依托信息化手段构建医院感染绩效考核一体化管理体系

目的探索一种科学、客观、高效的医院感染管理新模式,提高医院感染管理质量。方法依托计算机网络技术研发一套医院感染绩效考核一体化管理体系,医院感染管理对应用医院感染绩效考核一体化管理体系前后医院感染发病率、病原送检率、医院感染知识培训参学率、住院患者抗菌药物使用率、洗手液和手消毒剂消耗量进行比效。结果在应用绩效考核一体化管理体系前医务人员医院感染知识培训参学率、病原送检率分别为91.30%、34.87%;应用后分别为97.80%、47.98%,洗手液和手消毒剂消耗量明显提高;医院感染发病率、住院患者抗菌药物使用率应用前分别为3.78%、58.93%,应用后分别为2.20%、43.72%,差异均有统计学意义(P<0.05)。结论应用依托信息化手段构建医院感染绩效考核一体化管理体系,可有效提高全院医院感染管理质量与管理效能。     

海洋发光菌应用于三种有机毒物毒性效应的评估

目的观察3种有机毒物甲醛、乙腈和甲醇对海洋发光菌毒性的特点和规律。方法以甲醛、乙腈和甲醇为研究对象建立实验模型,以海洋发光菌明亮发光杆菌(photobacterium phosphoreum)T3变种为测试生物,用生物毒性测试仪测定样品及空白的发光度,计算相对发光率。结果发光菌的相对发光率与有机毒物的浓度呈负相关(r=-0.85~-0.99,P<0.01)。甲醛、乙腈和甲醇使明亮发光杆菌产生50%光损失时的浓度(EC50)分别为54.36μg/ml、19.58 mg/ml和37.92 mg/ml。结论海洋发光菌为有机毒物的毒性监测和评价提供直接证据,具有灵敏、快速等优点,可以弥补化学分析方法分析有机毒物毒性时的不足,具有广泛的应用前景。     

基于胜任力评价的社区卫生服务机构管理人员绩效考核体系探讨

目的构建适合我国国情的社区卫生服务机构管理人员绩效评价体系。方法从胜任力评价角度确定指标维度,通过文献研究筛选初选指标,通过两轮专家咨询确定社区卫生服务机构管理人员绩效评价体系构架,最后运用模糊综合评价确定指标权重。结果从工作业绩、领导能力、业务水平、满意度4个维度进行考核,共有一级指标4个,二级指标14个。结论针对当前社区卫生服务机构中管理人员绩效考核存在的问题,制定了一套适合的胜任力考核指标体系,指明了社区卫生服务机构管理人员绩效考核新方向。     

Individual differences in responses to ethanol and d-amphetamine: a within-subject study

BACKGROUND: In some individuals, ethanol (EtOH) produces marked stimulant-like subjective effects resembling those of stimulant drugs, like d-amphetamine (AMP). In this study, we examined the neurochemical basis of these individual differences by examining the same subjects' responses to both EtOH and AMP. A positive correlation between subjects' responses to the two drugs may suggest that AMP and EtOH produce their stimulant-like subjective effects by a shared mechanism. METHODS: Twenty-seven volunteers (17 male, 10 female), aged 21-35, received beverages or capsules containing EtOH 0.8 g/kg, AMP 10 or 20 mg, or placebo on four separate sessions in random order and under double-blind conditions. Various self-reported and objective drug effects were measured, including measures sensitive to subjective and cognitive stimulant-like effects. RESULTS: EtOH and AMP produced their prototypical subjective and behavioral effects, including increased ratings of stimulant-like subjective effects, increased heart rate and blood pressure, and improved vigilance performance after AMP and increased ratings of sedative-like subjective effects, increased heart rate and blood pressure, and impaired vigilance performance after EtOH. Consistent with previous reports, there was substantial intersubject variability in subjective responses to EtOH: some subjects reported primarily stimulant-like effects, whereas others reported primarily sedative-like effects. To examine the relationship between these responses to EtOH and subjects' responses to AMP, correlations were examined between effects of EtOH and AMP. For all subjects together, there was a significant positive correlation between responses to EtOH and 20 mg AMP on the ARCI A scale (a measure of stimulant-like subjective effects; r = 0.41, p < 0.05). Among only those subjects who reported primarily stimulant-like effects from EtOH, the correlation between EtOH and AMP was 0.64 (p < 0.05). CONCLUSIONS: Subjects who experience pronounced stimulant-like effects from EtOH also report greater stimulant effects from AMP, suggesting that these effects may be mediated through similar mechanisms. These correlations between the drugs' effects were not observed on other measures, such as DSST or vigilance task performance or heart rate. This may indicate that these other effects are mediated by separate mechanisms. The study illustrates a novel approach to studying the neurochemical basis of drug effects.     

