专管员参与集中配置抗菌药物存放时间管理的效果评价

目的探讨专管员参与集中配置抗菌药物存放时间管理的应用效果。方法组建专管员护士小组、制订并实施监督管理措施、加强抗菌药物使用的管理,对实施前、后集中配置抗菌药物存放时间和配送时间进行比较。结果通过运用专管员管理模式,有效缩短了集中配置抗菌药物存放时间及配送时间(P0.01)。结论采用专管员对集中配置抗菌药物的使用进行管理,可缩短药物的存放和配送时间,保证了药物在液体中的稳定性,有利于发挥抗菌药物的最佳疗效。     

静脉药物配置中心对护理人力资源优化配置的作用研究

目的 考察静脉药物配置中心(PIVAS)对护理人力资源配置的影响.方法 对比PIVAS开展前后静脉用药配制效率及各环节消耗工时,及PIVAS开展前后我院药学人力资源分配,分析PIVAS对我院护理、药学人员配置、工作效率的影响.结果 PIVAS开展后,显著节约了护理人力资源,优化了护理人力资源配置.结论 PIVAS集中配制静脉药物,有利于医院护理与药学的人力资源优化配置,促进护理事业发展,具有极大的推广价值.     

我院腹股沟疝手术抗菌药物预防性使用情况和合理性分析

为了解我院外科在预防性应用抗菌药物方面的现状,对我院2008年一季度腹股沟疝I类手术预防性用抗菌药情况进行调查,为合理使用抗菌药物提供参考. 材料与方法 一、调查对象 我院2008年一季度腹股沟疝修补术患者,术前均无感染,手术切口:I/甲类. 二、调查方法 根据卫生部颁布的<抗菌药物临床应用指导原则>(以下简称指导原则)[1]、美国医院药剂师学会(American Society of Health-system Pharmacists, ASHP）外科手术预防用抗菌药物指南[2]和<应用抗菌药物防治外科感染的指导意见>[3],从适应证、给药时机、抗菌药物品种、给药方法包括剂量和频次、给药疗程以及联合用药等方面进行评价.     

静脉药物配置中心对护理人力资源优化配置的作用研究

目的考察静脉药物配置中心（PIVAS）对护理人力资源配置的影响。方法对比PI—VAS开展前后静脉用药配制效率及各环节消耗工时，及PIVAS开展前后我院药学人力资源分配，分析PIVAS对我院护理、药学人员配置、工作效率的影响。结果PIVAS开展后，显著节约了护理人力资源，优化了护理人力资源配置。结论PIVAS集中配制静脉药物，有利于医院护理与药学的人力资源优化配置，促进护理事业发展，具有极大的推广价值。     

静脉药物配置中心工作人员的合理配置

静脉药物配置中心(PIVAS)增加了药师审核环节,能保证药物的规范配置,确保用药安全,便于药品管理,提高护理质量。而我国PIVAS起步较晚,在人力配置及管理方面缺乏规范化标准。本文就我院PIVAS的人力配置特点及管理方法进行了总结,为PIVAS的规范化管理提供参考。     

护理干预对剖宫产围术期抗菌药物使用的影响

目的:探讨护理干预在剖宫产围术期使用抗菌药物中的应用效果.方法:采用前瞻性调查的方法,选取实施护理干预后的2009年1～12月535例产科剖宫产围术期使用抗菌药物病例作为干预组,另选取实施护理干预前的2008年1～12月498例产科剖宫产病例作为对照组,并对两组进行分析、对照.结果:干预组术前首剂给药、给药间隔时间合理率明显高于对照组(P＜0.01),术后给药时间明显缩短(P＜0.01).结论:通过实施科学、有效的护理干预措施,能有效推进剖宫产围术期使用抗菌药物的合理性.     

门急诊静脉药物配置中心的建立与管理

通过门急诊静脉药物配置中心(PIVAS)各项工作流程、制度及管理体系的建立,使液体配置更为规范、安全,大大降低获得性感染的发生率。对药品实行集中管理,有效地监控药品质量,防止因过期失效而造成药品浪费。由药师审查处方,避免不合理的药物配伍,确保了用药的合理性。在生物安全柜内配置药液,加强了护士的职业防护。开展PIVAS工作后,把护士从日常的领药、配药工作中解放出来,使护士有更多的时间对病人进行护理巡视和健康宣教,从而提高了临床护理质量,使病人更为满意。     

启用静脉药物配置中心对护患的影响

目的探讨启用静脉药物配置中心(PIVAS)对患者和护理人员的影响。方法采用回顾性调查和问卷调查比较我院门诊输液患者实施PIVAS前后与配液有关的输液反应率、输液患者满意率和输液患者的疗程。结果启用PIVAS大大降低了所配置液体被污染的机率,由此降低了输液反应的发生率(P<0.05),患者对护理服务的满意度提高,除化疗患者外,91%的患者输液疗程小于3 d,而启用静脉配置中心以前,仅82%的患者疗程小于3 d。结论建立静脉药物配置中心,护理服务水平,治疗水平和管理效益均获提高。PIVAS值得向医院推广。     

启用静脉药物配置中心对护患的影响

目的 探讨启用静脉药物配置中心(PIVAS)对患者和护理人员的影响.方法 采用回顾性调查和问卷调查比较我院门诊输液患者实施PIVAS前后与配液有关的输液反应率、输液患者满意率和输液患者的疗程.结果 启用PIVAS大大降低了所配置液体被污染的机率,由此降低了输液反应的发生率(P＜0.05),患者对护理服务的满意度提高,除化疗患者外,91%的患者输液疗程小于3 d,而启用静脉配置中心以前,仅82%的患者疗程小于3 d.结论 建立静脉药物配置中心,护理服务水平,治疗水平和管理效益均获提高.PIVAS值得向医院推广.     

2009年1～3月我院门诊抗菌药物应用分析

目的:了解我院门诊抗菌药物的应用现状,逐步提高合理用药的水平。方法:随机抽取本院2009年度1～3月部分处方,统计抗菌药物的使用率、联合率、品种及给药情况等。结果:共调查3105张处方,抗菌药物的平均使用率为57.75%,基本持平。抗菌药联用:58.34%处方单用一种抗菌药物,36.36%处方二种抗菌药物联用,5.30%处方三种抗菌药物联用,给药途径:大多数为注射,占73.2%,其次为口服,占21.5%,外用占5.3%。结论:我院抗菌药物使用基本合理,但给药途径有待改善,给药方法有待提高,药师和医师应共同提高合理使用抗菌药物的水平。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.