成功抢救中药中毒致持续性室速 室颤1例

1 病例介绍 患者,男性,57岁.2006-10-31因心律失常、心源性休克急诊入院.患者既往健康.入院当天10:00服用个体中医诊所配制治疗腰椎间盘脱出的中药(组成:乳香、 没药、川芎、桂枝、赤芍、当归、元胡、山参、忍冬藤、落石藤、青峰藤、海峰藤、王不留行、续断、桑继生、伸筋草、桑枝、 桑叶及滑石粉,量不详).患者大约在服药后1 h出现胸闷、心悸症状,继而恶心、呕吐、大汗、肢端麻木.     

卫生部办公厅关于进一步增设全国流感监测网络实验室和哨点医院的通知卫发明电[2009]103号

天津市、山西省、内蒙古自治区、辽宁省、上海市、江苏省、浙江省、安徽省、江西省、山东省、湖南省、广东省、广西壮族自治区、海南省、重庆市、四川省、贵州省、云南省、西藏自治区、陕西省、甘肃省、青海省、宁夏回族自治区、新疆维吾尔自治区卫生厅（局）,新疆生产建设兵团卫生局,中国疾病预防控制中心：     

2006-2007年度河北省优秀期刊名单

思维与智慧、老人世界、河北学刊、共产党员、领导之友、语文教学之友、河北师范大学学报（哲学社会科学版）、河北经贸大学学报、河北法学、河北画报、文史精华、阅读与鉴赏、长城、旅游纵览、教育实践与研究、金融教学与研究、石油政工研究、邯郸学院学报、河北广播电视大学学报、河北大学成人教育学院学报、石油地球物理勘探、中国电梯、钻井液与完井液、邮政研究、     

SCI收录的《中国神经再生研究（英文版）》杂志国际投稿服务

特色优质服务项目：文章的翻译和语言润色及参考文献的核准服务。①服务对象：医学基础学科：生物学、酶学、细胞生物学、生理学、发育生物学、遗传学、放射生物学、分子生物学、生态学、神经生物学、微生物学、病毒学、基因工程、细胞工程、蛋白质工程、酶工程、微生物工程、生物技术、心理学。     

《临床心身疾病杂志》稿约

《临床心身疾病杂志》是中国医师协会系列杂志，由河南省卫生厅主管、河南省精神病医院主办的心身医学专业学术期刊，国内外公开发行（国内统一刊号：CN41—1353／R，国际标准刊号：ISSN1672187X）。本刊为双月刊，逢单月20日出版。主要以国内外精神、心理、心身医学的临床、教学、科研工作者为对象，提供精神医学、心理医学、心身医学及康复医学等领域的新成果、新理论、新技术、新方法、新经验，及时反映国内外医学的新进展、新知识和实用经验。凡临床精神医学、心理医学、心身医学及其分支，如儿童、老年、司法、病理、药理、生理、生化、遗传、瓷疫、流行病学调查、心理卫生咨询、防治、康复、护理、管理等方面的论著、经验、病例报告、专题研究、文献综述、讲座、编译、信息动态等均受欢迎。     

母亲的腊八粥

经过检查、输液、吸氧、雾化、打针、吃药一系例诊疗,母亲的心累、缺氧、气紧有所缓解。但抽血、检查、治疗的折腾又让患有类风湿与骨质疏松症的她肢体、关节、脊柱疼痛难忍,不停地呻吟着……     

《中华全科医学》杂志2010年征稿征订启事

《中华全科医学》杂志为中华人民共和国卫生部主管、中华预防医学会主办，国内外公开出版发行，国际标准刊号ISSN1674—4152，国内统一刊号CN11-5710／R。期刊为月刊，大16开，120页，每期定价8元，全年96元。主要栏目：专家论坛、全科基础研究、全科临床研究、全科医学探讨、全科医学教育、全科临床实践、全科临床护理、急诊医学、医疗卫生管理、医学检验、医学影像、技术交流、调查分析、专家讲座、药物与临床、社区卫生与康复、预防与保健、医疗与法律、中医中药、心理卫生、健康教育、卫生信息、国外医学进展、综述、     

论人际沟通系统的特性

从系统科学的角度来研究人际沟通,分析并归纳沟通系统的相互关联甚至交叉,但又有所区别的多重特性.认识沟通系统的整体性、相互依存性、目的性、针对性、模糊性、非线性、多向性、阶段性、自我调节和控制、输入与输出、与环境交换、改变和适应、平衡和稳态、等同终点的特性.对促进临床护理中人际沟通的研究具有现实意义.     

