加强临床基础护理服务实施对策

加强医药体制改革的重要内容之一是要不断缩小医药收入的比例,转变传统的"重医疗轻护理、重专业轻基础、重技术轻服务"观念,卫生部强调加强医院临床护理工作及相关服务规范性要求,为临床护理工作今后发展的走向指明了方向,我院从加强基础护理服务管理入手,把临床护理和常规服务进行有机结合;通过倡导科学的医院文化,引导医院全员护士角色转变;建立基础护理服务的情景管理模式,改进和完善护理质量管理体系;建立适宜医院管理的监督、考核办法,引入正负激励机制.从而为患者提供了更加优质的服务.     

基于中医养生理论的健康管理思路

中医养生以"治未病"为主旨,渊源深远,经过两千多年的实践升华,已经成为全方位多角度的具有中国特色的健康管理系统,具有全科医疗的本质。中医养治手段丰富,疗效确切,但由于现有的中医养治手段尚未整合形成系统,无法统筹安排,无法体现中医养治的优势,制约了中医健康管理事业的发展。东直门医院健康管理中心整合多种中医养治手段,结合中医健康状态评估,借助现代信息管理技术,建立了"四时七养"中医养治平台。依据春夏秋冬"四时",施行"心养、气养、动养、居养、术养、食养、药养",进行个体化、全方位、多角度的中医动态养生调护,实现了医院、社区、居家一体化的中医养治,避免了"重治疗,轻预防;重实践,轻理论;重生理,轻心理;重结果,轻过程;重外管,轻自理;重警示,轻自觉"的不足。     

提高中药房管理和服务措施探讨

中药房是医院重要服务窗口,中药房管理是医院药事管理的重要部分。现阶段中药房管理,由于没有得到足够重视,发展相对缓慢。在中医医院里,重医务管理、轻中药管理工作;综合性医院里,重西药管理,轻中药管理问题普遍存在。探讨医院中药房管理的思路和方法,加强医院中药房管理的规范化、标准化建设,确保患者用药安全、有效、科学、     

基于"军字一号"的临床医师绩效考评体系的建立与应用

以"军字一号"数据为基础,量化临床医师工作成绩,科学准确地对临床医师工作业绩进行考评,达到强化个体质量意识,激发临床医师工作积极性,提高整体工作效率,提升医院科学管理水平,克服晋级晋职、立功受奖和奖金分配中的重科研轻临床、重成果轻成绩和重"副业"轻"主业"的弊端.     

"无陪护"护理服务面临的问题与对策

2010年2月卫生部发出了在全国卫生系统"开展优质护理服务示范工程"的活动通知,要求各医院夯实基础护理,丰富服务内涵,提高护理质量,并将整理床单位、洗脸、梳头等列入基础护理服务规范,彻底转变护理工作中"重专业、轻基础、重技术、轻服务"的观念.我院积极响应这次活动,在中风内科试行了"无陪护"病房,以满足病患对护理服务照护的需求.     

构建医学高职人才培养模式的思考

高等医学职业技术教育如何适应时代的需要,为社会培养合格的医学人才,已成为高等医学职业技术教育改革的热点.但在人才培养问题上,从思想观念、素质教育、教学质量到人才培养模式等方面都带有传统高等教育的烙印.重专业素质教育,轻综合素质培养;重知识传授,轻创新能力培养;重成才教育,轻成"人"教育,这种片面的人才培养观严重偏离了素质教育的核心和内涵.随着生物--心理--社会医学模式的建立,我们应把以知识传授为主体的人才培养方式,转变到以提高素质为主旨的人才培养模式上来.     

试论医院固定资产管理

医院固定资产作为医院总资产的重要组成部分,在为病人提供诊疗服务中起着举足轻重的作用.但现实工作中大多数医院重采购轻管理,固定资产利用率不高,没有物尽其用,管理中有不足之处.本文通过对固定资产管理现状的分析研究,提出加强医院固定资产管理的对策,促进医院管理水平的提高.     

中学外语教学考核方法的问题及对策

本文简述中学外语教学考核方法现状 ;指出中学外语教学考核的存在问题 :重知识 ,轻能力 ;重“产品”轻过程 ;重等第 ,轻述评 ;重笔试 ,轻口试 ;分析产生这些问题的原因 :缺乏专门管理 ;缺乏理论指导 ;交际性考核的操作难度大 ;提出解决中学外语教学考核问题的对策 ,着重介绍了澳大利亚维州中学外语教学考核的具体做法     

集中规范化教学管理模式在临床医学院的运行效果分析

本院是集医疗、教学、科研3种职能于一身的综合大型医院,临床教学在培养高素质医学人才中发挥着不可替代的作用,但存在着医疗、教学、科研发展不均衡的问题,特别是近年来出现的"重医疗轻教学"的思想,对培养高素质的临床医学人才不利.如何抓好临床教学管理以提升教学质量,是摆在广大临床医学教育工作者面前的大事[1].     

医院科研项目中期检查要点浅析

科研项目是医院科技实力的重要体现,也是医院科研管理工作的重中之重。项目的中期检查是管理过程中的重要一环,其主要目的在于对项目的研究水平、进展程度、经费支出情况、阶段性成果等进行考核与评估。所以开展科研项目中期检查有助于监管科研项目的执行进度,掌握经费使用情况,发现阻碍项目执行的因素,及时采取相应的解决措施,提高科研项目的研究质量。本文结合医院科研项目管理中重项目申报,轻过程监管,重科研成果,轻经费管理,重科技管理,轻综合协调的现状,着重对科研项目中期检查的要点进行分析,提出科研项目管理的改进措施,以不断规范医院科研项目执行过程,全面提升医院整体科研管理水平。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.