老年人的发病特点及预防

目的：通过对老年人健康状况的调查,总结老年人发病特点,提出预防和治疗措施,以期延长老年人的寿命,提高老年人生活质量。方法：将７８０铝调查对象集中於医院,按规范化标准作体格检查,并由主任医师作结论。结果：高血压、心脑血管道在病、白内障、前列腺疾患、肺气肿及糖尿病等为老年人常见病。结论：定期体检及提高基知务人璋减少和预防老年病的重要手段。     

Comprehensive Breast Centers: Priorities and Pitfalls

▪ Abstract: Comprehensive breast centers are developed for a variety of reasons, but the major motivations are usually to reduce psychological morbidity, develop an interdisciplinary team, provide comprehensive services in a patient-focused manner, improve clinical and emotional outcomes, and develop an organized "system" of care. However, the development of "comprehensive" breast centers presents far more of a challenge than a breast-imaging center and must be undertaken with great care and commitment. If the medical staff and operational issues are not appropriately identified and addressed, the long-term success will be threatened. Each breast center is different, but some of the principal priorities and pitfalls are described. The priorities relate to breast subspecialization, access and coordination, prospective treatment planning, and comprehensive programmatic services. Among the many potential pitfalls, the focus in this article is operational and OncoPolitics. ▪     

Effects of computer-assisted documentation in orthopedic surgery on budget and reimbursement

Summary Since 1995 German health maintenance laws require hospitals to document and code all referals, admissions and discharges using the 4-digit ICD. Operative procedures are documented and coded using the ICPM. Beginning in January 1996, reimbursement for health services requires a diagnosis-related billing and payment for special procedures. The decision for billing is based on documented diagnosis and therapy. This extended request for documentation makes an online access to diagnosis and therapy with a computer-assisted coding system advisable. In 1996 in our hospital each diagnosis and operation was manually documented and coded on a form. Since the beginning of 1997, documentation and coding has been exclusively computer-assisted. On the basis of documented diagnosis and therapy the computer provides the route of reimbursement. Retrospectively we evaluated the number of charged diagnosis-related billings and payments for special procedures from January to April of 1996 and 1997. It became evident that with computer-assisted documentation and coding the number of detected and charged diagnosis-related billings and payments for special procedures was significantly increased in comparison with the previous year.      

Single-handed practices – their contribution to an undergraduate teaching network in the first year of the new curriculum

OBJECTIVES: The new curriculum at King's College School of Medicine and Dentistry, which commenced in September 1996, requires all medical undergraduates to have a general practice placement throughout the 5 years of their medical education. DESIGN: This paper discusses recruitment, training and support of teaching practices for the new curriculum, reviews the distribution of single-handed general practices in the network and, via a selection of monitoring and evaluation procedures, discusses the implications of a policy which is inclusive of single-handed practices. The findings relate to the experience of the first semester of the first year of the new curriculum. It also examines the contributions that single-handed practices have made to the teaching network and the kind of support needed, if single-handed practices are to continue to contribute to the King's teaching network. SETTING: King's College School of Medicine and Dentistry. SUBJECTS: Medical undergraduates. RESULTS: The findings of this paper revealed that over a third of general practice provision is via single-handed practices in South-east London. Within the undergraduate teaching network, 10% of practices are single-handed. Students are welcomed and receive a learning experience comparable to those students in larger practices. Attendance at training events has proved difficult for some of these tutors, but the extra input from the department, in order to address this deficit, has not been onerous. Indeed, single-handed practices have not been unique with regard to difficulties in attendance at training events. CONCLUSIONS: The study concludes that single-handed practices can make satisfactory provision for undergraduates in the new curriculum and there is no evidence from this study to suggest otherwise.     

Occupational exposure to hexachlorocyclohexane

Summary Sixty male workers in a lindane (y-hexachlorocyclohexane)-producing factory were examined with regard to health in comparison with an external control group of 20 clerks.Case history, physical examination, neurologic status, and ECG revealed no significant differences between groups. However, the following significant differences in clinical-chemical blood tests were ascertained: higher polymorphonuclear leukocyte count, lower lymphocyte count, higher reticulocyte count, lower prothrombin (Quick's) test, and lower blood concentrations of creatinine and uric acid. No significant differences were observed in total red and white blood cell as well as platelet counts, hemoglobin content, the other counts of differential blood picture, -GT, GOT, GPT, LDH, cholinesterase, triglycerides, cholesterol, and urea.In spite of a pronounced exposure to the -, -, and -isomers of hexachlorocyclohexane, no signs of severe impairment of health were observed; only small deviations in some laboratory tests were found having no pathologic significance. However, biological monitoring and health supervision of HCH-exposed workers should be carried out.     

Exercise and heart disease. Epidemiology of the "exercise hypothesis"

The "exercise hypothesis" states that exercise protects against coronary heart disease. Reviewed herein is the epidemiologic evidence for and against the "exercise hypothesis." The weight of evidence supports the view that exercisers have a lower risk of coronary disease, but that vigorous exercise cannot always prevent progression of coronary atherosclerosis and does increase the risk of sudden death in persons with advanced coronary atherosclerosis. It is concluded that the "exercise hypothesis" is plausible, even likely, but still unproved.     

Health for all Nigerians: some revolutionary management dimensions

Health For All by the Year 2000, usually referred to as HFA/2000, is a goal that has been accepted by most nations of the world. PHC is the strategy designed to achieve this laudable goal. In Nigeria, there is no doubt that remarkable strides have been made to achieve the goal of HFA/2000 in recent years. However, in order to fully realise this goal, some further revolutionary management steps are needed. This article first examines the progress on HFA made so far in Nigeria; and then, discusses some management initiatives that need to be taken or accelerated to be able to reach that desirable destination.     

Health and unhealth in chronic disease

When health is defined from a holistic view, traditional measures of control in diabetes, such as analysis of blood glucose or HbA1c, are of limited use as indicators of health and unhealth. On the other hand, evaluation of attitudes and certain personality variables might provide guidance both in discovering unhealth and in creating individual self-care programmes for its treatment. In the present study the subjective experience of health and unhealth was studied in a defined population of patients with insulin dependent diabetes mellitus (IDDM). The patients could be divided into three categories: a) those not abandoning important goals because of their diabetes, b) "adapted abandoners" and, c) those abandoning vital aspects of life. On the basis of the findings, the question of how "problem patients" can be identified and treated is discussed.