Physicians’ reasons for failing to comply with computerized preventive care guidelines

The objective of this study was to assess reasons for physicians’ noncompliance with computer-generated preventive care reminders. In an academic general internal medicine practice, a survey of physicians’ reasons for noncompliance found that 55% of reminders were not complied with. Reasons included “not applicable” in 22.6% (test done elsewhere, patient too ill, no uterus), “next visit” in 22.5% (physician too busy, patient too ill), and “patient refuses” in 9.9% (test not necessary or too costly, patient too busy or fears result). We conclude that although noncompliance with reminders is sometimes appropriate, making time for prevention and patient education may augment preventive care. Received from the Department of Medicine, Wishard Memorial Hospital, and the Indiana University School of Medicine, the Regenstrief Institute for Health Care, and the Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, Indianapolis, Ind. Supported in part by grants HS07632, HS07763, and HS07719 from the Agency for Health Care Policy and Research (AHCPR). Dr. Litzelman was supported in part by a Robert Wood Johnson Generalist Physician Faculty Scholar Award (022318). The opinions expressed herein are solely those of the authors and do not necessarily represent the authors’ institutions, AHCPR, or the Robert Wood Johnson Foundation.     

Determinants of Successful Weight Loss After Using a Commercial Web-Based Weight Reduction Program for Six Months: Cohort Study

Background

The Internet is widely available and commonly used for health information; therefore, Web-based weight loss programs could provide support to large parts of the population in self-guided weight loss. Previous studies showed that Web-based weight loss interventions can be effective, depending on the quality of the program. The most effective program tools are visual progress charts or tools for the self-monitoring of weight, diet, and exercises. KiloCoach, a commercial program currently available in German-speaking countries, incorporates these features. A previous investigation showed that the program effectively supports users in losing weight.

Objective

We investigated weight loss dynamics stratified by weight loss success after 6-month use of KiloCoach. Furthermore, we analyzed possible associations between intensity of program use and weight loss. The results are intended for tailoring user recommendations for weight-loss Internet platforms.

Methods

Datasets of KiloCoach users (January 1, 2008 to December 31, 2011) who actively used the platform for 6 months or more were assigned to this retrospective analysis. Users (N=479) were 42.2% men, mean age of 44.0 years (SD 11.7), with a mean body mass index (BMI) of 31.7 kg/m² (SD 3.2). Based on the weight loss achieved after 6 months, 3 success groups were generated. The unsuccessful group lost <5%, the moderate success group lost 5%-9.9%, and the high success group lost ≥10% of their baseline body weight. At baseline, the unsuccessful (n=261, 54.5%), moderate success (n=133, 27.8%), and high success (n=85, 17.8%) groups were similar in age, weight, BMI, and gender distribution.

Results

After 6 months, the unsuccessful group lost 1.2% (SD 2.4), the moderate success group lost 7.4% (SD 1.5), and the high success group lost 14.2% (SD 3.8) of their initial weight (P<.001). Multivariate regression showed that early weight loss (weeks 3-4), the total number of dietary protocols, and the total number of weight entries were independent predictors for 6-month weight reduction (all P<.001) explaining 52% of the variance in weight reduction. Sensitivity analysis by baseline carried forward method confirmed all independent predictors of 6-month weight loss and reduced the model fit by only 11%. The high success group lost weight faster and maintained weight loss more efficiently than the other groups (P<.001). Early weight loss was associated with weight maintenance after 1 year and 2 years (both P<.001). Weight dynamics did not differ between men and women over 6 months when adjusted for baseline and usage parameters (P=.91). The percentage of male long-term users was unusually high (42.2%).

Conclusions

Our results suggest that early weight loss and close program adherence (ie, 5 dietary protocols per week and weekly entering of current weight), especially in the early phase of program usage, can improve weight loss outcome.     

护理服务精准加载法在永久性肠造口病人中的应用分析

目的:观察护理服务精准加载法在永久性肠造口病人中的应用效果。方法:选择收治于我院接受低位直肠癌永久性肠造口者88例为研究样本,以随机数字表法分为试验组和对照组各44例,对照组按永久性肠造口常规护理执行,试验组接受护理服务精准加载法干预,对两组干预后的各观察指标进行比较。结果:试验组永久性肠造口者干预后的肠造口自我效能评分和自我护理能力评分显著高于对照组,肠造口相关并发症发生率显著低于对照组(P<0.05)。结论:采用护理服务精准加载法对永久性肠造口病人施加干预,可显著提升该类病人肠造口自我效能与自护水平,降低肠造口相关并发症发生率。     

