支气管肺泡灌洗液中纤毛柱状细胞与蠊缨滴虫甄别的临床研究

目的 探讨我国现有文献中报道的蠊缨滴虫肺部感染是否被误判,蠊缨滴虫是否为引起肺部感染的致病原.方法 对2012年6月至2013年5月北京大学人民医院诊治的6例肺部疾病患者BALF中发现的顶端带有纤毛的活细胞的活动状态、光镜特点及电镜下的超微结构进行研究,鉴定其来源和性质,确定是否为蠊缨滴虫,同时进行文献检索.以“蠊缨滴虫”和“Lophomonas blattarum”为关键词,在万方数据库、中国知识资源总库和PubMed数据库中检索相关文献,复习文献中提供的细胞图片及诊断方法,确定文献中肺蠊缨滴虫感染的诊断是否正确.结果 6例患者BALF 中发现的活细胞,在光镜及电镜下观察均表现为气道纤毛上皮细胞的特点,细胞核位于细胞的基底部,且不具有蠊缨滴虫特有的结构(萼器、核周小管、轴丝).文献报道的蠊缨滴虫感染病例均依据细胞的活动性及具有纤毛的特点进行诊断,未对照文献报道的“蠊缨滴虫”的形态和结构进行超微结构研究.所有发表文献中的细胞染色图片与本研究发现的上皮细胞形态基本一致.结论 在过去的20年中,我国报道的有关“蠊缨滴虫”肺部感染的病例均为误诊,目前尚不能确定蠊缨滴虫为引起肺部感染的致病原.     

肝吸虫性肝胆疾病22例分析

目的通过对肝吸虫致肝胆疾病的临床分析,增加对该病的认识,减少误诊。方法回顾性分析本院1992年至2012年以肝胆疾病入院后确诊为肝吸虫病患者22例。其中男19例,女3例,平均年龄45.41岁,其中入院诊断为胆囊炎或胆结石8例、肝吸虫病7例,其他7例。结果实验室检查ALT升高者14例（63.63%）、AST升高者16例（72.72%）、TBil升高者11例（50.00%）、GGT升高者17例（77.27%）、嗜酸性粒细胞（E）升高者14例（63.63%）、大便集卵检查确诊10例（45.45%）,胆汁涂片确诊7例（31.82%）、肝吸虫抗体检测确诊2例、既往肝吸虫病史者3例;经驱虫及综合治疗后预后良好。结论肝吸虫病具有地方性,临床少见且临床表现无特异性,易与其他肝胆疾病混淆,误诊率高。对于病因不明腹痛、黄疸、肝损害患者应注意询问患者及家人有无特殊饮食史,应注意行相关检查明确诊断,避免延误治疗。     

Adverse drug events resulting from patient errors in older adults

OBJECTIVES: To characterize the types of patient-related errors that lead to adverse drug events (ADEs) and identify patients at high risk of such errors. DESIGN: A subanalysis within a cohort study of Medicare enrollees. SETTING: A large multispecialty group practice. PARTICIPANTS: Thirty thousand Medicare enrollees followed over a 12-month period. MEASUREMENTS: Primary outcomes were ADEs, defined as injuries due to a medication, and potential ADEs, defined as medication errors with the potential to cause an injury. The subset of these events that were related to patient errors was identified. RESULTS: The majority of patient errors leading to adverse events (n=129) occurred in administering the medication (31.8%), modifying the medication regimen (41.9%), or not following clinical advice about medication use (21.7%). Patient-related errors most often involved hypoglycemic medications (28.7%), cardiovascular medications (21.7%), anticoagulants (18.6%), or diuretics (10.1%). Patients with medication errors did not differ from a comparison group in age or sex but were taking more regularly scheduled medications (compared with 0-2 medications, odds ratio (OR) for 3-4 medications=2.0, 95% confidence interval (CI)=0.9-4.2; OR for 5-6 medications=3.1, 95% CI=1.5-7.0; OR for >or=7 medications=3.3, 95% CI=1.5-7.0). The strongest association was with the Charlson Comorbidity Index (compared with a score of 0, OR for a score of 1-2=3.8, 95% CI=2.1-7.0; OR for a score of 3-4=8.6, 95% CI=4.3-17.0; OR for a score of >or=5=15.0, 95% CI=6.5-34.5). CONCLUSION: The medication regimens of older adults present a range of difficulties with the potential for harm. Strategies are needed that specifically address the management of complex drug regimens.     

