基于标准化患者法评价四川农村基层医生两种慢性病诊断准确性及其影响因素

目的 运用标准化患者法评估四川农村地区基层医生不稳定型心绞痛和2型糖尿病两种慢性病诊断准确性现状,探讨基层医生两种慢性病诊断准确性的主要影响因素,为提升基层医生两种慢性病诊断准确性提供科学依据。方法 采用多阶段随机整群抽样方法,抽取四川省自贡市5个区/县50个乡镇100个村为研究现场,以调查当日在岗的全科及内科医生作为研究对象。共进行两轮数据采集,第1轮采集样本乡镇卫生院和村卫生室医生的基本信息;第1轮调查完成1个月后,运用标准化患者法开展第2轮调查,收集农村基层医生对不稳定型心绞痛和2型糖尿病诊断结果信息。运用Logistic回归分析农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性的影响因素。结果 共纳入172名农村基层医生,完成186次标准化患者访问,正确诊断率为48.39%。其中不稳定型心绞痛的正确诊断率为18.68%(17/91),2型糖尿病的正确诊断率为76.84%(73/95)。Logistic回归分析显示,具有执业医师资质的农村基层医生更有可能做出正确诊断(OR=4.857,95%CI=1.076~21.933,P=0.040)。农村基层医生在诊断过程中涉及的必要问诊和检查条目越多,做出正确诊断的概率越高(OR=1.627,95%CI=1.065~2.485,P=0.024)。与不稳定型心绞痛相比,农村基层医生对2型糖尿病做出正确诊断的可能性更高(OR=6.306,95%CI=3.611~11.013,P<0.001)。结论 四川农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性整体较差,建议以基层医生慢性病诊断过程质量改善为突破口,提升基层医生执业水平,进而提高慢性病诊断准确性。     

氯雷他定联合阿伐斯汀治疗慢性难治性荨麻疹的效果及安全性分析

目的 探讨氯雷他定联合阿伐斯汀治疗慢性难治性荨麻疹的效果及安全性。方法 选择2019年1月至2020年6月本院接收的慢性难治性荨麻疹患者85例,采用随机数字表法将其分为对照组(42例)和观察组(43例)。对照组采用阿伐斯汀胶囊口服治疗,在对照组基础上,观察组采用氯雷他定片口服治疗,治疗4周后,比较两组临床疗效、实验室相关指标[白细胞(WBC)、5-羟色胺(5-HT)、血清免疫球蛋白(IgE)]、安全性。结果 观察组临床总有效率(95.35%)高于对照组(78.57%),差异有统计学意义(χ2=5.308,P=0.021);治疗4周后,观察组5-HT水平(127.65±8.61)μg/L高于对照组的(104.52±9.32)μg/L,IgE水平(57.41±7.53)IU/mL、WBC水平(9.20±1.95)g/L低于对照组的(72.26±8.40)IU/mL、(11.31±2.04)g/L,差异有统计学意义(t=11.889、8.587、4.875,P均=0.000);观察组不良反应发生率(11.63%)与对照组(7.14%)对比,差异无统计学意义(χ2=0.501,P=0.713)。结论 予以慢性难治性荨麻疹患者氯雷他定联合阿伐斯汀治疗效果确切,可改善患者实验室相关指标,且未明显增加不良反应,安全性较高。     

Dual-Energy Computed Tomography as an Adjunct in the Evaluation of Peripheral Chronic Total Occlusions: A Feasibility Study

This study investigated the role of dual-energy computed tomography (CT) for lesion characterization in patients with peripheral arterial disease manifesting with chronic total occlusions (CTOs). Forty-one symptomatic patients with CTOs underwent dual-energy CT angiography before endovascular treatment. The lesions were subsequently analyzed in a dedicated workstation, and 2 indexes—dual-energy index (DEI) and effective Z (Z_eff)—were calculated, ranging from 0.0027 to 0.321 and from 6.89 to 13.02, respectively. Statistical analysis showed a significant correlation between the DEI and Z_eff values (P < .001). The interobserver intraclass correlation coefficient was 0.91 for the mean Z_eff values and 0.86 for the mean DEI values. This technique could potentially provide useful information regarding the composition of a CTO.     

