养生之道——访著名老中医宋祚

祚民教授，国家级名老中医，1944年毕业于孔伯华北京国医学院后，自开诊所，解放后创办联合诊所，又转至公立医院工作，在医疗岗位上，已辛勤耕耘60余载，治病救人无数，桃李遍布京城。如今，以八旬之躯，应诊不疲，毫无倦意，精神矍铄，思路清晰，举止谈吐优雅，无一丝耄耋之象。为此，本刊特作专访，整理如下。     

巧用茅根治肾炎

茅根味甘，性寒，无毒。有凉血，止血，清热，利尿等功效。传统上以其治热病烦渴，吐血，鼻血，肺热，喘急，淋病，小便不利，水肿黄疸等。用茅根治急性肾炎，经济，简便，而且效果好。     

糖尿病并发周围神经病变误诊为冠心病1例

患者，男，51岁，主因“左后背疼痛2d”入院，该患者无明显诱因出现左后背伴左上肢疼痛，伴胸闷，心前区不适，无胸痛，无发热，无恶心呕吐，无大汗淋漓，既往冠心病，糖尿病病史，血糖控制不理想，BP：120／70mmHg，双肺（一），HR70次／min，率齐，低钝，未闻及杂音，心电图显示心肌缺血，诊断为冠心病，急性冠脉综合征。给予扩张血管，营养心肌，活血化瘀等药物治疗，胸闷症状好转，仍后背疼痛，     

预激综合征引起室上性心动过速1例

患儿，男性，8岁，因心悸1d入院。就诊时胸闷、心悸、乏力、精神差，少言懒动，汗出。体格检查：T36．5℃，P232次／min，R32次／min，血压测不到，神志清楚，面色无华，瞳孔等大等圆，对光反射存在，唇淡，咽不充血，颈软，颈静脉搏动明显急促，双肺呼吸音清，心率232次／min，律齐，心音弱，各瓣膜听诊区未闻及病理性杂音，腹平软，上腹部压痛明显，无反跳痛，肝脾未及，余无异常。实验室检查，血常规：     

夏季除湿有良方

进入夏季，环境温度升高，湿度变大，天气闷热。特别是梅雨季节，湿热熏蒸，更是导致各种疾病的常见原因。湿邪侵犯人体，容易导致腹部胀满，食欲不振，大便溏泄，小便混浊，头重如裹，身体沉重困乏，     

支气管哮喘食疗方三款

芝麻杏仁糊 处方：黑芝麻1000g，甜杏仁200g，白糖250g，蜂蜜250g。 制法与服法：芝麻洗净，滤干，入铁锅内，用旺火不停翻炒，炒至水汽蒸发，不断发出噼啪声，离火，盛碗，冷却后研碎，备用；杏仁快速洗净，打碎成泥，备用。将熟芝麻、杏仁泥倒入大磁盆内，加白糖、蜂蜜拌匀，磁盆不盖，让水蒸汽进入，隔水用旺火蒸3小时，离火、冷却。     

改造你 还是改造我？

对婚姻过于理想化 因爱，一切皆对，因恨，一切皆错，恋爱时，浪漫的感情充斥了整个心房，“情人眼里出西施”，总是自觉，不自觉地把对方理想化，偶像化，对方的优点就是优点，缺点也是优点，婚后，由浪漫走入了现实，过起了实实在在的生活，两个各自生活了二十几年的人组成了一个新家庭，即使再相似，也会有生活习惯，价值观念不相同的地方。     

子宫切除手术前后健康教育的作用

例1：患者，女，43岁，因更年期子宫功能性出血，重度贫血而入院，经病理切片证实为子宫内膜腺瘤型增生，行全子宫切除手术，当其得知需要手术治疗便出现心理紧张，有恐惧感，心跳加快，血压上升至21．3／12．6kPa，伴头昏，面色苍白，四肢发冷，出冷汗，针对患者的心理状态，入院后，责任护士热情接待，亲切交谈，常规介绍了病区环境，管理制度，该患者的主治医生。     

顼教授咨询信箱

我今年75岁，患高血压10余年，刚开始服卡托普利，血压控制还可以。由于服药时间长，引发咳嗽不止，停药后就好了。后换为硝苯地平，尼群地平片，波依定，蒙诺等药物，低压正常，高压居高不下，脉差一直较大。现在服络活喜，每天早晚各一片，寿比山隔天服，血压有所好转，但高压还是没有恢复正常，一直在150～140毫米汞柱之间。我想知道用什么办法能使高压降下来？有医生讲，年纪大，动脉硬化，高压能控制在140～150毫米汞柱就可以，这种说法是否对？     