一种实测实量引导植入位点的精准牙种植技术

正确的植入位点对于种植修复的长期稳定有效十分重要,为提高植入的精准度,临床上越来越多地使用外科导板、手术导航等来控制位点,引导种植体的植入。但是一方面由于这类数字化手段存在过程繁琐、费用较高等问题,大量的病例仍然是由自由手植入的;另一方面,在术前、术中、术后缺乏快速实用的实测位点的方法,不少病例只有术后锥形束CT检查时才发现位点不良,改正位点的代价不小。本文介绍一种适用于各类种植系统的全程植入位点的实测方法及其引导的精准植入技术。本技术由实测尺子引导,包括测量尺和术中定位尺两部分。术前使用测量尺测量术区三维空间,根据实测数据结合锥形束CT数据进行种植方案和数量引导设计,术中用实测尺子引导全程种植,兼顾实测核查。这种方法实现了植入手术从术前空间分析、术中精准植入引导及术后位点实测评价的全程可量化,可全程及时调整位点,提高了植入精度,是一项适宜推广的牙种植实用技术。     

机械通气治疗新生儿并发呼吸机相关肺的相关因素及预防措施探讨

目的 探讨机械通气治疗新生儿并发呼吸机相关性肺炎(VAP)的相关因素及预防措施。方法 回顾性分析2018年1月至2020年12月于我院行机械通气治疗的200例新生儿临床资料,根据VAP发生情况分为VAP组与非VAP组,统计两组资料,分析机械通气患儿并发VAP的相关危险因素,并制定相关预防措施。结果 200例行机械通气治疗的新生儿中,有70例发生VAP,占比为35.00%(70/200);VAP组胎龄＜37周、出生体重＜2.5kg、营养不良、通气时间≥5d、吸痰次数≥6次、合并败血症占比均高于非VAP组,差异有统计学意义(P＜0.05);Logistic回归分析：胎龄＜37周、出生体重＜2.5kg、营养不良、通气时间≥5d、吸痰次数≥6次、合并败血症是机械通气患儿并发VAP的独立危险因素(P＜0.05且OR≥1)。结论 胎龄＜37周、出生体重＜2.5kg、营养不良、通气时间≥5d、吸痰次数≥6次、合并败血症是机械通气患儿并发VAP的独立危险因素,临床需予以高度重视。     

糖尿病前期中医药防治的临床科研探索与实践

糖尿病是人类慢性疾病中患病人数最多的疾病之一。目前早期糖尿病的诊疗管理只注重出现临床症状的患者,忽略了在发展成为糖尿之前这一阶段(糖尿病前期pre-diabetes)的诊疗管理在糖尿病的发生发展中所起的作用,从而使得流行病学调查的数据向我们展现了一个糖尿病患病人数持续高速增长的态势。作者认为,建立基于糖尿病前期患者的特定科研模式,以新的理论指导临床,以临床验证新的理论,有助于发展中医药治疗糖尿病前期的理论与创新,从而延缓糖尿病前期患者发展为糖尿病的趋势。论文通过对糖尿病前期的理论进行溯源,强调未病先防;通过糖尿病前期的临床诊疗探索实践,总结治方创新;分析糖尿病前期研究的热点问题,提出应对策略;以指南解读和全面筛查夯实基础,实施中医药早期干预等方面进行详细分析,对临床及科研对糖尿病前期中医药防治研究思路与方法有较高的指导意义。     

持续性异位妊娠的诊治及预防进展

持续性异位妊娠是异位妊娠保守性手术后的并发症之一,严重损害患者身心健康并造成经济负担。其发生与血h CG值、停经天数、包块大小、手术方法及术后h CG值的监测等多种因素有关。其治疗和预防方法也多种多样,包括不予任何处理的期待治疗、以甲氨蝶呤(MTX)为主的药物保守治疗和手术治疗三种,而手术治疗的路径又可分为腹腔镜或开腹手术。目前如何掌握好手术方法,合理、适时应用药物,减轻患者痛苦和费用仍是一个难题。     

免疫比浊法用于全自动生化分析仪中产生钩状效应的防范

目的正确认识免疫透射比浊法应用于全自动生化分析仪上的抗原过量产生的钩状效应及对这种钩状效应的防范。方法首先对仪器的测量线性范围上限和仪器自动稀释重做功能进行设置,然后对设置前超过测量范围上限的样本进行设置测定及设置前且人工对倍稀释测定。结果设置前测定组平均值为2.49g/L设置后测定组平均值为3.31g/L设置前且人工对倍稀释测定组平均值为3.33g/L。结论高剂量钩状效应使强阳性标本误测为弱阳性,甚至假阴性结果,高浓度标本误测为低值,所以对仪器进行设置且对标本倍比稀释来进行测定,测出来的值更接近真值。