强化过程控制和精细化管理保证护理质量持续改进

质量管理是医院生存和发展的战略战术。质量就是生命,质量就是效益,21世纪护理质量的起步要求是护理质量管理者应在缺陷预防和质量持续改进方面做出尝试,护理管理者应在推行精细化管理,强化护理过程控制方面做出努力,以满足广大病人的健康服务需求。1质量发展及其概念1.1护理质量管理的发展阶段美国护理质量管理大体经历了3个历史性发展阶段:20世纪70年代“质量控制阶段”,20世纪80年代“质量保证阶段”,20世纪90年代“质量促进阶段”。质量控制阶段的主要特点:①由质量管理人员发现已出现的质量问题,然后做出处理;②技师评价方式为依照标准…     

Barotrauma in guinea pigs--stimulated tests of diving

For a systematic understanding of the effect of diving on hearing ability and middle and inner ear morphology, we have carried out simulated tests on 65 healthy guinea pigs, under water 60 meters deep, and then decompress rapidly. The tests proved that hearing ability changed most significantly 7 days after diving. After diving, all tympanogram curves, except those in 3 ears, changed to type B. Thirty-nine (37.85%) middle ears had been damaged, 4 (3.88%) had inner ears injured, as seen under light microscope. During decompression, three animals had nystagmus. Screen electronmicroscopy showed hair cell destruction and hair derangement. Transmission electronmicroscopy showed mitochondria damage. The results showed that damages in middle and inner ears were mainly mechanical, sometimes metabolic.     

Intrathecal morphine for post-thoracotomy pain

We wished to investigate possible differences in the duration of postoperative analgesia and the incidence of respiratory depression after the intrathecal injection in the lumbar area of 10 micrograms/kg morphine in hypobaric and hyperbaric solution for relief of post-thoracotomy pain. Twenty-nine patients received morphine plus dextrose (hyperbaric) and 21 received morphine in preservative-free normal saline. The duration of analgesia was longer with the morphine in the normal saline group than in the hyperbaric group (P less than 0.04). One patient developed delayed respiratory depression. Our data support the use of morphine in normal saline mixtures for greater duration of analgesia after thoracic operations.     

五倍南星膏外敷治疗颌下淋巴结炎26例

自1998年2月-2004年12月共应用五倍南星膏治疗颌下淋巴结炎病人26例，收到良好的临床效果，现报告如下：     

Kindergarten children's representation and understanding of written number symbols

Two samples of kindergarten children's representation and understanding of written number symbols were examined in two time points in one academic year. About 85% of Chinese five year olds (mean = 5 years 10 months) were able to use conventional number symbols to represent the quantity of 30 or larger. At the end of the kindergarten year, 94% of Chinese six year olds (mean = 6 years 4 months) were able to use conventional number symbols to represent the quantity of 100 or larger. Some Chinese six year olds had problems in representing written addition and subtraction tasks. Children's ability to represent written number symbols, ability to represent written addition and subtraction formula and their performance on written addition and subtraction were closely related. The performance of children in a university-affiliated childcare center was better than that of the center serving working-class families in Time 1, but the performance reversed at the end of the kindergarten year.     

北方亦多湿续论

我在20世纪80年代初期,曾发表“北方亦多湿论”的短文,但失之过简,今按四时更迭,主要节令交替详细阐述之。在未入正题之前,先读一下毛主席的《沁园春·雪》,俾对北方气候有所了解:“北国风光,千里冰封,万里雪飘,望长城内外,惟余莽莽,大河上下,顿失滔滔。山舞银蛇,原驰蜡象,欲与     

Survey of psychiatric disorders in a Taiwanese village population six months after a major earthquake.

BACKGROUND AND PURPOSE: The catastrophic Chi-Chi earthquake of September 21, 1999 in Taiwan provided a unique opportunity to study the disaster's psychiatric impact on survivors. This study assessed the development of psychiatric disorders among residents in a Taiwanese village near the epicenter of the earthquake within 6 months of the disaster. METHODS: A total of 442 of the 602 actual living residents of Tong-Chi village who were over 16 years of age and were present in the community at the time of the earthquake were included in this population survey. Subjects were interviewed by psychiatrists using the Mini-International Neuropsychiatric Interview and questionnaires to collect demographic information and risk factors for psychiatric disorders 4 to 6 months after the earthquake. RESULTS: The prevalence rates were 9.5% for current major depression, 2.8% for past major depressive episode, and 7.9% for post-traumatic stress disorder (PTSD). Females had significantly higher rates of most psychiatric disorders. After controlling for covariates, the significant risk factors for PTSD were female gender and having sought medical service after the earthquake. Significant risk factors for major depressive episode were divorced/widowed status, education level equal to or below primary school, and prominent house damage. CONCLUSION: This population survey of earthquake disaster survivors found an increased prevalence of psychiatric disorders after exposure to a catastrophic earthquake. These results highlight the need for prompt therapeutic attention to residents of earthquake disaster areas after the event.     

Acute pancreatitis combined with acute Budd-Chiari syndrome as the initial manifestation of small cell lung cancer.

Tumor metastasis to the pancreas is a rare but recognized cause of acute pancreatitis. Autopsy series have reported a 24-40% of pancreatic involvement in small cell lung cancer. However, only a very few cases of tumor-induced acute pancreatitis have been described. Budd-Chiari syndrome complicating lung cancer is a rarely reported condition. We report a 68-year-old woman with extensive small cell lung cancer with the unusual initial presentation of both acute pancreatitis and acute Budd-Chiari syndrome. This patient suffered from progressive epigastralgia for 3 weeks. Severe epigastralgia with radiation to back and progressive jaundice developed 2 days prior to admission. After admission, the liver enlarged rapidly and the ascites increased markedly. Chest roentgenogram showed a mass lesion over the left lower lung field. Poorly differentiated carcinoma cells were found in ascites and bone marrow. The patient died on the ninth day of hospitalization before chemotherapy was initiated. Prompt diagnosis of extensive-stage small cell lung cancer may allow early chemotherapy treatment which favorably influences recovery when the pancreatitis is mild. Although prolonged survival might have been expected had this patient recovered from pancreatitis and received chemotherapy, diagnosis was delayed due to difficulty in immunohistochemical diagnosis of the tumor and the unusual clinical presentation. The use of stains employing antibodies against neurofilament and neuron-specific enolase cell antigens is important for early diagnosis of poorly differentiated metastatic tumor cells.