检测干血片样品中促甲状腺素和苯丙氨酸实验影响因素的研究

目的探讨新生儿筛查滤纸干血样法检测过程中,可能影响促甲状腺激素(TSH)及苯丙氨酸(Phe)测定结果的因素.方法分别用酶免疫标记法和细菌抑制法检测滤纸血片TSH及Phe含量.结果 TSH测定干血片中TSH在4°C环境能够稳定30 d,血斑中心到边缘1/2以内区域检测结果最为可靠;新生儿出生72 h后采血结果稳定,季节间TSH水平有差异,血片递送周期应限制在15 d以内.Phe测定制板温度以55°C～60°C为宜;试剂中加入抗生素可以有效降低假阴性率;72 h后采血可降低假阳性率.结论采血时间、标本保存时间、血片处理等因素影响筛查结果,选择最佳试验条件,能较好地保证新生儿筛查试验质量.     

检测干血片样品中促甲状腺素和苯丙氨酸实验影响因素的研究

目的　探讨新生儿筛查滤纸干血样法检测过程中 ,可能影响促甲状腺激素 (TSH)及苯丙氨酸 (Phe)测定结果的因素。方法　分别用酶免疫标记法和细菌抑制法检测滤纸血片TSH及Phe含量。结果　TSH测定 :干血片中TSH在 4°C环境能够稳定 30d ,血斑中心到边缘 1/ 2以内区域检测结果最为可靠 ;新生儿出生 72h后采血结果稳定 ,季节间TSH水平有差异 ,血片递送周期应限制在 15d以内。Phe测定 :制板温度以 5 5°C～6 0°C为宜 ;试剂中加入抗生素可以有效降低假阴性率 ;72h后采血可降低假阳性率。结论　采血时间、标本保存时间、血片处理等因素影响筛查结果 ,选择最佳试验条件 ,能较好地保证新生儿筛查试验质量     

BA-ELISA法测定干血斑促甲状腺素含量的影响因素探讨

目前,大多数国家主要采用酶标法、免疫荧光法利时间分辨法测定滤纸干血斑促甲状腺素(TSH),以筛查新生儿甲状腺功能低下症(CH).由于TSH在血液中含量甚微,加之滤纸为其取样载体,其测定结果受多种因素影响,稍有疏忽就可能出现漏诊,使患儿丧失早期诊断和治疗的机会.为探讨滤纸采血-测定TSH的影响因素,减少或避免CH的漏诊,我们对滤纸血片TSH的生物素-亲和素酶联免疫56吸附实验(BA-ELISH)测定结果的影响因索进行了探讨.     

先天性甲状腺功能减低症和苯丙酮尿症的筛查结果分析

目的:了解我省新生儿先天性甲状腺功能减低症(CH)及苯丙酮尿症(PKU)的发病情况.方法:新生儿出生48～72 h喂足6次奶后足跟部采血,滴在规定的S&;S903滤纸片上,室温自然干燥后,CH筛查采用时间分辨免疫分析法(DELFIA)检测滤纸干血斑中促甲状腺素(TSH)的浓度,PKU筛查采用荧光定量法检测滤纸干血斑中苯丙氨酸的浓度.结果:对我省部分地区28 721例新生儿进行筛查,确诊CH11例,发病率为1/2 611(11/28 721);未检出PKU.结论:新生儿筛查是早期发现CH和PKU患儿、及时诊断、治疗和预防智力低下发生,提高人口素质的重要措施,值得大力推广.     

对5 824例新生儿疾病筛查结果的探讨

[目的]分析和总结了我院新生儿疾病筛查情况.[方法]1996年3月-2004年12月出生的新生儿5 824例喂奶72 h后,取足跟血3滴于特定滤纸上,测定促甲状腺激素(TSH)浓度和苯丙氨酸(Phe)含量,筛查先天性甲状腺功能低下症(CH)和苯丙酮尿症(PKU).[结果]我院新生儿筛查率83.30%,CH发生1例,未检出PKU患儿.[结论]新生儿疾病筛查是减少残疾儿发生的有效手段.     