Factors influencing the response and survival of patients with liver metastases from breast cancer receiving OK-432-combined adoptive immunotherapy

Summary The response and survival of 26 patients with liver metastases from breast cancer, who received OK-432-combined adoptive immunotherapy from 1984 to 1990, were evaluated. OK-432-combined adoptive immunotherapy was comprised sequential treatment via the hepatic artery with a streptococcal preparation, OK-432 (1–5 KE), and adoptive transfer of lymphocytes expanded in T-cell growth factor and sonicated tumor extract antigen. Seventeen (65%) patients responded to the therapy. The median survival time of all patients after treatment was 13 months (range, 2–63 months). Of the 20 prognostic factors analyzed, performance status (PS) alone was related to response (P<0.01). The response rate of the patients with a PS of 0–2 was 83% but only 25% in those with a PS of 3 or 4. In univariate analysis, 11 factors significantly influenced the survival: tumor response; size of primary tumor; menopausal status; PS; serum bilirubin, albumin, lactate dehydrogenase and glutamate-oxalate transaminase (aspartate aminotransferase); the extent of liver involvement; and the number and the proliferation rate of transferred lymphocytes. The MST was 22.8 months for the responders versus 2.8 months for the nonresponders (P<0.01). In multivariate analysis, the most important factor associated with survival was the tumor response, as well as PS, liver involvement, lactate dehydrogenase and albumin. These results suggest that OK-432-combined adoptive immunotherapy can be considered a candidate for a randomised control study and these factors should be used for stratification.Abbreviations TCGF T-cell growth factor - PS performance status - MST median survival time - CR complete response - PR partial response - NC no change - PD progressive disease     

晚期血吸虫病疾病负担评价方法的比较研究

目的　比较晚期血吸虫病（晚血）伤残调整寿命年（Disability?adjusted life year, DALY）的评价方法，为准确评价晚血疾病负担提供依据。方法　以2017年湖南省晚血救助病例为研究对象，分别采用全球疾病负担（The global burden of disease and injury，GBD）通用症状法、增加晚血常见症状后的改良GBD法和基于患者生命质量评价的生命质量法，计算晚血患者健康寿命损失年（Years lived with disability, YLDs）。结果　GBD通用症状法计算得出湖南省晚血患者YLDs为673.94 人·年，人均YLDs为0.181人·年，YLDs率为10.61人·年/10万人；改良GBD法计算得出晚血患者YLDs为728.77人·年，人均YLDs为0.196人·年，YLDs率为11.48人·年/10万人；生命质量法计算得出晚血患者YLDs为1 761.99人·年，人均YLDs为0.474人·年，YLDs率为27.75人·年/10万人。改良GBD法计算所得湖南省晚血患者YLDs较GBD通用症状法高8.14%，生命质量法计算所得YLDs是GBD通用症状法的2.61倍。在纳入计算的各种主要晚血症状中，按照对晚血疾病负担贡献的高低排序，依次为腹水、中度贫血、重度贫血、腹泻和便血。结论　与GBD通用症状法、改良GBD法相比，生命质量法能更全面地评估晚血患者的YLDs。     

Diagnosing delirium by telephone

To determine whether delirium can be diagnosed by telephone, we interviewed 41 subjects aged 65 years or older 1 month after repair of hip fracture, first by telephone and then face-to-face. Interviews included the modified telephone Mini-Mental State Examination and the Delirium Symptom Interview. Delirium was diagnosed using the Confusion Assessment Method diagnostic algorithm, and the telephone results were compared with the face-to-face results (the "gold standard"). Of 41 subjects, 6 were delirious by face-to-face assessment; all 6 were delirious by telephone (sensitivity 1.00). Of 35 patients not delirious by face-to-face assessment, 33 patients were not delirious by telephone (specificity = 0.94). We conclude that telephone interviews can effectively rule out delirium, but the positive diagnosis should be confirmed by a face-to-face assessment, especially in populations with a low prevalence of delirium.     

