Influence of study goals on study design and execution

From the viewpoint of a clinician who makes recommendations to patients about choosing from the multiple possible management schemes, quantitative information derived from statistical analyses of observational studies is useful. Although random assignment of therapy is optimal, appropriately performed studies in which therapy has been nonrandomly “assigned” are considered acceptable, albeit occasionally with limitations in inferences. The analyses are considered most useful when they generate multivariable equations suitable for predicting time-related outcomes in individual patients. Graphic presentations improve communication with patients and facilitate truly informed consent.     

护理管理人员学习需求调查与建议

目的 了解护理管理人员的学习需求，加强对护理管理人员的培训。达到提高医院护理管理水平和护理质量的目的。方法 对三所三级医院护士长以上的管理人员进行了问卷式教育需求调查。结果 护理管理人员继续教育内容首选是管理知识和管理技能，其次是护理新知识，新技术。结论 继续教育内容应因需，因岗设置，并形成制度化和规范化。     

Adiponectin polymorphisms,adiposity and insulin metabolism: HERITAGE family study and Oulu diabetic study

Aims/hypothesis. Adiponectin is an adipocytokine with lowered blood levels in obesity and Type 2 diabetes mellitus. We sought to define the specific effects of different alleles of the gene encoding adiponectin.

Methods. We studied the associations of adiponectin gene sequence variations with body fat distribution and insulin indices in 503 White and 276 Black subjects of the HERITAGE Family Study cohort and subjects from a Finnish population.

Results. The His111 allele frequency of the Tyr111His polymorphism in Finnish Type 2 diabetic subjects (n?=?254) was higher (5.1%) than in control subjects (n?=?270) (2.6%; P?=?0.033). In the HERITAGE cohort, the His111 allele was associated with a lower insulin sensitivity index (P?=?0.018) and a higher acute insulin response to glucose (P?=?0.0098) in Whites. Other variants showed associations with adiposity and plasma lipid values only in Blacks. Among Blacks, the IVS2+G62T variant was associated with body fat (P?=?0.002) and total cholesterol values (P?=?0.005), and the Gly15Gly variant with cholesterol (P?=?0.009) and triglyceride (P?=?0.05) levels. The haplotype derived from these two polymorphisms was associated with total body fat, while the IVS2+G62T and Tyr111His–haplotype was associated with body fat and disposition index.

Conclusions. The carriers of the His111 allele may have a higher risk of developing Type 2 diabetes mellitus. Racial differences were found between Blacks and Whites in body composition and lipids according to ACDC genotypes. Sequence variants in the adiponectin gene appear to be associated with diabetes and diabetes‐related phenotypes.     

Adiponectin polymorphisms, adiposity and insulin metabolism: HERITAGE family study and Oulu diabetic study

AIMS/HYPOTHESIS: Adiponectin is an adipocytokine with lowered blood levels in obesity and Type 2 diabetes mellitus. We sought to define the specific effects of different alleles of the gene encoding adiponectin. METHODS: We studied the associations of adiponectin gene sequence variations with body fat distribution and insulin indices in 503 White and 276 Black subjects of the HERITAGE Family Study cohort and subjects from a Finnish population. RESULTS: The His111 allele frequency of the Tyr111 His polymorphism in Finnish Type 2 diabetic subjects (n=254) was higher (5.1%) than in control subjects (n=270) (2.6%; P = 0.033). In the HERITAGE cohort, the His111 allele was associated with a lower insulin sensitivity index (P = 0.018) and a higher acute insulin response to glucose (P = 0.0098) in Whites. Other variants showed associations with adiposity and plasma lipid values only in Blacks. Among Blacks, the IVS2+G62T variant was associated with body fat (P = 0.002) and total cholesterol values (P = 0.005), and the Gly15Gly variant with cholesterol (P = 0.009) and triglyceride (P = 0.05) levels. The haplotype derived from these two polymorphisms was associated with total body fat, while the IVS2+G62T and Tyr111His-haplotype was associated with body fat and disposition index. CONCLUSIONS: The carriers of the His111 allele may have a higher risk of developing Type 2 diabetes mellitus. Racial differences were found between Blacks and Whites in body composition and lipids according to ACDC genotypes. Sequence variants in the adiponectin gene appear to be associated with diabetes and diabetes-related phenotypes.     

