Characteristics of Acute Asthma Patients Attended Frequently Compared with Those Attended Only Occasionally in an Emergency Department

Asthma patients that depend on emergency department (ED) services are generally considered to have extremely poor disease control and prognosis. It is important to identify characteristics related to poor disease control and frequent visits to the ED to apply appropriate clinical management. This study comprised a cross-sectional survey of consecutive patients with asthma exacerbation (age ≥12 years) presenting at the adult ED of a large, tertiary care, university-affiliated hospital over a 2-month period. The frequent visitors (FV) were defined by ≥3 visits to the ED in the preceding year, and the occasional visitors (OV) by ≤2 visits. Eighty-six patients (61 females and 25 males) were included in the study (mean age 38 ± 18 years). Of these patients, 51.2% were FV and 48.8% were OV. Sixty-nine percent had annual income lower than A$3000 and 66.3% had ≤8 years of the formal education. Only 18.6% had used inhaled corticosteroids, 79.1% identified the asthma attack severity, 70.9% increased or initiated inhaled β-agonist, 20.9% increased or initiated steroid therapy, and 55.8% had an asthma action plan for attack. The number of hospital admissions in past year (OR 4.3, P = .02), use of home nebulizer (OR 3.6, P = .05) and the lack of a written asthma action plan (OR 3.3, P = .03) were independently associated with frequent visits to the ED. We conclude that a substantial proportion of the patients that visit the ED are FV. These patients are more likely to have hospital admission in the past year, to use a home nebulizer, and to lack a written asthma action plan. They should be considered the most important target for asthma education.     

Association Between Outpatient Follow-Up and Pediatric Emergency Department Asthma Visits

Background. The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that patients receive a follow-up outpatient asthma visit after being discharged from an emergency department (ED) for asthma. Objective. To measure the frequency of follow-up outpatient asthma visits and its association with repeat ED asthma visit. Design. We conducted a retrospective cohort study of children with asthma using claims data from a university-based managed care organization from 01 1998 to 10 2000. We performed a multivariate survival analysis using Cox proportional hazards model to determine the effect of follow-up outpatient asthma visits on the likelihood of a repeat ED asthma visit, after controlling for severity of illness, patient age, gender, insurance, and the specialty of the primary care provider. Results: A total of 561 children had 780 ED asthma visits. Of these, 103 (17%) had a repeat ED asthma visit within 1 year. Almost two-thirds of children (66%) did not receive outpatient follow-up for asthma within 30 days of an ED asthma visit. Outpatient asthma visits within 30 days of an ED asthma visit are associated with an increased likelihood (relative risk = 1.80; 95% confidence interval 1.19, 2.72) for repeat ED asthma visits within 1 year. Conclusions. Most patients do not have outpatient follow-up after an ED asthma visit. However, those patients that present for outpatient follow-up have an increased likelihood for repeat ED asthma visits. For the primary care provider, these outpatient follow-up visits signal an increased risk that a patient will return to the ED for asthma and are a key opportunity to prevent future ED asthma visits.     

应急指挥系统在SARS定点医院中的实践

当SARS袭击北京之际，北京市卫生局即将北京胸科医院定为收治SARS病人定点医院，成立了由卫生局直接领导的北京胸科医院应急指挥系统，加强了组织领导，从8所医院临时抽调医务人员1800余人加强胸科医院，并成立了救治专家组、隔离防护专家组、护理专家组、中医药治疗协作组。共收治SARS及其疑似者453人，至6月24日，转院22人，排除SARS诊断20人，死亡26人，其余全部痊愈出院。病死率为5．79％。实践证明：成立应急指挥系统对抗击SARS起到了重要的作用。今后国家应建立和京善奕发事件府急公共卫生系统．并建议三级以上的医院设置感染科或单独病区。     

用化学发光自显影技术快速检测鸭沙门氏菌

应用我室建立的化学发光自显影技术检测鸭沙门氏菌。用酶标抗体与硝酸纤维素膜上固定的细菌结合,再同发光底物溶液作用,使X线胶片感光,根据胶片上的黑斑进行半定量,可检出100个菌。其检测特异性好,约2小时即可出报告。     

重症急性胆管炎急症手术中胆总管末端狭窄的处理(附37例分析)

目的探讨急诊手术中胆总管末端狭窄的手术方法.方法回顾性分析553例急诊胆总管切开探查术中并发胆总管末端狭窄37例的临床资料.结果37例中行胆总管十二指肠吻合术29例;例出‘s括约肌切开成形术3例;单纯T管引流5例.随访27例,随访率75.7%,疗效满意.结论胆总管十二指肠吻合术及Oddi‘s括约肌成形术是治疗胆总管末端良性狭窄的良好术式,但各有利弊,而胆总管十二指肠吻合术更适于急诊手术及基层医院开展.严格掌握其适应症及手术原则是减少术后并发症的关键.     

Fluorotyping of HLA-C: differential detection of amplicons by sequence-specific priming and fluorogenic probing

Conventional PCR-SSP, which is based on an agarose gel-based read-out, has the disadvantages of time-consuming post-PCR steps and low potential for automation. The aim of our study was to sort out these drawbacks by establishing a fluorescence-based PCR-SSP system for HLA-C. The assay relies on the sequence-specific identification of amplicons with individually labeled probes that are cleaved during successful PCR by the 5'-3' exonuclease activity of the Taq-DNA Polymerase. The oligonucleotides are labeled with a unique and spectrally resolvable fluorescent reporter dye at the 5' terminus (FAM or TET) and a common quencher dye at the 3' terminus (TAMRA). In case of amplification, the reporter escapes from the quenching control caused by the physical separation of the dyes, resulting in a significant increase of the reporter fluorescence. This allows simultaneous and differential detection of the specific HLA (FAM) and internal control (TET) product. The HLA-C fluorotyping information is based on the individual reporter fluorescence released by 18 PCR primer mixes. Using this method, we analyzed 145 samples previously typed with conventional PCR-SSP and found a concordance rate of 100%. Furthermore, fluorotyping revealed quantitative results that may indicate the presence of homozygosity by high signal intensities. This provided extra protection not to miss new alleles which are not amplified by the current primer mixes. These features as well as the capability of high sample throughput and the possibility of automation makes fluorotyping an attractive tool for PCR-based HLA typing.     

聚合酶链反应检测淋球菌的临床应用

应用ＰＣＲ法对１１３例临床标本中淋球菌菌体内所特有的４．２ｋｂ隐蔽性质粒上的ｃｐｐＢ基因进行了检测。与直接涂片法相比，ＰＣＲ法的敏感性和特异性分别达１００％和８７．５％。     

基于DSP的远程监护终端系统的研究

阐述一种基于DSP的远程家庭监护终端的程序设计。包括心电的采集，用小波变换完成QRS波的检测，最后将心电波形数据和检测结果通过互联网传输到医院的心电服务器上。     

基于多分辨率分析的心电图QRS波检测

从多分辨率分析出发，构造出一个用于心电图R波检测的滤波器，并在此滤波器的基础上提出了一种新的R波检测算法。本文详细论述了滤波器的构造方法和新的R波检测算法的原理及在实现中采用的一些策略，经MIT-BIH标准心律失常数据库验证，该算法对于各种干扰尤其是肌电干扰具有很强的抑制能力。算法实现简单，计算量小，在ECG信号的脱机和实时处理程序中均可使用。