甘肃省不同级别医疗机构卫生技术人员变动特征调查分析

目的了解2005～2007年甘肃省不同级别医疗机构卫技人员变动特征及变动趋势,为甘肃省卫生人力资源优化配置及稳定发展卫生人才队伍提供依据。方法通过分层整群抽样,对3年来甘肃省不同级别医疗机构新增、离职卫技人员的数量、学历和职称情况进行调查。结果 2005～2007年甘肃省不同级别医疗机构新增卫技人员所占比例均比离职卫技人员所占比例高。2005～2007年省级、一类地区市（州）级和二类地区市（州）及县（区）级医疗机构新增卫技人员比例呈上升趋势;省级、各类地区市（州）级和一类地区县（区）级医疗机构离职卫技人员比例呈上升趋势。新增卫技人员学历均以中专为主。各级医疗机构离职卫技人员中均以中级职称人员增加幅度较大。结论新增卫技人员学历偏低,高素质卫技人员流失严重,应稳定和加强卫生人才队伍建设,以满足日益增长的医疗卫生需要。     

广西口腔卫生人力资源现状调查分析

目的 分析广西口腔卫生人力资源的现状,探讨存在的问题及其原因.方法 采用普查方法对广西l4个地市103个区县1 971个口腔医疗机构进行调查.结果 截至2009年底广西拥有牙椅4 296张;口腔卫生人员5 426人,其中口腔医生4 431人(81.66%),护士731人(13.47%),医技264人(4.87%);10万人执业(助理)牙医数为7.06、护士数为1.35,10万人牙椅数为8.36,医护比为1 ∶0.19;口腔医生和护士年龄构成呈橄榄型,学历均以专科为主,分别占62.24%、92.89%,职称均以初级职称为主,分别占57.82%、63.88%;不同地区口腔卫生人力资源差异较大.结论 广西口腔医生和护士数量严重不足、素质总体偏低,口腔卫生人力资源各地区间分布不平衡.     

西部区域基层医生职业认同及职业规划现状

目的:调研西部区域基层医生职业认同及职业规划现状,为基层科学配置医疗人力资源提供依据。方法:便利选择西部5省市112家县级及以下医疗机构,对其符合条件的252位从业人员进行自制问卷调查,了解其对自身职业的认同度及规划愿景。结果:西部地区基层医疗机构临床医生临床综合素质及个人收入偏低,机构等级越低,该特征越为明显;此外,级别越高的医疗机构,医生职业热爱度越低,选择继续教育和深造的医生越多。结论:西部地区基层医疗机构在人力资源管理上存在不足,且目前难以全面进行改善,医学院校应专门为基层医疗机构培养可独当一面的全科医生,以最经济的方式应对和解决现有问题。     

富拉尔基区医疗机构医生资源调查分析及管理对策

目的了解富拉尔基区(简称富区)医疗机构医生资源分布状况,为卫生规划提供依据。方法采用定量和定性相结合、普查和典型机构调查相结合的SWOT分析法对富区医疗机构医生资源分布现状和管理中的优势和存在的问题进行系统分析。结果2005年富区每千人拥有医生2.56人,明显高于全市的平均水平。学历分布:二、三级医疗机构医生以本科学历为主,分别为50.19%、72.19%,而一级医疗机构、卫生所和村卫生室的医生主要是中专学历,分别占39.11%和73.26%;职称分布:三级医疗机构医生以高级职称为主,占49.11%,一、二级医疗机构以中级职称为主,分别为43.88%、33.56%。结论2001～2005年富区每千人拥有医生人数呈上升趋势,中高级职称的人数和本科及以上学历的人数逐年增加。     

烟台市狂犬病暴露处置门诊人力资源配置现状调查

目的：通过分析烟台市狂犬病暴露处置门诊卫生人力资源基本情况,为该领域内的人力资源管理提供科学依据。方法：收集烟台市狂犬病暴露处置门诊复核换证统计数据,对烟台市2013年狂犬病暴露处置门诊工作人员的基本信息进行统计描述,并对不同级别医疗机构其工作人员的学历、职称等进行差异性分析。结果：目前烟台市共设置178个狂犬病暴露处置门诊,工作人员1252人。年龄以30－40岁居多,占总人数的43．0％;男女性别比为0．76：1,平均工作年限为5．55年,机构中平均人数为7．03人;不同级别医疗机构的工作人员其工作年限、学历结构、职称结构均具有显著性差异。结论：该市狂犬病暴露处置门诊人员数量、人员学历结构和职称结构均有待进一步优化,人力资源建设需进一步加强。     

