科玛嘉念珠菌培养基鉴别念珠菌的系统评价

目的评价科玛嘉念珠菌培养基鉴别常见致病性念珠菌的准确性。方法检索MEDLINE、EMBase、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(CSJD)、中国期刊全文数据库(CJFD)等数据库,并通过其他途径全面收集文献,采用诊断性试验准确性质量评价工具(QUADAS)标准评价文献质量,用Meta-Disc软件制作综合受试者工作特征(SROC)曲线,评价科玛嘉显色培养基鉴别常见致病性念珠菌的准确性。结果纳入符合标准的文献7篇。7篇文献均报道了科玛嘉念珠菌培养基检测白色念珠菌的准确性,总灵敏度和总特异度分别为98.3%、98.8%,SROC曲线下面积(AUC)为0.998 0;6篇文章报道了科玛嘉念珠菌培养基检测热带念珠菌的准确性,总灵敏度和总特异度分别为92.5%、99.8%,AUC为0.998 3;5篇文章报道了科玛嘉念珠菌培养基检测光滑念珠菌的准确性,总灵敏度和总特异度分别为98.3%、98.7%,AUC为0.996 8。结论科玛嘉培养基能快速鉴定临床常见念珠菌,鉴定结果准确可靠。     

Evaluation of CHROMagar Candida for presumptive identification of clinically important Candida species

CHROMagar Candida is a recently described and differential medium for the isolation and the presumptive identification of clinically important yeasts. We evaluated it with 262 yeast strains from clinical specimens, including 173 Candida albicans, 21 Candida tropicalis, 8 Candida krusei, 49 Candida glabrata, and 12 strains of other yeast species. Strains were presumptively identified on the basis of colony color and texture. These observations were compared with conventional identification results. Candida albicans was identified correctly in 170 (98%) of the 173 strains. A total of 46 of the 205 specimens that were plated on CHROMagar contained mixed cultures of yeast. Thirty-seven (80%) of these mixed cultures were not detected in the original specimens. CHROMagar Candida was useful for the rapid presumptive identification of Candida albicans and facilitated the recognition of mixed cultures. For other yeast species, it may provide additional information to laboratories that do not regularly perform identifications beyond the germ tube test.     

Rapid identification of the Candida species from direct blood cultures by CHROMagar Candida

We evaluated the ability of CHROMagar Candida to identify Candida species isolated directly from blood cultures. A total of 50 clinical isolates of Candida were incubated at 35 degrees C, and once growth was established, an aliquot of each was plated onto CHROMagar Candida medium. A control specimen was plated directly from Sabouraud's dextrose agar. Following incubation at 30 degrees C, all yeast isolates were identified by colony morphology and colour. We were able to identify all isolates of C. albicans (n = 20), C. tropicalis (n = 14), C. glabrata (n = 6), and C. krusei (n = 5), which were isolated from blood or from control cultures. This study demonstrated that CHROMagar Candida reliably isolated and identified yeast taken directly from blood cultures. We conclude that this rapid and easy method of identifying Candida species will enable clinicians to quickly choose the appropriate antifungal agent. This should decrease patient morbidity and mortality.     

科玛嘉念珠菌显色培养基在酵母菌鉴定中的应用评价

目的评价科玛嘉念珠菌显色培养基在酵母菌鉴定中的应用。方法用科玛嘉念珠菌显色培养基和Vitek32-YBC卡鉴定52株酵母菌。结果52株酵母菌中,科玛嘉显色基鉴定出33株白色念珠菌,13株热带念珠菌,2株光滑念珠菌,4株其他念珠菌。YBC卡鉴定出32株白色念珠菌,12株热带念珠菌。结论显色法需时短,价格适中,可鉴定92%左右的致病酵母菌。YBC卡鉴定菌种较显色法多,但鉴定时间长,价格高。     

门急诊观察室开展评星活动的做法与成效

为了更好地贯彻星级护理服务,提高护理质量和病人满意度,2004年9月起在门诊急诊观察室首创开展“评星公示栏”活动,星级护士的评价贯穿护理活动全过程;引入了公平的竞争机制、建立有效的激励机制:从而完善了管理机制,规范了护士的服务行为,提高了护士的综合素质和优质护理服务水平。     

