Background and Aim: Respiratory tract infection (RTI) is a common reason for consulting primary health care. Antibiotic prescribing for RTIs varies among physicians indicating that national guidelines are not always a...Background and Aim: Respiratory tract infection (RTI) is a common reason for consulting primary health care. Antibiotic prescribing for RTIs varies among physicians indicating that national guidelines are not always adhered to. The aim was to study if antibiotic prescribing and use of near-patient tests were different among physicians who complete an audit registration and those who discontinue their participation. Method: A prospective cohort study where physicians participated in an APO (Audit Project Odense) process, making an audit registration for every appointment with a patient who had a respiratory tract infection during 4 weeks in 2008 and 4 weeks in 2009. Between the registrations, a limited educationally oriented intervention was made. 18 Primary Health Care Centres located in three counties in southern of Sweden with 77 primary health care physicians participated. When comparing proportions the Chisquare test was used. Mann Whitney U-test was used when comparing independent groups and Wilcoxon’s signed-rank test was used when comparing dependent groups. Results: Of the 77 physicians, 38 participated only at baseline (group 1) and 39 participated in both registrations (group 2). The overall use of CRP near-patient tests was 37% in group 1 and 28% in group 2 (Chisquare p < 0.001), and the overall use of Strep-A near-patient tests was 31% and 20%, respectively (Chisquare p < 0.001). When the Strep-A near-patient test was negative in pharyngitis/tonsillitis, antibiotics were prescribed to 45% in group 1 and to 12% by group 2 (Chisquare 0.003). Conclusion: In conclusion, this study showed that physicians, who were more inclined to complete audit participation, used near-patient tests and prescribed antibiotics more correctly, according to the national guidelines for respiratory tract infections, than physicians who discontinued the participation. To achieve a rational use of antibiotics, near-patient tests and prescription of antibiotics must be used according to guidelines.展开更多
目的了解重症监护病房(intensive care unit,ICU)护士对危重症患者转运接近失误事件的认知,为促进危重症患者转运安全管理提供参考。方法应用现象学研究方法,对湖南中医药大学第一附属医院的13名ICU护士进行半结构式深度访谈,采用Colaiz...目的了解重症监护病房(intensive care unit,ICU)护士对危重症患者转运接近失误事件的认知,为促进危重症患者转运安全管理提供参考。方法应用现象学研究方法,对湖南中医药大学第一附属医院的13名ICU护士进行半结构式深度访谈,采用Colaizzi 7步分析法对访谈资料进行资料分析并提炼主题。结果共提炼5个主题:(1)ICU护士对危重症患者转运接近失误的认知不足;(2)护士能力不足、制度执行偏差与突发情境压力导致危重症患者转运接近失误的发生;(3)ICU护士面对转运接近失误时存在恐惧、自责、感激与侥幸等复杂心理体验;(4)ICU护士常采用隐瞒、选择性求助等方式应对转运接近失误事件;(5)ICU护士危重症患者转运接近失误管理实践的障碍因素(人力资源配置不当或不足、护理管理者重视不够、未组织案例分析、非惩罚性上报机制有待完善)。结论ICU护士对危重症患者转运接近失误事件认知有待提高,各级管理者需高度关注并不断优化ICU护士危重症患者转运接近失误事件管理系统和完善实践模式,以促进危重症患者转运工作有序、高效地实施。展开更多
文摘Background and Aim: Respiratory tract infection (RTI) is a common reason for consulting primary health care. Antibiotic prescribing for RTIs varies among physicians indicating that national guidelines are not always adhered to. The aim was to study if antibiotic prescribing and use of near-patient tests were different among physicians who complete an audit registration and those who discontinue their participation. Method: A prospective cohort study where physicians participated in an APO (Audit Project Odense) process, making an audit registration for every appointment with a patient who had a respiratory tract infection during 4 weeks in 2008 and 4 weeks in 2009. Between the registrations, a limited educationally oriented intervention was made. 18 Primary Health Care Centres located in three counties in southern of Sweden with 77 primary health care physicians participated. When comparing proportions the Chisquare test was used. Mann Whitney U-test was used when comparing independent groups and Wilcoxon’s signed-rank test was used when comparing dependent groups. Results: Of the 77 physicians, 38 participated only at baseline (group 1) and 39 participated in both registrations (group 2). The overall use of CRP near-patient tests was 37% in group 1 and 28% in group 2 (Chisquare p < 0.001), and the overall use of Strep-A near-patient tests was 31% and 20%, respectively (Chisquare p < 0.001). When the Strep-A near-patient test was negative in pharyngitis/tonsillitis, antibiotics were prescribed to 45% in group 1 and to 12% by group 2 (Chisquare 0.003). Conclusion: In conclusion, this study showed that physicians, who were more inclined to complete audit participation, used near-patient tests and prescribed antibiotics more correctly, according to the national guidelines for respiratory tract infections, than physicians who discontinued the participation. To achieve a rational use of antibiotics, near-patient tests and prescription of antibiotics must be used according to guidelines.
文摘目的了解重症监护病房(intensive care unit,ICU)护士对危重症患者转运接近失误事件的认知,为促进危重症患者转运安全管理提供参考。方法应用现象学研究方法,对湖南中医药大学第一附属医院的13名ICU护士进行半结构式深度访谈,采用Colaizzi 7步分析法对访谈资料进行资料分析并提炼主题。结果共提炼5个主题:(1)ICU护士对危重症患者转运接近失误的认知不足;(2)护士能力不足、制度执行偏差与突发情境压力导致危重症患者转运接近失误的发生;(3)ICU护士面对转运接近失误时存在恐惧、自责、感激与侥幸等复杂心理体验;(4)ICU护士常采用隐瞒、选择性求助等方式应对转运接近失误事件;(5)ICU护士危重症患者转运接近失误管理实践的障碍因素(人力资源配置不当或不足、护理管理者重视不够、未组织案例分析、非惩罚性上报机制有待完善)。结论ICU护士对危重症患者转运接近失误事件认知有待提高,各级管理者需高度关注并不断优化ICU护士危重症患者转运接近失误事件管理系统和完善实践模式,以促进危重症患者转运工作有序、高效地实施。
文摘目的建立基于临床肿瘤标本的胃癌转移模型,为胃癌的转移研究提供个体化动物模型。方法将胃癌新鲜的手术标本移植到裸鼠皮下,建立胃癌患者异种移植(patient-derived xenograft,PDX)模型。进一步通过手术将皮下瘤组织原位移植到裸鼠胃部肌层,连续观察裸鼠的体征状态,通过近红外荧光活体成像技术检测肿瘤转移的发生。解剖荷瘤小鼠,将肺部转移灶进一步移植裸鼠皮下获得实体瘤。HE染色观察原发瘤与转移瘤的结构特征,(short tandem repeat) STR分析原发瘤和转移瘤的遗传特性。PCR-Array分析转移瘤和原发瘤中转移相关基因的表达。结果成功建立胃癌PDX模型,移植瘤组织结构与患者保持基本一致;通过胃部原位移植发现编号C19751的小鼠发生肺和肝的转移。其中肺转移灶皮下移植后获得了实体瘤,STR分析显示原发瘤保持了与肺转移瘤一致的遗传特征。PCR-Array结果显示,与原发瘤相比,转移瘤中CXCL12,IGF1和MMP2基因表达均显著上调。结论利用临床肿瘤标本成功建立胃癌转移模型,为胃癌转移研究提供了良好的个体化模型。
