Reduction in hospitalwide incidence of infection or colonization with methicillin-resistant Staphylococcus aureus with use of antimicrobial hand-hygiene gel and statistical process control charts.

OBJECTIVE: To evaluate the impact of serial interventions on the incidence of methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: Longitudinal observational study before and after interventions. SETTING: The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU). INTERVENTIONS: A series of interventions including the introduction of an antimicrobial hand-hygiene gel to the intensive care unit and a hospitalwide MRSA surveillance feedback program that used statistical process control charts but not active surveillance cultures. METHODS: Serial interventions were introduced between January 2003 and May 2006. The incidence and rates of new patients colonized or infected with MRSA and episodes of MRSA bacteremia in the intensive care unit and hospitalwide were compared between the preintervention and intervention periods. Segmented regression analysis was used to calculate the percentage reduction in new patients with MRSA and in episodes of MRSA bacteremia hospitalwide in the intervention period. RESULTS: The rate of new patients with MRSA in the ICU was 6.7 cases per 100 patient admissions in the intervention period, compared with 9.3 cases per 100 patient admissions in the preintervention period (P=.047). The hospitalwide rate of new patients with MRSA was 1.7 cases per 100 patient admissions in the intervention period, compared with 3.0 cases per 100 patient admissions in the preintervention period (P<.001). By use of segmented regression analysis, the maximum and conservative estimates for percentage reduction in the rate of new patients with MRSA were 79.5% and 42.0%, respectively, and the maximum and conservative estimates for percentage reduction in the rate of episodes of MRSA bacteremia were 87.4% and 39.0%, respectively. CONCLUSION: A sustained reduction in the number of new patients with MRSA colonization or infection has been demonstrated using minimal resources and a limited number of interventions.     

阿魏酸钠对花生四烯酸代谢的影响

利用放射薄层方法测定兔血小板花生四烯酸代谢产物TXB₂,PGE₂和PGF_2α。用放射免疫法测定兔血小板TXB₂及主动脉6-keto-PGF_1α。阿魏酸钠(SF,0.1～3.2 mmol/L),抑制¹⁴C-花生四烯酸转化为TXB₂,呈剂量效应关系,IC₅₀为0.762 mmol/L。SF在较高浓度(0.8～3.2mmol/L)时亦抑制PGE₂,PGF_2α的生成。用放免法观察到,SF对血小板TXB₂和动脉壁6-keto-PGF_1α的生成均有抑制作用,对TXB₂的作用较强。结果提示,SF可抑制兔血小板和动脉壁环氧酶活性。     

Need for instruction and support of the wives of patients with myocardial infarction

The study investigates the need for instruction and support among wives of patients with myocardial infarction, applying the 'stress' theory. The data were gathered by questionnaires completed by 59 wives of patients with myocardial infarction. Feelings and symptoms indicative of stress did occur among wives of the patients. They assessed instruction especially concerning home care, as being inadequate. They stated that the support they received had come largely from their own relatives; more than one third of the respondents said they had received support from a nurse; one fifth said they had not received it from anyone. The 'instruction' model for wives and other relatives of patients with myocardial infarction, introduced at the end of the article, emphasizes the importance of relevant information and support to the close relatives of patients with myocardial infarction.     

Constructing a deprivation index based on census data in large Spanish cities(the MEDEA project)

OBJECTIVES: a) To describe the methodology used to construct a deprivation index by census tract in cities, to identify the tracts with the least favorable socioeconomic conditions, and b) to analyze the association between this index and overall mortality. METHODS: Several socioeconomic indicators (Census 2001) were defined by the census tracts of the following cities: Barcelona, Bilbao, Madrid, Seville and Valencia. The correlations with the standardized mortality ratio (1996-2003), and the dimensionality of the socioeconomic indicators were studied. Finally, the selected indicators were aggregated in an index, in which the results of the factor loadings from extraction of a factor by principal components were used as weighting values. RESULTS: The indicators with the strongest correlations with overall mortality were those related to work, education, housing conditions and single parent homes. In the analysis of dimensionality, a first dimension appeared that contained indicators related to work (unemployment, manual and eventual workers) and education (insufficient education overall and in young people). In all the cities studied, the index created with these 5 indicators explained more than 75% of their variability. The correlations between this index and mortality generally showed higher values than those obtained with each indicator separately. CONCLUSIONS: The deprivation index proposed could be a useful instrument for health planning as it detects small areas of large cities with unfavorable socioeconomic characteristics and is associated with mortality. This index could contribute to the study of social inequalities in health in Spain.     

