Handoff strategies in settings with high consequences for failure: lessons for health care operations.

OBJECTIVE: To describe strategies employed during handoffs in four settings with high consequences for failure. DESIGN: ANALYSIS: of observational data for evidence of use of 21 handoff strategies. SETTING: NASA Johnson Space Center in Texas, nuclear power generation plants in Canada, a railroad dispatch center in the United States, and an ambulance dispatch center in Toronto. MAIN MEASURE: Evidence of 21 handoff strategies from observations and interviews. RESULTS: Nineteen of 21 strategies were used in at least one domain, on at least an 'as needed' basis. CONCLUSIONS: An understanding of how handoffs are conducted in settings with high consequences for failure can jumpstart endeavors to modify handoffs to improve patient safety.     

子宫内膜异位症中单核-巨噬细胞分泌VEGF水平的研究

目的 :探讨单核 -巨噬细胞分泌血管内皮生长因子(VEGF)的水平在子宫内膜异位症(内异症)发病机制中的作用。方法 :采用酶联免疫吸附试验 ,检测20例内异症患者 (内异症组Ⅱ期2例 ,Ⅲ期8例 ,Ⅳ期10例 )、30例非内异症患者 (对照组 )外周血单核细胞及腹腔液巨噬细胞培养上清液中VEGF的含量。结果 :内异症组腹腔液巨噬细胞培养上清液中VEGF的含量高于对照组 (P<0.05),而外周血单核细胞培养上清液中VEGF的含量与对照组差别无统计学意义。各期内异症组外周血单核细胞及腹腔液巨噬细胞分泌VEGF的水平差别无统计学意义 ,与AFS -r评分无关。结论 :内异症患者主要通过腹腔液巨噬细胞分泌高水平的VEGF ,促进异位内膜的黏附、种植 ,VEGF的分泌水平与临床分期无关。     

正常人血清瘦素水平及其与性别、体质量指数和腰臀比的关系

目的:研究正常人群血清瘦素水平及其与性别、体质量指数(BMI)和腰臀比(WHR)的关系。方法:以我市体检人群中的300例志愿者作为研究对象,并根据体质量分为正常组155例和肥胖组142例,测定血清瘦素(RIA法)、身高、体质量、腰围和臀围。结果:正常组的血清瘦素水平不服从正态分布,中位数6.66μg/L,正常组81例女性瘦素中位数为8.89μg/L,双侧90%瘦素浓度范围为5.43～15.39μg/L;74例男性瘦素中位数为3.15μg/L,双侧90%瘦素浓度范围为0.25～9.99μg/L。BMI与性别因素对血清瘦素水平均有显著影响,两者比较差别有统计学意义(P<0.001)。肥胖组的血清瘦素水平呈正态分布,男性血清瘦素为(9.14±4.77)μg/L;女性血清瘦素为(19.34±10.90)μg/L。女性和男性的BMI、WHR均与瘦素浓度呈线性相关。结论:血清瘦素浓度性别差异显著,与BMI及WHR显著相关,肥胖组血清瘦素浓度比正常组显著升高。     

Metabolic risk factors in patients with ureteropelvic junction obstruction and renal calculi

PURPOSE: We performed a prospective study to determine the incidence and spectrum of metabolic abnormalities predisposing to stone formation in patients with ureteropelvic junction obstruction and renal calculi. MATERIALS AND METHODS: A total of 47 consecutive patients with congenital ureteropelvic junction obstruction underwent metabolic evaluation of stone risk factors. Of these patients 21 had associated stones (study group), while 26 did not (control group). Logistical regression, Wilcoxon rank sum and Fisher's exact tests were performed to determine whether there was a significant difference between these groups in regard to the presence of metabolic risk factors. RESULTS: Demographically and symptomatically the 2 groups were equivalent except that the study patients were older. The 24-hour urinary excretion of calcium was significantly higher in study than in the control patients (p = 0.007). While the incidence of hypercalciuria and hyperuricosuria was also higher in the study population, these differences were not significant (p = 0.08 and 0.07, respectively). CONCLUSIONS: Metabolic abnormalities predisposing to stone formation are present more frequently in patients with ureteropelvic junction obstruction who have associated stones compared to those who do not. As such, urinary stasis alone does not explain stone formation in these cases. Rather, the local physiological environment of urine likely has a predisposing role. In addition to restoring unobstructed urinary flow, consideration should be given to metabolic evaluation and prophylactic treatment for affected patients.     

