循证医学与医学图书馆

循证医学意为“遵循证据的医学”近年来在国际临床医学领域越来越受重视。循证医学要求医务人员由以理论为基础加经验的医学模式向以科学证据为基础的模式转变。循证医学模式要求医生在临床工作中不断提出问题并通过严格的检索、挑选和评价文献来回答这些问题。面对这一状况，本文提出了医学图书馆应在完善服务设施、优化服务资源、变革服务模式、提高馆员素质等方面去适应。     

医院图书馆开展循证医学信息服务的探讨

对医院图书馆开展循证医学信息服务的必要性和意义;信息资源和人员优势;服务模式等问题进行阐述和探讨,最后提出循证医学信息服务的开展对医院图书馆自身的要求。     

医院图书馆员与循证医学

探讨医院图书馆建设与循证医学关系问题.认为循证医学的建立对医院图书馆员提出了新的要求,图书馆员必须 更新知识,提高素质,优化服务资源,拓宽服务范围,改变服务模式,才能更好地服务于临床实践.     

医院图书馆建立循证医学网页

循证医学是二十世纪九十年代迅速兴起的以证据为基础的医学，它使临床研究与实践进入了一个全新的时代。在循证医学时代，图书馆扮演了一个重要的角色，那么，如何能更好地为用户提供优质的循证医学信息服务，这对直接面向临床的医院图书馆提出了挑战。我馆于2001年下半年开始，在军队医院信息系统的基础上建立了循证医学网页，     

循证医学信息服务保障体系建设

黑龙江省的医学信息服务部门主要由各类型医学院校的图书馆和各个大、中、小型的医院图书馆（室）组成,担负着为各个医学院校提供医学信息服务的任务。据调查,至目前为止在所有的医院图书馆中,还没有一家单位采购了循证医学证据数据库（Cochrane Library,Best evidence以及Ovid检索平台等）,即使是较有经济实力的哈尔滨医科大学所属的几家医院的图书馆也只能检索CNKI光盘数据库和MEDLINE网络信息。对这些单位工作人员的循证医学知识的调查显示,他们对循证医学所知甚少。较大型的医学图书馆虽然拥有较丰富的综合性医学文献检索系统,但也没有采购循证医学证据数据库,更没有提供循证医学信息服务的具体部门。这样的医学信息服务现状迫切需要有一个合适的组织机构来组织、规划循证医学信息服务工作。     

循证医学环境中的医学信息服务

循证医学是20世纪90年代诞生的一种新的临床医学模式.证据来源的筛选和最好证据的检索是循证医学实践的关键,这对图书馆医学信息服务提出了更高的要求,同时也促进了图书馆信息服务的发展.     

循证医学与医院图书馆的信息服务

简述了循证医学的概念及基本特点 ,要求医务人员由以理论为基础加经验的医学模式向以科学证据为基础的模式转变 ,在临床工作中不断提出问题并通过严格的检索、挑选和评价文献来回答这些问题 ,因此医院图书馆的信息服务工作应从完善服务设施、优化服务资源、变革服务模式、提高馆员素质等方面来提高服务质量     

医院图书馆要为循证医学提供信息支撑

简要介绍循证医学的定义、证据的来源以及医院图书馆为之提供信息服务的方法、途径,对医院图书馆为循证医学的开展提供信息支撑作一探讨。     

循证医学实践——医学图书馆面临的机遇和挑战

循证医学是20世纪80年代发展起来的一种新的临床医学模式，循证医学实践就是如何将现有的、客观的研究证据应用到临床实践中的过程。阐述了循证医学实践给医学图书馆带来的重大发展机遇和医学图书馆在循证医学环境下所面临的巨大挑战，并就如何抓住机遇、迎接挑战提出了具体建议。     

河北省医院图书馆提供循证医学证据服务的可行件研容

对河北省医院图书馆提供循证医学证据服务的需求特点以及供给能力进行分析.结果 显示,临床读者对图书情报人员开展循证医学信息服务工作有一定客观需求,但半数图书馆员的循证医学临床证据服务意识欠缺,缺乏馆藏循证医学文献资源,馆员专业素质参差不齐,医学专业知识不足,普遍缺少专门循证医学临床证据检索技能培训.但是,在检索能力和时间两方面具备一定优势.指出河北省医院图书馆暂不具备开展全方位循证医学证据检索和评价服务的条件,需要在馆藏资源建设和馆员素质教育等方面努力,以循证医学思想为出发点,深化现有文献服务工作.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.