Review of gout clinic in a tertiary hospital setting

Although updated consensus guidelines, and effective therapies, are available for management of gout, suboptimal management remains an issue. Barriers were identified and addressed as part of a dedicated, structured gout clinic. More frequent appointments resulted in a faster rate of serum urate reduction, and the clinic provided the opportunity for the education of both patients and general practitioners in the management of gout.     

Potential efficacy of garlic lock therapy in combating biofilm and catheter-associated infections; experimental studies on an animal model with focus on toxicological aspects

BackgroundLife-threatening central venous catheter-related infections are primarily initiated by biofilm formation on the catheter surface. Antibiotic lock therapy is recommended for eradicating intraluminal biofilm. In the era of antibiotic resistance, antibiotics of natural origins provide an effective and cheap option for combating resistant strains. Garlic especially stole the spotlight because of its impressive antimicrobial effectiveness against such superbugs.AimIs to estimate the potential use of fresh garlic extract (FGE) as a lock agent against multi-drug resistant (MDR) bacteria.MethodsThe agar well diffusion and broth microdilution techniques were employed to test the antimicrobial activities of FGE against five MDR strains; E. coli, Pseudomonas aeruginosa (P. aeruginosa), Klebsiella pneumoniae (K. pneumoniae), Serratia marscens (S. marscens) and Methicillin-resistant Staphylococcus aureus (MRSA). Then the protective and therapeutic efficiencies of FGE against bacterial biofilms were in-vitro evaluated; at concentrations of 100, 75, 50 and 25%; in tissue culture plate (TCP) and on the polyurethane (PU) sheets using the crystal violet (CV) assay and colony-forming unit (CFU), respectively. Scanning electron microscopy (SEM) was also used to confirm eradication of biofilms on PU sheets. Finally, systemic and deep tissue infections by P. aeruginosa and MRSA were induced in mice that were then treated by FGE at either 100 or 200 mg/kg for seven days. Where the antibacterial activity was assessed by tissue and blood culturing at the end of the treatment period. Biochemical, hematological and histological parameters were also investigated.ResultsFGE exhibited potent in-vitro and in-vivo antibacterial and antibiofilm activities against MDR strains. It not only didn’t exhibit toxicological effects at the hematological and the histological levels but also provided protective effects as demonstrated by the significant drop in the biochemical parameters.ConclusionFGE has the potential to be used as a prophylactic and/or therapeutic lock agent against biofilm-associated infections caused by MDR bacteria.     

慢病药学门诊的规范化工作模式探索及实例分析

目的 探索慢病药学门诊的工作模式。方法 通过介绍慢病药学门诊服务模式及1例高血压伴失眠患者就诊实例,阐述慢病药学门诊各就诊步骤的服务要点。结果 通过对患者进行药物重整,用药教育及生活方式指导等药物治疗管理,患者改善了症状,提高了对疾病的认识及用药依从性。结论 慢病药学门诊规范工作模式具有一定可行性。     

某院生殖医学中心门诊超说明书用药调查分析

摘 要 目的：分析生殖医学中心门诊超说明书用药情况,为临床合理用药提供参考,并进一步规范临床超说明书用药行为。 方法: 采用回顾性调查法,抽取2018年1~12月生殖医学中心门诊处方中所有超说明书用药处方,根据药品说明书,对超说明书用药处方进行统计分析,查阅相关指南、文献等对其用药合理性进行分析评价。 结果: 超说明书用药类型包括超适应证用药、超剂量用药和超给药途径用药。黄体酮注射液、左卡尼汀口服液、雌二醇/雌二醇地屈孕酮片等均有相关国内外指南推荐,循证医学证据级别较高,其超说明书用药较合理;羟乙基淀粉200/0.5氯化钠注射液、戊酸雌二醇片、辅酶Q10片等其有效等级有效性具有争议;硒酵母片、维生素E胶丸未见相关文献、指南、国内外权威医学专著等报道,属于经验用药。 结论: 某院生殖医学中心门诊超说明书用药的现象广泛存在,虽然多数有循证医学证据支持,但也存在不合理用药现象。医院应重视超说明书用药情况,并建立相关管理制度予以规范,临床医师应当谨慎用药,药师应当严谨审方发药,从而降低超说明书用药带来的执业风险,促进医院合理用药水平。     

某地区6590例妇科门诊患者宫颈人乳头瘤病毒感染情况及基因亚型分析

目的:探讨某地区6590例妇科就诊人群人乳头瘤病毒(HPV)的感染状况及基因亚型的分布特征。方法:选取辽宁省人民医院妇科门诊患者6590例为研究对象,采用HPV-DNA核酸分子快速杂交法检测所有患者的HPV总体感染情况及基因分型。结果:6590例患者中,HPV阳性率为19.36%,其中高危型HPV占91.22%,低危型HPV占8.78%,患者发生多重感染276例,其中双重感染占76.45%;16~29岁患者阳性率(25.18%)最高,50~59岁患者阳性率(20.40%)次之,≥70岁患者阳性率(13.97%)最低。16~29岁患者多重感染率(6.72%)最高,其次为70~83岁患者(6.14%)。高危型感染率前5位依次为HPV16、52、58、53、39,低危型感染前3位为HPV81、11、6。结论:妇科门诊患者中HPV的感染率较高,并以高危型感染为主。定期进行HPV筛查,有利于预防及早期发现宫颈病变。     

A Time Motion Study in the Immunization Clinic of a Tertiary Care Hospital of Kolkata, West Bengal

Background:

A time and motion study is used to determine the amount of time required for a specific activity, work function, or mechanical process. Few such studies have been reported in the outpatient department of institutions, and such studies based exclusively on immunization clinic of an institute is a rarity.

