护士长临床护理信息动态报告制度的建立与效果评价

目的:探讨护士长临床护理信息动态报告制度在病区优质护理服务管理中的作用和效果。方法:设计病区临床护理信息动态报告表,并通过电子信息系统填报和提交建立每日报告和定期考核制度,比较应用护理信息动态表前、后护士长对病区临床护理信息动态的掌握情况。结果:建立临床护理信息动态报告制度后护士长对病区实际收治病人数重危病人数、手术病人数、一级护理病人数、完全不能自理病人数、部分自理病人数、当日在岗护士数、责任护士分管床位数等重要护理信息数据掌握程度提高,与之前相比差异具有统计学意义(P<0.05)。结论:护士长临床护理信息动态报告制度的建立规范了护士长的工作程序,促进了护士长每日动态掌握护理工作情况和人力资源状况,提高了护士长临床护理质量管理的效率和效果。     

肿瘤科实施PBL教学培养学生循证医学思维模式的探索

目的建立适合肿瘤科教学特点的PBL教学体系,培养学生循证医学临床思维模式。方法在肿瘤科临床教学中,选取40名临床医学系七年制学生,进行"以问题为基础的学习(PBL)",与传统教学方法进行对比研究,探讨PBL启发式教学在培养学生循证医学临床思维模式方面的作用。结果 PBL教学组理论学习成绩中基础知识部分成绩与传统教学组无明显差异,但是临床问题分析及处理能力考核成绩显著优于传统教学组(P<0.001)。结论在肿瘤科临床教学中的运用和实施PBL教学法,能够使得学生的循证医学思维得到良好的建立,临床能力得到更好的提高,该方法值得进一步实践推广。     

湖北省二级医院病案科现状调查

目的了解湖北省病案科（室）的现状,为加强我省二级医院的病案科（室）建设提供依据。方法通过问卷法调查湖北省二级医院病案科（室）的组织管理、人员配置、科研培训、信息化管理及科室制度的现状,采用描述性统计对收集的数据进行分析。结果 54.44%的病案科（室）归医务处管理,病案工作人员业务用房面积大于50m2病案科室仅占20.11%,病案管理者专业背景以护理（28.36%）和临床医学（16.36%）居多,11项病案科室制度的覆盖率均在70%以上。结论病案室制度建设较完善,基础设施严重不足,从业人员结构不合理,信息化管理水平参差不齐。     

湖北省三级医院病案管理人员现状调查

目的了解湖北省三级医院病案管理人员的配置情况,为提高我省病案管理人员的综合素质提供依据。方法通过问卷法调查湖北省病案管理人员在三级医院的配置情况,包括性别、年龄、学历、职称、专业、从业年限、专业培训和科研情况。结果病案管理人员男女比例为1比3.13,年龄主要以青壮年为主,学历以本科和大专为主,专业背景以护理和临床居多。结论增加人员编制,建立级别管理制度,提升病案管理人员的专业水平,以促进病案的信息化管理。     

Computed Tomography Image Analysis Before and After Treatment of Anti-Neutrophil Cytoplasmic Antibody−Associated Pulmonary Interstitial Fibrosis in 8 Patients

PurposeThe purpose of this study was to observe the treatment response of anti-neutrophil cytoplasmic antibody (ANCA)−associated pulmonary interstitial fibrosis in 8 patients before and after glucocorticoid or immunosuppressive therapy.MethodsThe clinical features and computed tomography imaging findings of the 8 patients in our hospital from October 2011 to October 2013, were retrospectively analyzed.FindingsMean age of the 8 patients was 72.6 (range 60−80) years. Five patients exhibited cough, sputum, and chest tightness, including 2 patients with fever. One patient developed hemoptysis, 1 patient exhibited abnormal urinalysis and developed renal insufficiency, and 1 patient developed limb pain. Two patients exhibited high urine erythrocytes and 2 patients had renal dysfunction and urinary abnormalities. One of the latter patients, upon renal biopsy, had focal proliferative necrotizing glomerulonephritis (consistent with vasculitis damage) with stage II to III mild nephropathy. Seven cases were anti−myeloperoxidase-ANCA, and 1 case was anti−proteinase 3-ANCA. All 8 cases exhibited streaks and grid shadows in chest imaging; 2 cases exhibited limited ground-glass patches; 1 case displayed multiple large patches of exudative shadows, indicating diffuse alveolar hemorrhage; 2 cases exhibited obvious honeycomb manifestations; and 1 case exhibited significant traction bronchiectasis. The ground-glass opacities disappeared after corticosteroid or immunosuppressive therapy; however, for streaks and grid shadows, no significant changes in the images were observed after treatment from 2 weeks to 10 months.ImplicationsANCA-associated pulmonary interstitial fibrosis most often in elderly patients with many complications. In these patients ground-glass opacities in computed tomography images, corticosteroid or immunosuppressant therapy may be effective. Clinicians should consider the poor efficacy and side effects of these therapies in the fibrosis stage of the disease.     

