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.     

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。     

血液中Aβ1-42和P-tau-181对阿尔茨海默病临床诊断的应用价值

探讨血液中β淀粉样蛋白1-42(Aβ1-42)、磷酸化tau-181(P-tau-181)对阿尔茨海默病的诊断价值。采用ELISA方法检测阿尔茨海默病患者、非阿尔茨海默病痴呆患者、健康中老年人血液中Aβ1-42和P-tau-181的浓度。阿尔茨海默病组Aβ1-42浓度低于非阿尔茨海默病痴呆组(P=0.005)和健康对照组(P=0.000),P-tau-181的浓度高于非阿尔茨海默病痴呆组(P=0.000)和健康对照组(P=0.000)。利用ROC曲线发现,Aβ1-42和P-tau-181对于诊断阿尔茨海默病的灵敏度分别为65.3%、63.6%,特异性分别为76.4%、73.1%;而应用Aβ1-42/P-tau-181的比值诊断阿尔茨海默病的灵敏度为80.0%,特异性为85.1%。Aβ1-42/P-tau-181的比值作为诊断指标其灵敏度和特异性较高,对阿尔茨海默病的诊断有较大的应用价值。     

遗忘的药物——呋喃妥因在尿路感染中的应用

随着抗生素的不断发明和应用,目前临床中已经发生很多耐药菌的尿路感染,极大地增加了医疗负担。呋喃妥因虽已使用50多年,但很少耐药菌株,费用低廉,临床仍有广阔的应用前景。本文复习呋喃妥因的相关指南推荐、作用机制、体内代谢、临床抗菌特点和副作用等,希望引起对这个被临床逐渐遗忘的药物重视。     

遗忘的药物——呋喃妥因在尿路感染中的应用

随着抗生素的不断发明和应用,目前临床中已经发生很多耐药菌的尿路感染,极大地增加了医疗负担.呋喃妥因虽已使用50多年,但很少耐药菌株,费用低廉,临床仍有广阔的应用前景.本文复习呋喃妥因的相关指南推荐、作用机制、体内代谢、临床抗菌特点和副作用等,希望引起对这个被临床逐渐遗忘的药物重视.     

阿尔茨海默病的免疫学治疗研究进展

1　阿尔茨海默病 (Ａｌｚｈｅｉｍｅｒ’ｓｄｉｓｅａｓｅ ,ＡＤ)免疫学治疗的机制应用免疫学方法阻断老年斑 (ＳＰ)的形成、清除已形成的ＳＰ的机制可能是多方面的。首先 ,Ａβ抗体进入脑后与Ａβ - 4 2形成稳定的复合物 ,阻止Ａβ- 4 2之间相互粘附形成沉积[1] 。其次 ,Ａβ抗体与Ａβ - 4 2结合后 ,阻止Ａβ - 4 2由可溶的α螺旋结构向具有毒性的β片层结构转化 ,进而减少Ａβ - 4 2对神经细胞的毒害作用[1] 。其三 ,Ａβ - 4 2抗原抗体复合物可激活补体系统对生成Ａβ的神经胶质细胞进行杀伤 ,从而阻断Ａβ - 4 2的生成[1] 。其四 ,Ａβ…     

泵注时间依赖性抗生素延长给药时间的研究进展

随着抗生素的普遍应用,细菌耐药性成为困扰人类的一大难题。鉴于新药研发的速度远远落后于细菌耐药性的产生,人们把研究的方向更多地投向优化现有抗菌药物的药效学指标,从而提高其杀菌活性的方向上来,并因此发展了一些新的理论及方法。本文就两种时间依赖性抗生素:哌拉西林他唑巴坦及美罗培南延长给药时间带来的临床效果进行综述,从概念、药动学和药效学依据、临床效果研究等方面进行多方面分析。探讨治疗敏感菌感染时哌拉西林他唑巴坦和美罗培南最佳给药方法。为延长时间依赖性抗生素输注时间提高临床疗效、推广应用该方案提供理论依据。     

防止耐药菌的院内爆发

临床上多重耐药菌感染的现象正在日渐严重,从而引发了越来越严重的耐药菌院内感染现象.从医务工作者角度来控制这一现象的有效措施包括:规范医护人员的手卫生,控制侵入性操作引起的感染,合理使用抗生素,有效筛查和隔离疑似感染患者等.     

