危重病患儿应激性高血糖的临床研究

对探讨应激性高血糖对危重病患儿的影响，我院ＩＣＵ１９９５年１月－１９９５年１２月对２５５例急性病患儿进行了血糖监测，结果血糖〉６．６７ｍｍｏｌ／Ｌ１０７例；高血糖与器官功能障碍关系密切，一个和三个顺官功能衰竭时血糖分别为８．８９±３．０３ｍｍｏｌ／Ｌ和１３．２０±４．４５ｍｍｏｌ／Ｌ。两个和 器官功能衰竭时血糖分别为１０．６３±４．８２ｍｍｏｌ／Ｌ和１６．８０±１０．４６ｍｍｏｌ／Ｌ：，血虎高期     

Developing a worker role: Stories of four people with mental illness

Background and Aims:  Work plays an important role in adults' well-being, irrespective of health status. Vocational rehabilitation can enable people with mental illness to return to open employment. A narrative approach was used to explore how individuals with a mental illness made sense of their work-related experiences.
Methods and Results:  Four Clubhouse members in open employment for at least 6 months completed in-depth, semistructured interviews, from which narratives were created to reveal events, significant persons and actions that assisted these individuals to resume work. Woven into the participants' stories were four 'impelling forces' contributing to a sense-of-self as a worker. These impelling forces were: support from significant others, the personal meaning of work, experiences within the Clubhouse programme, and the ongoing struggle with illness. Implications for occupational therapy practice are discussed.
Conclusion:  The findings of this study urge occupational therapists and others to provide opportunities to provide on-going support to people with a mental illness who seek paid employment.     

Impact of Generalist Care Managers on Patients with Diabetes

Objective. To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes.
Study Setting. Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network.
Study Design. A retrospective cohort study comparing diabetic patients treated by generalist care managers with matched controls was completed. Exposure patients had one or more contacts with a care manager; controls were matched on utilization, demographics, testing, and baseline glucose control. Using role-specific information technology to support their efforts, care managers assessed patients' readiness for change, followed guidelines, and educated and motivated patients.
Data Collection. Patient data collected as part of an electronic patient record were combined with care manager-created databases to assess timely testing of glycosylated hemoglobin (HbA1c) and low-density lipoprotein (LDL) levels and changes in LDL and HbA1c levels.
Principal Findings. In a multivariable model, the odds of being overdue for testing for HbA1c decreased by 21 percent in the exposure group ( n =1,185) versus the control group ( n =4,740). The odds of being tested when overdue for HbA1c or LDL increased by 49 and 26 percent, respectively, and the odds of HbA1c <7.0 percent also increased by 19 percent in the exposure group. The average HbA1c levels decreased more in the exposure group than in the controls. The effect on LDL was not significant.
Conclusions. Generalist care managers using computer-supported diabetes management helped increase adherence to guidelines for testing and control of HbA1c levels, leading to improved health status of patients with diabetes.     

Practice variation in perioperative antibiotic use in Japan.

OBJECTIVE: Under the fee-for-service system, the overuse and misuse of perioperative antibiotics have become serious concerns in Japan. The objective of the present study is to investigate practice variations of perioperative antimicrobial prophylaxis between and within hospitals, and to identify any opportunities for improvement. METHODS: We polled 319 surgeons in six specialties employed by 11 teaching hospitals in Japan. We developed questionnaires with vignettes, asking physicians about their practice of antimicrobial prophylaxis in six surgical procedures (gastrectomy, hysterectomy, cataract surgery, clipping of cerebral aneurysm, hip fracture surgery, and coronary artery bypass graft) and utilization of institutional clinical pathways. RESULTS: Average durations of prophylaxis varied by procedure, from 1.6 days for cataract surgery to 5.8 days for clipping surgery. Variation was also observed between institutions for the same procedure, e.g. institutional averages for the duration of prophylaxis for gastrectomy ranged from 2.3 to 7 days. Large intra-institutional variation in prophylaxis duration and inconsistent use of clinical pathways were observed in the cases of gastrectomy, hip fracture surgery, and clipping surgery. At one hospital, 20% of physicians performing gastrectomy indicated the use of an institutional clinical pathway, and prophylaxis duration ranged from 3 to 6 days. For cataract surgery and hysterectomy, clinical pathways were universally applied and intra-institutional practice variation was small, yet prophylaxis duration varied widely between hospitals and third-generation cephalosporins were used extensively. Average length of prophylaxis for hysterectomy ranged from 1.8 to 6 days and 43% of respondents prescribed third-generation cephalosporins. CONCLUSIONS: In Japan, perioperative antimicrobial prophylaxis lacks standardization. Efforts to strengthen an evidence-based approach to antimicrobial prophylaxis need to be made a priority at both the national and institutional levels.     

Life Satisfaction in a Sample of Outpatients with Severe Mental Disorders: A Survey in Northern Italy

This paper presents a cross-sectional survey of subjective quality of life in a sample of 40 Italian patients with disabling mental disorders living in the community. The patients self-rated their quality of life by the Satisfaction with Life Domains Scale. They were satisfied in relation to basic needs, such as housing, food or clothing and appreciated to some extent the services received, but were very unhappy about their income and their intimate sexual relationships. This Italian sample appeared less satisfied than most samples of people with severe mental disorders investigated by the same instrument in other countries. This may be related to the high level of psychopathology and disability shown by patients for whom survival in the community is in itself an achievement. However, lack of money and poor sexual life are common concerns of long-term mentally ill. How to address such problems is a major challenge for community psychiatric services.     

现代复苏技术在危重新生儿转运中的应用体会

目的：探讨现代复苏技术在危重新生儿转运中的应用及其临床价值。方法:对我院2000年3月-2004年2月危重新生儿转运中接受心肺脑复苏(CPCR)的26例息儿进行回顾性分析，总结出危重新生儿转运中CPCR程序及其要点。结果：在26例息儿中，转运前给予CPCR 18例，占69.2％；转运途中给予CPCR 8例，占30.8％；除2例息儿复苏失败于转运途中死亡外，其余24例均复苏成功，成功率为92.3％。结论：危重新生儿转运中的CPCR程序具有临床实用价值。     

浅谈绩效考评工具

绩效考评工具在整个人力资源管理与考评系统中处于核心地位。科学的绩效考评工具应具有工作分析、考评工具的信度、效度3个必要的、不可缺的基本特征。绩效考评工具主要包括特征导向、结果导向和行为导向3种。开发绩效考评工具应针对企事业单位的实际情况；针对不同领域、不同层次的员工开发出以工作分析为基础、信度和效度良好、实用性强的绩效考评工具，从而发挥绩效考评的作用；对员工的工作进行开发和指导，以提高员工的业绩和对工作的成就感、满意度。     

攻补兼施治疗肝硬化腹水探析

肝硬化腹水成因不一,虚实错杂,变化多端。就疾病整体而言,本虚标实,乃肝、脾、肾为损,标实为气滞,血瘀,水遏三者因果导致恶性循环,正气日衰,膨胀日甚,笔者根据肝病治则,即腹水期以治水为先,勿忘行气治血,水退后以健脾补肾为主,勿忘调肝理气。使“水精四布,五经并行”。     

对"齐二药"假药事件若干问题的反思

中山大学附属第三医院在经历了“齐二药”假药事件的严峻考验后,以切身的体会总结了在药品的生产流程的监控、流通环节的管理、不良事件的处理等方面的教训,并提出要建立完善监管体系和理赔补偿机制的建议。