五常法用于手术室规范化管理

目的 :提高手术室护理及管理的质量和效率。方法 :应用“五常法”原理 ,对人、物、环境进行规范改进 ,设计了流程图 ,规范了手术室护士言行、技术、手术物品准备与放置标准等。从形式化→行事化→习惯化推进 ,形成专科护理准则 (标准 )。结果 :器械准备完好率、物品准备完好率、贵重仪器使用管理完好率、手术科室及病人满意率五常组均高于常规组。结论 :五常法管理有效地提高了手术室质量     

18h判读CHROMagar MRSA显色筛查培养基的研究

目的评估CHRO Magar耐甲氧西林金黄色葡萄球菌(MRSA)显色培养基在孵育18h时判读的敏感性和特异性等试验指标。方法选择2007年7月至2009年5月临床分离的176株MRSA阳性菌株和738株MRSA阴性菌株,分别孵育18h和24h判读后进行特异性和敏感性比较。结果 18h和24h判读结果的特异性分别为84.1%、90.0%;敏感性分别为92.1%、87.0%;阳性预测值分别为72.0%、67.0%;阴性预测值分别为96%、97%;阳性似然比分别为10.5、8.2;阴性似然比分别为0.17、0.11。与18h比较,在24h判读结果中有11株阳性菌株在孵育24h时变色(18h判读为阴性),20株阴性菌株在孵育18h时出现红色。假设MRSA的患病率分别为15%、25%、35%时孵育18h的判读阳性预测值分别为65%、78%、85%;孵育24h的判读阳性预测值分别为60%、74%、82%。结论数据证明CHROMagar MRSA用于MRSA的筛查在18h时就具有较高的特异性和敏感性;随着患病率的增高,18h和24h判读阳性预测值差距缩小;在实际工作中,18h判读可缩短样本报告周期,并且使临床医生在选择抗生素时更加快速、准确。     

Laboratory evaluation of the CHROMagar KPC medium for identification of carbapenem-nonsusceptible Enterobacteriaceae

CHROMagar KPC was evaluated with 53 carbapenem-nonsusceptible strains. KPC-producing Klebsiella pneumoniae and Enterobacter cloacae grew efficiently and yielded metallic blue colonies (100% sensitivity). Poor or no growth or atypical colony color were evident with KPC-producing Escherichia coli (71.4% sensitivity) and ertapenem-resistant KPC-nonproducing K. pneumoniae (72.7% sensitivity). CHROMagar KPC appears applicable for processing carbapenem-resistant Enterobacteriaceae surveillance specimens, but its performance might possibly be suboptimal in the presence of KPC-negative ertapenem-resistant strains or for detection of KPC-producing E. coli.     

手术室应用"五常法"的管理体会

我院手术室QC小组于 2 0 0 2年 4月起应用“五常法”原理 ,对泌尿专科手术实施“五常法”活动 ,经半年多实践 ,取得了良好的效果 ,现将我院手术室“五常法”活动的实践体会介绍如下。1　“五常法”　　起源于日本的“五常法”(seiri ,seiton ,seiso ,seiketsu ,shit suke) ,包括常组织、常整顿、常清洁、常规范、常自律。常组织 :判断必需与非必需的物品 ,并将必需物品降到最低程度。目的是把“空间”腾出来活用 ,并防止误用。常整顿 :把留下来的必需物品依规定位置放 ,并放置整齐 ,加以标示。目的是整齐、有标示 ,不用浪费时间寻找东西。…     

Room temperature tunable multicolor phosphorescent polymers for humidity detection and information encryption

Amorphous polymer-based room temperature phosphorescence (RTP) materials exhibiting tunable emission colors have received tremendous attention and are extremely challenging to prepare. Herein, polyacrylamide-based RTP materials with tunable multicolor emission were prepared via copolymerizing phosphor with concentration dependent luminescence colors and acrylamide with different molar ratios. The hydrogen bonding interactions and chemically crosslinked structures in these polymers effectively restrict the mobility of phosphors and activate efficient RTP emission. The molar ratio of phosphor and acrylamide has a significant influence on the photophysical properties of these polymers, which can be used to fabricate multicolor materials. In addition, the RTP intensity decreases with increasing humidity due to the disassociation of hydrogen bonding by adsorption of water, manifesting as a humidity sensor. Benefiting from the distinguishable RTP lifetimes and the responsiveness to humidity, triple encoding for information encryption is successfully realized.