Interobserver and intra-observer errors in obtaining visually selected anatomical landmarks during registration process in non-image-based navigation-assisted total knee arthroplasty

This study investigated the errors of obtaining visually selected anatomic landmarks for use in the registration process in a passive optical non-image-based computer-assisted total knee arthroplasty system in 5 fresh frozen cadavers. The projected maximum errors in the femoral mechanical axis (due to registration errors of the center of the distal femur) were 0.7 degrees in the coronal and 1.4 degrees in the sagittal plane. The projected maximum errors in the tibial mechanical axis arising from registration errors of the center of the proximal tibia were 1.3 degrees in the coronal and 2 degrees in the sagittal plane. The projected maximum errors in the transepicondylar axis were 9.1 degrees (registration errors of the medial femoral epicondyle) and 7.2 degrees (registration errors of the lateral femoral epicondyle). It should be noted that the results may be partly related to the use of the particular system in this experiment.     

The effect of patient position on blood loss in primary cemented total hip arthroplasty

Introduction  The total blood loss of 101 cemented primary total hip arthroplasties was studied in a prospective randomised study. Materials and method  Fifty of them were implanted in the supine position and 51 in the lateral position. The patients were matched for sex, height, weight and ASA grade. Only one surgeon carried out the operations using the same operative technique and identical prosthesis in both groups. Results  The intraoperative blood loss associated with the supine position was 1,156 ml (954–1,265 ml) and 1,129 ml (989–1,310 ml) in the lateral position. There was no difference when comparing the two groups (P = 0.41). Conclusion  Patient positioning in supine or lateral during total hip arthroplasty surgery has no bearing on the total amount of blood loss.     

Making patients safer: nurses' responses to patient safety alerts

Title. Making patients safer: nurses’ responses to patient safety alerts. Aim. This paper is a report of a study to determine whether action required by patient safety alerts was effectively taken. Background. Over the last 10 years, there has been a growing awareness of the number of patients unintentionally harmed in the course of their treatment. Safety alerts are designed to reduce the incidence of adverse events by removing these predisposing factors. Method. A multi‐method study was carried out in 20 acute, two mental health, four ambulance and 15 primary care provider organizations in the United Kingdom in 2006–2007 using surveys, interviews with senior managers and front‐line staff, collection of documentary evidence and equipment audit. The implementation of three safety alerts for nursing action is reported. Findings. Most staff were aware of the dangers posed by gloves to staff with latex allergy, but only 20% were aware of the types of common equipment that posed a danger to sensitive patients. Almost 40% of nurses were unable to give a correct acidity value to allow nasogastric feeding to commence. One alert, on needle‐free intravascular connectors, was distributed in only a few organizations as the term used was unfamiliar at all levels of the organization. Conclusion. Healthcare providers have succeeded in setting up successful systems to disseminate alerts to middle management level, but there is evidence that implementation of recommendations by nurses is sub‐optimal.     

Organic acidemias: a methylmalonic and propionic focus

The management of children with organic acidemias (OAs) is limited in nursing literature. This article focuses on the two more common OAs, methylmalonic and propionic acidemias. Literature search was done on PUBMED, CINAHL, OVID, UptoDate, and GeneReview. The benefit of early diagnosis and treatment has been well documented, but many unresolved aspects of care management remain. Patient care is a complex necessitation and a lifelong follow-up for complications. Caring for patients with OA requires that nurses increase their familiarity with metabolic genetics and develop a better understanding of proper medical and nursing management while research continues to determine the most beneficial treatment and long-term care management methods.     

甲下黑色素瘤误诊原因分析

目的 分析甲下黑色素瘤的误诊原因,探索其早期诊断依据.方法 总结8例甲下黑色素瘤患者的临床特征,分析误诊原因.结果 8例中误诊为其他指甲疾病并对应治疗(抗感染及抗真菌)6例(其中4例曾行拔甲,1例反复激光冷冻),误诊为血管瘤1例.7例于我院行跨关节截指术,病理均证实为甲下黑色素瘤.结论 临床表现多样、无黑色素性黑色素瘤的存在、局部活组织取材病理检查不充分以及病变初期的病理诊断困难,是导致甲下黑色素瘤误诊的常见原因.提高临床医生对该病的认知度和敏感度有助于早期诊治.