Comparison of Family clinic Community Health Service Model with State—owned Community Health Service Model

Based on a survey of community health service organization in several cities,community health service model based on the family clinic was compared with state-owned community health service model,and status quo,advantages and problems of family community health service organization were analyzed.Furthermore,policies for the management of community health service organization based on the family clinic were put forward.     

佩尔地平治疗妊娠高血压病人的护理管理路径

目的探讨护理管理路径在应用佩尔地平治疗的重度子痫前期病人的效果，以期达到最佳的治疗效果，并减少并发症的发生。方法将用佩尔地平针治疗的重度子痫前期的病人486例随机分为两组，一组按常规护理，另一组按制定的护理管理路径护理。结果患者依从性对照组为168例，占70％；观察组为228例，占92．68％，P〈0．05，其差异有统计学意义。胎死宫内发生率对照组为9．16％，观察组为0．81％，P〈0．05，其差异有统计学意义。血压的稳定性对照组为36．3％，观察组为97．6％，P〈0．05，其差异有统计学意义。结论护理管理路径可以提高重度妊娠高血压疾病的治疗效果，减少并发症的发生。     

流行性出血热危险因素的病例对照研究

用病例对照研究方法探索建德县罹患流行性出血热(EHF)的危险因素。经临床诊断和血清学证实的97例EHF病例,按年龄、性别和住同一医院与其他疾病病人作1:1配对调查。条件logistic回归模型分析,发现村中曾有EHF史、外出他县、野宿和直接接触鼠类四个因素是罹患EHF的危险因素,其相对危险度分别为35.67、11.94、18.18和7.36。病例家属隐性感染率(4.95％)与对照家属隐性感染率(5.12％)相似;病例与对照家中捕获的鼠类及其EHF抗体、抗原阳性率无显著性差异。     

The Swedish childhood diabetes study — a multivariate analysis of risk determinants for diabetes in different age groups

Summary In a nationwide incident case-referent study stepwise univariate analysis has revealed several risk determinants for childhood diabetes mellitus. In a multivariate analysis we have determined the set of risk determinants that would independently predict childhood Type 1 (insulin-dependent) diabetes. Possible interactions between the risk determinants and differences in risk profiles with different ages at onset were also examined. Reported familial insulin-treated and non-insulin-treated diabetes were significant risk factors in all age groups, as was also a low frequency of milk intake. The frequency of infections and a high intake of foods rich in nitrosamine tended to interact (OR 11.8, p=0.053) indicating a synergistic effect. A Cox regression analysis revealed that stressful life events during the last year was the only variable that tended to affect the age at onset (p=0.055). This indicated that psychological stress may rather precipitate than induce Type 1 diabetes. A short breast-feeding duration (OR=3.81), and an increased body height (OR=3.82) contributed significantly to the predictive model in only the youngest age group (0–4 years). An increased frequency of infections in the year preceding onset (OR=2.15) and no vaccination against measles (OR=3.33) contributed significantly to the model only in the age group 5–9 years. Various nutrients had different impacts on the risk of developing Type 1 diabetes in different age groups. It is concluded that in the genetically susceptible child, risk factors which are associated with eating habits, frequency of infections, vaccination status, growth pattern and severe psychological stress affect the risk of developing diabetes independently of each other. The set of risk determinants varies with the age at onset. A high frequency of infections and a high frequency of nitrosamine-rich food intake seem to have a synergistic effect on the risk of developing diabetes in childhood.     

Leiomyosarcoma originating in Meckel's diverticulum: Report of a case and a review of 59 cases in the English literature

A 49-year-old woman was referred to our hospital with complaints of epigastric colicky pain and high fever. Abdominal computed tomography and ultrasonography showed a solid tumor in the lower abdomen. Laparotomy revealed a neoplastic mass arising in Meckel's diverticulum; therefore, a segment of the ileum, including the tumor-possessing diverticulum, was resected with a lymph node dissection. A histologic examination confirmed the lesion to be leiomyosarcoma. In the English literature, 59 cases of leiomyosarcoma in Meckel's diverticulum were reported from 1941 to 1994. The majority of patients were in their 4th decade of life, with both sexes equally affected. The most frequent symptoms associated with this disease were abdominal pain with nausea, vomiting, and melena. The majority were larger than egg-size. Although Meckel's diverticulum is difficult to diagnose preoperatively, mesenteric arteriography may at times prove useful. The standard management of this particular tumor is wide segmental resection, including the tumor and diverticulum with lymph node dissection.     

