医学影像诊断设备网络化在放射科管理中的应用探讨

目的:试探讨实现医学影像诊断设备网络化对提高放射科质量的重要性及实用性。材料和方法:CT、MRI、Sun Advantage Windows(简称AW)2.0工作站连接成医学数字影像传输(DICOM)网络;DICOM服务器与各图像浏览及诊断报告书写终端连接成Ethernet网络;二者再通过集线器连接成PACS。结果:应用PACS技术,实现数字化图像在医学影像诊断设备网络化内的传送,中心存储,在DICOM 3.0标准水平的相互兼容图像交流以及诊断的报告的规范化、计算机化、实现无胶片管理医院。结论:实现医学影像诊断设备网络化提高了工作效率和管理水平,具广阔的应用前景。     

基于Web的医院决策支持信息系统设计与实现

集成众多的数据源为医院提供一个良好的决策支持信息系统,是医院网络时代对信息系统的基本要求之一。本文给出了Web环境下医院决策信息支持系统的实例,并探讨了相关的技术及实现方法。     

内含报酬率法在医院大型项目投资决策中的应用

根据财务管理中内含报酬率原理，介绍其在医院实际工作中的具体运用。同时提出：为了保证分析评价的科学性、客观性，必须遵循实际现金流量原则和增量原则，做好对沉没成本、机会成本、分摊费用、业务收支、折旧费用等5方面的判断和识别。     

Nerve ring of the hypostome in hydra. I. Its structure, development, and maintenance.

The anatomy and developmental dynamics of the nerve ring in the hypostome of Hydra oligactis were examined immunocytochemically with an antiserum against a neuropeptide and with neuron-specific monoclonal antibodies. The nerve ring is unique in the mesh-like nerve net of hydra. It is a distinct neuronal complex consisting of a thick nerve bundle running circumferentially at the border between the hypostome and tentacle zone. Immunostaining showed that the nerve ring was heterogeneous and contained at least four different subsets of neurons. During head regeneration and budding, the nerve ring appeared only after the nerve net of ganglion and sensory cells had formed. Every epithelial cell is continuously displaced with neurons toward either head or foot in an adult hydra. However, the ectoderm in the immediate vicinity of, and including, the nerve ring constitutes a stationary zone that is not displaced. Tissue immediately above this zone is displaced toward the tip of the hypostome, while tissue below is displaced along the tentacles. Correspondingly, the production of new neurons in the ring as measured by their differentiation kinetics is much slower than in surrounding areas. Thus, the nerve ring is static and stable in contrast to the dynamic features of the nerve net of hydra.     

METABOLIC ALKALOSIS IN INFANTS: ROLE OF WATER DEPLETION AND CHANGES IN COMPOSITION OF STOOL

Simple calculations of the effect of volume depletion on the concentration of titratable base of blood show this effect to be largely adequate to account for commonly observed degrees of metabolic alkalosis in patients with mild or extreme dehydration due to obstructive vomiting. This suggests that hydrochloric acid depletion per se may not be a major determinant of the blood acid-base status in such conditions. Clearly, part of the base equivalents missing in the extracellular fluid may be sought in the cell water; but currently available evidence concerning gastrointestinal transport of acid and base invites a conception of gastrointestinal acid-base homeostasis–and the hypothesis that in obstructive vomiting changes in the composition of stool may appreciably modify the effect of gastric hydrochloric acid depletion. In studies of intracellular buffering and net base balance in gastric alkalosis, it must be realized that the primary extracellular disturbance may be largely contractional and that stool losses (or luminal pooling) of base may be an important variable.     

Rising Inability to Obtain Needed Health Care Among Homeless Persons in Birmingham, Alabama (1995–2005)

Background  Homeless persons depend disproportionately on the health-care safety net for medical services. National reports identify financial strains to this safety net. Whether this has affected homeless persons is unknown. Objectives  We quantified changes in the proportion of homeless persons reporting unmet need for health care in Birmingham, Alabama, comparing two periods, 1995 and 2005. We assessed whether a period effect was independent of characteristics of persons surveyed. Design  Analysis of two surveys conducted with identical methods among representative samples of homeless persons in 1995 (n = 161) and 2005 (n = 161). Measurements  Report of unmet need (inability to obtain care when needed) was the dependent variable. Two survey periods (1995 and 2005) were compared, with multivariable adjustment for sociodemographic and health characteristics. Reasons for unmet need were determined among the subset of persons reporting unmet need. Results  Unmet need for health care was more common in 2005 (54%) than in 1995 (32%) (p < 0.0001), especially for non-Blacks (64%) and females (65%). Adjusting for individual characteristics, a survey year of 2005 independently predicted unmet need (odds ratio 2.68, 95% CI 1.49–4.83). Among persons reporting unmet need (87 of 161 in 2005; 52 of 161 in 1995), financial barriers were more commonly cited in 2005 (67% of 87) than in 1995 (42% of 52) (p = 0.01). Conclusion  A rise in unmet health-care needs was reported among Birmingham’s homeless from 1995 to 2005. This period effect was independent of population characteristics and may implicate a local safety net inadequacy. Additional data are needed to determine if this represents a national trend. An abstract of these findings was presented at the 2008 Annual Meeting of the Society of General Internal Medicine.