Severe Pneumonia Mortality in Elderly Patients Is Associated With Downregulation of Toll-like Receptors 2 and 4 on Monocytes

BackgroundElderly patients with pneumonia have a high mortality rate. Since Toll-like receptor (TLR) signaling is involved in the inflammatory response, we conducted a prospective observational case–control study to assess the relationships of TLR2 and TLR4 mortality with elderly patients with pneumonia.MethodsClinical and laboratory data were collected from these elderly patients with pneumonia (patient group; n = 40) and healthy age-matched subjects (control 1; n = 20). TLR2 and TLR4 expression levels on blood monocytes were examined, and inflammatory cytokine tumor necrosis factor-a (TNF-a), interleukin- 1 (IL-1) and interleukin-6 (IL-6) plasma concentrations were analyzed.ResultsIncreased TLR2 and TLR4 expression levels were detected in elderly patients with severe pneumonia compared with healthy subjects. Furthermore, we observed a positive correlation between TLR2 and TLR4 expression levels and IL-1 and IL-6 levels, and TLR2- and TLR4- positive cell percent expressions correlated with TNF-a levels. By day 28 of observation, the mortality rate of the patient group was 30%. Decreased TLR2 and TLR4 expression was observed in deceased patients compared with survivors. APACHE (Acute Physiology and Chronic Health Evaluation) II scores and CURB-65 scores (Confusion, blood Urea nitrogen, Respiratory rate and low Blood pressure scores) were lower in survivors.ConclusionsThese findings demonstrate a previously undocumented association between mortality in elderly patients with severe pneumonia and decreased TLR2 and TLR4 expression. Our results highlight that TLRs can be targeted in the development of improved immune modulation therapies for these patients.     

南方某城市不同医疗保险政策对医疗服务的影响分析

目的描述比较2003～2010年南方某市综合医保、住院医保、农民工医保和少儿医保政策下医疗服务的差异,探讨不同医保政策对医疗服务的影响,为医疗保险管理部门提供控制策略。方法从南方某市医保局获得2003～2010年该市医疗服务费用数据,把费用分成门诊、住院两部分,通过对各种医保类型患者的总费用（药品费用、诊疗费用）、人均费用（药品费用、诊疗费用）、均次费用（药品费用、诊疗费用）的比较,发现各医保类型的费用变化趋势和差异,分析不同参保类型对医疗服务的影响。结果不同医保患者的门诊费用、住院费用中的总费用（药品费用、诊疗费用）、人均费用（药品费用、诊疗费用）、均次费用（药品费用、诊疗费用）差异均有统计学意义,综合医保各项指标较高,农民工医保各项指标较低。结论综合医保的各项指标著高于其他类型,农民工医保各项指标较低。要注意控制综合医保的医疗费用,提高农民工医保的医疗服务水平。在门诊费用控制中要注意控制比例较高的药品费用。     

感染相关的抗N-甲基-D-天冬氨酸受体脑炎的临床特点分析

目的:总结感染后出现的抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的临床特点。方法:收集5例感染后出现的抗NMDAR脑炎患者临床病历资料,并检索感染性因素相关的NMDAR脑炎的文献资料,分析此类疾病的临床特点。结果:5例(男4,女1)呼吸道感染后出现的抗NMDAR脑炎患者,平均年龄23.4岁,所有患者均未发现肿瘤,3例合并其他自身免疫性抗体。感染至发病的时间(5.2±2.8)d。主要症状包括发热、精神行为异常、癫痫发作、小便障碍,平均确诊时间达(40.6±25.4)d。血清和脑脊液的NMDAR抗体滴度均达到()。脑脊液检查以轻度细胞数升高和/或蛋白升高为主,有4例出现头颅磁共振及脑电图检查异常,2例进重症监护病房。经过免疫治疗后,有3例预后良好,2例预后一般。5例患者病程中均出现反复发作,2年内总复发次数达11次。结论:感染因素可以诱发抗NMDA抗体脑炎,其多在感染后1周内发病。主要症状仍以发热、精神行为异常为主,容易误诊为病毒性脑炎,脑脊液NMDAR抗体检测有助于明确诊断,免疫治疗后复发率高、预后欠佳。     

医学院校临床医学研究生医患沟通技能培养策略探讨

有效的医患沟通是构建和谐医患关系的重要基础,然而我国对临床医学研究生医患沟通技能的培养依然缺乏医患沟通类专门课程,存在理论与实践脱钩、应用性低、教学方法僵化、缺乏吸引力等诸多问题。为提升医学院校临床医学研究生的医患沟通技能,构建和谐医患关系,应针对临床医学研究生设置医患沟通类专门课程,并从调整理论结构,加强医患沟通教学的实用性,转变学生学习态度,引导学生主动学习,优化教学方法,增强课程吸引力等方面对教学策略和学习平台进行优化改进,以期通过提升临床医学研究生的医患沟通素养,进而达到改善医患关系的目的。     

公有医院开展资本运营的思考

介绍了医院资本运营的概念和内涵,论述了医院资本运营的重要意义和方式,重点分析了公有医院资本运营中存在的问题.