Onboard ship evaluation of the effectiveness and the potential environmental effects of PERACLEAN Ocean for ballast water treatment in very cold conditions

This study verified the effectiveness and the potential toxic impact of PERACLEAN Ocean ballast water treatment for very cold freshwater (0.1-0.5 degrees C) in real ballast tank (750 m(3)) conditions aboard a ship and in large-volume (4.5 m(3)) polyethylene tanks. Concentrations of peracetic acid (PAA) and hydrogen peroxide (H2O2) gradually dropped by 41-59% over 5 days. The treatment altered the quality of the treated waters by causing a pH drop of 0.9-1.3 units and a fourfold to sevenfold increase in dissolved organic carbon and organophosphates concentrations. More than 90% of the biomass of free-floating micro-organisms and viable phytoplankton were eliminated within 48 h after treatment. The treatment resulted in 100% mortality in caged fish exposed to treated waters but was totally ineffective against adult zebra mussels and some nematods living in tank sediments. Toxic response from ecotoxicological assays indicated that treated waters after 5 days should be diluted by a factor of 1:2 to 1:200 to reduce toxicity below selected endpoints of acute lethality tests. On the basis of PAA degradation rate, fresh waters treated with 100-ppm PERACLEAN Ocean should be kept in ballast tanks for 15-20 days after treatment to reduce toxicity. It is concluded that the treatment can be an effective biocide to rapidly eliminate organisms of the water column inside the ballast tanks over a wide range of environmental conditions, but that the discharge of the toxic treated waters should be properly managed to minimize potential environmental impact.     

医生工作倦怠的研究进展

采用文献研究法对有关医生工作倦怠的研究资料进行了分析与整合。研究者主要采取了四种研究视角,从影响因素与干预措施、后果等方面对医生的工作倦怠进行了研究。最后,针对研究中存在的问题从实证与理论方面提出了改进的建议。     

药剂科办好医院《药讯》之刍议

目的:探讨提高医院《药讯》办刊质量的方法。方法:分析《药讯》办刊现状,发现存在的问题,结合笔者工作经验,提出办好医院《药讯》的合理化建议。结果与结论:《药讯》目前有纸质版和网络版2种形式,有规模的医院基本上都有自己的《药讯》,但质量参差不齐;可通过规范《药讯》内容、格式,突出高效、实用的特点及提高编辑质量等方面来提高医院《药讯》的质量。     

上海口岸首例邮轮大规模诺如病毒感染爆发的应急处置

〔目的〕通过对某大型邮轮一起诺如病毒引起的急性胃肠炎疫情处置,关注国际间疫情变化,为国境口岸突发公共卫生事件快速反应提供对策依据。〔方法〕通过对来沪某大型邮轮的一起诺如病毒引起的急性胃肠炎的临床诊断、流行病学调查、实验室检测和卫生检疫措施的实施,探讨口岸突发公共卫生事件的快速反应对策。〔结果〕经过对邮轮上患者样本和食品样本的细菌学和病毒学检测,结合流行病学调查和临床表现确定为诺如病毒引起的急性胃肠炎,采取了以传染源控制和管理为重点、切断传播途径和保护易感人群等卫生检疫措施后控制了疫情的蔓延。〔结论〕国境卫生检疫应在排除检疫传染病的情况下,扩大疾病监测范围,以控制常见的、多发的、易引起突发公共卫生事件的传染病为重点。根据新的《国际卫生条例》的规定,调整国境口岸卫生检疫策略,加强口岸卫生检疫核心能力建设,建立应对突发公共卫生事件快速反应体系的新机制,为防止疾病的国际传播提供技术保障。     

