医院危机管理的探讨

医院危机是由某种因素引发的对医院正常运作秩序或声誉造成负面影响的事件。2009年6月，福建省南平市第一医院发生一起医患纠纷，随着矛盾升级，最终爆发成群体性冲突事件，此事件让举国震惊。“南平事件”的发生，有着很大的社会必然性，     

建立新型医疗文化:让医生回归本职 患者回归理性

<正>随着人民群众医疗服务需求不断增长,医疗服务的供需矛盾日益突出,医患矛盾逐渐升级。总的来看,近年来我国发生的医患矛盾数量多且表现形式激烈,呈现出由偶发性转向常态化、由情绪发泄转向高额索赔、由医患争执转向群体性事件的态势。极端、过激的医患冲突已经严重妨碍医院正常医疗秩序,成为影响社会和谐稳定的突出问题。     

医患纠纷恶化的症结

当前，医患纠纷频发，由此引发的暴力冲突有越演越烈之势。医患纠纷具有客观性和必然性，但医患纠纷并不一定造成群体性暴力事件，只是群体性暴力事件形成的前提条件。那么，部分医患纠纷为何会一步一步恶化呢？     

医学研究生医德教育问题探讨

医德教育自古有之,是随医学出现而产生的,并在医学教育中占有重要位置。当前,医疗行业医患矛盾突出、医疗纠纷频繁,甚至酿成医患冲突和群体性事件,已成为不可忽视的社会问题。究其原因,既有社会层面的,也有制度层面的,而医者本身的行为规范和道德品质亦是其中的一个重要方面。因而医学研究生的医德教育也是必须面对的课题。     

邻避冲突群体性事件治理初探

随着我国社会政治、经济和科技的发展,公民权利意识、环保意识日益增强,由此一些地区因邻避冲突引发的群体性事件呈现不断增多的态势。探析邻避冲突群体性事件的成因、特点,加强应对措施研究,能有效防范、管理、处理社会安全风险,有力应对、处置、化解社会安全挑战,确保社会安定、人民安心。     

避免医患暴力需多管齐下 回应“谁在逼医生动粗”

(2011年第10期P26案例)近期,医患暴力冲突事件屡有发生,从言语冲突到动刀伤人,有愈演愈烈的趋势。由医患纠纷升级到医患暴力冲突事件,这其中固然有当事人双方各自的责任,但更不能忽视社会环境带来的示范效应。在犯罪学中有个著名的"破窗效应"理论:如果有人打坏     

论医患关系中的信息问题与管理对策

近年来 ,我国医患关系日趋紧张 ,医患冲突日渐增多 ,由医患冲突引起的恶性案件频发。文章认为 ,造成这种状况的主要原因之一是医患之间客观地存在着严重的信息不对称现象。为此 ,卫生主管部门、医院和患者自身都应该采取积极、有效的措施 ,尽力缩小医患之间的信息不对称 ,避免医患冲突和医疗恶性案件的发生。     

医患关系紧张的原因及应对策略

近年不断发生的暴力伤医事件,给医务人员的生命安全构成重大威胁,冲击了正常的医疗秩序,危害极大。医患关系紧张的原因是多方面的,必须充分认识和谐医患关系的重大意义,从多角度、多层次防范医患冲突、化解医患矛盾、构建医患和谐关系。     

军队医院处理群体性医患纠纷的思考

本文分析群体性医患纠纷事件的特点,提出军队医院应客观正确面对医患纠纷,争取患者和亲属的理解认同,加强与地方政府、公安的沟通协调,依法打击“医闹”等非法团伙,严密控制事态的升级,同时严密关注舆论动向,及时应对虚假信息的传播。     

化解医患纠纷,功夫用在纠纷外 访卫生部原副部长、中国医师协会会长殷大奎

最近几个月,医患冲突事件频频见诸媒体,再次将医患纠纷这一话题推上舆论的风口浪尖。这是否意味着医患关系恶化了?如何重建医患信任?近日,卫生部原副部长、中国医师协会会长殷大奎接受媒体采访,道出了自己对化解医患纠纷的看法。医患关系相对改善,还未走出谷底     

Body mass index and body fatness in childhood

PURPOSE OF REVIEW: The prevalence of overweight, as assessed by a high body mass index (kg/m), has greatly increased among children and adolescents over the last three decades. Because body mass index is a measure of excess weight rather than excess body fatness, it is important to understand the ability of a high level to identify children who truly have excess adiposity. This review covers the measurement and classification of overweight and obesity, the expression of body composition data, and the relation of body mass index to adiposity. RECENT FINDINGS: Although adiposity has typically been expressed as percentage body fat, the use of the fat mass index (fat mass/height) and the fat-free mass index (fat-free mass/height) may provide more information. For example, body mass index differences among relatively thin children have been found to largely reflect differences in fat-free mass index, whereas differences among relatively heavy children are primarily due to differences in fat mass index. In addition, the ability of overweight to identify obese children is greatly influenced by the cutpoints selected for body mass index and adiposity. The use of inappropriate cutpoints, rather than the limitations of body mass index, may account for the frequently reported finding that many obese children are not overweight. SUMMARY: The use of fat mass index and fat-free mass index in expressing body composition data allows one to easily assess the contribution of each to body mass index. If appropriate cutpoints are used, a high body mass index level is a moderately sensitive and a very specific indicator of excess adiposity among children.     

