Crossing boundaries,re-defining care: the role of the critical care outreach team

There is clear indication that both government and professional policy in the United Kingdom supports a radical change in the role of healthcare practitioners, with a move towards a patient-focused service delivered by clinical teams working effectively together. Recent health service imperatives driving the agenda for flexible clinical teams have occurred simultaneously with an increased public and political awareness of deficits in availability of critical care services. Against this policy backdrop, working across professional and organizational boundaries is fundamental to supporting quality service improvements. In the acute care sector, the development of critical care outreach teams is an innovation that seeks to challenge the traditional support available for sick ward patients. Activity data and observations from the first 6-month evaluation of two critical care outreach teams identify the need for clinical support and education offered by critical care practitioners to ward-based teams. The experiences from such flexible clinical teams provides a foundation from which to explore key issues for intradisciplinary and interdisciplinary working across clinical areas and organizational boundaries. Adopting innovative approaches to care delivery, such as critical care outreach teams, can enable clinical teams and NHS trusts to work together to improve the quality of care for acutely ill patients, support clinical practitioners working with this client group, and develop proactive service planning.     

Short flexible fiberoptic colonoscopy in routine office examinations

Through experience with 1,464 examinations using the short flexible fiberoptic colonscope, the author concludes it to be the preferred instrument for endoscopy of the distal bowel. He finds it superior to the rigid instrument in detection of polyps and early malignant disease of the distal descending and sigmoid colons. The flexible instrument is generally less uncomfortable for the patient and is readily accepted as a routine part of a thorough colonic and rectal examination. Read at the meeting of the American Society of Colon and Rectal Surgeons, Hollywood, Florida, May 11 to 16, 1980.     

柔性管理在现代医院管理中的应用体会

介绍了柔性管理的内涵及其在现代医院管理中的适应性,杭州市余杭区中医院通过对医院民主平等环境的营造、医务人员精神需求与创造性的培养等方面应用柔性管理,取得了一定的成效。     

盐酸青藤碱纳米柔性脂质体的制备及其性质研究

目的制备盐酸青藤碱纳米柔性脂质体,探索其体外透皮给药的规律与机制。方法采用薄膜分散法制备以丙二醇为柔软剂的盐酸青藤碱纳米柔性脂质体,考察卵磷脂、胆固醇与丙二醇对脂质体包封率的影响;高效液相色谱(HPLC)法测定青藤碱的量,原子力显微镜(AFM)、透射电镜(TEM)和光子相关光谱仪(PCS)描述其物理性质。采用双室扩散池法研究其体外透皮给药规律,透皮给药结束后用扫描电镜(SEM)观察皮肤表面结构的变化。结果卵磷脂、胆固醇和丙二醇的质量分数分别为3%、0.02%、25%时,制备的柔性脂质体对盐酸青藤碱的包封率为(66±2.3)%;其外观为圆形或椭圆形,内部为多层囊泡结构,粒径为(170±26)nm,表面电位为-(43±3.4)mV。柔性脂质体能够使角质层结构变得紊乱无序,角质细胞间隙增大而提高皮肤对药物的渗透性。结论纳米柔性脂质体能够显著提高盐酸青藤碱透皮给药效果,可作为盐酸青藤碱透皮给药的新型纳米载体。     

柔性化管理在护理质量督导中的应用

目的探讨柔性化管理在护理质量督导中的应用效果。方法更新护理质量督导理念,在护理质量标准的制订、一级质量控制人员的培训、护理质量检查结果反馈方式等方面,采用柔性化管理的护理督导模式,对全院护理质量进行柔性化督导管理。结果护理质量各项评价指标(除核心制度提问和特级、一级护理)和护理综合满意度均提高(P<0.01)。结论柔性化管理适应现代护理质量督导的特点,满足了新形势下患者需求的变化和护理服务内涵的更新,有利于护理质量的提高。     

Combined application of laryngoscopy and flexible bronchoscopy in endobronchial foreign body extraction

Foreign body aspiration is a life-threatening emergency in children. An 11-year-old girl presented at the emergency department with a case of accidental foreign body aspiration. The patient had symptoms of acute respiratory distress followed by cyanosis of the lips. Radiological examination demonstrated a radiopaque foreign body. Under analgesic and amnestic anesthesia, we extracted the metal bead using alligator forceps, with a direct laryngoscope and a flexible bronchoscope. This method afforded an improved visual access to the operative field and allowed for intra-operative manipulation, thus obviating the need for thoracotomy.     

Adaptive design method based on sum of p-values

Bauer and Kohne proposed an adaptive design using Fisher's combination of independent p-values based on subsamples from different stages (Biometrics 1994; 50(4):1029-1041). Their method provides great flexibility in the selection of statistical methods for hypothesis testing of subsamples. However, the choices for the stopping boundaries are not flexible enough to meet practical needs (Biometrics 2001; 57(3): 886-891). In this paper, an adaptive design method is proposed using linear combination of the independent p-values. The method provides great flexibility in the selection of stopping boundaries and no numerical integration is required for the two-stage designs. The stopping boundaries and p-values can be calculated manually. The operating characteristics of the adaptive designs are studied using computer simulations with and without sample size adjustment. Examples are presented for superiority and non-inferiority trials with different endpoints (normal, binary, and survival) under different adaptations. The statistical efficiency of the proposed method is compared with other methods based on conditional power.