联合用药干预对门诊抗菌药物注射剂应用安全性的影响

目的:提高门诊抗菌药物注射剂应用的安全性。方法:采用前瞻性随机对照方法,选取我院门诊2007年应用抗菌药物注射剂的患者为研究对象,随机分为对照组与干预组,针对联合用药因素,采用宣传教育、行政干预、监督检查等措施进行临床干预,观察干预前、后的联合用药合理性、不良反应发生率等变化情况。结果:与对照组相比,干预组联合用药合理性明显提高(P<0.01),干预后不良反应发生率降低。结论:针对联合用药因素进行干预,可提高门诊抗菌药物注射剂应用的安全性。     

2008年某医院抗菌药应用评价

目的：比较干预前后某医院抗菌药应用状况,评价抗菌药应用合理性。方法：以处方分析指标和药物利用频度为指标,对比抗菌药干预前（2007年4季度）后（2008年）用药情况。结果：2008年抗菌药处方数比例为19．81％,二联以上用药维持为30％左右,平均处方中抗菌药的品种为1．35左右;但抗菌药平均处方费用和抗菌药应用强度逐渐下降,医师用药剂量与标准之比趋向于1。主要使用的抗菌药品种趋于分级管理的要求。结论：2008年我院抗菌药的应用趋于合理。干预措施成效令人满意。     

广州市部分三甲医院临床护士艾滋病病毒职业暴露的预防干预研究

目的：旨在探索对临床护士开展艾滋病病毒（HIV）职业暴露的预防干预效果.方法：运用培训教育前后对比的研究方法,采用无记名问卷调查方式,并实测针刺伤发生密度,基线调查292人,干预后调查233人,数据采用SPSS 13.0软包进行2检验.结果：目标人群对相关知识的正确认知率普遍高达90%以上,但深层次的知识正确认知率偏低（HIV病员的血粘到正常皮肤时间长于5分钟、而且血量较大可能被传染,正确认知率只有75.7%;HIV窗口期正确认知率只有77.9%）,一些关键而重要知识点正确认知率没有达到100%（如 16.5%不知道怎样处理被污染针头刺伤的伤口）.干预前后正确认知率、危险操作行为、针刺伤、锐器伤的发生密度均有差异性（P〈0.05）,并呈正相关.结论：广州市临床护士对HIV职业暴露的防护意识很高;知识的正确认知率普遍较高;相关培训未达100%全员培训;培训干预对HIV职业暴露起到积极的预防作用.     

CT引导下靶位注射胶原酶治疗腰椎间盘突出症中、远期疗效观察

目的探讨CT引导下靶位注射胶原酶治疗腰椎间盘突出症的中、远期疗效。方法在CT引导下经皮靶位注射胶原酶准确到达突出物治疗腰椎间盘突出症50例。结果随访36～60个月,总有效率分别为82．97％（大于36个月）、82．23％（大于60个月）。结论把握好适应证,CT引导下经皮穿刺靶位注射胶原治疗腰椎间盘突出症准确、安全、简便、有效,是此类患者首选的治疗方法之一。     

Managing the residual cardiovascular disease risk associated with HDL-cholesterol and triglycerides in statin-treated patients: A clinical update

Cardiovascular disease (CVD) is a significant cause of death in Europe. In addition to patients with proven CVD, those with type 2 diabetes (T2D) are at a particularly high-risk of CVD and associated mortality. Treatment for dyslipidaemia, a principal risk factor for CVD, remains a healthcare priority; evidence supports the reduction of low-density lipoprotein cholesterol (LDL-C) as the primary objective of dyslipidaemia management.While statins are the treatment of choice for lowering LDL-C in the majority of patients, including those with T2D, many patients retain a high CVD risk despite achieving the recommended LDL-C targets with statins. This ‘residual risk’ is mainly due to elevated triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) levels. Following statin therapy optimisation additional pharmacotherapy should be considered as part of a multifaceted approach to risk reduction. Fibrates (especially fenofibrate) are the principal agents recommended for add-on therapy to treat elevated TG or low HDL-C levels. Currently, the strongest evidence of benefit is for the addition of fenofibrate to statin treatment in high-risk patients with T2D and dyslipidaemia. An alternative approach is the addition of agents to reduce LDL-C beyond the levels attainable with statin monotherapy.Here, addition of fibrates and niacin to statin therapy is discussed, and novel approaches being developed for HDL-C and TG management, including cholesteryl ester transfer protein inhibitors, Apo A-1 analogues, mipomersen, lomitapide and monoclonal antibodies against PCSK9, are reviewed.     

