国内首例达芬奇机器人单孔肾上腺肿瘤切除术的护理配合

目的：探讨国内首例行达芬奇机器人单孔肾上腺肿瘤切除术的护理配合方法。方法：总结我院1例达芬奇机器人单孔肾上腺肿瘤切除术患者的手术护理配合方法。结果：患者手术过程顺利,手术成功,于术后10天顺利出院。结论：达芬奇机器人单孔肾上腺肿瘤切除术具有创伤小、出血少、疼痛减轻、术后恢复快等优势,值得推广。     

预先离断尿道黏膜的整块剜除法在中小体积前列腺剜除术中的应用

目的:探讨预先离断尿道黏膜的整块剜除法在中小体积前列腺增生患者经尿道钬激光前列腺剜除术(HoLEP)中的疗效及安全性。方法:回顾性分析2016年7月至2018年7月应用钬激光预先分离前列腺尖部尿道黏膜的整块剜除法进行HoLEP手术的中小体积前列腺增生症50例患者的资料,评估该手术方法的适用范围、优点、疗效及并发症情况。结果:50例手术均成功,手术时间(36.5±12.2)min,切除腺体质量(29±13.2)g。术后第1天血红蛋白为(119±15.2)g/L,术后4周前列腺症状评分(9.4±3.6)分、最大尿流率(22.5±2.3)mL/s、剩余尿量(23.4±9.2)mL、生活质量评分(2.4±1.4)分,均较术前明显改善(P0.05)。术后4例(8.0%)主诉出现尿频、尿急症状,3例(6.0%)出现短暂压力性尿失禁。结论:预先离断尿道黏膜的钬激光整块剜除法手术解剖标志明晰、操作简便、疗效肯定,能有效避免尿道黏膜撕脱损伤和杠杆拉伤,尿失禁并发症发生率较低,对治疗中小体积前列腺增生简单、实用。     

Impact of Hepatitis A vaccination with a two-dose schedule in Panama: Results of epidemiological surveillance and time trend analysis

PurposeIn April 2007, Panama introduced Hepatitis A universal vaccination using a two-dose schedule (Havrix^® junior; GSK Vaccines, Belgium). We assessed the impact of this hepatitis A vaccine three years after it was recommended for universal mass vaccination in Panama.Materials and methodsHepatitis A vaccination impact was assessed using two different approaches. The first approach used retrospective data (incidence and number of cases for all age groups), collected from the passive surveillance of the Epidemiologic Surveillance System of the Ministry of Health of hepatitis A and unspecified hepatitis before (2000–2006) and after (2008–2010) introduction of hepatitis A vaccine. The second approach was a prospective hospital-based active surveillance for hepatitis cases conducted in subjects (0–14years) during 2009–2011 at three sentinel hospitals in Panama.ResultsOverall, the annual incidence of hepatitis A and unspecified hepatitis in 2008, 2009 and 2010 were 13.1, 7.9 and 3.7 per 100,000 subjects, lower than the baseline incidence of 51.1 per 100,000 subjects. In comparison to the mean baseline period (2000–2006), there was an 82% mean reduction in the overall hepatitis-related outcomes (hepatitis A and unspecified hepatitis) after vaccine introduction (2008–2010) in all age groups.In the hospital-based surveillance (2009–2011), of the 42 probable viral hepatitis A cases, nine cases were confirmed as acute hepatitis A (8 in 2009, 1 in 2010). Of these confirmed cases, two belonged to the targeted vaccine group (1–4 years) but were not vaccinated.ConclusionsOur study suggests that the introduction of two-dose hepatitis A vaccines in Panama has contributed to the reduction in the incidence of overall hepatitis-related outcomes for all age groups, suggesting herd protection. Additional monitoring is required to document a sustained long-term effect.     

Hybrid forum or network? The social and political construction of an international ‘technical consultation’: Male circumcision and HIV prevention

The technical consultation in Montreux, organised by World Health Organization and UNAIDS in 2007, recommended male circumcision as a method for preventing HIV transmission. This consultation came out of a long process of releasing reports and holding international and regional conferences, a process steered by an informal network. This network's relations with other parties is analysed along with its way of working and the exchanges during the technical consultation that led up to the formal adoption of a recommendation. Conducted in relation to the concepts of a ‘hybrid forum’ and ‘network’, this article shows that the decision was based on the formation and consolidation of a network of persons. They were active in all phases of this process, ranging from studies of the recommendation's efficacy, feasibility and acceptability to its adoption and implementation. In this sense, this consultation cannot be described as the constitution of a ‘hybrid forum’, which is characterised by its openness to a debate as well as a plurality of issues formulated by the actors and of resources used by them. On the contrary, little room was allowed for contradictory discussions, as if the decision had already been made before the Montreux consultation.     

