多媒体教学在大学生预防艾滋病健康教育中的效果评价

目的探讨对大学生进行艾滋病教育的有效方式,为研究适合我国高校的艾滋病教育模式提供参考。方法利用多媒体课件对承德市592名大学生进行艾滋病课堂教学,并在教育前后配合问卷调查,对教育效果进行评估。结果教育后,大学生对艾滋病基本知识的掌握情况有显著提高,对艾滋病感染者的态度有了明显转变。在若干种教育形式中,以多媒体课堂教学最受大学生欢迎。讨论利用多媒体课件对大学生进行艾滋病课堂教学效果显著,深受学生的欢迎。     

Routine outcomes monitoring as part of children and young people's Improving Access to Psychological Therapies (CYP IAPT) – improving care or unhelpful burden?

This brief commentary article considers the implications of intensive outcome monitoring which is central to children and young people's Improving Access to Psychological Therapies (CYP IAPT) in England and Wales. Services are being provided with a range of free software solutions to enable data collection, and guidance on interpretation of the measures, but there will still be some burden of data entry and collation for already overstretched services. It may be that the utility of the feedback will go some way to offset the sense of burden but this remains to be seen. Whether commissioners and others will rise to the challenge of supporting this aspect may prove crucial to the success or otherwise of such intensive ROM use. Many aspects of the CYP IAPT approach are new and whilst drawing on experience from earlier pilots of session by session monitoring in CAMHS both in the UK and abroad, and from Adult IAPT, there is likely to be much for us to learn. Time will tell whether the approach helps to improve the care children and young people receive but we are cautiously optimistic.     

Do Poison Center Guidelines Adversely Affect Patient Outcomes as Triage Referral Values Increase?

Abstract

Background.?The purpose of this study was to determine whether patient outcomes were adversely affected as healthcare referral values increased for two common poisonings: acute, unintentional acetaminophen (APAP) poisonings and acute, unintentional iron (Fe) poisonings. We hypothesized that symptom rates would increase with high referral values. Methods.?Qualifying 1997 exposures were separated by substance (APAP or Fe) and then further stratified into three healthcare referral value ranges. Symptomatic and asymptomatic patients were totaled for each stratum. Expected vs. observed distributions of symptomatic and asymptomatic patients across triage referral strata for a given substance and treatment location were compared using chi‐square test for independence. The Wilcoxon–Mann–Whitney test was used to compare the distribution of patients across referral strata for home vs. healthcare facility locations for a specific substance. Results.?There were no statistically significant differences in the distribution of symptomatic patients within referral value strata for APAP or for Fe. There was also no difference in distribution of symptomatic patients across strata when comparing home vs. healthcare facility for APAP and Fe. Conclusion.?Referral values as high as 201 mg/kg for APAP and 61 mg/kg for Fe do not appear to adversely affect patient outcomes.     

Clinicopathologic features of adult EBV-associated B-cell lymphoproliferative disease

In the present study, 21 cases of adult/late-onset EBV-associated lymphoproliferative disease (AELPD) with an uncertain malignant potential were investigated with regard to their histomorphology, immunophenotype, clonal rearrangement of the heavy chain (IgH) and T-cell receptor (TCR) genes and clinical course.The cases were histomorphologically reevaluated and assigned to one of three morphological groups: mononucleosis-like, Hodgkin-like, or polymorphous. In addition, cases with or without detectable necrosis were investigated for differences in clinical outcome.Overall survival was highest in the group with Hodgkin-like morphology (4/4 patients), followed by patients with mononucleosis-like phenotype (4/5 patients surviving). Cases with polymorphous morphology showed the poorest survival rates with 7/12 patients dead of disease (58%). 4/6 patients with histologically detectable necrosis died (66%), but only 4/15 patients without necrosis (27%). 11/21 cases with AELPD showed clonal rearrangement for IgH (n?=?4), TCR (n?=?5) or IgH?+?TCR (n?=?2). 5/11 patients with clonal rearrangement died (45%), and this percentage was similar in all of the three subgroups.In conclusion, the present study shows that polymorphous morphology and detection of necrosis in AELPD are frequently linked to a fatal clinical course, whereas Hodgkin-like morphology seems to be associated with a more favourable prognosis. Clonal rearrangement of IgH or TCR is frequent in AELPD, but prognosis is unpredictable from this feature.     

Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update

Breast-conservation surgery (BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty (TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon’s experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.     

Impaired quality of life after bicycle trauma

IntroductionBicycle crashes often affect individuals in working age, and can impair quality of life (QoL) as a consequence. The aim of this study was to investigate QoL in bicycle trauma patients and to identify those at risk of impaired QoL.Patients and methods173 bicycle trauma patients who attended a level I trauma centre from 2010 to 2012 received Hadorn's QoL questionnaire six months after their crash. Medical data was collected from the patient's records. Univariate ordinal logistic regression was used to investigate the association between QoL and other factors.Results148 patients returned the questionnaire (85.5%). The majority had only mild or minor injuries (85.1%; n = 126). However, 72.1% (n = 106) still suffered from pain or other physical symptoms more than six months after their bicycle crash. Patients with a Glasgow Coma Scale (GCS) ≤13 or an Injury Severity Score (ISS) >15 experienced impaired emotions/outlook on life (p-values 0.003 and 0.045, respectively). Physical suffering was reported by patients with a GCS ≤13 and in those with injuries to the cervical spine (p-values 0.02 and 0.025, respectively). Patients with an ISS >15 or facial fractures experienced limitations in daily activities (p-values 0.031 and 0.025, respectively).ConclusionsMore than 70% of bicycle trauma patients suffered physically more than six months after their crash, even though only 15% were severely injured. Risk factors for an impaired QoL were cervical spine injuries or facial fractures, a GCS ≤13 and an ISS >15.     

Evaluation of Non Diseased Specified Outcome Measures in Hand Injuries to Assess Activity and Participation Based on ICF Content

The objective of the study is to provide information about non disease specified outcome measures which evaluate disability in patients who have impairments in hand and upper extremity and to find the extent to which they are evaluating “disability” based on ICF hand Core Set (activity limitation and participation restriction). MEDLINE, CINAHL, GOOGLE SCHOLAR , OVID and SCIENCE DIRECT databases were systematically searched for studies on non disease specified outcome measures used to evaluate upper extremity function; only studies written in English were considered. We reviewed titles and abstracts of the identified studies to determine whether the studies met predefined eligibility criteria (eg, non disease specified out come measures used in hand injured patients). All the outcome measures which had eligibility included. After full text review ,7 non disease specified outcome measures in hand were identified. Studies were extracted, and the information retrieved from them. All the outcome measures which had incuded, were linked with ICF hand core set disability part (activity and participation). All of them only linked to 16 (42 %) components of ICF hand Core Set, which were most activity and less participation from ICF. None of the non disease specified out come measures in hand injuries cover all domains of disability from the ICF Hand Core Set.