Two cases of dysfibrinogenemia characterized by abnormal FPB release: fibrinogen Madrid I & II

Congenital dysfibrinogenemia was found in two non related and asymptomatic families. Low levels of plasma fibrinogen were found using a chronometric assay but normal levels were found using both an immunologic method and a method to measure the fibrin formed after two hours incubation with thrombin. Kinetic analysis of fibrinopeptide release revealed a delay in the thrombin catalyzed release of fibrinopeptide B from both abnormal fibrinogens. Timed release of fibrinopeptide A was normal. Analysis of fibrinopeptides by high-performance liquid chromatography showed the same retention times in both normal and abnormal fibrinogens. Polymerisation of fibrin monomers and the sialic acid content per mol of fibrinogen were normal. Although these cases seem similar, until their structural defects are determined, it is proposed to provisionally designate them fibrinogens Madrid I & II.     

白藜芦醇对动物离体心房收缩力和心率作用的种属差异性比较

目的:观察白藜芦醇对豚鼠、小鼠和家兔离体心肌收缩力和心率的影响。方法:实验于2005-08/2006-12在河北医科大学西校区实验中心完成。①实验分组:离体豚鼠、小鼠和家兔心肌各分为9组:空白对照组、溶剂对照组、递增累积浓度白藜芦醇组(浓度为10-6,3×10-6,10-5,3×10-5,10-4,3×10-4mol/L),白藜芦醇对照组(5×10-5mol/L),ATP敏感性钾通道阻断剂格列苯脲(5×10-5mol/L)预孵育 白藜芦醇组,钙激活钾通道阻断剂四乙胺(10-3mol/L)预孵育 白藜芦醇组,电压依赖性钾通道阻断剂4-氨基吡啶(10-3mol/L)预孵育 白藜芦醇组,内向整流钾通道阻断剂氯化钡(10-4mol/L)预孵育 白藜芦醇组,乙酰胆碱调节钾通道阻断剂阿托品(10-5mol/L)预孵育 白藜芦醇组。②实验方法:不同类型的钾通道阻断剂均预孵育15min后,分别加入白藜芦醇(终浓度为5×10-5mol/L),连续记录30min,与相应动物白藜芦醇对照组相比较。③评估指标:分析不同阻断剂与白藜芦醇联用对心房收缩力下降率及心率抑制率的影响。结果:①白藜芦醇可降低豚鼠和小鼠离体心肌收缩力和心率(P<0.05),并被ATP敏感性钾通道阻断剂格列苯脲和钙激活钾通道阻断剂四乙胺部分阻断。②白藜芦醇可降低家兔离体心肌心率,格列苯脲可阻断白藜芦醇的负性变时作用。③电压依赖性钾通道阻断剂4-氨基吡啶、内向整流钾通道阻断剂氯化钡、乙酰胆碱调节钾通道阻断剂阿托品均不能阻断白藜芦醇对3种不同动物离体心房收缩力和心率的作用(P>0.05)。结论:白藜芦醇可呈剂量依赖性减慢豚鼠、小鼠和家兔的心率,白藜芦醇可减弱豚鼠心肌收缩力,其作用是与开放ATP敏感性钾通道有关,而与电压依赖性钾通道、内向整流钾通道和乙酰胆碱调节钾通道无关。同时,钙激活钾通道也参与了白藜芦醇对豚鼠和小鼠离体心房收缩力和/或心率的抑制作用。白藜芦醇对离体心肌收缩力和心率的作用有种属差异性。     

The advantages and challenges of unannounced standardized patient methodology to assess healthcare communication

Objective

This paper provides an overview of the implementation of using unannounced standardized patients (USPs) to conduct health communication research in clinical settings.

Methods

Certain types of health communication situations are difficult to capture because of their rarity or unpredictable nature. In primary care the real reasons for a visit are frequently unknown until the consultation is well under way. Therefore, it is logistically difficult for communication studies to capture many real-time communications between patients and their physicians. Although the USP methodology is ideal for capturing these communication behaviors, challenges to using this method include developing collaborative relationships with clinical practices, logistical issues such as safeguarding the identity of the USP, training USPs and creating their identities, maintaining fidelity to the role, and analyzing the resultant data.

Results

This paper discusses the challenges and solutions to USP implementation. We provide an example of how to implement a USP study using an on-going study being conducted in primary care practices.

Conclusion

This paper explores the advantages and challenges as well as strategies to overcome obstacles to implementing a USP study.

Practice implications

Despite the challenges, USP methodology can contribute much to our understanding of health communication and practice.     

A historical reflection of the contributions of Cajal and Golgi to the foundations of neuroscience

In 1906, the Spaniard Santiago Ramón y Cajal and the Italian Camillo Golgi shared the Nobel Prize in Physiology or Medicine, in recognition of their work on the structure of the nervous system. Although both were well-known scientists who had made a large number of important discoveries regarding the anatomy of the nervous system, each defended a different and conflicting position in relation to the intimate organization of the grey matter that makes up the brain. In this communication we will review the importance of Cajal's studies using the method of impregnation discovered by Golgi, as well as the relevant studies carried out by Golgi, the concession of the Nobel Prize and the events that occurred during the Nobel conferences. In summary, we will précis the important contribution of both scientists to the founding of modern Neuroscience.