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81.
目的:了解杭州市萧山区梅毒流行病学特征和发病趋势,为制定防制策略提供依据。方法:采用描述流行病学方法对萧山区2004-2013年梅毒发病资料进行三间分布分析;应用回顾性时空重排扫描统计量探测高发聚集区;构建SARIMA模型进行趋势预测。结果:萧山区梅毒发病率从2004年的18.52/10万上升至2013年的58.85/10万,呈明显上升趋势。男女发病比为0.72∶1,主要集中在20~39岁年龄段,职业以农民居多。回顾性时空聚集分析确定了5个可能的梅毒发病聚集区域。模型为SARIMA(0,1,1)(0,1,1)12。结论:萧山区(特别是中部地区)梅毒的流行情况较为严重,应采取综合性防制措施,有效控制梅毒流行。 相似文献
82.
Sydney E.S. Brown Ryan M. Antiel Thane A. Blinman Susanna Shaw Mark D. Neuman Chris Feudtner 《Journal of pain and symptom management》2019,57(5):971-979
Context
Do-not-resuscitate (DNR) orders are common among children receiving palliative care, who may nevertheless benefit from surgery and other procedures. Although anesthesia, surgery, and pediatric guidelines recommend systematic reconsideration of DNR orders in the perioperative period, data regarding how clinicians evaluate and manage DNR orders in the perioperative period are limited.Objectives
To evaluate perioperative management of DNR orders at a tertiary care children's hospital.Methods
We reviewed electronic medical records for all children with DNR orders in place within 30 days of surgery at a tertiary care pediatric hospital from February 1, 2016, to August 1, 2017. Using standardized case report forms, we abstracted the following from physician notes: 1) patient/family wishes with respect to the DNR, 2) whether preoperative DNR orders were continued, modified, or suspended during the perioperative period, and 3) whether life-threatening events occurred in the perioperative period. Based on data from these reports, we created a process flow diagram regarding DNR order decision-making in the perioperative period.Results
Twenty-three patients aged six days to 17 years had a DNR order in place within 30 days of 29 procedures. No documented systematic reconsideration took place for 41% of procedures. DNR orders were modified for two (7%) procedures and suspended for 15 (51%). Three children (13%) suffered life-threatening events. We identified four time points in the perioperative period where systematic reconsideration should be documented in the medical record, and identified recommended personnel involved and important discussion points at each time point.Conclusion
Opportunities exist to improve how DNR orders are managed during the perioperative period. 相似文献83.
We report an active surveillance study of the occurrence of specific antibodies to European Bat Lyssavirus Type 1 (EBLV-1) in bat species, scarcely studied hitherto, that share the same refuge. From 2004 to 2012, 406 sera were obtained from nine bat species. Blood samples were subjected to a modified fluorescent antibody virus neutralization test to determine the antibody titer. EBLV-1-neutralizing antibodies were detected in six of the nine species analyzed (Pipistrellus pipistrellus, P. kuhlii, Hypsugo savii, Plecotus austriacus, Eptesicus serotinus and Tadarida teniotis). Among all bats sampled, female seroprevalence (20.21%, 95% CI: 14.78%–26.57%) was not significantly higher than the seroprevalence in males (15.02%, 95% CI: 10.51%–20.54%). The results showed that the inter-annual variation in the number of seropositive bats in T. teniotis and P. austriacus showed a peak in 2007 (>70% of EBLV-1 prevalence). However, significant differences were observed in the temporal patterns of the seroprevalence modeling of T. teniotis and P. austriacus. The behavioral ecology of these species involved could explain the different annual fluctuations in EBLV-1 seroprevalence. 相似文献
84.
《The journal of pain》2014,15(4):377.e1-377.e35
Previous research describes an inconsistent relation between temporal changes in transversus abdominis or lumbar multifidus and temporal changes in clinical outcomes. Unfortunately, a relevant systematic review is unavailable. As a result, this systematic review was designed to summarize evidence regarding the association between temporal changes in muscle morphometry and activity in response to treatment, and temporal changes in clinical outcomes. Candidate publications were identified from 6 electronic databases. Fifteen articles were included after scrutinization by 2 reviewers using predetermined selection criteria. The methodological quality of these articles was appraised using a standard tool. These methods revealed strong evidence that temporal alterations in transversus abdominis thickness change during contraction (as measured by B-mode or M-mode ultrasound) or feedforward activation of transversus abdominis (assessed via electromyography, tissue Doppler imaging, or M-mode ultrasound) were unrelated to temporal changes in low back pain (LBP)/LBP-related disability. There was limited evidence that temporal changes in transversus abdominis lateral sliding or lumbar multifidus endurance were unrelated to temporal changes in LBP intensity. Conflicting evidence was found for the relation between temporal changes in lumbar multifidus morphometry and temporal changes in LBP/LBP-related disability. This review highlights that temporal changes in transversus abdominis features tend to be unrelated to the corresponding LBP/LBP-related disability improvements, whereas the relation between multifidus changes and clinical improvements remains uncertain.PerspectiveThis systematic review highlighted that changes in morphometry or activation of transversus abdominis following conservative treatments tend not to be associated with the corresponding changes in clinical outcomes. The relation between posttreatment changes in characteristics of lumbar multifidus and clinical improvements remains uncertain. 相似文献
85.
