抗菌药物预防盆腔炎产妇剖宫产手术部位感染的临床研究

目的 探讨抗菌药物预防盆腔炎产妇剖宫产手术部位感染的临床用药方法,降低医院感染率。方法 选取2011年5月-2013年9月合并盆腔炎的剖宫产产妇317例,随机分为对照组154例和观察组163例,对照组产妇术后给予抗菌药物长程(连续3d)应用,观察组产妇给予抗菌药物短程(1d)应用;对两组产妇分娩情况、术后体温状况、产褥病率、切口感染率以及血像升高情况进行统计,数据采用SPSS13.0进行分析。结果 观察组与对照组分娩及术后计数指标均以血像升高为主,分别为59.74%、62.58%;观察组产妇抗菌药物使用费用明显低于对照组,两组比较,差异有统计学意义(P<0.05)。结论 与其他剖宫产产妇相比盆腔炎产妇发生感染的概率更大,预防性应用抗菌药物很有必要,通过1d的短程用药可以达到连续3d长程用药的预防感染效果,同时又能有效控制产妇的治疗费用,达到医患双方的共赢。     

乳腺手术预防性使用抗菌药物与术后切口感染关系

目的探讨乳腺手术预防性使用抗菌药物与乳腺术后伤口感染关系,为合理应用抗菌药物提供参考依据。方法选择2013年1月-2015年6月医院收治非感染性乳腺手术患者200例,随机分为观察组与对照组各100例,对照组术前给予抗菌药物预防切口感染,观察组术前未给予抗菌药物,比较两组患者围手术期切口感染率、术后体温及白细胞计数情况,数据采用SPSS 19.0软件进行统计分析。结果观察组围手术期切口感染率为2.0%,对照组为1.0%,差异均无统计学意义;两组患者术后体温、WBC计数围手术期各时间段比较差异无统计学意义;观察组住院时间、住院费用分别为(7.75±1.25)d、(10263.5±138.25)元,对照组为(7.25±1.5)d、(11358±162.56)元,两组比较住院费用差异有统计学意义(P0.05)。结论乳腺手术预防性使用抗菌药物与乳腺术后切口感染无关,是一种不合理应用抗菌药物的措施,且增加了患者住院费用。     

抗菌药物预防性应用对降低腹股沟疝修补术感染的临床研究

目的探讨使用抗菌药物预防腹股沟疝无张力修补术后切口感染的临床效果。方法选取2013年3-12月行无张力疝修补术的腹股沟疝患者280例,随机分为对照组144例、观察组136例,对照组患者术前30min给予头孢替安静脉滴注,观察组患者未给予抗菌药物,对两组患者术后感染率、白细胞计数、中性粒细胞所占比例进行统计,并记录两组患者术后住院时间、切口愈合时间等。结果观察组和对照组患者术后切口感染率分别为1.39%和1.47%,观察组患者白细胞计数以及中性粒细胞比例分别为(7.74±0.78)×109/L和(71.93±5.30)%,对照组分别为(7.79±0.75)×109/L和(72.33±5.02)%,上述指标组间比较,差异均无统计学意义;观察组患者住院时间、伤口愈合时间分别为(1.22±0.38)d和(6.82±0.77)d,对照组患者分别为(1.15±0.42)d和(6.54±0.48)d,两组比较差异无统计学意义;观察组患者药费为(301.98±28.75)元,明显少于对照组的(422.76±40.84)元,两组比较差异有统计学意义(P<0.05)。结论对于无张力修补术治疗腹股沟疝的患者,在围手术期预防性应用抗菌药物对于降低切口感染率或者促进伤口愈合无效果,反而增加治疗的费用,因此无必要预防性应用抗菌药物预防感染。     

