急诊手术治疗重症胸部创伤性休克患者的效果

目的探讨重症胸部创伤并创伤性休克患者采用急诊手术治疗的效果。方法选取深圳市龙岗中心医院2018年12月—2019年12月收治60例重症胸部创伤并创伤性休克患者,随机分为对照组和观察组各30例,对照组采用常规对症治疗,观察组采用急诊手术治疗,统计分析治疗有效率、患者满意率、术后切口愈合及呼吸功能恢复时间、并发症发生率。结果观察组总有效率为96.67%,高于对照组的76.67%;患者总满意率为93.33%,高于对照组的73.33%;术后切口愈合时间为(3.46±0.23)d,低于对照组的(4.35±0.51)d;呼吸功能恢复时间为(6.73±0.88)d,低于对照组的(7.52±0.96)d;并发症发生率为6.67%,低于对照组的26.67%,差异均有统计学意义(P0.05)。结论急诊手术治疗重症胸部创伤并创伤性休克患者效果较好,总有效率相对较高,可加快切口愈合速度,并且治疗后患者呼吸功能恢复速度较快,满意率相对较高,并发症发生率明显较低,可有效改善患者预后。     

鼻塞式持续气道正压通气联合氨溴索治疗新生儿肺炎对症状改善时间及肺功能的影响

目的 鼻塞式持续气道正压通气联合氨溴索治疗新生儿肺炎对症状改善时间及肺功能的影响。方法 纳入2020年11月—2022年11月在浙江大学医学院附属儿童医院确诊的新生儿肺炎118例。所有患者均接受对症治疗：抗炎、止咳及营养支持等。对照组患者单纯接受盐酸氨溴索治疗，7.5 mg/(kg·d),2次/d,治疗周期7 d。观察组患者在对照组基础上，接受鼻塞式持续气道正压通气治疗。评价指标分别为、临床症状、肺功能、临床效果及不良反应。结果 两组患儿胎龄、病程、分娩方式及致病原因的患者例数数据均衡，差异无统计学意义(P>0.05)。对照组患儿退热改善时间(6.53±1.12)h,止咳改善时间(5.63±1.17)d,肺部阴影改善时间(6.45±1.57)d,住院天数(15.86±2.63)d;观察组患儿退热改善时间(4.14±0.86)h,止咳改善时间(4.07±1.26)d,肺部阴影改善时间(4.53±1.63)d,住院天数(10.74±3.70)d。观察组患儿退热改善时间、止咳改善时间就、肺部阴影改善时间及住院天数均小于对照组患儿，差异有统计学意义(t=13.001,6.969,6.517,8.663,均P<0.05)。治疗前，对照组患儿呼吸峰流速(57.68±7.74)mL/s,达峰容积比(27.45±5.64)%,达峰时间比(28.74±5.53)%;观察组患儿呼吸峰流速(57.89±8.14)mL/s,达峰容积比(27.17±6.11)%,达峰时间比(28.58±6.42)%。治疗后，对照组患儿呼吸峰流速(62.42±7.74)mL/s,达峰容积比(34.85±6.63)%,达峰时间比(33.75±4.66)%;观察组患儿呼吸峰流速(74.75±8.62)mL/s,达峰容积比(37.76±5.88)%,达峰时间比(37.75±5.09)%。治疗前，两组患儿呼吸峰流速、达峰容积比及达峰时间比数据比较差异均无统计学意义(t=-0.123,0.259,0.145,均P>0.05)。治疗后，两组患儿肺功能均有所改善，同时观察组患儿呼吸峰流速、达峰容积比及达峰时间比均高于对照组患儿，差异均有统计学意义(t=-8.159,-2.522,-4.452,均P<0.05)。对照组痊愈14例，好转31例，无效14例，总有效率76.27%;观察组痊愈28例，好转27例，无效4例，总有效率93.22%。观察组总有效率明显高于对照组(χ2=10.498,P<0.05)。对照组发生恶心4例，呕吐5例，腹泻2例，总发生率18.64%;观察组发生恶心3例，呕吐3例，腹泻2例，总发生率13.56%。两组不良反应发生率数据比较差异无统计学意义(χ2=0.173,P>0.05)。结论 鼻塞式持续气道正压通气联合氨溴索治疗可以明显缩短新生儿肺炎临床症状消失时间及住院天数，临床治疗效果更好，明显改善患儿肺功能且不会增加不良反应的发生率。     

