The quality of acute stroke units on a nation-wide level: the Austrian Stroke Registry for acute stroke units

Concepts for stroke units that cover the acute phase vary. Therefore, the network of acute stroke units that is being set up in Austria in a uniform way is of general interest. This nationwide network has been established in accordance to evidence-based recommendations and prespecified criteria for available resources. The location for such a unit follows a maximum of 90-min isochrones (transport time) to the hospital. The quality of the network is currently documented and the results are reported. A nationwide stroke registry was prospectively performed on 15 stroke units that were already functional in this network. The aim was to document the quality performance of Austrian stroke units, focusing on rapid admissions, ready availability of investigations and therapies performed. Outcome measures were Barthel scale, Rankin score and percentages of complications. Between August 1998 and December 2000, 2,313 patients with ischemic stroke or with primary intracerebral hemorrhage admitted to an Austrian stroke unit within 24 h after onset of symptoms were prospectively included. Forty-three percent of the patients had a moderate or severe stroke. Fifty-seven percent of all patients were admitted to the stroke unit within 3 h after the onset of symptoms. Twenty-seven percent of these patients were brought in by ambulance accompanied by an emergency physician. Two percent of patients were admitted by helicopter. Fifty-four percent of patients had their first brain imaging within 30 min after admission, another 26% within 3 h. Intravenous thrombolysis was performed in 4.1% of patients. The overall stroke-unit mortality was about 6.8% and mortality at 3 months was 12.9%. The outcome at 3 months showed a modified Rankin Scale score of 0 or 1 in 47% of patients, denoting none or mild impairment. This network of acute stroke units is highly efficient in terms of rapid admissions, short intrahospital delays, as well as rapid use of readily available investigations. Stroke units seem to be well accepted by the general public and the medical community because our data show that all types of strokes are treated in Austrian stroke units, including severe strokes. The total number of concurrently treated acute strokes in other institutions across Austria is not known and no formal comparison with other systems of hospitalized care was undertaken, therefore further research is necessary.     

糖尿病增大无症状心肌缺血发生率

用常规心电图及动态心电图监测的方法，分别观察３０例糖尿病人和３０例非糖尿病人无症状心肌缺血的发生率。发现无症状心肌缺血在糖尿病组显著高于非糖尿病组（Ｐ〈０．０５），部分糖尿病人有严重心肌缺血却无胸痛症状，可能与其植物神经功能损害引起痛阈提高、血中内啡肽水平增高导致痛觉敏感性下降有关，用动态心电图监测可提高无症状心肌缺血的检出率。     

论公费医疗大额死亡病例的资源消耗与医学目的

从北京市公费医疗大额消耗的９２例死亡病例的费用结构及住院城数的统计，提示由住院日地长，贵重卫生资源的盲目过量投入等而致。这与中国国情不符。因此，医学目的概念应更新，以及应如何正确对待死亡病例的医疗服务值得进行讨论。     

谈医院改革趋势

由于我国经济体制的转轨，经济增长方式的转换，正在带动、辐射、影响并制约着医院的建设和发展，医院改革将朝着以下趋势深化：一是在区域卫生发展规划指导下建设医院；二是开展社区服务是医院服务保障模式改革的大趋势；三是医院体制改革将寻求实现政府计划与市场调节的最佳结合；四是社会医疗保险制度改革将对医院带来重大影响；五是深化和完善补偿机制与价值体系改革仍是医院的重要课题；六是加大法规建设力度形成依法治院的新格局。     

截瘫患者血红蛋白水平的10年回顾性分析

通过对97例截瘫住院患者连续10年的Hb测定结果进行回顾性分组研究,结果表明,无并发症组10年中Hb分布较一致,其均值与正常人比较无显著性差异(P>0.05),但12.3％的病例Hb水平低于正常人下限;当截瘫并发泌尿系感染、尿毒症或难治性褥疮等病症时,则导致Hb水平的降低。提出Hb测定结果,可做为在整体水平上观察截瘫患者的治疗及康复效果的指标。     

葡萄糖酸锌糖浆的制备与含量测定方法

本文报告了葡萄糖酸锌糖浆的制法及用二甲橙指示剂法测定含量的方法。结果表明制法简便,含量测定方法准确。     

再论医院后勤服务社会化的可行性

目前，经济高速发展，服务体系和水准相对滞后，加上管理者素质的提高，现代管理技术的应用，以及后勤管理体制的改革，为医院后勤工作向社会分离提供了条件，也为推进医院后勤服务社会化提供了机遇。但规范卫生服务市场体系是后勤服务社会化的保障，故要建立：卫生物质流通、后勤人才流动、经济信息市场及卫生建设筹资机构。在推进后勤服务社会化时尚需解决：①支持条件；②实施集团联盟；③注意经营定位等问题。     

如何做好主任查房

主任查房是医疗质量的重要保证。主任要做好查房工作，必须：１．思想重视。２．做好查房准备，其中包括选好病人，做到“三看”。３。认真组织，包括查房按时开始，注重三个目的和三个程序，即病历报告，看病人，讨论严格的查房纪律．４查房后要严格检查，包括检查病历，医嘱，病人，了解查房中的意见的记录，执行的情况以及新出现的问题，从而保证主任查房的效果。     

更新护理观念 促进护理学科发展

随着新的医学模式的确立，护理学科的核心思想已从以疾病为中心的功能护理逐步发展为以病人为中心的整体护理阶段。其内涵：把病与病人，反生物学的病人与社会和心理学的人，把病人与其所处的环境，把病人从入院－出院－康复都作为一个整体，目前，我国护理工作主体仍处于以疾病为中心的护理思考指导下的功能制护理，局限了护理学科的发展，近年来，我国护理界引进了整体护理，并将其思想应用于临床护理工作中，进行了多方位探讨，旨