ICU产ESBLs肺炎克雷伯杆菌与整合子相关性研究

产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯杆菌是医院重症感染的主要分离株,因此笔者收集90株重症监护病房(ICU)分离的产ESBLs肺炎克雷伯杆菌进行药敏试验,检测Ⅰ类整合子及其可变区以及所携带耐药基因盒类型。90株菌株Ⅰ类整合子检出率64.4%,对抗生素的耐药率除哌拉西林,哌拉西林/他唑巴坦外均有统计学意义;可变区检出率为45.6%,携带基因盒:32株携带aadA1,2株携带dfrA15,7株携带aadA1+aadB。可见ICU携带Ⅰ类整合子的产ESBLs肺炎克雷伯杆菌具有较高的耐药性并介导氨基糖苷类耐药。     

某院3年医院感染患者细菌分离及耐药性分析

应用WHONET5.3软件对2005年1月至2007年12月检出的1 749株病原菌种类、分布及其耐药性进行统计分析.结果发现院内感染病原菌以条件致病菌为主,革兰阴性菌检出率61.8%,革兰阳性菌的检出率33%,真菌检出率为5.2%.大肠埃希菌及肺炎克雷伯菌属的ESBLs阳性率分别为34.4%和48.9%.MRSA和MRCNS的检出率分别为40.8%和36.4%.大多数病原菌对抗生素产生多重耐药性.由此可见,由于临床抗生素的广泛使用,病原菌不断变迁且其耐药性逐渐上升,应加强耐药性监测及合理使用抗生素,以有效控制细菌感染和耐药性播散.     

某院3年医院感染患者细菌分离及耐药性分析

应用WHONET5．3软件对2005年1月至2007年12月检出的1749株病原菌种类、分布及其耐药性进行统计分析。结果发现院内感染病原菌以条件致病菌为主,革兰阴性菌检出率61．8％,革兰阳性菌的检出率33％,真菌检出率为5．2％。大肠埃希菌及肺炎克雷伯菌属的ESBLs阳性率分别为34．4％和48．9％,MRSA和MRCNS的检出率分别为40．8％和36．4％。大多数病原菌对抗生素产生多重耐药性。由此可见,由于临床抗生素的广泛使用,病原菌不断变迁且其耐药性逐渐上升,应加强耐药性监测及合理使用抗生素,以有效控制细菌感染和耐药性播散。     

导言：重视重症患者镇痛、镇静治疗的规范化与个体化

重症患者的镇痛、镇静问题一直伴随重症医学学科的发展,目前尽管已成为重症加强治疗病房（Intensive Care Unit,ICU）重要的工作内容之一,但国内外仍普遍存在评估不足及治疗过度等问题。2010年国内的调查结果显示,能够对重症机械通气患者合理实施镇痛、镇静评估与治疗者竞然不到1／3。     

抗生素滥用现象剖析与建议

抗生素是广泛用于治疗感染性疾病最常用的药品之一,但在应用过程中滥用现象愈演愈烈,这不仅造成药品的严重浪费,还增加细菌耐药性的产生,对社会造成巨大的危害。通过对其现象、后果及原因的分析,提出了控制抗生素滥用的建议。     

抗生素滥用现象剖析与建议

抗生素是广泛用于治疗感染性疾病最常用的药品之一,但在应用过程中滥用现象愈演愈烈,这不仅造成药品的严重浪费,还增加细菌耐药性的产生,对社会造成巨大的危害.通过对其现象、后果及原因的分析,提出了控制抗生素滥用的建议.     

新生儿重症监护病房肺炎克雷伯菌分布及耐药性分析

为明确新生儿重症监护病房环境物表肺炎克雷伯菌分布及耐药情况,本研究通过药敏试验、基因分型等方法对环境物表分离株进行菌株分型,并结合临床病例对细菌耐药及流行情况进行分析。结果显示,129例环境物表标本中分离鉴定肺炎克雷伯菌5株,其中ST11型3株,ST20型2株。与该病房临床分离株比对,24株与ST11型药敏结果一致,另6株与ST20型结果一致。环境物表和医务人员是携带和传播病原体的重要途径,完善感染控制措施能有效防止病原体的感染和传播。     

