基于SWOT分析法的城市医疗集团管理策略

近年来,随着我国医药卫生体制改革的不断深化,纵向整合型区域性医疗集团化的战略发展成为了医疗体制改革的热点。为优化医疗卫生资源、落实分级诊疗制度,许多省市已经开始组建以地市级三级公立医院为核心,带动其他成员医疗卫生机构共同进步的良性、可持续性发展模式的医疗集团。该文运用管理学理论中的SWOT分析法,通过文献阅读、资料收集和参考借鉴相关的学术成果,系统探讨了以南宁市某三甲医院为例,在组建医疗集团发展时面临的优势、劣势、机遇和挑战,并对此提出对策建议,以期为医院医疗集团改革科学、高效、快速发展提出适宜的应对策略,为医院引领区域性医疗集团运行模式的选择提供决策支持。     

新型冠状病毒肺炎下护理人员心理状况调查及应对策略研究

目的 了解郑州市新型冠状病毒肺炎患者定点收治医院护理人员的心理状况,从而为应对突发公共卫生事件医务人员的心理卫生、心理干预咨询提供参考的理论依据及指导.方法 选择本市新型冠状病毒肺炎疑似及确诊患者定点救治医院护理人员,共收集到462名护理人员信息,采用填写网络问卷SCL-90量表的方法进行调查,并与常模数据做对比,用SPSS19.0统计软件进行统计分析.结果 最终完成436名护理人员调查统计与分析,SCL-90量表总得分为(144.51±36.20),高于1986年全国常模(129.96±38.26)分以及2006年全国常模(130.021±33.626)分.其中,躯体化、强迫、抑郁、焦虑、恐怖因子分高于护士常模(P＜0.05)及全国常模(P＜0.05).结论 新型冠状病毒肺炎疫情期间,本市护理人员存在一定的心理压力.我们应注意到护理人员的心理压力以及引起压力的主要危险因素,并采取积极有效的方式应对,采取针对性措施进行疏导,减轻护理人员的心理压力,保证护理人员工作有效顺利进行.     

氦氖激光对小鼠小脑信息传递物质一氧化氮及环磷酸鸟苷含量的影响

目的：研究低功率氦氖激光对小鼠小脑信息传递物质的影响。方法：采用雄性BALB／C小鼠,随机分为对照组,辐射后即刻组、1h组、2h组,注入氮氖合酶（NOS）抑制剂的辐射后即刻组、副射后1h组,用波长632．8nm、功率密度5mW/cm^2连续氦氖激光每天局部辐射1次,每次1h,连续5d。对照辐射功率密度为0。结果：辐射组分别于辐射后即刻、1h小脑组织中一氧化氮（NO）代谢产物亚硝酸根（NO2^-)及环磷酸鸟苷（cGMP)含量均升高（P＜0．01）,辐射2h二者均降至正常,此增高效应可同时被NOS抑制剂阻断。结论：低功率氦氖激光可使小鼠小脑NO代谢产物NO2^-及cGMP含量短暂性升高,在氦氖激光辐射产生的生物学效应中涉及NO／cGMP信息传递机制。     

Clinical significance of magnetic resonance imaging of bone marrow in patients with leukemia

Acute leukemia is a clonal malignancy ofhematopoietic tissue characterized by proliferation ofabnormalblastcellsin the bone marrow and impairedproduction of normal blood cells.Magnetic resonanceimaging( MRI) isuseful in characterizing normal andabnormal bone marrow ( BM) because of its ability todistinguish fatfrom denser,more cellulartissuessuchas leukemia.MRIalso presentsa more global view ofthe BM than biopsy materials and,therefore,mayprovide a better understanding of diffuse hematopoi-…     

