全自动微生物鉴定药敏分析仪对临床相关细菌药敏测定能力的评估

目的评估Vitek 2 Compact全自动微生物鉴定药敏分析仪对临床相关革兰阴性菌和革兰阳性菌的药敏测定能力。方法选取89株北京协和医院临床菌株（革兰阴性菌48株，革兰阳性菌41株）和66株本实验室保存的参考菌株（革兰阴性菌41株，革兰阳性菌25株）为评估菌株，分别采用Vitek 2 Compact AST-GN09（革兰阴性菌）、AST-P536（葡萄球菌）、AST-P534（肠球菌和无乳链球菌）和AST-P533（肺炎链球菌）药敏卡进行药敏测定，测定结果与参考方法Etest结果进行对照。32株以CLSI纸片确证法检测为ESBL阳性的菌株（其中包括16株经PCR扩增测序确定产SHV或CTX-M型ESBLs的菌株），以Vitek 2 Compact检测其是否产ESBLs。结果根据临床和实验室标准协会（CLSI）规定的药敏折点，对Vitek 2 Compact和Etest法测得的药敏结果进行解释，在全部的1626株细菌一抗生素组合中，Vitek 2 Compact药敏测定的标准符合率（CA）为90．83％，严重错误（VME）为4．91％，重大错误（ME）为2．09％，一般错误（MIE）为6．40％。90％以上的肠杆菌科菌、非发酵糖菌、微球菌科菌和链球菌科菌分别在11、13、11和12h内完成测定。32株ESBL阳性菌以Vitek 2 Compact检测均为阳性。结论Vitek 2 Compact能够对临床相关革兰阴性菌和革兰阳性菌的药物敏感性进行准确、快速的测定，对ESBLs检测的敏感性、特异性高，是临床微生物实验室的有利工具。     

腹膜透析患者规范化健康指导的效果评价

目的:分析健康教育对腹膜透析(PD)患者并发症发生及生活质量的影响。方法:编写“腹膜透析患者归家前后指导”健康教育小册子,使护士对PD患者能进行规范化指导;对特殊人群强化口头指导;对120例PD患者在实施教育前后透析过程中存在的问题进行回顾性调查分析。结果:健康教育后患者感染发生率比教育前明显减少(P<0.01),且减少并发症的发生,使患者顺应性提高。结论:编写“腹膜透析患者归家前后指导”与口头健康教育指导相结合,能提高培训效果,减少并发症发生。     

The impact of international experience on student nurses' personal and professional development

Background: Many student nurses undertake international clinical experience during their education programmes, which raises the question ‘How do these experiences impact on students nurses’ personal and professional development?’ Method: A case study was conducted in one School of Nursing in the United Kingdom. Student nurses participating in a new module, International Nursing and Health Care, which included clinical experience overseas, gave qualitative accounts of their international experiences and subsequent learning. Their accounts were also compared with the perceptions and expectations of the module facilitators. Findings: While there were some similarities in student experience and facilitator expectations, there were also notable differences. The students believed that their international experiences had a deep impact on their personal development, helping them make the transition from student to qualified nurse. The case study raised further questions about the acquisition of cultural knowledge and the facilitation and provision of learning from experience.     

Evaluating evidence-based practice within critical care

Background and Aims: Between 2002‐2005 the Trust undertook an action research project to evaluate a corporate practice development strategy. During this period clinicians became practitioner‐researchers utilising a variety of methods to evaluate the influence of practice development. One aspect of this focused upon evaluation of evidence based guidelines. This article concentrates upon this process and the learning from this within critical care. Method: Within critical care it was recognised that the standard of guidelines and protocols varied in terms of the amount of evidence used to underpin decision making. A group was set up to evaluate and appraise these using a structured format such as the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Findings: The initial evaluation (cycle 1) highlighted learning associated with the process of using the instrument within critical care, as well as where the quality of the guidelines could be improved. The second cycle of evaluation demonstrated that implementation of the action plans as a consequence of cycle 1 resulted in an improvement in the quality of the guidelines. It also resulted in streamlining the process of undertaking guideline appraisal across a Trust. Discussion and Conclusions: Action resulting from analysis of the findings of cycle 1 led to a cultural change in which the structure of a tool such as the AGREE instrument could be beneficial in the development of future guidelines. This has been sustained both within critical care and Trust wide with various initiatives such as the establishment of critical care multidisciplinary guideline development groups and a Trust wide electronic library management system.     

