传染性非典型肺炎医院内集簇发病的临床分析

目的 分析一起医院内传染性非典型肺炎(非典)集簇发病的临床和流行病学特点，探讨有效的防治措施。方法 对22例医院获得性非典型肺炎患临床资料进行回顾性分析。结果 3例院外感染的非典患引起22例院内感染，潜伏期为1～11 d。全部患(100％)均有高热、头痛、咳嗽和气促，10例(40％)有严重呼吸困难，12例(48％)关节、肌肉剧痛，4例(16％)有少量湿啰音。全部患(100％)血白细胞总数无升高，血培养、衣原体抗体均为阴性。3例(12％)X线胸片呈双肺间质性改变；22例(88％）呈斑片状浸润影。结论 部分传染性非典型肺炎具有极强的传染性，接触的医护人员为高危人群。严格的防护措施和综合治疗甚为必要。     

Appropriateness of colonoscopy in a university hospital

An open access endoscopy system allows for the direct scheduling of endoscopies by non-gastroenterologist physicians without prior gastroenterology consultation. The aim of our study was to examine our practice of open access endoscopy by evaluating the appropriateness of referrals for colonoscopy and to determine whether there were differences depending on the specialty of the referring clinician. The indication for colonoscopy was assessed in 499 consecutive outpatients referred for colonoscopy at University Hospital, Kuala Lumpur over a 12-month period. The American Society of Gastrointestinal Endoscopy (ASGE) guidelines were used to determine the appropriateness of referrals. 80.6% of colonoscopies requested by the gastroenterologist were performed for accepted indications compared to 50.6% of referrals by the primary care physician (p<0.001) and 67.0% of referrals by the surgeon (p=0.006). The rate of colonoscopies generally not indicated was 2.1% for the gastroenterologist, 25.0% for the internist (p=0.002) and 7.5% for the surgeon (p=0.04). The rate of indications not listed in the ASGE guidelines was significantly lower for requests made by gastroenterologists (17.3%) than those requested by primary care physicians (44.2%; p<0.001). Patients who have had prior consultation with the gastroenterologist were significantly more likely to undergo colonoscopy for appropriate indications than among patients who were referred through an open access system. The rate of inappropriate indications for colonoscopy was also significantly lower when the gastroenterologist made the referral. A substantial proportion of colonoscopies (25.4%) was performed for indications not listed in the ASGE guidelines.     

深圳地区46例传染性非典型肺炎患者临床和实验室特点分析

目的　研究深圳地区传染性非典型肺炎患者的临床特点。方法　对深圳地区 4 6例传染性非典型肺炎患者的年龄、性别、流行病学资料、临床表现、实验室资料及预后进行分析。结果　男∶女 =1.3∶ 1,平均30 .5岁。儿童发病率较低 ,且一般不转为重症 ;>4 5岁的中老年人易转为重症。具有传染性强 ,易家庭聚发及单位群发的流行病学特点。易重症化 (4 7.2 6 % ) ,病死率为 4 .3% ,易发生I型呼衰 (15 .2 % )。所有患者均有发热 ,热程平均 (9.0 7± 4 .2 3)d ,多为弛张热。重症患者热程长于普通患者。大多数患者均有呼吸道症状。胸片示肺部炎症改变出现时间多为发热后 3～ 4d ,持续时间平均 (16 .7± 10 .3)d。重症患者肺部炎症持续时间长于普通患者 (P <0 .0 5 ) ,易发生肺纤维化 (34.78% )。易发生肝功能损害。重症患者更易发生肝功能损害 (P <0 .0 0 5 ) ,且损害程度较重。CD4 /CD8 细胞计数入院时平均为 (17.9± 5 .6 ) % / (2 4 .2± 6 .5 ) % ,明显下降。重症患者CD4 /CD8 细胞计数为 (12 .6± 4 .5 ) % / (19.6± 9.5 ) % ,下降更明显。结论　传染性非典型肺炎患者的年龄、热程、肺部炎症持续时间、肝功能损害明显、CD4 /CD8 细胞计数明显下降等可作为早期判断SARS患者重症化的指标。     

