Analysis of a new method for assessing activity of combinations of antimicrobials: area under the bactericidal activity curve

We have applied a new method of assessment of bactericidal activity in vivo. Calculation of area under the bactericidal activity curve (AUBC) provides a value which involves both the in-vitro bactericidal activity of the drug and its pharmacokinetics. With this method, the activity of combinations of antimicrobials can be assessed in vivo by comparing the AUBC obtained from the combination vs the sum of AUBC from each drug alone. This method may allow a more rational selection of dosage regimens and drug combinations for the treatment of infections.     

1例安装心脏起搏器合并心房扑动电复律患者的护理

电复律目前已成为救治室颤和其他快速心律失常患者的首选重要措施,但对安置永久性心脏起搏器患者施行电复律治疗较少见.2004年5月,我科对1例安装永久性心脏起搏器合并心房扑动的患者成功实施电复律,现将护理体会介绍如下.     

单导线心房同步心室按需型起搏器的临床应用——附11例报告

目的：探讨单导线心房同步心室按需型起搏器（ＶＤＤ）起搏系统的心房电极的感知功能特点和房室同步起搏率。方法：为１１例窦房结功能正常的完全性房室传导阻滞患者植入单导线ＶＤＤ,并随访观察。结果：术中心房感知电极位于心房中、上部的Ａ波振幅高于位于下部者,深吸气、深呼气、咳嗽对Ａ波振幅略有影响,但无显著性差异（Ｐ〉０．０５）。中位随访时间１１个月,心房感知电极的阀值稳定,无显著性变化。房室同步起搏率９例为１００％,１例为８０％,１例为７０％。无发生肌电干扰和快速性心律失常。结论：单导线ＶＤＤ起搏系统具有简便、心房感知功能稳定、房室同步起搏率高的特点,适用于窦房结功能正常的完全性房室传导阻滞患者。     

Intermittent mode reversion to VOO of a dual chamber pacemaker model

This report describes an asymptomatic patient with a DDDR pacemaker system (Inos Cls, Biotronik) that showed intermittent mode reversion to VOO and sometimes to VVI without a detectable source of electromagnetic interference and oversensing. Patients with this Biotronik model should be carefully assessed along with a surface ECG before placing the programming head.     

Emergency guide wire pacing: new methods for rapid conversion of a cardiac catheter into a pacemaker

We developed a new electrode to convert rapidly a previously inserted pulmonary artery or left ventricular catheter into a pacemaker. One method of doing this is by withdrawal of the pulmonary artery catheter from the pulmonary artery to the right ventricle by pressure control, and a Teflon-coated guide wire, stripped of 5 mm of insulation at its tip, is advanced through the catheter to contact the endocardium. In the second method, the pacing electrode is advanced through the distal lumen of the catheter while it is positioned within the pulmonary artery and withdrawn into the right ventricle while pacing. Finally, a third Method involves advancement of the guide wire electrode into the left ventricle through a pigtail catheter. To pace, the guide wire electrode is connected to the cathode of a pacemaker referenced to a skin electrode. We paced 10 of 10 right heart cardiac catheterization, intra- and postoperative surgery patients by methods 1 and 2, and 4 of 4 left heart catheterization patients by method 3. Thresholds (mean ± SEM) for guide wire pacing were: right ventricle 1.52 ± 0.4 mA; left ventricle 1.33 ± 0.1 mA. Guide wire pacing is rapid, reliable, and requires little operator skill. Our indications for guide wire pacing are: 1) emergency right ventricular pacing in operative or intensive care unit patients with unexpected bradyarrhythmias who have an indwelling pulmonary artery catheter; and 2) emergency left ventricular pacing in left heart cardiac catheterization patients with contrast-induced bradyarrhythmias.     

Novel method for assessing postantibiotic effect by using the Coulter counter.

To study postantibiotic effect, viable counts are routinely acquired by the pour plate technique. However, this technique is laborious and time-consuming; the required sample dilutions also cause excessive errors and material wastage. A new total cell counting technique in which a Coulter counter is used to obtain more efficient postantibiotic effect measurements has been developed.     

Development of a novel method for assessing balance: the quantitative posturography system

Balance is the ability to maintain equilibrium while sitting or standing. There are a number of different methods which are used to assess balance: technical methods such as sway magnetometry, ataxia meter and force platforms, and clinical methods such as the functional reach test, Berg balance test and fall risk index. The most frequently used technical method is the force platform. There are two types of force platform, a static and a dynamic force platform, of which the dynamic force platform has been found to be more sensitive to detect impaired balance. The quantitative posturography system (QPS) described in this paper is a type of dynamic force platform; however, it has a simpler design than the currently available dynamic force platforms and can match the subject's sway exactly for tilting in the anterio-posterior and medio-lateral directions with its novel design. This paper describes the novel design of the QPS and its calibration.     

