中国医院感染管理组织建设30年调查

目的了解我国医院感染管理组织建设30年的发展情况。方法对全国12个省（直辖市、自治区）医院感染管理组织建设进行调查。结果共调查166所医院,其中三级医院96所（57.83%）;164所有建立医院感染管理科年份的医院中,1995年之前建科的医院46所（28.05%）,1995—2005年建科的医院63所（38.41%）,2005—2015年建科的医院55所（33.54%）。165所医院每千床专职人员数从1995年的4.80名下降至2015年的4.09名,1995—2015年医院感染管理科专职人员类别构成比较,差异有统计学意义（χ2=26.22,P＜0.01）。1995—2015年各省份医院感染管理科专职人员学历、专业构成比较,差异有统计学意义（χ2值分别为242.91、47.10,均P＜0.01）。1995、2005年专职人员学历均以大专及以下学历为主,所占比率分别为70.81%、53.30%;2015年以本科学历（53.79%）为主,博士、硕士所占比率分别为2.45%、22.86%。专职人员专业均以护理为主,所占比率由1995年的58.38%下降至2015年的45.96%。结论我国医院感染管理组织建设经历了30年,取得了一定成绩,但仍存在一些问题,需要继续提高专职人员比例,优化人员结构。     

23例高空坠落伤患者的急救护理

目的总结急诊科对23例危重高空坠落伤患者的抢救护理体会。方法分析23例高空坠落伤患者的临床资料、急救措施、护理方法等情况。结果 23例危重高空坠落伤患者,3例病情过重,出现呼吸心跳停止,送院不及时,来诊时已死亡;6例因伤势过重,或合并多器官衰竭,经抢救无效后死亡,其余14例患者经抢救病情稳定后转入院作进一步的治疗处理。结论在抢救危重高空坠落伤的患者时必须迅速、及时、到位,维持患者的基本生命支持,在保证呼吸和循环的前提下保持气道通畅,积极治疗循环衰竭及低血容量性休克,密切观察病情变化及做好抢救护理,尽最大努力挽救患者的生命及恢复患者的基本功能。     

跌倒危险因素评分表在神经内科病房中的应用

目的探讨跌倒危险因素评分表在神经内科住院患者中的应用效果。方法应用跌倒危险因素评分表对2010年1～ 8月本院收治存在跌倒危险因素的167例患者进行评估,根据评估结果采取针对性预防护理措施。出院前调查患者跌倒发生率及对护士防跌倒护理工作满意度。结果患者住院期间未发生跌倒不良事件,患者对护士防跌倒护理工作满意度为99.8% 。结论对神经内科患者采用跌倒危险因素评估表进行评估,根据评估结果,采取针对性护理措施预防跌倒,能有效预防患者跌倒不良事件的发生。     

Relationship between fear of falling and balancing ability during abrupt deceleration in aged women having similar habitual physical activities

The purpose of this study was to evaluate the influence of fear of falling on balancing ability during abrupt deceleration in aged women. The subjects were 20 women aged between 67 and 75 years. They were classified into two groups, one having a fear of falling (group FF, n = 10) and another without this fear (group NFF, n = 10). The two groups had similar daily physical activities. Changes in the centre of foot pressure (CFP) were measured during postural sway following horizontal deceleration of the force platform on which they were standing, and the response time and CFP displacement were evaluated. In addition, the electromyogram (EMG) onset in the tibialis anterior muscle and medial gastrocnemius muscle during abrupt deceleration, and its difference between the two muscles were measured. and the relative level of co-contraction of antagonistic muscles (the co-contraction index, CCI) in the lower extremity muscle group was calculated. The response time and CFP displacement immediately after abrupt deceleration were significantly higher in group FF than in NFF (P < 0.05). The EMG onset in the two muscles did not significantly differ between the two groups. The difference in EMG onset between the two muscles was significantly lower in group FF than in NFF (P < 0.05). The CCI was significantly higher in group FF than in NFF (P < 0.05). These results suggest that there were negative effects of a fear of falling on the balancing ability immediately after abrupt deceleration. This may be because a fear of falling increases the co-contraction of antagonist muscles in the lower extremity muscle group.     

Nail discoloration occurring after 8 weeks of minocycline therapy

Minocycline-induced nail pigmentation is an uncommon side-effect. It usually develops after years of the therapy, and coincides with other pigmented sites. We report a 73-year-old male and a 33-year-old female developing nail discoloration after 8 weeks of therapy of 100 mg minocycline twice daily. No other pigmentation was found elsewhere on the skin, mucous membranes, teeth or sclerae of them. Our cases demonstrate that nail pigmentation can occur after short-term minocycline therapy, and propose the possibility that nail discoloration may precede other pigmentary changes.     

