不同刷手方法的临床应用与效果分析

目的:比较不同刷手方法的临床应用与效果,探讨最佳的外科洗手方法。方法:将参加择期手术的168名手术人员,按随机方法分为A、B、C三组各56名。A组采用常规消毒法,B组采用纱布擦洗外科手消毒法,C组采用揉搓外科洗手法,比较外科洗手后即刻、1、2、3 h手部皮肤的细菌菌落数,以检测消毒效果。结果:3种外科洗手方法消毒效果可靠,各时间段细菌培养结果比较无显著性差异(P0.05),但细菌菌落数随着外科手消毒后时间的延长而增多。结论:揉搓式外科洗手法消毒效果可靠,操作流程简单,节约洗手时间。     

指甲清洁器和洗手刷清除污物的效果

目的：比较外科手消毒中指甲清洁器和洗手刷清除指甲下污物效果。方法选取我院手术室护士70名随机分为指甲清洁器组和洗手刷组每组35例。分别采用一次性指甲清洁器和洗手刷预处理指甲清洁器组和洗手刷组护士手。采用4％葡萄糖洗必泰外科手消毒剂对指甲清洁器组和洗手刷组进行外科手消毒；外科手消毒后对优势手进行细菌采样计数。结果外科手消毒后指甲清洁器组平均菌落数为（2.7±1.2）CFU/cm2，洗手刷组平均菌落数为（3.1±0.9）CFU/cm2，两组菌落数无统计学差异；两组均未检出金黄色葡萄球菌、大肠杆菌和铜绿假单胞菌。结论外科手消毒中指甲清洁器与传统的洗手刷具有相同的去污效果。     

一种快速手消毒剂现场消毒效果观察

目的观察一种快速手消毒剂的实际消毒效果。方法通过现场消毒试验方法,对该快速手消毒剂对外科手实际消毒效果进行了观察,同时与聚维酮碘作平行比较。结果两组各200人次分别使用快速手消毒剂和聚维酮碘消毒后,即刻、60、120、180 min等4个时段采样检测,全部无细菌生长。200人次使用某品牌快速手消毒剂消毒手部皮肤,无1例出现红斑、水肿和皮疹,有3例出现瘙痒,不良反应率为1.5%。200人次使用聚维酮碘消毒手部皮肤,不良反应率为6%。结论快速手消毒剂和聚维酮碘对医务人员外科手消毒效果无差别,消毒后均未培养出存活细菌,但快速手消毒剂消毒后皮肤速干性好,不良反应率低。     

不同清洁洗手方法对外科手消毒效果的影响

本研究通过比较不同清洁洗手方法对外科手消毒效果的影响,从而找到最佳外科手消毒方式.结果发现,清洁洗手与外科手消毒相结合的消毒效果明显优于直接进行外科手消毒的效果,清洁洗手是提高外科手消毒剂对手臂皮肤消毒效果的基础,现报道如下.     

3M爱护佳免洗外科手消毒液消毒效果观察

目的 探讨3M爱护佳免洗外科手消毒液皮肤消毒的效果.方法 试验组和对照组各随机选择30名医护人员,试验组用3M爱护佳免洗外科手消毒液进行外科手消毒;对照组采用传统皂液刷手后,丹尼尔牌皮肤手消毒液涂擦进行外科手消毒.然后采样行细菌学监测,结果 两组资料比较,实验组皮肤消毒前平均细菌数为3.2 cfu/cm2,对照组医务人员手部皮肤在消毒前平均细菌数为3.18 cfu/cm2,两组细菌菌落数无明显差异(P＞0.05);皮肤消毒后平均细菌数均为0 cfu/cm2,两组消毒效果无差异,无统计学意义.结论 3M爱护佳免洗外科手消毒液具有皮肤消毒效果可靠、操作简便省时、不易挥发、不易受污染等优点.     

爱护佳手消毒液不同消毒方法在术前应用的比较分析

目的 比较3M公司生产的2种爱护佳手消毒液在外科手消毒中的应用效果.方法 将参加手术的医护人员随机分为实验组121例和对照组116例.实验组的手消毒采用揉搓法,手消毒液为9200+9230.对照组的手消毒采用刷手法,消毒液为9241-D+9250.比较2组手消毒效果.结果 2组手消毒效果比较无显著差异,但揉搓法更加人性化,操作者的依从性更高.结论 在外科手消毒时建议使用9200+9230手消毒液揉搓消毒的方法.     

三种模式对新生儿重症监护病房物体表面清洁消毒效果比较

摘要 目的 比较抹布集中高温清洗后浸泡250 mg/L含氯消毒剂、消毒湿巾、抹布手洗三种方法的清洁消毒效果。方法 采用随机对照试验,在新生儿重症监护病房（NICU）对上述3种清洁消毒方法的效果进行对比研究。结果 清洁消毒前,3组物体表面的细菌菌落数无显著差异（F=0.96,P＞0.05）;清洁消毒后30 min、2 h、6 h,3组物体表面菌落数比较有统计学差异（F=10.59,P＜0.05）,其中高温清洗消毒组与消毒湿巾组比较无差异,但两组菌落数明显少于抹布手洗组。前两种方法在消毒前后的菌落数均有显著差异;而抹布手洗组消毒前后不同时点的菌落数比较无统计学差异（F=2.25,P＞0.05）。结论 综合3种方法消毒效果,建议普通病区使用抹布集中高温清洗消毒方法,重点病区及ICU使用消毒湿巾进行物体表面清洁。     

4种消毒方法对流动采血车采血护士手消毒效果观察

目的观察4种手消毒方法对流动采血车上护士手消毒的效果。方法按手消毒剂的不同分为肥皂洗手组、乙醇甘油组、碘伏组和乙醇复方消毒液组,分别对每组消毒剂使用前、后采样,对比观察各消毒方法的使用效果及洗手、干燥时间。结果肥皂洗手组合格率显著低于其他3组消毒效果,且平均洗手、干燥时间明显长于其他3组消毒方法。乙醇甘油消毒后平均菌落数显著少于其他3种方法。结论乙醇甘油手消毒剂具有杀菌效果良好,对完整皮肤无刺激性,适于流动采血车采血护士手的消毒,值得推广使用。     

海绵块浸吸诗乐氏消毒液洗手法应用体会

随机选择80名手术人员手臂,采用海绵块浸吸诗乐氏消毒液洗手法为观察组,另80名采用肥皂刷手加75％酒精泡手的传统洗手法为对照组,2组在洗手消毒前后及手术结束后(50min～5h)脱去手套进行肉眼观察和细菌培养结果显示2组局部皮肤均无红、肿、疼、痒等过敏反应,洗手前手术人员手指细苗培养有腐生葡萄球菌,表皮葡萄球菌,大肠杆菌,金黄色葡萄球菌等,洗手消毒后、手术结束时,观察组灭菌率100％,对照组是93.75％、92.5％,提示海绵块浸吸诗乐氏消毒液洗手法优于传统洗手法。而且此法具有刷手程序简单、省时、经济等优点,解决了消毒剂的准确计量问题,值得推广应用。     

外科手消毒剂的研究进展

外科洗手是预防手术切口感染、保证手术成功的重要环节,也是防止医院感染的重要措施之一.外科手消毒是医院最早开展的消毒措施,也是获得公认的手卫生措施.手术前手和前臂皮肤用消毒剂消毒是手术前的必备程序.长期以来.外科手消毒剂不断发展、创新,在种类、剂型、使用方法等方面都发生了一系列变化.现就外科手消毒剂的研究和发展状况作如下介绍.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.