麻醉机呼吸环路碱石灰尘埃污染的情况

目的：观察通气时碱石灰尘埃向呼吸环路中的排放及被呼吸道阻留的情况。方法：麻醉机环路连接集尘袋及筛装新碱石灰。ＪＴ库尔特颗粒计数仪动态测定排尘量。其颗粒测量范围为１～１２５μｍ３，通气１０分后测定呼吸环路加集尘袋内的尘埃量即为总尘量，收取称干重得尘埃分散度。通过对Ｎａｒ－ｃｏｍｅｄ、Ｄｒａｇｅｒ、Ｓｕｌａｒ８０８和１０３麻醉机行上述测量后，另以前者（Ｎ机）为例，其环路按相应处理分干燥、湿化和过滤三组，志愿者模拟通气１０分测定环路含尘量后与总尘量差得气管肺的阻留量。结果：四种麻醉机环路内碱石灰尘埃的分散度达１３ｍｇ／ｍ３以上。尘埃排放量与通气时间呈正比（ｒ＝０．９５，Ｐ＜０．０１）。Ｎ机干燥组中总排尘量的半数以上被气管肺阻留。湿化组该阻留量明显下降（Ｐ＜０．０５），而过滤组环路内总排尘量和气管肺阻流量下降更为显著（Ｐ＜０．０１）。结论：使用新碱石灰通气时，麻醉机环路内存在严重的尘埃污染，环路内湿化有一定的防尘作用，但以滤过处理效佳。     

Blunting Occam's razor: aligning medical education with studies of complexity

Clinical effectiveness and efficiency in medicine for patient benefit should be grounded in the quality of medical education. In turn, the quality of medical education should be informed by contemporary learning theory that offers high explanatory, exploratory and predictive power. Multiple team‐based health care interventions and associated policy are now routinely explored and explained through complexity theory. Yet medical education – how medical students learn to become doctors and how doctors learn to become clinical specialists or primary care generalists – continues to refuse contemporary, work‐based social learning theories that have deep resonance with models of complexity. This can be explained ideologically, where medicine is grounded in a tradition of heroic individualism and knowledge is treated as private capital. In contrast, social learning theories resonating with complexity theory emphasize adaptation through collaboration, where knowledge is commonly owned. The new era of clinical teamwork demands, however, that we challenge the tradition of autonomy, bringing social learning theories in from the cold, to reveal their affinities with complexity science and demonstrate their powers of illumination. Social learning theories informed by complexity science can act as a democratizing force in medical education, helping practitioners to work more effectively in non‐linear, complex, dynamic systems through inter‐professionalism, shared tolerance of ambiguity and distributed cognition. Taking complexity science seriously and applying its insights demands a shift in cultural mindset in medical education. Inevitably, patterns of resistance will arise to frustrate such potential innovation.     

血管紧张素转换酶基因多态性与肺源性心脏病的相关性

①目的　探讨血管紧张素转换酶 (ACE)基因的插入 缺失 (I D)多态性与肺源性心脏病 (肺心病 )的关系。②方法　选取肺心病病人 63例 ,正常对照组 40例。常规制备外周血白细胞DNA ,采用多聚酶链反应 (PCR)检测两组人群ACE基因的I D多态性。③结果　肺心病组和正常对照组均检测到ACE基因的II,ID及DD 3种基因型 ,肺心病组 3种基因型的频率分别为 0 .45 ,0 .41和 0 .1 4 ,正常对照组为 0 .42 ,0 .41和 0 .1 7,两组比较差异无显著性 (χ2 =2 .1 57,P >0 .0 5) ;两组I,D等位基因频率分别为 0 .54 ,0 .46和 0 .61 ,0 .39,两组间比较差异无显著性(χ2 =1 .2 57,P >0 .0 5)。④结论　ACE基因I D多态性与肺心病发生无明显相关性     

慢性胃炎患者外周血T淋巴细胞亚群的改变

本文报导了55例慢性胃炎患者T淋巴细胞亚群的检测结果,按年龄分组与42例健康对照比较分析.结果表明慢性胃炎组患者CD_ ~3 细胞比例明显低于对照组(P<0.001),其中青年患者(20～35岁)CD_3~ 值低下最显著(P<0.001),中老年组CD_3~ 值虽低于中老年对照组,但未达到统计学有意义的程度.同时青年患者CD_4~ 值也低于同年龄对照组(P<0.002).慢性胃炎组的CD_4~ /CD_8~ 比值也较对照组为低(P<0.02),以中青年患者为明显(P<0.02和P<0.005).提示青年慢性胃炎患者的细胞免疫功能减弱较中老年患者明显.     

Patients' expectations of osteopathic care: a qualitative study

Background

Research has shown that patients'' expectations of health care and health‐care practitioners are complex and may have a significant impact on outcomes of care. Little is known about the expectations of osteopathic patients.