Contribution of rivaroxaban to the international normalized ratio when switching to warfarin for anticoagulation as determined by simulation studies

Aim

This study evaluated the influence of rivaroxaban 20 mg once daily on international normalized ratio (INR) during the co-administration period when switching from rivaroxaban to warfarin.

Methods

We developed a calibrated coagulation model that was qualified with phase I clinical data. Prothrombin time and INR values were simulated by use of phospholipid concentrations that matched Neoplastin Plus® and Innovin® reagents. To simulate the combined effects of rivaroxaban and warfarin on INR during switching, warfarin initiation was simulated by adjusting the magnitude of the warfarin effect to reach the desired target INRs over the course of 21 days. The warfarin effect values (obtained every 6 h) and the desired rivaroxaban plasma concentrations were used. Nomograms were generated from rivaroxaban induced increases in INR.

Results

The simulation had good prediction quality. Rivaroxaban induced increases in the total INR from the warfarin attributed INR were seen, which increased with rivaroxaban plasma concentration. When the warfarin only INR was 2.0–3.0, the INR contribution of rivaroxaban with Neoplastin Plus® was 0.5–1.2, decreasing to 0.3–0.6 with Innovin® at median trough rivaroxaban plasma concentrations (38 μg l⁻¹).

Conclusions

The data indicate that measuring warfarin induced changes in INR are best performed at trough rivaroxaban concentrations (24 h after rivaroxaban dosing) during the co-administration period when switching from rivaroxaban to warfarin. Furthermore, Innovin® is preferable to Neoplastin Plus® because of its substantially lower sensitivity to rivaroxaban, thereby reducing the influence of rivaroxaban on the measured INR.     

Fluoride in drinking water and diet: the causative factor of chronic kidney diseases in the North Central Province of Sri Lanka

A significant number of people in the North Central Province of Sri Lanka suffer from chronic kidney diseases (CKD), and the author revisits existing literature related to CKD to find its causative factor. There is a direct connection between high fluoride levels in drinking water and kidney disease, and there are unhealthy levels of fluoride in the groundwater in Sri Lanka’s CKD-affected areas. Based on the following observations, the author believes with confidence that excess fluoride in drinking water and in the locally grown food in the affected areas are the culprits of CKD in Sri Lanka.

• Fluoride excretion rate is considerably lower in children than adults, leading to renal damage of children living in areas with high fluoride.
• Adults who had renal damage due to fluoride in childhood are vulnerable to CKD with continued consumption of water from the same source.
• Patients with chronic renal insufficiency are at an increased risk of chronic fluoride toxicity.
• High content of fluoride in groundwater paves the way to excess fluoride in local food crops, consequently adding more fluoride to the systems of the consumers.
• People who work outdoors for prolonged periods consume excess water and tea, and are subjected to additional doses of fluoride in their system.
• In the mid-1980s, the increase in water table levels of the affected areas due to new irrigation projects paved the way to adding more fluorides to their system through drinking water and locally grown foods.

     

2013年连州市农村饮水安全工程水质卫生状况调查

目的了解连州市2013年农村饮水安全工程水质卫生状况,为有效运行管理提供依据。方法对连州市12个乡镇的185个农村饮水安全工程水质卫生状况进行调查,随机抽取45个监测点,分别于枯水期和丰水期采集出厂水和末梢水进行检测。结果全市185宗农村饮水安全工程中,具备完全水处理工艺工程的占11.35%,大多数工程仅对水质沉淀、过滤处理;日供水量300t的占70.05%,82.17%的工程未对水质进行消毒或有效消毒。共采集180份,合格率60.56%,枯水期、丰水期水质分别为52.22%、68.89%,不同采样时期、水处理方式、供水能力、消毒情况合格率差异均有统计学意义(P值均0.05)。主要超标项目是微生物学指标。结论连州市农村饮水安全工程水质合格率偏低,微生物污染较为严重,存在传播介水传染病的隐患。     

基层医疗卫生机构建立继续医学教育合作平台的思考

根据部队基层医疗卫生机构开展继续医学教育的实际困难,结合军队医院优势资源,建立继续医学教育合作平台,运用多种形式开展继续医学教育,提升基层医疗卫生机构人员的技能水平,进而提高保障能力.     

深化教学模式改革以培养德技双馨人才--以黑龙江护理高等专科学校教改为例

探讨高等专科学校教学模式改革问题。以黑龙江护理专科学校为例,总结分析教学模式改革经验。该校自2010年由中专学校合并升格以来,积极贯彻国家职教文件精神,围绕培养德技双馨高技能人才目标,在深化教学模式改革方面做了创新性和具有成效的改革尝试。