Experimental vascularized total joint autografts--a primate study

Autogenous vascularized and nonvascularized total joint transfers were studied in the hands of Macaca fascicularis monkeys. Nine second toe proximal interphalangeal joints were transferred as a vascularized free graft to the hand, and the excised finger joints were transferred to the foot as a nonvascularized free graft. The grafts were examined clinically and histopathologically at 16 weeks to 10 months. Two of the nonvascularized free grafts were amputated because of infection and necrosis. Three had chronic infections. The four surviving nonvascularized grafts demonstrated necrosis of the hyaline cartilage and degenerative changes. Of the nine vascularized joints, one developed a wound infection that required amputation, another failed at 2 weeks because of wound dehiscence, and the remaining seven survived with preservation of the hyaline articular surfaces. The experimental technique was designed to be easily applied to clinical use. A skin island is provided as a "patency/viability monitor." The extensor mechanism is included in the graft for early function.     

山西省医生对医疗保健体系及民营医疗服务的意向调查

通过对不同性质医疗机构医生关于医疗保健体系及民营医疗服务的意向性调查,旨在了解公立和私立医院医生对工作现状的满意程度,了解行医者对民营医疗及整个卫生系统的态度和评价.     

Do emergency nurses and doctors agree in their triage assessment of dyspneic patients?

ObjectivesThis study investigated the inter-observer agreement (IOA) between doctors and nurses on triaging adult ED dyspneic patients.MethodsThis was a prospective observational study comparing eight trained ED nurses with doctors. Each patient was assessed by a nurse and two doctors (1 and 2) who decided on four-point Patient Acuity Category (PAC) and triage management steps. The primary outcome was the proportion of resuscitation room escalations from consult. Secondary outcomes included proportions and IOA of assigned PAC and steps in triage management. The investigators reported IOA as the k statistic (95% CIs) and percent agreement.Data/resultsThere were 22/302 (7.3%) escalations; one from clinical deterioration. Proportions of assigned PAC status by nurses, Drs 1 and 2 were: PAC 1: 20.2–24.2%; PAC 2: 71.5–72.8%; PAC 3: 4.3–7.0%; PAC 4: 0.0–0.7%. The IOA was at least fair to moderate [k: 0.33 (0.22–0.43) to 1.00] in all steps of management except for electrocardiogram [k: 0.19 (0.10–0.27) to 0.45 (0.35–0.55)] ordering. The percent agreement ranged from 81 to 100% for all management steps except for chest Xray (66–73%) and electrocardiogram (61–71%) ordering.ConclusionTrained ED nurses were safe and managed adult dyspneic patients as well as doctors at triage.     

旴江医家论痰饮

"百病多由痰作祟",痰是人体水液代谢障碍所形成的病理产物,又是导致众多病证的致病因素。旴江医学著作宏富,内容丰厚,其中包括许多关于痰饮的精辟论述。对旴江主要医家有关痰饮病因、病机、辨证及防治的论述进行总结。     

县级医院医生对癌痛治疗认知现状的调查及对策

目的：调查县级医院医生对癌痛治疗认知现状,并分析相应的对策。方法采用自行设计的医生癌痛治疗认知调查问卷对贵港市6家县级二级甲等医院医生进行调查。结果已培训医生对癌痛治疗基础知识、麻醉药品成瘾性、按时给药方法、吗啡类药物使用等的认知程度高于未培训医生,差异有统计学意义（P〈0.05）。结论本市县级医院医生对癌痛治疗的知识了解不够深入,建议继续加强县级医院医生对癌痛治疗的培训。     

PBL教学模式在康复科进修医生培训中的应用效果分析

目的分析PBL教学模式在康复科进修医生培训中的应用可行性,并研究其应用效果。方法我院于2012年开始全面推行进修医生的PBL教学模式,以2012年1-12月间参与康复科进修学习的32名医生作为对照组,行传统LBL教学模式（授课中心教学模式）,以2013年1-12月间参与康复科进修学习的35名医生作为研究组,行PBL教学模式（问题中心教学模式）。以问卷调查的方式统计进修医生对该教学模式的主观认可度,同时由带教医生设置试卷,考核进修医生对康复科医疗技术的掌握程度。结果 1观察组对培训模式的总主观认可率97.1%,对照组为75.0%,组间差异具备统计学意义（P〈0.05）;2两组进修医生入科成绩均值相近,差异不具备统计学意义（P〉0.05）,但观察组出科成绩平均（88.4±3.6）分,显著性优于对照组（78.6±2.9）分,组间差异具备统计学意义（P〈0.05）。结论应用PBL教学模式能够有效激发康复科医生的学习积极性,可促进其综合能力的提升,具备推广价值,值得临床采用。     

新形势下影响医患关系的因素分析

目的:探讨影响医患关系的主要原因,以帮助缓解医患矛盾。方法:采用自制调查表对400例住院病人作问卷调查和对某院253例医疗投诉及医疗纠纷进行分析。结果:在众多影响医患关系的因素中,医护人员的综合素质是主要原因之一。结论:提高医护素质,和谐医患关系是我们迫切需要面对的问题。     

名老中医经验共性规律及个性差异比较研究

名老中医共性及个性经验的知识发现.结果:发现了名老中医运用某些治法、方剂及药物的特点得出了不同名老中医针对中、西医疾病的异病同治规律,从而总结出不同老中医临床经验的共性规律及个性差异.结论:比较名老中医经验的异同,有利于更加深入地认识中医个体化医学的核心内涵,发现其共性规律,明确个性经验产生的原因,为今后开展验证性研究,形成更加科学的中医经验理论提供了基础.同时,为后学者博采众长、学习和汲取多位名老中医经验提供了示范,对促进中医药的传承和发展具有一定意义.     

产科医护人员产后出血评估现状调查

目的了解产科医护人员对产后出血评估现状,为研发科学、有效、实用的产后出血预警评估工具提供依据。方法采用方便抽样方法,于2019年4月6—13日抽取全国92家医院的产科医护人员进行问卷调查,采用自行设计调查问卷调查其一般资料和产后出血评估现状等。本次研究共发放问卷4490份,问卷回收后进行审核,检查填写内容的完整性,有效问卷为4490份,回收问卷的有效率为100%。结果4490名调查对象中,有4406名产科医护人员所在的医院进行产后出血高危因素评估,占98.1%。不同类别的医院产后出血高危因素评估情况比较差异有统计学意义(P<0.05)。在进行产后出血高危因素评估的医院中,77.6%的产科医护人员所在的医院由医生和护士或助产士共同评估产后出血高危因素,62.1%的产科医护人员所在的医院运用产后出血高危因素评估表进行评估;对孕产妇进行产后出血高危因素评估的时机排名前2位为产后评估与产时评估,产科医护人员对出血量的测量方法采用最多的是称重法,产科医护人员认为在开展产后出血高危因素评估工作遇到的困惑,"没有合适的产后出血高危因素的评估工具"排名最高。结论产科医护人员对产后出血高危因素的评估较为重视,但缺乏连续动态评估产后出血高危因素,出血量的测量方法也有待统一,各医院管理者及产科医护人员急需适合临床应用的产后出血评估工具。