Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections

Screening of potential MRSA-positive patients at hospital admission is recommended in German and international guidelines. This policy has been shown to be effective in reducing the frequency of nosocomial MRSA transmissions in the event of an outbreak, but the influence of screening on reducing hospital-acquired MRSA infections in a hospital setting where MRSA is endemic is not yet well-documented. This study describes the effect of hospital-wide screening of defined risk groups in a 700-bed acute care hospital during a period of 19 months. In a cohort study with a 19-month control period, the frequencies of hospital-acquired MRSA infections were compared with and without screening. In the control period, there were 119 MRSA-positive patients, of whom 48 had a hospital-acquired MRSA infection. On the basis of this frequency, a predicted total of 73.2 hospital-acquired MRSA infections was calculated for the screening period, but only 52% of the expected number (38 hospital-acquired MRSA infections) were observed, i.e., 48% of the predicted number of hospital-acquired MRSA infections were prevented by the screening programme. The screening programme was performed with minimal effort and can therefore be recommended as an effective measure to help prevent hospital-acquired MRSA infections.     

瑞格列奈与迪沙片治疗新诊断2型糖尿病的疗效对比观察

比较对新诊断2型糖尿病患者应用瑞格列奈（11例）和迪沙片（10例）治疗4周后空腹血糖（FPG）、餐后2h血糖（2hPG）、晨3点血糖（3aPG）,空腹胰岛素（FIns）、餐后2h胰岛素（2hIns）,糖化白蛋白的值。结果显示,与迪沙片组相比,瑞格列奈组治疗后空腹血糖、餐后2h血糖的下降幅度更为明显,但低血糖的发生次数反而减少。     

Pancreas Graft Salvage Using Pancreatico-Duodenectomy With Enteric Drainage

As demand for donor pancreases increases, attempts are being made to utilize even marginal grafts for transplantation. Injury during pancreas recovery can predispose to posttransplant complications and graft loss. Early recognition and correction can salvage these grafts. The authors report an instance of poor segmental perfusion of the pancreas graft that was salvaged by pancreas head resection and enteric drainage through a Roux-en-Y pancreatico-jejunostomy.     

精神病人与正常人戒烟前后焦虑抑郁症状的对照研究

目的　了解精神病人和正常人戒烟前后精神状况的变化及差异性 ,探讨戒烟措施。方法　对 71例精神病人和 5 0例正常人戒烟前及戒烟后 1周分别应用汉密顿焦虑量表 (HAMA)、汉密顿抑郁量表 (HAMD)、焦虑自评量表 (SAS)、抑郁自评量表 (SDS)、简明精神病量表 (BPRS )进行测评。结果　精神病人强制性戒烟前HAMA、HAMD、SAS、SDS、BPRS分值分别为 (8.2 1± 6 .4 1)、(7.6 4± 5 .71)、(36 .81± 7.14 )、(33.71± 7.1)、(2 9.4 5± 8.4 7) ;戒烟后HAMA、HAMD、SAS、SDS、BPRS分值分别为 (16 .4 5± 6 .34)、(19.73± 8.71)、(5 8.1± 12 .12 )、(5 6 .31± 11.4 )、(37.32± 7.95 ) ;戒烟前后 5种量表分值变化与正常人戒烟前后分值变化比较有极显著性差异(P <0 .0 1)。结论　对精神病人强制性戒烟可引起明显的情绪反应 ,应适宜控制病人吸烟 ,建立一个合理的管理制度     

普外科住院患者营养状况评价

目的　调查本院 2 0 0 2～ 2 0 0 3年间普外科住院患者的营养状况。方法　采用多项营养评价指标测定 4 0 12例非急诊住院患者营养状况 ,分析年龄、疾病等因素与营养状况之间关系。结果　各项指标进行营养评价得出本院普外科非急诊患者营养不良的发生率分别是 :BMI 2 1 3% ,TSF5 0 6 % ,MAC 2 0 5 % ,AMC 2 1 2 % ,SGA 38 0 % ,MNA 2 0 8% ,ALB 2 4 2 % ,PA 35 4 % ,TLC 5 5 8%。 >6 0岁组老年患者、消化道疾病患者及恶性肿瘤患者营养不良发生率分别高于≤ 6 0岁患者、消化道外疾病患者及良性疾病患者 ,差异有显著性 (P <0 0 5 )。结论　本院普外科住院患者的营养不良发生率为 2 0 5 %～ 5 5 8% ,不同的营养评价指标得出的营养不良发生率不同。     

