重症监护患者获得性肺炎的相关因素分析

目的:探讨重症监护病房(ICU)患者发生获得性肺炎的危险因素、病原体分布及药敏情况。方法:对我院重症监护病房2000年11月～2002年1月住院的52例获得性肺炎患者的临床和细菌学资料进行回顾性分析。结果:①52例患者获得性肺炎的发病危险因素有:机械通气、侵入性治疗、意识障碍、应用制酸剂、高龄,其发病相对危险度分别为7.82、5.58、2.68、2.53、1.24;②痰培养共检出病原菌128株:G~-杆菌93株(占72.66％),G~ 球菌22株(占17.19％),真菌13株(占10.16％);③128株致病菌对所选的抗生素有很高的耐药率。结论:机械通气、侵入性治疗、意识障碍、应用制酸剂、高龄是ICU获得性肺炎的主要危险因素;G~-杆菌是获得性肺炎的主要致病菌,真菌感染有增加趋势。     

Animals as sentinels of chemical terrorism agents: An evidence-based review

Objectives.The goal of this systematic review was to identify evidence that animals could serve as sentinels of an attack with a chemical terrorism agent. Methods.The biomedical literature was systematically searched for evidence that wild or domestic animals exposed to certain chemical weapons of terrorism had either greater susceptibility, shorter latency period, or increased exposure risk versus humans. Additionally, we searched for documented reports of such animals historically serving as sentinels for chemical warfare agents. Results.For a small number of agents, there was limited evidence that domestic and/or wild animals could provide sentinel information to humans following an airborne attack with chemical agents, usually related to increased potential for environmental exposure. Some of this evidence was based on anecdotal case reports, and in many cases high quality chemical terrorism agent evidence regarding comparative susceptibility, exposure, and latency between humans and sentinel animal species was not found. Conclusion.Currently, there is insufficient evidence for routine use of animals as sentinels for airborne chemical warfare agents. At the same time, Poison Center surveillance systems should include animal calls, and greater communication between veterinarians and physicians could help with preparedness for a chemical terrorism attack. Further analysis of comparative chemical warfare agent toxicity between sentinel animal species and humans is needed.     

Depression in Primary Care

Depression is a heterogeneous disorder with a wide range of presentations. Most patients with depression are seen in primary care, where it is often unrecognized; thus, screening for depression is important. Medical conditions can mimic depression and vice versa. For mild cases of depression, symptom monitoring and nonpharmacologic strategies are generally recommended initially, whereas psychotherapy and antidepressant drugs are first-line treatment for moderate to severe cases. Patients with depression often experience relapse, recurrence, or both, and multiple options are available. Primary care providers are central to screening, diagnosing, and subsequently treating or referring these patients.     

The Effects of Weapons of Mass Destruction on Children

PURPOSE: Children are especially vulnerable to the effects of chemical and biological weapons of mass destruction (WMD) because of physiologic, pharmacologic, and developmental characteristics. Presentation of signs and symptoms of exposure to biological and chemical agents are similar to those seen in adults. Pediatric considerations for decontamination and treatment of child victims of biological and chemical agents are discussed. CONCLUSION: As front-line providers, nurses need to be aware of potential agents, their uses and effects as WMD, and recommended treatments. PRACTICE IMPLICATIONS: Understanding the additional physiologic and situational needs of children, nurses can optimize the survival and outcomes of children when disaster strikes.     

Dietary migraine: recent progress in the red (and white) wine story

The concept of dietary migraine as a clinical entity remains controversial. We review here such objective evidence that has been put forward for its existence. Red wine, in particular, is commonly alleged to initiate attacks in susceptible individuals. We discuss how some of its recently described pharmacological properties might trigger off the sequence of events leading to migrainous headache.     

