基于微流控芯片的动态胚胎培养

目的:在微流控芯片上模拟输卵管收缩和纤毛运动引起的流体机械刺激和生化刺激,发展一种接近生理状态的胚胎动态培养方法,探讨其在体外受精-胚胎培养中的价值。方法:按功能构建微流控芯片,优化流体速度,使小鼠受精卵在芯片微孔中接受持续的灌注培养,同时在芯片上实现胚胎发育的监测。比较用微流控芯片法和常规微滴培养法的胚胎发育情况和囊胚形成率。结果:微流控培养系统流体速度在10μl/h时胚胎发育情况较好,获得的囊胚率最高(47.9%,23/48)。体外受精胚胎在微流控培养组5~8细胞发育率、桑葚胚发育率和囊胚形成率均明显高于微滴培养组(53.1%/46.6%、50.3%/41.5%和45.5%/35.5%),两组之间比较差异均有统计学意义(P均0.05)。而两种培养方法获得的2~4细胞发育率分别为63.4%和60.2%,差异无统计学意义。结论:胚胎培养过程中的物理微环境会影响胚胎质量,这种基于微流控芯片的胚胎动态培养方法可以显著改善胚胎质量,有希望成为辅助生殖技术中胚胎培养的一种新型工具。     

某院医务人员患者安全文化认知情况调查与分析

目的了解医务人员对患者安全文化认知及建设的现状,为患者安全管理及研究提供依据。方法2012年1月随机抽取上海市中医医院257名医务人员,应用患者安全文化现状评价调查问卷进行调查,用以了解临床医务人员的患者安全文化态度及其机构相关的患者安全文化。结果不同专业医务工作者在团队精神、安全措施、医院管理及交接班程序之间存在差异,提示具有重要的研究意义。其中药剂人员（4．5±0．6）以及护理部工作人员（4．5±0．6）的总分认知度最高,医技人员总分认知度最低（4．4±0．5）。不同职务的医务人员认同的患者安全文化,副／高级（4．8±0．4）〉中级（4．6±0．6）〉初级（4．4±0．5）。患者安全文化待改进领域：“人员配置”“工作量”“如果发生医疗安全（不良）事件,医院更加重视帮助与教育”反应率〈50％,是医务人员共同认为有待改进地方的前几位。结论某院有积极的患者安全文化,但仍需完善现有的不良事件报告系统及加强高风险科室的安全管理与人员教育培训。     

Adolescent Use of the Emergency Department Instead of the Primary Care Provider: Who,Why, and How Urgent?

PurposeAdolescents frequently rely on emergency medical care, rather than using primary care providers (PCPs). Our objectives were to characterize a population of adolescents presenting to a large, urban emergency department (ED) and to examine the reasons why they present to the ED, rather than to their PCP's office.MethodsAdolescents ages 12 to 21 years and their parents/guardians were invited to participate and asked to complete a brief online survey. Demographic data and triage information were collected from electronic medical records.ResultsOf 203 participants, 66% (n = 134) had public insurance, and 40% (n = 82) were triaged as nonurgent. Nearly all (93%, n = 189) reported having a PCP or primary clinic. The most common reasons given for presenting to the ED were participant perception of illness requiring immediate care (34%), followed by PCP referral to the ED (21%). Those with public insurance (odds ratio = 4.44; 95% CI 2.01 to 9.81) or no insurance/unknown insurance status (odds ratio = 4.77; 95% CI 1.34 to 17.01) were more likely to be triaged as nonurgent than those with private insurance.ConclusionsMany adolescents in this study were triaged as nonurgent, with several participants perceiving they were acutely ill requiring immediate physician care. Further analyses revealed that private insurance was significantly associated with urgent triage status. Future studies could educate adolescents and families about appropriate use of the ED or examine PCP offices directly to determine practices for phone triage and ED referrals of adolescents.     

Recognising Autism Spectrum Disorders in Primary Care: Perspectives of Speech and Language Therapists

Understanding the process of recognising autism spectrum disorders (ASD) in children is important, both for achieving timely identification of children's difficulties and for ensuring positive experiences for families. Professionals working in primary care services are suitably positioned to identify children requiring referral for diagnostic assessment of ASD through their early contact with children and their families. Speech and language therapists (SLTs) in particular are well situated to recognise ASD, as concerns regarding communication development are frequently raised by parents of children who later go on to receive an ASD diagnosis. This small-scale qualitative study aimed to explore primary care SLTs' experiences of recognising potential ASD in children. Five SLTs working in primary care services in the Republic of Ireland participated in semi-structured interviews. Thematic analysis of the data revealed that participants were concerned with two key events: firstly, accurately recognising potential ASD in children; and secondly, discussing the possibility of ASD with parents. The SLTs' experiences of these events were found to be influenced by both individual and wider organisational factors. The findings are discussed in the context of the current literature on ASD identification and implications for practice are considered.     

