Phosphate Supplementation in Parenteral Nutrition

Pronounced serum phosphate deficiency has been shown to be deleterious when starting parenteral nutrition in severely malnourished patients. The consequences of phosphate deficiency and the need for phosphate supplementation in critically ill patients are not well known. Thirty ICU patients randomized into two groups were studied. The patients received complete parenteral nutrition with and without addition of extra phosphate. The low phosphate group got 7.5 mmol phosphate (from the phospholipids in the fat emulsion) and the high phosphate group got 60-80 mmol phosphate/day. There were no significant differences in serum phosphate or calcium levels between the groups. In the high phosphate group the phosphate balance was positive and calcium balance zero while in the low phosphate group both phosphate and calcium balances were negative. The phosphate content in a standard nutrition programme is not sufficient to create a positive phosphate balance. With the addition of 80 mmol phosphate/day a positive balance was achieved. It is hard to establish guidelines for the administration of phosphate in ICU patients. 20-40 mmol may normally be satisfactory but we have shown that ICU patients may need and can tolerate up to 80 mmol/day.     

Parental acceptance of restraint methods used for children with intellectual disabilities during dental care

This study evaluated 209 Brazilian parents' acceptance of the use of restraint during dental care for their children with intellectual disabilities. Participants were interviewed end they also watched a video on physical restraint techniques, sedation, and general anesthesia. There was a statistically significant relationship for 22.9% of the parents. The odds ratio revealed that participants were more likely to accept physical restraints for their child when parents were over the age of 35 and from an underprivileged economic class and when the children had previously experienced physical restraints. Dental healthcare professionals should consider the individual needs of each patient and consult with the child's family if there is a need to use restraints.     

ICU内开展中药辨证食疗的观察研究

目的 探讨中药辨证食疗对危症患者营养支持的安全性和有效性.方法 ICU内危重患者109例,随机分为实验组(中药食疗组)59例和对照组(传统EN+PN营养支持组)50例.观测两组病人参加实验后第3、7天的营养及免疫功能的评估:血淋巴细胞计数、HB、TP、ALB、GPT、BUN、T-Chol、K+、Na+、Cl-、Ca2+以及恢复肛门排气、排便时间、不适反应、营养支持费用.结果 运用中药辨证食疗组患者的营养善优于单纯要素营养组,未发现需中止灌注的并发症,各项监测指标两组间无明显差异,实验组费用为对照组的1/3.结论 在对危重病人营养支持时添加调理的中药,无并发症发生,并且有利于调节机体的代谢和免疫功能.     

Can Sick Children Tell Time?: Emergency Department Presentation Patterns of Critically Ill Children

OBJECTIVE: Children show a consistent pattern of ED use, with the majority of patients presenting during the late afternoon and evening hours. This study evaluated whether such a diurnal pattern also exists for critically ill children and the implications of such a presentation pattern on ED staffing. METHODS: A review was performed of the ED diagnoses and times of presentation for children less than 12 years of age at 28 nonpediatric hospitals over the six-year period from July 1990 to October 1996. In addition to total ED pediatric visits, a subset of critically ill children (CIC) were identified as those with an ED diagnosis of: meningitis, cardiac arrest, diabetic ketoacidosis, status epilepticus, meningococcemia, or epiglottitis, or those undergoing endotracheal intubation in the ED. A second group of non-critically ill children (NCIC) was composed of children with an ED diagnosis of otitis media, tonsillitis, or pharyngitis. Data collected on each patient included age, diagnosis, site of care, and time of service. Presentation patterns for all three groups were compared for time of day, with statistical analysis through chi-square, ANOVA, and Spearman's rho correlation. RESULTS: A total of 409,820 pediatric ED visits were examined, with 688 CIC children and 28,344 NCIC identified. Presentation patterns for NCIC visits mirrored those of the total pediatric population, with the traditional increase in the late afternoon and evening hours (correlation 0.96). CIC presented much more erratically, with a distribution spread more uniformly throughout the day compared with the total pediatric population (correlation 0.72). Thirty-seven percent of CIC presented during the evening hours of 16:00 to 24:00, compared with 49% for NCIC and 53% for the total pediatric population, while 22% of CIC presented from 24:00 to 08:00 compared with only 13% of NCIC and 10% of total pediatric patients (p < 0.001). CONCLUSION: Critically ill children present more uniformly throughout the day and do not have the same presentation patterns as ambulatory children. ED staffing should reflect this difference and not focus pediatric ED services simply on hours of peak pediatric visits.     

