How does fast track affect quality of care in the emergency department?

STUDY OBJECTIVES: Use of fast track has been shown to improve the emergency department flow of less urgent patients. It has been speculated, however, that this could negatively affect the care of urgent patients. The objective of this study was to determine whether a dedicated fast track for less urgent patients [Canadian Triage and Acuity scale category 4/5 (CTAS 4/5)] affected (1) the time to assessment for urgent patients (CTAS 3), (2) the length of stay for less urgent patients (CTAS 4 and 5), and (3) the left-without-being-seen rate. METHODS: In June 2003, fast track was opened in our emergency department from 13:00 to 19:00 h. A before-after intervention comparison analysis was completed for 1 week in Aug 2002 and the same week in Aug 2003. Data collected included (1) time to assessment of CTAS 3 patients, (2) the length of stay for CTAS 4/5 patients, and (3) percentage of patients who left without being seen. RESULTS: A total of 368 patients were reviewed for 2002 and 380 patients were reviewed for 2003. Median time to assessment of CTAS 3 patients presenting from 13:00 to 19:00 h was reduced from 66 min (Interquartile range: 40, 94 min) in 2002 to 60 min (IQR: 38, 108 min) after fast track was open in 2003 (P = 0.95). Median length of stay of CTAS 4 and 5 patients was reduced from 170 min (IQR: 111, 256 min) to 110 min (IQR: 69, 185 min) (P < 0.001). The overall left-without-being-seen rate decreased from 5% (20/368) to 2% (9/380). CONCLUSION: A dedicated fast track for CTAS 4/5 patients can reduce the length of stay and the left-without-being-seen rate with no impact on CTAS 3 patients seen in the main emergency department.     

Point mutation in exon 4 of presenilin-1 gene and early-onset familial Alzheimer disease

INTRODUCTION Alzheimer disease can be classified into familial Alzheimer disease (FAD) and sporadic Alzheimer disease (SAD)[1]. Among FAD, ear- ly-onset FAD(EOFAD) is a familialform in which the onset ofsymptoms occurs before the age of 60 to 65 years, an…     

股骨髁部骨折四种内固定方法的疗效比较

目的对股骨髁部骨折四种内固定方法的疗效进行比较分析,指导临床合理选择和应用。方法自2000年8月~2005年8月,对291例股骨髁部骨折分别应用“L”型髁钢板(LSCP)、动力髁螺钉(DCS)、逆行交锁髓内钉(GSCN)及微创内固定系统(LISS)的疗效进行回顾性比较分析,包括股骨髁上骨折143例和股骨髁间骨折75例。获随访218例,平均随访时间38·6个月(3~58个月)。按AO/OTA分类,A型(关节外骨折)143例,其中A2型80例,A3型63例;C型(完全关节内骨折)75例,其中C2型37例,C3型38例。结果四种内固定方法的骨愈合率及HSS功能评定结果分布有统计学差异(P<0·05)。LISS组的骨愈合率及HSS功能评定优秀结果分布最高,而LSCP组骨愈合率及HSS功能评定优秀结果分布最低。最终所有骨不连患者经翻修后全部获得骨性愈合。结论微创内固定系统在治疗A3、C2及C3型股骨髁部骨折中,较其他内固定方法具有骨愈合率高和功能恢复满意等特点,值得临床推广应用。     

二甲双胍对多囊卵巢综合征患者胰岛素样生长因子-1的影响

目的探讨二甲双胍对多囊卵巢综合征（PCOS）患者血清胰岛素样生长因子-1（IGF-1）及胰岛素样生长因子结合蛋白-1（IGFBP-1）水平的影响及其作用机制，明确二甲双胍治疗的临床效果。方法2002年1—11月对山西医科大学第二医院24例PCOS患者给予二甲双胍500mg，一日3次，8～24周治疗，比较治疗前后血清IGF-1、IGFBP-1、空腹胰岛素及睾酮水平，并对月经恢复、排卵、妊娠情况进行分析。结果二甲双胍可降低血清空腹胰岛素及睾酮水平，能显著升高IGFBP-1水平，治疗前后血清IGF—1水平差异无显著性。单纯二甲双胍治疗后月经恢复率为41．67％（10／24）；自然排卵率为25．00％（6／24），自然妊娠率为12．50％（3／24）。二甲双胍加促排卵治疗共18个周期，排卵周期率66．67％（12／18），妊娠周期率为11．11％（2／18）。结论二甲双胍可以降低血清空腹胰岛素及睾酮水平，增高IGFBP-1水平，可以改善卵泡微环境，有助于月经恢复，提高促排卵和妊娠率．是治疗PCOS的重要手段。     

