多器官衰竭代谢支持的实验研究

本实验对腹腔感染造成多器官衰竭的动物观察了不同全静脉营养配方在代谢支持中的作用。结果显示:在兔感染性多器官衰竭早期,实行代谢支持能够不同程度地增加体重、促进蛋白质合成和扭转负氮平衡。适当减低糖供给的非蛋白热量可以减轻应激反应,增加氮保留和改善肺功能。供给氨基酸过多则增加应激反应、增加尿氮排出和加重呼吸负担。     

User satisfaction with a real-time automated feedback system for general practitioners: a quantitative and qualitative study.

OBJECTIVE: The GRIF automated feedback system produces real-time comments on the appropriateness of diagnostic tests ordered by general practitioners (GPs) based on recommendations from accepted national and regional practice guidelines. We investigated the experiences of GPs with this system and, more specifically, with the recommendations produced by the system as well as their views on using this system in daily practice. SETTING: We tested the GRIF system in an experiment in a laboratory setting and in a daily practice trial. STUDY PARTICIPANTS: General practitioners. INTERVENTION: In the laboratory experiment, GPs used the GRIF system to assess the appropriateness of 30 request forms. Each of the GPs was confronted with requests they had submitted to the diagnostic unit of the hospital in the past. In the field trial, the GRIF system was applied during patient consultations for 1 year. MAIN OUTCOME MEASURES: We measured GPs' satisfaction with the system using a questionnaire, and also conducted group discussions (in the laboratory experiment) and in-depth interviews (in the field trial) to elicit GPs' opinions of and experiences with the system. In addition, we explored GPs' reasons for not accepting the comments offered by the GRIF system. RESULTS: The results show that the GPs in the laboratory experiment had more positive attitudes towards the system compared with participants in the field trial. All discussion groups and most of the GPs in the field trial regarded receiving the immediate feedback during the test ordering process as an important advantage. The most frequently mentioned reason to reject the recommendation was disagreement with the content and/or the recommendations in the practice guidelines. CONCLUSION: Apart from securing agreement on guideline content, a prerequisite for using GRIF in daily practice on a large scale is that more attention is paid to promotion of the guidelines and their adoption, and stimulation of a positive attitude towards the practice guidelines among the users.     

高等中医药院校贫困生心理健康、防御方式和社会支持的相关分析

目的探讨不同心理健康状况的贫困大学生的防御方式和社会支持特点及其关系。方法采用防御方式问卷(DSQ)、社会支持评定量表、症状自评量表(SCL-90)对302名中医院校贫困大学生进行测评。结果贫困生的心理健康水平低于国内青年常模,但在人口学统计变量上的差异不显著;不同心理健康水平的学生的防御方式和社会支持均具有显著性差异,心理健康状况差的学生较心理健康好的学生更多地使用不成熟的防御策略,且在客观支持、主观支持、对支持的利用度和总分上均显著地低于心理健康状况好的学生;不成熟的防御策略对心理健康具有显著影响。结论贫困生的心理健康与防御方式和社会支持之间具有显著的关联性,应从转导不成熟的防御策略和营造良好社会支持系统两方面对贫困生的心理健康进行维护。     

Intimacy and mental disorder in late middle age. Report of the TURVA project

This study, which was carried out as part of the TURVA project on psychosocial adaptation in old age, is concerned with the significance of social support to people approaching retirement age. The population consisted of 200 urban dwellers and 189 rural dwellers, who were studied at the age of 62. The subjects were either about to retire in the near future or had already retired, and it was assumed that this event causes a certain amount of stress, which may lead to mental disturbance regardless of the amount of social support available to the individual. Intimate relationship and close friendship served as the measures of social support. Mental disturbances were assessed on the basis of the General Health Questionnaire (36-item version) and the number of psychic and especially depressive symptoms. The prevalence of mental disturbance and depressive symptoms was lowest in those people who lived in a close marital relationship and who also described their spouse as empathic. Psychic symptoms were most common in those people who said their relationship to their spouse was distant and who described them as unempathic. The subjects who were not married fell in-between these 2 groups regardless of whether they had an intimate relationship with someone of the opposite sex. A positive marital relationship seemed to provide a shield against depression, while a negative marital relationship tended to make the individual more vulnerable to depression. The role of a close non-marital friendship depended on the respondent's sex. In women, it was associated with a high prevalence of depressive symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)     

The influence of clinical problems, age and social support on outcomes for elderly persons referred to regional aged care assessment teams

