血清尿素、肌酐在两生化分析系统间检测的偏倚评估

目的：通过对同一临床实验室两生化分析系统进行方法对比分析和预期偏倚评估，探讨UREA、CREA在两生化分析系统之间是否具有可比性或检测结果的偏倚是否在允许的范围内，以确保检测结果的准确稳定。方法：按照美国临床实验室标准化委员会(NCCLS)EP9-A文件的要求，以美国强生Vitros-750生化分析仪为比较方法，日立7600生化分析仪为实验方法，用患者样品对UREA、CREA进行了检测，对两分析系统之间的预期偏倚进行评估。结果：在所测定UREA、CREA中，预期偏倚在方法线性范围内均可以被接受。结论：UREA、CREA可在两生化系统上任意检测。当实验室内同一项目存在两套以上分析系统检测时，需对其进行对比分析和偏倚评估，对这些项目在分析系统间的偏倚有了准确的评价管理依据，才能保证检测结果的准确稳定。     

Text message-based lifestyle intervention in primary care patients with hypertension: a randomized controlled pilot trial

Abstract

Objective

To evaluate the feasibility of a randomized controlled pilot study with lifestyle-promoting text messages as a treatment for hypertension in primary care.     

Computer assisted management of information in an intensive care unit

Summary In order to use the capability of computers for handling large amounts of information, we developed a program for the acquisition, handling, storage and retrieval of administrative and clinical information generated in the 20 bedded multidisciplinary critical care unit of a University Hospital. At an initial phase a personal computer (PC) was used to collect information from 4362 patients, that included registration data, coded admission problems, techniques and special treatments, and final diagnosis. This information combined with free text provided a discharge report. Complementary programs allowed calculation and storage of hemodynamic and gas exchange parameters. This experience led to a second phase in which a computer with microprocessor Intel 80386 at 25MHz, 8MB RAM, 310 MB hard, disk and a streamer for 150MB cartridge tape back up, using UNIX operating system, permitted multiple users working simultaneously through 1 central console and 7 ASCII terminals. Data input included demographic data, previous and admission problems in coded form, present history and physical examination in free text, list of present problems in coded form, comments on evolution, record of special techniques and treatments, laboratory data, treatment, final diagnosis and facility for using all the information to elaborate the final report. Side modules provide help for drugs dosing, protocols for specific conditions and clerical routines. The system is open for connection to other areas of the Hospital. Data from more than 2000 patients have been included so far. The program is used by medical, nursing and clerical staff with high degree of acceptance. All patients have their clinical information filed and 100% of the final reports are elaborated with the program.We conclude that a PC supported application is not adequate for implementing a historical database. On the contrary the integration of a relational database management system with a text editor in a more potent multiuser set up, provides a highly efficient tool to handle all the data generated during the patients' admission.     

