Functioning and disability 6–15 years after traumatic brain injuries in northern Sweden

Objectives –  To assess long‐term functioning and disability after traumatic brain injury (TBI). Material and methods –  Individuals (n = 88) in Norrbotten, northern Sweden, who had been transferred for neurosurgical care were assessed with internationally established TBI outcome measures 6–15 years post‐injury. Results –  There was an improvement in overall outcome from discharge from inpatient rehabilitation to follow‐up. Many individuals had a high degree of motor and cognitive functioning, which enabled them to live independently in their own home without assistance, but there remained a disability related to community reintegration and social participation. This affected their productivity and to some degree their marital stability. The remaining disability and reduced productivity were related to the age at injury and the injury severity. Conclusions –  Our data showed that individuals with a TBI can achieve and maintain a high degree of functioning many years after the injury. Increasing age and a greater injury severity contributed to their long‐term disability.     

冬凌草单药及与化疗合用治疗食管癌205例

目的:观察冬凌草单药及与化疗合用治疗食管癌的临床疗效.方法:448例患者,均经病理细胞学和X线检查确诊为食管癌.其中早期癌76例,均采用冬凌草单药治疗.晚期癌372例,167例采用冬凌草单药治疗,205例采用冬凌草与化疗合用.结果:用冬凌草单药治疗早期食管癌患者3,5,10,13 a的生存率明显高于未治疗组(98.68% vs 51.52%,84.02% vs 28.62%,63.49% vs 11.45%,50.13% vs 8.59%;P<0.001).对于晚期食管癌,冬凌草联合化疗应用,其总有效率明显高于以PYM(BLM)为基础的单一化疗(66.82% vs 42.85%,P<0.01).冬凌草与化疗合用组与单一化疗对照组相比副作用基本相同,无明显差异(P>0.05).结论:对于早期食管癌患者,冬凌草能控制疾病发展延长生存时间;对于晚期食管癌患者,冬凌草能增强化疗的作用.     

Semmelweis’ present day follow-up: Updating bacterial sampling and enrichment in clinical hygiene

Potentially dangerous antibiotic resistant contaminants have permanently penetrated at least well-off western populations. The danger is so evident that some hospitals have started to refuse accepting patients who carry such bacteria. Sampling and enrichment measures in hygiene monitoring must be updated as they are corner stones in handling the problems and safeguarding the health care units. Their patients, when exposed to microorganisms are strenuous to treat. Sometimes even this fails, if the infections are spreading in weakened patients. The present review summarizes currently used technologies and the abilities of bacteria to avoid detection. Improved protocols on environmental monitoring in healthcare units are required. They should be comparable with contamination control in industries. Actually these measures in health care should be even stricter because human lives are directly endangered as the resistance of especially elderly patients is low.     

The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context

In this study we consider the process of the clinical encounter, and present exemplars of how assumptions of both clinicians and their patients can shift or transform in the course of a diagnostic interview. We examine the process as it is recalled, and further elaborated, in post-diagnostic interviews as part of a collaborative inquiry during reflections with clinicians and patients in the northeastern United States. Rather than treating assumptions by patients and providers as a fixed attribute of an individual, we treat them as occurring between people within a particular social context, the diagnostic interview. We explore the diagnostic interview as a landscape in which assumptions occur (and can shift), navigate the features of this landscape, and suggest that our examination can best be achieved by the systematic comparison of views of the multiple actors in an experience-near manner. We describe what might be gained by this shift in assumptions and how it can make visible what is at stake for clinician and patient in their local moral worlds—for patients, acknowledgment of social suffering, for clinicians how assumptions are a barrier to engagement with minority patients. It is crucial for clinicians to develop this capacity for reflection when navigating the interactions with patients from different cultures, to recognize and transform assumptions, to notice ‘surprises’, and to elicit what really matters to patients in their care.     

