A bedside test for methaemoglobinemia improved antidote use in propanil poisoning

Background: In 2008, self-poisoning with the herbicide propanil had a case-fatality of around 11% in Sri Lanka. A simple quantitative methaemoglobinemia bedside test was developed so that treatment could be titrated according to the methaemoglobin level.

Objective: To determine whether the new method influenced patient management and changed the case fatality of propanil self-poisoning.

Method: The bedside test (using an inexpensive validated colour chart) was introduced in three hospitals (Anuradhapura, Polonnaruwa and Galle) in Sri Lanka from 2008. Junior ward staff were given a brief training on how to use the chart for quantitative estimation of methaemoglobin in patients with propanil poisoning and utilize the results in the context of the national treatment guidelines for propanil poisoning. It was taught that the bedside test should be done repeatedly from admission until it showed consistently low values of methaemoglobin. Treatment with the antidote methylene blue was suggested for patients whose methaemoglobin was greater than 20%. Limited clinical data on poisoning have been prospectively collected from these hospitals from 2003. The case-fatality and management before and after the change were compared with data up to December 2014.

Results: The case-fatality decreased from (38/401) 9.5% to (8/262) 3.1% [difference: ?6.4%, 95% CI: ?10 to ?3]. Methylene blue use increased from under 10% of patients before to 55% of patients after the intervention. More patients received repeat doses and infusions, and few received ascorbic acid and exchange transfusion.

Conclusion: The simple bedside test for methaemoglobinemia was readily adopted into routine practice and led to large changes in management. A substantial reduction in mortality from propanil poisoning occurred after this intervention.     

医疗查房与护理教学查房相结合在ICU护理教学中的应用

目的：探讨医疗查房与护理查房相结合在ICU护理教学中的应用。方法将120名护理本科实习生分为对照组和实验组各60名。对照组采用传统的查房模式,实验组采用医疗查房与护理教学查房相结合的查房模式,比较两组学生出科的专科理论知识及操作技能成绩、教学效果及自我评价。结果实验组专科理论知识及操作技能成绩、教学效果及自我评价均优于对照组( P<0.05)。结论医疗查房与护理教学查房相结合的方法在ICU临床教学中规范护理教学应用,有利于提高ICU的临床教学质量及培训学生的综合能力。     

抓住医护消费信息 建立特诊病房

报道运用社会主义市场经济机制，抓住医疗消费信息，开设特诊病房的经验，并重点介绍了特诊病房的设置、人员结构、疗护理管理细则、收费和分配原则等。     

护士长在病区管理中的"不和谐"因素分析与对策

在医疗护理活动中,营造和谐的医疗环境,对于提高医疗护理质量,满足病人需求至关重要。通过对护士长在病区管理中的“不和谐”因素分析,分别找出与科主任、医生、护士以及病人之间的“不和谐”因素,并制订相应的对策,充分发挥护士长的协调作用,从而保证各项医疗护理工作顺利开展。     

心理咨询热线在SARS隔离观察病房工作中的作用

探讨心理咨询热线在突发传染性疾病流行期对隔离观察患者心理干预技术的特色。对严重急性呼吸综合征隔离观察病房患者进行心理干预 ,为患者提供了情感宣泄、情感支持、情感交流、信息传递的渠道 ,对心理危机问题做到早发现、早处理。心理热线服务方式简便、快捷、有效 ,避免交叉感染。     

Primary nursing: staff perception of changes in ward atmosphere and role

The value of a primary nursing care delivery structure remains undecided. This study was carried out on an acute psychiatric admissions unit as it changed its care delivery system to that of primary nursing. A review of the literature highlights the inconclusive nature of previous investigations. The principle of evidence-based practice raises the need for further research to put this issue to rest. The staff perception of this change on both the atmosphere of the ward and on the role of the nurses themselves was analysed. A general reduction in satisfaction with role was discovered, as was a reduction in eight out of 10 subscales of the Ward Atmosphere Scale (Moos 1989). As primary nursing generally receives favourable reviews by nurses, and was in fact positively received by the staff in this study at the time of initiation, this negative result is surprising. It is conjectured that primary nursing may be an ideal philosophy of nursing that is difficult to realize due to constraints surrounding contemporary nursing practice.     