Parvovirus B19 serology in early inflammatory polyarthritis--experience from a tertiary core teaching hospital in South India

This study was done to look for IgM antibody to parvovirus B19 in early inflammatory arthritis patients and their clinical correlations, if any. This was a retrospective case sheet based study and follow-up. IgM antibody to parvovirus B19 was studied in 47 patients who presented to the rheumatology outpatient department with early arthropathy of less than 24 weeks' duration during their first 3 months of onset or flare of arthritis. Seropositive patients were followed up till date. Seven out of the 47 patients had IgM parvo B19 antibody. Five of the 7 had underlying chronic infective, inflammatory and other pre-existing diseases. In 5 patients, the arthritis resolved completely. In the remaining 2, mild recurrent arthralgias were attributed to existing inflammatory diseases. Fever was present in the majority, but none of them had rash. The arthropathy was symmetrical type in the majority. Only 7 (14.8%) out the 47 patients with early inflammatory arthritis had antibody to parvovirus B19, 5 of the 7 had self-limiting course; there was no association of this virus with chronic inflammatory arthropathy in this cohort over a 9-year follow-up.     

综合性医院收治传染性非典型肺炎患者医护人员职业防护与对策

目的探讨综合性医院收治传染性非典型肺炎医护人员个人防护方法与对策.方法建立传染性非典型肺炎收治隔离区,制定预防医院感染及医护人员防护措施,规范了医护人员进入隔离病区和离开隔离病区的具体防护方法.结果在疫情流行期间,与传染性非典型肺患者密切接触的工作人员有256名,全院无一例医务人员、住院患者及陪护人员感染发病,避免了传染性非典型肺炎在医院内的传播,有效预防了医护人员与患者间的交叉感染.结论严格各项防护措施,医护人员有防护的暴露可避免或减少传染性非典型肺炎在医院内感染发生.     

血清学实验室检查在梅毒临床诊断中的应用研究

目的:比较分析甲苯胺红不加热血清反应素试验(TRUST)、梅毒胶体金法(SYP)、双抗原夹心酶联免疫法(ELISA)三种实验室检查方法的诊断意义。方法:临床入选226例志愿者,通过梅毒螺旋体颗粒凝集试验(TPPA)检查,分为TP-PA(+)组(n=129)和TPPA(-)组(n=97),均采用TRUST、SYP和ELISAA检测其梅毒螺旋体抗体。结果:TPPA(+)组和TPPA(-)组之间的TRUST阳性率、SYP阳性率及ELISA阳性率均具有统计学差异(P<0.05);在TPPA(+)组中,与TRUST和SYP相比较,ELISA阳性率最高,高达96.12%(P<0.05)。而在TPPA(-)组中,与TRUST和ELISA相比较,SYP阳性率最高,为20.62%(P<0.05)。与TRUST和SYP相比较,ELISA的灵敏度和Youden指数最高(P<0.05)。与TRUST相比较,ELISA对不同阶段梅毒阳性率均显著升高(P<0.05)。结论:ELISA具有较高的敏感度和特异度、成本低、操作简易优点,可以替代TPPA作为梅毒血清学诊断的首选方法。     

Statistical forecasting in a hospital clinical laboratory

Three forecasting methodologies were applied to monthly laboratory test count data in order to arrive at a best procedure for forecasting ahead to cover the next fiscal year. The purpose of the forecasting was, first, to aid in reimbursement and income decisions and, second, to assist in operations management decisions within the laboratory itself. The Box-Jenkins ARIMA models were found to be superior in all cases, and forecasts for individual test counts (as opposed to packages of tests billed as a unit) were improved if forecasts for inpatients and outpatients were done separately and then aggregated. With 2 years of experience to go on, the annual forecast error stands at around 4.5%.     

