667例骨科手术切口目标监测与干预效果评价 FREE

目的 了解引起骨科手术切口感染的因素,采取有效措施预防与控制骨科手术切口感染。方法 分2个阶段对在洁净手术室进行的骨科手术切口进行监测,第1阶段即2008年3月1日-12月31日（调查阶段）,主要调查感染情况及相关因素;第2阶段即2009年1月1日-5月31日（干预阶段）,根据前阶段的调查结果对可干预的相关因素进行干预。比较两阶段的感染率。结果 调查阶段的手术切口感染率为5.07%（23/454）,干预阶段的手术切口感染率为1.41%（3/213）,干预阶段切口感染率显著降低（χ2=4.25,P＜0.05 ）。结论 加强洁净手术室的管理、保证手术器械及用物灭菌质量、围手术期合理使用抗菌药物、正确进行外科手消毒、严格执行换药操作规程、提高医护人员感染控制意识等干预措施可有效预防与控制骨科手术切口感染。     

两种不同脐部护理方法对预防新生儿感染的效果比较

目的探讨两种脐部护理方法对减少新生儿脐部感染和败血症的效果。方法分别对2012年1—6月(改进前)、2012年7—12月(改进后)入住某院产科及新生儿科的新生儿采取两种不同的脐部护理方法,比较两组新生儿脐部感染和败血症发生情况。结果脐部护理方法改进前后新生儿脐部感染发病率分别为1.12%、0.35%,两者比较差异有统计学意义(χ2=4.75,P=0.029),新生儿败血症发生情况差异无统计学意义(P=0.251)。结论加强对新生儿感染监测及其家属的健康宣教,改进护理方法,可有效降低新生儿感染的发生。     

下呼吸道感染病原菌分布及耐药性分析 FREE

目的探讨某院下呼吸道感染患者病原菌种类及耐药状况,为临床治疗提供参考。方法对2005-2006年下呼吸道感染住院患者送检的痰及下呼吸道分泌物标本进行普通细菌培养、鉴定,并采用K B纸片琼脂扩散法进行药敏试验。结果分离217株病原菌,以革兰阴性杆菌为主,共145株,占总菌株数的66.82％,其中肺炎克雷伯菌、铜绿假单胞菌分别占29.03％、13.37％,产超广谱β 内酰胺酶（ESBLs）的肺炎克雷伯菌和大肠埃希菌检出率分别为30.16％和25.00％;革兰阳性球菌中耐甲氧西林凝固酶阴性葡萄球菌占59.09％,耐甲氧西林金黄色葡萄球菌占46.67％。结论该院下呼吸道感染病原菌以革兰阴性杆菌为主,且耐药性日益严重,应不断进行监测,合理使用抗菌药物。     

手术器械清洁方法国内研究进展

医疗器械使用后,应进行彻底地清洁处理,去除附着在上面的血液、黏液和体液等有机物,这是预防和控制医院感染,保证医疗安全的重要环节。器械清洁方法正确与否,清洗质量合格与否,清洗后的维护和保养及如何通过物理和化学方法将器械上的有机物、无机物和微生物清除到安全的水平,对保证灭菌效果和控制交叉感染具有重要的作用［1］。在所有环节中,器械清洗是基础和前提,如果清洁不彻底,医疗器械上残留的有机物会在微生物的表面形成一层保护层,妨碍消毒灭菌因子与微生物接触或延迟其作用,影响消毒灭菌效果。因此,器械清洗质量是否合格尤为重要。     

990株临床非发酵菌的种群分布及耐药谱分析 FREE

目的了解某院临床标本分离的非发酵菌菌种分布及耐药谱,为临床用药提供依据。方法回顾性分析该院2004年1月-2008年12月临床各科室送检标本分离的990株非发酵菌资料。结果990株非发酵菌分为11个菌属,其中以不动杆菌属细菌最多,占43.43%（430/990）;假单胞菌属和窄食单胞菌属次之,分别为34.75%(344/990)和10.71%(106/990)。分离最多的前4种菌依次为铜绿假单胞菌（29.19%）、洛菲不动杆菌(20.61%)、醋酸钙-鲍曼不动杆菌复合种(13.74%)和嗜麦芽窄食单胞菌(10.71%)。标本中以痰液分离菌数最多,占79.80%(790/990),其次为咽拭子7.88%（78/990）、体液6.87%(68/990)。5年来,铜绿假单胞菌对替卡西林、头孢西丁、头孢噻肟、亚胺培南、奈替米星、复方磺胺甲口恶唑、培氟沙星、庆大霉素、呋喃妥因和妥布霉素的耐药率变化显著（P＜0.005或P＜0.05）,耐药率＜30%的抗菌药物有头孢他啶和亚胺培南;不动杆菌属对阿莫西林/克拉维酸、庆大霉素、妥布霉素和复方磺胺甲口恶唑的耐药率变化显著（P＜0.005或P＜0.05）,耐药率＜30%的抗菌药物有替卡西林、亚胺培南和奈替米星。结论非发酵菌为医院感染的主要病原菌,对常用抗菌药物的耐药率高,且多重耐药现象严重,应定期监测细菌变迁和耐药性变化,指导临床合理用药。     

