Performance comparison between the mycobacteria growth indicator tube system and L?wenstein-Jensen medium in the routine detection of Mycobacterium tuberculosis at public health care facilities in Rio de Janeiro, Brazil: preliminary results of a pragmatic clinical trial

In view of the fact that the World Health Organization has recommended the use of the mycobacteria growth indicator tube (MGIT) 960 system for the diagnosis of tuberculosis and that there is as yet no evidence regarding the clinical impact of its use in health care systems, we conducted a pragmatic clinical trial to evaluate the clinical performance and cost-effectiveness of the use of MGIT 960 at two health care facilities in the city of Rio de Janeiro, Brazil, where the incidence of tuberculosis is high. Here, we summarize the methodology and preliminary results of the trial. (ISRCTN.org Identifier: ISRCTN79888843 [http://isrctn.org/])     

开展英语查房竞赛的做法与体会

为了强化全院医务人员的英语学习氛围，介绍了开展英语查房竞赛的具体做法：严密组织，上下协作；观摩示范，统一标准精选评委，认真审材，并谈了体会。     

Chemistry Test Ordering Patterns after Elimination of Predefined Multitest Chemistry Panels in a Children's Hospital

Predefined multitest chemistry panels (PMCPs) have constituted a large proportion of laboratory tests and patient charges, even in pediatric settings, despite the absence of documented clinical utility for PMCPs and the general availability of random access analyzers that do not require predefined test combinations. We eliminated PMCPs in our tertiary children's hospital but placed no other restrictions on ordering, and observed a 32.7% reduction in the number of automated chemistry tests ordered. All 23 tests in the previous PMCPs showed a decline in utilization, >50% for 8 of the tests and 20–50% for 13 others, and this change was sustained throughout an 8-month follow-up period. The total number of orders for one or more tests increased by 8.2%, but the variety of combinations that were ordered increased by 280%. The most substantial changes included a decrease in the number of orders for combinations of >15 tests, and increases in the number of orders for single tests and combinations of 2 to 5 tests. Orders for combinations identical to all of the former PMCPs declined, with the exception of the 4-test electrolyte panel. There was a marked decline in orders for a 7-test panel identical to the recently defined HCFA-AMA Basic Metabolic Panel, and orders for combinations identical to the HCFA-AMA Liver Function and Extended Metabolic panels were vanishingly rare and nonexistent, respectively. The calculated reduction in patient charges was much greater than actual cost savings, but the reduction in total tests and increase in the variety of test combinations suggest that significant savings can be realized if clinicians are encouraged to order only the tests or combinations they need without imposing procedural, financial, and regulatory burdens. Received June 30, 1998; accepted November 16, 1998.     

Prevalence of human papilloma virus in men attending the infertility clinic

Summary. Subclinical human papilloma virus is a potential carcinogen in the male and female genital tract. The sexually active male infertility population represents a high risk group for harbouring this disease. To determine the prevalence of subclinical human papillomavirus in this group, penoscopy was done on 96 male patients visiting the infertility clinic. The feasibility of routine penoscopy as part of the infertility work-up was also investigated. Of the 96 patients 20 had acetowhite lesions on their penes with penoscopy. Thirteen patients (13.5%), 12 proven by biopsy of the aceto-white lesions, and one proven by fluid in situ hybridization on superficial epithelial cells of the distal urethra, were positive for human papillomavirus. Two of the 12 biopsy-positive cases were also proven positive by fluid in situ hybridization. It was concluded that human papillomavirus had a high prevalence amongst asymptomatic male patients attending the infertility clinic and that penoscopy should be included as routine investigation in the work-up of the male infertility patient.—     

对沙市新生儿常规接种乙肝疫苗的卫生服务评价

８７年开始，沙市对新生儿开展常规乙肝疫苗预防接种，经过两年多的努力现在已经走上了计划免疫的轨道。本文应用卫生服务评价理论，通过对有关资料的统计学处理，按照劳埃姆有关卫生服务评价的八项内容，分析和评价该工作进展，效果和效益。结论：该工作具有可行性、有效性和指导性，在我国城市进行常规乙肝预防工作中有重要意义。     

Shy-Drager综合征19例临床分析

目的 Shy-Dmger综合征（SDS）的临床特征。方法 回顾性分析19例SDS患者的临床资料。结果 19例患者均有直立性低血压，而心率变化不大；大部分患者有晕厥、尿便障碍、性功能障碍；其它症状有共济失调、呛咳、无汗、喘呜、帕金森样症状及锥体束征等。给予利他林、管通、美多巴等治疗，症状改善不明显。结论 直立性低血压是SDS的重要特点，临床缺乏特异性检查方法。目前尚无有效治疗手段，预后差。     

建材市场污染状况及对从业人员健康影响的研究

目的:了解建材市场的主要污染物及其污染水平;研究低浓度甲醛、苯系物暴露对从业人员的健康影响。方法:采用调查问卷了解调查对象的一般情况;AHMT分光光度法及热解吸-气相色谱法分析现场的甲醛及苯系物浓度;应用临床检测的标准方法测定血常规;聚合酶链式反应(PCR)方法检测研究对象的GSTT1基因型。结果:研究组现场的主要污染物为甲醛、苯、甲苯、二甲苯,4种主要的污染物均未超过国家标准,苯浓度在研究组和对照组现场之间无显著性差异,甲醛、甲苯、二甲苯浓度在两个现场之间具有显著性差异;研究组的白细胞计数、中性粒细胞绝对值、中间细胞绝对值分别为6.41、3.74、0.38 G/L,对照组分别为7.53、4.44、0.43 G/L,三者均为研究组小于对照组,但都在正常值范围内,其余血常规指标在两组之间无显著性差异;研究组按照GSTT1基因型分层,GSTT1基因缺失型的白细胞及中性粒细胞值为7.19、4.21 G/L,GSTT1基因非缺失型二者的值分别为6.14、3.15 G/L,GSTT1基因缺失型大于非缺失型,但其均数在正常值范围内。结论:建材市场的主要污染物为甲醛、苯、甲苯、二甲苯,受温度及湿度的影响,冬季污染物的释放量减少,使板材市场的污染物浓度维持在较低的水平。低浓度甲醛、苯系物暴露时,与对照组相比,机体的血常规观察到了变化,且GSTT1基因型对血常规的变化有影响。