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101.
作者采用肌蒂移植术治疗胸腰段陈旧性脊髓损伤56例.脊髓功能恢复率提高至Franke 1个等级以上者占76.8%(43/56).本文讨论了肌蒂移植术对陈旧性脊髓损伤的适应证.安徽省宿州市骨伤科医院淮北煤矿基建局医院 相似文献
102.
103.
Rianne Bindels Arie Hasman Mieke Derickx Jan W J Van Wersch Ron A G Winkens 《International journal for quality in health care》2003,15(6):501-508
OBJECTIVE: The GRIF automated feedback system produces real-time comments on the appropriateness of diagnostic tests ordered by general practitioners (GPs) based on recommendations from accepted national and regional practice guidelines. We investigated the experiences of GPs with this system and, more specifically, with the recommendations produced by the system as well as their views on using this system in daily practice. SETTING: We tested the GRIF system in an experiment in a laboratory setting and in a daily practice trial. STUDY PARTICIPANTS: General practitioners. INTERVENTION: In the laboratory experiment, GPs used the GRIF system to assess the appropriateness of 30 request forms. Each of the GPs was confronted with requests they had submitted to the diagnostic unit of the hospital in the past. In the field trial, the GRIF system was applied during patient consultations for 1 year. MAIN OUTCOME MEASURES: We measured GPs' satisfaction with the system using a questionnaire, and also conducted group discussions (in the laboratory experiment) and in-depth interviews (in the field trial) to elicit GPs' opinions of and experiences with the system. In addition, we explored GPs' reasons for not accepting the comments offered by the GRIF system. RESULTS: The results show that the GPs in the laboratory experiment had more positive attitudes towards the system compared with participants in the field trial. All discussion groups and most of the GPs in the field trial regarded receiving the immediate feedback during the test ordering process as an important advantage. The most frequently mentioned reason to reject the recommendation was disagreement with the content and/or the recommendations in the practice guidelines. CONCLUSION: Apart from securing agreement on guideline content, a prerequisite for using GRIF in daily practice on a large scale is that more attention is paid to promotion of the guidelines and their adoption, and stimulation of a positive attitude towards the practice guidelines among the users. 相似文献
104.
陈情 《山西职工医学院学报》2004,14(4):20-21
目的:通过对精神分裂症合并肺炎患者和老年肺炎患者进行对照观察分析,探索老年精神分裂症合并肺炎的临床特点,为临床诊治提供资料。方法:对35例CCMD-2-R精神分裂症合并肺部感染的患者及35例同期老年肺炎患者对照分析。结果:发现老年精神分裂症合并肺炎患者与老年肺炎患者在神经精神症状和消化系统症状方面差异有显著性。结论:对老年精神分裂症合并肺炎患者更要细致观察,精心护理,早发现、早诊断、早治疗,以降低其死亡率。 相似文献
105.
Integrating human factors into the medical curriculum 总被引:3,自引:0,他引:3
Background The study of human factors is a scientific discipline that deals with the interactions between human beings and the elements of a system. This is important because shortcomings in these areas, if unchecked, can result in adverse outcomes. Research into human factors in industries where safety is paramount has provided the basis of countermeasures against human error. Adverse outcomes in medicine resulting from human error exact a high cost in both patient suffering and financial outlay.
CRM training One of the approaches used to minimise the effect of human error is to train people in a set of knowledge, skills and attitudes that underpin the domain-specific competencies for that profession. These are referred to as non-technical skills (NTS). In aviation, such an approach has been shown to be both translatable from the training environment to the workplace and effective in reducing adverse outcomes.
Discussion Medicine has incorporated this style of training, usually centred around simulator-based courses, but as yet in a piecemeal, episodic fashion which relies on participants volunteering to attend courses. Unlike other industries there is no systematic approach to linking the content of this teaching with the more conventional range of topics. As a consequence it is difficult to assess the impact of human factors training in medicine. This is partly because very little work has been done to date in identifying the key non-technical skills required in medicine, and the overall experience of workplace based assessment is limited. Lessons from other high reliability organisations may help to address the main challenges of developing the content, integrating it into the curriculum, reinforcing the concepts in the workplace through staff development and establishing its role in summative assessment. 相似文献
CRM training One of the approaches used to minimise the effect of human error is to train people in a set of knowledge, skills and attitudes that underpin the domain-specific competencies for that profession. These are referred to as non-technical skills (NTS). In aviation, such an approach has been shown to be both translatable from the training environment to the workplace and effective in reducing adverse outcomes.
