1078848例妇女普查情况分析及干预措施讨论

目的了解南京地区妇女病普查普治情况，以便有针对性地探讨干预措施。方法采用常规妇女病普查方法．并对资料进行回顾性分析。结果近五年南京城市普查率在85％以上，而农村普查率出现下降趋势；患病率城市明显高于农村，且城乡之间差异有统计学意义（P〈0．01）。每年妇科疾病中宫颈糜烂占居首位，宫颈癌、卵巢癌、性病的患病率均呈上升趋势，而乳腺癌呈下降趋势。结论妇女病普查普治工作应明确规定承担妇女病普查职责的职能机构，规范普查项目及内容，规范妇科疾病的诊治，切实提高妇女病普查普治质量。     

Video analysis of communication in paediatric consultations in primary care.

BACKGROUND: There is a paucity of research evidence concerning communication in paediatric consultations between GPs, adults, and child patients. AIM: This study was carried out to identify features of the interaction between a doctor, a child patient aged 6-12 years, and their carer in the consultation associated with the child's participation. DESIGN OF STUDY: A qualitative analysis of video recordings of 31 primary care paediatric consultations was undertaken, using strategies from the methodology of conversation analysis. SETTING: Primary care, Suffolk, UK. METHOD: NHS GPs from three primary care trusts (PCTs), were invited to participate in this study. Sixteen volunteers from this sample took part. RESULTS: Analysis of the interaction in the consultations revealed that the children had little involvement. Children participated when invited to do so, and took more time than adults to answer a doctor's question. An adult carer was less likely to answer on behalf of a child, when they were in a position to see that the doctor's gaze was directed at the child, and the doctor addressed the child by name. Adult carers, who had not voiced their own concerns first, were seen to interrupt doctor-child talk. In consultations where the participants sat in a triangular arrangement, all parties being an equal distance apart, triadic talk was noted. CONCLUSION: Child involvement in the primary care consultation is associated with adult carers being able to voice their own concerns early in the consultation, and children being invited to speak with the appropriate recipient design.     

Understanding general practice: a conceptual framework developed from case studies in the UK NHS

BACKGROUND: General practice in the UK is undergoing a period of rapid and profound change. Traditionally, research into the effects of change on general practice has tended to regard GPs as individuals or as members of a professional group. To understand the impact of change, general practices should also be considered as organisations. AIM: To use the organisational studies literature to build a conceptual framework of general practice organisations, and to test and develop this empirically using case studies of change in practice. This study used the implementation of National Service Frameworks (NSFs) and the new General Medical Services (GMS) contract as incidents of change. DESIGN OF STUDY: In-depth, qualitative case studies. The design was iterative: each case study was followed by a review of the theoretical ideas. The final conceptual framework was the result of the dynamic interplay between theory and empirical evidence. SETTING: Five general practices in England, selected using purposeful sampling. METHOD: Semi-structured interviews with all clinical and managerial personnel in each practice, participant and nonparticipant observation, and examination of documents. RESULTS: A conceptual framework was developed that can be used to understand how and why practices respond to change. This framework enabled understanding of observed reactions to the introduction of NSFs and the new GMS contract. Important factors for generating responses to change included the story that the practice members told about their practice, beliefs about what counted as legitimate work, the role played by the manager, and previous experiences of change. CONCLUSION: Viewing general practices as small organisations has generated insights into factors that influence responses to change. Change tends to occur from the bottom up and is determined by beliefs about organisational reality. The conceptual framework suggests some questions that can be asked of practices to explain this internal reality.     

综合ICU中低年资护士培训方法探讨

目的探讨为综合ICU培养合格的护理人员的方法。方法根据ICU护士应具备的素质及低年资护士的特点,采用定期集中培训、一对一带教、参加护理查房等方法,对基础理论和基本技能进行强化,重点加强了ICU专科护理知识地训练。结果通过客观考核和主观考核,效果良好。结论经过为期12个月两个时段较规范的岗位培训,低年资护士能较好的适应ICU工作。     

Genetic Structure of Spatial and Verbal Working Memory

Working memory (WM) encompasses both short-term memory (storage) and executive functions that play an essential role in all forms of cognition. In this study, the genetic structure of storage and executive functions engaged in both a spatial and verbal WM span task is investigated using a twin sample. The sample consists of 143 monozygotic (MZ) and 93 dizygotic (DZ) Japanese twin pairs, ages 16 to 29 years. In 155 (87 MZ, 62 DZ) of these pairs, cognitive ability scores from the Kyodai Japanese IQ test are also obtained. The phenotypic relationship between WM and cognitive ability is confirmed (r = 0.26–0.44). Individual differences in WM storage and executive functions are found to be significantly influenced by genes, with heritability estimates all moderately high (43%–49%), and estimates for cognitive ability comparable to previous studies (65%). A large part of the genetic variance in storage and executive functions in both spatial and verbal modalities is due to a common genetic factor that accounts for 11% to 43% of the variance. In the reduced sample, this common genetic factor accounts for 64% and 26% of the variance in spatial and verbal cognitive ability, respectively. Additional genetic variance in WM (7%–30%) is due to modality specific factors (spatial and verbal) and a storage specific factor that may be particularly important for the verbal modality. None of the variance in cognitive ability is accounted for by the modality and storage genetic factors, suggesting these may be specific to WM.     

