ROMEO: rethink organization to improve education and outcomes.

AIMS: Scarcity of resources, expertise and evidence-based models have so far limited delivery of patient-centred diabetes education. We have developed and validated a group care approach that is applicable to everyday clinical practice and cost-effective in improving metabolic control, knowledge of diabetes, health behaviours, and quality of life in Type 2 diabetes. A clinical trial (ROMEO) was planned to evaluate applicability and reproducibility of group care in other outpatients facilities and assess its impact on a larger patient population. METHODS: Multicentre, randomized, controlled clinical trial of group vs. individual care in the routine management of Type 2 diabetes. Nine hundred patient aged < 80, with diabetes of > or =1 year known duration, treated by either diet alone or diet and oral agents, will be recruited in 15 centres and followed for 4 years. Training of physicians, nurses and dietitians included preparation of operating manual and videos, interactive sessions, and evaluation of local facilities and resources. RESULTS: Primary measurements: 3-monthly HbA1c, fasting blood glucose, body weight, waist-hip ratio, yearly blood lipids, and bi-yearly assessment of knowledge of diabetes, health behaviours and quality of life. Secondary outcomes: systolic and diastolic blood pressure, evaluation of ECG for ischaemia and QT interval, hypoglycaemic and anti-hypertensive medication and cardiovascular events. Analysis will be by intention-to-treat. DISCUSSION: If ROMEO confirms that group care can be successfully implemented in different clinics, a novel clinico-pedagogic tool will have been acquired to support patient-centred education, improve lifestyle and outcomes, support team work, enhance providers' attitudes and competencies and ameliorate diabetes care organization.     

Short-term subjective efficacy of doxazosin in predicting probability of prostatectomy in the management of benign prostatic hyperplasia in patients with severe symptoms

BACKGROUND: The severity of symptoms still constitutes the major indication for transurethral prostatectomy, despite the extensive utilization of medical treatments. The aim of the study presented here was to investigate the impact of doxazosin on symptoms in relation to the probability of consequent surgery in severely symptomatic patients. METHODS: Patients with an International Prostate Symptom Score (IPSS) between 18 and 35 were included in the study. The patients received 4 mg/day doxazosin, and subjective efficacy was assessed by IPSS at the first and third months. In addition, the patients were classified at the third month according to a single question regarding satisfaction with medical treatment in terms of symptom relief as 'ineffective, no change, and effective'. RESULTS: A total of 178 patients constituted the study group. Mean total symptom scores were 24, 19 and 17 at baseline, first and third months, respectively (P < 0.05). According to results of the questionnaire, 23% of the patients claimed the treatment was ineffective, and subsequently, the majority of this group (93%) underwent prostatectomy in a year. In addition, 33% of the patients reported no change in their symptoms, while 44% reported that the medication was effective. However, after 1 year, 59% and 15% of these cases underwent surgical treatment, respectively. The probability of surgery in the 'ineffective' group was significantly higher compared to the remaining groups (P < 0.05). CONCLUSION: The majority of patients with severe symptoms who were not satisfied with the medication at the 3rd month underwent surgery. This observation may provide a predictor for subsequent probability of prostatectomy. Therefore, reassessment of patients would be a cost-effective approach for the treatment of BPH in severely symptomatic patients.     

医院制剂室的软件管理

为了探讨医院制剂室的软件管理 ,我们根据《医疗机构制剂配制质量管理规范》的要求 ,分析了我们的软件动态与静态资料 ,提出了自己的一些解决方案。     

我国医院信息系统必走整合之路

论述了我国医院信息系统(HIS)整合的重要意义和原则,介绍了HIS整合的方法措施以及经验.     

The hospital as an enterprise: management strategies

After introducing the context in which health systems exist in developing as well as in industrialized countries, the author describes the role that hospitals are expected to play as 'enterprises'. The rationale behind such a role is explored and the experience so far available discussed. Evidence from several developing countries suggests caution and tends to discourage radical and indiscriminate introduction of market‐oriented reforms, which international donors seem to be spearheading in Africa's health systems. It is likely, however, that a limited, gradual introduction of selected elements of these reforms (such as some aspects of contracting out, managerial decentralization, the split between purchasing and providing functions) may find its place and eventually have a positive impact on the performance of the health systems. But the 'mystique of markets' must not be allowed to deprive public hospitals of the sense of social utility and of the caring ethos which are essential requisites of a meaningful and effective public health system.     