Discussion Medicine has incorporated this style of training, usually centred around simulator-based courses, but as yet in a piecemeal, episodic fashion which relies on participants volunteering to attend courses. Unlike other industries there is no systematic approach to linking the content of this teaching with the more conventional range of topics. As a consequence it is difficult to assess the impact of human factors training in medicine. This is partly because very little work has been done to date in identifying the key non-technical skills required in medicine, and the overall experience of workplace based assessment is limited. Lessons from other high reliability organisations may help to address the main challenges of developing the content, integrating it into the curriculum, reinforcing the concepts in the workplace through staff development and establishing its role in summative assessment. 相似文献
106.
John L. Adams Matthias Schonlau José J. Escarce Meredith Kilgore Michael Schoenbaum Dana P. Goldman 《Health services & outcomes research methodology》2003,4(3):151-167
In order to better inform study design decisions when sampling patients within and across health care providers we develop a simulation-based approach for designing complex multi-stage samples. The approach explores the tradeoff between competing design goals such as precision of estimates, coverage of the target population and cost.We elicit a number of sensible candidate designs, evaluate these designs with respect to multiple sampling goals, investigate their tradeoffs, and identify the design that is the best compromise among all goals. This approach recognizes that, in the practice of sampling, precision of the estimates is not the only important goal, and that there are tradeoffs with coverage and cost that should be explicitly considered. One can easily add other goals. We construct a sample frame with all phase III clinical cancer treatment trials that are conducted by cooperative oncology groups of the National Cancer Institute from October 1, 1998 through December 31, 1999. Simulation results for our study suggest sampling a different number of trials and institutions than initially considered.Simulations of different study designs can uncover efficiency gains both in terms of improved precision of the estimates and in terms of improved coverage of the target population. Simulations enable us to explore the tradeoffs between competing sampling goals and to quantify these efficiency gains. This is true even for complex designs where the stages are not strictly nested in one another. 相似文献
107.
51例应用Begg正畸技术矫治错畸形,各种类型的牙性及轻度骨性错畸形,均取得满意的效果。对牙轴唇倾并伴有深覆的安氏Ⅱ类错打开咬合、内收前牙的效果尤佳。 相似文献
108.
胃癌组织中KAI1、nm23及P53的表达及其临床意义 总被引:5,自引:4,他引:1
目的:探讨正常胃黏膜、不典型增生胃黏膜及癌组织中KAI1、nm23及P53蛋白的表达.方法:应用SP法免疫组化检测22例正常胃黏膜,65例不典型增生胃黏膜及74N胃癌组织中的KAI1、nm23及P53蛋白的表达.结果:正常胃黏膜、不典型增生胃黏膜及胃癌组织中,KAI1和nm23阳性率呈降低趋势,组间差异性有统计学意义(x2=20.885, P<0.001;x2=29.133,P<0.05):P53蛋白阳性表达率呈增加趋势,组间差异性有统计学意义(x2=21.954,P<0.001).Fisher精确概率检验显示:在胃癌组中不同的浸润深度、有无淋巴结转移和脉管侵犯组内KAI1、nm23及 P53组阳性表达率的差异性有统计学意义(x2 =20.885,P<0.001;x2=29.133,P<0.05;x2= 21.954,P<0.001);而在年龄、性别组间的差异性无统计学意义.Spearman等级相关分析显示 KAI1与nm23表达呈正相关(r=0.859,P<0.05); KAI1与P53表达呈负相关(r=-0.859,P<0.05), nm23与P53表达呈负相关(r=-0.874,P<0.05) 结论:抑癌基因KAI1与nm23的缺失以及P53 蛋白的过表达可能是胃癌发生、发展及浸润和转移的重要原因之一. 相似文献
109.
余国平 《中华现代外科学杂志》2006,3(20):1633-1635
目的探讨如何控制腹腔镜胆囊切除术(LC)开展初期的并发症及中转率。方法制定八条质量控制措施,总结分析568例LC临床资料。结果并发症6例,仅占1.2%,中转手术8例,中转率仅1.6%。结论在开展LC初期只要加强质量控制,完全可以避开高并发症、高中转率这种所谓的自然规律。 相似文献
110.
不同层次护生对临床教学质量的评价 总被引:3,自引:0,他引:3
目的分析不同层次护生对临床教学质量评价的差异,以便采取有针对性的教学方法.方法护生在每个科室实习结束后,采用自行设计的临床教学评价表对每名护生进行问卷调查,然后分别从中专、大专、本科护生填写的调查表中各随机抽取30%进行分析.结果对病房教学氛围和护士长教学管理的评价,本科与中专、大专护生间比较,差异有显著性意义(均P<0.05),中专与大专护生间无差异(P>0.05);对带教老师的评价,本科与中专、大专与中专护生间均差异有显著性意义(P<0.01,P<0.05),本科与大专间无差异(P>0.05).结论不同层次护生对临床教学质量评价的侧重点不同,本科生对病房教学氛围及护士长教学管理的要求较高,大专生次之.在临床教学中应根据护生的学历层次,采取有针对性的教学方法,以便不断提高临床教学质量. 相似文献