灾难及突发事件住院信息管理系统研究现状及趋势

信息工作是决策的依据和先导,如何准确、及时、高效地收集、整理、分析灾难及突发事件信息、伤病员基本信息、救治信息等,已成为医院管理信息学的研究热点问题,也是医院在灾难和突发事件大量伤员信息管理中面临的难点问题。本文就灾难及突发事件住院信息管理系统研究现状及趋势进行综述。     

A 3-year longitudinal study of quality-of-life outcomes of elderly patients with implant- and tooth-supported fixed partial dentures in posterior dental regions

doi: 10.1111/j.1741‐2358.2011.00592.x
A 3‐year longitudinal study of quality‐of‐life outcomes of elderly patients with implant‐ and tooth‐supported fixed partial dentures in posterior dental regions Background: Clinical studies have mainly been focused on oral health‐related quality‐of‐life (OHRQoL) outcomes of removable dentures. Objective: To evaluate therapy of elderly patients with implant‐supported fixed partial dentures (IFPD) and tooth‐supported fixed partial dentures (FPD) in the posterior dental regions. Patients and methods: The OHIP49 was used to measure OHRQoL in 64 patients with IFPD and 38 patients with FPD, before, 3 weeks and 3 years after rehabilitation. A control group (CG) consisted of 62 individuals. Results: The Oral Health Impact Profile questionnaire (OHIP) follow‐up scores of the patients with FPD and the patients with IFPD were significantly smaller in comparison with the baseline scores (p < 0.01). The OHIP scores were further reduced at the 3‐year follow‐up. The patients with IFPD had significantly higher scores than the patients with FPD and the CG at the baseline and at the follow‐ups. In the patients with FPD, both age groups (≤60 and >60) showed equal improvement of the OHRQoL. In the IFPD group, patients older than 60 years showed better improvement (p < 0.05). There were no significant differences dependent on gender and antagonistic teeth (p > 0.05). Conclusion: The FPD and the IFPD treatment showed significant improvement of OHRQoL. The FPD treatment improved OHRQoL equally in both age groups, while the IFPD treatment improved OHRQoL better in older patients.     

医患不信任问题对医方医疗行为的影响及对策分析

目的 客观真实的描述医患间的信任现状及其对医方医疗行为的影响,并提出相关对策建议。方法 对北京市5家三甲医院医务人员和患者共1 010人进行问卷调查,对25位医务人员进行定性访谈,通过统计分析描述并分析医患不信任问题现状及其对医方医疗行为的影响。结果 医方对于医患关系的评价低于患方,存在感觉患者不信任医方的担忧;继而产生了其言行过分谨慎、规避风险、消极自保的行为,甚至偏离医学科学原则的现象。结论 医患不信任情况的确存在,已经对于医方的医疗行为造成了不良影响,必须从政府、医院以及媒体3方面采取应对措施,以缓解医患间的不和谐关系,重建医患间不可或缺的信任。     

Levels and trends in cardiovascular risk factors and drug treatment in 4837 elderly Dutch myocardial infarction patients between 2002 and 2006

Background

It is important to gain insight into opportunities for secondary prevention of cardiovascular disease. Our aim was to investigate levels and trends in cardiovascular risk factors and drug treatment in Dutch post-myocardial infarction (MI) patients between 2002 and 2006 and to make comparisons with the EUROASPIRE surveys (1999–2007).

Methods

We analysed data from 4837 post-MI patients (aged 69 years, 78% men) from 32 Dutch hospitals, using baseline cross-sectional data from the Alpha Omega Trial.

Results

Between 2002 and 2006, significant declines were found in the prevalence of smoking (23% to 16%, p < 0.001), hypercholesterolaemia (≥5 mmol/l; 54% to 27%, p < 0.0001) and hypertension (≥140/90 mmHg; 58% to 48%, p < 0.001). The prevalence of antithrombotic drugs was high (97%). The prevalence of lipid-modifying drugs and antihypertensives was high, and increased (74% to 90%, p < 0.0001 and 82% to 93%, p < 0.001, respectively). The prevalence of obesity (27%) was high in 2002 and decreased to 24% in 2006, albeit not significantly. Diabetes prevalence was high and increased between 2002 and 2006 (18% to 22%, p = 0.02). In comparison with EUROASPIRE patients, who were on average 8–10 years younger, our study in 2006 included patients with lower levels of obesity, hypertension, hypercholesterolaemia, diabetes and lower use of antiplatelets and β-blockers, but similar levels of lipid-modifying drugs.

Conclusions

This study showed that older Dutch post-MI patients were adequately treated with drugs, and that risk factors reached lower levels than in the younger EUROASPIRE patients. However, there is room for improvement in diet and lifestyle, given the high prevalence of smoking, obesity, and diabetes.

Electronic supplementary material

The online version of this article (doi:10.1007/s12471-012-0248-z) contains supplementary material, which is available to authorized users.     

