专科医院住院部各科医疗质量综合评价的初步探讨

目的：探讨专科医院住院各科工作情况综合评价方法,向临床科室提供医疗质量信息,促进医疗质量的提高。方法：以医院工作报表为数据来源,用秩和比法从诊疗质量,工作强度和经济效益三方面量化科室医疗质量考核指标。结果：综合数能更全面、有效、合理地评价住部各科医疗质量优劣等级,提出科室改进的指标。结论：此评价方法简便,实用,有利于深化院内改革,强化行政部门管理。     

中医内科急症概论(上)

论述了急症的基本特点为大实大虚,邪正消长多变;多脏同病,但有主次先后;多病证,但又同中有异。急症的病机要点为：①内外合邪,因果夹杂;②病理因素责之风火（热）痰瘀,常可转化并见;③邪盛酿毒,有外受、内生之别;④邪实机闭是急症阴竭阳脱、气血消亡的基础;⑤病性多实,但常虑实夹杂;⑥病机之间的演变转化,可致多证相关。     

福州市院前急救2341例呼救与应急处理情况的分析

目的　研究福州市“12 0”院前急救系统的呼救原因、呼救时间、反应时间、处理时间与患者年龄等各项指标间的相互关系 ,为制定急救对策提供依据。　方法　从福州市“12 0”院前急救调度室约 1.5万例呼救信息资料中 ,以 15 %比例单纯随机抽样 2 34 1例 ,对相关指标进行相应的χ2 、秩和检验。　结果　 (1)前 3位呼叫原因为交通意外 (Traf)、心血管疾病 (CVD)和挫裂挤压伤 (L ac)。 (2 )交通意外 /挫裂挤压伤 (Traf/ L ac)和心血管疾病 /脑血管意外 (CVD/ CVA)呼救高峰时间段均为上夜。 (3) Traf/ L ac多见于 30～ 5 9岁 ,CVD/ CVA多见于 6 0岁以上患者。 (4)夜间呼叫多 ,夏秋季为忙季。 (5 )院前急救人员出诊平均反应时间为 5 .74m in,平均处理时间为 2 4.90 min。　结论　“12 0”呼救规律的分析对于制定相关急救措施、妥善处理有重要的指导意义。     

《得心集医案》辨治急难证的思路与方法

总结分析了清代医家谢星焕《得心集医案》辨治急难证的特点：在辨证方面注重天人合一,善于辨别真假错杂之证,尤长于以脉诊决疑释难,妇科难证多求诸奇经八脉;在治疗方面法度严谨,善于化裁古方,急救方法多变,涌吐、针灸、鼻饲、敷脐等多有采用。     

The emergency medicine training needs of rural general practitioners

This study aimed to identify the emergency medicine training needs of rural general practitioners (GPs) in the catchment area of the Hunter Rural Division of General Practice. The GPs were surveyed using a questionnaire in which they were asked about their confidence levels in a number of specific emergency medicine skills, and about the areas of emergency medicine that they saw as priorities for upskilling. More than a third of GPs who were responsible for on-call work at the hospital indicated that they had low levels of confidence in a number of their emergency medicine skills, in particular skills relating to paediatric emergencies, cardiovascular emergencies, and respiratory emergencies. These emergency medicine domains were also seen as high priorities for upskilling by the majority of the respondents. The study shows that rural doctors need the opportunity to access emergency medicine training that provides upskilling not only in the management of clinical problems, but also in practical procedures.     

浅谈医院门诊部工作的主要特点与基本要求

翔实地阐述了门诊工作的特点：服务对象与病种的复杂性及心态的多样性;医疗质量监控缺乏系统必 ;病人就诊高峰的相对集中性;门诊诊治工作的时效性与风险性;急诊抢救工作的突发性与应性;门诊业务工作的多元性、专业性和服务保障工作的整体性;门诊部管理职能的双重性,同时提出了相应的基本要求。     

An action research investigation into the feasibility of experienced registered sick children's nurses (RSCNs) becoming children's emergency nurse practitioners (ENPs)

• ? Emergency nurse practitioners (ENPs) formally developed in accident and emergency (A & E) departments as a direct response to waiting times for the walking wounded, the need to reduce junior doctors hours and changes in nursing practice.
• ? ENPs existed informally for many years in minor injuries units and specialist ophthalmic departments.
• ? This study aimed to examine whether or not the role of ENP could be applied to the specialist service of a paediatric casualty department.
• ? The results showed that 3% of patients could be seen and treated to conclusion by a children's ENP, and some patients could have their care accelerated by a children's ENP.
• ? The introduction of children's ENPs would have an impact on waiting times, junior doctors work-load and the quality of patient care.

     

Anaesthetic management of acute blunt thoracic trauma

Sunnybrook Health Science Centre is an adult regional trauma unit serving metropolitan Toronto and environs. We undertook a nvo-year retrospective review of patients admitted to our institution with blunt thoracic trauma. Three hundred and thirty-three patients with blunt trauma and an injury severity score (ISS) greater than 17 required emergency surgery. Of these, 208 had blunt thoracic injuries while 125 did not have chest injuries. Both groups were similar with respect to age but patients with thoracic trauma had a greater ISS. (P < 0.05) and greater intraoperative mortality (P < 0.01). The aetiology of the intraoperative deaths with one exception was exsanguination. Emergency thoracotomy or sternotomy indicated a poor prognosis with a mortality rate of 80%. The most common intraoperative problem was an elevated airway pressure. Awake intubation was undertaken in 77.5% of patients requiring anaesthesia and surgery because of the potentially compromised airways and difficult intubations due to the nature of the associated injuries. Finally, 74% of patients undergoing urgent surgery required mechanical postoperative ventilation. The presence of blunt chest trauma should be considered a marker of the severity of injury sustained by the patient.     

通腑泄热豁痰法治疗急性脑出血42例疗效观察

目的:观察通腑泄热豁痰法治疗急性脑出血的临床疗效。方法:将80例患者随机分为2组。治疗组42例根据病情对症采用西医常规处理,并口服或鼻饲通腑泄热豁痰方药;对照组38例以常规西药治疗。2组均以4周为1疗程,观察2组疗效及意识状态、运动功能的变化。结果:治疗组显效32例,有效3例,无效2例,死亡5例,总有效率83.3％;对照组显效19例,有效4例,无效6例,死亡9例,总有效率60.5％。2组总有效率比较,差异有显著性意义(P<0.05)。治疗组治疗后意识状态及运动功能评分均显著提高(P<0.001)。结论:通腑泄热豁痰方药对急性脑出血效果显著优于常规西药治疗。