我国抗菌药物临床应用专项整治情况调查与分析

目的 了解抗菌药物临床应用专项整治以来,我国医院的抗菌药物使用情况。方法 2011年和2012年分别选取了241所医院进行调查。运用系统随机抽样方法抽取5—9月期间医院的门诊处方和住院病历进行分析。抗菌药物使用强度（每百人天DDDs值）、门诊患者抗菌药物处方比例、综合I类切口手术预防使用抗菌药物比例等为主要分析指标。结果 从2011年至2012年,被调查医院的平均抗菌药物使用强度和综合I类切口手术预防使用抗菌药物比例下降有统计学意义;门诊患者抗菌药物处方使用率整体变化不显著,联合用药情况仍普遍存在。且医院的规模与抗菌药物使用存在显著关联性。结论 仍需通过进一步加强抗生素耐药性监测以及对医务工作者和公众抗菌药物使用培训等管理措施,从本质上改善抗菌药物使用情况。     

某三甲医院抗菌药物临床规范化应用的现状分析

??????? 目的 分析和调查抗菌药物临床应用的情况,研究规范化应用抗菌药物在临床使用的效果。方法 根据计算机管理系统提供的抗菌药物用药信息,对某三甲综合医院抗菌药物临床应用专项整治前、后医院门诊患者抗菌药物处方比例及住院患者抗菌药物使用率、使用强度、I类手术预防用药率等指标进行调查及分析。结果 门诊患者抗菌药物处方比例降低至6.2﹪;住院患者抗菌药物使用率降低至49.7﹪;抗菌药物使用强度降低至42.48;I类手术预防用药率降低至32.1﹪。结论 抗菌药物临床规范化应用,促进医院抗菌药物临床合理使用的效果显著。     

医院抗菌药物临床应用专项整治持续效果分析

?????? 目的 分析抗菌药物临床应用专项整治对医院住院患者抗菌药物临床用药的持续效果。方法 采用回顾性调查方法,以开展抗菌药物临床应用专项整治前后的2010—2012为研究时间,对医院住院患者抗菌药物使用率、使用强度、用药金额及清洁手术预防用药率、清洁手术术后24小时停药率进行调查及分析。结果 2010—2012年,抗菌药物使用率分别为70.0%、64.4%和49.3%,抗菌药物使用强度分别为73.3、58.2和37.9,抗菌药物用药金额占药费总额比例分别为21.9%、16.2%和11.1%;清洁手术预防用抗菌药物比率分别为95.5%、91.0%和50.3%,清洁手术术后24小时停药率分别为11.0%、27.2%和42.0%。结论 抗菌药物临床应用专项整治对抗菌药物的合理使用起到了积极的促进作用。     

2009年我院抗菌药物用药强度分析

目的 分析住院患者2009年抗菌药物用药强度。方法 以限定日剂量（DDD）为单位,以DDD/100人天值计算抗菌药物使用强度。结果 住院患者抗菌药物平均用药强度为88.32。二代头孢、三代头孢、其他β内酰胺类和头孢呋辛钠、头孢米诺钠、头孢哌酮舒巴坦钠分别位于各类别及各品种抗菌药物用药强度的前3位。各科室抗菌药物用药强度的中位数为78.37,泌尿外科、普外二科和腔镜外科位于前3位。结论 医院可能存在抗菌药物用药过度、用药集中等问题,应进一步加强监督管理。     

按病种管理在降低妇科抗菌药物使用强度中的应用

目的 探讨按病种管理在降低抗菌药物使用强度中的应用效果。方法 通过对妇科4个病区5个常见病种（子宫平滑肌瘤、卵巢囊肿、卵巢恶性肿瘤、子宫内膜恶性肿瘤和宫颈恶性肿瘤）使用抗菌药物的对比分析,找到问题症结所在,对妇科围手术期抗菌药物使用存在问题进行改进,并将改进前后状况进行比较。结果 妇科抗菌药物使用强度从42DDD下降到38DDD,达到国家标准。结论 按病种管理在降低抗菌药物使用强度管理中取得了较好的效果,值得推广。     

