现代院前急救体系的构建

充分分析目前中国的院前急救体系，剖析中国院前急救的现状及需求，构建出具有中山特色的院前急救体系。通过中国经济发达地区中、小城市院前急救体系的构建，完善EMSS体系，着重加强院前急救的救治能力和水平．从而促进了整体急救水平的提高。     

加强高职高专医学生公共卫生和临床医学整合教育的思考

文章讨论了由突发公共卫生事件引发的对构建现代公共卫生和临床医学整合教育模式的反思及其对策措施.透过SARS危机，暴露出我国现行医学教育体制上存在的医防分离的严重性，提示我们应借鉴21世纪医学生培养目标与要求，改革医学教育模式，促进多学科、跨专业的合作，建立以社区为目标、以问题为中心的公共卫生与临床医学整合教育的全新综合化课程体系;积极推广计算机辅助教育（CAI），加强运用现代化教学手段;建设以社区实践为主要内容的公共卫生和临床医学整合教育基地，加强高职高专医学生实践技能的培养，以构建新型高职高专医学人才培养模式，培养防治结合的新型实用型医学人才.     

结合综合性医院门诊就诊特点强化门诊特色管理

目的 通过分析医院2005年门诊病人就医的规律，揭示门急诊工作量的变化规律，指导、加强门诊医疗质量的科学化管理。方法 采用整群抽样调查法，对2005年1月～12月门诊患者就诊资料进行分析。结果 1年中门诊量在前5位的科室依次是儿科、内科、妇产科、五官科、外科；死亡病人数在前5位的系统依次是神经、呼吸、循环、急症、创伤：死亡疾病顺位前5位依次是肺性脑病、脑出血、急性心肌梗死、感染性休克、外伤。结论 医院应加强学科建设，参考疾病谱以确定学科建设和发展方向，建立优质、高效、低耗、快捷的门诊医疗服务体系，强化门诊特色管理，提高医疗服务质量。     

广州地区重大化学危害源识别和中毒控制与应急医疗技术预案库制备的研究

目的识别、确定广州地区存在的可能引起重大化学危害(含职业危害)事故的毒物谱库,为化学事故应急救援行动提供技术依据。方法⒈应用循证医学的方法,研究分析包括从安监部门登记的化学品资料中识别出广州地区存在的重大化学(含职业危害)危害源,筛选与其相关的中毒控制与应急医疗技术资料数据;⒉应用计算机技术编制成数据库文本和应用软件。结果⒈制成广州地区重大化学(含职业危害)危害源的中毒控制与应急医疗技术预案库文件文本与应用软件;⒉建立广州地区化救技术网络信息服务平台,向社会提供有关化学品的毒性、化学事故预防控制及应急处置、应急医疗技术预案信息。结论该中毒控制与应急医疗技术预案库,可作为化学事故应急救援行动的技术依托,使政府部门启动化学事故应急救援预案时,从技术预案库快速查询到化学事故应急救援行动所需的决策依据。     

119份死亡病案中急诊、门诊病历缺陷分析

目的检查死亡病案的急诊、门诊病历终末质量,找出这些病案存在的缺陷,总结经验,吸取教训,提高急诊医疗质量。方法参照江苏省卫生厅下发的《病历书写规范》第四版急诊、门诊病历的规则、要求,对2004年我院的119份急诊、门诊病历中死亡病案出现的主要问题归纳为病程记录的完整性、病史、体检、辅助检查、诊断、治疗、医生履行告知义务及其他方面八个部分,逐份逐项进行质量缺陷检查。结果119份死亡病案中门诊病历存在着不同程度的缺陷,以医生履行告知义务、病程记录不完整、病史缺陷问题较为突出。对策急诊门诊病案不光是医疗文书,同时也是法律文书,应站在法律的高度来增强自我保护意识,遵循及时、真实、全面、准确、完整的原则,以严谨的态度认真书写急诊门诊病历。     

微生物实验室如何应对突发公共卫生事件

目的:本研究的目的在于探讨微生物实验室如何应对突发公共卫生事件。方法:通过查阅国内外微生物实验室应对突发公共卫生事件的相关资料和总结微生物实验室实际工作经验提出应对方案。结果:通过研究,提出了建立预案、进行人员培训、对仪器设备不断进行更新配备与核查、适量储备消耗性材料、选择合适的方法、充分利用当地医疗机构的资源、配备必要的生物安全设施及与流行病学医生等合作与沟通的一整套方案。结论:微生物实验室在面对突发公共卫生事件时,采取上述方案能够快速、有效地应对突发公共卫生事件,变被动为主动,从而认为该方案是安全有效的工作方式。     

Lower rates of emergency department injury visits among Latino children in the USA: no association with health insurance.