肺癌化疗患者肺部感染联合用药治疗的临床疗效评价

目的研究分析肺癌患者化疗后肺部感染应用痰热清注射液联合抗菌药物治疗的临床疗效,为临床治疗肺癌化疗后肺部感染提供参考依据。方法选取2011年7月-2013年7月收治的50例肺癌化疗后肺部感染患者,随机分成研究组和对照组,各25例;对照组单纯给予抗菌药物治疗,研究组在对照组基础上联合痰热清注射液治疗,对两组治疗后临床疗效等情况进行观察对比。结果治疗总有效率研究组为92.0%、对照组为72.0%,研究组总有效率显著优于对照组,差异有统计学意义(P<0.05);研究组住院时间(20.8±5.9)d,发热缓解时间(3.5±1.2)d,肺部啰音消失时间(3.7±1.1)d,咳嗽、咳痰减少时间(3.3±1.2)d;对照组住院时间(27.1±6.2)d,发热缓解时间(6.0±1.7)d,肺部啰音消失时间(4.8±1.4)d,咳嗽、咳痰减少时间(4.4±1.7)d;研究组上述指标显著低于对照组,差异有统计学意义(P<0.05)。结论痰热清注射液联合抗菌药物治疗肺癌化疗后肺部感染临床疗效显著,可迅速改善患者临床症状,缩短住院时间,提升生活质量。     

肺部感染评分对老年重症肺炎患者抗菌药物选择的干预及对预后影响

目的 探讨肺部感染评分对老年重症肺炎患者抗菌药物选择的干预及对预后的影响.方法 选择老年重症肺炎患者58例,随机分为观察组与对照组各29例;观察组患者根据肺部感染评分予以抗菌药物治疗;对照组患者给予常规抗菌药物治疗.结果 观察组和对照组患者的抗菌药物使用疗程分别(9.78±2.45)d、(17.95±3.43)d,平均住院时间分别为(3.97±4.12)d、(23.87±4.38)d;病死率分别为10.3％、31.0％,真菌定植率分别为10.3％、27.6％;两组患者的住院费用比较差异无统计学意义.结论 肺部感染评分对老年重症肺炎患者抗菌药物选择的干预及对预后具有良好效果.     

抗菌药物降阶梯疗法联合支气管肺泡灌洗术治疗急性脑梗死患者肺部感染的临床疗效

目的评价抗菌药物降阶梯疗法联合支气管肺泡灌洗术治疗急性脑梗死合并肺部感染患者的疗效,为合理用药提供依据。方法将2012年10月-2013年10月95例急性脑梗死合并肺部感染患者,随机分为观察组48例、对照组47例,观察组采用抗菌药物降阶梯疗法联合支气管肺泡灌洗术治疗,对照组采用常规抗菌药物治疗联合支气管肺泡灌洗术治疗,分别观察其临床疗效、细菌清除率、肺部感染吸收天数、入住神经内科重症监护病房(NICU)天数。结果观察组患者治疗有效率及细菌清除率为93.75%及90.48%,明显高于对照组的65.96%及61.67%,差异有统计学意义(P<0.05);观察组平均肺部感染吸收时间和平均住NICU时间为(6.9±1.7)d和(12.6±4.1)d,明显少于对照组(12.4±1.9)d和(17.8±3.7)d,差异有统计学意义(P<0.05)。结论以降阶梯疗法联合支气管肺泡灌洗术为基础的局部与全身抗菌药物联合治疗,是治疗急性脑梗死合并肺部感染的有效方法。     

手足口病患儿以康复新液联用干扰素治疗的临床效果分析

目的:观察康复新液连用干扰素治疗手足口病患儿的临床效果。方法:选取本院2015年12月至2016年12月接诊的手足口病患儿120例,将其随机分为观察组与对照组,每组各60例,对照组患者单纯肌内注射干扰素,观察组患者在此基础上联合康复新液治疗。两组患儿均治疗7d,对比两组患儿的治疗效果。结果:观察组患儿的平均退热时间为(2.17±0.39)d,溃疡消退时间(2.2±0.52)d,手足疱疹消退时间(2.3±0.4)d,治疗总有效率为95%;对照组患儿的平均退热时间为(3.56±0.45)d,溃疡消退时间(3.1±0.65)d,手足疱疹消退时间(4.5±1.1)d,治疗总有效率为83.3%.两组患儿的观察指标对比差异显著,具有统计学意义(P0.05)。结论:康复新液联合干扰素治疗小儿手足口病的临床效果显著,能够在短时间内缓解临床症状,值得推广使用。     

重症颅脑损伤并发肺部感染原因分析及早期物理治疗效果观察

目的 分析重症颅脑损伤并发肺部感染,观察早期物理治疗效果.方法 选择颅脑损伤并发肺部感染患者作为研究对象,进行细菌学分析,并随机分为观察组和对照组；观察治疗效果、呼吸功能和神经功能.结果 共检出病原体45株,其中细菌35株占77.78％,支原体属6株占13.33％,病毒4株占8.89％；观察组治疗总有效率94.29％、血氧饱和度(96.3±10.32)％、动脉血氧分压(94.18±10.38)mm Hg,明显高于对照组,呼吸恢复平稳时间(1.89±0.24)d、X线征象消失时间(6.92±0.82)h、肺部啰音消失时间(5.23±0.62)d明显低于对照组.结论 重症颅脑损伤合并多种病原菌同时感染,早期物理治疗能够促进呼吸功能和神经功能的恢复,对于颅脑损伤并发肺部感染具有积极的临床价值.     