中国疟疾从控制走向消除——消除阶段的目标策略和措施

我国于2010年正式启动了国家消除疟疾行动,计划于2020年在全国范围内消除疟疾。要如期实现消除疟疾的目标,必须要客观认识疟疾消除阶段的特点,制订科学合理的防控策略和技术措施。本文通过对疟疾控制和消除阶段的比较,分析疟疾消除阶段目标、策略和措施调整与转变的必要性和紧迫性,对我国现行的消除疟疾"1 3 7定点清除"工作模式的背景、定义、工作重点及技术难点进行阐述,以增进各级医疗卫生机构对我国当前消除疟疾目标、策略和措施的认识,促进相应策略和措施的创新和贯彻落实,推动我国消除疟疾工作。     

Prognosis and treatment in patients admitted with acute myocardial infarction on weekends and weekdays from 1997 to 2009

Background

Less invasive treatment and poorer outcomes have been shown among patients admitted with acute myocardial infarction (AMI) on weekends compared to weekdays.

Objectives

To investigate the ‘weekend-effect’ on mortality in patients with AMI.

Methods

Using nationwide registers we identified 92,164 patients aged 30–90 years who were admitted to a Danish hospital with a first AMI from 1997 to 2009. Patients were stratified according to weekday- or weekend admissions and four time-periods to investigate for temporal changes. All-cause mortality at 2, 7, 30, and 365 days was investigated using proportional hazards Cox regression.

Results

Mortality rates were higher on weekends within seven days of admission in 1997–99 (absolute difference ranging from 0.8 to 1.1%). Weekend–weekday hazard-ratios were 1.13 (1.03–1.23) at day 2 and 1.10 (1.01–1.18) at day 7. There were no significant differences in 2000–09 and estimates suggested an attenuation of the initial ‘weekend-effect’.Overall, the use of coronary angiography (34.9% vs. 72.3%) and percutaneous coronary intervention (6.6% vs. 51.0%) within 30 days increased, as did the use of statins (49.9% vs. 80.1%.) and clopidogrel (26.7% vs. 72.7%). The cumulative mortality decreased during the study period from 5.4% to 2.5% at day of admission, from 19.5% to 11.0% at day 30 and from 28.0% to 19.0% at day 365 (all tests for trend p < 0.0001).

Conclusions

No persistent ‘weekend-effect’ on mortality was present in patients with AMI in 1997–2009. Overall, mortality rates have decreased concomitantly with an increased use of current guideline-recommended invasive and medical therapy.     

High-sensitivity C-reactive protein and atherosclerotic disease: From improved risk prediction to risk-guided therapy

There is compelling experimental and clinical evidence suggesting a crucial role for inflammation in the initiation and also the progression of atherosclerosis. Numerous biomarkers involved at various levels of the inflammation cascade have been shown to be associated with adverse cardiovascular outcomes. Yet, to date, it is not clear whether inflammation simply accompanies the atherosclerotic process or represents a major driver. Among all blood biomarkers, C-reactive protein (CRP), the classical acute phase reactant that can be measured with high-sensitivity (hs) assays seems to be the most promising candidate. It has already found its way into the guidelines in primary prevention. Hs-CRP can also be used to identify a high-risk group for recurrent events in patients with manifest atherosclerosis. Several post hoc analyses of large-scale randomized clinical trials testing various statins have indicated that, besides low density lipoprotein (LDL) cholesterol, hs-CRP levels might also further aid in tailoring statin treatment. The large JUPITER trial has prospectively confirmed these findings in primary prevention in patients with elevated hs-CRP but normal LDL cholesterol levels. Still, statin therapy is not a specific anti-inflammatory regime acting on the inflammation cascade. Thus, to directly test the inflammation hypothesis, a novel, more proximally located cytokine-based approach is needed. Canakinumab, a fully human monoclonal antibody against interleukin-1β, might represent a promising compound in this regard and provide a proof of concept. If successful, this may become a novel strategy to treat high-risk patients with stable atherosclerotic disease to prevent recurrent events on top of standard medical care.     

100例青年高血压病例分析

目的：了解青年高血压的患病病因,并探讨干预措施的效果。方法随机观察2010年6月-2012年6月发现的18～36岁青年高血压100例,根据病史、体格检查、生化检查及特殊检查,进行诊断分类和治疗。以66例原发性高血压为观察组,随机选取同期100例18～36岁血压正常者为对照组,分别观察每组肥胖、高盐、嗜酒、吸烟以及家族史情况,并进行方差分析。结果100例青年高血压中,原发性高血压占66％,白大衣高血压占18％,肾实质性高血压占7％,原发性醛固酮增多症占4％,肾血管性高血压占3％,嗜铬细胞瘤占2％,及时给予积极处理,均收到明显效果。肥胖、嗜酒、高盐及家族史两组间差异有统计学意义（P＜0.05）,而吸烟无统计学意义（P＞0.05）。结论原发性高血压主要原因是遗传、嗜酒、肥胖和高盐饮食,继发性高血压在青年中比例可达16％。建议加强对青年进行健康教育,尽量早发现、早治疗、以提高青年人的健康素质。