基层医疗机构医疗设备维护维修管理模式的实践探讨

为解决社区卫生服务中心地域分散、缺乏设备维修工程师、缺少信息化管理等困难,金山区与专业设备管理服务公司合作,对辖区内社区卫生服务中心的医疗设备进行委托管理。本文对金山区社区卫生服务中心2015~2017年所有医疗设备使用及维修情况进行分析,阐述了金山区通过建立医疗设备预防性维护机制、医疗设备档案网络化覆盖管理、多举措保障医疗设备正常运行、按年度固定包干服务费用等方式,进一步提高了医疗设备使用效率,从而提高基层卫生服务质量。     

湿润烧伤膏在慢性糖尿病足溃疡愈合中的作用:随机对照试验

目的评估湿润烧伤膏（MEBO）在促进慢性糖尿病足溃疡（DFUs）愈合中的疗效和安全性。方法2005年至2010年间就诊于科威特艾哈迈迪医院的慢性糖尿病足溃疡患者被随机分为MEBO组（66例患者,82处溃疡）和生理盐水湿润敷料组（62例患者,78处溃疡）。前瞻性收集患者的人口统计学特征以及溃疡创面特点等数据。试验12周期间每隔两周计算一次患者的溃疡表面积（SA）和愈合指数（HI）,24周时记录继发性截肢和新溃疡形成的情况。结果两组患者的人口学特征,临床症状及溃疡特点相似。MEBO组患者在第2周和第4周时分别有愈合指数的明显升高和溃疡表面积的明显下降（P〈0．01）;与生理盐水组在治疗12周时25．7％的完全愈合率相比,MEBO组一半以上的溃疡创面（53．7％）都实现了完全愈合（P=0．0006）;治疗12周时,生理盐水组28．2％的患者愈合指数〈0．5,而MEBO组无1例此状况（P=0．0001）;治疗24周时,13位患者（10．2％）行足前段截肢术,而其中只有2例患者（3％）来自MEBO组（P=0．035）;此外,每组各有2例患者在治疗24周后出现了新溃疡（P〉0．05）。实验过程中MEBO组未见任何副反应。结论1）除了具备安全性以外．MEBO可显著促进慢性糖尿病足溃疡的愈合,治疗12周时就可实现超过50％的完全愈合结果;2）MEBO组患者治疗24周后的截肢率也明显下降。     

75g/L氯化钠溶液对创伤失血性休克液体复苏临床疗效的Meta分析

目的 以Meta分析方法研究75 g/L氯化钠(NaCl)溶液对创伤后失血性休克液体复苏的临床疗效. 方法 检索PUBMED、EMBASE、OVID、Cochrane图书馆、EBSCO数据库,根据制定的入选标准筛选随机对照试验(randomized controlled trial,RCT),并进行文献质量评价.对选定的RCT提取和分析患者的血压、血红蛋白、血钠和病死率等指标,以等渗晶体液为参照评价75 g/L氯化钠溶液的有效性和安全性.采用Review Manager 5.0.25分析提取的相关数据. 结果 共有6篇RCT符合入选标准.分析表明75 g/L氯化钠溶液相对于等渗晶体液可以早期、快速提升血压(标准差=6.23,95％CI 2.78～9.69,P＜0.01),同时可以造成血红蛋白含量的下降(标准差=-6.11,95％CI -8.25～ -3.96,P＜0.01);75 g/L氯化钠溶液产生的短期高渗状态总体上是有效和安全的(标准差=7.97,95％ CI 7.55～ 8.38,P＜0.01);75 g/L氯化钠溶液组与等渗晶体液组比较,创伤失血性休克患者的住院病死率差异无统计学意义(风险率=0.96,95％ CI0.84 ～1.10,P＞0.05). 结论 创伤后失血性休克液体复苏中使用小容量75 g/L氯化钠溶液是安全和有效的.     

原子吸收法测定碱回收白泥中的镉

目的建立原子吸收法测定碱回收白泥中镉的方法。方法采用硝酸-高氯酸对碱回收白泥进行消解后,过滤定容,在选定的条件下,用原子吸收法测定镉的含量。结果镉在浓度0.05~2.00 mg/L时,线性关系良好,R=0.999 4。相对标准偏差为4.9%~8.5%,加标回收率为85.2%~90.6%,方法的最低检测质量浓度为0.25 mg/kg。结论该检测方法,精密度好,准确度高,适用于碱回收白泥中镉的测定。     

District‐level impacts of health system decentralization in Indonesia: A systematic review

The local‐level impacts of decentralizing national health systems are significant yet infrequently examined. This review aims to assess whether localized health services delivery in Indonesia, which commenced a health system decentralization process in 2001, achieved its objectives or could be enhanced. A systematic review was undertaken to collate published evidence regarding this topic and synthesize key findings holistically using the six building blocks framework of the World Health Organization (WHO) to categorize health system performance. Four research databases were searched in 2016 for relevant evidence published between 2001 and 2015. The inclusion criteria were relevance to the topic of decentralization impacts at the district level, original research, and published in English. Included articles were appraised for quality using a standardized tool, with key findings synthesized using the WHO building blocks. Twenty‐nine articles met the inclusion criteria and categorized under the WHO building blocks categories. The findings highlight problematic impacts of decentralization related to three building blocks: service delivery, health financing, and workforce. In the 15 years of post‐decentralization in Indonesia, the service delivery, health workforce, and health financing blocks should be prioritized for further research and policy evaluation to improve the overall health system performance at the district level.     