医院等级评审对围手术期预防应用抗菌药物影响评价

目的 为规范医院围手术期抗菌药物预防性应用、探索合理干预措施管理提供依据。方法 通过医院感染监测系统,调取2013年3月、5月医院外科手术病历728例作为非干预组;调取2013年10月、2014年1月全院外科手术病例742例作为干预组。通过各项指标分析比较干预前后围手术期预防性使用抗菌药物情况。结果 开展围手术期抗菌药物临床应用专项整治活动后,Ⅰ类切口手术抗菌药物使用率由100%降至31.66%,围手术期抗菌药物使用率由100%降至59.03%,且术后切口部位感染并未出现增长。术前0.5～2h用药率由整治前的81.59%升高至100%（P ＜0.05)。专项整治后围手术期预防应用抗菌药物时长由5.72天降至1.56天。整治后围术期抗菌药物合理应用明显提高。结论 医院开展围手术期抗菌药物预防应用专项整治取得明显成效。     

质量管理工具在抗菌药物使用强度管理中的运用

目的 探讨质量管理工具在抗菌药物使用强度管理中的应用价值。方法 采用PDCA循环、追踪方法学、根本原因分析法、头脑风暴法、鱼骨图、决策树等管理工具,寻找医院抗菌药物使用强度管理中存在的问题并进行持续质量改进。结果 通过质量管理工具的应用,医院抗菌药物使用强度明显下降,并控制在每百人天40 DDDs以下。结论 质量管理工具应用于抗菌药物使用强度管理,能有效发现并解决问题,促进抗菌药物临床合理使用。     

采用综合干预措施 加强抗菌药物使用管理

目的 通过采取综合干预措施,促进住院患者抗菌药物的临床合理应用。方法 采用抗菌药物合理使用国际指标进行基线调查后,进行多手段干预,用SPSS12.0软件进行统计分析调查结果,评价干预措施的有效性和可行性。结果 接受抗菌药物治疗的住院患者使用抗菌药物的平均品种数从干预前的2.06种降到干预后的1.78种,抗菌药物治疗的平均费用从干预前的1 038.26元降到干预后的696.21元,抗菌药物的平均使用天数从干预前的6.99 天下降到干预后的5.81天,接受抗菌药物治疗患者的平均住院日从干预前的13天下降到干预后的10天,其他多项指标均有改善。结论 综合干预措施对提高合理用药水平效果显著,促进了管理水平的提升。     

持续改进围术期预防性抗菌药物不合理使用成效分析

?????? 目的 分析围术期预防性抗菌药物使用中不合理使用的原因,并采取相应的干预对策。方法 2005年以来定期调查围术期抗菌药物预防使用状况,根据调查和反馈的结果不断改进干预措施。积极使用计算机网络和HIS的后台管理进行干预,同时将查出问题反馈给手术医生等一系列干预措施。结果 通过连年的综合干预,围术期抗菌药物带入手术室使用率从51.19%上升到97.33%,围术期预防性抗菌药物使用品种合格率从25.03%上升到79.68%,围术期预防性抗菌药物使用平均天数I类手术从5.49天下降到1.72天,II类手术从6.29下降到3.79天。结论 多部门联动、综合干预、持续改进是取得成效的关键。     

综合医院社区获得性肺炎住院诊疗的过程质量分析

目的 分析上海市浦东新区区属公立综合医院社区获得性肺炎（CAP）住院诊疗的过程质量。 方法 根据国家卫生和计划生育委员会对社区获得性肺炎（CAP）质量控制的要求,对浦东新区7所区属公立综合医院随机抽取的151份CAP病案进行评价。 结果 浦东新区区属公立综合性医院社区获得性肺炎（CAP）住院诊疗基本符合我国卫生和计生委对社区获得性肺炎（CAP）质量控制的要求;但在检查规范性和抗菌药物合理使用方面,三级医院、北区二级医院和南区二级医院表现不一。 结论 浦东新区卫生行政部门和医院应进一步加强社区获得性肺炎（CAP）质量控制,改进检查和抗菌药物使用。     

JL-DRGs在综合医院管理中的应用探讨

目的 探讨JL-DRGs在综合医院管理中的应用。方法 对2012年和2013年运行JL-DRGs管理前后的全部出院病例进行统计分析。结果 2013年开始全面运行JL-DRGs后平均住院日下降17.74%,均次费用下降13.49%,医保超支年度累计减少1 866万元,平均每月医保超支额度下降39.23%,医疗质量、效率均显著提升。结论 JL-DRGs在大型综合医院管理中应用效果好,可以积极促进医院提质升效并降低运营成本。     

