青年人大肠癌误诊原因探讨

目的 探讨青年人大肠癌的误诊原因，以便早期诊断治疗。方法 回顾性分析62例青年人大肠癌的诊断及其治疗效果。结果 本组直肠癌36例中被误诊为结肠炎7例，痔疮并出血5例，痢疾3例，肛周脓肿并肛瘘2例；结肠癌26例中被误诊为阑尾周围脓肿3例，结肠炎2例，缺铁性贫血1例。误诊率37．1％。结论 青年人大肠癌早期临床症状不明显，恶性程度高，预后差,其治疗水平有赖于对这些特征的认识，力争早期诊断及治疗。     

'Not everything that can be counted counts and not everything that counts can be counted'– towards a critical exploration of modes of satisfaction measurement in sheltered housing

This paper reflects on a research project funded by a consortium of leading sheltered housing (SH) providers and their regulatory body, the Housing Corporation. The project aimed to ascertain which aspects of SH older people perceived to be central to their satisfaction and the methods they judged most appropriate to measuring this. We outline key policy developments of importance to SH (specifically the development of performance measurement regimes), and changes in the nature of SH, which are driving providers to re‐evaluate how they measure user satisfaction. We discuss the aims of the project, our methodology and findings, and conclude by raising critical questions about the process of measuring satisfaction within an increasingly managerialised housing system. We argue that this favours standardised methods of information gathering (such as questionnaires) rather than engage with clients in order to develop methods and systems capable of eliciting qualitative issues of concern to them. Our conclusions are, we believe, applicable to health and social care provision, where similar tensions exist around performance measurement and user satisfaction.     

老年退行性腰椎管狭窄症的手术疗效分析

目的:探讨老年退行性腰椎管狭窄症患者减压手术的疗效。方法:1997年1月～2003年12月收治的70岁以上且获得2～6年随访的退行性腰椎管狭窄症患者106例,男49例,女57例;年龄70～82岁,平均76.3岁;病史4～10年,平均6.7年。42例并存1种内科疾病,55例并存两种或以上的内科疾病。均经过正规保守治疗无效。术前联合内科诊治并存的内科疾病。95例行单纯全椎板切除减压术;11例采用椎板减压、椎弓根固定、椎间植骨融合术,对手术疗效进行回顾性分析。结果:无围手术期死亡病例。出现并发症22例次,经对症及内科联合处理后好转。单纯减压组术后3周配戴腰围下床活动;内固定组术后3～5d下床活动。平均随访3年10个月,Oswestry评分从术前59.64±11.07分改善至16.81±7.36分。所有患者连续行走从术前不足15min改善到至少30min。95.2%患者自诉生活质量明显提高。结论:老年退行性腰椎管狭窄症患者在积极控制并存内科疾病的基础上,手术减压治疗对神经功能的恢复有重要作用,可获得较满意的临床疗效。     

粤西地区血小板聚集率正常人群参考范围的建立

目的 :为粤西地区血小板聚集率的临床检测提供参考标准。方法 :采用北京普利生仪器有限公司生产的 L BY-NJ型多功能血液凝聚仪。以终浓度 2 .5 μmol/ L ADP为诱导剂 ,对 6 38例正常人按年龄、性别分组 ,分别检测血小板 1m in、3min、5 min及 Max聚集率 ,并进行统计学分析。结果 :各年龄组男女性别 PAG无显著性差异 ( P>0 .0 5 ) ;小于 35岁年龄组与 35～ 5 5岁年龄组比较 ,PAG无显著性差异 ( P>0 .0 5 ) ;35～ 5 5岁年龄组与大于等于 5 5岁年龄组比较 ,1min及 3mim PAG存在显著性差异 ( P<0 .0 5 )、5 min及 Max PAG相差非常显著 ( P<0 .0 1) ;小于 35岁年龄组与大于等于5 5岁年龄组比较 ,PAG有非常显著性差异 ( P<0 .0 1) ;小于 5 5岁年龄组与大于等于 5 5岁年龄组比较 ,PAG差异有极显著性意义 ( P<0 .0 1或 P<0 .0 0 1)。结论 :5 5岁以上年龄组与 5 5岁以下年龄组的 PAG结果 ,可作为粤西地区同类方法PAGT的正常参考值供临床检测参考     