探针熔解曲线在耐药结核病快速筛查中的临床应用研究

目的 研究探针熔解曲线在耐药结核病快速筛查中的临床应用价值。方法 选取2020年1月—2021年3月镇江市第三人民医院收治的378例肺结核患者为研究对象,依次完成传统罗氏固体药物敏感性检测（比例法）、探针熔解曲线技术检测常用的6种药物耐药结果,包含利福平、异烟肼、乙胺丁醇、链霉素、氧氟沙星、阿米卡星,和比例法进行对比,计算探针熔解曲线技术检测6种药物的敏感度、特异度、阳性预测值、阴性预测值、符合率与约登指数。结果 与比例法作比较,熔解曲线技术检测利福平耐药性的敏感度、特异度、阳性预测值、阴性预测值、符合率、约登指数分别为91.70%、98.10%、61.10%、99.70%、97.90%、0.898;异烟肼是87.90%、94.20%、59.20%、98.80%、93.65%、0.821;乙胺丁醇是87.50%、97.03%、38.89%、99.72%、96.83%、0.845;链霉素是91.30%、98.19%、87.50%、98.79%、97.35%、0.895;氧氟沙星是94.74%、98.89%、81.82%、99.72%、98.68%、0.936;阿米卡星是80.00%、99...     

《国际检验医学杂志》2011年栏目及文章相关要求

1、述评2、专题6、硕博论坛3、论著版面页2.5页、中英文摘要、关键词3～5个、参考文献12条4、临床检验研究版面页2页、中英文摘要、关键词3～5个、参考文献12条5、基础实验研究版面页2页、中英文摘要、关键词3～5个、参考文献12条     

Using Patient Care Quality Measures to Assess Educational Outcomes

Objectives To report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine. Methods A workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures. The workgroup completed a structured exercise to examine the linkage of patient care process and outcome measures to educational effectiveness. Results The workgroup selected 62 measures for inclusion in its final set, including 43 measures for 21 clinical conditions, eight medication measures, seven measures for procedures, and four measures for department efficiency. Twenty‐six measures met the more stringent criteria applied post hoc to further stratify and prioritize measures for development. Nineteen of these measures received high ratings from 75% of the workgroup and external stakeholder raters on importance for care in the ED, measures quality of care, and measures educational effectiveness; the majority of the raters considered these indicators feasible to measure. The workgroup utilized a simple framework for exploring the relationship of residency program educational activities, competencies from the six Accreditation Council for Graduate Medical Education general competency domains, patient care quality measures, and external factors that could intervene to affect care quality. Conclusions Numerous patient care quality measures have potential for use in assessing the educational effectiveness and performance of graduate medical education programs in emergency medicine. The measures identified in this report can be used as a starter set for further development, implementation, and study. Implementation of the measures, especially for high‐stakes use, will require resolution of significant measurement issues.     

Measures of surgical quality: what will patients know by 2005?

RATIONALE, AIMS AND OBJECTIVES: Many objective measures rating quality of doctors, hospitals, and medical groups are publicly reported. Surgical patients may have more opportunity to use quality measures than other types of patients to guide their choice of provider. If surgical patients are able to choose higher quality providers, overall surgical quality might increase. OBJECTIVE: To determine what procedure-specific measures of surgical quality are available to consumers facing surgery in California and what new measures will be available by 2005. METHODS: We searched for and surveyed organizations publicly reporting data on health care quality in California. We asked about current quality measures and new measures set for public release by 2005. Included measures had to be procedure-specific and results separated by hospital. The main outcome measures were the number of quality measures; conceptual aspect of quality measured; and type of risk-adjustment used. RESULTS: Eighteen organizations publicly report any health care quality measures in California. These organizations report 333 measures, of which 32 (10%) are procedure-specific measures of surgical quality. There is at least one quality measure for 21 different procedures; these procedures account for 14% of all major operations. Three new measures will be released by 2005. CONCLUSIONS: Californians facing surgery have limited information regarding quality of their care; few new measures are planned. Eighty-six per cent of patients would find no quality measures related to planned procedures. Public release of performance data is unlikely to improve the quality of health care unless the number and comprehensiveness of measures increase dramatically.     