三级综合医院护理人员安全文化认知现状调查

目的 描述和探讨三级综合医院的护理人员安全文化认知情况,为保障患者安全提出改进措施。方法 采用问卷调查法对1358名护理人员的安全文化认知情况进行调查和分析。结果 维度最高分为科室内团队合作（4.12±0.36）,积极反应率86.28%,维度沟通的公开性积极反应率最低,仅为36.28%。结论 临床护理人员在安全文化认知方面仍有待加强,人员配置及事故报告是构建安全文化的主要障碍,医疗机构应从系统角度出发,建立非惩罚性的事故报告制度,有效避免护患纠纷和安全事故的发生。     

Determination and diagnostic value of CA9 mRNA in peripheral blood of patients with oral leukoplakia

Background: Oral leukoplakia is one of the most common oral premalignant disorder. The classical evaluation through tissue biopsy is not always valid to evaluate the risk of malignization.

Material and methods: RT-qPCR was performed on 47 blood samples (21 patients with leukoplakia, 2 with oral squamous cell carcinoma (OSCC), and 24 healthy patients) and on 11 tissue samples (3 leukoplakia, 4 OSCC, and 4 samples of healthy tissue).

Results: There are significant differences in expression between the different groups (F?=?4.057, p?=?.006). The Duncan post hoc test shows that the only group that differentiates is the tumour tissue. Using Wilcoxon test, different covariables of patients with leukoplakia were analysed with respect to the group of healthy patients and no significant differences were observed.

Conclusions: The diagnostic route through liquid biopsy has not been conclusive in this study, but there are significant differences in the levels analysed in the different tissue samples.     

Mammotrope heterogeneity in the pituitary gland of European ferret,Mustela putorius furo: An immunoelectron-microscopic study

Employing the superimposition technique of electron-microscopic immunocytochemistry ultrastructural heterogeneity of the mammotropes in the pituitary gland of the European ferret,Mustela putorius furo,was studied. On the basis of the size of their secretory granules, the mammotropes were classified into three subtypes, type-I, type-II and type-Ill, which may correspond to different developmental or physiological states of a single cell type. Simultaneous study of mammotropes and somatotropes in several pairs of serial semithin sections demonstrated the occasional occurrence of bihormonal somatomammotropes /mammosomatotropes which may represent a transitional stage of the progenitor stem-somatotrope during its differentiation into mammotrope; alternatively it may be a functional intermediate during the cross-transformation of somatotrope into mammotrope or vice versa.     

Genome analysis of amaranths: Determination of inter- and intra-species variations

Amaranths are an important group of plants and include grain, vegetable and ornamental types. Despite the economic importance of the amaranths, there is very little information available about the extent and nature of genetic diversity present in the genus Amaranthus at molecular level. We now report the randomly amplified polymorphic DNA (RAPD) profiles of different species of Amaranthus as well as different accessions of the species. These RAPD analyses have been carried out using 65 arbitrary sequence decamer primers. From the RAPD data, an UPGMA dendrogram illustrating the inter-as well as intra-species relationships has been computed. The putative hybrid origin of A.dubious from A. hybridus and A. spinosus is also ruled out by the RAPD data. The trends of species relationships amongst the amaranths determined by RAPDs is consistent with their cytogenetic and evolutionary relationships that have already been determined. NBRI Communication No:464 (N.S.).     

Cloning of acryIIIA endotoxin gene ofBacillus thuringiensis var.tenebrionis and its transient expression inindica rice

Damage caused to rice production by coleopteran insects like rice weevil (Sitophilus oryzae), a stored grain insect pest and rice hispa (Dicladispa armigera), a pest of the growing plant is quite high. In order to combat the damage, generation of insect resistant transgenic rice plant was considered desirable. CryIIIA endotoxin ofBacillus thuringiensis var.tenebrionis, a 65 kDa protein toxic to coleopteran insects, figured as the candidate gene product. Thus, the cryIIIA gene was isolated from a local isolate ofBacillus thuringiensis var.tenebrionis. The gene was tailored at the N-terminal end to its minimal size by using a synthetic ATG codon which replaced the first codon next to ATG of threonine to proline. This modification did not affect the functional property of the gene product. A chimeric construct of the modifiedcryIIIA gene was developed containing CaMV35S promoter andnos terminator for plant expression. The expressibility of thecryIIIA gene inindica rice was judged through test for transient expression in indica rice protoplasts.     

