新旧《医院财务制度》衔接的体会

镇江是全国两轮医改的试点城市。文章从6个方面总结镇江四院率先执行新《医院财务制度》所取得的经验,为全国顺利接轨服务。     

刘嘉湘治疗癌性发热经验

刘嘉湘认为本病病机往往由于患者阴阳气血虚损,或气血痰湿郁滞,癌毒内蓄,蕴积化热而成。临床上要根据患者脉证辨析其病因病机以治病求本。临床以中晚期患者并发此证较多,此时患者多以正气亏虚为主要矛盾,尤以阴虚或者气阴两虚者多见。总体上从内伤发热辨治较为适合,临床应详辨病机,辨证论治,多从阴虚发热、气虚发热、气郁发热、湿郁发热、热毒炽盛5型论治,同时要明辨标本,退热抗癌。     

终末期肾病患者对护理专业性社会支持体验及期望的叙事研究

目的了解终末期肾病患者住院期间对护理人员提供社会支持的体验及需求,为护士实施全面有效的社会支持提供依据。方法采用立意抽样法选取14例终末期肾病住院患者为研究对象,采用半结构式访谈提纲进行深入访谈并按三维度叙事分析法进行转录和分析。结果患者住院期间感受到的护理专业性社会支持主要有:护理帮助支持、情感支持、沟通和信息支持;患者期望获得及时的评价支持,更多的情感支持,针对性、多样化的沟通信息支持。结论护理人员为终末期肾病患者提供专业性社会支持时应关注患者的期望,提升护理服务效能。     

Experience with NORPLANT® in Egypt

Experience with the contraceptive NORPLANT in Egypt dates back to early 1980 when the first multicentre trial was initiated. To date, more than 3000 women have received this contraceptive at the Assiut University Family Clinic alone. Analysis of the overall experience in this clinic has indicated a 5-year cumulative continuation rate of 51 and a pregnancy rate of 1.8 per 100 women.

Clinical pharmacology studies pertaining to the safety of NORPLANT in our community have indicated no deleterious effect on the lipid profile, liver functions and blood coagulation system. Two studies conducted in Egypt have indicated that the initiation of NORPLANT use shortly after delivery does not have any unfavourable effect on lactational performance, or on physical or psychomotor development of the breast-fed infants. This is particularly important in Arab and Moslem cultures where prolonged breast-feeding is emphasized.

A study utilizing focus-group discussion to assess users' attitudes to NORPLANT has indicated the need to improve the informational/educational package given in the service by emphasizing certain cultural considerations.

On the whole, this first implant method has proven to be safe and acceptable in Egypt, where there is a special need for long-term methods for contraception, particularly as sterilization is not socially acceptable.     

基于置信规则库的慢性萎缩性胃炎陈永灿辨证经验挖掘

[目的] 根据名老中医陈永灿(下称陈氏)诊治慢性萎缩性胃炎(chronic atrophic gastritis，CAG)的临床资料和诊疗方案，挖掘基于置信规则库(belief rule base，BRB)的CAG辨证经验。[方法] 对症候信息进行编码，将症候“有、无”分别赋值为“1、0”，以此建立CAG中医症候信息数据库。将编码后的信息作为CAG辅助诊断模型的输入特征，通过BRB挖掘症候信息与证素之间的关系，利用证据推理(evidence reasoning，ER)融合算法对输入特征进行激活处理并输出结果，最后根据输出的证素结果结合临床实际得到证型。[结果] 在收集到的572例CAG病例数据集上对CAG辅助诊断模型进行训练及测试，证实该模型准确率达到79.07%，优于传统的支持向量机(support vector machine，SVM)算法；由预测结果得到的证型主要为脾虚气滞型、寒热错杂型、肝胃郁热型。[结论] CAG辅助诊断模型在实际临床运用中具有可行性，表明人工智能技术有助于名老中医经验的传承和传播。     

Aiding risk information learning through simulated experience (ARISE): Using simulated outcomes to improve understanding of conditional probabilities in prenatal Down syndrome screening

ObjectiveTo determine whether the use of visually-presented simulated experiences to communicate statistical information can improve an individual’s understanding of conditional probabilities—specifically the positive predictive value (PPV) of prenatal screening tests for Down syndrome.MethodsIn Experiment 1 (N = 64) and Experiment 2 (N = 180) participants were asked to estimate the PPV of a prenatal screening test for Down syndrome based on either (1) explicit statistics regarding the prevalence of Down syndrome and the sensitivity and specificity of a prenatal screening test for Down syndrome, or (2) experiencing up to 5000 simulated test results over a short time.ResultsParticipants’ estimates of the PPV were more accurate when they had learned via simulated experiences (79% accuracy) compared with estimates based on explicitly described statistics (14%). Participants in the simulated experience condition also reported decreased interest in screening and decreased concern with a positive test result.ConclusionA visual paradigm presenting simulated experiences improves PPV estimates, compared to estimates derived from explicitly provided statistics, while also shifting attitudes away from screening.Practice implicationsThe use of simulated experiences may prove to be simple but powerful tool to communicate complex statistical information to patients in medical decision making situations.     

侯春光主任中医师运用经方治疗小儿情志类疾病经验

侯春光主任中医师善于应用经方治疗小儿情志类疾病,侯老师临证强调审察病机,随证施治,方证对应,附小儿抽动障碍、精神性烦渴症、睡眠障碍、擦腿综合征4则验案,以资验证。     

Being in transit and in transition The experience of time at the place,when living with severe incurable disease ‐ a phenomenological study

The aim of this study is to describe the experience of time as it presents itself at the place being situated when living with severe incurable disease and receiving palliative care. The empirical data consist of 26 open‐ended interviews with 23 patients receiving palliative care at home, at a palliative day care, in a palliative bed unit in hospital or in a nursing home in Norway. A common meaning of a shifting space for living emerged from the analysis and was revealed through three different aspects: (i) Transition from a predictable to an unpredictable time: To live with severe incurable disease marks a transition to a changed life involving an ongoing weakened and altered body with bothersome symptoms making experience of time different and unpredictable. (ii) Transition between a safe and unsafe time: When time is unpredictable, feeling safe is revealed as essential to how time is experienced at the place being situated. (iii) To be in transition from a homely to a homeless existence: In a time of increased bodily weakness, unpredictable ailments and displacements, the sense of belonging to the place is revealed as significant to the experience of time. Not knowing where to be in a time of change is like an existential cry of distress where the foothold in existence is lost. The findings are discussed and interpreted as an embodied experience originating from the passage of time continually affecting life sometimes so fundamentally that it marks a transition to a changed space of life that is reflected in the experience of time.     

17例胰岛细胞瘤患者的整体护理

目的探讨对胰岛细胞瘤患者进行整体护理的作用。方法收集新疆医科大学第一附属医院消化血管外科中心胰腺外科2006年1月—2011年4月收治的17例胰岛细胞瘤患者的临床资料,分别从诊断、术前、术后、引流管护理等方面进行分析。结果通过对患者进行针对性的整体护理,包括诊断方面的护理、安全教育、心理护理、血糖监测等特殊护理措施,17例胰岛细胞瘤患者均痊愈出院。结论对胰岛细胞瘤进行整体护理有利于降低患者意外和并发症的发生率。