创伤急救一体化的实践与探索

论述了创伤救治新理念,阐述了创伤急救从传统模式向现代模式转变,即急诊科创伤急救模式由“全科型”向“专业化”转变、创伤医师培养模式由“通科型”向“专业型”转变。通过我院急诊科在创伤急救的快速临床反应机制、急诊创伤重点救治机制、创伤急救院内衔接机制和协调机制、急诊创伤病房规范化管理机制及创伤急救小组运作机制的实践,探讨了构建基于“三环理论”急诊科创伤急救一体化模式。     

公共娱乐场所的噪声问题及其控制

本文通过对常德市区娱乐场所噪声的三年研究,对14个娱乐场所174个监测点的数据统计结果、8个娱乐场所的辐射噪声声级监测结果和市区噪声污染分布进行分析。通过主观试验进行了节目噪声的烦扰度调查,绘出了噪声污染分布图和辐射噪声对邻近居民工作和休息很干扰百分数的关系图。通过现场调查对降低娱乐场所噪声的可能方法提出了自己的意见,为噪声控制提供参考。     

A theoretical model of the evolution of virulence in sexually transmitted HIV/AIDS.

INTRODUCTION: The evolution of virulence in host-parasite relationships has been the subject of several publications. In the case of HIV virulence, some authors suggest that the evolution of HIV virulence correlates with the rate of acquisition of new sexual partners. In contrast some other authors argue that the level of HIV virulence is independent of the sexual activity of the host population. METHODS: Provide a mathematical model for the study of the potential influence of human sexual behaviour on the evolution of virulence of HIV is provided. RESULTS: The results indicated that, when the probability of acquisition of infection is a function both of the sexual activity and of the virulence level of HIV strains, the evolution of HIV virulence correlates positively with the rate of acquisition of new sexual partners. CONCLUSION: It is concluded that in the case of a host population with a low (high) rate of exchange of sexual partners the evolution of HIV virulence is such that the less (more) virulent strain prevails.     

Program-target method in hospital management

The experience gained in developing the system of targets for a number of urban multi-profile hospitals suggests an opportunity for using a programme-target method in the management of an inpatient facility. The Samashko All-Union Research Institute of Social Hygiene, Public Health Economics and Management has developed a system of programme-target management, consisting of relatively autonomous blocks: the identification of actually existing hospital problems; the elaboration of the conception of hospital development; the building of a tree of targets; the projecting of structures for hospital management; the elaboration and implementation of programmes. The identification of problems is based on the analysis of factographic tree of hospital targets. The analysis of the problem situation and possible ways of solving the problems allow to elaborate the conception of hospital development. In order to simplify the procedure for the building of a tree of targets the subdivision of targets into the targets-results, targets-processes and targets-objects is being introduced. On the basis of tree of targets the structure of management is being projected and programmes are being developed. The uniformity of methods used in this system makes it possible to presuppose the possibility of applying them at any institution and at any level of public health management.     

Significance of ultrasonic studies of the splenic hilus in malignant lymphoma

In the course of abdominal ultrasonography of patients suffering from malignant lymphoma the authors observed frequently morphological alteration of the splenic vein in the hilus of spleen. Three conditions were determined which when occurring simultaneously created cases of dilated vein in the hilus of spleen. The incidence rate of dilated vein of the hilus of spleen has been determined in patient group with lymphoma and "healthy" control group. It was studied whether in cases with morphological alteration of the vein in the hilus of spleen the occurrence of abdominal nodal manifestations or the alteration of the sonographic structure of the spleen were detectable at a higher rate in the group of patients suffering from lymphoma. On the basis of the results the authors are of the opinion that when the sonographic signs of the dilated splenic vein of the hilus of spleen are present the negative result of sonography must be considered more carefully than usual and other more sensitive diagnostic methods must be applied for the detection of the abdominal manifestations of lymphoma.     

Effectiveness of postgraduate training of the heads of women's consultation clinics

The second stage of the efficacy assessment of the postgraduate education of the heads of women's consultation clinics was analyzed. They underwent training at the Central Order of V.I. Lenin Institute of Advanced Training of Physicians according to the experimental cycle of the problem-target programme which was developed on the basis of the claims raised for heads of women's consultation clinics. Postgraduate students were characterized according to their length of service and the posts occupied. The second stage of the efficacy assessment of advanced education involved the analysis of the introduction of new forms and methods of work in women's consultation clinics. The analysis was carried out by means of introduction charts used at the students' places of work, special assessment criteria being applied. The study findings were grouped by the type of activity of the clinic's heads. The conclusions were very specific and indicated the necessity of improving the work of this out-patient chain of the obstetric and gynecologic service.     

