沭阳县乡镇医院人力资源现况分析

目的:通过对沭阳县部分乡镇医院卫生人力资源状况的调查与分析,发现其中存在的问题,探讨政府在乡镇医院卫生人力的提高?培养?引进等方面承担的责任,以及政府履行职能的措施?途径和方法?方法:采用问卷调查的方式,对人力资源基本资料的总量?学历?职称构成进行整合?结果:获得沭阳县部分乡镇医院卫生人力资源的基本现状?存在问题为改制以来沭阳县乡镇医院卫生人力资源总量不足,总体素质不高等?结论:改制后沭阳县乡镇医院人力队伍各方面情况改善不明显?政府以及各相关部门要积极做好乡镇医院卫生人力资源配置规划,搭建促进人才提高的平台,提升乡镇医院现有卫生人员业务素质,督促乡镇医院要做好卫生人力的定位和培养方案?     

江苏省乡镇卫生院卫生人力资源的现状分析及对策研究

了解江苏省乡镇卫生院卫生人力资源现状,分析乡镇卫生院卫生人力资源在分布?专业结构?年龄?职称?学历及执业资格等方面存在的问题,探讨如何构建适应乡镇卫生院事业发展需要的卫生人才队伍,满足基层医疗卫生服务需求,为政府卫生行政部门合理配置卫生人力资源提供参考?     

宁夏：完善基层医疗卫生体系服务医改

为建立与“人人享有基本医疗卫生服务”试点配套的基层医疗卫生机构运行机制,宁夏将采取系列措施完善基层医疗卫生服务体系建设。据自治区政府介绍,宁夏将从业务用房、基本设备、人力资源、财政投入、服务功能、管理制度等方面加强基层医疗卫生机构建设,使之与基本医疗卫生服务需要相适应。为此,宁夏将加快农村乡镇卫生院、村卫生室和城市社区卫生服务机构基础设施建设,实现基层医疗卫生服务网络的全覆盖。另外,宁夏还将加强城市社区和乡村卫生专业技术人员和护理人员的培养培训。制订优惠政策,鼓励高等医学院校毕业生和中高级卫生技术人员到乡村和社区卫生机构服务。开展城市医院支援农村、社区卫生工作,并作为二级以上医疗机构专业技术人员职称晋升、聘任的必备条件。对长期在乡镇卫生院和村卫生室工作的卫生技术人员在职称晋升、待遇政策等方面给予适当倾斜,稳定乡村医疗卫生队伍。     

安徽出台城市医生下乡服务意见

在一个聘任周期内，如不到农村乡镇卫生机构工作满３个月，将不得晋升高一级专业技术职务。安徽省卫生厅下发了《关于城市卫生技术人员到乡镇卫生机构定期服务的实施意见》。《意见》规定，从２００５年起，安徽省将实施这一强制性措施，以促进卫生人才向农村流动，提高农村的医疗卫生服务水平。城市卫生技术人员到乡镇工作的主要任务是：协助开展卫生改革；为农民提供优质的医疗卫生服务；帮助乡镇培养技术骨干；开展健康教育，普及卫生知识，同时接受锻炼和教育，提高自身的政治和业务素质。选派对象为省市二、三级医院的医师和主治医师；…     

加强继续医学教育实施管理的理论与实践

目的:在卫生医疗卫生事业不断发展的新形势下,加强卫生技术人员新理论、新业务、新技术、新方法的学习。方法:加强医院继续医学教育的实施,建立健全管理体制和管理制度;组织落实好继续教育项目的申报和实施;加强经费投入,做好督促检查。结果:继续医学教育在我院顺利实施。结论:加强继续医学教育实施的管理,是促进医院继续医学教育发展,提高卫生技术人员的业务素质,提高医院的整体水平的有效措施。     

