海南省妇幼保健机构现状与创等达标的对策

根据《妇幼保健机构等级评审标准》（下称《标准》）要求，对全省２０个妇幼保健机构现状进行了调查。结果显示：我省妇幼卫生工作基础薄弱，离《标准》要求差距较大；各机构间的发展极不平衡；县（市）级机构整体水平偏低，业务用房、人员、设备、床位等建设滞后；服务项目单一，二级专业分科不完善等矛盾较为突出。据此提出，在创等达标工作中，要依靠各级政府，努力争取各方面的支持，抓住机遇，迎接挑战，重点抓好软件建设，加强在职培训，积极引进人才，拓宽服务范围，规范自我，依法服务。     

Current practice in the pre-operative assessment of patients for elective repair of abdominal aortic aneurysmA survey of UK hospitals

A postal survey of 100 hospitals throughout the United Kingdom and Ireland was conducted to assess current practice in the pre-operative assessment and use of pulmonary artery catheters in patients undergoing elective abdominal aortic aneurysm repair. Seventy-four completed questionnaires were received. The survey revealed that 53% of respondents hold designated pre-operative assessment clinics, attended by anaesthetists in 54% and cardiologists in 26%. However, only 4% of respondents have a written protocol for stratifying patients and assessing peri-operative risk. By far the commonest investigation of choice for further cardiological assessment is transthoracic echocardiography (67%). Other investigations of choice are multiple update gated acquisition (MUGA) scan (13%), dipyridamole thallium imaging (9%), exercise ECG (6%), stress echocardiography (1%) and stress MUGA (1%). Two units (3%) never undertook further investigation. Pulmonary artery flotation catheters are used as a routine by 9% of respondents, dependent upon left ventricular ejection fraction by 65%, dependent on other factors by 7% and not used at all by 19%. The survey reveals widespread variation in pre-operative assessment of patients undergoing elective repair of abdominal aortic aneurysm.     

Distinguishment of A 42 Capsomere Structure of Icosohedral Virion from A 32 One by Electron Microsco

ＤｉｓｔｉｎｇｕｉｓｈｍｅｎｔｏｆＡ４２ＣａｐｓｏｍｅｒｅＳｔｒｕｃｔｕｒｅｏｆＩｃｏｓｏｈｅｄｒａｌＶｉｒｉｏｎｆｒｏｍＡ３２ＯｎｅｂｙＥｌｅｃｔｒｏｎＭｉｃｒｏｓｃｏｐｅＣｎｅｎＢｉｎｇｙｉｎｇ（陈丙莺）；ＺｈｏｕＴｏｎｇ（周）（Ｄｅｐａｒｔｍｅ...     

磁共振胰胆管成像诊断胆系梗阻性疾病的临床评价

目的　探讨磁共振胰胆管成像 (MRCP)对胆道梗阻性疾病的临床诊断价值。方法　对 42例胆道梗阻患者进行MRCP检查 ,并经手术病理或 /和其它影像学和临床资料证实。结果　①本组MRCP定位诊断率为 10 0 % ,定性准确率为 83 % ;②扩张的胆道表现为枯枝状 2 3例、软藤状 15例、腊肠样 4例 ;③梗阻端呈倒杯口状 6例、截断状 5例、杵状 17例、鸟嘴状 9例、鼠尾状 5例。结论　MRCP对胆道梗阻性疾病定位诊断准确 ,结合MRI及源像对胆道梗阻性疾病的定性诊断也具有较高的特异性 ,是一种安全快捷、非创伤性的检查方法 ,能为胆道梗阻的诊治及术后评估提供可靠的依据。     

农村公共卫生投融资机制存在的问题及对策

当前,农村公共卫生投融资规模不能适应农村居民的卫生服务需要,投融资结构不合理,致使投融资效果不佳,不利于农村卫生事业的发展。为此,需要从四个方面改革农村公共卫生投融资机制:一是要建立健全国家财政投资保障制度,发挥财政在农村公共卫生投资中的主体作用;二是要改革运行模式,拓宽融资渠道;三是要改善投资结构,优化资源配置;四是要创新管理体制,提高农村公共卫生服务能力。     

教学医院学科人才绩效评价体系的构建与应用研究

目的：建立临床医学院学科人才绩效评价体系，促进临床医学院人才建设，提高学科人才管理水平。方法：运用系统方法、层次分析方法、专家咨询法、权值因子判断表法等建立绩效评价指标体系，并在某临床医学院实测应用，反馈验证评价体系的可靠性和科学性。结果：经实测应用，此体系对学科人才的评估总分呈正态分布，一、二级指标区分度较高，三级指标独立性强，其变量间相关率(经偏相关纠正)为2．67％。结论：此评价体系有较强的可靠性和科学性，具有一定的创新性，能综合评价学科人才的绩效水平。     

医学本科生综合素质全程评估体系研究

目的：拟订了军队医学本科生综合素质评估指标体系，给出医学生综合素质全程评估方法。方法：利用Access数据库编写了军队医学本科生综合素质全程评估软件。并在我校临床医学本科98级“3 2”改革模式和“4 1”传统模式中各随机抽取60名学员进行了初步应用。结果：A、B两班在思想道德素质、专业素质、心理素质、军体素质、基本能力素质、综合素质平均分差异有显性意义，二在科学化素质方面无显性差异。结论：本评估体系可对学生个体进行全程动态评估，并可用于教学改革成效的评价。     

Practical selection criteria for unenhanced cranial CT in patients with acute headache

We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with acute or acutely worsened headache. Data were collected from chart review of 333 consecutive patients presenting to an emergency department and who were clinically selected for cranial CT. Patients with a positive neurologic examination were at 10.7 times greater risk for a positive CT than the rest of the sample (p<1.5 – 10⁻¹⁰). Using only neurologic examination to select patients for CT would have missed 30.3% of the positive scans. The amnesia, depressed sensorium, and hypertension variables had CT yields approximating 10% or greater even in the presence of a negative neurologic examination. Together with a positive neurologic examination, these variables detected 87.9% of the patients in this sample with positive scans; their absence had a negative predictive value of 98.0%. Of the four patients with positive scans who would have been missed using this strategy, one was discharged directly from the emergency department anyway and the other three developed positive neurologic examinations within 24 hours. One died of causes unrelated to the intracranial pathology. Positive neurologic examination, hypertension, history of amnesia, or a depressed sensorium provide reasonable initial guidelines to select for CT patients with an acute headache.     

Health status measurement in Parkinson's disease: validity of the PDQ-39 and Nottingham Health Profile.

We assessed the feasibility and psychometric properties of two commonly used health status questionnaires in Parkinson's disease (PD): the generic Nottingham Health Profile (NHP) and the disease-specific 39-item Parkinson's disease Questionnaire (PDQ-39), from a cross-sectional postal survey of PD patients (N = 81), using traditional and Rasch measurement methodologies. Overall response rate was 88%. Both questionnaires were found feasible, although the NHP performed less well. The PDQ-39 had fewer floor effects and was better able to separate respondents into distinct groups than the NHP, whereas the latter exhibited less ambiguous dimensionality and better targeting of respondents with non-extreme scores. Reliability and validity indices were similar, and potential differential item functioning by age and gender groups was found for both questionnaires. PDQ-39 response alternatives indicated ambiguity. With few exceptions, questionnaire scales were unable to meet recommended standards fully. While preliminary, this study illustrates the need for thorough evaluation of outcome measures and has implications beyond the questionnaires used here. Although promising, both questionnaires warrant further developmental work and stronger support of measurement validity before they could be considered fully suitable for valid use in PD, in particular in earlier stages of the disease.