The impact of different prioritisation policies on waiting times: Case studies of Norway and Scotland

We investigate the distributional consequences of two different waiting times initiatives, one in Norway, and one in Scotland. The primary focus of Scotland's recent waiting time reforms, introduced in 2003, and modified in 2005 and 2007, has been on reducing maximum waiting times through the imposition of high profile national targets accompanied by increases in resources. In Norway, the focus of the reform introduced in September 2004, has been on assigning patients referred to hospital a maximum waiting time based on disease severity, the expected benefit and the cost-effectiveness of the treatment. We use large, national administrative datasets from before and after each of these reforms and assign priority groups based on the maximum waiting times stipulated in medical guidelines. The analysis shows that the lowest priority patients benefited most from both reforms. This was at the cost of longer waiting times for patients that should have been given higher priority in Norway, while Scotland's high priority patients remained unaffected.     

A MBULANCE,F IRE,AND P OLICE D ISPATCH T IMES C OMPARED WITH THE A TOMIC C LOCK

Objectives. To quantify any differences between the times used by public safety answering points (PSAPs) in a multijurisdictional county compared with the atomic clock and to determine whether there was consistency in any time differences. Methods. All 25 ambulance, fire, and police PSAPs were contacted by telephone. The current time in hours, minutes, and seconds on the dispatch center's timepiece was -requested. The atomic clock time was simultaneously recorded. Time differences between the reported and atomic clock times were calculated and the absolute values were used to calculate the mean difference. The procedure was repeated one week later. Consistency in time deviation was evaluated by subtracting the time differences between weeks 1 and 2 for each center. Results. All 25 centers were contacted and three declined to participate. Time differences ranged from ?551 to 117 seconds (mean difference: 61.2 ± 120.3) for week 1 and ?103 to 79 seconds (mean difference: 36.9 ± 33.4) for week 2. Time deviations between weeks 1 and 2 were: 0 seconds for one center, 1 to 30 seconds for 12 centers, 31 to 60 seconds for four centers, and more than 60 seconds for five centers. Conclusions. The maximum time difference between dispatch center and atomic clock times was 551 seconds. This difference may be clinically significant for time-dependent research, quality improvement tasks, or medical legal reviews when multiple PSAPs are involved. Lack of consistency in time deviation over one week suggests systematic adjustment for these differences may not be possible.     

论中医和希腊医学哲学理论的异同

中国和希腊,看似遥远的两个国家在古代哲学思想方面却近乎一致。古人一直在探寻自然现象的本质问题,并一直在试图回答这些系统联系的基础。在诸多问题中,他们最感兴趣的是天体运动,健康与疾病的相互关系,以及物质运动的原理。通过探究两种不同文化背景基础哲学理论的异同。     

以“小学”校读古医籍之用例

校读是校书与读书的结合。书用校读,边校边读,在校正了讹误的同时,也对书有了更准确的理解。反过来,只有对书有比较准确的理解,才能正确的勘校其谬误。而校读古籍最重要的就是必须具备一定的"小学"功底,没有"小学"功底,则无从读书,更无从校书。"小学"的知识如版本学、文字学、音韵学、训诂学、金石学以及近代出土文物学等都在校读古医籍中具有重要作用。     

Ketamine and midazolam is an inappropriate preinduction combination in uncooperative children undergoing brief ambulatory procedures

