A randomized,sham-controlled trial of intraductal meibomian gland probing with or without topical antibiotic/steroid for obstructive meibomian gland dysfunction

ImportanceObstructive meibomian gland dysfunction (MGD) can be refractory to medical therapy. Intraductal meibomian gland (MG) probing may offer a potential therapeutic approach for these patients, but no randomized trials have been conducted to date.ObjectiveTo assess clinical changes after intraductal MG probing for patients with refractory obstructive meibomian gland dysfunction.DesignRandomized, double-masked, sham-controlled clinical trial.SettingSingle-center, tertiary referral center.Participants42 patients with refractory obstructive MGD associated with lid tenderness.InterventionsEnrolled patients received one of the following treatments: 1) MG probing plus post-procedural topical sulfacetamide/prednisolone ointment (Blephamide®), 2) MG probing plus post-procedural lubricating ointment (GenTeal), or 3) sham probing plus GenTeal ointment. The probing was performed on the upper lids of both eyes.Main outcome measuresPrimary outcome measures were symptoms as measured by Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE), as well as tear break-up time (TBUT). Secondary outcome measures were other clinical signs. Safety of the procedure was also evaluated by investigating the treatment-related adverse events. At baseline and 4 weeks after the procedure a masked observer evaluated the following outcome measures: symptom questionnaires, including OSDI and SANDE, upper lid tenderness, lid margin telangiectasia, corneal fluorescein staining, conjunctival lissamine green staining, TBUT, Schirmer's test, and meibomian glands yielding liquid secretion (MGYLS).ResultsCompared to baseline, the MG probing/Blephamide® group showed significant improvements in both OSDI and SANDE scores and the MG probing/GenTeal group demonstrated a significant improvement only in SANDE score. In contrast, the Sham/GenTeal group did not show any statistically significant changes in symptoms. There were no statistically significant changes in clinical signs in any group at the 4-week visit, except for improvement of lid tenderness in the sham probing group.ConclusionsMG probing/Blephamide® results in a significant improvement in symptoms in patients with refractory obstructive MGD without any significant effect on clinical signs. Larger studies are warranted to determine the efficacy of MG probing.Trial registrationClinicaltrials.gov(identifier NCT02256969, Filed on 08/13/2014)     

基于信息化的化疗相关性恶心呕吐多维管理模式的构建

目的 构建基于信息化的化疗相关性恶心呕吐的多维管理模式。方法 通过查阅文献、质性访谈、专家会议法开发化疗相关性恶心呕吐症状管理微信公众号,构建基于信息化的医护患共同参与的多维管理模式。结果 建立了化疗相关性恶心呕吐的症状管理平台,包括：患者端微信公众号和医护电脑端,明确了使用方法、医护职责,确定了以症状管理平台为媒介的化疗相关性恶心呕吐的多维管理模式。结论 基于信息化的化疗相关性恶心呕吐的多维管理模式具有较强的科学性和实用性,满足了患者和医护症状管理的需求,及时发现患者有无发生化疗相关性恶心呕吐,给予对应的预防和干预措施,提高患者生活质量,保证化疗顺利进行。     

杭州市184例反流性食管炎的临床特点及生存质量分析

目的通过症状量表和汉化版SF-36生存质量量表研究杭州市1年内经胃镜诊断的反流性食管炎(RE)患者的临床特点和生存质量状况。方法收集2004年9月至2005年9月杭州市七家省市级医院消化科门诊就诊的RE患者184例,记录患者的临床特点和生存质量状况,并进行相关因素的分析。结果REA级和B级的患者明显多于C级和D级患者。性别、吸烟、饮酒以及RE分级对症状评分无显著影响(P>0.05),年龄对症状评分有显著影响(P<0.05)。RE患者在SF-36各个维度的积分均有下降。吸烟、饮酒、年龄、性别以及内镜下分级对生存质量量表综合得分影响无显著性意义(P>0.05)。患病时间、症状量表评分对生存质量量表综合得分影响有显著性意义(P<0.05)。结论杭州市RE患者病情多较轻,年龄对RE症状的严重程度有显著影响,症状的严重程度和患病时间是影响患者生存质量的主要因素。     

Symptom burden in stable COPD patients with moderate or severe airflow limitation

Objectives

To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.

Background

Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation.

Methods

A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations.

Results

The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups.

Conclusions

Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.     

