门诊服务台导医的人性化服务

我院是集医疗、科研、教学为一体的地级市"二级甲等"综合性医院,是全市医疗技术的指导中心.由于每日门诊人流量大,且不同的科室分布在各个楼层内,前来就医的患者对医院环境不熟悉,所以患者往往因盲目寻找科室,而延误就诊时间.为了方便患者就诊,我院自1991年设置了门诊服务台,配备了导医护士,实施人性化服务,指导患者就医,现介绍如下.     

耐甲氧西林金黄色葡萄球菌qacA基因的检测及分型

目的对我院不同标本中分离的45株耐甲氧西林金黄色葡萄球菌（methecillin resistant staphylocccus aureus,MRSA）相关耐消毒剂基因qacA进行检测和类型分析,为我院合理使用消毒剂,阻止多重耐药的MRSA再流行,减少院内感染提供依据。方法收集分离自我院患者的MRSA45株,采用聚合酶链式反应（PCR）对该45株MRSA耐消毒剂基因qacA进行检测并采用脉冲场凝胶电泳（PFGE）方法进行类型分析。结果45株MRSA检出qacA基因18株,阳性率为40％,其中呼吸内科、烧伤科标本分离的MRSA中qacA基因检出率较高分别为13％、16％。我院携带qacA基因的MRSA有A～E5个型,主要流行株为A型和B型。结论呼吸内科和烧伤科等科室的MRSA携带的qacA基因是导致胺类、胍类等临床常用消毒剂耐药的主要原因,流行菌株可在各病区之间传播,应引起重视。     

石家庄市第四医院 石家庄市妇产医院 石家庄市妇女健康体检中心

石家庄市妇女健康体检中心是经河北省卫生厅批准的专业化妇女健康体检机构，是一个集体检、治疗、保健、疗养为一体的综合型科室。中山位于医院内门诊大楼六层，为全封闭的专业健康体检机构。设有独立的内科、外科、妇产科、儿科、五官科、检验科、B超室等体检科室。配备经验丰富的专家及医护人员，定期聘请省内外知名专家来中心指导业务工作，进行医疗保健科普教育和健康咨询指导。     

浅议手术室的安全管理

<正>手术室是集检查、诊疗、手术、抢救于一体的重要场所,是一个比较特殊的职能部门,也是医院的重要科室之一,手术室安全管理的好坏,直接关系到患者的治疗效果,同时也影响临床科室的医疗工作质量,现就手术室安全管理浅议几点,体会如下。     

药剂科的管理现状与发展思考

药剂科工作是医院医疗工作的重要组成部分,药剂科的管理与其他科室相比有其特殊性,是集医院药品调剂、供应、制剂、科研、临床等为一体的综合性科室。药剂科的工作直接关系到医院的经济收入,确保临床用药安全有效,是提高医院社会效益和体现医院精神文明的窗口。药剂科的工作,     

某医院2011—2014年感染病原菌分布与耐药性研究

目的了解主要病原菌的分布及其对抗菌药物的耐药性,为临床科室感染性疾病的治疗提供科学依据。方法对2011—2014年医院感染病例的各类标本分离的病原菌,采用法国梅里埃公司VITEK-2 compact全自动细菌鉴定仪进行鉴定和药敏分析。结果共检出病原菌5112株,其中革兰阴性菌3815株占74.63%,革兰阳性菌1035株占20.25%,真菌262株占5.12%。主要革兰阴性菌依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动菌;主要革兰阳性菌依次为金黄色葡萄球菌、表皮葡萄球菌。检出的革兰阴性菌对亚胺培南的耐药率为0~5.19%,革兰阳性菌对万古霉素的耐药率为0.00%;检出病原菌最多的科室是神经外科,其次为神经内科、重症医学科、肾病内分泌科;以痰液标本送检率最高。结论医院不同科室的主要标本类型和常见菌种各有不同,病原菌对常见抗菌药物的耐药性不同。通过调查分析,为指导临床科室合理使用抗菌药物提供科学依据。     