影响糖尿病足坏疽愈合的因素及针对性护理研究

目的探讨针对影响糖尿病肢端坏疽患者愈合因素进行针对性的护理。方法在600例糖尿病足坏疽住院患者中随机抽取168例分成2组,根据2组患者血浆蛋白、动脉硬化下肢血流量、微循环障碍程度、患足骨质破坏情况、缺乏糖尿病足坏疽的防治知识进行分析,找出影响愈合的因素,并做好针对性的护理工作。结果168例糖尿病足坏疽患者,下肢血流量、足背动脉搏动及甲襞微循环比较,2组差异有显著性意义(P<0.05);2组足坏疽合并肾病、骨质破坏和血红蛋白改变情况比较,2组差异有显著性意义(P<0.05)。结论根据糖尿病足坏疽患者影响愈合的因素,进行针对性的护理,加快了糖尿病足坏疽患者的愈合速度,同时综合治疗有利于糖尿病足坏疽的早日愈合,可以减少截肢,提高了糖尿病足坏疽患者的生活质量。     

TEN YEARS' EXPERIENCE IN LOW VISION PRACTICE

The Low Vision Clinic at the Palmerston North Hospital has now been oerating for 70 years. Over the course of these ten years a number of factors have emerged which can be as readily applied to general ophthalmological practice as to low vision practice. The philosophy of low vision care is one of which all ophthalmologists should be aware and includes factors to be taken into account when dealing with children, people in the workplace, and everyday factors involved in daily living activities, all of which are equally relevant in routine ophthalmological practice. This paper endeavours to share some thoughts on these factors and also discusses means by which the visually handicapped can be helped in areas where specialist low vision services are not readily available.     

Microalbuminuria in diabetes: relationships between urinary albumin excretion and diabetes-related variables

A single observer reviewed 842 of the 917 known diabetic patients registered with 40 GPs in the Poole area. Fifty-nine per cent (493) of those reviewed submitted a timed overnight urine collection to measure albumin excretion rate (AER) and overnight albumin/creatinine ratio (ON-Alb/Creat); 43 samples were excluded because of urinary tract infection and/or proteinuria. A random urine sample was obtained in 607 diabetic patients to measure the random albumin/creatinine ratio (R-Alb/Creat); 68 specimens were excluded because of infection and/or proteinuria, and in a further 10 samples urinary creatinine was not measured. Stepwise multiple regression analyses found significant associations with the following variables: for AER, blood glucose (p = 0.001), smoking category (p = 0.002), sex (p = 0.034), and systolic blood pressure (p = 0.035); for R-Alb/Creat, blood glucose (p = 0.001), retinopathy (p = 0.004), systolic blood pressure (p = 0.004), diastolic blood pressure (p = 0.015), coronary artery disease (p = 0.02), sex (p = 0.034), and vibration sense (p = 0.038). Interestingly, glycosylated haemoglobin was not a significant determinant of albuminuria in either analysis.     

Removal of famotidine by haemodialysis in elderly anuric patients

Summary The effect of haemodialysis on the pharmacokinetics of oral famotidine has been studied in five elderly anuric patients. Famotidine 20 mg was administered in a cross-over design to patients on and not on haemodialysis.The elimination rate constant of haemodialysis (k) was 4.6-fold larger than the systemic elimination rate constant (k_e). Although the mean maximum serum concentration of famotidine during haemodialysis (141.5 ng·ml^–1) was not significantly lower than that without haemodialysis (195.6 ng·ml^–1), the AUC up to 5 h during haemodialysis was significantly decreased to 58.1% of the value without it.The data suggest that famotidine is dialysable by haemodialysis.     

Multiple Cerebral Haematomata and Peripheral Nerve Palsies Associated with a Case of Juvenile Diabetic Ketoacidosis

A 15-year-old girl presented de novo in diabetic ketoacidosis having been comatose for 24 h (day 1). A CT scan and lumbar puncture performed on admission were normal and her conscious level slowly improved over several days. On day 7 she had central neurological signs of bilateral knee clonus and an extensor plantar response. In addition, she had developed lower motor neurological signs of an ulnar nerve palsy of the left forearm, and ulnar, median, and radial nerve palsies of the right forearm. Magnetic resonance imaging (MRI), performed on day 12, showed multiple small cerebral haematomata with appearances at least several days of age. The scattered lesions were localized particularly to the parieto-occipital region, with sparing of the basal ganglia and without cerebral oedema, a novel feature not previously described in juvenile ketoacidosis. Four months later there was minimal residual disability of her right arm. The clinical findings together with the MRI images suggested that the peripheral nerve and central lesions were temporally related, suggesting a common aetiology. However, it is likely that MRI showed cerebral lesions which may have been missed by the conventional CT scanning performed initially.