商州市劳教人员艾滋病认知健康教育效果分析

目的　了解收容劳教人员对艾滋病认知情况和相关态度 ,提高他们对艾滋病的认知。方法　教育前后采取相同问卷 ,以不记名自填式答卷方式对教育前后艾滋病认知状况进行调查。结果　健康教育后 ,收容劳教人员对艾滋病的认知显著提高 (P <0 0 5 )。对婚前、婚外性行为持正确态度的比例有所增加 ,但无显著性差异。选择部分安全行为的趋向显著提高。结论　在收容劳教人员中开展艾滋病健康教育是可行的 ,但扭转有关不正确态度需要长期的过程     

温州市农村贫困人群卫生服务需求和利用分析

通过对近2000份调查表的分析,评价温州市农村贫困人群在就诊过程中对医疗机构的选择、未就诊原因方面的特点,提出提高卫生服务利用的方法。     

盐酸齐拉西酮在中国健康志愿者中的药代动力学研究

目的评价国产盐酸齐拉西酮胶囊的人体药代动力学特点;初步评价国产盐酸齐拉西酮胶囊的安全性。方法采用HPLC法测定血浆中齐拉西酮浓度。10位男性健康受试者进食时单剂量口服40mg盐酸齐拉西酮胶囊。于服药前及服药后0.5、1、2、3、4、5、6、8、10、12、24、36、48小时采集5m l血样。抗凝处理取血浆,-20℃保存,用于血药浓度的测定。安全性评价包括体检、实验室检查(心电图、血常规、生化常规及尿常规等)及不良事件的记录。结果主要药动学参数:Cm ax为(175.0±63.73)ng/m l;Tm ax为(3.80±1.32)h;MRT为(9.37±1.53)h;t1/2为(6.10±1.65)h;Ka为0.1831±0.0708/h;Kel为0.1219±0.0349/h;Vd为(685.3±325.4)L;C l为(83.30±34.50)L/h;AUC0→t为(1312±261.3)ng/m l/h,AUC0→∝为(1339±261.1)ng/m l/h。药物不良事件主要为嗜睡、口干、头昏、静坐不能、体位性低血压等,程度多为轻至中度,均能在短时间内缓解。结论研究结果显示了国产盐酸齐拉西酮在中国人中药代动力学特点,单剂量口服胶囊40mg是安全的。     

白内障扶贫复明手术探讨

目的：探讨山区白内障扶贫复明手术。方法：采用改良现代白内障囊外摘出术或小切口非超声乳化白内障摘除术，对2675只眼白内障施行复明手术。结果：术后第一天矫正视力0．3者57只眼(2．13％)，0．5～0．8者1829只眼(68．37％)，≥0．9者509只眼(19．03％)。角膜水肿71只眼(2.65％)，后囊膜破裂致玻璃体脱出87只眼(3．25％)，全部均可同时植入人工晶体。结论：采用改良的白内障摘除手术，做到开源节流，既能使更多的贫困患者接受复明手术，又保证了手术质量。     

Mortality and suicide rates of involuntarily committed patients

The mortality and suicide rates for involuntarily committed patients in Denmark are presented. Two cohorts of psychiatric patients committed to a mental hospital from January 1, 1971 to December 31, 1975 (8322 people) and January 1, 1981 to December 31, 1985 (5253 people) have been followed. The standard mortality rate (SMR) in relation to the total Danish population were 4.9 (4.5–5.4) and 5.2 (4.7–5.8), respectively, for the two cohorts, during the first year after involuntarily commitment to a mental hospital. During the same period, the SMR for suicide among the committed patients were 44.9 (37.1–53.9) and 30.9 (24.2–38.9), respectively. The crude suicide rates among the committed patients during the first year after the commitment were 14.3 and 14.0, respectively, per 1000 years, unchanged between the cohorts. Short length of stay in hospital (< 14 days), a nonpsychotic main diagnosis, male sex, and age 35 years or more were equally related to high risk of suicide in the 1971 cohort as evaluated to proportional hazard methods (Cox regression), and short length of stay and commitment on the danger indication provided the most information in relation to high suicidal risk in the 1981 cohort. Methodological problems and the reasons for the results are discussed.