基于循证指南和精准医学时代背景下肝癌诊疗的思考与总结

正信息时代,瞬息万变,新的医学理念和技术层出不穷,不断更新着人们对于疾病的认知模式。近些年来,诸多国家和地区遵循循证医学,筛选出最可靠并具有一定的临床运用价值的研究成果,更新发表了各种专家共识或临床指南,指导世界各地医师的诊疗[1]。肝癌的诊治作为全球性的难     

Development and Testing of the Preparation for Labor and Birth Instrument

ObjectiveTo develop and assess the reliability and validity of a new instrument used during the third trimester of pregnancy to measure women’s confidence in their ability to achieve physiologic birth, the Preparation for Labor and Birth (P-LAB) instrument.DesignTwo-phase instrument development study that consisted of item generation and a prospective field test.SettingField testing occurred in five midwestern U.S. prenatal clinics.ParticipantsParticipants in the field test were 203 nulliparous and parous pregnant women who intended to give birth vaginally.MethodsPsychometric testing consisted of test–retest reliability testing and assessments of content validity, face validity, and construct validity. We measured construct validity using exploratory factor analysis and correlation with the Sense of Coherence Scale.ResultsThe 22-item P-LAB showed good content validity, good internal consistency, and stability over time. All items had content validity index scores greater than or equal to 0.8, and the total instrument content validity index was 0.95. We identified four factors related to women’s confidence in their ability to achieve physiologic birth: Planned Use of Pain Medication, Relationship With Care Provider and Supportive Birth Environment, Beliefs About Labor, and Labor Support (social and professional). Cronbach’s alpha coefficient for the four extracted factors were .93, .76, .73 and .74, respectively. Intraclass correlation [95% confidence interval] for the total questionnaire was .92 [.88, .94]. We found no linear association between total P-LAB scores and sense of coherence.ConclusionOur findings demonstrate acceptable initial psychometric properties for the P-LAB instrument. Additional testing is required to evaluate the instrument’s construct, convergent, and divergent validity.     

BILT肝病治疗仪对肝硬化患者血小板参数与凝血的影响

目的探讨肝硬化患者采用BILT肝病治疗仪治疗对血小板参数与凝血的影响。方法本次共选择80例肝硬化患者,分组就常规对症支持(对照组)与加用BILT肝病治疗仪(观察组)治疗。对凝血机制和预后的影响进行比较。结果观察组临床情况优于对照组(P<0.05)。结论肝硬化患者采用BILT肝病治疗仪治疗,可显著减轻临床症状,具较高安全性,值得广泛推广应用。     

Determinants for a low health-related quality of life in asthmatics

People with asthma suffer from impaired health-related quality of life (HRQL), but the determinants of HRQL among asthmatics are not completely understood. The aim of this investigation was to study determinants of low HRQL in asthmatics and to study whether the determinants of HRQL differ between sexes and age groups. A cohort of three age groups in Sweden was investigated in 1990 using a questionnaire with focus on respiratory symptoms. To study quality of life, the generic instrument Gothenburg Quality of Life was used. The participants were also investigated with interviews, spirometry, and allergy testing. Asthma was diagnosed in 616 subjects. Fifty-eight per cent (n = 359) of the subjects were women; and 24% were smokers, 22% ex-smokers, and 54% were non-smokers. Women were more likely than men to report poor health-related quality of life. Respiratory symptoms severity was another independent determinant of a lower quality of life as well as airway responsiveness to irritants. Current and former smokers also reported lower quality of life. Finally, absenteeism from school and work was associated with lower quality of life. Factors such as sex, smoking habits, airway responsiveness to irritants, respiratory symptom severity, allergy, and absenteeism from school and work were associated with low HRQL in asthmatics.     

一种锁定式钻头保护器

设计一款锁定钻孔深度的钻头保护器，操作简单、安全。