Bicycle helmet use by children. Evaluation of a community-wide helmet campaign

To assess the effect of a community-wide bicycle helmet campaign on helmet use, we observed 9827 children riding bicycles at sites in high-, middle-, and low-income census tracts in Seattle, Wash (intervention city), and Portland, Ore (control city); observations were made during 2-week intervals before and 4, 12, and 16 months after the campaign's start. Helmet use increased from 5.5% before the campaign to 15.7% afterward in Seattle and from 1.0% to 2.9% in Portland. Strong associations were found between helmet use and white compared with black or other race; riding geared vs nongeared bicycles; riding at playgrounds, in parks, or on bicycle paths vs on city streets; and riding with adults or other children compared with riding alone. The proportions of helmet wearers, adjusted for these variables, increased from 4.6% to 14.0% in Seattle and from 1.0% to 3.6% in Portland, a significantly greater increase in use in Seattle compared with Portland. We conclude that a community-wide bicycle helmet campaign can increase helmet use among children.     

Persistence of improvement in antibiotic prescribing in office practice

We evaluated persistence of the prescribing improvement seen in a previous statewide controlled trial, which measured improvement in the prescribing of contraindicated antibiotics and oral cephalosporins in the year after an educational intervention. Doctors visited by physician-counselors substantially improved their prescribing of both classes of drugs. The beneficial effect of the physician-counselors persisted throughout year 2, with attributable reductions in prescribing of 30% and savings of $950 for each doctor visited. The marked and lasting improvement in prescribing produced by the physician-counselors suggests using this model to develop ongoing programs to improve prescribing.     

彻底消毒前后神经内科病房病原菌构成及耐药性检测

目的:观察神经内科病房彻底消毒前后病原菌构成与耐药性的变化,为院内感染的防治提供理论依据.方法:对神经内科病房进行彻底消毒并空闲至少3个月后,只收新患者,并严格按照院内感染防治方法进行管理,标本按常规方法留取,送检.采用法国梅里埃VITEK2-compact自动微生物鉴定仪进行菌株鉴定与药敏测定.结果:消毒后病原菌检出...     

Impact of an electronic antibiotic advice and approval system on antibiotic prescribing in an Australian teaching hospital

The impact of a computer-based infectious diseases electronic antibiotic advice and approval system ("IDEA(3)S") was assessed as an alternative to a labour-intensive, phone-based approval system. IDEA(3)S-based approvals replaced 48% of all approvals for the most frequently requested antimicrobial agents (ceftriaxone/cefotaxime, vancomycin) and were associated with stable overall rates of antimicrobial use. Antibiotic prescribing for community-acquired pneumonia was 76% concordant with IDEA(3)S recommendations, and clinical acceptance of IDEA(3)S was excellent. Successful implementation required a coordinated, evidence-based approach between clinicians, pharmacists and hospital administration, together with ongoing staff education and feedback of results. IDEA(3)S is a useful new adjunct to routine clinician consultation to support appropriate antibiotic prescribing for a number of common indications in hospitals.     

评论：NICE指南关于抗生素在自限性呼吸道感染的初级治疗中的使用

NICE关于呼吸道感染中抗生素使用的最新指南中一条最重要的信息就是：综合了目前大量的证据证实：对大部分患者而言，抗生素的使用并没有带来很有意义的结果。对大部分临床医生而言，这已经不是什么新闻了。大部分人都认为需要对这些观点做出改变，而且也已经在对这些感染进行治疗时做出了改变。     

LASIK矫治高度屈光参差性弱视儿童的双眼视功能变化

目的 观察高度屈光参差性弱视儿童LASIK手术矫治前后双眼视功能的变化,评价LASIK矫治儿童高度屈光参差性弱视的疗效.方法 采用前瞻性非随机自身对照方法观察72例高度屈光参差性弱视儿童病例,将其分为近视和远视2组,在做LASIK手术前后,分别测定患者的视功能.术后随访36个月.结果 近视组和远视组在术后36个月时视功能(裸眼视力,最佳戴镜矫正视力,三级视功能,不等像)均有明显改善,P-VEPP100波振幅逐渐升高,潜时逐渐缩短,振幅与潜时均在术后24个月时达到最佳.结论 LASIK手术矫治儿童高度屈光参差性弱视明显改善了弱视儿童的双眼视功能,显示出良好的弱视治疗效果.     

