可调钠透析对维持性血液透析高血压患者的近期疗效管理分析

目的研究可调钠透析对维持性血液透析高血压患者近期疗效管理。方法选取该院2014年8月—2015年8月收治的200例维持性血液透析高血压病人,随机分为观察组和对照组,其中观察组106例,对照组94例,对照组应用常规标准透析法,观察组应用可调钠透析。结果对照组在进行常规透析以后的血压、心率、血清钠含量3类指标数据变化差异无统计学意义(P>0.05)。而观察组在使用可调钠透析的方式进行透析后患者的血压出现了明显的变化,差异有统计学意义(P<0.05);但是,心率及血清钠含量的变化较为平缓,差异无统计学意义(P>0.05)。结论可调钠透析使得维持性血液透析高血压患者能够获得更加安全的治疗,值得临床推广应用。

医护一体化管理在妇幼保健医院抗感染疗效管理中的应用

院内感染的发生对妇幼及患儿的临床治疗非常不利,且妇幼保健医院专科感染具有阶段性、高峰期、聚集性等特点,需要加强相关感染控制和预防。本研究通过探讨医护人员工作模式在感染管理中的应用,对妇幼保健院的医护一体化管理进行了调查分析,现报告如下。

疾病暨疗效管理在国外的发展

与药事照顾和临床药学不同的是，疾病暨疗效管理是基于疾病进展过程采管理医疗服务，以达到最大的有效性与效率，将医疗资源投入在最能提高质量与降低成本的医疗方法上。

疾病暨疗效管理药师该怎么做

疾病暨疗效管理不仅能强化药房专业性形象，还有助于增加药房的营业额，是非常好的会员行销模式。从美信的慢性病专业健康照顾案例来看，药师为病患提供疾病暨疗效管理，关键要做的是帮助病患及早发现病情和治疗、提醒顾客注意用药安全以及帮助他们养成健康的生活习惯。

社区医院联合多重管理模式对社区慢性心力衰竭患者的疗效分析

目的探讨社区医院联合多重管理模式应用于慢性心力衰竭患者的效果。方法选择我站接收的社区慢性心力衰竭患者分成对照组和观察组各40例,对照组行传统的管理方法,观察组行社区医院联合多重管理模式,比较两种管理模式对社区慢性心力衰竭患者的疗效。结果对2组患者的SF-36量表得分进行比较,观察组患者8项分数均显著高于对照组,差异有统计学意义(P<0.05)。通过对社区医生的管理,心力衰竭诊断正确率有了显著提高(P<0.05),其他用药指标也有显著提高(P<0.05)。观察组满意度明显高于对照组,2组比较差异有统计学意义(P<0.05)。结论采用社区医院联合多重管理模式取得了积极的效果,改善了干预质量,满足了社区慢性心力衰竭患者的具体需求。

安体舒通联合骨化三醇治疗糖尿病肾病患者的疗效观察

目的:探讨安体舒通联合骨化三醇治疗糖尿病肾病(DN)患者与单用安体舒通或骨化三醇在疗效、药物剂量的差异,研究联合用药治疗对DN患者尿蛋白、转化生长因子-β1(TGF-β1)等的影响。方法:以2013年8月至2014年8月肾内科收治的DN患者75例为研究对象,分为安体舒通组(A组)、骨化三醇组(B组)及联合用药组(C组),分别予以不同的用药方案,共治疗6个月。结果:C组用药剂量最少,总有效率最高(92.0%);C组副作用明显低于A组,与B组相近;B组的Scr、UAER明显高于A组和C组(P均<0.05)。三组的TGF-β1、IL-6、TNF-α、CRP均有下降趋势,且C组下降明显低于A、B组(P均<0.05)。结论:安体舒通联合骨化三醇治疗DN的疗效好,可明显减少单药剂量的使用,比起单独用药副作用更少;可显著改善患者的肾功能和尿蛋白,降低炎性因子水平,延缓肾纤维化的进程,考虑可能与两种药物同时降低了TGF-β1的表达有关。

FDA出台新规定旨在加强临床研究药物安全管理

近日，FDA正式发布对Ⅰ期临床研究药物安全性和疗效管理的规定，要求处于Ⅰ期临床研究阶段的药物也必须符合通用药品生产管理规范（cGMP）和FDA临床研究的相关要求。该规定的出台，无形中增加了药品研发的成本，提高了市场准入的技术门槛。

