下腰痛与慢性前列腺炎的关系

目的:探讨下腰痛(low back pain,LBP)与慢性前列腺炎(chronic prostatitis,CP)的关系,提高LBP的诊治水平.方法:以2008年6月至2009年12月间在我院骨科门诊就诊的以LBP为主诉的男性患者及泌尿外科门诊就诊的cP患者为研究对象.统计非特异性下腰痛(NLBP)中cP的发生率,及cP中NLBP的比例,并采用对照研究方法比较两科联合治疗与单一专科治疗的效果差异.结果:骨科就诊LBP患者中NLBP占81.7%.NLBP患者中有CP的,占43.3%,其中年龄在20～60岁患者中占60.3%.首诊在泌尿外科的CP患者中20.5%(107/522)有LBP症状,其中,NLBP 100/107例占LBP患者的93.5%.两科联合治疗的有效率明显优于单一专科治疗(P＜0.05).结论:CP有可能是男性LBP的主要病因之一,尤其是青中年NLBP患者应该请泌尿外科会诊,行CP方面的检查,联合诊治.对于有LBP症状的CP患者也应该请骨科会诊,与泌尿外科联合诊治.     

综合医院泌尿外科对男护士的需求调查

目的了解综合医院泌尿外科对男护士的需求,为医院男护士人才的合理配置及科学管理提供参考。方法采用调查问卷对2所三级甲等综合医院泌尿外科医护人员进行调查,并对数据进行统计和分析。结果 79.17%(133/168)的泌尿外科医护人员认为需要招收男护士,63.10%(106/168)的泌尿外科医护人员认为男护士在护理事业的发展中能发挥更好的作用,并且有61.31%(103/168)的医护人员认为男性适合从事护理行业。结论综合医院泌尿外科医护人员对男护士有一定需求,建议合理分配男护士人才及科学管理男护士资源。     

临床医师对临床研究基本概念的认知问卷调查

目的了解临床医师对临床研究的认知情况、临床研究中存在的困难、希望得到哪些培训。方法从2012年至2014年,在中国全部省市(除台湾外)、多个医院、不同临床科室的医师中开展了问卷调查,了解临床医师对随机对照研究、病例对照研究、队列研究的基本概念的认知情况。结果 1 122份有效问卷,约90%来自我国三甲医院,代表了国内最高水平的临床医师。医生的中位年龄39岁。50%的临床医师参加或负责过随机对照试验(RCT)研究,52.8%的医师认为RCT属于前瞻性研究,其他医师认为可以是回顾性研究或不清楚。约50%的医师对RCT的设计原则"随机、对照、盲法"有不正确的理解。16.8%的医师听说过CONSORT声明。在参加或主持过RCT研究的医师中,只有19.6%的医师知道CONSORT声明。14.5%的医师认为病例对照研究属于前瞻性研究。医院等级、年龄、学历、所在城市对认知水平有一定的影响。13.8%医师希望采用网络授课培训的方式,其余医师希望面对面授课培训。86%的医师认为最佳的培训方式为案例讨论。结论国内一些临床医师对临床研究的基本概念尚不清楚,这是一些已经完成的临床研究质量不高的根本原因。建立系统培训和考核制度是刻不容缓的任务。     

提高对原发性小血管炎的认识

血管炎病(vasulitides)是一组由不同病因引起而导致血管壁炎症、炎症细胞浸润和(或)血管壁坏死、血管阻塞和组织供血不足的疾病。作为风湿病的一大类，血管炎病因其临床表现复杂和诊治困难而长时间未被临床医师很好地认识。因此，加强对血管炎病的研究和提高对其认识至关重要。     

睾丸扭转误诊原因分析及防范措施

1 误诊原因分析 1. 1 对睾丸扭转认识不足 对于睾丸扭转三级医院与二级医院、一级医院或者社区医疗机构在误诊率上存在显著差异,以往有学者报道睾丸扭转在三级医院与二级医院、一级医院的首诊误诊率分别为31％、83％和100％.基层医院医师,尤其是非泌尿外科专业医师对睾丸扭转缺乏足够认识,临床遇及睾丸肿痛患者时通常初步诊断...     

