烧伤患者静脉切开置管时间的探讨

目的对烧伤患者静脉切开置管的时间进行研究。方法从１９９３年１月～１９９６年１２月对７８例次大面积烧伤静脉切开置管输液者，拨管后留取管端作细菌培养。结果在创面上行静脉切开者，留管１０天以下阳性率占２０％，留管１０～１５天阳性率占３６．３％，留管１５天以上阳性率１００％。在健康皮肤处静切者，留管１５天以内培养均无菌生长，留管１６～２０天阳性率占５０％。结论在创面上静切时，留管１０天以下为宜；在健康皮肤处静切，留管１５天以下为好；留管时间越长细菌逆行感染机会越多     

股静脉留置带肝素帽套管针输液的运用体会

一种良好的静脉输液途径，要求能迅速建立，长期保持通畅，能重复使用并可耐受各种不同渗透液体的输入。自１９９５年４月至１９９７年５月，我院采用带肝素帽的套管针，经皮穿刺股静脉血管内留针的输液方法，为１１２例患者进行了输液治疗，获得了满意的效果，现将临床运...     

静脉留置套管针病人的需求

静脉套管针在临床上得到广泛应用，在静脉输液中应用套管针可以减少静脉穿刺次数，延长了每次静脉穿刺的间隔时间；使静脉输液更加方便，减轻了护士的工作量。为了解病人在使用套管针后的需求，以进一步做好病人护理，对本科58例静脉套管针病人进行了调查，现报告如下：     

套管针对小儿头皮静脉输液重注的影响

目的 了解套管针与钢制头皮针穿刺对小儿头皮静脉输液重注的影响、探讨降低重注率的方法,以减轻患儿输液反复穿刺的痛苦,减少护士重复工作量,从而提高护士工作效率及护理质量。方法 选择1999年8月～2000年12月新入院、初次输液、输液部位在前额部的头皮静脉输液的患儿999例,按入院时间先后随机分成套管针组和头皮针组进行比较。结果 套管针组503例,重注5例,重注率0.99％,头皮针组496例,重注73例,重注率14.72％,X~2=65.34,P<0.001,差异有非常显著性、套管针留置时间平均为3.54d,可减少每天重复穿刺。结论 采用套管针穿刺是小儿头皮静脉输液理想的穿刺针,对儿科临床护理实践具有实用价值。     

输液后司徒假单胞杆菌医院感染5例

１　临床资料　　１９９７年９月２５日上午在儿科病房发生了５例输液反应,５例患者均在输液后３０～６０分钟后出现寒颤、高热,体温高达３８．７～４０．３℃。５例患者发生在半小时之内,经积极处理,患者均在５～１５分钟内症状缓解,无一例死亡。２　热原学检查２．１　热原检查　对患者使用的留置针、输液器、注射器、输液瓶里余留液体及用于留置针抗凝用的肝素液体进行了鲎试验检查,肝素液为阳性,其余均为阴性。２．２　细菌培养　将高度可疑的肝素液进行细菌培养,并做患者血培养检查,结果肝素液和患者血液均培养出司徒假单胞菌…     

支气管肺泡灌洗液细菌定量培养对下呼吸道感染的诊断价值

目的：观察不同方法采样培养对下呼吸道感染病原学诊断价值。方法：采用支气管肺泡灌洗液（ＢＡＬＦ）细菌定量培养,并与保护标本刷（ＰＳＢ） 和痰培养进行比较。结果：感染组１６ 例患者２１ 例次采样,ＢＡＬＦ 法１９次阳性（≥１０５ｃｆｕ／ｍｌ） ,ＰＳＢ法１５ 例次阳性（≥１０３ ｃｆｕ／ｍｌ）,两种方法所获菌株一致率为７２．４％ （２１／２９）,定量培养结果相关程度好（ｒ＝０ ．８０７ ,Ｐ＜ ０．００１） 。非感染组２０ 例,ＢＡＬＦ法３ 例阳性,ＰＳＢ法１ 例阳性。ＢＡＬＦ法和ＰＳＢ法特异性分别为８５－０ ％ 和９５－０％ ,敏感性分别为９０－５ ％ 和７１－４％ ,两种方法的敏感性和特异性无统计学差异。痰标本分别与ＢＡＬＦ和ＰＳＢ标本培养结果比较,需氧菌株一致率分别为３３－３％ （２４／７２）和２３－６ ％（１７／７２）。结论：ＢＡＬＦ细菌定量培养与ＰＳＢ方法对下呼吸道感染的病原菌诊断具有相同的诊断价值,且操作简便安全。     

