荆州市妇幼保健院学术论文在荆州市卫生系统的地位分析

【摘要]目的评价荆州市妇幼保健院学术发展轨迹和论文质量。方法以《万方医学网期刊全文数据库》中被收录的论文及其被其他论文引用的情况为研究对象进行计量学统计。结果荆州市妇幼保健院医学论文近两年已在数量上实现了飞跃,但其质量尚处于初级阶段,影响力非常有限,尚有待于在质量上的实现突破。结论虽然推进重点学科和专科建设战略是提高学术地位的有效途径,但多数论文质量有待提高。     

The use of tissue sealant to prevent fistula formation after laparoscopic distal pancreatectomy

Background Pancreatic fistula occurs in about 20% of patients undergoing laparoscopic pancreatectomy. A variety of techniques have been described to decrease this rate, with limited success. Fibrin sealants are products that promote the adhesion of tissue surfaces to each other. This report demonstrates the use of fibrin sealants to decrease the incidence of pancreatic fistula. Methods After completion of the laparoscopic or hand-assisted distal pancreatectomy, 5 ml of fibrin sealant (Tisseal; Baxter Healthcare, One Baxter Parkway, Deerfield, IL, USA) is applied to the cut edge of the pancreatic remnant. Omentum, which has been dissected to expose the raw surface, is then applied over the pancreatic remnant and fastened to the cut edge by the fibrin sealant. A drain is placed over the omentum in the left upper quadrant. Postoperative computed tomography (CT) scans are obtained on postoperative day 3 to determine whether any fluid collections are present. A pancreatic fistula is defined as any amylase-rich fluid found in the drain or any juxtaposed fluid collection next to the pancreatic remnant on postoperative day 3. Results A total of eight patients underwent laparoscopic distal pancreatectomy with the use of fibrin sealant. These were compared with the previous 13 patients who underwent laparoscopic distal pancreatectomy without fibrin sealant. No patients in the fibrin sealant group experienced pancreatic fistula, as compared with three patients (23%) in the no sealant group. Conclusions Although this series was small, it does suggest that the use of fibrin sealant may reduce the incidence of postoperative pancreatic fistula formation after laparoscopic distal pancreatectomy. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass

Background Over the past 20 years, there has been an ongoing discussion about the importance of gastric pouch size as a key factor influencing weight loss after bariatric surgery. This analysis aimed to determine the relationship between initial gastric pouch size and excess weight loss (EWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods Between August 2002 and March 2005, 320 LRYGB were performed at Yale New Haven Hospital. The patients’ demographics were entered into a longitudinal, prospective database. Upper gastrointestinal series were routinely performed on postoperative day 1. Pouch size was measured as area (cm²) on an anteroposterior radiograph at maximum pouch distention. Linear regression analysis was performed to determine the association between pouch size and weight loss at 6 and 12 months postoperatively. Adjustments were made for age, gender, and preoperative body mass index (BMI). Results The mean age of the patients was 41.2 years. Of the 320 study patients, 261 were women (81.6%) and 59 were men (18.4%). The mean preoperative BMI was 51.1 kg/m²; the mean 6-month EWL was 50.5%; the mean 12-month EWL was 62.5%; and the mean pouch size was 63.9 cm². A statistically significant, negative correlation between pouch size and EWL was found at 6 months (β = –0.241; p < 0.01) and at 12 months (β = –0.302; p < 0.02). The findings show that male gender (β = 0.147; p < 0.04) and preoperative BMI (β = 0.190; p < 0.01) are positively correlated with pouch size. Conclusion The analysis demonstrates that initial gastric pouch size is not the only significant component for successful weight loss after LRYGB. Male gender and increased preoperative BMI were identified as factors predicting pouch size. Efforts to standardize small pouch size for all patients seems important to the success of surgical therapy for morbid obesity.     

Low-dose heparin for the prevention of post-ERCP pancreatitis: a randomized placebo-controlled trial

Background  As suggested by observational and animal studies, heparin has antiinflammatory effects that could prevent acute post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Low-molecular-weight heparin did not reduce the incidence of post-ERCP pancreatitis in a controlled study. The current study aimed to determine whether prophylactic administration of low-dose unfractionated heparin, which has potentially more antiinflammatory capability, can prevent acute post-ERCP pancreatitis. Methods  Patients scheduled for ERCP in the authors’ department were randomized to receive unfractionated heparin (5,000 IU) or placebo (saline solution 0.5 ml) administered subcutaneously 20 to 30 min before the ERCP. Patients who had undergone endoscopic sphincterotomy in the past were excluded from the study. Post-ERCP pancreatitis was defined according to criteria established by Cotton: abdominal pain combined with a threefold elevation of blood amylase 24 h after the ERCP. Results  The study enrolled 106 patients. One patient was excluded from the analysis due to inaccessible papilla of Vater, leaving 51 patients in the heparin group and 54 in the placebo group, for a total of 105 patients (62 women and 43 men) with a mean age of 64.6 years. The rate of post-ERCP pancreatitis was not different between the groups (heparin, 4 patients, 7.8%; placebo, 4 patients, 7.4%). Two patients in each group experienced mild bleeding. Conclusions  The study did not demonstrate a significant effect of low-dose unfractionated heparin in the prevention of post-ERCP pancreatitis. A multicenter trial with a larger number of patients is needed to demonstrate a benefit from this drug.     