急诊分诊创伤评估法应用研究

目的 为了探讨埘急诊创伤患者的快速有效评估方法,以防预检分诊时的漏检和误检,延误创伤患者救治.方法 于2006年1月1日至2006年12月31日,采用创伤评估法,即CRAMS评分和创伤评估程序相结合,应用于浙江大学医学院附属第二医院收治的4023例创伤患者的评估.结果 CRAMS<7分(为重伤):2430例;创伤评估程序发现有危及生命的解剖部位伤1979例;值得重视的是:采用创伤评估法发现,在CRAMSi≥>7分的1593例刨伤患者中,仍存在危及生命伤46例.结论 CRAMS法可作为类选;创伤评估程序可作解剖部位损伤的评估;二者结合而成的创伤评估法能弥补相互的缺陷,既能保证重伤患者及时有效的抢救,同时义可合理利用急诊资源.     

应用Delphi法建立术前访视模式的效果评价

目的 探讨应用Delphi法建立的术前访视模式的应用效果.方法 采用Delphi法建立术前访视标准化程序,比较采用术前访视标准化程序前后的患者平均住院时间、住院费用及患者满意度.结果 采用经Delphi法建立的术前访视模式后,同类型手术患者的住院时间、治疗费用及患者满意度均较未使用前有明显改善.结论 Delphi法用于建立医院术前访视标准化程序,具有针对性强、代表性强、权威程度高的优点,充分利用了优秀的医疗经验,为患者提供均一、稳定的术前准备工作,为患者获得更好的医疗服务打下了基础,值得临床推广应用.     

互动交流模式在临床护理教师培养中的效果分析

为了进一步提高临床护理教学质量，在教学过程中实施了互动交流模式，结果发现，该教学模式能激发学生的学习潜能，促进临床护理教师综合能力的提高，从而在教学相长中提高了教学质量。     

互动交流模式在临床护理教师培养中的效果分析

为了进一步提高临床护理教学质量,在教学过程中实施了互动交流模式,结果发现,该教学模式能激发学生的学习潜能,促进临床护理教师综合能力的提高,从而在教学相长中提高了教学质量。     

Preliminary evaluation of a clinical syndrome approach to assessing cancer-related fatigue

The objectives of this study were to evaluate the reliability, validity, and utility of a newly developed clinical syndrome approach to assessing cancer-related fatigue. Fifty-one patients who underwent blood or marrow transplantation an average of 6.9 months previously were administered a standardized interview designed to identify the presence of a clinical syndrome of cancer-related fatigue. Patients also completed self-report measures of fatigue, depression, and health-related quality of life. Comparisons among independent raters demonstrated high rates of reliability for the presence or absence of a cancer-related fatigue syndrome and its symptoms. Twenty-one percent of patients (n = 11) were found to meet criteria for diagnosis of a cancer-related fatigue syndrome. Compared to patients not meeting the diagnostic criteria, patients meeting the criteria reported fatigue that was greater (P < or = 0.05) in its severity, frequency, pervasiveness, and interference with quality of life. Patients who met criteria also demonstrated poorer role functioning, less vitality, and more depressive symptomatology (P < or = 0.05). These findings provide preliminary evidence of the reliability and validity of the methods used to assess the proposed clinical syndrome and suggest their utility in identifying patients experiencing clinically significant cancer-related fatigue.     

Noninvasive continuous blood pressure measurement during anaesthesia: A clinical evaluation of a method commonly used in measuring devices

The objective of the study was assess the utility during anaesthesia of noninvasive continuous blood pressure measurement techniques which use intermittent oscillometric blood pressure measurement for their calibration. The assessment was performed by comparing noninvasive blood pressure with intra-arterial blood pressure. The noninvasive blood pressure measurement device used for evaluation was the NCAT N-500 which uses tonometry for its continuous measurements. Fifteen patients were studied. In 10 patients the intra-arterial blood pressure curve (IBP) was recorded from the radial artery (radial artery group), and in 5 patients it was recorded from the brachial artery (brachial artery group). In all patients the oscillometrically calibrated tonometric blood pressure (OTBP) was recorded from the other arm. To discriminate between calibration dependent measurement error and tonometric measurement error, the OTBP signal was recalibrated against the IBP signal to get the intra-arterial calibrated tonometric pressure curve (ITBP). OTBP-IBP reflected the overall measurement error, ITBP-IBP the error of the tonometric measurement, and OTBP-ITBP the calibration dependent measurement error. According to criteria formulated in the discussion the accuracy and agreement of the ITBP-IBP measurements were clinical acceptable. Accuracy and agreement of OTBP-IBP and of OTBP-ITBP were not clinical acceptable. Correlation of dynamic behavior was lower for OTBP than for ITBP. A significant effect of site difference between calibration measurements and continuous measurements was not found. It is concluded that the approach of continuous noninvasive blood pressure measurement based on the combination of two different measurement methods, in which the continuous method is calibrated by the oscillometric method, lead to clinical unacceptable accuracy and agreement in the patient group studied.     

Faecal calprotectin: a bright future for assessing disease activity in Crohn's disease

Calprotectin is a calcium-binding protein with in vitro bacteriostaticand fungistatic properties. It is found in abundance in neutrophils,where it accounts for 60% of the protein in the cytosol; lowerconcentrations are found in monocytes and reactive macrophages.It was hoped that measurement of faecal calprotectin would representa surrogate marker of neutrophil influx into the bowel lumenand in turn act as a marker of intestinal inflammation. Studiesto date support this hypothesis; increased levels of faecalcalprotectin are found in inflammatory bowel disease,^1,2 coloniccancer³ and non-steroidal anti-inflammatory drug (NSAID)