Daily nutrient intake represents a modifiable determinant of nutritional status in chronic haemodialysis patients.

BACKGROUND: In maintenance haemodialysis patients, daily food intake is changeable; however, its relationship with nutritional status is unexplored. This study aimed to evaluate the isolated, long-term effect of daily nutrient intake on nutritional status in haemodialysis patients. METHODS: We performed a prospective 1-year controlled study in 27 chronic haemodialysis patients, without recognized risk factors for malnutrition. Each day for 1 week, four times in the year, we measured protein nitrogen appearance, and assessed dietary protein (DPI) and energy (DEI) intake from dietary diaries. We compared the nutritional outcome of patients spontaneously reducing nutrient intake below the threshold of 0.8 g/kg body weight/day for DPI and 25 kcal/kg body weight/day for DEI during the week (LOW, n = 8), with controls at adequate nutrient intake (CON, n = 19). An interventional 6-month study was then carried out in LOW to verify the cause-effect relationship. RESULTS: All patients showed a day-by-day reduction of whole nutrient intake during interdialytic period, which was mostly relevant in the third interdialytic day (L3). During the 1-year study, even in the presence of adequate dialysis dose and normal inflammatory indexes, body weight (68.0 +/- 5.5 to 65.8 +/- 5.9 kg), serum albumin (3.96 +/- 0.07 to 3.66 +/- 0.06 g/dl) and creatinine (9.2 +/- 1.1 to 8.1 +/- 0.7 mg/dl) significantly decreased in LOW but not in CON. Diaries evidenced in LOW a reduced number of meals at L3 that was explained by the fear of excessive interdialytic weight gain. During the interventional study, daily DPI and DEI increased at L3; this was associated with a significant increment of body weight, and serum albumin and creatinine levels. CONCLUSIONS: In maintenance haemodialysis patients the persistent, marked reduction of daily nutrient intake, even if limited to a single day of the week, is an independent determinant of reversible impairment of nutritional status.     

医院图书馆人力资源开发和管理

探讨网络环境下医院图书馆人力资源开发和管理的重要性和必要性。指出文献、设备及人才是图书馆资源的三大部分 ,起着相互配合、相互支持的作用。人力资源的开发、利用程度 ,直接影响网络环境下医院图书馆职能的发挥和自身的建设与发展。提出增强医院图书馆人力资源管理效能和建设高素质人才队伍的方法和设想     

硫喷妥钠治疗小儿难治性惊厥持续状态疗效观察

目的 探讨对小儿难治性惊厥持续状态的有效治疗方法。方法 对14例小儿难治性惊厥持续状态采用硫喷妥钠治疗并观察疗效。结果 硫喷妥钠治疗有效率为100％，1例出现呼吸抑制，3例于停药后复发。结论 硫喷妥钠对小儿难治性惊厥持续状态有明显疗效，但易发生呼吸抑制。惊止后应维持一段时间，以免复发。     

宁夏卫生人力资源现状分析

目的　了解宁夏卫生人力现状 ,提出建设性意见。方法　采用普查分类统计分析的方法。结果　现有卫生人员 2 3485名 ,其中卫生专业技术人员 18838名 ,每千人拥有 4 .35名卫生人员和 3.36名卫生专业技术人员。结论　年龄和职称分布合理 ,卫生人力资源总量较 16年前明显增加 ,卫生专业技术人员增长了 83.5 7% ,研究生偏少 ,本科学历比例较小 ,卫生人力资源过于集中在银川市     

Factors Affecting Cardiac Catheterization Rates in Elders with Acute Coronary Syndromes