老年心力衰竭患者血清降钙素原监测指导抗感染治疗的临床价值

目的探讨老年心力衰竭患者血清降钙素原(PCT)监测指导抗感染治疗临床效果,为临床诊治提供参考依据。方法选择2013年1月-2014年9月140例老年心力衰竭患者均合并肺部感染,按自愿原则将患者分为对照组与观察组,对照组60例患者根据临床表现及病情采用常规抗感染治疗,观察组80例患者根据血清PCT指标调整抗感染治疗方案,对比两组患者治疗前后有效率、治疗费用、住院时间、抗菌药物使用时间、二重感染率、炎性指标等。结果患者治疗有效率观察组为80.00%、对照组为78.33%,两组对比差异无统计学意义;观察组治疗费用、住院时间、抗菌药物使用时间、抗菌药物费用分别为(11 241.6±873.3)元、(12.2±1.9)d、(9.4±1.5)d、(2 248.9±381.1)元均优于对照组,对比差异均有统计学意义(P<0.05);观察组与对照组治疗后血沉、C-反应蛋白(CRP)均有明显改善,对比差异有统计学意义(P<0.05),观察组治疗后CRP为(12.1±2.8)mg/L,改善明显优于对照组,对比差异有统计学意义(P<0.05)。结论根据PCT指导老年心力衰竭患者抗感染治疗,以缩短治疗时间、降低治疗成本、改善患者预后,值得临床推广应用。     

类风湿关节炎继发糖尿病患者肺部感染的临床治疗效果观察

目的探讨胰岛素联合抗菌药物治疗类风湿关节炎继发糖尿病患者肺部感染的临床效果,为临床治疗提供参考依据。方法选择2007年3月-2012年12月医院收治的80例类风湿关节炎继发糖尿病患者发生肺感染的临床资料,将其分为观察组和对照组,每组各40例,观察组患者采用胰岛素联合抗菌药物进行治疗,对照组患者使用口服降糖药联合抗菌药物进行治疗,比较两组患者的治疗效果,数据采用SPSS 17.0统计软件进行分析。结果观察组患者的血糖达标时间及住院时间分别为(4.3±0.5)d、(8.0±2.1)d,均明显优于对照组患者,且差异有统计学意义(P<0.05),而且观察组患者的总有效率为100.0%,明显高于对照组患者的85.0%,差异有统计学意义(P<0.05)。结论胰岛素联合抗菌药物治疗类风湿关节炎继发糖尿病并发肺感染患者疗效显著,有效缩短住院时间节省费用,值得临床广泛应用。     

支气管肺泡灌洗在重症肺炎患儿中的应用价值

目的探讨支气管肺泡灌洗(BAL)在重症肺炎患儿中的应用价值,以指导临床选择有效抗菌药物。方法选择医院PICU重症肺炎患儿126例,按就诊顺序随机分为对照组和观察组各63例,对照组留取深部痰液送细菌培养,观察组给予BAL,采集支气管肺泡灌洗液(BALF)采用法国生物梅里埃公司VITEK测试系统进行细菌鉴定及药敏测定;对两种标本的培养阳性率进行比较,并根据药敏结果选择相应的抗菌药物,4周后观察治疗效果,用SPSS 16.0软件进行统计分析。结果痰液培养阳性率为49.2%,BALF培养阳性率为68.3%;对照组住院(18.44±3.80)d、发热(10.27±4.11)d、使用抗菌药物退热(9.13±4.12)d、肺部体征消失时间(11.06±3.94)d,观察组分别为(14.33±3.56)d、(7.29±4.17)d、(5.43±3.43)d、(6.33±2.97)d;对照组治疗总有效率69.8%,观察组总有效率88.9%,两组比较均差异有统计学意义(P<0.01)。结论 BALF直接取材于病变部位,培养阳性率高,可更好地指导临床选择有效抗菌药物,同时BAL可促使肺泡液排出,有利于炎症吸收,对重症肺炎的恢复有意义。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.