不同量的普通凹凸棒和酸化凹凸棒处理，连翘药材及银翘解毒颗粒水煎提取液，评价其吸附澄清效果，并与自然静置沉淀法进行比较。结果：普通凹凸棒对无效成分具有较明显的吸附清除作用，对连翘苷含量没有明显吸附影响。酸化凹凸棒对连翘苷含量有较明显的吸附作用，对无效成分也有一定的吸附清除作用。结论：凹凸棒可作为银翘解毒颗粒水煎提取液的吸附澄清剂，尤其是酸化凹凸棒值得作进一步的表面结构修饰研究，以优化其吸附澄清效果。     

水血同治法治疗糖尿病视网膜病变

糖尿病视网膜病变是糖尿病常见且严重的并发症,眼底表现出多种渗出、出血等病变,不外"痰""瘀".本文对痰瘀在糖尿病视网膜病变中的作用机理、成因进行了探讨,并对运用水血同治法对其治疗进行总结.