Objectives

To explore osteopathic patients'' expectations of private sector care.

Design

Focus groups and individual interviews with purposively selected patients; this was the qualitative phase of a mixed methods study, the final phase being a patient survey.

Setting and participants

A total of 34 adult patients currently attending for treatment at private osteopathic practices across the United Kingdom.

Intervention

Focus group discussions and individual interviews around expectations before, during and after osteopathic care.

Outcome measures

Thematic analysis of text data to identify topics raised by patients and to group these into broad themes.

Results

Many components of expectation were identified. A preliminary conceptual framework describing the way the therapeutic encounter is approached in osteopathy comprised five themes: individual agency, professional expertise, customer experience, therapeutic process and interpersonal relationship.

Discussion and Conclusion

The components of expectation identified in this phase of the study provided potential question topics for the survey questionnaire in the subsequent phase of the investigation. The model developed in this study may add a new perspective to existing evidence on expectations. Further research is recommended to test the findings both within private practice and the National Health Service.     

Establishing local priorities for a health research agenda

Aim/Background

To describe the two‐stage prioritization process being used by the UK National Institute for Health Research''s Collaboration for Leadership in Applied Health Research and Care for the South‐West Peninsula (or PenCLAHRC) – a joint health service and university partnership and reflect on implications for the wider context of priority setting in health‐care research.

Method

PenCLAHRC''s process establishes the priorities of Stakeholders including service users across a regional health system for locally relevant health services research and implementation. Health research questions are collected from clinicians, academics and service users in Devon and Cornwall (UK) using a web‐based question formulation tool. There is a two‐stage prioritization process which uses explicit criteria and a wide Stakeholder group, including service users to identify important research questions relevant to the south‐west peninsula locality.

Results

To date, a wide variety of health research topics have been prioritized by the PenCLAHRC Stakeholders. The research agenda reflects the interests of academics, clinicians and service users in the local area. Potential challenges to implementation of the process include time constraints, variable quality of questions (including the language of research) and initiating and maintaining engagement in the process. Shared prioritization of local health research needs can be achieved between Stakeholders from a wide range of perspectives.

Conclusions

The processes developed have been successful and, with minor changes, will continue to be used during subsequent rounds of prioritization. Engagement of Stakeholders in establishing a research agenda encourages the most relevant health questions to be asked and may improve implementation of research findings and take up by service users.     

臭氧法与紫外线法空气消毒效果的观察

目的　探讨ICU病房安全、简便、有效的空气消毒方法。方法　对比分析臭氧法与紫外线法消毒前后空气细菌培养菌落数。结果　①两种消毒方法空气消毒 30min前后空气细菌培养菌落数比较差异均有显著意义 (P值分别 <0 0 0 0 1与 0 0 0 1) ;②与紫外线法相比 ,臭氧法消毒效果更为彻底 (P <0 0 0 1)。结论　臭氧消毒法不失为ICU病房一种安全、简便、有效的空气消毒方法。     

0.002%碘伏液擦浴预防皮肤褶烂的疗效观察

笔者对 ICU15 0例重症患者分别使用 0 .0 0 2 %碘伏液及常规温水擦浴 5分钟 ,每天 1次进行对比观察 ,结果表明 ,用 0 .0 0 2 %碘伏液沐浴组对预防皮肤褶烂的发生效果显著 ,对控制院内感染具有重要意义 ,值得推广使用。     

AQUARIUS血液净化系统的报警分析及处理

本文总结了我科2006年1月至2010年12月,应用Aquarius血液净化系统治疗的危重症患者129例（394次）报警原因、分布特点及正确的处理方法,并探讨提高血液净化系统的安全性及高效性的措施。     

Feasibility study suggests no impact from protected engagement time on adverse events in mental health wards for older adults

Hospital adverse events, such as falls, violence and aggression, security, self‐harm, and suicide, are difficult to manage in older people with dementia. The purpose of the present study was to determine whether protected engagement time (PET) resulted in lower adverse events and incidents compared to comparable non‐PET wards for people admitted to inpatient older people's mental health wards. Ten inpatient wards for older people were included. Five followed a PET‐management pathway, while five continued usual care. All adverse events and incidents were recorded in routine hospital records over 72 weeks. Data were gathered from these records and analysed as rate per person per week to assess differences in frequency and type of adverse events between wards. A total of 4130 adverse events were recorded. In the PET wards, a mean of 0.38 adverse events occurred per person per week compared to 0.40 in non‐PET wards. No statistically‐significant differences were found between PET and non‐PET wards for adverse events (P = 0.93), or for adverse events of any particular type (P ≥ 0.15). Therefore, there is no evidence to suggest that PET has any impact on adverse events in older people's mental health wards. Further investigation with a larger cohort is warranted, using a definitive, phase 3, clinical trial.