A polymer with tunable multicolor was prepared via copolymerizing a phosphor with concentration dependent luminescence and acrylamide based on chemical crosslinking and hydrogen bonding interactions for humidity detection and information encryption.     

Room temperature oxidative desulfurization with MoO3 subnanoclusters supported on MCM-41

Subnano MoO₃/MCM-41 was successfully prepared through doping (NH₄)₆Mo₇O₂₄ in the synthesis process of MCM-41. The morphology of MoO₃/MCM-41 was visually observed by TEM and HADDF-STEM. N₂ sorption, XPS and Raman were further applied to investigate the structure of the material. MoO₃/MCM-41 was used in the oxidative desulfurization process with tert-butyl hydroperoxide as oxidant. MoO₃/MCM-41 showed outstanding catalytic activity and recycling ability at room temperature.

MoO₃ subnanoclusters encapsulated in MCM-41 exhibited enhanced catalytic activity and stability for oxidative desulfurization at room temperature.     

"Tako-tsubo" cardiomyopathy and duloxetine use

We report the case of a 68-year-old woman in whom the use of duloxetine, a potent serotonin and norepinephrine reuptake inhibitor, was associated with "tako-tsubo" cardiomyopathy (TTC). Although several pathophysiological mechanisms for TTC have been proposed, available evidence suggests that an excess of catecholamines may play a major role. Our patient had a history of myocardial infarction with normal coronary arteries, probably the first manifestation of TTC. We speculate that duloxetine may have precipitated TTC by increasing plasma catecholamine concentration in a predisposed patient.     

"五常法"在门诊手术室护理质量管理中的应用

目的研究"五常法"在门诊手术室护理质量管理中的应用效果.方法把"五常法"应用于门诊手术室日常管理中,按照"五常法"原理,对手术室人、物、环境进行规范化改进,通过制定"五常法"审核表,对工作现场进行常组织、常整顿、常清洁、常规范、常自律,并定期进行检查评估,持续不断改进.结果门诊手术室护理质量明显提高:手术器械、物品准备完好率,精密、贵重仪器使用保管完好率,急救物品完好率,物品消毒灭菌合格率,手术科室及患者满意率等均明显提高(P值均＜0.05).结论在门诊手术室开展"五常法"活动,能有效提高护理质量和服务质量,确保医疗护理安全,达到护患双赢的目的.     

“五常法”在门诊手术室护理质量管理中的应用

目的 研究“五常法”在门诊手术室护理质量管理中的应用效果。方法 把“五常法”应用于门诊手术室日常管理中，按照“五常法”原理，对手术室人、物、环境进行规范化改进，通过制定“五常法”审核表，对工作现场进行常组织、常整顿、常清洁、常规范、常自律，并定期进行检查评估，持续不断改进。结果 门诊手术室护理质量明显提高：手术器械、物品准备完好率，精密、贵重仪器使用保管完好率，急救物品完好率，物品消毒灭菌合格率，手术科室及患者满意率等均明显提高（P值均〈0．05）。结论 在门诊手术室开展“五常法”活动，能有效提高护理质量和服务质量，确保医疗护理安全，达到护患双赢的目的。     

“5S”活动规范手术室无菌物品间管理的效果评价

目的规范手术室无菌物品间的管理,提高手术室工作效率和护理质量。方法成立“5S”活动小组,制定实施计划,对无菌物品间物品进行“5S”管理。结果“5S”活动实施前后,无菌物品过期重消毒、环境整理和查过期物品时间及取放无菌物品时间比较有显著性差异（P〈0．001）。结论“5S”活动规范了手术室无菌物品间的管理,确保了病人安全,提高了护士的整体素质。