Background: Elder patients with acute coronary syndromes (ACS) are less likely to receive cardiac catheterization. The reasons for this are unclear.
Objectives: To assess whether elder patients who had a documented history of dementia, lived in extended care facilities, or had do not intubate–do not resuscitate (DNR-DNI) advance directives were less likely to receive cardiac catheterization, despite having ACS with high-risk features.
Methods: This was a medical record review conducted at an urban teaching hospital. DNR-DNI status before hospitalization, extended care facility (nursing home or assisted living) residence, and a previous diagnosis of dementia were obtained from the medical record. Patients 65 years and older who presented to the emergency department with acute myocardial infarction or with unstable angina with ST segment deviation were included. Univariate and multivariate logistic regression were performed, and odds ratios (ORs) were reported with their 95% confidence intervals (CIs).
Results: Of the 201 eligible patients, 66 (32.8%) patients did not undergo cardiac catheterization. In the univariate analysis, patients who had dementia, resided in extended care facilities, or were DNR-DNI were less likely to receive cardiac catheterization. Only extended care facility residence (OR, 0.18; 95% CI = 0.04 to 0.83) and DNR-DNI status (OR, 0.19; 95% CI = 0.04 to 0.92) remained significantly associated with decreased cardiac catheterization in the multivariate analysis.
Conclusions: Elder patients with ACS residing in extended care facilities or who are DNR-DNI are less likely to receive cardiac catheterization. Future studies concerning the quality of ACS care for elders should take these variables into account.     

肛门病手术应用低浓度小剂量利多卡因局麻的效果

目的观察低浓度小剂量利多卡因在肛门病手术中的应用效果。方法选择接受肛门病手术者100例,手术时用0．25％盐酸利多卡因5-20ml,根据病情和手术需要作局部浸润麻醉。结果通过100例的肛门手术观察,结果显示麻醉满意顺利83例,麻醉良好17例,无1例麻醉无效失败。总有效率100％。此法麻醉效果确切,未发现严重不良反应。结论此法具有易于掌握,效果好而安全的优越性,适于临床应用和推广。     

灌肠灵治疗慢性结、直肠炎68例临床观察

目的 :观察灌肠灵治疗慢性结、直肠炎的临床疗效。方法 :对 136例符合慢性结、直肠炎诊断标准的患者 ,随机分为灌肠灵治疗组与对照组各 6 8例。两组治疗均为保留灌肠 ,每日 1次 ,10d为 1疗程 ,共 2疗程。结果 :治疗组优于对照组 ,总有效率为 91.1%与 72 .1% ,P <0 .0 5。结论 :灌肠灵治疗慢性结、直肠炎是目前疗效较好的一种理想方法     

航渡营养口粮抗疲劳实验研究

目的：评价航渡营养口粮抗疲劳功能。方法：50只小鼠随机分成氨基酸低，中，高剂量组，混合饲料组和对照组，进行运动耐力测定，血清尿素氮浓度测定和血糖测定。结果：给予氨基酸的小鼠，与对照组比较负重游泳时间明显延长（P＜0．05），小鼠负重游泳至力竭时血清尿素氮浓度明显降低（P＜0．01），氨基酸高剂量组和混合饲料组小鼠血糖水平高于对照组。结论：航渡营养口粮能有效地提高小鼠机体运动耐力，维持血糖水平，降低血清尿素氮浓度，抗疲劳。     

东林书院讲经活动与道德救世理念

明中后期，王学盛极一时，程朱式微，以顾宪成、高攀龙为首的东林学人以东林书院为依托，起而纠王学空疏之流弊。究明儒学道脉，“提撕天下万世”，成为其讲经活动的主要目的，儒家经典成为其讲经活动的主要内容，体现了学术与政治相结合的道德救世理念。     

脑电双频指数指导老年病人异丙酚麻醉诱导用量

[目的]通过监测老年病人麻醉诱导时脑电双频指数(BIS)的变化,探讨既能维持足够麻醉深度又能避免严重低血压的异丙酚诱导用量。[方法]40例ASA II～I级的老年病人(65～85岁),随机分成两组。A组静脉注射异丙酚1.6 mg/kg;B组静脉注射异丙酚,其用量是使BIS下降到40～50时的用量。两组均复合维库溴铵0.1 mg/kg和瑞芬太尼1ug/kg诱导后行气管插管分别记录基础值、插管前、插管后1 min、5 min和10 min时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),同时记录诱导异丙酚用药量和BIS的变化。[结果]A组异丙酚诱导用药量(99.7±18.05)mg,平均(1.64±0.7)mg/kg,B组(82.9±12.5)mg,平均(1.35±0.5)mg/kg,差异有统计学意义(P﹤0.05)。A组血压(BP)和BIS比B组明显降低。[结论]老年病人异丙酚麻醉诱导的合适用量为(1.35±0.5)mg/kg;既能维持老年人足够的麻醉深度又能避免严重低血压的发生。