孕期体重变化率与足月产新生儿体重关联剂量反应关系的研究

目的 探讨孕期体重变化率与足月产新生儿出生体重关联强度的剂量反应关系。方法 选取2006年1月至2013年12月江苏省昆山市围产保健监测系统18 868名孕产妇与足月产新生儿为研究对象。使用多因素logistic回归及限制性立方样条法分析产妇孕期体重变化率[即(末次产检体重-初次产检体重)/(末次产检孕周-初次产检孕周)]与足月产新生儿出生体重关联强度及其剂量反应关系。调整因素包括产妇年龄、教育程度、孕前BMI、户籍状态、经产妇、初次产检孕周与胎儿性别。结果 高水平的孕期体重变化率在孕前低BMI(OR=3.15, 95%CI: 1.40~7.07)、正常BMI(OR=3.64, 95%CI: 2.84~4.66)、超重(OR=2.37, 95%CI: 1.71~3.27)的产妇中与分娩足月巨大儿有统计学关联;孕前低BMI(OR=0.28, 95%CI: 0.13~0.61)及正常BMI(OR=0.37, 95%CI: 0.22~0.64)产妇与分娩足月低体重儿有统计学关联。孕期体重变化率与分娩足月巨大儿的关联强度呈现非线性“S”形剂量反应关系(非线性检验P<0.000 1);与分娩足月低体重儿的关联强度呈“L”形非线性剂量反应关系(非线性检验P<0.000 1)。结论 孕期体重变化率与分娩足月低体重儿的关联强度呈现“L”形曲线, 而与分娩足月巨大儿的关联强度呈现“S”形曲线。     

Development of a tool for screening the severity of locomotive syndrome by the loco-check

BackgroundThe loco-check has been widely used to raise awareness of locomotive syndrome (LS) not only in the general population but also among medical practitioners. However, a screening tool of the loco-check for LS-1, LS-2, and LS-3 has not yet been established. The present study developed a screening tool for use with the loco-check to detect LS-1, LS-2, and LS-3.MethodsA cross-sectional study of 1659 community-dwelling older adults (730 males, 929 females) with a mean age of 73.8 ± 6.0 years old (range, 65–96 years old) was conducted, based on the Standards for Reporting Diagnostic Accuracy (STARD). All subjects underwent the loco-check as an index test and the 25-question Geriatric Locomotive Function Scale (GLFS-25) as a reference standard at the same time. Subjects with a GLFS-25 total score of ≤6 points, 7–15 points, 16–23 points, and ≥24 points were diagnosed with non-LS, LS-1, LS-2, and LS-3, respectively. A conventional receiver-operating characteristic curve analysis was used to confirm the optimal cut-off values of the loco-check score and their sensitivity and specificity to identify LS-1, LS-2, and LS-3, with a preference for a slightly higher sensitivity as the tool is intended primarily for screening purposes.ResultsThe optimal cut-off values of the loco-check score to discriminate LS-1, LS-2, and LS-3 as a screening tool were 1 point (sensitivity 85.4% and specificity 64.9%), 2 points (sensitivity 88.8% and specificity 75.1%), and 3 points (sensitivity 87.6% and specificity 84.6%), respectively.ConclusionsOur findings may help both the general population and medical practitioners become roughly aware of and estimate the severity of LS, which will contribute to its use in community health activities and the dissemination of the concept of LS.     

Comparative study of the subserosal versus submucosal dye injection method for sentinel node biopsy in gastric cancer

AimsTo determine the most efficient injection method for a sentinel node (SN) biopsy in gastric cancer.MethodsGastric adenocarcinoma patients without serosal invasion and distant metastasis were prospectively enrolled in this study. Isosulfan blue was injected into the subserosa (SS) of the first set of 71 consecutive patients and an intraoperative endoscopic submucosal (SM) injection of the same dye was injected into the second set of 50 consecutive patients. After the biopsy of blue-stained SNs, a gastrectomy with a D2 lymphadenectomy was performed. All dissected lymph nodes were evaluated for metastasis. The results of the SN biopsies were compared between the SS and SM dye injection methods.ResultsDetection rate (0.92 vs 0.94), mean number of SNs (2.5 vs 2.9) and sensitivity (0.61 vs 0.46) of the SN biopsies were not significantly different between the SS and SM injection methods (P>0.05). The operation time was significantly shorter in the SS than the SM injection method (159.7 vs 172.7 min, P=0.030).ConclusionsBoth injection methods were equally efficient in their roles for a SN biopsy in gastric cancer. However, the SS injection method was more preferable due to its easy technique and short operation time.     

Perceptions of health care professionals towards clinical practice guidelines: The case of Diabetes Mellitus in Saudi Arabia

BackgroundClinical practice guidelines are developed by healthcare policy makers and disseminated to practitioners in order to minimize practice variations and to improve the quality of care. Problems arise when there is a sole reliance on passive dissemination strategies such as mailing or publishing the guidelines, as these approaches do not usually lead to the adoption.ObjectiveThis study aims to explore the perspectives of the health care professionals toward the Saudi National Diabetes Guidelines in terms of awareness, adherence and their preferred dissemination and implementation strategies of the guideline.MethodA cross-sectional survey was conducted among physicians and nurses working in twenty primary health care centers in the city of Riyadh between February and March 2019.ResultsNearly half of the total 179 respondents reported that they were unaware of the guidelines (49.1%), and 92% of the remaining 91 participants who were aware of the guideline reported that they had first heard about it through their official mail. The mean scores ranked according to the most preferred methods for disseminating and implementing the diabetes guidelines were as follows: via reminder systems 4.35 ± 0.74, financial incentives 4.33 ± 0.65, and audit and feedback 4.27 ± 0.58. On the other hand, the least favorable strategies were traditional education 3.79 ± 0.96 and the distribution of the guideline by mail 3.13 ± 0.95.ConclusionThe level of awareness of the diabetes guidelines among the primary health care professionals was suboptimal. This was more likely due to the Ministry of Health’s reliance on passive implementation strategies. In order to have the guidelines translated into clinical practice, active and targeted implementation strategies such as reminder systems, audit and feedback must be considered by the Saudi health policy makers.     

Microbiology of wound infection after oral cancer surgery

IntroductionThe aim of present study is to investigate the most common infection pathogen found in the postoperative wounds, following surgical treatment of oral and oropharyngeal cancer, in order to identify the most suitable antibiotic treatment.Patients and methodsWe analyzed patients with squamous cell cancer of oral and oropharyngeal region. In patients who developed postoperative wound infection, wound swabs were taken from three different sites: the cannula, wounds on the neck and wounds in the oral cavity.ResultsIn total 195 patients were included. The postoperative wound infection was detected in 115 patients (59%). In average, the swabs were taken 8 days after the surgery. The similar bacterial species from all three sites were detected in 24 patients (12,3%). In comparison, we found that there was statistically significant difference in the bacteria abundance from all three sites (p=0,031). There were significantly more bacteria in the wounds of the neck than cannula (p=0,007) and in the wounds in the oral cavity than cannula (p=0,002). No statistically significant difference between the wound on the neck and in the oral cavity was found. The most frequently isolated bacterial family was Enterobacteriaceae. Other more commonly isolated bacteria species were Staphylococcus spp. (G+), Pseudomonas aeruginosa (G-), Corynebacteruim spp. (G +) and Acinetobacter baumanii (G-).ConclusionBased on the most commonly isolated groups of pathogens we concluded that probably the best empiric antibiotic treatment of wound infections until antibiogram is completed might be achieved from the group of aminoglycosides or quinolones. Antibiotic therapy should be reviewed if necessary when antibiogram is completed.