Modell eines computergestützten qualitätssicherungssystems in der verbrennungsintensivtherapie

Zusammenfassung Ausgehend von Überlegungen für ein angemessenes Qualitätssicherungssystem im intensiv-medizinischen Bereich werden die Voraussetzungen für ein ganzheitliches Qualitätsmanagementsystem im Krankenhaus entworfen. Die Grundlage für ein dynamisches Qualitätssicherungssystem ist auf der dokumentatorischen Ebene eine umfassende Datenbasis, die auf einer zeitlich und datentechnisch unbegrenzten Patientenakte basiert. Die notwendige Hard- und Softwarestruktur wird durch die konsequente Anwendung einer Client-Server-Architektur gewährleistet. Die ständige Überprüfung der bestehenden Qualitätsziele in einem ökonomischen Regelkreis benötigt ein System mit flexiblen Abfragemechanismen. Dieser informatorische Datenzugriff auf jeder Hierarchieebene der Krankenhausstruktur wird durch das Konzept des Data-Warehouse ermöglicht, das als Datenbanksystem mit subjektorientierten, integrierten, zeitvariablen und beständigen Informationen konzipiert ist.

---

A computer-assisted quality-assurance model for burn intensive care applications

The prerequisites for an integrated quality management system for hospitals were developed as a result of considerations regarding the necessity of an appropriate quality-assurance system for the intensive care sector. The basis for a dynamic quality-assurance system on the documentational level is a comprehensive data base containing patient files unlimited in terms of time and data technology. The necessary hardware and software structure will be provided by consistent application of a client-server architecture. Permanent surveillance of existing quality objectives within the scope of an economic close-loop system requires a system with flexible query mechanisms. Informational data access from all hierarchical level within the hospital organization is facilitated by the data warehouse concept, a data base system with subject-oriented, integrated, time-variable, and persistent data.

     

Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency—diagnosis,plasma carnitine fractions and management in a further patient

Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase (LCHAD), the third enzyme of the mitochondrial -oxidation pathway, carries out the dehydrogenation of 3-hydroxyacyl-CoA compounds of 12–18 carbon length. To date only nine cases of LCHAD deficiency have been documented. We report a further patient who as a neonate developed non-specific gastro-intestinal symptoms and at 5 months of age cardiomyopathy, recurrent hypoketotic hypoglycaemia and gross alterations of plasma carnitine fractions. Dietary management with medium chain triglycerides led rapidly to clinical improvement. There was a close correlation between the clinical condition, plasma carnitine fractions and cardiac function. At 2 years of age she is developing normally.     

Double β-lactam regimen compared to an aminoglycoside/β-lactam regimen as empiric antibiotic therapy for febrile granulocytopenic cancer patients

In a prospective, randomized trial, 205 febrile episodes in granulocytopenic cancer patients were treated with ceftazidime with or without tobramycin (C±T), both agents being administered only if the initial granulocyte count was below 200/l, or ceftazidime plus piperacillin (C+P). The overall response rate was 71% (39 of 60 for C±T and 45 of 58 for C+P). Logistic regression analyses documented no evidence of a significant difference between the two regimens in overall treatment effect after accounting for the linear effects of potentially important variables, such as infection type and granulocyte count. Although the response rates for the subgroup of patients with bacteremias was better with the C+P regimen (P=0.06), there was no difference in response for patients with bacteremia and profound (<100/gml) sustained granulocytopenia. The double -lactam combination demonstrated in vitro synergism in 73%; antagonism was not seen. Both regimens produced execllent serum bactericidal levels (C±T geometric mean peak 1:170; C+P peak 1:137) against gram-negative but not gram-positive pathogens (1:4; 1:7 respectively) that had caused bacteremia. Emergence of resistance and significant coagulopathy and/or bleeding did not occur during therapy. Antibiotic-related nephrotoxicity was noted in 7 of 95 trials in the C+P and in 6 of 89 trials in the C±T group (P=0.19). The incidence of secondary infections in patients with profound (<100/l) sustained granulocytopenia was lower in the C±T group (P=0.04). Alimentary canal anaerobic flora preservation with C±T, and suppression with C+P, was demonstrated. These results suggest that these regimens are of similar effectiveness and neigher is associated with major toxicity.     

