An analytical framework of physician productivity and variation in utilization.

The utilization of medical services by patients is an important determinant of doctor productivity, but this factor does not appear to have been given much attention in previous studies. In order to answer the question of why is there a wide variation in doctor output at low level medical facilities in China, an analytical framework of doctor productivity and utilization is developed. The simulation model is used to produce data that can be analyzed by such a framework. Great uncertainty about patient flows is one reason for the average lower and varying doctor productivity in lower level health facilities. Until uncertainty can be reduced, more flexibility is needed at the lower level to cope with changing utilization patterns and patient characteristics. The management by doctors of non-patient care activities (preventive programmes, medical research, teaching, and administration) is crucial to any approach to using doctor resources more effectively and efficiently.     

人乳头瘤病毒感染超微结构观察

本文对5例典型尖锐湿疣标本及10例可疑人乳头瘤病毒感染标本进行透射电子显微镜观察。结果典型尖锐湿疣标本中仅1例于细胞核内见到人乳头瘤病毒,排列规则呈结晶状。其余14例标本的细胞内均见不同程度的由病毒感染所引起的非特异性病理变化。本文对人孔头瘤病毒及受感染细胞的超微结构进行了初步探讨。     

Effect of cholestyramine on the formation of pigment gallstone in high carbohydrate diet-fed hamsters.

This study was designed to investigate the effect of cholestyramine on the formation of pigment gallstones in high carbohydrate diet-fed hamsters and whether that effect occurred because of cholecystokinin action. Forty seven hamsters were divided into three groups: group I(n = 16) was fed on normal rodent chow(43% carbohydrate), group II(n = 14) was fed on a high CHO diet(65% carbohydrate), group III(n = 17) was fed on a high CHO diet containing 4% cholestyramine. Gallstones developed in 0% of group I, 42.9% of group II and 5.9% of group III(P < 0.05, group II vs III). To evaluate the chronic status of cholecystokinin level, the wet weight of pancreas and the average area of pancreatic acinar in microscopic high power field were measured. There was no significant difference between group II and group III in pancreatic weight and average area of pancreatic acinar(P > 0.05). In gallbladder bile analysis, there was also no significant difference between group II and group III in cholesterol, phospholipid, total calcium, total bilirubin and bile acid levels. In conclusion, cholestyramine decreases the frequency of pigment gallstone formation in high CHO diet-fed hamsters, but it is not clear whether the mechanism of cholestyramine decreasing the gallstone formation is due to the action of cholecystokinin.     

植物神经癫痫52例脑电图分析

报道52倒6个类型植物神经癫痫,重点分析了脑电图的变化,脑电图异常率100％,69.4％的病例出现两侧阵发性4～7Hzθ节律及6和14Hz阳性棘波,提示中线深部有功能紊乱,亦支持丘脑及脑干部有病变。此外蝶骨电极能提高脑电图对本病的阳性诊断率,值得采用。本文证明脑电图对植物神经性癫痫与非癫痫的鉴别诊断,具有肯定的价值。     

在医疗纠纷案件中医疗机构应注意的问题

我们广大医疗机构,特别是三级甲等医院承担着繁重的医疗、保健和防疫等任务,许多医务人员是满负荷甚至超负荷地工作,出个把失误在所难免,作为法官,我个人对这些都能理解,但是作为患者,疾病对于他们来讲就是一件大事,有些甚至是天塌下来的事。他们抱着对医疗机构、医生的信任前来就医,把自己的生命健康交到医生手上,如果因为医生的疏忽导致不良损害的发生,对这个患者来说,就是100%,不仅造成患者本身的痛苦和伤害,还可能会对患者家庭、甚至社会造成损害,所以必须最大限度地避免由于我们的问题造成患者的不良损害的发生。     

A systematic review of outcomes assessed in randomized controlled trials of surgical interventions for carpal tunnel syndrome using the International Classification of Functioning, Disability and Health (ICF) as a reference tool

Background  

A wide range of outcomes have been assessed in trials of interventions for carpal tunnel syndrome (CTS), however there appears to be little consensus on what constitutes the most relevant outcomes. The purpose of this systematic review was to identify the outcomes assessed in randomized clinical trials of surgical interventions for CTS and to compare these to the concepts contained in the International Classification of Functioning, Disability and Health (ICF).     

移动式数字X线机应用前景展望

移动式X线机实现了影像信息的数字化采集、存储、调阅、检查报告的生成、审核、查询和输出等功能,从满足突发公共卫生事件的应急需要和卫生防疫的需要来展望,其市场应用前景看好.     

血浆置换床边治疗重型肝炎临床观察

目的探讨血浆置换(简称PE)床边治疗重型肝炎的临床疗效。方法60例病例采用常规内科治疗加PE治疗,比较PE治疗前后临床症状缓解时间及血生化变化。结果临床症状缓解迅速,黄疸减退,白蛋白、胆碱脂酶升高,PT恢复,补体上升,不影响肾功及电解质。结论PE为重型肝炎一种行之有效的治疗方法。     

舒芬太尼对心脏瓣膜置换术患者麻醉诱导期血液动力学的影响

目的观察舒芬太尼对心脏瓣膜置换术患者麻醉诱导期血液动力学的影响。方法心脏瓣膜置换手术患者20例,随机分为舒芬太尼组(S组,n=10)和芬太尼组(F组,n=10)。全麻诱导:咪唑安定0.1～0.3mg/kg,维库溴铵0.1～0.2mg/kg。S组使用舒芬太尼1μg/kg,F组使用芬太尼10μg/kg。血液动力学监测:心电Ⅱ导联示波,有创动静脉测压,放置6腔Swan-Ganz导管,采用美国Baxter-2型连续心排血量多功能监测仪,测定心脏指数(CI)和肺毛细血管嵌压(PCWP)。观察心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)和肺毛细血管嵌压(PCWP)。分别于麻醉诱导前(T1)、麻醉诱导后气管插管前(T2)、插管后1分钟(T3)、5分钟(T4)和10分钟(T5)记录观察指标。结果HR、MAP、CVP和PCWP两组变化趋势基本一致。麻醉诱导后及气管插管后部分时间S组HR和MAP低于F组(P<0.05或P<0.01),插管后S组CVP明显高于F组(P<0.05或P<0.01)。麻醉诱导或气管插管后,F组CI明显下降(P<0.05或P<0.01),S组均无明显变化。观察期间PCWP均无明显变化。结论舒芬太尼可安全的用于心脏瓣膜置换手术。     

先天性后侧半椎体切除术治疗角形脊柱后凸畸形

目的探讨先天性后侧半椎体切除术治疗角形脊柱后凸畸形的适应证、手术方法及临床效果. 方法采用该方法手术治疗角形脊柱后凸25例,经后路暴露双侧椎板,自双侧分离暴露关节突外侧和横突, 切除横突.沿椎弓根自骨膜下向前分离, 暴露多余的半椎体, 切除多余的一节椎弓和后侧半椎体,自后路行双侧弓根螺钉加压棍固定. 结果本组无脊髓损伤、感染等术后并发症发生.20例随访5～10年, 远期效果好; 3例随访1年以上, 矫正效果良好; 2例术后尚未及1年, 正在随访中.Cobb's角从术前平均68°降至术后平均11°. 结论先天性后侧半椎体切除术的年龄范围为8～22岁,年龄越大越趋向于作全脊柱截骨术.