艾滋病合并眼底病变的形态学研究

目的探讨HIV／AIDS合并相关性眼底血管的形态学表现。方法对16例艾滋病合并眼底病变的患者，进行眼部B超和眼底检查，并对其检查结果进行回顾分析。结果16例患者中，其中男12例，年龄27～46岁，平均37岁；女4例，年龄33~40岁，平均35．5岁。共检出23只眼有明显的阳性表现。检眼镜检查均提示眼底血管迂曲，间断或串珠状狭窄，甚至出血或血管周围呈“毛刷状”，末稍血管呈片状出血。B超检查显示玻璃体腔不同程度的回声光点和沿着血管的“毛刷状”光束，出血时，眼球壁回声隆起，内界面回声欠光滑，甚至出现絮状物或强回声膜状隆起。结论眼B超和眼底镜对艾滋病合并眼底病形态学改变的诊断起重要的作用，结合艾滋病临床表现，可以提高眼底病的诊断和鉴别诊断水平，并与非艾滋病眼底形态学病变进行鉴别诊断。     

上海市黄浦区2002-2005年新发盲人原发致盲病因分析

目的通过对新发盲人致盲疾病的统计分析,探讨致盲病因。方法对上海市黄浦区2002—2005年新发704例盲人的原发致盲病因作了统计分析。结果居致盲疾病前3位的分别是白内障、眼底病变和青光眼。眼底病变中,高度近视的眼底并发症致盲所占比例最高。结论白内障盲人已有可靠的手术方法复明,并广为重视;高度近视的眼底并发症致盲情况不容忽视。     

数码彩色眼底照相对糖尿病视网膜病变早期诊断模式的研究

目的采用直接眼底镜检查、数码彩色眼底照相、荧光素眼底血管造影及光学相干断层扫描等4种方法,对糖尿病视网膜病变患者进行检查和评估,探讨早期糖尿病视网膜病变筛查方法。方法对2009年1月~2010年1月就诊我院眼科门诊的糖尿病患者,进行直接眼底镜检查、数码彩色眼底照相、荧光素眼底血管造影及光学相干断层扫描检查。以荧光素眼底血管造影诊断为标准,分析各种检查结果的敏感性、特异性及与眼底荧光血管造影诊断的一致性。结果以糖尿病视网膜病变1期为筛查阈值时,眼底彩色照相的敏感性、特异性均明显高于直接眼底镜检查,Kappa检验有高度一致性;以糖尿病视网膜病变2期为筛查阈值时,直接眼底镜检查与眼底彩色照相的特异性基本一致,但眼底彩色照相的敏感性明显高于直接眼底镜检查,Kappa检验有高度一致性。同正常组相比,糖尿病视网膜病变1期视网膜各方位厚度并无明显增加,糖尿病视网膜病变2期各方位神经上皮层厚度比相应方位的正常组增加。结论数码彩色眼底照相可作为糖尿病视网膜病变2期以上患者的主要筛查诊断方法。     

Comparing the Utility of the Non-Mydriatic Fundus Camera to the Direct Ophthalmoscope for Medical Education

Visualization of the fundus is an important component of any ophthalmologic exam. Students are taught to visualize the fundus using a direct handheld ophthalmoscope. However, this device has many limitations, which may be a detriment to medical education and patient care. The invention of the non-mydriatic automatic fundus camera could significantly improve medical education. Our study examined the ability of a group of 5 medical students to visualize pathology and form a diagnosis with a traditional handheld ophthalmoscope and an automatic fundus camera. With the direct ophthalmoscope, none of the students were able to visualize the macula, a crucial aspect of the ophthalmologic exam. With the automatic fundus camera, all students were able to visualize the fundus. The latter modality also increased the proportion of students that was able to correctly diagnose the patients with diabetic retinopathy, 100% vs 40%. On average, students were also more confident in their ability to visualize basic retinal anatomy with the automatic fundus camera, 9.6/10 vs 6.4/10. Thus, incorporating the non-mydriatic automatic fundus camera into medical education, alongside the handheld ophthalmoscope, has the potential to improve both learning outcomes and patient care.     