Model for the physics and physiology of fluid administration

This article describes a model designed to provide an understanding of fluid flow in intravenous systems and human subjects. Experiments were developed which demonstrate that the model can represent common clinical situations. The model depicts physical devices as ideal resistors, pressure sources, and flow sources. The patient's venous system is depicted as a combination of ordinary and Starling resistors. For flows between 0 and 300 ml/hr, both physical devices and patients are adequately represented by a straight line representing the pressure-flow relationship (PFR): pressure = opening pressure + flow × resistance, where the slope is the resistance to fluid flow and the intercept is the opening pressure. The PFR for a normal vein is characterized by a flat slope (vein resistance =22±20 mm Hg/L/hr, mean ± SD) and a low intercept (opening pressure =15±8 mm Hg). The PFR for a partially obstructed vein has a resistance equal to that of an unobstructed vein and an opening pressure elevated approximately equal to the pressure obstructing the vein. For perivascular tissue, the PFR has a steep slope (tissue resistance =1,125±1,376 mm Hg/L/hr), while tissue opening pressure depends on the amount of fluid infused. At the onset of fluid extravasation (infiltration), tissue pressure usually is lower than venous pressure (8±8 versus 15±8 mm Hg), until fluid fills the distensible tissue compartment. In clinical practice, when infiltration or obstruction occurs, flow decreases and the clinician adjusts the roller clamp until correct flow resumes; no problem is obvious. The combined model for the intravenous tubing and venous systems explains the behavior of current clinical infusion devices.Presented in part at the Sixth Medical Monitoring Technology Conference, Vail, CO, March 1986; at the Annual Meeting of the American Society of Anesthesiologists, Las Vegas, NV, October 1986; at the Seventh Medical Monitoring Technology Conference, Vail, CO, March 1987; at a meeting on Computers in Critical Care and Pulmonary Medicine, San Diego, CA, June 1987; at the Annual Meeting of the American Society of Anesthesiologists, Atlanta, GA, October 1987; at the Regional Meeting of the Association for the Advancement of Medical Instrumentation, Cincinnati, OH, October 1987; at the Institute of Electrical and Electronics Engineers Ninth Annual Conference of the Engineering in Medicine and Biology Society, Boston, MA, November 1987; and at a meeting of the American Society of Hospital Pharmacists, Atlanta, GA, December 1987.Supported in part by grants from IVAC Corp.The author thanks the following individuals for important intellectual and/or technical assistance: Peter Basser, PhD, Avital Cnaan, PhD, Adriane Concus, MD, John Fox, MD, David Gissen, MD, David Joseph, MD, Anne Kamara, David Leith, MD, Leonard Lind, MD, Richard Morris, MB, BS, Barbara Orlowitz, MEE, Mary Anne Palleiko, RN, Beverly Philip, MD, Daniel Raemer, PhD, David Scott, MB, BS, John Stelling, MPH, and Marie vanRensberg, MB. At IVAC Corp: Walter Bochenko, BSEE, MBA, Robert Butterfield, BSEE, Douglas Christian, RPh, MBA, Alan Davison, BS, David Doan, PhD, Alan Somerville, BSEE, MS, Robin Wernick, BSEE, MS.     

A virtual reality environment for evaluation of a daily living skill in brain injury rehabilitation: reliability and validity

OBJECTIVE: To establish the stability and validity of information collected in a virtual reality environment from persons with traumatic brain injury (TBI). DESIGN: Prospective correlation design to examine 3-week test-retest results for equivalence reliability between computer-simulated and natural environments. SETTING: A residential rehabilitation center for brain injury. PARTICIPANTS: Fifty-four consecutive patients with TBI who received comprehensive rehabilitation services and who were at different stages of recovery. INTERVENTION: An immersive virtual kitchen was developed in which a meal preparation task involving multiple steps was performed. The subjects completed meal preparation both in a virtual reality kitchen and an actual kitchen twice over a 3-week period. MAIN OUTCOME MEASURES: Time and errors on task completion using virtual reality assessment, actual kitchen performance (analogous to the virtual reality environment), occupational therapy (OT) evaluation, and neuropsychologic tests. RESULTS: The stability of performance using the simulated virtual environment was estimated with intraclass correlation coefficients (ICCs). The ICC value for total performance, based on all steps involved in the meal preparation task, was.76 (P<.01). The construct validity of the simulated environment was examined by correlating performance in the virtual environment with that in the actual kitchen (r=.63, P<.01), the OT evaluation (r=.30, P=.05 for meal preparation; r=.40, P=.01 for cognitive subskills), and neuropsychologic tests (r=.56, P<.01 for the full-scale intelligence quotient [IQ]; r=.40, P<.01 for the verbal IQ; r=.56, P<.01 for the performance IQ). Finally, a multiple regression analysis revealed that the virtual reality environment test was a good predictor for the actual assessment kitchen (beta=.35, P=.01). CONCLUSION: The virtual reality system showed adequate reliability and validity as a method of assessment in persons with brain injury.     

