绝经前后T1期乳腺癌患者临床特征的分析

目的:分析T1期(肿瘤直径<2cm)原发性乳腺癌女性患者绝经前后在肿瘤大小、病理分类、淋巴结转移率和数目。方法:常规病理检验以及应用免疫组化、HE法分别测定绝经前乳腺癌患者和绝经后乳腺癌患者者的ER、PR。结果:两组患者在肿瘤大小上无明显差异,但绝经前乳腺癌患者浸润导管癌的百分比为 84. 7%,绝经后乳腺癌患者的浸润导管癌百分比为 62. 2%,经χ2 检验,P<0. 01。两组淋巴结转移率分别为 39. 3%和 25. 5%,经χ2 检验,P<0. 01。两组ER和PR阳性伴淋巴结转移的比例经χ2 检验,P<0. 05。结论:绝经前乳腺癌患者和绝经后乳腺癌患者在病理分类、淋巴结转移率及数目、ER、PR阳性伴淋巴结转移上有显著性差异。对于T1原发性乳腺癌患者不论有无淋巴结转移,均应行癌肿切除伴Ⅰ、Ⅱ级淋巴结清扫。     

从事全胃肠外营养工作的心得

目的:交流从事全胃肠外营养(TPN)工作的心得。方法:查阅近年来相关国内外文献,结合自己的工作实践进行回顾、总结和分析。结果与结论:从事TPN工作的临床药师应不断接受业务教育,凭借专业优势与临床加强联系,善于分析、总结临床信息,推动临床药学发展。     

深圳市南山区医疗机构消毒效果分析

目的:了解南山区各医院及个体诊所卫生消毒状况。方法:对2002~2003年间区属各医院及个体诊所消毒效果的监测结果进行统计分析。结果:2002年与2003年区镇医院消毒效果平均合格率分别为94.4%和97.1%,个体诊所平均合格率分别为87.6%和89.8%。结论:区(镇)医院消毒效果优于个体诊所,空气合格率普遍较低,卫生防疫机构要加大力度进行监督检测,同时加强对医务人员进行消毒知识培训。     

冬凌草单药及与化疗合用治疗食管癌205例

目的:观察冬凌草单药及与化疗合用治疗食管癌的临床疗效.方法:448例患者,均经病理细胞学和X线检查确诊为食管癌.其中早期癌76例,均采用冬凌草单药治疗.晚期癌372例,167例采用冬凌草单药治疗,205例采用冬凌草与化疗合用.结果:用冬凌草单药治疗早期食管癌患者3,5,10,13 a的生存率明显高于未治疗组(98.68% vs 51.52%,84.02% vs 28.62%,63.49% vs 11.45%,50.13% vs 8.59%;P<0.001).对于晚期食管癌,冬凌草联合化疗应用,其总有效率明显高于以PYM(BLM)为基础的单一化疗(66.82% vs 42.85%,P<0.01).冬凌草与化疗合用组与单一化疗对照组相比副作用基本相同,无明显差异(P>0.05).结论:对于早期食管癌患者,冬凌草能控制疾病发展延长生存时间;对于晚期食管癌患者,冬凌草能增强化疗的作用.     

多模式临床支持系统的研究进展

目的探讨多模式临床支持系统的研究进展。方法通过了解国际多模式临床支持系统发展和运作情况,并与传统的临床支持系统进行对比,探讨多模式临床支持系统的国际研究进展情况。结果在多模式临床支持系统概念、目的及特点认识的基础上,了解了多模式临床支持系统的国际进展情况。结论临床支持系统模式的发展和演变,为多学科协作诊治模式提供了新的临床辅助,加强了循证医学的临床实践和相应的提升体系,但临床支持系统项目在目前我国医院的应用还需要进一步探讨和研究。     

Semmelweis’ present day follow-up: Updating bacterial sampling and enrichment in clinical hygiene

Potentially dangerous antibiotic resistant contaminants have permanently penetrated at least well-off western populations. The danger is so evident that some hospitals have started to refuse accepting patients who carry such bacteria. Sampling and enrichment measures in hygiene monitoring must be updated as they are corner stones in handling the problems and safeguarding the health care units. Their patients, when exposed to microorganisms are strenuous to treat. Sometimes even this fails, if the infections are spreading in weakened patients. The present review summarizes currently used technologies and the abilities of bacteria to avoid detection. Improved protocols on environmental monitoring in healthcare units are required. They should be comparable with contamination control in industries. Actually these measures in health care should be even stricter because human lives are directly endangered as the resistance of especially elderly patients is low.     

The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context

In this study we consider the process of the clinical encounter, and present exemplars of how assumptions of both clinicians and their patients can shift or transform in the course of a diagnostic interview. We examine the process as it is recalled, and further elaborated, in post-diagnostic interviews as part of a collaborative inquiry during reflections with clinicians and patients in the northeastern United States. Rather than treating assumptions by patients and providers as a fixed attribute of an individual, we treat them as occurring between people within a particular social context, the diagnostic interview. We explore the diagnostic interview as a landscape in which assumptions occur (and can shift), navigate the features of this landscape, and suggest that our examination can best be achieved by the systematic comparison of views of the multiple actors in an experience-near manner. We describe what might be gained by this shift in assumptions and how it can make visible what is at stake for clinician and patient in their local moral worlds—for patients, acknowledgment of social suffering, for clinicians how assumptions are a barrier to engagement with minority patients. It is crucial for clinicians to develop this capacity for reflection when navigating the interactions with patients from different cultures, to recognize and transform assumptions, to notice ‘surprises’, and to elicit what really matters to patients in their care.     

实习医生临床技能操作短期集中培训的可行性分析

探索临床技能培训和提高学生临床实践能力的有效方法.通过培训前考核、观看教学片、指导教师示范、模拟练习、现场点评、培训后考核等方式,比较培训前后考核成绩.通过短期集中培训,使实习生在临床技能方面快速提高.学生们很快掌握了临床基本技能操作规范,为更好地投入到临床实习打下了良好的基础.     

子宫内膜萎缩疗法治疗青春期功血362例临床研究

目的：探讨子宫内膜萎缩疗法治疗青春期功血（DUB）的止血效果。方法：将362例平均分为观察组（采用炔诺酮、戊酸雌二醇联合疗法止血）和对照组（单用炔诺酮子宫内膜萎缩疗法止血），两组各181例，比较两组的止血效果。结果：观察组和对照组止血有效率分别为96．13％（174／181）和92．27％（167／181），两组比较差异无统计学意义（踟105）；观察组和对照组控制出血时间分别为（28．69±14．87）h和（29．72±15．34）h，两组比较差异无统计学意义（踟．05）。观察组和对照组的完全止血时间分别为（32．80±19．10）h和（47．30±18．60）h，两组比较差异有统计学意义（／9〈0．05）。观察组和对照组的住院天数平均为（6．10±2．80）d和（6．9±2．60）d，观察组住院时间短于对照组（P〈0．01）。结论：炔诺酮止血疗法和炔诺酮、戊酸雌二醇联合疗法治疗青春期功血效果均较好，但炔诺酮、戊酸雌二醇联合疗法治疗效果更佳。