201例新生儿监护病房新生儿听力筛查报告

目的比较新生儿监护病房（NICU）新生儿和出生正常新生儿听力筛查状况之间的差异,为进一步制定有效的干预和治疗措施提供依据。方法选取2006年2月至2009年5月儿科NICU新生儿201例为病例组,在其住院3-7d内予以听力筛查,未通过者均在出生后42d复查,仍没通过者出生后3个月再次复查。另选取同期出生正常的202例新生儿作为对照组,全部在生后42d予以听力筛查;未通过者出生后3个月复查。结果在出生后42d,NICU组单耳及双耳未通过的检出率（59.70‰,39.80‰）均高于对照组单耳及双耳的未通过检出率（19.80‰,4.95‰）,差异有统计学意义（2χ=4.207,P〈0.05;2χ=5.604,P〈0.05）。在出生后3个月时,NICU组单耳及双耳未通过的检出率（34.83‰,34.83‰）也均高于对照组单耳及双耳的未通过检出率（4.95‰,4.95‰）,差异有统计学意义（2χ=4.622,P〈0.05;2χ=4.622,P〈0.05）。结论NICU组新生儿听力筛查未通过率高于出生正常组新生儿,提示入住NICU的高危因素和（或）疾病因素可能会对新生儿听力功能产生损伤。儿科医生应重视NICU新生儿在出院前后的听力筛查工作,做到早期发现,早期干预,早期治疗。     

3105例新生儿听力筛查的护理体会

目的：提高新生儿听力筛查的准确率,以降低假阳性率。方法：通过对3105例新生儿听力筛查的程序、听力筛查仪的选择、测试环境的选择、婴儿测试状态、婴儿测试的位置与卫生问题的护理体会。结论：提高了筛查的准确率,减少产妇和家长不必要的担心和紧张,以达到减少儿童听力障碍发生率和保障儿童身体健康的目的。     

随身听对大学生听力健康影响的调查与分析

目的探讨大学生使用随身听对听力健康的影响及对其可能造成听力损伤的特征进行评价和估测。方法通过对研究对象进行纯音听力测试和主观听力状况的相关问卷调查,分析接触随身听使用时间与听力健康状况的关系。结果随着使用随身听时间的延长,各频率段听阈有上移趋势。经方差分析,观察组与对照组听阈比较,差异有统计学意义(P<0.05);1~3 a的观察组与对照组的听阈比较,差异无统计学意义(0.01相似文献   

201例妊娠前女性常见耳聋基因的突变筛查

目的：对妊娠前女性进行常见耳聋基因突变筛查,初步测算天津地区育龄女性常见耳聋基因的突变频率和突变类型。方法：应用耳聋基因芯片,针对GJB2,SLC26A4,GJB3基因以及线粒体12S rRNA基因的9个突变热点,对201例妊娠前女性进行携带者筛查,对检测到携带突变的女性的配偶进行GJB2或SLC26A4基因的Sanger测序。结果：在201例样本中共检出突变携带者10例,检出率为4.98%。包括GJB2基因突变6例,SLC26A4基因突变3例,线粒体12S rRNA基因突变1例。对10例携带者配偶进行测序发现1例GJB2基因235delC杂合突变携带者的配偶携带109G＞A杂合突变。结论：对听力正常女性进行常见耳聋基因突变检测可有效筛查出携带者,进而可以为减少聋儿出生提供线索和依据。     

非综合征型神经性耳聋的线粒体基因突变研究(英文)

目的探讨国人非综合征型神经性耳聋患者线粒体基因突变。方法收集非综合征型神经性耳聋病例262例,其中散发病例168例,69例同代有耳聋患者,25例不止1代有耳聋患者,采用限制性片段长度多态性分析线粒体基因中的下列3个点突变:1555A→G,3243A→G,7445A→G。结果在5个母系遗传家系和10个散发病例中发现线粒体基因突变,占全部病例的5.7%。结论应考虑在非综合征型神经性耳聋中患者线粒体基因突变的筛查,特别是母系遗传家系成员。     

