Methicillin-resistant Staphylococcus aureus is one of the important pathogens of healthcare-associated infections. In order to prevent and control the transmission of the drug-resistant organism in healthcare facilities, the Healthcare Infection Society and the Infection Prevention Society jointly conducted the guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus in 2021. This article introduces the guide from the background, preparation process, main prevention and control measures and further studies, and compares the guidelines with the current prevention and control measures in China, so as to provide a methodological reference for preparation of the guide for domestic infection prevention and control practitioners, and provide evidence-based prevention and control strategies for clinical practice.
目的 觀察七氟烷吸入復合骶管阻滯、基礎麻醉復合骶管阻滯及單純靜脈全麻在小兒腹股溝區手術的應用。 方法 將2008年5月-2009年8月收治的90例ASAⅠ~Ⅱ級擇期手術患兒分為3組：Ⅰ組為七氟烷吸入復合骶管阻滯組，Ⅱ組為靜脈麻醉復合骶管阻滯組，Ⅲ組為全憑靜脈麻醉組。每組30例，觀察3組麻醉效果。 結果 Ⅰ組患兒心率、平均動脈壓、呼吸頻率變化不明顯，Ⅱ組和Ⅲ組患兒術中和術后心率、平均動脈壓較術前升高（Plt;0.05），呼吸頻率明顯低于術前；Ⅲ組患兒蘇醒時間明顯延長，Ⅰ組和Ⅱ組患兒蘇醒期并發癥低于Ⅲ組，其中Ⅲ組患兒術后躁動與哭鬧多見。 結論 七氟烷吸入復合骶管阻滯用于小兒腹股溝區手術，患兒易于接受，麻醉過程中呼吸循環功能穩定，蘇醒快，清醒質量高，蘇醒期不良反應少，是臨床上值得推廣的麻醉方法。
【摘要】 目的 了解學生對醫院感染職業防護的基礎知識的認知程度和學習需求。 方法 2010年3月采用自行設計問卷，對參加《醫院感染與職業防護》課程學習的醫學學生進行摸底調查。 結果 92.73%不知道標準預防措施和銳器傷后的正確處理方法及補救措施；27.27%不知道抽血時應戴手套；25.45%不清楚醫務人員“六步洗手法”；90.91%不知曉工作服應交醫院統一洗滌。 結論 學生防護知識薄弱，防護行為不全面、不規范。教學應重點幫助學生樹立標準預防觀念，掌握正確職業防護知識，在臨床工作中以避免和減少各種危險因素的侵襲。【Abstract】 Objective To examine and evaluate the students’ knowledge and needs in studying hospital infection control and occupational protection. Methods Using a self-designed questionnaire in March 2010, we did a survey on students who attended the course of hospital infection control and occupational protection. Results Among all the students, 92.73% did not know standard prevention measures, and the correct treatment and remedial measures for sharp injuries; 27.27% did not know gloves should be worn at the time of blood drawing; 25.45% did not know the "six-step" hand-washing; and less than one out of ten students used hospital laundry to wash their uniform. Conclusions The students have a low level of relevant knowledge on occupational protection, and their protection behaviors were not complete or standard. Therefore, the teaching should help and support students to have a concept of standard prevention, and acquire sound knowledge and behavior of occupational protection in order to avoid and reduce the risk factors from their future clinical practices.
ObjectiveTo improve activities of daily living (referring to Barthel Index) in the older inpatients.MethodsIn January 2016, a quality control circle (QCC) was established. According to 10 steps in activity of QCC, we figured out the causes of low Barthel Index score in older inpatients by using Plato method and Fishbone Diagram which were common methods of QCC. In addition, we designed and implemented a rectification program to improve Barthel Index score.ResultsAfter intervention of QCC, the average Barthel Index score of the older inpatients increased from 72.40±6.42 to 89.30±5.87 with a statistical difference (P<0.01); the satisfaction percent of hospitalized patients increased from 94.5% to 98.7% with a statistical difference (P<0.01). The percentage of registered nurses whose theoretical test score were over 90 increased from 57% to 88% (P<0.01) and the satisfaction percent of nurses increased from 90.5% to 95.6% (P<0.01). Moreover, the member’s ability of learning, discovery, analysis and problem solving, communication, application of QCC skills were improved.ConclusionThe application of QCC activities will increase older inpatients’ Barthel Index score, improve the satisfaction of patients and nursing staff, and enhance the members’ ability of solving problems by using QCC skills.