脑萎缩专业药物研制成功

脑萎缩是一种脑组织细胞相对减少而引起脑神经功能失调的疾病。发病缓慢，早期症状为头痛，头晕，健忘，失眠，腰膝酸软，手足麻木，尿频，尿急，行为异常，多疑，自私，说话不利索，行动迟缓等。     

感受服务在非全麻手术患者护理中的应用

目的探讨护士模拟非全麻手术患者的“感受服务”,提高护理质量和患者满意度的效果。方法手术室护士模拟患者,体验其围手术期的各种感受和需求,讨论总结后制定出满足患者需求的护理措施,落实并收集患者的反馈意见及建议,再针对存在问题进行改进和再体验。结果护士为非全麻手术患者提供服务的主动性增强,患者对手术室护理工作满意度显著提高,手术室护理服务质量实现了可持续发展。结论开展感受服务是提高非全麻手术患者满意度和促进手术室护理服务质量可持续发展的有效途径。     

手术患者交接单在围术期安全管理中的应用

目的：探讨手术患者交接单对手术患者围术期安全管理质量的影响。方法针对外科病房至手术室、手术间至恢复室或病房以及恢复室至病房等手术患者转运过程的三个关键交接环节容易疏忽和遗漏的细节设计核查项目,形成手术患者交接单,比较应用交接单前后2012年和2013年围术期各交接环节的缺陷率、手术患者和手术科室医护人员对麻醉科/手术室的服务质量满意度。结果2013年临床应用交接单后,影像资料遗漏/遗失、手术部位安全标识不全、病情交接不清和交接前后病情变化责任不明等交接缺陷病例数显著下降,2013年手术患者和手术相关科室对麻醉科/手术室的服务质量满意度显著提升。结论应用手术患者交接单可以有效减少围术期交接环节差错的发生率,提升围术期安全管理质量。     

手术室病人安全管理现状与对策研究

目的了解全国医院手术室安全管理现状。方法对全国3个经济层的36家代表性医院进行问卷调查及深入访谈。结果手术室在人员配置、规章制度建设、手术室布局、设备配置、手术操作环节等仍有问题存在。结论医院手术室应合理配置人力资源,提高护理人员专业素质;建立健全手术室规章制度并且要严格监督执行;科学的改进手术室布局流程;合理配置手术室设备;加强在术前评估和病人识别方面的工作;完善差错报告系统,提高病人安全。     

哈尔滨市综合医院手术室病人安全管理现状与对策研究

采用随机抽样的方法,在哈尔滨市随机抽取5家三级、5家二级综合医院的手术室进行病人安全管理现状调查。从手术室护理人员构成、人员培训、规制、布局流程、设备配置、病人辨识、消毒灭菌、医护配合8个方面全面分析了目标医院在手术室病人安全管理方面存在的问题,并提出改进对策,旨在改善手术室管理现状,保障手术室病人安全。     

医院门急诊患者满意度调查分析

目的了解三级甲等医院门急诊就诊患者的满意度。方法选取某大学三所三级甲等医院,采用自行设计问卷对556名门急诊患者就其对医院服务满意度进行测评。结果患者对医院门急诊环境设施的满意率为91．16％;对就医等候或排队时间的满意率为87．59％;对工作人员服务效率和服务态度的满意率为95．60％;对医务人员医疗行为和技术水平的满意率为93．51％;对服务效果的满意率为95．77％。不同年龄组和文化程度组患者对门急诊的满意率总分比较有统计学意义（P〈0．05）,不同户籍所在地患者对是否愿意再到这所医院就医比较有统计学意义（P〈0．05）。结论总体而言,患者对医院门急诊服务的满意度较高,但仍有许多地方需要改进。①门急诊环境应更加舒适;②就诊环节应更加优化;③医疗费用应更加合理。     

Gradual Electronic Health Record Implementation: New Insights on Physician and Patient Adaptation