医疗设备管理面临的新挑战

目前,医疗服务价格的调整特别是大型医疗设备的检查费用下调和高值耗材附加收费的封顶限制及药品加成的即将取消,在一定程度上减轻了患者的经济负担,但同时也造成医院收入大幅下降。作为设备管理部门,如何从医疗设备配置和管理等方面来引导、配合事关医院生存和患者福祉的医疗服务结构调整,是新形势下的新挑战。通过探讨提出从严格控制医疗设备购置费用、优化医疗设备配置、保证常规医疗设备和提高管理水平等4个方面争取找到一条使病患和医院双方共赢的道路。     

A global view of suicidal behaviour

Suicidal behaviour is a major public health problem. There is no one explanatory theory of suicidal behaviour, and various combinations of sociological and biological/medical interventions are required to reduce associated mortality and morbidity. The importance of primary prevention varies from community to community, and may have an impact at the population level. However, individual suicidal persons always require optimum assessment and management and that is usually provided by primary care and emergency physicians. This paper provides an overview of issues to be addressed in the assessment and management of suicidal patients. See Commentary, page 8.     

论医院质量管理推行ISO9000族标准的必要性

为了迎接医疗市场的竞争和挑战 ,医院将应用于工业企业的ISO90 0 0族标准引入到医疗服务领域。它通过严格的过程控制 ,使医院实现了质量管理制度健全化、系统化、合理化 ,大大减少了服务中的差错 ,全面提高了服务质量 ;通过工作程序化及持续改进 ,改善了医务人员的工作环境 ,提高了医院运作效率和运营效益。本文从现行的质量管理的不足分析入手 ,从八个方面阐述医院质量管理推行IS0 90 0 0族标准的必要性 ,以此来说明医院的质量管理采用ISO90 0 0族标准 ,将会使医院的质量管理有一个质的飞跃。事实证明通过认证的医院已从中收益。     

成批硫化氢中毒抢救的组织与管理

目的 :探讨成批硫化氢中毒患者抢救时的组织与管理。方法 :由护理部及监护室护士长统筹安排 ,将 15位患者分成由 7个监护小组组成的 7个监护小单元实施程序化抢救 ,并统一调配抢救物资、器械。结果 :14例患者抢救成功治愈 ,1例患者心肺复苏成功后死于多脏器功能衰竭。结论 :有效、合理的护理组织与管理 ,能够争取抢救时间 ,提高成批硫化氢中毒患者的抢救成功率。     

12 840例小儿麻痹后遗症外科治疗统计分析

目的 :探讨我国现存小儿麻痹后遗症病人的年龄结构、医疗需求、手术类别及外科治疗的有关问题 ,为此类患者的治疗提供参考。方法 :回顾性分析了 1985年 9月～ 2 0 0 3年 5月之间手术治疗的小儿麻痹后遗症 12 840例 ,实施手术 3 15 62次。从病人初次手术年龄、手术部位、下肢瘫痪情况、步态及手术类别进行统计归类。结果 :首次手术年龄 2 5岁以下者 1172 1例 ,占同期病例总数的 91 2 9% ,其中下肢髋部手术占总手术的 15 2 8% ,膝部占 3 0 19% ,踝足占 48 73 % ,下肢均衡术占5 14 % ,上肢手术占 0 5 %。结论 :现存的小儿麻痹后遗症 70 %以上年龄 <3 5岁 ,5 0 %以上的农村患者既往未实施过正确的矫形手术治疗。对中国遗留的百万小儿麻痹后遗症进行系统的现代矫形外科治疗 ,仍是骨科界的一项艰巨任务