How to think about interprofessional competence: A metacognitive model

Phenomenological evidence describing life history patterns frequently occurring in cancer patients, typically involving bereavement or other separation, may be explicable in terms of behavioural conditioning. Emotional loss has been demonstrated to produce biochemical changes which have an adverse effect on immune function. The emotional loss may become a conditioned stimulus so that further loss will produce immunosuppression, possibly greater than in the first instance, as a result of a process of sensitization. The model proposes a number of testable hypotheses, and implies that behavioural and psychological techniques could become important factors in promoting an environment conducive to healthy immune function.     

糖尿病诊断指标糖化血红蛋白的检测方法及临床意义

糖尿病目前已被国际社会列为人类健康头号杀手的非传染性疾病。血糖的检测在糖尿病的诊断、治疗及预防急性和慢性并发症中尤为重要。糖化血红蛋白（glycatedhemoglobin Alc，HbAlc）是反映既往2～3个月平均血糖水平的指标，用于评估长期血糖控制状况。目前HbAlc检测已经被推荐作为糖尿病诊断试验。现对HbAlC的检测方法及其临床意义作一综述。     

试用敷、擦、服三法治癌之回顾

将敷法、擦法、服法相结合治疗癌症,能取得一定效果。     

乳胶粒子法检测甲胎蛋白的应用

目的:评价Latex法检测甲胎蛋白(AFP)的临床应用价值。方法:对血清标本做批内批间重复性测定试验及La-tex法与电化学发光法进行对比测定。结果:Latex法与电化学发光法检测AFP结果无显著差异,Latex法与电化学发光法平均回收率分别为95.5%和96.7%。结论:电化学发光法灵敏度、精密度高,但其仪器、试剂价格高,不适于全面推广;Latex法与电化学发光法检测AFP结果无显著差异,相关性好,快速、结果稳定,试剂便宜在全自动生化仪上检测,可广泛应用。     

Reduced theophylline clearance due to hepatic congestion secondary to right heart failure - A population pharmacokinetic study

Theophylline, a beneficial drug with bronchodilatory and anti-inflammatory effects, is used for the treatment of respiratory diseases. Pulmonary (PC) and hepatic congestion (HC) are secondary to the development of left- and right-sided heart failure (HF), respectively. This study aimed to evaluate the effects of PC and HC on theophylline clearance (CL) by population pharmacokinetic (PPK) analysis with consideration of the severity of HF assessed by the New York Heart Association (NYHA) functional classification. We obtained 710 minimum steady-state concentrations from 201 Japanese bronchial asthma patients with and without HF. PPK analysis was performed by NONMEM. In the analysis, the left ventricular ejection fraction, smoking (SMK), clarithromycin (CAM), sex, and age were also considered as covariates. The final model of apparent theophylline clearance (CL/F) was as follows: CL/F (L/hr/kg) = 0.0465 × 1.40^SMK × 0.870^CAM × 0.863^{HC(+)NYHA II} × 0.634^{HC(+)NYHA III} × 0.586^{HC(−)NYHA IV} × 0.467^{HC(+)NYHA IV}. SMK is a well-known factor that markedly enhances theophylline clearance through the induction of CYP1A enzymes, while CAM has been reported to inhibit CYP3A4. The final model indicates that HF patients with HC show reduced clearance of theophylline depending on the severity of HF. In this study, no effects of PC were observed.     

2种不同微创手术方法治疗良性前列腺增生症的临床观察

目的:观察经尿道前列腺等离子双极电切(TUPKP)与经尿道前列腺单极电切术(TURP)治疗良性前列腺增生症患者的临床效果。方法:回顾性分析我院自2009年10月～2011年10月住院的130例良性前列腺增生症患者,随机分为实验组和对照组,每组各65例。实验组采用TUPKP,对照组采用TURP。结果:实验组和对照组术中、术后手术时间、术中出血量、术后平均住院天数、膀胱冲洗时间以及留置尿管时间,差异有统计学意义(P<0.05);实验组和对照组术后半年IPSS评分、QOL评分、残余尿和并发症等指标,差异无统计学意义(P>0.05)。结论:TUPKP与TURP治疗良性前列腺增生症患者的临床效果相当,经尿道前列腺等离子双极电切术相对更安全,值得临床推广应用。     

