目的 了解医院内血源性职业暴露高风险人群，有针对性采取防护措施，降低血源性职业暴露的发生率。 方法 对2008年1月－2011年12月四川省妇幼保健院52例血源性职业暴露医务人员，按照暴露人群、暴露方式、暴露病种、暴露地点的不同进行调查分析。 结果 52例职业暴露人群中护士27例（占51.9%）；产房和手术室为高发职业暴露场所，共32例，分别为17例（占32.7%）和15例（占28.8%）；职业暴露病种主要为乙型肝炎，共27例（占51.9%）；暴露方式主要为针刺伤，共37例（占71.2%）。 结论 提高医务人员职业防护意识，规范操作流程，加强自身防护是减少职业暴露的根本所在。
Objective To explore the application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians, and compare it with traditional rotational training. Methods Continuing physicians who received training in the Department of Neurology of Xuanwu Hospital, Capital Medical University between March 2021 and February 2023 were selected. The continuing physicians who received traditional rotational training between March 2021 and February 2022 would serve as the control group, and the continuing physicians who received four-dimensional teaching library model training between March 2022 and February 2023 would serve as the experimental group. The Mini-CEX scale was used to evaluate the clinical comprehensive abilities of two groups of continuing physicians. At the same time, self-made questionnaires were used to evaluate the evaluation of two groups of continuing physicians on different teaching modes. Results A total of 55 continuing physicians were included. Among them, there were 27 people in the control group and 28 people in the experimental group. There was no statistically significant difference in the comparison of general information between the two groups (P＞0.05). At the time of graduation, all items on the Mini-CEX scale in the experimental group were higher than those in the control group (P<0.05). The survey questionnaire results showed that the experimental group scored higher than the control group in terms of improving learning interest, improving self-learning ability, improving clinical thinking, improving analysis and problem-solving ability, improving doctor-patient communication ability, and increasing teamwork (P<0.05). Conclusion The application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians is better than that of traditional rotational training, which can significantly improve the clinical comprehensive ability of continuing physicians and is worth promoting.
Hot topics on the diagnosis and antimicrobial therapy of ventilator-associated pneumonia, including clinical diagnostic criteria, evaluation of biomarkers, ventilator associated events, clinical pulmonary infection score, ventilator-associated tracheobronchitis, microbiological diagnosis and duration of therapy were discussed. The viewpoints in the guidelines of America, Europe and Japan were also reviewed.
在过去二十年间，麻醉技术和手术技术的改进使肺部恶性肿瘤患者的手术死亡率大大降低，但术后并发症仍是主要问题。肺切除术后的常见并发症是肺部并发症[1]，主要表现是低氧血症，尤其在肺功能减退的肺切除患者中发病率更高[2]。目前国内对低氧血症的诊断缺乏统一的诊断标准，一些作者采用Russell等[3]提出的标准，吸空气氧的情况下，患者动脉血氧饱和度（SpO2）≤92%，大于30 s就可诊断为术后低氧血症。也有作者建议[4]将一次或以上血气检查PaO2lt;8 kPa或PaO2/FiO2lt;300 mm Hg（1 mm Hg=0.133 kPa）作为诊断低氧血症的标准。30%~50%的术后患者可发生低氧血症，一般认为这样的低氧血症是一过性的，对大多数患者是无害的[5]。但如果合并心脑或其他器官动脉硬化或其他原因的血管阻塞，这种低氧血症就是很危险的[6]。常见低氧血症的原因是肺萎陷不张和误吸、心源性肺水肿、静脉输入液体过量、通气血流比例失调和急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）[7]，其中ALI/ARDS是肺切除术后患者死亡的主要原因[8-10]。
【摘要】 目的 探讨并分析导致肺曲霉病患者误诊的原因，为早期诊断并及时正确治疗提供科学的依据。 方法 回顾性分析2010年1-4月间确诊为肺曲霉病的3例患者在诊治过程中被误诊的原因。 结果 3例患者均缺乏明显的特异性临床表现和影像学表现，最后确诊均依据病理学活检证实。 结论 肺部的曲霉菌感染缺乏特异性的临床和影像学表现，及早行纤维支气管镜检查或肺组织活检可提高早期诊断率。【Abstract】 Objective To analyze the misdiagnostic causes of pulmonary aspergillosis. Methods The clinical data of three patients with pulmonary aspergillosis from January to April 2010 were retrospectively analyzed, and the misdiagnostic causes were analyzed. Result No specific clinical and imaging findings were found in the three patients, and pulmonary aspergillosis was finally diagnosed according to the pathological biopsy. Conclusion Pulmonary aspergillus lacks specific clinical and imaging manifestations; early fiberoptic bronchoscopy or pulmonary biopsy may improve the rate of accurate diagnosis.
