医学留学生心胸外科英语教学体会

如何做好医学留学生英语教学工作已威为诸多医学院校新的教学难题.本文结合心胸外科的教学特点,提出在提高教师自身英语能力同时,注意教材选择,充分备课,借助多媒体和互动教学模式,营造和谐的教学氛围,提高医学留学生心胸外科学教学质量.     

医学留学生心胸外科英语教学体会

如何做好医学留学生英语教学工作已成为诸多医学院校新的教学难题,本文结合心胸外科的教学特点,提出在提高教师自身英语能力同时,注意教材选择,充分备课,借助多媒体和互动教学模式,营造和谐的教学氛围,提高医学留学生心胸外科学教学质量。     

解剖学在临床心胸外科教学中的应用探索

解剖学是一门实用性很强且与临床医学相衔接的基础课程,是学习、掌握其他学科特别是手术学科的基础[1]。心胸外科学所涉及的局部解剖学知识比较复杂,基础理论抽象、深奥,医学生普遍因为其难以掌握而容易失去兴趣。     

心胸外科侵入性操作护理的医院感染监控管理

目的探讨重症监护室危重病人医院感染与侵入性操作的关系。方法通过回顾性分析2004年1月～2009年1月重症监护室危重病人140例并与未组建监护室前心胸外科住院的140例病人进行比较分析。结果重症监护室病人医院感染率明显低于未组建监护室前重症监护的病人,医院感染与侵入性操作密切相关。结论构筑质量控制体系,提高医院感染意识是控制医院感染的有效措施。     

美肤免缝拉链在心胸外科手术的应用

目的对美肤免缝拉链在心胸外科手术中无创伤下闭合皮肤切口的应用研究.方法随机将心胸外科手术病人40例分为两组,拉链组应用拉链无创伤下闭合皮肤伤口,对照组常规缝合皮肤切口,观察伤口疼痛、愈合、感染及美观等情况.结果拉链组关闭皮肤切口时间明显缩短,操作简单,伤口疼痛明显轻于对照组.伤口愈合良好,拉链组伤口无红肿, 无渗血液,无伤口裂开,愈合更美观.结论外科免缝拉链是一种全新、无创伤性、快速、安全的伤口闭合方法,具有极佳的美容效果.     

心胸外科侵入性操作护理的医院感染监控管理

目的 探讨重症监护室危重病人医院感染与侵入性操作的关系.方法 通过回顾性分析2004年1月～2009年1月重症监护室危重病人140例并与未组建监护室前心胸外科住院的140例病人进行比较分析.结果 重症监护室病人医院感染率明显低于未组建监护室前重症监护的病人,医院感染与侵入性操作密切相关.结论 构筑质量控制体系,提高医院感染意识是控制医院感染的有效措施.     

美肤免缝拉链在心胸外科手术的应用

目的：对美肤免缝拉链在心胸外科手术中无创伤下闭合皮肤切口的应用研究．方法：随机将心胸外科手术病人40例分为两组，拉链组应用拉链无创伤下闭合皮肤伤口，对照组常规缝合皮肤切口，观察伤口疼痛、愈合、感染及美观等情况．结果：拉链组关闭皮肤切口时间明显缩短，操作简单，伤口疼痛明显轻于对照组．伤口愈合良好，拉链组伤口无红肿，无渗血液，无伤口裂开，愈合更美观．结论：外科免缝拉链是一种全新、无创伤性、快速、安全的伤口闭合方法，具有极佳的美容效果．     

135例老年心胸外科患者围手术期护理分析

目的 探讨心胸外科患者的围手术期护理原则.方法 选取我院2006年7月～2009年9月收治的135例行心胸外科手术治疗患者的临床资料,随机分为治疗组(80例)和对照组(55例),对照组患者采用常规护理,对治疗组患者强化术前护理,严密观察术中、术后情况,并进行出院指导,观察两组患者的并发症,总结护理经验.结果 治疗组患者术后并发症明显少于对照组,两组患者比较差异有统计学意义(P＜0.05).结论 对行心胸外科手术治疗的患者进行系统性围手术期护理,能提高手术成功率,减少术后并发症,提高患者的生活质量.     

目标教学观模教学的体会

单元教学的实施 ,是按单元设计进行的 ,其控制程序是 :教学设计→目标认定→预习诊断→课堂教学→评估反馈→矫正补救 ,最后才是达成目标。本人在 2 0 0 0年度下学期做了一次全校性的公开课 ,课题是“泌尿系统的概论及肾的形态和位置” ,采取的是美国当代杰出的心理学家和教育学家布卢姆的知识传授课模式 ,具体实施的过程就是围绕这一单元设计进行的。1　认定目标1 1　知识目标 3个 :①说出泌尿系统的组成 ;②解释肾门、肾蒂、肾窦、肾区的概念 ;③描述肾的形态。1 2　技能目标一个 :④确定肾的位置及体表投影1 3　态度目标一个 :⑤爱心的奉…     