肥胖病人急性阑尾炎腹腔镜手术与开腹手术临床效果比较分析

目的分析对肥胖急性阑尾炎病人实施腹腔镜阑尾切除与开腹阑尾切除的临床治疗效果。方法回顾性分析我院2007年1月至2011年12月期间腹腔镜阑尾切除与开腹阑尾切除相关资料。结果实施腹腔镜阑尾切除手术病人的总体并发症发生率与致死率均较低,住院时间较短,住院费用较少,两种方法相比差异显著,具有统计学意义。结论对于肥胖病人实施腹腔镜阑尾切除手术比实施开腹阑尾切除手术更为安全可靠,疗效更好,不论阑尾炎是否穿孔,腹腔镜阑尾切除手术应作为首选方法。     

超声引导与传统PICC 置管术在老年患者中应用的对比性研究

目的:比较超声引导下PICC置管术与传统PICC置管术在老年患者中的应用情况,评价其效果。方法:回顾性分析2009年1月至2010年12月期间解放军总医院南楼老年患者PICC置管情况,记录超声引导及传统PICC置管两种方法的成功率与并发症情况。结果:超声引导组共512例次,传统PICC组共384例次,超声引导组均选择肘上静脉置管,传统PICC置管组均选择肘下静脉;超声引导组一次置管成功率及总成功率分别为96.7%,99.6%,传统PICC组分别为78.6%,86.2(P<0.01);超声引导组相关并发症发生率5.9%,对照组为12.0%(P<0.01)。结论:采用超声引导下PICC穿刺置管术显著提高了置管成功率,降低了PICC相关并发症发生率,与传统PICC组比较优势明显,值得临床推广。     

眼科手术等候期患者家属对健康教育需求的调查

目的:了解眼科手术等候期患者家属对健康教育的需求。方法:采用自行设计的调查问卷对100名在患者手术过程中等候的家属进行调查。调查内容包括手术等候中希望获得的相关信息及其需求程度,需要的健康教育方式及每种健康教育的需求程度。结果:1).眼科手术等候中,家属强烈需要的信息有手术效果(76%)、术后饮食指导(60.4%)、手术费用(57.3%)、患者目前病情(54.2%)、术后头位指导(51%)。2).最需要的健康教育方式是与医生护士交谈(66%)。结论:对手术等候期的患者家属应根据需求实施科学有效的健康教育,用恰当的方式及时提供家属想要了解的信息,使他们具有良好的应对能力和心理承受能力,在照顾患者的过程中为患者提供有效的支持系统。     

无陪护老年病人住院期间护理需求的质性研究

目的:了解无陪护老年病人在住院期间的护理需求。方法:采用质性研究中现象学研究的半结构化、面对面、深度访谈方法采访11位内科无陪护老年病人,之后依据Claizzit的现象学资料7步分析法分析、整理资料。结果:无陪护老年病人住院期间的需求涉及病室、护理人员、陪护人员三方面。结论:无陪护老年病人住院期间有着其特殊需求,无陪护的原因主要有经济因素及陪护人员综合素质较低、无统一管理等,所以除了医院在护理工作中针对这类病人给予一些特殊照护外,呼吁政府建立规范的陪护人员培训及管理机构,为广大患者提供正规、专业化的陪护。     

Monoclonal antibodies in the treatment of lymphoid malignancies

Rituximab (Rit) was the first monoclonal antibody approved for therapeutic use in cancer patients. Rit is a chimeric mouse/human monoclonal antibody, consisting of the human IgG1 and k constant Fc region, and a mouse variable Fab region specific against the B-cell antigen CD20. Rit exerts its antilymphoma activity through many different mechanisms. Binding of antibody to CD20 antigen, provokes apoptosis through downstream signals that lead to caspase-3 activation. Complement activation by the Fc portion of the antibody results in complement-dependent cytotoxicity. However, the most effective mechanism of action seems to be antigen-dependent cellular cytotoxicity. Effector cytotoxic cells such as natural killer cells (NK) are activated after binding to the Fc portion of the anti-CD20 molecule. Activated NK cells kill the coated lymphoma cells with the use of granzyme-perforin system. More recently, pre-clinical data support the concept that Rituximab can provoke a vaccination-like effect. Finally in-vitro experiments and clinical trials have shown that co-administration of the antibody with cytotoxics confers a strong synergistic effect. The relative contribution of these mechanisms in vivo and in different lymphoma subtypes is not well known and remains to be further evaluated.

Among the different histological groups, follicular lymphoma (FL) has been proven to be the most sensitive to Rit when used as a single agent, with overall response rates of 80% and 50% in untreated and previously treated patients, respectively. Moreover, Rit in combination with chemotherapy is superior to chemotherapy alone in terms of response rate and event-free survival, while early data indicate a significant prolongation in overall survival as well. Similarly, the addition of Rit to standard chemotherapy improves the disease-free and overall survival of patients with diffuse large B-cell lymphoma. There is no doubt that Rit represents one of the greatest achievements of biotechnology engineering. However, we need to understand better the mechanisms of its action as well as the mechanisms of resistance to Rit, in order to design more effective treatment modalities.     

Obesity Research in Canada: Literature Overview of the Last 3 Decades

Objective: To identify research published on obesity in Canada, to explore the range of areas studied, and to identify gaps and areas that merit future research attention. Research Methods and Procedures: Medline and International Pharmaceutical Abstracts databases were searched from 1970 onwards. Original articles were identified and categorized by areas of interest. Results: A total of 1186 relevant articles were identified: 17, 136, 687, and 346 articles during the 1970s, 1980s, 1990s, and 2000 to 2003, respectively. Of the articles, 816 were considered original studies and accepted for this analysis. Twelve research areas were identified: basic science involving animal experiments (29%), human experiments (16%), populations surveys (14%), obesity‐related comorbidities (13%), diagnostic/surgical issues (11%), nonpharmacological approaches (7%), drug‐related issues (4%), anthropometrics (2%), impact of weight loss (2%), cost/healthcare use (1%), attitudes/perceptions (0.9%), and models/procedures (0.5%). Two‐thirds of all research was conducted in Quebec (34%) and Ontario (33%). Discussion: Given the multifactorial nature of obesity, Canadian obesity research covers a broad range of areas with a predominance of basic science but lesser emphasis on community and primary care studies. Furthermore, there was a paucity of research on either clinical management of medical conditions in obese patients or clinical aspects that go beyond weight loss. Thus, although Canada appears well represented in basic research, more attention to exploration of clinical issues and healthcare delivery for obese patients appears warranted.