Associations Between Social Media Engagement and Vaccine Hesitancy

There has been a surge in vaccine hesitancy following the Coronavirus pandemic. This study measured the prevalence of and identified factors associated with vaccine hesitancy and social media use. An online survey was administered (n?=?1050) between May and July 2021. Chi-square tests were used to examine bivariate associations with vaccine hesitancy (partially vaccinated and unvaccinated participants). Logistic regression was used to identify associations between social media use and vaccine hesitancy. Chi-square tests showed women (69.7% vs 28.2% men, p_adjusted?=?.002), African American participants (52.3% vs 17.8% white, p_adjusted?<?.001), high school diploma (54.4% vs 38.6% college degree, p_adjusted?<?.001), political unaffiliated (15.8% vs 14.5% republican, p_adjusted?<?.001), Muslim (10.0% vs 0% Jewish, p_adjusted?<?.001), and never married/single (53.9% vs 17.0% married, p_adjusted?<?.001) were more likely to be vaccine hesitant. Controlling for all demographic variables (age, race, gender, and education), more frequent use of social media for reading news was associated with lower vaccine hesitancy (OR 0.35, 99% CI 0.20, 0.63, p?<?0.001). However, using social media as a source of vaccine information without any other trusted source (health department, doctor, CDC,) was associated with higher odds of being vaccine hesitant (OR 2.00, 99% CI 1.15, 3.46, p?=?0.001). People who use social media without referencing trusted sources may be particularly vulnerable to disinformation or vaccine hesitant persons are more likely exposed to non-trusted social media sites as their only information source.

     

“以学生为中心”教学模式在医学教育中的运用 FREE

“以学生为中心”教学模式是美国医学教育的基本点，是一种比较成功和有特色的教育模式［1］。笔者在美国加洲大学San Diego分校(UCSD)工作期间，通过与美国大学教师和学生的广泛接触，亲身感受到了中国医学教育与美国医学教育的差别，认为我国目前传统的医学教育与发达国家还存在很大的差别，主要表现在我国目前的教育模式从小学到大学，仍然为传统的“填鸭式”教学，即“以教师为中心”的教学模式，学生缺乏独立思考，自我表现，自我创新的机会。这在医学教育中表现尤其明显，学生很多时候并没有真正理解所学内容，为了考试去死记硬背。这样培养出来的学生往往高分低能，而很多有创造性的医学人才也不能脱颖而出。在美国笔者所在的大学，在生物和医学研究方面，有4位诺贝尔奖获得者，笔者感觉我们很多硬件并不逊于国外大学，而我们为什么没有诺贝尔奖获得者呢？其中一个很重要的原因就是我们培养的学生缺乏独立创造能力，在素质和能力方面远逊于国外大学。
鉴于“以教师为中心”的教学模式存在很多弊端，笔者在我校2004级临床医学7年制49名学生的传染病学临床教学中，大力推行了“以学生为中心”的教学模式，主要体现以下几方面。     