The relationship between body fat mass and fat-free mass

It has been suggested that there is a curvilinear relationship between lean body or fat-free mass and body fat mass. In order to confirm this relationship, body composition was measured by determining body density and total body water using deuterium-labeled water in subjects varying widely in body fat mass. There were 29 males and 75 females with body mass index ranging from 20 to 66 kg/m2. The relationship between fat-free mass and fat mass appeared to be linear over the range of body fat from 10 to 90 kg: males R2 = 0.67 (p less than 0.0001) and females, R2 = 0.47 (p less than 0.0001). The amount of variance explained was not greater when the log of fat mass was used in place of fat mass alone. Multiple regression analysis demonstrated that the relationship between fat-free mass and fat mass remained significant (p less than 0.001) after adjusting for body height, age, and fat distribution. It is concluded that over the range of body fat extending from 10 to 90 kg there is a positive and linear relationship between fat-free body mass and fat mass.     

Towards an Understanding of Physiological Body Mass Regulation: Seasonal Animal Models

This review is based around a number of interlinked hypotheses that can be summarised as follows: (i) mammalian body mass is regulated, (ii) the mechanisms that effect this regulation are common to all mammalian species, including humans, (iii) the neurochemical substrates involved in long term body mass regulation and in determining the level of body mass that will be defended may not be the same as those involved in short term energy homeostasis, or body mass defence, or may be differentially engaged, and (iv) “appropriate” body mass is encoded somewhere within the mammalian brain and acts as a comparator to influence both nutritional and reproductive physiology. These issues are of direct relevance to the epidemic of obesity in the Westernised human population and the poor success rate of conventional weight loss strategies. It is our contention that seasonal rodent models, and the Siberian hamster in particular, represent extremely valuable tools for the study of the mechanistic basis of body mass regulation. The Siberian hamster model is often perceived as an unusual mammalian variant that has evolved an almost counter-intuitive strategy for surviving periods of anticipated seasonal food shortage. However, there is compelling evidence that these animals are able to adjust their body mass continually and progressively according to their photoperiodic history, i.e. a seasonally-appropriate body mass. These adjustments to appropriate body mass are memorised even after the animals have been driven away from their normal body mass trajectory by imposed food restriction. Thus, photoperiod, acting through the pineal hormone, melatonin, is able to reset the desired body mass for a given time in the seasonal cycle. Importantly, daylength provides a tool to manipulate the body mass control system in an entirely physiological and stress-free manner. While resetting of body mass by photoperiod represents a level of control apparently confined to seasonal mammals, it has the potential to reveal mechanisms of generic importance in the regulation of energy homeostasis.     

彩色多普勒超声在诊断非典型异位妊娠中的应用

目的探讨彩色多普勒超声在诊断非典型异位妊娠中的应用价值。方法应用彩色多普勒超声对子宫及附件区进行扫查,发现病变时,仔细观察包块的边界、内部回声及与周围脏器的关系。将超声诊断结果与手术病理结果对照。结果本组选择住院手术治疗的异位妊娠患者42例,其中,胎囊型9例,漂浮型5例,包块型28例。包块型中衰减包块型9例,混合包块型13例,实性包块型6例。结论当附件区探及胎囊样结构,内可及卵黄囊及胎芽回声时,可明确诊断为异位妊娠;当患者盆腔结构紊乱,且可探及囊实性或实性不均质回声区,探头加压时疼痛加强,腹盆腔探及无回声区,伴尿HCG阳性时,高度怀疑异位妊娠。     

护理类高职校低体质量与正常体质量女大学生体质健康状况调查

目的 了解护理类高职院校女大学生体质现状;为改善女大学生体质状况及合理开展体育活动提供依据。方法 南京某护理类高职校分层整群抽取9个班发放调查问卷,调查女大学生生活习惯、饮食习惯以及运动习惯等。结果 低体质量女大学生自我感觉体质健康状况较正常体质量者更差(P<0.05)。低体质量组参加运动频率显著低于正常体质量组(P<0.05)。低体质量者节食比例更高,运动比例更低(P<0.05)。结论 女大学生中普遍存在亚健康现象,低体质量女大学生存在较为严重的过度减重现象。希望通过适当的运动提高女大学生身体素质。     

Car size or car mass: which has greater influence on fatality risk?