脑内腺苷介导白介素-1β引起的大鼠的行为性抑郁

目的：研究腺苷在白细胞介素-1诱导的大鼠行为性抑郁中的作用。方法：应用Porsolt游泳试验观察大鼠脑室注射白介素-1β引起的行为性抑郁,通过注射非特异性腺苷受体拮抗剂咖啡因和特异性A1和A2腺苷受体拮抗剂,确定脑内腺苷在白细胞介素-1β引起的大鼠行为性抑郁中的作用以及介导这种作用的受体。结果：脑内注射白细胞介素-1β(8-32ng／kg,icv)可导致大鼠在Porsolt游泳试验中漂浮时间明显地延长,非特异性腺苷受体拮抗剂咖啡因(7mg／kg,ip)和特异性A2a腺苷受体拮抗剂(1mg／kg,ip)预处理能够缩短漂浮时间的延长。结论：脑内注射白细胞介素-1β可引起大鼠的行为性抑郁,脑内腺苷通过A2a受体介导白细胞介素-1β的这种作用。     

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。     

Les unités de soins intensifs psychiatriques (USIP) : expériences françaises et internationales

Psychiatric Intensive Care Units (PICU) propose a secure setting for patients with acute behavior disturbances who can not be managed in psychiatric general wards. Physical violence acts against patients or hospital staff, substance abuse, non-compliance for care and treatment, intensity of symptoms or absconding are frequent motives for admission. Patients are compulsorily detained in secure conditions. They are admitted from psychiatric facilities of a health area or by agreement between hospitals. Multidisciplinary working in psychiatric intensive care is essential, delivered by qualified staff. Care and treatment must be centered on the patient, multidisciplinary, intensive, comprehensive with an immediacy of response to critical situations. As length of stay should not exceed 2 months in duration, interface and liaison with original services of patients are important issues. In France, PICU exist notably at Cadillac, Lyon, Paris, Nice, Eygurande, Montpellier, Pau and Prémontré. These facilities appear as a missing level, an interesting alternative in mental health care system, between psychiatric general wards and maximum security hospitals. This paper reports the creation of a National Association of PICU in France, the existence of national minimum standards and international experiences.     

Retrieval inhibition of trauma-related words in women reporting repressed or recovered memories of childhood sexual abuse

Several authors have argued that survivors of childhood sexual abuse (CSA) who report to have repressed their traumatic memories are more skilled in forgetting emotional stimuli than survivors who have always remembered the abuse. The current experiment employed a list-wise directed forgetting task to investigate whether women reporting repressed (n = 16) or recovered (n = 23) memories of CSA are better at forgetting disturbing material, relative to women reporting having always remembered their abuse (n = 55) or reporting no history of abuse (n = 20). We found no support for the hypothesis that women reporting repressed or recovered memories of CSA are especially versed in inhibiting retrieval of trauma-related words. Additional analyses revealed that participants characterized by a repressive coping style did not display a superior retrieval inhibition mechanism for negative material.     

幽门螺杆菌根除失败原因及补救策略分析

幽门螺杆菌（Hp）与胃炎、消化性溃疡、胃黏膜相关淋巴组织淋巴瘤及胃癌关系密切。随着根除Hp治疗在临床的普遍开展,Hp根除率逐渐下降,其主要原因是日益突出的抗生素耐药及患者对药物依从性差。对根除治疗失败者进行补救治疗已成为Hp治疗研究领域的新热点。由于各地的Hp耐药率及感染者个体情况存在很大差异,目前尚未形成统一规范的补救策略,遵循个体化的补救策略已逐渐被大家所接受。     

Treating bed time resistance with the bed time pass: a systematic replication and component analysis with 3-year-olds

Bedtime resistance, a common pediatric problem, that was displayed by 4 unrelated 3-year-old children was treated with the bedtime pass (i.e., provision of a small notecard exchangeable for one trip out of the bedroom after bedtime) plus extinction. Bedtime resistance was eliminated for all participants. Further, treatment did not produce extinction bursts, as is common when using extinction procedures alone. Component analysis with 1 participant suggested that use of both components of the intervention produced the best outcomes. Findings extend the literature on the treatment of pediatric bedtime resistance as well as the application of behavior analysis to clinical psychology and pediatric care.     

Persistent alterations in biological profiles in women with abuse histories: influence of premenstrual dysphoric disorder.