A goal of total knee arthroplasty is to obtain symmetric and balanced flexion and extension gaps. Controversy exists regarding the best surgical technique to utilize to obtain gap balance. Some favor the use of a measured resection technique in which bone landmarks, such as the transepicondylar, the anterior-posterior, or the posterior condylar axes are used to determine proper femoral component rotation and subsequent gap balance. Others favor a gap balancing technique in which the femoral component is positioned parallel to the resected proximal tibia with each collateral ligament equally tensioned to obtain a rectangular flexion gap. Two scientific studies have been performed comparing the two surgical techniques. The first utilized computer navigation and demonstrated a balanced and rectangular flexion gap was obtained much more frequently with use of a gap balanced technique. The second utilized in vivo video fluoroscopy and demonstrated a much high incidence of femoral condylar lift-off (instability) when a measured resection technique was used. In summary, the authors believe gap balancing techniques provide superior gap balance and function following total knee arthroplasty. 相似文献
86.
Clifton Wijaya David S. Leonard John B. Kinsella Donald P. McShane 《International journal of surgery case reports》2013,4(1):33-35
INTRODUCTIONPrimary squamous cell carcinoma (SCC) of the tympanic membrane is exceptionally rare. We describe the history, investigation and management of this disease.PRESENTATION OF CASEA 68-year-old woman presented with a three month history of intermittent otorrhoea and external ear canal (EAC) pruritus. Otoscopy revealed a polypoidal granular nodule, confined to the posterior aspect of the tympanic membrane. Examination under anaesthesia (EUA) confirmed that the lesion was confined to the tympanic membrane, with a surrounding rim of normal drum. Biopsies were consistent with well differentiated SCC.DISCUSSIONFollowing discussion at multi-disciplinary team meeting for treatment planning, the patient underwent lateral temporal bone resection with ipsilateral superficial parotidectomy and selective neck dissection. Post-operative histology confirmed an SCC confined to the tympanic membrane.CONCLUSIONSCC of the tympanic membrane is an extremely rare condition. As with early temporal bone SCC, surgical resection with adjacent structure clearance remains the primary treatment modality. 相似文献
87.
K. Vehik R. F. Hamman D. Lezotte J. M. Norris G. J. Klingensmith D. Dabelea 《Diabetic medicine》2009,26(10):961-967
Objective Studies have suggested that the age at diagnosis of Type 1 diabetes (T1D) is decreasing over time. The overload hypothesis postulates that risk factors, such as accelerated growth, may be responsible for this decrease. We assessed changes in age, body mass index (BMI), weight and height at diagnosis with T1D in non‐Hispanic white (NHW) and Hispanic (HISP) young people from Colorado, using data from the IDDM Registry and SEARCH Study. Methods In three time periods, 656 (1978–1983), 562 (1984–1988) and 712 (2002–2004) young people aged 2–17 years were newly diagnosed with T1D. Age, weight, height and presence of diabetic ketoacidosis (DKA) at diagnosis with T1D were obtained from medical records. Trends over the three time periods were assessed with regression analyses. Results Age at diagnosis decreased by 9.6 months over time (P = 0.0002). Mean BMI standard deviation score (SDS), weight SDS and height SDS increased over time (P < 0.0001), while prevalence of DKA decreased (P < 0.0001). Increasing height over time accounted for 15% (P = 0.04) of the decreasing age at diagnosis with T1D. Conclusions Our study provides evidence that increased linear growth, but not increased BMI or weight over time, may account, at least in part, for the younger age at diagnosis of T1D in Colorado children. This finding supports the hypothesis that increasing environmental pressure resulting from changes in potentially preventable risk factors may accelerate the onset of T1D in children. 相似文献
88.
Long-term effects of ethics education on the quality of care for patients who have do-not-resuscitate orders 总被引:1,自引:0,他引:1
Dr. Daniel P. Sulmasy OFM MD Peter B. Terry MD Ruth R. Faden PhD MPH David M. Levine MD MPH ScD 《Journal of general internal medicine》1994,9(11):622-626
Objective: To assess the long-term clinical impact of a broad-based ethics education program for medical houseofficers with specific
emphasis on appropriate care for patients who have do-not-resuscitate (DNR) orders.
Design: Prospective, with an initial randomized phase.
Setting: The medical service of a university teaching hospital.
Participants: Medical houseofficers and their inpatients.
Interventions: A pilot program in 1988, and a full program with a two-year curricular cycle from 1989 to 1991.
Measurements and main results: The authors measured compliance with specific standards of care by reviewing charts of patients who had DNR orders at baseline
(n=39, 1988), after the pilot phase (n=57, 1989), and at the end of the first curricular cycle (n=56, 1991), noticing who wrote the DNR order, whether the reasons for the order and appropriate consent were documented, and
whether there was documented attention to any of 11 concurrent care concerns (CCCs), such as spiritual needs, the appropriateness
of tube feedings or pressors, and adjustment of analgesic dose. The percentage of DNR orders written by houseofficers increased
from 26% in 1988 to 67% in 1991 (p<0.01). The percentage of charts documenting the rationale and consent for the DNR order
was consistently high. The percentage of charts documenting attention to any CCC increased from 68% in 1988 to 86% in 1991
(p<0.01). The mean number of CCCs addressed per DNR order increased from 1.34 in 1988 to 2.14 in 1991. The mean number of
CCCs addressed per DNR order for patients who had AIDS increased from 0.89 in 1988 to 2.25 in 1991 (p=0.03).
Conclusions: The quality of care for patients who had DNR orders, both overall and for those who had AIDS, improved over long-term observation
in the setting of an ethics education program for medical houseofficers. The results suggest that ethics education may alter
physician practices and improve patient care.
Presented in part at the annual meeting of the Society of General Internal Medicine, Arlington, Virginia, April 29, 1993.
Supported by a Charles E. Culpeper Foundation Medical Humanities Award to Dr. Sulmasy. Computational assistance was provided
by CLINFO system of the National Institutes of Health (RR00035). 相似文献
89.
90.