BACKGROUND: We prospectively studied the effects of intramuscular (i.m.) ketamine alone, or combined with midazolam, on mask acceptance and recovery in young children who were uncooperative during induction of anaesthesia. METHODS: The Institutional Review Board (IRB) approval was obtained to study 80 children, 1-3 years, scheduled for bilateral myringotomies and tube insertion (BMT). Mask induction was attempted in all the children. Those who were uncooperative were randomly assigned to one of the four preinduction treatment groups: group I, ketamine 2 mg.kg(-1); group II, ketamine 2 mg.kg(-1) combined with midazolam 0.1 mg.kg(-1); group III, ketamine 2 mg.kg(-1) with midazolam 0.2 mg.kg(-1); or group IV, ketamine 1 mg.kg(-1) with midazolam 0.2 mg.kg(-1). Anaesthesia was continued with nitrous oxide and halothane by facemask. RESULTS: Children in all treatment groups achieved satisfactory sedation in less than 3 min following the administration of the preinduction drug(s). Compared with patients who received halothane induction (comparison group), the use of ketamine alone did not significantly (P > 0.0167, a Bonferroni corrected significance level) delay recovery and discharge times (18.8 +/- 2.5 and 82.5 +/- 30.7 min vs 12.6 +/- 4.6 and 81.0 +/- 33.8 min, P = 0.030 and P = 0.941, respectively). Patients who received ketamine/midazolam combinations, however, had significantly longer recovery and discharge times vs halothane (32.3 +/- 14.0 and 128.0 +/- 36.6 min, P = 0.001, P = 0.007, respectively). These times were so clinically unacceptable, that the study had to be terminated with only 17 patients receiving study drugs. CONCLUSIONS: It is concluded that ketamine/midazolam combination is not appropriate for preinduction of anaesthesia in paediatric ambulatory patients because of unacceptably prolonged recovery and delayed discharge times.     

Chronic expanding hematoma in the psoas muscle

We report an unusual case of chronic expanding hematoma in the psoas muscle. A 53-year-old man was admitted for evaluation of a mass shadow in the left lower lung field on chest X-rays. He had also been suffering from dull left back pain. A computed tomography scan showed a cystic lesion with a rim enhancement in the left retroperitoneal space. Mixed signal intensity in a mosaic pattern was seen on a T2-weighted magnetic resonance image. We could not rule out a suspicion of a neoplastic intratumoral hemorrhage. Due to increased pain and the definite diagnosis, surgery was performed. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. The expansion process is thought to be due to the irritant effects of blood and its breakdown products, which cause repeated exudation and bleeding from capillaries in the granulation tissues.     

基于中医古籍文献的升降散应用溯源及探析

通过对中医古籍中有关升降散论述的文献梳理,全面探讨其内涵。本方是在大黄、僵蚕为雏形的基础上增加蝉蜕、姜黄而成方,几经易名,终在杨璿《伤寒瘟疫条辨》中为后人所熟知。本方广泛用于治疗瘟疫,以丸剂、散剂为主,方便携带,便于服用;重用大黄旨在祛邪、逐秽;应用时视人之体质强弱和量其毒之轻重而判断用药多寡,并辅以米酒、生蜜等以顾护正气。杨璿将其由治疗“热疫”的专方扩展为治疗“表里三焦大热”的通用方剂,扩大了本方治疗疾病范围。     

新时期加强高校大学生思想政治教育初探

加强和改进大学生思想政治教育,是提高党的执政能力,巩固党的执政地位,把中国特色社会主义不断推向前进的时代要求,高校应重视大学生思想政治教育,全面提高高校思想政治工作者的思想素质,努力培养合格人才。     

《孟氏幼科》文献考察与版本研究

清代医家孟河撰《孟氏幼科》六卷,成书于1678年,为中医儿科经典著作,目前学界对其版本认识、版本之间的关系仍有存疑之处.本文通过对《孟氏幼科》现存版本的对比和考证,发现《著石堂新刻幼科秘书》《著石堂新刻幼科百效》《著石堂新刻幼科直言》实为同一本书.在《中国中医古籍总目》记载的现有版本基础上新发现了乾隆五十年本;温州市图...     

孟文瑞《春脚集》学术特色

清代医家孟文瑞撰《春脚集》,共四卷,是一部综合性方剂类著作,临床实用性强。卷一至卷三以人体部位分部设篇,再按病证列方;卷四以内、外、妇、儿分设专篇选方。集历代成方、验方484首。《春脚集》将人体部位共分为十七部,方便读者按图索骥,根据病位、症状检索方剂,便于临床用药。全书选方体现了中医独具特色的“简、便、验”精髓。