Cooperation. Relationship between district and referred medical center services

Theoretic basis of cooperation relationship between organizations are reviewed. Second one, these theoretic concepts are applied to the relationship between district and reference medical Centers and Services, focusing on main problems of that relationship. The relevant role of communication and its new technologies are also discussed.     

社区卫生服务中心一次性医疗耗材的管理

随着生活水平的提高,医疗条件的改善,社区居民对自身的健康越来越重视,一次性医疗耗材在社区卫生服务中心已被广泛使用,有效地预防了医源性疾病,为防止环境污染,保障人体健康和生命安全,医疗机构应该加强对一次性医疗耗材的管理.     

Survey-guided process consultation in a Veterans Administration medical center psychology service.

During an assessment of an organizational effectiveness intervention in a psychology service in a Veterans Administration hospital, 13 psychologists assigned to the psychology service provided survey, Work Environment Scale (WES), and structured interview data. A written evaluation report was provided to all Ss, and a feedback session was scheduled involving the chief, the consultants, and the staff. Three subsequent group consultations involving all Ss were conducted, with consultants serving as process commentators, not content experts. To assess the impact, the WES was readministered following consultation. Four scales showed significant differences in a positive-change direction. 24 mo later, a 2nd administration of the WES was completed. On 7 of 10 scales, the reported increase in job satisfaction between August 1982 and July 1984 was significant. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stressors of professionals and trainees at APA-approved counseling and VA medical center internship sites.

The purpose of this study was to assess the perceived stress experienced by professionals and trainees during psychotherapy and supervisory activities at American Psychological Association-approved university counseling center and Veterans Administration (VA) medical center internship sites. One hundred thirty-five staff members (90 professionals, 43 interns, 2 practicum students) from fourteen VA centers and 144 staff members (79 professionals, 37 interns, 28 practicum students) from twelve university counseling centers responded to a questionnaire used to assess perceived stress. In data analysis, we compared the stress of professionals and trainees. In secondary analysis, we compared stressors of staffs at VA and counseling centers. We also investigated beliefs that contributed to the stress experienced. Results indicate that professional staff find their experiences less stressful than do interns, who find their experiences less stressful than do practicum students. Also, VA staff members reported less stress than did counseling staff. Results are compared with previous research in this area, and previous conclusions regarding the universality of stressors are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of adenosine in patients hospitalized in a university medical center

A 54-year old woman was scheduled for thoracotomy for excision of a tumor of the left upper lobe. Reduced thyromental distance and thyroid enlargement were identified by the preoperative physical examination and inability to visualize the larynx was encountered during direct laryngoscopy. A 37-Fr left sided double lumen tube was inserted in trachea with great difficulty after three failed attempts. One lung anesthesia underwent uneventfully and postoperatively it was decided to exchange the double lumen tube to a single lumen tracheal tube. After the extubation, five failed attempts of reintubation were performed. A laryngeal mask airway (LMA) size 3 was passed easily achieving an airtight airway. The patient underwent an uneventful prolonged (105 min) weaning via the LMA which was left in place until the patient regained full consciousness. Peripheral oxygen saturation remained greater than 95% throughout the airway manipulation. LMA insertion is an easy non-invasive technique and should be considered whenever airway management proves difficult.     

A comparison of suicidal and nonsuicidal elders referred to a community mental health center program

Sociodemographics, clinical characteristics, and life stressors of community-dwelling suicidal risk and nonsuicidal risk elders referred to a community aging and mental health provider were compared in this study. Information was collected through case manager surveys and agency records on 683 older adults referred to the Elder Services Program of Spokane Mental Health in 1994 and the first 6 months of 1995. This sample included 109 individuals who were clinically judged to be at suicide risk by case managers at the time of initial assessment. Comparisons between suicidal risk and nonsuicidal risk elders indicated that suicidal elders were younger, more likely to be separated or divorced, and more likely to report a previous history of suicidal behavior. Results of a logistic regression analysis indicated that living alone, depression or anxiety disorder, and higher levels of emotional disturbance predicted suicide risk status. In addition, medical problems, family conflict, and relationship loss predicted suicide risk status in this particular sample. Individuals at suicide risk were also more likely to have a family physician than others. Implications of findings for identification and treatment of suicidal elders are discussed.     