即刻种植与延期种植修复单颗前牙缺失的效果分析

目的对比分析即刻种植与延期种植修复单颗前牙缺失的效果。方法选取2018年5月-2019年5月在沈阳市口腔医院进行单颗前牙缺失种植修复治疗的患者200例,依据种植修复时间的不同分为对照组和观察组各100例。对照组采用延期种植修复,观察组采取即刻种植修复。比较两组的整体修复效果。结果观察组种植成功率为98%,高于对照组的93%,但差异无统计学意义(P>0.05)。观察组修复后不同时间点种植义齿修复美学效果评分和牙周袋深度,以及术后总并发症发生率、1年后主观满意度各项评分均优于对照组,差异均有统计学意义(P<0.05)。结论即刻种植与延期种植修复单颗前牙缺失的效果接近,并且即刻种植修复的义齿美观效果更好,患者满意度较高。     

耳鸣频率与蜗性听力损失患者DPOAE的相关性研究

目的：分析蜗性听力损失伴耳鸣患者畸变产物耳声发射,耳鸣频率两者之间的关系。方法：DPOAE以系统自带的设置,其中f1：f2=1.22,f2频率范围0.553~8.837 kHz,L1=65 dBSPL,L2=55 dBSPL,测定常规频率（125 Hz~8 kHz）的纯音听阈,并进行耳鸣匹配测试。结果：耳鸣频率与DPOAE比较,耳鸣频率在3000 Hz,4000 Hz,6000 Hz,8000 Hz的有175耳（78.5%）,DPOAE F2幅值下降频率在3125 Hz、4416 Hz、6250 Hz、8837 Hz的有194耳（86.7%）,耳鸣频率与DPOAE F2幅值下降频率具有一一对应关系的为46耳（20.1%）。结论：耳鸣的频率范围与DPOAE下降频率范围在蜗性聋中有对应关系,     

高频听力损失劳动者焦虑情绪及其影响因素

[目的]探讨高频听力损失劳动者焦虑情绪及其影响因素,为心理干预提供参考。[方法]采用焦虑自评量表(SAS)对108例高频听力损失劳动者(高频听力损失组)进行测试,并与110例听力正常的接噪劳动者(听力正常组)进行比较。[结果]高频听力损失组SAS评分、双耳高频平均听阈和焦虑情绪发生率均高于听力正常组,两组比较差异有统计学意义(t=3.242,t=4.694,χ2=5.893,均P<0.05);非条件logistic多因素回归分析显示,听力损失的相关因素是双耳高频平均听阈增高及接噪工龄较长。[结论]高频听力损失劳动者较易产生焦虑情绪,应关注该人群的心理健康问题。     

遗传性中频听力下降家系遗传学特征分析

目的：分析一个中国遗传性中频听力下降家系的临床听力学特征并探讨其遗传学规律。方法：通过家系调查,对家系成员进行全身系统检查及临床听力学检测,分析遗传规律,绘制遗传图谱并进行听力学特征分析。结果：此耳聋家系成员共计8人,其先证者为感音神经性聋,无全身其他系统异常。耳聋遗传方式为常染色体显性遗传,听力表型为迟发型、以中频下降为主的听力损失。结论：该家系遗传学特征分析符合常染色体显性遗传非综合征型中频听力下降家系,为后续针对此家系进行候选基因突变筛查、连锁分析及致病基因的定位与克隆研究奠定了基础。     

即刻种植修复与延期种植修复治疗前牙缺失患者的效果比较

目的比较即刻种植修复与延期种植修复治疗前牙缺失患者的临床效果。方法选择2017年1月至2019年1月我院收治的90例前牙缺失患者,随机分为两组各45例。对照组行延期种植修复,观察组行即刻种植修复。比较两组的牙周袋深度、美学效果及不良反应发生率。结果修复1个月、 3个月及6个月后,观察组的牙周袋深度少于对照组,美学评分高于对照组,且不良反应发生率低于对照组,差异有统计学意义(P <0.05)。结论与延期种植修复相比,即刻种植修复治疗前牙缺失患者效果更佳,有利于缩短患者的治疗时间,维持植体周围软组织健康状态,提升口腔美感,同时减少不良反应发生,应用价值较高。     