住院病人的抑郁障碍

抑郁是一种情绪障碍,过去常认为这是精神疾患,属于精神病学范畴。其实不然,在过去的近30年里,许多研究已发现在综合医院的内外科病人中伴发的情绪抑郁问题比例相当高。目前国外的研究趋于一致的看法为:在内外科病房中约1/4～1/3的病人伴有抑郁或其他心理障碍,且有相当高比例的病人未被临床医师认识。 [流言学]~[1～3] 1.住院病人 Schwab调查美国 Florida一所医院不同内科病房的 153例病人,发现22～23％的病人伴有抑郁,男女病人发生的比例基本相同,但女性多表现为躯体的不适,而男性则表现为失望。抑郁表现常被内科医师忽略,一方面可能是临床工作太忙,没有充分的时间与病人交谈;另一方面则可能是“想找出真正的病因而妨碍了内科医师对病人情绪问题的重视”。 Moffic和Paykel调查了美国NewHaven的Connecticut医院150例内科住院病人,发现住院一周内24％的病人有明显的临床抑郁表现,且在住院期间这一比例再上升5％。其中53％的抑郁病人内科医师认为没有精神异常,只有 14％的病人被内科医师认为有抑郁,但接受抗抑郁治疗者仅9％。65％的抑郁病人其抑郁是躯体疾病的后果;21％的     

产超广谱β-内酰胺酶大肠埃希菌医院感染情况及防控对策

目的了解某医院住院患者产超广谱β-内酰胺酶(ESBLs)大肠埃希菌感染情况,为临床防控产ESBLs大肠埃希菌引起的感染提供科学依据。方法对某医院2010年产ESBLs大肠埃希菌感染的住院患者进行调查。结果 2010年住院患者中检出产ESBLs大肠埃希菌182例,检出前两位的科室为重症医学科34例(18.7%)和泌尿外科29例(15.9%),医院感染病例58例占ESBLs大肠埃希菌检出率31.9%,其中重症医学科18例(31.0%)、泌尿外科13例(22.4%)。结论重症医学科、泌尿外科是产ESBLs大肠埃希菌的高发科室。应依据产ESBLs大肠埃希菌特点,采取预防控制措施,减少产ESBLs大肠埃希菌在医院的传播和医院感染病例的发生。     

泌尿外科医师对三种前列腺MRI诊断报告满意度的调查研究

目的从前列腺MRI报告的准确性、对治疗方案的指导意义及泌尿外科医师对报告的主观感受3个参数分别评估我院泌尿外科医师对3种前列腺MRI报告,即传统自由文本报告(报告A)、TNM分期结构化报告(报告B)及PI-RADSTMv2联合(或不联合)TNM分期的结构化报告(报告C)的满意度。材料与方法调查研究2007年10月至2018年12月我院泌尿外科医师对放射科出具的3381份3种类型前列腺MRI报告的满意度。采用Likert五分量表法分别从报告的准确性、报告对治疗方案的指导意义及泌尿外科医师对报告的主观感受3个参数进行满意度评分。满意度统计方法用Kruskal-WallisH检验和Nemenyi检验。结果泌尿外科医师对报告B和报告C的总满意度均显著高于报告A(P<0.05),但对报告B和报告C的总满意度之间差异无统计学意义(P>0.05)。在报告对临床治疗方案的指导意义上,泌尿外科医师对报告B和报告C的满意度之间差异有统计学意义(P<0.05),但在报告的准确性及医师对报告的主观感受上,泌尿外科医师对报告B和报告C的满意度之间差异无统计学意义(P>0.05)。在对3个参数的满意度评价上,泌尿外科医师对报告B和报告C满意度均高于报告A(P<0.05)。结论与传统自由文本报告相比,泌尿外科医师对结构化的前列腺MRI报告更满意。     

小儿多尿的常见原因及处理

小儿多尿症状在临床上比较常见，由不同的病因引起，若延误治疗会影响患儿的生长发育甚至会危及生命。临床医师要加强认识，积极有效地处理。     

慢性前列腺炎相关病原体的临床研究

目的了解本地区慢性前列腺炎(CP)相关病原体的分布和感染情况,探讨引起CP的主要致病因素。方法对407例CP患者的前列腺液进行直接镜检、细菌、淋球菌(NG)、真菌(CA)、解脲支原体(UU)、人型支原体(Mh)和沙眼衣原体(CT)进行检测,并对检测结果分组进行比较分析。结果CP的主要致病菌是葡萄球菌,其次是大肠埃希菌。排在前4位致病菌分别为:金黄色葡萄球菌(10.32%)、表皮葡萄球菌(7.86%)、大肠埃希菌(7.62%),溶血性葡萄球菌(4.91%)和CT(4.91%)。A组的细菌感染率高于B组,非细菌病原体感染率低于B组。混合感染占相当比例(10.81%)。CP患者前列腺液直接镜检结果,3组间无显著差异。结论葡萄球菌是CP的主要致病菌,非细菌病原体可引起CP,而不是主要致病因素。混合感染和患者的精神心理因素是CP难以治愈的重要因素。CP患者前列腺液有形成分的改变与何种病原体感染无相关性。     

