Organ Donation After Acute Brain Death: Addressing Limitations of Time and Resources in the Emergency Department

It is not unusual for emergency physicians to quickly identify whether a patientwould have wanted to be resuscitated or intubated in a cardiac arrest situation,but patients’ other preferences for end-of-life care or organ donation are lesscommonly ascertained in the emergency department. Typically, the decisionprocess regarding such goals at end of life may be “deferred” to the intensivecare unit. We present a case illustrative of the complexity of discussing organdonation in the emergency department and suggest that patients who die in theemergency department should be afforded the respect and consideration providedin other parts of the hospital, including facilitation of organ transplantation.As circulatory determination of death becomes a more common antecedent to organtransplantation, specific questions may arise in the emergency departmentsetting. When in the emergency department, how should organ donation beaddressed and by whom? Should temporary organ preservation be initiated in thesetting of uncertainty regarding a patient’s wishes? To better facilitatediscussions about organ donation when they arise in emergency settings, wepropose increased coordination between organ procurement organizations andemergency physicians to improve awareness of organ transplantation.     

医院急诊创伤评分的临床应用价值分析

目的:研究分析医院急诊创伤评分(ETS)的临床应用价值,为急诊抢救提供更加合适的临床方案。方法:选择2012年6月至2013年6月在我院急诊抢救的90例患者作为研究对象。以数字法随机分成观察组和对照组,每组各45例。对照组由抢救医师依照患者病史、症状及体征进行急救诊断;观察组则由抢救医师根据ETS评分进行记录判定,辅助其作出急救诊断。统计并对比两组患者急救情况、院内转运时间及抢救时间,分析影响患者抢救成功的危险因素。结果:观察组患者在明确诊断及抢救成功方面的比例均显著高于对照组,但死亡率显著低于对照组,差异均有统计学意义(均P0.05)。观察组的院内转运时间及抢救时间均显著少于对照组,差异均有统计学意义(均P0.05)。Logistic回归分析显示,年龄60岁,未使用ETS评分及合并多处创伤均为影响患者抢救成功的危险因素。结论:ETS评分可较好的判定出急诊创伤患者的伤情,利于抢救治疗,有效增加抢救成功率,值得临床推荐。     

Especies de Aspergillus en ambientes hospitalarios con pacientes pediátricos en estado crítico

BackgroundAspergillus is a group of opportunistic fungi that cause infections, with high morbimortality in immunosuppressed patients. Aspergillus fumigatus is the most frequent species in these infections, although the incidence of other species has increased in the last few years.AimsTo evaluate the air fungal load and the diversity of Aspergillus species in hospitals with pediatric patients in critical condition.MethodsThe Intensive Care Unit and Burns Unit of a pediatric hospital were sampled every 15 days during the autumn and spring seasons. The air samples were collected with SAS Super 100^® and the surface samples were collected by swab method.ResultsThe UFC/m³ counts found exceeded the acceptable levels. The UFC/m³ and the diversity of Aspergillus species found in the Intensive Care Unit were higher than those found in the Burns Unit. The fungal load and the diversity of species within the units were higher than those in control environments. The use of both methods –SAS and swab– allowed the detection of a higher diversity of species, with 96 strains of Aspergillus being isolated and 12 species identified. The outstanding findings were Aspergillus sydowii, Aspergillus niger, Aspergillus flavus, Aspergillus terreus and Aspergillus parasiticus, due to their high frequency. Aspergillus fumigatus, considered unacceptable in indoor environments, was isolated in both units.ConclusionsAspergillus was present with high frequency in these units. Several species are of interest in public health for being potential pathogenic agents. Air control and monitoring are essential in the prevention of these infections.     

