Quality in Clinical Practice

This paper reports the proceedings of the discussion panel assigned to look at clinical aspects of quality in emergency medicine. One of the seven stated objectives of the Academic Emergency Medicine consensus conference on quality in emergency medicine was to educate emergency physicians regarding quality measures and quality improvement as essential aspects of the practice of emergency medicine. Another topic of interest was a discussion of the value of information technology in facilitating quality care in the clinical practice of emergency medicine. It is important to note that this is not intended to be a comprehensive review of this extensive topic, but instead is designed to report the discussion that occurred at this session of the consensus conference.     

老年慢性病患者常见症状与生存质量的相关性研究

目的 探讨老年慢性病患者常见症状间的相互关系及其对生存质量的影响,以寻找提高其生存质量的护理对策.方法 采用焦虑自评量表、老年人抑郁量表、SF-36量表对230例老年慢性病患者进行常见症状及生存质量调查,并分析各种症状间的关系以及症状与生存质量的相关性.结果 老年慢性病患者生存质量八大项目得分偏低.常见躯体症状包括躯体疼痛、头晕、疲乏、睡眠障碍发生率依次为25.73%、33.80%、25.00%、22.05%.常见心理症状焦虑和抑郁得分为38.35±7.26、8.71±5.21.且各种常见症状之间呈正相关(r=0.80～0.612,P<0.05),各种常见症状与生存质量呈负相关(r=-0.175～-0.623,P<0.05).结论 在老年慢性病患者居家护理过程中,须及时采取积极有效护理措施控制或减轻病人症状,且躯体症状护理与心理护理应并重,措施实施与原因排查应同步,主要症状与次要症状要兼顾,以提高其生存质量.     

Concepts of health and disease and caries prediction: a literature review

Abstract— Biomedical determinants of dental caries have been more extensively investigated than psychosocial factors and their impact on caries prevalence and incidence seems to be greater. However, a majority of these investigations relate to children and adolescents. An implementation of social and psychologic variables may be more relevant regarding dental caries in adults. In addition, a multidisciplinary approach might improve our understanding of dental caries as a multifactorial disease and bridge the gap between a biomedical concept and a more holistic approach to dental health.     

Action Research: a valuable research technique for service delivery development

The evaluation of healthcare practice and service delivery is fraught with difficulties. Service development and / or delivery occurs within socially dynamic settings which are in a continual state of change. Service development also often involves large elements of improvisation. The action research approach is useful for health service research, as it supports collaboration between researchers and practitioners, and not only allows but makes explicit that the action researcher has both roles within the setting being studied. This paper discusses action research methodology and offers insight into principles that favor its use for service delivery development. This includes consideration of the interactive variables within studies of health care systems and the importance of evaluating relationships between stakeholders to understand how these factors or variables, which cannot be controlled for, are responsible for successful development of the service. Action research facilitates change and helps bridge the heory--practice gap. With the current dynamic changes within both the pharmacy profession and national health services, researchers may find the action research technique of value when considering new roles and innovative ways of engaging in collaborative, multi-disciplinary working to improve delivery of patient care.Accepted july 2004     

甲状腺切除术中喉返神经损伤的预防

目的：探讨降低喉返神经损伤的方法。方法：2005年9月-2007年1月共有375例甲状腺手术患者，对其喉返神经损伤进行分析。结果：375例病人中有5例喉返神经损伤，其中甲状腺腺瘤3例，桥本甲状腺炎1例，甲状腺癌1例，损伤后立即行喉镜检查示声带处于外展位。给予营养神经治疗，15 d-3个月后完全恢复，喉镜检查示声带正常。结论：喉返神经损伤可以预防，关键是术者应熟悉喉返神经的解剖结构和变异，熟悉其与周围组织及血管的关系，要有手术区域的组织结构特别是喉返神经走行的“立体影像”。     

