疾控机构质量监督工作的实践与体会

通过分析某疾控机构近年质量监督过程中的措施、成效和存在问题,探讨如何利用有效的监督方式,促进实验室管理体系持续改进。认为应将质量监督渗透到日常工作中,并培养监督员良好的沟通技巧,同时对监管效果进行评价等。     

孕早期血红蛋白水平与妊娠期糖尿病的关联性

目的：探讨孕早期血红蛋白（Hb）与妊娠期糖尿病（GDM）发病风险间的关系。方法：应用病例对照研究设计,对109例GDM孕妇（GDM组）和151例健康孕妇（对照组）的临床资料进行分析。结果：单因素分析显示GDM组孕妇年龄、孕前体质量指数（BMI）、孕早期Hb浓度、孕早期收缩压、孕早期舒张压、文化水平、孕次、产次均明显高于对照组（P〈0．05）。将孕早期Hb浓度按四分位间距分为四组,比较各四分位和GDM组发病的关系,发现Hb浓度升高,GDM发生风险增加;spearman相关分析示孕早期Hb浓度与GDM的发生呈正相关（r=0．201,P=0．001）。在校正了可能的混杂因素后,多元loglstic回归分析结果显示,孕早期高Hb水平（Hb〉130g／L）可显著增加GDM的发生风险（OR=3．54,95％CI：1．60～7．83,P=-0．002）。结论：孕早期高Hb浓度将增加GDM的发病风险,应加强对孕早期妇女血Hb水平的监测,为有效预测及预防GDM的发生提供依据。     

精准医学视域下护理专业实践的革新与展望

随着精准理念向临床医学各个专业迅速渗透,精准护理应运而生。通过溯源精准护理的内涵、理清其概念范畴,从护理评估、症状管理、用药督导和健康教育4个方面分析精准医学视域下护理理念的革新和实践进展,展望精准护理的未来前景,以期为精准护理研究和实践的深入推进提供参考。     

Targeting insulin inhibition as a metabolic therapy in advanced cancer: A pilot safety and feasibility dietary trial in 10 patients

ObjectiveMost aggressive cancers demonstrate a positive positron emission tomographic (PET) result using ¹⁸F-2-fluoro-2-deoxyglucose (FDG), reflecting a glycolytic phenotype. Inhibiting insulin secretion provides a method, consistent with published mechanisms, for limiting cancer growth.MethodsEligible patients with advanced incurable cancers had a positive PET result, an Eastern Cooperative Oncology Group performance status of 0 to 2, normal organ function without diabetes or recent weight loss, and a body mass index of at least 20 kg/m². Insulin inhibition, effected by a supervised carbohydrate dietary restriction (5% of total kilocalories), was monitored for macronutrient intake, body weight, serum electrolytes, β-hydroxybutyrate, insulin, and insulin-like growth factors-1 and -2. An FDG-PET scan was obtained at study entry and exit.ResultsTen subjects completed 26 to 28 d of the study diet without associated unsafe adverse effects. Mean caloric intake decreased 35 ± 6% versus baseline, and weight decreased by a median of 4% (range 0.0–6.1%). In nine patients with prior rapid disease progression, five with stable disease or partial remission on PET scan after the diet exhibited a three-fold higher dietary ketosis than those with continued progressive disease (n = 4, P = 0.018). Caloric intake (P = 0.65) and weight loss (P = 0.45) did not differ in those with stable disease or partial remission versus progressive disease. Ketosis was associated inversely with serum insulin levels (P = 0.03).ConclusionPreliminary data demonstrate that an insulin-inhibiting diet is safe and feasible in selected patients with advanced cancer. The extent of ketosis, but not calorie deficit or weight loss, correlated with stable disease or partial remission. Further study is needed to assess insulin inhibition as complementary to standard cytotoxic and endocrine therapies.     