Specific serotonin uptake inhibitors in patients referred to a psychiatrist

During a twelve month period (1995), 261 patients were referred to a psychiatrist (the author) by their general practitioners. Forty-eight patients (18%) were being treated with antidepressive medicine when first seen. Only seven patients were being treated with the traditional tricyclic antidepressive medicine, while 39 received specific serotonin reuptake inhibitors (SSRI) and two patients received other kinds of antidepressants. The SSRIs seem to be prescribed to a wide range of patients providing an unclear clinical picture, and it is assumed that the patients' desire to try the famous and popular pills is crucial when the therapeutic decision is made. The weakening of the ontological stase of endogenous depression should also not be underestimated.     

Relation of intelligence to childhood depression in children referred to an educational diagnostic center

Basing on literature and 230 own functional examinations of the cervical spine, the author reports on a roentgenological method which satisfies practical requirements. In patients with degenerative and post-traumatic changes, the extent and localisation of the disorders of function and structure of the vertebrae can be determined by this method, enabling discovery of functional disorders in a large number of patients with clinical cervical spine syndrome. X-ray functional testing is shown to be a necessary complement to conventional x-ray diagnosis and clinical examination.     

Use of psychiatric services by patients referred to a consultation unit

The psychiatric case registers for the hospital catchment area were examined to determine the use of psychiatric services over a 14-year period by a 4-year cohort of consecutive inpatient referrals to the consultation-liaison service of a British general hospital. Two-thirds of the subjects had no other psychiatric care during the survey period, but a third made considerable use of a wide range of specialist psychiatric services. Alcohol problems and dementia were notably associated with complex history of psychiatric management. Management of patients with repeated episodes of psychiatric care requires close collaboration with other services.     

Psychiatric consultation to a general hospital medical evaluation service

Psychiatric consultation to a general hospital medical evaluation service was reviewed and compared with consultation patterns for general hospital inpatients and psychiatric emergency service patients. Results of a questionnaire survey indicated nearly 1 in 5 patients admitted to this acute medical service (24-hour maximum stay) required psychiatric consultation. A study of those patients seen by psychiatric consultants is reported. The prevalence of depressive illness as well as the psychiatric hospitalization referral rate was substantially greater than in general hospital inpatient or psychiatric emergency service evaluations. The implications of this relatively new area of consultation-liaison for hospital staffing and medical education are discussed.     

Subjective symptoms and sleep apnea among persons referred to a sleep center. A questionnaire survey

The aim of this study was to evaluate the relation between symptoms and clinical characteristics and the frequency of increased apnoea and hypopnoea activity. The study population consisted of 135 persons referred to a sleep centre. One hundred and fifteen patients (85%) completed a questionnaire and were subsequently monitored during one night's sleep. Fifty-two persons (45%) had an Apnoea Hypopnoea Index (AHI = the mean number of apnoea and hypopnoea episodes per hour of sleep) > or = 10. Forty-one (36%) had an Apnoea Index (AI = the mean number of apnoea per hour of sleep) > or = 10. Symptoms and clinical characteristics had no significant correlation to increased apnoea activity; however, there was a significant relationship between self-reported frequent breathing pauses during sleep and increased AHI and AI. Symptoms and clinical characteristics are not capable of identifying persons with increased apnoea activity.     

Enterococcal bacteremia in a medical center

BACKGROUND: The enterococci have become important nosocomial pathogens. They can cause multiple site infections and enterococcal bacteremia becomes more frequently associated with a high mortality rate. Previous studies of enterococcal bacteremia showed a variety of results. To establish the significance and importance of enterococci as nosocomial pathogens in this hospital, to characterize their clinical pictures and to search for the risk factors for mortality, this retrospective study was performed. METHODS: There were 208 cases of enterococcal bacteremia which occurred from 1988 to 1992. Twenty-seven cases had no medical charts, dismissing possibility of evaluation. Finally, 181 cases of enterococcal bacteremia were analysed. RESULTS: One hundred and eighteen episodes were nosocomial infections. Polymicrobial bacteremia occurred in 68.5% of the patients and the most common co-isolate was Pseudomonas aeruginosa. Those patients (78.5%) with underlying diseases and malignancies were the most common underlying problems. The portal of entry could be found in 69.6 percent of patients, with the gastrointestinal tract the most common sources. Antimicrobial susceptibility testing showed high gentamicin resistance rate (89.5%), and ampicillin still had about 80 percent sensitivity rate. The group who received specific antibiotic therapy for enterococcus showed lower mortality (36.4% versus 47.6%). Only one case had infective endocarditis. Forty-nine patients suffered from septic shock, the cause of 30 deaths. Totally 75 patients died during hospitalization. Besides sepsis, another major cause of death was their underlying diseases itself. CONCLUSIONS: Enterococci have no doubt become important nosocomial pathogens and enterococcal bacteremia were associated with high mortality, especially in elderly patients with underlying diseases such as malignancy or diabetes. When clinically dealing with sepsis from the gastrointestinal or biliary tract, especially when previous cephalosporins therapy showed no response, the possibility of enterococcal bacteremia should always be considered.     

