Souffrance des institutions, souffrance en institution. La formation comme espace de relation

At the present time, quantitative administrative logic, necessity of productivity-profitability, gain of time and consensus, tend to depose thought and subject, leading dehumanization and decline of collective. Hospital institution has difficulties in coming to terms with sociopolitical changes which penetrate it. Group and institutional ties are affected; they participate largely in suffering of institutions as well as that of medical persons and patients. The authors show that mental institution reveals a part of society in suffering and the possible existence of spaces for elaborating. After having thoroughed their issue through the questions of a hollow subject, lack of linkage, conflict in primary task and crisis of transmission, the authors question resorts that institution finds to change and they present a situation of formation. They show that this one can be revealing about institutional suffering, but also creative of a space for elaborated thought in institution. According to them, “spaces of relation” exist, as this space of formation, in a transitional link and, as relational and emotional bond. Those ones enable medical person to abandon the time of immediacy which reinforce them in urgency and act, and to start elaboration.     

论高校人才培养与可持续发展

高素质人才培养与可持续发展，尤其是经济持续发展之间有着非常密切的关系。本文就知识经济时代的到来，高校应如何培养能适应社会、经济发展需要的高素质创新人才，提出了一些改进教学观念、教学内容和方法的途径及措施。     

中药汤剂服用频次及合理性研究现状

中药服用方法是中医治病临床有效性与安全性关键环节,日服用频次为其主要内容之一,直接关乎临床结果。古代医学典籍对服药频次的记载甚为详尽,灵活机变,极具中医药的特色。然而目前临床中药汤剂大多每日1剂,分2～3次服用,千篇一律。关于汤剂日服次数是否合理的现代循证或药理学实验研究结果仍较少。文章将对经典医书载录的中药服用频次及其合理性的现代科研成果做出总结,以供临床处方用药和进一步科学探索参考。     

公立医院新闻宣传伦理学思考

我国当前公立医院的医疗广告与医疗新闻宣传活动中存在着不同形式的道德伦理失范的现象,导致损害患者生命健康权,侵犯隐私权等恶果的发生。对这些现象进行分析探讨,认为公立医院在宣传中应该侧重健康知识宣传,以新技术报道为主,及时报道突发公共卫生事件,加强宣传引导,推进医疗机构健康发展。     

我院住院部750份医嘱质量统计与分析

目的:了解新的《处方管理办法》实施以来新疆八一钢铁集团公司医院的贯彻执行情况,以提高医嘱质量,保障医疗安全,为今后医院临床药师合理参与用药提供参考。方法:回顾性分析2010年11月—2011年11月750份住院病历中的长期和临时医嘱单,结合病历中医生书写的病程记录、有关疾病治疗标准等诊断依据以及对应的医嘱,判定用药的合理性,对不合理的医嘱进行统计分析。结果:在抽查的750份病历中不合理医嘱为141份,占总抽查病历的18.8%。不合理医嘱中表现为:医嘱书写不规范占46.8%;药品选择不合理占19.1%;重复给药、药品使用不当占21.3%;溶媒选用不当以及无药敏试验分别占6.4%。结论:医嘱用药基本合理,但仍存在一定问题,不合理医嘱中存在的问题应引起医师的注意,同时临床医师与药师需共同加强药学知识的学习。     

Absolute vs relative improvements in congenital diaphragmatic hernia survival: what happened to “hidden mortality”

Purpose

The aim of this study is to determine if there has been a true, absolute, or apparent relative increase in congenital diaphragmatic hernia (CDH) survival for the last 2 decades.

Method

All neonatal Bochdalek CDH patients admitted to an Ontario pediatric surgical hospital during the period when significant improvements in CDH survival was reported (from January 1, 1992, to December 31, 1999) were analyzed. Patient characteristics were assessed for CDH population homogeneity and differences between institutional and vital statistics-based population survival outcomes. SAS 9.1 (SAS Institute, Cary, NC) was used for analysis.

Result

Of 198 cohorts, demographic parameters including birth weight, gestational age, Apgar scores, sex, and associated congenital anomalies did not change significantly. Preoperative survival was 149 (75.2%) of 198, whereas postoperative survival was 133 (89.3%) of 149, and overall institutional survival was 133 (67.2%) of 198. Comparison of institution and population-based mortality (n = 65 vs 96) during the period yielded 32% of CDH deaths unaccounted for by institutions. Yearly analysis of hidden mortality consistently showed a significantly lower mortality in institution-based reporting than population.

Conclusion

A hidden mortality exists for institutionally reported CDH survival rates. Careful interpretation of research findings and more comprehensive population-based tools are needed for reliable counseling and evaluation of current and future treatments.     

Use of calcium supplements and the risk of coronary heart disease in 52–62-year-old women: The Kuopio Osteoporosis Risk Factor and Prevention Study

Background

To analyse prospectively the effect of calcium or calcium + D supplementation on coronary heart disease (CHD) in 52–62-year-old women.

Methods and results

10,555 52–62-year-old women from the population-based Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) who did not have CHD at baseline were followed for nearly 7 years in 1994–2001. Information about use of calcium supplements and health events was obtained from two repeated questionnaires in 1989 and 1994. Information about causes of death during the follow-up was obtained from the Statistics Finland. Information about CHD and other disease morbidity before and during the follow-up was obtained from the Registry of Specially Refunded Drugs of the Finnish Social Insurance Institution (SII). Cox's proportional-hazards models were used to estimate the risk of CHD morbidity related to the use of calcium supplements. At baseline, 2723 women reported current use of calcium or calcium + D supplementation. During the follow-up, CHD was diagnosed in 513 women. Compared to non-users of calcium/calcium + D supplements, the multivariate adjusted hazard ratio (HR) of CHD was 1.24 (95% CI 1.02–1.52) in women who used these supplements. The multivariate adjusted HR for CHD morbidity in postmenopausal women who used calcium/calcium + D supplements was 1.26 (95% CI 1.01–1.57).

Conclusions

Calcium or calcium + D supplementation appears to increase the risk of CHD among women before old age.     

The Outline of the Health Care Mechanism And MedicalSystem Management of U.K.

The author had lived in England for one year. He briefly outlined the current management of the medical institution of U. K. , based on personal experience of his stay. Three prospectors will be highlighted in this paper.     

社区卫生服务中心综合评价指标体系及其应用研究

目的 构建反映“六位一体”功能的社区卫生服务中心综合评价指标体系。方法 运用文献查阅和德尔菲评估法从初选的59个指标中筛选出反映社区卫生服务功能的评价指标，用得到的指标对杭州市部分社区卫生服务中心进行模拟评价，并与杭州市卫生局2004年社区卫生服务中心实际评价结果相比较，论证其一致性。结果 本研究根据德尔菲法确定了24个评价指标，用其对杭州市社区卫生服务中心进行评价的结果与杭州市卫生局自身评价的结果间存在正相关(r=0．711，P=0．003)，且两指标体系有87．5％的一致性。结论 本研究的服务功能指标能够较好地体现“六位一体”功能，具有良好的政策导向作用；各项评价指标能够全面地评价社区卫生服务中心，且容易操作，表明本研究指标体系具有较好的实际应用价值。