医院数字化膳食管理系统的开发研制

目的：开发智能型的患者订餐工具和后台管理软件。方法：通过该院自编的应用程序读取医院信息系统(HIS)上患者的基本信息和饮食医嘱，利用掌上电脑和数据库开发技术，完成患者订餐及订餐后的信息管理。结果：系统投入运行后，订餐速度明显提高，差错率明显降低，患者就餐满意度也有所提高。结论：该系统的使用将明显提高该院膳食保障服务水平。     

护理导师制教学法的临床应用研究

目的:为培养适应在新医学模式下开展以病人为中心整体护理工作的护理人员,改革传统临床教学模式,采用护理导师教学法,以提高教学质量.方法:制定导师职责,制定导师的选择聘任标准,制定导师培训方案,实施导师制教学法的临床过程,实行双向教学评价,通过以上活动达到提高教学质量的效果.结果:320余名实习学生调查表明,12%的学生认为护理导师教学法形式明显优于其它教学形式,82%的学生认为优于其它教学形式.结论:护理导师教学法提高了临床教学水平和导师的整体素质,也促进了临床护理质量和临床教学质量的不断提高.     

Autonomy and modernisation: the management of change in an English primary care trust

Recent New Labour policy for the ‘modernisation’ of Government places a good deal of emphasis on decentralisation. This emphasis is particularly marked in relation to the organisation of primary care. However, like hospitals and other National Health Service institutions, primary care trusts (PCTs) are subject to a substantial raft of centrally established performance targets and indicators, including those which contribute to the public award of between zero and three performance ‘stars’. This raises questions about the extent to which employees can exercise autonomy in the context of rigid top‐down directives. This paper presents findings from a study using participant observation and interviews to examine the impact of a training course aimed ostensibly at increasing employee autonomy in an English PCT. The suggestion is that attempts to make employees more autonomous can be seen as a strategy for increasing central control based upon the internalisation by the employees of centrally promulgated values. The attraction of such strategies is that they may be potentially more effective and less costly than alternative strategies of direct control. However, the study suggests that the outcome of attempts by such methods as programmes to increase employee autonomy may be very different from those intended.     

The Usefulness of Magnetic Resonance Imaging in the Diagnosis of Anterolateral Impingement of the Ankle

The purpose of this study is to assess the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of anterolateral impingement of the ankle and to assess the most helpful sequence in making the diagnosis. Twenty-four patients who had undergone ankle arthroscopy were chosen. Twelve patients had arthroscopically documented anterolateral impingement, and 12 patients with no impingement on arthroscopy served as controls. Two musculoskeletal radiologists and an orthopedic surgeon, blinded to the operative diagnosis, retrospectively reviewed selective MRI images in the sagittal, axial, and coronal planes. The sensitivities and specificities were calculated for all 3 reviewers. The Kendall coefficient of concordance was calculated for overall agreement among reviewers. Sensitivities varied from 0.75 to 0.83, whereas specificities varied from 0.75 to 1.00. Using the Fisher exact test of contingency, the sensitivities and specificities showed that all reviewers' interpretations were statistically significant with P = .039, .001, and .012, respectively. The axial images were felt to be most helpful in making the diagnosis. The physicians felt that the sagittal images were helpful in 67%, 83%, and 100%, respectively. MRI is a useful tool that can aid the clinician in the diagnosis of anterolateral impingement of the ankle. T1 sagittal images demonstrating displacement of the normal fat signal anterior to the fibula by scar can be useful and help to confirm the diagnosis.     

不同临床和病理分型对肝门部胆管癌切除术预后的影响

目的 研究临床和病理分型与肝门部胆管癌切除术疗效的关系。方法总结1993年至2004年在解放军总医院肝胆外科手术切除的肝门部胆管癌198例病例资料。结果临床分型Ⅰ型34例，Ⅱ型60例，Ⅲa型27例，Ⅲb型33例，Ⅳ型19例，Ⅴa型6例。Ⅴb型19例。病理高分化腺癌35例，中分化腺癌52例，低分化腺癌54例，三者的中位生存期分别为29．5、11、5．5个月；病理切缘阴性者与切缘阳性者生存率有显著性差异（P 〈0．05）。手术并发症出现率41．4％，围手术期死亡1例。结论肝门部胆管癌根据临床分型进行相应的手术治疗；病理切缘阴性是影响预后的主要因素之一；围手术期正确处理，是减少手术并发症，提高患者生活质量和延长生存期的关键。     

安庆市肺结核病流行现状调查分析

目的了解安庆市肺结核病流行现状．为制定结核病控制对策提供科学依据。方法对1997～2001年结核病疫情报告和结核患者登记年报表进行分析。结果5年间，安庆市年均肺结核病报告发病率为61．15／10万，初治涂阳治愈率为90．31％，归口管理单位查痰率为91．05％。结论归口管理是提高本市结核病防治工作成效的重要措施。     

Pharmacologic management of overactive bladder

Overactive bladder (OAB) is a prevalent and costly condition that can affect any age group. Typical symptoms include urinary urgency, frequency, incontinence and nocturia. OAB occurs as a result of abnormal contractions of the bladder detrusor muscle caused by the stimulation of certain muscarinic receptors. Therefore, antimuscarinic agents have long been considered the mainstay of pharmacologic treatment for OAB. Currently, there are five such agents approved for the management of OAB in the United States: oxybutynin, tolterodine, trospium, solifenacin and darifenacin. This article summarizes the efficacy, contraindications, precautions, dosing and common side effects of these agents. All available clinical trials on trospium, solifenacin and darifenacin were reviewed to determine its place in therapy.     

Undergraduate psychiatry teaching in Ethiopia

Many epidemiological studies have shown the magnitude and seriousness of mental disorders in developing countries. However, mental health care remains unsatisfactory owing to lack of skilled manpower and many other social and medical priorities. General practitioners and other health personnel can significantly help in extending mental health care provided they receive adequate training during their medical curriculum. With this aim, the Department of Psychiatry at Addis Ababa University runs a 6-week full-time course for undergraduate medical students. Its chief objectives, teaching methods, achievements and shortcomings are discussed in the paper.     

优化结构提高效率实现医院可持续发展

随着我国医疗保险的大范围实施，医院只有优化结构、提高效率，才能实现可持续发展。以财务管理为出发点，分析了目前大型医院所面临的现行国家医疗政策、外部环境以及内部约束等条件，提出强化医疗业务管理．建立科学合理的医疗业绩考核指标体系：平均住院天数、出院人数、手术量、门诊预约率，促进医疗业绩的提高：强化财务管理，建立现代医院财务考核指标体系：结余率、人均结余、病人人均费用，对各个科室的经济效益进行考核，促进医院经济效益的提高。