儿科病房抗生素耐药情况调查及干预对策

调查儿科病房送检标本中优势细菌分布情况及耐药率,272株优势菌中产β-内酰胺酶菌占69.5%,其主要原因是儿科抗生素使用率明显高于成人,且较多的应用β-内酰胺类抗生素,分析儿科抗生素应用现状及危害,并提出抗生素滥用的干预对策。     

非牧区布氏杆菌病的诊治——布氏杆菌病30例临床分析

研究滨州地区布氏杆菌病的流行病学、临床特征、治疗及预后情况.对2010年4月～2012年9月入住我院的30例布氏杆菌病患者的临床特征及疗效进行分析.滨州地区布氏杆菌病在4月～6月高发,近3年发病人数有增多趋势.主要表现为发热、多汗、乏力及关节痛,部分可出现肝脾大、血小板减少.多西环素、利福平、左氧氟沙星联合治疗1个疗程(6周),治愈率为80％.滨州地区布氏杆菌病发病率较前升高.对发热伴血小板减少的患者要想到布氏杆菌病的可能.须加强对病畜的检疫工作,提高个人防护意识,重视从事养殖业及畜牧业人员的防疫.早期、规范、联合抗生素治疗是关键.     

儿科病房抗生素耐药情况调查及干预对策

调查儿科病房送检标本中优势细菌分布情况及耐药率,272株优势菌中产β-内酰胺酶菌占69.5%,其主要原因是儿科抗生素使用率明显高于成人,且较多的应用β-内酰胺类抗生素,分析儿科抗生素应用现状及危害,并提出抗生素滥用的干预对策.     

Medical Crisis Counseling on a Pediatric Intensive Care Unit: Case Examples and Clinical Utility

The intensive care unit is one of the most stressful and demanding work sites of the pediatric psychologist. The rapid changes in health status that necessitate stays on the intensive care unit often constitute an emotional roller coaster ride for both family members and the staff caring for their child. The Medical Crisis Counseling (MCC) intervention model is a useful approach to providing psychological support in the pediatric intensive care setting. A representative year's worth of consultation requests from the multidisciplinary intensive care unit of a large urban pediatric hospital is described and discussed in the context of the MCC model.     

重症加强监护医学与临床思维

重症加强监护医学的发展史,也是其临床思维的发展史,一个由个体性呼吸衰竭救治观念转化为集群性救治启动了重症加强监护学的建立,它们的发展带动亦受益于其临床思维、动态思维的发展。重症加强监护的实施,引发了医学伦理学新的思考与选择,而新的生物技术革命,必将导致重症加强监护医学及其临床思维的巨大变革。     

Learning from women with psychosis

The article describes psychoanalytic reflections in the work of a consultant psychiatrist responsible for a recently developed female intensive care unit. The manifestations of aggression were observed to be different from that of male patients. The behavioural manifestation of aggression by women was linked to the themes of secrets, and of hidden aggression, which are described in the analytic literature as feminine characteristics. The relationships between women as sibling inpatients and with female staff may explain some of the difficulties in managing aggression. Hidden aggression in the dyad of female-to-female transferences and countertransference may contribute to problems in all female inpatient settings. Bringing together the themes of psychosis and of women from a psychoanalytic perspective, the author suggests that the care pathway leading to transfer to the intensive care unit may exacerbate psychotic symptoms in acute states, due to specific vulnerabilities of women. The provision of specialized inpatient services for women may be more therapeutic if female development and the nature of their relationships were better understood.     

Finding alternatives to the streets for the homeless mentally Ill: Efficacy at a state hospital intensive placement unit

The authors describe a sample of homeless mentally ill patients receiving extended psychiatric care on an intensive placement unit. Summaries of 246 discharges were reviewed to examine demographic and clinical factors associated with extended psychiatric care and postdischarge placement. It was found that homeless patients requiring extended care were often medically ill and substance abusing. Residential placements were accepted by most patients on discharge. It was determined that homeless psychiatric patients benefited from extended care on an inpatient unit designed to alleviate anxieties regarding living arrangements and psychiatric treatment systems historically rejected by this population.The authors wish to thank Charlotte Seltzer, CSW, for her cooperation on this project.     

