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.     

浅谈医院档案的管理和利用

探讨医院档案管理问题.对医院几类档案的管理和利用进行了分析,提出加强档案管理和利用.     

加强中小型医院档案管理工作

探讨中小型医院档案管理工作.通过分析中小型医院档案工作现状,进而从软硬件两个方面就如何提高中小型医院档案管理工作的服务和指导功能作了一定阐述.     

基于工作一个人匹配理论的临床医生职业耗竭风险因素分析

基于Maslach引入组织行为学中工作～个人匹配（job～person fit）理论范式来解释职业耗竭，并发展其原有的三维度理论。以临床医生为对象，从工作负荷、控制感、报酬、团队、公平、价值趋向6个方面来根据个人与工作的匹配程度，对其所发生职业耗竭现象的风险因素进行分析，并探讨现实中可行的控制策略来促进临床医生的职业投入感，减少职业耗竭感，从而提高医疗服务的效率和质量。     

MANAGEMENT TO PREVENT BLEEDING DURING ENDOSCOPIC SUBMUCOSAL DISSECTION USING THE FLUSH KNIFE FOR GASTRIC TUMORS

The gastric vasculature responsible for intraoperative bleeding in endosocpic submucosal dissection (ESD) is the ramified vascular network occupying the middle of the submucosal layer and large vessels penetrating the muscle layer. Appropriate management for these vessels must be addressed. The trimming of the ramified vascular network can be safely performed with coagulation mode following shallow mucosal cutting. A large penetrating vessel usually requires precoagulation prior to dissection. These procedures are effectively performed with the water jet short needle knife (Flush knife).     

Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline

The aim of this international guideline on dementia was to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with dementia. It covers major aspects of diagnostic evaluation and treatment, with particular emphasis on the type of patient often referred to the specialist physician. The main focus is Alzheimer's disease, but many of the recommendations apply to dementia disorders in general. The task force working group considered and classified evidence from original research reports, meta-analysis, and systematic reviews, published before January 2006. The evidence was classified and consensus recommendations graded according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. The recommendations for clinical diagnosis, blood tests, neuroimaging, electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, genetic testing, tissue biopsy, disclosure of diagnosis, treatment of Alzheimer's disease, and counselling and support for caregivers were all revised when compared with the previous EFNS guideline. New recommendations were added for the treatment of vascular dementia, Parkinson's disease dementia, and dementia with Lewy bodies, for monitoring treatment, for treatment of behavioural and psychological symptoms in dementia, and for legal issues. The specialist physician plays an important role together with primary care physicians in the multidisciplinary dementia teams, which have been established throughout Europe. This guideline may contribute to the definition of the role of the specialist physician in providing dementia health care.     

重型颅脑损伤开颅术中急性脑膨出的防治

目的探讨重型颅脑损伤开颅术中急性脑膨出的原因及对策。方法对120例重型颅脑损伤开颅术中急性脑膨出的原因、对策及预后进行回顾性分析。结果（1）迟发血肿65例，其中同侧脑内血肿10例，硬膜外血肿8例，对侧硬膜外血肿21例，硬膜下血肿10例，脑内血肿9例，大脑纵裂血肿7例；（2）急性弥漫性脑肿胀40例；（3）外伤性大面积脑梗死15例；（4）复合伤患者有30例。合并胸部、腹部及四肢骨折，有明显的低血压和低血氧症状；（5）术中操作不当，误诊误治10例。结论重型颅脑损伤开颅术中急性脑膨出的主要原因有迟发性颅内血肿，弥漫性脑肿胀，严重脑水肿，广泛脑梗死，术中操作不当，对病情的误诊误治，麻醉问题等。根据不同的原因进行正确处理，可以降低急性脑膨出的重残率及病死率。     

大肠海绵状血管瘤的诊治（附8例报告）

目的 探讨大肠海绵状血管瘤的临床特点、诊治原则和疗效。方法回顾1997年至2004年收治的8例大肠海绵状血管瘤患者的临床资料。结果8例患者平均年龄18岁．其中直肠海绵状血管瘤4例．直肠和乙状结肠海绵状血管瘤3例．金大肠海绵状血管瘤1例。临床表现为反复发作的无痛性便血和贫血。术前行电子结肠镜、腹部X线平片、气钡双重对比造影、CT和MRI等检查明确诊断。昕有患者均行于术治疗．平均随访36月（10～96月）．全部治愈。结论增强对本病的认识．重视电亍二结肠镜仵大肠海绵状血管瘤的首诊作用．影像学检杏进一步确定病变部位和血管瘤的范围,手术治疗是有效的治疗手段。     

精神病患者回归综合医院开放病房治疗可行性研究

目的探讨建立综合医院开放式心理病房治疗精神病患者的意义及可行性。方法对广东医学院附属医院心理病房采用开放式管理模式 ,并分析 12 0 0例住院患者的疗效。结果综合医院开放式心理病房管理模式具有患者生活自由、人际交往方便、可保持与外界社会的接触、治疗效果好、住院天数短、经济效益佳、精神症状更易控制等优点。结论综合医院建立开放式管理的心理病房有利于精神病患者的治疗 ,是现代精神病治疗发展的趋势。