耐碳青霉烯类鲍曼不动杆菌感染暴发的分子流行病学研究

目的分析某院耐碳青霉烯类鲍曼不动杆菌（CRAB）的分子流行病学特征和耐药机制,为预防和控制医院感染提供依据。方法对该院2010年1月-2012 年5月临床分离的32株CRAB,采用随机扩增多态性DNA法进行基因分型,并进行流行病学分析;通过改良Hodge试验和EDTA协同试验对碳青霉烯酶进行表型分析;检测外排泵抑制剂羰基氰氯苯腙（CCCP）对美罗培南最低抑菌浓度（MIC）的影响,筛选外排泵表型阳性菌株。结果32株CRAB检测出9种基因型,其中以A（10株）、H（7株）两种基因型为主,其次为I型（4株）,B和E基因型各3株,其他基因型各有1或2株。2012年3-5月分离11株CRAB,10株为H(7株)和I(3株)两种基因型,1株为A型。21株（65.63%）CRAB检测到OXA 23特异性条带,且其在改良Hodge试验中均为阳性（包括2012年3-5月分离的11株CRAB）;除1株CRAB检测到NDM 1外,其余金属β 内酰胺酶基因检测均为阴性;CRAB在CCCP存在的条件下对美罗培南MIC仅有轻微改变,均为外排泵表型阴性。CRAB主要分布在重症监护室（13株）和神经外科（7株）。结论该院2012年3-5月间暴发了CRAB同一基因型克隆株的医院感染,鲍曼不动杆菌对碳青霉烯类药物耐药的主要机制是表达OXA 23;鲍曼不动杆菌对美罗培南耐药与外排泵无关,产NDM 1菌株已在该院出现。     

平板接种法监测牙科综合治疗台水路菌落总数的可行性研究

目的研究平板接种法监测牙科综合治疗台水路（DUWLs）菌落总数的可行性。方法采集某院DUWLs系统50份水样标本,分别采用平板接种法和国家生活饮用水标准检验方法中规定的倾注平板法进行培养,比较两种方法的检测结果。结果倾注培养法和平板接种法检测DUWLs中菌落计数,差异无统计学意义（T=315.50,P＞0.05）;检测菌落数的合格率分别为58.00%和52.00%,差异亦无统计学意义（χ2=0.57,P＞0.05）。结论平板接种法与国标倾注平板法检测DUWLs系统中的菌落总数无差异。平板接种法操作简单,易于细菌的初步鉴定,日常水质监测中可替代国标倾注平板法。
［中图分类号］R181.3+2     

2008—2010年某院临床主要病原菌分布及耐药性变迁

目的探讨某院临床近年主要病原菌分布及耐药性,为临床合理用药提供依据。方法收集该院2008年1月-2010年12月分离自门诊及住院患者的病原菌资料,对其构成及耐药性作统计分析。结果共分离病原菌7 008株,其中革兰阴性菌3 961株（56.52％）,革兰阳性菌1 582株（22.57％）,真菌1 465株（20.91％）;居前3位的病原菌依次为白假丝酵母菌（1 015株,15.00%）、铜绿假单胞菌（906株,12.93%）、大肠埃希菌（874株,12.47%）。2008-2010年,金黄色葡萄球菌中耐甲氧西林株总检出率为85.07％(678/797),凝固酶阴性葡萄球菌中耐甲氧西林株总检出率为73.17％(150/205);大肠埃希菌和肺炎克雷伯菌产超广谱β 内酰胺酶株的总检出率分别为64.19％（561/874）、46.31％（301/650）。金黄色葡萄球菌对万古霉素、替考拉宁敏感,对复方磺胺甲口恶唑敏感率（68.42％～74.51%）较高,对其余抗菌药物敏感率均＜30%;凝固酶阴性葡萄球菌对万古霉素、替考拉宁敏感;大肠埃希菌和肺炎克雷伯菌对亚胺培南和美罗培南敏感率（95.52％～100.00％）最高,大肠埃希菌对第三代头孢菌素头孢噻肟、头孢曲松、头孢哌酮和氟喹诺酮类环丙沙星、左氧氟沙星敏感率均＜30％。3年铜绿假单胞菌对头孢他啶和美罗培南的敏感率均较高,分别为60.31%~85.83%、59.38%~73.23%。结论该院分离的主要病原菌对常用抗菌药物耐药性普遍较高,应加强监控,合理使用抗菌药物,有效预防和控制医院感染的发生。     

