Crevasse fall in the Antarctic: a patient's perspective

As a veterinarian working on an Adélie penguin research program, I was to spend six months on an island off the coast of Mawson Station in the Australian Antarctic Territory. During a field training exercise on my third day at Mawson, I fell into a crevasse with my four-wheel-drive quad bike and was crushed between the bike and the crevasse wall six metres below the rim. I had hypothermia and abdominal injuries, and underwent two emergency surgical procedures at Mawson Station. Sixteen days after the accident, I was evacuated by helicopter and ship. Here, I describe my experiences.     

从患者角度探索制约双向转诊的影响因素

目的 从患者的角度探讨制约双向转诊实施的因素,促进长沙市分级诊疗体系的形成.方法 通过分层随机抽样的方法,根据长沙市各个区域的经济发展情况将其分为高、中、低3等,每等级2个区,共6个区,再按照其经济情况划分为高、中、低3等,分别选取2个基层医疗机构,随机抽取361例患者进行问卷调查.对特殊参与双向转诊的患者、医生进行深度访谈.结果 患者到基层医院首诊为60.9％,对双向转诊的知晓度为21.1％,经历过双向转诊并且对双向转诊服务满意的为85.7％,在病情需要的情况下愿意经过基层医疗机构转诊到上级医院为82.9％,在病情需要的情况下愿意经过上级医院转诊到基层医疗构进行康复治疗为77.6％.结论 患者选择基层医疗机构首诊较少,家庭契约式服务签约率较低,双向转诊知晓度不高.     

体外循环手术患者的ICU管理

目的 探讨体外循环术后的护理,总结护理经验,提高护理水平,减少并发症,降低死亡率.方法 对88例患者做好术后相关护理管理.结果 88例中有1例因心衰而死亡,1例发生低体温,其余均好转或治愈.结论 为体外循环术后病人进行严格的监护管理,可提高手术成功率,保证患者生活质量,减少并发症.     

浅析流浪精神病患者的住院管理

目的:探讨流浪精神病患者的住院管理新模式.方法:对2005年7月～2009年3月流浪精神病患者的住院管理进行回顾性分析.结论:流浪精神病患者是弱势人群中的弱势,需要用心去关爱,需要全社会去关爱.全民参保救助流浪精神病患者带来新的管理模式.     

Diabetes mellitus. A perspective on management.

Diabetes mellitus results in multiple complications including over 10,000 new cases of blindness each year in the United States. The evidence that consistent good control significantly reduces these complications is overwhelming, i.e., a return to normal or close to normal glycemic state. This evidence is reviewed. Particularly noteworthy are data showing that when hemoglobin A1c values are consistently less than 8.4% (with 8.0% being the upper limit of normal), only 2.9% of subjects with existing retinopathy progress to a more severe retinopathy, whereas with higher hemoglobin A1cs, there is a progressive increase of severe retinopathy. Multiple biochemical hemodynamic and endocrine processes which appear abnormal in diabetes, return to normal when euglycemia is reestablished. Despite such evidence, physicians often resist conclusions regarding proper management of the diabetic state. The reasons are briefly reviewed.     

Republished article: The impact of diabetic retinopathy: understanding the patient's perspective

Understanding the impact of a condition from the patient's perspective is important, and different types of patient-reported outcomes or instruments are available to help with this. This review article summarises the current evidence on the impact of diabetic retinopathy (DR) and its associated vision impairment on patient-reported outcomes. We have included research that has used a range of outcome measures to assess the impact of DR on generic health-related quality of life, utility, vision-functioning and vision-specific quality of life. This review also offers clarification on frequently misused psychometric terminologies to help clinicians and researchers better understand the literature associated with patient-reported outcome research. Overall, the evidence suggests that DR, particularly in its vision-threatening stages, has a substantial, negative impact on the patient. However, our understanding of the impact of DR is currently restricted due to limitations inherent in currently available patient-reported outcome measures. We conclude by discussing potential directions for future research in this area, such as item banking and computer adaptive testing.     

医院药品管理行为的伦理透视

本文对省、地（市）、县三级医院药品管理情况进行调查和分析,医院进药途径的多渠道化,对贵重药品、进口药品、合资药品的不合理偏重造成了医疗费用的上涨,加重了病人的经济负担。本文还就如何加强医院药品管理提出可行性对策。     

Sex-related differences in coronary revascularization practices: the perspective from a Canadian queue management project.

