Presented herein are the concepts and methodology for the appraisal indicator model of personal performance management in hospitals. Based on studies of mature appraisal indicator models for hospital departments and the particularity in the process of personal performance evaluation, the authors hold that the model of such an appraisal model should comprise an indicators inventory, data warehouse,indicators system, and appraisal database among others. It is also described that the evaluation process is made up of targets identification, indicators selection, weight distribution, performance implementation and data updating, on top of recommendations for building the model.

Objective To sum up the experiences in the prevention and treatment of systemic infection after burn injury. Methods 309 burn patients with systemic infection treated in our department from January 1990 to December 2003 were enrolled in this study. The patients were divided into two groups according to their hospitalized time: group 1(from 1990 to 1996) and group 2(from 1997 to 2003). The incidence and mortality of systemic infection were compared between the two groups, and the efficacy of different treatment strategies was analyzed. Results The morbidity of postburn systemic infection in the patients was 6.98%(309/4430). The incidence and mortality of systemic infection were 5.68% and 0.30% in the group 2, respectively, which were significantly lower than those in the group 1. Conclusion Rapid and adequate fluid resuscitation for burnshock, effective control of wound infection, early excision of crust and skin grafting for deep burnwounds, and reinforcement of organ support were key factors to decrease the incidence of systemic infection and increase the curative frequency. Once burn wound sepsis occurred, prompt removal of infectious necrotic tissues was a key means to ensure a good clinical outcome.

Objective To summarize the therapeutic effect of recombinant human growth hormone and early enteral nutrition in severely burned patients. Methods 35 cases were randomly divided into group EN and group PN.Group EN was treated with early enteral nutrition(EEN) and recombiant human growth hormone(rhGH) ,while group PN was given parenteral nutrition. The plasma levels of pre-albumin (PA), C-reactive protein (CRP) , tunmor necrosis factor α(TNFα) ,fasting blood glucose(FBG) were measured after burn injury. Comparision was made in length of hospital stay, wound healing time,incidence of burn sepsis, gastrointestinal stress ulcer bleeding and enteral nutrition intoleranc. Results Incidence of burn sepsis,gastrointestinal stress ulcer bleeding and enteral nutrition intoleranc in group EN were significantly lower than those of group PN(P ＜ 0.05). The serum levels of CRP、TNFα、FBG in group EN were significantly lower than those of group PN (P ＜ 0.05). The serum PA was decreased at all times in two periods and was markedly decreased in group EN(P ＜0.05). Length of hospital stay and the healing time of donor site, deep partial thickness burn wound, skin transplantion area were significantly shortened in group EN compared with group PN. Conclusion Early enteral nutrition was beneficial for the improving of nutrition state of the burn patients,and the reduction of the incidence of burn sepsis and the hospitalization time.