Questionnaire survey on the understanding of epilepsy among non-medical persons

Background: A questionnaire survey was conducted on the understanding of epilepsy and febrile seizures in preschool teachers, public health nurses, and parents or caregivers of children with epilepsy.
Methods: The survey was performed in three different sites at different dates. The participants were 16 preschool teachers, 25 public health nurses, and 34 parents or caregivers of children with epilepsy.
Results: Seventy-seven percent of the participants thought that epilepsy was not always untreatable. Sixty-seven percent of the participants thought that epilepsy was not a hereditary disease. Sixty-one percent of the participants considered that repetitive seizures cause brain damage, and 93% of them thought that patients with epilepsy must be treated. Seventy-six percent of the participants thought that febrile seizures evolve into epilepsy if left untreated. Seventy-seven percent of the participants considered that vaccination can be performed in patients with epilepsy or febrile seizures, and 89% of them thought that swimming should not be forbidden in patients with epilepsy or febrile seizures. There was no significant difference in the answers with regard to the positions of the participants except in one question.
Conclusions: The present questionnaire survey provided some information on the understanding of epilepsy among non-medical persons. A nationwide public survey is needed to clarify the problems in the public understanding of epilepsy.     

Bartonella quintana in Body Lice and Head Lice from Homeless Persons, San Francisco, California, USA

Bartonella quintana is a bacterium that causes trench fever in humans. Past reports have shown Bartonella spp. infections in homeless populations in San Francisco, California, USA. The California Department of Public Health in collaboration with San Francisco Project Homeless Connect initiated a program in 2007 to collect lice from the homeless to test for B. quintana and to educate the homeless and their caregivers on prevention and control of louse-borne disease. During 2007–2008, 33.3% of body lice–infested persons and 25% of head lice–infested persons had lice pools infected with B. quintana strain Fuller. Further work is needed to examine how homeless persons acquire lice and determine the risk for illness to persons infested with B. quintana–infected lice.     

肾功能亢进在重症患者中的发生率及对万古霉素应用的影响

目的： 研究肾功能亢进（ARC）在重症患者中的发生率和ARC对重症患者血清万古霉素浓度的影响。方法： （1）回顾性分析2016年1月-2017年6月某院重症医学科收治的所有检测过肾功能的患者，分析其ARC发生率。（2）回顾性分析2016年1月-2017年6月在该院重症医学科接受万古霉素常规剂量1 g q12h治疗的患者，评价ARC对血清万古霉素浓度的影响。结果： （1）本研究共纳入患者3 045名，研究结果表明重症患者ARC发生率为15.6%（474/3 045）。ARC组患者年龄显著低于非ARC组，肌酐清除率和GFR明显高于非ARC组。（2）本研究共纳入50例患者，ARC组的万古霉素稳态谷浓度显著低于非ARC组，谷浓度中位数分别为5.72（3.73，8.27）μg·mL^-1和14.06（8.74，22.14）μg·mL^-1，P<0.05。但2组之间的临床结局、微生物结局和死亡率没有显著差异。ARC组万古霉素稳态谷浓度低于10 μg·mL^-1的重症患者达78.9%，较非ARC组（29.0%）比例更高。万古霉素稳态谷浓度与年龄显著相关（ρ=0.739，P<0.05），与肌酐清除率显著相关（ρ=-0.716，P<0.05）。结论： 重症患者ARC发生率较高，ARC会使患者的万古霉素浓度难以达到治疗目标，这类患者需要根据肌酐清除率进行必要的给药剂量调整。     

中医"治未病"说略

"治未病"是中医学先进和超前的医学思想,既是医疗保健的理想境界,也是衡量医者水平的重要标志。"未病"包括无疾之身、疾病隐而未发、发而未传三种状态;"治未病"具有三种境界,可概括为"未雨绸缪,保身长全""见微知著,救其萌芽""料在机先,阻截传变"。现代"治未病"切入点可以表达为:养生是基础,体质是根本,关注高危人群、发病先兆和干预亚健康状态是重点。中医"治未病"的意义主要体现于减轻医疗卫生负担、保障民众健康、发挥中医优势、实现中西医对话与交流等方面。     

危重症患者并发深部真菌感染的早期治疗

目的 探讨在危重症病房患者并发深部真菌感染进行早期抗真菌治疗的适应证以及治疗效果.方法 对60例患者进行真菌病原学检测,同时进行早期经验性治疗,首选大扶康,200 mg每12小时1次,静脉滴注,对大扶康无效或根据病原学改用二性霉素B治疗.结果 60例真菌感染患者,其中白色念珠菌念珠最多占42例(70.00%),感染部位肺部最多占39例(65.00%),两种以上真菌感染及两个以上部位感染的患者分别为4例(6.67%)和5例(8.33%).大扶康的有效率为60.00%,大扶康无效者对二性霉素B有效率为41.67%,总的有效率76.67%,无效率8.33%,死亡率15.00%.结论 对急危重症的患者,真菌感染的早期治疗是关键,大扶康对大多数患者有效,需早期用药.     

微量注射泵湿化对人工气道效果的观察

目的观察微量注射泵与传统湿化方法的效果，使之临床应用。方法选择150例机械通气患者，随机分为两组，统一表格记录，进行连续观察，将获得资料进行统计分析。结果微量注射泵组无发生刺激性咳嗽及痰阻、痰痂形成1例、气道粘膜损伤出血2例、肺部感染5例：传统组刺激性咳嗽67例、气道粘膜损伤出血10例、痰痂形成21例、痰阻16例、肺部感染26例。结论微量注射泵湿化是一种简单、安全、稳定、有效的方法，减少流程、提高效率。