针对居民的医疗保健要求探索全科医疗的开展

通过对宜川街道赵园二委１７００余户居民进行家庭健康问卷调查,结果大约有３０％居民愿意接受全科医疗服务模式,４０％居民需要上门服务,当遇到常见病时首选一级医院医生为对象占５０％,７０％居民认为上门服务应该是有偿的。为此,笔者认为基层医院应在社区卫生服务中大力地探索,只要有市场就应去占领,而且是一级医院赖以生存的社区,应以全科医疗服务模式去改变医患之间关系,把预防保健、医疗、康复、健康教育融为一体,使     

试析大型综合医院在社区医疗服务中的作用

根据国家城市卫生服务体系改革的原则及对基层医院和大医院的功能定位,分析大型综合医院在社区医疗服务中的作用。指出大型综合医院应加强与城市基层医院的联系,建立全科医生培训基地,为社区医疗服务输送适用人才,建立切实可行的转诊制度,成为社区医疗服务的坚强后盾,提高社区医疗服务的质量和水平,促进社区医疗服务的发展。     

Orbital infarction and melting in a patient with systemic lupus erythematosus

OBJECTIVE: To present a patient with systemic lupus erythematosus who developed infarction and melting of the orbit secondary to her systemic disease. DESIGN: A case report. PARTICIPANT: A 61-year-old white woman with a 5-year history of systemic lupus erythematosus. METHODS: The patient presented with left orbital pain, limitation of extraocular movements, and a fistula from the ethmoid sinus to the upper eyelid. A detailed examination with computerized tomography, ultrasound, and a comprehensive medical evaluation with laboratory testing was performed. Histopathologic analysis with special stains of the orbital tissues was also performed. RESULTS: Histopathologic examination of the biopsy specimens revealed the features of an inflammatory process involving the orbit, similar to a panniculitis. These include a lymphocytic reaction with a predominance of plasma cells, vasculitis with occlusion, and thickening of the vessel walls, necrosis, and hyalinization of fat. CONCLUSION: This is a unique case in which infarction and melting of the entire orbital structures occurred in the presence of systemic lupus erythematosus. The underlying disease process is a lupus-related panniculitis. The authors stress that this is a very rare entity and that other diseases should be ruled out before entertaining this diagnosis.     

Radiation exposure: a new risk factor for idiopathic perifoveal telangiectasis

Objective

To examine the association between previous radiation exposure and idiopathic perifoveal telangiectasis (IPT).

Effects of general anaesthetic procedures on mitochondrial function of human skeletal muscle

Background: General anaesthetics inhibit mitochondrial function in animal models. However, very few studies have been performed in humans, and the results have not been conclusive. Methods: We prospectively studied the oxygen consumption and the individual enzyme activity of each complex of the mitochondrial respiratory chain of skeletal muscle mitochondria in 54 healthy individuals who underwent general anaesthesia for orthopaedic surgery. The control group (n = 54) was made up of individuals submitted to the same orthopaedic procedure under regional anaesthesia (n = 31), and patients who underwent muscle biopsies for diagnostic purposes by local anaesthesia (n = 23). Results: We found a significant decrease in the oxidation of glutamate (−36%), succinate (−25%) and ascorbate (−29%) in the general anaesthetic group compared with the controls (P < 0.001 for all substrates). The level of such inhibition was similar for volatile anaesthetics with strong (halothane) or weak (isoflurane) negative inotropic effect. By contrast, the enzymatic activity of all individual complexes and the coupling of oxidative phosphorylation did not differ between the two groups. Conclusion: We conclude that during general anaesthetic procedures there is an extensive inhibition of substrate oxidation in human muscle mitochondria, and that it is not caused by a direct effect on complexes of the mitochondrial respiratory chain or through uncoupling oxidative phosphorylation. Received: 27 July 1998 / Accepted in revised form: 27 October 1998     

An action research investigation into the feasibility of experienced registered sick children's nurses (RSCNs) becoming children's emergency nurse practitioners (ENPs)

• ? Emergency nurse practitioners (ENPs) formally developed in accident and emergency (A & E) departments as a direct response to waiting times for the walking wounded, the need to reduce junior doctors hours and changes in nursing practice.
• ? ENPs existed informally for many years in minor injuries units and specialist ophthalmic departments.
• ? This study aimed to examine whether or not the role of ENP could be applied to the specialist service of a paediatric casualty department.
• ? The results showed that 3% of patients could be seen and treated to conclusion by a children's ENP, and some patients could have their care accelerated by a children's ENP.
• ? The introduction of children's ENPs would have an impact on waiting times, junior doctors work-load and the quality of patient care.

     

The characteristics of suicide attempters admitted to the main general hospital in Fiji Islands

Objective: To study the characteristics of suicide attempters attending the main general hospital in Fiji Islands. Method: Consecutive suicide attempters were clinically evaluated, and their sociodemographic and clinical characteristics were compared with those of other patients seen in the psychiatric service between January 15, 1999 and January 14, 2000. Results: Thirty-nine suicide attempters were seen, representing 36.8% of all the cases referred to the psychiatric service. The prevalence of attempted suicide in the Greater Suva Area was 34.8 per 100,000. Majority (56.4%) were young (16–25 years), Indians (59%), female (61.5%), students (41%), never married (74.4%) and of Hindi faith (48.7%). The commonly used methods were ingestion of drugs and pesticides. The intention to die was present in 20 (51.3%) of the population. Social problems and/or psychiatric comorbidity were present in over 60% of cases. Suicide attempters were significantly younger, more of single persons (P<.0001), and fewer were in employment (P<.001) than nonsuicidal cases seen. The difference was not significant when the two groups were compared regarding gender, race or religion. Conclusions: Young people attempt suicide in disturbed psychosocial milieu, using available poisoning methods with strong desire to die. Apparently, high proportion of female Indians in this group reflects high rate of service utilization by them. Unemployment is an insignificant predisposing factor.     

Does smoking cessation improve mental health?

There is a possibility that cessation of smoking improves mental health, but there are no studies that have demonstrated this. A cohort study was performed for 1 year in 18 males who spontaneously stopped smoking (cessation group) and 173 who continued to smoke (smoking group). The mental health state was evaluated using the Japanese version of the 30-item General Health Questionnaire (GHQ-30) before the cessation of smoking and 6 months and 1 year after smoking cessation. Changes in the GHQ score were compared between the cessation and smoking groups. In order to control the effects of confounding factors, multiple regression analyses were performed using the GHQ score after 6 months and 1 year as dependent variables. The GHQ score in the cessation group significantly decreased 6 months and 1 year after smoking cessation (P < 0.04 and 0.01, respectively, by paired t-test). In the smoking group, the GHQ score slightly decreased. Repeated measure analysis of variance revealed that the decrease in the GHQ score in the cessation group was significantly larger than in the smoking group. Multiple regression analysis revealed significant effects of smoking cessation on mental health after controlling for other confounding factors. It can be concluded that smoking cessation may improve mental health.