泌尿外科临床实践中的法律问题

现代医学已经不再是医师与病人两者之间的简单关系 ,始终具有技术和人道双重性。泌尿系统是一个生理的通道 ,可以比较容易地将新的技术、材料通过新的治疗手段输入进去 ,而由此带来的社会文化问题 ,特别是医学法律问题 ,也表现得尤为突出和尖锐。过多的法律诉讼 ,增加了泌尿外科医师的心理负担。为了避免不必要的诉讼 ,要求医师熟练掌握诊疗技术 ,增强法律意识 ,依法保护自己和患者的合法权益。     

The influence of patient race and social vulnerability on urologist treatment recommendations in localized prostate carcinoma

BACKGROUND: In localized prostate carcinoma (PCa), many studies have found that black subjects receive radical prostatectomy (RP) less often than white subjects. Such disparities involve barriers to health care, comorbid illnesses, tumor characteristics, and patient preferences. It is unclear whether differences in urologist treatment recommendations also might play a role. METHODS: Using a randomized, 2 x 2 factorial design, we presented 2000 urologists with a clinical vignette and asked them to recommend treatment of a healthy 70-year-old patient with low-risk, clinically localized PCa. Options included either RP, external beam radiotherapy, brachytherapy, cryotherapy, observation, or hormonal therapy. There were 2 variables within 4 otherwise-identical versions of the vignette: 1) patient race (black vs. white) and 2) social vulnerability (middle-income and married vs. low-income and widowed). We used multivariable logistic regression to model the effects of patient race, social vulnerability, and their interaction on recommendations for RP versus radiotherapy. RESULTS: The response rate was 66.1% (n = 1313). Race and social vulnerability interacted (P = 0.05) such that the highly vulnerable black patient received an RP recommendation 14.4% less often than his less vulnerable counterpart; the difference between the 2 white patients was 4.2%. DISCUSSION: Race interacts with social vulnerability to influence urologist recommendations for RP. Because PCa tends to be more lethal in blacks, urologists may view such patients as good candidates for RP. However, black race may amplify perceptions of social vulnerability, heightening urologists' concerns about poor surgical outcomes and follow-up. These findings affirm the importance of modeling interactions between race/ethnicity and other social variables in health disparities research.     

Morphine responsiveness in a group of well-defined multiple sclerosis patients: a study with i.v. morphine.

Pain in multiple sclerosis (MS) is more common than has previously been believed. About 28% of all MS patients suffer from central pain (CP), a pain that is difficult to treat. In the present study we have investigated the responsiveness of this pain to morphine. Fourteen opioid-free patients (eight woman and six men) with constant, non-fluctuating, long-lasting CP caused by MS were investigated. Placebo (normal saline), morphine and naloxone were given intravenously in a standardized manner. The study design was non-randomized, single blind and placebo controlled. Ten patients experienced less than 50% pain reduction by placebo and less than 50% pain reduction by morphine. Four patients were opioid responders, i.e. had minimal or no effect on pain by placebo, >50% pain reduction after morphine and >25% pain increase after naloxone, given intravenously following morphine. However, this response was obtained after high doses of morphine (43 mg, 47 mg, 50 mg and 25 mg; mean 41 mg). Thus, compared with nociceptive pain, only a minority of the patients with CP due to MS responded to morphine and only at high doses. The present results are in accord with experimental studies indicating that neuropathic pain is poorly responsive but not totally unresponsive to opioids. The results do not support the routine use of strong opioids in MS patients with CP.     

护理专科毕业生就业心理调查分析

目的:了解当前我校专科毕业生的就业心理,更好地开展就业指导与服务工作。方法:采用自设的问卷对本校护理专科毕业生的就业心理进行调查。结果:从对我校护理专科毕业生就业心理调查分析可以看出:学生选择直接就业的占据了很大一部分,对于就业的形势基本上抱有积极自信的态度,在工作单位性质选择上,国有综合医院成为大多数学生的首选,在实习单位中想直接就业的比重也较大,大多数认为求职前最需要的是提高自身的专业能力。结论:应通过学生就业指导体系,实施个性化指导。     

