复苏室患儿苏醒期探视信念和态度量表的初步构建及信效度评价

目的 构建护士对麻醉复苏室(post-anesthesia care unit,PACU)患儿苏醒期家属探视信念和态度的量表并评价其信效度。方法 通过回顾相关文献、专家咨询等方法构建护士对PACU患儿苏醒期家属探视信念和态度的量表暂定版,采用暂定版对460名PACU护理人员进行调查并检验其信效度。结果 修订的PACU患儿苏醒期家属探视信念和态度量表包含20个条目,其中信念维度3个因子,17个条目;态度维度1个因子,3个条目。总量表的Cronbach′s α系数为0.924,重测信度为0.898,内容效度为0.892。探索性因子分析提取信念维度3个因子的累积方差贡献率62.423%,各维度之间的相关系数为0.53～0.65,各维度与量表总分之间的相关系数为0.73～0.91,验证性的因子分析证实PACU患儿苏醒期家属探视信念和量表各项适配指数均达标。结论 PACU患儿苏醒期家属探视信念和态度量表有较好的信效度,可用作PACU护士对患儿苏醒期家属开放性探视信念和态度测评工具的参考。     

Successful management and technical aspects of major liver resection in children: A retrospective cohort study

Optimal treatment of patients with various types of liver tumors or certain liver diseases frequently demands major liver resection, which remains a clinical challenge especially in children.Eighty seven consecutive pediatric liver resections including 51 (59%) major resections (resection of 3 or more hepatic segments) and 36 (41%) minor resections (resection of 1 or 2 segments) were analyzed. All patients were treated between January 2010 and March 2018. Perioperative outcomes were compared between major and minor hepatic resections.The male to female ratio was 1.72:1. The median age at operation was 20 months (range, 0.33–150 months). There was no significant difference in demographics including age, weight, ASA class, and underlying pathology. The surgical management included functional assessment of the future liver remnant, critical perioperative management, enhanced understanding of hepatic segmental anatomy, and bleeding control, as well as refined surgical techniques. The median estimated blood loss was 40 ml in the minor liver resection group, and 90 ml in major liver resection group (P < .001). Children undergoing major liver resection had a significantly longer median operative time (80 vs 140 minutes), anesthesia time (140 vs 205 minutes), as well as higher median intraoperative total fluid input (255 vs 450 ml) (P < .001 for all). Fourteen (16.1%) patients had postoperative complications. By Clavien-Dindo classification, there were 8 grade I, 4 grade II, and 2 grade III-a complications. There were no significant differences in complication rates between groups (P = .902). Time to clear liquid diet (P = .381) and general diet (P = .473) was not significantly different. There was no difference in hospital length of stay (7 vs 7 days, P = .450). There were no 90-day readmissions or mortalities.Major liver resection in children is not associated with an increased incidence of postoperative complications or prolonged postoperative hospital stay compared to minor liver resection. Techniques employed in this study offered good perioperative outcomes for children undergoing major liver resections.     

Expression and prognostic value of FOXP1 in esophageal squamous cell carcinoma

BackgroundForkhead box protein P1 (FOXP1) has been suggested as a prognostic marker in several malignant tumors. However, the significance of FOXP1 in esophageal squamous cell carcinoma (ESCC) is still unclear. The purpose of this study was to investigate the expression pattern of FOXP1 in normal esophageal tissue and ESCC and to analyze the clinicopathological significance and prognostic value of FOXP1 in ESCC.MethodsFOXP1 was detected by immunohistochemistry using tissue microarrays containing tumor tissues and adjacent normal tissues from 270 ESCC patients with oncological follow-up data.ResultsNormal esophageal tissues predominantly showed an exclusive nuclear FOXP1 (n-FOXP1) expression pattern, and no exclusive cytoplasmic FOXP1 (c-FOXP1) staining was found. In ESCC, the expression rates of exclusive n-FOXP1-positive, exclusive c-FOXP1-positive, both nuclear and cytoplasmic positive and complete negative were 14.4%, 28.9%, 10.4% and 46.3%, respectively. High n-FOXP1 expression was significantly correlated with decreased postoperative recurrence and distant metastasis (P < 0.05). Furthermore, elevated c-FOXP1 expression was significantly associated with regional lymph node metastasis and distant metastasis (P < 0.05). High c-FOXP1 expression had an effect on shorter overall survival (OS) time, but the difference was not statistically significant (P > 0.05). Kaplan–Meier analysis showed that ESCC patients with high n-FOXP1 expression survived significantly longer than patients with low n-FOXP1 expression. Multivariate analysis confirmed that patients with high n-FOXP1 staining exhibit good prognosis and n-FOXP1 was an independent factor for ESCC prognosis.ConclusionsOur results suggest that FOXP1 plays an essential role in ESCC progression and prognosis and may be a useful biomarker for predicting survival.     

Compliance with clinical guidelines and adherence to antiretroviral therapy among patients living with HIV

Objective: Evaluation of provider compliance with antiretroviral (ARV) treatment guidelines and patient adherence to ARVs is important for HIV care quality assessment; however, there are few current real-world data for guideline compliance and ARV adherence in the US. This study evaluated provider compliance with US Department of Health and Human Services (DHHS) guidelines and patient adherence to ARVs in a US population of patients with HIV.

Methods: This was a retrospective claims study of adults with HIV-1 receiving ARV treatment between January 2010–December 2014. Follow-up began at first ARV treatment and ended at health plan disenrollment or study end. ARV regimens for treatment-naïve patients were categorized as “preferred/recommended”, “alternative”, or “non-preferred/recommended/alternative” according to DHHS guidelines. ARV adherence was evaluated using proportion of days covered (PDC) and medication possession ratio (MPR).

