Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium diffcile(the Benefits of Enhanced Terminal Room Disinfection study):a cluster-randomised,multicentre,crossover study

中文:背景患者入院后可从不当消毒的环境表面获得多药耐药菌和艰难梭菌。本文确定了3种强化的终末消毒(入住同一病房的两名患者之间的消毒)策略,对感染耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、艰难梭菌(CD)和多重耐药不动杆菌的影响。方法本文在美国东南部的9家医院开展了一项务实的、集群-随机、交叉研究。凡曾有感染或定植目标细菌感染患者居住过的病房,患者出院后随机采取4种消毒策略中的一种方法进行终末消毒:对照(季胺盐类消毒剂消毒,但凡遇到CD采用含氯消毒剂);UV(季胺盐类+UV-C消毒,但凡遇到CD采用含氯消毒剂+UV-C);含氯消毒剂;含氯消毒剂+UV-C。凡入住目标病房的患者被列为暴露人群。这4种终末消毒方法分别在每家医院连续实施7个月的周期。本文随机设计这几种消毒策略在每家医院内的实施顺序(1:1:1:1)。主要产出的结果是,观察暴露患者中目标细菌的感染的发生或定植情况,以及ITT人群中暴露患者CD感染发生率。本研究ClinicalTrials.gov注册编号:NCT01579370。结果共有31 226名患者暴露,其中21 395(69%)符合标准,包括4 916名对照组,5 178名UV组,5 438名含氯消毒剂组,以及5 863名含氯消毒剂+UV组。在对照组中,22 426个暴露日中有115名患者发生目标细菌的感染(51.3/10000暴露日)。在标准清洁策略的基础上增加UV消毒的暴露患者,其目标细菌感染的发生率明显较低(n=76;33.9/10 000暴露日;RR:0.70,95%CI:0.50～0.988;P=0.036)。含氯消毒剂组(n=101;41.6/10 000暴露日;RR:0.85,95%CI:0.69～1.04;P=0.116),或含氯消毒剂+UV组患者(n=131;45.6/10 000暴露日;RR:0.91,95%CI:0.76～1.09;P=0.303)的目标细菌的感染率,其差异无统计学意义。同样,在含氯消毒剂的基础上增加UV消毒,暴露患者中CD感染率也没有发生改变((n=38 vs 36;30.4 vs 31.6/10 000暴露日;RR:1.0,95%CI:0.57-1.75;P=0.997)。解释污染的医疗机构环境是获得病原微生物的重要来源;强化终末消毒可以降低这一风险。     

Guidelines for infection control in dental health care settings--2003

BACKGROUND: The Centers for Disease Control and Prevention, or CDC, is the lead federal agency for disease prevention in the United States. It has been 10 years since CDC infection control guidelines for dental health care settings were last published. During those 10 years, new technologies and issues have emerged, and other CDC infection control guidelines for health care settings have been updated. RESULTS: In light of these developments, CDC collaborated with experts in infection control to revise its infection control recommendations for dental health care settings. Existing guidelines and published research pertinent to dental infection control principles and practices were reviewed. This article provides background information, describes the process used to create these guidelines, and lists the new recommendations. CLINICAL IMPLICATIONS: CDC believes that dental offices that follow these new recommendations will strengthen an already admirable record of safe dental practice. Patients and providers alike can be assured that oral health care can be delivered and received in a safe manner.     

Comparison of Ileal Digested Production of Parental Rice and Rice Genetically Modified With Cowpeas Trypsin Inhibitor

INTRODUCTION With the rapid development of genetically modified foods in the world, the safety assessment of these novel foods is becoming the first task for governments, scientists, and consumers. At the same time, nutritional assessment is an important …     

A dynamic block-randomization algorithm for group-randomized clinical trials when the composition of blocking factors is not known in advance

We present an algorithm for randomizing units in blocks for controlled trials when the composition of blocking factors is not known in advance. For example, suppose the desired goal of an intervention study is to randomize units to one of two interventions while blocking on a dichotomous factor (e.g., gender), but the total number of units, and therefore number or composition, of males and females among those units assembled for randomization cannot be determined in advance. This situation arises in randomized trials when subjects are scheduled to be randomized as a group, but not all of the subjects show up for the visit. Since investigators do not know which of the scheduled subjects will or will not show up, a dynamic randomization scheme is required to accommodate the unknown composition of the blocking factor once a group of subjects (units) is assembled for randomization. These settings are further complicated when there is more than one blocking factor. In this paper, we present an algorithm that ensures the integrity of the randomization process in these settings.     

