基层医院医疗纠纷特点及防范对策

文章对基层医院医疗特点进行了分析,认为防范医疗纠纷的措施包括：强化医院内部管理、倡导医学人文精神、提高业务水平、增强法制观念、尊重患者权力、加强医患沟通、强化纠纷管理、注重解决纠纷技巧等。     

浅谈《医学免疫学》教学中的几个结合

免疫学教学中,学生往往觉得晦涩难懂,从而产生厌学情绪,问题的症结在于学生缺乏兴趣和学习主动性,解决问题的出路在于改变单一的教学手段,紧密结合现代教学方法,加强与其他学科渗透,重视实验操作,鼓励学生参与教学互动,在各种方法相互结合取长补短中达到最佳的教学效果。     

Factors related to outcome following a work hardening program

The purpose of this study was to determine factors related to a return to work following the completion of a work hardening program. Data from the Workers' Compensation Board of Alberta Millard Rehabilitation Centre for 1527 discharges, collected over 22 months, were examined retrospectively. Factors related to return to work were compared bivariately using logistic regression procedures. A multiple logistic regression model for return to work was also determined. The principle predictor of return to work was job-attached status to the pre-injury employer. Other factors related to return to work were education, primary diagnosis, injury to admission time, job attachment to the pre-accident employer, employer's annual payroll, and vocational direction. Due to the strength of the association between job-attached status to the pre-injury employer and a return to work, it was concluded that attempts to maintain this relationship should be a priority for rehabilitation providers and insurance carriers.     

加快推进继续医学教育工作 为卫生事业发展奠定基础

探讨继续医学教育工作。结合我国继续医学教育工作的实际，应在以下方面加快推进继续医学教育工作：进一步提高认识，切实加强对继续医学教育工作的领导；进一步完善继续医学教育相关制度，加强和规范继续医学教育的监督管理；加大对农村和基层继续医学教育工作的支持力度；突出重点，加快推进医学继续教育工作：加强继续医学教育管理干部队伍建设。     

A 4-year study of Pseudomonas aeruginosa susceptibility to antibiotics (1998-2001) in northern Lebanon

Four hundred and sixty-four Pseudomonas aeruginosa strains were isolated in northern Lebanon at the Islami Hospital Microbiology department, in Tripoli. The purpose of this study was to evaluate the susceptibility of these strains to antibiotics, to compare this susceptibility according to the nature of the sample and the year of sampling. The results show that urinary samples were the most frequent (39.3%), followed by wound samples (21.2%), and ear samples (16.5%). The average rate of susceptible strains was 39.8% to ticarcillin, 56.9% to piperacillin, 58.2% to piperacillin + tazobactam, 74.1% to imipenem, 63.3% to ceftazidime, 60.4% to cefepime, 62.1% to aztreonam, 60.3% to netilmicin, 57.5% to gentamicin, 62.2% to tobramycin, 69% to amikacin, 100% to colistin, 45.4% to pefloxacin and ofloxacin, 57.7% to ciprofloxacin and 1.3% to rifampicin. The study showed that the strains isolated from pulmonary secretions were the most resistant to antibiotics.     

Young adults: vulnerable new targets of tobacco marketing

OBJECTIVES: We examined young adult smoking patterns and receptivity to cigarette advertising to assess vulnerability to tobacco marketing strategies. METHODS: We obtained data from a telephone survey of 12,072 Massachusetts adults. RESULTS: Smokers aged 18 to 30 years were more likely than older adults to smoke only occasionally and to consume fewer than 10 cigarettes per day. They also were more receptive to cigarette marketing and were more likely to be frequent patrons of bars and clubs. CONCLUSIONS: Many young adult smokers are in the initiation phase of smoking and are likely to undergo a transition to either nonsmoking or heavier smoking. If unimpeded by regulation, tobacco promotion in bars and clubs is likely to lead to increased adult smoking prevalence.     

以人为本科学发展推动医院工作全面进步

推进医院工作全面进步,必须以“三个代表”重要思想统揽医院工作的全局;必须用科学发展观指导医院的建设和发展;必须注意把握医院改革的方向和重点;必须探索和推行以服务第一为理念的经营战略。     

Dependency, social factors, and the smoking cessation process: the doctors helping smokers study

We analyzed data obtained from a representative sample of the smoking patients (n = 1,338) of 66 family physicians to determine predictors of attempts to stop smoking, desire to quit smoking, and successful smoking cessation. Compared to subjects who made no attempt to quit smoking, subjects who tried to quit smoking tended to be younger, had tried to quit smoking in the year prior to the study, waited longer before smoking their first cigarette of the day, had more desire to quit smoking, and had more social support for quitting. Education and cigarettes smoked per day were not independently related to the subject making a quit attempt. Desire to quit smoking was associated with an attempt to quit in the year prior to the study and social support for smoking cessation (support of spouse, second most important social contact, and physician). Desire to quit smoking was not independently related to age, education, or dependency on cigarettes (measured by the number of cigarettes smoked per day and the length of time a subject waited before smoking the first cigarette of the day). Compared to subjects who tried to quit and failed, subjects who succeeded were older, smoked fewer cigarettes per day, and waited longer to smoke their first cigarette of the day. Spouse support, support of the second most important social contact, and advice of a doctor to quit smoking were not independently related to whether or not a cessation attempt would be successful. These data suggest that successful smoking cessation requires two components: social support to make an attempt to quit and the ability to overcome dependency on cigarettes to make the attempt successful.     

