手术室实施计划巡回无缝隙护理的临床研究

目的：分析手术室实施计划巡回无缝隙护理的临床效果。方法选取该院2014年7—9月进行择期手术的90例患者,随机分成观察组与对照组,每组各45例,观察组患者采取计划巡回无缝隙护理,对照组患者采取常规功能制护理,对比两组患者的临床护理效果。结果经过护理干预后,观察组满意度明显高于对照组(P<0.05),SAS、SDS评分明显低于对照组(P<0.05),心率、血压波动情况明显小于对照组(P<0.05)。结论在手术室内实施计划巡回无缝隙护理效果较好,不仅能减少并发症,同时也能改善护理质量。     

国外医务人员支援边远地区的做法和相关研究综述

医务人员支援边远地区（specialist outreach）是缓解医疗资源分布不均,促进公平、提高患者就医福利,最终建立分级诊疗体系的有效手段。本文对国外医务人员支援边远地区的发展历程和相关研究进行综述,并对我国开展相关工作提出建议。     

《走街会心录》与清初闽台走街医学

闽南和台湾历来有一些叫做走街仔的医生，他们也是中医，所掌握的医学却另有特色，这里权称为走街医学。介绍偶然发现的清初走街仔的医著《走街会心录》，考证其作者的祖籍和生平，论述明清鼎革后走街仔大量涌现并具有崇高医德的历史原因。而后依据该书，着重探讨其时的走街医学，总结为下述几点──强调整体观念、经验积累丰富、集民间疗法之大成、有地域的局限性、临床与理论脱节。     

Teen outreach: a grassroots experiment in social psychiatry.

In response to concerns about the social and psychological needs of teenagers, a Teen Outreach Program was established in Beckley, West Virginia. This program has received great support from the local community and can be conceived of as a grassroots experiment in social psychiatry. In the program's first year, trained teenage volunteers under adult supervision, handled over 400 calls from teenagers on such topics as relationship problems, suicidal thoughts, drug and alcohol abuse, and sexuality. Teen Outreach is perceived by the entire community as beneficial and has expanded to encompass 33 counties.     

Effectiveness of a nurse-based outreach program for identifying and treating psychiatric illness in the elderly

Context  Elderly persons with psychiatric disorders are less likely than younger adults to be diagnosed as having a mental disorder and receive needed mental health treatment. Lack of access to care is 1 possible cause of this disparity. Objective  To determine whether a nurse-based mobile outreach program to seriously mentally ill elderly persons is more effective than usual care in diminishing levels of depression, psychiatric symptoms, and undesirable moves (eg, nursing home placement, eviction, board and care placement). Design  Prospective randomized trial conducted between March 1993 and April 1996 to assess the effectiveness of the Psychogeriatric Assessment and Treatment in City Housing (PATCH) program. Setting  Six urban public housing sites for elderly persons in Baltimore, Md. Participants  A total of 945 (83%) of 1195 residents in the 6 sites underwent screening for psychiatric illness. Among those screened, 342 screened positive and 603 screened negative. All screen-positive subjects aged 60 years and older (n=310) and a 10% random sample of screen-negative subjects aged 60 years and older (n=61) were selected for a structured psychiatric interview. Eleven subjects moved or died; 245 (82%) of those who screened positive and 53 (88%) of those who screened negative were evaluated to determine who had a psychiatric disorder. Data were weighted to estimate the prevalence of psychiatric disorders at the 6 sites. Intervention  Among the 6 sites, residents in 3 buildings were randomized to receive the PATCH model intervention, which included educating building staff to be case finders, performing assessment in residents' apartments, and providing care when indicated; and residents in the remaining 3 buildings were randomized to receive usual care (comparison group). Main Outcome Measures  Number of undesirable moves and scores on the Montgomery-Asberg Depression Rating Scale (MADRS), a measure of depressive symptoms, and the Brief Psychiatric Rating Scale (BPRS), a measure of psychiatric symptoms and behavioral disorder, in intervention vs comparison sites. Results  Based on weighted data, at 26 months of follow-up, psychiatric cases at the intervention sites had significantly lower (F₁=31.18; P<.001) MADRS scores (9.1 vs 15.2) and significantly lower (F₁=17.35; P<.001) BPRS scores (27.4 vs 33.9) than those at the nontreatment comparison sites. There was no significant difference between the groups in undesirable moves (relative risk, 0.97; 95% confidence interval, 0.44-2.17). Conclusions  These results indicate that the PATCH intervention was more effective than usual care in reducing psychiatric symptoms in persons with psychiatric disorders and those with elevated levels of psychiatric symptoms.      

微创外科时代的普外科

在外科手术中把手术切口做小,并尽可能地减少对患者的损伤,是千百年来外科医师的梦想.早在18世纪,奥地利维也纳的外科医师Philip Bozzini(1773-1809年)就因发明了最原始的内镜而被誉为"内镜之父",在他的墓志铭上写着:"纪念已故的Philip Bozzini医学博士,他,一个德国人,第一次看到人体中空脏器的内部."至此,人类不断地改进并发明新的内镜和腹腔镜.     

