2010～2012年医院感染现患率调查分析

目的 了解医院感染现患率、抗菌药物使用及微生物送检的动态变化.方法 按照《医院感染预防与控制标准操作规程》中横断面调查方法,对2010年7月27日、2011年9月8日和2012年8月10日（0：00～24：00）所有住院患者进行调查.结果 医院感染现患率逐年下降,平均为2.69％；感染部位以下呼吸道为主,平均占50.57％,并呈逐年上升趋势；感染高发科室有ICU、血液内科、肾内科、神经外科、新生儿科；抗菌药物使用率平均为59.44％,逐年下降；病原学送检率平均为57.51％;3年共检出病原体106株,以革兰阴性细菌为主.结论 通过连续的现患率调查可掌握医院感染的动态变化,医院感染的高发部位及高危科室,为今后医院感染管理重点提供依据.     

2008-2011年产气肠杆菌的临床分布及耐药性分析

目的 分析产气肠杆菌临床分布特点及对常用抗菌药物的耐药性变化,以更好地指导临床的合理使用抗菌药物.方法 采用WHONET5软件统计分析2008年1月-2011年12月临床分离的产气肠杆菌临床分布和耐药率.结果 4年内共分离到产气肠杆菌459株,其中2008-2011年分别检出108、101、130、120株；病原菌主要来源于住院患者的痰液213株占46.4％、胆汁70株占15.3％、血液51株占11.1％、尿液50株占10.9％;4年耐药监测显示,亚胺培南和美罗培南的耐药率在2.0％～7.9％,呈明显的逐年上升趋势；头孢类抗菌药物除头孢唑林耐药率较高约90.0％外,其他如头孢替坦、头孢曲松、头孢他啶、头孢吡肟等耐药率由最高的55.5％下降至最低28.5％,氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦等复合制剂耐药率也由最高70.2％下降至最低21.1％,同时阿米卡星、庆大霉素等氨基糖苷类等药物的耐药率亦呈下降趋势,最高30.4％,最低为0,对喹诺酮类的耐药率约30.0％,保持相对稳定.结论 4年产气肠杆菌对头孢菌类、氨基糖苷类、复合制剂等药物的耐药率有所降低,而碳青霉烯类药物的耐药率呈上升趋势,说明细菌耐药性存在动态的变化,及时对细菌耐药性进行分析,依据药敏结果合理选用抗菌药物,严格掌握适应证,可减少或延缓耐药菌株的播散.     

The effect of speaking rate on velopharyngeal function in healthy speakers

The purpose of this study was to assess the effect of speaking rate variation on aerodynamic and acoustic measures of velopharyngeal (VP) function. Twenty-seven healthy adult speakers (14 males, 13 females) participated in the study. The modified pressure-flow method was used to collect aerodynamic data of /m/ and /p/ segments in the word ‘hamper’ and the utterances ‘Mama made some lemon jam’ (MMJ) and ‘Buy Bobby a puppy’ (BBP). SPL was collected simultaneously with aerodynamic data for all utterances. A Nasometer was used to obtain nasalance scores and nasalance distance for MMJ and BBP. Sentences were produced at normal, fast, slow, and slowest speaking rates. The results showed that nasal airflow and VP orifice area were unaffected by speaking rate variations in males and females, whereas intra-oral pressure appeared to decrease as speaking rate slowed for both speaker groups. However, this effect was removed by statistically controlling SPL. Nasalance and nasalance distance (MMJ – BBP) did not change with speaking rate variation. There was a statistical difference between nasalance scores produced by male and female speakers. The results suggested that aerodynamic and acoustic measures of velopharyngeal function are not affected by variation in speaking rate in healthy males and females.     

如何检测血液透析器超滤系数

目的:探讨新版国际标准ISO 8637:2010中超滤系数的分析检测方案。方法:计算滤过液流率和跨膜压之间的回归线斜率作为超滤系数。结论:通过该方案可以确定血液透析器产品的超滤系数。     

What Factors Contribute to Headache-Related Disability in Teens?

BackgroundOur aim was to describe the relationship between risk factors, such as stress, depression, and anxiety, and potentially protective factors against pediatric headache-related disability, such as mindfulness, resilience, and self-compassion, and to determine teens' interest in mind-body skills training to help reduce headache-related disability.MethodsThis was a cross-sectional survey among adolescents seen in an academic neurology clinic reporting four or more headaches monthly using standardized instruments to determine the relationship between putative risk and protective factors as well as physiologic markers of inflammation and vagal tone and headache-related disability.ResultsAmong the 29 participants, 31% were male, the average age was 14.8 years, average headache frequency was 11.6 per month, and the most commonly reported trigger was stress (86%). The only risk or protective factor significantly associated with headache-related disability was depression (r = 0.52, P = 0.004). Depression was negatively correlated with mindfulness, resilience, and self-compassion (P < 0.01 each) and positively correlated with stress, sleep disturbance, and anxiety (P < 0.01 each). Biomarkers of vagal tone and inflammation were correlated with each other but not with headache-related disability or depression. There was strong interest in learning skills like slow, deep breathing practices supported by a smart phone application to reduce stress and the negative impact of headaches on daily life.DiscussionAmong teens with frequent migraine headaches, depression is the strongest risk factor for headache-related disability. Stress is viewed as a headache trigger, and teens reported wanting to learn simple stress management strategies supported by a smart phone application to help reduce headache-related disability.     