双目间接检眼镜的特点及其在眼科学中的应用

介绍了双目间接检眼镜的特点及其在眼科检查和手术2方面的应用。双目间接检眼镜因其独特的照明系统及成像原理，与直接检眼镜相比具有许多独特的优点。在双目间接检眼镜下，大多数眼底疾病可以得到正确的诊断。作者认为到目前为止，双目间接检眼镜检查法是最方便、优越的眼底检查方法，在眼底检查、眼科手术、治疗中，具有很高的应用价值。     

Fundus anomalies: what the pediatrician's eye can't see.

BACKGROUND: With increasing workloads for hospital doctors, routine funduscopy may be abandoned. It is not known how often pediatricians perform funduscopy and how skilled they are in performing it. OBJECTIVE: To assess hospital pediatricians' ability to diagnose abnormalities of the ocular fundi and to determine whether a short tutorial can improve their skills. METHODS: Physicians working at the pediatric division of a university-affiliated hospital participated in the study. All participants completed an anonymous questionnaire regarding their experience and skills in performing funduscopy. A pictorial quiz containing 20 fundus pictures of common findings in children was given. After completing the quiz, a 45-minute tutorial on common fundus anomalies was given. At the end of the lecture, the same quiz was given again. The percentage of correct answers for each quiz was scored. RESULTS: Sixteen physicians completed the study (11 pediatric residents and five senior pediatricians). Most participants did not feel competent at performing a fundus examination [mean score on a visual analog scale 1.96; range 0 (not competent at all) to 7]. The mean score for the fundus pictures quiz given before the tutorial was 48% (range 37-58%). The average score of the residents (47%) did not differ significantly from that of the senior pediatricians (42%). After the tutorial the mean grade increased significantly to 60% (P = 0.002). This was true both for residents (63%; P = 0.001) and seniors (55%; P = 0.004). CONCLUSIONS: Our study shows that funduscopy is being neglected by pediatricians. Even a short tutorial may significantly improve the diagnostic value of this test.     

某企业办公室人员眼底动脉硬化情况的调查分析

目的了解办公室人员眼底动脉硬化情况,探讨脑力劳动对眼底动脉硬化是否有影响.方法以某开发区合资企业128名办公室人员为观察组,而同企业95名工人和后勤人员(不接触视屏和有害化学物)为对照组.分别检查视力、眼底动脉情况,测量血压,检验空腹血糖、血脂,分析结果.结果观察组眼底动脉硬化率为24.22%,对照组为9.47%,两组眼底动脉硬化率之间差异有显著性(P＜0.05).结论办公室紧张的脑力劳动对眼底动脉硬化可能有一定影响.     

2306例知识分子眼底动脉硬化调查

２３０６例知识分子眼底动脉硬化调查沈阳市红十字会医院眼科李松滨，李桂华沈阳市心血管病人群监测防治中心郭宝霞近年来，高血压、冠心病等心、脑血管疾病的发病率明显升高、早期诊断、早期治疗至关重要。我们对２３０６名知识分子进行检查时，发现眼底动脉硬化与心、脑...     

Technology: a strategic factor in hospital planning

Hospital administrators cannot afford to sit back, amazed at technological progress. They must be able to assess technology--both currently available and planned for the future--and they must be willing to adapt to rapid change. Assessing and planning for technology are essential for future survival.     

出生体重大于2000g新生儿眼底筛查结果分析

目的探讨出生体重大于2000g的新生儿眼底疾病的发生情况及开展早产儿视网膜病筛查的必要性。方法用双目间接眼底镜和（或）RetCamⅢ对2012年出生的636例新生儿进行眼底筛查,按胎龄分为两组（胎龄≥37周组和胎龄〈37周组）,分析比较各种眼底疾病的发生及救治情况。结果总患病概率为12．89％。其中最常见的眼底病变为视网膜出血（占8．65％）、早产儿视网膜病（占2．20％）和玻璃体混浊（占0．94％）。结论这类新生儿最常见眼底疾病为视网膜出血,顺产新生儿发生率高于剖宫产新生儿。积极地开展眼底筛查,进行随访很有必要。     