Therapeutic effects of individual physical therapy in ankylosing spondylitis related to duration of disease

Summary Physical therapy in ankylosing spondylitis (AS) is considered important for maintaining or improving mobility, fitness, functioning, and global health. We studied the influence of disease duration on the short term effects of supervised individual therapy. One hundred forty-four AS outpatients (modified New York Criteria; mean age: 43 years; median duration of disease: 4 years; range: 0–33) received 12 supervised individual treatments in a 6-week course of 30 minutes. Endpoints were: spinal mobility (thoracic and lumbar flexion and extension, chest expansion, cervical rotation), fitness (maximum work capacity by ergometry), functioning (Sickness Impact Profile (SIP) and the Functional Index (FI)), and global patient assessment of change on a visual analogue scale. After 6 weeks patients had improved in all endpoints, but only significantly in rotation (8 degrees, 10%), fitness (6 watt, 4%), and SIP (0.6, 14%; t-test, p<0.05). Global patient assessment improved by 1.1 (22%). Plots of change scores and disease duration showed no evident relation. We also divided the population into two groups, with the median disease duration as a cut-off. No relevant difference in improvement was found between short duration and long duration groups (t-test of change scores, p>0.05). In addition, no relevant correlation was found between change scores and disease duration (p>0.01). It may be concluded that irrespective of disease duration, short term supervised individual therapy is effective in AS, slightly improving mobility, fitness, functioning and global health.     

Patienten-zentrierte Evaluation der Krankheitsauswirkungen bei muskuloskelettalen Erkrankungen: Auswahl und Testung von Outcome-Instrumenten

Zusammenfassung Die Untersuchung der Effektivit?t und Kosten-Wirksamkeit von Interventionen, die Evaluation von epidemiologischen Studien der Krankheitsauswirkungen sowie Versorgungsstudien und klinisches Qualit?tsmanagement bedingen alle die standardisierte Erfassung von patienten-relevanten Parametern mit validierten, metrisch getesteten, zuverl?ssigen und verlaufsempfindlichen Frageb?gen. Dabei ist die sorgf?ltige Auswahl und Testung des Outcome-Instrumentariums in der Planungsphase aus wissenschaftlichen, ethischen und schlu?endlich auch ?konomischen Gründen ausschlaggebend. Die Auswahl von Instrumenten umfa?t die Recherche mit Hilfe von medizinischen Datenbanken (z. B. MEDLINE), die Prüfung der Face-Validit?t (mi?t ein Instrument, was wir zu messen beabsichtigen?) und der Kompatibilit?t (wird das Instrument international verwendet?). Die Testung von Instrumenten umfa?t die Prüfung der Zuverl?ssigkeit (reliability), der internen Konsistenz (internal consistency) und der Empfindlichkeit (sensitivity). Wichtig ist die Prüfung der praktischen Eignung (Interpretation der Skalen und Scores, Akzeptanz in der Studienpopulation). Vor Einsatz eines Instrumentes empfiehlt sich die Rücksprache mit den Entwicklern (Copyright Fragen, Scoring, aktuelle Version). Eingegangen: 25. August 1997 Akzeptiert: 26. September 1997     

Prevalence and reversibility of pulmonary dysfunction in refractory systemic lupus: improvement correlates with disease remission following hematopoietic stem cell transplantation

AIM: To report the prevalence and reversibility of pulmonary function test (PFT) abnormalities among systemic lupus erythematosus (SLE) patients, refractory to therapy, undergoing hematopoietic stem cell transplantation (HSCT). METHODS: Thirty-four SLE patients received 200 mg/kg cyclophosphamide and 90 mg/kg equine antithymocyte globulin followed by HSCT. PFTs were performed prior to, at 6 months, and yearly following HSCT. RESULTS: The prevalence of significant PFT abnormalities was high (97%). Low FEV(1) and FVC occurred in 26 of 34 patients (76%). A significant abnormality in diffusion capacity of the lung for carbon monoxide (Dlco) occurred in 26 of 32 individuals able to complete Dlco testing (81%). Dlco 18 months after HSCT. Five of 28 patients had a normal entry FVC; for each, the FVC remains normal. Of the 23 patients with an abnormal baseline FVC, 18 have improved, 15 completely and 3 partially. Eight of these 18 patients also have improved Dlco. The two patients with a diagnosis of SLS and one patient with SLE-related pulmonary hypertension improved in both parameters. Only 5 of 23 patients with an abnormal FVC did not improve. Each of these five patients retained active lupus in spite of HSCT. CONCLUSION: The prevalence of lung impairment among SLE patients requiring long-term immune suppression is high. Following HSCT, pulmonary impairments can improve, which is sustained if disease control is sustained.