基层医院护理人员层级培训需求调查分析

目的 了解基层医院各层级护士岗位培训需求.方法 根据业务能力以及工作资质,我院护理人员分为5个等级(N0-N4).于2014年2月,采取随机抽样不同级别的护理人员共254名,进行培训需求问卷调查(以问卷调查表的形式).结果 各层级护士培训需求侧重点有所不同,不同层级护士培训需求存在交叉现象(在临床护理基础技能、科研能力、管理能力的培训需求比较,差异有统计学意义(P＜0.05);在临床护理高级技能、沟通能力、教学能力、专业认同的培训需求比较,差异无统计学意义(P＞0.05).结论 通过调查分析,为建立基于能级进阶模式的基层医院护理人员培训方式和内容提供了科学依据.     

Comparing triage algorithms using HPV DNA genotyping,HPV E7 mRNA detection and cytology in high-risk HPV DNA-positive women

BackgroundHigh-risk human papillomavirus (hrHPV) DNA positive women require triage testing to identify those with high-grade cervical intraepithelial neoplasia or cancer (≥CIN2).ObjectiveComparing three triage algorithms (1) E7 mRNA testing following HPV16/18/31/33/45/52/58 genotyping (E7 mRNA test), (2) HPV16/18 DNA genotyping and (3) cytology, for ≥CIN2 detection in hrHPV DNA-positive women.Study designhrHPV DNA-positive women aged 18–63 years visiting gynecology outpatient clinics were included in a prospective observational cohort study. From these women a cervical scrape and colposcopy-directed biopsies were obtained. Cervical scrapes were evaluated by cytology, HPV DNA genotyping by bead-based multiplex genotyping of GP5+6+-PCR-products, and presence of HPV16/18/31/33/45/52/58 E7 mRNA using nucleic acid sequence-based amplification (NASBA) in DNA positive women for respective HPV types. Sensitivities and specificities for ≥CIN2 were compared between E7 mRNA test and HPV16/18 DNA genotyping in the total group (n = 348), and E7 mRNA test and cytology in a subgroup of women referred for non-cervix-related gynecological complaints (n = 133).ResultsSensitivity for ≥CIN2 of the E7 mRNA test was slightly higher than that of HPV16/18 DNA genotyping (66.9% versus 60.9%; ratio 1.10, 95% CI: 1.0002–1.21), at similar specificity (54.8% versus 52.3%; ratio 1.05, 95% CI: 0.93–1.18). Neither sensitivity nor specificity of the E7 mRNA test differed significantly from that of cytology (sensitivity: 68.8% versus 75.0%; ratio 0.92, 95% CI: 0.72–1.17; specificity: 59.4% versus 65.3%; ratio 0.91, 95% CI: 0.75–1.10).ConclusionFor detection of ≥CIN2 in hrHPV DNA-positive women, an algorithm including E7 mRNA testing following HPV16/18/31/33/45/52/58 DNA genotyping performs similar to HPV16/18 DNA genotyping or cytology.     

An Evaluation of the Level of Service/Case Management Inventory in an Australian Community Corrections Environment

Risk assessments are crucial in aiding criminal justice practitioners because they provide a standardized instrument that aims to identify risk factors that may influence whether an individual will reoffend. This helps to tailor an offender's case-management program to ensure offenders are accessing the appropriate services and interventions and to keep the community safe from future reoffending. The aim of the current study was to investigate the validity and predictive utility of the LS/CMI in a sample of Australian offenders. The results indicate that the LS/CMI has a weak discriminative ability for non-Indigenous males. However, it predicts recidivism in non-Indigenous female offenders at an accuracy level no greater than chance. This finding should be interpreted with caution due to the small female offender sample size. These findings for non-Indigenous offenders are consistent with previous Australian and international research. It also highlights the importance of validating risk assessments for specific populations.     

Destination healthcare facility of patients with suspected traumatic brain injury in Scotland: Analysis of pre-hospital data

Background

Traumatic brain injury is common. Guidelines from the Brain Trauma Foundation and the Scottish Intercollegiate Guidelines Network recommend that patients with suspected severe traumatic brain injury should be treated in centres with neurosurgical expertise. Scotland does not have a framework for the delivery of trauma care. The aim of this study was to examine the demographic characteristics of incidents involving patients who have suffered a suspected traumatic brain injury, and to evaluate the level of the destination healthcare facility which patients are currently taken to.

Methods

Retrospective analysis of prospectively collected Scottish Ambulance Service data on incidents involving traumatic injury, between Nov 2008 and Oct 2010. Two groups of casualties were analysed: those who had a Glasgow coma scale of less than 14 (GCS < 14), and those who had a Glasgow coma scale of less than 9 (GCS < 9).