浅谈制约基层医院临床药学服务发展的因素

制约药学服务发展的基本原因药师素质不高:长期以来,我国医疗机构药学人员普遍存在“二低”现象,即低学历、低职称。基层医疗机构药学人员准入条件低,大部分是中等卫生学校或职业教育的毕业生,主管药师以上的人员的职称多是凭工龄熬上去的,高的学历多是第二学历,所学专业也不纯     

河南省艾滋病高发地区村级卫生人力资源现状分析

目的:了解河南省艾滋病高发地区村级卫生人力资源的现状。方法:问卷调查艾滋病高发地区乡村医生的年龄、学历、职称等基本情况,接受艾滋病防治专业知识培训情况、每日工作时间及其满意度等。结果:乡村医生整体学历、职称水平较低,培训不足,工作时间过长,对现任工作满意度不高。结论:建议乡村医生尤其是年轻医生接受继续教育,上级部门应加强乡村医生培训;政府适当提高乡村医生工资水平,改善其工作环境,逐步为其提供养老及医疗保障。     

不同层次护士重症护理思维能力的评估与管理对策

目的 对不同层次护士的重症思维能力进行针对性的分析与评估,归纳护理工作质量的管理方法 .进一步提高重症护理的质量水平.方法 将18名具有重症护理经验的护士纳入本研究,对其在2015年3月~2016年3月期间护理过的63例重症患者的临床病例资料进行回顾性分析.于护理交流总结会上对护理场景、护理措施进行阐释,由资深医师、护师共同讨论并确定护理标准,对18名护士的重症护理思维能力进行评估.按照职称、学历的差异对不同护师的重症护理思维能力进行评估.结果 职称不同,护士的重症思维能力不同,职称高的护士在重症护理过程中的思维能力水平明显好于职称低的护师,比较差异具有统计学意义(P<0.05);另外,学历高的护士其重症护理的思维能力水平明显高于学历低的护士,比较差异具有统计学意义(P<0.05).结论 重症护理中护士的思维能力受到工作经验、学历等因素的影响,为了进一步提高护理水平,需要充分尊重这种差异性,制定具有针对性的护理培训及质量管理措施.     

北京市朝阳区施行"双诊制"的影响因素分析

目的 从社区卫生服务中心和二三级医院两个方面探讨影响北京市朝阳区"双诊制"深入开展的因素.方法 随机抽取100名二三级医院医生和210名社区卫生服务中心医生,采取医生自填问卷的方式进行调查.结果 社区医生与二三级医院医生的学历、职称间差异均有统计学意义(P＜0.01).二三级医院有下转经历的医生比例(54.00%)显著低于社区有向上转诊经历的医生比例(89.95%),差异有统计学意义(P＜0.01);双向转诊的原因主要为技术、设备条件限制和社区不能确诊的疑难复杂病例;医疗机构缺乏信息沟通、没有统一的转诊制度和标准、患者不理解双向转诊制度和患者不相信社区的医疗水平是双向转诊的主要影响因素.社区医生认为首诊制存在困难的原因为:社区卫生服务机构整体医疗水平有限,难以承担首诊重任(70.33%),社区医疗机构和医院间转诊不顺畅(65.07%).结论 社区首诊制的完善需要人才政策的进一步调整;加强医疗机构间的协作沟通机制,建立规范顺畅的双向转诊制度;需要进一步加强社区首诊制的制度建设和宣传工作.     

全科型示范卫生院集里卫生院人力资源状况分析

目的了解全科型示范卫生院集里卫生院的人力资源现状,为全科型卫生院人力资源的合理配置提供依据。方法采用普查法,对2009年浏阳市集里镇卫生院卫生人员的数量、专业、学历、职称、执业资格等进行了调查与分析。结果集里镇卫生院现有职工331人中308人为卫生技术人员,医生、护理、医技、管理人员所占比例分别为38.31%、46.43%、11.36%、1.62%,医护比=1∶1.2;学历分布为:本科及以上29.6%、大专57.1%、中专13.3%;职称分布为:初级64.6%、中级21.4%、高级4.2%、其他未定级9.8%;77.97%的医生具备执业医师资格,11.86%的医生具备执业助理医师资格。结论集里卫生院人员配备相对充足,卫生技术人员的专业、学历、职称分布均优于湖南省及全国乡镇卫生院平均水平。但卫技人员的专业结构宜重视适应全科医学的发展,应进一步提升卫技人员的学历与职称。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.