支气管肺隔离症1例报道

男性,28岁,体检发现右下肺肿块1月余,无明显自觉症状.以往有肺结核病史.胸部X线平片(图1)显示右肺下叶后基底段一6 cm×4 cm×5 cm的团块影,边缘清晰,双肺上叶可见陈旧性结核灶.CT增强扫描(图2)显示右下肺肿块,中央CT值约40HU,增强后无强化,肿块内侧可见一粗大的血管断面伴随,血管与肿块关系密切.CT血管造影(CTA)MIP重建显示一较大的血管自膈下发出一直径约1cm的供血动脉,并可见引流的肺静脉影(图3).     

采用一式三份数码对号入座法管理病案号

采用"对号入座法"管理病案号,先把姓名索引卡、病案封面、病案号索引簿预先印上号码.待病人入院,取出相应一式三份号码,做好各种索引.结果,派出的病案号被取出,乘下空白的是未使用.如果旧病友再次入院;就要在病案的姓名索引中或电脑中查找旧号,这样有效地控制重号、漏号.     

注射吸毒致破伤风的临床特点及分析

目的探讨注射吸毒致破伤风的诊断与治疗。方法回顾性分析了9例注射吸毒者破伤风的临床资料。结果9例注射吸毒致破伤风的病人中,5例治愈,4例死亡,死亡原因:3例因呼吸肌痉挛和分泌物过多阻塞呼吸道窒息死亡,1例因呼吸衰竭死亡。结论注射后皮肤和软组织感染可认为是引起破伤风外伤伤口。注射吸毒破伤风应按重症破伤风处理。及时气管切开或气管插管机械辅助呼吸可降低死亡率。     

隆突性皮纤维肉瘤23例临床分析

本文报告了我科1978～1990年间收治的降突性皮纤维肉瘤23例,均经组织学证实.治疗以手术切除为主,术后局部复发率为65.2%.无一例发生转移.切除不彻底是复发的主要原因.作者指出广泛切除是防止复发的主要措施,手术前后的放疗有可能减少复发.     

Practice‐based evidence: benchmarking NHS primary care counselling services at national and local levels

There are a number of problems for evidence‐based practice (EBP) including limited generalizability of efficacy research results, the consequent lack of confidence in the relevance of such research, and the conceptual distance of most practitioners from the research process. The result is that EBP, although sound in principle, often fails to achieve its aim of improving practice. Practice‐based evidence (PBE) provides a complementary bridge for the gap between research and practice to offset some of these problems, promoting collaboration between mental health services and academic institutions. This paper presents the initial results of such a collaboration via three phases: (1) the development of a referential database for primary care counselling services, (2) ‘practitioner‐friendly’ feedback on grouped data to services, and (3) the combination of the two to build an evidence base for work with ethnic minorities—an area in which research trials are not well adapted to provide much evidence. Copyright © 2003 John Wily & Sons, Ltd.     

H∞ control of switched linear discrete‐time systems with polytopic uncertainties

In this paper, the problem of designing H_∞ state‐feedback controllers for switched linear discrete‐time systems with polytopic uncertainties is investigated. Two approaches on designing robust and parameter‐dependent H_∞ controllers are proposed and the existence conditions of the desired controllers are derived and formulated in terms of a set of linear matrix inequalities. By solving the corresponding convex optimization problem, the desired controllers are obtained, respectively, and different optimal H_∞ noise‐attenuation level bounds of corresponding closed‐loop systems are given as well. The designed controllers have their own advantages and disadvantages regarding the conservatism and realization complexity. An illustrative example emerging in networked control systems (NCS) and numerical simulations are presented to show the applicability and effectiveness of the obtained theoretic results. Copyright © 2006 John Wiley & Sons, Ltd.     

Doctor – How do I use my EpiPen?

Parents and children who have been prescribed an Epipen are often unable to demonstrate its correct administration. One contributory factor may be that doctors are unfamiliar with the EpiPen and are unable to demonstrate the correct administration of the pen to the family. The aim of this study was to determine the rate of correct EpiPen demonstration by junior and Senior Medical Staff at a major tertiary paediatric Hospital. Junior and Senior medical staff were scored on their ability to correctly use the EpiPen trainer. A 6 step scoring system was used. One-hundred doctors were recruited (Residents n = 31, Senior Residents n = 39, Fellow/Consultants n = 30). Junior and Senior Medical staff had similar scores for EpiPen demonstration, the number that needed to read the EpiPen instructions prior to use and the frequancy of accidental self-injection into the thumb. Only two doctors (2%) demonstrated all 6 administration steps correctly. The most frequent errors made were not holding the pen in place for >5 seconds (57%), failure to apply pressure to activate (21%), and self-injection into the thumb (16%). Ninety five doctors needed to read the instructions, and of these, only 39 (41%) then proceeded to correctly demonstrate the remaining 5 steps. Forty-five doctors had previously dispensed an EpiPen, but only three demonstrated its use to parents/children with a trainer. The majority of doctors do not know how to use an Epipen and are unable to provide appropriate education to parents/children. In 37% of cases, the demonstration would not have delivered adrenaline to a patient.     

Comparison of Methodologies for Calculating Quality Measures Based on Administrative Data versus Clinical Data from an Electronic Health Record System: Implications for Performance Measures

New reimbursement policies and pay-for-performance programs to reward providers for producing better outcomes are proliferating. Although electronic health record (EHR) systems could provide essential clinical data upon which to base quality measures, most metrics in use were derived from administrative claims data. We compared commonly used quality measures calculated from administrative data to those derived from clinical data in an EHR based on a random sample of 125 charts of Medicare patients with diabetes. Using standard definitions based on administrative data (which require two visits with an encounter diagnosis of diabetes during the measurement period), only 75% of diabetics determined by manually reviewing the EHR (the gold standard) were identified. In contrast, 97% of diabetics were identified using coded information in the EHR.The discrepancies in identified patients resulted in statistically significant differences in the quality measures for frequency of HbA1c testing, control of blood pressure, frequency of testing for urine protein, and frequency of eye exams for diabetic patients. New development of standardized quality measures should shift from claims-based measures to clinically based measures that can be derived from coded information in an EHR. Using data from EHRs will also leverage their clinical content without adding burden to the care process.     

过氯酸铵对家兔肺组织TGF-β1和TNF-αmRNA表达的影响

目的探讨过氯酸铵（AP）对家兔肺组织转化生长因子-β1（TGF-β1）和肿瘤坏死因子-α（TNF-α）mRNA表达的影响。方法将25只家兔随机分为5组：AP低（22．5mg／kg）、中（45mg／kg）、高（90mg／kg）剂量组，对照组（生理盐水）和博来霉素组（BLMA5，4mg／只），采用气管内注入方式每周染毒1次，共染毒13周，于第23周处死家兔并取肺组织，用逆转录聚合酶链式反应（RT-PCR）检测肺组织中TGF-β1和TNF-α mRNA的表达。结果AP不同剂量染毒后，低、中、高各剂量组及博来霉素组的TGF-β1（1．11±0．22，1．54±0．18，1．84±0．10，2．36±0．85）和TNF-α mRNA（1．10±0．24，1．26±0．11，1．87±0．11，2．34±0．75）表达均比对照组（0．47±0．09，0．51±0．24）明显升高，差异有统计学意义（P〈0．05或P〈0．01）。结论AP可使家兔肺组织中致纤维化细胞因子TGF-β1，和TNF-α mRNA表达增加。