Socioeconomic status and prevalence of allergic rhinitis and atopic eczema symptoms in young adolescents

Environmental factors are known to influence the development of allergic rhinitis and atopic eczema in genetically susceptible individuals. Socioeconomic status (SES) may be an important indicator of risk for these conditions. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase 1 written questionnaire was used to determine the prevalence and severity of allergic rhinoconjunctivitis and atopic eczema symptoms in 4947 pupils aged 13-14 years attending 30 schools in socioeconomically diverse areas of Cape Town. Home addresses were used to stratify participants into five SES bands. Relationships between symptom prevalence and severity, and SES, recent urbanization and upward socioeconomic mobility were examined. Logistic regression was used to generate odds ratios (OR) and 95% confidence intervals (CI) in order to assess overall trends by SES. The prevalences of self-reported allergic rhinitis symptoms and recurrent itchy rash in the past year were 33.2% and 11.9% respectively. Girls had a significantly higher prevalence of all symptoms than boys. The prevalence of allergic rhinitis symptoms increased from lowest to highest SES (overall OR for rhinitis symptoms in past year = 1.16, 95% CI 1.11-1.21). There was no significant trend in reported eczema symptoms by SES other than for the question, 'Have you ever had eczema' (OR = 0.88, 95% CI 0.83-0.93). Longer period of urbanization was weakly associated only with recurrent itchy skin rash (OR = 1.05, 95% CI 1.01-1.09). 'Socially mobile' pupils, i.e. those resident in the lowest SES areas but attending highest SES schools showed significantly higher prevalences of eczema and some rhinitis symptoms than pupils attending lowest SES schools. These findings may reflect differences in reporting related to language, culture and access to medical care rather than real differences in prevalence.     

男性参与计划生育状况及其影响因素分析

目的:分析男性参与计划生育状况及其影响因素。方法:对全国31个省16 994名已婚育龄妇女进行问卷调查。结果:近10年来,有48.05%的男性与妻子讨论过避孕,25.75%的男性参加过计划生育/生殖健康培训,14.90%的男性参与避孕方法决策,27.59%的男性曾经使用过避孕套,5.10%的男性采用男性绝育术。多因素分析结果提示:男性参与与居住地(城镇/农村)、本人或妻子的文化程度等有较大关联。结论:我国男性尤其是农村男性参与计划生育程度有待提高。建议加大男性参与宣传教育的力度,扩展男用避孕方法种类以及全面推进避孕方法知情选择。     

雌激素和血管内皮细胞生长因子促进血管瘤增殖的体外实验研究

目的：研究雌二醇(E2)和血管内皮细胞生长因子(VEGF)在促进血管瘤血管内皮细胞(HVEC)增殖中的作用和相互关系，以及4羟基他莫昔芬(4OH—TAM)对该促进作用的影响。方法：取2例雌激素受体阳性的皮肤增生期草莓状血管瘤标本，采用组织块培养法培养HVEC。HVEC原代及传代培养在M199培养液中进行，传至第三代时改用无雌激素培养液IMEM进行干预实验，实验分5组：组1(无干预，为对照组)、组2(加E2)、组3(加VEGF)、组4(加E2和VEGF)、组5(加E，、VEGF和4OH—TAM)。分别在0、3、6、9d进行细胞计数(CC)和流式细胞仪DNA增殖指数(PI)检测。结果例1在第9d时，组2示HVEC轻微增殖，CC和PI分别为组1的1．38倍和1．61倍；组3示CC及PI明显增加，分别为组2的2．10倍和1．61倍；组4示OC及PI的增加更加显著，分别是组3的1．62倍和1．40倍；组5的OC和PI与组1相仿。例2的实验结果与例1相似。结论：体外实验显示雌激素能够轻微促进HVEC增殖；VEGF可明显促进HVEC增殖；而雌激素和VEGF同时存在时，对HVEC的促增殖作用更加显著，二者存在协同作用；他莫昔芬能抑制这种协同促增殖作用。     

影响大规模疫苗接种的社会经济因素分析

目的 了解影响成人疫苗接种率的有关社会经济影响因素。方法 选择广西河池市2个城镇，对5～60岁登记在册居民按有对照的组群随机抽样原则进行伤寒Vi疫苗和A群流脑疫苗的大规模接种；比较接种者的人口学和社会经济特征与接种率的关系。结果 应接种对象118071人，实际接种92476人，接种率为78．32％，其中伤寒Vi疫苗76．87％；流脑疫苗79．69％。城市接种率为77．29％，农村接种率为80．58％；5～9岁接种率最高，为89．65％；20～29岁组最低，仅为69．07％；男女接种率分别为79．07％和82．11％；高收入住户人群接种率最高达到90％左右；18～60岁人群中，按受教育程度分析以“小学毕业”人群接种率最高，为78．34％；按居住单元分析，学生的人群接种率最高，达92．01％，私营业主和退休人群接种率最低，分别为69．71％和68．82％；居住未满1年者的人群接种率最低．为62．5％．居住1～2年者接种率最高，为84．47％。结论 受教育程度、经济收入、居住年限以及城乡差别对接种率并无直接影响；流动性大、老年人是影响疫苗接种率的主要因素。