Designs and decisions: The creation of informal measures for assessing speech production in children

Abstract

Speech-language pathologists (SLPs) frequently assess children's speech to diagnose and identify areas of difficulty, then determine appropriate intervention goals. Formal measures are available for assessment; however, many SLPs use informal measures within clinical practice. The purpose of this two-part mixed methods study was to describe informal measures created to assess children's speech. Study 1 involved a systematic review of 39 informal measures identified via journal database and internet searches, scanning of reference lists, and submission by SLPs and researchers. The measures were reviewed in terms of their conceptualization (content and format) and operationalization (evaluation and validation). Common conceptual features included assessment of consonant singletons, single words, computer format, and picture-naming. Few measures provided information addressing operational criteria; in particular, they lacked evaluation of their effectiveness. Study 2 involved an inductive thematic analysis of journal entries from eight creators of informal measures that explored key considerations in the development process. Informal measures were created due to the absence of measures which were sufficiently comprehensive and culturally appropriate, plus a desire to incorporate technology. Considerations in the creation of informal measures included sourcing research and existing measures to inform the measures’ development, maximizing children's engagement, and utility. SLPs must be cautious when using informal measures due to their lack of operationalization. However, these measures often address SLPs’ needs and so operationalization of informal measures would be beneficial for the profession.     

The concordance of self-report with other measures of medication adherence: a summary of the literature

OBJECTIVE: The objective of this study was to evaluate the concordance of self-report measures of medication adherence (interview, diary, or questionnaire) with nonself-report measures of adherence (administrative claims, pill count or canister weight, plasma drug concentration, electronic monitors, or clinical opinion). METHODS: A literature search was conducted to identify published reports in which self-report and nonself-report measures of adherence were used within the same study. The concordance of measures within each study was categorized as high, moderate, or low based on a comparison of the adherence estimates. RESULTS: Eight-six comparisons of self-report to nonself-report measures of adherence were identified. Thirty-seven of the 86 comparisons (43%) were categorized as highly concordant. However, concordance varied substantially by type of self-report measure and nonself-report measure. Self-report measures, in general, were highly concordant with electronic measures in only 17% of comparisons, whereas they were highly concordant with other types of nonself-report measures in 58% of comparisons (chi-square = 14.30, P <0.01). When comparing self-report measures, interviews had significantly lower concordance with nonself-report measures as compared with questionnaires or diaries (chi-square = 8.47, P = 0.01). In 15 comparisons of interviews with electronic measures, none of the comparisons were highly concordant, whereas questionnaires and diaries had moderate-to-high concordance with electronic measures in 12 of 16 comparisons (75%). CONCLUSIONS: The concordance of self-report and other measures of medication adherence varies widely based on the type of measures used. Questionnaires and diaries tend to have moderate-to-high concordance with other measures of medication adherence. However, interview-based self-reports are not concordant with electronic measures. Questionnaire and diary methods could be preferable to interviews for self-reported medication adherence.     

Reliability and construct validity of some cognitive measures of clinical reasoning

The past few years have seen a growing interest in understanding clinical reasoning processes by using the research methods of cognitive psychology. Nevertheless, a gap remains between the basic research methods and the application of these methods as evaluative instruments. The present research applied standard psychometric “yardsticks"—reliability and construct validity—to several cognitive measures of recall and perception used in previous studies. The cognitive measures were compared to measures of clinical performance derived from encounters with simulated patients and to conventional measures of knowledge based on multiple‐choice questions and modified essay questions.

The cognitive measures demonstrated reliability comparable to that of the conventional tests and considerably exceeding that of the clinical performance measures. Validity coefficients were comparable for all the measures. A calculation of reliability per unit of testing time indicated that the cognitive measures were more efficient than the other measures. These results provide at least a preliminary indication that the gap between cognitive measures and conventional measures of clinical performance can be narrowed.     