精神科开放式病房病人自杀危险因素调查

开放式精神科病房预防病人自杀自伤是护理管理中非常重要的内容之一。本文针对开放式住院病人的自杀危险因素调查,发现抑郁症占开放式病房住院总数的48.2%,开放式病人自杀危险评分为14.33±8.08,中度自杀危险性病人占29.5%,高度自杀危险性病人占15.8%。男女病人之间的自杀危险因素无显著差异(P>0.05);总自杀危险在51~60岁和21~30岁段评分最高,但P>0.05,无统计学差异;在各类自杀危险因素中,病人的自杀观念的评分最高2.33±2.06,有63.6%的病人存在自杀观念,其次是自杀企图(1.18±1.89,32.7%的病人存在)和无助、无望、自我评价低。在第二类危险因素中,病人的焦虑情绪评分较高0.87±0.67,而且70.9%的病人存在焦虑情绪。另外,自杀危险因素与年龄、诊断、职业、病程和婚姻有关,P<0.05或P<0.01。其中,第二类危险因素与年龄有关,P<0.01,第三类危险因素与诊断、住院次数和职业有关,P<0.05。上述结果提示,开放式精神科病房应高度重视病人的自杀危险,根据病人自杀危险的高危因素,开展针对性的预防,以保障病人的安全。     

Understanding the preterm human heart: What do we know so far?

Globally, preterm birth affects more than one in every 10 live births. Although the short-term cardiopulmonary complications of prematurity are well known, long-term health effects are only now becoming apparent. Indeed, preterm birth has been associated with elevated cardiovascular morbidity and mortality in adulthood. Experimental animal models and observational human studies point toward changes in heart morphology and function from birth to adulthood in people born preterm that may contribute to known long-term risks. Moreover, recent data support the notion of a heterogeneous cardiac phenotype of prematurity, which is likely driven by various maternal, early, and late life factors. This review aims to describe the early fetal-to-neonatal transition in preterm birth, the different structural and functional changes of the preterm human heart across developmental stages, as well as potential factors contributing to the cardiac phenotype of prematurity.     

N0tchl、N0tch2表达与移行细胞肿瘤恶变及发展关系的研究

目的研究Notch通路相关基因蛋白Notchl、Notch2在移行细胞肿瘤恶变中的作用。方法利用免疫组化SP法对比检测Notchl、Notch2在移行上皮乳头状瘤、具有恶性潜能的乳头状瘤、低级别尿路上皮癌、高级别尿路上皮癌各30例中的表达,并与其临床病理参数进行对比研究。结果各个级别肿瘤中均存在Notchl、Notch2的表达;Notchl在移行上皮乳头状瘤、具有恶性潜能的乳头状瘤、低级别尿路上皮癌、高级别尿路上皮癌中的阳性表达率呈现下降趋势,其阳性表达率随病变级别升高而明显降低;其表达水平与病变程度间存在明显负相关（r=-0．6791,P=0．0021）。Notch2在移行上皮乳头状瘤、具有恶性潜能的乳头状瘤、低级别尿路上皮癌、高级别尿路上皮癌中的阳性表达率呈现上升趋势,其阳性表达率随病变级别升高而明显增加;其表达水平与病变程度间存在明显正相关（r=0．6612,P=0．0001）。Notchl在尿路上皮癌中表达水平与组织学类型、浸润深度、淋巴结转移密切负相关（P〈O．05）,与肿瘤体积、TNM分期无关（P〉O．05）;Notch2表达水平与肿瘤体积、组织学类型密切相关（P〈O．05）,与淋巴结转移、TNM分期、浸润深度无关（P〉O．05）。Notchl和Notch2在移行细胞肿瘤不同病变中的表达水平的相关性分析显示：两者表达存在明显负相关（r=-0．6608,P〈0．05）。结论Notchl、Notch2介导的上皮间质转换参与移行细胞肿瘤恶变,同时两者在移行上皮癌变中发挥协同作用,与肿瘤发展密切相关。