Natural orifice surgery: initial clinical experience

Background  Natural orifice translumenal endoscopic surgery (NOTES) has moved quickly from preclinical investigation to clinical implementation. However, several major technical problems limit clinical NOTES including safe access, retraction and dissection of the gallbladder, and clipping of key structures. This study aimed to identify challenges and develop solutions for NOTES during the initial clinical experience. Methods  Under an Institutional Review Board (IRB)-approved protocol, patients consented to a natural orifice operation for removal of either the gallbladder or the appendix via either the vagina or the stomach using a single umbilical trocar for safety and assistance. Results  Nine transvaginal cholecystectomies, one transgastric appendectomy, and one transvaginal appendectomy have been completed to date. All but one patient were discharged on postoperative day 1 as per protocol. No complications occurred. Conclusion  The limited initial evidence from this study demonstrates that NOTES is feasible and safe. The addition of an umbilical trocar is a bridge allowing safe performance of NOTES procedures until better instruments become available. The addition of a flexible long grasper through the vagina and a flexible operating platform through the stomach has enabled the performance of NOTES in a safe and easily reproducible manner. The use of a uterine manipulator has facilitated visualization of the cul de sac in women with a uterus to allow for safe transvaginal access.     

英语医学论文写作模式分析

如何采用符合国际通用的学术规范的论文模式是我国医学专业学生和研究人员在撰写医学英语论文时遇到的一个重要问题。论文逻辑结构和展开方式如果不符合英语语言的使用习惯,不仅不利于论文作者的研究发现和成果的有效传递和交流,也直接影响论文在国际医学学术刊物上的发表。本文结合学术论文已有研究成果中的语步—步骤(move-step)分析法,将英语医学论文的展开归纳为逐层推进、逻辑严密的9个步骤,分别介绍各个步骤的常用英语表达模式,以期为医学专业的学生和广大从事医学研究和实践的医生和研究人员,在用英语写作研究报告、提交国际研讨会论文、或投稿国际医学专业期刊时,扫清语言文字的障碍和文章架构的烦恼,提供一个科学、有效的参照工具。     

区县疾控中心科技论文分析及管理对策

目的通过对北京市某区县疾控中心2006-2010年论文发表情况进行分析,为基层疾控中心进行科研管理提供基础资料和新思路,为疾控系统绩效考核科研目标的实现提供依据。方法使用SPSS16.0软件运用构成比、趋势性χ2检验等分析等方法对该疾控中心2006-2010年度公开发表科技论文以及人员特征的描述和分析。结果 2006-2010年间论文发表数量逐年增加,核心期刊比例逐年提高(χ2MH=7.673,P=0.006),发表论文人数的比例逐渐增加(χ2MH=10.169,P=0.001)不同学历、不同职称人员论文发表完成情况不同,随着学历、职称的提高,论文完成情况越好(χ2=169.687,P=0.000;χ2=72.02,P=0.000)。结论优化调整激励措施和人力构成有利于论文发表数量和质量的提高,区县疾控中心应提高科研管理能力,提高不同层次人员的科研能力和论文写作能力,探索制定基层疾控中心论文指标的可能性。     

护理科研论文小组在中小型医院护理管理中的作用

目的探讨提高中小型医院护理科研和论文写作水平的新途径。方法在全院7个护理单元中各抽调1名护理科研和论文写作方面的骨干,组成护理科研论文小组。开展组织护理科研、论文写作知识的培训,收集院内护理科研、论文写作方面的情况,修改拟投稿的护理论文,组织院内护理学术交流,协助护理科研课题的申报等工作。结果全院护理科研课题申报有了零的突破,全院护理人员在统计源期刊上发表的论文数量增加。结论成立护理科研论文小组可有效提高中小型医院护士的护理科研和论文写作水平,促进整体护理质量的提高。     

Programme alignment in higher‐level planning processes: a four‐country case‐study for Sexual and Reproductive Health

With international development assistance focussed on poverty reduction, national and sector‐wide planning processes have become increasingly important in setting agendas. Sector‐Wide Approaches (SWAps), Poverty Reduction Strategy Papers (PRSPs), and other higher level planning processes, including Millennium Development Goals (MDGs) reporting, have required new levels of engagement in national and sectoral planning processes. For Sexual and Reproductive Health (SRH), this has had mixed consequences, despite raising the profile of SRH in national planning agendas, and emphasizing the potential of SRH to contribute to the reduction of poverty. Drawing on case‐study research from four countries, this paper analyzes alignment of SRH policy with higher‐level planning processes. It found that SRH managers are rarely engaged in higher‐level planning processes, and while SRH features prominently in the [health] sections of PRSPs, it is not reflected in other sections, and does not necessarily correspond to more resources. Despite these limitations, these planning processes offer synergies that could improve the contribution of SRH to health sector development and poverty reduction. The paper recommends that local donor organizations, including key UN agencies, offer greater support for SRH programme managers in promoting the pro‐poor and systems‐wide strengths of SRH programmes to planners and policy makers. Copyright © 2009 John Wiley & Sons, Ltd.