Patient,Provider, and Treatment Factors Associated with Poor-Quality Care for Schizophrenia

Interventions are needed to improve the quality of care for schizophrenia. However, in designing these interventions it would be helpful to understand better which patients are at highest risk for poor-quality care and why care for this disorder is often of poor quality. We study the extent to which patient and treatment factors are associated with poor-quality care in 224 patients randomly sampled from two mental health clinics. Quality of medication management is evaluated using an established method based on national treatment recommendations. Multivariate regression is used to study the effect of patient and treatment factors on treatment quality, controlling for provider. Risk for poor-quality care was greater for patients who were more severely ill, older, and less compliant with treatment recommendations. There were trends toward poor management of symptoms in men and substance abusers, and poor management of side effects in Black patients. Provision of poor-quality care was associated with failure to document symptoms and side effects in the medical record. Interventions to improve care for schizophrenia should attend to the need for accurate clinical assessment and strategies for managing challenging clinical situations.     

叶酸拮抗乙酰水杨酸致大鼠卵黄囊毒性作用的研究

以全胚胎培养模型结合免疫组化和电镜技术等探讨了乙酰水杨酸和叶酸对大鼠卵黄囊及胚胎的影响。结果表明：培养基含乙酰水杨酸３００μｇ／ｍｌ组的卵黄囊直径和胚胎体长均显著低于阴性对照组,胚胎畸形率明显增高。组织学检查发现卵黄囊厚度变薄。间质层血岛、微血管数量明显减少,血管壁细胞不连续,血管发育不良。卵黄囊内皮层细胞顶端微绒毛少见。内皮层细胞的溶酶体、内质网及核蛋白体等结构和数量均有明显改变。而６０ｍｇ／ｋｇ叶酸灌胃鼠血清与乙酰水杨酸联合应用后,则卵黄囊的上述毒性作用明显减轻或消失,提示叶酸能明显拮抗乙酰水杨酸致大鼠卵黄囊的毒性作用。     

乳腺癌（改良）根治术住院流程与平均住院日

参照业务流程重组的理论与方法研究了乳腺癌根治术的住院流程。结果显示,该病种住院流程存在的主要问题有：诊疗服务的随意性过大,等待诊疗服务的时间过长,患者入院标准的掌握过松,对该病种往院注程进行重组,将在不影响医疗服务质量的前提下有效缩短平均住院日。     

Evaluation of whole blood catalase estimation for diagnosis of malignancy

Whole blood catalase levels were estimated using a disc flotation method in 209 random patients with a wide variety of malignancies. Fifty patients had received no treatment, and the remainder, although having undergone prior therapy, had recurrent or metastatic disease at the time of the study. No relationship was found between the presence of cancer and catalase levels. A direct relationship was found for catalase with hemoglobin levels in both normal and patients' samples. Whole blood catalase is of no value in diagnosis and monitoring of cancer. The decreased catalase values found here and reported previously by others are the result of low hemoglobin levels found in many patients with cancer.     

Unusual fractures and dislocations of the axis vertebra

Seven percent of 400 patients with cervical spine fractures and/or dislocations had unusual lesions of the axis. The authors have analyzed axis injuries by review of radiographs and clinical data and have derived a classification of traumatic conditions. Uncommon traumatic axis abnormalities are discussed with reference to incidence, causes, clinical findings, mechanism of injury, and roentgen characteristics.Picker Scholar, James Picker Foundation     

生孢梭菌孢子作为生物指示剂用于残存概率灭菌工艺验证的可行性

测定并分析生孢梭菌孢子在不同介质及不同温度下的耐热参数，评价生孢梭菌孢子的耐热特性及其作为生物指示剂在残存概率湿热灭菌工艺验证中的应用。     

口腔溃复平膜剂的研究

目的：优选口腔溃复平膜剂（黄柏，龙胆草，青黛等）最佳处方。建立膜剂中盐酸小檗碱含量的测定方法。方法：以膜剂外观和融化时间为指标。采用L9（3^4)正交试验筛选处方，反相液相色谱法测定膜剂中盐酸小檗碱的含量。结果：膜剂最佳处方为：中药提取液40mL,PVA0.588:PVA1788为4：1.5，甘油含量8%，CMC-Na0.25g；测定方法中盐酸小檗碱的平均回收率为97.7%。结论：膜剂的外观（包括可塑性，粘附性及抗拉强度）和融化时间等指标均符合质量标准的要求，采用反相液相色谱法可有效控制溃复平膜剂中盐酸小檗碱的含量。     

维生素B12工业生产技术的进展

介绍了维生素B12生产过程中菌株的选育和工艺的优化进展，包括二步发酵工艺和膜反应器的应用与改进。通过菌株选育和工艺改进大大提高了产量，推进了生产。特别是膜技术和其他分离技术的联用弥补了单一膜反应器中原料利用率低的缺点，具有良好的生产应用价值。     

5-氯吲哚酮的合成

目的 优化5--氯吲哚酮合成工艺，提高其收率。方法 以对氯苯胺为起始原料，与水合氯醛及盐酸羟胺反应生成对氯异亚硝基乙酰苯胺，然后在浓硫酸作用下经环合、水解得到5—氯靛红，再经Wolff—Kishner—黄鸣龙反应得到5—氯吲哚酮。结果与结论 总收率可达71％。本法具有原料价廉易得，反应条件温和，操作简便，收率高等优点。     

固体光气法合成洛莫司汀

以固体光气(三光气)为起始原料，经过在无水甲苯溶液中与环己胺反应生成环己基异氰酸酯，再经与氨基乙醇和氯化亚砜的一锅法反应生成1-(2-氯乙基)—3—环己基脲(氯化物)，最后再亚硝化，即得洛莫司汀。原料易得，各步反应条件温和，操作方便，步骤比文献方法(4步)减少一步，总收率由文献方法的23．7％提高为49．8％，适于工业规模制备。