58例前部缺血性视神经病变的临床分析

目的：观察前部缺血性视神经病变的视野检查和眼底荧光血管造影等特征,探讨其对前部缺血性视神经病变的临床应用价值。方法：对58例（58眼）前部缺血性视神经病变的视野和眼底荧光血管造影的图像进行分析。结果：眼底表现以视盘苍白水肿为最常见。视野主要表现为与生理盲点相连的象限性、相对性或绝对性缺损,其中上方缺损9眼（占15.5%）,下方缺损21眼（占36.2%）。大部分36眼（62.1%）眼底荧光血管造影表现为早期视盘缺血区弱荧光,晚期荧光增强。结论：本组病例42只眼（占72.4%）仅依靠眼底荧光血管造影表现可以确定视盘缺血的部位,16只眼（占27.6%）视盘缺血部位的确定需要结合视野检查结果。因此,视野检查结合眼底荧光血管造影可提高前部缺血性视神经病变的诊断率。     

上海市中心城区2型糖尿病患者视网膜病变现况调查

目的评价上海市中心城区成年人2型糖尿病患者糖尿病视网膜病变的患病率及相关因素。方法采用整群抽样方法选取上海市中心城区30岁以上已诊断为2型糖尿病的患者1039例，其中资料完整者767例纳入本研究。结果（1）767例患者完成1534张眼底摄片，其中不能分级者95例（12．4％），可以分级者672例（87．6％）；（2）非增殖期糖尿病视网膜病变145例，占可分级2型糖尿病患者的21．6％，其中轻度59例（8．8％）、中度75例（11．2％）、重度11例（1．6％），增殖期糖尿病视网膜病变9例（1．3％）；（3）糖尿病视网膜病变者较非病变者年龄更长，糖化血红蛋白、尿素氮和肌酐更高，逐步logistic回归分析显示糖尿病病程及空腹血糖水平为糖尿病视网膜病变的危险因素。结论上海市中心城区30岁以上已诊断2型糖尿病患者视网膜病变的现患率为22．9％，空腹血糖和糖尿病病程是影响因素。     

微波对体外培养视网膜神经细胞损伤的光镜与电镜观察

为了探讨２４５０ＭＨｚ微波对眼底的损伤，采用体外培养视网膜神经细胞，按微波强度分为３组进行微波辐照１ｈ，进行光镜和透射电镜观察。结果表明，３０ｍＷ／ｃｍ＾２微波辐照可使视网膜神经细胞发生凋亡，６０ｍＷ／ｃｍ＾２微波辐照可导致细胞坏死。可见，微波可损伤体外培养的视网膜神经细胞，诱发细胞凋亡，随着微波辐照强度的增大，损伤程度加重。     

Polarization method of examining the fundus and anterior chamber of the eye

The method using polarization light proved to be efficient for examining eye tissues. It provides better contrast of some ocular elements, and thus, more reliable detection of pathological changes, more complete extinction (relaxation) of reflexes which hamper the observation and photograph of different eye parts. To interprete the patterns observed on the fundus in crossed polaroids, a matrix method is recommended for calculation of intensity of light passing through the optically-anisotropic layers of the eye ball. Data of clinical examinations carried out on pilot models of ophthalmological instruments confirmed diagnostic value of the polarization method for the eye study.     

GP consortia: navigating ambiguity to produce greater public value?

The UK's NHS is about to be significantly remodelled according to a white paper published in July 2010 that outlines the devolution of commissioning responsibilities away from strategic health authorities and primary care trusts to consortia of GPs, which are to be established at local level. Details of how the new GP consortia will operate are as yet unclear, but in essence they will be strategic alliances and it is likely that they will develop more or less formal arrangements between consortia partners, such as those of a commercial joint venture. This article draws on primary research into strategic alliances between organizations in all sectors. It suggests that there can be significant challenges for those working within strategic alliances, given that these tend to be beset by ambiguity and political tensions. In a context of ever greater transparency and accountability, it will be crucial to attend to the human aspects of strategic alliances since these represent significant risk if neglected. Conversely, alliances also offer the opportunity to develop the synergy of people, organizations and communities to deliver greater public value. Successful collaborations need to get three things right: governance, operations and behaviours. Relationships between consortia partners have a significant bearing on their ability to deliver desired outcomes. They must be able to build and maintain trust. Consortia partners will need sophisticated negotiating and stakeholder management skills and must be able to engage the public in setting the strategic goals for which they will be accountable. They also need strategic and operational management skills and must be able to cope with ambiguity and manage complexity. This paper argues that specific forms of leadership are needed in collaborative arrangements to mobilize people for positive action. People must work together by willingly and effectively pooling their initiative and expertise, and create a product or energy that is greater than the sum of their parts. The nature of leadership required to produce such high performance outcomes is likely to supersede leadership that is the result of structural relationships or of individual action. In particular, distributed leadership is likely to be relevant.     

