58例医疗纠纷尸体解剖病理学分析

目的:探讨涉及医疗纠纷病人死亡的原因,分析死亡所发生的病理学特点。方法:对58例不明死因的尸体进行系统解剖与组织病理学检验,部分做法医学毒物分析。结果:在58例尸检中,病理性死亡52例,心血管系统疾病最多,其次为呼吸系统疾病;机械性外力导致死亡4例。猝死42例。结论:科学的尸体解剖,准确的死因分析,不但为医疗事故的鉴别、判定及医疗事故的处理提供医学依据,而且丰富和发展了相关临床学科的内容。     

Public health nursing: an autonomous career for World War II nurse veterans

The 1944 G.I. Bill increased accessibility of higher education to male veterans. Less is known about how its availability affected opportunities for female veterans. The purpose of this study was to examine nurse veterans' use of the G. I. Bill at one large public university. Primary sources included archival documents of one large public university as well as articles published in professional nursing and medical journals of the 1940s and 1950s. Secondary sources addressing nursing and nursing education history, and the history of the G. I. Bill provided further context. Historical research methodology was conducted. Findings demonstrate that nurse veterans desired more independence in practice following the war. Archival documents of one large public university show that nurse veterans used G. I. Bill funds to seek degrees in public health nursing. The specialty of public health provided increased independence and autonomy of practice not experienced in hospital based care. G.I. Bill educational funds provided these nurse veterans the means to attain degrees in public health nursing, providing them the opportunity for more autonomous practice.     

The Foundation Programme and the emergency department: a review of the curriculum and experience of a UK pilot

The emergency department will have an important role within the Modernising Medical Careers Foundation Programme (FP) in the United Kingdom. Many of the key competencies required of Foundation training relate to acute medical care. However, the Foundation curriculum is a large and complex document. Some of the detail within it has particular implications for emergency medicine. Issues of curriculum content, teaching styles, and assessment have a potentially significant effect upon established working practices in a typical unit. This paper examines the FP curriculum to allow a clearer understanding of its key elements. Problems in relation to delivery of teaching and the quantity of assessment required are highlighted and solutions discussed. Experience from a UK pilot site for Foundation training in emergency medicine which began in August 2004 is used to illustrate how some of these issues have been addressed. The review concludes with a series of practical hints and tips which others may find useful as they prepare to incorporate FP trainees locally.     

Acute Pain Is Underassessed in Out-of-hospital Emergencies

OBJECTIVES: To evaluate the quality of pain assessment by emergency medical services (EMS) in out-of-hospital emergencies. METHODS: A prospective study was conducted on a convenience sample of patients during a one-year observation period. Pain ratings assessed by emergency patients were documented at three different intervals during the emergency call, and compared with concomitant assessments by EMS providers. A visual analog scale (VAS) and a verbal pain scale (VPS) were used for pain assessment. Repeated-measures ANOVA and Dunnett's t-test were used for data analysis. RESULTS: Fifty-one out of 70 eligible patients met inclusion criteria. In most emergency patients the intensity of pain was underestimated by EMS, especially when pain was severe (p = 0.0001). During the course of transport, both pain and pain assessment by EMS improved significantly (p = 0.0001). The VAS and VPS were significantly correlated (p = 0.0001). CONCLUSIONS: EMS providers significantly underestimate their patients' pain severity. EMS providers should be more attentive to their patients' complaints and comfort.     

清宫散治疗药物流产出血80例疗效观察

目的 观察清宫散治疗药物流产出血的疗效。方法 两组病例均采用同种方法服用米非司酮、米索前列醇，治疗组在服用米索前列醇后2h口服中药清宫散，对照组不再加用任何药物治疗。结果 清官散治疗药物流产出血80例，完全流产71例，不全流产8例，流产失败1例。完全流产率88．75％。对照组60例，完全流产22例，不全流产33例，流产失败5例，完全流产率36．76％。两组完全流产率比较经统计学处理有显著性差异（P〈0．01）；阴道出血在12d内干净者，治疗组占93．75％，而对照组占51．66％，两组的阴道出血持续时间比较经统计学处理有显著性差异（P〈0．01）。结论 清宫散配合药物流产终止早孕能显著提高完全流产率，缩短药流的阴道出血时间，有较高的临床实用价值。     

The Cancer Care Monitor: psychometric content evaluation and pilot testing of a computer administered system for symptom screening and quality of life in adult cancer patients

Technology is making the routine screening of symptoms and the measurement of quality of life (QoL) more feasible at the point of care. However, most existing symptom screening scales and QoL measures were not developed for clinical use and were not formatted and validated for administration through computerized mediums. The Cancer Care Monitor (CCM) is a symptom-based scale developed for administration on pen-based computers. This study is an initial evaluation of the reliability and validity of the CCM. Three samples of adult outpatients provided ratings on 38 physical, psychological, and functional oriented items of the CCM that comprise six symptom scales and one global QoL index. All additive scales are converted to normalized T scores. Reliability was examined through internal consistency and confirmatory factor analysis. Convergent and divergent validity were examined by comparing CMM scores to established measures of corresponding constructs and physician judgments. Alternative forms reliability was established by comparing paper and pencil administration with computer administration. Internal consistency reliability and factor analyses confirmed the structure of the CCM as comprising six primary symptom scales and one global QoL index. Internal consistency reliabilities ranged from 0.80 to 0.89. The pattern of correlations between CCM scales and established measures supported the convergent and divergent validity of the CCM scales. Alternate forms reliability based on paper and computer forms of the CCM scales was high. Patients indicated a preference for the computer-administered version. Results suggest that CCM items can be scored as a reliable and valid measure of constructs related to physical, psychological, and functional status, and global health-related QoL in adult cancer patients. Future studies should replicate and further evaluate the properties of the CCM, especially in relation to clinical utility.