本院门诊处方抗菌药物联合应用调查分析

分析新疆伊犁州奎屯医院于2009年10月处方中抗菌药物联合应用情况,并对纳入的92张处方进行分析,发现有不合理应用的问题.     

The impact of disability on performance in a high-stakes postgraduate surgical examination: a retrospective cohort study

ObjectiveDespite rising numbers of doctors in the workforce with disabilities, little is known about the impact of disabilities on postgraduate performance. To ensure all groups are treated fairly in surgical training, it is essential to know whether any attainment differences exist in markers of surgical performance. To address this gap, we assessed the impact of disabilities on performance on the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS).DesignRetrospective cohort study.SettingSecondary care.ParticipantsAll UK MRCS candidates attempting Part A (n = 9600) and Part B (n = 4560) between 2007 and 2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included.Main outcome measuresChi-square tests and correlation coefficients established univariate associations with MRCS performance, while multiple logistic regressions identified independent predictors of success.ResultsThough MRCS Part B pass rates were similar (p = 0.339), candidates with registered disabilities had significantly lower first-attempt Part A pass rates (46.3% vs. 59.8%, p < 0.001). Candidates with disabilities also performed less well in examinations taken throughout school and medical school, and after adjusting for prior academic performance and sociodemographic predictors of success, logistic regression found that candidates with disabilities were no less likely to pass MRCS than their peers (odds ratio 1.04, 95% confidence interval 0.66 to 1.62). No significant variation was found in MRCS performance between type of disability or degree of limitations caused by disability (p > 0.05).ConclusionAlthough candidates with registered disabilities performed less well in formal, written examinations, our data indicate that they are as likely to pass MRCS at first attempt as their peers who achieved similar grades at high school and medical school. In order to enable equity in career progression, further work is needed to investigate the causes of attainment differences in early career assessments.     

Three germline mutations in the TP53 gene

Three germline mutations in the TP53 tumor-suppressor gene are reported, two of which are not reported previously. A missense mutation at codon 265 of TP53 was found in three patients of a family that complied with the definition of the Li-Fraumeni syndrome. A nonsense mutation in codon 306 was found in a woman who had had a rhabdomyosarcoma at age 4 and a subsequent breast cancer at age 22. She was part of a Li-Fraumeni-like family, but the parental origin of the mutation could not be traced. Finally, while screening for somatic alterations in TP53 in a series of 141 sporadic breast tumors, we detected a constitutional missense mutation in codon 235 in a woman diagnosed with breast cancer at age 26 and a recurrence 4 years later. The recurrence, but not the primary tumor, showed an additional missense mutation at codon 245 as well as loss of the wild-type allele. This suggests that the 245 mutation was particularly important for tumor progression and that there might exist heterogeneity in terms of cancer predisposition potential among the various germline TP53 mutations. Hum Mutat 9:157–163, 1997. © 1997 Wiley-Liss, Inc.     

经阴道彩色多普勒能量图诊断异位妊娠的价值

目的　早期诊断异位妊娠 ,提高异位妊娠的诊断率。方法　经阴道彩色多普勒能量图检查。结果　①妊娠囊周围见滋养层血流 ,妊囊内见胚芽及闪烁的心管搏动 ;②复杂型包块见滋养层周围性血流或血流丰富 ;③飘浮型包块内血流丰富。滋养层周围性血流或附件包块血流丰富区脉冲多普勒频谱形态各异或呈低阻力型动脉频谱 ,阻力指数 (RI) 0 43± 0 0 5。结论　经阴道彩色多普勒能量图检查是早期诊断异位妊娠的有效方法 ,诊断率10 0 %。     

Differential time course of the vasodilator action of various calcium antagonists

Summary— It is rather the rate of the vasodilator effect than its magnitude which determines the triggering of reflex tachycardia associated with dihydropyridine calcium antagonists (DHP-CA). We therefore compared the rate of the vasodilator effects of a series of CA (both DHP and non-DHP) in rat isolated mesenteric artery preparations (size 256 ± 3 μm, length 2 mm) from male Wistar rats (weighing 300–350 g) in an isolated wire myograph according to Mulvany and Halpern [12]. The mean force of the KCl-induced contraction amounted to 2.3 ± 0.1 mN/mm. Potency (given as IC₅₀-values), differential time course of action and recovery of the contractile response of the vessels after wash-out were established. These three parameters adhere to the following sequences; (1. potency) S,S-barnidipine > (S)-lercanidipine > barnidipine HCl > amlodipine > nifedipine, lacidipine > (R)-lercanidipine > verapamil, mibefradil; (2. differential time course) lacidipine, amlodipine > (S)- and (R)-lercanidipine. S,S-barnidipine, barnidipine HCl > mibefradil, verapamil, nifedipine; (3. recovery) nifedipine > verapamil, S,S-barnidipine, amlodipine > barnidipine, lacidipine > mibefradil, (R)-lercanidipine > (S)-lercanidipine. In conclusion, S,S-barnidipine proved to be the most potent vasodilator agent; interestingly, barnidipine was 20 times less potent when applied as a racemic mixture. A slow onset of action in DHP is a very important mechanism in preventing reflex tachycardia. For non-DHP (verapamil, mibefradil) reflex tachycardia probably is prevented by a direct effect on the conductive tissue in the myocardium.     

HOW DO GENERAL PRACTITIONERS MANAGE PATIENTS AT RISK FROM STROKE?

SUMMARY This study assessed by means of a postal questionnaire how general practitioners (GPs) manage patients at risk from stroke. Of the 640 GPs sent a questionnaire, 294 (46%) replied. In patients with a recent transient ischaemic attack or minor ischaemic stroke, 24% of responding GPs would not arrange any investigations. Sixty-one per cent refer under half of their patients for further investigation, although 99% of GPs would commence aspirin. Seventy-seven per cent of GPs were aware of the benefits of carotid surgery. For patients in atrial fibrillation, most GPs (77%) thought that warfarin reduced stroke rates, but only 20% would consider commencing warfarin, although 26% would commence aspirin. In hypertensive patients, the GPs' threshold for treatment ranged from 135 to 200mmHg systolic (median 160mmHg), and from 90 to 110mmHg diastolic (median 100mmHg). Most GPs (84%) would treat isolated systolic hypertension with a median threshold of 180mmHg (range 140-240mmHg). The results of this study suggest that some patients at risk from stroke may not receive optimal investigation and treatment in the community.     

Deep brain stimulation and the ethics of protection and caring for the patient with Parkinson's dementia

Deep brain stimulation (DBS) is an effective neurosurgical treatment for patients with advanced Parkinson's disease (PD) suffering from motor complications that are refractory to further medication management. DBS requires an invasive procedure of implanting brain electrodes while awake, followed by implantation of neurostimulators under general anesthesia. The neurostimulator requires battery monitoring and replacement approximately every 3 to 5 years. These two elements of the technology provide numerous decision points about continuing therapies that can involve ethical choices. Although motor function can be improved with subthalamic nucleus (STN) DBS, the long‐term risks of living with implanted hardware should be carefully evaluated for patients with diminishing cognitive capacity. We describe two cases where ethical dilemmas occurred postoperatively as a result of cognitive decline and describe salient ethical dimensions that illustrate the need for a proactive postoperative plan for supervision as a prerequisite for surgery to include neuropsychological testing to predict the likelihood of net benefit to the patient and family beyond just motor improvement. © 2008 Movement Disorder Society