Results: The analysis included 25,320 patients (84.4% male, mean age 45.3 years) and 39,071 regimens. Preferred/recommended regimens were most common during each study year, but the proportion of non-preferred/recommended/alternative regimens was substantial (15.9–20.6%). Only 53.6% of patients had optimal adherence by PDC ≥0.95, and 57.9% by MPR ≥0.95. Guideline non-compliance and sub-optimal adherence were more prevalent among female vs male patients (22.6% vs 14.8% [in 2014] and 65.9% vs 53.7%, respectively).

Conclusions: Provider non-compliance with DHHS guidelines and sub-optimal ARV adherence among patients with HIV remain common in real-world practice, particularly for female patients. Healthcare providers should follow the latest clinical guidelines to ensure that patients receive recommended therapy, and address non-adherence when selecting ARV regimens.     

医学检验专业本科毕业论文写作带教体会

检验科是医院最大的样本和数据中心,是医学检验专业重要的实践教学基地。撰写毕业论文是对学生综合素质要求最高的实践环节,如何让学生在做好实习工作的同时顺利完成毕业论文撰写具有挑战性,笔者结合前人经验,总结自身带教心得,介绍一种"阶段性引导,模块化写作"的教学方法。该方法包括四个维度:首先,制定阶段化教学目标,明确各阶段的教学重点;其次,设计阶段性任务模块,作为教学基础内容;再次,制定详细的实施方法,保障阶段任务顺利完成;最后,设置明确的阶段考核指标,量化考评教学质量。科学论文写作是本科生毕业前的最高挑战,对带教教师同样具有较高的要求,就毕业论文写作这一教学任务进行方法探索和经验总结,对提高本科毕业生的综合素质具有重要意义。     

SARIMA模型在苏州市肺结核发病预测中的应用

目的 建立苏州市肺结核发病的SARIMA模型并预测发病,为苏州市肺结核防控提供参考。方法 收集结核病信息管理系统（新）中苏州市2010年1月—2018年12月肺结核月发病数,通过时间序列分析建立SARIMA模型并预测苏州市2019年肺结核的发病情况。结果 苏州市肺结核发病数具有明显的季节周期性,每年的发病最高峰为5月,发病最低谷为2月。苏州市肺结核发病数的最佳拟合模型为SARIMA (0,1,1)×(0,1,1)₁₂,AIC=9.590,SBC=9.644,模型参数均具有统计学意义,模型残差为白噪声序列,模型的预测值与实际值平均绝对百分比误差MAPE=7.943%,模型预测精度较高。预测苏州市2019年肺结核发病数为3 467例,月发病数平均值为289例,发病水平较2018年略有下降。结论 SARIMA(0,1,1)×(0,1,1)₁₂模型能较好拟合出苏州市肺结核发病数的时间变化趋势,可应用于苏州市肺结核月发病数的短期预测。     

社会工作视角下社区精神障碍患者职业康复服务的研究进展

通过对美国、德国及我国香港和大陆地区关于社区精神障碍者职业康复的服务进行梳理,提出关于本土精神健康社会工作在这一领域的反思现有的职业康复服务未形成层级性、专业化的体系,缺乏横向可达的资源网络,因而难以满足精障者在职业康复过程中的多元需求,精神健康社会工作者亟需在宏观、中观和微观等各层面进行努力。     

虚拟仿真实验教学项目在临床医学等专业学生培养中的应用

合理设置课程对于人才培养质量起到关键性作用。在临床医学人才培养的课程体系中融入虚拟仿真实验教学项目，是人才培养以及信息化与高等教育实践教学深度融合的内在要求。基于我校虚拟仿真实验教学的开展情况，对虚拟仿真实验教学项目如何在医学生培养中发挥作用进行归纳和总结，包括如何选择虚拟项目，如何融入课程体系等，并以问卷等方式对其教学效果进行调查。结果显示：大部分学生认为虚拟仿真实验教学项目的应用有助于知识的拓展，有助于提升学习效果，有助于培养临床医学人才的临床思维和科研素质，有助于培养自主学习和终身学习能力，有助于掌握信息技术等相关技能。但如何更好地实现虚实融合等问题值得我们进一步的探索和研究。     

苏州市初治菌阴肺结核患者就诊延迟现况及临床特征

目的 分析初治菌阴肺结核患者就诊延迟现况及临床特征,为制定有效措施提供科学依据。方法 应用横断面研究,收集苏州市5家结核病定点医院初治菌阴肺结核患者人口学、经济来源、生活方式、结核病知识、主要病史及进入结核病定点医院前发病和就诊等临床资料,采用Logistic回归方法进行统计分析。结果 379例初治菌阴肺结核患者就诊延迟186例,就诊延迟率为49.08%。老年人(OR=1.898,95% CI=1.157~3.112,P=0.011)、日工作时间大于8 h(OR=1.774,95% CI=1.014~3.102, P=0.044)、流动人口(OR=3.252; 95% CI=1.807~5.855, P<0.001)和发热(OR= 2.061,95% CI=1.021~4.160,P=0.043)是初治菌阴肺结核患者发生就诊延迟的危险特征,而咯血(OR= 0.356, 95% CI= 0.164~0.773,P=0.009)是就诊延迟的保护特征。结论 初治菌阴肺结核患者就诊延迟现象较严重,需对不同临床特征的患者采取综合干预措施,减少就诊延迟发生。