Total versus tube-related additional work of breathing in ventilator-dependent patients

BACKGROUND: In tracheally intubated or tracheostomized spontaneously breathing patients, tube resistance can highly increase the patient's work of breathing. In this study we focused upon the relationship between total (WOBtot) and tube-related additional inspiratory work of breathing (WOBadd) and compared different ventilatory modalities for proper tube compensation. METHODS: In ten tracheostomized spontaneously breathing patients we measured WOBtot and WOBadd in the continuous positive airway pressure (CPAP) mode, under inspiratory pressure support of 5, 10, and 15 cmH2O in the pressure support ventilation (PSV) mode, and under flow-adjusted pressure support in the automatic tube compensation (ATC) mode. WOBadd and WOBtot were calculated on the basis of measured tracheal pressure and esophageal pressure, respectively. Inspiratory peak tracheal pressure above PEEP was taken as an estimate of pressure support beyond mere tube compensation (i.e., overcompensation). RESULTS: The percentage of the tube-related WOBadd on WOBtot in the CPAP mode was 52%. It decreased with increasing pressure support in the PSV mode from 32% (PSV 5 cmH2O) to 17% (PSV 15 cmH2O). WOBadd was only 15% of WOBtot in the ATC mode. In contrast to the other ventilatory modes, reduction of WOBadd in the ATC mode was achieved with the smallest amount of overcompensation, i.e. with minimal pressure assist beyond mere tube compensation. CONCLUSION: In tracheally intubated or tracheostomized spontaneously breathing patients, adequate compensation of tube resistance (i.e. with minimal overcompensation and minimal undercompensation) is best done by the ATC mode.     

浙江省萧山区1988—2004年交通伤害死亡流行趋势和疾病负担分析

目的了解1988—2004年萧山区居民交通伤害死亡的变化趋势、地区特点和疾病负担,为有关部门制定预防和控制交通伤害措施提供科学依据。方法使用全死因登记监测资料,描述交通伤害死亡水平及其变化趋势,并计算交通伤害死亡率、潜在减寿年数(PYLL)和潜在工作减寿年数(WPYLL)。结果萧山区1988—2004年交通伤害累计死亡3543人,年平均死亡率为23.15/10万,占伤害死亡的36.86%,居伤害死亡第1位;居民交通伤害死亡水平以每年3.80%的速度递增;交通伤害死亡水平与机动车数量呈正强相关;17a来交通伤害死亡平均减寿30.88人.a,20～59岁年龄段的PYLL标化率和WPYLL标化率均高于其他年龄段,是交通伤害的高危人群。结论17a来交通伤害死亡率上升明显,交通伤害是青壮年的主要死因,交通伤害导致的PYLL和WPYLL是明显的,带来了沉重疾病负担,应引起全社会特别是政府部门的重视,并针对其死亡特点,制定有效的控制策略。     

基于健康寿命损失的事故伤残间接损失统计

事故一旦发生,往往造成人员伤亡和财产损失,事故伤亡不仅导致经济损失,而且导致人员健康寿命的损失。该文首次应用DALY(伤残调整寿命年)来计算2005年我国工矿商贸企业伤亡事故导致的伤残寿命损失,基于国家公布的2005年我国工矿商贸企业事故的基础数据,计算2005年因事故伤亡导致的健康寿命损失至少有3651862人年,折合成静态经济损失约878亿元。通过计算健康寿命损失可以从一个全新的角度发现事故所造成人员伤亡引起的间接损失,为全面分析事故损失,进一步完善事故人员赔偿提供了科学依据。     

高校教育管理人员的作满意度调查

目的研究高校教育管理人员工作满意的现状及其影响因素。方法采用自编的教育管理人员工作满意度问卷对310名高校教育管理人员进行问卷调查。结果高校教育管理人员的工作满意度处于中等偏上水平,其中晋升发展的满意度最低(x珋=2.78),同事关系的满意度最高(x珋=3.91)。不同性别、年龄、职务、月收入水平的高校教育管理人员的工作满意度得分差异显著;工作满意度与工作效率具有显著的正相关(r=-0.362,P0.01),回归分析表明,在控制了人口统计变量之后,工作本身的满意度可以显著正向预测工作效率(β=0.353,P0.001)。结论高校教育管理人员对晋升发展的满意度偏低;性别、年龄、职务、月收入等显著影响高校教育管理人员的工作满意度;教育管理人员对教育管理工作本身的满意可以显著正向预测工作效率。     

Work-related skin and airway symptoms among Swedish dentists rarely cause sick leave or change of professional career

Dentistry usually is 'wet work' with risk of damage to the skin barrier, and the hands may be exposed to skin irritants and contact-sensitizing substances used in dental materials or gloves. Airway irritants may also be present. This study assessed the consequences of work-related skin and airway symptoms among dentists in terms of contact with health authorities, sick leave, or changes in the professional career. A questionnaire on these factors was answered by more than 3000 Swedish dentists. Only 6% of the respondents had consulted a physician, although 22% had noted work-related skin symptoms. In 2% the skin symptoms had caused sick leave, and about 2% had reported their skin symptoms as an occupational disease. Two per cent had consulted a physician owing to work-related airway symptoms, which is a minor part of the 13% who had experienced such symptoms when in contact with dental materials. Twenty-five dentists (<1%)had been on sick leave because of work-related airway symptoms. Only 19 dentists reported change of activities or occupation owing to work-related skin or airway symptoms, and in most cases these symptoms only contributed to their decision. In summary, whereas sick leave in dentists because of musculoskeletal problems may be common, the present study shows that this is not the case for workrelated skin or airway symptoms, and such symptoms seldom affect the dentists' professional career.     

Learning about Practice from Practice: A Peer-based Methodology

A recommendation from the Social Work Task Force was that all employers of social workers should conduct a regular “health check” of the social work profession to learn from practice as part of a continuous cycle of improvement. This article documents how the London Borough of Tower Hamlets has gone about this. I describe the methodological and practical pathway we followed so that others can see what we did and why we did it. Like other busy social work offices, we had to set out a plan of methodological action in order that we achieved the learning from practice to inform our health check, and it is the planning work that is engaged with in this article. We have found that by involving and engaging our staff in the health check work, we have gained more than we had set out to find. An organisational commitment to act on what social workers have told us about practice is offering the senior management team new ideas about the best ways of delivering professional and reflective support mechanisms for staff. Learning from practice is now one of the core functions for the new Principal Social Worker.     

医院护士工作满意度影响因素的调查分析

目的研究本市护士工作满意度的影响因素,为改善和提高本院护士队伍的稳定性奠定理论基础。方法随机抽取本市二级医院的230名护士进行调查。调查内容主要包括一般资料和工作满意度调查,对收集的资料进行统计学分析。结果医院护士最满意的是补助情况,其中值班补助最为满意,最不满意的是领导的认可情况。结论本市医院护士工作满意度未达到基本满意水平。