疼痛学教学的体会

疼痛学从1931年Dogliotti将乙醇注入患者的蛛网膜下腔并获得癌痛患者的长期止痛效果开始，世界发达国家即开展了顽粤性痛症的姑息治疗研究，不过临床实际工作的进展非常缓慢。1975年成立了国际疼痛学会，疼痛治疗作为一个新兴的专业才在世界各国陆续开展起来。     

Nosocomial outbreak due to extended-spectrum-beta-lactamase- producing Enterobacter cloacae in a cardiothoracic intensive care unit

Enterobacter cloacae has been associated with several outbreaks, usually involving strains that overproduce chromosomal beta-lactamase or, uncommonly, strains expressing extended-spectrum beta-lactamases (ESBL). Only sporadic cases of ESBL-producing E. cloacae have been identified in our hospital in recent years. We describe the epidemiology and clinical and microbiological characteristics of an outbreak caused by ESBL-producing E. cloacae in a cardiothoracic intensive care unit (CT-ICU). Prospective surveillance of patients with infection or colonization by ESBL-producing E. cloacae among patients admitted to the CT-ICU was performed during the outbreak. Production of ESBL was determined by decreased susceptibility to expanded-spectrum cephalosporins and a positive double-disk test result. Clone relatedness was determined by pulsed-field gel electrophoresis (PFGE). From July to September 2005, seven patients in the CT-ICU with ESBL-producing E. cloacae were identified (four males; median age, 73 years; range, 45 to 76 years); six patients had cardiac surgery. Four patients developed infections; three had primary bacteremia, one had ventilator-associated pneumonia, and one had tracheobronchitis. ESBL-producing E. cloacae showed resistance to quinolones and aminoglycosides. PFGE revealed two patterns. Five isolates belonged to clone A; two carried a single ESBL (pI 8.2 and a positive PCR result for the SHV type), and three carried two ESBLs (pIs 8.1 and 8.2 and positive PCR results for the SHV and CTX-M-9 types). Isolates belonging to clone B carried a single ESBL (pI 5.4 and a positive PCR result for the TEM type). Review of antibiotic consumption showed increased use of cefepime and quinolones during June and July 2005. The outbreak was stopped by the implementation of barrier measures and cephalosporin restriction. ESBL production could be increasingly common in nosocomial pathogens other than Escherichia coli or Klebsiella pneumoniae.     

Biofilm formation of Candida spp. isolates from patients at a cardiothoracic intensive care unit

Invasive Candida infections in seriously ill patients are rare but associated with high mortality, while Candida colonization of the mucocuteneous surfaces is common in patients admitted to intensive care units. To investigate biofilm formation as a possible virulence factor, we analyzed the biofilm formation of 128 non-invasive isolates from long-term ICU patients and that of 106 invasive bloodstream isolates. Candida biofilms were quantified by the percent transmittance (%Tbloc) method. Crystal Violet (CV) staining was used as marker of biofilm thickness, and XTT assay was used as a marker of the metabolic activity of Candida cells. The ability of biofilm formation was 99.2% in the non-invasive isolates versus 96.2% in the bloodstream isolates (%Tbloc vs.%Tbloc not significant). However, high biofilm production (%Tbloc, ≥35) was more frequent among the non-invasive isolates compared to the bloodstream isolates (78.1 vs. 72.5, p<0.001).     

Effects of mobile phone use on specific intensive care unit devices

Background and Aims:

To observe the effects of mobile phone use in the vicinity of medical devices used in a critical care setting.

Subjects and Methods:

Electromagnetic interference (EMI) was tested by using two types of mobile phones – GSM and CDMA. Mobile phones were placed at a distance of one foot from three medical devices – syringe pump, mechanical ventilator, and the bedside monitor – in switch off, standby, and talking modes of the phone. Medical devices were observed for any interference caused by the electromagnetic radiations (EMR) from the mobile phones.

Results:

Out of the three medical devices that were tested, EMI occurred while using the mobile phone in the vicinity of the syringe pump, in the ‘talk mode.’ The mean variation observed in the calculated and delivered volume of the syringe pump was 2.66 ml. Mechanical ventilator did not show any specific adverse effects with mobile phone use in the one-foot vicinity. No other adverse effects or unexplained malfunctions or shutdown of the syringe pump, mechanical ventilator, or the bedside monitor was noted during the study period of 36 hours.

Conclusion:

EMI from mobile phones have an adverse effect on the medical devices used in critical care setup. They should be used at least one foot away from the diameter of the syringe pump.     