Management of midgut volvulus with extensive necrosis by “patch,drain, and wait” in early infancy and childhood

Midgut volvulus with extensive intestinal necrosis in the newborn period and in early infancy and childhood presents a difficult therapeutic dilemma of how to control sepsis and preserve a maximum and life-sustaining amount of large and small intestine. This problem is similar to that faced in cases of necrotizing enterocolitis with extensive intestinal ischemia and necrosis. The successful use of the patch, drain, and wait approach in necrotizing enterocolitis suggested its potential usefulness in midgut volvulus with similarly extensive necrosis in early life [7]. The basic principles of this approach involve maximum bowel salvage by avoidance of both resection and enterostomy; extensive bilateral Penrose drainage of the peritoneal cavity to provide an exit for sepsis and debris for peritonitis control; and de facto enterostomies for potential enteric fistula capture, gastrostomy for upper gastrointestinal tract venting and decompression, and Broviac catheter placement for long-term hyperalimentation. Three cases involving the successful use of this approach are reported.     

Anesthetic management of a patient with Hallermann-Streiff syndrome

Key words  airway management - difficult intubation - Hallermann-Streiff syndrome     

特区经济学的理论前提

实行特殊政策和实施特殊管理体制是世界经济特区共有的基本特征。正是这两个基本特征构成了特区经济学的两个理论前提。对经济特区实行特殊政策和实施特殊管理体制进行理论分析 ,目的在于为构筑特区经济学的理论体系作理论上的准备     

Vascular compression of the airway: Indications for and results of surgical management

Vascular compression of the airway is a significant cause of respiratory compromise in children. While the indications for surgical repair are sometimes life threatening, they can also be subtle. This retrospective study examines 45 surgical cases of tracheobronchial compromise secondary to vascular compression at a large children's hospital between July 1983 and February 1996. A total of 34 were diagnosed with innominate artery compression, ten with a double aortic arch and one with an anomalous right subclavian artery. The 45 patients, 25 male and 20 female, ranged in age from 12 days to 11 years at surgery (average 13 months). A total of 21 (47%) presented with proven or suspected episodes of cyanosis or apnea. All 45 patients had evidence of vascular compression during microlaryngoscopy and bronchoscopy. The diagnosis was confirmed by magnetic resonance imaging (MRI) in 23/45 (51%), barium swallow in 22/45 (49%) and aortogram in 3/45 (7%). There was one death. One patient had a tracheotomy before surgery and continues to require it after surgery. Complete resolution of symptoms was achieved in 39/45 (87%) with five requiring more than one operation before their symptoms resolved completely. A total of four patients experienced a recurrence of symptoms within a variable length of time after surgery. Surgical indications and treatment alternatives will be discussed.     

从白衣战士到医药教育家--简记国家卫生部原医教局局长朱潮

简要回顾了朱潮早期的革命生涯和战斗经历,着重介绍了他在全国解放后的数十年来从事全国医药教育管理领导工作上所取得的主要业绩和重要贡献。同时,还对他的工作精神、思想作风和为人处事等作了简述。     

A literature review of the prehospital use of neuromuscular blocking agents by air medical personnel to facilitate endotracheal intubation

Air medical personnel in the United States have used neuromuscular blocking agents to facilitate endotracheal intubation in the field for more than a decade. This literature review examines 15 studies to investigate their experience and explores the following specific areas: the intubation success rate in patients who did or did not receive these agents, the intubation success rate of air medical personnel before and after they incorporated these agents into their practice, the neuromuscular blocking agents and adjunct medications used by air medical personnel, and the disposition of patients who could not be intubated after an agent was given. The data suggest that, overall, air medical personnel use these agents safely and effectively. Suggestions are offered for future studies, including examining ground time when agents are used to facilitate intubation, complications of their use in this setting, and the use of simulators to train personnel in the administration of these medications.     

衡阳地区不孕不育者支原体感染现状

目的　了解湖南省衡阳地区不孕不育者解脲脲原体 (Uu)、人型支原体 (Mh)感染现状。　方法　设计Uu、Mh特异性引物 ,用PCR扩增 13 7例不孕不育者标本 ,统计分析Uu、Mh感染情况。　结果　在 13 7例不孕不育者中 ,Uu阳性 5 1例 ( 3 7.2 % ) ,Mh阳性 3 6例 ( 2 6.3 % )。　结论　不孕不育者的Uu与Mh感染率明显高于正常生育者 ( χ2 =8.70 ,P <0 .0 5 )。