酷似流行性出血热的伤寒(附3例报告)

本例分析3例伤寒患者,初因有“三红”(面、颈、前胸充血潮红)、血小板减少、蛋白尿而误诊为流行性出血热。说明“三红”等并非流行性出血热所特有,非典型伤寒也可出现,故诊断前应细致检查综合分析。尤其对酷似流行性出血热伴有热程长、肝脾肿大、白血球减少的患者,应考虑到伤寒。     

26例肺炎性假瘤的误诊和治疗分析

本文报告26例肺炎性假瘤的误该和治疗,指出近年本病发病率有增高趋势,男性40岁以上病人明显增加。其临床症状、X线表现酷似肺癌。对其特点认识不足,病理检查亦往往有误。术前检查及观察不够充分、仓促手术为误诊的重要原因。本文提出了避免误诊和防止手术范围扩大的几点意见。     

Preventing Wrong Tooth Extraction

Objective of WorkWrong-site tooth extraction (WSTE) is the most common serious patient safety incident in dentistry. Safety checklists have significantly reduced wrong-site surgery, although their benefit is unproven in primary care dentistry. Our quality improvement project developed and implemented a checklist optimised for oral surgery procedures in primary care to reduce WSTE risk.Material and MethodsLocal best practice for tooth extraction record-keeping (LBP), using national guidelines and standards was devised. We then retrospectively audited tooth extraction record-keeping against LBP. Deficiencies in current record-keeping practice were identified and used to design a checklist aimed at improving compliance. We provided a computerised safety checklist compliant with LBP to eleven clinicians at three general dental clinics within our region. The checklist included a pre-operative safety check, a pause to re-confirm the surgical site and a post-operative record-keeping proforma. The checklist was linked to our record-keeping software for use during tooth extraction. We audited checklist completion and compliance with LBP fortnightly for ten weeks.ResultsThe introduction of a safety checklist resulted in increased compliance with LBP for tooth extraction record keeping. At week ten, 67% of records contained the computerised safety checklist. This resulted in a 50% increase in overall compliance with LBP for tooth extraction compared to baseline.ConclusionsA computerised safety checklist for tooth extraction in primary care has potential to improve patient safety by adopting measures to prevent WSTE and standardising communication between clinicians. Checklists in general practice should be encouraged.     

晶状体脱位继发急性闭角型青光眼误诊分析

目的:分析晶状体脱位继发急性闭角型青光眼的临床特点及误诊原因。方法:对晶状体脱位继发急性闭角型青光眼患者36例(41只眼),采用房角镜和(或)超声生物显微镜(UBM)检查,根据其临床特点,选择适当的手术治疗。结果:41只眼中31只眼(75.61%)误诊为原发性急性闭角型青光眼。单眼晶状体脱位继发急性闭角型青光眼的前房深度较对侧眼明显变浅,差异有统计学意义(P<0.05)。术后1个月,患者视力不同程度提高;眼压正常。结论:晶状体脱位继发急性闭角型青光眼容易误诊为原发性急性闭角型青光眼,误诊原因主要为病史询问不清、眼部检查不仔细。治疗晶状体脱位继发急性闭角型青光眼,需要解除晶状体因素,才能提高手术成功率。     

试论我国口腔护理

世界卫生组织把口腔健康作为人类现代文明的一个标志,口腔健康状态是反映生命健康质量的一面镜子.目前,我国关注口腔健康的人增多了,但掌握正确口腔保健知识的人却很少.事实证明,使病人实践良好的卫生习惯是对口腔护理最大的挑战,医护人员的健康教育是最好的途径.当前,对口腔科护士进行知识和技能的专业化教育培训,是我国口腔护理事业亟需解决的关键问题.     

Risk-taking decisions in pathological gamblers is not a result of their impaired inhibition ability

This work investigates whether inhibition impairments influence the decision making process in pathological gamblers (PGs). The PG (N = 51) subjects performed the Iowa Gambling Task (IGT as the measure of the decision making process) and two tests of inhibition: the Stroop (interference inhibition), and the Go/NoGo (response inhibition), and were compared with demographically matched healthy subjects (N = 57). Performance in the IGT block 1 and block 2 did not differ between the groups, but the differences between the PGs and healthy controls began to be significant in block 3, block 4 and block 5. PGs learned the IGT task more slowly than the healthy controls and had non-optimal outcomes (more disadvantageous choices). Impaired IGT performance in PGs was not related to an inhibition ability measured by the Stroop (interference response time) and the Go/NoGo (number of commission errors) parameters. Further controlled studies with neuroimaging techniques may help to clarify the particular brain mechanisms underlying the impaired decision making process in PGs.     

临床护理差错分析与对策

通过对2000～2008年某院临床护理工作中发生的28起二类护理差错进行回顾性分析,采取对策,提高护理人员对护理差错的防范意识,减少护理差错的发生。从而提高护理工作质量,提高病人的满意度。     

儿童屈光不正性弱视的疗效观察

目的探讨儿童屈光不正性弱视的临床疗效及预后。方法排除器质性眼病和病理性斜视,对105例屈光不正性弱视儿童进行散瞳、验光、配镜、遮盖及精细目力训练等。结果本组年龄越小治愈率越高,弱视程度越轻治疗效果越好,弱视的性质不同疗效亦不同,屈光参差性弱视疗效最差,重度性弱视几乎无治愈。结论儿童在视觉发育期屈光不正性弱视预后较好。关键在于早期发现,及时和正确治疗,绝大多数视力可提高,一部分可获得正常视力。     

An historical review of the Harvard and the National Cancer Institute food frequency questionnaires: Their similarities,differences, and their limitations in assessment of food intake

Food Frequency Questionnaires (FFQ) are pre-coded forms consisting of selected foods that are usually grouped based on their nutrient constitution. By carefully selecting food items that are most important to the basic diet and by grouping them, a relatively short questionnaire can be developed to estimate nutritional exposure accurately, at a relatively low cost. Two major FFQs, the Harvard University/Willett's Questionnaire and the National Cancer Institute/Block's Questionnaire as well as their modified versions have been used in different studies. In general the contents of two FFQs are similar. However, nuances in structure and cognitive aspects set them apart. The objectives of this paper are three fold. First, to provide a historical review of the process of design and development of each FFQ. Second, to compare their cognitive and structural similarities and differences, and finally, to discuss their limitations and biases associated with estimating food intake.     

《脉诀刊误》的版本及学术特点

《脉诀刊误》,元代戴启宗撰著。该书撰成后近200年,未能刊刻,后由汪机加以校核,并附以诸家脉书要语和《矫世惑脉论》,于1523年刊刻。该书对《脉诀》在脉形描述、脉体主病等方面的谬误加以修订,并对“七表八里九道”的分类进行了驳斥。对于研究学习脉学,该书还提出了“分、合、偶、比、类”的方法。