丙型肝炎病毒职业暴露处理与追踪随访

目的了解临床医务人员发生丙型肝炎病毒(HCV)职业暴露后处理过程及感染情况,为HCV职业暴露的防护提供经验。方法调查5例发生HCV职业暴露医务人员的暴露环节、暴露后处理方法及追踪随访结果。结果5例发生HCV职业暴露的医务人员均为临床护士,1例确诊为职业暴露后急性感染HCV。发生HCV暴露后,均给予常规心理支持和咨询,4例排除感染者很快恢复正常的工作和生活;确诊被感染者暂时调离临床一线岗位,加强心理支持,坚持完成1年聚乙二醇干扰素联合利巴韦林的抗病毒治疗后痊愈。结论医务人员发生HCV职业暴露后及时上报、进行HCV RNA感染监测;确诊感染HCV后尽早联合聚乙二醇干扰素及利巴韦林抗病毒治疗,是治愈HCV急性感染的关键措施。     

Healthcare Cost and Predictive Factors: High- and Low-Utilization Model Development

Healthcare costs in the U.S. are the highest in the world and are increasing rapidly. With increasing costs, employers and health insurance companies are trying to contain the cost of healthcare. This study aims at developing a predictive model relating enrollees' healthcare insurance claims to their health risks while controlling for gender, age, and their previous year's claims. Our study findings suggest that age, gender, and a previous year's healthcare expenditure are strong predictors of healthcare cost and that none of the six biomarkers was a significant predictor. Even though these biomarkers failed to contribute to the predictive model, they are, nonetheless, important predictors of future chronic diseases, many of which are leading causes of death in the U.S.     

Health Marketing and Sales Distribution Software Related to Computer User Satisfaction

No abstract available for this article.     

The four Ps of patient experience: A new strategic framework informed by theory and practice

This article proposes a new strategic framework to assist healthcare organizations in achieving great patient experiences in the healthcare setting. We synthesize models of practice and literature relevant to the patient experience in order to propose the four Ps of patient experience. Key levers used in this model are: (a) trained autonomous physicians, (b) multidisciplinary partners, (c) alternative places of care delivery matched to patient conditions and needs, and (d) standardized yet flexible processes. Healthcare leaders will be able to use the proposed framework to develop detailed strategies toward improving patient satisfaction and experiences.     

Improving the Work Potential of Brain-Injured Adolescents and Young Adults

Brain injured individuals have a unique set of skills and deficits which make them difficult to place in traditional lobs and work programs. Although they may function at a relatively high level intellectually, these individuals often demonstrate deficits in attention, motivation, memory, and social skills. A variety of strategies must be employed in assessing and developing the work potential of the brain injured individual. This paper describes a work program that has been designed to meet the unique needs of the brain injured population. Case examples are included to illustrate application of these strategies.     

Patient Influences on Satisfaction and Loyalty for GP Services

Little is known about the influence that patients themselves have on their loyalty to a general practitioner (GP). Consequently, a theoretical framework that draws on diverse literature is proposed to suggest that along with satisfaction, patient loyalty is an important outcome for GPs. Comprising 174 Australian patients, this study identified that knowledgeable patients reported lower levels of loyalty while older patients and patients visiting a GP more frequently reported higher levels of loyalty. The results suggest that extending patient-centered care practices to encompass all patients may be warranted in order to improve patient satisfaction and loyalty. Further, future research opportunities abound, with intervention and dyadic research methodologies recommended.     

Hepatitis B and influenza vaccines: Important occupational vaccines differently perceived among medical students

Healthcare personnel (HCP) are at risk from occupational exposure to airborne and bloodborne pathogens, and the risk of infection among HCP is greater than among the general population.