膀胱肿瘤切除术后尿路感染病原学和危险因素

目的观察膀胱肿瘤切除术后患者尿路感染发生情况与病原学特征,分析诱发尿路感染的危险因素,并提出合理且具备针对性的冲洗对策,为未来膀胱肿瘤切除术后尿路感染的预防提供合理参考。方法回顾性分析连云港市第一人民医院2016年1月-2019年1月接受经尿道膀胱肿瘤切除术治疗的451例膀胱肿瘤患者的临床资料,收集患者病例资料,全部患者术后均定期取尿液标本进行细菌培养,参照相关标准判定患者尿路感染情况,记录患者一般情况,包括一般人口学资料(性别、年龄、体质量、受教育程度等),同时记录患者糖尿病的疾病合并情况,将术后尿路感染可能的危险因素纳入初步分析,Logistic多因素回归分析膀胱肿瘤切除术后发生尿路感染的危险因素。结果451例膀胱肿瘤切除术患者术后第3天尿液中细菌培养阳性例数为80例,阳性率为17.74%,在使用抗菌药物后,患者尿液中细菌培养阳性率逐渐降低,各时点尿液细菌阳性培养率比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析检验证实,高龄、血糖水平控制不佳、术前留置导尿管、多发肿瘤是膀胱肿瘤切除术后尿路感染的危险因素(OR>1,P<0.05);80例术后尿液细菌培养阳性患者共分离出87株菌株,其中革兰阴性菌66株占75.86%,革兰阳性球菌21株占24.14%。结论膀胱肿瘤切除术后患者有较高的尿路感染风险,革兰阴性菌是主要的感染病原菌,年龄、基础疾病、肿瘤位点、术前导尿管留置等是影响因素,这类患者应引起临床高度重视。     

Quality improvement training for burn care in low-and middle-income countries: A pilot course for nurses

BackgroundThere is an urgent need to empower practitioners to undertake quality improvement (QI) projects in burn services in low-middle income countries (LMICs). We piloted a course aimed to equip nurses working in these environments with the knowledge and skills to undertake such projects.MethodsEight nurses from five burns services across Malawi and Ethiopia took part in this pilot course, which was evaluated using a range of methods, including interviews and focus group discussions.ResultsCourse evaluations reported that interactive activities were successful in supporting participants to devise QI projects. Appropriate online platforms were integral to creating a community of practice and maintaining engagement. Facilitators to a successful QI project were active individuals, supportive leadership, collaboration, effective knowledge sharing and demonstrable advantages of any proposed change. Barriers included: staff attitudes, poor leadership, negative culture towards training, resource limitations, staff rotation and poor access to information to guide practice.ConclusionsThe course demonstrated that by bringing nurses together, through interactive teaching and online forums, a supportive community of practice can be created. Future work will include investigating ways to scale up access to the course so staff can be supported to initiate and lead quality improvement in LMIC burn services.     

新型冠状病毒肺炎疫情期间肺癌患者的应对措施

新型冠状病毒肺炎(COVID-19)是近段时间我国面临的重大公卫事件，我国是肺癌大国，为了加强肺癌患者对这一疾病的认识，在疫情期间，使广大肺癌患者做好自身疾病的管理，做好对新型冠状病毒肺炎的预防。本文结合肺癌患者自身特点，对新型冠状病毒肺炎的易感性、鉴别诊断、防护、治疗，以及肺癌患者的随访、抗肿瘤用药、营养、手术等方面进行探讨，并结合两者的关系综合归纳，可以为广大肺癌患者更好地应对疫情提供参考。     

Fourteen years of litigation claims in cardiothoracic surgery in the United Kingdom National Health Service

Approximately 36 400 cardiac and 23 100 thoracic operations are carried out in the United Kingdom between 2006 and 2015. National Health Service (NHS) resolution, as known as the NHS litigation authority, is one of the essential bodies of the Department of Health. Its purpose is to provide NHS expertise to resolve concerns fair and square share learning for improvement. We aim to evaluate and increase awareness of medicolegal cases in cardiothoracic surgery. Total numbers and details of claims coded by NHS resolution in cardiothoracic surgery from 2004 to 2017 were requested under the Freedom of Information Act 2000. The data provided in successful claims is further breakdown into damages paid to the claimant, defence cost, claimant cost paid and the sum of the three. In contrast, unsuccessful claims only include the defence cost. Moreover, data provided also includes further analysis of primary causes and primary injuries for Claims Closed/Settled with damages paid. There were 753 claims recorded from 2004 to 2017, of which 415 (55.11%) were successful. The number of claims has been steadily increasing since 2004, with two significant raises from 2009/10 to 2010/11 (37‐55, 48.64% raise) and 2012/13 to 2013/14 (49‐69, 40.82% raise). The mean successful claim ratio was 69.58% (range, 47.56%‐ 83.33%) There is also a steady increase in the successful ratio from 2004 to 2017. In summary, this is the first study published in relation to litigation claims on cardiothoracic surgery in the United Kingdom. The results have provided insight on claims made against cardiothoracic surgery.     

民族生留学生考试不及格原因与对策调查

为了解临床医学专业留学生和民族生较为严重的功课不及格的原因并寻求相应的对策，课题组于2005年12月进行了学生问卷调查，2006年4月对教师进行了半结构式访谈调查和访谈发现，学生的汉语水平和原有的学习基础、学习生活习惯、对学校教学管理制度和管理系统的熟悉程度、自学时间和学习努力程度、学校学院教师对待他们方式等是主要的影响因素；根据调查与访谈，课题组针对影响因素归纳出了相应的对策，     

广东省城乡街头食品存在问题分析

1994年随机抽取广东省20个市315家街头食品经营户，按《广东省街头食品卫生检查评分标准》进行审评，结果，一类户占8．6％，二类户占43．8％，三类占47．6％．存在主要问题是饮食经营场所不卫生和设施简陋．食具消毒卫生质员不能有效得到保证．食品交叉污染因素较多，存在引发食物中毒潜在危险．食品从业人员个人卫生意识差．食品卫生监督力量薄弱，管不胜管．     

AVIATION NURSING IN THE WESTERN AUSTRALIAN KIMBERLEY

ABSTRACT: This article provides a brief overview of the Western Australian (WA) Kimberley Royal Flying Doctor Service and the role of the flight nurse who accompanies patients requiring aerial medical evacuation from rural and remote WA. Two short case histories of head injured patients evacuated from the Kimberley region will be outlined and some of the potential concerns associated with transferring patients at altitude in a confined and altered working environment will be discussed.     

梅毒诊治中存在问题及对策

目的：阐述对梅毒诊治中存在的问题并提出对策。方法：对本院检出的72例梅毒病例进行临床分析。结果：72例中44％(39／72)的患者未进行正规治疗及定期复查，51．3％。(16／39)的患者确诊后和治疗前未做滴度测定。结论：对可疑病人常规行梅毒血清学试验，早期诊断，正规足量治疗，治疗前行滴度测定，定期复查是诊治的关键。