46例慢性阻塞性肺疾病合并下呼吸道真菌感染的临床分析

目的探讨慢性阻塞性肺疾病(COPD)并发下呼吸道真菌感染的因素。方法选择46例COPD并发下呼吸道真菌感染患者为试验组,32例单纯COPD患者为对照组,比较抗菌药物、激素使用和呼吸机辅助通气的情况。结果试验组和对照组在抗菌药物使用种类、持续时间、激素使用时间、呼吸机辅助通气方面差异均有统计学意义;试验组治疗后sTREM-1为(8.95±3.77)pg/ml,显著高于对照组治疗后,试验组治疗后降钙素原与C-反应蛋白分别为(1.57±1.04)ng/ml和(50.68±21.41)mg/L,均显著低于治疗前。结论对于治疗效果不佳、抗菌药物或者激素使用时间长、使用呼吸机的COPD患者,应及时进行病原学检查,早期诊断真菌感染并及时治疗。     

肾内科住院患者院内深部真菌感染的相关因素分析

目的 探讨肾内科住院患者院内深部真菌感染的临床特征及相关因素,为更好地防治肾内科住院患者院内深部真菌感染提供借鉴.方法 对肾内科近1年出院的1000例患者的住院资料进行回顾性分析,有院内深部真菌感染的病例为感染组(A组),无院内深部真菌感染的病例为非感染组(B组),比较两组患者相关因素.结果 肾内科住院患者院内深部真菌感染的发生率为2.3%;感染部位依次为:呼吸道(67.3%)、泌尿道(21.2%)和胃肠道(11.5%);A组患者中糖尿病所占比率、平均年龄、使用抗菌药物、肾上腺糖皮质激素及免疫抑制剂的人均天数、透析患者所占比例均高于B组,差异有统计学意义(P<0.05);而患者的血红蛋白、血清白蛋白水平均低于B组,差异有统计学意义(P<0.05);两组患者平均住院时间、进行有创检查的人均次数等差异无统计学意义(P>0.05).结论 肾内科住院患者院内深部真菌感染发生率较高;尤以呼吸道易感染;糖尿病、高龄、长时间使用抗菌药物、肾上腺糖皮质激素、免疫抑制剂、营养不良、透析等均会增加肾内科住院患者院内深部真菌感染.     

老年COPD患者肺部感染的影响因素及临床药师的干预作用研究

目的探究影响老年COPD患者肺部感染的危险因素及临床药师的干预作用。方法选取2016年1月-2018年1月在南京市胸科医院接受救治的181例COPD患者纳入本次研究。根据是否发生肺部感染,分为感染组和非感染组。采用单因素及多因素Logistic回归分析影响COPD老年患者肺部感染的危险因素。比较COPD老年肺部感染患者治疗前后炎性指标水平、感染控制情况及不良反应发生率。结果 181例COPD老年患者中83例(45.86%)患者发生肺部感染。单因素及多因素Logistic回归分析结果显示年龄、呼吸情况、抗菌药物滥用情况、合并症及住院时间是影响COPD老年患者肺部感染的危险因素。监护组和对照组患者治疗后,WBC、PCT和hs-CRP水平均较治疗前降低,差异均有统计学意义(P均0.05)。监护组患者治疗后,WBC、PCT和hs-CRP水平降低较对照组更为明显,差异有统计学意义(P0.05)。监护组患者肺部感染治疗的总有效率高于对照组,不良反应发生率低于对照组,差异均有统计学意义(P均0.05)。结论高龄、机械通气、滥用抗菌药物、合并症2种及住院时间长是COPD老年患者肺部感染的独立危险因素。临床药师干预COPD老年肺部感染患者治疗有利于提高治疗效果。     

