建立中医临床教学全面质量管理体系的探讨

在既往临床教学管理经验的基础上,汲取ISO9000族标准管理理念的精华,结合东方医院自身特点,探讨建立符合高等中医教育规律,具有自我监控、自我改进能力的中医临床教学全面质量管理体系。     

Performance characteristics of 10 home mechanical ventilators in pressure-support mode: a comparative bench study

OBJECTIVE: Inspiratory pressure (Pi) support delivered by a bilevel device has become the technique of choice for noninvasive home ventilation. Considerable progress has been made in the performance and functionality of these devices. The present bench study was designed to compare the various characteristics of 10 recently developed bilevel Pi devices under different conditions of respiratory mechanics. DESIGN: Bench model study. SETTING: Research laboratory, university hospital. MEASUREMENTS: Ventilators were connected to a lung model, the mechanics of which were set to normal, restrictive, and obstructive, that was driven by an ICU ventilator to mimic patient effort. Pressure support levels of 10 and 15 cm H(2)O, and maximum were tested, with "patient" inspiratory efforts of 5, 10, 15, 20, and 25 cm H(2)O. Tests were conducted in the absence and presence of leaks in the system. Trigger delay, trigger-associated inspiratory workload, pressurization capabilities, and cycling were analyzed. RESULTS: All devices had very short trigger delays and triggering workload. Pressurization capability varied widely among the machines, with some bilevel devices lagging behind when faced with a high inspiratory demand. Cycling was usually not synchronous with patient inspiratory time when the default settings were used, but was considerably improved by modifying cycling settings, when that option was available. CONCLUSIONS: A better knowledge of the technical performance of bilevel devices (ie, pressurization capabilities and cycling profile) may prove to be useful in choosing the machine that is best suited for a patient's respiratory mechanics and inspiratory demand. Clinical algorithms to help set cycling criteria for improving patient-ventilator synchrony and patient comfort should now be developed.     

职业中专学生心理健康状况与干预效果分析

[目的]了解职业中专学生心理健康状况，找出目前最困扰职业中专学生的心理问题，为有效实施心理健康干预措施，提高学生心理素质提供依据。[方法]对某职业中专1872名中专学生采取整群分层抽样的方法进行现况调查，列出心理问题前20位，对学生进行有计划的实施心理健康主动干预，然后对干预前后的资料进行分析比较。[结果]干预措施前后的总均分差异有统计学意义（t=24．7156，P〈0．01）。干预措施实施前后学生心理健康水平有明显改变。[结论]职业中专学生这个特殊的群体心理健康总体水平较低，有计划的实施心理健康主动干预已刻不容缓。     

Examining clinical trial results with single-subject analysis: an example involving behavioral and nutrition treatment for young children with cystic fibrosis

OBJECTIVE: To examine the process of change in a clinical trial of behavioral and nutrition treatment for children age 18-48 months with cystic fibrosis (CF) using single-subject analysis. METHODS: The 5-week treatment included nutrition counseling and child behavioral management training for parents and was designed to increase energy intake measured by diet diaries 600-800 calories per day. RESULTS: Energy intake changed at each meal, only when treatment was introduced (week 1: snacks, 420 to 691; week 2: breakfast, 325 to 443; week 4: lunch, 350 to 443; and week 5: dinner, 373 to 460 calories per day). Total daily intake increased in a systematic fashion that exceeded the criterion set each week during treatment. CONCLUSIONS: Toddlers and preschoolers with CF meet energy intake recommendations as a result of behavioral intervention. Single-subject research designs are important methodologies for advancing clinical investigation in pediatric psychology.     

浅议生命伦理学中的民主自由

目前的生命伦理学正处于一种“缺乏最终根据”的危机之中，道德直觉的缺失实际上源于最高的伦理原则——如自由、人权、民主和正义等绝对的普遍价值的缺位和忽略；从灵魂深处启发、唤醒国民的自由民主意识和愿望，构建尊人和自尊的人文环境，乃是生命伦理学的必然诉求。     

卫生高级人才评审中量化评价的探讨

该介绍了在卫生高级专业技术职务任职资格评审面试中引入量化评价标准的具体方法。该体系分为5大类,17项指标、50档打分刻度,对被评进行逐项打分,计算出总分。及格参考分数线分为4档。该体系中17项指标经过高评委和学科组专家反复论证筛选而确立。整套方法经过验证,与专家直接投票吻合率达99％。     

城市生活垃圾小型转运设施设置实例研究

分析了现行城市生活垃圾转运设施设置的有关标准与设计规范中存在的问题,指出了两点修改建议。对广州市市区小型垃圾转运站的设置进行了说明,估算了广州市小型垃圾转运站的需求量。     

中医与中西医结合治疗肿瘤疗效评价相关因素的探索

中医及中西医结合治疗肿瘤的疗效特点为改善患者生存质量及延长生存期,而现今沿用WHO制定的实体瘤疗效标准不能客观反映以上特点。本文分析了其不适用于中医治疗肿瘤疗效评价的原因,同时分析现行的中医治疗恶性肿瘤的疗效评价标准以及相关因素,包括生存质量(社会、心理、生物学方面)、实体瘤缓解率以及生存期等诸多因素。结合中医学的学科特点和中医及中西医结合治疗恶性肿瘤的疗效特点,认为生存质量、生存时间、肿瘤缓解率是疗效评定的主要因素。     

中药质量标准研究方法与思路

综述近年来医药界工作者对中药质量控制方面的新进展与新思路 ,为中药药材、制剂、生产和临床研究提供文献基础     

学生心理健康状况调查分析

目的：了解学生心理健康状况,为有效实施心理卫生干预提供依据,方法：对武汉工业学院2045名本科,大专,中专学生采取分层整群抽样的方法进行现状调查,以SCL－90自评量表测评分析,结果,学生SCL－90得分总体水平低于中国成人常规,中专学生各因子均分高于本科,大专生,大学本科各年级因子≥2分比较有一定差异,神经症初筛检出率为45％,结论：大中专学生这个特殊群体心理健康总体水平较低,有计划的实施心理卫生主动干预已刻不容缓。