Concern about falling is associated with segmental control when turning in older adults

BackgroundHealthy young adults typically exhibit a progressive ‘top-down’ reorientation of body segments (i.e., head, trunk, then pelvis) during turning. This behaviour is less evident in older adults at risk of falling, who often reduce angular displacement between body segments during turns. The potential functional and psychological contributors to this so-called ‘en-bloc’ turning strategy are not yet understood.Research questionAre there associations between concern about falling and variables representing en-bloc turning (i.e., increased coupling between body segments)?MethodsTwenty-one older adults were assessed while turning during an adaptive walking task. We collected data from markers forming the head, trunk, and pelvis segments, while gait velocity throughout the turn was calculated from a sternum marker. We correlated several variables with concern about falling alone, as well as while controlling for functional balance ability.ResultsCorrelation analyses revealed that concern about falling was related to en-bloc turning strategies and slower gait velocity throughout the turn, when analysed independently of functional balance. When controlling for balance ability, en-bloc turning strategies between the head and trunk, as well as the head and pelvis, remained significantly associated with concern about falling.SignificanceFindings offer an insight into the potential role that psychological characteristics may have in determining older adults’ turning behaviour and associated risk of falling.     

青海省35岁以上妇女骨质疏松流行病学调查

目的　通过测量青海城市、农村、牧区 35岁以上妇女骨密度 (BoneMineralDensi ty) ,获得该地区 35岁以上妇女骨密度 (BMD)状况及骨质疏松 (Osteoporosis)患病率以及相关因素 ,为预防和诊断骨质疏松 (OP)提供科学依据。方法　用以色列SunlihTOmnisenseTM70 0SBineSonomeTer测受试者桡骨BMD。结果　 ( 1 )随年龄增加BMD逐渐下降 ,城市妇女BMD大于农村 ,农村妇女BMD大于牧区 ;汉族BMD大于回族 ;回族妇女与藏族妇女之间无明显差异。 ( 2 )OP患病率随年龄增加而上升 ,牧区妇女OP患病率高于农村妇女 ;农村妇女OP患病率高于城市妇女。 ( 3)BMD减少与年龄增长、绝经年限、体育锻炼、牛奶的摄入相关。青海省 35岁以上妇女骨质疏松症患病率为 49.0 9%。结论　青海地区妇女应加强锻炼 ,增强营养 ,尤其是 5 5岁以上的妇女 ,普及预防OP知识 ,并采取相应的干预措施 ,减少OP的发生     

A Computational Model for Simulation of Shallow Water Waves by Elastic Deformations in the Topography

We propose a coupled model to simulate shallow water waves induced by elastic deformations in the bed topography. The governing equations consist of the depth-averaged shallow water equations including friction terms for the water free-surface and the well-known second-order elastostatics formulation for the bed deformation. The perturbation on the free-surface is assumed to be caused by a sudden change in the bottom beds. At the interface between the water flow and the bed topography, transfer conditions are implemented. Here, the hydrostatic pressure and friction forces are considered for the elastostatic equations whereas bathymetric forces are accounted for in the shallow water equations. The focus in the present study is on the development of a simple and accurate representation of the interaction between water waves and bed deformations in order to simulate practical shallow water flows without relying on complex partial differential equations with free boundary conditions. The effects of location and magnitude of the deformation on the flow fields and free-surface waves are investigated in details. Numerical simulations are carried out for several test examples on shallow water waves induced by sudden changes in the bed. The proposed computational model has been found to be feasible and satisfactory.     

日间手术在香港的发展

日间手术由于可降低费用,节省能源而在许多发达国家得到普及,近几年已被引入香港。建立日间手术中心的目的与香港医院管理局的核心价值相一致。其优点为:降低不必要的住院率;提高病床使用率;有效地利用能源;缩短术次间隔;缩短择期手术患者等候时间。     

Callosotomy for severe epilepsies with generalized seizures: Outcome and prognostic factors

Summary The purpose of the present study was to verify the effect of callosotomy on generalized seizures, to check the effect on other seizure types and to search for possible prognostic factors.Twenty patients with a minimum follow-up of one year (mean 3.5 years) were available for our analysis. In six of them the callosotomy was performed in two stages (total: 26 surgical procedures). Age ranged from 14 to 40 years (mean 23 years). Different aetiologies were known in 15 patients. Duration of epilepsy ranged from 6 to 23 years (mean 15 years). The frequency of seizures ranged between 19 and 750 per month.The most significant effect of surgery was the complete suppression of the generalized seizures associated with falling in 9/19 and their reduction of more than 80% in 7/19 patients (total good results: 16/19). The generalized tonic-clonic seizures were less affected. The surgical effect on the partial seizures was very variable, the partial simple seizures being the most affected. A positive statistical association with the outcome of the generalized seizures with fall was found for a presurgical seizure frequency below 90 per month, a prevalent bilateral EEG epileptic activity and, to a less extent, the absence of cerebral structural lesions. The role of age, aetiology, duration of the disease, single or more seizure types, mental impairment and extent of callosotomy remains uncertain. Disconnection syndrome does not appear if the splenium is spared.The present findings confirm that the main indication for callosotomy is the occurrence of generalized seizures with fall. Surgery can be initially limited to the anterior 2/3 of the corpus callosum; further posterior section of the corpus, excluding the splenium, should be regarded as a second step, when necessary.