应用插入传声器法测量护耳器在高强脉冲噪声作用下的声衰减

该研究的目的是应用插入传声器研究一种护耳器声衰减现场人体客观测试法。插入传声器上装有一个外径为1.5毫米的有机树指软管用以将耳道的声压传递给耳道外部的传声器。经实验室实验和处理得出一个公式以修正软管本身带来的影响。实验结果表明插入传声器法所测护耳器声衰减结果和传统的主观法所测结果在低于3.15KHz频段内是一致的。并克服了主观法低频段生理噪声误差.因此插入传声器法是一可靠的人体客观测试方法。现场测试还表明泡沫塑料耳塞(E.A.R)的声衰减与大容积耳罩一样。耳塞、耳罩同时佩戴声衰减效果有大幅度提高(提高6-18dB)。     

高危型人乳头瘤病毒DNA检测在宫颈癌前病变筛查中的价值

目的评价高危型人乳头瘤病毒（HPV）DNA检测在宫颈癌筛查中的应用价值。方法2005—2007年期间,在连云港市第一人民医院进行健康检查的已婚妇女1240例（其中无临床症状1026例,有妇科症状214例）,门诊就诊宫颈异常者534例。进行宫颈癌前病变筛查,采用PCR荧光定量检测高危型HR-HPV.DNA,以病理组织学诊断结果为金标准,应用约登指数比较HPV.DNA和薄层液基细胞技术（LTCT）筛查效果。结果1774例受检者平均年龄（35±10.2）岁,经病理学诊断HPV感染51例（3.24%）,宫颈上皮内瘤变（CIN）Ⅰ级49例,Ⅱ级26例,Ⅲ级17例,浸润癌6例,内膜瘤2例,湿疣26例。以病理学确诊为金标准,HR-HPV.DNA检测CINⅡ、Ⅲ的敏感度95.35%,特异度91.67%,阳性预测值22.16%,阴性预测值99.87%,约登指数0.87;HR-HPV.DNA检测＋LTCT检测敏感度100.0%,特异度100.0%,阳性预测值100.0%,阴性预测值100%,约登指数1.0。HR-HPV.DNA在健康妇女和不同宫颈病变中的阳性率分别是正常（炎症）4.80%（78/1626）、不典型鳞状上皮细胞（ASCUS）50.67%（38/75）、低度鳞状上皮内病变（LSIL）94.44%（34/36）、高度鳞状上皮内病变（HSIL）100%（31/31）、鳞癌100（6/6）。结论HR-HPV.DNA检测在宫颈癌前病变和宫颈癌的筛查中具有敏感度高和阴性预测值高的特点,LTCT与HR-HPV.DNA联合检测可提高筛查的敏感度和阴性预测值。     

High Rates of Positive Severe Combined Immunodeficiency Screening Among Newborns with Severe Intestinal Failure

Purpose

Severe combined immunodeficiency (SCID) screening by T‐cell receptor excision circles (TREC) has been part of Massachusetts routine newborn screening since 2009. Tetratricopeptide repeat domain 7A gene (TTC7A) mutations responsible for hereditary multiple intestinal atresia with combined immunodeficiency (MIA‐CID) were also recently identified. We reviewed newborn SCID screening among infants with intestinal failure and correlated results with patient characteristics and outcomes.

Methods

Records of infants with severe intestinal failure and available newborn screen results treated at a single center 2009–2016 were reviewed retrospectively. Patients with 1 or more positive SCID screens (<252 TREC copies/μL) were compared with those without positive screens. TREC copies/μL were compared with population norms.

Results

Of 70 included infants, 34% had newborn screens with TREC <252 copies/μL, compared with 0.3% of the general population; TREC levels for the cohort were lower than the general population (p<0.001). Of those with positive screens, 42% had prior or subsequent negative screening, 8% had no further workup, and 50% had flow cytometry showing: severe T‐cell lymphopenia (absolute CD3+ <1500 cells/mcL) in 8, 3 of whom had TTC7A mutation–associated MIA‐CID. Four had CD3+ >1500 cells/mcL. MIA‐CID patients had the lowest serum citrulline in the cohort; 4 of the 8 patients with CD3+ <1500 cells/mcL on flow cytometry had newborn screening notable for severe hypocitrullinemia (<3 μM).