Causes and outcomes of new onset status epilepticus and predictors of refractoriness to therapy

We aimed to evaluate the determinants of outcome in new onset refractory status epilepticus (SE). A retrospective analysis of patients with new onset SE admitted between May 2005 and October 2013 was performed. Regression analysis was used to determine factors that affect progression of new onset SE to refractory status epilepticus (RSE) and mortality. Among 114 patients with new onset SE, 52 patients progressed to RSE. Sixty seven (58.7%) were men. New onset RSE patients were younger than new onset SE patients (mean 35.9 ± standard deviation18.2 versus 28.7 ± 20.2 years; p = 0.050). Cryptogenic aetiology was the most significant determinant of progression of new onset SE to RSE (Exp [β] = 5.68; p = 0.001). The overall mortality in the entire group was 23.7%, significantly higher in new onset RSE group (40.4% versus 9.7%; p < 0.0001). New onset RSE patients with symptomatic and cryptogenic etiology did not differ for clinical characteristics and outcome. Acidosis was the strongest predictor of mortality in the entire cohort (Exp [β] = 8.72; p = 0.005). Nearly half of the patients with new onset SE progressed to RSE. While cryptogenic aetiology determined progression of new onset SE to RSE, acidosis was associated with mortality. The outcome was similar between symptomatic and cryptogenic new onset RSE.     

Forest valuation and risk

This paper aims to illustrate ways in which sources of risk can affect the valuation of a commercial plantation estate. Deterministic and stochastic analyses of a hypothetical commercial plantation estate are compared. Both are built on a long-term harvest schedule of wood flows that typifies current planning and valuation practices for large commercial plantation estates. The stochastic analyses incorporate typical systematic risks, including those associated with harvest yields, costs, prices and fire. Deterministic valuation using a market discount rate that includes a risk premium underestimates the expected value of the combined asset. Applying such a discount rate to a stochastic valuation would double count risk. Stochastic analysis forces owners to focus on a risk-free discount rate reflecting their time preference for net income flows over time, rather than using a valuer’s current discount rate. Stochastic analyses of valuations enable better assessment of the sensitivity of valuations to the impact of fire frequency, climate change, product prices in the immediate future and land prices, as illustrated in this study.     

Spatial accessibility to colonoscopy and its role in predicting late‐stage colorectal cancer

ObjectiveTo better determine the relationship between spatial access to colonoscopy and colorectal cancer (CRC) outcomes, our objective was to examine the agreement of the classic, enhanced, and variable two‐step floating catchment area (2SFCA) methods in evaluating spatial access to colonoscopy and to compare the predictive validity of each method related to late‐stage CRC. 2SFCA methods simultaneously consider supply/demand of services and impedance (ie, travel time).Data SourcesColonoscopy provider locations were obtained from the South Carolina Ambulatory Surgery Database. ZIP code tabulation area (ZCTA) level population estimates and area‐level poverty level were obtained from the American Community Survey. Rurality was determined by the United States Department of Agriculture''s Rural‐Urban Commuting Area codes. Individual‐level CRC data were obtained from the South Carolina Central Cancer Registry.Study DesignUsing the classic, enhanced, and variable 2SFCA methods, we calculated ZCTA‐level spatial access to colonoscopy. We assessed agreement between the three methods by calculating Spearman''s rank coefficients and weighted Kappas (Κ). Global and Local Moran''s I were used to assess spatial clustering of accessibility scores across 2SFCA methods. We performed multilevel logistic regression analyses to examine the association between spatial accessibility to colonoscopy, area‐ and individual‐level factors, and late‐stage CRC.Principal FindingsWe found strong agreement (Weighted Κ = 0.82; 95% CI = 0.79‐0.86) and identified similar clustering patterns with the classic and enhanced 2SFCA methods. There was negligible agreement among the classic/enhanced 2SFCA and the variable 2SFCA. Across all 2SFCA methods, regression models showed that spatial access to colonoscopy, rurality, and poverty level were not associated with greater odds of late‐stage CRC, though Black race was associated with late‐stage CRC across all models.ConclusionsNone of the 2SFCA methods showed an association with late‐stage CRC. Future studies should explore which elements (spatial or nonspatial) of access to care have the greatest impact on CRC outcomes.