Two year audit of perinatal mortality at Kathmandu Medical College Teaching Hospital.

Introduction: Perinatal mortality rate is a sensitive indicator of quality of care provided to women in pregnancy, at and after child birth and to the newborns in the first week of life. Regular perinatal audit would help in identifying all the factors that play a role in causing perinatal deaths and thus help in appropriate interventions to reduce avoidable perinatal deaths. Aims and objectives: This study was carried out to determine perinatal mortality rate (PMR) and the factors responsible for perinatal deaths at KMCTH in the two year period from November 2003 to October 2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the still births and early neonatal deaths in KMCTH during the two year period from November 2003 to October 2005. Details of each perinatal death were filled in the standard perinatal death audit forms of the Department of Pediatrics, KMCTH. Perinatal deaths were analyzed according to maternal characteristics like maternal age, parity, type of delivery and fetal characteristics like sex, birth weight and gestational age and classify neonatal deaths according to Wigglesworth's classification and comparison made with earlier similar study. Results: Out of the 1517 total births in the two year period, 22 were still births (SB) and 10 were early neonatal deaths (ENND). Out of the 22 SB, two were of < 1 kg in weight and out of 10 ENND, one was of <1 kg. Thus, perinatal mortality rate during the study period was 19.1 and extended perinatal mortality rate was 21.1 per 1000 births. The important causes of perinatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and associated maternal factors like antepartum hemorrhage and most babies were of very low birth weight. According to Wigglesworth's classification, 43.8% of perinatal deaths were in Group I, 12.5% in Group II, 28.1% in Group III, 12.5% in Group IV and 12.5% in Group V. Discussion: The perinatal death audit done in KMCTH for 1 year period from September 2002 to August 2003 showed perinatal mortality rate of 30.7 and extended perinatal mortality rate of 47.9 per 1000 births. There has been a significant reduction in the perinatal mortality rate in the last 2 years at KMCTH. Main reasons for improvement in perinatal mortality rate were improvement in care of both the mothers and the newborns and the number of births have also increased significantly in the last 2 years without appropriate increase in perinatal deaths. Conclusion: Good and regular antenatal care, good care at the time of birth including appropriate and timely intervention and proper care of the sick neonates are important in reducing perinatal deaths. Prevention of preterm births, better care and monitoring during the intranatal period and intensive care of low birth weight babies would help in further reducing perinatal deaths. Key words: Perinatal mortality rate (PMR), still births, early neonatal death (ENND), Total perinatal death (PND).     

北京协和医院急诊缓和医疗会诊实践

目的 对北京协和医院急诊科发起的缓和医疗会诊进行总结梳理。方法 回顾性分析2017年1月至2020年6月北京协和医院急诊科提出的22次缓和医疗会诊资料。结果 共18例患者接受缓和医疗会诊,其中,男6例,女12例,平均年龄(65±8)岁(36~88岁);10例患者会诊1次,6例患者会诊2次,2例患者未完成会诊;15例患者为恶性肿瘤,3例患者为非肿瘤性疾病。会诊原因中,61.1%(11/18)是关于沟通;61.1%(11/18)是减轻患者的痛苦症状。离世地点方面,8例在本院离世,6例在其他医疗机构离世。结论 北京协和医院急诊对缓和医疗会诊存在明确需求,会诊能给急诊医患双方带来帮助。     

急诊内科昏迷患者220例诊治体会

目的探讨急诊内科昏迷患者的病因构成和早期诊断处理方法,以降低病死率。方法对我院急诊内科2010年1月至2011年6月收治的220例内科昏迷患者的临床资料进行回顾性分析,分析昏迷患者的病因构成和总结早期诊断处理的经验体会。结果本组患者昏迷原因比例最高为酒精中毒,达22.27%(49/220),其次为脑出血,比例为18.18%(40/220);病死率最高的是溺水和脑出血,比例分别为50.00%和45.00%。抢救之后,好转184例(83.64%),死亡36例(16.36%)。结论恰当的早期处理、尽快地做出病因诊断和病因治疗、保护好患者的多脏器的功能、预防感染是抢救昏迷患者的重要措施,对提高抢救成功率、降低病死率具有重要临床意义。     

Medical diagnosis and treatment of 220 cases of coma in the Emergency Department

目的 探讨急诊内科昏迷患者的病因构成和早期诊断处理方法,以降低病死率.方法 对我院急诊内科2010年1月至2011年6月收治的220例内科昏迷患者的临床资料进行回顾性分析,分析昏迷患者的病因构成和总结早期诊断处理的经验体会.结果 本组患者昏迷原因比例最高为酒精中毒,达22.27％(49/220),其次为脑出血,比例为18.18％(40/220);病死率最高的是溺水和脑出血,比例分别为50.00％和45.00％.抢救之后,好转184例(83.64％),死亡36例(16.36％).结论 恰当的早期处理、尽快地做出病因诊断和病因治疗、保护好患者的多脏器的功能、预防感染是抢救昏迷患者的重要措施,对提高抢救成功率、降低病死率具有重要临床意义.     