Abstract Background: Aged Care Assessment Teams (ACATs) have been established throughout Australia during the past seven years. Early studies of their effect have concentrated on their impact on the rate of institutionalisation of disabled elderly, the clinical characteristics of referred cases and the relationship between disability and recommended care plan. Aims: The aim of this study was to explore the relationship between age, clinical features and social characteristics of AC AT subjects with outcomes at 12 months after assessment. Methods: The examination of an arbitrary sample of persons referred to ACATs over a year by one generalist geriatrician with follow-up of all cases by the three ACATs associated with the study was carried out. All analyses were performed on raw data presented as categorical variables in the form of contingency tables. Results: The sample included 324 subjects who suffered from 2030 clinical problems with a mean of 6.5 per person aged 75 or over and 5.5 for those under 75. Cardiovascular and neurological disease were the commonest source of problems. Study of accommodation outcome at 12 months, for those subjects who survived this period revealed that, in the older group, over 60% of subjects with neurological disease were resident in nursing homes while the majority of all other groups remained in the community, as did two-thirds of those aged under 75. Admission to a nursing home was independent of social support for older subjects with neurological disease, but it played a significant role in those with cardiopulmonary or musculoskeletal disease. Conclusions: The study demonstrates that for one-year survivors there is an increased likelihood of admission to a nursing home of people aged 75 or over with neurological disease, while those under 75 were more likely to remain at home. The association was independent of whether spouse, family or friends were living with the subject. (Aust NZ J Med 1994; 24: 378–385.)     

Support networks and dementia

Based on data from a sample of 4500+ people aged 65+ living in the community (ie not in residential care) in Liverpool, this article presents data on the availability of kin and levels of contact with family, friends neighbours and community groups, and compares the distribution of support network types of those identified as cases of dementia with non-cases. It is shown that dementia sufferers are more likely to live with others and to have more contact with family members and less contact with friends, neighbours and community groups than non-sufferers. It is also shown that the distribution of network type is distinctively different for cases and non-cases and it is suggested that this reflects the greater ability of some types of network to support continued community residence in the face of the onset of dementia.     

Medical education for minorities at a US medical school

The University of Washington School of Medicine (UWSM) has initiated new efforts to build a regional minority applicant pool and to expand its educational programmes to accommodate students from disadvantaged backgrounds. Specific interventions include: establishment of medical career planner position to coordinate region-wide outreach; pre-entry education; and support activities once enrolled. This study describes specific services and presents sociodemographic and performance data on 56 minority and 280 majority students entering the UWSM between 1981 and 1985. Economic status and educational background of minority students were significantly below that of majority students, several flexible academic policies enabled most students to achieve mastery in courses and to progress through the curriculum. The educational data base utilized in this study, and those at other institutions, can assume important roles in the identification of problem areas in the education of disadvantaged students and in evaluation of the interventions attempted.     

联勤后我分部医院开展优质服务的做法

为探讨军队医院联勤后开展联勤优质服务工作的管理，本介绍了我分部所属医院开展优质服务的做法，即：端正服务态度，增强服务意识，狠抓内涵建设，提高服务质量，改善医疗设备，美化诊疗环境，完善制度措施，加强监督管理等落实联勤优质服务。     

An Intrapleural Lung Prosthesis: Rationale, Design, and Testing

Abstract: Extracorporeal life support (ECLS or ECMO) is standard treatment for severe respiratory failure but poses many contraindications to future lung transplantation. The solution to this dilemma is the implantable gas exchange device (IGED) or artificial lung. Preliminary efforts to create such an artificial lung have been made since 1970 and include designs involving single devices, intravascular devices (i. e., IVOX), and combination heart–lung devices, Stringent requirements govern the design of such a device, the most important of which are high gas exchange efficiency, low resistance to blood flow, and size. This paper describes such a device. It incorporates large diameter inflow and outflow ports in close proximity and a low resistance wound hollow fiber core encapsulated in a compliant outer shell which conserves the work of the right ventricle. In a large animal model (adult sheep) this device was connected in line with the main pulmonary artery in series with the native lungs. This configuration has the advantages of using the lungs as an embolic filter, perfusing the lungs with fully oxygenated blood, and maintaining the integrity of the anatomy necessary for transplant. Laboratory experiments have run >8 h. Preliminary data show that the animals have remained hemodynamically stable while the devices have supported the animals completely by supplying 100% O₂ saturation with PO₂ values ranging from 250–350 mm Hg. Additionally, this model makes possible the study of respiratory failure without introducing other variables such as extracorporeal circuits or pumps. The other metabolic, endocrine, and reticuloendothelial functions of normal and injured lungs can now be studied more precisely by excluding these variables. Further studies are needed to evaluate this device in chronic (long–term implantation) experiments before clinical application.