高频振荡机械通气在血液肿瘤及多种疾病并发儿童急性低氧性呼吸衰竭中的应用

目的 评估儿童急性低氧性呼吸衰竭（acute hypoxemic respiratory failure,AHRF）给予高频振荡机械通气（high-frequency oscillatory ventilation,HFOV）治疗的意义.方法 回顾2011年1月至2013年9月收入我院PICU诊断为AHRF的病例,首先给予常规机械通气（CMV）,当PIP＞ 30cmH2O（1 cmH2O =0.098 kPa）或PEEP＞ 10 cmH2O、FiO2100％时具有以下情况之一：（1）SpO2 ＜90％或PaO2 ＜60 mmHg（1 mmHg =0.133 kPa）;（2）有严重呼吸性酸中毒（PaCO2＞ 80mmHg）;（3）严重气漏（纵隔气肿或气胸）,改为HFOV通气治疗.收集患儿性别、年龄、住PICU时间、CMV通气时间、HFOV通气时间等一般资料.分别于CMV通气末（H0）及HFOV后2 h（H2）、6 h（H6）、12 h（H12）、24 h（H24）、48 h（H48）记录并比较各时间点呼吸机参数（平均气道压、振幅、频率、FiO2）、氧合指数（PaO2/FiO2、OI）、动脉血气、心率、血压变化.分别比较存活组与死亡组、血液肿瘤组及非血液肿瘤组在H0、H2、H6、H12、H24、H48时间点的指标变化.结果 HFOV通气后,H2时间点PaO2较H0升高[76.9（61.9～128.0） mm-Hg vs 50.1 （49.5 ～ 68.0） mmHg],差异有统计学意义（P=0.006）.H2、H48时间点PaO2/FiO2分别较Ho、H24升高,差异有统计学意义[94.9（66.8 ～ 138.9） mmHg vs 68.0（49.5 ～ 86.8）mmHg,P=0.039;135.0（77.6 ～240.0）mmHg vs 90.7（54.6 ～ 161.7） mmHg,P=0.023）].所有患儿收缩压、舒张压、心率在各时间点没有明显变化（P＞0.05）.存活组（n=9）与死亡组（n=14）相比,PaO2/FiO2、OI在H6、H12、H24、H48差异有统计学意义（P＜0.05）.非血液肿瘤组（n=10）与血液肿瘤组（n=13）相比,OI在H2、H6差异有统计学意义[19.2（13.9～26.6） vs 33.8（19.7 ～48.3）,P=0.049;16.0（8.4～27.1） vs28.9（20.9 ～38.9）,P=0.027）],两组的平均气道压在H2、H6、H12差异有统计学意义（P＜0.05）.两组病死率差异无统计学意义（40.0％ vs 76.9％,P=0.086）.结论     

Visual impairment and associated factors among primary school children in Gurage Zone,Southern Ethiopia

BackgroundVisual impairment is one of the major public health problems worldwide, especially in developing countries.ObjectiveTo determine the prevalence of visual impairment and its associated factors among school children in Gurage Zone, Southern EthiopiaMethodsA cross sectional study was conducted in eight primary schools of Gurage Zone. A total of 1064 pupils, of whom589 boys and 475 girls were selected using multistage sampling technique. Socio-demographic characteristics of the participants were collected using structured questionnaires and visual acuity was measured using Snellen''s chart. Logistic regression analysis was used to determine the associated factors of visual impairment.ResultsThe prevalence of visual impairment was 5.2%. Factors significantly associated with visual impairment were age group of 13–18 years (AOR = 9.44, 95% CI = 3.83 – 23.25), school grade level of 5- 8 (AOR = 2.97, 95% CI = 1.23 – 7.17), rural residents (AOR = 2.59, 95% CI = 1.22 – 5.54), family''s monthly income of less than 2000 Ethiopian Birr (AOR = 2.87, 95% CI = 1.08 – 7.61) and visually impaired parents (AOR = 2.16, 95% CI = 1.06 – 4.39).ConclusionThis study found that the prevalence of visual impairment was 5.2%.     

不同护生对临床教学评价分析

应届本科毕业护生与自考专升本护生虽然都可以获得本科文凭，但他们却有着完全不同的学习和生活经历，对临床实习的期望也不尽相同。然而，由于各种原因，在临床教学过程中，很多带教老师却对两种护生采取相同的带教方法。为了解两种护生对临床教学的评价，笔者对1年来在本院实习结束后的护生进行了书面调查。现报告如下。     

产科护士工作压力源与应对方式调查

[目的]了解产科护士工作压力源和常用的应对方式,以期帮助护士采取积极的应对方式缓解工作压力,维护身心健康。[方法]采用问卷调查法对58名产科护士工作压力源和应对方式进行调查。[结果]产科护士工作压力来源依次为:病人护理方面的问题、护理专业及工作方面的问题、管理及人际方面的问题、时间分配及工作量问题、工作环境及仪器设备问题。其中主要压力源子条目分别为担心工作中出现差错事故、经常倒班、工作量太大等。产科护士常采用的应对方式为积极应对,其中主要为尽量看到事物好的一面,与人交谈、倾诉内心烦恼等。[结论]护理管理者应了解产科护士的主要工作压力源,帮助护士积极应对。     

践行快速康复外科理念对子宫全切术后下肢深静脉血栓形成的影响

目的探讨快速康复外科理念对子宫全切术后下肢深静脉血栓形成的影响。方法将2012年5月—2014年4月在该院接受子宫全切术治疗的90例患者纳入该研究,根据随机原则分组。对照组接受常规手术处理,实验组围术期践行快速康复外科理念。对比两组患者术后下肢深静脉血栓发生率、下床活动时间、肛门排气时间、住院时间的差异性。结果与对照组对比,发现实验组患者术后下肢深静脉血栓发生率明显较低,下床活动时间、肛门排气时间、住院时间均明显较短,组间差异有统计学意义(P<0.05）。结论对子宫全切术患者围手术期践行快速康复外科理念可降低术后下肢深静脉血栓形成的风险,促进康复进程。