Graves甲亢多种治疗方法对Graves眼病影响的系统评价

目的 通过榆索、分析文献系统评价131I、手术、抗甲状腺药物(ATD)治疗Graves病(GD)对Graves眼病(GO)的影响.方法 检索了MEDIJNE(1966年-2006年3月)、EMBASE(1984-2005年)、The Cochrane Library(2006年第1期)、中国生物医学文献光盘数据库(EBMdisc,1978年1月-2006年4月)和中国学术期刊全文数据库(CNKI,1994-2006年)所收录的有关不同GD治疗方法对GO影响的文献,同时从参考文献中追溯文献.对纳入研究的方法学质量进行评价,根据是否采取预防甲状腺功能低下(简称甲低)发生的措施对纳入研究进行亚组分析,结果采用RevMan4.2软件进行统计学分析.结果 最终纳入随机对照研究5项,非随机对照研究2项,病例对照研究1项,共1625例患者.Meta分析显示:如GD治疗后早期未采取措施预防甲低,131I与手术治疗、131I与ATD治疗GD在诱发或加重GO以及减轻GO症状方面莘异有统计学意义[检验值分别为2.31,5.97,3.70,5.55;P均＜0.05];如GD治疗后早期采取措施预防甲低,手术与ATD治疗GD在诱发或加重GO以及减轻GO症状方面差异无统计学意义(检验值分别为0.27,0.99;P均＞0.05),尚无研究涉及131I治疗GD后早期采取甲低预防措施时131I对GO的影响.结论 若未及时采取甲低预防措施,131I较ATD、手术治疗GD更容易诱发或加重GO,减轻GO的症状却不如后两者,对于治疗前已有活动性GO的患者,应慎用131I.     

Subchondroplasty in the treatment of bone Marrow lesion in early Knee Osteoarthritis: A systematic review of clinical and radiological outcomes

BackgroundKnee osteoarthritis (KOA) is increasingly prevalent in North American society. The significant societal burden it represents makes it essential to promote and target new treatments in earlier phases of the disease. Among others, subchondroplasty is a newly documented technique using calcium phosphate injection targeting the osteochondral lesions preceding KOA, also known as Bone Marrow Lesions (BMLs). This article aimed to review the existing literature on clinical and radiological outcomes of subchondroplasty in the treatment of BMLs in KOA.MethodA systematic review was performed using PubMed, Embase, Medline and Cochrane Database of Systematic Reviews. Studies on calcium phosphate injections into BMLs for KOA and its clinical and radiological outcomes were screened and reviewed by independent evaluators.ResultsAfter screening, ten articles were included, totaling 540 patients. Follow-up ranged from 6 months to 7 years. Overall, the procedure showed significant functional and quality of life improvement, as well as pain relief, as shown by Patients-Reported Outcomes Measures (PROMs). There were very few complications reported, the most important being leakage of calcium phosphate outside the targeted site. Conversion rate to total knee arthroplasty (TKA) ranged from 14 % to 30 % at 2 years post-procedure. Long term radiological outcomes have been poorly documented.ConclusionsSubchondroplasty is a promising avenue for the treatment of KOA. However, quality evidence is still required before any real conclusions and practical management guidelines can be drawn. Prospective, randomized studies with a control group and a rigorous assessment of long-term clinical and radiological outcomes are recommended.     

夹脊穴辨

对名为夹脊穴的4穴及与之相混淆的肘椎穴进行了辨析，阐述了各穴的出处、定位、主治的区别，提出针灸工具书、教科书等应规范腧穴的名称及定位，以免在交流时造成概念及应用上的混乱。     

Does a dedicated program for young breast cancer patients affect the likelihood of fertility preservation discussion and referral?

