香港华人妇女产后抑郁危险因素的前瞻性研究

目的：产后抑郁是一种常见的精神障碍，对产妇、新生儿和其它家庭成员导致广泛的伤害。产后抑郁的病因学研究大多是基于西方样本，对其中的社会文化原因也缺乏实证研究。本研究从人口学、心理社会及种族文化因素等方面探讨中国妇女产后抑郁症状学的决定因素。方法：在大学附属综合医院产前门诊连续收集登记的中国孕妇959例，从她们第一次产前检查开始评估（基线），以后分别在孕期的最后3个月、产后即刻和产后3个月时评估。调查涉及的危险因素分6个方面：人口学和社会经济背景，躯体疾病及精神疾病病史，产前抑郁情绪，围生期应激源，人际关系，和种族文化环境。采用等级回归进行分析。因变量是产后3个月时的抑郁评分。结果：决定产后抑郁症状学的因素有：目前的生活事件，缺乏社会支持，婚姻不满意，既往有故意自伤史，以及产前存在抑郁情绪。婆媳关系不好和没有陪月在产后阶段也与抑郁评分高有关联。结论：西方研究所确立的产后抑郁危险因素大体适用于中国妇女。产褥期的社会文化特点同样对产妇情绪有影响。     

矽肺对肺癌及总死亡影响的回顾性队列研究

目的 利用香港矽肺患者队列的资料进行分析,探讨矽尘、矽肺与肺癌的关系.方法 选择1981年1月1日至1998年12月31日期间在香港尘肺诊所登记的2789例男性矽肺病例为研究对象,取用同时期一般男性人群作为对照.用人年的方法估计各死因的标化死亡比(SMR),用Axelson's法间接调整吸烟的混杂影响.矽尘与肺癌的剂量-效应关系采用多因素p-spline平滑法模型来拟合最佳风险模型.结果 该组研究队列人数为2789,共观察24 992.6人年,失访率仅为2.9%.该队列主要工种为建筑工人(5 1.09%)和地下沉箱操作工人(37.54%).队列总死亡人数为853人,平均死亡年龄为(63.8±10.27)岁,整个队列中86例死于肺癌.全死因及全癌的SMR均明显上升,首位死因是呼吸道疾病,肺癌的5MR明显增加(SMR:1.69,95%CI:1.35～2.09).去除年龄、时期和吸烟的混杂因素的影响,矽肺对肺癌的相对危险度下降到1.12(95%CI:0.89～1.38).间接调整吸烟的混杂影响后建筑工人及地下沉箱工人肺癌的相对危险度分别为1.09(95%CI:0.82～1.42)和1.56(0.98～2.36).多因素p-spline平滑法风险模型分析显示,肺癌与累积呼吸性矽尘总量或平均矽尘浓度的关系无剂量-效应关系.结论 队列研究未发现接触矽尘或矽肺能增加肺癌死亡的危险,平滑法模型拟合的风险模型并不支持矽尘与肺癌死亡之间存在剂量-效应关系.     

A continuous quality improvement project to reduce medication error in the emergency department

BACKGROUND:

Medication errors are a common source of adverse healthcare incidents particularly in the emergency department (ED) that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.

METHODS:

In 2009, a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.

RESULTS:

Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed, discussed, endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents (MI) from 16 to 6 was achieved before and after the improvement work.

CONCLUSION:

This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.KEY WORDS: Medication error, Medication safety, Continuous Quality Improvement (CQI)     

An evaluation of compliance and performance following the introduction of the Inter-Facility Transport Triage Guideline

BACKGROUND: In Hong Kong, the reorganization of healthcare frame work for better utilization of resources has led to an increase in the frequency of inter-facility transport in recent years. An Inter-Facility Transport Triage Guideline (IFTTG) was introduced and evaluated on its compliance and performance. This study aimed to evaluate the compliance to the IFTTG and performance of inter-facility transport after the IFTTG was implemented.METHODS: The patients who required emergency IFT with accompanying personnel in two consecutive periods (pre-implementation period: January 1, 2006 to April 30, 2006; post-implementation period: May 1, 2006 to August 31, 2006) were included. The compliance to pre-transport triage and transport team configuration was evaluated by a review panel with eight performance indicators identified. The performance indicators were compared individually and as an overall score.RESULTS: Sixty-eight (26 in the pre-implementation period and 42 in the post-implementation period) IFTs were reviewed. There was demonstrable improvement on compliance to the IFTTG. The appropriateness of pre-transport triage increased from 34.6% to 54.8% whereas appropriateness of transport team configuration rose significantly from 73.1% to 92.9% (P<0.05). Staff performance on individual IFT performance indicator was satisfactory in both periods and the means of overall score on performance indicators were 7.12 and 7.29 respectively. The most improved performance indicator was the appropriateness of transport team configuration.CONCLUSIONS: The compliance and performance with the newly implemented IFTTG were satisfactory. However, staff comment and satisfaction with the use of the new guideline should be collected so as to achieve continuous quality improvement.     

二氢埃托啡透皮给药系统的研究

报道了二氢埃托啡透皮贴片系统(DHE-TDS)的研制情况,并对该系统进行了初步动物实验,结果说明,以PVA,PVP、乳糖等为主要基质制成的DHE-TDS对皮肤的刺激性属轻度,用家兔腹部贴片。测定药库中药物剩余量,结果推知药物释放符合一级原理。大鼠实验证明,DHE-TDS稳定释药时间为用药后4～32h,大鼠扭体实验证明DHE-TDS一次用药,镇痛作用持续时间至少48h。此制剂是否有成瘾性,尚待证明。     

吡罗昔康与β-环糊精包合物结构的核磁共振研究

本文采用~1HNMR和二维NOE等方法研究了吡罗昔康与β-环糊精包合物的结构。化学位移变化和NOE的结果提示,在溶液中二者的摩尔比为1:1时,主要是药物的苯环部份包藏在β-环糊精的空腔内。     

Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors

BACKGROUND： The traditional method of pituitary tumor excision is transseptal microscopic excision; however, the transnasal transsphenoidal endoscopic approach has shown comparable results with the transseptal microscopic approach at some institutions. The objective of this study is to compare the two types of sellar and parasellar mass resection： transnasal transsphenoidal endoscopic excision versus transseptal microscopic excision. METHODS： A retrospective cohort analysis was performed on subjects who were referred to a tertiary hospital for surgical management of sellar or parasellar masses. The two groups of patients either underwent a transnasal endoscopic approach with endoscopic excision or transseptal microscopic excision.     

急性冠脉综合征采用氯吡格雷和阿司匹林治疗后引起的出血并发症

介绍:CURE(theClopidogrelinUnstableAnginatoPreventRecurrentEvents,氯吡格雷预防不稳定型心绞痛复发事件)研究显示不稳定型心绞痛(UAP)和非ST段抬高的心肌梗死(NSTEMI)患者联合使用阿司匹林(ASA)和氯吡格雷的益处。我们试图评价在一些未选择的丹麦患者中引入CURE标准是否增加出血的危险。材料和方法:CURE标准完成于2001年12月Odense大学医院的心脏科。本研究主要观察了2个为期1年的时间段:第1段,从2000年12月到2001年11月;第2段,从2001年12月到2002年12月。回顾病例表,登记主要的出血并发症和初级临床终点(非致死性的心肌…