固体清洗剂和多酶清洗剂清洗手术器械的效果比较

目的比较固体清洗剂和液体多酶清洗剂清洗手术器械的效果,并进行成本分析,为消毒供应中心提供新的清洗技术选择。方法将消毒供应中心4台清洗消毒机随机平分为实验组和对照组,实验组使用固体清洗剂,对照组使用液体多酶清洗剂对手术器械进行清洗。对两组手术器械的清洗效果,采用目测(裸眼和10倍光源放大镜）、ATP生物荧光检测和蛋白残留检测方法进行效果评价,并对两组的清洗成本以及产生的医疗废弃物进行统计分析。结果肉眼裸视评价清洗效果,实验组合格率为97.70%（4 678/4 788）,对照组为92.01%（5 075/5 516）;10倍光源放大镜评价清洗效果,实验组合格率为94.30%（2 546/2 700）,对照组为88.72%（2 453/2 765）;实验组合格率均高于对照组,差异具有统计学意义（P=0.000）。ATP荧光检测法评价清洗效果,实验组合格率为84.41%（996/1 180）,对照组为86.83%（1 042/1 200）,两组差异无统计学意义（P=0.092）。实验组蛋白残留检测阳性率为3.71%（26/700）,对照组为16.31%（106/650）,实验组蛋白残留检测阳性率比对照组低,差异有统计学意义（P=0.000）。实验组清洗成本为对照组的2/3;实验组产生医疗废弃物（塑料薄膜）0.40 kg,对照组（空桶）为12.30 kg。结论固体清洗技术可以高效去除手术器械的蛋白污染,并降低清洗成本,减少医疗废物的产生,是值得推广的新型清洗技术。     

Dedication of Special Issue of <Emphasis Type="BoldItalic">JBHS&;R</Emphasis> in Memory of Douglas Longshore

This special issue is dedicated to the memory of Douglas Longshore, who was affiliated with the UCLA Integrated Substance Abuse Programs and RAND. The special issue reflects Longshore’s research legacy in the areas of addiction and health services research and his many productive collaborations with other investigators.     

创面分泌物涂片检查在开放性地震伤气性坏疽诊治中的运用 FREE

目的 探讨创面分泌物涂片检查在开放性地震伤气性坏疽诊治中的作用。方法 开放性地震伤患者入院后均常规行伤口分泌物细菌学涂片筛查,怀疑气性坏疽者立即予以隔离,并视病情采取相应手术和抗感染治疗。创面处理后再次行分泌物涂片筛查,阳性者予以再手术治疗。结果 对376例开放性损伤468次创面分泌物涂片,结合临床诊断为气性坏疽者25例,其中初次涂片结果显示革兰阳性（G+）粗大杆菌20例,培养确认气性坏疽杆菌者12例（包括5例涂片阴性者);创面处理后分泌物涂片显示仍有少量G+粗大杆菌残留者12例,再次扩创后涂片未发现G+粗大杆菌。截至2008年7月底,25例患者创面全部愈合。救治期间,在分诊时即诊断出气性坏疽,无漏诊和医院感染病例发生。
结论 在发生大面积开放性创伤患者聚集时,合理使用创面分泌物涂片检查,有助于及时、准确筛查出创伤性气性坏疽,提高治疗效果并防止医院感染。     

一种医院感染监测系统的设计与应用 FREE

目的 开发医院感染监测软件（HIMS）,有效监控医院感染。方法结合医院的实际需求,设计一种医院感染监测系统,并与软件公司合作,开发相应的HIMS,将其嵌入医院信息系统中。结果 该系统在医院感染监测工作中得到具体应用,发挥了实时监控、预警报告的作用,取得良好效果。结论 该系统能较好地满足医院感染监测的各项基本功能需求,达到了预期效果。     

Obésité : que nous dit l’épidémiologie ?

In most developed and developing countries, a regular increase of the prevalence of obesity has been documented during the last decade(s) of the xxth century. The last figure from the USA is for the first time discordant with this general trend by showing a clear slowing down since year 2000. In children likewise, a rapid increase in the prevalence of obesity took place in the second half of the xxth century but recent publications from France, Switzerland, UK, USA also report a stabilization of childhood overweight and obesity prevalences. The experience of developing countries clearly shows the impact of socioeconomic status improvement and urbanization on the prevalence of obesity. In developed countries like France, a striking element was the diffuse nature of the adult obesity epidemic observed from the 1990s. The general improvement of living conditions after the Second World War probably explains the diffuse nature of the epidemics. Specifically, the changes in the nutritional status of children that happened at that time have long lasting consequences for adult obesity epidemics. Indeed, a new current in epidemiology, lifecourse epidemiology, has prompted over the past decade a new approach of the pathophysiology of chronic diseases, including obesity. Lifecourse epidemiology considers factors affecting the susceptibility to diseases over the whole life with critical periods during developmental phases. Critical periods for the susceptibility to obesity have been documented in prenatal life, during the first 6 months of postnatal life and from 3 years on starting at the time of the adiposity rebound. Parental obesity is involved at each of the critical periods. The transgenerational transmission of obesity is explained by genetic factors, shared lifestyle but also epigenetics especially during the early developmental periods. The slowing down of the childhood obesity epidemics observed in several developed countries may signal that factors affecting the early susceptibility to obesity have recently changed.     