高血压最佳治疗(HOT)试验及其临床意义

高血压最佳治疗研究（ＨＯＴ）是有１８ ７９０ 名高血压患者参加的以钙离子拮抗剂（非洛地平）为基础用药的研究（ 分级加用ＡＣＥ抑制剂、β＿ 受体阻滞剂和利尿剂）， 用于探索３ 个不同目标舒张压值的降压效果（８０ｍｍＨｇ、８５ ｍｍＨｇ 和９０ ｍｍＨｇ）。随访结束时，三组患者均达到目标血压，但是其舒张压、收缩压在相邻组间的差别很小，仅２ ｍｍＨｇ 左右。三组间心血管疾病事件危险性没有显著性差异，而冠心病事件危险性在最低目标血压组也是刚有显著性差异。在糖尿病亚组，所有心血管疾病事件的发生率有显著性降低。这一结论和“英国糖尿病前瞻性研究”相一致，显示较低的血压水平可降低主要心血管事件和微血管疾病的危险性。在ＨＯＴ研究中，最低目标血压组达到的平均血压是１４４／８２ ｍｍＨｇ，与另一组平均目标血压为１５４／８７ ｍｍＨｇ 相比，这１０／５ ｍｍＨｇ 的差别可以减少三分之一的糖尿病死亡，几乎一半的中风危险性和三分之一的微血管并发症。ＨＯＴ研究调查了在高血压患者中，每天服用乙酰水杨酸７５ ｍｇ 对于心血管疾病事件的影响，证实冠心病事件的危险性降低三分之一，但缺血性中风或心血管疾病死亡率均无明显下降。     

Single case study and evidence-based practice

Single case study and evidence-based practice With the current emphasis upon evidence-based medicine in statutory health care provision in the UK, mental health nursing is challenged to justify its approaches. Psychological theories, once taken for granted in mental health nursing, are now being challenged by new definitions of evidence. In this paper the authors focus upon the use of individual case study. The discussion questions the validity of applying the hierarchies of evidence proposed by evidence-based medicine to mental health nursing theory and practice. The role of case study as the prime source of evidence is argued and is justified in mental health nursing research and practice.     

Migraine and idiopathic narcolepsy--a case-control study

In order to evaluate a possible association between migraine and idiopathic narcolepsy, we performed a multicentre case-control study on the comorbidity of narcolepsy and different headaches. In total, 96 patients with idiopathic narcolepsy were enrolled. The migraine frequency in the patients and in the control group was 21.9% and 19.8%, respectively (P = 0.722). The migraine features did not differ significantly between both groups. However, headache fulfilling the criteria for tension-type headache was significantly more often reported by narcolepsy patients than by the control group (60.3% vs. 40.7%, P= 0.006). We conclude that there is no association between migraine and narcolepsy but that patients with narcolepsy show more unspecific headache, probably due to sleep disturbances.     

老年脑缺血实验研究与临床研究相关性的问题与思考

脑缺血是临床常见病，增龄在其发病中起重要作用．由于老年人存在机体衰老、潜在多重危险因素、应激调节减退、多器官受损、治疗预后差等限制了临床研究的开展，实验研究显得尤为重要。但目前存在着实验研究动物选取和模型制备是否合理，实验过程和临床特征能否一致，临床研究与实验研究结果能否互证等问题，直接影响了老年脑缺血实验研究与临床研究的相关性．制约了研究的突破。解决这些问题则是实验研究为临床研究提供依据和切入点，以及临床研究印证实验结果并为实验研究提出问题和提供信息的关键。     

The Initiating Dialysis Early and Late (IDEAL) study: study rationale and design.

OBJECTIVES: The primary objective of the IDEAL study is to determine whether the timing of dialysis initiation has an effect on survival in subjects with end-stage renal disease (ESRD). The secondary objectives are to determine the impact of "early start" versus "late start" dialysis on nutritional and cardiac morbidity, quality of life, and economic cost. DESIGN: Prospective multicenter randomized controlled trial. Patients are randomized to commence dialysis at a glomerular filtration rate (by Cockcroft-Gault) of either 10-14 mL/minute/1.73 m2 ("early start") or 5-7 mL/min/1.73 m2 ("late start"), with stratification for dialysis modality (hemodialysis vs peritoneal dialysis), study center, and the presence or not of diabetes mellitus. SETTING: Dialysis units throughout Australia and New Zealand. PATIENTS: Patients with ESRD commencing chronic dialysis therapy. OUTCOME MEASURES: Three years from randomization, all-cause mortality, morbidity, and economic impact; structural and functional cardiac status, nutritional state, and quality of life will be assessed. RESULTS: To date, 388 patients of a minimum 800 patients have been entered and randomized into the study. Current recruitment rates suggest sufficient patients will be enrolled by December 2004 and follow-up completed by December 2007. CONCLUSIONS: The IDEAL study will provide evidence for the optimal time to commence dialysis.     

Bronchogenic carcinoma a review and study

The preceding review of bronchogenic carcinoma and our own experience with lung cancer patients, indicate that long-term survival of these patients has only minimally improved. Advanced lung cancer does not significantly respond to the current treatment armamentarium, but present research and clinical trials of such new treatments as immunotherapy and interferon therapy may give hope for the future. At present our biggest weapon against lung cancer is still the elimination of cigarette smoking. Until we achieve this unlikely goal or greatly improve our success in treating the disease, we will need to continue our commitment to assist the patient with lung cancer in achieving the highest quality of life.     

芯片实验室技术及其研究进展

本文着重从技术及应用方面,对芯片实验室在近几年内的研究现状和未来的发展趋势予以综述。介绍了芯片实验室的加工技、基本构造以及常用的几种检测手段,并详细阐述了该技术在临床分析、核酸分析、多肽和蛋白质测定等生化分析中的应用。