安徽省420株结核分枝杆菌对一线和二线抗结核药物药敏结果分析

目的研究并分析安徽地区420例结核分枝杆菌对一线、二线抗结核药物菌耐药情况，为结核病临床治疗和结核病控制提供科学依据。方法采用绝对浓度法对420例结核分枝杆菌临床分离株进行一线、二线抗结核药物敏感试验。结果对一线抗结核药物总耐药率和耐多药率分别是29．05％和14．52％；其中初治耐药率和耐多药率分别是15．93％、6．79％，复治耐药率和耐多药率分别是52．86％、30．0％；RIF、INH、SM、EMB耐药率分别是22．14％、20．0％、17．38％和0．95％。抗二线结核药物总耐药率为22．62％，其中左氧氟沙星和丙硫乙烟胺的耐药率较高，分别为13．33％（56／420）和12．86％（54／420），年龄段41～60岁耐药率均显著高于其他年龄段（P〈0．05）；男性和女性病例组间均无统计学显著性差异（P〉0．05）。结论安徽地区结核菌耐药情况仍然十分严重，应加强抗结核药物的耐药性监测，同时根据药敏试验结果选择科学有效的化疗方案。     

EFFECTS OF EXERCISE-INDUCED FATIGUE WITH AND WITHOUT HYDRATION ON STATIC POSTURAL CONTROL IN ADULT HUMAN SUBJECTS

Postural instability can be the result of various factors, including fatigue. Although it is well known that exercise-induced fatigue may be responsible for a decrease in performance, its effects on postural control, as well as those of hydration, have been relatively little explored. This study evaluated the effects of fatigue, with and without rehydration, on postural control in 10 healthy subjects who regularly practice sports activities. All subjects were submitted to three types of ergocycle exercises: maximal oxygen uptake (Vo2max) and submaximal exercises in no-hydrated and hydrated conditions at a power corresponding to approximately 60% of the Vo2max of each subject. Static posturographic tests were performed immediately before (control) and after exercises. The postural control performance decreased from the best to the worst: control, hydration, dehydration, and Vo2max. Fast Fourier transformation of the center of foot pressure showed three patterns of amplitude spectral density, with an increase of spectral amplitude for dehydration, more important for Vo2max conditions. Spectral amplitudes for control and hydration conditions were relatively similar. This hierarchy suggests that fatigue mainly alters muscular effectors and sensory inputs, such as proprioception, resulting in poor postural regulation. Moreover, fluid ingestion could be responsible for the preservation of muscular functions and of sensory afferences accurately regulating postural control.     

应用知信行模式提高ICU护士对多重耐药菌感染防控的效果

目的观察应用知信行模式提高ICU护士对多重耐药菌感染防控的效果。方法成立防控小组,组织学习多重耐药菌感染相关知识,建立防控制度并逐一实施。结果实施后护士知信行问卷得分较实施前提高,多重耐药菌防控知识能力专项测评成绩也高于实施前,手卫生依从性由实施前59.8%提高到91.3%。结论知信行模式可提高ICU护士对多重耐药菌感染防控的效果。     

The Effects of Fatigue From Overnight Shifts on Radiology Search Patterns and Diagnostic Performance

PurposeThe aim of this study was to assess the effect of overnight shifts (ONS) on radiologist fatigue, visual search pattern, and diagnostic performance.MethodsThis experimental study was approved by the institutional review board. Twelve radiologists (five faculty members and seven residents) each completed two sessions: one during a normal workday (“not fatigued”) and another in the morning after an ONS (“fatigued”). Each radiologist completed the Swedish Occupational Fatigue Inventory. During each session, radiologists viewed 20 bone radiographs consisting of normal and abnormal findings. Viewing time, diagnostic confidence, and eye-tracking data were recorded.ResultsSwedish Occupational Fatigue Inventory results demonstrated worsening in all five variables (lack of energy, physical exertion, physical discomfort, lack of motivation, and sleepiness) after ONS (P < .01). Overall, participants demonstrated worse diagnostic performance in the fatigued versus not fatigued state (P < .05). Total viewing time per case was longer when fatigued (35.9 ± 25.8 seconds) than not fatigued (24.8 ± 16.3 seconds) (P < .0001). Total viewing time per case was longer for residents (P < .05). Mean total fixations generated during the search increased by 60% during fatigued sessions (P < .0001). Mean time to first fixate on the fracture increased by 34% during fatigued sessions (P < .0001) and was longer for residents (P < .01). Dwell times associated with true- and false-positive decisions increased, whereas those with false negatives decreased.ConclusionsAfter ONS, radiologists were more fatigued with worse diagnostic performance, a 45% increase in view time per case, a 60% increase in total gaze fixations, and a 34% increase in time to fixate on the fracture. The effects of fatigue were more pronounced in residents.     