Principles of educational outreach ('academic detailing') to improve clinical decision making

With the efficacy and costs of medications rising rapidly, it is increasingly important to ensure that drugs be prescribed as rationally as possible. Yet, physicians' choices of drugs frequently fall short of the ideal of precise and cost-effective decision making. Evidence indicates that such decisions can be improved in a variety of ways. A number of theories and principles of communication and behavior changes can be found that underlie the success of pharmaceutical manufacturers in influencing prescribing practices. Based on this behavioral science and several field trials, it is possible to define the theory and practice of methods to improve physicians' clinical decision making to enhance the quality and cost-effectiveness of care. Some of the most important techniques of such "academic detailing" include (1) conducting interviews to investigate baseline knowledge and motivations for current prescribing patterns, (2) focusing programs on specific categories of physicians as well as on their opinion leaders, (3) defining clear educational and behavioral objectives, (4) establishing credibility through a respected organizational identity, referencing authoritative and unbiased sources of information, and presenting both sides of controversial issues, (5) stimulating active physician participation in educational interactions, (6) using concise graphic educational materials, (7) highlighting and repeating the essential messages, and (8) providing positive reinforcement of improved practices in follow-up visits. Used by the nonprofit sector, the above techniques have been shown to reduce inappropriate prescribing as well as unnecessary health care expenditures.     

Evaluation of the role of a specialist tracheostomy service. From critical care to outreach and beyond

The impact that a new specialist tracheostomy service, designed specifically for the care of patients with tracheostomies, was assessed in terms of type of tracheostomy tube used, time to first tube change, time to decannulation, and incidence of tracheostomy related complications in a teaching hospital with no on-site ear, nose, and throat facility. A total of 170 patients were studied. After service implementation, fewer patients (17.6%, n = 21) were discharged from the intensive treatment unit to the wards with tracheostomy tubes compared with the first group (39%, n = 20) (p = 0.006), and the number of tracheostomy related complications on the wards were significantly reduced (p = 0.031).     

泌尿外科后腹腔镜与传统开放手术的护理研究

目的:研究后腹腔镜优于传统开放手术的护理特点,以提高护理工作的效率和质量。方法:对两组患者均行心理护理、术前准备、术后护理,从护理角度比较两组间的差异。结果:腹腔镜手术组术后2~3 d拔除引流管,1~5 d拔除导尿管,平均住院6 d,出院时行动自如;传统开放手术组术后2~5 d拔除引流管,1~7 d拔除导尿管,平均住院10 d,出院时牵吊感明显。结论:泌尿外科后腹腔镜手术微创、安全,减轻患者痛苦、缩短住院日,提高了护理工作效率。     

Sub-specialisation in surgery and the continuing challenge of providing emergency surgery services

The future viability of general surgery may depend on combining subspecialty elective surgery with full-scope acute practice in both public and private settings.     

手法复位加中药熏洗治疗旋前外展型踝关节骨折效果探讨

目的：分析研究手法复位加中药熏洗治疗旋前外展型踝关节骨折的临床应用价值。方法：选取2008年8月至2012年8月在该院接收的旋前外展型踝关节骨折患者一共有56例,对56例患者采取手法复位加中药熏洗治疗,对其临床治疗效果给予分析。结果：56例患者,其中优43例（76.79％）;良10例（17.86％）;差3例（5.36％）,优良率为94.64％,临床手术以后跟踪随访6个月～3年,病人全部治愈。结论：旋前外展型踝关节骨折采取手法复位加中药熏洗治疗,可以使相关症状得到明显改善,使临床治疗效果进一步提高,具有临床推广价值。     

机器人辅助手术系统在微创内镜手术中的应用

目的探讨有关机器人辅助手术系统在微创内镜手术中应用。方法检索国内外有关资料,进行分析综合。结果机器人辅助的内镜手术已成功应用到外科手术的各个领域并显现出独特优势。结论机器人辅助手术系统弥补了传统内镜手术系统的缺点,为进一步完善内镜手术提供了新的途经,并有利于远程手术的实现。     

机器人辅助外科手术系统在肝胆胰外科中的应用

随着机械力学、计算机学、远程数据分析技术等科技水平的不断提高,用于外科手术的机器人研究及其临床应用方兴未艾,多年来逐渐形成以达芬奇手术系统(Da Vinci surgical system)和宙斯遥控机器人手术装置(ZEUS system)为主体的手术机器人临床应用装置.     

机器人外科手术系统在心脏外科中的应用

目前,在达芬奇机器人外科手术系统辅助下可进行的心脏手术包括冠状动脉旁路移植术、二尖瓣成形和置换术、先天性心脏病纠治术、心房颤动消融术、起搏导线植入术、心内肿瘤切除术等,本文就其现状和发展作一介绍.