医院流程再造及临床路径实施中的量化研究

本文通过对医院流程化管理及临床路径研究过程中影响或贯穿整个过程的信息,提出精确化数据化定量分析,通过对个别流程的数据收集,利用计算机软件模拟,以达到揭示、改进流程瓶颈的目的。     

Der diagnostische Wert der LDH-Bestimmung und ihrer Isoenzyme bei intrakraniellen Prozessen

Summary LDH and the 5 isoenzymes were determined in cerebral spinal fluid in cases of intracranial processes (tumors, angiomas, hydrocephalus). No significant changes were found.

     

Ginsenosides Rb1 and Rg1 effects on mesencephalic dopaminergic cells stressed with glutamate

Ginseng, the root of Panax ginseng C.A. Meyer (Araliaceae), is a well known and popular herbal medicine used worldwide. Among more than 30 ginsenosides, the active ingredients of ginseng, ginsenosides Rb1 and Rg1 are regarded as the main compounds responsible for many pharmaceutical actions of ginseng. In our study, primary cultures from embryonic mouse mesencephala were exposed to neurotoxic glutamate concentration and potential protective effects of these two ginsenosides on survival and neuritic growth of dopaminergic cells were tested. Treatment of primary mesencephalic culture with 500 microM glutamate for 15 min on the 10th day in vitro (DIV) increased the release of lactate dehydrogenase (LDH) into the culture medium, the propidium iodide (PI) uptake by cultured cells and the total number of nuclei with condensed and fragmented chromatin (apoptotic features) as evaluated with Hoechst 33342. Moreover, it extensively decreased the number of tyrosine hydroxylase immunopositive (TH+) cells and adversely affected the length and number of their neuronal processes. The toxic effect of glutamate was primarily mediated by over-activation of N-methyl-D-aspartate receptor (NMDA) as treatment of cultured cells with (+)-MK 801, an NMDA receptor antagonist, nearly abolished dopaminergic cells loss and LDH release induced by glutamate. When either ginsenoside was added alone for six consecutive days (at final concentrations 0.1, 1, 10, 20 microM), ginsenoside Rb1 (at 10 microM) significantly enhanced the survival of dopaminergic neurons compared to untreated controls. In these cultures, neurite lengths and numbers were not affected by both ginsenosides. Against glutamate exposure, ginsenosides Rb1 and Rg1 could not prevent cell death. However when pre-treating for 4 days or post-treating for 2 days following glutamate exposure, they significantly increased the numbers and lengths of neurites of surviving dopaminergic cells. Thus our study indicates that ginsenosides Rb1 and Rg1 have a partial neurotrophic and neuroprotective role in dopaminergic cell culture.     

Neutrophil Migration in Opposing Chemoattractant Gradients Using Microfluidic Chemotaxis Devices

Neutrophils migrating in tissue respond to complex overlapping signals generated by a variety of chemotactic factors (CFs). Previous studies suggested a hierarchy between bacteria-derived CFs and host-derived CFs but could not differentiate neutrophil response to potentially equal host-derived CFs (IL-8 and LTB₄). This paper reports neutrophil migration in conflicting gradients of IL-8 and LTB₄ using a microfluidic chemotaxis device that can generate stable and well-defined gradients. We quantitatively characterized the movement of cells from time-lapse images. Neutrophils migrate more efficiently toward single IL-8 gradients than single LTB₄ gradients as measured by the effective chemotactic index (ECI). In opposing gradients of IL-8 and LTB₄, neutrophils show obvious chemotaxis toward a distant gradient, consistent with previous reports. When an opposing gradient of LTB₄ is present, neutrophils show less effective chemotaxis toward IL-8 than when they are in a gradient of IL-8 alone. In contrast, the chemotactic response of neutrophils to LTB₄ is not reduced in opposing gradients as compared to that in a single LTB₄ gradient. These results indicate that the presence of one host-derived CF modifies the response of neutrophils to a second CF suggesting a subtle hierarchy between them.This revised version was published online in May 2005 with corrected author affiliations     

Process models of interrelated speech intentions from online health-related conversations

Being related to the adoption of new beliefs, attitudes and, ultimately, behaviors, analyzing online communication is of utmost importance for medicine. Multiple health care, academic communities, such as information seeking and dissemination and persuasive technologies, acknowledge this need. However, in order to obtain understanding, a relevant way to model online communication for the study of behavior is required. In this paper, we propose an automatic method to reveal process models of interrelated speech intentions from conversations. Specifically, a domain-independent taxonomy of speech intentions is adopted, an annotated corpus of Reddit conversations is released, supervised classifiers for speech intention prediction from utterances are trained and assessed using 10-fold cross validation (multi-class, one-versus-all and multi-label setups) and an approach to transform conversations into well-defined, representative logs of verbal behavior, needed by process mining techniques, is designed. The experimental results show that: (1) the automatic classification of intentions is feasible (with Kappa scores varying between 0.52 and 1); (2) predicting pairs of intentions, also known as adjacency pairs, or including more utterances from even other heterogeneous corpora can improve the predictions of some classes; and (3) the classifiers in the current state are robust to be used on other corpora, although the results are poorer and suggest that the input corpus may not sufficiently capture varied ways of expressing certain speech intentions. The extracted process models of interrelated speech intentions open new views on grasping the formation of beliefs and behavioral intentions in and from speech, but in-depth evaluation of these conversational models is further required.     