宜宾市3类重点人群男性吸烟行为调查及影响因素研究

目的了解宜宾市医生、教师和公务员3类重点人群男性吸烟状况及其影响因素。方法采用问卷调查方法,对抽取的医生、教师和公务员982人进行调查,描述其中525名男性的吸烟现状;应用logistic回归模型探讨其吸烟的影响因素。结果525人中吸烟者191人,吸烟率36.4%,影响3类人群中男性吸烟的主要因素有年龄、工龄、职称、相关知识、相关态度等因素。结论宜宾市医生、教师、公务员中男性吸烟率较高,应继续加强在医生、教师和公务员这3类重点人群中开展控烟工作,广泛宣传烟草相关知识和戒烟技能,努力降低其吸烟率,尽量减少对其他人群的影响。     

乡村医生报酬水平及影响因素分析

目的了解新农合乡村医生报酬水平,为制订合理的补偿方案提供参考。方法采用流行病学现场研究方法进行调查。结果昆明市乡村医生的平均补偿水平较低,仅为120．0元／月。累积比数模型分析表明,影响乡村医生报酬的因素有文化程度、累计工作年限、职称、开展医疗活动的地点、卫生服务活动的区域和从事计划免疫的天数。结论目前,昆明市新农合乡村医生卫生服务工作报酬水平较低。相关部门应适当提高报酬水平,并不断调整和完善补偿方案。     

514例婴幼儿高压氧治疗中医务人员与家长沟通问题分析

目的了解婴幼儿高压氧治疗中操作人员与家长沟通的问题。方法对514例婴幼儿高压氧治疗患儿家长沟通中存在的问题进行总结。结果对治疗效果过高期待（54．1％）,不配合（39．7％）．对治疗效果不正确评价（21．4％）,不合理要求（12．8％）。结论与家长沟通存在许多问题,有效沟通有利于婴幼儿高压氧治疗的顺利进行,减少医患冲突,消除医疗服务中不安全的潜在隐患。     

杨学信主任医师治疗高血压病的临床经验

杨学信老师在整理古代文献的基础上,结合临床实际,提出"多维平衡法"治疗眩晕的方法。从病因病机、学术思想、辨证经验、治则治法、组方用药五方面进行论述,系统的归纳了杨老师辨治高血压病的经验。这些经验对临床有重要的意义,值得进一步探讨。     

Corrélation entre les notes obtenues aux ECOS et aux épreuves de connaissances et analyse des facteurs associés à une meilleure réussite aux ECOS chez les étudiants de DFASM1 et 2 au CHU de Dijon

RationaleObjective structured clinical examinations (OSCEs) were introduced to evaluate students not only on their knowledge, but also on their clinical skills and attitudes. The objectives were to study the correlation between OSCE scores and scores obtained to traditional knowledge examinations and to analyse factors associated with better OSCE performance in DFASM1 and 2 students at Dijon university hospital.MethodsThis was a prospective observational study conducted among all fourth and fifth year medical students in Dijon. The scores on the OSCE elective tests (2022) and the average score on the knowledge tests (2021–2022) were collected and their correlation measured. A questionnaire asked students about their demographic characteristics, their investment in formative and practicum OSCEs, their level of empathy (Jefferson questionnaire) and their personality traits (NEO-Pi-R).ResultsOf 549 students, 513 completed all tests. Scores on OSCE and faculty knowledge tests were correlated (r = 0.39, P < 0.001). Of these, 111 (20%) students responded to the questionnaire, and 97 were analized. We did not observe any significant difference between students who performed better on OSCEs than on knowledge tests and those who did not, regarding their age, their investment in formative tests, their personality traits or their level of empathy.ConclusionOur results underline the need to optimize the evaluation of empathy and clinical skills in OSCE tests, using new tools, in order to better discriminate between students on these skills.     

郑魁山教授"温通"针法临证运用规律总结

“温通针法”是郑魁山教授在数十年的临床实践中,独创的治疗各种疑难杂症的特色针刺手法,该手法补泻兼施,具有温经通络、化痰浊、祛风散寒、行气活血、扶正驱邪的作用,临床用于治疗冠心病、头面五官疾病、脑病、风寒湿痹等难治性病症,常获良效。