呼吸机相关性气管支气管炎对慢性阻塞性肺疾病预后的影响

目的探讨呼吸机相关性气管支气管炎(VAT)对慢性阻塞性肺疾病(COPD)患者预后的影响,为临床治疗提供参考依据。方法选取2012年1月-2013年12月RICU住院进行有创机械通气治疗的COPD患者136例,其中13例确诊为VAT,设为VAT组,配对病例13例,设为对照组,比较两组患者预后。结果 13例VAT患者送检标本检出细菌共19株,其中18株为多药耐药菌,占94.7%,对照组7株占77.8%(P<0.05);VAT组混合感染患者6例占46.2%,对照组3例占23.1%(P<0.05);VAT相关的常见病原菌为铜绿假单胞菌、鲍氏不动杆菌和MRSA;VAT组机械通气时间明显延长,为22d,对照组仅为13d(P<0.05);VAT组患者ICU住院时间也明显延长为28d,对照组仅为16d(P<0.05);VAT组中使用恰当抗菌药物治疗的患者为6例占46.2%,与使用非恰当抗菌药物的患者相比,机械通气时间较短,分别为12d和20d,ICU住院时间较短,分别为17d和23d,但上述差异无统计学意义。结论 VAT会导致COPD患者机械通气和ICU住院时间延长,恰当的初始抗菌药物治疗有助于改善VAT患者预后。     

老年下呼吸道医院感染白色假丝酵母菌的临床干预

目的 探讨控制老年患者下呼吸道白色假丝酵母菌医院感染的相关因素及干预措施.方法 将2006-2007年老年住院患者作为对照组,2008-2009年老年住院患者作为干预组;应用SPSS 11.0统计软件,比较干预前后两组的感染率、抗菌药物使用率.结果 干预后白色假丝酵母菌医院感染率明显下降,差异有统计学意义(t=2.29,P<0.05);干预后抗菌药物使用率从68.27%降至55.36%,差异有统计学意义.结论 有效地控制老年患者下呼吸道白色假丝酵母菌医院感染的相关因素,合理使用抗菌药物是减少二重感染的关键.     

固本宁肺方对接受吸入激素治疗的慢阻肺患者呼吸道感染的影响

目的探讨固本宁肺方对接受吸入激素治疗的慢阻肺患者呼吸道感染的影响,对临床治疗慢阻肺患者的效率进行分析,为临床治疗提供可靠的依据。方法选择2013年6月-2016年6月于医院接诊的慢阻肺患者160例,将其分为两组,对照组采用常规治疗,常规治疗加用固本宁肺治疗的为观察组,每组各有80例患者,通过对两组患者治疗后的临床疗效、呼吸道感染发生率和治疗前后的免疫功能情况进行对比。结果两组治疗后的CD_3、CD_4水平均有上升,观察组上升的幅度明显大于对照组,差异均有统计学意义(P<0.05),两组CD_8水平有所下降,观察组下降的幅度大于对照组,差异有统计学意义(P<0.05);观察组发生上呼吸道感染1例,咽部真菌感染1例,发生率为2.5%,对照组发生上呼吸道感染4例,下呼吸道感染3例,咽部真菌感染2例,发生率为11.25%,观察组的呼吸道感染发生率明显低于对照组,差异有统计学意义(P<0.05);观察组总有效率为92.5%,对照组总有效率为71.25%,观察组明显高于对照组,差异有统计学意义(P<0.05)。结论采用固本宁肺方对接受吸入激素治疗的慢阻肺患者进行治疗,能够提高治疗的疗效,降低呼吸道感染的发生率,提高患者的免疫功能,效果显著,值得推广应用。     