Prosecutor seeks new law to shield HIV exposure victims

Chautauqua County (NY) prosecutor James P. Subjack is asking State legislators to enact legislation to make it easier to prosecute people who recklessly transmit HIV to others. Subjack's office prosecuted the case of Nushawn Williams, who is linked to 11 cases of HIV in women and girls. Dozens more said they were exposed to HIV via sex with Williams, but only five would cooperate in prosecuting Williams. Most were unwilling to be part of a "media frenzy," and wanted to protect their own privacy. Subjack asked for laws to protect identities of victims of crimes involving HIV exposure, to make it a felony for people to engage in sex with a partner who is not informed of HIV-positive status, and to give law enforcers easier access to public health records of people with HIV. Six bills pertaining to cases like Williams' have been proposed, but none include provisions to protect the victims' identities or to grant greater access to health records. Contact information is included.     

The Impact of Government Regulations on Early Childhood Services: Perceptions of Early Childhood Professionals in the South West of England

This study investigated the impact of government regulations pertaining to the operation of a range of early childhood services on day to day practice within such services. A non random sample of twenty four early childhood service managers in the south west of England participated in structured interviews in order to assess their awareness of existing government regulations and to what extent existing regulations were used to guide day to day practice. Qualitative content analyses of the interview data revealed that the majority of managers were aware of a range of documents pertaining to regulations but considerable confusion existed about which regulations were considered to be imperative. The majority of respondents considered government regulations to be related more to meeting minimum standards rather than to quality assurance. Quality was perceived to be related to the commitment to good practice. The data indicate that government regulations have a minimal impact upon the day to day practice of early childhood professionals, pointing to the need for in-service opportunities to assist early childhood professionals to make greater connections between regulations, practice and quality.     

Coordinating Canada's research response to global health challenges: the Global Health Research Initiative

The Global Health Research Initiative (GHRI) involving the Canadian International Development Agency, the Canadian Institutes of Health Research, Health Canada and the International Development Research Centre seeks to coordinate Canada's research response to global health challenges. In light of numerous calls to action both nationally and internationally, an orientation to applied health policy and systems research, and to public health research and its application is required to redress global inequalities in wealth and health and to tackle well-documented constraints to achieving the United Nations Millennium Development Goals. Over the last four years, the GHRI has funded close to 70 research program development and pilot projects. However, longer-term investment is needed. The proposed dollars 100 million Teasdale-Corti Global Health Research Partnership Program is such a response, and is intended to support teams of researchers and research users to develop, test and implement innovative approaches to strengthening institutional capacity, especially in low- and middle-income countries; to generating knowledge and its effective application to improve the health of populations, especially those most vulnerable; and to strengthen health systems in those countries. While Canada stands poised to act, concerted leadership and resources are still required to support "research that matters" for health and development in low- and middle-income countries.     

Precision Food Parenting: A Proposed Conceptual Model and Research Agenda

Precision medicine, nutrition and behavioral interventions are attempting to move beyond the specification of therapies applied to groups, since some people benefit, some do not and some are harmed by the same therapy. Instead, precision therapies are attempting to employ diverse sets of data to individualize or tailor interventions to optimize the benefits for the receiving individuals. The benefits to be achieved are mostly in the distant future, but the research needs to start now. While precision pediatric nutrition will combine diverse demographic, behavioral and biological variables to specify the optimal foods a child should eat to optimize health, precision food parenting will combine diverse parent and child psychosocial and related variables to identify the optimal parenting practices to help a specific child accept and consume the precision nutrition specified foods. This paper presents a conceptual overview and hypothetical model of factors we believe are needed to operationalize precision food parenting and a proposed research agenda to better understand the many specified relationships, how they change over the age of the child, and how to operationalize them to encourage food parenting practices most likely to be effective at promoting healthy child food choices.     

Measure aiming to expand family planning introduced in Congress

Responding to promising state efforts to expand Medicaid-funded family planning services, Senators John Chafee (R-RI) and Dianne Feinstein (D-CA) introduced legislation on March 25 to make it easier for other states to follow suit. The Family Planning State Flexibility Act would give states the option to expand Medicaid family planning services to additional low-income women without first seeking a waiver from the federal government. Under existing law, states desiring to extend family planning services to low-income women whose incomes are above the state's regular Medicaid eligibility ceiling must apply to the Health Care Financing Administration for special permission to do so. The Chafee-Feinstein bill would eliminate this administrative obstacle and allow states to expand coverage to all women with incomes up to 185% of the federal poverty level, extend eligibility for family planning beyond the current cutoff point of 60 days postpartum, or extend eligibility for up to 1 year for women losing Medicaid coverage because of an increase in family income.     

