Heparin effect on ionised calcium concentration

The effect of heparin on plasma ionised calcium was studied by adding it in increasing amounts to whole blood from 10 normal subjects. There was no significant change in ionised calcium from the addition of 1 U/ml but a significant fall of 0.02 mmol/1 when 2 U/ml were added and a progressive further fall with increasing concentrations. Heparin from three different manufacturers produced similar results. The effect of heparinisation in vivo was studied during regular haemodialysis on 10 patients with chronic renal failure. Following intravenous injection of 10000 U of heparin there was a consistent and significant fall averaging 0.03 mmol/l.     

刘嘉湘教授辨治肝癌经验

辨治肝癌，依据肝脏的生理特点及肝癌的病理变化遣方用药。肝喜疏泄条达而恶抑郁，疏通气血是刘师治疗肝癌的基本法则。由于肝癌发生的实质在于肝脏的阴阳失去平衡，治疗的目的在于调和阴阳。临床上需根据疾病的症状及发展的不同阶段，采取补肝益气法、健脾理气法或养阴柔肝法，兼以解毒利湿、化瘀散结，达到补泻结合，取效良好     

中医中药治疗胃脘痛120例临床观察

运用中医中药辨证治疗胃脘痛120例,分为肝郁气滞、脾胃气虚和阴虚郁热三个证型,分别采用疏肝理气,健脾和胃及滋阴清热等方法治疗,总有效率达94.7%.经统计学处理,对肝郁气滞型疗效最好,与脾胃气虚型相比有一定差异,与阴虚郁热型相比有显著差异(P<0.05);阴虚郁热型疗效最羞,与脾胃气虚型相比有显著差异(P<0.05).     

What has trust got to do with it? Cardiac risk reduction and family physicians' discussions of evidence-based recommendations

The management of patients through the use of evidence-based medicine has become the 'mantra' of medicine within many Western countries. Evidence-based medicine is aimed at providing the best objective, scientific care to all patients, and reducing as far as possible patients' risks of disease and complications from disease. Based on family physicians' discussions of the use of evidence-based recommendations for two cardiac diseases, this paper explores how subjectively-based trust enters into family physicians' decision to use evidence-based medicine. In addition, we show how trust influences physicians' work of recommending evidence-based medicine to patients, and physicians' perceptions of why patients follow recommendations aimed at risk reduction. We conclude that although much of the current discussion about evidence-based medicine assumes a 'rational' model of physician behaviour based on the application of the 'best objective scientific' results, subjectively-based perceptions of trust influence physician practices, and point to the need to understand the power of relational issues in influencing physician practices even when utilizing evidence-based knowledge.     

Benefits of the DICOM Structured Report

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change. Biography Rita Noumeir is a professor at the Department of Electrical Engineering of the University of Quebec, école de Technologie Superieure in Montreal. A founding member of the Imaging, Vision, and Artificial Intelligence Laboratory (LIVIA), her main research interest is the Healthcare Information Technology, specifically, Interoperability, Electronic Patient Record, Security, Information Confidentiality, and Image Processing. As a member of both Technical and Planning International IHE Radiology Committees, Dr. Noumeir took part over the last 5 years in developing many Integrating the Healthcare Enterprise (IHE) Integration Profiles in Radiology and in organizing several Integration Demonstrations. She is a cofounder of IHE Canada. Dr. Noumeir contributed to many research and development projects in collaboration with several Canadian and international companies in medical imaging and healthcare information. Currently, she collaborates with the Diagnostic Imaging Team of Canada Health Infoway to define the principles and architecture for sharing imaging information between multiple healthcare institutions. She plays a leading role in the development of this solution that is published as an IHE Integration Profile for which she is the editor. Rita Noumeir holds a Ph.D. and a Masters degree in Biomedical Engineering from école Polytechnique of Montreal specializing in Medical Imaging. She is a professional engineer, and a member of the Ordre des ingénieurs du Québec.     

