Contextualizing the lived experience of quality of life for persons with spinal cord injury: A mixed-methods application of the response shift model

Objective: The objective of this study was to gain greater insight into individuals’ quality of life (QOL) definitions, appraisals, and adaptations following spinal cord injury (SCI).

Design: A mixed-methods design, applying the Schwartz and Sprangers response shift (RS) model. RS is a cognitive process wherein, in response to a change in health status, individuals change internal standards, values, or conceptualization of QOL

Setting: Community-dwelling participants who receive medical treatment at a major Midwestern medical system and nearby Veterans’ Affairs hospital.

Participants: A purposive sample of participants with SCI (N?=?40) completed semi-structured interviews and accompanying quantitative measures.

Interventions: Not applicable.

Outcome Measures: Qualitative data were analyzed using content analysis to identify themes. Analysis of variance were performed to detect differences based on themes and QOL, well-being, and demographic and injury characteristics.

Results: Four RS themes were identified, capturing the range of participant perceptions of QOL. The themes ranged from complete RS, indicating active engagement in maintaining QOL, to awareness and comparisons redefining QOL, to a relative lack of RS. Average QOL ratings differed as a function of response shift themes. PROMIS Global Health, Anxiety, and Depression also differed as a function of RS themes.

Conclusion: The RS model contextualizes differences in QOL definitions, appraisals, and adaptations in a way standardized QOL measures alone do not.     

老年人股骨粗隆间骨折手术时机对预后影响的临床研究

目的：探讨老年股骨粗隆间骨折手术时机对临床预后结局的影响。方法整群选取2015年1月—2016年1月该院收治的老年股骨粗隆间骨折患者68例为研究对象。根据患者手术时间将其分为A组与B组, A组32例,B组36例,观察两组患者不同年龄术后30 d、1年的死亡情况。结果两组患者术后30d、1年死亡率比较差异无统计学意义,P>0.05；但A组、B组患者中超过80岁的患者术后1年死亡率明显低于80岁以下年龄患者,P<0.05,差异具有统计学意义。结论年龄超过80岁的老年股骨粗隆间骨折患者术后1年死亡率相对较高。     

A systematic review of the safety and efficacy of non-operative management in patients with high grade liver injury

IntroductionThe liver is the most frequently damaged organ in blunt abdominal trauma. It is widely accepted that hemodynamically stable patients with low-grade liver trauma should be treated with non-operative management, however there is controversy surrounding its safety and efficacy in high-grade trauma. The purpose of this review is to investigate the role of non-operative management in patients with high-grade liver trauma.MethodsPubMed and reference lists of PubMed articles were searched to find studies that examined the efficacy of non-operative management in high-grade liver injury patients, and compare it to operative management. Non-operative management was considered successful if rescue surgery was avoided. Outcomes considered were success, mortality, and complication rates.ResultsThe electronic search revealed 2662 records, 8 of which met the inclusion criteria. All 8 studies contained results suggesting that non-operative management was safe and effective in hemodynamically stable patients with high-grade liver trauma. By combining the outcomes of the different studies, non-operative management had a high success rate of 92.4% (194/210) in high-grade liver trauma patients, which was near the overall 95.0% non-operative management success rate. Non-operative management also had mortality and complication rates of 4.6% (9/194) and 9.7% (7/72) in high-grade injury patients, respectively, compared to operative management's 17.6% (26/148) and 45.5% (5/11).ConclusionNon-operative management of liver trauma is safe and effective in hemodynamically stable patients with high-grade liver injury. It is associated with significantly lower mortality compared with operative management. More studies are required to evaluate complications of non-operative management in high-grade liver injury.     

1381例先天性室间隔缺损的外科治疗

目的总结先天性室间隔缺损(VSD)手术治疗的临床经验。方法1992年12月至2005年10月手术治疗VSD1381例,男性835例,女性546例,年龄2天至55岁,平均(4.6±3.2)岁。体重2.5～80(14.5±10.7)kg,<10kg者487例(35.3%)。均在低温体外循环下手术,必要时应用深低温低流量及改良超滤技术。直视缝合823例,补片修补558例。结果术后30d内死亡24例(其中11例年龄<6个月),死亡率1.74%;晚期死亡1例。主要并发症发生率9.7%。结论手术治疗室间隔缺损效果满意。但<6个月龄的低体重婴儿应严格控制手术适应证。干下型VSD应早期手术,防止主动脉瓣关闭不全的发生。术后应重视对呼吸系统、循环系统的监护与治疗,重视对肺动脉高压围术期处理     

