Assessment of Counselling for Acute Diarrhoea in North-Eastern German Pharmacies—A Follow-Up Study Using the Simulated Patient Methodology

Aim: As the primary aim of this study, we analysed whether the quality of advice provided by pharmacies in the period between 2014 (baseline study) and 2017 (follow-up study) could actually be increased using a single written performance feedback given to each pharmacy in 2014. The secondary aim of the follow-up examination was to analyse whether the quality of advice differed depending on the professional group providing the advice. Methodology: To ensure the least possible distortion in the comparison between the baseline and the follow-up studies, the study design used for the follow-up examination in 2017 was not changed compared to the baseline examination in 2014. The data for the follow-up examination were therefore collected using the simulated patient method in all 21 pharmacies in a city in the north-east of Germany. Three female and two male test buyers used four different scenarios for self-medication of acute diarrhoea in all of the pharmacies (a total of 84 test purchases). Results: There were significant differences between the overall results from the baseline study (2014) and the follow-up study (2017) (Wilcoxon signed rank test;z = –2.065, p = 0.039, r = 0.225). In the overall average, the pharmacies in 2017 achieved only 2.7 (30%) of 9 possible points whereas in 2014 they achieved 3.3 (37%). The quality of advice between the professional groups did not show any significant differences (Kruskal-Wallis test: χ2(2) = 1.946;p = 0.378, r = 0.027). Conclusions: The quality of advice for acute diarrhoea in adults declined over time. A written performance feedback intended to improve the quality proved ineffective. Interventions with a far greater impact are required to achieve an improvement in the quality of advice provided.

ICU老年有创机械通气患者早期肠内营养喂养不耐受现状及影响因素分析

目的:调查ICU老年有创机械通气患者喂养不耐受的现状并探究其影响因素,为识别喂养不耐受高危人群提供理论依据。方法:本研究选取实施肠内营养支持治疗的老年有创机械通气患者202例作为研究对象。采用一般情况资料调查表、肠内营养不耐受状况调查表进行持续5 d的数据收集,采用二元Logistic回归方程进行多因素分析。结果:二元Logistic回归结果显示,鼻饲速度>40 mL·h^(-1)(OR=5.826)、使用血管活性药物(OR=2.581)、呼吸末正压增高(OR=0.821)、低血清白蛋白(OR=1.050)是老年有创机械通气患者喂养不耐受的危险因素,床头抬高≥30°(OR=0.339)、使用可溶性膳食纤维(0R=0.325)是老年有创机械通气患者喂养不耐受的保护因素,差异具有统计学意义(P<0.05)。结论:鼻饲速度、血管活性药物、呼吸末正压、血清白蛋白、床头抬高≥30°、使用可溶性膳食纤维是老年有创机械通气患者喂养不耐受的影响因素,临床工作中应关注以上因素以预测患者喂养不耐受的发生,保证患者营养供给,改善患者预后。

致泻性大肠埃希菌在腹泻患者及家禽畜中的分布状况研究

目的 :了解致泻性大肠埃希菌在我市腹泻病人及家禽、家畜 ,肉制品中的带菌状况及血清型分布 ,通过耐药性试验及相关因素分析 ,找出防制措施。方法 :用改良EC肉汤进行增菌 ,用EMB和O157∶H7专用培养基进行致泻性大肠埃希菌的分离、培养 ,用生物梅里埃P2 0 E生化及血清学进行鉴定 ,用KB法作药敏试验。结果 :从 198例腹泻病人中检出 78株致泻性大肠埃希菌 (45 90 % )、从 312个家禽中检出 95株 (30 4 5 % )、从 2 4 8例家畜中检出 5 0株 (2 0 16 % )、从171例肉制品中检出 2 0株 (11 6 9% )。检出的致泻性大肠埃希菌共有 10个血清型且存在不同程度的耐药性。结论 :在腹泻病人中 ,致泻大肠埃希菌的感染率高达 4 5 90 % ,家禽、家畜及肉制品中的带菌率也高达 2 2 5 6 % ,且人、畜、禽的带染菌型基本一致 ,90 %的分离菌株具有广泛的耐药性。

从海南岛300例腹泻病人粪便标本分离耶氏菌

采用CIN培养基，从海南岛300例腹泻病人粪便标本分离培养出耶氏菌11株．其中，小肠结肠炎耶氏菌4株，血清型0：3；中间型耶氏菌7株.这7个中间型耶氏菌菌株均能分解鼠李糖、密二糖和棉子糖．