Reversal of diabetes in BB rats by transplantation of encapsulated pancreatic islets

Prolonged survival of pancreatic islet allografts implanted in diabetic BB rats was achieved by encapsulation of individual islets in a protective biocompatible alginate-polylysine-alginate membrane without immunosuppression. Intraperitoneal transplantation of the encapsulated islets reversed the diabetic state of the recipients within 3 days and maintained normoglycemia for 190 days. Normal body weight and urine volume were maintained during this period, and no cataracts were detected in the transplant recipients. In contrast, control rats receiving transplants of unencapsulated islets experienced normoglycemia for less than 2 wk. These results demonstrated that microencapsulation can protect allografted islets from both graft rejection and autoimmune destruction without immunosuppression in an animal model that mimics human insulin-dependent diabetes.     

郑州市尘肺流行病学调查研究

尘肺是我国工业生产中危害最严重的职业病。1988年以来,郑州市持续开展了尘肺流行病学调查。1992年全市粉尘作业厂矿接尘人数为103542人,尘肺累积病人2758例,其中现患2541例,死亡217例。尘肺累积患病比为2.59%,现患率为2.39%,病死率为7.87%。尘肺累积病例以巩义市、郑州矿务局、密县为较多;按系统以煤炭(包括县煤炭)、机械、轻工、有色金属为多;尘肺病主要为矽肺及煤工尘肺。统计分析各种尘肺的发病工龄、发病年龄、死亡年龄以及各期别晋级年限等数据。对郑州市尘肺的发展趋势作了预测。     

计算机技术定量分析三尖瓣返流患者右室收缩和舒张功能的研究

本研究对３０例三尖瓣返流患者同步进行了多普勒超声心动图和右心导管检查，应用计算机软件程序对三尖瓣返流频谱曲线进行微分处理。结果表明，两种技术测量的右室压力最大上升速率、右室心肌最大生理缩短速度、右室压力最大下降速率以及右室心肌松驰时间常数均高度相关（ｒ分别为０．９３，０．８６，０．９４，０．９５），表明三尖瓣返流压差法能够无创性估测右室收缩和舒张功能，应用计算机软件程序能够使测量方法简便、准确。     

手术治疗跟骨塌陷性骨折

目的　评估跟骨塌陷性骨折手术治疗的效果。方法　 1996年 5月～ 2 0 0 0年 6月共手术治疗跟骨塌陷性骨折 15例 ,8例内固定 ,7例植骨 ,平均随访 14个月 ,参照AOFAS评分对患者有否疼痛、步态、距下关节活动 ,是否支架辅助、术后X线照片等加以评估。结果　两组结果无明显差异。 2例手术切口皮缘坏死 ,6例疗效为优 ,9例为良。结论　跟骨塌陷性骨折手术解剖复位能取得好的效果     

复方华蟾胶囊抗小鼠肿中瘤作用的实验研究

目的了解复方华蟾胶囊抗小鼠移植性肿瘤的作用.方法以小鼠肝癌22(H22)、小鼠肉瘤180(S180)为瘤株,应用动物移植性肿瘤的体内试验法对药物进行抗癌药效学试验.结果复方华蟾胶囊灌胃4,2 g/kg@d,连续14 d,对小鼠移植性肝癌实体型生长有明显的抑制作用,抑瘤率分别为38.09%,30.95%.对小鼠移植性S180实体型生长有明显的抑制作用,抑瘤率分别为34.7%,30.08%.复方华蟾胶囊对荷瘤小鼠的胸腺和脾脏重量无影响.结论复方华蟾胶囊在试验条件下有一定抗肿瘤作用.     

5339例创伤患者创伤及死亡特点分析

目的　探讨创伤患者创伤及死亡特点。方法　回顾性分析 1996年 1月至 2 0 0 0年 12月我院收治 5 3 3 9例创伤患者的临床资料。结果　 5 3 3 9例创伤患者中男性 3 910例 ,女性 14 2 9例 ,平均受伤年龄 (3 5 3± 3 3 7)岁 ,2 0～ 2 9岁占 64 19%。治愈好转5 168例 ,死亡 47例 ,3 1例死于重型、特重型颅脑损伤。结论　创伤的高危人群为青壮年 ,且男性多于女性 ,交通事故是本组创伤的第一位原因。把创伤的预防与控制作为一项政府工程 ,加强宣传和教育 ,改善交通状况等均对创伤的预防与控制有重要意义