慢阻肺急性加重期患者延迟就医与家庭动力学的相关性研究

目的研究慢阻肺急性加重期患者延迟就医与家庭动力学的相关性,希望能够为慢阻肺急性加重期患者拟定护理措施提供科学依据。方法选取2017年1月-2019年12月我院240例诊断为慢阻肺急性加重期的患者为研究对象。根据患者入院就医的时间进行分组,时间≥24h的延迟就医的患者为观察组,时间<24h的及时就医患者为对照组。结果两组患者在文化水平、家庭年收入、在职状态、医疗保险和婚姻状况和APACHEⅡ评分比较(P<0.05)。观察组患者疾病观念、个性化、系统逻辑和家庭氛围得分比对照组高(P<0.05)。Pearman的相关性分析结果显示:慢阻肺急性加重期患者延迟就医时间与各个层面分数以及家庭动力总分呈现负相关性(P<0.05)。应变量为延迟就医为应变量,患者的一般资料为自变量,经Logistic回归分析结果表明:延迟就医的影响因素为文化水平、家庭动力评分、职业状态、家庭收入、婚姻状况和APACHEⅡ评分。结论慢阻肺急性加重期患者家庭动力总分与疾病观念、个性化、系统逻辑和家庭氛围得分与延迟就医时间呈现负相关性,患者延迟就医的影响因素是家庭动力学评分。     

瘀热型慢性前列腺炎与心理性因素及性功能的相关性

目的分析瘀热型慢性前列腺炎(CP)临床症状与心理性因素及性功能的相关性。方法收集2020年6月至2021年6月在南京市江宁中医院泌尿外科门诊诊治的91例瘀热型CP患者的临床资料进行回顾性分析,使用美国国立卫生研究院慢性前列腺炎症状指数评分表(NIH-CPSI)、中医证候量表、7项广泛性焦虑障碍量表(GAD-7)、抑郁症筛查量表(PHQ-9)、疼痛灾难化量表(PCS)、国际勃起功能评分表(IIEF-5)和早泄诊断量表(PEDT)对患者进行评估,对量表评定结果进行Pearson相关性分析和多元线性回归分析。结果(1)症状量表:NIH-CPSI总分与中医量表总分、GAD-7总分呈正相关,中医证候量表总分与CPSI、GAD-7、PHQ-9、PCS、PEDT总分呈正相关(P<0.05);CPSI总分随中医量表总分递增而升高,中医证候量表总分随CPSI疼痛症状、PHQ-9总分递增而升高(P<0.05)。(2)情绪量表:GAD-7总分与CPSI、中医证候量表总分、排尿症状、PHQ总分、PEDT总分呈正相关,PHQ-9总分与中医证候量表总分、疼痛及排尿症状、PCS总分、PEDT总分呈正相关,PCS总分与中医证候量表总分及疼痛症状分值呈正相关(P<0.05);GAD-7总分随PHQ-9总分递增而升高;PHQ-9总分随中医证候量表排尿症状、GAD-7、PCS分值递增而升高;PCS总分随中医证候量表疼痛症状、PHQ-9分值递增而升高(P<0.05)。(3)性功能量表:IIEF-5总分与中医证候量表疼痛分值呈负相关,PEDT总分与中医证候量表总分及疼痛症状、GAD-7、PHQ-9分值呈正相关(P<0.05);IIEF-5总分随中医证候量表疼痛症状分值递减而升高(P<0.05)。结论瘀热型CP患者表现为以疼痛为主,伴随排尿异常、情绪异常、认知障碍和性功能障碍的系列症状,同时使用中医证候量表及CPSI评估能较好的反映其病情的严重程度。     

Tocilizumab en el tratamiento del rechazo humoral crónico activo resistente a terapia estándar

