Different opinions of physicians on the importance of measures to prevent acquisition of Pseudomonas aeruginosa from the environment

BACKGROUND: Since chronic infection with mucoid Pseudomonas aeruginosa (PA) is associated with deteriorating lung function, many parents of young children with cystic fibrosis (CF) fear the first PA positive throat swab as a milestone in the progression of the disease. To reduce the risk of PA acquisition from the environment, they perform preventive measures at home or outdoors. METHODS: In an attempt to evaluate the attitude of CF physicians towards these measures and the respective consulting practice, we mailed a questionnaire to all 65 certified paediatric CF centres in Germany. RESULTS: Physicians from 54 (83%) CF clinics replied. They expressed widely different ideas about the impact of the environment for the acquisition of P. aeruginosa, and recommended a large spectrum of preventive measures. Some physicians proposed only few precautions, which focussed on the prevention of cross-infection between patients, whereas others suggested prevention of any contact with moist or wet places, e.g. use different toothbrushes for mornings and evenings, or do without air-conditioning in the car. CONCLUSIONS: CF physicians have different opinions on the risk of PA acquisition from the environment. Doctors who recommend strict precautions could engender a parental fear of a ubiquous threat from invisible bacteria. The resulting extended safety measures might impair the family's quality of life.     

Facilitating access to glucometer reagents increases blood glucose self-monitoring frequency and improves glycaemic control: a prospective study in insulin-treated diabetic patients.

AIMS: To investigate whether availability of glucometer reagents increases the frequency of self-blood glucose monitoring (SBGM) and improves glycaemic control in diabetic patients. METHODS: Sixty-two insulin-treated diabetic patients were randomized to two groups, matched for age, gender, education, income, type and duration of diabetes, years of insulin treatment, number of daily insulin injections, and haemoglobin (Hb)A1c. All patients were given a glucometer, but one group (no cost, NC) was provided glucometer test strips free of charge. The other group (control, C) had to purchase strips as they found it necessary. Both groups of patients were followed longitudinally at 2-monthly intervals for 12 months with measurement of blood glucose and HbA1c, and the frequency of SBGM was determined by downloading the glucometer memory. RESULTS: The SBGM frequency was significantly higher in the NC group vs. the C group during the first 4 months (2.0 +/- 0.2 tests/day vs. 1.4 +/- 0.1 tests/day, P<0.025). Mean HbA1c remained stable over the 12 months in the NC group, whereas an increase with time was observed in the C group. The difference in HbA1c between the two groups was significant (P<0.002) after 6 months. Random blood glucose measured at each visit and average glucose recorded by the glucometer were also lower in the NC group vs. the C group (P<0.005). There was a negative correlation between HbA1c and SBGM frequency, and HbA1c in patients testing at least twice a day was lower than in those testing less than twice a day (8.8 +/- 0.2% vs. 9.6 +/- 0.2%, P<0.001). CONCLUSIONS: In this prospective study, having easy access to glucometer strips provided free of charge to patients increased SBGM frequency. The relationship between HbA1c and SBGM frequency supports the view that SBGM is an essential tool in diabetes management.     

Evaluation ofin vitro drug screening leads using experimental models of human ovarian cancer

Summary Five compounds which were identified as potential new anticancer drugs inin vitro screening with the human tumor colony forming assay were selected for further evaluation usingin vitro andin vivo models of human ovarian cancer. Three of five compounds were found to inhibitin vitro colony formation of ovarian cancer cell lines derived from both untreated and combination chemotherapy refractory patients. One compound was also found to prolong survival in a human ovarian carcinoma xenograft model system. This compound, chloroquinoxaline sulfonamide, was selected for development and has shown preliminary indication of activity in phase I clinical testing.     

胆汁4种初级结合型胆汁酸的多因素判别对胆汁成石性的判断价值

本文运用二值回归判别法探讨了胆汁中4种初级结合型胆汁酸含量变化对胆汁成石性的判断价值。根据52例测试数据得出4因素二类判别函数:Y=0.0395X_1-0.0386X_2 0.0185X_3 O.0586X_4-1.0513。87例自、回代结果表明,该判别函数在判断符合率、错误率、假阳性率、假阴性率等诸方面均较使用1种初级结合型胆汁酸作为判别指标优越。     

