脱细胞猪真皮基质敷料覆盖治疗小儿特重度烧伤深Ⅱ度创面的护理

目的总结脱细胞猪真皮基质覆盖治疗小儿特重度烧伤深Ⅱ度创面的护理重点。方法回顾性分析2015年4月至2016年4月广州市红十字会医院烧伤重区收治的9例特重度烧伤小儿应用脱细胞猪真皮基质敷料覆盖深Ⅱ度创面的临床资料和护理措施。结果 9例特重度烧伤患儿均平稳渡过休克期,于2~3周全部治愈。结论脱细胞猪真皮基质急诊覆盖治疗小儿特重度烧伤深Ⅱ度创面可以促进创面愈合,护理重点在于生命体征观察与输液护理、疼痛管理与心理护理及术后加强创面生物敷料观察与护理。及时发现、去除脱细胞猪真皮基质敷料下积液、积脓,维持敷料的干燥,防止脱细胞猪真皮基质敷料缩窄影响肢端血运。     

某二级医院中专学历护士核心能力调查分析

目的了解临床中专学历护士核心能力现状,为培养中专学历护士核心能力提供参考依据。方法采用《一般资料调查表》及《中国注册护士核心能力量表》对197名临床中专学历护士进行问卷调查,回收有效问卷183份。结果 183名中专学历护士的核心能力总分为(151.45±35.62)分,各条目均分为(2.59±0.26)分;1~5年护龄护士得分最低,16~20年护龄护士得分最高,不同护龄组护士的核心能力得分差异有统计学意义(P0.05);职称为护士的中专学历护士核心能力得力最低,与护师、主管护师组比较差异均有统计学意义(P均0.05),而护师、主管护师职称的护士核心能力得分差异无统计学意义(P0.05);急诊科护士得分最高,ICU护士得分最低,不同科室护士核心能力得分差异有统计学意义(P0.05)。结论二级医院临床中专学历护士核心能力处于中等水平,护理管理者要加强护士的岗位培训,在工作中分层级使用及管理,促进护士核心能力水平的提升。     

海南汉族人群痛风患者血脂情况及健康教育管理策略

目的对海南汉族人群痛风患者血脂情况进行调查,探讨采取相应健康教育管理策略实施情况。方法 2016年1-5月对海南省三家医院(海南医学院附属医院、海南省人民医院、海口市人民医院)的体检中心痛风汉族患者300例(观察组)进行问卷调查,与同期正常的体检者300例(对照组)进行比较,并对痛风患者进行多样化、个性化的健康教育,比较患者与健康人群血脂水平(TC、TG、LDL-C、HDL-C)情况,随访3个月后,健康教育管理干预前后干预患者依从性得分情况,痛风知识掌握率、血尿酸值情况及痛风复发率情况。结果观察组患者TC、LDL-C、TG浓度高于对照组,HDL-C水平低于对照组(P0.05);经过健康教育管理1个月后,痛风患者依从性得分显著高于干预前;痛风知识知晓率显著高于干预前,血尿酸值水平及痛风复发率低于干预前(P0.05)。结论海南汉族痛风患者血脂发生显著变化,健康教育管理后,患者依从性提高,病情缓解,培养患者自我管理能力。     

Combinative multi-scale level set framework for echocardiographic image segmentation

In the automatic segmentation of echocardiographic images, a priori shape knowledge has been used to compensate for poor features in ultrasound images. This shape knowledge is often learned via an off-line training process, which requires tedious human effort and is highly expertise-dependent. More importantly, a learned shape template can only be used to segment a specific class of images with similar boundary shape. In this paper, we present a multi-scale level set framework for segmentation of endocardial boundaries at each frame in a multiframe echocardiographic image sequence. We point out that the intensity distribution of an ultrasound image at a very coarse scale can be approximately modeled by Gaussian. Then we combine region homogeneity and edge features in a level set approach to extract boundaries automatically at this coarse scale. At finer scale levels, these coarse boundaries are used to both initialize boundary detection and serve as an external constraint to guide contour evolution. This constraint functions similar to a traditional shape prior. Experimental results validate this combinative framework.     