Results

126,934 incidents were identified and analysed. 3890 (3.1%) patients had a GCS of less than 14, and 657 (0.5% of total) had a GCS of less than 9. Almost one-third of incidents involving patients with either a GCS < 14 or GCS < 9 occurred in the greater Glasgow health board area. The Lothian health board region had the second-highest number of patients with either a GCS < 14 or GCS < 9. Only 13.8% of patients with a GCS < 14, and 16.7% of those with a GCS < 9, were taken to a hospital with a neurosurgical service.

Conclusions

Many patients who may harbour a traumatic brain injury are taken to a facility which may not be equipped or staffed to deal with such injuries. This mismatch needs to be addressed. However, the care of patients with head injuries is only one aspect of trauma care. The UK has long lagged behind North America in terms of the quality of trauma care provided, although the provision of trauma care in England is currently undergoing major changes. Scotland should consider the development of a similar service delivery framework.     

阿尔茨海默病大鼠海马胆固醇水平升高对tau蛋白磷酸化程度增加的影响

目的观察海马胆固醇含量升高后tau蛋白磷酸化程度的变化,探讨其在阿尔茨海默病(AD)中可能的作用。方法水迷宫训练大鼠7 d筛选合格大鼠后,海马直接注射不同剂量胆固醇,72 h后水迷宫检测行为学变化,并以免疫印迹和免疫组织化学方法检测大鼠海马tau蛋白磷酸化水平。结果注射胆固醇后72 h,中高剂量组大鼠水迷宫潜伏期明显延长(P<0.01),tau蛋白PHF-1位点磷酸化水平明显增高(P<0.01),tau-1明显降低(P<0.01),总tau蛋白(R134d)无明显变化。结论海马胆固醇水平升高可导致tau蛋白磷酸化程度增加,可能参与AD的形成。     

慢性乙型肝炎患者α-干扰素治疗前后血清脂联素水平的变化

目的 观察慢性乙型肝炎(CHB)患者α-干扰素治疗前后血清脂联素水平的变化,探讨其与α-干扰素应答的关系.方法 31例男性CHB患者接受α-干扰素治疗6个月,治疗前及治疗结束应用EHSA法检测血清脂联素水平,同时检测肝功能、血脂、空腹血糖(FBG)、HBV DNA等.测量人体身高、体重,计算体重指数(BMI).以20例男性健康体检者为正常对照组.结果 CHB患者血清脂联素水平明显高于正常对照组(P＜0.01).治疗后干扰素应答组血清脂联素水平显著降低,应答组与不应答组α-干扰素治疗前脂联素水平无显著性差异(P＞0.05).结论 CHB患者血清脂联素水平与肝脏炎症活动相关,但不能作为α-干拢素应答的预测因素.     

RETRACTED: Early outcome of arthroscopic Bankart's repair for Recurrent traumatic anterior shoulder instability

Background/objectives

Despite the improvements in the methods of arthroscopic stabilization of anterior shoulder instability, a recurrence rate of as high as 30% is reported in the literature. In this context, we report the outcome of arthroscopic Bankart repair in anterior shoulder instability, with the use of bio-absorbable suture anchors for patients that were followed up for at least two years from the date of surgery.The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2-year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder.

Methods

Data from 79 shoulders in 74 patients were collected over 4 years (2005–2009). Each patient was followed up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their anterior shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated.

Results

SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a pre and post-operative mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation.

Conclusion

Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.     

Trauma network for severely injured patients

Survival after severe trauma may depend on a structured chain of care from the management at the scene of trauma to hospital care and rehabilitation. In the USA, the trauma system is organized according to a pre-hospital triage by paramedics to facilitate the admission of patients to tertiary trauma centres. In France, trauma patients are transported to the most suitable facility, according to the on-scene triage by an emergency physician. Because French hospital's resources become scarce and expensive, the access to all techniques of resuscitation after severe trauma is restricted to tertiary trauma centres, at the expense of prolonged duration of transfer to these centres with a possible impact on mortality. The Northern French Alps Emergency Network created a regional trauma network system in 2008. This organization was based upon the interplay between the resources of each hospital participating to the network and the categorization of trauma severity at the scene. A regional registry allows the assessment of trauma system, which has included 3,690 severe trauma patients within the past 3 years. Bystanders, medical call dispatch centres, and interdisciplinary trauma team should form a structured and continuous chain of care to allocate each severe trauma patient to the best place of treatment.