力学在食管胃腔内弹力环扎吻合术的应用

本文探讨食管胃腔内弹力环扎吻合术的力学机理。这是一种不用任何缝合材料或吻合器进行胃食管吻合的新技术,我们已成功应用于临床。取临床所用的乳胶管按该材料多向异性特征、实验条件以及弹力环数目分为8组,每组3个样品进行各种体外力学试验。通过应力—应变(拉力—伸长)关系曲线和定伸长松驰试验确定它的力学特性是一种粘弹性材料。根据实验所得的应力换算为弹力环对食管和胃组织所施加的最佳压力(压强)是4.23±0.23Kg/cm~2,这样才能保证这一种新颖的吻合术可达到简便、安全、可靠的目的。     

开展电话回访搭建医患沟通桥梁

通过对3 500余人次的有效电话回访,实施健康教育、健康指导3000余人次,受理健康咨询500余人次,协调和化解各类医疗纠纷20余起。电话回访搭起了和谐医患关系的桥梁。     

丙泊酚、氯胺酮全凭静脉麻醉应用于烧伤病人的临床研究

目的:研究微量注射泵输注丙泊酚和氯胺酮全凭静脉麻醉在烧伤患者切痂植皮手术中的临床效果。方法:选择期手术患者,随机分为丙泊酚、氯胺酮组(P·K组)和咪达唑仑、氯胺酮组(M·K组)。P·K组术前10min首次静注丙泊酚2mg·kg和氯胺酮2mg·kg。M·K组术前10min首次静注咪达唑仑0 2mg·kg、氯胺酮2mg·kg ,随后两组以微量注射泵输注控制在P·K组丙泊酚6 6 . 6 6 μg·kg-1·min-1和氯胺酮4 1 .6 6 μg·Kg-1·min-1。记录注药后5、10min、切痂、取皮、植皮及停药后5、10min各时段无创血压(MAP)心率(HR)脉搏氧饱和度(SpO2 )及两组氯胺酮用药量变化。结果:P·K组氯胺酮用药量比M·K组少,P·K组MAP和HR无明显变化(P >0 . 0 5 ) ,M·K组MAP、HR均较麻醉前升高(P <0 . 0 1) ,两组SpO2 于诱导注药后均有一过性下降,数分钟恢复正常,两组比较差异无显著意义(P >0 . 0 5 )。结论:微量注射泵输注丙泊酚和氯胺酮全凭静脉麻醉安全可行,副作用小,可控性强,适用于烧伤患者切痂植皮手术。     

Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care.

OBJECTIVES: To examine patient satisfaction with and recommendation of a hospital, with a special focus on the correlation of these measures to patient ratings of interpersonal and technical performance of the hospital. DESIGN: Telephone survey of patients with four specific conditions after their discharge from hospitals. SETTING: Accredited district teaching hospitals and above, nationwide in Taiwan. PARTICIPANTS: A total of 4945 patients from 126 hospitals diagnosed with or undergoing procedures related to stroke, diabetes mellitus, Caesarean section, or appendectomy were interviewed by telephone. MAIN OUTCOME MEASURES: Overall patient satisfaction and recommendation were measured by single-item questions. Interpersonal skills were measured by three items: doctors' explanation, attitude, and caring. Technical skills were measured by another three items: hospital equipment, clinical competence, and outcome of treatment. RESULTS: Interpersonal skills were as influential or more influential than clinical competence on patient satisfaction for three of the four disease categories. In contrast, technical competence was a more influential predictor for recommendation for patients in all four disease categories. CONCLUSION: The preliminary results imply that a hospital with high percentage of patient satisfaction does not necessarily receive a high level of recommendation. This finding provides new insights for researchers and for hospital managers who devote resources exclusively for achieving the highest possible levels of patient satisfaction.     

SRTR Center-Specific Reporting Tools: Posttransplant Outcomes

Measuring and monitoring performance—be it waiting list and posttransplant outcomes by a transplant center, or organ donation success by an organ procurement organization and its partnering hospitals—is an important component of ensuring good care for people with end-stage organ failure. Many parties have an interest in examining these outcomes, from patients and their families to payers such as insurance companies or the Centers for Medicare and Medicaid Services; from primary caregivers providing patient counseling to government agencies charged with protecting patients.
The Scientific Registry of Transplant Recipients produces regular, public reports on the performance of transplant centers and organ procurement organizations. This article explains the statistical tools used to prepare these reports, with a focus on graft survival and patient survival rates of transplant centers—especially the methods used to fairly and usefully compare outcomes of centers that serve different populations. The article concludes with a practical application of these statistics—their use in screening transplant center performance to identify centers that may need remedial action by the OPTN/UNOS Membership and Professional Standards Committee.