The evaluation of an undernutrition risk score to be used by nursing staff in a teaching hospital to identify surgical patients at risk of malnutrition on admission: a pilot study

Background The purpose of this study was to evaluate an undernutrition risk score (URS) developed by the Dietetic Department of an acute tertiary referral hospital in Dublin with the aim that the URS could be used by nursing staff, to identify surgical patients at risk of malnutrition on admission.
Methods Forty surgical patients (16 males and 24 females) were recruited, within 5 days of admission. A standard objective nutritional assessment was carried out on each patient. This consisted of a 3-day diet history, anthropometric indices including: weight, armspan, mid-upper arm circumference, mid-arm muscle circumference and hand grip dynamometry. A nutrition risk index (NRI) screening tool was also used by a single observer to categorize patients as having low, moderate or severe risk of malnutrition. The indices used for the NRI were serum albumin and percentage weight loss. The URS assessed patients with respect to changes in weight and appetite, gut function and disease status and was completed by nursing staff by interview for each of the patients recruited.
Results The URS was successful in detecting 71.4% ( n  = 10) of surgical patients who were classified as being at some risk (moderate/severe) for undernutrition by the NRI. However, 11.8% ( n  = 4) of the patients who were categorized by the NRI as being at moderate risk for undernutrition were classified as being at low risk by the nursing staff using the URS. The URS was found to be most sensitive in the detection of those at low or severe risk for undernutrition and least sensitive for those at moderate risk.
Conclusion The undernutrition risk score in this study provided an accurate and consequently useful screening tool that could be used for surgical patients who are capable of feeding themselves independently.     

结核病病例发现工作考核指标体系的研制和论证

目的研制和论证一套结核病病例发现工作考核指标。方法焦点组讨论、头脑风暴法和结核病防制机构意向调查。结果得到10项结核病病例发现工作考核指标和4项关键指标。结论该套指标体系为考核和评价结核病病例发现工作提供了依据。     

ATP生物荧光技术对复用医疗器械清洗效果评价研究

目的研究生物荧光技术用于医疗器械清洗效果评价。方法利用ATP生物荧光技术对全省67家医院的部分复用医疗器械清洗效果进行检测和评价。结果从67家医疗机构共抽样121件清洗后医疗器械,检出带齿类器械ATP光单位中位值为545 RUL,清洗质量合格率为74.42%;检出不带齿类器械ATP光单位中位值为457 RUL,合格率为64.29%;检出管腔类器械ATP光单位中位值为12 523 RUL,合格率为42.86%。结论 ATP生物荧光技术用于医疗器械清洗质量评价具有快速、科学和实用性,检测结果能部分反应实际清洗质量。     

湖北省2008年血吸虫病疫情控制考核评估

目的考核评估湖北省预防控制血吸虫病中长期规划防治目标和效果。方法分析湖北省2007、2008年血吸虫病疫情控制资料;查阅和审核15个县(市、区)(以下简称县)2004-2008年血吸虫病防治资料;每县随机抽取3个流行村,现场调查人、畜血吸虫病感染情况,资料整理和归档情况,考核和评估血吸虫病疫情现状。结果防治资料表明全省5408个流行村人群、家畜感染率均降至5%以下。15个县、45个抽样村2004-2007年资料均为合格;2008年资料整理系统、规范,得分均>70分,建立了以村为单位的反映疫情变化的档案资料。现场考核的15个县3279个流行村的人畜感染率均降至5%以下,其中人群感染率≥1%的村2544个(占77.58%),<1%的村578个(占17.63%),为0的157个(占4.79%),人群平均感染率最高的是公安县(3.72%),家畜(耕牛)感染率最高的是沙市区(3.51%)。现场调查45个流行村,人畜感染率均在5%以下,其中人群感染率最高的3个村分别为公安县积玉村(2.98%)、嘉鱼县复阳村(2.50%)、潜江市进步村(2.46%)。耕牛感染率最高的3个村分别为江陵县花彭村(3.51%)、监利县烟灯村(2...     