胆道镜应用对肝胆胰术式选择的影响

目的 探讨分析胆道镜检查在肝胆胰疾患术式选择中的价值。方法 回顾分析1994～2004年收集术中或联合术后应用胆道镜治疗肝胆胰疾患2276例临床资料，进行分析及总结。结果 1966例肝胆管胆石患者胆道残留结石率从34．5％降至9．6％；82例术中胆道镜发现合并胆管狭窄，其中45例肝胆管膜状狭窄者在胆道镜指导下实施了有效扩张治疗；胆总管下段梗阻患者中224例肿瘤依据形态学检查，结合术中扪诊及活检组织学检查得到确诊，并采取了相应的手术方式。结论 胆道镜的应用有利于肝胆胰疾患术式的选择，可使一些较为复杂的胆道手术变得简单易行；对术前未能确诊的病变可以达到明确诊断并指导选择合理的术式。     

耳垂复合组织游离移植修复鼻小柱过短畸形

目的 探讨因鼻小柱过短所致鼻尖低平畸形的矫治方法.方法 对8例鼻尖低平伴鼻小柱过短者,采用鼻小柱切口,首先应用肋软骨或Medpor行支撑杆移植矫正撑起鼻尖,鼻小柱切口的继发创面采用耳垂复合组织游离移植修复.结果 8例游离移植的耳垂复合组织均成活良好,随访1～2年形态满意,色泽与周围组织无明显差别,供区无明显继发畸形.结论 应用耳垂复合组织游离移植修复鼻小柱过短畸形,不仅适用于外伤性缺损修复,而且也适用于鼻部的美容性修复,是一种患者容易接受、操作简单安全、疗效好、供区无后遗明显继发畸形的修复方法.     

绝经前后T1期乳腺癌患者临床特征的分析

目的:分析T1期(肿瘤直径<2cm)原发性乳腺癌女性患者绝经前后在肿瘤大小、病理分类、淋巴结转移率和数目。方法:常规病理检验以及应用免疫组化、HE法分别测定绝经前乳腺癌患者和绝经后乳腺癌患者者的ER、PR。结果:两组患者在肿瘤大小上无明显差异,但绝经前乳腺癌患者浸润导管癌的百分比为 84. 7%,绝经后乳腺癌患者的浸润导管癌百分比为 62. 2%,经χ2 检验,P<0. 01。两组淋巴结转移率分别为 39. 3%和 25. 5%,经χ2 检验,P<0. 01。两组ER和PR阳性伴淋巴结转移的比例经χ2 检验,P<0. 05。结论:绝经前乳腺癌患者和绝经后乳腺癌患者在病理分类、淋巴结转移率及数目、ER、PR阳性伴淋巴结转移上有显著性差异。对于T1原发性乳腺癌患者不论有无淋巴结转移,均应行癌肿切除伴Ⅰ、Ⅱ级淋巴结清扫。     

特殊部位异位妊娠的临床分析

目的探讨特殊部位异位妊娠的临床特点，误诊原因及治疗原则。方法对1996年1月至2003年12月诊治的256例特殊部位异位妊娠进行回顾性分析。结果特殊部位异位妊娠发生率占同期异位妊娠的3．36％，术前诊断率48．4％，所有的患者均行手术。视术中情况进行不同的处理，所得标本均经病理切片证实，全部患者愈后良好。结论特殊部位异位妊娠的临床表现不典型，容易漏诊误诊，一旦怀疑本病应尽早住院，及时明确诊断并手术，患者愈后良好。     

外伤性延迟性脾破裂的诊断和治疗（附21例报告）

目的探讨外伤性延迟性脾破裂的发病规律、临床特点、诊断和治疗方法。方法结合国内外资料及本组病例进行回顾性分析。结果明确诊断16例，误诊为肝破裂2例，宫外孕破裂2例，脾肿瘤1例。21例均手术治疗，行脾切除14例，其中保留副脾2例；脾切除加自体脾组织网膜内移植术3例；脾缝合修补术3例；脾部分切除术1例。死亡1例，原因有就诊晚、失血性休克。结论本病由于腹腔内出血与受伤时间间隔长，容易误诊。诊断除依靠病史、临床表现外，应及时进行腹腔穿刺、B超及CT检查。治疗以脾切除为主，可根据病情、脾破裂的程度以及是否有合并伤等情况采取保脾手术。