【摘要】 目的 探討抗氧化應激是否參與參附注射液預處理誘導的腎臟保護作用。 方法 健康成年雄性SD大鼠21只隨機分為假手術對照組（Sham組）、腎臟缺血再灌注組（I/R組）和參附注射液組（SF組）；SF組給予參附注射液10 mL/kg腹腔注射，每日1次，連續給藥7d。麻醉下行右腎切除后，用無損傷動脈夾鉗夾左側腎蒂60min，再灌注24 h，制備腎缺血再灌注損傷動物模型。比較各組SD大鼠再灌注24 h腎臟組織中超氧化物歧化酶（superonidedismutase，SOD）水平、過氧化氫酶（catalese，CAT）和丙二醛（malonicalaldehyed，MDA）含量。 結果 與Sham組相比，I/R和SF組腎臟組織SOD和CAT顯著降低，而MDA明顯升高（Plt;0.05）；與I/R組比，參附注射液能明顯增加SOD和CAT水平（Plt;0.05），降低MDA含量（Plt;0.05）。 結論 參附注射液預處理可增強缺血再灌注損傷腎臟組織抗氧化應激，其表現為增強SOD和CAT的活力，減少MDA的生成。【Abstract】 Objective To explore the protective effect of Shenfu injection combined with antioxidant system on rats’ kidney after ischemia-reperfusion injury. Methods Twenty-one male Sprague Dawley (SD) rats were randomly divided into 3 groups: sham operation group (Sham group), ischemia-reperfusion group (IR group), and shenfu injection treated group (SF group). The rats were anesthetized with valebarbitone. Bilateral kidneys were exposed through midline incision. The right kidney underwent the nephrectomy and left renal pedicels were occluded for 60 minutes with a traumatic mini-clamp and then unclamped for 24 hours. Animals in SF group received Shenfu injection (10 mL/kg) through intraperitoneal injection every day for 7 days. About 24 hours after reperfusion, superoxide dismutase (SOD), CAT and malonical aldehyde (MDA) were measured. Results The levels of MDA were lower in SF group than those in IR group (Plt;0.05). The level of SOD and CAT in SF group increased more significantly than which did in IR group (Plt;0.05). Conclusion Our finding suggests that antioxidant system in SF group works more efficiently than IR group to overcome oxidative stress in renal ischemia-reperfusion injury.
Objective To observe the effect of pars plana vitrectomy (PPV) with epiretinal membrane peeling (ERMP) and (or) internal limiting membrane peeling (ILMP) and silicone oil tamponade for highly myopic macular hole retinal detachment (MHRD) with posterior staphyloma. Methods Eighty-five highly myopic MHRD patients (85 eyes) were enrolled in this study. All the patients were examined for corrected visual acuity (CVA), slit lamp microscope and preset lens, indirect ophthalmoscope, A/B ultrasound, optical coherence tomography (OCT) and intraocular pressure examination. The average axial length was (29.1plusmn;1.8) mm. There were 24 eyes with diffuse choroid atrophy and 61 eyes with partial choroid atrophy. The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis. The average logMAR CVA was 1.93plusmn;0.37. All the patients were treated with PPV and triamcinolone acetonide or indocyanine green (ICG) assisted ILMP and (or) ERMP and silicone oil tamponade. TA assisted ERMP was performed in 21 eyes; with ICG assisted ILMP in 56 eyes and TA assisted ILMP in eight eyes. The duration of silicone oil tamponade was (6.2plusmn;1.6) months. CVA, retina and macular hole status and complications were observed postoperatively. Differences between preoperative and postoperative CVA were evaluated by the t test and correlation analysis. Multiple logistic regression analysis was performed to assess the influence of individual preoperative factors on the initial anatomical success. Differences in the macular hole closure rate between eyes with or without macular schisis were evaluated for statistical significance using corrected chi-square. Results The mean logMAR CVA was 1.34plusmn;0.48 after surgery, which significantly improved compared to that before surgery (t=39.38, P＜0.01). The CVA after surgery was independent of axial length (r=0.142, P＞0.05), choroid atrophy (t=0.23, -0.165,P＞0.05) and macular hole closure (t=0.12, -0.005, P＞0.05). The retina reattached in 79 eyes (92.9%) and recurrence of retinal detachment occurred in six eyes (7.1%). Multiple logistic regression analysis indicated that recurrence of retinal detachment was independent of choroid detachment, proliferative vitroretinopathy, axial length, choroid atrophy and ILMP (OR=1.428, 5.039, 0.815, 2.578, 0.432; P＞0.05). Of these 85 eyes, macular hole closed in ten eyes (11.8%), macular hole did not close in 75 eyes (88.2%). There were 24 eyes (28.2%) experienced high intraocular pressure during the first 2 weeks after surgery, all of them were under control with drugs. There were 12 eyes (14.1%) presented with high intraocular pressure before the silicone oil removal, all of them were under control only by silicone oil removal. Conclusion For the treatment of MHRD with posterior staphyloma, PPV combined with ERMP and (or) ILMP and silicone oil tamponade show a high retinal reattachment rate.