军队医院聘用护士实施专业技术职务评聘分开的体会

笔者对目前护理队伍存在的问题及护理队伍管理现状进行了分析，指出在军队医院聘用护士中实施专业技术职务评聘分开的必要性，阐述了实施评聘分开的具体做法：(1)建立并完善评聘分开制度，设立岗位聘任委员会，拟定聘任实施细则，对拟聘人员进行审定并实施聘任。(2)从任期、岗位聘任条件、岗位任期内应完成的工作和应达到的学术水平、聘任办法、岗位聘任后的待遇5个方面制订了具体的实施办法。体会：(1)稳定了护理队伍。(2)构建了合理的护理职称结构。     

念珠菌乳胶免疫层析法的性能评价

目的评价念珠菌乳胶免疫层析法检测试剂盒(以下简称念试剂)检测阴道分泌物中念珠菌的性能和种属特异性。方法采用涂片/革兰染色法和念试剂检测354例怀疑为念珠菌阴道炎妇女阴道分泌物和9种属22种阴道常见感染微生物,并与涂片/革兰染色法半定量比较,评价念试剂的临床标本检测性能及种属特异性。结果与涂片/革兰染色法相比,念试剂的灵敏度为93.81%,特异度为99.10%,准确性97.31%,阳性预期值为98.14%,阴性预期值为96.90%;与涂片/革兰染色法半定量相比,该念试剂检测阴道分泌物中的念珠菌在标本中念珠菌浓度较低时仍然具有较高的特异度、可接受的灵敏性;在种属特异度评价,6种念珠菌阳性,其他16种阴道常见感染微生物均为阴性。结论念试剂检测阴道分泌物中念珠菌具有较高的临床和种属特异度、灵敏度、阳性预测值和阴性预测值。     

围术期疲劳测评量表用于大肠癌患者癌因性疲乏评估的实证研究

目的检验围术期疲劳测评量表(identity-consequence fatigue scale,ICFS)用于大肠癌患者癌因性疲乏测量的实证效度和信度。方法 2012年12月至2013年6月,使用ICFS和Piper疲乏修订量表对111例大肠癌患者进行癌因性疲乏评估。采用Cronbachα系数评价量表的内部一致性信度,相关性分析和区分度分析评价量表的实证效度。结果 ICFS总的Cronbachα系数为0.831,5个子量表的Cronbachα系数在0.687~0.921之间;相关性分析显示,ICFS疲乏症状、疲乏结果及总得分与Piper量表总得分之间的相关系数分别为0.679、0.568、0.749,区分度分析显示ICFS能区分不同TNM分期和是否化疗患者的癌因性疲乏程度。结论 ICFS具有良好的内部一致性和实证效度,用于评估大肠癌患者的癌因性疲乏有效、可靠。     

运用隶属函数对医疗质量进行综合评价

目的 对医疗质量进行综合评价。方法 运用隶属函数构造数学模型,再进行模糊合成。结果 用该法对某医院1995、1996、1997三年的医疗质量进行了综合评价。结论 该法能客观反映实际情况,是一种较好的综合评价方法。     

连续性肾脏替代治疗机的应用与维护

通过多例急、慢性肾功能患者使用连续性肾脏替代治疗机治疗,介绍意大利prisma(CRRT)机的应用与维护要点。     

Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies：A review of the literature

Eosinophilic esophagitis （EE） and gastroesophageal reflux disease （GERD） have overlapping clinical, manometric, endoscopic and histopathologic features. The diagnosis of EE is nowadays based upon the presence of 15 or more eosinophils per high power field （eo/HPF） in esophageal biopsies. We report the cases of two young males suffering from dysphagia and recurrent food impaction with reflux esophagitis and more than 20 eo/HPF in upper-mid esophagus biopsies, both of which became asymptomatic on proton pump inhibitor （PPI） therapy. The first patient also achieved a histologic response, while EE remained in the other patient after effective PPI treatment, as shown by 24-h esophageal pH monitoring. Topical steroid therapy combined with PPI led to complete remission in this latter patient. GERD and EE may be undistinguishable, even by histology, so diagnosis of EE should only be established after a careful correlation of clinical, endoscopic and pathologic data obtained under vigorous acid suppression. These diagnostic difficulties are maximal when both diseases overlap. Limited data are available about this topic, and the interaction between EE and GERD is a matter of debate. In this setting, upper-mid esophagus step biopsies and esophageal pH monitoring of patients on PPI therapy are pivotal to evaluate the role of each disease. A PPI trial is mandatory in patients with a histopathologic diagnosis of EE; in those unresponsive to PPI treatment, EE should be suggested. However, a clinical response to PPI may not rule out quiescent EE, as shown in this report.