OBJECTIVE: To assess sex-related differences in coronary revascularization practices in a Canadian setting. DESIGN: Prospective analytic cohort study. SETTING: Regional referral office in Toronto. PATIENTS: A selected but consecutive group of 131 women and 440 men referred by cardiologists for revascularization procedures between Jan. 3, 1989, and June 30, 1991. INTERVENTIONS: Coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). Nurse-coordinators placed the referral with a surgeon or interventional cardiologist at one of three hospitals, who then communicated directly with the referring cardiologist. MAIN OUTCOME MEASURES: Symptom status at referral, procedures requested and performed, and time from referral to procedure. RESULTS: Although the women were more likely than the men to have unstable angina at the time of referral (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.38 to 3.79, p = 0.0006), more women than men (16.8% v. 12.1%) were turned down for a procedure. Significant sex-related differences in practice patterns (p < 0.001) persisted after controlling for age or for the referring cardiologists' perception of expected procedural risk. A stepwise multivariate model showed that anatomy was the main determinant of case management; sex was the only other significant variable (p = 0.016). The referring physicians requested CABG more often for men than for women (p = 0.009), and the men accepted for a procedure were much more likely to undergo CABG than the women (OR 2.40, CI 1.47 to 3.93, p = 0.0002). Although the women undergoing CABG waited shorter periods than the men (p = 0.0035), this difference was attributable to their more severe symptoms. CONCLUSIONS: In this selected group women had more serious symptoms before referral but were turned down for revascularization more often than men. Reduced use of CABG rather than PTCA largely accounted for the sex-related differences in revascularization. Once accepted for a procedure women had shorter waiting times, which was appropriate given their more severe symptoms.     

Gastric cancer invading the esophagus--improved management.

From 1978 to 1989, a total of 1272 patients with gastric cancer were admitted to Kurume University Hospital. Of these, 1184 (93%) underwent gastric resections. Of the resected cancers, 140 cases were gastric cancers invading the esophagus, as confirmed by postoperative pathological studies. For all 168 gastric cancers invading the esophagus, the resectability rate was 83% (140/168). These cancers were subdivided chronologically, with those during 1978-1983 included in Group 1 and those during 1984-1989 in Group 2. Group 2 patients were treated with a higher proportion of aggressive extended radical operations, such as combined resections of the diaphragm and lymph node dissections as far as the paraaortic lymph nodes (N4). The resectability rate was 76% in Group 1 and 93% in Group 2, due to the more aggressive operations. A lower esophagectomy with a total gastrectomy, mainly from a left thoracoabdominal approach, was performed for 71% of the patients in Group 1, and for 90% in Group 2. Lymph node metastasis was related to the extent of esophageal invasion and inversely related to the 5 year-survival rate. In all cases of esophageal invasion of less than 1 cm, there were no mediastinal lymph node metastases, and the 5 year-survival rate was 76%. On the other hand, when esophageal invasion was more than 4 cm, 50% had mediastinal lymph node metastases and the 5 year-survival rate was zero. The tumor size was also related to lymph node metastasis. When the maximal tumor length was less than 5 cm, a negative lymph node metastasis was found in 78% of cases, and the 5 year-survival rate was 76%.(ABSTRACT TRUNCATED AT 250 WORDS)     

The final illness in cancer: the widow''s perspective.

Widows of cancer patients were compared with other widows in general and with widows of men with chronic cardiovascular disease in particular, special attention being given to the vicissitudes of the final illness. Despite the recent emphasis on the need for open communication about the impending death between the dying patient and his family, interviews with 73 women whose husbands had died of cancer revealed that 40% of those who had been told their husband was dying refused to accept the warning. Only 29% of the couples openly discussed the possibility of the husband dying of his disease. More than half of those who did not talk with their husband about the impending death reported that this made no difference to their initial adjustment to bereavement. The stress for a woman of her husband's final illness leads to an especially difficult bereavement period; for example, significantly more widows of cancer patients than of patients with other illnesses perceived themselves to be in poor health during the initial bereavement period. Some of the problems specific to cancer patients and their families are described, along with recommendations for their alleviation.     

心理契约视角下的非编卫生人力管理研究

分析了上海市胸科医院非编人员现状和管理措施，从心理契约视角论证了非编人员心理归属感低、人员离职率高、医院文化认同感低、心理防范意识强等特征，并提出了建设以人为本的医院文化、完善绩效考核和转编办法、提高城市归属感、注重职业培训、充分信息沟通、提高工作满意度等加强非编人员心理契约的对策建议。