以技术创新驱动医疗服务质量新跃升

阐述了技术创新的定义与内涵,剖析了技术创新在提升医疗服务质量中的支撑、牵引与驱动作用。结合自身实践,从技术创新的理论与实践、高新技术的引进与应用、微创技术的拓展与延伸、信息技术的整合与挖掘等方面,对技术创新促进服务质量提升的实现途径进行了探讨,并指出要实现技术创新,必须突出以人为本、规模适度、绿色医疗等发展理念。     

Circadian‐Rhythm Differences among Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation

The purpose of the study was determine whether patients with chronic obstructive pulmonary disease (COPD) exacerbation who present to the emergency department (ED) during the night (00:00 to 07:59 h) vs. other times of the day have more severe COPD exacerbation, require more intensive treatment, and have worse clinical outcomes. A multicenter cohort study was completed involving 29 EDs in the United States and Canada. Using a standard protocol, consecutive ED patients with COPD exacerbation were interviewed, and their charts were reviewed. Of 582 patients enrolled, 52% were women, and the median age was 71 yrs (interquartile range, 64–77 yrs). Nighttime patients (15% of cohort) did not differ from patients presenting at other times except that they were less likely to have private insurance, more likely to have a history of corticosteroid use, and have a shorter duration of symptoms exacerbation. Except for a few features indicative of more severe COPD exacerbation (such as higher respiratory rate at ED presentation, greater likelihood of receiving noninvasive positive pressure ventilation, and increased risk of endotracheal intubation), nighttime patients did not differ from other patients with respect to ED management. Nighttime patients were approximately three‐fold more likely to be intubated in the ED (odds ratio, 3.46; 95% confidence interval, 1.10–10.9). There were no day‐night differences regarding ED disposition and post‐ED relapse. Except for some features indicating more severe exacerbation, nighttime ED patients had similar chronic COPD characteristics, received similar treatments in the ED, and had similar clinical outcomes compared with patients presenting to the ED at other times of the day.     

Circadian-rhythm differences among emergency department patients with chronic obstructive pulmonary disease exacerbation

The purpose of the study was determine whether patients with chronic obstructive pulmonary disease (COPD) exacerbation who present to the emergency department (ED) during the night (00:00 to 07:59 h) vs. other times of the day have more severe COPD exacerbation, require more intensive treatment, and have worse clinical outcomes. A multicenter cohort study was completed involving 29 EDs in the United States and Canada. Using a standard protocol, consecutive ED patients with COPD exacerbation were interviewed, and their charts were reviewed. Of 582 patients enrolled, 52% were women, and the median age was 71 yrs (interquartile range, 64-77 yrs). Nighttime patients (15% of cohort) did not differ from patients presenting at other times except that they were less likely to have private insurance, more likely to have a history of corticosteroid use, and have a shorter duration of symptoms exacerbation. Except for a few features indicative of more severe COPD exacerbation (such as higher respiratory rate at ED presentation, greater likelihood of receiving noninvasive positive pressure ventilation, and increased risk of endotracheal intubation), nighttime patients did not differ from other patients with respect to ED management. Nighttime patients were approximately three-fold more likely to be intubated in the ED (odds ratio, 3.46; 95% confidence interval, 1.10-10.9). There were no day-night differences regarding ED disposition and post-ED relapse. Except for some features indicating more severe exacerbation, nighttime ED patients had similar chronic COPD characteristics, received similar treatments in the ED, and had similar clinical outcomes compared with patients presenting to the ED at other times of the day.     

医院图书馆建立学科馆员制度的制约因素探讨

目的：探讨在医院图书馆建立学科馆员制度和开展学科化服务的必要性与可行性。方法：通过上海市三级医院图书馆的人员、信息服务基础、数字化资源建设及学科馆员设置比例等的调研数据,分析其影响医院图书馆开展学科化服务的制约因素。结果：目前医院图书馆开展学科化服务存在：大环境、制度、评估指标、人员素质、和数字化资源建设六方面的主要制约因素。结论：学科馆员制度设置和学科化服务的开展是医院图书馆发展的方向和主流。通过对制约因素的揭示,在现有的条件和状态下,可通过制度保证、完善评估机制和标准、人员的继续教育和资源共建共享等措施,逐步提高医院图书馆学科馆员设置比例,以提升医院图书馆服务水平。     

Application of Spatial Location Information to SIP

This paper introduces an approach for providing the Spatial Location (SLO) information of the Session Initiation Protocol (SIP) devices connected to wire and wireless IP networks. The aim of the paper is to set up the framework for providing emergency call services. This method uses SIP as transport and the SLO as data format inserted in the SIP payload. It analyses the relationship among the network elements involved in the architecture, and its functionality for providing emergency call services using SIP. In conclusion, this proposal track down an emergency call via SIP, and additionally enables SIP to support some other location-related services such as messaging, and location-based commerce.     

