护理部在建立ISO9001质量管理体系中的职能作用

护理服务质量是医院核心竞争力的重要组成部分。建立科学、规范、有效的护理质量管理体系是医院实施ISO9001质量体系认证过程中的重要环节。护理部在建立护理质量管理体系过程中应充分发挥组织、培训、沟通和协调的职能作用,确保体系符合科学质量管理的要求,实现护理质量的持续改进。     

普及社区卫生服务的障碍和所需配套政策研究

中共中央、国务院《关于卫生改革与发展的决定》提出“改革城市卫生服务体系，积极发展社区卫生服务，逐步形成功能合理、方便群众的卫生服务网络”。１９９９年全国卫生工作会议确定的５个工作重点，第一就是：在区域卫生规划指导下，优化卫生资源配置，大力发展社区卫生...     

多发性骨髓瘤3例误诊分析

多发性骨髓瘤是浆细胞异常增生的恶性血液病，其临床表现多种多样，容易造成误诊，现分析３例误诊病例，了解其误诊原因，进一步了解该病，减少误诊。１病历摘要例１：女性，４６岁。主因乏力、纳差１０余天住院，伴有头晕，无四肢疼痛。查体：中度贫血貌，睑结膜及甲床苍...     

慢性胃炎治疗影响因素的对照研究

目的：以总有效率为评定指标，观察慢性胃炎治疗过程中伴有并发症等影响因素和无明显影响因素对疗效的影响。方法：治疗过的慢性胃炎240例，设研究组、治疗组和对照组，观察在治疗慢性胃炎的同时兼顾其影响因素与采用传统方法单一治疗胃炎二者间的疗效差异。结果：在治疗慢性胃炎的同时兼顾其影响因素的治疗，明显提高治愈率，缩短治疗时间，取得满意疗效，统计学差异均有显著性。结论：对慢性胃炎的治疗在注重原发病治疗的同时，重视其影响因素的祛除，能够提高治愈率，取得更好效果。预后因素有积极影响。     

Long term treatment of lamivudine in chronic hepatitis B patients with severe liver fibrosis——ten-year follow-up outcomes of NUCB 4006 trial

Objective To evaluate the clinical and histological outcomes in a cohort of chronic hepatitis B (CHB) patients who had histologically confirmed severe liver fibrosis and received lamivudine (LAM) therapy for up to 10 years. Methods Thirty-nine CHB patients with severe liver fibrosis (Ishak fibrosis score≥4) were treated with LAM for up to 10 years. Disease progression liver histological improvement, virological and biochemical responses were evaluated during follow-up. Data were analyzed using paired t test, Fisher exact test and Willcoxon test. Results Twenty-eight patients completed the 10-year follow-up. There were 5 (17.9% ) patients with disease progression.At the end of follow up, 16 patients received a second liver biopsy, which showed significant improvement of histological activity index (1.1 ± 1.4 vs 7. 1 ± 3.2, t =- 0.82, P＜0.01 ) and Ishak fibrosis score (3.6±2.2 vs 5.3±0.7, t= -2.89, P＜0.05) compared to baseline. There were 3 cases with Ishak fibrosis score improved from F5 to F0. Among 27 patients, 3(11% ) cases achieved hepatitis B surface antigen (HBsAg) loss and 2 (7 % ) achieved HBsAg seroconversion. At the end of follow-up, 19 out of 23 (83% ) hepatitis B e antigen (HBeAg) positive patients obtained HBeAg loss and 9 (39 % ) obtained HBeAg seroconversion. During LAM treatment, 11 patients experienced virological breakthrough or detected documented LAM-related resistance mutation. The viral loads of all patients were below 1 ×103 copy/mL at the end of follow-up after rescued by add-on or switch to another nucleotide analog.Conclusions Long-term LAM therapy can delay the disease progression in CHB patients with severe liver fibrosis, increase HBsAg and HBeAg loss rates, sustain suppression of HBV replication at a low level and even totally reverse the liver fibrosis in some patients. The effect of LAM resistance mutation on disease outcomes would be reduced by rescue therapy.     

英国健康服务体系的中国审视

2012年伦敦奥运会落下帷幕,在欣赏奥运健儿以优异成绩淋漓尽致地诠释奥运精神的同时,开幕式上的一幕更令笔者难以忘怀:在英国女王出场、国旗升起之际,600余位来自英国国家健康服务体系(National HealthService System,NHS)的医护人员推着320张病床,进入开幕式现场,摆出流光溢彩的"NHS"和"GOSH"(Great Ormond Street Hospital,伦敦大奥蒙德街儿童医院)。英国人利用举世瞩目的奥林匹克盛会的机会,向全世界展现、宣传了其引以为豪的国家健康服务体系,让全世界看到了以"健康为中心"的服务模式的成功范例。     

人腹膜间皮细胞对卵巢癌SKOV3细胞黏附、迁移和侵袭力的影响

目的：探讨人腹膜间皮细胞（HPMC）对卵巢癌SK-OV3细胞黏附、迁移、侵袭力的影响及可能机制.方法：建立HPMC原代培养的方法;采用免疫细胞组织化学法鉴定原代HPMC;验证HPMC中部分细胞因子的表达;采用黏附、迁移及侵袭实验观察HPMC与卵巢癌SKOV3细胞相互作用时对SKOV3细胞转移力的影响,及其作用机制是否与CXCL12-CXCR4轴有关.结果：成功培养出了HPMC.鉴定分离出的细胞符合间皮细胞的特征.HPMC中表达CXCL12、间皮素,不表达CXCR4.SKOV3与HPMC共同培养组的吸光度、迁移和侵袭细胞数显著高于单独SKOV3培养组,差异有统计学意义（P〈0.05）.稳定高表达CXCR4的SKOV3细胞（SKOV3-CX-CR4-cDNA）与HPMC共同培养组的吸光度、迁移和侵袭的细胞数目显著高于其余3组,差异均有统计学意义（P〈0.05）.结论：HPMC与SKOV3细胞相互作用时,增强了SKOV3细胞黏附、迁移和侵袭力,其作用机制与CXCL12-CXCR4轴有关.     

经颅多普勒超声经眼窗、颞窗检测大脑中动脉、前动脉血流速度的比较

目的探讨经颅多普勒超声（TCD）经眼窗与经颞窗检测大脑中动脉（MCA）、大脑前动脉（ACA）血流速度的差异,以寻求经眼窗检测途径来提高脑血管血流信号检出率。方法使用TCD仪,分别经眼窗与颞窗检测双侧MCA、ACA血流速度。结果经眼窗检测MCA峰值流速Vs（74.77±15.16）cm/s低于经颞窗者（84.80±13.83）cm/s,差异有统计学意义（P〈0.05）;经眼窗检测ACA峰值流速Vs（76.65±14.01）cm/s与经颞窗者（74.85±16.37）cm/s,差异无统计学意义（P〉0.05）。结论由于经眼窗与经颞窗检测MCA时,探头与血管之间的夹角不同,所以经眼窗检测到的MCA血流速度一般低于经颞窗检测,在做出TCD结论时应结合频谱形态和杂音、临床症状考虑,以提高TCD检测水平。