Clinical practice is the most important environment to acquire clinical knowledge

The amount of learning devoted to clinical teaching in medical schools is under pressure from increased amounts of time devoted to so-called 'basic sciences' and recent emphasis on non-medical competencies. Clinical teaching, in direct contact with real patients and supervised by experienced clinical teachers, should remain the core of medical education. Competing subjects should be regarded as important, but limited, corollaries.     

哮喘儿童血清变应原特异性IgE检测与分布特征

目的:了解哮喘患儿过敏原分布特征。方法:256例哮喘患儿分别进行血清吸入性和食入性过敏原特异性IgE检测。结果:哮喘患儿吸入性过敏原特异性IgE阳性211例,阳性率为82.4%,71.1%为两种或两种以上过敏原特异性IgE阳性;食入性过敏原特异性IgE阳性45例,阳性率为17.6%,8.2%为两种或两种以上过敏原特异性IgE阳性。结论:哮喘患儿以吸入性过敏原为主,多数为多种过敏原混合致敏,近年夏秋季发病率升高,夏秋季杂草花粉可能为其过敏原。     

多参数监护仪黑屏的常见故障原因及排除思路

黑屏是多参数监护仪的常见故障,分析其工作原理,介强了检修思路分析和排除此类故障的一般工作流程。     

Urban woodland habitat is important for tick presence and density in a city in England

Urban green spaces provide an opportunity for contact between members of the public and ticks infected with pathogens. Understanding tick distribution within these areas and the drivers for increased tick density or Borrelia infection are important from a risk management perspective. This study aimed to generate data on tick presence, nymph density and Borrelia infection across a range of urban green space habitats, in order to identify those that may potentially present a higher risk of Lyme borreliosis to members of the public. Several sites were visited across the English city of Bath during 2015 and 2016. Tick presence was confirmed in all habitats surveyed, with increased likelihood in woodland and woodland edge. Highest nymph densities were also reported in these habitats, along with grassland during one of the sampling years. Adult ticks were more likely to be infected compared to nymphs, and the highest densities of infected nymphs were associated with woodland edge habitat. In addition to Lyme borreliosis causing Borrelia genospecies, Borrelia miyamotoi was also detected at several sites. This study adds to the growing evidence that urban green space habitats present a public health risk from tick bites, and this has implications for many policy areas including health and wellbeing, climate adaptation and urban green space planning.     

Ten years of KISS: the most important requirements for success

Ten years ago, in January 1997, data collection for the German national nosocomial infection surveillance system was established, which is known by the acronym KISS (Krankenhaus-Infektions-Surveillance-System). Meanwhile KISS was able to demonstrate a beneficial effect from ongoing surveillance activities and appropriate feedback to the users in combination with reference data for ventilator associated pneumonia, primary bloodstream infections and surgical site infections. Significant reductions of infection rates between 20-30% over 3 years periods in the components for intensive care units, operative departments and neonatal intensive care units were demonstrated. Due to our experience the following requirements have to be fulfilled to keep a surveillance system successful over longer periods: close contact between the participating institutions, consideration of new developments, timely regular data feedback and constant reevaluation of the way of data presentation, data validity and demonstration of its contribution to the reduction of healthcare associated infections (HAI). The article describes in more detail how KISS tries to fulfill these requirements.     

Dissection of culture media for embryos: the most important and less important components and characteristics

Improvements in culture media formulations have led to an increase in the ability to maintain the mammalian embryo in culture throughout the preimplantation and pre-attachment period. Amino acids and specific macromolecules have been identified as being key medium components, whereas temporal dynamics have been recognised as important media characteristics. Furthermore, other laboratory factors that directly impact embryo development and viability have been identified. Such factors include the use of a reduced oxygen tension, an appropriate incubation system and an adequate prescreening of all contact supplies. With rigourous quality systems in place, it is possible to obtain in vivo rates of embryo development in vitro using new media formulations while maintaining high levels of embryo viability. The future of embryo culture will likely be based on novel culture chips capable of providing temporal dynamics while facilitating real-time analysis of embryo physiology.     

Posttraumatic stress disorder in children exposed to intimate partner violence: the clinical picture of physiological arousal symptoms

In recent years, researchers have focused on acquiring a better understanding of the development of posttraumatic stress disorder (PTSD) in children under the age of six following exposure to chronic trauma, such as intimate partner violence (IPV). Despite a number of empirical studies on early childhood PTSD, few have examined how children differ in the clinical presentation of PTSD symptomatology. There may be wide variability in the presentation of symptoms within the four clusters of PTSD symptoms: re-experiencing, alterations in physiological arousal, negative alterations in cognitions and mood, and avoidance. Symptoms of physiological arousal may be particularly difficult for parents and therapists to identify and report on because many of these symptoms are internal sensations (e.g. racing heart beat), and they are most often evaluated out of context (e.g. in reports of past behaviour). Thus, little is known about the presentation of these symptoms in preschoolers. To better identify physiological arousal symptoms as they occur, this study examined therapists’ qualitative reports on the presentation of physiological symptoms of 56 young children exposed to IPV while they participated in an intervention programme. Results indicated that children were most likely to exhibit emotion dysregulation, behavioural outbursts, mood swings and temper tantrums when physiologically aroused. The presence of temper tantrums as a component of arousal and reactivity is consistent with recent Diagnostic and Statistical Manual of Mental Disorders (fifth edition) changes, which include these elements as new criteria for PTSD in children aged six and younger. Behavioural examples are described and implications discussed for clinical intervention.