中小医院PACS云服务平台架构研究

目的设计一种基于云计算技术的新型PACS模式,从而减少中小医院PACS系统建设的难度和成本。方法结合云计算技术中的SaaS模式,提出了基于云计算技术的SaaS模式的“云PACS”。并从云显示、云工作流以及云归档等3个部分设计了“云PACS”。结果“云PACS”这种灵活租用的软件使用模式,可以缩短中小医院PACS建设的周期,减少建设以及维护所需的成本。结论基于云计算的PACS将是新一代PACS的发展方向,将为中小医院、区域医疗以及集团化医院的PACS建设带来新的思路。     

脑性瘫痪MRI研究进展

MRI技术是目前明确脑部结构损伤的重要诊断技术,对确定脑瘫的病理类型、病因及损伤时间有重要意义,其改变与脑瘫类型、出生胎龄、病因及损伤时间密切相关。作者就不同类型脑瘫的MRI影像学改变及其与出生胎龄、损伤时间、病因相关性的研究进展做一综述。     

慢性前列腺炎患者生存质量及心理状态分析

目的初探慢性前列腺炎(CP)患者生存质量和心理状态以及治疗前后的变化。方法采用症状自评量表(SCL-90)和焦虑自评量表(SAS),对22例正常人及74例CP患者在治疗前后进行问卷调查,评价其生存质量和心理状态的关系。结果患者生存质量和治疗效果与病程、心理状态密切相关。结论正规治疗可以明显提高CP患者的生存质量;患者的心理状况影响预后。     

Prospective study of pneumonia: unexpected incidence of legionellosis

In a prospective study of the etiology of pneumonia in patients hospitalized at a university hospital, all respiratory secretions were tested for routine pathogens as well as Legionella. A diagnosis was established in 60 of 87 patients studied. Of the 37 nosocomial infections, six were caused by L micdadei. Gram-negative rods, Staphylococcus aureus, and Streptococcus pneumoniae and Haemophilus influenzae were also important organisms in this group. In the community-acquired cases, gram-negative rods caused 26% of infections. These data emphasize both the importance of Legionella in hospitals and the changing spectrum of both hospital- and community-acquired pneumonia.     

Chronic Pain Prevalence and Associated Factors in a Segment of the Population of São Paulo City

A cross-sectional epidemiologic survey was performed to determine the prevalence of chronic pain (CP) and to identify associated factors in a random sample of persons 15 years or older from a segment of the population of São Paulo City, Brazil. A total of 1,108 eligible participants were randomly selected, and face-to-face interviews were performed with 826 individuals (74.5%) between December 2011 and February 2012. Chronic Pain Grade, Hospital Anxiety and Depression Scale, and EuroQol-5D were used to verify pain characteristics and the associated signs of psychological distress. A prevalence of 42% (95% confidence interval, 38.6–45.4) was observed for CP, and the participants with CP had an average pain intensity of 5.9 (standard deviation = 1.9) and a pain-related disability of 4.1 (standard deviation = 3.2) on a 0 to 10 scale. Persistent pain was present in 68.6% of those with CP, and 32.8% of the population sample had high-intensity or high-interference pain (Chronic Pain Grade II, III, and IV). Quality of life was significantly worse among the CP individuals. The following factors were independently associated with CP: female gender, age 30 years or older, ≤4 years of education, symptoms consistent with anxiety, and intense physical strain. Indicators of pain severity increased with pain grades.PerspectiveCP is highly prevalent in the city of São Paulo and has a considerable impact on health-related quality of life. Demographic, socioeconomic, and psychological factors are independently associated with this condition.     

Physicians and complementary and alternative medicine cancer therapies in Greece: a survey

OBJECTIVES: To assess the prevalence of complementary and alternative medicine (CAM) cancer therapies and attitudes toward them in a nonrandom sample of physicians in Greece. SUBJECTS: Four hundred and ninety-four (494) physicians from private practices and hospitals in the Athens area were approached to complete a questionnaire on perceived cancer etiology, self-reported knowledge, and attitudes about CAM therapies used by cancer patients. Two hundred and thirty-six (236) (47.8%) questionnaires were returned. RESULTS: Greek physicians are most familiar with homoeopathy (58.5%), diets (58.1%), antioxidants (vitamin C) (55.9%), and acupuncture (47.9%). Perceived rates of patients using CAM are low. Predominantly, physicians shared concepts of carcinogenesis accepted by conventional biomedicine. Only physicians who considered disorders of cellular metabolism or in the flow of body energy to be relevant believed that homoeopathy could be an adequate CAM therapy. CONCLUSIONS: Greek physicians in our sample displayed little interest in CAM. However, media and Internet coverage may generate a greater demand for these methods in the future in Greece and physicians will thus need to be better informed.