综合医院内科与中医科门诊抑郁障碍患病率比较

目的调查沈阳市不同级别综合医院内科和中医科门诊病人抑郁障碍的患病率。方法采用分层随机整群抽样方法抽取沈阳市23家综合医院进行调查,共调查7448例年龄?15岁的内科和中医科门诊病人。调查员在门诊于病人就诊前使用扩展的一般健康问卷(GHQ-12)为筛查工具,将病人分为精神疾病高、中、低危险组,然后由精神科医生使用DSM-Ⅳ定式临床检查(SCID-I/P)对高、中、低危险组100%、40%、10%的调查对象进行SCID诊断。结果沈阳市综合医院内科门诊任何抑郁障碍的总现患率为11.01%(95%CI10.05%-12.06%),中医科抑郁障碍患病率为16.22%(95%CI13.23%-19.87%),高于内科门诊抑郁障碍患病率,RR值为0.68。结论沈阳市综合医院中医科门诊抑郁障碍患病率高于内科门诊,应该更加关注中医科就诊患者的抑郁障碍问题。     

综合性医院老年病人抑郁症状的调查分析

目的 :分析综合性医院老年病人的抑郁症状特征及影响因素。方法 :应用中文版流调用抑郁量表 (CES -D) ,调查同济医院住院和门诊的 3 15例老年患者 (年龄≥ 60岁 )。结果 :①在 3 15例老人患者中 ,共有 70例老年患者 (占 2 2 2 % )肯定有抑郁症状 ,5 3例 (16 8% )可能存在抑郁症状 ;②CES -D总分女性组明显高于男性组 (t=2 0 3 2 ,P <0 0 1) ,且教育程度越低抑郁症状越明显 (F =3 75 6,P <0 0 1) ;③CES -D总分的多元逐步回归分析提示所有被调查老人及内科组老人的CES -D总分明显受其教育程度的影响。结论 :在综合性医院对老年病人进行抑郁症状的常规筛查是必要的     

司帕沙星对试验动物的一般药理研究

小鼠单次经口灌服司帕沙星4、20和100mg/kg后,动物的活动正常,未出现兴奋的抑制作用;小鼠单次经口灌服司帕沙星4、20和100mg/kg,与戊巴比妥钠镇静催眠无明显协同作用;给猫静脉注射司帕沙星4、16和64mg/kg,对动物呼吸和心血管系统无明显影响。     

急性超容血液稀释对血流动力学的影响

目的 观察不同人工胶体液行急性超容血液稀释(AHHD)对血流动力学的影响.方法 45例ASA Ⅰ～Ⅱ级腹部手术患者,随机分为3组:对照组(C组)、6%羟乙基淀粉组(H组)及4%琥珀酰明胶组(G组).在麻醉诱导后开始输液或扩容:C组输入林格液15 ml/kg,H、G组输入林格液15 ml/kg和胶体液20 ml/kg,均在40 min内完成.监测3组术前、麻醉诱导后、输液或扩容20 min、输液或扩容40 min时心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI),外周血管阻力(SVR)的变化.监测H、G组患者扩容前后血细胞比容(Hct)的变化.结果 H、G组在扩容末,Hct下降,H组由术前0.385±0.043降至0.304±0.045,G组由术前0.395±0.035降至0.312±0.038.H、G组HR、MAP、CI、CVP、SVR术前值和麻醉诱导后值与C组的差异没有统计学意义(P>0.05).输液或扩容20 min、输液或扩容40 min时H、G组HR、CI、CVP、MAP高于C组,其差异有统计学意义(P<0.05);在扩容20 ml/kg后H组CVP增高达(13.13±3.51)cm H2O(1 cm H2O=0.098 kPa),G组增加达(14.88±1.33)cm H2O.结论 在40 min内静脉输入20 ml/kg的6%羟乙基淀粉、4%琥珀酰明胶,是一种有效的超容血液稀释方法.但会造成心脏负荷的显著增加,使用异氟醚和硝酸甘油能有效地减轻心脏前负倚.     

Can subjects with a positive allergen skin test be selected by a short questionnaire?

The objective was to evaluate a postal questionnaire screening procedure for selection of subjects with positive reactions to skin prick tests with common allergens. The project consisted of a screening, with subsequent skin prick test of two selected groups. The setting was the Glostrup Population Studies institute in Copenhagen, Denmark. Participants in the screening included 8000 subjects, aged 15–69 years. The subjects were randomly selected from the population of western Copenhagen County, Denmark. From the 6998 respondents (87.5%), 793 subjects were randomly selected (Random Group), and 788 subjects were chosen on the basis of their answers to the questionnaire (Symptom Group). Both groups were invited to take skin prick tests. Attendance rates were 75.5% (Random Group) and 80.6% (Symptom Group).
The main outcome measures were responses (yes or no) to the specific questions and the subjects' skin reaction (positive or negative). The association between symptoms and skin reactivity, adjusted for the effects of sex and age, was summarized by odds ratios. Symptoms on exposure to allergens were highly associated with positive skin reactivity. In the Symptom Group the percentage of subjects with at least one positive skin reaction was 57.7%, which was twice as much (28.4%) as in the Random Group. The results show that it was possible to select a group with high skin reactivity on the basis of the symptoms reported in the screening. Questions about exposure to allergens were the most appropriate for selection of this group.