Neutrophil CD64 expression is a predictor of mortality for patients in the intensive care unit

Background: Neutrophil CD64 has been shown to be a promising biomarker for bacterial infection and sepsis identification. However, the prognostic value of CD64 in predicting the likelihood of survival for patients in intensive care unit (ICU) is unclear. Methods: A total of 797 patients in the ICU of Xin-Hua Hospital, Shanghai, China were enrolled. We determined the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores from these patients and collected blood samples to measure the levels of neutrophil CD64, thyroid hormone and C-reactive protein (CRP). We assessed the association between APACHE II scores or these biomarkers and mortality of patients in the ICU. Receiver operating characteristic (ROC) curves were generated and the Area Under the Curve (AUC) for each indicator was determined. Results: The AUC for CD64 was 0.752 ± 0.026, which was higher than that of FT3 (0.696 ± 0.028) and CRP (0.672 ± 0.026). APACHE II scores had the highest AUC (0.872 ± 0.018). The level of neutrophil CD64 expression positively associated with CRP and APACHE II, and negatively correlated with FT3. Multiple regression analysis revealed that APACHE II scores (Standard β value = 0.183, P < 0.001), CD64 (Standard β value = 0.518, P < 0.001) or log (CRP) (Standard β value = 1.203, P < 0.001) independently predicted ICU mortality. Conclusion: CD64 had the greatest power for predicting ICU mortality other than APACHE II scores. This result indicates that CD64 may be used as a biomarker to in combination with the use of APACHE II scores to improve the accuracy of predicting mortality outcome for patients in the ICU.     

Survey on hospital‐acquired urinary tract infection in neurological intensive care unit

This study aimed to explore the causes, incidence, and risk factors of urinary tract infection patients in neurological intensive care unit (ICU). Patients (n = 916) admitted to the neurological ICU from January 2005 to December 2010 were retrospectively surveyed for urinary tract infections. There were 246 patients in neurological ICU who were diagnosed with hospital‐acquired urinary tract infection during that period of time (26.9%). Forty‐three cases were upper urinary tract infection, and 203 cases were lower urinary tract infection. The top three strains were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumoniae. Older age (UTI rate, 22.6%), female patients (21.7%), hospital stay for more than 7 days (16.7%), diabetes (11.7%), and catheterization (21.1%) were the risk factors for hospital‐acquired urinary tract infection. There is a high incidence of nosocomial urinary tract infection in the neurological intensive care unit. Active prevention program and surveillance need to be carried out in neurological ICU, especially in those with risk factors.     

Physician experience with viewing digital radiographs in an intensive care unit environment

After several years of continuous operation, the utility of digital viewing stations as assessed by bedside clinicians has been investigated through the distribution of questionnaires to past and present users. The results of the questionnaire have indicated that the bedside physicians prefer using the workstations over handling film. For evaluation of line placements, chest tubes, and pleural effusions, the physicians prefer softcopy display over hardcopy. However, for analysis of air space disease and diagnosis of pneumothorax, images displayed on the workstation were not believed to be as useful as standard hardcopy.     

Four-year experience with bronchial asthma in a pediatric intensive care unit.

Charts of all children with severe acute asthma admitted to the Pediatric Intensive Care unit (PICU) of this hospital between January 1987 and December 1990 were reviewed retrospectively. There were 47 admissions for life threatening asthma to the PICU over this period, representing about 2% of all acute asthma admissions to our hospital. The mean duration of symptoms in these patients before admission was 54 hours. Only 55% of the PICU admissions had received bronchodilators before coming to our hospital emergency room from where they were admitted. From arterial blood gas analysis, 57% of the patients had hypercapnia (PaCO2 > 45 mmHg). All the patients received nebulized salbutamol frequently as well as intravenous aminophylline and hydrocortisone. Mechanical ventilation was used in only 8.5% of the patients. Only two patients developed pneumothorax, neither of whom had been mechanically ventilated, but they did not require surgical intervention for drainage. There was only one death in a patient who was known to have sickle cell anemia and developed sagittal sinus thrombosis. We conclude from our series that the mortality for children with life threatening asthma admitted to PICU is very low if bronchodilators and steroids are used optimally in their management, along with judicious selection of those requiring mechanical ventilation.     

An outbreak of CTX-M-15-producing Klebsiella pneumoniae isolates in an intensive care unit of a teaching hospital in Kuwait

Objective: This study reports an outbreak of Klebsiella pneumoniae infections in 14 patients during a 2-month period (August–September, 2008) in the intensive care unit (ICU) of a teaching hospital in Kuwait. Materials and Methods: The clinical sources were blood (9), urine (3) and respiratory secretions (2) identified by the automated VITEK-2 ID System. Susceptibility testing was performed by the E-test method. Extended-spectrum β-lactamase (ESBL) production was assessed using the ESBL E-test and confirmed by PCR. Carriage of bla genes was determined by PCR and sequence analysis. The transferability of resistance phenotypes was demonstrated by conjugation experiments and clonal relatedness was determined by PFGE. Results: The isolates were susceptible to imipenem, meropenem, and tigecycline and produced ESBL. All isolates yielded an amplicon of 499 bp with universal consensus primers (MA primers). DNA sequence analysis showed that they all harboured bla_CTX-M-15and bla_TEM-1genes. The environmental isolate obtained from a suction machine was also CTX-M-15/TEM-1 producer. The resistance phenotypes were transferrable to the Escherichia coli J53^r strain. PFGE, revealed two clones, A and B, related with a Dice coefficient of >94.1%. A mortality rate of 21.4% was recorded. Conclusion: The outbreak was contained by robust and aggressive infection control measures. This study highlights the first outbreak of CTX-M-15-producing K. pneumoniae associated with high mortality in an adult medical ICU in Kuwait.