提速列车舒适度相关因素分析

目的：通过对提速列车舒适度调查，找出影响旅客列车舒适度的相关因素。方法：通过对微小气候的监测了解列车车厢内空气质量；通过问卷调查了解舒适度。结果：影响旅客列车舒适度的因素有照度、车速、风速、CO2浓度；其中舒适度与照度、车速呈正相关，与风速、CO2浓度呈负相关。结论：提速后列车应加强采光照明、控制风速和CO2浓度，以提高乘客舒适度。     

The law, medical ethics, and transplants

A discussion of four aspects of the legislation and of the medical ethics of the transplants is presented: the concept of death, the donation of organs, the selection of receivers and the future of the therapeutic transplants. The prominent paragraphs of the General Law of Health of the country about cerebral death, the two legal forms and organs donors' ethics, the criteria and more frequent problems for the selection of receivers, and the character of medical technology of transition of the therapeutic transplants are included.     

我国边远地区医疗废物处置技术和管理模式探讨

本文在分析中国边远地区医疗废物管理和处置现状基础上，从医疗废物收集、隔离包装、贮存、运输、处置等方面阐述了中国边远地区医疗废物管理和处置存在的问题及需求，并根据中国边远地区医疗废物产生和排放特性，针对边远地区运输距离远、处置技术缺乏、环境风险大、不易监督等特点，从其全过程管理角度出发，提出了可适用的医疗废物处置技术及管理模式。     

医疗事故技术鉴定结论差异的分析及启示

医疗事故技术鉴定实行多次鉴定制 ,各次鉴定结论是卫生行政部门、司法机关处理医疗纠纷的重要依据和证据 ,具有法律证明效力。通过对结论差异案例的原因分析 ,提出正确理解和准确把握医疗事故定义是正确判定医疗事故的关键和核心 ;恰当地运用举证责任分配原则是医疗事故技术鉴定的重要环节 ;完善《医疗事故处理条例》、《医疗事故分级标准》、《医疗事故技术鉴定暂行办法》是鉴定结论准确、公正的基础 ;准确地把握法律法规的主旨 ,依法鉴定是保障医疗事故技术鉴定性准确的保证     

承德市冬季室内不同采暖方式与人体健康效应

学校和家庭不同采暖方式的４４０名９岁组儿童的健康效应调查结果表明：集中供暖学校儿童肺功能中ＦＥＶ１．０％和Ｖ７５均高于燃煤炉采暖学校儿童，学校家庭均集中供暖的女生高于学校家庭均燃煤炉采暖的女生；家庭采暖方式相同的不同采暖方式学校间，集中供暖学校男女生嗜中性白细胞噬菌率高于燃煤炉采暖学校，学校家庭均集中供暖的男女生均高于学校家庭均燃煤炉采暖的男女生；家庭集中供暖的燃煤采暖学校学生血清ＩｇＧ高于集中供     

住院病案精细化质量管理体系的建立与应用

目的通过建立住院病案精细化质量管理体系,加强住院病案质量控制,减少临床病案缺陷以消除医疗隐患。方法针对住院病案存在的15类问题,建立住院病案精细化管理基本模式:制定一套量化、细化的住院病案精细化评价标准,建立三级病案质控负责制,开展持续的住院病案精细化管理培训,通过PDCA循环管理不断提高病案及医疗质量。结果基本杜绝了住院病案的严重缺陷,病案中的重大差欠数明显减少,医护人员对病案质量的重视度明显提高。结论建立和应用住院病案精细化质量管理体系能有效减少病案缺陷,提高医疗质量。     

Provision of armed force personnel with sanitary-and-epidemiological well-being under the current conditions

Health protection and provision of sanitary-and-epidemiological well-being in military personnel are largely determined by the efficiency of the prophylaxis unit of the medical service of the Armed Forces of the Russian Federation, which is part of the uniform federal state sanitary-and-epidemiological surveillance system of the Russian Federation. The activity of the prophylaxis unit of a medical service of the Armed Forces of the Russian Federation in maintaining sanitary-and-epidemiological well-being in the troops (forces) of the Ministry of Defense of the Russian Federation is accomplished in the presence of a number of unsolved problems to make sanitary-and-hygienic provision of military staff with vital activity and in that of the high epidemiological significance of acute respiratory infections, community-acquired pneumonias, streptococcal infections, childhood infections, tuberculosis, and meningococcal or HIV infections, etc. The author has defined the priority activities of the prophylaxis unit of a medical service in maintaining sanitary-and-epidemiological well-being in the Armed Forces of the Russian Federation under the present conditions, including the objectification of state sanitary-and-epidemiological surveillance in its Armed Forces, by using the capabilities of a modernized laboratory base of sanitary-and-epidemiological facilities, improving the system for immunoprophylaxis of infectious diseases, and organizing disinfection measures in the Armed Forces of the Russian Federation.     