How robust are district health systems? Coping with crisis and disasters in Rutshuru,Democratic Republic of Congo

background Since the eighties, the North Kivu Province socio-economic environment has been deteriorating. This province also faced an influx of Rwandan refugees in July 1994. The objective of the paper is to show how a rural health district has been able to adjust and maintain its medical activities under unfavourable conditions. method Performances of the local health system were assessed through the analysis of routine medical data collected in the Rutshuru Health District (RHD) between 1985 and 1995. Specific data collected during the Rwandan refugee crisis measured the workload of RHD due to the refugees. results For 11 years, health infrastructures have remained accessible and functional in RHD. The curative utilization and preventive coverage rates increased. Obstetrical activities were intensified from a quantitative as well as from a qualitative point of view. Between July and October 1994, the RHD treated 65 000 cases of various pathological conditions in Rwandan refugees settled outside the camps. This corresponds to 9.3% of consultations for Rwandan refugees settled on RHD's territory and represents a 400% increase in the curative workload for the RHD health services. Human and financial resources remained at a very low level, especially when compared with those available in the camps through relief agencies. conclusion The RHD was severely affected by various stresses but its services managed to provide significant and efficient response to these crises. Health district systems may constitute an effective tool to provide health care under adverse conditions.     

DNA碱变性增色效应及其老化性改变的实验研究

采用变性法测定青、老龄小鼠和青、老龄大鼠各组肝ＤＮＡ的增色效应。结果表明：老龄小鼠肝ＤＮＡ碱变性增色效应高于青龄小鼠，老龄大鼠肝ＤＮＡ碱变性增色效应高于青龄大鼠，差异均有显著性意义（Ｐ＜０．０１）．这提示动物衰老时ＤＮＡ碱变性增色效应增高。     

北京市基层医生有关降压药物知识水平的现状

目的了解北京市二级医院、一级医院以及卫生服务中心(站)的医生常用降压药物的知识水平。方法2005-04-2005-11,采用不记名闭卷笔试的方法对北京市7个城近郊区共817名基层医生进行降压药物知识的调查。结果(1)有41.0%的医生不能为合并慢性喘息性支气管炎和高尿酸血症的高血压患者选择《中国高血压防治指南(2005年修订版)》(以下简称指南)推荐的降压药物,分别有43.2%和48.2%的医生不能为合并心肌梗死和合并糖尿病的高血压患者选择指南推荐的降压药物。(2)有93.6%的医生在降压0号慎用/禁忌证的选择中存在错误,89.8%的医生在β受体阻滞剂慎用/禁忌证的选择中存在错误,88.4%的医生在降压药联合应用的选择中存在错误。(3)医生常用降压药物的知识水平随着职称和学历的升高而增加,但高级职称和大本及以上学历的医生对常用降压药物的知识掌握也较差。结论基层医生常用降压药物的知识处于较低的水平,亟需提高。     

河北省农村人群肠道蠕虫感染调查

目的 了解河北省农村人群肠道蠕虫的感染现状，为今后寄生虫病的防治提供科学依据。方法 选择6个县15个1990年全国人体寄生虫分布调查中签点，按照《全国人体重要寄生虫病现状调查方案和实施细则》的要求和方法，于2002年进行人体肠道蠕虫感染状况的调查。结果15个调查点粪检7316人，共检出5种肠道蠕虫虫卵，其中蛔虫感染117例，感染率1．60％；鞭虫感染7例，感染率0．10％；钩虫感染4例，感染率0．05％；东方毛圆线虫感染3例，感染率0．04％；粪便检出蛲虫卵4例。采用透明胶纸肛拭法检查683名12岁以下儿童，检出蛲虫感染134例，感染率19，62％。结论 本次调查结果与第一次人体寄生虫分布调查相比，蛔虫感染率下降幅度最大，下降了94．97％，鞭虫和钩虫也有较大幅度下降，但12岁以下儿童蛲虫感染率仍为19．62％，仅下降了26．43％，说明目前河北省12岁以下儿童蛲虫感染仍然比较严重，今后应加强儿童的蛲虫病防治工作。