Risk management and system failure analysis in mental health investigations

This editorial explores the way in which mental health investigations are developing in England and in particular those involving a homicide. A move away from traditional panel inquiries and towards investigations using root cause analysis (RCA) is aimed at shifting the focus from individual blame to identifying system failure. Thus it is envisaged by policy makers that the RCA approach will offer greater learning opportunities for mental health services. The key difficulties associated with panel inquiries are highlighted before describing the intended benefits of the RCA approach. Finally, five key areas where systematic research can support the development of this approach are suggested.     

高龄食管癌贲门癌的外科治疗

目的探讨高龄食管癌贲门癌患者手术适应证的选择及围手术期的处理.方法回顾性分析36例65岁以上高龄食管癌贲门癌手术病例的临床资料.结果36例中,手术切除35例,切除率为97.2%.术后并发症25例(69.4%),其中肺部并发症19例(76%),心血管系统并发症15例(60%),全组无死亡.术前合并有肺部疾病12例中术后发生肺部并发症10例(83.3%),手术操作时间≥4 h的17例中术后发生肺部并发症14例(82.4%)、发生心血管系统并发症12例(70.6%),术后有肺部并发症的19例中发生心血管系统并发症13例(68.4%),与相应对照组比较,经x2检验两者差异有显著性(P＜0.05或P＜0.01).术后生存率随访结果与其他年龄组相仿.结论高龄食管癌贲门癌患者术前应积极准备,严格掌握手术适应证,术中尽量缩短时间,并进行妥善有效的围手术期的综合处理.     

陕西省农村医疗机构现状研究

本研究采用定性与定量方法分析陕西省农村医疗卫生机构现状。研究表明，陕西省农村卫生组织仍不能适应农村经济发展和群众医疗保健需要，与全面实现小康和基本实现现代化的目标还有相当大的差距。一是农村卫生经济政策贯彻不力。二是农村卫生人员素质不高，学历结构不合理。高学历比例太低，无学历占18．36％。三是农村医疗保障制度改革滞后。四是管理体制和运行机制改革亟待深化。     

关于构建小康社会医疗保障体系的政策建议

根据党的十六大提出的“全面建设小康社会”的宏伟目标，提出构建小康社会医疗保障体制的政策建议：从单一的医疗保障向健康保障拓展；从单一人群向整体人群拓展。同时认为要树立协作观、处理好乡镇企业职工参保、基层操作层面的利用、药品目录的重新制定等问题。     

乡村医疗卫生集团化运作和管理的调查与思考

通过对安徽省太湖县城西乡实施的“乡村医疗卫生集团化运作和管理”项目的现场调查，了解该项目实施的背景、进展和主要问题，提出“乡村医疗卫生集团化运作和管理”是“乡村医生股份合作制联合体”的一种形式，将是农村基层卫生机构管理体制的有效实现形式之一。     

略谈公立医院产权制度改革

介绍公立医院改制的几种基本模式，认为在我国对部分公立医院实行产权制度改革是历史发展的必然，并且迟改不如早改、股份制改不如全部退出、被动突围不如主动突围。与此同时，国家应建立较完善的医疗保障制度；加强对改制后医院的监管，而不是一卖了之。     

对医院后勤体制改革的探讨——加强市场经济条件下医疗设备科的管理

本文结合实际情况，就医院后勤体制改革这个问题对现阶段市场经济条件下如何加强医疗设备科的管理进行初步的探讨。     

数据仓库在军字一号工程药品信息管理分析中应用研究

目的探讨如何应用数据仓库技术构建军字一号工程药品信息统计资源库。方法运用Oracle9.2和OWB9.0数据仓库生成软件,构建药品信息统计资源库,并利用Oracle9iDiscoverer工具进行数据挖掘。结果从药品信息统计资源库中挖掘出大量的管理信息,并生成了相应的报表和视图。结论应用数据仓库技术构建医院药品信息统计资源库,可从中得到丰富的辅助决策信息,拓展了HIS信息资源利用空间。     

Success of de novo reimplantation of the artificial genitourinary sphincter

PURPOSE: We evaluate our experience with de novo reimplantation of the artificial genitourinary sphincter with a particular emphasis on mechanical and nonmechanical failure rates. De novo reimplantation is defined as implantation of an artificial sphincter following removal of a previously placed sphincter for erosion and/or infection and a waiting period of several months. MATERIALS AND METHODS: A retrospective analysis of more than 400 patients with an artificial sphincter revealed 23 who underwent de novo reimplantation between January 1983 and October 1998. All patients were men with a mean age of 66.5 years (range 16 to 88) and all had a urethral cuff. Reasons for cuff removal were erosion in 12 cases (52.2%), infection in 10 (43.5%) and intraoperative urethral injury in 1 (4.3%). Mean waiting period was 6.8 months (range 1.5 to 32) between explantation and de novo reimplantation. Mean followup was 32.6 months (range 1 to 108). RESULTS: Of the 23 patients 20 (87%) had no mechanical or nonmechanical failures and 3 (13%) had nonmechanical failures, including 2 patients (8.7%) whose cuff eroded into the urethra and 1 (4.3%) who had recurrent urinary incontinence which was successfully treated with implantation of a tandem cuff. There were no mechanical failures or infections in this group of patients. CONCLUSIONS: Our study suggests that de novo artificial sphincter reimplantation is an excellent treatment option. It is safe and associated with complication rates that are comparable to those of primary implantation.     

儿童鞍区肿瘤术后血钠紊乱的临床研究

目的：研究儿童鞍区肿瘤术后血钠紊乱的发病机制、变化规律及其治疗措施。方法：对1997年4月至2002年10月间269例鞍区肿瘤术后并发血钠紊乱的患儿进行回顾性研究。记录手术当日及术后每日定时检测的血钠值及其相应的治疗措施。结果：450例儿童鞍区肿瘤患儿术后269例出现血钠紊乱。其中72．5％(195／269)出现于手术当日和术后第1d。83．3％(224／269)患儿于出现血钠紊乱后10d内恢复正常，第7d左右出现一个恢复的高峰期。根据血钠紊乱的临床经过可分为三种类型：①暂时型：一般于7～10d之内血钠恢复正常；②三相型：血钠紊乱持续一段时间后出现1-3d的正常期，然后又出现血钠紊乱；③持续型：血钠紊乱持续10d以上。结论：儿童鞍区肿瘤术后血钠紊乱变化有一定规律性。掌握其变化规律及原因可及时有效地纠正血钠，缩短儿童鞍区肿瘤术后血钠紊乱的病理经过。