住院精神病人院内感染的部位及高峰时间分析

目的　探讨精神科住院病人院内感染的部位及高峰时间。方法　采用圆形统计法对 1997年 1月～2 0 0 2年 12月间每月院内感染人数作圆形统计分析。结果　精神科住院病人院内感染以呼吸系统最多见 ,占5 6 4 8% ;感染高峰时间具有显著性差异 (Y =0 14 5 ,P <0 0 5 ) ,高峰时间约为 12月 17日 (按季节为初冬 )。结论　在感染高峰季节应加强对院内感染的监控和防治     

赖型钩端螺旋体重组DNApCX7的特异性鉴定和限制性内切酶谱分析

本实验将赖型钩端螺旋体（简称钩体）ＤＮＡ基因库的克隆ｐＣＸ７制备成￣（３２）Ｐ－重组ＤＮＡ探针，对８个不同血清群的１７株问号状钩体、双曲钩体ＰａｔｏｃⅠ株以及细螺旋体３０５５株ＤＮＡ进行打点杂交；同时用１５种ＤＮＡ片断进行限制性内切酶谱分析。结果表明，该重组ＤＮＡ具有问号状钩体种（Ｓｐｅｃｉｅｓ）特异性，但与不同问号状钩体之间的同源性程度有差别；限制性内切酶谱分析发现ｐＣＸ７重组ＤＮＡ片段长约１．７ｋｂ，具有１个Ｂｇ１Ⅱ识别位点和３个ＢｓｔＢ１识别位点。     

大鼠子宫内膜抗菌成分的初步分析

作者以１％乙酸冲洗ＳＤ大鼠子宫内膜，获得子宫内膜酸溶性提取物。利用琼脂糖弥散法和电泳凝胶琼脂糖弥散法抗菌试验发现，子宫内膜提取物有三条主蛋白带对致病性大肠杆菌ＭＬ－３５Ｐ耐药株有强抗菌活性，这三条抗菌蛋白带命名为ＲａｔＵＰ－１，ＲａｔＵＰ－２和ＲａｔＵＰ－３，分别占子宫内膜提取物总蛋白量的４．５％，５．７％和６．６％。虽然提取物存在溶菌的活性，但其含量甚微，在ＡＵ一ＰＡＧＥ图谱上亦未能显现溶菌酶条带。本实验的结果提示子宫内膜合成一类抗菌多肽，可能在子宫抗菌机制中发挥重要作用。     

Intuition from Beginning to End? Bion's Clinical Approaches

This paper is intended to offer a foundation for comparison of the approaches of Wilfred Bion and Donald Winnicott. In particular, I try to plot the oscillation of Bion's clinical method from his early Group period at the Tavistock Clinic (up to around 1950) when he emphasized countertransference; his part‐object interpretation method in the 1950s after his analysis with Klein when he and colleagues were experimenting with the psychoanalysis of people in psychotic states (1953–59); and then his return to his investigation of the intuitive approach to clinical data, around 1965–70.     

Trends in Medicare Part D Medication Therapy Management Eligibility Criteria

Background

To increase the enrollment rate of medication therapy management (MTM) programs in Medicare Part D plans, the US Centers for Medicare & Medicaid Services (CMS) lowered the allowable eligibility thresholds based on the number of chronic diseases and Part D drugs for Medicare Part D plans for 2010 and after. However, an increase in MTM enrollment rates has not been realized.

Objectives

To describe trends in MTM eligibility thresholds used by Medicare Part D plans and to identify patterns that may hinder enrollment in MTM programs.

Methods

This study analyzed data extracted from the Medicare Part D MTM Programs Fact Sheets (2008–2014). The annual percentages of utilizing each threshold value of the number of chronic diseases and Part D drugs, as well as other aspects of MTM enrollment practices, were analyzed among Medicare MTM programs that were established by Medicare Part D plans.

Results

For 2010 and after, increased proportions of Medicare Part D plans set their eligibility thresholds at the maximum numbers allowable. For example, in 2008, 48.7% of Medicare Part D plans (N = 347:712) opened MTM enrollment to Medicare beneficiaries with only 2 chronic disease states (specific diseases varied between plans), whereas the other half restricted enrollment to patients with a minimum of 3 to 5 chronic disease states. After 2010, only approximately 20% of plans opened their MTM enrollment to patients with 2 chronic disease states, with the remaining 80% restricting enrollment to patients with 3 or more chronic diseases.

Conclusion

The policy change by CMS for 2010 and after is associated with increased proportions of plans setting their MTM eligibility thresholds at the maximum numbers allowable. Changes to the eligibility thresholds by Medicare Part D plans might have acted as a barrier for increased MTM enrollment. Thus, CMS may need to identify alternative strategies to increase MTM enrollment in Medicare plans.