以脑室出血为首发表现烟雾病患者的护理

对16例以脑室出血为首发表现的烟雾病患者行侧脑室引流术，结果患者手术均获成功，无并发症发生。平均住院13．6d出院。提出术前进行心理护理，做好充分术前准备；术后密切观察病情变化，正确掌握脑室引流袋的高度，观察引流液的量和颜色，保持脑室引流通畅；做好腰穿置管后脑脊液置换的护理，及时观察并发症的发生，予以出院指导等，对巩固手术疗效，促进患者康复至关重要。     

Mindestmengen

BACKGROUND: Consequences of the volume outcome relationship are controversial. Objectification based on data analysis is strongly needed. The aim of this publication was to analyse the effects of volume outcome reallocations based on German inpatient data. METHOD: The analysis based on inpatient data of the Krankenhauszweckverband Koeln, Bonn und Region (Hospital Association of the Cologne and Bonn Region) of 2002 and 2005. Relevant data sets were identified according to the effects of current German regulations on volume outcome on the special fields liver transplant, kidney transplant, complex pancreatic surgery, and complex oesophageal surgery. RESULTS: The effects of current German regulations on volume outcome results differed greatly between the four surgical specialities. There were fewer effects on kidney transplant, but due to an already very high level of centralisation 34% (oesophagus) and 8% (pancreas) of the hospitals stopped related surgery. This affected 8.9% (oesophagus) and 2.2% (pancreas) of related cases. CONCLUSION: Concentration and the formation of specialised medical centres are results of the implementation of volume outcome relationships. The quality of medical treatment does not automatically improve from this development. It is necessary to analyse any correlation between quality and frequency of treatment or other criteria such as know-how, structure and process management, and multidisciplinarity.     

More training needed in chronic care: a survey of US physicians.

PURPOSE: Although more than 125 million North Americans have one or more chronic conditions, medical training may not adequately prepare physicians to care for them. The authors evaluated physicians' perceptions of the adequacy of their chronic illness care training to and the effects of training on their attitudes toward care of persons with chronic conditions. METHOD: In November 2000 through June 2001, the authors surveyed by telephone a random sample of U.S. physicians who had > or =20 hours of patient contact per week. The interview instrument examined demographics, career satisfaction, practice characteristics, perceived adequacy of chronic illness care training in ten competencies (geriatric syndromes, chronic pain, nutrition, developmental milestones, end-of-life care, psychosocial issues, patient education, assessment of caregiver needs, coordination of services, and interdisciplinary teamwork), and effect of training on attitudes toward chronic illness care. RESULTS: Of 1,905 eligible physicians, 1,236 (65%) responded (270 family or general practitioners, 231 internists, 129 pediatricians, 335 nonsurgical specialists, and 271 surgeons). Most physicians reported their chronic disease training was less than adequate for all ten competencies. Family practitioners were more likely (p <.05) to report adequate training in seven competencies compared with internists, and in two to four competencies when compared with pediatricians, nonsurgical specialists, or surgeons. Most physicians reported that training had a positive effect on attitudes toward care of people with chronic conditions, including the ability to make a difference in their lives (74-84%). CONCLUSIONS: Physicians perceived their medical training for chronic illness care was inadequate. Medical schools and residencies may need to modify curricula to better prepare physicians to treat the growing number of people with chronic conditions.     

长春花叶片愈伤组织诱导及培养过程中生物碱合成类型的变化和调节及有关酶的分析

在４种不同培养基上诱导长春花叶片愈伤组织发生的过程中,叶片中含量较高的文多灵（ｖｉｎｄｏｌｉｎｅ）和长春质碱（ｃａｔｈａｒａｎｔｈｉｎｅ）迅速降解至极低水平,而在叶片中含量较低的阿玛碱（ａｊ－ｍａｌｉｃｉｎｅ）和蛇根碱（ｓｅｒｐｅｎｔｉｎｅ）的合成却逐渐增加,同时酸性和碱性过氧化物酶（ｐｅｒｏｘｉｄａｓｅ）活性呈上升趋势,尤其碱性过氧化物酶与蛇根碱和阿玛碱的相关性较密切。光照和黑暗中的变化趋势基本一致,但光照可提高过氧化物酶的活性,对培养物的长春质碱、文多灵和蛇根碱的合成有利。不同的培养基对生物碱的合成影响较大,２,４－Ｄ显著抑制生物碱的合成,持续光照使愈伤组织的生长受到抑制,使阿玛碱向其蛇根碱转化。     

甘肃省张掖市中老年人骨关节炎流行病学调查分析

目的调查甘肃省张掖市人群骨关节炎流行病学资料,为骨关节炎的防治提供参考数据。方法采用随机整群抽样的方法,在张掖市6个县区40岁以上的人口进行抽样,发放骨关节炎健康状况调查表,并对获得的数据进行统计分析。结果在1 341名资料完整的调查对象中,男性共有653人,平均年龄(60.75±12.33)岁;女性共有688人,平均年龄(53.82±14.35)岁;骨关节炎患者共247例,患病率为18.4%。其中,男性骨关节炎患者75例,患病率为11.5%;女性骨关节炎患者172例,患病率25.0%。女性的患病率比男性更高,而整体患病率随着年龄增大而增高(P0.05)。文职类工作和慢跑为骨关节炎患病的保护性因素,而游泳和武术则会增加骨关节炎的患病风险(P0.05)。结论甘肃省张掖市人群骨关节炎整体患病率较高,应加强骨关节炎的防治工作。     

估算的肾小球滤过率、血尿酸和纤维蛋白原与缺血性脑卒中溶栓后脑出血转化的关系及对结局的预测价值

目的探讨估算的肾小球滤过率(eGFR)、血尿酸(SUA)、纤维蛋白原(FIB)与缺血性脑卒中溶栓后脑出血转化及临床结局的关系。方法选取158例缺血性脑卒中用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓患者,包括无脑出血转化121例、脑出血转化37例。采用Logistic回归方程分析rt-PA静脉溶栓后脑出血转化影响因素;对比不同早期神经功能患者eGFR、SUA、FIB水平;评价eGFR、SUA、FIB对早期神经功能恶化(END)的预测价值;比较不同eGFR、SUA、FIB水平患者的累积生存率。结果rt-PA静脉溶栓2 h、24 h后,脑出血转化者eGFR、SUA、FIB水平较无脑出血转化者降低(P<0.05)。Logistic回归分析显示,年龄、基线NIHSS评分、基线舒张压、大面积脑梗死及溶栓后2 h和24 h的eGFR、SUA、FIB均为rt-PA静脉溶栓后脑出血转化的影响因素(P<0.05)。END患者溶栓后2 h和24 h的eGFR、SUA、FIB均低于非END患者(P<0.05)。ROC曲线分析显示,溶栓后24 h的eGFR、SUA、FIB联合预测END的曲线下面积为0.809,大于任一单一指标,其灵敏度、特异度分别为80.95%、74.14%。生存分析结果表明,溶栓后24 h的eGFR、SUA、FIB高水平组的累积生存率高于低水平组(P<0.05)。结论eGFR、SUA、FIB与缺血性脑卒中预后密切相关,监测上述指标有助于脑出血转化诊断及END预测。