新形势对医院药师的要求与思考

分析新医改形势下,社会大众对医院药师提出的更具体、更高的要求。在探讨医院药师的现状与现实要求的差距的基础上,针对医院药师药学服务工作开展的状况,提出怎样提高医院药师的职业素质、从而来满足社会对药师的要求。     

The composite first person narrative: Texture,structure, and meaning in writing phenomenological descriptions

This paper illustrates the use of composite first person narrative interpretive methods, as described by Todres, across a range of phenomena. This methodology introduces texture into the presently understood structures of phenomena and thereby creates new understandings of the phenomenon, bringing about a form of understanding that is relationally alive that contributes to improved caring practices. The method is influenced by the work of Gendlin, Heidegger, van Manen, Gadamer, and Merleau-Ponty. The method''s applicability to different research topics is demonstrated through the composite narratives of nursing students learning nursing practice in an accelerated and condensed program, obese female adolescents attempting weight control, chronically ill male parolees, and midlife women experiencing distress during menopause. Within current research, these four phenomena have been predominantly described and understood through quantified articulations that give the reader a structural understanding of the phenomena, but the more embodied or “contextual” human qualities of the phenomena are often not visible. The “what is it like” or the “unsaid” aspects of such human phenomena are not clear to the reader when proxies are used to “account for” a variety of situated conditions. This novel method is employed to re-present narrative data and findings from research through first person accounts that blend the voices of the participants with those of the researcher, emphasizing the connectedness, the “we” among all participants, researchers, and listeners. These re-presentations allow readers to develop more embodied understandings of both the texture and structure of each of the phenomena and illustrate the use of the composite account as a way for researchers to better understand and convey the wholeness of the experience of any phenomenon under inquiry.     

The effects of Lonomin V, a toxin from the caterpillar (Lonomia achelous), on hemostasis parameters as measured by platelet function

Platelets play a central role in hemostasis during vascular injury. Patients affected with the hemorrhagic syndrome caused by contact with Lonomia achelous caterpillars (Lac) Lepidoptera distributed in various South American countries, show digestive, pulmonary and intraperitoneal bleeding in combination with hematomas and echymosis. In the present study, we have evaluated the effects of Lonomin V (serine protease isolated from Lac hemolymph) on some functional properties of platelets, evaluating its importance in primary hemostasis. Platelet adhesion to fibrinogen was reduced by 19, 20, 36, and 37% after pre-treated with 0.2, 2, 20 and 40 nM of Lonomin V, respectively. Pre-incubation of the platelets with 408 nM of Lonomin V, for 4 min at 37 °C, resulted in complete inhibition of the collagen-induced platelet aggregation, in contrast to 56% inhibition of the ADP - induced platelet aggregation. Lonomin V also inhibited anti-α_IIbβ₃ integrin binding to platelets by 56, 57, 52 and 54% at concentrations of 0.2, 2, 20 and 40 nM respectively. Additionally, Lonomin V inhibited anti-P-selectin binding to platelets by 28, 37, 33 and 33% at the same concentrations. The platelets tested with Lonomin V did not modify their viability. In summary, Lonomin V inhibited platelet aggregation, probably caused by the degradation of collagen. The anti-platelet activity of Lonomin V has been shown to be unique and a potentially useful tool for investigating cell-matrix and cell-cell interactions and for the development of antithrombotic agents in terms of their anti-adhesive activities.     

新医改形势下区域卫生资源合理分配

2009年中共中央、国务院提出了新医改方案,明确要求要提高基本医疗卫生服务可及性,有效减轻居民就医费用负担,切实缓解“看病难、看病贵”问题。并要求转变礼区卫生服务模式,逐步承担起居民健康“守门人”的职责。在新医改的形势下,目前卫生资源配置所存在的问题尤为突出,并亟待解决。只有对区域卫生资源进行合理公平的分配,才能彻底解决好人民群众的健康问题。     

原发性低钾性厨期性麻痹与甲状腺毒症继发周期性麻痹的比较分析

目的比较分析原发性低钾性周期性麻痹与甲状腺毒症继发周期性麻痹的异同点、临床特征,以便提高诊治水平。方法选择低钾性周期性麻痹患者45例,回顾性分析其临床资料。结果45例低钾性周期性麻痹患者中,原发性低钾性周期性麻痹28例（A组）,甲状腺毒症继发周期性麻痹17例（B组）;两组患者在性别、临床表现、诱因、肌酸激酶、补钾时的剂量与血钾水平均没有关系等方面具有共同点。两组患者的高代谢症状、血钾水平、反弹性高钾血症的出现等方面存在不同之处。结论低钾性周期性麻痹有其临床特点,预后关键在于早期诊断和及时补钾。补钾剂量不可以根据发病时血钾水平定量,以及甲状腺毒症继发周期性麻痹在补钾过程中容易出现反弹性高钾血症,所以要密切监测血钾水平,并积极根治甲状腺毒症。     

继发性肝癌与原发性肝癌血清AFP检测的临床意义

目的分析探讨血清甲胎蛋白（AFP）在对继发性肝癌和原发性肝癌临床诊断的意义和价值。方法选取2009年7月-2010年12月来我院进行诊断并确诊的87例肝癌患者,进行血清AFP检测,并记录患者血清AFP〉20μg／L,及〉400μg／L,其中〉400μg／L为阳性。结果原发性肝癌患者血清AFP〉20μg／L有46例,阳性数即血清甲胎蛋白〉400μg／L有39例,阳性率为81．25％;而在继发性肝癌患者中血清AFP〉20μg／L有19例,血清AFP阳性数10例,阳性率为25．64％。原发性肝癌的血清AFP阳性率明显高于继发性肝癌,两组患者的诊断阳性率差异具有显著性（P〈0．05）。结论血清甲胎蛋白诊断原发性肝癌的准确率较继发性肝癌高,但敏感性,特异性均不够理想,可辅助其他实验室诊断提高肝癌的确诊率。     

应激性溃疡20例临床分析

目的 探讨应激性溃疡(SU)的发生机制、临床表现及预后.方法 回顾性分析20例SU的临床资料.结果 SU在内科急症中以脑血管病最常见,男性多于女性,SU症状可作为首发症状.20例中有5例死亡,15例生存并好转.结论 当SU症状作为首发症状,而原发疾病症状不明显时,容易疏忽原发疾病-应激相关疾病的诊断.当SU 出现上消化...     

规范基层医院用药 杜绝药品不良反应

通过结合基层医院工作的具体实践及工作体会,探讨基层医院安全用药存在的问题,并提出相应措施。从而促进和提高基层医院合理用药水平,提高用药服务质量,确保用药安全。     

氨氯地平联合吲哒帕胺治疗原发性高血压的临床疗效观察

目的探讨氨氯地平联合吲哒帕胺治疗原发性高血压的临床效果。方法87例原发性高血压患者被随机分为A,B和C组,A组给予氨氨地平治疗,B组给予吲哒帕胺治疗,C组给予联合治疗。结果治疗半年后,3组微量白蛋白尿率过滤,血清肌酐,和血压等指标均有不同程度的改善,且C组改善效果最为显著（P〈0．05）。结论氨氯地平与吲哒帕胺联合应用于原发高血压患者,能更好的发挥两种药物的优势,是值得临床上考虑的治疗方案。