Objective To analyze the effect of nimodipine on prevention and treatment of patients with severe burn sepsis. MethodsTwenty-eight cases were randomized into nimodipine treatment group (n = 14) and routine group (n = 14). Besides general chnical therapy scheme treatment,the treatment group was administrated with saline plus nimodipine (15 μg/(kg · h)), while the routine group was given saline only. The Plasma concentration levels of total calcium (Ca2 +), free calcium (iCa2 +), C-reactive protein (CRP), procalcitonin (PCT), tunmor necrosis factor α (TNF-α), brain natriuretic petide (BNP) and interleukin-6 (IL-6) were measured. The hemodynamic indices of patients with severely burn sepsis were determined by transesophageal echo-Doppler device,hemodynamic indices including aortic blood flow (ABF), left ventricle ejection time (LVET), max acceleration (ACC), total systemic vascular resistance (TSVR). Mean artery pressure (MAP) and heart rate (HR) were measured. ResultsABF, ACC, LVET and TSVR were improved after therapy in the routine group(t = 3.93,3. 37,3.75,7.02) (P ＜ 0.01 or 0.05). ABF, ACC, LVET and TSVR were mproved after therapy in the treatment group (t =6.46,4.98,6.29,4.60) (P ＜0.01 or 0.05). ABF, ACC and LVET were increased after general clinical therapy scheme and was markedly increased in the treatment group (t = 2.29,2.07,2.23)(P＜0.01～0.05).TSVR was decreased after general clinical therapy scheme and was markedly decreased in the treatment group (t =2.14) (P＜0.05). Plasma TNF-α, IL-6 and CRP levels were decreased after therapy in the routine group (t =2.38,2.29,2.45)(P＜0.01 or 0.05). Plasma TNF-α, IL-6 and CRP levels were decreased after therapy in the treatment group (t =4.04,4.04,2.56)(P ＜0.01or 0.05). Plasma PCT and BNP levels were decreased in the treatment group (t =5.45,2. 44) (P ＜ 0.01 or 0.05). TNF-α, IL-6, CRP, PCT and BNP were decreased after generalclinical therapy scheme and was markedly decreased in the treatment group (t = 2.20,2.17,2.19,2.17,2.61) (P ＜0.01 or 0.05). Plasma Ca2+ and iCa2+ levels were decreased. However,MAP were increased in the two groups, although no difference was found between the two group(P ＞0.05). ConclusionsEarly applying of calcium channel blockers (CCB) can markedly inhibit the degree of inflammatory medium in serum, thereby preventing the development of excessive inflammation response and subsequent multiple organ dysfunction syndrome associated with severely burned sepsis. It can effectively inhibit intracellular Ca2+ overload caused by myocadial infection injury,which may contribute to the effect of acupuncture in reducing myocardial injury and protecting myocardial performance and improving prognosis.

OBJECTIVE To investigate the phylogenetic analysis of Acinetobacter baumannii strains in elderly.METHODS The 33 kinds resistant genes were detected by PCR and cluster analysis.RESULTS The positive rates of AmpC(chromosome type),TEM and PER were 85%,55% and 25%,respectively.The positive rates of aac(3)-Ⅰ,ant(3″)-Ⅰ,aac(3)-Ⅱ,aac(6′)-Ⅰb and armA were 95%,95%,40%,15% and 35%,respectively.The positive rate of qacE△1-sul1 was 75%.There were very high positive percentages of AmpC(chromosome type),TEM,PER,aac(3)-Ⅰ,ant(3″)-Ⅰ,armA and qacE△1-sul1 genes in A.baumannii isolates among elderly.There were clones transmitted phenomenon.CONCLUSIONS The resistance phenotype of A.baumannii isolates among elderly is in accordance with genetic testing.A.baumannii can induce clones transmitted hospital infection.

OBJECTIVE To investigate the beta-lactamase gene and intⅠ1 gene in ESBLs-producing Klebsiella pneumoniae.METHODS Beta-lactamase gene and intⅠ1 gene were analyzed by PCR.RESULTS The positive rates of TEM,SHV,OKP,CTX-M-1group,CTX-M-2group,CTX-M-9group,GES,PER,VEB,OXA-10,ACT-1,LEN,DHA,and intⅠ1 were 51.4%,0%,0%,17.1%,0%,11.4%,0%,0%,0%,0%,0%,5.7%,17.1%,and 60%,respectively.Beta-lactamase gene was found in 62.9%,intⅠ1 gene was found in 60%.CONCLUSIONS There are very high positive percentages of beta-lactamase gene and intⅠ1 gene in ESBLs-producing K.pneumoniae.

