一体化医学语言系统中的循环等级关系

主要讨论了一体化医学语言系统(UMLS)超级叙词表中的循环等级关系和产生原因,及其识别和消除方法.     

Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006.

Postpartum hemorrhage (PPH) is the main cause of maternal mortality. Yet, even though solutions have been identified, governments and donor countries have been slow to implement programs to contain the problem. While poverty and low educational level remain the underlying cause of PPH, the current literature suggests that active management of the third stage of labor can prevent it. The International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) are attempting to address the chronic PPH crisis by educating their members on best practices and on troubleshooting where resources are inadequate. Some studies found oxytocin to be preferable to misoprostol in settings where active management is the norm. However, secondary clinical effects may prove more troublesome with oxytocin than with misoprostol, and misoprostol may prove to be more practical and equally effective in low-resource settings. Two new interventions are also proposed, the anti-shock garment and the balloon tamponade.     

股骨干骨折内固定术后不愈合27例分析

报告股骨干骨折切开复位内固定术后不愈合27例。其中，17例钢板固定者，只4例符合要求，9例髓内针固定者，有5例针短小。尚伴有固定方法，钢板或髓内针断裂，以及感染等方面原因有。本组再手术26例1次手术治愈，1例2次手术治愈。绝大部分经带蒂骨皮质剥离^[1]和坚强内固定术后而愈合，不需植骨。产生骨折不愈合的诸因素中，以忽视内固定的基本原则与术中操作不当为主。     

提高灌注溶石疗法的研究(附87例分析)

应用2%复方去氧胆酸钠、2%复方偏磷酸钠及Ⅰ号或Ⅱ号复方桔皮油乳剂等溶石剂经胆道引流管灌注治疗87例胆道残石病例。治疗前经 X 线或胆道镜确诊。残石部位:肝外胆管31例;肝内胆管37例;肝内外胆管19例。治疗中从引流瓶及大便淘洗中发现大量胆石碎片,经化学分析及电镜检查,与体外溶石试验结果一致。治疗结果:56例全溶,占64.37%;19例残石变小或变少,占21.24%;4例因肝内胆管病变中转手术,占4.86%;8例因治疗反应停止溶石,占9.20%。4例肿大的肝脾缩小,脸色由灰暗变为红润。对改善溶石治疗的有关措施进行了讨论。     

An audit of pain and vomiting in paediatric day case surgery

Three hundred and thirteen paediatric day case patients were prospectively audited to assess postoperative pain, nausea and vomiting using data sheets completed by nursing staff, anaesthetists and parents. The incidence of nausea and vomiting was 7.3% and was commoner in older children and those who had received opioids. Forty per cent of patients had some degree of postoperative pain; 17% of these patients were scored as having severe pain. Of children who had pain on returning home (31.4%), 85% of these required paracetamol. Fifteen per cent of children had a disturbed night due to pain and/or vomiting after their operation and 28.5% of children had pain on the following day. Boys undergoing circumcision were responsible for a disproportionately high percentage of the severe pain scores. Audit has helped to highlight deficiencies in the service provided and has led staff to try and improve their methods of analgesia.     

Hospital versus population controls in a retrospective study on diet and stomach cancer

The aim of the present study is to evaluate drawbacks and advantagesof the choice of hospital versus population controls in a casecontrol study on diet and cancer through the analysis of a retrospectivestudy on diet and gastric cancer (GC) conducted in Forli, Italy,involving 232 cases, 430 population controls and 252 hospitalizedcontrols. The present paper reports the comparison of resultson diet and GC risk obtained using the 2 types of controls.Population controls tended, in general, to eat all kinds offoods slightly more frequently (bread, pasta, cold cuts, freshfish, seasoned cheeses, legumes, garlic, onions and preservedfruits), with the exception of cooked vegetables, which werereported less frequently by population than by hospital controls.ORs for specific foods adjusted for confounders and other foodswere consistent in the separate models including populationand hospital controls respectively for all food groups, withthe exception of cooked vegetables which represented a protectivefactor only when hospital controls were considered (high consumers,population controls: adjusted, OR=0.9, trend p value 0.54; highconsumers, hospital controls, adjusted OR=0.5, trend p value<0.01). Hospital controls were slightly less often currentsmokers (22.6 versus 30.0%) and more often regular wine drinkers(57.5 versus 47.8%) compared with population controls, but noneof these variables was associated with GC risk. The main resultsin this study were consistent using both types of controls,nevertheless the distribution of some dietary variables notrelated to the disease under study differed between the 2 controlgroups, suggesting some caution in the use of hospital controlswhen studying diseases other than GC.     

对高等学校创收收入管理的思考

随着我国教育体制改革的推进,高等学校的资金来源也发生了较大变化,创收收入成为高校收入中的很大一部分,高校的各个基层单位的创收收入也在不断增加,对于这部分资金的管理,有着十分重要的现实意义。目前的创收收入管理比较松散,存在很多弊病。需要通过纳入学校财务统一管理、严格创收分配支出管理、制定创收分成比例、定期检查等办法加强管理,使这部分资金得到合理利用,促进高校的教育、教学的发展。     

医院医用物资管理初探

随着科技的发展,医院应用新型材料的数量和金额不断增长.如何提高效率、展现最佳效果,是目前医院医用物资管理面临的重要问题.本文主要就目前医院医用物资管理一体化的概念、特点、优势和实施进行讨论.     

Childhood convulsive status epilepticus: epidemiology, management and outcome

Convulsive status epilepticus (CSE) in childhood is a medical emergency and its aetiology and outcome mean that it should be studied separately from adult CSE. The incidence in developed countries is between 17 and 23/100,000 with a higher incidence in younger children. Febrile CSE is the commonest single group with a good prognosis in sharp distinction to CSE related to central nervous system infections which have a high mortality. The aim of treatment is to intervene at 5 min and studies indicate that intravenous (i.v.) lorazepam may be a better first-line treatment than rectal diazepam and i.v. phenytoin a better second-line treatment than rectal paraldehyde. An epidemiological study strongly supports the development of prehospital treatment with buccal midazolam becoming a widely used but unlicensed option in the community. More than two doses of benzodiazepines increase the rate of respiratory depression without obvious benefit. The 1 year recurrence rate is 17% and the hospital mortality is about 3%.     

Physician assistants in academic radiology: the harborview experience

We describe a model of how physician assistants can be used in an academic medical center to expand radiologist productivity, and to enhance the departmental academic and educational missions. At Harborview Medical Center, following a training program and graduated responsibility under supervision, physician assistants provide initial interpretation of radiology studies, consultation to referring physicians, and perform less complicated interventional procedures. Acceptance of physician assistants by the radiologists, radiology residents, and referring physicians has been high. Although the impact of physician assistants on departmental clinical productivity is difficult to measure, our data suggest that radiologists are more efficient when physician assistants are assigned to service, both in terms of numbers of studies interpreted, and timeliness of reporting and billing. As a result of the success of our program, we believe that physician assistants can have an important role in radiology practice.