Iatrogenic bile duct injuries:Etiology,diagnosis and management

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

Efficacy of surgical resection in management of isolated extrahepatic metastases of hepatocellular carcinoma

AIM:To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma(HCC). METHODS:We retrospectively reviewed the medical records of 140 patients with pathologically proven extrahepatic metastases of HCC and evaluated the outcomes of those who had undergone surgical resection(SR)for extrahepatic metastatic lesions.Prognoses made on the basis of extrahepatic metastatic sites were also examined. RESULTS:The survival rates of patients who underwent SR of extrahepatic metastases were significantly better than those of patients who did not receive SR. For the SR group,1-and 3-year survival rates were 24%and 7%,respectively,while for the non-resection group,the survival rates were 8%and 0%,respec- tively(P<0.0001).Survival rates related to metastatic sites were also significantly superior after SR of extrahepatic metastases:median survivals were 32 mo with lung metastasis,10 mo with bone metastasis,6.1 mo with brain metastasis. CONCLUSION:SR can provide survival benefits forpatients with 1 or 2 isolated extrahepatic metastases and who concurrently exhibit good hepatic functional reserve and general performance status as well as successful treatment of intrahepatic HCC.

Role of surgical intervention in managing gastrointestinal metastases from lung cancer

AIM:To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal(GI)-tract metastases,focusing on therapeutic options and outcomes.METHODS:Our institution(the National Taiwan University Hospital) diagnosed 8159 patients with lung cancer between 1987 and 2008,of which 21 developed symptomatic GI metastases.This study reviewed all of the patients' information,including survival data,pathological reports,and surgical notes.RESULTS:The most common histological type of lung cancer was adenocarcinoma,and 0.26% of patients with lung cancer developed GI metastases.The median duration from lung cancer diagnosis to GI metastases was three months(range,0-108 mo),and the average time from diagnosis of GI metastasis to death was 2.8 mo.Most patients with symptomatic gastric and/or duodenal metastases exhibited GI bleeding and were diagnosed by panendoscopy.In contrast,small bowel metastases typically presented as an acute abdomen and were not diagnosed until laparotomy.All patients with small bowel or colonic metastases underwent surgical intervention,and their perioperative mortality was 22%.Our data revealed a therapeutic effect in patients with solitary GI metastasis and a favorable palliative effect on survival when metastases were diagnosed preoperatively.In patients with multiple GI metastases,the presentation varied according to the locations of the metastases.CONCLUSION:Surgical treatment is worthwhile in a select group of patients with bowel perforation or obstruction.Physicians should be more alert to symptoms or signs indicating GI metastases.

Steroid-sparing strategies in the management of ulcerative colitis:Efficacy of leukocytapheresis

Active ulcerative colitis （UC） is frequently associated with infiltration of a large number of leukocytes into the bowel mucosa. Leukocytapheresis is a novel nonphar- macologic approach for active UC, in which leukocytes are mechanically removed from the circulatory system. Current data indicate that leukocytapheresis is effica- cious in improving response and remission rates with excellent tolerability and safety in patients with UC. Corticosteroid therapy remains a mainstay in the treat- ment of active UC, however, long-term, high doses of corticosteroids usually produce predictable and po- tentially serious side effects. If leukocytapheresis can spare patients from exposure to corticosteroids, the risk of steroid-induced adverse events should be mini- mized. This may be of great benefit to patients because severe side effects of steroids seriously impair health- related quality of life. In this article, we reviewed cur- rent evidence on whether leukocytapheresis can avoid or reduce the use of corticosteroids in the manage- ment of patients with UC. Several studies have shown that leukocytapheresis was effective for steroid-nafve patients with active UC. Furthermore, both short-term and long-term studies have demonstrated the steroid- sparing effects of leukocytapheresis therapy in patients with UC. Although the evidence level is not striking, theavailable data suggest that leukocytapheresis can avoid or reduce the use of corticosteroids in the management of UC. Large, well-designed clinical trials are necessary to more accurately evaluate the steroid-sparing effects of leukocytapheresis in the management of UC.

