Aggressive therapy of infants with renal failure

Nine infants, who presented with renal failure within the first 3 months of life, were treated with continuous ambulatory peritoneal dialysis (CAPD). Seven infants survived to an age of 12–15 months, when they received transplants. Two patients died while on CAPD. Six infants are alive with a functioning renal allograft, at an average age of 35.5 months and an average of 22 months post-transplant. Neurological development is normal in four of the six infants tested. The mean current height of the six transplant recipients is just below 2 SD from the mean.     

医院图书馆过刊剔旧工作的思考

分析了医院图书馆过刊剔旧的必要性与可行性,提出了剔旧原则与建立全国性文献剔除网络中心的设想.     

急性心肌梗塞猝死的诱因及抢救(附13例报告)

本文报告了急性心肌梗塞猝死13例。分析猝死的诱因主要有血清钾浓度降低,严重心律失常,包括室内传导阻滞、室性并行心律、室性早搏等。近年来急性心肌梗塞的发病率日趋增高,心源性猝死也随之增多,有必要对猝死的诱因进行探讨,以采取有效的抢救措施。     

Comparison of Family clinic Community Health Service Model with State—owned Community Health Service Model

Based on a survey of community health service organization in several cities,community health service model based on the family clinic was compared with state-owned community health service model,and status quo,advantages and problems of family community health service organization were analyzed.Furthermore,policies for the management of community health service organization based on the family clinic were put forward.     

佩尔地平治疗妊娠高血压病人的护理管理路径

目的探讨护理管理路径在应用佩尔地平治疗的重度子痫前期病人的效果，以期达到最佳的治疗效果，并减少并发症的发生。方法将用佩尔地平针治疗的重度子痫前期的病人486例随机分为两组，一组按常规护理，另一组按制定的护理管理路径护理。结果患者依从性对照组为168例，占70％；观察组为228例，占92．68％，P〈0．05，其差异有统计学意义。胎死宫内发生率对照组为9．16％，观察组为0．81％，P〈0．05，其差异有统计学意义。血压的稳定性对照组为36．3％，观察组为97．6％，P〈0．05，其差异有统计学意义。结论护理管理路径可以提高重度妊娠高血压疾病的治疗效果，减少并发症的发生。     

Leiomyosarcoma originating in Meckel's diverticulum: Report of a case and a review of 59 cases in the English literature

A 49-year-old woman was referred to our hospital with complaints of epigastric colicky pain and high fever. Abdominal computed tomography and ultrasonography showed a solid tumor in the lower abdomen. Laparotomy revealed a neoplastic mass arising in Meckel's diverticulum; therefore, a segment of the ileum, including the tumor-possessing diverticulum, was resected with a lymph node dissection. A histologic examination confirmed the lesion to be leiomyosarcoma. In the English literature, 59 cases of leiomyosarcoma in Meckel's diverticulum were reported from 1941 to 1994. The majority of patients were in their 4th decade of life, with both sexes equally affected. The most frequent symptoms associated with this disease were abdominal pain with nausea, vomiting, and melena. The majority were larger than egg-size. Although Meckel's diverticulum is difficult to diagnose preoperatively, mesenteric arteriography may at times prove useful. The standard management of this particular tumor is wide segmental resection, including the tumor and diverticulum with lymph node dissection.     

The burden of brain diseases in Europe.

The burden [as defined by the World Health Organisation (WHO)] of brain diseases (neurological, neurosurgical and psychiatric diseases together) is very high and yet resources spent on these diseases are not necessarily commensurate with the extent of this burden. However, hard data on the burden of brain diseases in Europe have not previously been easily accessible. The Global Burden of Disease (GBD) 1990 study conducted jointly by the WHO, Harvard University and the World Bank provided new measures that are now becoming universally accepted and have been used also in a repeat study: The GBD 2000. The key parameter of the study is disability adjusted life years (DALY), which is the sum of years of life lost (YLL) caused by premature death and years of life lived with disability (YLD). In the present report, data from the GBD 2000 study and from the World Health Report 2001 on brain diseases is extracted for the territory of Europe. This territory corresponds roughly to the membership countries of the European Federation of Neurological Societies. The WHO's Report has a category called neuropsychiatric diseases, which comprises the majority but not all the brain diseases. In order to gather all brain diseases, stroke, meningitis, half of the burden of injuries and half of the burden of congenital abnormalities are added. Throughout Europe, 23% of the years of healthy life is lost and 50% of YLD are caused by brain diseases. Regarding the key summary measure of lost health, DALY, 35% are because of brain diseases. The fact that approximately one-third of all burden of disease is caused by brain diseases should have an impact on resource allocation to teaching, reasearch, health care and prevention. Although other factors are also of importance, it seems reasonable that one-third of the curriculum at medical school should deal with the brain and that one-third of life science funding should go to basic and clinical neuroscience. In addition, resource allocation to prevention, diagnosis and treatment of brain diseases should be increased to approach, at least, one-third of health care expenditure. With the present data on hand, neurologists, neurosurgeons, psychiatrists, patient organizations and basic neuroscientists have a better possibility to increase the focus on the brain.     

医疗设备管理面临的新挑战

目前,医疗服务价格的调整特别是大型医疗设备的检查费用下调和高值耗材附加收费的封顶限制及药品加成的即将取消,在一定程度上减轻了患者的经济负担,但同时也造成医院收入大幅下降。作为设备管理部门,如何从医疗设备配置和管理等方面来引导、配合事关医院生存和患者福祉的医疗服务结构调整,是新形势下的新挑战。通过探讨提出从严格控制医疗设备购置费用、优化医疗设备配置、保证常规医疗设备和提高管理水平等4个方面争取找到一条使病患和医院双方共赢的道路。     

A global view of suicidal behaviour

Suicidal behaviour is a major public health problem. There is no one explanatory theory of suicidal behaviour, and various combinations of sociological and biological/medical interventions are required to reduce associated mortality and morbidity. The importance of primary prevention varies from community to community, and may have an impact at the population level. However, individual suicidal persons always require optimum assessment and management and that is usually provided by primary care and emergency physicians. This paper provides an overview of issues to be addressed in the assessment and management of suicidal patients. See Commentary, page 8.     

论医院质量管理推行ISO9000族标准的必要性

为了迎接医疗市场的竞争和挑战 ,医院将应用于工业企业的ISO90 0 0族标准引入到医疗服务领域。它通过严格的过程控制 ,使医院实现了质量管理制度健全化、系统化、合理化 ,大大减少了服务中的差错 ,全面提高了服务质量 ;通过工作程序化及持续改进 ,改善了医务人员的工作环境 ,提高了医院运作效率和运营效益。本文从现行的质量管理的不足分析入手 ,从八个方面阐述医院质量管理推行IS0 90 0 0族标准的必要性 ,以此来说明医院的质量管理采用ISO90 0 0族标准 ,将会使医院的质量管理有一个质的飞跃。事实证明通过认证的医院已从中收益。