大肠埃希菌临床分布及耐药性分析

目的 了解医院大肠埃希菌临床分布、标本类型、不同科室及不同年龄耐药情况,为临床合理使用抗菌药物提供依据.方法 收集亳州市人民医院2011―2018年门诊与住院病人送检10827株大肠埃希菌,回顾性分析其耐药性变化、科室分布及标本来源.结果 8年间大肠埃希菌分离率为3.92％,分离率呈下降趋势(P<0.05).共收集非重复菌株9302株,其中产超广谱β-内酰胺酶(ESBLs)大肠埃希菌5547株,占59.63％.标本来源主要为尿液,占26.01％;科室分布以普外科最多,占27.77％.药敏分析显示,大肠埃希菌对头孢曲松及庆大霉素的耐药性有所下降(P<0.05).产ESBLs菌株对大多数抗菌耐药率明显高于非ESBLs菌株(P<0.05).痰液标本分离菌对氨曲南耐药率高于其他标本的分离菌(P<0.05).呼吸内科分离菌耐药率高于其他科室的分离菌.老年病人分离菌耐药率高于其他年龄的分离菌.结论 大肠埃希菌耐药形势严峻,且不同科室、不同标本、不同年龄段及不同时间耐药率有所差异.临床医师需结合本单位、本科室耐药情况,合理选用抗菌药物.同时需加强大肠埃希菌监测及抗菌药物管理,减少细菌耐药的出现.     

听神经瘤术中面神经的分型及手术策略

目的 探讨听神经瘤术中面神经受肿瘤侵害所呈现的形态并进行分型.方法 回顾性分析116例听神经瘤术中显微镜下所见的面神经受肿瘤侵害所呈现的各种形态,以及面神经与肿瘤之间的解剖位置关系并进行分型,根据面神经的不同形态及与肿瘤之间的不同关系探讨术中对面神经分离与保护的措施.结果 听神经瘤术中见面神经受肿瘤侵害存在五种类型,即正常型、扁平型、膜状型、穿透型及弥散型.结论 据面神经在术中的形态及与肿瘤间的关系分离和保护面神经,可大大提高面神经的功能保留率.     

供应室与临床

现代医院供应室越来越被临床所重视，它是医院的一个重要组成部分。是保证临床各科室医疗工作正常进行的中心，是融技术性、业务性、知识性为一体的临床服务科室。其工作范围广，接触面大，内容繁琐，质量要求高，它的工作质量直接关系到病人的生命安危，关系到医疗工作质量的提高，给临床工作带来直接或间接的影响。为此我对供应室的     

当代护士长应该具备的素质

护士长是医院中最基层的管理者，具有沟通及协调科室内外关系的桥梁作用，并担负着科室以及所属病房管理和专科护理业务技术的直接指导任务，对提高科室整体护理水平发挥着重要作用，如何发挥科室的最大潜能，护士长的综合素质产生着重大影响，笔者在护士长的岗位上工作了7年，认为当代护士长应该具有强烈的事业心、责任心、进取心，能灵活的运用管理技巧，创造最佳凝聚力。     

MS—PCR法检测血管紧张素原基因M235T多态性

目的 建立新型突变基因分离聚合酶链反应（MS-PCR）法检测血管紧张素原（AgT)基因M235T多态性,以正确评估其与家族性原发性高血压的关系。方法 建立PCR-RFLP和MS-PCR法最佳实验体系,验证敏感性及特异性。结果 （1）PCR-RFLP体系中,随内切酶量和消化时间的增加,消化反应越彻底,以0.075ug基因组DNA扩增产30UnitTth111-I酶消化3小时为最佳反应体系。（2）MS-PCR法一次扩增即可确定AgT基因型。（3）10个标本以PCR-RFLP法检测者基因型均为MT,而MS-PCR法仅1例为MT型,余9例均为TT型（90%）。结论 传统的PCR-RFLP可能因消化不彻底而造成结果判断的误差;MS-PCR以其高敏感性和特异性成为检测基因多态性的快速、简便、可靠的方法。     