2008—2011年北京协和医院重症监护病房细菌耐药性监测

  目的  了解重症监护病房病原菌分布及其耐药情况。  方法  2008年1月至2011年12月间北京协和医院重症监护病房患者中连续分离到3507株非重复细菌, 采用纸片扩散法对临床分离菌株进行药敏试验, 按美国临床实验室标准化研究所2011年标准判读药敏结果, 采用WHONET 5.4软件分析数据。  结果  3507株非重复细菌中, 革兰阴性菌占74.7%, 革兰阳性菌占25.3%。10种最常见的细菌分别为:鲍曼不动杆菌(28.1%)、铜绿假单胞菌(12.8%)、金黄色葡萄球菌(10.0%)、大肠埃希菌(7.8%)、肺炎克雷伯菌(7.7%)、凝固酶阴性葡萄球菌(7.1%)、嗜麦芽窄食单胞菌(5.2%)、屎肠球菌(4.4%)、阴沟肠杆菌(2.3%)、粪肠球菌(2.3%)。4年中耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulasenegative staphylococci, MRCNS)的总检出率分别为74.9%(262/350)和83.4%(206/247), MRSA中有82.6%的菌株对磺胺甲噁唑-甲氧苄啶敏感, MRCNS中有79.6%的菌株对利福平敏感。均未发现对万古霉素、替考拉宁和利奈唑胺耐药的菌株。粪肠球菌对氨苄西林(18.2%)、呋喃妥因(5.6%)和磷霉素(2.7%)的耐药率较低, 屎肠球菌对万古霉素和替考拉宁的耐药率分别为9.5%和7.5%, 粪肠球菌对二者的耐药率分别为1.3%和1.3%。产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的总检出率分别为60.2%(165/274)和46.8%(126/269)。鲍曼不动杆菌泛耐药株(除外米诺环素)的总检出率为60.4%(596/987), 铜绿假单胞菌泛耐药株的总检出率为5.6%(25/450)。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为82.8%和83.8%, 对米诺环素的敏感率为58.0%。铜绿假单胞菌对阿米卡星的耐药率最低, 为16.8%, 对亚胺培南和美罗培南的耐药率分别为42.6%和35.3%。  结论  在重症监护病房, 碳青霉烯类抗生素对大肠埃希菌和肺炎克雷伯菌仍保持高活性, 鲍曼不动杆菌耐药性呈增长趋势, 特别是多重耐药和泛耐药菌株。     

Improving Care for Women With Urinary Incontinence in Primary Care

Urinary incontinence (UI) is highly prevalent in primary care, disproportionately impacts women, and is associated with poor quality of life related to significant psychological, physical, social, and financial burdens. UI places significant economic burden on the United States health care system. Cost-effective, first-line UI treatments improve continence and can be successfully offered in primary care. Unfortunately, UI is largely untreated, in part because health care providers fail to inquire about involuntary urine leakage and are uncomfortable with UI diagnosis and treatment. The aim of this article is to familiarize clinicians with UI risk factors and effective nonpharmacologic management strategies for primary care.     

Evaluation of Care in Psychogeriatric Units: Family Support in Quality of Care

ABSTRACT As institutionalised psychogeriatric patients are very vulnerable, a pilot project was undertaken to develop an instrument to evaluate the quality of their care. The proposed instrument is based on qualitative findings from observations, interviews, records and literature review. It focuses on individual patients, groups of patients, families and the unit, and includes nine items which are measured in terms of administrative, affective and instrumental aspects of care. This paper only describes the data gathered on one of these foci—the involvement of families as both providers of care and as clients requiring support. From the data it appears that the family role as a provider of care is enhanced by support received from the staff and, therefore, family support was selected as an item by which to evaluate quality of care. Material from the data was used as examples for assigning quantitative values to aspects of family involvement.     

British Association of Critical Care Nurses position statement on the use of restraint in adult critical care units

Critical care nurses in the United Kingdom have become increasingly concerned about the use, potential abuse and risks associated with physical restraint of patients. Restraint in critical care is not only confined to physical restraint but can also encompass chemical and psychological methods. There are concerns regarding the legal and ethical issues relating to the (ab)use of physical restraint techniques in critical care. The aim of this article was to present the British Association of Critical Care Nurses (BACCN) position statement on the use of restraint in adult critical care units and to provide supporting evidence to assist clinical staff in managing this process.     

Physical Restraints in Geriatric Care

The aim of the present study was to investigate the use of physical restraints in institutional elder care and staff knowledge about and attitudes toward the use of these restraints. Poor knowledge and negative attitudes toward the use of restraints were found among staff. Significant differences between various staff categories were found concerning knowledge about the use of restraints; nurse aids had the lowest and physicians the highest scores on the knowledge test. Nurse aids demonstrated the least negative attitudes (were most prone to use restraints) and physicians the most negative. Furthermore, there was a significant relation between attitudes and knowledge, i.e. staff with poor knowledge also demonstrated the least negative attitudes toward the use of restraints. Despite these negative attitudes among staff, we found a large proportion of restrained patients in the institutions investigated. Twenty-nine percent of the patients at the investigated clinics were physically restrained. The most common reason given was that restraints were used to prevent falls. No documentation of the observed use of restraints was found in any of the restrained patients' hospital records.