乳腺癌患者确诊期症状群特征的潜在剖面分析

目的 调查我国首次确诊乳腺癌患者术前症状群的内部特征,并分析不同类别间人口学变量的分布差异。 方法 2021年6－12月,采用便利抽样方法选取上海市某三甲医院收治的首次确诊为乳腺癌患者198例作为研究对象。采用一般人口学问卷、疼痛数字评分表、状态-特质焦虑量表、匹兹堡睡眠质量指数量表、FACIT疲劳量表进行调查,对该症状群的结果进行潜在剖面分析,检验不同类别间的人口学变量分布差异。 结果 乳腺癌患者术前疼痛-焦虑-疲乏-睡眠障碍症状群可分为高症状组、中症状组和低症状组3个类别。3组患者分别有80例（40.40%）、91例（45.96%）、27例（13.64%）。相比于低症状组,高症状组、中症状组患者生活质量得分较低,但差异无统计学意义（P＞0.05）。不同类别的乳腺癌患者术前症状群在年龄（F=3.310,P=0.039）、职业分布上（χ2=15.041,P=0.020）存在差异（P＜0.05）。结论 首次确诊乳腺癌患者术前症状群存在异质性,年龄和职业是影响首次确诊乳腺癌术前症状群潜类别的重要影响因素。医护人员应关注年轻在职的首次确诊的乳腺癌患者,提供个性化的护理措施,从而提高患者的生活质量。     

Accuracy of the Modified Somatic Perception Questionnaire and Pain Disability Index in the Detection of Malingered Pain-Related Disability in Chronic Pain

The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. Patients were grouped based on independent psychometric evidence of MPRD. Results showed that MSPQ and PDI scores were not associated with objective medical pathology. However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosocial obstacles to effective treatment and triggering further psychological assessment and/or treatment.     

Cumulative False Positive Rates Given Multiple Performance Validity Tests: Commentary on Davis and Millis (2014) and Larrabee (2014)

Controversy has arisen over interpretation of performance validity tests (PVTs) when multiple PVTs are given. Some papers state that more stringent criteria are needed to judge overall performance as invalid, while others argue that concerns about the number of PVTs are overstated and that widely used criteria are appropriate. We examine theoretical models and assumptions, and analyze published data to determine the magnitude of effects implied by theory and observed in practice. Assertions advanced in the primary papers are examined for consistency with the empirical data. Existing theoretical models do not account well for the diverse empirical data, substantial empirical effects remain poorly understood, and the primary papers include assertions that are not empirically supported. The results indicate that: (a) neuropsychology lacks solid theoretical bases for estimating PVT failure rates given various combinations of PVTs, and thus needs to rely on empirical data; (b) existing empirical data fail to support the application of any uniform criteria across the broad range of scenarios involving multiple PVTs; and (c) practice should rely on empirical studies involving combinations of PVTs that have been studied together, in samples clearly appropriate to the individual case, using experimental designs germane to the questions under consideration.     

青少年系统性红斑狼疮患者疾病体验的质性研究

目的 深入了解青少年系统性红斑狼疮患者的疾病体验,为临床医护人员制订针对性的干预策略提供参考依据。方法 采用现象学研究方法,选取2022年1月—4月在北京市某三级甲等综合医院儿科就诊或住院的11例青少年系统性红斑狼疮患者进行半结构式访谈,使用Colaizzi 7步分析法提炼主题。结果 青少年系统性红斑狼疮患者的疾病体验可归纳为4个主题：(1)不良生理体验,包括疼痛、疲劳;(2)负性心理体验,包括遭受他人的伤害、对自我的偏见、对疾病的恐惧、对未来的担忧;(3)疾病应对方式,包括抵触与抗拒、妥协与屈服、接纳与调适;(4)正性心理体验,包括感受到他人关爱、获得自我成长。结论 儿科医护人员应重视青少年系统性红斑狼疮患者在患病过程中的身心感受,针对性地给予科学、有效的干预,以促进其身心舒适。     

Evaluation and validation of the Core Lower Urinary Tract Symptom Score as an outcome assessment tool for the treatment of benign prostatic hyperplasia: Effects of the α1‐adrenoreceptor antagonist silodosin

We investigated the Core Lower Urinary Tract Symptom Score as an outcome assessment tool for the treatment of lower urinary tract symptoms using silodosin. In addition, the ability of the Core Lower Urinary Tract Symptom Score to detect overactive bladder in male patients with lower urinary tract symptoms was examined. The present study included 241 males with benign prostatic hyperplasia treated at 31 medical facilities between June 2009 and December 2010. All patients were given silodosin, and the effects of silodosin intake were measured using four questionnaires: the Core Lower Urinary Tract Symptom Score, International Prostate Symptom Score, Overactive Bladder Symptom Score and Quality‐of‐Life index. The efficacy of silodosin for treating lower urinary tract symptoms was validated according to the total scores of all four questionnaires weighted equally (P < 0.05). Spearman's ρ among the Core Lower Urinary Tract Symptom Score, International Prostate Symptom Score and Overactive Bladder Symptom Score showed a mild‐high correlation. However, the correlation between the baseline values of the Core Lower Urinary Tract Symptom Score and Quality‐of‐Life index was low in the groups with benign prostatic hyperplasia (ρ = 0.314) and benign prostatic hyperplasia/overactive bladder (ρ = 0.244). Our findings showed the Core Lower Urinary Tract Symptom Score, both its total score and each subscore, is able to show the efficacy of silodosin, similar to other questionnaires. The Core Lower Urinary Tract Symptom Score is also useful for identifying overactive bladder symptoms in patients with benign prostatic hyperplasia. As the Core Lower Urinary Tract Symptom Score does not correlate well with the Quality‐of‐Life index, these two questionnaires might be better used in combination to assess treatment outcomes.