四川省临床医生对医学信息的认知及需求

问卷调查显示,四川省临床医生对医学信息的认知情况较好,信息需求意愿较强,但需采取措施缓解其信息需求和获取能力之间的矛盾,为其提供价廉优质的医学信息服务。     

临床医生信息需求调查与分析

临床医生作为信息用户中的一支特殊群体,其信息需求受到医疗机构的性质,临床医生的社会责任,职业道德,工作环境及其工作流程的影响。而作为医学图书情报工作机构,应该针对临床医生这一特殊的信息需求群体,深入到临床医生职业工作的信息流和职业活动的信息机制层次,分析揭示临床医生的信息需求实质以及对信息服务的需求,探讨需求与利用的关系,行之有效地开展信息服务工作,为临床用户提供帮助。本文采用问卷调查、与用户直接沟通、参与用户业务活动（查房及病例讨论）、文献调查以及综合分析的方法,主要以湘雅二医院的临床医生为调查对象,统计分析了临床医生的信息需求特点并探讨了影响其需求的因素,以期对图书馆及其他信息服务机构采取相应的信息服务对策有所帮助。     

临床医生对医学信息的认知情况分析

对四川省三级医院、二级医院、基层医疗卫生机构610名临床医生进行问卷调查,结果显示四川省临床医生对医学信息的认知不足、学习时间较少、学习途径仍以教科书为主、不同职称医生对医学信息掌握有差异。对此需加强信息素质教育,增强其主动获取医学信息的意识。     

临床医生对医学信息的认知及需求情况调查

通过问卷调查,了解临床医生对医学信息的认知及需求情况,以便有针对性地提供医学信息服务。调查发现,33.47%的临床医生听说过信息素养,认为信息素养对临床诊疗水平的提高非常重要或重要的比例为90.68%;74.69%的临床医生听说过医学信息资源,但了解其内涵的比例为48.63%;听说过循证医学的比例为83.02%,知道循证医学内涵的比例为71.39%,认为临床医生有必要运用循证医学开展临床诊断治疗的比例达91.40%,愿意接受文献检索能力等方面培训的比例较高(84.33%),且大部分医生愿意支付费用接受医学信息服务,但参加过关于信息检索或网上资源利用方面培训的比例仅占23.61%,依靠电子医学文献数据库获取医学信息的比例仅占36.63%。提示,临床医生对医学信息的认识较高,信息需求意愿较强,但由于多种原因,存在信息需要与需求之间的矛盾,需采取措施加以缓解,提供价廉优质的医学信息服务。     

循证医学与医学信息服务

循证医学是“遵循证据的医学”，目的在于系统地收集与当前临床状况切实相关的研究，并通过解释论证得出有意义的临床信息，从而帮助临床医生做出最佳决策。医院图书馆是临床医生开展循证医学提供信息服务的最佳场所。     

医学院校图书馆服务基层医生的新途径

调查了基层医生信息资源利用现状、信息需求种类、满足程度、获取方式以及对未来获取医学信息的期望等,分析了医学院校图书馆服务基层医生的可行性,探讨了全媒体时代医学院校图书馆为基层医生提供特色化信息服务的新途径。     

医学院校图书馆为乡镇医生提供医学信息服务的探讨

调查了乡镇医生的职业素质、存在问题及其对医学信息的需求,分析了医学院校图书馆面向乡镇医生开展信息服务的优势,探讨了医学院校图书馆为乡镇医生提供信息服务的途径和方法.     

“双一流”建设和“互联网+”背景下医院图书馆用户信息需求分析与精准信息服务

调查分析医院图书馆的用户信息需求,为实现精准信息服务提供科学参考。根据用户最常使用的数据库类型、文献类型和使用数据库资源时最常遇到的问题,分析他们希望获得的学科服务和开展的讲座培训内容等需求特征,提出医院图书馆应以用户需求出发,树立主动化、联盟化的信息服务理念,提供便捷化、精准化的医学信息资源,形成个性化、专业化的信息服务模式等建议,为医院医疗、教学、科研快速发展提供有力信息支撑。     

医院图书馆用户的信息需求与服务

随着知识经济时代的到来 ,图书馆也正在逐步向数字化转变 ,其服务内容、服务手段和服务方式也将随之发生变化。因此 ,医院图书馆对自己所处的环境和面临的挑战必须有一个清醒的认识。1　医院图书馆用户信息需求的新特点随着现代医学科学技术的飞速发展 ,医学临床、科研、教学过程中的信息需求已经发生了深刻的变化[1 ] 。1.1　信息需求的全方位与综合化　医学工作者迫切要求医院图书馆能针对他们承担的任务 ,提供全方位的医学信息保障 ,提供能满足他们多方面要求的信息服务[2 ] 。1.2　信息需求的开放性与社会化　用户全方位与综合化的信息…     

现代化医院中信息科的定位与职能

信息科是现代化医院中医院管理系统的支持部门，是临床医疗工作和科研工作的数据库、知识库和信息库。为医院的医疗和科研工作提供完善的医学信息服务是信息科的中心任务和主要职能。信息科必须不断加强自身业务建设，才能满足医院现代化发展的需求。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.