A comparative study of the therapeutic effect in two protocols: video-assisted thoracic surgery combined with laparoscopy versus right open transthoracic esophagectomy for esophageal cancer management

Objective: The aim was to evaluate the best intra-thoracoscopic surgery technique between video-assisted thoracic surgery (VATS) combined with laparoscopy and right open transthoracic esophagectomy, in patients with esophageal cancer. Methods: From November 2006 to May 2008, 221 patients with esophageal cancer were enrolled in this study, prospective randomized in two groups. 111 patients were performed the VATS technique (Experimental group), whereas in the other 110 patients esophagectomy was adopted by thoracotomy (Control group). Results: The time consuming of Experimental group was 272.3 min in average with a standard deviation(std) of 57.9, and it was 218.7 min in average with std of 91.0 in the control group (P=0.000). The operative blood loss was 219.7±194.4 mL in the Experimental group, compared with 590.0±324.4 mL in the control group, with significant difference (P=0.000). Postoperative hospital stay of Experimental group was 9.6±1.7d, and it was 11.4±2.3d in the control group (P=0.000). There was no-delayed union of incision in the Experimental group, but 6.36% in the control group (P=0.007). The disorder of gastric emptying occurred 0.9% in the Experimental group, whereas 6.4% in the Control group. There was no significant difference in survival curves and rates (P=0.555). Conclusion: There were several advantages of VATS technique, such as reduced hemorrhage, better recovery, few complications, and great number of lymph node dissection, although there was no significant difference in long-term survival rate. Thus the VATS combined with laparoscopy technique was worthy of generalization in esophageal surgery with good prospects.

Antimicrobial management of intra-abdominal infections:Literature's guidelines

Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial use.Two sets of guidelines for the management of intra-abdominal infections were recently published.In 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA) created guidelines for the diagnosis and management of complicated IAIs.The new SIS-IDSA guidelines replace those previously published in 2002 and 2003.The World Society of Emergency Surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug methodology.These guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.

The empirical study on enhancing the management of private hospitals at the beginning of their foundation

The private hospital has increased the capacity of health service delivery in number and is going to become an important supplement for medical resources. The thesis is combined with the actual situation of Chongqing Tongkang Orthopedic Hospital after its opening within half a year, so as to discuss the enlightenment from the position of medical institution, the performance management, the hospital culture and competitive environment at the beginning of the private hospital＇s foundation.

Why do we have to review our experience in managing cases with idiopathic fistula-in-ano regularly?

"Why do we have to review our experience in managing idiopathic fistula-in-ano regularly?" In order to answer this apparently simple question,we reviewed our clinical and surgical cases and most important relevant literature to find a rational and scientific answer.It would appear that whatever method you adopt in fistula management,there is a price to pay regarding either rate of recurrence (higher with conservative methods) or impairment of continence (higher with traditional surgery).Since,at the moment,reliable data to identify a treatment as a gold standard in the management of anal fistulas are lacking,the correct approach to this condition must consider all the anatomic and clinicopathological aspects of the disease;this knowledge joined to an eclectic attitude of the surgeon,who should be familiar with different types of treatment,is the only guarantee for a satisfactory treatment.As a conclusion,it is worthwhile to remember that adequate initial treatment significantly reduces recurrence,which,when it occurs,is usually due to failure to recognise the tract and primary opening at the initial operation.

Long-term treatment with proton pump inhibitor is associated with undesired weight gain

AIM:To examine the effects of long-term proton pump inhibitor (PPI) therapy on body weight (BW) and body mass index (BMI) in patients with gastroesophageal reflux disease (GERD).METHODS: The subjects were 52 patients with GERD and 58 sex-and age-matched healthy controls. GERD patients were treated with PPI for a mean of 2.2 years (range, 0.8-5.7 years), and also advised on lifestyle modifications (e.g. selective diet, weight management). BW, BMI and other parameters were measured at baseline and end of study.RESULTS: Twenty-four GERD patients were treated daily with 10 mg omeprazole, 12 with 20 mg omeprazole, 8 with 10 mg rabeprazole, 5 with 15 mg lansoprazole, and 3 patients with 30 mg lansoprazole. At baseline, there were no differences in BW and BMI between reflux patients and controls. Patients with GERD showed increases in BW (baseline: 56.4±10.4 kg, end: 58.6±10.8 kg, mean±SD, P<0.0001) and BMI (baseline: 23.1±3.1 kg/m2, end: 24.0±3.1 kg/m2, P<0.001), but no such changes were noted in the control group. Mean BW increased by 3.5 kg (6.2% of baseline) in 37 (71%) reflux patients but decreased in only 6 (12%) patients during treatment.CONCLUSION: Long-term PPI treatment was associated with BW gain in patients with GERD. Reflux patients receiving PPI should be encouraged to manage BW through lifestyle modifi cations.