Objective To analyze the treatment of old united lateral condyle fractures of humerus in children.Methods From January 1997 toFebruary 2002, 13 cases of old united lateral condyle fractures of humerus were treated. There were 11 boys and 2 girls. Their age was from 4 to 11 years(7.2 years on average). The primary diagnosis results were 4 cases of degree Ⅰ fracture, 5 cases of degree Ⅱ fracture and 4 indefinitely diagnosed cases. Elbow extension disorder occurred in 13 cases, which was limited 30-70°. The elbow flexion was limited morethan 90°. X-ray films showed 10 nonunion and 3 malunion of fracture. The timefrominjury to operation was 32 to 81 days (56 days on average) in 12 cases and6 months in 1 case. All cases were treated by open reduction and internal fixation. One case was treated combined with implanting bone. Results After a follow-up of 3 to 8 years(5.4 years on average), no cubitus varus or valgus occurred.Five cases had growth disturbances of the lateral condyle of the distal humerus. The movement of these elbow joints improved from 40° to 70° (56° on average). The time of clinical bone union was 6 to 8 weeks and no nonunion and delayed union were observed in X-ray films. Conclusion It is important to accurately diagnose for treatment of lateral condyle fractures of the humerus in children so as to reduce the occurrence of malunion of fracture. It can save the joint function and reduce the cosmetic deformity effectively to operate as earlyas possible.
ObjectiveTo briefly describe the specific contents and analyze the implementation effects of the information-based training system on neurology residents.MethodsSince February 2020, an information-based training system was carried out in the standardized training center for residents in the Department of Neurology, Xuanwu Hospital of Capital Medical University. The effect of the information-based training system was measured by comparing the numbers of training lessions and examinations, participation rates of training lessions and examinations, and mock examination results after 4 months of training of the resident trainees in Grade 2017 under the information-based training mode (n=35) with those of the resident trainees in Grade 2016 under regular face-to-face training mode (n=35). Chi-square test was used for comparison between training groups.ResultsCompared with those in Grade 2016, the number of lessons in Grade 2017 increased by 87.0% (43 vs. 23), the participation rate of lessons in Grade 2017 was higher (100.0% vs. 87.0%, P<0.001), the number of examinations in Grade 2017 increased by 87.5% (15 vs. 8), the participation rates of examinations were both 100.0%, and the pass rate of the mock examination in Grade 2017 was higher (94.3% vs. 77.1%, P=0.040).ConclusionThe training method and effect of the standardized training model of the information-based training system for resident doctors are worthy of recognition, providing a reference for medical teaching, especially for the standardized training of resident physicians.
目的 调查四川省妇幼保健院医院感染发生情况及影响因素，以改进医院感染发病率监测方法与医院感染预防和控制措施。 方法 对2011年9月19日0：00～24：00所有住院患者进行调查，包括当日出院、转院、死亡的患者，但不包括新入院患者，使用全国医院感染监控网统一设计的调查表，采用床旁调查和查阅病历相结合，对调查结果进行统计分析。 结果 应调查住院患者112例，实际调查109例，实查率为97.3%；发生医院感染4例，现患率为3.7%。医院感染部位以呼吸道为主，抗菌药物使用率为64.2%。 结论 通过医院感染现患率调查，可以在短期内全面了解医院感染的现状，针对性的制定医院感染监控措施，预防和控制医院感染的发生。
ObjectiveTo briefly describe the specific contents of the “four-dimensional integration” standardized training model for neurology residents and analyze the implementation effects.MethodsSince September 2019, the Standard Training Center for Residents in Department of Neurology, Xuanwu Hospital of Capital Medical University trained residents under “four-dimensional integration” standardized training model, including primary knowledge teaching, basic skill training, clinical thinking training, and student group learning. The effect of the “four-dimensional integration” model was measured by comparing the midterm assessment results after four months of training of the resident trainees in Grade 2019 under the “four-dimensional integration” training mode (n=37) with those of the resident trainees in Grade 2018 under regular training mode (n=32). The midterm assessment was conducted through standardized and objective clinical examinations, including three evaluations (theory, skills, and clinical drills), and the pass rate of tests was evaluated through Fisher’s exact probability method for comparison between training groups.ResultsThere was no significant difference in the pass rate of theoretical assessment (100.0% vs. 96.9%, P=0.464) or the pass rate of Mini-Clinical Evaluation Exercise (100.0% vs. 90.6%, P=0.095) between the two groups. The pass rate of skill assessment in Grade 2019 was significantly higher than that of the students in Grade 2018 (94.6% vs. 71.9%, P=0.018).ConclusionThe “four-dimensional integration” standardized training model for neurology residents and it effect are worthy of recognition, which can provide a reference for medical teaching, especially for the standardized training of resident physicians.
ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.