社区卫生服务机构实施基本药物制度效果及建议

目的：时社区卫生服务机构实施基本药物制度的效果进行分析,并提出建议,促进基本药物制度顺利实施。方法：选取山东省20所实施基本药物制度的社区卫生服务机构为研究对象。通过查阅文献确定本次调查的指标,即基本药物配备量、门诊工作量、门诊收入、人均医疗费用等。制定调查问卷,由调查的社区卫生服务机构方面进行填写,通过对比分析对社区卫生服务机构实施效果进行评价。结果：基本药物配备量只占基本药物目录的58．9％;门诊量和处方张数增加25％以上,但人员编制只增加5．2％;门诊费用下降24．4％,药品费用下降39．6％,人均诊疗费用下降42．9％;财政补偿增长52．6％。结论：基本药物制度初见成效,能够降低患者门诊费用,使基本医疗下沉到社区,有效引导患者进入社区卫生服务机构就诊。但基本药物配备量不足,社区卫生机构人员编制缺乏等问题突出,配套政策仍需进一步完善,并且加大推行力度。     

急诊重症监护病房耐甲氧西林金黄色葡萄球菌定植与感染调查分析

目的 调查急诊重症监护病房( EICU)耐甲氧西林金黄色葡萄球菌(MRSA)定植与感染状况,为实时控制医院感染暴发流行提供参考依据.方法 对临床资料进行分析,环境卫生学监测采样方法参照卫生部《消毒技术规范》,制定干预措施.结果 6例MRSA定植和感染病例平均年龄62.5岁,原发性基础疾病重;41份环境标本和16份来自接触阳性患者的医务人员手部标本中均分离到病原菌,阳性率分别为24.39％和18.75％.结论MRSA定植是造成医院感染的源头,将仅出现定植的病例并入感染病例进行统计分析,可实时监控院内医院感染的暴发.     

苹果非疫区建设中的苹果蠹蛾监测与防控

为了保护我国苹果蠹蛾主产区免受苹果蠹蛾Cydia pomonella(L.)的危害、突破国际贸易技术壁垒,促进苹果这一我国优势农产品的出口,2004年,我国农业部开始在西北黄土高原、环渤海湾2个中国苹果优势产区建设苹果非疫区,总面积达133.3万hm2。在非疫区建设的8年时间中,已在全国范围内建立了完善的苹果蠹蛾监测网络;至2010年,监测点总数达8000余个,调查面积达133.3多万hm2。在苹果蠹蛾防控方面,主要通过建立完善的应急反应体系及非疫区档案管理制度,加强公众宣传以及提高苹果非疫区外围的检疫和防治力度等措施,阻止了苹果蠹蛾在我国的进一步扩散蔓延。     

Decisional procalcitonin thresholds are not adapted toelderly patients admitted to the emergency room

Context: Diagnosis of sepsis in elderly is challenging.

Objectives: We investigated whether procalcitonin concentrations in elderly differed from values for the general population.

Methods: Procalcitonin measurement was assessed prospectively in 307 apyretic patients ≥75 years visiting the emergency department.

Results: Median age was 86 years [IQR81–90] and 222 (72%) were female. Procalcitonin concentration was 0.057 µg/L [0.040–0.092]; 99th percentile was 0.661 µg/L. Patients with procalcitonin concentrations above decisional thresholds had lower glomerular filtration rate and higher C-reactive protein concentrations. Conclusions: Baseline procalcitonin levels are increased in elderly. Elevated values are common and associated to low-grade inflammation and lower eGFR.     

论医院药学服务的有效开展

目的探讨对药学服务的性质,明确药学服务的涵义,促进我国医院药学服务工作的有效开展。方法对与药学服务密切相关的各学科分别加以分析。结果在我国目前特定的条件下,医院药学服务工作能否有效开展并不单单取决于临床药师,而是更多地取决于医院管理层对医院药学服务的认识程度和重视程度,取决于医院开展药学服务的管理体制和管理机制。结论多学科支撑性是医院药学服务的基本特性,这一性质决定了医院药学服务的有效开展需要多种技术人才的通力协作。