15 750例新生儿眼底筛查结果分析及随访管理

目的 探讨广角数码视网膜成像系统(RetCam3)在新生儿眼底筛查中的临床价值,并对患儿预后情况进行随访。方法 回顾性分析行RetCam3 眼底筛查的15 750例新生儿的临床病例资料。结果 接受筛查,检出眼底病变5 196例(32.99%),其中视网膜出血(retinal hemorrhage,RH)4 312例(27.38%)、视网膜白点症312例、视网膜色素沉着186例、足月新生儿类早产儿视网膜病变样改变132例、视网膜血管异常64例、早产儿视网膜病变(retinopathy of prematurity,ROP)56例、脉络膜缺损40例、视网膜黄染27例、视神经发育异常17例、玻璃体出血14例、永存原始玻璃体增生症(persistent hyperplastic primary vitreous,PHPV)12 例、视网膜膜前出血10例、黄斑缺损6例、白化病眼底改变4例、牵牛花综合征合并PHPV1例、视网膜母细胞瘤(retinoblastoma,RB)1例、色素失禁症(incontinentia pigmenti,IP)1例、杯/盘比大1例。结论 广角数码视网膜成像系统可及时发现新生儿眼底病,为临床实时、有效的指导和干预提供依据。     

Using malarial retinopathy to improve the classification of children with cerebral malaria

The mechanisms leading to death in cerebral malaria (CM) remain unclear. We compared clinical and laboratory data among children with CM, categorized by ocular fundus findings, to elucidate differences that suggest different underlying pathological processes. From 1999-2005, standard examinations, treatment and record keeping were used for children with a clinical diagnosis of CM. Children were divided into ocular subgroups: normal fundus (N), malarial retinopathy (R), or papilloedema alone (P) and appropriate statistical tests were used to compare clinical and laboratory findings among groups. Eight hundred and eighty children who had eye examinations within 6 h of admission were included in the analysis. The groups differed significantly in case-fatality rates: Group P, 44.4% (95% CI 25.3-63.2), Group R, 18.0% (95% CI 15.6-22.3) and Group N, 7.0% (95% CI 4.2-9.8). There were also significant differences among the groups in blood pressure, prevalence of deep breathing, haematocrit, parasite density, platelet concentration and, among survivors, hours taken to recover from coma. Differences among groups suggest that different underlying pathophysiological processes are operating in children with CM defined by existing criteria. Our proposed classification, by improving the specificity of diagnosis, would enhance consistency among different study sites and prove useful in future research studies.     

Finding and keeping nurses: every hospital manager's challenge

To reduce the impact of the nursing shortage, hospital administrators must do whatever is necessary to develop an environment where nurses want to work. Nurses have many choices in job selection, and they must be able to clearly perceive the benefits of working in one hospital over another. Hospital administrators who have a desire to be leaders in quality patient care must be innovative and creative in their attempt to recruit and retain nurses. The shortage of nurses is not only real but is probably permanent. The economics of the health care industry are not likely to change. The winners will be the nurses, as their overall quality of work life will improve.     

Tolerance of ambiguity among MD/MBA students: implications for management potential.

BACKGROUND: Health care is increasingly characterized by uncertainty and turbulence. In an environment of rapid change, flexibility is critical to the success of managers and organizations. Future physician executives must also be open to change and must be able to deal with the uncertainties of management; they must be able to tolerate the ambiguity in management situations. METHOD: This study uses tolerance of ambiguity measures to analyze students at six medical schools offering dual-degree (MD/MBA) programs. Students enrolled in dual-degree programs were assessed and compared with a control group of traditional medical students. RESULTS: MD/MBA students exhibit a higher tolerance of ambiguity than traditional medical students. FINDINGS: As a characteristic associated with leadership ability, tolerance of ambiguity offers a potential indicator of future success as a physician executive. As such, tolerance of ambiguity might be used for selective admissions to medical school and as an indicator of a student's potential to transition between clinical and management functions. As students match personality traits with career choices, those who serve their learning needs must anticipate differences across selected disciplines, roles, and responsibilities.