Splenomegaly in 2,505 patients in a large university medical center from 1913 to 1995. 1913 to 1962: 2,056 patients

Splenomegaly was studied retrospectively at the University of California, San Francisco, School of Medicine, on all patients (N = 2,056) for the years 1913 to 1962. The patients were classified into several diagnostic groups, and these groups were tested for statistical significance (chi(2)) with many clinical and laboratory variables to determine their predictive value. Hematologic disorders were associated with 57% of cases of splenomegaly and 81% of cases of massive splenomegaly. Among patients with splenomegaly, 19% had infectious diseases, 11% had hepatic diseases, and 9% had congestive or inflammatory disorders. The residual 4% were considered to have primary splenic disorders or a disorder of unknown cause. The commonest diseases associated with splenomegaly were hematologic (acute and chronic leukemias), infectious (malaria, endocarditis, and tuberculosis), hepatic (chronic liver disease), congestive (congestive heart failure), inflammatory (thyrotoxicosis), and other (cancers not metastatic to the spleen). The diseases most frequently associated with massive splenomegaly were the chronic leukemias. The disease with the highest incidence of massive splenomegaly was myelofibrosis (23 of 29 patients, 78%). Splenectomy was performed in 154 patients (7%), primarily for hematologic amelioration and hepatic hypersplenism. Hematologic diseases showed significant associations with lymphadenopathy, generalized lymphadenopathy, massive splenomegaly, and cytoses (P .001) and with progressive splenic enlargement (P < .02). Infectious diseases showed significant association with fever, and hepatic diseases showed significant association with abnormal results of liver function tests (P < .001). The findings of this retrospective study should be validated prospectively.     

Evaluation of glaucoma patients referred to a university clinic during one year

Infections by Aeromonas spp. are a rare cause of systemic infection in normal and immunocompromised hosts. We report the cases of two patients with acute non-lymphoblastic leukemia who developed septic shock by Aeromonas species with unusual soft-tissue complications. One patient who was undergoing consolidation chemotherapy developed septic shock by Aeromonas hydrophila with rhabdomyolysis and subsequent soft-tissue destruction consistent with myonecrosis. She recovered with combination antibiotic therapy and supportive care. The second patient developed neutropenia due to ganciclovir treatment for post-allogeneic transplant cytomegalovirus antigenemia. He developed a rapidly progressive septic shock due to Aeromonas sobria with rhabdomyolysis, multi-organ failure and bilateral lower limb myonecrosis, and died within 48 hours. The portal of entry was not identified in either case. These cases confirm the potentially aggressive nature of these bacteria in neutropenic cancer patients with an unusual tendency to produce muscular and soft-tissue destruction.     

Reinventing the academic medical center

In this study we have demonstrated that the native rabbit sperm protein, Sp17, is a 22- to 24-kDa triplet of proteins in washed ejaculated rabbit spermatozoa and is unaffected by capacitation. However, during the acrosome reaction, Sp17 is processed from a 22- to 24-kDa triplet of proteins to a triplet of proteins at 17-19 kDa by the removal of amino acids from the C-terminal. Recombinant rabbit Sp17 (rRSp17) can also be proteolytically processed by acrosome-reacted spermatozoa in a similar manner. Protease inhibitors prevent the proteolytic processing of Sp17. Both forms of native Sp17 remain associated with acrosome-reacted spermatozoa and are solubilized by ionic detergents. Previously, sequence analysis of Sp17 revealed that Sp17 amino acids 108-137 were 52% identical to the calmodulin binding domain of neuromodulin and contained an IQ motif found in other calmodulin binding proteins. In this study, a truncated recombinant Sp17, rRSp17CB, which lacks amino acids 118-146, including the potential calmodulin binding site, was made. Recombinant rabbit Sp17, but not rRSp17CB, binds to calmodulin in the presence of Ca2+ or EDTA, under reduced or nonreduced conditions in biotinylated-calmodulin overlay assays. In DSS crosslinker experiments, calmodulin bound to rRSp17 in a 1:1 ratio but not to rRSp17CB. Additionally, biotinylated rRSp17 interacts with native sperm calmodulin. We propose that the processing of native Sp17, by removing a C-terminal fragment during the acrosome reaction, might be a mechanism to regulate the calmodulin binding activity of Sp17 and provide calmodulin at specific sites after the acrosome reaction.