重症监护病房患者导尿管相关尿路感染风险评分系统的建立与验证

目的建立并验证重症监护病房(ICU)患者导尿管相关尿路感染(CAUTI)风险评分系统,为ICU降低CAUTI的发生率提供依据。方法对常州市第一人民医院ICU在2017年1月-2018年12月期间1026例留置导尿管患者进行CAUTI目标性监测,利用1∶1简单化随机方法分为模型组和验证组,各513例。根据模型组数据筛选出CAUTI影响因素,建立风险评分系统应用于验证组,计算验证组中每例患者的风险评分。采用模型组和验证组数据建立受试者工作特征曲线图(ROC),根据ROC曲线下面积判断该风险评分系统建立的有效性。结果本研究期间患者发生CAUTI 44例,千日感染率为3.99‰。ICU住院时间、插管日数、未正确固定尿管、未规范执行手卫生是模型组导尿管插管患者CAUTI发生的影响因素(P<0.05)。利用此结果建立CAUTI风险评分系统,发现验证组中的高、中、低风险得分患者CAUTI发生率的差异有统计学意义,得分越高者患CAUTI的风险更高。最终利用该评分系统对模型组及验证组患者绘制ROC曲线,发现二者ROC曲线下面积均接近1,且差异无统计学意义,再次说明该评分系统具有较好的预测效果。结论建立CAUTI风险评分系统,采取针对性的早期干预可降低CAUTI的发生率,为患者提供最优经验治疗。     

Fecal Incontinence: A Stepwise Approach to Primary Care Management

Fecal incontinence can adversely affect quality of life, leading to embarrassment and social isolation. It occurs more often in older adults and is a common reason for nursing home referrals. Numerous treatments are available, but most patents self-treat and often do not report their symptoms. Advanced practice nurses providing primary care develop a rapport with the patient, allowing him or her to elicit important information about this sensitive subject. Interventions are designed to relieve symptoms and decrease incontinence episodes, ultimately improving quality of life. Management follows a stepwise approach beginning with conservative methods and newer technologies when indicated.     

Retrospective analysis of clinical outcomes in bilateral cleft lip and palate patients after secondary alveolar bone grafting and premaxilla osteotomy,using a new dento-maxillary scoring system

Evaluation of relevant clinical outcomes in patients with bilateral cleft lip and palate (BCLP) after secondary aveolar bone grafting (SABG) and premaxilla osteotomy (PMO), through the use of a new scoring system.Data were collected retrospectively from all patients with BCLP who were operated on between 2004 and 2014, at the end of follow-up. The treatment protocol consisted of SABG + PMO in patients aged between 9 and 13 years. At the end of follow-up, the following parameters were scored: (un)interrupted dental arch, skeletal sagittal relationship, bone height using the Bergland/Abyholm criteria, and the presence of postoperative fistula. These parameters were combined to produce a dento-maxillary scoring system, giving a final score between 1 and 10. For statistical analysis, the independent t-test was used.Of 55 children, 45 were suitable for analysis. The mean age at time of surgery was 12.0 years (8.9–16.4 yrs), and the mean follow-up time was 11.7 years (5.8–15.8 yrs). The average number of surgeries executed under general anesthesia was 6 (range: 3–11). The average dento-maxillary score in this patient cohort was 7.6 (1–10; median: 8). Among these patients, 31 had an uninterrupted dental arch; the average Bergland/Abyholm score was 2.07; 30 patients exhibited an Angle class I incisor relationship; and, in 38 cases, the oronasal communication was closed after SABG + PMO treatment. A significant effect of fistulas was seen on dento-maxillary score (p = 0.001). Specifically, a significant effect of fistulas was seen on interrupted dental arch (p = 0.002) and on Bergland/Abyholm score (p = 0.037).The proposed dento-maxillary scoring system is a straightforward tool that can be used to describe and analyze the amount of dento-maxillary rehabilitation at the end of the treatment. Persistence of oronasal fistulas in patients with BCLP has a significant impact on interruption of the dental arch, and can influence dental results at the end of the second decade.     