Radiofrequency Current Ablation of Porcine Right Atrium: Increased Lesion Size with Bipolar Two Catheter Technique Compared to Unipolar Application In Vitro and In Vivo

Interruption of atrial flutter and fibrillation by RF catheter ablation may be favored by large, elongated lesions. We administered RF current in unipolar and bipolar mode in porcine right atrium. Bipolar ablation was performed between the tip electrodes of two serially coupled catheters. With 4-mm tip electrodes in vitro, lesion length increased from a mean (SD) of 7.9 (1.2) mm at 3 mm-interelectrode distance (IED) to 13.3 (3.3) mm at 9-mm IED, but decreased at 12-mm IED due to nonconfluent lesions (P < 0.0001), With 4 mm distal electrodes and 8 mm IED, bipolar lesions were 65% longer than corresponding unipolar ablations. Switching to bipolar mode increased the lesion length more than increasing electrode tip length to 6 mm in unipolar mode. Power and temperature controlled ablation created equally sized lesions. Twelve anesthetized pigs were randomized to unipolar or two catheter bipolar temperature controlled ablation of the right atrial free wall. Bipolar ablation created confluent lesions with endocardial length × width of 13.5 (5.8) × 7.3 (3.7) mm, unipolar ablation 6.4 (2.8) × 4.6 (1.4) mm (P < 0.001 when comparing length and P = 0.013 for lesion width). The atrial lesions in both groups were transmural and extended into hilar lung lesions with maximal depth of 3.0 (1.1) and 2.6 (1.0) mm, respectively (P = 0.44). Five bipolarly and four unipolarly ablated pigs developed right diaphragmal paresis. We conclude that bipolar ablation may be preferable in situations where large, elongated lesions are favorable. The two catheter technique is feasible in porcine right atrium. Both bipolar and unipolar ablation of the porcine right atrial free wall may frequently be complicated by injury to the phrenic nerve and adjacent lung tissue.     

Occupational stress management programmes: a practical overview of published effect studies

There are many occupational stress management programmes availablewhich are designed to prevent and cure the negative aspectsof job-stress. The focus of the programmes can be directed towardsthe individual worker, the working group, the organization ofthe work or the organization as a whole. Moreover, programmesshow a considerable variation with respect to the type of interventionsthey promote and their underlying assumptions, as well as theirduration and costs. In this paper, effect studies of occupationalstress programmes published between 1987 and 1994 are reviewed.The aim is to give a practical overview of the variety in occupationalstress programmes, their scope, applicability and the evidenceof their effectiveness. The paper updates the review by DeFrankand Cooper published in 1989.     

医药团结合作 建设放心药房

总结了全国放心药店现场交流会后,全国各地放心药房建设的情况。强调了建设放心药房工作的意义,指出建设放心药房是中医医疗机构精神文明建设的重要部分,是落实中央指示,加强药品管理的具体行动,是加强中医医疗机构内涵建设的重要内容,是保证中医医疗质量的关键环节。对进一步做好放心药房建设工作提出了要求:规范进货行为,把好药品进货关;不断深化改革,加强内部管理;认真贯彻国家有关法规,继续整治药品回扣违法行为;加强医药团结合作,建立稳定的供需关系;加强领导,务求实效,使“放心药房”建设深入持久地开展下去。     

吉林省38所医院护理工作抽查情况分析

吉林省第一周期的医院评审工作基本结束,为了巩固成果,防止滑坡,吉林省医院评审委员会多次组织专家对38所二三级甲乙等医院护理工作进行现场抽查。对吉林省护理工作的概况及抽查中发现的共性问题进行了分析。同时建议:加强护理人员的职业道德教育;解决护理人员编制不足问题;提高护理人员技术劳务价值;运用激励手段提高护理工作质量。     

关于放射治疗科室的组建

论述了医院组建放射治疗科室进行可行性分析时应考虑的因素,从技术设施、诊疗室与住院病房等方面介绍了放射治疗科的基本组建要求。