子宫内膜萎缩疗法治疗青春期功血362例临床研究

目的：探讨子宫内膜萎缩疗法治疗青春期功血（DUB）的止血效果。方法：将362例平均分为观察组（采用炔诺酮、戊酸雌二醇联合疗法止血）和对照组（单用炔诺酮子宫内膜萎缩疗法止血），两组各181例，比较两组的止血效果。结果：观察组和对照组止血有效率分别为96．13％（174／181）和92．27％（167／181），两组比较差异无统计学意义（踟105）；观察组和对照组控制出血时间分别为（28．69±14．87）h和（29．72±15．34）h，两组比较差异无统计学意义（踟．05）。观察组和对照组的完全止血时间分别为（32．80±19．10）h和（47．30±18．60）h，两组比较差异有统计学意义（／9〈0．05）。观察组和对照组的住院天数平均为（6．10±2．80）d和（6．9±2．60）d，观察组住院时间短于对照组（P〈0．01）。结论：炔诺酮止血疗法和炔诺酮、戊酸雌二醇联合疗法治疗青春期功血效果均较好，但炔诺酮、戊酸雌二醇联合疗法治疗效果更佳。     

治疗时机对创伤性漂浮膝预后的影响

目的:探讨不同的手术时机对于创伤性漂浮膝术后功能恢复的影响。方法:回顾性分析42例接受手术治疗并获得随访的漂浮膝患者术后膝关节功能恢复情况,将患者按接受手术的时间分为72h内（23例）和72h后（19例）手术组,根据Karlstrom标准对两组患者术后膝关节功能恢复情况进行评定,将评定结果使用SPSS10·0软件进行统计学分析。结果:随访11个月⁶年,平均26个月,72h内接受手术者膝关节功能恢复情况优10例,良7例,中5例,差1例;72h后接受手术者优2例,良5例,中4例,差8例,两组结果差异有显著性统计学意义（P<0·01）。结论:早期手术坚强内固定、早期进行功能锻炼对于漂浮膝损伤远期功能的恢复具有重要的意义。     

支气管动脉栓塞术治疗咯血的疗效分析

目的 评价支气管动脉栓塞术治疗咯血的临床疗效.方法 对45例咯血患者用明胶海绵颗粒、聚乙烯醇(PVA)微球栓塞剂行支气管动脉栓塞术.结果 45例患者均成功行支气管动脉栓塞术,41例咯血完全控制,4例复发,复发率8.9%,5例患者术后出现胸痛和低热不适,无需特别处理,可自行缓解,未出现穿刺部位血肿和截瘫等并发症.结论 支气管动脉栓塞术是治疗咯血的一种快速、安全、有效的方法.     

慢性肝病合并细菌感染临床特点分析

目的 :分析慢性肝病合并细菌感染的特点。方法 :对 1997～ 2 0 0 2年住院的慢性重度、重症肝类及肝硬化合并细菌感染患者 52例进行回顾性分析。结果 :其中医院内感染占 2 9 8%。感染的部位 :腹腔感染 40 4% ,血液感染17 3 % ,呼吸道感染 18 1% ,肠道感染 9 6% ,胆道感染 7 7% ,口腔感染占 6 3 % ,其他感染占 3 3 % ,重型肝炎的感染率最高 ,其次为肝硬化和慢性重度肝炎。结论 :肝病患者免疫力低下 ,易于合并细菌感染 ,感染使病情加重 ,影响肝病的愈后 ;提高患者免疫力 ,增强控制医院感染的措施 ,重视潜伏感染状态病灶的处理 ,早期诊治感染可提高肝病患者的生存率     

Enhancing laboratory report contents to improve outpatient management of test results

In today''s environment, providers are extremely time-constrained. Assembling relevant contextual data to make decisions on laboratory results can take a significant amount of time from the day. The Regenstrief Institute has created a system which leverages data within Indiana Health Information Exchange''s (IHIE''s) repository, the Indiana Network for Patient Care (INPC), to provide well-organized and contextual information on returning laboratory results to outpatient providers. The system described here uses data extracted from INPC to add historical test results, medication-dispensing events, visit information, and clinical reminders to traditional laboratory result reports. These “Enhanced Laboratory Reports” (ELRs) are seamlessly delivered to outpatient practices connected through IHIE via the DOCS4DOCS clinical messaging service. All practices, including those without electronic medical record systems, can receive ELRs. In this paper, the design and implementation issues in creating this system are discussed, and generally favorable preliminary results of attitudes by providers towards ELRs are reported.