针刺对第三腰椎横突综合征的止痛作用与镇痛机制探讨

目的:观察针刺治疗第三腰椎横突综合征的止痛作用,并探讨其镇痛机制。方法:对40例第三腰椎横突综合征患者进行针刺治疗(穴取横突处阿是穴、肾俞、委中,3次/周,3周为1个研究周期);并于治疗前(第0周)、治疗后(第3周)、回访时(第5周)用视觉模拟评分法(Visual Analogue Scale,VAS)进行疼痛评分;并用酶联免疫吸附试验(Enzyme Linked Immunosorbent Assay,ELISA)法检测血清白细胞介素6(Interleukin-6,IL-6)、白细胞介素10(Interleukin-10,IL-10)的水平。结果:治疗后(第3周)时,VAS值下降(P0.05),血清IL-6、IL-10水平上升(P0.05);回访时(第5周)VAS值下降(P0.05),血清IL-6、IL-10水平下降(P0.05)。结论:针刺对第三腰椎横突综合征有很好的止痛作用,其镇痛机制很可能是促进细胞因子的代谢进程。     

碳酸氢钠复方电解质注射液制备工艺的优化

目的 优化碳酸氢钠复方电解质注射液的制备工艺.方法 对制剂处方进行分析,以pH值、钙离子浓度、可见异物为主要评价指标,比较不同制备工艺对产品质量的影响.结果 优选的碳酸氢钠投料条件:配液温度为50 ±5℃,投料时需充入CO2并调节pH4.5 ～6.5,碳酸氢钠应最后投料.结论 配液温度、药液pH值对注射液成品质量的影响显著,应进行严格控制;采用优化工艺制备的产品主要指标达到课题设计要求,解决了含碳酸氢钠电解质注射液的工业化大生产与稳定性问题.     

Implementation of Robert's Coping with Labor Algorithm© in a large tertiary care facility

Objectiveto implement use of Roberts’ Coping with Labor Algorithm^© (CWLA) with laboring women in a large tertiary care facility.Designthis was a quality improvement project to implement an alternate approach to pain assessment during labor. It included system assessment for change readiness, implementation of the algorithm across a 6-week period, evaluation of usefulness by nursing staff, and determination of sustained change at one month. Stakeholder Theory (Friedman and Miles, 2002) and Deming's (1982) Plan-Do-Check-Act Cycle, as adapted by Roberts et al (2010), provided the framework for project implementation.Settingthe project was undertaken on a labor and delivery (L&D) unit of a large tertiary care facility in a southwestern state in the USA. The unit had 19 suites with close to 6000 laboring patients each year.Participantsfull, part-time, and per diem Registered Nurse (RN) staff (N=80), including a subset (n=18) who served as the pilot group and champions for implementing the change.Findingsa majority of RNs held a positive attitude toward use of the CWLA to assess laboring women's coping with the pain of labor as compared to a Numeric Rating Scale (NRS). RNs reported usefulness in using the CWLA with patients from a wide variety of ethnicities. A pre-existing well-developed team which advocated for evidence-based practice on the unit proved to be a significant strength which promoted rapid change in practice.Implications for practicethis work provides important knowledge supporting use of the CWLA in a large tertiary care facility and an approach for effectively implementing that change. Strengths identified in this project contributed to rapid implementation and could be emulated in other facilities. Participant reports support usefulness of the CWLA with patients of varied ethnicity. Assessment of change sustainability at 1 and 6 months demonstrated widespread use of the algorithm though long-term determination is yet needed.     

医院急诊流程重组应用研究

本研究采用过程方法、持续质量改进理论、控制论等,对急诊流程现况进行充分认识.通过现况分析,明确急诊流程的关键环节、关键质控点和影响急诊医疗质量的主要原因.在此基础之上,制定急诊流程重组的基本框架和实施方案,明确急诊流程重组的总体目标为:以病人为中心,实现就诊全程时间更短、诊疗行为更规范、效率更高.此方案在解放军304医院急诊科进行了实际应用,并对应用前后的部分指标进行了对比分析,得到了较为满意的结果,急诊病人人均全程就诊时间较重组前明显缩短,人均医生就诊时间较前有所延长,人均检查等待时间较前明显缩短.     

三峡库区向家湾垃圾填埋场渗滤液处理方案选择

介绍向家湾垃圾填埋场建立场内独立的污水处理站,采用多技术集成处理垃圾渗滤液,其处理工艺厌氧调节-UASB-SBR-化学絮凝沉淀工艺将两级厌氧消化、生物硝化和反硝化等生物过程与化学过程相结合,去除COD的同时去除高浓度氨氮,具有可操作性和经济性。