Palliative Care Consultation Service and Palliative Care Unit: Why Do We Need Both?

Background.

Palliative care (PC) infrastructure has developed differently around the globe. Whereas some institutions consider the palliative care unit (PCU) a valuable component, others report that the sole provision of a state-of-the art palliative care consultation service (PCCS) suffices to adequately care for the severely ill and dying.

Objective.

To aid institutional planning, this study aimed at gathering patient data to distinguish assignments of a concomitantly run PCU and PCCS at a large hospital and academic medical center.

Methods.

Demographics, Eastern Cooperative Oncology Group performance status, symptom/problem burden, discharge modality, and team satisfaction with care for all 601 PCU and 851 PCCS patients treated in 2009 and 2010 were retrospectively analyzed.

Results.

Patients admitted to the PCU versus those consulted by the PCCS: (a) had a significantly worse performance status (odds ratio [OR], 1.48); (b) were significantly more likely to suffer from severe symptoms and psychosocial problems (OR, 2.05), in particular concerning physical suffering and complexity of care; and (c) were significantly much more likely to die during hospital stay (OR, 11.03). For patients who were dying or in other challenging clinical situations (suffering from various severe symptoms), self-rated team satisfaction was significantly higher for the PCU than the PCCS.

Conclusion.

This study presents a direct comparison between patients in a PCU and a PCCS. Results strongly support the hypothesis that the coexistence of both institutions in one hospital contributes to the goal of ensuring optimal high-quality PC for patients in complex and challenging clinical situations.     

阜外心血管病医院科研平台的建设和运行效果

中国医学科学院阜外心血管病医院于2004年整合全院资源建设了三个科研平台:中心实验室、病理生理中心、动物中心,旨在为全院的科研人员和研究生提供仪器设备的使用、技术培训、实验指导及动物实验等.在介绍三个科研平台的运行情况的基础上,分析了科研平台建成后对人才培养、医院科研发展的推动作用.     

病例组合的统计分类——医疗卫生管理的一项基础研究

目的：论证病例组合的统计分类是医疗卫生管理的一项基础研究。方法：从病例组合的定义、应用范围、历史回顾到具体的统计方法，论述进行该项研究的重要意义。结果：４万病例的ＡＩＤ分类预实验，形成了１３２个病例组合。结论：病例组合研究必要且可行     

麻醉诱导期罗库溴胺与阿曲库胺不同注射速度对血流动力学的影响

目的观察腹腔镜胆囊切除手术麻醉诱导期不同注射速度的罗库溴胺与阿曲库胺对血流动力学的影响。方法57例择期进行腹腔镜胆囊切除手术的患者随机分为R1、R2、A1、A2四组。监测并记录诱导前,肌松药注射后1、3min及手术结束时的平均动脉压（MBP）、心率（HR）,同时评估插管条件。结果A,组中,肌松药注射后1、3min的MBP比诱导前有明显下降,HR明显增快。其他各组MBP、HR未观察到明显变化。各组手术结束时的MBP、HR与诱导前比较,差异无统计学意义。结论麻醉诱导时快速注射罗库溴胺与阿曲库胺,阿曲库胺明显影响血流动力学。     

鼻内窥镜下手术与自唇龈沟切开剥离术治疗鼻前庭囊肿的疗效对比

目的：探究鼻内窥镜下手术与自唇龈沟切开剥离术治疗鼻前庭囊肿的临床疗效。方法择取我院2009年1月至2014年12月收治的鼻前庭囊肿患者进行抽样,选取48例患者随机分成两组,对照组推行传统自唇龈沟鼻前庭囊肿摘除术,实验组于鼻内窥镜引导下经鼻前庭径路切除囊肿,对比两组临床治疗效果。结果实验组平均手术时间（ min：20．52±5．23 vs 47．43±20．65）、平均出血量（ ml：11．56±3．65 vs 62．23±40．75）及伤口平均愈合时间（ d：3．96±0．53 vs 5．94±0．57）均低于对照组,且术后伤口疼痛程度（轻／中／重度：85．71％／14．29％／0 vs 41．67％／45．83％／12．50％）、面部肿胀程度（轻／中／重度：79．17％／20．83％／0 vs 41．67％／41．67％／16．66％）改善情况及面部麻木酸胀发生率（0 vs 16．66％）均优于对照组,差异具有显著统计学意义（P＜0．05）。结论鼻内窥镜下手术治疗鼻前庭囊肿临床疗效确切,安全指数高,临床上应引起足够重视。     