A test of the resource security and the body mass index reference point hypotheses of body dissatisfaction amongst adolescents in eight countries

Objective. This study aimed to identify cultural-level variables that may influence the extent to which adolescents from different cultural groups are dissatisfied with their bodies.

Design. A sample of 1730 male and 2000 female adolescents from Australia, Fiji, Malaysia, Tonga, Tongans in New Zealand, China, Chile, and Greece completed measures of body satisfaction, and the sociocultural influences on body image and body change questionnaire, and self-reported height and weight. Country gross domestic product and national obesity were recorded using global databases.

Results. Prevalence of obesity/overweight and cultural endorsement of appearance standards explained variance in individual-level body dissatisfaction (BD) scores, even after controlling for the influence of individual differences in body mass index and internalization of appearance standards.

Conclusions. Cultural-level variables may account for the development of adolescent BD.     

浅析基层医院医患纠纷的原因及防范

近年来,基层医院医患纠纷逐年增多,通过1999²013年在基层工作实践体会,发现基层医院医患纠纷发生的原因多个方面:基层医院改革和管理不成熟,医务人员技术水平、沟通、服务不到位,医院内部不团结、缺乏自我保护意识;患者对医疗服务期望值过高、依从性差、经济条件差并法制观念薄弱;以及社会、媒体等方面的原因。对此,应当加强基层医院的内部管理、提高医务人员综合素质、加强医患沟通、增强自我保护意识,树立基层医院良好的形象,才能有效缓解医患关系的紧张,构建和谐的医疗环境。     

在医院文化建设中培树典型的实践与体会

培育和选树先进优秀医务人员典型是医院深入开展文化建设的重要内容。培树典型应在"选准典型、宣传典型、搭建平台"方面下功夫,发挥先进典型的示范效应和引导作用,使之成为传播卫生核心价值观的重要载体,为医院发展提供精神动力。     

我国实现分级有序医疗的障碍及对策

本文简要概述了当前就医行为错位、混乱和无序的现象,说明存在卫生资源匮乏与相对富余的结构性矛盾,从政策制定与实施过程中的问题以及制度本身所固有的缺陷、市场发育和健康社会文化等方面初步分析了上述现象产生的原因,提出了理顺医疗服务价格机制、建立与恢复转诊制度、增强公众对基层医疗卫生服务的信心以及通过健康教育推动健康社会文化建设等方面的政策建议,以实现分级有序医疗,改善资源利用效率,确保我国医改预期目标的实现。     

医院文化品牌建设探索与实践

本文分析我国医院文化建设普遍存在的问题,阐述医院文化品牌建设的必要性、紧迫性;介绍我院在行为文化、制度文化、精神文化、环境文化、科技文化、创新文化建设方面的做法;结合医院文化建设的实践,提出构建和谐医患关系、提升医院核心竞争力,应加强医院文化品牌建设。     

某三级医院连续4年血培养分离菌构成及耐药性

目的了解血培养病原体的分布及其耐药性,为临床合理用药提供依据。方法对某院2008年1月-2011年12月间门诊及住院患者血培养标本分离的非重复病原体资料进行统计分析。结果670株血培养病原体中,革兰阴性杆菌306株（45.67％）,革兰阳性球菌329株（49.11％）,真菌35株（5.22%）;检出率居前3位的病原菌依次为凝固酶阴性葡萄球菌（23.88%）、大肠埃希菌（19.40%）和金黄色葡萄球菌（12.98%）。药敏结果显示,血流感染的多重耐药葡萄球菌对复方磺胺甲口恶唑、利奈唑胺及万古霉素的敏感性（耐药率为0～20.34%）高。革兰阴性杆菌（不动杆菌属除外）对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦及阿米卡星的耐药率为0～27.27%;耐药率最高的革兰阴性菌为不动杆菌属。血培养真菌分离率较高的为近平滑假丝酵母菌（2.38%）及白假丝酵母菌（1.79%）。结论早期送血培养做病原学检查,重视血培养分离的多重耐药菌株并加强监测,可及时为临床诊断和治疗提供可靠依据。