肿瘤患者合并肺部念珠菌感染药敏测定研究

采用ＲＰＭＩ１６４０及ＦＤＡ抗生素３号两种培养基的微量稀释法对肿瘤患者合并肺感染分离出５１株念珠菌进行药敏对比测定。结果显示二性霉素Ｂ在两种培养基中均具有非常好的抗菌活性，敏感率均为９８．０％，其次酮康唑也显示出良好的抗菌活性，敏感率均为９４．１％。相比之下，在ＲＰＭＩ培养基中伊曲康唑和氟康唑的敏感性稍差，敏感率分别为９２．２％和９０．２％，但在ＦＤＡ抗生素３号培养基中，伊曲康唑和氟康唑敏感性明显下降，敏感率分别为７０．６％和６６．７％。为此我们建议抗真菌药敏试验，尤其是咪唑类药物应该选用ＮＣＣＬＳ推荐的ＲＰＭＩ１６４０培养基做药敏试验     

Patient satisfaction with health care providers in South Africa: the influences of race and socioeconomic status.

OBJECTIVE: The first democratic government elected in South Africa in 1994 inherited huge inequalities in health status and health provision across all sections of the population. This study set out to assess, 4 years later, the influence of race and socioeconomic status (SES) on perceived quality of care from health care providers. DESIGN: A 1998 countrywide survey of 3820 households assessed many aspects of health care delivery, including levels of satisfaction with health care providers among different segments of South African society. RESULTS: Fifty-one percent (n = 1953) of the respondents had attended a primary care facility in the year preceding the interview and were retained in the analysis. Both race and SES were significant predictors of levels of satisfaction with the services of the health care provider, after adjusting for gender, age, and type of facility visited. White and high SES respondents were about 1.5 times more likely to report excellent service compared with Black and low SES respondents, respectively. CONCLUSION: In South Africa, race and SES are not synonymous and can no longer be considered reliable proxy indicators of one another. Each has distinct and significant but different degrees of association with client satisfaction. Any assessment of equity-driven health policy in South Africa should consider the impacts of both race and SES on client satisfaction as one of the indicators of success.     

耳穴疗法治疗老人失眠症之临床研究

目的:尝试利用科学性之方法探讨耳穴磁疗对老人失眠症之效果.方法:120位60岁或以上之老年患者,随机分配入三组.第一组及第二组为对照组,分别贴有灯芯或王不留行籽(不加压);第三组为实验组,贴有每粒含66高斯之磁珠(不加压).为针对老年患者常见之脏腑功能衰弱而致失眠,各人均选取相同之穴位:神门、心、肾、肝、脾、皮质下及枕,疗程共3周.结果:疗程完毕后,使用磁珠作耳疗之实验组于治疗前后的睡眠效果指数有明显之改进(P＜0.05),显效17%,有效为65%,总有效率为82%.此外,利用多元回归之反向淘汱法分析女性参加者之数据,发现利用磁珠作耳疗及参加者年龄对预测睡眠效果指数达显著水准(F3,106=9.04,P＜0.001,R2=0.20).结论:耳穴磁疗能有效地改善老人失眠症.     

Patient-controlled intranasal diamorphine for postoperative pain: an acceptability study

A patient acceptability study was conducted using patient-controlled intranasal diamorphine. Patients undergoing nonemergency orthopaedic or gynaecological surgery self-administered intranasal diamorphine for 24 h postoperatively. Pain, pain relief, sedation, respiratory rate, nausea and vomiting were assessed regularly. After 24 h, patients and their attending nurses completed a questionnaire assessing satisfaction and practical aspects of the technique. Satisfaction was reported as good or complete by 69% of patients and 69% of nurses. Pain relief was assessed as better than expected by 45% of patients and better than normal by 50% of nurses. Seventy-nine per cent of patients would be pleased to use patient-controlled intranasal diamorphine again and 89% of nurses would be happy for their patients to use it again. Sedation was uncommon and mild and there were no episodes of significant respiratory depression. Fifty-three per cent of patients reported no nausea and 74% did not vomit at any stage. There were seven withdrawals, four due to problems with the device and three due to therapeutic problems. The nasal spray may need modification to improve reliability. However, we found patient-controlled intranasal analgesia an effective technique, which was well tolerated by patients and nurses and was without unpleasant side-effects. Further work to determine how it performs compared with intramuscular or intravenous analgesia is now needed.     

氯沙坦和非洛地平治疗中老年高血压合并高尿酸血症的疗效观察

[目的 ]　比较氯沙坦和非洛地平对中老年高血压合并高尿酸血症的疗效。　 [方法 ]　 60例中老年高血压合并高尿酸血症患者随机分成两组 ,分别服用氯沙坦 (氯沙坦组 ,n =3 0例 )和非洛地平 (非洛地平组 ,n =3 0例 ) ,分别测定两组患者治疗前后的血压、2 4h动态血压、血尿酸、空服血糖、血脂和肝肾功能。　 [结果 ]　氯沙坦和非洛地平均有明显的降压效果 (P <0 .0 1) ,两组的降压效果相似 (P <0 .0 5 ) ,但氯沙坦降低血尿酸的效果优于非洛地平 (P <0 .0 0 1) ,对血糖、肝肾功能、血脂均无明显作用 ,未发生明显不良反应。　 [结论 ]　氯沙坦治疗中老年高血压安全、有效 ,与非洛地平相似 ,并且有降低高血尿酸作用     

Patient Capacity in Mental Health Care: Legal Overview

The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in which the law may further adapt to a more functional assessment of capacity, because the nature of law shows that legal reforms usually take place only when new methods have been accepted by the field. This is not yet the case today.     

杭州市老年人主要食物摄入量与营养调查

目的了解杭州市老年人的年主要食物摄入量与营养状况,找出存在的主要问题,探讨解决的对策。方法随机抽样调查了杭州市老年大学学员的体质指数、年主要食物摄入量、营养相关疾病患病率及对营养与膳食知识的了解与需求程度。结果杭州市老年人体质指数为22.3±3.1,人均每年主要食物摄入量为:口粮98.6kg,豆类30.1kg,蔬菜110.1kg,水果63.3kg,食用植物油16.2kg,食糖5.0kg,肉类20.1kS,蛋类19.7kg,奶类56.8kg,水产品34.7kg。营养相关疾病患病率较高。结论接受调查的人群年主要食物摄入量基本达到2010年城乡居民食物与营养发展目标中的城市居民人均每年主要食物摄入量的要求,膳食结构基本合理,但仍需加强营养指导。     

补肾复活汤治疗48例老年股骨颈骨折的疗效观察

目的:探讨补肾复活汤对老年股骨骨颈骨折患者的治疗效果.方法:用补肾复活汤内服治疗老年股骨颈骨折48例,设对照组48例,通过1～6个月的治疗,观察治疗后骨折的愈合情况.结果:治疗组患者折愈合率达64.6%.结论:补肾复活汤有明显改善骨折端的血液循环,促进骨折愈合的作用.