OBJECTIVES. Proposed increases in corporate average fuel economy standards would probably lead to lighter cars. Well-established relationships between occupant risk and car mass predict consequent additional casualties. However, if size, not mass, is the causative factor in these relationships, then decreasing car mass need not increase risk. This study examines whether mass or size is the causative factor. METHODS. Data from the Fatal Accident Reporting System are used to explore relationships between car mass, car size (as represented by wheelbase), and driver fatality risk in two-car crashes. RESULTS. When cars of identical (or similar) wheelbase but different mass crash into each other, driver fatality risk depends strongly on mass; the relationship is quantitatively similar to that found in studies that ignore wheelbase. On the other hand, when cars of similar mass but different wheelbase crash into each other, the data reveal no dependence of driver fatality risk on wheelbase. CONCLUSIONS. Mass is the dominant causative factor in relationships between driver risk and car size in two-car crashes, with size, as such, playing at most a secondary role. Reducing car mass increases occupant risk.     

维生素D受体基因与骨量的关系

近年来对维生素D受体(VDR)基因和骨量关系的研究颇有争议。有许多研究认为维生素D受体基因多态性与骨量有关联。但还有一部分研究未能证实VDR基因多态性与骨量的关联。本文就VDR基因与钙吸收、骨量、药物治疗的关系和VDR基因的协同作用以及与其它基因、环境因素的交互作用对骨量影响的研究进展进行了综述。     

Thoracic and respirable aerosol fractions of spray products containing non-volatile compounds

A versatile and simple mass balance method for the measurement of the release fraction of thoracic and respirable particles of non-volatile compounds of spray products is presented. The release fractions are defined as the ratio between the mass of suspended non-volatile particulate matter in the thoracic and respirable particle size range and the total mass of non-volatile material released with the spray action. For its determination, a spray bolus of short duration and of defined mass is sprayed into a well stirred control chamber. The respirable and thoracic aerosol mass associated with the spray bolus is determined by measuring the time averaged mass concentration inside the control volume and the half time of the exponential concentration decrease to be expected in well stirred systems to correct for mass losses during sampling.

?The method is used for a wide range of spray products and technologies for which the release fractions vary by orders of magnitude. A set of data is presented elucidating the relationship between spray technology and fine particle release. Furthermore, a simple rule of thumb was derived from the data that allows for estimation of the release fractions based on a characteristic diameter of the spray droplets. The usefulness of the mass balance method for substance classification as well as for generating input data for exposure assessment and indoor air quality modeling is discussed.     

The Underappreciated Role of Low Muscle Mass in the Management of Malnutrition

Preserving muscle is not only crucial for maintaining proper physical movement, but also for its many metabolic and homeostatic roles. Low muscle mass has been shown to adversely affect health outcomes in a variety of disease states (eg, chronic obstructive pulmonary disease, cancer, cardiovascular disease) and leads to an increased risk for readmission and mortality in hospitalized patients. Low muscle mass is now included in the most recent diagnostic criteria for malnutrition. Current management strategies for malnutrition may not prioritize the maintenance and restoration of muscle mass. This likely reflects the challenge of identifying and measuring this body composition compartment in clinical practice and the lack of awareness by health care professionals of the importance that muscle plays in patient health outcomes. As such, we provide a review of current approaches and make recommendations for managing low muscle mass and preventing muscle loss in clinical practice. Recommendations to assist the clinician in the optimal management of patients at risk of low muscle mass include the following: (1) place muscle mass at the core of nutritional assessment and management strategies; (2) identify and assess low muscle mass; (3) develop a management pathway for patients at risk of low muscle mass; (4) optimize nutrition to focus on muscle mass gain versus weight gain alone; and (5) promote exercise and/or rehabilitation therapy to help maintain and build muscle mass. The need to raise awareness of the importance of screening and managing ‘at risk’ patients so it becomes routine is imperative for change to occur. Health systems need to drive clinicians to treat patients with this focused approach, and the economic benefits need to be communicated to payers. Lastly, further focused research in the area of managing patients with low muscle mass is warranted.     

The interrelationship between body topology and body composition varies with age among women

The purpose of this analysis was to evaluate the relationship between age and the size and distribution of the fat and lean tissue compartments in a population-based sample of women. The study population consisted of the 875 women aged 18-94 y in the Iowa Bone Health Study who reported never smoking. Fat mass and lean mass were measured using dual X-ray absorptiometry. Hip and waist circumference and height were measured using standardized protocols. Regression was used to model the associations among age, composition and topology measures. When fat mass was modeled as a function of hip and waist circumference as well as age, age(2) and height, the age x height and age x waist circumference interaction terms remained in the fitted model and collectively accounted for 91% of the variance. In contrast, the quadratic model of age alone accounted for 8% of the observed variance in fat mass. Lean mass was modeled in two segments, with age dichotomized at 58 y. Age alone did not predict lean mass in women <58 y but did predict lean mass in women >/=58 y, with the modeled relationship including interactions with waist circumference and height. These models accounted for 70% of observed variance in lean mass. Age is associated with body composition but explains <10% of variation. When measures of height and circumferences are available, amounts of lean and fat mass are highly predictable. This is particularly important for lean mass because no other surrogate measures exist for lean mass, whereas there are surrogates for fat mass, including body mass index.