Posterior amorphous corneal dystrophy caused by a de novo deletion

We present a newborn diagnosed with posterior amorphous corneal dystrophy (PACD). PACD is a rare disorder with partial or complete posterior lamellar corneal opacification. Genetic screening showed a deletion of chromosome 12q21.33-q22 containing the identified four small leucine-rich proteoglycans (SLRP’s) associated with this particular dystrophy. Neither parents were carrier of the deletion. To our knowledge, this is the first report of a de novo mutation causing PACD.     

神经内科住院患者并发下呼吸道感染病原菌分布及耐药性分析

目的 了解引起神经内科住院患者下呼吸道感染的病原菌分布及其耐药性,为临床预防医院感染及用药提供科学依据.方法 采集2009年1月-2011年12月医院神经内科并发下呼吸道感染的住院患者的下呼吸道分泌物并送检,应用法国生物梅里埃公司Bact/Alert 3D120全自动血培养仪及VITEK-2 Compact全自动细菌鉴定、药敏分析系统进行细菌培养、鉴定及药敏分析.结果 2009年1月-2011年12月神经内科住院患者并发下呼吸道感染207例,共培养出菌株516株；检出的病原菌中,以革兰阴性菌为主437株占84.69％,主要以肺炎克雷伯菌、铜绿假单胞菌为主；革兰阳性菌85株占11.24％,主要以金黄色葡萄球菌为主；真菌21株占4.21％,主要以白色假丝酵母菌为主；其中,肺炎克雷伯菌对哌拉西林/他唑巴坦、亚胺培南、美罗培南等抗菌药物敏感,敏感率分别为98.14％、100.00％、100.00％,对氨苄西林、哌拉西林等抗菌药物耐药,耐药率为98.76％、70.19％,铜绿假单胞菌主要对头孢唑林、头孢呋辛酯、头孢呋辛钠敏感,敏感率均为100.00％,对磺胺甲噁唑/甲氧苄啶耐药,耐药率为98.65％,金黄色葡萄球菌对莫西沙星敏感,敏感率为78.05％,对红霉素、克林霉素等药物耐药,耐药率均为100.00％,真菌对氟康唑、两性霉素B等抗真菌药物普遍敏感,敏感率均为100.00％.结论 医院感染是神经内科常见的并发症,引起神经内科住院患者下呼吸道感染的主要病原菌为革兰阴性菌,加强神经内科患者及抗菌药物的管理,监测感染病原菌的构成及耐药性,对预防医院感染非常重要.     

Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: A sociotechnical analysis

Integration of clinical decision support services (CDSS) into electronic health records (EHRs) may be integral to widespread dissemination and use of clinical prediction rules in the emergency department (ED). However, the best way to design such services to maximize their usefulness in such a complex setting is poorly understood. We conducted a multi-site cross-sectional qualitative study whose aim was to describe the sociotechnical environment in the ED to inform the design of a CDSS intervention to implement the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules for children with minor blunt head trauma. Informed by a sociotechnical model consisting of eight dimensions, we conducted focus groups, individual interviews and workflow observations in 11 EDs, of which 5 were located in academic medical centers and 6 were in community hospitals. A total of 126 ED clinicians, information technology specialists, and administrators participated. We clustered data into 19 categories of sociotechnical factors through a process of thematic analysis and subsequently organized the categories into a sociotechnical matrix consisting of three high-level sociotechnical dimensions (workflow and communication, organizational factors, human factors) and three themes (interdisciplinary assessment processes, clinical practices related to prediction rules, EHR as a decision support tool). Design challenges that emerged from the analysis included the need to use structured data fields to support data capture and re-use while maintaining efficient care processes, supporting interdisciplinary communication, and facilitating family-clinician interaction for decision-making.     

Clinical Practice Guidelines on the Internet

Abstract

Access to quality information on the Internet for health care situations can be problematic. Currently there is a tremendous wealth of practice guidelines available over the Internet. The Institute of Medicine defines practice guidelines as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. This article discusses the role of practice guidelines in health care decision making, and highlights some of the practice guidelines that are available over the Internet.     

神经内科患者发生下呼吸道感染的危险因素分析

目的 了解医院神经内科患者下呼吸道感染发生率及引起下呼吸道感染的危险因素,为临床预防和控制医院感染提供参考.方法 对1348例神经内科住院患者临床资料进行逐份查阅,回顾性分析患者医院感染情况及引起感染的危险因素.结果 调查病历1348份,其中发生医院感染132例,医院感染率9.79％,感染部位分布:下呼吸道感染41例、上呼吸道感染35例、泌尿道25例、胃肠道14例、皮肤软组织6例、五官4例、其他7例,分别占26.52％、31.06％、18.94％、10.61％、4.55％、3.03％、5.30％；患者年龄、性别、患病季节、基础疾病、烟酒史、意识状态、住院时间、预防使用抗菌药物、气管切开、气管插管、机械通气及留置导尿均是导致神经内科发生下呼吸道感染的危险因素(P＜0.05)；主要病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌、肠球菌属及凝固酶阴性葡萄球菌,分别占21.74％、19.57％、17.39％、13.04％、10.87％、8.70％.结论 针对引起的下呼吸道感染的危险因素进行预防与控制,对降低下呼吸道感染具有重要意义.     

标准化病人教学视频联合PCMC教学模式在感染科的应用

目的探讨标准化病人教学视频联合问题导向临床医学教学模式(PCMC)在感染科护理教学中的应用。方法于2018年9月—2019年1月将学校2017级42~47六个班级共计60名学生作为研究对象,42~44班为观察组(n=30),45~47班为对照组(n=30)。对照组采用标准化病人教学视频教学,观察组在上述教学模式基础上增加使用PCMC教学模式,比较两组最终考核成绩及教学满意度。结果观察组理论知识考核成绩及专业技能考核成绩均高于对照组,差异有统计学意义(P<0.05);观察组教学满意度比对照组高,差异有统计学意义(P<0.05)。结论标准化病人教学视频联合PCMC教学模式可显著提高感染科学生理论知识及专业技能成绩,提升教学满意度。     

精细化临床带教在儿科急诊实习生中的应用

目的分析精细化临床带教在儿科门急诊实习生临床带教中的应用价值。方法以2018年7—11月于医院儿科门急诊临床专业实习生48例为对照组,采用传统教学法,以2019年7—11月于本院儿科门急诊实习的52例临床专业实习生为试验组,采用精细化临床带教,包括一对一CBL带教和一对一日常考核,对比两组带教效果。结果试验组实习生实习结束后的理论成绩、实践成绩和案例临床诊疗思维能力,均明显高于对照组,组间差异具有统计学意义(P<0.05)。结论在儿科门急诊运用精细化临床带教,包括一对一CBL带教和一对一日常考核教学模式,能显著提高实习生理论、实践、病例综合分析能力以及对实习满意度,具有较好的教学效果。     

感染科住院医师规范化培训的实践与探索

住院医师规范化培训是医学生毕业后教育的重要组成部分,是培养合格的、具有综合素养的青年医师的重要手段。西安交通大学第二附属医院感染科在住院医师规范化培训的实践与探索中,逐步建立了符合专业特点的规培管理体系,包括规培管理梯队、规培实施细则、三阶段评价反馈体系、教学相长双向培训模式、三维评价体系等,旨在以岗位胜任力为导向,从理论知识、临床技能、医学人文素养、科研能力、人际沟通能力,多维度高质量的进行住院医师规范化培训工作。