XT-2000i全自动血液分析仪检测网织红细胞的评价与应用

目的评价Sysmex XT-2000i测定网织红细胞(Ret)的性能。方法用XT-2000i检测Ret,并与参考方法检测结果进行比较。结果XT-2000i检测Ret的精密度高(高、中、低值标本的批内和批间Cv%<5%),在1.58×109/L~273×109/L范围内线性良好(r=0.9952),互染率低(0.15%),与人工法相关性较好(r=0.9648),具有良好的敏感性,结论XT-2000i检测Ret具有快速、简便、准确、稳定、精密度高等特点。     

Prevalence of Apparent Treatment-Resistant Hypertension in the United States According to the 2017 High Blood Pressure Guideline

ObjectiveTo evaluate the prevalence of apparent treatment-resistant hypertension (aTR-hypertension) in US adults with treated hypertension by using the nationally representative National Health and Nutrition Examination Survey (NHANES).Patients and MethodsNonpregnant US adults older than 20 years with a self-reported history of treated hypertension who had blood pressure measured in NHANES cycles 2007 to 2014 were included in this study. Study participants were stratified into 4 groups according to average blood pressure and antihypertensive medication use: well-controlled hypertension, undertreated hypertension, aTR-hypertension by the 2017 guideline, and aTR-hypertension by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guideline. National Health and Nutrition Examination Survey sample weights were used to estimate the national prevalence.ResultsFrom 2007 to 2014, 5512 participants with treated hypertension representing 46.7 million people nationally were included. Compared with JNC 7 guideline criteria, application of the 2017 high blood pressure guideline criteria increased the prevalence of aTR-hypertension in US adults with treated hypertension from 12.0% to 15.95%, identifying an additional 1.85 million individuals with aTR-hypertension nationally. Individuals newly reclassified as having aTR-hypertension were younger. However, the prevalence of thiazide diuretic use remained less than 70%, and that of mineralocorticoid antagonist use remained less than 10% regardless of the guideline definition.ConclusionOn the basis of the 2017 high blood pressure guideline, the prevalence of aTR-hypertension is 15.95% in US adults with treated hypertension. This represents an absolute increase of 4% (1.85 million additional individuals nationally) compared with the JNC 7 guideline definition, with a consistent increase across all subpopulations with treated hypertension.     

多支架植入治疗恶性高位梗阻性黄疸

目的:评价高位恶性梗阻性黄疸多支架治疗的疗效及临床价值。材料与方法:26例高位恶性梗阻性黄疸。经单侧穿刺放置2枚支架18例,双侧穿刺放置支架8例,其中5例放置2枚支架,3例放置3枚支架,共植入支架51枚。结果:所有病例均一次完成支架植入,技术成功率100%。治疗后总胆红素由318.5±67.7μmol/L降至142.6±49.3μmol/L,无严重并发症发生。结论:多支架植入有利于提高高位恶性梗阻性黄疸的减黄效果,有利于进一步提高病人的生存质量和延长生存期。     

CT灌注成像在星形细胞瘤术后随访检查中的价值

目的研究星形细胞瘤术后CT灌注检查的应用价值.方法星形细胞瘤部分切除术后19例,放射治疗前后常规CT及CT灌注检查;星形细胞瘤全切术后26例,CT灌注随访检查.结果残留肿瘤放疗后,低级星形细胞瘤仅PS值下降;高级星形细胞瘤的CBF、CBV和PS均下降 (P<0.05). 星形细胞瘤全切后,手术区与正常脑白质的CBF、CBV和PS差异无显著性意义(P>0.05).结论 CT灌注成像可监控残留星形细胞瘤放疗的效果.     

MRTA在三叉神经痛病因学诊断中的应用研究

目的探讨三又神经痛患者血管压迫的MRTA（磁共振断层血管成像）表现及其病因诊断价值。方法对216例临床上诊断为三叉神经痛的患者术前行MRTA检查，均行微血管减压术，MRTA表现并与手术结果进行对照。结果216例三叉神经痛患者MRTA显示有208例在患侧有血管接触后压迫：小脑上动脉80例（37．04％），小脑前下动脉36例（16．67％），小脑后下动脉17例（7．87％），基底动脉39例（18．05％），多根血管32例（14．81％），未发现血管12例（5．56％）；手术所见216例均有血管接触或压迫：小脑上动脉75例（34．72％），小脑前下动脉33例（15．28％），小脑后下动脉15例（6．95％），基底动脉38例（17．59％），多根血管34例（15．74％），动脉＋静脉14例（6．48％），静脉7例（3．24％）。结论MRTA能清晰显示三叉神经脑池段与毗邻血管之间的关系，对三叉神经痛患者是否有血管接触或压迫的判断具有较高的敏感度和准确度，为手术医生提供术前评估和指导术中治疗有重要价值。     

主动脉狭窄性病变血管内支架植入术的临床观察

目的对主动脉狭窄性病变的血管内支架(ES)植入术进行疗效观察与评价.方法 14例主动脉狭窄患者,包括大动脉炎(TA)10例,动脉粥样硬化(AS)1例,先天性主动脉缩窄(CoA)3例,均行经皮血管内支架植入术.术后随访10～102个月.结果 14例血管内支架植入术治疗成功率为100%.术后即刻疗效好,跨狭窄处收缩压差由术前(70.00±24.33) mmHg降至(2.43±3.76)mmHg(P<0.01),术前与术后主动脉狭窄段最窄处直径由(5.57±1.45)mm增至(12.28± 2.09)mm(P<0.01).随访12例疗效满意;1例TA转为活动期;1例CoA症状反复行外科手术治疗.结论血管内支架植入术治疗主动脉狭窄性病变可获得满意的临床效果.