9例经股静脉穿刺置入PICC导管的临床应用

目的扩大PICC导管应用的范围。方法对9例患者实施经股静脉穿刺置入PICC导管至下腔静脉,患者分别为上腔静脉入口处鸟嘴样狭窄1例,装有心脏起搏器患者1例,肿瘤患者外周静脉条件差3例,双上肢烧伤1例,双侧乳腺癌根治术后1例,上肢外周血管细小PICC导管经外周静脉穿刺失败2例。结果9例患者置管均一次穿刺成功,配合适切的护理措施,无一例发生并发症。结论经股静脉穿刺置入PICC导管至下腔静脉安全、可行,扩大了PICC导管应用的范围。     

9例经股静脉穿刺置入PICC导管的临床应用

目的扩大PICC导管应用的范围。方法对9例患者实施经股静脉穿刺置入PICC导管至下腔静脉,患者分别为上腔静脉入口处鸟嘴样狭窄1例,装有心脏起搏器患者1例,肿瘤患者外周静脉条件差3例,双上肢烧伤1例,双侧乳腺癌根治术后1例,上肢外周血管细小PICC导管经外周静脉穿刺失败2例。结果9例患者置管均一次穿刺成功,配合适切的护理措施,无一例发生并发症。结论经股静脉穿刺置入PICC导管至下腔静脉安全、可行,扩大了PICC导管应用的范围。     

健康教育提高肿瘤患者PICC置管依从性的观察

目的研究健康教育对肿瘤患者对经外周静脉行中心静脉置管(PICC)依从性的影响。方法选择我科肿瘤患者76例,观察健康教育前及后对超声引导PICC的知晓率和PICC置管的依从性及PICC的不良反应,如栓塞、感染、堵管、疼痛等。结果健康教育前后的PICC的知晓率和PICC置管的依从性分别为8.5%,5.7%;96.5%,73.95%,PICC的不良反应为外周静脉炎5例,导管栓塞2例,治疗当中无导管脱出病例。无1例发生化疗药物外渗。结论健康教育可以提高患者对PICC置管的知晓率和依从性。     

乳腺癌化疗患者外周置人中心静脉导管相关上肢静脉血栓形成的临床诊疗

目的探讨乳腺癌化疗患者外周置人中心静脉导管（PICC）相关上肢静脉血栓形成的临床诊疗。方法回顾性分析北京协和医院2011至2012年938例乳腺癌化疗患者中,PICC相关有症状上肢静脉血栓形成的发生率、诊断和治疗。结果10例乳腺癌患者出现PICC相关有症状上肢静脉血栓,发生率为1．1％（10/938）,每1000个导管留置日中的血栓例数为0．11,共携带导管1035d,置管后血栓发生中位时间23．5（4～176）d,9例患者采用低分子肝素抗凝,中位抗凝时间为14（3～50）d,5例患者抗凝后继续使用导管,所有患者均无肺栓塞发生。结论PICC相关上肢静脉血栓形成在乳腺癌化疗患者中发生率低,早期诊断及治疗后,仍可取得较好的临床结局。     

改良塞丁格技术联合血管超声在乳腺癌患者术后化疗经外周静脉置入中心静脉导管置管中的作用

目的探讨改良塞丁格技术联合血管超声在乳腺癌患者术后化疗经外周静脉置入中心静脉导管（PICC）置管中的临床效果。方法将接受术后化疗乳腺癌患者120例按照随机数字表法分为观察组和对照组各60例,观察组采用改良塞丁格技术联合血管超声PICC置管,对照组采用传统盲穿PICC置管,比较两组患者一次穿刺成功率、一次置管成功率、置管后机械性静脉炎及静脉血栓的发生率。结果观察组一次穿刺成功率、一次置管成功率、置管后机械性静脉炎发生率分别为91．67％、100％和3．33％,对照组一次穿刺成功率、一次置管成功率、置管后机械性静脉炎发生率分别为76．67％、86．67％和45％,两组比较差异均有统计学意义（P=0．0061,P=0．0434,P〈0．0001）。观察组置管后静脉血栓发生率为0,对照组置管后静脉血栓发生率为6．67％,两组比较差异无统计学意义（P=0．1187）。结论将改良塞丁格技术联合血管超声PICC置管应用于乳腺癌患者术后化疗置管成功率高,置管后机械性静脉炎发生率低,具有较高的临床应用价值。     