抗生素口服治疗小儿肺炎的可行性评价

目的：探讨抗生素口服途径治疗小儿肺炎的可行性、优越性。方法：在观察期间临床诊断为细菌性小儿肺炎的病例（非危重的,年龄6个月～5岁为主）,随机分为抗生素口服观察组与抗生素静脉对照组,对病例的病情转归、不良反应、治疗过程患儿依从性等资料进行综合评价。结果：口服抗生素治疗小儿非严重肺炎与静脉使用抗生素的疗效差异无统计学意义,而小儿对治疗的依从性组间差异有统计学意义,口服途径有优势。结论：抗生素口服方法治疗非严重小儿肺炎是有效的,作为常规首选治疗非严重小儿肺炎的可行性、优越性更切合现行的医疗服务模式。     

Effects of computer-aided clinical decision support systems in improving antibiotic prescribing by primary care providers: a systematic review

Objective To assess the effectiveness of computer-aided clinical decision support systems (CDSS) in improving antibiotic prescribing in primary care.Methods A literature search utilizing Medline (via PubMed) and Embase (via Embase) was conducted up to November 2013. Randomized controlled trials (RCTs) and cluster randomized trials (CRTs) that evaluated the effects of CDSS aiming at improving antibiotic prescribing practice in an ambulatory primary care setting were included for review. Two investigators independently extracted data about study design and quality, participant characteristics, interventions, and outcomes.Results Seven studies (4 CRTs, 3 RCTs) met our inclusion criteria. All studies were performed in the USA. Proportions of eligible patient visits that triggered CDSS use varied substantially between intervention arms of studies (range 2.8–62.8%). Five out of seven trials showed marginal to moderate statistically significant effects of CDSS in improving antibiotic prescribing behavior. CDSS that automatically provided decision support were more likely to improve prescribing practice in contrast to systems that had to be actively initiated by healthcare providers.Conclusions CDSS show promising effectiveness in improving antibiotic prescribing behavior in primary care. Magnitude of effects compared to no intervention, appeared to be similar to other moderately effective single interventions directed at primary care providers. Additional research is warranted to determine CDSS characteristics crucial to triggering high adoption by providers as a perquisite of clinically relevant improvement of antibiotic prescribing.     

初级医疗中的呼吸道感染疾病预后——准确信息有助于减少抗生素应用

就在亚历山大·弗莱明（Alexander Fleming）及其团队因发现青霉素的抗菌作用而获得诺贝尔奖的同年（1954）,弗莱明提出要警惕细菌耐药的风险。     

抗菌药物治疗儿童蜂窝织炎的药物经济学研究

目的运用药物经济学的分析方法,探讨儿童蜂窝织炎的最佳药物治疗方案,以最低成本获得最佳的治疗效果。方法采用药物经济学方法分析河北省儿童医院2012年1月~2014年3月儿童诊断为蜂窝织炎的155份病历,根据给药方案分成5组,进行成本-效果分析。结果头孢硫脒、头孢硫脒＋甲硝唑、头孢替唑钠、头孢曲松钠及头孢孟多酯钠的有效率分别为97.14%、98.33%、95.65%、95.45%和93.33%,治疗效果比较,差异无统计学意义（χ2=1.863,P=0.761）,各组治疗成本分别为3362.08、3551.05、4549.11、3916.75、4053.82元,各组C/E值分别为34.61、36.11、47.56、41.03、43.44,其中头孢硫脒所用治疗方案成本最小,成本-效果比值最低。结论头孢硫脒给药方案是治疗儿童蜂窝织炎的最佳方案。