阻生第三磨牙生长方向与牙根数目关系的探讨

目的对临床拔除的1035颗阻生第三磨牙的生长方向（阻生类型）与牙根数目的关系进行分析与探讨。方法记录1035颗阻生第三磨牙拔除前阻生类型（生长方向）和拔除后牙根数目。结果阻生类型中，下颌以近中阻生最多见（50．559／6），其次为垂直阻生（45．05％），远中阻生最少（4．40％）；上颌以颊向阻生最多见（60．12％），其次为垂直阻生（35．58％），腭向阻生和远中阻生最少。下颌牙根数目有四类：两根（60．99％）、融合根（34．62％）、多根（3．859／6）和单根（0．55％）；上颌牙根数目有五类：融合根（56．44％）、三根（20．25％）、两根（17．79％）、四根（4．29％）和单根（1．23％）。下颌近中阻生、垂直阻生和远中阻生中两根比率、融合根比率分别为64．13％、33．70％，59．75％、32．93％，37．50％、62．50％。上颌颊向阻生、垂直阻生、腭向阻生和远中阻生中融合根比率分别为56．12％、56．9％、50％、66．67％。结论阻生第三磨牙的牙根数目与生长方向（阻生类型）有关，这一结果对临床顺利拔除阻生第三磨牙有重要指导意义。     

稽留流产的胚胎绒毛染色体分析

目的稽留流产是妇科最常见的疾病之一,近几年来不断呈现上升趋势。探讨胚胎染色体异常与稽留流产之间的关系。方法在无菌条件下采集稽留流产患者的胚胎绒毛,利用培养法进行绒毛染色体检测,并进行分析。结果在采集的100例绒毛标本中,成功培养94例。检出绒毛染色体异常核型有62例,其中数目异常造成的绒毛染色体异常高达90.32%。结论染色体异常是导致稽留流产的重要因素之一。胚胎染色体异常的研究,对于了解稽留流产发生的原因以及指导下一次正常怀孕有着非常重要的意义。     

The relationship between plasma high density lipoprotein cholesterol levels and cholesteryl ester transfer protein activity in six species of healthy experimental animals

Plasma high-density lipoprotein cholesterol (HDL-C) concentrations are regulated by plasma cholesteryl ester transfer protein (CETP) in humans. The aim of this study was to ascertain the relationship between plasma HDL-C and plasma CETP activities in mouse, rat, dog, hamster, rabbit and monkey. In this study, the plasma HDL-C levels were highest in dogs and lowest in rabbits among the six species. Plasma CETP activities were higher in hamsters, rabbits and monkeys compared to mice, rats and dogs. The present study shows that there are species differences in HDL-C and CETP activity in six species of healthy experimental animals, with the six species being separated into two types. The first type showed a high HDL-C/TC ratio with low or absent CETP activity, and included mouse, rat and dog, whereas the second type showed a low HDL-C/TC ratio and high CETP activity, and included hamster, rabbit and monkey. The present study also shows that there is a strong relationship between plasma HDL-C levels and CETP activity in high CETP activity animals and that the relationship between the HDL-C/TC ratio and CETP activity is an important factor in all animals, regardless of CETP activity level.     

小儿中医体质分型研究现状与展望

综述了小儿中医体质分型及与发病倾向、证型、预防、治疗、康复相互关系的研究现状,肯定中医体质分型研究对临床防治起到了重要的指导意义,并指出目前存在的不足之处。     

幽门螺杆菌对甲硝唑耐药与rdxA基因分型及cagA基因的关系

目的: 研究幽门螺杆菌(Helicobacter pylori H. pylori)甲硝唑耐药菌株相关基因的突变与甲硝唑耐药性的关系。方法: 将贵阳医学院附属医院胃镜室分离H. pylori采用E-Test法对甲硝唑进行药敏试验后,PCR扩增rdxA、frxA、fdxB和cagA并对该基因进行测序。采用限制性内切酶片段长度多态性分型方法(RFLP)对rdxA基因进行分型。结果: 313株H. pylori对甲硝唑耐药率为87.2%。其与NCBI已登录的国际标准菌株H. pylori 26695相应基因序列比对,cagA基因阳性率为100%, cagA基因在某些位点存在共同突变,还存在大量其他位点的随机散在突变, rdxA基因除了存在4个位点共同突变外,还有其他位点的散在突变。rdxA基因可分为两型,Ⅰ型与Ⅱ型的比例为293:20,Ⅰ型耐药率为86.3%,Ⅱ型耐药率为100%。同时发现fdxB、frxA基因突变呈现出一定的规律性,具有碱基替换、插入和缺失3种类型的突变。结论: 我院幽门螺杆菌甲硝唑耐药率较高,rdxA基因以Ⅰ型为主,而rdxA基因Ⅱ型的H. pylori均产生甲硝唑耐药,与H. pylori甲硝唑耐药性密切相关。rdxA基因突变及cagA基因阳性是耐甲硝唑的主要原因。     

