东莞市2004年流脑疫情分析及防制对策探讨

目的对东莞市2004年流脑疫情进行分析,为探讨东莞市流脑防治策略提供依据。方法采用描述性和分析性流行病学研究方法对东莞市2004年的流脑疫情、流行菌株进行分析,采用纸片法检测菌株的药敏情况。结果东莞市流脑以散发为主,也偶有暴发疫情发生;外来青工是发生流脑的高危人群;流脑流行的优势菌群和耐药性均已发生较大改变。结论建议在外来青工中开展A+C群流脑菌苗普种。在疫情处理时,选择脑膜炎双球菌对之敏感的利福平等药物作为预防药物     

Intra-articular injection of culture-expanded adipose tissue-derived stem cells for knee osteoarthritis: Assessments with clinical symptoms and quantitative measurements of articular cartilage volume

BackgroundIntra-articular administration of adipose tissue-derived stem cells (ADSC) is an alternative treatment option for knee osteoarthritis (OA) after conventional treatment fails; however, the clinical results related to the severity of OA grade and changes of cartilage volumes after the administration of ADSC is unknown. This study aimed to determine 1) clinical outcomes after the ADSC administration in knee OA with consideration of radiographic OA grades and 2) changes in cartilage volumes after ADSC administration.MethodsThis observational study included 86 knees from 51 patients who underwent intra-articular administration of cultured ADSC; 47 patients (80 knees) completed follow-up for 6 months (follow-up rate: 93%). The Knee injury and Osteoarthritis Outcome Scores (KOOS) were reported at baseline and 1, 3, and 6 months after the administration. The efficacy rate in the Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) was evaluated using the KOOS. Cartilage volume of the knee joint was measured using quantitative 3-dimensional magnetic resonance imaging (3D-MRI) software at baseline and 6 months in 52 knees in 31 patients (follow-up rate: 61%).ResultsAll items on the KOOS except “sports/recreation” improved significantly at 6 months with more significance in knees with a Kellgren–Lawrence (KL) grade 2 or 3 compared with KL grade 4 knees. The OMERACT-OARSI responder at 6 months was significantly greater in knees with KL grade 2 or 3 (64%) than in knees with KL grade 4 (42%, p = 0.045). Cartilage volume changes varied among patients and were not related to the changes in KOOS after ADSC administration.ConclusionsIntra-articular administration of ADSC in knee OA improved KOOS at 6 months. The effects were more significant in knees with KL grade 2 or 3 than with KL grade 4. Changes in KOOS were not related to change in cartilage volumes after ADSC administration.     

Objective outcome measures may demonstrate continued change in functional recovery in patients with ceiling effects of subjective patient-reported outcome measures after surgery for lumbar degenerative disorders

Background ContextThe 6-minute walking test (6WT) has been previously shown to be a reliable and valid outcome measure. It is unclear if the 6WT may further help to detect differences in well performing patients that reach a ceiling effect in PROMs after surgery.PurposeTo evaluate changes and timing of change in objective functional impairment (OFI) as measured with the smartphone-based 6WT in relation to patient-reported outcome measures (PROMs) after surgery for degenerative lumbar disorders (DLD).Study designProspective observational cohort study.Patient SampleFifty consecutive patients undergoing surgery for DLD.Outcome MeasuresPatients self-determined their OFI using the 6WT application (6WT-app) and completed a set of paper-based PROMs before, 6 weeks and 3 months after surgery.MethodsFifty patients undergoing surgery for DLD were assessed preoperatively (baseline), 6 weeks (6W) and 3 months (3M) postoperatively. Paired sample t-tests were used to establish significant changes in raw 6-minute walking distance (6WD) and standardized Z-scores, as well as PROMs. Pearson correlation coefficient was used to define the relationship between 6WT and PROMs. Floor and ceiling effects were assessed for each PROM (visual analogue scale [VAS], core outcome measure index [COMI], Zurich claudication questionnaire [ZCQ]).ResultsMean 6WT results improved from 377 m (standard deviation - SD 137; Z-score: 1.8, SD 1.8) to 490 m (SD 126; -0.7, SD 1.5) and 518 m (SD 112; -0.4, SD 1.41; all p<.05) at 6W and 3M follow-up. No significant improvement was observed between 6W and 3M for the ZCQ, VAS back and leg pain. While correlation between 6WT and all PROMs were weak at baseline, correlation coefficient increased to moderate at 3M. A considerable ceiling effect (best possible score) was observed, most notably for the ZCQ physical performance, VAS back and leg pain in 24%, 20%, and 16% of patient at 6W and in 30%, 24%, and 28% at 3M.ConclusionSObjective functional tests can describe the continued change in the physical recovery of a patient and may help to detect differences in well performing groups as well as in cases where patients' PROM results cannot further improve because of a ceiling effect.     

Test–Retest Reliability and Responsiveness of the Computerized Adaptive Test of Social Functioning in Persons With Stroke

ObjectiveTo examine the test–retest reliability, minimal detectable change (MDC), responsiveness, and efficiency of the Computerized Adaptive Test of Social Functioning (Social-CAT) in patients with stroke.DesignRepeated-assessments design.SettingA department of rehabilitation of a medical center.ParticipantsIn total, 31 patients with chronic stroke and 65 patients with subacute stroke were recruited.InterventionNot available.Main Outcome MeasureSocial-CAT.ResultsThe Social-CAT showed acceptable test–retest reliability (intraclass correlation coefficient, 0.80) and small random measurement error (MDC%: 18.0%). However, heteroscedasticity was found (r between the means and the absolute change scores: 0.32), so the MDC% adjusted cut-off score is recommended for determining real improvement. Regarding responsiveness, the Social-CAT showed large differences (Kazis’ effect size and standardized mean response: 1.15 and 1.09, respectively) in subacute patients. Regarding efficiency, the Social-CAT required an average of 5 items and less than 2 minutes for completion.ConclusionsOur findings indicate that the Social-CAT is a reliable and efficient measure with good test–retest reliability, small random measurement error, and good responsiveness. Thus, the Social-CAT is a useful outcome measure for routine monitoring of the changes in social function of patients with stroke.     

手术室护士心理压力的形成因素分析及应对措施

目的分析手术室护士心理压力的形成因素,并探寻有效的改善措施。方法将手术室50名在职护理人员作为观察组,调查分析其压力源,采用手术室心理压力问卷对护士心理状态进行调查。另选取50例正常成人作为对照组,对其心理压力问卷调查。对观察组护士给予干预治疗,采用症状自评量表(SCL-90)对干预前后的效果进行评定。结果观察组护士的心理压力源中手术室工作的特殊性所占比例最大,为96%,其余依次为工作负荷过重、害怕发生差错事故、患者不理解、自身业务能力不强;观察组护士干预前焦虑、抑郁评分明显高于对照组,组间比较差异具有统计学意义(P<0.05),干预后观察组护士焦虑、抑郁评分与对照组较为相近,两组比较无明显差异(P>0.05);观察组干预前各因子评分明显高于对照组,干预后各因子评分均较干预前发生显著下降(P<0.05);干预后各因子评分与对照组较为接近,无明显差异(P>0.05)。结论手术室护士心理压力的来源较多,实施有效的干预措施可明显减轻其心理压力,提高护士心理健康水平。