氯噻吨与氯氮平治疗精神分裂症的效果比较

目的评价氯噻吨治疗精神分裂症的临床效果和副作用。②方法采用双盲法,将符合ＣＣＭＤ－２－Ｒ精神分裂症诊断标准的４１例病人随机分为氯噻吨组和氯氮平组,治疗４２ｄ,用ＢＰＲＳ,Ｓｉｍｐｔｏｎ,ＴＥＳＳ量表评价临床疗效及副作用。③结果氯噻吨与氯氮平总体疗效相似,氯噻吨对情感平淡、紧张焦虑、运动阻滞及敌对性等症状见效较快。二者的副作用均不明显,氯噻吨以锥体外系反应为主,氯氮平则以心动过速、流涎及粒细胞缺乏为主。④结论氯噻吨能有效地控制各种精神病症状,锥体外系反应重于氯氮平     

Histological characteristics of sternoclavicular beta 2-microglobulin amyloidosis and clues for its histogenesis

BACKGROUND: The pathogenesis of beta 2-microglobulin amyloidosis (A beta 2m) has yet to be fully elucidated. METHODS: We describe the distribution and extent of A beta 2m deposition and macrophagic infiltration in cartilage, capsule, and synovium of sternoclavicular joints obtained postmortem from 54 patients after 3 to 244 (median 46) months of dialysis. Twenty-four nonuremic patients served as a control group. The diagnosis of amyloidosis (A) rested on a positive Congo Red staining (typical birefringence) and that of A beta 2m on positive immunostaining of the A deposits with a monoclonal anti-beta 2m antibody. The size of A deposits was measured. RESULTS: A beta 2m was detected in 32 (59%), and non-beta 2m amyloid (Anon beta 2m) was detected in an additional 8 (15%) of the 54 dialyzed patients. A beta 2m deposits were present in the cartilage of all A beta 2m (+) patients (100%). They were localized solely in the cartilage in 27% of the cases, either as a thin patchy layer or as a continuous thicker layer (identified as stage I). A beta 2m was additionally present in the capsule and/or synovium without macrophages in 27% of the cases (identified as stage II). The correlation between the size of cartilaginous deposits and dialysis duration (P = 0.02) as well as with the prevalence (P = 0.03) and size of capsular deposits (P = 0.02) suggests that stage II is a later stage of A deposition. Clusters of macrophages were detected around capsular and synovial amyloid deposits in 46% of the cases (identified as stage III). The longer duration of dialysis in those with stage III as well as the relationship between the size of the A beta 2m deposits and the prevalence of macrophagic infiltration suggests that stage III is the last stage of A beta 2m deposition. Marginal bone erosions were observed in 9 out of 12 patients with stage III deposits. Their size was correlated with that of cartilaginous deposits (P = 0.01). Among the 24 control patients, Anon beta 2m was detected in 12 patients (cartilage 100%, capsule 8%, synovium 30%). CONCLUSIONS: The earliest stage of A beta 2m deposition occurs in the cartilage. A beta 2m subsequently extends to capsule and synovium. These two first stages do not require macrophage infiltration. Macrophages are eventually recruited around larger synovial or capsular deposits in the final stage. Marginal bone erosions develop in this late stage.     

谈医务人员的医德导向问题

随着历史的变革,人们的道德取向发生了变化。面对商品经济大潮的冲击,医务工作者应树立什么样的医德观,塑造什么样的医护形象,对此,认为一是应加强医德导向,二是增强医德意识,三是坚持医德评价,以提高遵守社会主义医德规律的自觉性     

对我国卫生资源配置和使用几个深层次问题的思索

我国卫生资源既贫乏又浪费已成为业内人士的共识,但又是一个困扰我国卫生事业发展的实际而又紧迫的问题,这个问题解决不好,就会人为无谓地降低我国卫生事业的公益性和福利性的“含金量”。,作者认为：要使我国有限的生效充分而合理利用,就要立足于我国的基本国情,在确保市场的微观调节的前提下,必须运用政府的宏观调控行为和政策指导手段,尽可能为管理体制的改革扫描障碍和给予法制保障。     

乳腺癌（改良）根治术住院流程与平均住院日

参照业务流程重组的理论与方法研究了乳腺癌根治术的住院流程。结果显示,该病种住院流程存在的主要问题有：诊疗服务的随意性过大,等待诊疗服务的时间过长,患者入院标准的掌握过松,对该病种往院注程进行重组,将在不影响医疗服务质量的前提下有效缩短平均住院日。     

计算机2000年问题对医院的影响及对策

计算机２０００年问题对医院最明显的影响是计算机系统届时交病的信息丢失,财务系统不能正常工作,网络瘫痪等。此外,由于嵌入式问题将造成医疗设备运行混乱,从而危及病人的生命和健康。医院应采取的对策是：认知计算机２０００年问题,产品清查,确定问题范围,对问题进行评估,制定应急计划,制定解决方案,具有体实施和检验验证。     

强化动态管理 确保医疗质量稳步提高

医疗质量是医院管理永恒的主题。医疗质量直接关系到病人的生命安危,关系到医院的生存与发展。我院实行动态医疗质量管理,提出突出“三抓”,从增强全体医务人员的医疗质量意识入手,逐步完善制度,建立以“四级检查法”为主要手段的质量考核体系,确保医疗质量称稳步提高。     

浅谈新时期医院窗口的文明建设

医疗保险制度的建立和卫生监督执法等配套改革措施的出台,表明我国卫生改革已迈入一个全新的发展时期。医院的窗口服务面临一些新情况,新问题：病人方便就医的意识逐渐增强;求医过程中,病人自我保护意识增强;居民对健康的理解不再局限于没有疾病,阶段性的身心健康检查和体整需要逐渐增大。     

儿童疾病单病种质量管理体系的研究

在总结分析武汉地区儿童疾病结构用度春诊疗规律的基础上,运用现代医院全面质量管理的理论,建立了以儿科常见病、多发 为主,兼纳部分专科疾病的２４个儿童疾病单病种质量控制标准及规范的组织管理和考核评价第统。形成以增强病种质量控制能力为核心的儿童疾病单病种质量管理体系。该管理体系运用后,医院医疗质量管理水平和社会、经济效益得到了同步提高,并了医务人员的医疗行为,使医院步入优质、低砂和高效的运营轨道。     

浅谈医院门诊部工作的主要特点与基本要求

翔实地阐述了门诊工作的特点：服务对象与病种的复杂性及心态的多样性;医疗质量监控缺乏系统必 ;病人就诊高峰的相对集中性;门诊诊治工作的时效性与风险性;急诊抢救工作的突发性与应性;门诊业务工作的多元性、专业性和服务保障工作的整体性;门诊部管理职能的双重性,同时提出了相应的基本要求。