Healthcare worker feedback on duodenoscope reprocessing workflow and ergonomics

BackgroundThe objectives of this survey study were to assess duodenoscope precleaning and manual cleaning times, identify human factors issues in duodenoscope reprocessing workflow or ergonomics, and ascertain any best practices in duodenoscope reprocessing.MethodsResearchers developed the confidential, qualitative, online Duodenoscope Reprocessing Workflow and Ergonomic Design Human Factors Survey with an intended audience of healthcare workers (HCWs) who routinely perform duodenoscope precleaning or manual cleaning. The unrestricted survey link was distributed to target HCW email addresses in December 2020; the survey closed in January 2021.ResultsThree hundred and forty-one individuals completed the survey. Most respondents complete duodenoscope precleaning in 10 minutes or less and manual cleaning in 16-to-30 minutes. Most respondents’ facilities use fixed distal endcap duodenoscopes. Most respondents experience pressure to work faster when cleaning duodenoscopes and reported that cleaning duodenoscopes caused fatigue or discomfort in at least one body part. Mentoring HCWs and retaining experienced staff were 2 primary duodenoscope reprocessing best practices identified by respondents.Discussion and ConclusionsTo enhance duodenoscope cleaning, facilities should provide ample reprocessing work spaces with incorporated height-adjustable work surfaces, train HCWs on validated duodenoscope reprocessing instructions, provide step-by-step instructions for HCWs when duodenoscope cleaning is performed, mentor reprocessing HCWs, and retain experienced staff.     

成人小脑髓母细胞瘤MR成像和NSE表达水平

目的:探讨成人小脑髓母细胞瘤的MRI表现及神经元特异性烯醇化酶(Neuron-Specific Enolase,NSE)特点。方法:对17例经手术病理证实的成人小脑髓母细胞瘤的MR表现进行分析。免疫组化法检测肿瘤组织中NSE表达。ELISA试剂盒检测血清NSE水平。结果 :髓母细胞瘤均位于小脑半球,其中右侧11例,左侧6例,部分累及小脑蚓部,肿瘤形状多不规则,小脑皮髓质同时受累,实质部分多分布性,10例为男性,发病年龄最大者为64岁。肿瘤实性部分与小脑灰质比较,T1WI为略低信号,T2WI为等或稍高信号。髓母NSE表达水平和强度显著高于正常人脑组织细胞瘤(P<0.01),17例髓母细胞瘤中NSE大部分呈强阳性表达。病理学显示光学显微镜下组织是原始的、未分化的肿瘤细胞,核梭形,形成许多菊形团瘤细胞。部分组织体积较小,向髓母细胞分化。局部分化为神经节细胞。结论:成人小脑髓母细胞瘤的MRI表现有一定的特征性,能够与其他小脑肿瘤相鉴别。NSE可作为小脑髓母细胞瘤的神经损伤指标。     

经纤维支气管镜局部冲洗治疗支气管扩张症53例报告

目的探讨经纤维支气管镜（以下简称纤支镜）局部灌洗注药治疗支气管扩张症的疗效。方法53例支气管扩张病人除常规治疗外，还采用纤维支气管镜反复气道灌洗和注药，在纤维支气管镜治疗前后常规监测患者临床情况、通气换气功能及血气指标。结果灌洗注药后患者体温迅速下降，外周血白细胞、痰液量明显减少，X线胸片明显改善。灌洗后血气指标（PaO2，SaO2及PaO2／FiO2）改善；肺通气功能检测（VC、FEVI、FEVI％、VS0、V25及MVV）明显改善（P〈0．05）。结论经纤维支气管镜肺泡灌洗和注药能有效清除痰痂和气道分泌物，解除支气管的阻塞，改善患者通气换气功能，是一种安全、简便实用的治疗支气管扩张的有效手段。     

乙肝病毒感染合并肝内胆汁淤积对妊娠的影响

目的:探讨乙肝病毒感染合并肝内胆汁淤积对妊娠的影响。方法:妊娠期肝内胆汁淤积症(ICP)合并乙肝病毒感染(HBV)孕妇83例为HBV+ICP组,无HBV感染的单纯ICP 253例为ICP组,比较两组妊娠结局及其合并症。结果:HBV+ICP组的肝功能异常、胆汁酸高,胎儿窘迫、早产和新生儿窒息等妊娠合并症高于ICP组,差异有统计学意义(P<0.05);两组间的死胎、产后出血及新生儿体重等差异无统计学意义(P>0.05)。结论:HBV感染合并ICP可增加妊娠风险。     

彩色多谱勒超声诊断胎盘早剥的价值

目的探讨彩色多谱勒超声(color doppler ultrasound,CDU)诊断胎盘早剥的价值和超声声像图特征。方法回顾性分析2008年1月至2014年6月南充市中心医院42例胎盘早剥住院患者的超声表现,并对其漏诊、误诊原因进行分析总结。结果 42例胎盘早剥患者中,产前超声诊断26例,诊断符合率61.9%,漏诊12例(28.6%),误诊4例(9.5%)。结论彩色多谱勒超声检查具有无创、安全、快捷等临床优势,是诊断胎盘早剥最重要的辅助检查手段。     

间充质干细胞移植治疗终末期肝病前后血清甲胎球蛋白的变化

目的探讨间充质干细胞(mesenchymal stem cell,MSC)移植治疗终末期肝病甲胎球蛋白(α-fetoprotein,AFP)的变化,观察病人肝功能有无改善。方法 MSC移植治疗73例终末期肝病患者,其中包括失代偿期肝硬化患者45例,慢性重症肝炎5例,监测疗前和疗后1周、疗后1个月、2个月AFP及肝功能变化。结果疗后1周AFP较疗前明显升高,其后降低,2个月至疗前水平,差别有统计学差异(P<0.05)。白蛋白(serum albumin,ALB)疗后1月、2月与疗前相比,差别有统计学意义(P<0.05)。胆碱酯酶疗后2月较疗前明显升高,差别有统计学意义(P<0.05)。所有接受干细胞移植的患者观察过程中未出现肝脏及其他器官肿瘤。结论 MSC移植治疗终末期肝病患者安全有效。