����ʽ����ֲ���������ĸĽ�

目的 总结背驮式肝移植时病肝切除及肝流出道重建的经验。方法 回顾性分析1999年1月至2002年10月行67例背驮式肝移植时病肝切除及肝流出道重建的方法改进及效果。结果 肝移植病例围手术期死亡7例，手术死亡率为10.45％。2例存活超过3年，8例存活超过2年，19例存活超过1年。结论 病肝切除及肝流出道重建方法的改进有利于提高背驮式肝移植的成功率、减少技术性并发症。     

医用耗材采购决策中存在的问题与对策

本文分析了目前医疗机构医用耗材采购中存在的一些问题和造成危害的原因，提出了要解决这些问题，就要建立和完善集中决策机制等对策思路。     

示范区创建活动与社区卫生服务长效机制的建立和可持续发展对策的思考

通过第三方评估全国社区卫生服务示范区是我国社区卫生服务发展史上的一大创举。此项活动的开展,极大的提高了各地政府对发展社区卫生服务的思想认识、政策理解和经费投入力度。通过创建和评估活动,系统总结了各申报地区社区卫生服务的经验和特色,分析了存在的问题和不足,提出了发展社区卫生服务的对策和建议,制定了社区卫生服务可持续发展的长效机制,取得了预期效果,达到了预期目的。随着《国务院关于发展城市社区卫生服务的指导意见》的出台,示范区的典型示范效应会日益凸显出来,对我国社区卫生服务的发展将起到不可估量的作用。     

化学气相淀积过程中钛酸丁酯热解反应机理及动力学

利用热解-色质联用分析系统,对文题进行了研究,发现其热解过程是一个复杂的多元反应过程。在500～800℃,钛酸丁酯(Ⅰ)热解尾气产物主要是烯烃、醇、醚和醛类化合物。经热解机理分析,发现Ⅰ的重排断裂反应是整个热解过程的主反应,其反应动力学常数为3.87×10~5,活化能为69.3 kJ/     

Evidence for a reflex provoking contraction of the renal pelvis (with some comments on its clinical implications)

The effect of swallowing a small quantity of water or of solid food (biscuit) on the renogram curve was observed in 177 patients. Swallowing provoked contraction of the renal pelvis in 63% of the kidneys with a pelvicalyceal system which was neither obstructed nor dilated, with expulsion of a substantial fraction of the contents within 30 s. This did not occur in obstructed or denervated kidneys, nor in patients with a high transection of the spinal cord. Evidence is adduced that this contraction is mediated reflexly. This effect may be used diagnostically to distinguish physiological dilatation from obstruction. The implications when performing and interpreting renography are discussed. Correspondence to: M.V. Merrick     

Expanding Our Strategies to Study the Process of Change

The conceptual and methodological framework proposed by Doss (this issue) makes valuable suggestions for strategic choices in future research. This commentary addresses conceptual and terminological distinctions adopted by Doss, as well as his criticism of add-on/ dismantling studies. We also suggest research topics and methodological developments that could be integrated in Doss's framework to further expand understanding of therapeutic change.     

医院管理"四部曲"

结合医院管理实际,实施管理四部曲。即:完善机制、教育先行、督察到位、奖惩分明。阐明持续改进是完善机制的内在需求;及时清理是完善机制的有力保障;易于操作是完善机制的必备条件。同时,突出教育的基础性地位;强调监督的关键性环节;放大奖惩的激励性效应。     

Integrating children's services in England: national evaluation of children's trusts

Background Poor co‐ordination of services can have severe consequences for disadvantaged children with complex needs. Since 2003 national and local governments in England embarked on sweeping reforms aimed at improving and integrating local health, education and social services for children. These were to be organized locally by children's trusts and piloted by 35 children's trust pathfinders. Methods This study described and compared the experience of integrating children's services in all 35 children's trust pathfinders, covering 20% of children in England. It had a prospective mixed‐methods design. Over 3 years we interviewed 147 managers and professionals working in the children's trusts, including 172 semi‐structured interviews, carried out two questionnaire surveys of the 35 children's trusts and analysed official documents. Results In most areas different agencies jointly commissioned children's services, especially for mental health, disabilities and multi‐purpose children's centres, and increasingly pooled finances. Provision of multi‐agency and multi‐professional services was increasing. Professionals generally supported these changes but found them stressful. All children's trusts appointed directors of children's services and established boards representing multiple agencies. Systems for sharing information about individual children were mostly in place but were still underused. Health services were generally less involved in joint work than were local authorities' education and social care services, with notable exceptions. Areas where local authorities and health authorities shared geographical boundaries made most progress. Some children's trusts made few changes beyond their statutory obligations. Conclusion Children's trusts enabled major changes to services in areas where local actors and organizations were motivated and empowered. In other areas the remit of children's trusts was often too broad and vague to overcome entrenched organizational and professional divisions and interests. Policymakers need to balance facilitation of change in areas with dynamic change agents with methods for ensuring that dormant areas and agencies are not left behind.     

Controlled Release of Substituted Benzole and Naphthoic Acids Using Carbopol ® Gels: Measurement of Drug Concentration Profiles and Correlation to Release Rate Kinetics

Purpose. The objective of this study is to correlate drug release mechanism with measured drug concentration profiles in gel layers of Carbopol^® matrices containing mesalamine or benzoic acid. Methods. Release rate experiments with Carbopol^® matrices were performed using a rotating disk apparatus. Matrices were frozen and the gel layer in the matrices was sliced using a microtome in a cryostat. Drug concentration profiles were determined by direct measurement of the concentration of the drug in the gel slices. The pH of the slices was measured using microelectrodes, and water content was measured by Karl Fisher titration. Results. The concentration gradient in mesalamine matrices decreased over time and correlated with square root of time release rate kinetics. The concentration profiles of benzoic acid were unchanged over time and correlated with zero order release rate kinetics. Carbopol gel layers were highly hydrated (93–95% water). Gel layers in matrices with mesalamine had a more alkaline microenvironmental pH. This higher pH resulted in increased growth of the thickness of the gel layer and a reduction drug diffusivity in comparison to benzoic acid matrices. Conclusions. The release rate kinetics of mesalamine and benzoic acid correlated to the measured concentration profiles. The shape of the concentration profiles is determined by the rate of growth of the Carbopol^® gel layer and drug diffusivity.     

控制医疗费用的主体与方式研究

按照财权决定事权的原则，医疗费用的司控主体取决于医疗费用的支付主体。国家、医疗保险和个人作为医疗费用的三大支付主体，其中具有代表性、集合性、专业性的医疗保险无疑是司控医疗费用的最佳主体。但是，在委托代理框架内的契约约束机制，并无法有效控制知识经济背景下医疗技术、知识、信息资本的相对垄断对医疗保险与医疗服务所产生的交易成本和医疗费用的增长。基于纵向一体化的医疗保险与医疗服务合并，可以有效规制外生的交易成本，控制医疗费用的增长，降低医疗保险的风险成本并提高医疗资源的配置效率和社会利用效率。