围手术期规范使用抗菌药物对老年患者Ⅰ类切口感染影响的研究

目的探讨围手术期规范使用抗菌药物对普通外科老年患者Ⅰ类切口手术部位感染(SSIs)的影响,以控制预防性抗菌药物使用率、降低I类切口SSI发生率。方法回顾性分析医院普外科2011年1月-2015年12月收治的217例60岁、行Ⅰ类切口手术治疗的老年患者临床资料,以临床开始严格规范使用抗菌药物(2013年7月)为时间点,将在此时间点之前,经验性使用抗菌药物的老年手术患者85例为对照组,在时间点之后严格规范使用抗菌药物的老年手术患者132例为试验组,比较两组患者SSI发生率、抗菌药物使用率的差异。结果试验组SSI发生率为1.5%,低于对照组的2.4%,差异无统计学意义;试验组与对照组的围手术期预防用药使用率分别为1.5%、48.2%,差异有统计学意义(P0.05)。结论围手术期规范使用抗菌药物可降低老年患者预防用药;针对Ⅰ类切口手术规范用药观念的推广使临床医师提高了合理使用抗菌药物的意识,对感染管理部门在预防与控制手术部位切口感染方面提出了更高的要求。     

神经外科清洁手术预防用药及手术部位感染分析

目的分析神经外科清洁手术预防用药时间与手术部位感染(SSI)发生率的关系,以降低SSI发生率。方法以2012年1月-2013年6月收治的386例开颅手术患者为研究对象,参照原卫生部颁布的《抗菌药物临床应用指导原则》和《医院感染诊断标准》,采用统计方法分析围手术期抗菌药物预防使用与SSI发生率。结果 386例开颅手术患者抗菌药物使用率为100.00%,其中三代头孢菌素中的头孢曲松占83.42%,一、二代头孢菌素占15.80%,均为单联使用,选择范围合理;术前和术后给药时间不合理的分别占41.45%和74.61%;在术后不同时间用药的SSI发生率差异无统计学意义。结论术前合理时间内预防用药可以有效降低SSI发生率,术前精心准备、术后精心护理、严格无菌技术、规范手术操作是避免过度依赖抗菌药物,降低SSI发生率的有效措施。     

普外科患者围手术期应用抗菌药物预防切口感染的效果评价

目的 比较普外科围手术期应用抗菌药物与术后应用抗菌药物预防切口感染效果,探讨围手术期规范应用抗菌药物的临床价值.方法 随机选择普外科手术患者520例,按照随机数字法分规范组及对照组各260例,规范组参照卫生部《抗菌药物临床应用指导原则》应用头孢唑林或头孢呋辛;对照组术前、术中未用药,术后应用头孢唑林或头孢呋辛静脉滴注.结果 规范组术后发热率为16.54％、退热时间(4.12±2.34)d、切口感染率为1.92％,与对照组比较,差异无统计学意义;规范组术后住院时间为(8.23±2.34)d,短于对照组的(11.78±3.17)d,差异有统计学意义(P＜0.05).结论 普外科手术术前应用单剂、术后短时间应用抗菌药物预防切口感染是有效、可行的模式,值得临床使用.     

抗菌药物对骨科围术期预防感染的影响

目的探究抗菌药物对骨科围术期预防感染的影响。方法选择2016年1月-2019年1月瑞安市人民医院骨科收治的手术患者82例,随机数表法分为对照组和研究组,每组各41例,其中对照组围术期给予常规应用抗菌药物,研究组围术期给予干预性应用抗菌药物,观察两组抗菌药物使用情况、抗菌药物费用,并对抗菌药物使用的合理性进行评价。结果研究组住院时间、手术部位感染、治疗各项费用均低于对照组,差异有统计学意义(P<0.05);两组体温异常情况比较,无统计学差异;两组围术期抗菌药物使用均主要以单一用药为主,研究组单一用药多于对照组,二联用药低于对照组,差异有统计学意义(P<0.05);研究组在抗菌药物品种选择、预防用药时机、术后用药时间等围术期抗菌药物使用合理率均高于对照组,差异有统计学意义(P<0.05);两组治疗前肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8、C-反应蛋白(CRP)各项血清炎性因子水平比较,无统计学差异;治疗后,两组血清炎性因子水平均下降,差异有统计学意义(P<0.05)。结论干预性应用抗菌药物对骨科围术期预防感染效果显著,在降低手术部位感染发生率的同时,提高抗菌药物使用合理性、缩短住院时间、降低住院费用。     