PURPOSE Although there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient communication and behaviors and patients’ responses.METHODS We undertook a 22-month, triangulation design, mixed methods study of gradual EHR implementation in a residency-based family medicine outpatient center. Data collection included participant observation and time measurements of 170 clinical encounters, patient exit interviews, focus groups with nurses, nurse’s aides, and office staff, and unstructured observations and interviews with nursing staff and physicians. Analysis involved iterative immersion-crystallization discussion and searches for alternate hypotheses.RESULTS Patient trust in the physician and security in the physician-patient relationship appeared to override most patients’ concerns about information technology. Overall, staff concerns about potential deleterious consequences of EHR implementation were dispelled, positive anticipated outcomes were realized, and unexpected benefits were found. Physicians appeared to become comfortable with the “third actor” in the room, and nursing and office staff resistance to EHR implementation was ameliorated with improved work efficiencies. Unexpected advantages included just-in-time improvements and decreased physician time out of the examination room.CONCLUSIONS Strong patient trust in the physician-patient relationship was maintained and work flow improved with EHR implementation. Gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information.     

The Path of Patient Loyalty and the Role of Doctor Reputation

Patient loyalty to doctors is relevant to medical services in which doctor–patient relationships are central and for which competition has increased in recent years. This study aims at understanding the process whereby patients develop loyalty to their doctor and doctor reputation has a moderating role. Based on a randomization of subjects, the study offers and tests an explanation chain representing key variables determining patient loyalty: patient commitment, trust and satisfaction, and doctor reputation. Primary data was collected using a structured questionnaire from a quota sample of regular patients in a large city in South America. The patients most committed to their doctor are more loyal to them. In turn, commitment is determined by patient trust, which is determined by patient satisfaction. Doctor reputation positively influences both patient trust and satisfaction. The explanation chain not only gives an account of how patient loyalty is formed; it also identifies a path health professionals can follow to secure patient loyalty.     

Utilizing patient advocates in Parkinson’s disease: A proposed framework for patient engagement and the modern metrics that can determine its success

The wide application of patient engagement and its associated benefits has increased across government, academic and pharmaceutical research. However, neither an identified standard practice for the process of engagement, nor utilization of common metrics to assess associated outcomes, exists. Parkinson's Foundation developed a patient engagement framework and metrics to assess engagement within the academic research and drug development sectors. This approach was developed over the course of several years through assessing the literature, acquiring feedback from researchers and people with Parkinson's disease and adapting practices to be relevant and generalizable across patient engagement projects. This framework includes the: 1) creation of a scope of work, 2) establishment of guiding principles, 3) selection and training of participants, 4) co‐determination of project metrics, 5) execution of the project and 6) dissemination of project findings. Parkinson's Foundation has also worked with academic, government and pharmaceutical stakeholders to identify metrics that assess both the quality of patient engagement and outcomes associated with patient engagement on projects. By improving patient engagement project methodologies and metrics, global clinical trials can have access to evidence‐based patient engagement practices to more efficiently capture the needs of, and potentially benefit, the patient community.     

责任制分组管理对手术室护理管理质量的影响

目的 研究手术室护理管理中运用责任制分组管理模式的临床效果.方法 从2019年1月—12月在我院手术的患者中抽取100例作为主要对象,运用数字随机表法将其分为两组,50例/组.对照组实施常规护理管理,观察组实施责任制分组管理模式,比较两组的干预效果.结果 观察组的手术室护理管理质量评分和患者满意度评分均显著高于对照组,...     

Patient involvement in patient safety: what factors influence patient participation and engagement?

BACKGROUND: Patients can play an important role in improving patient safety by becoming actively involved in their health care. However, there is a paucity of empirical data on the extent to which patients take on such a role. In order to encourage patient participation in patient safety we first need to assess the full range of factors that may be implicated in such involvement. OBJECTIVE: To delineate factors that could affect the participation of the patient in quality and safety issues in their health care. METHOD: Literature review of patient involvement in health care, drawing from direct evidence (specifically from the safety context) and indirect evidence (extrapolated from treatment decision-making research and the wider patient involvement in health care literature); synthesis and conceptual framework developed, illustrating the known and putative factors that could affect the participation of the patient in safety issues in their health care. MAIN RESULTS: Five categories of factors emerged that could affect patient involvement in safety: patient-related (e.g. patients' demographic characteristics), illness-related (e.g. illness severity), health-care professional-related (e.g. health care professionals' knowledge and beliefs), health care setting-related (e.g. primary or secondary care), and task-related (e.g. whether the required patient safety behaviour challenges clinicians' clinical abilities). CONCLUSION: The potential for engaging patients in patient safety is considerable but further research is needed to examine the influences on patient involvement, the limits and the possible dangers. Patients can act as 'safety buffers' during their care but the responsibility for their safety must remain with the health care professionals.