IntroductionThere is no consensus on the most appropriate treatment for chronic active antibody-mediated rejection (cAMR). Recent studies suggest that treatment with tocilizumab (TCZ) may stabilize graft function, decrease the intensity of donor-specific HLA antibodies (DSAs) and reduce inflammation of microcirculation.Patients and methodsObservational study with renal allograft recipients diagnosed with cAMR (n = 5) who had not submitted a response to traditional treatment based on the combination of plasma replacements, immunoglobulins, and rituximab. Patients were told to be treated with TCZ as compassionate use in six doses per month (8 mg/kg/month). Renal function, proteinuria, and the intensity of DSAs were monitored during follow-up.ResultsFive patients, average age 60 ± 13 years, three male and two retrasplants (cPRA average 55%) with preformed DSAs. Treatment with TCZ was initiated within 47 ± 52 days of biopsy. In two cases treatment was discontinued after the first dose, by severe bicitopenia with cytomegalovirus viremia and by graft failure, respectively. In the three patients who completed treatment, no stability of renal function (serum creatinine from 1.73 ± 0.70 to 2.04 ± 0.52 mg/dL, e-FGR 4 6 ± 15 to 36 ± 16 mL/min), showed increased proteinuria (3.2 ± 4.0 to 6.9 ± 11.0 g/g) and the intensity of DSAs maintain stable. No changes were observed in the degree of inflammation of microcirculation (g + pt 4.2 ± 0.8 vs. 4.3 ± 1.0) or in the degree of transplant glomerulopathy (cg 1.2 ± 0.4 vs. 1.8 ± 1.0).ConclusionsTCZ therapy does not appear to be effective in modifying the natural history of chronic active antibody-mediated rejection, does not improve the degree of inflammation of microcirculation and does not reduces the intensity of DSAs.     

弹性抗阻运动对慢性阻塞性肺疾病康复疗效的Meta分析

目的 系统评价弹性抗阻运动(弹力带/弹力管)对慢性阻塞性肺疾病(COPD)患者康复疗效的影响。方法 检索Cochrane Library、PubMed、Web of Science、中国知网、维普、万方和生物医学文献数据库中关于弹性抗阻运动治疗COPD患者的临床随机对照试验,检索时限自建库至2020年9月。最后纳入文献11篇,其中英文9篇,中文2篇,共485例患者。采用Cochrane风险偏倚评估工具及物理治疗证据数据库量表进行质量评价,采用RevMan 5.2软件进行分析。这一系统评价在PROSPERO(CRD42020208659)上登记。结果 弹性抗阻运动组与传统抗阻运动组(如举重训练机、体重训练) 6 min步行试验距离(6WMD) (MD = 1.19, 95%CI -7.02~9.39, P = 0.78)、COPD患者自我评估测试(CAT) (MD = -0.43, 95%CI -2.42~1.57, P = 0.68)和肌力(MD = 0.23, 95%CI -1.06~1.52, P = 0.73)无显著性差异,两组间异质性不高。弹性抗阻运动组与非抗阻运动组6MWD (MD = 18.30, 95%CI -8.92~45.52, P = 0.19)和CAT (MD = -0.59, 95%CI -3.78~2.60, P = 0.72)无显著性差异,研究间异质性较高。结论 弹性抗阻运动也许是一种潜在的替代传统抗阻训练的方法,但弹性抗阻运动对运动耐力、生活质量、肺功能的影响尚不明确。     

Adherence to Chronic Kidney Disease Screening Guidelines Among Patients With Type 2 Diabetes in a US Administrative Claims Database

ObjectiveTo examine the screening rates for kidney damage and function among patients with type 2 diabetes (T2D) and chronic kidney disease stage at diabetes diagnosis using a US administrative claims database.Patients and MethodsThis cohort study used a claims database enriched with laboratory results data. Patients with T2D (defined as 1 inpatient or 2 outpatient claims for diabetes), aged 18 years or older, and with at least 1 year of follow-up enrollment were identified. Patients with type 1 diabetes, kidney disease, or other related conditions at baseline were excluded. We estimated screening rates using laboratory orders for serum creatinine and estimated glomerular filtration rate (eGFR) measurement and urine albumin to creatinine ratio (UACR). Chronic kidney disease severity was reported using the Kidney Disease: Improving Global Outcomes classification based on laboratory results.ResultsA total of 1,881,447 patients with T2D were eligible for analysis. Mean ± SD age was 63.1±13.1 years; 947,150 patients (50.3%) were male. Serum creatinine tests were ordered within 14 days of the index date among 290,722 patients of 622,915 (46.7%) patients with newly-recognized T2D. Overall, 1,595,964 patients (84.8%) had at least one serum creatinine test ordered during the 1-year follow-up period. Fewer patients received a UACR test during follow-up (814,897 [43.3%]). Less than half of all patients with T2D received a laboratory test order for both serum creatinine and urine albumin measurements during the follow-up period.ConclusionPhysicians treating patients with diabetes are selectively adhering to chronic kidney disease screening guidelines, as indicated by high rates of eGFR testing, but less frequent UACR testing. Despite recommendations to monitor both eGFR and UACR, less than half of patients were screened for albuminuria during the 1-year follow-up.