Patient- and clinician-rated outcome measures for clinical decision making in rehabilitation

Outcome measures can be classified as clinician rated and patient rated. Clinician-rated measures predominantly assess impairments, whereas patient-rated measures, also known as patient-based measures, are designed to evaluate the impact of the injury on a patient's daily activities, work, and recreation. Currently, there is a greater reliance on clinician-rated impairment measures for clinical decision making, specifically with treatment planning and assessing outcomes of care. To comprehensively evaluate the effect of an injury, patient-rated outcome measures must be used because they allow for the assessment of a patient's ability to perform daily activities and participate in work and recreation that is affected by an injury. Clinician-rated impairment measures should be used to guide the development of a treatment program, and patient-rated measures should be used for both treatment program development and assessing treatment outcomes in daily clinical practice. The purposes of this article are to describe patient- and clinician-rated outcome measures and to provide guidance and illustrate the benefits of the use of these measures in clinical decision making and documenting outcomes of care.     

100份护理病历中护理措施存在的问题及对策

随机抽取我科１９９７年３月—１１月１００份整体护理病历,对其中８１４个护理问题对应的４６５５条护理措施进行分析,结果陈述不清楚、欠条理的２６５条（５．７％）,措施可行性差１４７条（３．２％）,护理措施与护理问题不符１０７条（２．３％）,措施缺乏科学依据８８条（１．９％）,护理措施与医疗措施混淆２０１条（４．３％）。提出：正确掌握护理措施意义及范畴,遵循护理措施与护理问题一致的原则,从实际出发,制定切实可行的有效的护理措施。     

Changes in attitudes towards restrictive alcohol policy measures: the mediating role of changes in beliefs

Aim: From 2005 to 2009, increased support for restrictive alcohol policy measures was observed in the Norwegian population. This article addresses whether this increase was mediated by changes in belief about the effectiveness of restrictive measures and belief about the harm caused by drinking. Method: The data were derived from five surveys conducted during the period 2005–2009 (N = 7244). In each survey, we used identical measures of attitudes towards regulation of price and availability, belief in the effectiveness of such measures and belief in the association between overall consumption and harm. Results: During the period, there was an increase in support for restrictive policy measures; in belief in the effectiveness of these measures and in belief in the harm caused by drinking. Increased support for restrictive measures was partly mediated by changes in beliefs in terms of statistically significant indirect effects from both belief in the effectiveness of such measures and belief in the harm caused by drinking. Half of the increased support for restrictive measures could be attributed to changes in beliefs. Conclusion: Strengthening people’s belief in the effectiveness of restrictive measures and in the harm caused by drinking may increase public support for restrictive alcohol policy measures.     

Measuring health in quantitative studies

For quantitative studies it is essential to select (and sometimes even construct) outcome measures, which are appropriate for measuring the specific aspect of health you are interested in. The measures should be valid, repeatable, and sensitive to change. It is complex and time-consuming to develop outcome measures afresh, so choose existing measures whenever possible and use them in the way they were intended. Measures may be generic or specific and should match the subjects involved. Objective measures, though accurate, may be less relevant to patients than subjective measures, particularly for CAM therapies. Findings made with one measure are more credible if they are supported by a second, as are results produced with the same measures used to measure outcomes in conventional medical studies. Careful planning of the analysis will help reveal any problems with measures.     

Ultrasound measures of muscle thickness: intra‐examiner reliability and influence of body position

Ultrasound is an inexpensive and practical alternative to gold standard measures of muscle mass. Changes in body position may lead to intra‐muscular fluid shifts that may affect the reliability of ultrasound measures. We assessed test–retest reliability of ultrasound measures of muscle thickness and the effect of position on these measures. Measures of muscle thickness were made from B‐mode ultrasound images in 18 healthy participants. Repeated measurements were made by one examiner from two participant positions; standing and recumbent, from 18 anatomical sites. Results demonstrated high test–retest reliability for measures taken in both participant positions [intra‐class coefficient (ICC) scores 0·65 to 0·94], except for the recumbent posterior lower leg measures (ICC 0·34). Recumbent measures were significantly smaller than those taken with participants standing. Length of time participants spent lying down did not significantly affect measures, indicating that any changes in intra‐muscular fluid related to the time spent recumbent are negligible.