抗结核药物所致皮疹临床特点及停药指征的探讨

目的 探讨抗结核药物所致皮疹的临床特点及停药指征.方法 对1998-2005年收治的3 082例住院结核病人中,因抗结核药物所致皮疹296例病人进行分析.结果 变态反应总发生率为10.3%,皮疹发生率为9.6%（296例）,其中单纯皮疹88例,占2.9%,皮疹伴其他系统表现一种或一种以上者208例,占6.7%;无皮疹者22例,占0.7%.皮疹病例总停药率为61.5%.结论 抗结核药物所致过敏反应多为全身性,发生过敏反应后,绝大多数单纯皮疹病人经过抗过敏处理后仍可维持原方案继续治疗,而皮疹伴有明显肝功能异常、心律失常、关节痛和过敏性休克者均需立即停用抗结核药物,并且避免再次使用.     

The role of insurance data in setting priorities for netball injury prevention strategies

The aim of this study was to investigate insurance records for a one-year period to determine the injury frequencies and costs associated with different age groups in netball. The insurance records for all netball claims made during 1999 in Victoria were obtained from the insurer and entered into a database. The overall injury rate was 9.49 injuries per 1000 players, with 829 claims for injuries filed with the insurance company. Of all injuries claimed for, 85.3% were to the lower limb, 8.7% to the upper limb, 3.1% to the spine/torso and 2.9% to the head and face. Lower limb injuries accounted for 85.4% of costs, upper limb injuries 10.7% and head/neck/torso injuries 3.9% of total injury costs. Knee injuries accounted for 56.9% of total costs, with ankle and calf/Achilles injuries costing 12.7 and 11.8% of total costs, respectively. Injury prevention strategies should therefore be directed to three main injuries taking into account costs and incidence. These injuries were: ankle sprains, knee ligament sprains and Achilles tendon strains. Specifically, the prevention program for Achilles injuries should be directed to the >25 years age groups.     

77例慢性心力衰竭住院病例药物治疗分析

目的:评估循证医学心血管疾病成果是否普及到小城市医疗中心.方法:采用回顾性住院病例77例分析,按年度统计对比.结果:77例次慢性心力衰竭(CHF)患者药物治疗仍以传统治疗为主,ACE抑制剂应用大幅度提高,β-受体阻滞剂应用极少,醛固酮拮抗剂未见应用.结论:循证医学成果已影响到小城市医疗中心,但推广范围及力度不够,β-受体阻滞剂是薄弱环节,靶剂量概念仍有待进一步提高.     

高等医药院校大学生健康人格培养模式研究

健康人格是个体身心顺利发展的重要保证，是大学生适应社会、充分发挥自己能力的心理基础。而目前许多高等医药院校在大学生健康人格培养方面，普遍重视不够。本文从学校、教师、失学生自身三个角度，试探索出一套适合高等医药院校大学生健康人格建立和发展的培养模式，以期为对以后的心理健康教育工作有一定的启发和指导作用。     

Benefits of arthroscopic tuberculoplasty in posterior ankle impingement syndrome

The purpose of this work was to describe the posterior ankle impingement syndrome related to the posterolateral tubercle of the talus bone and to present a retrospective analysis of our results after arthroscopic plasty of the tubercle in 15 ankles with a mean 3-year follow-up. Fifteen cases of posterior ankle impingement (PAI) underwent arthroscopic excision of an impinging bone spur. All the patients (13) were retrospectively evaluated at an average of 36 months after index surgery. There were seven women (bilateral in two of them) and six men. Ten were involved in different kinds of sport and three were professional ballet dancers. Preoperative symptoms included pain localized in the posterior ankle, limitation of motion, weakness and swelling. All patients had failed a course of conservative therapies. Surgery was performed through posterolateral and posteromedial portals as described by van Dijk. After soft tissue debridement, partial resection of the posterolateral process was performed until there was complete plantar flexion without bone impingement. Postoperatively, all patients followed the same rehabilitation protocol. Improvement in their impingement symptoms was recorded in all of them according to AOFAS score. One of them (7%) still had occasional discomfort. The results suggest that arthroscopic bone decompression of the posterolateral tubercle in cases of PAI resistant to non-surgical therapies is an effective treatment.