血管紧张素Ⅱ对H9C2细胞中NLRP3炎性体的作用

【摘要】 目的 探讨血管紧张素Ⅱ（AngⅡ）对H9C2细胞中NLRP3的作用。方法 培养H9C2细胞株,选用对数生长期的H9C2细胞进行试验,用10 6mol/l的AngⅡ予以刺激,于不同的时间点收集细胞,通过实时荧光定量PCR（RT qPCR）及蛋白质印迹法（Western blot）分别检测细胞中NLRP3、ASC、Caspase 1、IL 1β的基因和蛋白水平;通过酶联免疫吸附法（ELISA）检测细胞培养液上清液中IL 1β的含量。结果 NLRP3、ASC、Caspase 1及IL 1β的基因相对表达量在各处理组与0h组相比差异有统计学意义（P＜005）。Caspase 1及IL 1β的蛋白相对表达量在各处理组与0h组相比差异有统计学意义（P＜005）。细胞培养液上清液中IL 1β的含量在各处理组与0h组相比差异有统计学意义（P＜005）。结论 血管紧张素Ⅱ可促使H9C2细胞中NLRP3、ASC、Caspase 1和IL 1β的基因及蛋白表达水平增加,同时也可使细胞培养液上清液中IL 1β的含量增加;AngⅡ可通过激活NLRP3炎性小体导致心肌细胞慢性炎症的发生而导致心肌重构,参与心肌病的发生发展过程。     

Patients choice for method of early abortion among comprehensive abortion care (CAC) clients at Kathmandu Medical College Teaching Hospital (KMCTH)

Objective: The over all objective of the study was to determine different methods of abortion opted by CAC clients at KMCTH. The specific objective of the study was to know the reasons for pregnancy termination and to know the reasons opted for either medical or surgical method of abortion. Methodology: A hospital based prospective study was carried out for a period of six months at KMCTH from 1st January 2006 to 31st June 2006. All the patient undergoing CAC services were included for the study. Clients were provided with written and verbal information regarding the methods of terminating early abortion and its associated complications. After that they were asked to give their informed choice and decision. All the pertinent information was entered on pre-structured questionnaire. Results: During the study period a total of 100 patients underwent CAC services. The commonest reason for termination pregnancy was no desire for additional children (60%) followed by youngest child too small or short spacing (21%). 74% of the patients opted for surgical abortion, 23% patient opted for medical abortion and 3% of the patient remain undecided. Reasons for favouring surgical method of abortion was that surgical abortion is complete (35), repeated visits are avoided (18), quick (10) would be with service provider and feel safe (5), lack of expectancy (2) side effect of medical treatment (1), twin pregnancy (1), easy (1), fear of pain (1). Medical method of abortion was favoured due to fear of surgery (9), easy and less painful (8) and maintains privacy (6). Conclusion: Factors affecting the choice of abortion method appear to be numerous and complex. Providers need to be sensitive to differences in women's values and life circumstances when counselling them about an abortion method. In particular, providers should incorporate into their counselling sessions what women need to know about the characteristics of abortion methods and help women to identify what is the best option for them. Key words: Early abortion medical methods, surgical methods, choice.     

急诊医学教学模式改革的探讨

急诊医学教学质量对于人民的健康保障而言至关重要,所以,我们应该尽可能提高急诊教学的水平。总结了我院急诊科20多年的教学实践工作经验,探讨了急诊医学教学的独特模式,从而提出急诊医学的教学模式应从以下几个方面进行改革:1急诊医学教学模式应以症状体征为中心进行教学;2降阶梯思维模式应该贯穿在急诊医学教学之中;3应该在急诊医学教学中加强医学生的人文素质教育;4急诊医学教学中应引进及推广PBL教学方法。     

改革大学英语教学模式培养高素质的医学人才

以培养高素质的医学人才为目标,本文从转变教学观念,改进教学模式,创新考试评价体系,以及把课堂教学及课外活动紧密结合等方面,探讨了医科大学大学英语教学模式的改革。     

改革大学英语教学模式 培养高素质的医学人才

以培养高素质的医学人才为目标,本文从转变教学观念,改进教学模式,创新考试评价体系,以及把课堂教学及课外活动紧密结合等方面,探讨了医科大学大学英语教学模式的改革。     

北京协和医院建立普通内科临床教学基地方法效果初探

北京协和医院普通内科是国内首个综合教学医院学术性普通内科。我们在部分协和医科大学2000级学生中进行了普通内科病房教学内容和形式的改革,通过综合考试及问卷进行初步评估,发现学生在理论知识掌握的同时临床综合能力也得到很大提高,证明综合医院普通内科可以成为良好的临床教学基地。     

依托综合性教学医院急诊科开展全科医生规范化培训的思考

我国全科医生规范化培训尚处于探索阶段,缺乏规范和统一的培养模式。急诊医学和全科医学之间存在着广泛的内在联系和共通之处,依托综合性教学医院急诊科开展全科医生规范化培训具有一定的优势。在开展规范化培训之前,首先应对教学对象、教学内容及教学目标进行分析,做好充分的教学准备。教学过程中应采用灵活多样的教学形式,并利用科学的教学评价方法,以获得较好的教学效果。     