PurposeTo assess whether a dedicated program for young breast cancer patients, including a nurse navigator, improves the frequency of: a) fertility discussion documentation and b) fertility preservation (FP) referrals.MethodsA retrospective chart review and prospective survey were undertaken of breast cancer patients diagnosed at age 40 or younger between 2011 and 2013 who received adjuvant or neo-adjuvant chemotherapy at two academic cancer centers in Toronto, Canada. The Odette Cancer Centre (OCC) has a dedicated program for young breast cancer patients while Princess Margaret Cancer Centre (PM) does not. Patient demographics, tumor pathology, treatment and fertility discussion documentation prior to systemic chemotherapy administration were extracted from patient records. Prospective surveys were administered to the same cohort to corroborate data collected.ResultsEighty-one patient charts were reviewed at both OCC and PM. Forty-seven and 49 at OCC and PM returned surveys for a response rate of 58% and 60% respectively. Chart reviews demonstrated no difference in the frequency of fertility discussion documentation (78% versus 75% for OCC and PM, p = 0.71); however, surveys demonstrated higher rates of recall of fertility discussion at OCC (96% versus 80%, p = 0.02). A greater proportion of women were offered FP referrals at OCC, as observed in chart reviews (56% versus 41%, p = 0.09), and surveys (73% versus 51%, p = 0.04). Time to initiation of chemotherapy did not differ between women who underwent FP and those who did not.ConclusionA dedicated program for young breast cancer patients is associated with a higher frequency of FP referrals without delaying systemic therapy.     

Perception et impact de la démarche de soin diététique : une enquête qualitative dans trois établissements de l’Assistance publique–Hôpitaux de Paris (AP–HP)

ObjectivesData on the perception of the nutrition care process in France are rare. In a logic of multidisciplinary care organization, the aim of the study was to shed light on the vision of dieticians and partner health professionals.Materials and methodsAn exploratory qualitative study was conducted between March and July 2018 in three AP–HP sites using focus groups and semi-directive interviews.ResultsSeventeen dieticians, four dietician managers and 48 other professionals were interviewed. Dieticians had a positive perception of the structuring effect of the care approach and the professionalization of documentation. Their vision was more mixed regarding improving patient care. A legitimization of their expertise and their contribution in interdisciplinarity have been well recognized.ConclusionThe nutrition care process is useful for the patients care and the dieticians enhancement. One step remains: the dieticians more active contribution to the interprofessional dynamic using this structured reflection, especially during staff meetings, for a better understood nutritional care shared by all. Nutrition diagnosis and the use of international dietetics and nutrition terminology for patient care will enable participation in research. The need to re-engineer studies is becoming unavoidable.     

The Sensational Hand: Clinical Assessment after Nerve Repair

Following the transection and repair of major nerve trunks in the forearm, the functional outcome is influenced by mechanisms in the peripheral, as well as in the central nervous system. In the present thesis the interest is focused on assessment of the outcome after nerve repair, central nervous factors influencing the outcome, and sense substitution to compensate for sensory loss. A new model instrument for routine documentation of the outcome after repair of a peripheral nerve is identified. The model includes assessments reflecting sensory, motor and pain/discomfort domains. Investigations of frequently used assessment instruments led to the construction and evaluation of a new test instrument for assessment of discriminative sensibility (tactile gnosis) to fit in the model. The summarised outcome, calculated from the model instrument and with a numerical scoring system, conforms well with the patient's opinion on the influence on activities of daily living resulting from the nerve injury, and demonstrates good reliability and validity. A reference interval for the outcome is presented, with the estimated 95% predicted values for the outcome up to five years after the nerve repair. Brain plasticity is a factor sensibility - tactile gnosis - in the adaptive process after a nerve injury, when the mind has to interpret new signal patterns, when objects are touched. For better understanding of the sensory outcome after nerve repair, central nervous factors were examined. Specific cognitive capacities, such as verbal learning and visuo-spatial logic capacity could be identified as being of importance for recovery of tactile gnosis. For patients with temporary or permanent sensory loss, a new principle for artificial sensibility based on sense substitution is presented. The hearing sense substitutes the sense of touch. The resemblance in perceptual experience between sound and touch is bridged by the stereophonic friction sound generated by touching objects, which is then amplified and transmitted to earphones. The delicate capacity of the sense of hearing to discriminate between the complex pattern of frequencies makes it reasonable to assume that hearing is able to take over functions normally devoted to touch. This is demonstrated in the thesis.     

Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: An intervention study

BackgroundNursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation.AimThe present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes.Design, setting and participantsAn intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009).MethodsThe nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics.ResultsThe implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions.ConclusionThis study provides evidence that the computerized decision support system and an educational program as implementation strategies had a positive influence on nursing documentation practice.