Reducing HIV stigma among healthcare providers in India using a partly tablet-administered intervention: the DriSti trial

ABSTRACT

HIV stigma has long been recognized as a significant barrier in the worldwide fight against HIV. Across cultures, stigma has been shown to cause psychological distress and act as a barrier to engagement in care. Health professionals can serve as a crucial source of HIV stigma, with drivers that include fears and transmission misconceptions and pre-existing negative attitudes towards marginalized groups. To increase their impact, stigma reduction interventions need to be scalable and sustainable as well as adaptable to different cultural contexts. The DriSti intervention was designed to meet these needs through an easily adaptable, mostly tablet-administered, interactive intervention delivered to ward staff (n?=?1,557) and nursing students (n?=?1,625) in 62 Indian institutions, using a cRCT design, with wait-list controls. Six-month outcome analyses, showed significant reductions in misconceptions (p?<?.001) and worry about acquiring HIV at work (p?<?.001). Intervention participants also reported significantly greater reductions in endorsement of coercive policies (p?<?.001) and in the number of situations in which they intended to discriminate against PLWH (p?<?.001) than control participants. This brief, scaleable intervention could be adapted for similar populations in the region, using different mHealth platforms and thus has important implications for current global stigma reduction initiatives and training curricula.     

责任制整体护理在结直肠外科病房的实现

目的：探讨责任制整体护理在结直肠外科病房的实施的可能性及实施效果。方法：总结责任制整体护理在某三级甲等医院结直肠外科病房的试验实施方案，调查执行该护理模式前后出院患者的满意程度和临床护理质量，并进行统计学分析。结果：试验执行责任制整体护理后，患者对临床护理的满意程度大幅提高，科室的临床护理质量也有显著提升，但是在护理文件整理方面仍有待调整。结论：责任制整体护理模式在结直肠外科病房可以实现，且能提高患者的满意程度和护理质量，深入实施后，能为患者提供更优质的临床护理服务。     

Electrophysiology of statistical learning: Exploring the online learning process and offline learning product

A continuous stream of syllables is segmented into discrete constituents based on the transitional probabilities (TPs) between adjacent syllables by means of statistical learning. However, we still do not know whether people attend to high TPs between frequently co‐occurring syllables and cluster them together as parts of the discrete constituents or attend to low TPs aligned with the edges between the constituents and extract them as whole units. Earlier studies on TP‐based segmentation also have not distinguished between the segmentation process (how people segment continuous speech) and the learning product (what is learnt by means of statistical learning mechanisms). In the current study, we explored the learning outcome separately from the learning process, focusing on three possible learning products: holistic constituents that are retrieved from memory during the recognition test, clusters of frequently co‐occurring syllables, or a set of statistical regularities which can be used to reconstruct legitimate candidates for discrete constituents during the recognition test. Our data suggest that people employ boundary‐finding mechanisms during online segmentation by attending to low inter‐syllabic TPs during familiarization and also identify potential candidates for discrete constituents based on their statistical congruency with rules extracted during the learning process. Memory representations of recurrent constituents embedded in the continuous speech stream during familiarization facilitate subsequent recognition of these discrete constituents.     

急诊科联合病房早期肺康复程序在AECOPD患者中的应用

目的 促进慢性阻塞性肺疾病急性加重期（AECOPD）患者肺康复。 方法 按急诊就诊时间将82例AECOPD患者分为对照组40例、观察组42例，两组均予常规治疗及护理，在此基础上对照组行常规肺康复措施；观察组组建多学科肺康复团队、制订和实施为期4周的三阶段肺康复方案。 结果 干预后，观察组患者的肺功能指标、动脉血氧饱和度、上下肢运动耐力评分、日常生活活动能力评分显著高于对照组，焦虑抑郁评分显著低于对照组（均P＜0.05）。 结论 多学科协作下急诊科联合病房早期分阶段肺康复方案可有效改善AECOPD患者肺功能及运动耐力，从而改善患者心身状态。     

Transitional cell carcinoma in a patient with X‐linked hyperimmunoglobulin M syndrome

Patients with X‐linked hyperimmunoglobulin M syndrome (XHIGM) have a defective CD40–CD40 ligand system and further immunoglobulin class‐switching. They may present with recurrent infection and malignancy involving the liver, pancreas or biliary tract. We report here a case of poorly differentiated transitional cell carcinoma in a young man with XHIGM even on regular treatment and discuss the possible pathogenesis. Given that the triggering of the CD40–CD40 ligand system has been found to improve tumor immunogenicity in recent studies, future immunotherapy targeting the CD40 ligand for these patients may be feasible to prolong their survival.     