Normative comparisons for large neuropsychological test batteries: User-friendly and sensitive solutions to minimize familywise false positives

Introduction. In neuropsychological research and clinical practice, a large battery of tests is often administered to determine whether an individual deviates from the norm. We formulate three criteria for such large battery normative comparisons. First, familywise false-positive error rate (i.e., the complement of specificity) should be controlled at, or below, a prespecified level. Second, sensitivity to detect genuine deviations from the norm should be high. Third, the comparisons should be easy enough for routine application, not only in research, but also in clinical practice. Here we show that these criteria are satisfied for current procedures used to assess an overall deviation from the norm—that is, a deviation given all test results. However, we also show that these criteria are not satisfied for current procedures used to assess test-specific deviations, which are required, for example, to investigate dissociations in a test profile. We therefore propose several new procedures to assess such test-specific deviations. These new procedures are expected to satisfy all three criteria. Method. In Monte Carlo simulations and in an applied example pertaining to Parkinson disease, we compare current procedures to assess test-specific deviations (uncorrected and Bonferroni normative comparisons) to new procedures (Holm, one-step resampling, and step-down resampling normative comparisons). Results. The new procedures are shown to: (a) control familywise false-positive error rate, whereas uncorrected comparisons do not; (b) have higher sensitivity than Bonferroni corrected comparisons, where especially step-down resampling is favorable in this respect; (c) be user-friendly as they are implemented in a user-friendly normative comparisons website, and as the required normative data are provided by a database. Conclusion. These new normative comparisons procedures, especially step-down resampling, are valuable additional tools to assess test-specific deviations from the norm in large test batteries.     

Incidence of appendicitis according to region of origin in first- and second-generation immigrants and adoptees in Sweden. A cohort follow-up study

Background. Geographic variations in incidence of appendicitis and proportion of perforations suggest environmental or genetic etiological factors. We study incidence of appendicitis and proportion of perforations according to geographical origin in immigrants and international adoptees in Sweden. Methods. A cohort of 11,557,566 Swedish residents – 277,104 first- and 377,773 second-generation immigrants and 57,304 adoptees – was followed from 1988 till 2010. Differences in proportion of operation for perforated appendicitis and negative appendectomy and standardized incidence ratios (SIR) of perforated and non-perforated appendicitis associated with geographic origin was analyzed. Results. High incidence rates are seen in first- and second-generation immigrants from South America for perforated (SIR 1.58 and 1.81, respectively) and non-perforated appendicitis (SIR 1.18 and 1.22, respectively), and in adoptees from South America for non-perforated appendicitis (SIR 1.07). Low incidence rates are seen for perforated appendicitis in first-generation immigrants and adoptees from Asia (SIR 0.74 and 0.56, respectively), and for non-perforated appendicitis in immigrants from Africa and Asia (SIR 0.69 and 0.76 in first-generation, 0.51 and 0.74 in second-generation, respectively) and in adoptees from Asia (SIR 0.71). A high proportion of perforated appendicitis is associated with a low incidence rate of non-perforated appendicitis but no increase in the incidence rate of perforated appendicitis. Conclusions. The association of different incidence of appendicitis with geographic origin which remains over generations and is seen in adoptees suggest genetic etiologic factors. The proportion of perforation can be high without an increased incidence rate of perforation and is therefore an imperfect indicator of quality of care.     

Glomerular filtration rate in the elderly and in the oldest old: correlation with frailty and mortality

The equations for estimating kidney function have become very popular in the last decade. However, the clinical and prognostic meaning of these measures may be very different in older populations. Two cohorts of people aged 65–89 years (older sample) and 90 or more (oldest old sample) were used to investigate the prognostic significance of estimated glomerular filtration rate (eGFR). Additionally, we also investigated whether combining frailty and eGFR may improve the accuracy of frailty in predicting mortality. We found that lower eGFR values were significantly more frequent among frail subjects in both groups. eGFR < 30 was associated with increased risk for all-cause mortality either in subjects aged 65–89 years (HR = 3.71, 95% CI = 1.23–11.2) or in those aged 90 or more (HR = 1.53, 95% CI = 1.05–2.23). In the latter group, a not significant trend for increasing mortality was also observed among people with eGFR > 60 (HR = 1.28, 95% CI = 0.72–2.26). In addition, the oldest old subjects with eGFR > 60 and eGFR < 30 had the lowest hand-grip strength and ADL values. Combining eGFR and frailty status significantly improved the accuracy of frailty in predicting mortality only in the older sample. In conclusion, a U-shaped relationship exists between eGFR and mortality in the oldest old, but not in older individuals. Our findings suggest that eGFR needs to be adjusted for muscle mass/physical performance when estimating kidney function in people aged 90 or more. Nevertheless, in subjects aged 65–89 years, eGFR may improve the accuracy of frailty status in predicting prognosis, thus suggesting that eGFR may represent an additional dimension of frailty syndrome.