Conclusion

Infants with intestinal failure have lower TREC copies/μL than the general population; one‐third had levels concerning for SCID, and 11% were diagnosed with severe T‐cell lymphopenia. The clinical implications and etiology of this phenomenon remain unknown, but may be related to hypocitrullinemia.     

Risk of Medication Errors at Hospital Discharge and Barriers to Problem Resolution

SUMMARY

Medication errors are common among older adults, particularly among those who are at heightened risk due to transfer between care settings. Determining accurate medications for hospitalized patients is a complicated process. This paper presents findings from a small pilot study conducted to identify medication documentation problems at the point of hospital discharge among older adults and the problems encountered in developing new technological systems to address these problems. A prospective study was conducted within a managed care medical center that included patient and physician surveys and chart reviews. A review of 104 medical records revealed several problems in the documentation of patient medication including legibility, use of medical abbreviations and incomplete and missing entries. While patients overall were satisfied with medications communication efforts at discharge, physicians surveyed reported that these methods were inadequate in transmitting medication lists to primary care physicians, patients and other care providers. Patients reported taking more drugs than what were listed in the medical record. These findings led to the development, testing, and implementation of an electronic medication sheet. Despite the success in developing this new system, few physicians engaged in its use, with most preferring to continue with their standard discharge practices of written communication.     

Evaluation of an Intervention to Increase Screening Colonoscopy in an Urban Public Hospital Setting

Only 50% of New Yorkers aged 50 and over reported ever being screened for colorectal cancer by any modality according to a recent household survey. The objective of this investigation was to assess the impact of a hospital-based intervention aimed at eliminating health care system barriers to timely colorectal cancer screening at Lincoln Medical Center, a large, urban public hospital in one of the nation's poorest census tracts. We conducted a retrospective analysis of all colonoscopies performed over an 11-month period, during which a multi-pronged intervention to increase the number of screening colonoscopies took place. Two “patient navigators” were hired during the study period to provide continuity for colonoscopy patients. A Direct Endoscopic Referral System (DERS) was also implemented. Enhancements to the gastrointestinal (GI) suite were also made to improve operational efficiency. Immediately following the introduction of the patient navigators, there was a dramatic and sustained decline in the broken appointment rates for both screening and diagnostic colonoscopy (from 67% in May of 2003 to 5% in June of 2003). The likelihood of keeping the appointment for colonoscopy after the patient navigator intervention increased by nearly 3-fold (relative risk = 2.6, 95% CI 2.2–3.0). The rate of screening colonoscopies increased from 56.8 per month to 119 per month. The screening colonoscopy coverage provided by this facility among persons aged 50 and over in surrounding Zip codes increased from 5.2 to 15.6% (RR 3.0, 95% CI 1.9–4.7). Efforts to increase the number of screening colonoscopies were highly successful, due in large part to the influence of patient navigators, a streamlined referral system, and GI suite enhancements. These findings suggest that there are significant health-care system barriers to colonoscopy that, when addressed, could have a significant impact on screening colonoscopy rates in the general population. Nash is with the Center for Urban Epidemiologic Studies, The New York Academy of Medicine, New York, NY, USA, the Department of Epidemology, International Center for AIDS Care and Treatment Programs, Columbia University, Mailman School of Public Health, New York, NY, USA; Azeez is with the Department of Gastroenterology, Lincoln Medical Center, Bronx, NY, USA; Vlahov is the Director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine, New York, NY, USA; Schori is with the Office of the Medical Director, Lincoln Medical Center, Bronx, NY, USA. An erratum to this article can be found at     

Hearing aid use in nursing homes. Part 2: Barriers to effective utilization of hearing AIDS