妇科清洁手术患者围术期预防用抗菌药物指征的探讨

目的探讨妇科清洁手术患者围术期预防用抗菌药物的指征,为规范妇科清洁手术患者围术期预防用药提供参考。方法选取医院2013年3月-2015年2月全部妇科清洁手术病例(剔除手术前已诊断感染的病例)1 057例,采用回顾性调查及电话回访相结合的方法,按是否合并其他情况分为未合并其他情况和合并其他情况包括:(年龄≥65岁、手术持续时间≥3h、盆腔积血或术中出血>1500ml、糖尿病、手术部位≥2个、盆腔粘连、慢性盆腔炎和阴道炎治疗后)两个组,对比分析不同人群预防用抗菌药物和未预防用抗菌药物患者手术部位感染(SSI)的情况。结果 1 057例妇科清洁手术患者SSI率为0.76%,其中未合并其他情况组397例,SSI率0.50%;合并其他情况组660例,SSI率0.91%;未合并其他情况组:未预防用抗菌药物患者SSI率0.68%,预防用抗菌药物患者SSI率0.40%,差异无统计学意义;合并其他情况组:未预防用抗菌药物患者SSI率0.85%,预防用抗菌药物患者SSI率0.98%,差异无统计学意义。结论未合并其他情况的妇科清洁手术患者围术期通常不需预防用抗菌药物;合并其他情况的妇科清洁手术患者围术期抗菌药物预防效果有限,术前对合并其他情况进行积极干预和纠正治疗,全面落实预防SSI的综合措施更为重要。     

术前抗菌药物预防性应用对剖宫产产妇术后感染及血清感染标志物水平的影响

目的分析术前应用抗菌药物对剖宫产产妇术后感染及血清感染标志物水平的影响,为治疗预防感染工作提供客观依据。方法选取2015年1月-2016年12月行剖宫产手术的962例产妇作为研究对象,将其随机分为研究组和对照组,每组各481例;对照组产妇于术后回病房后开始给予抗菌药物进行预防感染,研究组产妇于术前30min时开始给予抗菌药物进行预防感染;对两组产妇的术后感染率、感染部位、最高体温、切口愈合情况及住院时间、住院费用进行观察和比较;对两组产妇术前及术后1d时的血清降钙素原(PCT)、C-反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)水平进行检测和比较。结果研究组产妇的术后感染率和产褥感染率分别为5.82%和0.21%,对照组产妇分别为9.56%和2.08%,两组比较差异有统计学意义(P0.05);两组产妇最高体温和切口愈合级别比较差异均无统计学意义;研究组产妇的住院时间和住院费用分别为(4.26±0.41)d和(7116.45±282.36)元,均低于对照组产妇(P0.05);两组产妇术前血清感染标志物水平差异无统计学意义,研究组产妇在术后1d时的血清PCT、CRP、IL-6、TNF-α水平分别为(3.12±0.52)μg/ml、(8.15±1.51)mg/ml、(78.82±6.39)pg/ml、(53.18±5.64)pg/ml,均低于对照组产妇(均P0.05)。结论剖宫产术前应用抗菌药物进行预防感染,能够降低患者的术后感染率和血清感染标志物水平,促进患者康复,减少医疗费用。     

乳腺癌围手术期抗菌药物应用的临床研究

目的探讨乳腺癌围手术期不使用抗菌药物对患者术后手术部位感染(SSI)的影响。方法回顾性分析2011年1月-2012年12月甲状腺乳腺外科收治的乳腺癌手术患者411例,将其分为对照组202例、研究组209例,对照组围手术期预防性使用抗菌药物,研究组围手术期不使用抗菌药物,观察两组患者SSI发生率,并对SSI发生及相关因素进行分析,数据采用SPSS13.0统计软件进行处理。结果 411例乳腺癌手术患者术后发生SSI2例,发生率为0.48%,对照组患者SSI发生率0.49%,研究组为0.48%,两组比较差异无统计学意义,证实乳腺癌术后SSI与是否应用抗菌药物无关;两组SSI患者在糖尿病、新辅助化疗、高龄等相关因素方面比较,差异无统计学意义;进一步分析发现,2例SSI均与术后皮下血肿及皮瓣坏死有关。结论乳腺癌术后SSI发生率与年龄、肥胖、糖尿病、术后创面血肿及血清肿等高危因素有关,与预防性使用抗菌药物无关,乳腺癌围手术期不使用抗菌药物并不增加SSI发生率,同时可以减少医疗费用,可以避免使用抗菌药物带来二次感染、耐药等问题,值得临床推广应用。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.