普外科围手术期抗生素的应用探析

目的 观察普外科围手术期预防性应用抗生素的临床效果,探讨合理的应用方式.方法 选取该院普外科手术患者284例,随机分为2组每组142例.观察组于术前1h使用抗生素静脉滴注1次,手术时间超过3h者术中加用1次,Ⅰ类、Ⅱ类切口术后不再使用抗生素,Ⅲ类切口于术后12h加用1次,之后不再使用抗生素.对照组于术后当天开始使用抗生素,连续使用5d.观察并比较两组患者术后伤口感染率、术后住院时间和住院费用.结果 2组患者术后伤口感染率无显著性差异；观察组术后住院时间和住院费用均低于对照组.结论 普外科围手术期预防性应用抗生素可有效预防术后感染,且减少了抗生素的使用量.     

比较规范化和长期应用抗生素预防术后伤口感染的临床效果

目的：探讨规范化和长期应用抗生素预防术后伤口感染的临床效果。方法：选取本院2004年1月-2011年6月外科手术患者120例，随机分为研究组和对照组，研究组60例，按照规范化使用抗生素，平时不使用抗生素，对照组60例患者，长期使用大剂量抗生素，观察两组患者手术伤口的感染几率。结果：两组患者手术后的伤口感染率分别为1．67％、3．33％，差异无统计学意义。结论：手术期长期使用抗生素没有降低术后伤口感染几率。     

剖宫产手术预防性应用抗生素的对照研究

目的探讨剖宫产手术预防性应用抗生素规范化方案的临床效果及医疗费用合理支出的可行性.方法采用术中预防性应用抗生素(A组)和术后连续应用抗生素(B组)给药时间为3～5 d的方法进行临床疗效和经济学分析评价.结果使用抗生素时间的延长并不能降低术后伤口感染的发生,A组方案不影响伤口愈合,反而减少住院天数和医疗费用的支出.结论剖宫产手术术中预防性应用抗生素具有显著的临床意义,方法科学,效果显著,实用性及可操作性强.     

合并胎膜早破剖宫产患者围手术期预防应用抗生素临床分析

[目的]探讨合并胎膜早破的择期剖宫产患者围手术期预防应用抗生素是否要求延长用药时间. [方法]回顾性分析86例合并胎膜早破剖宫产手术患者,破膜时间小于72 h,根据用药途径及时间不同分为两组,两组术前0.5h内均静滴相同剂量头孢噻肟钠;A组56例,术中替硝唑局部用药,术后静滴头孢噻肟钠48 h停药;B组30例,术中胎儿断脐后静滴替硝唑,术后静滴头孢噻肟钠+替硝唑3～5 d停药. [结果]两组用药经济花费比较差异有统计学意义(P<0.001),两组术后病率、伤口感象、子官内膜炎、最高体温退热时间、白细胞数比较差异无统计学意义(P>0.05).[结论]合并胎膜早破剖官产患者围手术期预防性应用抗生素,在破水72 h内,既不需要延长用药时间又减少了药物的浪费及减轻了病员的经济负担.     

抗生素应用在单纯胆囊切除术中的价值

胆囊结石和胆囊息肉是外科常见病，其手术切口属Ⅱ类（沾染）伤口，有关是否应用抗生素预防伤口感染目前尚无统一的观点。本文回顾了本院2004年1月～2008年10月单纯性胆囊切除术患者围手术期抗生素的应用和术后伤口感染率情况，探讨预防性抗生素的应用价值。     

选择性剖宫产术预防性应用抗生素的探讨

[目的 ]　探讨术前预防性应用抗生素 ,降低剖宫产术后感染率的可行性。　 [方法 ]　选择性剖宫产病例 40 7例以不同给药方法分成两组 ,对术后病率、腹部伤口感染率、子宫内膜炎发生率、肠蠕动恢复时间等情况作比较。　 [结果 ]　预防组术后感染的发生率明显低于对照组 ,两组间差异有显著性 (P <0 .0 5 )。　 [结论 ]　剖宫产术预防性应用抗生素方法合理 ,效果理想 ,值得推广。     

预防性抗生素使用于选择性剖宫产者的临床分析

目的了解选择性剖宫产产妇围手术期抗生素使用时机与术后母儿感染的关系。方法将选择性剖宫产产妇1 019例,根据不同给药方案分为观察组501例,对照组518例。观察组断脐后5 min用抗生素一剂;对照组在切皮前30 min开始用抗生素,共用24~48 h。观察两组母儿感染率及抗生素用量。结果观察组和对照组在伤口感染、子宫内膜炎、尿路感染及新生儿黄疸与败血症发生率、入重症监护室率比较,差异无统计学意义(P0.05)。结论剖宫产预防性应用抗生素的时机并不影响产后感染的发生率,单剂量抗生素能达到预期效果。     

昂丹司琼术后预防性止吐作用的时效和量效关系

目的：探讨昂丹司琼用药时间和用药剂量对术后恶心呕吐（PONV）预防性效应的影响。方法：选择气管内全身麻醉下行腹腔镜胆囊切除手术（LC）患者200例。随机分为5组，每组40例，以双盲方式按下述方法给药：A组不给止吐药；B组麻醉前昂丹司琼4mg；C组术毕昂丹司琼4mg；D组麻醉前昂丹司琼8mg；E组术毕昂丹司琼8mg。记录手术后24h内PONV发作及补救止吐率。结果：与A组相比，C、E组病人PONV发生率及补救止吐率均有所降低，但差异无统计学意义（P〉0.05）。B、D组患者术后PONV发生率及补救止吐率则非常显著地低于A组、C组、E组水平（P〈0．01，P〈0．05）。B组与D组、C组与E组相比，PONV发生率及补救止吐剂率差异无统计学意义（P〉0．05）。结论：麻醉前应用昂丹司琼对全麻下行LC患者预防性止吐效应明显优于手术结束时用药，用药剂量的改变则对止吐效应无明显影响。     

剖宫产预防性使用抗生素的临床观察

目的:评价在有感染高危因素的剖宫产手术抗生素预防性用药的效果及探讨抗生素的使用疗程。方法:选择2005年10月~2006年2月在我院分娩的有感染高危因素的剖宫产病例,A组:采用围手术期抗生素预防性用药,共157例。B组:采用传统的抗生素使用方法,于手术后给药,共139例,比较两组用药情况及术后情况。结果:通过比较血CRP、血白细胞数、产褥病率及伤口感染的发生等,显示A组抗感染的效果优于B组,且明显缩短了抗生素使用时间及降低了药费。结论:在有感染高危因素的剖宫产手术,应采用抗生素预防性用药。     

肝硬化患者围手术期抗生素的使用和感染因素分析

目的：探讨合并肝硬化的外科患者围手术期治疗中抗生素的合理应用和手术感染因素防治措施。方法：随机设立治疗组和对照组；治疗组应用预定的原则在围手术期全程预防性使用抗生素，发生感染时抗生素可升级使用或根据药敏结果使用；对照组则只在术后发生感染时对症使用抗生素；由此比较两组病例的术后感染率和手术死亡率。结果：治疗组的术后感染率13．6％，显著低于对照组29．2％，P＜0．05，治疗组与对照组的术后合并症发生率和死亡率也有明显不同。结论：合并肝硬化的外科患者在围手术期预防性使用抗生素治疗，可以有效降低术后感染发生率和手术死亡率；肝硬化患者术后感染的主要部位是腹腔，主要原因是免疫功能减低和肠道内G^-杆菌的腹腔移位；术前加强保肝治疗是预防术后感染的基本步骤。     

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.     

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.     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.