新生儿干血片葡萄糖-6-磷酸脱氢酶测定的影响因素分析

目的探讨新生儿干血片葡萄糖-6-磷酸脱氢酶(G6PD)筛查过程中可能影响G6PD测定结果的因素。方法观察采血季节、新生儿性别及分娩方式、血样采集后样本的贮存条件及时间、干血片取样部位、加酮试剂后血片是否去除和加酮试剂后仪器测定时间等因素对检测结果的影响。结果采血季节、新生儿的分娩方式(顺产及剖宫产)、样本贮存条件及时间、加酮试剂后血片的处理方式及仪器测定时间的不同均可引起G6PD结果的差异。新生儿性别及干血片取样部位对G6PD的测定结果没有影响。结论影响新生儿干血片G6PD筛查试验结果的因素众多,选择最佳检测条件,才能较好保证筛查试验质量。     

新生儿疾病筛查血标本采集和运送中常见问题分析与对策

目的 了解新生儿疾病筛查血标本采集和运送现状.方法 选择2004年1～12月出生的新生儿310例为观察组,观察新生儿疾病筛查采集血标本的情况.发现实施新生儿筛查过程中,在采血部位、穿刺深度、血样干燥时间、产妇的配合等多个环节存在缺陷,并对2005年1～12月的新生儿疾病筛查检测对象310例(实施组)及时采取整改措施.结果 实施组复查率明显下降.结论 需重视对产科医护人员进行新生儿疾病筛查血标本采集、送检规范知识及操作培训,做好筛查宣教工作,改良采血部位及血样干燥时间,以提高标本采集合格率,确保标本送检质量.     

新生儿干血片葡萄糖-6-磷酸脱氢酶测定的影响因素分析

目的探讨新生儿干血片葡萄糖-6-磷酸脱氢酶（G6PD）筛查过程中可能影响G6PD测定结果的因素。方法观察采血季节、新生儿性别及分娩方式、血样采集后样本的贮存条件及时间、干血片取样部位、加酮试剂后血片是否去除和加酮试剂后仪器测定时间等因素对检测结果的影响。结果采血季节、新生儿的分娩方式（顺产及剖宫产）、样本贮存条件及时间、加酮试剂后血片的处理方式及仪器测定时间的不同均可引起G6PD结果的差异。新生儿性别及于血片取样部位对G6PD的测定结果没有影响。结论影响新生儿干血片G6PD筛查试验结果的因素众多，选择最佳检测条件，才能较好保证筛查试验质量。     

新生儿疾病筛查血标本采集和运送中常见问题分析与对策

目的了解新生儿疾病筛查血标本采集和运送现状。方法选择2004年1~12月出生的新生儿310例为观察组,观察新生儿疾病筛查采集血标本的情况。发现实施新生儿筛查过程中,在采血部位、穿刺深度、血样干燥时间、产妇的配合等多个环节存在缺陷,并对2005年1~12月的新生儿疾病筛查检测对象310例(实施组)及时采取整改措施。结果实施组复查率明显下降。结论需重视对产科医护人员进行新生儿疾病筛查血标本采集、送检规范知识及操作培训,做好筛查宣教工作,改良采血部位及血样干燥时间,以提高标本采集合格率,确保标本送检质量。     

滤纸干血片唐氏综合征产前筛查AFP和β-hCG检测的影响因素

目的 探讨滤纸干血片唐氏综合征产前筛查过程中可能影响AFP和β-hCG测定结果的因素.方法 观察不同的洗脱时间、不同保存条件和取样部位、末梢血/静脉血干血片等因素对滤纸干血片检测结果的影响.结果 末梢血和静脉血滤纸干血片检测结果相同.血片边缘取样和中央取样对检测结果没有影响.滤纸干血片完全洗脱时间为1小时.在25℃放置7天时,β-hCG检测结果偏高.结论 AFP和β-hCG在滤纸干血片中可稳定存在.采用冷链运输,按照标准流程进行操作,可保证滤纸干血片唐氏综合征产前筛查质量.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.