昏迷患者应用口咽通气管吸痰的护理体会

目的经口咽通气管建立起来的人工气道吸痰法,克服影响经鼻吸痰效果的因素,解决经鼻吸痰中存在的问题,有效清除昏迷病人气道分泌物。方法对13例昏迷患者采用了经口咽通气管辅助吸痰护理。结果13例昏迷患者均未因痰液堵塞而发生窒息,呼吸道梗阻症状明显改善、血氧饱和度由原来的90%以下上升到95%以上。结论昏迷患者口腔放置口咽通气管辅助吸痰,操作方法简便、易于掌握,它是一种能够在数秒钟内迅速获得通气的方法,不仅可以保持呼吸道通畅,纠正缺氧,降低脑损害,还可以避免舌后坠,减轻脑水肿,避免脑损害的发生。此方法是清除痰液潴留,改善通气功能,控制肺部感染的一项积极、有效的护理措施。     

Ethical dilemmas in fieldwork: forgotten issues in qualitative health research in Iberoamerica

This paper explores some ethical dilemmas faced while doing fieldwork. Ethical norms are not enough to appraise the relationship between researchers and participants; a reflexivity practice is needed to understand the dilemmas aroused during this process. Here four issues faced during fieldwork are presented. The academic social time usually defines the schedule of fieldwork; hence, the researcher may decide to follow the academic schedule or to arrange a different schedule with informants. Researchers usually decide which part of their identity will be disclosed for introducing themselves to the informants; but may also decide to hide who really he/she is. Researchers may cope with the dilemma to disclose their private life to informants during the fieldwork. Researchers also may decide to behave according to academic cultural norms of reciprocity or according to the cultural norms of participants. Finally, a reflexivity movement should be developed in Iberoamerica to define an agenda on ethical issues and to develop decolonizing strategies to debate these ethical dilemmas.     

加强医院药学管理 创新医院药学服务

随着科学技术的进步,医院药学发展的总趋势是进行医院药事管理,药学技术工作和药学服务要向临床靠拢。这就要求医院药学部门应掌握国内外药学发展动态,根据实际情况不断引进、吸收和应用现代药学新知识、新技术和新方法,创新医院药学管理。文章对此进行了分析,并就创新医院药学管理提出了建议。     

军队医院坚持为兵服务的做法

为积极做好为兵服务工作，军医大学要结合自身特点，在以下几方面下工夫：一是建章立制，坚持在医疗服务上下工夫；二是真帮实带，坚持在培养人才上下工夫；三是加大投入，坚持在提高为兵服务效能上下工夫；四是紧贴实际，坚持在提高部队战斗力水平上下工夫。为兵服务的主要经验与体会：一是领导重视、认识提高是坚持姓军为兵方向的关键；二是建立完善机制是提高为兵服务质量的重要保证；三是树立良好的医德医风是搞好为兵服务的基础。     

数字化移动式X线摄影系统(床边DR)的应用

目的:寻找一种能在曝光后立即得到确认一幅摄影图像,无需再进行暗盒更换或IP板读取的摄影系统。方法:通过引进岛津公司数字化移动式X线摄影系统来实现。结果:DR床边摄影与CR床边摄影相比,节省了时间,提高了图像分辨率的质量,降低了患者损伤,节省了运营成本。结论:实现了在曝光后摄影图像能立即得到确认,无需再进行暗盒更换或IP读取。     

Algo Used by Homecare Nonoccupational Therapists Selecting Bathing Assistive Technology: Enhancing Standardization by Exploring Clinical Reasoning

Algo is a clinical decision algorithm developed to support nonoccupational therapists in establishing assistive technology recommendations to enable physically disabled adults to perform their hygiene at home. This study aimed to explore the in-depth clinical reasoning of nonoccupational therapists using Algo to pinpoint the items leading to disagreements regarding recommendations. A multiple-case study was conducted with eight nonoccupational therapists trained to use Algo and filmed while using it with six standardized clients. Explicitation interviews were conducted for the conflicting recommendations. Identifying the key reasoning skills to develop in Algo users has led to three recommendations to enhance standardization with seniors.     

Application of control technology developed in the polyvinyl chloride industry to polymerization processes using acrylonitrile.

Polymerization processes for PVC are sufficiently similar to acrylonitrile polymerization processes to allow a significant transfer of control technology. This transfer should be of value to manufacturers of polyacrylonitrile, ABS/SAN resins, nitrile elastomer and latex who will need to install extensive additional controls to comply with the new permanent standard for acrylonitrile scheduled to be issued by OSHA in late 1978. Control strategies and individual controls developed to limit worker exposure in the PVC industry are described and evaluated relative to applicability to acrylonitrile polymerization processes.