Psychiatry in a postgraduate teaching hospital

A study is presented of 217 adults referred for psychiatric assessment from the wards of a postgraduate teaching hospital.     

Antibiotic-resistant staphylococci in a teaching hospital

A large, continuing outbreak of infection and colonisation with a Staphylococcus aureus which is resistant to methicillin and gentamicin is reported. Affected patients and staff members seen between September, 1980, and August, 1981, are reviewed in detail. Methods of management of such persons and their treatment, if required, are discussed. The antibiotic-resistant Staph. aureus is readily disseminated in hospitals and may cause outbreaks of infection in wards, which require isolation of affected patients in the attempt to control the problem. It is suggested that a special isolation unit is needed. Use of the few effective antibiotic agents should be restricted. Despite these measures, the spread of this organism may not be contained.     

Causes of atypical pneumonia: results of a 1-year prospective study.

In a protocol study of cases of atypical pneumonia over a 1-year period an etiologic agent was established in 16 cases: Legionella pneumophila in 8, Coxiella burnetii in 3, Chlamydia trachomatis in 2, Mycoplasma pneumoniae in 1, para-influenza 3 virus in 1 and cytomegalovirus in 1. In the remaining 11 cases no agent was identified; the illnesses in these cases tended to be less severe. The pneumonia took much longer to resolve in the patients with Legionnaires' disease than in all the other patients (mean interval from onset of symptoms to clearing of the chest roentgenogram: 69 days v. an average of 16 days). However, the length of stay in hospital was similar for the three groups: those with Legionnaires' disease, those with atypical pneumonia of unknown cause and those with atypical pneumonia of various other established causes. L. pneumophila infection may explain a proportion of atypical pneumonias that previously could not be diagnosed, although in this series the cause of 41% of the pneumonias remained unexplained.     

Bed usage in a Dublin teaching hospital: a prospective audit

Aims and methods  

We prospectively audited inpatient bed use in our hospital for the first three months of this year. While 70% (mean age 54±20.8 years) of our patients went home on the day they were medically discharged, 30% (mean age 70.3±18.3 years) remained in the hospital awaiting step-down facilities. The total of 486 bed days occupied by overstaying patients would if available, have allowed treatment of 54% more patients without any increase in the hospital complement of beds, preventing the cancellation of elective procedures and preventing patients remaining on trolleys overnight.     

建立丙型肝炎临床检验诊断路径的实验诊断学教学改革

目的 建立涵盖丙型肝炎诊断、鉴别诊断、药物毒副作用监测、治疗效果和预后评估的临床检验诊断路径,并探索以临床检验诊断路径为思路的实验诊断学教学。方法 根据丙型肝炎的临床诊疗指南,制订与疾病不同阶段相关的实验室检测策略,建立丙型肝炎的临床检验诊断路径,以武汉大学第一临床学院2018级和2019级七年制本科生为研究对象,通过随堂问卷和小测试比较其课堂教学效果。应用SPSS 19.0软件对数据进行t检验。结果 建立获得临床医生认可的丙型肝炎临床检验诊断路径,其涵盖丙型肝炎临床诊断、鉴别诊断、药物毒副作用监测、治疗效果和预后评估等全过程,该路径应用于2019级临床医学本科生课堂教学后,教学质量评估指标均有较大程度的提升（P<0.05）,其中“已掌握本节课重难点”提升最明显,2018级为（60.90±2.15）分,2019级为（84.80±3.44）分。2019级对教学方法的评价总分（94.02±4.29）明显高于2018级（79.21±3.68）（P<0.05）。随堂测验2018级为（78.10±4.92）分,而2019级平均成绩为（94.60±5.63）分,得分也显著提高（P<0.001）。结论 建立了丙型肝炎临床检验诊断路径并应用于实验诊断学教学,使实验诊断学与临床医学有机融合,同时显著提高了教学质量。