自然流程模式下缩短内科门诊病人非医疗时间的服务理念与技巧

当今,许多医院中典型的门诊流程是长期沿袭下来的一种自然过程,此流程存在的缺陷是以医务人员工作方便为主,患者就诊效率为辅。笔者分析了中国医科大学附属第一医院内科门诊病人在医院内无效滞留的时间的原因,探讨适合“以病人为中心”及自然模式下缩短内科门诊病人非医疗时间的服务理念与技巧。     

预防性过程监控对留置导尿泌尿系感染控制作用的研究 FREE

目的在“过程监控”基础上提出“预防性过程监控”概念及可行的监控方法,实验性应用于留置导尿相关泌尿系感染的控制中,评价监控方法的有效性。方法将某院神经内科2007年1-7月留置导尿的155例患者设为对照组,2007年8月-2008年2月留置导尿的141例患者设为实验组;对照组执行留置导尿常规护理,实验组除进行常规护理外,采用评估督促和宣传教育等方法进行预防性过程监控。结果实验组留置导尿相关泌尿系感染率为4.26%,明显低于对照组的16.13%（χ2=11.10,P＜0.01）;两组患者留置导尿的时间比较,实验组70%的患者留置导尿时间在13.10 d内,明显低于对照组的18 d;留置导尿11～30 d、＞30 d时,实验组导尿相关泌尿系感染率分别为6.67%、16.67%,明显低于对照组的30.77%、57.89%（分别χ2=8.27,P＜0.01;χ2=5.13,P＜0.05）。结论评估督促和宣传教育等预防性过程监控可有效预防医院感染。     

Availability, Utilisation and Quality of Basic and Comprehensive Emergency Obstetric Care Services in Malawi

Objective To establish a baseline for the availability, utilisation and quality of maternal and neonatal health care services for monitoring and evaluation of a maternal and neonatal morbidity/mortality reduction programme in three districts in the Central Region of Malawi. Methods Survey of all the 73 health facilities (13 hospitals and 60 health centres) that provide maternity services in the three districts (population, 2,812,183). Results There were 1.6 comprehensive emergency obstetric care (CEmOC) facilities per 500,000 population and 0.8 basic emergency obstetric care (BEmOC) facilities per 125,000 population. About 23% of deliveries were conducted in emergency obstetric care (EmOC) facilities and the met need for emergency obstetric complications was 20.7%. The case fatality rate for emergency obstetric complications treated in health facilities was 2.0%. Up to 86.7% of pregnant women attended antenatal clinic at least once and only 12.0% of them attend postnatal clinic at least once. There is a shortage of qualified staff and unequal distribution with more staff in hospitals leaving health centres severely understaffed. Conclusions The total number of CEmOC facilities is adequate but the distribution is unequal, leaving some rural areas with poor access to CEmOC services. There are no functional BEmOC facilities in the three districts. In order to reduce maternal mortality in Malawi and countries with similar socio-economic profile, there is a need to upgrade some health facilities to at least BEmOC level by training staff and providing equipment and supplies.     

Improving Care for the Treatment of Alcohol and Drug Disorders

The Network for the Improvement of Addiction Treatment (NIATx) teaches alcohol and drug treatment programs to apply process improvement strategies and make organizational changes that improve quality of care. Participating programs reduce days to admission, increase retention in care, and spread the application of process improvement within their treatment centers. More generally, NIATx provides a framework for addressing the Institute of Medicine’s six dimensions of quality care (i.e., safe, effective, patient-centered, efficient, timely, and equitable) in treatments for alcohol, drug, and mental health disorders. NIATx and its extensions illustrate how the behavioral health field can respond to the demand for higher quality treatment services.     

孕期教育及产前培训对分娩过程的影响

目的：探讨孕期教育和产前培训对初孕妇的心理状态和分娩过程的影响。方法：选择定期孕期检查直至分娩的初孕妇365例。随机分为观察组123例与对照组242例。对照组仅做定期产前检查,观察组除定期检查外还接受系统的孕期教育和产前培训,观察记录其分娩方式、产程时间及产后出血量,作对照分析。结果：观察组孕产妇的顺产率显著增加（P〈0.05）;手术产（剖宫产和胎头吸引产）率明显少于对照组（分别为P〈0.001和P〈0.05）;各产程时间均短于对照组,差异有统计学意义;产后出血发生率明显低于对照组（P〈0.05）。结论：接受孕期教育和产前培训的孕产妇的产时并发症明显减少,手术产率明显降低,保证了母婴健康,值得临床推广应用。     

苦瓜蛋白提取工艺的研究

目的优选苦瓜蛋白提取工艺。方法考察乙醇浓度、温度、加氯化钠的量三因素对结果的影响,用L9(34)正交表优选提取工艺。结果影响苦瓜蛋白结晶得率的主要因素依次是加入氯化钠的倍数,温度及乙醇浓度,最佳工艺为A3B1C3。结论确定最佳工艺为:在19℃下,用95%的乙醇,加0.05倍氯化钠所得的结晶得率最高。     

格列齐特中间体氮杂双环的工艺改进

本文对格列其特的中间体氮杂双环盐酸盐的合成工艺进行了改进,使工艺更适合工业化大生产的要求。     

降脂护肝胶囊醇提工艺的研究

目的对降脂护肝胶囊醇提工艺进行优选。方法采用L9（34）进行正交设计试验对降脂护肝胶囊醇提工艺进行优选,以丹酚酸B、齐墩果酸含量及总固体量为考察指标。结果最佳工艺条件为丹参、女贞子、郁金,采用7倍、6倍70%、乙醇回流2次,分别为1.5、1.0h。结论此工艺条件提取有效成分,能保证有效成分的含量。     

兰索拉唑的合成工艺改进

目的 改进兰索拉唑的合成工艺。 方法 以2,3-二甲基吡啶为起始原料,经4步反应合成目标化合物。结果与结论 目标化合物的总收率由文献的12.7% 提高到21.2%,其结构经熔点、质谱和¹H-NMR谱测试确证。改进后的合成方法较原工艺路线缩短,易于工业化生产。     

甲磺司特合成工艺改进

:目的 研究平喘药甲磺司特的合成工艺。方法 以丙烯酸甲酯为原料,经加成、水解和氯代反应得到3-甲硫基丙酰氯;以对硝基苯酚为原料,经成醚、开环及还原反应制得4-(3-乙氧基-2-羟基丙氧基)苯胺,中间体3-甲硫基丙酰氯与4-(3-乙氧基-2-羟基丙氧基)苯胺的酰化产物经对甲苯磺酸甲酯甲基化,制得目标产物甲磺司特。结果与结论 目标化合物的结构经核磁共振氢谱、元素分析、红外光谱、质谱等确证。简化后的合成工艺,总收率由文献报道的4.5％提高到9.97％(以对硝基苯酚计),该合成路线操作简单,更适合工业化生产。