培哚普利治疗对防治高血压合并脑卒中患者并发症的临床试验

目的 探讨培哚普利降压治疗对预防高血压合并脑卒中患者并发症的研究。方法 对155例既往有脑卒中病史的轻中度高血压病患者随机分组,进行三年的培哚普利及安慰剂的双盲对照临床试验,观察三年的治疗组及安慰剂组的血压、心脑血管并发症的发生率及病死率,在研究结束时给予连续3日动态血压监测(ambulatory blood pressuremonitoring,ABPM)。结果 与安慰剂组比较,治疗组3日动态血压监测示血压控制满意,三年心脑血管并发症的发生率和死亡率(分别为6.85％和2.74％)明显低于安慰剂组(17.10％和9.21％)。结论 培哚普利降压有效、平稳、持久,持续降压治疗对预防高血压合并脑卒中患者心脑血管并发症具有重要作用。     

北京市各级医院呼吸系病专业医师哮喘基本知识问卷调查结果分析

目的了解各级医院呼吸系病专业医师对哮喘基本知识的掌握情况，作为哮喘防治学组制定工作计划的依据。方法采用问卷调查方式，共调查市级或以上医院、市内区级医院和郊区县医院５５家，对象为呼吸内科或内科呼吸专业组的住院医师和主治医师，总计４３６人。结果无论是哮喘的基本概念，还是吸入治疗、抗炎治疗在哮喘治疗中的地位、峰流速仪的使用价值等，各级医院呼吸系病专业医师均存在不同程度的模糊认识，市级或以上医院医师回答问题情况明显优于市内区级医院和郊区县医院。结论哮喘的医师教育问题是一项非常重要的工作，工作的重点应放在基层医院。     

Air pollution and cardiovascular disease: a statement for healthcare professionals from the Expert Panel on Population and Prevention Science of the American Heart Association

Air pollution is a heterogeneous, complex mixture of gases, liquids, and particulate matter. Epidemiological studies have demonstrated a consistent increased risk for cardiovascular events in relation to both short- and long-term exposure to present-day concentrations of ambient particulate matter. Several plausible mechanistic pathways have been described, including enhanced coagulation/thrombosis, a propensity for arrhythmias, acute arterial vasoconstriction, systemic inflammatory responses, and the chronic promotion of atherosclerosis. The purpose of this statement is to provide healthcare professionals and regulatory agencies with a comprehensive review of the literature on air pollution and cardiovascular disease. In addition, the implications of these findings in relation to public health and regulatory policies are addressed. Practical recommendations for healthcare providers and their patients are outlined. In the final section, suggestions for future research are made to address a number of remaining scientific questions.     

Impact of Xuezhikang on coronary events in hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS)

Abstract

Background. The lowering of cholesterol concentrations in individuals at high risk for cardiovascular disease improves clinical outcome. Xuezhikang has a marked impact on lipids.

Methods. In this randomized, double-blinded, placebo-controlled, parallel-group clinical trial, a total of 2704 hypertensive patients with previous myocardial infarction (MI) were assigned either to placebo (n = 1341) or to Xuezhikang (0.6 g twice daily, n = 1363) for an average of 4.5 years. The primary end-point was recurrent coronary events; the secondary end-point was all-cause mortality and other clinical events, including adverse effects.

Results. There were no differences between the Xuezhikang and placebo group in base-line characteristics. However, Xuezhikang treatment reduced the incidence of coronary events by 43.0% (P = 0.02), deaths from coronary heart disease (CHD) by 30.0% (P < 0.01), and all-cause mortality by 35.8% (P = 0.001).

Conclusions. This study, for the first time, demonstrated that long-term Xuezhikang therapy resulted in significant reduction in cardiovascular events and death in Chinese hypertensive patients with previous MI in a safe manner.