Long-term management of GERD in the elderly with pantoprazole

The prevalence of gastroesophageal reflux disease (GERD) increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs) are central in the management of GERD and are unchallenged with regards to their efficacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is significantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower affinity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efficacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD.     

Making a working clinical diagnosis of HIV infection in infants in Zimbabwe

Objectives Clinical algorithms can be helpful in decisions about treatment and feeding options in infancy, but have had limited exposure to real data. This analysis uses data from a large clinical trial to test such algorithms, and thereby develop a successor which performs usefully in poor countries with high HIV‐prevalence. Methods The ZVITAMBO trial followed 14 110 mother‐baby pairs through infancy. 32% of mothers were HIV‐positive. Infants were HIV tested regularly using DNA PCR. Clinical signs were evaluated in terms of identifying HIV‐infection at 6 weeks, 6 and 12 months, using Zimbabwean, South African, and WHO generic adaptations of the WHO integrated management of childhood illness HIV algorithm. A modification, in which HIV‐exposed infants are first divided into being at least or less than median weight‐for‐age, was derived and evaluated. Results At 6 weeks 65% of all infected babies are less than median weight‐for‐age. Adding at least two clinical signs reduces sensitivity to 20% but those identified are 1.5 (95% CI 1.1–2.1) times more likely to die by 6 months than other infected infants. At 6 months, 86% of uninfected babies of HIV‐infected mothers can be identified by selecting those whose weight is greater than median or, if less than median, who exhibit <2 clinical signs. Conclusions In poor settings a simple clinical algorithm can identify children with probable HIV infection, especially those at risk of early death, who can then be referred for further testing and care, including highly active antiretroviral therapy. Most infants who are HIV‐uninfected can be identified at 6 months and provided with support to maintain infection‐free survival, including focussed infant‐feeding counselling.     

军队中小医院转型期信息科面临的挑战与对策

目的：探讨转型期军队中小医院信息科发展中存在的问题,提出合理的应对策略。方法：分析信息科职能新变化,从发展思路、人才队伍、建设投入等方面讨论影响信息科发展的关键因素。结果：通过提高思想认识、坚持主动作为、搞好统筹协调、重视人才建设等多方面努力,促进转型期中小医院信息科持续发展。结论：只有不断提高信息服务手段,加强信息制度建设,培养信息化专业人才,才能提高医院整体信息化能力。     

借助私有云技术构建HIS自助管理平台

利用云技术搭建自助管理平台,以提高服务质量为目的,加速医院信息化建设。让临床护理工作与行政审批制度分离,使医务人员能全身心投入到医疗工作中。同时开发基于安卓系统的移动客户端来进行审批验证,保障患者住院过程中的流畅性和完整性。为科室无人坚守服务打下了基础,增强临床用户的信息化体验,管理平台作为HIS应用的补充也可以维护医护工作站日常出现的问题。     

优质护理服务中实施PDCA管理模式的临床体会

目的对优质护理服务中实施PDCA管理模式的临床体会进行研究分析。方法从我院住院患者中选取96例进行研究分析,并按照患者临床护理措施将其分为治疗组(采用PDCA管理模式下优质护理措施护理)和对照组(采用常规临床护理措施护理),均为48例,对比两组患者的临床护理质量、器械以及药品操作合格率、基础理论操作率以及护理满意度。结果实施干预前,两组患者的危重症护理合格率、基础护理合格率、护理文件书写合格率、健康教育知晓率、急救物品以及器械完好率比较,无统计学意义(P>0.05),实施干预后,治疗组干预后效果明显于干预前,且干预后优于对照组,差异有统计学意义(P<0.05),治疗组护理满意率明显优于对照组(P<0.05)。结论在对患者护理过程中和优质护理服务中实施PDCA管理模式具有良好作用,可显著改善患者临床症状,提高患者对护理总满意度。     

基于医疗安全角度的医疗设备计量管理

本文从医疗安全的角度,对医疗设备计量管理过程中存在的问题进行探讨,并结合实际工作从院领导意识、组织、人员、计量环节等方面提出改进建议。     

医疗设备固定资产分类及信息化管理方法

本文分析了医疗设备固定资产分类管理的现状,介绍了常用的分类方法及优缺点,提出了基于医疗设备原理和功能分类的管理方法,指出了固定资产信息化管理的发展趋势。     

医院-社区一体化模式对社区老年高血压分级管理的效果

目的：评价医院-社区一体化分级管理模式对社区老年高血压患者的管理效果,探索社区老年高血压有效管理模式。方法：2013年6月采取随机抽样的方法从长沙市某社区卫生服务中心随机抽取218名原发性老年高血压患者(男121名,女97名),根据心血管风险分级,将研究对象随机分为3个管理组(低危、中危、高危/很高危),对各组分别展开6个月医院-社区一体化分级管理。采用《HILL-BONE高血压依从性评估表》及自行设计的《血压监测登记表》,评估老年高血压患者的血压控制情况和就医依从性。结果：干预6个月后,血压控制率由22.9%提高至88.1%(P<0.01);与基线水平比较,低危组、中危组、高危组/很高危组收缩压水平分别下降17,20和23mmHg(P<0.01),舒张压水平分别下降6,5和7mmHg (P<0.01);HILL-BONE高血压依从性由54.5%提高至87.4%(P<0.01)。结论：医院-社区一体化分级管理模式能提高社区老年高血压患者血压控制率、治疗依从性及合理用药率,值得在社区老年高血压病防治中推广。