BACKGROUND AND OBJECTIVE: Latino children have lower rates of injury visits to emergency departments (EDs) than non-Latino white and African American children. This study tests the hypothesis that this difference reflects health insurance status. DESIGN: Secondary analysis. Patients/ SETTING: Children under 19 years of age visiting EDs in the USA, sampled in the National Hospital Ambulatory Medical Care Survey of EDs (NHAMCS-ED) from 1997 to 2001. MAIN OUTCOME MEASURES: Rates of ED injury visits; ED injury visit rates by race/ethnicity stratified by health insurance and adjusted for other covariates; subtypes of injury visits; and procedures and hospital admissions by race/ethnicity. RESULTS: Injuries accounted for >56 million, or 40.5%, of total ED visits among pediatric patients. Injury visits occurred at lower rates for Latino children (9.9 per 100 person years) than non-Latino white and African American children (16.2 and 18.3, respectively), although total ED visit rates were similar. Regardless of health insurance status, Latino children had lower rates of injury visits than non-Latino white and African American children. Latino children had lower rates of the three major subtypes of injury visits (sports, accidental falls, struck by/between objects). Latino children had similar rates of procedures and hospital admissions to non-Latino white children. CONCLUSIONS: Irrespective of their insurance status, Latino children have lower rates of ED injury visits in the USA than non-Latino white children. Possible reasons for this difference include different healthcare seeking behavior or different injury patterns by race/ethnicity, but not differences in health insurance status or barriers to accessing ED care.     

Emergency department screening for risk for post-traumatic stress disorder among injured children.

OBJECTIVE: To discuss the successes and challenges associated with the implementation of a post-traumatic stress disorder (PTSD) screening tool in two pediatric emergency departments (ED). METHODS: The STEPP screening tool has been developed previously on an inpatient population of motor vehicle trauma patients. It was applied here to the general ED population at two different pediatric trauma centers. Nurse screeners were trained and a convenience sample of patients with unintentional injuries who met study criteria were screened in the ED. Feedback from nurse screeners was obtained. RESULTS: The process of implementing a screening tool to identify patients and their families significantly at risk for PTSD symptomatology presented some barriers, but overall acceptability of the process was high for both the emergency department staff and the patient. Recommendations for others considering implementation of screening programs in the ED are offered. CONCLUSIONS: Future research using screening protocols in the ED should, in their design, attempt to capitalize on the successes identified in the current protocol and circumvent barriers also encountered.     

The Evaluation of Suspected Pediatric Sexual Abuse

Children with suspected sexual abuse often present to the ED, not infrequently like those in the 2 cases described. Most children who are sexually abused have normal genital examinations, which should be explained in discussions with caretakers and investigators. Interviewing of the child should be avoided by the physician, except to establish current symptoms that may impact examination or testing. Exams should not be forced on children. The hymen is extremely sensitive in the unestrogenized female and should not be touched. Speculum examination is never performed in the prepubertal child, except under anesthesia by a practitioner experienced in child sexual abuse evaluation or gynecology. Examination under anesthesia by a physician experienced in surgical repair is indicated with active vaginal or rectal bleeding. In cases in which the examination is abnormal or inadequate, the subspecialist should be consulted. Patients with contact less than 72 hours before presentation may need forensic evidence collection, which should be coordinated with the subspecialist. Prepubertal females with vaginal discharge seen on examination should have testing sent not only for STDs, but also for non-STD etiologies including group A streptococcus and enterics. Postexposure prophylaxis (pregnancy, STD, HIV) should be considered when appropriate. There are many conditions that may be mistaken for sexual abuse. Detailed documentation of the history and the physical examination (written, drawings, and ideally photographs) is essential.