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.     

善存片联合健脾理气中药预防肿瘤患者化疗所致口腔溃疡的临床观察

目的观察在全身化疗前应用善存片联合健脾理气中药对肿瘤患者口腔溃疡的预防作用。方法将66例肿瘤患者随机分配为治疗组和对照组，每组33例。在全身静脉化疗前3天开始，治疗组每天口服善存片1片及健脾理气中药1剂，对照组服用维生素B：治疗，两组服药化疗后10天为1个疗程。每周期化疗结束后统计口腔溃疡的发生率，共4周期。结果治疗组口腔溃疡的发生率显著降低（P〈0．01）。结论善存片联合健脾理气中药可有效预防及治疗肿瘤患者化疗所致的口腔溃疡。     

A self-reported survey of Alzheimer's centers in Southwestern Pennsylvania

Directors of nursing at 23 nursing homes with Alzheimer's units in Southwestern Pennsylvania completed a self‐reported survey of 12 questions. Responses from the self‐administered questionnaires (100% response rate) revealed a wide variation in the staff categories assessing the oral health status of newly admitted residents with AD. The respondents described oral examinations that were incomplete when compared to the oral indicators listed in the Minimum Data Set. All nursing homes reported that oral hygiene was provided each day. The number of residents in a facility had a significant effect on the frequency of oral hygiene provided. Only 52% of the facilities reported yearly oral examinations for this population. According to the respondents, dental treatment was typically performed on‐site. The oral health care costs were paid by Medicare, Medicaid, the residents/family members, or by other undescribed resources. Insufficient time, staff, and training, as well as uncooperative behavior, were identified as barriers to optimum oral health care for residents with AD. Additional staff, specialized training, and increased government reimbursement were suggested to improve the oral health care for this group of older adults. For future studies, review of medical records and on‐site evaluation of the oral health care at these facilities should be required to verify the reported practices.     

对高等教育大众化背景下中医药高等院校专业建设问题的思考

中医药高等院校专业建设应随着社会的进步发展和社会的需求而不断拓宽、延伸其专业领域，本文从中医药高校的专业延伸的必要性、建设原则以及专业延伸的思路等三个方面对中医药高等院校的专业建设工作提出了几点思考。     

A randomized,double‐blind,placebo controlled,multi‐center study of intravenous iron sucrose and placebo in the treatment of restless legs syndrome

Iron deficiency may exacerbate symptoms in the Restless Legs Syndrome (RLS). We investigated the effect of intravenous iron sucrose or placebo on symptoms in patients with RLS and mild to moderate iron deficit. Sixty patients with primary RLS (seven males, age 46 (9) years, S‐ferritin ≤45 μg/L) recruited from a cohort of 231 patients were randomly assigned in a 12‐months double‐blind, multi‐centre study of iron sucrose 1000 mg (n = 29) or saline (n = 31). The primary efficacy variable was the RLS severity scale (IRLS) score at week 11. Median IRLS score decreased from 24 to 7 (week 11) after iron sucrose and from 26 to 17 after placebo (P = 0.123, N.S. for between treatment comparison). The corresponding scores at week 7 were 12 and 20 in the two groups (P = 0.017). Drop out rate because of lack of efficacy at 12 months was 19/31 after placebo and 5/29 patients after iron sucrose (Kaplan–Meier estimate, log rank test P = 0.0006) suggesting an iron induced superior long term RLS symptom control. Iron sucrose was well tolerated. This study showed a lack of superiority of iron sucrose at 11 weeks but found evidence that iron sucrose reduced RLS symptoms both in the acute phase (7 weeks) and during long‐term follow up in patients with variable degree of iron deficiency. Further studies on target patient groups, dosing and dosing intervals are warranted before iron sucrose could be considered for treatment of iron deficient patients with RLS. © 2009 Movement Disorder Society     

使用便携式微量输液泵持续输注氟尿嘧啶的临床观察及护理

目的：探讨使用便携式微量输液泵在肿瘤化疗中持续输注氟尿嘧啶的应用效果。方法：选取我科2006年3月-2008年7月96例癌症化疗病人按入院先后顺序分为对照组和实验组,每组48例。对照组采用传统的化疗方式,采用浅静脉留置针直接从外周静脉输注氟尿嘧啶（5-Fu）连续5天,每天维持6-8小时。实验组采用浅静脉留置针连接便携式微量输液泵持续泵入氟尿嘧啶（5-Fu）120h～135h,两组均以21天为1个周期,观察两组病人化疗毒副反应发生情况。结果：实验组化疗毒副反应发生率明显低于对照组,平均住院时间明显缩短,两组比较差异有统计学意义（P〈0.01）。结论：使用便携式微量输液泵持续泵入氟尿嘧啶能减轻病人的毒副反应,缩短住院时间,提高肿瘤病人生活质量,有效减轻护士的工作负担。     

新生儿出生信息样本分析

目的:了解和探讨新生儿出生信息的分布态势及规律。方法:对本院2006年1~6月间所有新生儿出生信息进行样本分析。结果:半年间分娩的新生儿共1075例,其中死亡19例,双胞胎15例,以1028例单胎活产新生儿的出生体重、胎龄及产妇年龄作为研究样本进行分析,统计数据与传统意义上的正常胎龄和新生儿体重基本相符,胎龄、体重均值均有所提高。结论:孕产妇的健康状况和新生儿的体质均有所改善,随胎龄的增加,新生儿出生体重亦随之增加,并且,目前新生儿的整体统计体重要大于现有的临床指标,因此,应对现有的临床指标进行适当调整,重新确定低出生体重儿和巨大儿的临床指标。     

预富集-石墨炉原子吸收光谱法测定药食两用中药浸泡液中痕量镉

提供了预富集-石墨炉原子吸收光谱法测定药食两用中药浸泡液中的痕量镉的新方法。采用吡咯烷二硫代氨基甲酸铵(APDC)作配位剂,在pH 5.0-8.0的条件下,用固体硅胶捕集、抽滤分离Cd-APDC配合物,然后用1 moL/L盐酸从膜滤纸上洗下硅胶,得到能够直接用石墨炉原子吸收光谱法测定的镉悬浊液。该法简便快速,富集100倍时的特征质量为2.8×10-14g。用此方法测定4药食两用中药浸泡液中的痕量镉,当n=5时,标准偏差为0.002 5-0.005 8,RSD为:0.012-0.052,样品的加标回收率为91.8%和111.1%,结果较为满意。