OBJECTIVE: To examine dysregulation in biological measures associated with histories of abuse in women and whether women with premenstrual dysphoric disorder (PMDD) differ in their dysregulation. DESIGN: Twenty-five women meeting prospective criteria for PMDD and 42 non-PMDD controls underwent structured interview to determine abuse histories and lifetime Axis I diagnoses, excluding those with current Axis I disorders or using medications. MAJOR OUTCOME MEASURES: Plasma cortisol and norepinephrine (NE), heart rate (HR), blood pressure (BP), and vascular resistance index (VRI) were assessed at rest and in response to mental stress. RESULTS: A greater proportion of PMDD women had prior abuse compared with non-PMDD women. Regardless of PMDD status, all abused women had lower plasma NE and higher HRs and tended to have lower plasma cortisol at rest and during stress. Abused women also reported more severe daily emotional and physical symptoms. Greater VRI and BP at rest and during stress were seen only in PMDD women with abuse. CONCLUSION: There is persistent dysregulation in stress-responsive systems in all abused women that cannot be accounted for by current psychiatric illness or medications, and PMDD women may be differentially more vulnerable to the impact of abuse on measures reflecting alpha-adrenergic receptor function.     

Understanding expert testimony on child sexual abuse denial after New Jersey v. J.L.G.: Ground truth,disclosure suspicion bias,and disclosure substantiation bias

The New Jersey Supreme Court held in New Jersey v. J.L.G. (2018) that experts can no longer explain to juries why sexually abused children might deny abuse. The court was influenced by expert testimony that “methodologically superior” studies find lower rates of denial. Examining the studies in detail, we argue that the expert testimony was flawed due to three problems with using child disclosure studies to estimate the likelihood that abused children are reluctant to disclose abuse: the ground truth problem, disclosure suspicion bias, and disclosure substantiation bias. Research identifying groups of children whose abuse can be proven without reliance on disclosure reveals that denial of sexual abuse is common among abused children.     

Linking thought suppression and recovered memories of childhood sexual abuse

There are two types of recovered memories: those that gradually return in recovered memory therapy and those that are spontaneously recovered outside the context of therapy. In the current study, we employed a thought suppression paradigm, with autobiographical experiences as target thoughts, to test whether individuals reporting spontaneously recovered memories of childhood sexual abuse (CSA) are more adept at suppressing positive and anxious autobiographical thoughts, relative to individuals reporting CSA memories recovered in therapy, relative to individuals with continuous abuse memories, and relative to controls reporting no history of abuse. Results showed that people reporting spontaneously recovered memories are superior in suppressing anxious autobiographical thoughts, both in the short term and long term (7 days). Our findings may partly explain why people with spontaneous CSA memories have the subjective impression that they have "repressed" their CSA memories for many years.     

Evaluating pediatric psychology consultation services in a medical setting: An example

We examined the nature of referrals to a health center-based pediatric psychology service from 1990 to 1993 and assessed the satisfaction of health professionals with these services. Archival evaluation of 1467 records showed that over half of the consultation requests came from general pediatrics, pediatric neurology, and surgical services and that 70% of the psychological services were delivered on an outpatient basis. The most frequent referrals were for cognitive/neuropsychological evaluation and externalizing behavior problems. Pediatric psychology trainees were involved in 94% of the consultations. Survey of health professionals (n = 143) indicated very high overall satisfaction with the quality of services delivered. Presenting problems yielding the greatest likelihood for future consultation requests were behavior problems, child abuse, coping with illness, and depression/suicide. Results are discussed in the context of previous evaluations of pediatric psychology services and recommendations for future evaluation research.     

Take care! The evaluation of a team-based burnout intervention program for oncology care providers

In this quasi-experimental study among staff of 29 oncology wards, the authors evaluated the effects of a team-based burnout intervention program combining a staff support group with a participatory action research approach. Nine wards were randomly selected to participate in the program. Before the program started (Time 1), directly after the program ended (Time 2), and 6 months later (Time 3), study participants filled out a questionnaire on their work situation and well-being. Results of multilevel analyses showed that staff in the experimental wards experienced significantly less emotional exhaustion at both Time 2 and Time 3 and less depersonalization at Time 2, compared with the control wards. Moreover, changes in burnout levels were significantly related to changes in the perception of job characteristics over time.