口腔颌面部严重创伤的麻醉处理

随着交通业与建筑业的迅速发展,发生口腔颌面创伤的概率日趋增多。本文就我们10年来收治的重度口腔颌面创伤患者的麻醉处理报道如下。1临床资料1.1一般资料本组口腔、颌面部严重创伤35例,男性21例,女性14例。创伤原因:车祸伤16例,爆炸伤7例,刀砍伤6例,坠落伤3例,其他3例。合并症:颅脑损伤12例,胸部损伤5例,腹部损伤4例,四肢驱干多发骨折及其他6例,伤后入院时间45min~180min。由于颌面部血运丰富,损伤严重,患者在入院时,口腔颌面、鼻腔有大量血液及分泌物喷出,软组织撕脱、裂伤、颌面部多处骨折,并存在创面严重污染,呼吸道不同程度梗阻。由于出血量多,大部分患者均有失血性休克表现血压(6.0~10.6)/(3.0~7.6)kPa,脉搏126bpm~168bpm,呼吸急促22次/min~38次/min。其中有11例伴有昏迷,3例伴有血气胸,SaO2在60%~82%。1.2急救措施迅速清理创面及口腔、鼻腔、呼吸道的血液、分泌物或异物,保证气道畅通。对有气道梗阻的患者放置鼻咽通气管,其中6例因情况紧急而行气管切开或插管,保证充分供O2;迅速开放2条~3条静脉通道,快速扩容积极抗休克;严密观察生命体征变化,保证...     

上海市卢湾区部分医院X-CT诊断医疗照射频率分析

目的了解我区部分医院X—CT检查占所有放射检查的比例，并分析2002至2004年X-CT各部位阳性检出率。方法分析X-CT诊断医疗照射频率的调查资料。结果CT检查占所有放射检查的比例为23．04％；除个别部位外，大部分阳性检出率均有所提高。结论X—CT检查的频率应予以控制，通过质控提高阳性检出率。     

颈椎病手术的麻醉管理

本文报道２３例颈椎病手术患者采用１％普鲁卡因与２％利多卡因混合液局麻加静脉哌替啶强化取得满意的效果。文中围绕呼吸管理问题对前、后手术入路的麻醉用药、输血、补液及头部固定等注意事项均作了具体介绍。     

ROMEO: rethink organization to improve education and outcomes.

AIMS: Scarcity of resources, expertise and evidence-based models have so far limited delivery of patient-centred diabetes education. We have developed and validated a group care approach that is applicable to everyday clinical practice and cost-effective in improving metabolic control, knowledge of diabetes, health behaviours, and quality of life in Type 2 diabetes. A clinical trial (ROMEO) was planned to evaluate applicability and reproducibility of group care in other outpatients facilities and assess its impact on a larger patient population. METHODS: Multicentre, randomized, controlled clinical trial of group vs. individual care in the routine management of Type 2 diabetes. Nine hundred patient aged < 80, with diabetes of > or =1 year known duration, treated by either diet alone or diet and oral agents, will be recruited in 15 centres and followed for 4 years. Training of physicians, nurses and dietitians included preparation of operating manual and videos, interactive sessions, and evaluation of local facilities and resources. RESULTS: Primary measurements: 3-monthly HbA1c, fasting blood glucose, body weight, waist-hip ratio, yearly blood lipids, and bi-yearly assessment of knowledge of diabetes, health behaviours and quality of life. Secondary outcomes: systolic and diastolic blood pressure, evaluation of ECG for ischaemia and QT interval, hypoglycaemic and anti-hypertensive medication and cardiovascular events. Analysis will be by intention-to-treat. DISCUSSION: If ROMEO confirms that group care can be successfully implemented in different clinics, a novel clinico-pedagogic tool will have been acquired to support patient-centred education, improve lifestyle and outcomes, support team work, enhance providers' attitudes and competencies and ameliorate diabetes care organization.     

Short-term subjective efficacy of doxazosin in predicting probability of prostatectomy in the management of benign prostatic hyperplasia in patients with severe symptoms

BACKGROUND: The severity of symptoms still constitutes the major indication for transurethral prostatectomy, despite the extensive utilization of medical treatments. The aim of the study presented here was to investigate the impact of doxazosin on symptoms in relation to the probability of consequent surgery in severely symptomatic patients. METHODS: Patients with an International Prostate Symptom Score (IPSS) between 18 and 35 were included in the study. The patients received 4 mg/day doxazosin, and subjective efficacy was assessed by IPSS at the first and third months. In addition, the patients were classified at the third month according to a single question regarding satisfaction with medical treatment in terms of symptom relief as 'ineffective, no change, and effective'. RESULTS: A total of 178 patients constituted the study group. Mean total symptom scores were 24, 19 and 17 at baseline, first and third months, respectively (P < 0.05). According to results of the questionnaire, 23% of the patients claimed the treatment was ineffective, and subsequently, the majority of this group (93%) underwent prostatectomy in a year. In addition, 33% of the patients reported no change in their symptoms, while 44% reported that the medication was effective. However, after 1 year, 59% and 15% of these cases underwent surgical treatment, respectively. The probability of surgery in the 'ineffective' group was significantly higher compared to the remaining groups (P < 0.05). CONCLUSION: The majority of patients with severe symptoms who were not satisfied with the medication at the 3rd month underwent surgery. This observation may provide a predictor for subsequent probability of prostatectomy. Therefore, reassessment of patients would be a cost-effective approach for the treatment of BPH in severely symptomatic patients.     

医院制剂室的软件管理

为了探讨医院制剂室的软件管理 ,我们根据《医疗机构制剂配制质量管理规范》的要求 ,分析了我们的软件动态与静态资料 ,提出了自己的一些解决方案。     

我国医院信息系统必走整合之路

论述了我国医院信息系统(HIS)整合的重要意义和原则,介绍了HIS整合的方法措施以及经验.     

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.     

Occupational stress management programmes: a practical overview of published effect studies

There are many occupational stress management programmes availablewhich are designed to prevent and cure the negative aspectsof job-stress. The focus of the programmes can be directed towardsthe individual worker, the working group, the organization ofthe work or the organization as a whole. Moreover, programmesshow a considerable variation with respect to the type of interventionsthey promote and their underlying assumptions, as well as theirduration and costs. In this paper, effect studies of occupationalstress programmes published between 1987 and 1994 are reviewed.The aim is to give a practical overview of the variety in occupationalstress programmes, their scope, applicability and the evidenceof their effectiveness. The paper updates the review by DeFrankand Cooper published in 1989.     

医药团结合作 建设放心药房

总结了全国放心药店现场交流会后,全国各地放心药房建设的情况。强调了建设放心药房工作的意义,指出建设放心药房是中医医疗机构精神文明建设的重要部分,是落实中央指示,加强药品管理的具体行动,是加强中医医疗机构内涵建设的重要内容,是保证中医医疗质量的关键环节。对进一步做好放心药房建设工作提出了要求:规范进货行为,把好药品进货关;不断深化改革,加强内部管理;认真贯彻国家有关法规,继续整治药品回扣违法行为;加强医药团结合作,建立稳定的供需关系;加强领导,务求实效,使“放心药房”建设深入持久地开展下去。