重型颅脑损伤的手术治疗

目的探讨重型颅脑损伤梯度减压的手术方法对预防术中脑膨出、降低死亡率及致残率的效果。方法对100例重型颅脑损伤患者采用分次减压手术方式及去骨瓣后，硬膜与颞肌筋膜瓣减张缝闭硬膜切口方法。结果40例脑肿胀患者术中脑嘭出6例占15．0％，死亡19例占47．5％；60例脑内血肿病人未发生脑膨出，死亡12例占20％。结论脑外伤后脑血管调节麻痹及血肿压迫继发脑水肿易造成脑膨出.术中分次减压降低了骨窗部位脑组织的顺应性，从而降低了局部的压力梯度，避免脑血管急性扩张，能有效防止脑膨出，降低死亡率及致残率。     

颅底中线区大型和巨大型脑膜瘤的显微手术切除

目的探讨颅底中线区不同部位大型和巨大型脑膜瘤手术入路和切除方式,并分析特殊类型脑膜瘤手术治疗方法。方法本组93例,男性26例,女性67例;平均年龄48.4岁。术前行神经影像学检查,根据肿瘤部位,选择相应手术入路,采用显微手术切除肿瘤。结果肿瘤全切除80例(86.02%),大部分切除13例(13.98%),死亡1例(10.75%)。除单条颅神经功能术前完全丧失外,术后神经功能改善者75例(81.52%),不变者10例(10.86%),加重者7例(7.6%)。经6月￣7年随访,13例(14.13%)肿瘤复发。结论颅底中线区大型和巨大型脑膜瘤手术切除难度大。要取得良好的手术效果,必须选择正确手术入路,采用分块切除方式,精心保护重要血管和神经。     

胰腺损伤的诊治分析

目的探讨胰腺损伤诊断,治疗经验及如何降低病死率。方法对我院1988年1月至2004年12月胰腺损伤27例进行回顾性分析。其中Ι级5例,II级7例,Ⅲ级8例,IV级6例,V级1例。单纯胰周引流12例,胰体尾切除8例,胰腺近端缝扎、远端与空肠Roux-en-Y吻合2例,胰头十二指肠修补加十二指肠憩室化2例,胰腺近端缝扎、远端与空肠Roux-en-Y吻合加改良十二指肠憩室化3例。结果痊愈25例(92.6%),死亡2例(7.4%)。结论根据外伤病史,腹部体征、B超CT及淀粉酶检查,对胰腺损伤是有较大邦助。必要时及做剖腹探查协助诊断。选择合理的手术方式可提高治愈率,减少并发症,降低死亡率。     

Derivation of Power M-Mode Transcranial Doppler Criteria for Angiographic Proven MCA Occlusion

BACKGROUND: Stringent transcranial Doppler (TCD) criteria for diagnosing occlusion are needed for more reliable TCD performance at bedside in the acute stroke setting. SUBJECTS AND METHODS: At three academic stroke centers, we performed TCD examination for patients with symptoms of cerebral ischemia who underwent digital subtraction angiography (DSA). We used a standard insonation protocol with power M-mode Doppler (PMD) TCD (TCD 100 M, Spencer Technologies Inc., Seattle, WA). We collected mean flow velocity (MFV), pulsatility indices (PI), and power M-mode resistance signature (absent, high, or low) in symptomatic middle (MCA), anterior (ACA), posterior (PCA), and in affected (a), ipsilateral (i), and contralateral (c-lat) cerebral arteries. Ratios of aMCA/c-lat MCA, aMCA/iACA, and aMCA/iPCA MFV were subsequently calculated. PMD-TCD flow findings were evaluated with a receiver-operating characteristic (ROC) analysis for angiographically proven MCA occlusion. RESULTS: We studied 120 patients with acute cerebral ischemia with PMD-TCD examinations prior to or immediately after DSA. Lower aMCA velocities pointed to higher probability of occlusion (P= .055). The aMCA/iPCA MFV ratio was superior to the aMCA/iACA ratio and strongly predictive of occlusion at a threshold ratio of 0.5 (RR 2.31 CI(95) 2.13-2.51). High resistance or absent M-mode flow signatures in the proximal MCA were present in 87% of M1 and M2 MCA occlusions (probability 87%). In the presence of a low-resistance PMD signature, obtaining the aMCA/iPCA MFV ratio <0.5 increases probability of occlusion to 87%. Normal MFV ratios and low-resistance M-mode signatures are highly predictive of a negative angiogram for MCA occlusion. CONCLUSION: In acute cerebral ischemia, reliable criteria for proximal MCA occlusion have been developed based on combination of MFV ratios and M-mode flow resistance signatures. Validation of these criteria will require multicenter studies.     

A Survey of Plants Used as Wild Vegetables in Four Districts of Botswana

A survey of plants used as wild vegetables was conducted in four districts of Botswana in August and September 2005. The objective was to determine which wild plants were used as vegetables in the study area, and to document their cooking and preservation methods. Fourteen species representing seven families were mentioned as wild vegetables. In addition, six species from four families had other uses in traditional medicine. The implications of the documented processing methods on the retention of nutrients in the vegetables are discussed.