抓住重点 不断创新 进一步深化卫生人事制度改革

论述了卫生干部制度改革、事业单位人事制度改革和专业人才队伍建设的思路和措施。指出,要以“三个代表”重要思想为指导,突出党政干部制度改革、事业单位人事制度改革和专业人才队伍建设三个重点,着力解决人员出口和工资分配制度两个难点问题。同时主动配合支援西部和农村卫生的重点工作,稳步推进农村和西部人才资源开发,大力推进卫生人才市场建设。     

选择性头部亚低温治疗新生儿缺氧缺血性脑病安全性临床多中心研究

目的：尽管小规模的临床研究表明亚低温治疗新生儿缺氧缺血性脑病（hypoxic-ischemic，HIE）是安全的，但仍需大规模的临床多中心的研究进一步证明。本研究目的通过临床多中心研究观察选择性头部亚低温治疗新生儿HIE的安全性。方法：入选标准：生后6 h以内；胎龄 ≥36周，体重≥2 500 g；脐动脉血气分析 pH < 7.0或BE ≤-16 mmol·L-1或生后1 min Apgar评分 ≤ 3并持续到5 min仍然 ≤ 5；生后6 h内出现脑病的临床表现或EEG明显异常。排除标准：严重先天性疾病、合并感染、其他原因导致颅内损伤、严重贫血（Hb < 120 g·L-1）。从2002年5月- 2006年2月共收集246例不同严重程度的新生儿HIE，随机分为治疗组（低温治疗）134例和对照组112例。低温组和常温组各失访17例和12例，故有效病例共217例（低温组117例，对照组100例）。低温组生后6 h内开始选择性头部亚低温治疗，维持鼻咽部温度（34±0.2）℃℃，肛温维持在35℃以上,持续72 h，然后自然复温。常温组维持肛温在36～37.5oC。两组均进行心电、血压、经皮氧饱和度、鼻咽部温度和肛温监测。发现心率失常者进行EEG检测。观察主要不良反应包括：死亡率、严重心律失常、静脉血栓或出血、难以纠正的低血压。低温组72 h时检测肝、肾功能和血常规、血电解质、血糖及血气分析。观察可能出现的其他不良反应。结果：低温组和常温组的死亡率分别为17.9％和25％(P＝0.20)，死亡原因中两组均以重度脑病(低温组和对照组分别为：6.8%和7%，P＝0.96)和呼吸衰竭(低温组和对照组分别为：6.8%和6%，P＝0.8)为主；对照组有1例患者出现室性心律失常和DIC；低温组发生DIC和消化道出血患者各1例；两组均未出现难以纠正的严重低血压和大静脉血栓。低温组和常温组发生严重不良反应的概率分别为 1.7％和2％（P＝1.0）。低温治疗期间心率降低，但仅有4例(3.4%)患儿心率低于80次/分钟；两组之间血压、肝及肾功能、电介质、血生化、血气分析及血常规的变化均无显著性差异。结论：选择性头部亚低温结合全身轻度低温72 h治疗足月新生儿HIE是可行的和安全的。     

面神经功能评价标准(讨论稿)

为了制订一个有权威性、与国际接轨、且全国同行认可的面神经功能的评价标准（面神经分级），2004年6月份《中华耳鼻咽喉科杂志》编辑部组织部分专家进行了讨论，并结合我国的具体情况，邀请相关专家完成了标准的起草，并组织北京的耳科学专家进行充分的讨论和修改。经过北京专家修改后的《面神经功能评价标准（系统）》讨论稿送给全国耳科学专家征求意见，大部分专家在2005年4月底之前将该地区同行对于标准草案的意见反馈回了编辑部。同时，编辑部将该草案放到中华耳鼻咽喉头颈外科网上（http：／／www．odhns．org．cn／）进一步在全国范围内征求意见。综合上述意见，再次整理该草案，并在2005年5月的山东济南耳科学学术会议上对草案的必要性及具体实施办法进行了热烈的讨论，提出了很多建设性的意见和建议。在制定面神经麻痹评分系统方面，大家认为建立国内统一的面神经麻痹评分系统是必要的，利于学术交流和与国际接轨。从长远角度出发，应该有中国的评价系统，这需要我们有目的地研究，建议暂按House—Brackmann标准，在国内进行多中心、前瞻性研究。然后根据多中心研究结果，制订我国面神经麻痹评分标准。根据以上意见，我们将该草案在本栏目中刊出，进一步征求全国各地专家和读者的意见和建议。希望广大专家和读者踊跃发表意见，可将您的看法用信件（100710，北京东四西大街42号耳鼻喉科姬广茜收）或者邮件（Email：jiguangqian@cma．org．cn）的方式反馈给我们。[编者按]     

骨膦和153钐乙二胺四甲撑磷酸治疗头颈 肿瘤骨转移的随机对照临床观察

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Oral Assessment Guide – test of reliability and validity for patients receiving radiotherapy to the head and neck region

KNÖÖS M. & ÖSTMAN M. (2009) European Journal of Cancer Care 19 , 53–60
Oral Assessment Guide – test of reliability and validity for patients receiving radiotherapy to the head and neck region
Radiotherapy to the head and neck region leads to severe side effects in the oral cavity but knowledge about severity and onset is scarce among oncology nurses in a radiotherapy department. The aim was to test the Oral Assessment Guide for reliability and validity for patients receiving radiotherapy to the head and neck region. A prospective design with repeated assessments was selected. Thirty-six outpatients admitted to the department for radiotherapy to the head and neck region were included. In connection with the treatment session, the oral cavity was examined every second day by a nurse and once a week by an oncologist. The results were documented on separate forms. All patients showed alterations in the oral cavity and side effects started early during the first week of treatment. The result from inter-rater reliability showed a high concordance in all categories (>71%). Cohen's kappa ( k ) showed good agreement for voice, swallow and saliva and moderate for lips, tongue, mucous membranes, gums and teeth/dentures. The association, the sensitivity, between dose of radiation and side effects was weak or moderate and the acceptability with patients and staff was generally good.     