老年糖尿病患者医院感染的临床特点及影响因素分析

目的探讨老年糖尿病患者医院感染的临床特点及影响因素分析。方法选取2013年1月-2016年12月医院住院的老年糖尿病患者300例临床资料,分析患者感染率、病原菌分布并分析老年糖尿病医院感染相关影响因素。结果 300例老年糖尿病患者医院感染42例,感染率为14.0%;42例老年糖尿病医院感染患者中,呼吸道感染、泌尿道感染、皮肤软组织感染、消化道感染分别为15例、11例、8例、5例,构成比为35.7%、26.2%、19.0%、11.9%,42例老年糖尿病医院感染患者共培养出病原菌67株,其中革兰阳性菌、革兰阴性菌、真菌分别为12株、41株、14株,构成比分别为17.9%、61.2%、20.9%,革兰阳性菌主要为耐甲氧西林金黄色葡萄球菌和肠球菌,革兰阴性菌主要为铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌;老年糖尿病患者医院感染和年龄、病程、糖化血红蛋白、空腹血糖、并发症、住院时间、侵入性操作及应用抗菌药物种类有关(P<0.05);年龄>70岁、病程≥5年、糖化血红蛋白>9%、空腹血糖≥15mmol/L、有并发症、住院时间≥4周、有侵入性操作、抗菌药物种类≥2种是老年糖尿病患者医院感染的独立危险因素(P<0.05)。结论老年糖尿病患者医院感染率较高,主要感染部位为呼吸道感染,主要病原菌为革兰阴性菌,临床应对高龄、病程长、糖化血红蛋白和空腹血糖高、合并并发症、住院时间长、抗菌药物种类多、有侵入性操作患者高度重视,预防医院感染的发生。     

渐进性早期康复护理在慢性阻塞性肺疾病机械通气并发呼吸机依赖患者中的应用效果

目的探讨渐进性早期康复护理在慢性阻塞性肺疾病(COPD)机械通气并发呼吸机依赖患者中的应用效果。方法选取2017年6月至2019年6月宜春市第二人民医院收治的90例COPD机械通气并发呼吸机依赖患者作为研究对象,按照随机数字表法分为对照组和观察组,各45例。两组均应用Boaray 5000C型呼吸机治疗,对照组采用常规护理,观察组采用渐进性早期康复护理,比较两组住院时间、呼吸机相关并发症发生情况。结果观察组住院时间短于对照组,差异有统计学意义(P<0.05);观察组呼吸机相关并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论渐进性早期康复护理应用于COPD机械通气并发呼吸机依赖患者中能够显著降低呼吸机相关并发症发生率,缩短患者住院时间。     

慢性肝衰竭患者真菌感染的危险因素分析

目的 探讨慢性肝衰竭患者真菌感染的相关危险因素,为临床防治提供依据.方法 选取广州中山大学附属第三医院2010年1月-2012年1月收治的60例慢性肝衰竭合并真菌感染患者作为研究对象,设为感染组,将同期未发生真菌感染60例患者设为对照组,对两组患者感染相关因素进行对比分析.结果 感染组病死率10.0％,明显高于对照组的5.0％,差异有统计学意义(P＜0.05)；感染组细菌感染率、抗菌药物使用率及侵入性操作例数分别为78.33％、93.33％、55例,对照组分别为18.33％、46.67％、18例,两组差异有统计学意义(P＜0.05)；logistic回归分析显示,住院期间合并细菌感染种类、总胆红素指数、住院天数、使用抗菌药物累积时间、侵入性操作及使用抗菌药物种类是慢性肝衰竭患者真菌感染的独立危险因素(P＜0.05).结论 针对慢性肝衰竭患者真菌感染相关危险因素,采取积极的防治措施,能有效地降低真菌感染率.     

医院真菌感染现状分析

目的分析医院真菌感染的现状,加强感染的防治。方法回顾性分析2008-2009年206例住院患者真菌感染的病例资料。结果真菌感染以呼吸道为主,感染率为0.96%;真菌种类白色假丝酵母菌占首位,为70.90%;高龄、抗菌药物的滥用、侵入性操作、激素的应用、放疗、化疗是真菌感染的危险因素。结论控制感染的危险因素、合理使用抗菌药物、减少侵入性操作是预防和控制医院真菌感染的关键。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.