Treatment of anaemia in cancer patients: implications for supportive care in the National Health Service Cancer Plan

SUMMARY

The National Health Service (NHS) Cancer Plan published in 2000 has a short-term focus on the most pressing problems of improving survival rates and replacing equipment. It also mentioned as a target 'improved quality of life for those affected by cancer'. Continuity of care for longer-term care programmes was seen predominantly in terms of palliative care. Recent National Institute for Clinical Excellence (NICE) reports may have reinforced this approach by focussing on the clinical and cost effectiveness of chemotherapy for late-stage cancer. The impact on local decision-makers has been that drug funds have been prioritised for use on survival-enhancing interventions, with few resources left for short and longer-term supportive care targeted primarily on improving quality of life. Within supportive care, resources are particularly limited for funding treatments such as erythropoietin for the management of cancer-related anaemia, a common and very debilitating side-effect of intensive therapy. The need for a re-focusing on supportive care is associated with cancer becoming, in many instances, a longer-term illness. The prevalence of

cancer is rising markedly due to increased survival rates. However, this creates a new challenge of reducing disability and improving quality of life. In surveys, patients have rated fatigue associated with anaemia as one of the most debilitating effects of their cancer and its treatment with chemotherapy. This paper reviews the evidence demonstrating the quality of life benefits of erythropoietin, and then considers the policy constraints that have limited the adoption of this treatment within the NHS. Through co-ordinated planning there are opportunities for cancer networks and primary care trusts (PCTs) working with cancer centres to develop more support in ways which are feasible and fundable. The case is argued that PCTs and cancer networks, in implementing the Cancer Plan locally, need to integrate short- and longer-term supportive care into their cancer service development plans, and recognise the importance of anaemia management as an integral part of this. Lessons can be learnt from UK renal services where anaemia management with erythropoietin is standard practice.     

耐甲氧西林金黄色葡萄球菌感染的流行病学调查、耐药性监测与预后因素分析

肥目的探讨耐甲氧西林金黄色葡萄球菌（MRSA）的流行分布和多药耐药趋势及预后相关因素，采取有效的医院管理措施。方法采用回顾性调查方法，VITEK-60全自动微生物分析系统进行细菌鉴定，K—B法做体外药敏试验，采用Logistic回归分析危险因素。结果445株金黄色葡萄球菌中MRSA检出率为46．96，其分离率有逐年增长的趋势（P〈0．05）；MR—SA检出率以老年痛科最高，其次重症监护病房，神经外科；药敏结果显示MRSA对万古霉素、利奈唑胺、替考拉宁全部敏感之外，对另外10种抗生素均不同程度耐药；多器官功能衰竭、住院时间长、长期大剂量使用广谱抗菌药物、机械通气、高龄、MRSA未清除、近期手术史是MRSA的独立危险因素，万古霉素、替考拉宁、利奈唑胺是MRSA感染的保护性因素。结论金黄色葡萄球菌耐药严重，MRSA的高检出率给临床治疗及控制医院感染带来较大困难；糖肽类抗菌药物可作为多药耐药金黄色葡萄球菌感染的首选抗菌药；MRSA感染的危险因素较多，尽早进行痛原学监测，及时发现、隔离和治疗对疾病预后有重要影响。     

A rapid,high‐throughput screening method for carriage of methicillin‐resistant Staphylococcus aureus

Rapid screening of methicillin‐resistant Staphylococcus aureus (MRSA) colonization prior to hospital admittance is important to reduce nosocomial infections and health care costs. Molecular detection of mecA and S. aureus specific target genes has become widely established for this purpose. However, there are still limitations in potential for high‐throughput screening in the methods described. We have compared the time aspects and workload of four different DNA preparation platforms, resulting in an automated and simple MRSA screening method which combines two liquid handling systems and a simple lysis buffer. We have further transferred our in‐house dual real‐time PCR to a fast‐PCR protocol, reducing the time and labour spent on these samples to a minimum.