Medication errors in chemotherapy: incidence,types and involvement of patients in prevention. A review of the literature

SCHWAPPACH D.L.B. & WERNLI M. (2010) European Journal of Cancer Care 19 , 285–292
Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature Medication errors in chemotherapy occur frequently and have a high potential to cause considerable harm. The objective of this article is to review the literature of medication errors in chemotherapy, their incidences and characteristics, and to report on the growing evidence on involvement of patients in error prevention. Among all medication errors and adverse drug events, administration errors are common. Current developments in oncology, namely, increased outpatient treatment at ambulatory infusion units and the diffusion of oral chemotherapy to the outpatient setting, are likely to increase hazards since the process of preparing and administering the drug is often delegated to patients or their caregivers. While professional activities to error incidence reduction are effective and important, it has been increasingly acknowledged that patients often observe errors in the administration of drugs and can thus be a valuable resource in error prevention. However, patients need appropriate information, motivation and encouragement to act as ‘vigilant partners’. Examples of simple strategies to involve patients in their safety are presented. Evidence indicates that high self‐efficacy and perceived effectiveness of the specific preventive actions increase likelihood of participation in error prevention. Clinicians play a crucial role in supporting and enabling the chemotherapy patient in approaching errors.     

Quality of life and adjuvant tamoxifen treatment in breast cancer patients

About two-thirds of all breast cancer patients are treated with adjuvant hormonal therapy. Side effects of tamoxifen and their effects on physical, emotional and social functioning have been shown to impair the quality of life. Aim of this paper was to evaluate the side effects and level of influence on the physical, emotional and social functioning caused by tamoxifen treatment. For assessment of quality of life an own questionnaire was designed. Between January 2001 and December 2003, 136 women with breast cancer and adjuvant tamoxifen therapy were included in this study. Data of side effects, physical and mental health and patients' self-evaluation identified detrimental effects on patients' quality of life. Prevalence and severity of symptoms were not influenced by length of tamoxifen treatment. Patients were damaged in their constitution in respect to previous chemotherapy and pre-existing diseases; no influence was found by age or histopathological tumour characteristics. Our survey determines that breast cancer patients experience significant influence on quality of life by the negative impact on the physical, emotional and social functioning caused by tamoxifen treatment. Explicit attention to changes in quality of life should be considered as part of the standard care for women receiving adjuvant tamoxifen treatment.     

Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children

Background

A quarter of all patients presenting to emergency departments are children. Although there are several large, well‐conducted studies on adults enabling accurate selection of patients with head injury at high risk for computed tomography scanning, no such study has derived a rule for children.

Aim

To conduct a prospective multicentre diagnostic cohort study to provide a rule for selection of high‐risk children with head injury for computed tomography scanning.

Design

All children presenting to the emergency departments of 10 hospitals in the northwest of England with any severity of head injury were recruited. A tailor‐made proforma was used to collect data on around 40 clinical variables for each child. These variables were defined from a literature review, and a pilot study was conducted before the children''s head injury algorithm for the prediction of important clinical events (CHALICE) study. All children who had a clinically significant head injury (death, need for neurosurgical intervention or abnormality on a computed tomography scan) were identified. Recursive partitioning was used to create a highly sensitive rule for the prediction of significant intracranial pathology.

Results

22 772 children were recruited over 2½ years. 65% of these were boys and 56% were <5 years old. 281 children showed an abnormality on the computed tomography scan, 137 had a neurosurgical operation and 15 died. The CHALICE rule was derived with a sensitivity of 98% (95% confidence interval (CI) 96% to 100%) and a specificity of 87% (95% CI 86% to 87%) for the prediction of clinically significant head injury, and requires a computed tomography scan rate of 14%.

Conclusion

A highly sensitive clinical decision rule is derived for the identification of children who should undergo computed tomography scanning after head injury. This rule has the potential to improve and standardise the care of children presenting with head injuries. Validation of this rule in new cohorts of patients should now be undertaken.One million patients with head injuries attend emergency departments each year in the UK, of whom as many as 50% are children^1,2,3; this proportion is similar in the US, where there are 95 000 hospital admissions from childhood head injuries, at a cost of over US$ 1 billion per year.^4,5,6 In contrast with the high incidence of head injury, mortality is comparatively low (6–10 per 100 000), and as few as 1 in 500 of all people attending the emergency department have a fatal outcome.^7,8 Thus, although emergency physicians see a large number of patients with head injury, they rarely see patients who have life‐threatening intracranial complications after the injury.Over the past decade, several decision rules have been derived and validated using high‐quality methods to identify adults with a head injury who require computed tomography scanning.^{9,10,11,12,13,14} Although children account for as many as half of all head injuries, no such well‐derived multicentre clinical decision rules exist for children. The American Academy of Pediatrics in 1999^14a concluded that they could not advocate an evidence‐based computed tomography scanning strategy because of the poor quality of studies on children.¹⁵ In 2003, The National Institute of Clinical Excellence in the UK found that the quality of studies on childhood head injuries was so poor that they issued a clinical decision rule for children that was derived and validated only in adults.¹⁶Our aim was to derive a sensitive clinical decision rule for the management of children presenting with an acute head injury, which would identify children at high risk so as to undergo computed tomography scanning and allow the remaining patients to be discharged with no investigation.