Intra- and inter-observer reliability assessment of widely used classifications and the “Ten-segment classification” of tibial plateau fractures

BackgroundTen-segment classification provides a different approach to the evaluation of tibial plateau fractures. The purpose of this study was to assess the intra- and inter-observer reliability of three widely used classification systems (Schatzker, Arbeitsgemeinschaft für Osteosynthesefragen (AO/OTA), and the updated three-column concept (uTCC)) with ten-segment classification in two-dimensional computed tomography (2D-CT) and three-dimensional computed tomography (3D-CT).MethodNinety 2D-CT and 3D-CT scans of patients with tibial plateau fractures were included in this retrospective cohort study. The included data were independently classified by six observers of different years of seniority and were independently observed and classified again after eight weeks. Inter-observer and intra-observer reliability of the four fracture classifications made by the six observers was analyzed using the kappa statistic. Kappa values were interpreted according to the categorical rating by Landis and Koch.ResultsWhen the inter-observer reliability was based on 2D-CT/3D-CT analysis, the mean Kappa values for the Schatzker, AO/OTA, uTCC, and ten-segment classification were 0.64/0.66, 0.56/0.59, 0.53/0.65, and 0.60/0.73, respectively. When intra-observer reliability was based on 2D-CT/3D-CT, the mean Kappa values for the Schatzker, AO/OTA, uTCC, and ten-segment classification were 0.68/0.83, 0.69/0.83, 0.74/0.85, and 0.80/0.91, respectively.ConclusionsThe use of 3D-CT is important for the reliable diagnosis and recognition of tibial plateau fracture features compared to 2D-CT. When using 3D-CT, ten-segment classification showed high intra- and inter-observer agreement.     

Identification of a cytokine-induced antiapoptotic molecule anamorsin essential for definitive hematopoiesis

Many growth factors and cytokines prevent apoptosis. Using an expression cloning method, we identified a novel antiapoptotic molecule named Anamorsin, which does not show any homology to known apoptosis regulatory molecules such as Bcl-2 family, caspase family, or signal transduction molecules. The expression of Anamorsin was completely dependent on stimulation with growth factors such as interleukin 3, stem cell factor, and thrombopoietin in factor-dependent hematopoietic cell lines, and forced expression of Anamorsin conferred resistance to apoptosis caused by growth factor deprivation in vitro. Furthermore, Anamorsin was found to act as an antiapoptotic molecule in vivo because Anamorsin-/- mice die in late gestation due to defective definitive hematopoiesis in the fetal liver (FL). Although the number of hematopoietic stem/progenitor cells in the FL did not decrease in these mice, myeloid, and particularly erythroid colony formation in response to cytokines, was severely disrupted. Also, Anamorsin-/- erythroid cells initiated apoptosis during terminal maturation. As for the mechanism of Anamorsin-mediated cell survival, a microarray analysis revealed that the expression of Bcl-xL and Jak2 was severely impaired in the FL of Anamorsin-/- mice. Thus, Anamorsin is considered to be a necessary molecule for hematopoiesis that mediates antiapoptotic effects of various cytokines.     

循证医学的定义、发展、基础及实践

循证医学是结合医生的个人专业技能和临床经验,考虑患者的愿望,对患者作出医疗决策而发展起来的新兴临床学科。高质量的证据是指尽可能保证结果真实性的、以患者为中心的临床研究数据。证据及其质量是循证医学的关键。研究人员应该尽量提供高质量的证据,临床医生应尽可能使用现有的最佳证据。循证医学在进行诊断和治疗决策时,考虑患者的愿望,从而体现以患者为中心的医疗服务宗旨。高素质的临床医生、最佳的研究证据、临床流行病学的基本方法和知识及患者的参与是循证医学的基础。循证医学实践包括提出问题,检索证据,评价证据,结合临床经验与最好证据对患者进行处理和效果评价5个步骤。     

A Conceptual Model for Nursing Information.

PURPOSE: This Conceptual Model for Nursing Information describes the core activities of nursing, the collection of information about these activities, and argues that these activities must be described using standardized nursing languages. DATA SOURCES: Relevant literature, both national and international, was reviewed and summarized. DATA SYNTHESIS: A maximum data set for nursing was developed. CONCLUSIONS: In the United Kingdom, a new and radical approach to the process of nursing is required; one that demonstrates that nursing is the decision-making that takes place in all core activities of nursing. IMPLICATIONS FOR NURSING PRACTICE: Unless nurses have a clear view of what the profession requires from technological solutions for the recording of nursing activities, less than optimal solutions will be forced upon the profession.