Introduction of the 2015 Law on Public Investments and Its Effects on Public Sector Accounting in Vietnam

The public sector has a key role to play in enhancing the local goods and services. The Government is fully aware of the fact that Vietnam needs a proper public sector as a product of the state＇s public policy, which provides high-quality and well-functioning educational, healthcare, or social security systems through the effective management and use of public funds. Those services need investments from them to achieve the objectives set by the official governments or the national programs annually. This paper introduces the content of law on public investments in Vietnam which will be effective in the year 2015. It employs an overview of this law and investigates the effect of public investment in infrastructure on economic performance in the case of Vietnam. Moreover, results suggest that there may be some effects on public sector accounting in Vietnam. This study compares between the 2015 law and accounting in non-business organizations in some aspects for clear clarification.

Limited Efficacy of Aspirin in Patients with Peripheral Arterial Occlusive Disease

Antiplatelet drugs represent one of the basic options for management of patients with different atherosclerotic diseases. Aspirin is the oldest and most often prescribed antiplatelet drug. It seems that it is most effective in coronary patients with clinically unstable disease, less effective in prevention of cerebrovascular incidents, and its efficacy is uncertain in peripheral artery disease （PAD） patients. One of the first meta-analysis indicated that antiplatelet drugs also significantly reduce cardiovascular events in patients with PAD. However, latest meta-analysis of randomized control trials of aspirin therapy involving patients with diabetes and PAD demonstrated no benefit of aspirin in reducing cardiovascular events. Also in patients with preclinical PAD aspirin did not result in a significant reduction of vascular events. The new anti-platelet drugs prasugrel, ticagrelol, picotamide seem to be more effective than aspirin in PAD patients, particularly in diabetic patients with PAD. However, evidence based data are scanty. New studies on PAD patients are necessary to better define the role of anti-platelet agents in these patient and one of the promising ways of access to anti-platelet treatment would be personalized anti-platelet therapy.

个性化舒适干预在儿科病房管理中的应用

目的探讨个性化舒适干预在儿科病房管理中的应用。方法选取2015年9月-2017年6月该院儿科病房收治的150例患儿为对照组,另选取2017年7月-2019年12月该院儿科病房收治的150例患儿为观察组。对照组患儿接受常规干预管理,观察组患儿在对照组基础上给予个性化舒适管理,比较两组患儿住院时间、住院费用、管理疗效评分及患儿父母满意度。结果观察组患儿住院时间和住院费用均明显少于对照组,差异均有统计学意义(均P<0.05)。入院时,两组患儿管理疗效评分比较,差异均无统计学意义(均P>0.05);出院时,观察组患儿管理疗效评分和父母满意度均明显高于对照组,差异均有统计学意义(均P<0.05)。结论个性化舒适管理可明显缩短儿科患儿住院时间,降低住院费用,提高管理疗效及患儿父母满意度,对临床实践具有指导意义。

把握机遇 突出特色 努力实现空军疗养院建设跨越式发展

近年来,空军疗养院工作在总部机关和各级党委的领导下,坚持为部队服务的方向,艰苦奋斗,扎实工作,较好地完成了疗养工作任务。今后几年总部将以特勤疗养工作为重点,加大投入力度,整治疗养环境,补充医疗设备,加快军队疗养院建设步伐。空军疗养院应紧紧抓住这个难得的发展机遇,科学规划,强化管理,加快建设,努力实现空军疗养院整体建设跨越式发展。 1 提高认识,切实加强对疗养院建设的组织领导 “姓军”为兵是军队疗养院的根本职能。