沾染液体火箭推进剂时的个人洗消技术进展

目的 回顾与分析国内外有关沾染液体火箭推进剂时个人洗消技术和方法的研究资料，提出有效的个人洗消技术和方法，以尽可能地避免染毒或减轻染毒伤员的伤害程度。资料来源与选择 结合我们已进行的有关研究和参加抢救的临床救治体会，并引用国内外公开发表的相关论文及著作。资料引用 论文28篇及3部专著。资料综合主要针对个人洗消技术的有效性与安全性对文献作者采用的方法和指标进行分析和综合。结论 迅速及时地进行有效的洗消，以尽早彻底清除沾染的毒物，是防治液体火箭推进剂中毒的首要措施，可以明显避免或减轻染毒伤员的伤害程度。     

医院医用物资管理初探

随着科技的发展,医院应用新型材料的数量和金额不断增长.如何提高效率、展现最佳效果,是目前医院医用物资管理面临的重要问题.本文主要就目前医院医用物资管理一体化的概念、特点、优势和实施进行讨论.     

幽门螺杆菌治疗中抗生素相关性腹泻的预防

目的 探讨双歧三联活菌胶囊（培菲康）对根除幽门螺杆菌（HP）治疗中所致抗生素相关性腹泻（AAD）的预防作用.方法 将128例HP阳性的胃及十二指肠溃疡患者随机分成A组（阿莫西林、甲硝唑、奥美拉唑、果胶铋四联治疗组）和B组（四联加培菲康治疗组）;两组抗生素疗程均为2周,奥美拉唑及果胶铋疗程为4周;抗生素治疗结束4周后复查13C-尿素呼气试验及尿素酶试验,判断根除HP疗效.结果 A、B组两组根除HP效果相近,根除率分别为92.19%和96.88%（P＞0.05）;AAD发生率B组明显低于A组（P〈0.05）,＞60岁患者AAD发生率明显高于〈60岁患者（P〈0.05）.结论 老年人AAD发生率高,培菲康能有效防治根除HP感染治疗中引起的AAD.     

医院人员咽部机会致病菌与岗位相关性的研究

目的 了解医院各类人员咽部带菌及药敏状况，以加强医院感染的预防和控制。方法 采用常规方法进行302份咽拭子标本培养和菌种鉴定，选择15种抗菌药物，用纸片扩散法对所分离的菌种进行药敏试验。结果 医院人员咽部机会致病菌的分离率为30．13％，护理人员咽部带菌率为41.32％，明显高于医技（20％，P〈0．05）和管理人员（9．52％，P〈0．01），临床医师（29．29％）高于管理人员（9．52％，P〈0．05）；副流感嗜血菌占分离菌株的56．57％，金黄色葡萄球菌占20．2％，肺炎克雷伯菌占10．1％，表皮葡萄球菌占7．07％；金黄色葡萄球菌对青霉素和苯唑西林的耐药率分别为75％和60％，表皮葡萄球菌对青霉素和苯唑西林的耐药率分别为57．1％和85．7％；副流感嗜血菌对哌拉西林、头孢唑林、头孢哌酮和庆大霉素耐药率为100．0％，对阿米卡星耐药率达98．2％。结论 医院各类人员咽部机会致病菌携带率存在差异；临床医护人员带菌率最高，管理人员最低；G^＋菌对青霉素和苯唑西林耐药率高，副流感嗜血菌对多种常用抗菌药物耐药；医院工作人员中临床医护人员是预防和控制医院感染的重点。     

“Watching time tick by…”: Decision making for Duchenne muscular dystrophy trials

ObjectiveThis interview study explored clinicians' perspectives and parents' decision making about children's participation in Duchenne muscular dystrophy (DMD) clinical trials.MethodsData from semi-structured interviews conducted with clinicians and parents in U.S. or Canada were assessed using thematic analysis.ResultsEleven clinicians involved in ten trials and fifteen parents involved in six trials were interviewed. Parents described benefit–risk assessments using information from advocacy, peers, professionals, and sponsors. Strong influence was attributed to the progressive nature of DMD. Most expected direct benefit. Few considered the possibility of trial failure. Most made decisions to participate before the informed consent (IC) process, but none-the-less perceived informed choice with little to lose for potential gain.Clinicians described more influence on parental decisions than attributed by parents. Clinicians felt responsible to facilitate IC while maintaining hope. Both clinicians and parents reported criticisms about the IC process and regulatory barriers.ConclusionsThe majority of parents described undertaking benefit–risk assessments that led to informed choices that offered psychological and potential disease benefits. Parents' high expectations influenced their decisions while also reflecting optimism. Clinicians felt challenged in balancing parents' expectations and likely outcomes. Prognosis-related pressures coupled with decision making prior to IC suggest an obligation to ensure educational materials are understandable and accurate, and to consider an expanded notion of IC timeframes. Anticipatory guidance about potential trial failure might facilitate parents' deliberations while aiding clinicians in moderating overly-optimistic motivations. Regulators and industry should appreciate special challenges in progressive disorders, where doing nothing was equated with doing harm.     

Embedding clinical interventions into observational studies

Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed.     

糖尿病夏科足临床特点分析

目的总结糖尿病夏科足的临床特点,提高临床医师对于本病的认识。方法回顾性分析11例2型糖尿病夏科足患者的临床特点。结果 11例患者中,男7例,女4例;平均年龄(60±11)岁;平均糖尿病病程16年;全部合并神经病变而无下肢血管病变;单侧足病变10例,双足病变1例;3例发病前有明确的外伤史。影像学表现为足部骨质破坏7例,关节间隙变窄6例,软组织肿胀3例,关节半脱位2例,关节融合2例,碎骨1例。11例患者一入院均遵医嘱限制活动。对足溃疡给予积极清创,换药。根据细菌培养及药敏试验结果选用抗生素治疗。10例合并足溃疡病例中,1例截趾后愈合,3例愈合,5例好转,1例自动出院后失访。3例出院后有足溃疡的复发。结论早期识别并给予制动等措施有助于足溃疡愈合和减缓夏科足畸形的发展。