Study of refrigeration towers associated with community outbreaks of legionellosis

OBJECTIVE: To evaluate the factors of risk of the risk cooling towers associated to a community outbreak of legionellosis according to its characteristics of maintenance and the quality of the water with the purpose of improving the systems of prevention of this one disease. METHOD: To compare the piece of information gathered between the 4 types of cooling towers: control 1, control 2, probable and confirmed. A total of 184 cooling towers have been studied associated to 17 community outbreak of legionellosis of the province of Barcelona (Spain) during the year 2004, of which 112 are control 1, 54 control 2, 8 probable and 10 confirmed. RESULTS: The confirmed towers are characterized by: high levels of conductivity, total aerobes, calcic hardness, total solids in dissolution, temperature and turbidity; low levels of chlorine (< 2 ppm); of use hypochlorite as disinfectant in a 10%; greater degree of breach of the revision program and cleaning of the internal elements of the tower (tray, stuffed and separating of drops); degree of performance of the periodic disinfections and the cleaning of deposits of the 100%. A 47% of the investigated towers do not use the previous treatments of the water in spite of diminishing the parametric values of the quantitatives variables. CONCLUSIONS: Measures of prevention of the legionellosis would be due to guarantee: a good quality of the water and the pursuit of its quantitatives variables; chlorine levels superior to 2 ppm; the evaluation of the individual risk for each installation; the performance of the 100% of the program of revision of the internal elements of the towers.     

Unmet need for induction of labor in Africa: secondary analysis from the 2004 - 2005 WHO Global Maternal and Perinatal Health Survey (A cross-sectional survey)

ABSTRACT: BACKGROUND: Induction of labor is being increasingly used to prevent adverse outcomes in the mother and the newborn. This study assessed the prevalence of induction of labor and determinants of its use in Africa. METHODS: We performed secondary analysis of the WHO Global Survey of Maternal and Newborn Health of 2004 and 2005. The African database was analyzed to determine the use of induction of labor at the country level and indications for induction of labor. The un-met needs for specific obstetric indications and at country level were assessed. Determinants of use of induction of labor were explored with multivariate regression analysis. RESULTS: A total of 83,437 deliveries were recorded in the 7 participating countries. Average rate of induction was 4.4% with a range of 1.4 - 6.8%. Pre-labor rupture of membranes was the commonest indication for induction of labor. Two groups of women were identified: 2,776 women with indications had induction of labor while 7,996 women although had indications but labor was not induced. Induction of labor was associated with reduction of stillbirths and perinatal deaths [OR - 0.34; 95% CI (0.27 - 0.43)]. Unmet need for induction of labor ranged between 66.0% and 80.2% across countries. Determinants of having an induction of labor were place of residence, duration of schooling, type of health facility and level of antenatal care. CONCLUSION: Utilization of induction of labor in health facilities in Africa is very low. Improvements in social and health infrastructure are required to reverse the high unmet need for induction of labor.     

工程量清单招标对医院基建项目的影响与对策分析

就目前招投标存在的问题,结合工程量清单招标具体情况,总结医院基建工程项目如何正确理解、认识和掌握工程量清单招标方法,并就目前工程量清单招标对医院基建項目影响因素进行分析,寻求医院基建工程项目与工程量清单招标相适应的措施。     

城市贫困人群生命质量及其主要影响因素

目的 研究城市贫困人群生命质量及其主要影响因素。方法 用SF-36量表对沈阳市237名贫困人群和261名对照人群的生命质量进行评价。经t检验、Logistic回归分析得出主要影响因素。结果 贫困人群与对照人群的生命质量有显著性差异。年龄、性别、医疗花费、债务、救济渠道、患病对贫困人群的生理健康影响明显；而医疗花费、教育花费、债务、救济渠道则是影响贫困人群心理健康的主要因素。除生理职能(RP)维度以外，其它维度的量化值均随困难年数增加而减少。结论 被调查贫困人群的生命质量低于对照人群，尤以35～50岁年龄段的贫困人群更为明显。贫困人群的生命质量受年龄、性别、医疗花费、债务、救济渠道、患病、教育花费等因素影响。     

Auditing the nursing care methodology

This study it describes the development of a process of audit of the Method of Assistance of Nursing in a unit of internment of a University Hospital. Identified the standards, the instrument was elaborated, under the form of indicators, in which had been examined, random, five handbooks with examination of the user "in loco". The data had been to add and classified in a quanti-qualification of the assistance of Nursing. The found results indicate the necessity of revision of the Standards of the Method of Assistance of Nursing and of the immediate retaking of the program of auditor of the assistance of Nursing.     

Deinstitutionalisation of Occupational Therapy and Health Care Administrators Knowledge

Administrators of 100 Brisbane health care agencies were surveyed about their level of knowledge of traditional and nontraditional roles of occupational therapy and other allied health professions. Administrators were found to have reasonable levels of knowledge of the allied health professions, poor knowledge of occupational therapy, and very low levels of knowledge of the nontraditional roles of occupational therapy. Lack of health care administrator awareness of occupational therapy is a barrier to the transition of the profession from institutionally based models of practice to working in community health settings.