OBJECTIVE: This study examined barriers to hearing aid use among persons who were reported to have a hearing aid and among those reported to have hearing difficulties but no hearing aids. SETTING: Interviews were conducted at a large, mid-Atlantic nonprofit nursing home. PARTICIPANTS: Both nursing home residents (279) and nursing staff members (51) were interviewed. DESIGN AND MEASUREMENTS: In a cross-sectional survey of nursing home residents, brief structured interviews were performed by trained research assistants with both residents and caregivers to obtain information regarding residents' hearing ability, hearing aid use and daily maintenance, and potential barriers to such use. RESULTS: Among residents reported to have hearing problems but who did not use a hearing aid, the major problem was neglect of the issue; participants did not know why residents did not have a hearing aid, residents had not had hearing evaluations, and staff members were not aware of hearing problems in residents. Among residents who did use a hearing aid, the majority (69%) of those for whom information was available had problems with the devices. The most common problems reported were that the device was hard or inconvenient to use, it did not fit well or hurt, and the device was not functioning well. The vast majority (86%) needed help taking care of the hearing aids. Close to half of the staff members had not received any training in the use or maintenance of the devices. Lack of delegation of responsibility for the management of hearing was identified for 29%, and relatives were used for maintenance of hearing aids in 14% of residents with hearing aids. CONCLUSIONS: Barriers to hearing aid use are therefore complex and multifactorial, involving lack of system commitment to utilization of hearing aids, lack of knowledge by staff members, inappropriate delegation and care procedures, hearing aid design and fit issues, and difficulties for residents in handling the hearing aids. Addressing these issues requires change on multiple levels, including change at the institutional level, concerning policy and training; change at the unit level, regarding care procedures and follow up; change at the individual level, providing better checks of fit and function of the hearing aids; and finally, change at the societal level, addressing design and cost issues for hearing aids in this population.     

Dementia and Poor Continuity of Primary Care Delay Hospital Discharge in Older Adults: A Population-Based Study From 2001 to 2016

ObjectivesDelayed discharge, remaining in acute care longer than medically necessary, reflects less than optimal use of hospital care resources and can have negative implications for patients. We studied (1) the change over time in delayed discharge in people with and without dementia, and (2) the association of delayed discharge with discharge destination and with the continuity of primary care prior to urgent admission.DesignA retrospective population-based study.Setting and ParticipantsDelayed discharge after urgent admission and length of delayed discharge were studied in all hospital users aged ≥70 years with at least 1 urgent admission in British Columbia, Canada, in years 2001/02, 2005/06, 2010/11, and 2015/16 (N = 276,299).MethodsLinked administrative data provided by Population Data BC were analyzed using generalized estimating equations (GEE), logistic regression analysis, and negative binomial regression analyses.ResultsDelayed discharge increased among people with dementia and decreased among people without dementia, whereas the length of delay decreased among both. Dementia was the strongest predictor of delayed discharge [odds ratio 4.76; 95% confidence interval (CI) 4.59–4.93], whereas waiting for long-term care placement [incidence rate ratio (IRR) 1.56; 95% CI 1.50–1.62] and dementia (IRR 1.50; 95% CI 1.45–1.54) predicted a higher number of days of delay. Continuity and quantity of care with the same physician before urgent admission was associated with a decreased risk of delayed discharge, especially in people with dementia.Conclusions and ImplicationsThis study demonstrates the need for better system integration and patient-centered care especially for people with dementia. Population aging will likely increase the number of patients at risk of delayed discharge. Delayed discharge is associated with both the patient's complex needs and the inability of the system to meet these needs during and after urgent care. Sufficient investments are needed in both primary care and long-term care resources to reduce delayed discharges.     

结、直肠癌患者术前营养风险筛查及术后复测

目的应用营养风险筛查2002(NRS2002)评分系统对住院结、直肠癌患者的营养风险进行筛查,并对术后可能发生的营养风险进行预测分析。方法选取我院未经放化疗处理的新入院结、直肠癌患者617例,测定血红蛋白、白蛋白、前白蛋白水平,比较上述各指标阳性率及其意义。其中测定体重者362例,依照NRS2002评分系统进行评分。结果血红蛋白、白蛋白、前白蛋白、体重各项指标的阳性率分别为27.29%、5.25%、19.23%和43.37%。对362例测定体重的结、直肠癌患者进行NRS2002评分,术前评分≥3分者65例,<3分者297例;术后评分≥3分和<3分者各占50%。结论结、直肠癌患者术前已存在的和术后潜在的营养风险较高。