The emergence and containment of severe acute respiratory syndrome spreaded in a general hospital

1　IntroductionOn 12March 2 0 0 3,WorldHealthOrganization(WHO)issuedaglobalalertonatypicalpneumonia ,calledsevereacuterespiratorysyndrome (SARS) ,af terreportsfromtheDepartmentofHealthofHongKongofanoutbreakofpneumoniainoneofitspublichospitals[1] .Ataboutthesametime ,WHOreceivedreportsofthesyndromefromChina ,Singapore ,Vietnam ,Thailand ,Indonesia ,Taiwan ,andPhilip pines,aswellasfromcountriesinothercontinentsincludingCanada ,theUnitedStates ,andGer many[2 ] .Afterthediseasespreadfr…     

Nosocomial tuberculosis in hospital staff. The size of the problem in a Hong Kong chest hospital.

In the past three decades, among 831 staff (over 6,862 staff-years) under regular chest radiographic survey in the Grantham Hospital, Hong Kong, the cumulative incidence of active pulmonary tuberculosis requiring treatment was 27 (belonging to 23 staff). Number of cases detected per year ranged from 0 to 3. The mean duration from the beginning of employment to the first evidence of disease was 6.43 years. Although this incidence is low, yet the hospital caters for quite a large number of patients with bacteriologically confirmed tuberculosis, we feel that the active screening program for hospital staff should be maintained, and that review of the situation is also recommended.

     

The application of PBL teaching in physiologyand the training of students′ integrated quality

目的 探讨PBL教学法在生理学教学中的应用,培养医学生有效利用网络资源和自主学习的能力,提高综合素质.方法 将2008级临床医学63名学生随机分成6组(每小组10～11人),每组学生施以不同问题进行PBL教学.结果 PBL教学法对提高学生获取信息能力、自主学习能力、团队协作能力、交流能力、时间控制能力等有明显的作用.结论 PBL教学法增强了生理学教学效果,提高了学生综合能力,值得在教学中推广.     

The efficiency of respiratory muscle strengthening training programs in pilots.

ＴＨＥＥＦＦＩＣＩＥＮＣＹＯＦＲＥＳＰＩＲＡＴＯＲＹＭＵＳＣＬＥＳＴＲＥＮＧＴＨＥＮＩＮＧＴＲＡＩＮＩＮＧＰＲＯＧＲＡＭＳＩＮＰＩＬＯＴＳＪｉＳｈｕｇｕｏ纪树国ａｎｄＧａｏＨｅ高和Ｏｂｊｅｃｔｉｖｅ．Ｔｏｅｖａｌｕａｔｅｔｈｅｅｆｉｃｉｅｎｃｙｏｆｒ...     

What difference does a neurologist make in a general hospital? Estimating the impact of neurology consultations on in-patient care

Background  To determine the impact of neurological consultations on the care of hospital in-patients and to ascertain patients’ perceptions, referrals were prospectively recorded over a 6-month period. The neurology team’s view and changes suggested to management were documented. All referred patients’ notes were reviewed at 6 months and the impact of a neurology referral was determined. Results  Two hundred and fifty-four (254) referrals were seen. There was a significant change in diagnosis in 55%, and in management in nearly 70%. Neurological referral facilitated earlier discharge for 65% patients. Thirty-seven of 163 patients contacted at 6 months did not know they were seen by a neurologist. Of those who knew, 57% felt referral had aided in their diagnosis and 86% felt it had aided treatment. Conclusions  Neurological consultations can make a significant difference to in-patient management. Early referral may lead to early discharge. Patient satisfaction was high but not without criticism.     

The future pattern of surgical department and training of surgeons in community hospitals.

ＴＨＥＦＵＴＵＲＥＰＡＴＴＥＲＮＯＦＳＵＲＧＩＣＡＬＤＥＰＡＲＴＭＥＮＴＡＮＤＴＲＡＩＮＩＮＧＯＦＳＵＲＧＥＯＮＳＩＮＣＯＭＭＵＮＩＴＹＨＯＳＰＩＴＡＬＳＩｎｔｈｅｗａｋｅｏｆｔｈｅｒｅｆｏｒｍａｎｄｏｐｅｎｉｎｇｐｏｌｉｃｙ，ａｒａｐｉｄｅｃｏｎｏ...     

The Mechanism of Luteal Regression in the Human

“——Few if any drugs with luteofytic unlion have proven to be of comraceptive value which may be due at teast in part,to our incomplete knowledge of the factors that conlrol the function and lifespan of the corpuslutenm——”     

What is the prevalence of rheumatic disorders in general medical inpatients?

It has been suggested that rheumatological disorders are underdiagnosed in patients with medical problems and that this might be rectified by incorporating a standard brief screening examination as part of the routine assessment of all patients admitted to hospital with medical conditions. Therefore the GALS screening examination was used to assess the prevalence of rheumatic disease in 100 patients admitted with acute medical problems and in a further 100 in the rehabilitative phase of their disease. The nature of locomotor dysfunction in all patients with a positive result was defined by an independent review and then sensitivity and specificity of the screening test was calculated for rheumatic disease in both populations.
The median age of the two populations were 63 and 78 years respectively, with more females in the rehabilitation group. The overall prevalence of a positive screening test was 53% in the acute and 94% in the chronic disease groups, although the false positive rate in the rehabilitation patients was 30% due to factors other than rheumatic disorders limiting locomotor function (mainly orthopaedic and neurological conditions). The diagnosis of a rheumatological disorder was made de novo in a significant minority (10%) of patients and was usually amenable to treatment. The commonest rheumatic disorder was osteoarthritis which accounted for 55% of all rheumatic disease, followed by inflammatory joint disease (16%), and osteoporosis (12%). In addition to osteoporosis, Paget''s disease of bone and polymyalgia rheumatica were found more frequently in those patients undergoing rehabilitation than in those admitted with an acute medical problem. A number of clinically important associations between medical and rheumatic disorders were found, such as stroke disease with shoulder capsulitis and heart failure with gout.
The sensitivity of the GALS screening test was extremely high (92% and 100%), while its specificity fell in the rehabilitation group from 83% to 17%. None the less, it is felt that this study indicates that the routine use of this test should be considered as part of the assessment of all hospitalised patients with medical problems, whether acute or chronic.


     

Is virtual bronchoscopy useful for physicians practising in a district general hospital?

Background: Virtual bronchoscopy software is now available to district general hospitals (DGHs). There is limited information on the clinical utility of virtual bronchoscopy and whether it offers any additional information over conventional axial computed tomography in the setting of a busy DGH chest unit. Methods: Virtual bronchoscopy and computed tomography findings were compared in all patients who had a virtual bronchoscopy study over a 12 month period. Results: Eighteen consecutive patients had virtual bronchoscopy for a specific clinical indication over the study period. Additional information was conveyed by virtual bronchoscopy in five patients (in four patients the airways distal to an obstruction were better visualised thereby influencing decisions about airway stenting and in one patient the virtual bronchoscopy study showed an endobronchial lesion missed on computed tomography). In nine patients who were unfit for fibreoptic bronchoscopy (FOB) the radiologist was more confident in excluding an obstructive airway lesion. The main indication for performing a virtual bronchoscopy study was to rule out an obstructive airway lesion in patients who were unfit for FOB (n = 11). Conclusion: Virtual bronchoscopy is feasible and useful in the management of a few selected patients in a DGH chest unit. Virtual bronchoscopy may convey additional information over computed tomography when the distal airways need to be visualised and for discrete endoluminal lesions.