医学生作为外科标准化病人的培训

标准化病人（Standardized Patient,SP）在发达国家应用相当广泛,我们在研究生临床考核中也采用了高年级医学生作为SP的客观结构化临床考试（Objective Structured Clinical Examination,OSCE）,取得了较满意的效果。但是外科SP要表现的症状多,描述的病情变化快,阳性体征多,要取得良好的效果并不容易。在外科标准化病人的培训和应用过程中,在脚本的编写、SP的培训等方面都其自身的特点。     

根治性肝包虫病外科治疗术式选择

目的　探讨一种新型根治肝包虫囊肿切除术式的临床应用价值。方法　对我院 3年间 (1999年～ 2 0 0 2年 )采用根治性肝包虫病外科手术治疗的 99例肝包虫病患者的资料分组 ;A组 :6 7例 ,行外膜内完整外囊摘除术 (新术式 ) ;B组 ;32例行传统外囊摘术 (以肝切除技术为基础的术式 )。临床观察指标为手术耗时、术后平均住院日、出血量、术后并发证、死亡率及原位复发率等进行回顾性分析。并对数据进行统计分析。结果　外膜内完整外囊摘除术式组的术后平均住院日、手术耗时、出血量等均低于传统外囊摘除术式组 (P<0 .0 5 ) ,术后并发证、死亡率、原位复发率无差异 ,(P>0 .0 5 )。结论　根治性肝包虫病外科治疗术式中 ,外膜内完整外囊摘除术式完全性高 ,应首选。     

全腔静脉肺动脉连接术在复杂发绀型先心病的应用及术式选择

目的：探讨不同方式的全腔静脉肺动脉连接术在复杂发绀型先天性心脏病中的选择及应用效果。方法：回顾性分析32例全腔静脉肺动脉连接术患者的临床资料：年龄5～24岁，平均（10±5）岁，体重13～55kg，平均（28±11）kg，病种包括单心室16例，右心室双出口并完全性心内膜垫缺损6例，完全性大动脉转位并完全性心内膜垫缺损3饲，三尖瓣闭锁6例，二尖瓣闭锁1例。其中，在低温体外循环心脏停跳下18例行右房内侧隧道法，1例行心外管道法，常温体外循环心脏跳动下10例行心外管道法．非体外循环下2例行心外管道法。1例行分次全腔静脉肺动脉连接术。结果：早期发生双侧胸腔积液3例，窦性心动过速2例。出院时指端血氧饱和度由术前的71．5％～84.5％提升到91％～96％；心功能改善。全组随访2个月～8年，无早、晚期死亡。结论：根据患者的年龄、体重、心内畸形等不同情况有选择地应用不同方法的全腔静脉肺动脉连接术，才能获得最佳的治疗效果。     

Trends in bariatric surgical procedures

Context  The increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions for morbid obesity. Objective  To examine trends for elective bariatric surgical procedures, patient characteristics, and in-hospital complications from 1998 to 2003 in the United States. Design, Setting, and Patients  The Nationwide Inpatient Sample was used to identify bariatric surgery admissions from 1998-2002 (with preliminary data for 12 states from 2003) using International Classification of Diseases, Ninth Revision, codes for foregut surgery with a confirmatory diagnosis of obesity or by diagnosis related group code for obesity surgery. Annual estimates and trends were determined for procedures, patient characteristics, and adjusted complication rates. Main Outcome Measures  Trends in bariatric surgical procedures, patient characteristics, and complications. Results  The estimated number of bariatric surgical procedures increased from 13 365 in 1998 to 72 177 in 2002 (P<.001). Based on preliminary state-level data (1998-2003), the number of bariatric surgical procedures is projected to be 102 794 in 2003. Gastric bypass procedures accounted for more than 80% of all bariatric surgical procedures. From 1998 to 2002, there were upward trends in the proportion of females (81% to 84%; P = .003), privately insured patients (75% to 83%; P = .001), patients from ZIP code areas with highest annual household income (32% to 60%, P<.001), and patients aged 50 to 64 years (15% to 24%; P<.001). Length of stay decreased from 4.5 days in 1998 to 3.3 days in 2002 (P<.001). The adjusted in-hospital mortality rate ranged from 0.1% to 0.2%. The rates of unexpected reoperations for surgical complications ranged from 6% to 9% and pulmonary complications ranged from 4% to 7%. Rates of other in-hospital complications were low. Conclusions  These findings suggest that use of bariatric surgical procedures increased substantially from 1998 to 2003, while rates of in-hospital complications were stable and length of stay decreased. However, disparities in the use of these procedures, with disproportionate and increasing use among women, those with private insurance, and those in wealthier ZIP code areas should be explored further.      

目标管理原理在医学教学中的实施

教育管理是教学活动的重要组成部分，是教育质量的重要保证。以目标管理原理在医学教育管理中的实施为主线，从教学的计划、组织、评价、指导以及“教”与“学”两方面的目标结合等，浅谈目标管理在教育教学中的应用。     

医院内部医疗设备维修管理相关问题探讨

医疗设备的院内维修管理,是保证医疗设备安全、准确工作重要环节.本文介绍了院内维修的基本内容,探讨了院内维修存在的故障判断难度大、维修质量严格、有一定的权限的特点,介绍了院内维修的组织管理及维修收费管理方法.     

Infection associated with modern surgical procedures

In postoperative wound infections due to Escherichia coli, 59% of the sepsis was caused by ten O-serotypes. For each serotype, except O6, the frequency of sepsis mirrors the frequency of carriage. Endogenous wound infection: evidence was presented but not discussed. Eleven patients had wound infections due to serotype O6, five were carriers of this serotype at the time of operation. Serotype O6 occurred significantly more frequently in wounds than in carriage specimens. In this study the strains showed enhanced infectivity in wounds.