Transsacral screw safe zone size by sacral segmentation variations

Variations in sacral segmentation may preclude safe placement of transsacral screws for posterior pelvis fixation. We developed a novel automated 3D technique to determine the safe zone size for transsacral screws in the upper two sacral segments in 526 adult pelvis computed tomography scans. Safe zone sizes were then compared by gender and sacral segmentation variations (number of neuroforamen and the presence/absence of lumbosacral transitional vertebrae, ±LSTV). Ten millimeters was used as the safety threshold for a large screw. 3 (0.6%), 366 (70%), and 157 (30%) sacra had 3, 4, or 5 neuroforamen, respectively. Eighty‐eight (17%) were +LSTV. Safe zone size depended on gender, number of neuroforamen in −LSTV sacra and presence of LSTV (p < 0.001) but not on the uni‐ or bilateral nature of the LSTV. 17% of −LSTV sacra were below the safety threshold in S1, 27% in S2, whereas 3% of +LSTV sacra were below in S1, 74% in S2. Of −LSTV sacra that cannot take an S1 screw safely, 77% can do so in S2, leaving only 4% of sacra that cannot accommodate a screw safely in either upper segment. The results demonstrate a predictable pattern of safe zone size based on gender and sacral segmentation variations. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:277–282, 2015.

     

三级医院延续性护理服务质量评价指标体系的构建

目的建立三级医院延续性护理服务质量评价指标体系,为客观评价与规范三级医院延续性护理服务提供参考。方法以"结构-过程-结果"模式为基础,结合现行延续性护理服务内容和患者需求,参考国内外文献和专家访谈形成问卷初稿;采用德尔菲(Delphi)法,通过2轮23名专家咨询初步确立三级医院延续性护理服务质量评价指标体系。结果专家咨询的权威系数、判断系数、熟悉系数分别为0.882,0.942,0.822;确定三级医院延续性护理服务质量评价指标体系,包括一级指标3项,二级指标10项,三级指标41项;一、二、三级指标的协调系数分别为0.736、0.521、0.627,具有统计学意义(均P0.01)。结论三级医院延续性护理服务质量评价指标体系内容科学可靠,有助于客观评价延续性护理服务质量,促进护理质量提升。     

Single and multiple respiratory virus infections and severity of respiratory disease: A systematic review

IntroductionThere are suggestions that virus co-infections may influence the clinical outcome of respiratory virus illness. We performed a systematic review of the literature to summarise the evidence.MethodsMEDLINE, EMBASE, Ovid and WEB of Science databases, major organisation websites and reference lists of published studies were searched. The quality of studies was assessed using the STROBE tool (von Elm et al., 1) Individual study data was analyzed using odds ratios and 95% confidence intervals as a measure of association between exposure (co-infection), patient outcome and results summarised using forest plots and tablesResultsNineteen (19) studies from all over the world were identified and included in the review. Most of the studies 73.7% (14/19) recruited children ≤6 years old. Evidence on the role of co-infection in increasing disease severity was inconclusive. In five out of eight studies, co-infection significantly increased risk of admission to general ward (OR: 2.4, 95% CI: 1.3 - 4.4, p = 0.005; OR: 2.4, 95% CI: 1.1 - 7.7, P = 0.04; OR: 3.1, 95% CI: 2.0 - 5.1, p = <0.001; OR: 2.4, 95% CI: 1.7-3.4, p = <0.0001 and OR: 2.3, 95% CI: 1.1 - 5.1, p = 0.34), one found it did not (OR: 0.59, 95% CI: 0.4 - 0.9, p = 0.02) and the other 2 had insignificant results. Similarly on risk of admission to ICU, some studies found that co-infection significantly increased risk of admission to ICU (OR: 2.9, 95% CI: 1.4 - 5.9, p = 0.004 and OR: 3.0, 95% CI: 1.7 - 5.6, p = <0.0001), whereas others did not (OR: 0.18, 95% CI: 0.05 - 0.75, p = 0.02 and OR: 0.3, 95% CI: 0.2 - 0.6, p = <0.0001). There was no evidence for or against respiratory virus co-infections and risk of bronchiolitis or pneumonia.ConclusionThe influence of co-infections on severe viral respiratory disease is still unclear. The observed conflict in outcomes could be because they were conducted in different seasons and covered different years and periods. It could also be due to bias towards the null, especially in studies where only crude analysis was conducted. Future studies should employ stratified analysis.     

Evaluation of transitional implant stabilized overdentures: a case series report

Transitional implants (TI) can immediately improve the stability and retention of existing unstable mandibular complete dentures. This study evaluated the improvement of mandibular complete denture stability and retention with the use of TI. Three TIs were placed in the intraforaminal region of the edentulous mandible of seven patients (three men, four women; mean age 69.7 years). The patients' existing mandibular complete dentures were immediately modified to TI-stabilized overdentures. Their masticatory movements (mandibular movements during mastication) were measured using a commercially available tracking device (BioPACK, Bioresearch, Japan), both before TI placement and about 1 month after delivery of the TI-stabilized overdentures. The mean time of each chewing phase (opening, closing, and occluding) and coefficients of variation were calculated. The patients also completed a questionnaire about the foods they could chew and indicated on a 100 mm Visual Analog Scale (VAS) their personal levels of comfort, ease of chewing, speech, and stability. For masticatory movements, there were no significant differences (P > 0.05) between the TI-stabilized overdentures and existing complete dentures. However, the number of foods that could be chewed increased, and the stability and comfort were reported as improved with the TI-stabilized overdentures. Using TIs, the stability and comfort of the existing mandibular complete dentures studied in this report could be immediately improved.