牛津急性疾病严重程度评分和生理评分系统对ICU患者病情评估的价值

目的 探讨牛津急性疾病严重程度评分（OASIS）和生理评分系统（PSS）在ICU患者病情评估和预后判断中的价值。方法 回顾性分析2016年8月至2017年8月在黄山市人民医院ICU住院的102例重症患者的临床资料,根据转归情况分为好转组（72例）与死亡组（30例）,比较两组患者的OASIS和PSS评分,计算OASIS和PSS评分的受试者工作特征（ROC）曲线下面积。结果 好转组患者OASIS、PSS评分、机械通气时间分别为（24.64±5.95）分、（4.18±2.36）分和（3.36±3.97）d,死亡组患者为（34.60±7.17）分、（6.47±2.66）分和（8.13±9.36）d,两组差异有统计学意义（P<0.05）。OASIS的ROC曲线下面积为0.856（95% CI：0.770~0.942,P<0.05）,评分为30.5分时Youden指数最大,为0.592。PSS评分的ROC曲线下面积为0.747（95% CI：0.637~0.858,P<0.05）,评分为5.5分时Youden指数最大,为0.421。结论 OASIS对ICU患者的病情评估与预后优于PSS评分。     

Exploration of Stratified Evidence Scoring Method of Acupuncture Clinical Practice Guidelines

Due to its own internal laws of development,Chinese medicine(CM)seems more inclined to empirical medicine in a relatively long historical period.It is considered to be lacking objective and unified clinical practice guidelines(CPGs),and the difficulties in diagnosis and therapeutic effect evaluation comes with it,have restricted its further inheritance,development and international communication.Over the years,our research group has been committed to improving the standardization theory and methodology of CM,also perfecting relative techniques for further application,which are all based on the stratified evidence scoring method.We have already applied this method to 45 issued guidelines,including 5 national guidelines,3 industrial guidelines,and 37 formulation/revision social organization guidelines.The stratified evidence scoring method has been recognized and used widely.It helps scholars and applicators to study,formulate,publish and popularize the acupuncture therapy clinical practice guidelines better,thus further promotes the development of acupuncture therapy.     

基于熵权-AHP法结合响应面法优化复方黄芪方絮凝工艺

目的 研究中药水提液絮凝过程,优化复方黄芪方的絮凝纯化工艺。方法 通过考察不同种类絮凝剂对水提液中有效成分保留率、出膏率、pH、黏度、浊度、电导率的影响,确定用于絮凝工艺中效果最佳的絮凝剂;并通过单因素试验考察絮凝反应工艺条件对絮凝效果的影响。在此基础上,以黄芪甲苷保留率、总黄酮保留率、出膏率的熵权-层次分析法（AHP）综合评分为评价指标,搅拌速度、药液质量浓度、絮凝剂加入量为考察因素,利用Box-Behnken响应面法优化其最佳工艺参数。结果 确定采用壳聚糖溶液作为絮凝剂,AHP结合熵权法可用于絮凝工艺多指标权重的建立,最佳工艺参数确定为搅拌速度360 r·min^–1、药液质量浓度0.20 g·mL^–1、絮凝剂添加量4.00 g·L^–1;纯化后药液黄芪甲苷保留率、总黄酮保留率分别达到85.86%、71.52%,出膏率降至29.16%。结论 优化后的絮凝工艺稳定可行,为中药水提液纯化工艺研究提供参考。     

Risk Factors and Scoring System as a Prognostic Tool for Epilepsy After Neonatal Seizures

BackgroundNeonatal seizures may cause irreversible changes to the immature brain and. A scoring system for early prognostic information could be a useful clinical tool. The aim of the study was to analyze risk factors for epilepsy after neonatal seizures, to validate Garfinkle's scoring system, and to analyze whether a new scoring system is feasible.MethodsA retrospective study of 176 newborns (59.1% boys, 40.9% girls, 70.5% term, 29.5% preterm; mean birth weight 2820 g), admitted to the Department of Neonatology, Division of Pediatrics, University Medical Centre, Ljubljana, because of neonatal seizures (clinical and/or neurophysiological), was performed. Epilepsy rate between 2 and 12 years of follow-up was 18.1%. Five independent predictors from Garfinkle's study and other known predictors were entered into hierarchical binary logistic regression models and analyzed through four steps to identify independent predictors of epilepsy. We tested whether any of the predictors was an effect modifier.ResultsOf five potential predictors from Garfinkle's score, electroencephalograph background findings and etiology were predictive. Etiologies, gestation, mode of delivery, duration of seizures, and other risk factors at birth were found to be independent predictors. Duration of seizures has a different effect on prognosis depending on the gestational age.ConclusionGestational age determines the association between duration of seizures and epilepsy. Scoring systems to predict development of epilepsy after neonatal seizures need to limit interaction between important predictor variables.