Objectives:To investigate nutritional support in severely burned patients with delayed fluid resuscitation. Methods:From January 1990 through December 2000,62 cases with delayed fluid resuscitation were admitted to our burn department and were divided by different periods into two groups:group N(1990-1994,n=26) and group A(1995-2000,n=36).Group A was treated with recombinant human growth hormone(rhGH),early enteral feeding(EEF) and glutamine(Gln). Plasma albumin,pre-albumin,insulin,blood glucose and urine glucose levels were measured and lymphocyte was counted immediately after hospitalization and postburn day(PBD) 1,3,7,14,21,28. Results:①The survival rate in group A was very significantly higher than in group N.The complication in group A was significantly lower than in group N.②The time of wound healing in group A was shorter than in group N.③Plasma albumin,pre-albumin levels and lymphocyte count were decreased in two groups and was more serious in the group N(P

OBJECTIVE To investigate the antibiotics-resistant genes in enterococci isolated from the 98th Hospital of PLA,Huzhou,Zhejiang Province,China.METHODS The antibiotics-resistant genes of TEM,aac(6′)/aph(2″),aph(3′)-Ⅲ,ant(2″)-Ⅰ,ant(4′,4″),ant(6)-Ⅰ,ermB,mefA,tetM,vanA,and vanB were analyzed by polymerase chain reaction(PCR) and verified by DNA sequencing in the 15 isolates of Enterococcus faecalis and 9 isolates of E.faecium.RESULTS The positive rate of the resistance genes of TEM,aac(6′)/aph(2″),aph(3′)-Ⅲ,ant(2″)-Ⅰ,ant(4′,4″),ant(6)-Ⅰ,(ermB,) mefA,tetM,vanA,and vanB in the 24 strains of enterococci tested were 37.5%,70.8%,25.0%,0.0%,0.0%,41.7%,75.0%,0.0%,41.7%,4.2%,and 4.2%,(respectively.) CONCLUSIONS The multidrug resistance of enterococci was a serious issue,and harbored antibiotics-resistance genes were the very important reasons of resistance to antibiotics in enterococci.

OBJECTIVE To investigate the ?-lactamase genes in 4 kinds of nonfermenting Gram-negative bacilli isolated from the 98th Hospital of PLA. METHODS Sixty strains of Acinetobacter baumannii,30 strains of Pseudomonas aeruginosa,19 strains of Stenotrophomonas maltophilia,and 15 strains of Flavobacterium were isolated from hospitalized patients.Nine kinds of ?-lactamases genes of TEM,SHV,OXA,CTX-M,PER,VEB,IMP,VIM and GES were analyzed by PCR and verified by DNA sequencing. RESULTS In A.baumannii and(P.aeruginosa),the positive rates of gene of TEM were 100.0% and 66.7%,respectively.SHV gene was positive in 18 of 60 strains of A.baumannii tested,17 of which were SHV-12 subtype ESBLs.The other was a new SHV type ?-lactamase nominated SHV-48.OXA gene was positive in 1 of 30 strains of P.aeruginosa tested,it was an OXA-10 subtype ESBLs.But the rest of genes were all negative. CONCLUSIONS There exist 4 kinds of(?-lactamase) genes at least in nonfermenting Gram-negative bacilli including TEM-1,SHV-12,SHV-48,and(OXA-10.)

Objective To evaluate the efficacy of the combined saphenous nerve-great saphenous vein flap and cutaneous branches of posterior tibial artery flap in repairing refractory wounds. Methods Eighteen cases of pedal chronic ulcers were treated with the combinedsaphenous nervegreat Saphenous vein flap and cutaneous branches of posterior tibial artery flap, in which the wounds were treated with vacuum suction techniques before the operation in 6 cases. Wounds were from 8 cm× 13 cm to 1 cm× 17 cm in zine after debricement, and the designed size of the flaps was from 8 cm× 14 cm to 11 cm× 18 cm. Results After the treatment, 18 cases were evaluated as excellent in 10 cases, and good in 8 cases, in which the primary sealing of the wounds was achieved in 17 cases, but one case presented with focal necrosis of smaal size owing to vein drainage disturbance in a distallypedicled flap, and was healed after flap transplantation. Follow-up for 6 months to 2 years showed that all the patients were satisfied with the results. Conclusions The combined flap has reliable blood supply, skin pedicle of the flap is longer, superior texture and satisfied appearance, and incisive area of the flap is larger. It is particularly useful in repairing refractory wound in foot.