Reduction in Mortality after Umbilical Cord Blood Transplantation in Children Over a 20-Year Period (1995-2014)

Infections and graft-versus-host disease (GVHD) have historically resulted in high mortality among children undergoing umbilical cord blood transplantation (UCBT). However, recent advances in clinical practice have likely improved outcomes of these patients. We conducted a retrospective cohort study of children (<18years of age) undergoing UCBT at Duke University between January 1, 1995 and December 31, 2014. We compared 2-year all-cause and cause-specific mortality during 3 time periods based on year of transplantation (1995 to 2001, 2002 to 2007, and 2008 to 2014). We used multivariable Cox regression to identify demographic and UCBT characteristics that were associated with all-cause mortality, transplantation-related mortality, and death from invasive aspergillosis after adjustment for time period. During the 20-year study period 824 children underwent UCBT. Two-year all-cause mortality declined from 48% in 1995 to 2001 to 30% in 2008 to 2014 (P?=?.0002). White race and nonmalignant UCBT indications were associated with lower mortality. Black children tended to have a higher risk of death for which GVHD (18% versus 11%; P?=?.06) or graft failure (9% versus 3%; P?=?.01) were contributory than white children. Comparing 2008 to 2014 with 1995 to 2001, more than half (59%) of the reduced mortality was attributable to a reduction in infectious mortality, with 45% specifically related to reduced mortality from invasive aspergillosis. Antifungal prophylaxis with voriconazole was associated with lower mortality from invasive aspergillosis than low-dose amphotericin B lipid complex (hazard ratio, .09; 95% confidence interval, .01 to .76). With the decline in mortality from invasive aspergillosis, adenovirus and cytomegalovirus have become the most frequentinfectious causes of death in children after UCBT. Advances in clinical practice over the past 20years improved survival of children after UCBT. Reduced mortality from infections, particularly invasive aspergillosis, accounted for the largest improvement in survival and was associated with use of voriconazole for antifungal prophylaxis.     

Effect of introduction of pentavalent vaccine as replacement for Diphtheria–Tetanus–Pertussis and Hepatitis B vaccines on vaccination uptake in a health facility in Nigeria

BackgroundThe introduction of a new vaccine into an immunization programme may affect the immunization system negatively or positively. The aim of this study is to determine the effect of the introduction of the pentavalent vaccine as replacement for DTP and Hepatitis B vaccines on timeliness, completion of the schedule and dropout rates among children attending a health facility.MethodologyThis was a retrospective cohort study which involved extracting immunization records of children attending the Institute of Child Health Child Welfare Clinic between June 2011 and May 2013. Pentavalent vaccine was introduced as a replacement for DTP and Hepatitis B vaccines in June 2012. The uptake, timeliness and dropout rates of different vaccines in the immunization schedule were determined for children who commenced immunization in the pre, peri and post introduction phases.ResultsA total of 1110 children were studied – 190, 410 and 510 who commenced vaccination in the pre, peri and post introduction phases of the pentavalent vaccine respectively. Uptake was significantly higher for all vaccines in the post introduction phase compared to pre and peri introduction phases (p < 0.001). Completion of the immunization schedule by 60.2% of the children who commenced vaccination in the post introduction phase was higher than the 31.6% and 41.7% for the pre and peri introduction phases respectively (p < 0.001). Significantly more visits were required to complete the schedule in the peri introduction phase compared to the pre and post introduction phases p < 0.001. Delay in receipt of the three doses of DTP/PENTA was significantly longer in the peri introduction phase compared to pre and post introduction phases.ConclusionThe introduction of pentavalent vaccine significantly improved uptake of vaccines and completion of the schedule but resulted in prolonged delay in receipt of vaccines during the introduction period.     