尿液结合性胆红素的纯化

OBJECTIVES: To develop a simple, practical method with fine yield and purity for separating conjugated bilirubin(Bc) from a sustainable and facile material in order that it could serve as a calibrator for total and direct bilirubin determination. METHODS: Isolating Bc from urine of patients with obstructive jaundice by CHCl3: CH3CH2OH(1:1, V/V) followed by CNBr activated Sepharose 4B-HAS affinity chromatography, we analyzed the products by the use of Doumas J-G diazo method and HPLC, respectively. RESULTS: Determined by J-G diazo method, the crude product extracted by CHCl3: CH3CH2OH(1:1, V/V) yields 90.2 +/- 5.4%(n = 3) of urine Bc, the ratio of Bc to total dry weight being 67.9 +/- 6.4%(n = 3). The final product purified by affinity chromatography with the ratio of separation of 1.5, 1.737 and analyzed by HPLC has the yield of 46.9% and purity of 94.7%(BDG of 76.2%, BMG of 18.5%). CONCLUSION: The above data demonstrate that urine conjugated bilirubin can be successfully purified by CHCl3: CH3CH2OH extraction followed by Sephrose-HSA affinity chromatography with sufficient purity and output.     

尿液结合性胆红素的纯化

目的　探索一种来源方便 ,具有延续性 ,利于胆红素测定校准物或质控物制备 ,且方法简便、实用、产率和纯度可靠的结合性胆红素 (Bc)纯化方法。方法　应用 CHCl3 ∶ CH3 CH2 OH(1∶ 1,V/V)萃取与 CNBractivated Sepharose4B- HSA亲和层析相结合的方法对胆道梗阻性高胆红素尿液进行分离纯化 ,并以 Doum as J- G法和 HPL C分析产品。结果　由 CHCl3 ∶ CH3 CH2 OH(1∶ 1,V/V)萃取所得的粗纯品经 J- G法检测产率为 90 .2±5 .4% (n=3) ,胆红素含量占总干重的 6 7.9± 6 .4% (n=3)。亲和层析的洗脱峰间的分离度为 1.5、1.737。层析后再萃取所得精纯品经 HPL C分析 ,产率为 46 .9% ,纯度 94.7% ,其中 BDG76 .2 % ,BMG18.5 %。结论　采用有机物萃取和 CNBr activated Sepharose4B- HSA亲和层析相结合的方法纯化结合性胆红素 (BMG& BDG)具有很好的可靠性和可行性     

8例大血管手术围手术期麻醉处理体会

大血管手术一般都有较大难度 ,围手术期一般都要求控制性降压、降温等特殊措施 ,有较特殊的血流动力学改变 ,因此对麻醉的要求较高 ,围手术期有其较特殊的处理方法 ,作者近期成功完成 8例大血管手术的麻醉 ,现将体会报告如下。1　临床资料1.1　一般资料　大血管手术 8例 ,男 5例 ,女 3例 ,年龄 40～ 6 8岁 ,平均 5 6岁。其中腹主动脉瘤切除、人工血管植入术4例 ,降主动脉假性巨大动脉瘤切除术 2例 ,肾癌根治、下腔静脉巨大癌栓取出术 2例 ,手术历时 2 6 0～ 6 5 0ｍｉｎ ,平均 380ｍｉｎ ,术中失血 3 5 0 0～ 92 0 0ｍｌ,平均 480 0ｍｌ。输…     

A comprehensive reconstruction strategy for moderate to severe faciocervical scar contractures

The focus of treatment of faciocervical scar contractures includes cervical reconstruction and elimination of hypertrophic scars. Unfortunately, most previous studies have neglected the esthetic appearance of scars. In this study, we tried to combine surgical therapy and ultrapulse fractional CO₂ laser (UFCL) to eliminate facial scars while restoring neck reconstruction and to establish the optimal conventional management for faciocervical contracture. Thirty-eight individuals were enrolled and divided into two groups. After received cervical release surgeries, comprehensive UFCL therapy group received treatment of UFCL at 3-month intervals, silicone sheets, and pressure garments, while another group only received treatment of silicone sheeting and compression. Twelve months after the termination of therapy, faciocervical scars of both two groups were assessed by two uninvolved physicians according to the Vancouver Scar Scale (VSS), and patients’ satisfaction survey was also recorded by the study participants using a patient four-point satisfaction scale. Thirty-six patients completed the treatment and follow-up. The results show that the VSS scores of both two groups decreased after 12 months, but comprehensive UFCL therapy group dropped more significantly than the conventional treatment group at follow-up session, which was statistically significant (P?<?0.001), and the patient satisfaction was higher than that of the conventional treatment group. This comprehensive treatment combined of surgery, UFCL, silicone sheets, and pressure garments works as an effective and esthetic reconstruction for moderate to severe postburn faciocervical scar contractures.