医院感染阴沟肠杆菌多重耐药基因分析 FREE

目的了解医院感染阴沟肠杆菌的耐药性及其耐药基因,为防控感染提供依据。方法对40株临床分离的阴沟肠杆菌,以纸片扩散法和琼脂稀释法进行药敏试验,聚合酶链反应(PCR)及序列分析法分析12种耐药相关基因。结果40株阴沟肠杆菌仅对亚胺培南和美罗培南高度敏感,敏感率均为100.00%;对头孢吡肟耐药率较低,为15.00%;对其他15种抗菌药物耐药率较高,为42.00%～92.50%。共检出8种耐药基因,分别为TEM 1、SHV 2a、CTX M 3、CTX M 9、AmpC、aac(3′) Ⅰ、IntⅠ1、sul1,大多数菌株携带sul1+IntⅠ1型基因;耐药谱共分为A～I 9型,以C和D型为主。抗菌药物耐药谱分型和基因分型有一定相关性。结论阴沟肠杆菌呈现多重和高度耐药性,耐药机制复杂且呈多种耐药机制共同作用。     

Effects of Hypoxia and Sedimentary Naphthalene on the Activity of <Emphasis Type="Italic">N</Emphasis>-acetyl-<Emphasis Type="Italic">β</Emphasis>-Glucosaminidase in the Epidermis of the Brown Shrimp, <Emphasis Type="Italic">Penaeus aztecus</Emphasis>

The brown shrimp, Penaeus aztecus, is subject to dual stresses of environmental hypoxia and contamination of polycyclic aromatic hydrocarbons (PAHs) in the northern Gulf of Mexico. The effects of hypoxia and sedimentary naphthalene, administered alone and in combination, on epidermal activity of N-acetyl-β-glucosaminidase (NAG), a biomarker for molt-interfering effects in P. aztecus, were investigated. It was found that hypoxia and sedimentary naphthalene, when given simultaneously, significantly inhibited epidermal NAG activity, suggesting that these two environmental stressors together can have adverse effects on molting of the brown shrimp. The results of this study also show that sedimentary naphthalene potentiates hypoxia effects on epidermal NAG activity.     

鲍曼不动杆菌肺部感染的临床特点及耐药性分析 FREE

目的分析和总结鲍曼不动杆菌肺部感染的临床特点及耐药规律。方法对2006年6月-2008年6月间住院的65例鲍曼不动杆菌肺部感染患者临床资料进行分析。结果鲍曼不动杆菌肺部感染在综合重症监护病房（ICU,41.54%）、神经内科监护病房（29.23%）、神经外科监护病房（10.77%）、呼吸内科（10.77%）较常见;对多种抗菌药物的耐药率＞70%;感染患者大多为年老体弱、基础疾病多、住院时间长且接受各种侵入性操作、感染前反复使用2种以上抗菌药物者;部分病例合并其他病原菌感染,以铜绿假单胞菌（34.55%）及嗜麦芽窄食单胞菌（20.00%）较多。结论鲍曼不动杆菌肺部感染患者病情重,对抗菌药物耐药率高,掌握其临床特点、感染分布及耐药规律,对临床预防与治疗尤为重要。     

Sexual dysfunctions in women with chronic pelvic pain. A modified sex-therapeutic model

Pelvic pain in women is frequently associated with sexual disturbances: inhibited sexual desire, excitement disorders (dyspareunia) and orgasmic dysfunctions. Women with chronic pelvic pain have a disturbed relationship with their own body. They lost the ability of living the body as a place of sensual joy and mutual communication. The goal of therapy is not only relieving from pain, but also that the women should learn (again) to enjoy life as much as the capacities allow this. Therapeutic measures include guidance and appropriate treatment: a biopsychosocially oriented approach. Formal psychotherapy, implying the working trough of deep, unconscious conflicts, anxieties, and angers from childhood, is not necessary and mostly not possible. Also formal sextherapy or psychosexual therapy (Kaplan) is not indicated. This paper describes the different steps of an appropriate and modified sextherapy on psychosomatic and psychodynamic lines. Difficulties, risks and chances of each step are demonstrated; a careful physical examination, information, counselling and emotional support, physical and psychological rest, drug therapy, the way of individual counselling and sexual enrichment program, couple sexual counselling and sextherapeutical sessions. Through these steps the woman can be accompanied to a new life style. The participation in a self-help group for women with emancipatoric goals opens some women's eyes for yet unused capacities and talents. Through these sessions both partners can learn how to live up a new partnership.