病案式教学在非医学专业《临床医学概论》教学中的初步实践与思考

目的探索病案式教学方法在非医学专业《临床医学概论》教学中的效果。方法以2011级生物技术专业学生为研究对象,将其随机分为试验组和对照组,以期末考核及学期末调查问卷的方式评价病案式教学与传统教学方法的优劣。结果多数学生及教师认为传统的教学模式不适用于非医学专业;试验表明,与对照组相比,试验组学生期末考试成绩、学习必趣及效率等显著提高,差异有统计学意义(P<0.05)。结论病案式教学模式与传统教学模式相比,能够显著提高非医学专业学生的考试成绩、学习兴趣及参与热情。     

医疗技术专门伦理委员会的建立与必要性

从医院工作实际分析,科学研究与新医疗技术引进存在差异,引进是重点。引进的新医疗技术属于临床医疗服务项目,故设立医疗技术伦理委员会可使该范围内伦理审查更具操作性,避免将成熟技术引进人为改变为研究。但伦理审查不可或缺,以保障医疗质量安全、提高医疗服务能力。审查重点是限制类医疗技术,不接受禁止类医疗项目;审查内容包括资质、设备条件及安全保障措施等;审查仍需遵循伦理学原则。     

临床诊疗指南简介

通过对国内外临床诊疗指南状况的研究,对临床诊疗指南的定义、背景、发展、目的和内容等进行综述,旨在为临床工作者合理运用临床诊疗指南提供参考.     

成都市金牛区婴幼儿喂养情况及其母亲的喂养知识调查

目的了解成都市金牛区婴幼儿喂养情况及其母亲的喂养知识水平,为合理喂养提供科学依据。方法以随机整群抽样的方法,抽取成都市金牛区400名婴幼儿的母亲进行问卷调查。结果 4个月母乳喂养率为67.35%,6个月母乳喂养率为57.80%,辅食添加时间为（4.61±1.13）月龄;6～12月龄鱼、肉和禽类添加率较低,仅为62.11%。不同年龄段低体重、生长迟缓、肥胖和超重发生率等方面比较差异无统计学意义（P〉0.05）;母亲的喂养知识水平与年龄、职业无显著相关性（P〉0.05）,与文化程度有关（r=0.132,P〈0.05）,母乳喂养者的喂养知识水平较高（χ2=7.055,P〈0.05）。结论婴幼儿喂养主要问题是母乳喂养率较低,婴儿辅食添加存在较早现象,婴儿动物性食物家长喂养知识水平较低,应积极宣传和普及科学喂养知识。     

美宝疤痕软膏联合超声波导入治疗小儿烧伤瘢痕

目的　观察美宝疤痕软膏联合超声波导入治疗小儿深度烧伤后瘢痕的演变过程和临床疗效, 探讨瘢痕组织再生复原皮肤的可能机理。方法　对1 例小儿深度烧伤后形成的局部瘢痕采用美宝疤痕软膏联合超声波导入仪进行局部治疗, 每天2 ~3 次, 定期复诊、检查和拍摄相片以记录瘢痕演变和再生恢复的情况, 对治疗效果进行追踪观察、分析和评价。结果　治疗1 周, 患儿的瘢痕局部干燥、瘙痒和疼痛等不适症状明显改善, 晚上能够安睡; 经过2 个月的治疗, 增生性瘢痕和瘢痕疙瘩逐步变小、变平和变软; 经过6 个月的治疗, 增生性瘢痕和瘢痕疙瘩平复、消失, 局部皮肤光滑、平整、富有弹性, 表浅性瘢痕皮肤颜色由紫红色逐步恢复, 接近正常皮肤颜色, 外观及功能恢复较好; 经过12 个月的治疗, 皮肤弹性进一步改善并接近正常, 原深色区域和白色区域的面积较前明显缩小, 颜色在逐步向正常皮肤颜色转变, 关节运动功能完全恢复正常, 对小儿的生长发育没有成不良影响。结论　小儿深度烧伤后形成的瘢痕通过美宝疤痕软膏联合超声波导入仪治疗, 实现了逐步恢复皮肤的正常结构和功能的作用, 临床效果肯定, 这可能与美宝疤痕软膏具有启动潜能再生细胞再生, 引导瘢痕组织细胞向生理性方向再生发展并终止异常病理性再生的作用有关, 瘢痕组织再生复原的机理有待组织细胞学方面的深入研究。     

重视导入教学,引导学生主动探究学习

目的探索导入教学在《中药学》教学中的应用和价值,为进一步推广提供依据。方法在《中药学》课堂教学中灵活采用温故、故事、形象显示、谚语和谜语、病案、设问置疑及巧设悬念等方法导入新课和新药。结果老师在各种教学评价中均获得了较高的评价。结论导入教学是引导学生主动探究学习的一种重要方法 。