山东滨州医学院附属医院疼痛科简介

科室设置1991年3月成立疼痛门诊,现门诊设普通门诊、专家门诊和普通治疗室、无菌治疗室各1间。门诊固定护师两名,1名负责普通治疗室的工作,主要是利用超激光疼痛治疗仪、疼痛治疗仪和骨质疏松治疗仪等治疗门诊患者;另1名负责无菌治疗室的工作,主要配合医师进行穴位、骶管或硬膜外、脊神经后内侧支、椎间孔和第三腰椎横突等阻滞及小针刀松解术等无菌操作治疗;同时又要负责无菌治疗室的卫生、消毒及各种无菌器械和敷料的准     

医学院附属医院临床实践教学问题与对策

临床实践教学是整个医学教育过程的重要环节,医学院附属医院临床实践教学质量直接关系到医学人才的培养质量。本文针对医学院附属医院临床实践教学中存在的问题进行分析,提出了相应的对策,最终达到保障临床实践教学质量的目的。     

Emergency Department Access to a Longitudinal Medical Record

Our goal is to assess how clinical information from previous visits is used in the emergency department. We used detailed user audit logs to measure access to different data types. We found that clinician-authored notes and laboratory and radiology data were used most often (common data types were used up to 5% to 20% of the time). Data were accessed less than half the time (up to 20% to 50%) even when the user was alerted to the presence of data. Our access rate indicates that health information exchange projects should be conservative in estimating how often shared data will be used and the wide breadth of data accessed indicates that although a clinical summary is likely to be useful, an ideal solution will supply a broad variety of data.     

自我介绍在急诊实习中的应用

目的探讨急诊实习生向患者主动说明学生身份后,患者是否还会允许其问诊和体检。方法首先调查就诊患者是否愿意实习生参与医学操作,然后由实习生主动向患者说明学生身份并介绍医学培训过程,最后让患者选择是否允许实习生问诊和体检。结果12名实习生调查了150名急诊就诊患者。在问卷调查中,76．7％的患者表示不会介意实习生参与医学操作,但有48％的患者表示当有实习生参与时自己应该被告知。当实习生向患者说明学生身份后,85．3％的患者允许其问诊和体检。结论当被告知实习生身份后,很多患者都愿意让其问诊和体检。     

三级医院非急诊就诊现象产生的伦理问题探讨

目的探讨三级医院急诊内科由于非急诊就诊患者就诊所产生的伦理问题。方法运用分层随机抽样的方法,在2010年1～12月,每月随机抽取一周,收集华山医院急诊内科就诊患者,判断并记录该患者是否是可以先在社区卫生服务中心就诊的非急诊就诊患者。结果在所有病例记录中,有39.5%的患者可以先在社区卫生服务中心就诊,属于非急诊就诊患者。真正的急诊患者等待就医、检验及治疗时间延长,医生对其的关注比例降低、交流时间减少,影响其的最优化治疗。结论应提高社区卫生服务中心综合实力,倡导非急诊就诊患者优先至社区卫生服务中心就诊;重视急诊工作,加强急诊人员配备;严格执行急诊准入标准。     

北京协和医院住院患者内分泌相关疾病871例会诊分析

目的 总结分析北京协和医院内分泌专科会诊病例构成情况.方法 统计北京协和医院内分泌科会诊医师2010年3月1日至2011年2月28日的会诊病例,分析病例构成情况.结果 共会诊患者871例,其中常规会诊675例(77.5％),急诊会诊196例(22.5％).会诊病例最多的是糖尿病,397例,占全部会诊病例的45.6％;其次为甲状腺功能亢进症(甲亢症),84例(9.6％).急诊会诊中以低钠血症最常见,45例(23.0％),其次为甲亢症,44例(22.4％).手术科室糖尿病会诊构成比(66.6％)明显高于非手术科室(45.6％).结论 内分泌科会诊医师应了解内分泌科会诊病例的构成特点,在会诊中不断总结经验,提高诊疗水平.     

4856份急诊留观病历书写质量分析

目的 分析某三甲医院急诊留观计算机打印病历的质量缺陷,探讨急诊留观病案的现状,为向电子病历过度做好准备.方法 以卫生部病历书写基本规范为标准,对某三甲医院急诊留观2013年1月-2014年4月16个月的病案进行质量分析.结果 4856份急诊留观病案中,缺陷病案1235份,缺陷率25.43％.主要存在问题包括病程记录中使用复制粘贴现象严重,不同上级医师查房记录雷同,占23.08％.另外,医师审签工作滞后,占31.4％,病历归档时间滞后,占21.13％.结论 现阶段急诊留观病案与真正意义上的电子病历还有一段距离,通过开发使用真正意义的急诊留观电子病历系统,.从根本上解决存在的问题,切实提高病案质量.实现病案为临床、科研等方面服务的目的.