ICU向患者家属开放的理论研究

ICU实行的基本是封闭式管理,这不仅带来了一些伦理问题,也容易引发医疗纠纷,从伦理学的需要、预防医疗纠纷、改善医患关系等方面探讨ICU向患者家属开放的必要性,分析开放存在的问题,论证了ICU向患者家属开放的可行性。     

Morality in the valley of the moon: The origins of the ethics of neonatal intensive care

One of the first areas of ethical concern in medicine was the neonatal intensive care unit. Questions first seen in this context soon entered the discourse of bioethical debate. The history of the ethics of neonatal care is described from the context of neonatology, and the emerging principles are outlined.     

Psychological Outcomes in Fathers of Critically Ill Children in the Pediatric Intensive Care Unit: A Systematic Review

Journal of Clinical Psychology in Medical Settings - Systematically review evidence of psychological distress in fathers of children admitted to the pediatric intensive care unit (PICU). Two...     

Premature twins on a neonatal intensive care unit

This paper presents observations of boy and girl twins on a neonatal intensive care unit, following them through from 10 days old to return home. The observer hypothesizes about the experience of the twins as they progress, based on detailed notes of their actions. The preoccupations of the parents are incorporated, as are reactions and interventions of staff. The place and possible functions of such observation by a child psychotherapist attached to such a unit are elaborated in the concluding section.     

Illness perception ratings of high-risk newborns by mothers and clinicians: Relationship to illness severity and maternal stress

Objective: Patients' views of illness are often thought to differ from those of medical staff, although this is rarely assessed. This study examined the correspondence between mothers' and clinicians' perceptions of the same high-risk newborns, as well as with an objective measure of illness severity. We also investigated how mothers' perceptions were related to reported stress. Methods: Mothers of 99 high-risk infants admitted to either a neonatal intensive care or neonatal high dependency unit, which offers specialized but not intensive care, completed illness perception ratings of their baby's condition as well as perceived stress 3 to 5 days following admission. At the same time, a standardized measure of neonatal illness severity was calculated and the baby's primary neonatologist completed illness perceptions ratings. Results: Unlike clinician ratings, mothers' illness perceptions were not significantly correlated with illness severity. Mothers generally rated babies in both units as sicker and having a more serious illness than did neonatologists. Whereas clinicians, compared with mothers, rated babies in intensive care as having an illness that would affect their life more and last for a longer time. Mothers rated medical treatment to be significantly more helpful than did clinicians, particularly for babies admitted to the high dependency unit. Mothers' stress was significantly associated with illness perceptions but unrelated to illness severity. Conclusions: Significant differences exist in the perceptions of illness severity, helpfulness of treatment, and the long-term effects of the baby's illness between parents and clinicians and this may lead to misunderstandings and misinterpretations in communication. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The acute psychobiological impact of the intensive care experience on relatives

There is a growing awareness amongst critical care practitioners that the impact of intensive care medicine extends beyond the patient to include the psychological impact on close family members. Several studies have addressed the needs of relatives within the intensive care context but the psychobiological impact of the experience has largely been ignored. Such impact is important in respect to health and well-being of the relative, with potential to influence patient recovery. The current feasibility study aimed to examine the acute psychobiological impact of the intensive care experience on relatives. Using a mixed methods approach, quantitative and qualitative data were collected simultaneously. Six relatives of patients admitted to the intensive care unit (ICU) of a District General Hospital, were assessed within 48 h of admission. Qualitative data were provided from semi-structured interviews analysed using interpretative phenomenological analysis. Quantitative data were collected using a range of standardised self-report questionnaires measuring coping responses, emotion, trauma symptoms and social support, and through sampling of diurnal salivary cortisol as a biomarker of stress. Four themes were identified from interview: the ICU environment, emotional responses, family relationships and support. Questionnaires identified high levels of anxiety, depression and trauma symptoms; the most commonly utilised coping techniques were acceptance, seeking support through advice and information, and substance use. Social support emerged as a key factor with focused inner circle support relating to family and ICU staff. Depressed mood and avoidance were linked to greater mean cortisol levels across the day. Greater social network and coping via self-distraction were related to lower evening cortisol, indicating them as protective factors in the ICU context. The experience of ICU has a psychological and physiological impact on relatives, suggesting the importance of identifying cost-effective interventions with evaluations of health benefits to both relatives and patients.