经外周静脉置入中心静脉导管置管出院患者延续护理服务需求的调查

目的　调查经外周静脉置入中心静脉导管（PICC）置管出院患者对延续护理服务的需求,为探索PICC置管患者的延续护理服务模式制定相关措施提供依据。方法　对2所三甲综合性医院共165例PICC置管出院患者进行问卷调查,调查内容包括PICC置管出院患者一般情况,对延续护理服务内容、方式、满意度及需求。结果　PICC置管出院患者延续护理需求较高,各延续护理服务方式合计非常需要占39.77%,需要占39.09%,但满意度较低,不满意占46.34%,满意仅占34.4%;不同年龄患者对建立健康教育网络平台和家庭访视需求差异有统计学意义（P＜0.05）,不同地区患者对举办健康知识讲座、创建健康教育网络平台和病友俱乐部的需求差异有统计学意义（P＜0.05）,不同文化程度患者对延伸护理需求差异无统计学意义。结论　医院应建立PICC延续护理服务团队,根据患者需求及疾病情况制定个体化的延续护理服务方案,从而达到满足患者需求、提高PICC置管出院患者自我护理目的。     

乳腺癌化疗患者外周置入中心静脉导管相关上肢静脉血栓形成的临床诊疗

目的 探讨乳腺癌化疗患者外周置入中心静脉导管（PICC）相关上肢静脉血栓形成的临床诊疗。方法　回顾性分析北京协和医院2011至2012年938例乳腺癌化疗患者中,PICC相关有症状上肢静脉血栓形成的发生率、诊断和治疗。结果　10例乳腺癌患者出现PICC相关有症状上肢静脉血栓,发生率为1.1%（10/938）,每1000个导管留置日中的血栓例数为0.11,共携带导管1035 d,置管后血栓发生中位时间23.5（4~176） d,9例患者采用低分子肝素抗凝,中位抗凝时间为14（3~50） d,5例患者抗凝后继续使用导管,所有患者均无肺栓塞发生。结论　PICC相关上肢静脉血栓形成在乳腺癌化疗患者中发生率低,早期诊断及治疗后,仍可取得较好的临床结局。     

颈外静脉及上肢静脉PICC血栓与感染的对比分析

目的通过颈外静脉与肘部静脉穿刺置入中心静脉导管(PICC)血栓形成及感染的对比分析,探讨二者行中心静脉置管的优缺点,为PICC置管的最佳途径提供临床依据。方法将2013年1月-2014年1月在医院肿瘤科住院行PICC的604例患者按置管部位不同分为两组,试验组330例选择颈外静脉行PICC,对照组274例选择肘部静脉行PICC,置管后比较两组血栓及感染率。结果试验组血栓发生率为5.15%,对照组为22.63%,两组置管患者血栓发生率比较差异有统计学意义(P<0.05);试验组感染率为2.1%、对照组为4.0%,两组置管患者感染率比较差异无统计学意义。结论颈外静脉PICC较肘部静脉PICC血栓发生率低,置管成功率高;两组置管患者导管相关性感染无明显差异;颈外静脉PICC值得临床推广使用。     

乳腺癌术后化疗PICC置管36例的护理

目的 探讨PICC置管乳腺癌术后化疗护理方法,预防和减少并发症的发生,减轻患者心理负担,提高患者生活质量.方法 针对PICC置管乳腺癌术后的化疗特点进行护理.结果 大部分患者恢复较好,生活质量有了明显的提高.结论 PICC置管乳腺癌术后的化疗护理是整体治疗的保证.     

主动握拳活动预防经外周静脉穿刺中心静脉置管(PICC)相关上肢静脉血栓形成的效果

目的探讨主动握拳活动对预防经外周静脉穿刺中心静脉置管(PICC)相关上肢静脉血栓形成的效果。方法选择2014年6—12月收治的PICC患者318例并按随机数字法分为对照组和试验组,各159例。两组均给予基础治疗与干预,其中对照组采用常规运动指导;试验组在对照组基础上采用主动握拳活动。比较两组干预前后血液流速、PICC相关上肢静脉血栓形成发生情况及患者满意度。结果活动干预后(置管后2周),试验组腋静脉最大血液流速及平均血液流速均明显大于对照组,差异有统计学意义(P<0.05);试验组PICC相关上肢静脉血栓形成的发生率低于对照组(P<0.05),满意度高于对照组(P<0.05)。结论 PICC由于其独特的优势在临床应用广泛,但静脉血栓等并发症也常有发生。主动握拳活动能有效预防静脉血栓的发生,从而减轻患者痛苦以及经济负担。     

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.     

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.     

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.     

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.