CA_(15-3)对术后乳腺癌的随诊价值

目的：探讨 Ｃ Ａ１５ － ３ 对术后乳腺癌的随诊价值。材料与方法：１９９６ 年６ 月至１９９６ 年１２ 月行常规放疗的术后乳腺癌患者４５ 例,于放疗前开始首次检测外周血 Ｃ Ａ１５ － ３ 值,在以后的随诊工作中,作为检查项目之一,即每１～３ 个月查血１ 次,监测时间为２ 年。结果：有复发转移与无复发转移两组的 Ｃ Ａ１５ － ３ 水平分别为（５６ ．２１ ±８ ．３７） Ｕ／ｍｌ,（１３ ．４９ ±２ ．２２） Ｕ／ｍｌ, Ｐ＜ ０ ．０１ ; Ｃ Ａ１５ － ３ 升高的５ 例复发转移患者, Ｃ Ａ１５ － ３ 首次升高均出现于临床或影像学检查之前,提早时间平均为（２ ．５４ ±１ ．３６） 个月;以 Ｃ Ａ１５ － ３ ＞ ３０ Ｕ／ ｍｌ 为阳性,６ 例复发、转移患者中,５ 例阳性,阳性率的９５ ％ 可信区间为３６ ％ ～１００ ％ ,３９ 例无复发、转移患者中,１ 例 Ｃ Ａ１５ － ３ 阳性,假阳性率的９５ ％ 可信区间为０ ～１４ ％ 。结论： Ｃ Ａ１５ － ３ 对乳腺癌术后的转移或复发有较好的特异性和阳性预测性,在术后随诊中有不可替代的预测作用。     

静脉留置针的应用及护理体会

目的探讨静脉留置针在临床中的应用效果。方法138例住院病人使用静脉留置针，于四肢浅表静脉进行穿刺输液，停止后用肝素盐水封管并留置，次日输液时直接将头皮针刺入肝素帽内，留置时间为2～7天。结果138例患者用留置针后感觉良好，静脉管道持续通畅，各种急救药物及时输入，达到预期效果，无1例发生静脉炎。结论静脉留置针是抢救危重病人快速、安全、有效的方法．保留了一条静脉通道，便于及时用药，避免反复穿刺，减轻病人痛苦，保护病人血管，减少感染机率，而且可提高护士工作效率，值得临床推广应用。     

静脉留置针在老年患者中的应用及护理

目的分析静脉留置针在老年患者中的应用效果及护理措施。方法选择我科自2012年2月-2014年1月收治的186例老年住院患者,对患者采用静脉留置针输液并采取相应的护理措施,观察套管的留置效果。结果使用时间达48-110h以上,无不良反应发生。结论为老年患者采用静脉留置针输液安全性高,可有效保护静脉,减轻患者痛苦,降低不良反应发生率。     

婴幼儿静脉留置部位和时间关系的对比研究

目的：探讨婴幼儿静脉留置针不同部位和时间的关系。为合理使用留置针提供临床依据。方法；对86例颈外静脉置管组和220例头皮静脉和四肢浅静脉置管组从留置时间及并发症两方面进行比较研究。结果：颈外静脉留置针组留置时间明显长于头皮和四肢浅静脉（P〈0．01），颈外静脉组并发症发生率亦显著减少（P〈0．05）。结论：婴幼儿颈外静脉留置时间长、输液安全。对于需要长期输液、肥胖或外周静脉发育不良的婴幼儿则可首选颈外静脉进行留置针输液，而对输液时间短的婴幼儿则考虑头皮及四肢浅静脉留置输液。     

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.     

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.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.