青岛市乡镇卫生院卫生人力资源现状分析与对策研究

目的了解青岛市乡镇卫生院卫生人力资源现状,为政府卫生行政部门合理配置乡镇卫生院卫生人员提供参考。方法 2010年7月,对青岛市109所乡镇卫生院的卫生人员进行问卷调查,对乡镇卫生院的卫生人力总量、卫生技术人员的学历、职称及专业构成情况进行分析。结果青岛市乡镇卫生院在职人员总数为7 286人,每千人口乡镇卫生院人员为1.31人;卫生技术人员的学历以大专、中专学历为主,本科及以上学历占21.11%;卫生技术人员职称以中级和初级为主,副高级及以上职称仅占2.12%;医护比为1∶0.79;临床医师与公共卫生医师比为1∶0.20。结论青岛市乡镇卫生院卫生人力资源总量偏低,人员学历、职称偏低,医护比例偏低,公共卫生人员配置较为合理。     

四川省雅安市宝兴县乡镇卫生院卫生人力资源配置调查

目的 调查分析宝兴县乡镇卫生院人力资源配置的现状和存在的问题.方法 采用全境调查法,对宝兴县9个乡镇卫生院的127名在岗职工进行问卷调查,访谈9个乡镇卫生院院长及相关的主管乡村卫生工作的地方官员;对调查数据进行总结分析.结果 该民族地区乡镇卫生院卫生人力资源配置不尽合理,中心卫生院与普通卫生院人力资源分布不均衡,医护比倒置,职称比例失衡,医技人员稀缺.结论 应调整该地区乡镇卫生院人才招聘结构,加强对卫生技术人才的培养,畅通职业晋升通道,提高卫生技术人员的待遇,增强乡镇卫生院的岗位吸引力,从而改善人力资源配置状况.     

2007年至2011年云南省乡镇卫生院卫生人力资源公平性趋势研究

目的评价2007年12月2011年12月云南省乡镇卫生院卫生人力资源配置的公平性.方法绘制Lorenz曲线和计算基尼系数以评价云南省乡镇卫生院卫生人力资源配置的公平性,并分析其200712月2011年12月的变化趋势.结果 2007年12月2011年12月云南省乡镇卫生院的卫生人力资源,若按人口分布配置,总的卫生技术人员基尼系数从0.24下降到0.12,执业(助理)医师基尼系数从0.22下降到0.19,注册护士基尼系数从0.19下降到0.16;若按地理面积分布配置,总的卫生技术人员基尼系数从0.09上升到0.13,执业(助理)医师基尼系数从0.10下降到0.08,注册护士基尼系数基本维持在0.01左右.结论云南省乡镇卫生院的卫生人力资源配置的公平性较好,而且按照地理配置的公平性优于按人口配置的公平性.     

甘肃省乡级卫生人力资源建设政策干预对比分析

目的 通过对2007年与2010年甘肃省乡级卫生人力资源状况的抽样调查与分析,了解甘肃省乡级医疗机构卫生技术人员基本状况,对比分析2007年实施有关卫生政策以后,对卫生技术人员基本状况的影响,评价卫生人力资源建设的成效.方法 采用分层整群抽样的方法,以乡镇级医疗机构卫生技术人员为研究对象,观察各机构卫生技术人员的数量、学历、职称等指标.结果 与2007年相比,各类地区乡级卫生技术人员以中青年为主且趋于年轻化,卫生技术人员所占比例提高,整体学历层次提高,但职称结构仍相对失衡.结论 医疗机构受到相关卫生政策的干预,卫生技术人员的数量及质量都有所提高,但仍不能满足基层需求,应加强基层卫生人才的引进工作,使卫生人力资源得到有效配置.     

乡镇卫生院服务能力建设的实证分析——以江苏省连云港市为例

目的:调查了解乡镇卫生院的能力建设情况,为促进新医改的落实提出建议?方法:以江苏连云港市为案例,采用文献检索?定量调查和定性访谈收集资料,资料分析以描述性为主?结果:区域卫生资源配置不均衡,向县级以上卫生机构集中;卫生院服务能力逐年提高,以粗放型增长为主;卫生技术人员整体素质不高,结构呈现优化趋势;公共卫生服务得到加强,医疗服务量增长迅速,“重医轻防”问题突出?结论:建议政府在区域卫生规划中,卫生资源向农村基层倾斜;卫生院应提高管理水平,走集约型发展的道路;相关部门积极制定和落实卫生人才设置规划,以灌南县为例,建立卫生人才中心;政府加大投入,加强绩效考核,促进卫生院重视公共卫生和基本医疗服务?     

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.