Herd‐level prevalence and incidence of porcine epidemic diarrhoea virus (PEDV) and porcine deltacoronavirus (PDCoV) in swine herds in Ontario,Canada

Porcine epidemic diarrhoea virus (PEDV ) and porcine deltacoronavirus (PDC oV) were first identified in Canada in 2014. Surveillance efforts have been instrumental in controlling both diseases. In this study, we provide an overview of surveillance components for the two diseases in Ontario (Canada), as well as PEDV and PDC oV incidence and prevalence measures. Swine herds located in the Province of Ontario, of any type, whose owners agreed to participate in a voluntary industry‐led disease control programme (DCP ) and with associated diagnostic or epidemiological information about the two swine coronaviruses, were eligible to be included for calculation of disease frequency at the provincial level. PEDV and PDC oV data stored in the industry DCP database were imported into the R statistical software and analysed to produce weekly frequency of incidence counts and prevalence counts, in addition to yearly herd‐level incidence risk and prevalence between 2014 and 2016. The yearly herd‐level incidence risk of PEDV , based on industry data, was 13.5%, 3.0% and 1.4% (95% CI : 11.1–16.2, 2.0–4.2, 0.8–2.3), while the yearly herd‐level incidence risk of PDC oV was 1.1%, 0.3%, and 0.1% (95% CI : 0.5–2.2, 0.1–0.9, 0.0–0.5), for 2014, 2015 and 2016, respectively. Herd‐level prevalence estimates for PEDV in the last week of 2014, 2015 and 2016 were 4.4%, 2.3% and 1.4%, respectively (95% CI : 3.1–6.0, 1.5–3.3, 0.8–2.2), while herd‐level prevalence estimates for PDC oV in the last week of 2014, 2015 and 2016 were 0.5%, 0.2% and 0.2%, respectively (95% CI : 0.1–1.2, 0.0–0.6, 0.0–0.6). Collectively, our results point to low and decreasing incidence risk and prevalence for PEDV and PDC oV in Ontario, making both diseases possible candidates for disease elimination at the provincial level.     

Deep weakly-supervised breast tumor segmentation in ultrasound images with explicit anatomical constraints

Breast tumor segmentation is an important step in the diagnostic procedure of physicians and computer-aided diagnosis systems. We propose a two-step deep learning framework for breast tumor segmentation in breast ultrasound (BUS) images which requires only a few manual labels. The first step is breast anatomy decomposition handled by a semi-supervised semantic segmentation technique. The input BUS image is decomposed into four breast anatomical structures, namely fat, mammary gland, muscle and thorax layers. Fat and mammary gland layers are used as constrained region to reduce the search space for breast tumor segmentation. The second step is breast tumor segmentation performed in a weakly-supervised learning scenario where only image-level labels are available. Breast tumors are first recognized by a classification network and then segmented by the proposed class activation mapping and deep level set (CAM-DLS) method. For breast anatomy decomposition, the proposed framework achieves Dice similarity coefficient (DSC) of 83.0 ± 11.8%, 84.3 ± 10.0%, 80.7 ± 15.4% and 91.0 ± 11.4% for fat, mammary gland, muscle and thorax layers, respectively. For breast tumor recognition, the proposed framework achieves sensitivity of 95.8%, precision of 92.4%, specificity of 93.9%, accuracy of 94.8% and F1-score of 0.941. For breast tumor segmentation, the proposed framework achieves DSC of 77.3% and intersection-over-union (IoU) of 66.0%. In conclusion, the proposed framework could efficiently perform breast tumor recognition and segmentation simultaneously in a weakly-supervised setting with anatomical constraints.     