Immunoprophylactic studies with a 43 kDa human circulating filarial antigen and a cross reactive 120 kDaBrugia malayi sodium dodecyl sulphate soluble antigen in filariasis

Bancroftian filariasis is a major public health problem affecting about 120 million people all over the world. Immunoprophylaxis may serve as an additional adjunct along with chemotherapy and anti larval measures for successful filaria control. Circulating filarial antigen fraction (CFA₂-6) containing 43 kDa antigen and adultBrugia malayi sodium dodecyl sulphate (S DS) soluble antigen fraction BmA-2 with a 120 kDa molecule were earlier shown to be reactive with endemic normal sera by immunoblotting and indirect ELISA techniques. BmA-2 was found to be highly cross reactive with CFA₂-6. Sera raised against both the antigen fractions showed about 90 % cytotoxicity to the parasites in the presence of jird peritoneal cells inin vitro as well as byin situ micropore chamber implantation technique. Further inin vivo studies using animal model, jirds CFA₂-6 and BmA-2 could induce about 90% protection to infection in immunized animals. In passive transfer studies of immunity it has been observed that BmA-2 induced protection is mainly antibody mediated.     

Mechanisms involved in natural killer cell mediated target cell death leading to spontaneous tumour regression

We have studied the mechanisms involved in the spontaneous regression of a rat histiocytoma in syngeneic hosts and tumour cell death processes. In addition to the natural killer (NK) cells which act through antibody dependent cellular cytotoxicity (ADCC), TNF-α also participates in the induction of necrosis in tumours. We have shown that the tumour cell is killed by necrosis which is perforce mediated, and apoptosis leading to target cell DNA fragmentation. A prior activation of the effector cells is essential before it can kill the target cell, as naive effector cells are ineffective. Activation of effector cells is mediated by Thl type of cytokines in viro andin vivo. IFN-γ seems to play an important role in tumour regression as injection of antibodies to IFN-γin vivo inhibited tumour rejection.     

Immunoprophylactic studies on cell wall associated proteins ofMycobacterium tuberculosis H37Ra

The cell wall protein peptidoglycan complex (CW-PPC) of Mycobacterium tuberculosis H₃₇Ra was isolated through sequential extraction of lipids, carbohydrates and soluble proteins. CW-PPC emulsified in FIA was found to induce significant protection in mice against challenge with LD₅₀ dose ofM. tuberculosis H₃₇Rv. To identify the immunoprotective components of CW-PPC, the proteins in avid association with peptidogican were dissociated by chemical treatment with trifluoromethanesulthonic acid (CF₃CO₃H): anisole (2:1). Immunoreactivity of total (CW-Pr) as well as its component proteins i.e., 71, 60 and 45 kDa proteins of cell wall was studied in animals immunized with CW-Pr-FIA. The 71 kDa protein was found to be most immunoreactive giving higher T-cell sensitization and humoral responses. Further, immunization of mice with 71 kDa-FIA demonstrated enhanced T- and B- cell responses. Mice immunized with 71 kDa-FIA gave significantly higher protection (P ≤ 0.05) against intravenous challenge with LD₅₀ dose ofM. tuberculosis H₃₇Rv, than BCG immunized animals. The results indicate the potential of 71 kDa cell wall protein as a suitable candidate for Cthe subunit vaccine.     

hsp 83 mutation is a dominant enhancer of lethality associated with absence of the non-protein codinghsrω locus inDrosophila melanogaster

Thehrsω or the 93D heat shock locus ofDrosophila melanogaster, which does not code for any protein, has an important role in development since nullosomy of this locus in transheterozygotes for two overlapping deficiencies, viz.,Df(3R) e ^Gp4 (eGp4) andDf(3R)GC14 (GC14), is known to cause a high (∼ 80%) mortality with the small number of escapee nullosomic flies being sterile, weak and surviving for only a few days. We now show that a majority of thehsrω-nulosomics die as embryo and that the 20% escapee embryos develop slower compared to their sibs carrying either one or two copies of thehsrω locus but after hatching survive to pupal/imago stage. Most interestingly, we further show that when onehsp83 mutant allele (hsp83 ^e4A) is introduced ineGp4/GC14 trans-heterozygotes, practically none of thehsrω-nullosomic embryos develop beyond the 1st instar larval stage. The specificity of this interaction betweenhsp83 andhsrω genes was further confirmed by examining the effect of thehsp83 mutant allele on other mutations in the 93D cytogenetic region. Therefore, we conclude that thehsp83 mutation acts as a dominant enhancer of the lethality associated with nullosomy for thehsrω gene. The observed genetic interaction between these two members of the heat shock gene family during normal embryonic development ofDrosophila reveals novel aspects of their biological functions.