海事立法与相关涉海立法的边界及协调研究

海事管理涉及面广,与一些涉海管理部门存在管理交叉。海事立法是一个系统工程,进一步明晰海事立法和其他涉海立法的边界,深入分析海事立法与其他涉海立法之间的交叉领域,着力加强海事立法与其他涉海立法的协调,对于加强海事立法和海事管理具有重要意义,有必要对我国海事立法与相关涉海立法的边界和协调加以深入研究。     

试论医学院校“以学生为本”的管理实践

本文从行政管理的角度,探讨了北京大学医学部“以学生为本”的管理实践,具体涉及了四个方面的内容:为学生配备学业精深、素质优良的师资队伍;为学生营造有利于个人潜能发展的学习实践平台;为学生提供高水平的服务型管理;为学生提供人性化的公共硬件设施.     

术中按需喷洒与术前口服二甲硅油在肠镜检查中的作用研究

〔摘 要〕 目的：探讨术中按需喷洒与术前口服二甲硅油在肠镜检查中的应用效果。 方法：选取 2020 年 1 月至 2021 年6 月于萍乡市人民医院行肠镜检查的无明显症状患者 90 例,按随机数字表法分为两组,对照组和观察组各 45 例。两组均使用聚乙二醇电解质散清洁肠道,对照组术前口服二甲硅油,观察组术中按需喷洒二甲硅油。比较两组患者肠道清洁分级、气泡分级、二甲硅油用量、肠镜检查操作时间、结肠息肉检出率及患者满意度。 结果：两组患者肠道清洁分级相比,差异无统计学意义（P ＞ 0.05）。观察组患者气泡分级 1 级率为 80.00 %,高于对照组的 62.22 %,差异具有统计学意义（P ＜ 0.05）。观察组患者二甲硅油用量为（14.58 ± 2.01）mL,少于对照组的（22.35 ± 2.65）mL,进、退镜时间分别为（8.89 ± 1.14）min、（8.33 ± 1.08）min,短于对照组的（9.76 ± 1.27）min、（10.27 ± 2.04）min,差异有统计学意义（P ＜ 0.05）。观察组患者结肠息肉检出率、患者满意度为 17.78 %、97.78 %,高于对照组的 4.44 %、82.22 %,差异具有统计学意义（P ＜ 0.05）。 结论：术中按需喷洒二甲硅油在肠镜检查中效果更佳,可减少二甲硅油用量,提高视野清晰度,缩短肠镜检查操作时间,并利于结肠息肉的检出,提高患者满意度。     

Environmental risk factors in outpatient recovery from malnutrition

Studies evaluating Nutrition Rehabilitation Centres indicate that they hold several advantages over alternative methods of care for malnourished children. Nonetheless, an important minority of outpatient cases attending such centres does not make adequate progress, and this has been attributed to shortcomings in their home environment.

A survey in Uganda showed that different features of the home environment affected progress for urban and rural outpatients. The findings also suggest that for both groups the child's home situation can indeed be used to explain his progress, with eight variables explaining around 70 percent of the variance in recovery scores. These variables describe the size of the child's family, the level of food resources available, and the amount of help his mother can martial in caring for him.

Information on these predictors of recovery could be recorded in the case notes on the child's first attendance at the clinic, thereby providing an initial estimate of the risk that he will not respond adequately to the outpatient treatment, requiring, instead, more intensive care.     

Implementing an interprofessional first-year teamwork project: some key reflections

Abstract

Implementing an interprofessional teamwork project for first-year students presents pedagogical and practical challenges. While transferable skills and attributes are important, engagement of students with limited professional experience in teamwork depends on relevance to current learning needs. This report outlines principles learned from planning and implementing a teamwork project for an interprofessional health administration and service development course. Practising interprofessional teamwork as leaders and teachers, aligning with previous, current and future teamwork content and processes and responding to student feedback and achievement have been the key factors in shaping the project over three semesters. Face-to-face and online interprofessional teamwork learning has necessitated developing resources that support self-direction, using familiar technology and providing enabling physical environments. Implications for first-year interprofessional teamwork are that structured well-resourced processes, responsiveness and alignment of learning all improve student outcomes.