Materials and Methods:

This was an observational cross sectional study done in the immunization clinic of R.G. Kar Medical College, Kolkata, over a period of 1 month (September 2010). The study population included mother/caregivers attending the immunization clinics with their children. The total sample was 482. Pre-synchronized stopwatches were used to record service delivery time at the different activity points.

Results:

Median time was the same for both initial registration table and nutrition and health education table (120 seconds), but the vaccination and post vaccination advice table took the highest percentage of overall time (46.3%). Maximum time spent on the vaccination and post vaccination advice table was on Monday (538.1 s) and nutritional assessment and health assessment table took maximum time on Friday (217.1 s). Time taken in the first half of immunization session was more in most of the tables.

Conclusion:

The goal for achieving universal immunization against vaccine-preventable diseases requires multifaceted collated response from many stakeholders. Efficient functioning of immunization clinics is therefore required to achieve the prescribed goals. This study aims to initiate an effort to study the utilization of time at a certain health care unit with the invitation of much more in depth analysis in future.     

深圳市眼科医院分时段预约挂号就诊模式改革的实践与探讨

为解决医院挂号难、看病等待时间长、患者不能有效疏导的问题,深圳市眼科医院全面推行分时段预约挂号就诊模式.医院以30分钟为一个预约时段,充分利用多种途径,给患者提供分时段预约挂号服务,使患者得到了实惠,提升了医院的管理效率,为患者提供了舒适的就医环境.在取得成效的基础上,结合预约制度实行的实际情况,对目前存在的问题进行了思考并提出应对建议.     

临床医生亚健康状态高阶因子模型分析

目的应用结构方程模型中高阶因子模型对临床医生亚健康状态进行评价。方法采用多阶段分层整群抽样方法,抽取福建省5个城市市级医院临床医生810人,运用亚健康状态自评量表进行调查与测评,应用一阶因子相关模型分析因子间相关性,应用二阶因子模型分析不同性别与年龄临床医生的亚健康综合指数得分。结果亚健康状态可以归因于情绪情感问题、躯体活力不足、生理功能减退及社会适应困难等4个因子间具有很强的相关性,相关系数为0.78～0.92(均P<0.001);在二阶因子模型中,4个因子对高阶因子—亚健康综合指数的载荷分别为0.95、0.97、0.87、0.88;女性临床医生的亚健康综合指数得分高于男性,30～45岁临床医生亚健康综合指数得分高于其他年龄的临床医生。结论高阶因子模型可以很好地对医生的亚健康状况进行评价。     

Estimated effects of asian dust storms on spatiotemporal distributions of clinic visits for respiratory diseases in taipei children (taiwan)

Background: Increases in certain cause-specific hospital admissions have been reported during Asian dust storms (ADS), which primarily originate from north and northwest China during winter and spring. However, few studies have investigated the relationship between the ADS and clinic visits for respiratory diseases in children.Objective: We investigated the general impact to children's health across space and time by analyzing daily clinic visits for respiratory diseases among preschool and schoolchildren registered in 12 districts of Taipei City during 1997-2007 from the National Health Insurance dataset.Methods: We applied a structural additive regression model to estimate the association between ADS episodes and children's clinic visits for respiratory diseases, controlling for space and time variations.Results: Compared with weeks before ADS events, the rate of clinic visits during weeks after ADS events increased 2.54% (95% credible interval = 2.43, 2.66) for preschool children (≤ 6 years of age) and 5.03% (95% credible interval = 4.87, 5.20) for schoolchildren (7-14 years of age). Spatial heterogeneity in relative rates of clinic visits was also identified. Compared with the mean level of Taipei City, higher relative rates appeared in districts with or near large hospitals and medical centers.Conclusion: To our knowledge, this is the first population-based study to assess the impact of ADS on children's respiratory health. Our analysis suggests that children's respiratory health was affected by ADS events across all of Taipei, especially among schoolchildren.     

临河地区乡村医生结核感染调查分析

目的为了了解乡村医生的结核菌感染及结核病患病率情况,为我国结核防控政策提供科学的依据,对临河地区乡村医生中实施结核感染检测。方法美国CDC工作人员自行设计调查表,对我们临河区的卫生行政部门注册的乡村医生进行了调查。结果通过本次调查的229名乡医中,9例X光异常,其中有2例确诊为结核,其余为气管炎或肺感染,PPD测试共226人,横径≥15mm的有42人,痰检15人,阳性2例。血相测试226人,其中阳性92人,阴性132人,不确定2人。结论本次调查不仅通过调查,基本掌握了临河地区乡村医生结核菌的感染率、结核病患病率;了解乡村医生的结核病对于呼吸感染控制的知晓情况,调查结果将为国家级结核防控政策提供科学的依据。