Creating context for the use of DNA adduct data in cancer risk assessment: I. Data organization

The assessment of human cancer risk from chemical exposure requires the integration of diverse types of data. Such data involve effects at the cell and tissue levels. This report focuses on the specific utility of one type of data, namely DNA adducts. Emphasis is placed on the appreciation that such DNA adduct data cannot be used in isolation in the risk assessment process but must be used in an integrated fashion with other information. As emerging technologies provide even more sensitive quantitative measurements of DNA adducts, integration that establishes links between DNA adducts and accepted outcome measures becomes critical for risk assessment. The present report proposes an organizational approach for the assessment of DNA adduct data (e.g., type of adduct, frequency, persistence, type of repair process) in concert with other relevant data, such as dosimetry, toxicity, mutagenicity, genotoxicity, and tumor incidence, to inform characterization of the mode of action. DNA adducts are considered biomarkers of exposure, whereas gene mutations and chromosomal alterations are often biomarkers of early biological effects and also can be bioindicators of the carcinogenic process.     

沙门氏菌中超广谱β-内酰胺酶的检测

目的:分析石家庄市公共场所从业人员沙门氏菌中产超广谱β-内酰胺酶菌型,确立有效的治疗措施,防止院内感染的爆发流行.方法:采用Etese试条法,对在感染人群中分离的55种沙门氏菌血清型进行了ESBLs产超广谱β-内酰胺酶的检测并观察其对15种抗生素敏感性.结果:检出9种沙门氏菌可产生超广谱β-内酰胺酶.感染的主要菌型分布于9个血清群、55个血清型.结论:分离的沙门氏菌耐药严重,产ESBLS沙门氏菌对新霉素、链霉素、庆大霉素、萘啶酸较敏感.     

The importance of alcoholic beverage type for suicide in Japan: a time-series analysis, 1963-2007

Background. Japan has one of the highest suicide rates in the world. Cohort analysis has suggested that alcohol consumption is a risk factor for suicide in Japan. However, this relationship has not been observed at the population level when a measure of per capita total alcohol consumption has been analysed. The present study employed a time‐series analysis to examine whether these contradictory findings may be due to the existence of beverage‐specific effects on suicide. Methods. An autoregressive integrated moving average model was used to assess the relationship between the consumption of different types of alcohol and suicide rates from 1963 to 2007. The data comprised age‐adjusted suicide rates for the ages 15–69, and information on beverage‐specific alcohol consumption per capita (15+). The unemployment rate was included as a control variable. Results. During 1963–2007, male suicide rates increased substantially whereas female rates decreased slightly. Consumption of distilled spirits was significantly related to male suicide rates (but not in women) with a 1 L increase in consumption associated with a 21.4% (95% confidence interval: 3.2–42.9) increase in male suicide rates. There was no statistically significant relationship between suicide and any other form of alcohol consumption (beer, wine, other alcohol). Conclusion. This is the first study that has shown an association between spirits consumption and male suicide in Japan. Potentially beneficial policy changes include increasing spirits prices through taxation, reducing the physical availability of alcohol and discouraging the practice of heavy drinking.[Norström T, Stickley A, Shibuya K. The importance of alcoholic beverage type for suicide in Japan: A time‐series analysis, 1963–2007. Drug Alcohol Rev 2012;31:251–256]     

Basal serum cortisol and dexamethasone-induced growth hormone release in the alcohol dependence syndrome

We assessed the basal serum cortisol and the growth hormone (GH) response to dexamethasone in a group of completely detoxified male alcoholics and a group of healthy controls. There was a significant baseline elevation of serum cortisol in the alcoholics relative to the controls, and in the type 2 alcoholics relative to the type 1 alcoholics. There was no difference found in GH response to dexamethasone between the alcoholics and controls or between the types of alcoholics. There was no relationship found between the age of subject, length of abstinence from alcohol or severity of alcohol dependence and GH response. There was a significant relationship between severity of alcohol dependence and type of alcohol abuser. This may indicate a subtle impairment of the HPA in post withdrawal alcoholics, and between types of alcoholics, which does not appear to be at the pituatary or hypothalamic level.