目的 總結靜脈制劑Ⅰ期臨床耐受性試驗中的護理要點。方法 2011年10月－12月，采用隨機、盲法、安慰劑平行對照試驗設計，在健康志愿者中按劑量遞增原則，逐組完成8個劑量單次靜脈滴注給藥耐受性試驗。 結果 試驗順利完成。靜脈制劑的Ⅰ期耐受性試驗中，研究護士在臨床試驗前需認真學習試驗方案，做好試驗病房、監護急救設施設備的充分準備，針對可能出現的不良反應制定切實可行的處理預案，試驗過程中密切監測，對出現的不良反應做好救治工作。特別針對靜脈制劑，須做好受試者的心理疏導，保證靜脈穿刺一次成功，減少受試者因情緒緊張、穿刺疼痛等因素干擾對試驗藥物耐受性的評價。 結論 Ⅰ期臨床耐受性試驗實施前準備充分，試驗過程中為受試者提供良好的試驗環境和心理護理，提高靜脈穿刺一次成功率，密切監測，可使試驗過程順利，并獲得客觀、準確的試驗結果。
Objective To evaluate the safety and tolerance of medicinal charcoal enteric-coated tablets in healthy volunteers. Methods A total of 44 healthy volunteers were randomly divided into 6 single-dose groups (0.5 g, 2 g, 4 g, 6 g, 8 g and 10 g) and a multiple-dose group (3 g, 3 times a day, for 14 days). The safety profile and tolerance were evaluated by observing symptoms, vital signs, and laboratory tests. Results No serious adverse event was reported for any volunteer. Abdominal distension occurred in 2 volunteers in the 4 g dose group and the 6 g dose group. One volunteer in the 8 g dose group experienced nausea and vomiting. Transient decrease in white blood cell count was observed in one volunteer in the 10 g dose group. Abdominal distension occurred in 2 volunteers of the multiple-dose group. Conclusion Based on our findings, the maximum tolerated dose of medicinal charcoal enteric-coated tablets in Chinese healthy volunteers is 10 g. The recommended dose for subsequent clinical trials is 3 g, 3 times a day.
Objective To evaluate the clinical result of using osseointegratedimplants to retain removable orbital prostheses in repairing orbital defects. Methods Two patients with orbital defects caused by orbitaltumor were treated. Each of them got 4 implants. After average 6 months, we performed the secondary operation. After 7 weeks, we took impressions to make the implant-retained prostheses. The magnetic attachment was adopted. The prostheses were made of polysiloxane material(Factor II,Lakeside,Ariz). Results Both of the patients got the successful facial prostheses and were followed up 2 and 8 years respectively. All the implants were integrated well. There were no apparent inflammatory reactions in the soft tissue around percutaneous implants. The patients were satisfied with the facial appearance. Conclusion Implant-retained orbital prostheses are safe and effective in repairing orbital defects.
ObjectiveTo evaluate systematically the relationship between obesity and clinical prognosis in acute respiratory distress syndrome (ARDS) patients.MethodsA systematic search was performed in Pubmed, EMBASE, Cochrane databases, Wiley, Ovid, Medline, CNKI, VIP and Wanfang. All studies that reported obesity in the clinical prognosis of ARDS and acute lung injury were included. A meta-analysis was performed using RevMan 5.0 and Stata 10.0.ResultsA total of 28 368 patients from 9 studies were included in this meta-analysis. The combined results showed that obesity was associated with the decreased mortality of ARDS [odds ratio(OR)=0.63, 95% confidence intervals (95%CI) 0.41 to 0.98, P=0.04]. In subgroup analysis, the result showed no obvious relationship between obesity and 28-day mortality in ARDS/ALI (OR=0.92, 95%CI 0.55 to 1.54, P=0.76). However, obesity was associated with lower risk of 60days and 90-day mortality in ARDS/ALI (60-day: OR=0.84, 95%CI 0.75 to 0.94, P=0.002; 90-day: OR=0.38, 95%CI 0.22 to 0.66, P=0.000 5). Compared with normal weight patients with ARDS, hospital length of stay, ICU length of stay, and duration of mechanical ventilation did not differ significantly [hospital length of stay: weighted mean difference (WMD)=3.61, 95%CI –0.36 to 7.57, P=0.07; intensive care unit (ICU) length of stay: WMD=1.52, 95%CI –0.22 to 3.26, P=0.09; duration of mechanical ventilation: WMD=–0.50, 95%CI –2.18 to 1.19, P=0.56], but ventilator-free days was significantly longer in obese patients (WMD=2.68, 95%CI 0.86 to 4.51, P=0.004).ConclusionsObesity is not associated with hospital length of stay, ICU length of stay, and duration of mechanical ventilation in patients with ARDS. However, obesity is associated with a reduction of long-term mortality and increased ventilator-free days in the patients with ARDS. Additional larger randomized controlled studies are needed to confirm the possible role of obesity in the clinical prognosis of ARDS.