动脉化疗栓塞治疗恶性梗阻性黄疸

目的：探讨胆道支架置放后动脉化疗栓塞治疗恶性梗阻性黄疸(MOJ)的并发症和疗效，研究影响黄疸复发时间和患者生存期的预后因素。方法：51例MOJ患者放置胆道支架后接受动脉化疗栓塞术(TACE)，观察手术并发症，血清胆红素下降程度，随访黄疸复发时间和患者生存期。分析性别，年龄，肿瘤类型，术前血清胆红素浓度、碱性磷酸酶、谷丙转氨酶、白蛋白、血红蛋白浓度，梗阻时间，梗阻水平10个因素对黄疸复发时间和患者生存期的影响。结果：51例共计放置支架64枚，行TACE术86次，技术成功率为100％。1例于术后1个月死亡，在治疗过程中，4例出现肝脓肿。4例失访，51例生存期为1～34个月，平均9．0个月，中位值8．0个月。22例黄疸复发，复发率43．2％，黄疸复发时间2～14个月，平均11．0个月，中位值9．0个月。单因素(P=0．010)和多因素(P=0．010)分析均显示术前血清总胆红素浓度是影响患者生存期的重要因素。单因素分析显示对黄疸复发有显著影响的因素为肿瘤类型(P=0．035)。结论：MOJ患者放置胆道支架后进行TACE术，可以延缓黄疸复发，延长患者生存期。术前血清总胆红素浓度高的患者生存期较短；肝细胞肝癌患者的黄疸复发时间较非肝细胞肿瘤患者明显延长，黄疸复发率亦低于后者。     

急诊科不同时段护理活动的调查

目的 调查急诊科不同时段的护理活动,为急诊护理人力配备提供参考依据.方法 经过统一培训后的调查人员以连续观察法,用表格记录的方式对急诊科当日在岗护理人员24 h的直接护理时数、间接护理时数、相关护理时数、个人活动时间及等待患者时间进行测算并与现有人力比较.结果 在不同时段急诊护理活动量不同,14:30～17:30及17:30～22:00,每位护士每小时平均工作45 min,是工作最繁忙时段.结论 在17:30～22:00时段护理活动多,具有所需护理时数多的规律,管理人员要用好等待病人时间及所需护理时数较少的时段,合理安排人力.     

Determinants of Discharge Disposition From Acute Care for Survivors of Hypoxic-Ischemic Brain Injury: Results From a Large Population-Based Cohort Data Set

ObjectiveTo identify determinants of discharge disposition from acute care among survivors of hypoxic-ischemic brain injury (HIBI), stratified by sex.DesignPopulation-based retrospective cohort study using provincial data in Ontario, Canada. The determinants were grouped into predisposing, need, and enabling factors using the Anderson Behavioral Model.SettingAcute care.ParticipantsSurvivors of HIBI aged ≥20 years at the time of hospitalization and discharged alive from acute care between April 1, 2002, and March 31, 2017. There were 7492 patients with HIBI, of whom 28% (N=2077) survived their acute care episode.InterventionsNot applicable.Main Outcome MeasuresDischarge disposition from acute care, categorized as complex continuing care (CCC), long-term care (LTC), inpatient rehabilitation (IR), home with support, home without support, and transferred to another acute care.ResultsThe discharge dispositions for the 2077 survivors were IR 23.4% (n=487), CCC 19.5% (n=404), LTC 6.2% (n=128), home without support 31.2% (n=647), home with support 15.1% (n=314), and other 4.6%. Multinomial multivariable logistic regression analysis using home without support as the reference category revealed that female patients were significantly more likely than male patients to be discharged to LTC/CCC. Those who were older, were frail, and had longer stay in acute care or special care unit (SCU) were more likely to be discharged to LTC/CCC. The only significant determinant for IR was longer stay in acute care. Survivors with cardiac-related injury were less likely to be discharged to LTC/CCC. Income was a significant factor for male patients but not for female patients in the sex-stratified analysis. The following variables were investigated but were not significant determinants in this study: need factors (comorbidity score, prior psychiatric disorders, health care utilization) and enabling factors (income quintile, rural area of residence).ConclusionsPredisposing (age, sex) and need factors (frailty, acute care days, SCU days, type of injury) were significant determinants of discharge disposition from acute care after HIBI. In spite of a system with universal coverage, sex differences were found, with more female patients being discharged to CCC/LTC rather than IR, controlling for age and other confounders. These findings should be considered in appropriate discharge planning from acute care for survivors of HIBI.