头皮式套管针在新生儿外周动静脉同步换血疗法中的应用

我科于1999年1月至今在新生儿高胆红素血症等疾患外周动静脉同步换血疗法中应用头皮式套管针做头皮静脉及桡动脉穿刺留置达到理想的治疗目的.现报告如下:     

小儿头皮静脉留置针的护理

目的:探讨小儿头皮静脉留置针的护理及临床作用.方法:按头皮静脉留置针的操作规程进行操作及护理.结果:严格的无菌技术、规范无误的操作及护理是保证小儿头皮静脉留置针留置成功的关键.结论:熟练掌握正确应用小儿头皮静脉留置针,可为患儿提供安全舒适的护理,减少了患儿穿刺难,反复穿刺的痛苦,提高了护理工作效率及质量.     

头皮穿刺持续引流治疗颅内积液

近年来我们对7例颅内积液,积脓患者采用头皮穿刺持续引流,取得较为好的效果,现报告如下。材料与方法:采用一次性输液器,根据年龄选用7至9号输液针头,塑料负压壶一个。患者仰卧,头偏向健侧,根据触诊及CT定位,选择适当穿刺点,通常取卧位低位,手持针柄与头皮呈45度角穿刺,针尖指向骨孔或修补材料的孔隙中,调整穿刺方向,成功后将导管分别连接针尾与负压壶,针头固定与同静脉穿刺。     

一次性小儿头皮静脉留置针的改良及应用的方法与技巧

头皮静脉留置针目前已广泛应用于临床输液患儿,可减少头皮静脉穿刺次数,保护穿刺的头皮静脉,减轻患儿的痛苦,提高护士的工作效率,有利于临床用药和紧急抢救。但由于：（1）小儿好动、哭闹、出汗多;（2）头皮静脉走向有一定的坡度且笔直充盈部分表浅而且相对成人短得多;（3）留置针的尾部设计重量过重,长度过长,“头轻脚重”等等因素,目前儿科临床上虽然首次头皮静脉穿刺非常成功,但是留置针放置的时间却不能令人满意。因此,如何预防小儿头皮静脉留置针脱落是儿科护理工作者所面临的重要难题。     

套管针对小儿头皮静脉输液重注的影响

目的 了解套管针与钢制头皮针穿刺对小儿头皮静脉输液重注的影响、探讨降低重注率的方法,以减轻患儿输液反复穿刺的痛苦,减少护士重复工作量,从而提高护士工作效率及护理质量。方法 选择1999年8月～2000年12月新入院、初次输液、输液部位在前额部的头皮静脉输液的患儿999例,按入院时间先后随机分成套管针组和头皮针组进行比较。结果 套管针组503例,重注5例,重注率0.99％,头皮针组496例,重注73例,重注率14.72％,X~2=65.34,P<0.001,差异有非常显著性、套管针留置时间平均为3.54d,可减少每天重复穿刺。结论 采用套管针穿刺是小儿头皮静脉输液理想的穿刺针,对儿科临床护理实践具有实用价值。     

＂压力环＂在静脉输液固定中的应用效果观察

目的 探讨静脉输液患者头皮针塑料管的固定方法,提高患者输液治疗的安全与舒适.方法 将240例静脉输液患者随机分为对照组（120例）与观察组（120例）,观察组输液穿刺完毕采用＂压力环＂固定方法固定头皮针塑料管;对照组输液穿刺完毕常规固定头皮针塑料管.观察输液过程中头皮针滑脱、固定松脱、头皮针塑料管反折等情况.结果 观察组头皮针滑脱率、固定松脱率、头皮针塑料管反折率均显著低于对照组,差异有统计学意义（P〈0.05）.结论 ＂压力环＂固定法可减少输液时头皮针滑脱、固定松脱及头皮针塑料管反折,减少重新固定,提高患者的舒适度,固定效果良好.     

两种浅静脉留置针置管方法在老年患者中应用的对比观察

目的:提高老年患者浅静脉留置针穿刺的成功率.方法:选取我科2016年1月-2016年7月老年脑梗塞住院患者120例,随机分为对照组60例,观察组60例、对照组采用见回血后,左右手边进边退配合送管方法置管.观察组采用见回血后,左手始终固定穿刺部位,右手食指固定针翼位置,右手拇指延着血管方向缓慢推Y型接口送管,右手食指同时拉针翼往后缓慢退出针芯前段的方法置管.结果:观察组穿刺成功率明显高于对照组.结论:采用观察组穿刺方法,解决了老年患者浅静脉留置针置管困难的问题,提高了工作效率,值得推广.     

小儿头皮静脉穿刺套管针时头皮消毒方法研究

目的 探讨小儿头皮静脉穿刺套管针时头皮消毒的最有效的方法. 方法将100例行头皮静脉套管针穿刺的患儿随机分成实验组和对照组,实验组患儿头皮采用两遍络合碘(碘伏)加一遍酒精的消毒方法,对照组患儿头皮采用两遍酒精消毒的方法.套管针留置过程中观察穿刺部位的皮肤有无红、肿、水泡、脓疱并记录范围,拔出套管针时采集局部皮肤表面的标本进行细菌培养. 结果两组比较,穿刺部位的红、肿和细菌培养结果的差异有统计学意义(P＜0.05). 结论小儿头皮进行套管针穿刺时采用两遍络合碘(碘伏)加一遍酒精的消毒方法能减少局部头皮的反应和感染,较传统的两遍酒精的消毒方法更有效.     

CT增强扫描对比剂外渗的原因及预防

目的分析CT增强扫描对比剂外渗的原因。方法将需要做CT增强扫描的患者分为观察组1300例,对照组650例。两组分别采用静脉留置针和蝶翼头皮针进行静脉穿刺注射对比剂,观察两组患者CT增强扫描时对比剂外渗情况。结果采用静脉留置针进行CT增强扫描患者1例发生对比剂外渗（0.07%）,蝶翼头皮针进行静脉穿刺注射对比剂,19例对比剂外渗,渗漏发生率（2.92%）。结论采用静脉留置针进行CT增强扫描,可以减少对比剂外渗,确保CT扫描图像质量。     

小儿静脉留置针的应用与体会

静脉输液是临床常见的操作技术,使用金属头皮针需每天进行穿刺,活动时易刺破血管。近年我院开展了静脉留置针技术应用于临床,此套管针柔韧性好,可保护血管,减少穿刺次数,减轻病人的痛苦,对血管壁的刺激性小,减少静脉炎和液体外渗的发生。现将该技术应用体会介绍如下。1材料和方     

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.     

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.     

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.     

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.