腹部多脏器损伤的救治

报告了腹部多脏器损伤１５８例的救治情况。致伤因素中交通事故和高空坠落伤占６７．０％，抢救存活１３２例，存活率８３．５％；死亡２６例，病死率１６．５％。作者分析了病死率与致伤暴力强、现场急救延误、就诊时间及受伤的脏器数的密切关系。作者认为院前救护、院内正确诊断、及时治疗、果断手术是抢救成功的重要环节；术中应仔细探查、止血，术后应注意防治多脏器衰竭的发生。     

临床医师处方抗菌药物前需思考的几个问题

2001年和2003年卫生部全国医院感染监测网调查结果均显示,医院横断面抗菌药物的平均使用率在54%以上,联合用药较为普遍.国内监测结果也表明细菌耐药性日益严重.针对上述问题,提出临床医师在面对病人开处方抗菌药物之前,须思考的问题:是否有使用抗菌药物的适用症?是否了解选用的抗菌药物,选用何种药物?是否有联合使用抗菌药物的指征?采用何种给药途径、给药剂量、给药时间?是否属于特殊宿主或针对特殊病原体的感染使用抗菌药物?密切观察抗菌药物治疗是否有效?针对局部感染是否需要穿刺或外科手术引流病灶?是否已出现抗菌药物的不良反应?是否存在药物相互作用?是否存在不合理使用抗菌药物情况?并且针对每个问题提出了建议.     

The hospital as an enterprise: management strategies

After introducing the context in which health systems exist in developing as well as in industrialized countries, the author describes the role that hospitals are expected to play as 'enterprises'. The rationale behind such a role is explored and the experience so far available discussed. Evidence from several developing countries suggests caution and tends to discourage radical and indiscriminate introduction of market‐oriented reforms, which international donors seem to be spearheading in Africa's health systems. It is likely, however, that a limited, gradual introduction of selected elements of these reforms (such as some aspects of contracting out, managerial decentralization, the split between purchasing and providing functions) may find its place and eventually have a positive impact on the performance of the health systems. But the 'mystique of markets' must not be allowed to deprive public hospitals of the sense of social utility and of the caring ethos which are essential requisites of a meaningful and effective public health system.     

我院平均住院日状况的调查分析

目的：通过对医院平均住院日情况的简要分析，以探索缩短平均住院日的有效途径。方法：从统计室提取数据，与病案核对，计算相对指标。结果：我院的平均住院日呈下降趋势，但与卫生部颁布的标准还有差距，中医各科和康复科科别的平均住院日更长一些。结论：我院的平均住院日还有潜力可挖，术前住院日多数病种都较长，应在医疗质量和护理质量上狠下功夫，加强科室间的协作，降低平均住院日，减少无效住院日。     

对《2007年医院管理年活动方案》的认识与思考

针对新出台的2007年医院管理年活动方案，文章归纳了2007年管理年活动的主要内容和重点要求，并针对当前我国医院实际，紧密结合《医院管理评价指南（试行）》，从理念、质量、服务和管理4个方面着重分析了医院管理者应当关注的问题，以更好地贯彻落实管理年的有关精神和要求，科学制定出适合各级医院特点的更为具体和更具操作性的实施细则，促进我国公立医院管理水平不断提升。     

Serum digoxin and beta-methyldigoxin in elderly patients on hospital admission: correlation with home compliance and clinical variables

Summary Serum digoxin and beta-methyldigoxin (BMD) were measured in 165 elderly patients (age >60 years) admitted to hospital, of whom 109 had been treated at home with digoxin and 56 with BMD.The mean BMD level was significantly lower than that of digoxin (1.1 vs. 1.4 ng/ml). Creatinine clearance and daily dose were the variables most strongly associated with digoxin level, and the prescribed dose and serum albumin were the best predictors of the BMD concentration. Compliance was assessed by a compliance index (CI), namely the ratio of the measured glycoside concentration, corrected for creatinine clearance, over the expected steady-state dose, calculated from a hospitalized reference group. Compliant individuals in both treatment groups, i.e. those with a CI > the median value, were characterized by a lower daily dose and dosage frequency.Toxicity, whether clinical or electrocardiographic, was present in 9% of the patients and was associated only with a significantly higher mean serum level of the drug.     

中医医院内部审核的策划与实施

通过对所在中医医院ISO9001族质量管理体系实施过程中历次内部审核的总结,探索既符合中医医院实际工作又满足标准要求的内部审核模式,形成科学化的内审流程。     

The contribution of nurses to children's well-being in hospital: a selective review of the literature

• ? The literature demonstrating the effects of child hospitalization is reviewed prior to a review of selected aspects of a child's hospital experience.
• ? Despite the clearly demonstrated benefit of preparatory work with children and their parents, it appears that British nurses have not widely incorporated well-researched techniques into their practice.
• ? Hospitalization appears to be a lonely experience both for children and their parents.
• ? Pain management is also reviewed and it is clear that optimal pain relief has yet to be attained.

     

An assessment of PKI and networked electronic patient record system: lessons learned from real patient data exchange at the platform of OCHIS (Osaka Community Healthcare Information System)

To enhance medical cooperation between the hospitals and clinics around Osaka local area, the healthcare network system, named Osaka Community Healthcare Information System (OCHIS), was established with support of a supplementary budget from the Japanese government in fiscal year 2002. Although the system has been based on healthcare public key infrastructure (PKI), there remain security issues to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority in contract with the Japanese Medical Information Systems Organization (MEDIS) in 2003. This paper describes the experimental design and the results of the study concerning message security.