Reliability of the self-awareness of deficits interview for adults with traumatic brain injury

Primary objective : This paper investigates the test-re-test reliability of the Self-Awareness of Deficits Interview (SADI) for assessing level of self-awareness in clients with traumatic brain injury (TBI).

Research design : Twenty rehabilitation clients with TBI were interviewed using the SADI and re-test interviews were conducted 2-4 weeks later.

Methods and procedures : Two checklists were used to collect collateral information on the client from significant others and rehabilitation staff. This information was used to assist in assigning SADI scores.

Main outcomes and results : High test-re-test reliability was demonstrated for both total (ICC = 0.94) and sub-section scores (ICC = 0.85, 0.86 and 0.86). The results, combined with previous research indicating the high inter-rater reliability of the SADI, suggest the SADI is a reliable means of evaluating level of self-awareness. Further research is required to investigate other psychometric properties of the SADI and the two checklists.     

Executive function and self-awareness of "real-world" behavior and attention deficits following traumatic brain injury

OBJECTIVE: To investigate the relationship between executive function and awareness of real-world behavioral and attentional dysfunction in persons with moderate and severe traumatic brain injury (TBI) and uninjured controls. DESIGN: Observational 2-group study. PARTICIPANTS: Thirty-six persons with moderate to severe TBI and residual cognitive deficits, recruited from therapy programs and the community, and 30 uninjured control participants of similar age, education, gender, and race. MEASURES: Eight clinical measures of executive function were combined in a composite score, the Executive Composite (EC). Awareness of behavioral and attentional lapses in everyday life was estimated using Self and Significant Other (SO) ratings on the Dysexecutive (DEX) Questionnaire and the Cognitive Failures Questionnaire (CFQ). RESULTS: Participants with TBI scored significantly worse on the EC than control participants and exhibited impaired self-awareness (ISA) compared to controls. Control participants agreed closely with their SOs on both the DEX and CFQ scales, whereas the SOs of TBI participants reported significantly greater degrees of difficulty on both scales than was endorsed by participants with TBI. Low-EC scorers within the TBI group had significantly worse ISA than controls, lending support to the hypothesis that executive function is related to ISA in chronic, moderate to severe TBI. Executive function and discrepancy scores demonstrated a modest but statistically significant association across the sample. CONCLUSION: Although executive function was associated with ISA in this sample, further research is needed to determine whether executive function deficits contribute in a causal fashion to ISA, and which of the cognitive operations within executive function are responsible for supporting self-awareness.     

孕产妇母乳喂养自我调节动机现状及影响因素研究

目的 了解孕产妇母乳喂养自我调节动机现状及其影响因素,为开展母乳喂养干预以延长母乳喂养时间提供依据。方法 采用便利抽样法抽取在围生期保健门诊就诊的孕产妇（处于孕晚期或产后42 d）201例,应用简体中文版母乳喂养自我调节问卷进行母乳喂养自我调节动机的横断面调查。结果 孕产妇母乳喂养自我调节动机得分为（18.26±3.29）分;多元线性回归分析显示,年龄、孕产期、孕期是否接受过母乳喂养指导是影响孕产妇母乳喂养自我调节动机的主要因素（均P<0.01）。结论 孕产妇母乳喂养自我调节动机水平处于中等,医护人员应评估母亲母乳喂养自我调节动机水平,确定对母乳喂养自我调节动机有积极影响的关键因素,并实施相应的干预措施,提高母乳喂养动机,延长母乳喂养持续时间。     

Risk factors and underlying cardiovascular diseases in incident ESRD patients

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in dialysis patients. The aim of this study was to evaluate the prevalence of cardiovascular risk factors and of CVD on admission to hemodialysis. METHODS: Data were collected in 31 Italian clinics belonging to a clinic network using a prospective database (EuCliD), the main purpose of which is the support of quality assurance. Six hundred and thirty-six patients, mean age 63.9+/-15.4 years, admitted between January 1, 2000 and September 30, 2003, were separated into two groups on the basis of presence of CVD and observed for a median follow-up period of 16 months. RESULTS: In the CVD group, patients were significantly older and the percentage of diabetics and smokers was significantly greater than in the CVD-free group. There were no significant differences between the groups in term of uremia-related risk factors. According to logistic regression analysis evaluating the impact of traditional and nontraditional cardiovascular risk factors, only smoking habit (OR 1.87, 95% CI 1.25-2.79) and diabetes (OR 1.87, 95% CI 1.19-2.95) were associated with a higher relative risk for the presence of CVD at baseline. At the time of admission, CVD was present in 27% of patients. The following de novo development of CVD was observed: hypertensive disease (0.28 new cases/100 pt-years), ischemic heart disease (0.71 new cases/100 pt-years), other forms of heart disease (1.57 new cases/100 pt-years), disease of arteries, arterioles, etc. (1.85 new cases/100 pt-years) and cerebrovascular disease (0.71 new cases/100 pt-years). The rate of developing de novo CVD events was 3.70 per 100 patient-years. CONCLUSIONS: The prevalence of cardiovascular risk factors is already high at admission to dialysis. Despite the care provided to dialysis patients, a significant proportion of patients develop de novo CVD.     

Hematospermia: An investigation of the bleeding site and underlying lesions

Background : The site of hemorrhage and causative lesions in patients with hematospermia were evaluated using the puncture technique for seminal vesicles and/or müllerian duct cysts under ultrasound guidance.
Methods : Twenty-one patients aged 26–75 years (mean, 49.8 years) underwent transperineal needle aspiration of the seminal vesicles and/or müllerian duct cysts guided by transrectal ultrasonography (TRUS).
Results : Dark reddish seminal vesicle fluid was aspirated and the site of bleeding was considered to be the seminal vesicles in 11 patients (52%) (group A). In group A, abnormalities of the seminal vesicles were noted in nine patients (82%). These consisted of dilated seminal vesicles in seven (bilateral in four, unilateral in three), a seminal vesicle cyst in one and seminal vesicle amyloidosis in one. A müllerian duct cyst was confirmed to be the bleeding site in two patients (10%; group B). The bleeding site was estimated to be organs rather than the seminal vesicles in four patients (group C), in all of whom ectopic prostatic tissue was observed in the prostatic urethra. In groups B and C, seminal vesicle abnormalities were not detected by TRUS. In the remaining four patients (group D), failure to aspirate seminal vesicle fluid means that it is unclear whether hemorrhage was from the seminal vesicle or from another source. In group D, ectopic prostatic tissue was demonstrated in the prostatic urethra of three patients and unilateral seminal vesicle dilation was detected by TRUS in one patient.
Conclusion : Puncture of the seminal vesicles and/or müllerian duct cysts under ultrasonic guidance as well as cystourethroscopy is a useful and minimally invasive examination for determination of the bleeding site responsible for hematospermia.     

PTSD and ADHD: underlying factors in many cases of burnout

Objective: To analyse the extent to which traumatic life events, post‐traumatic stress disorder (PTSD) and the neuropsychiatric disorder attention deficit hyperactivity disorder (ADHD) can be contributors associated with burnout and the long‐term sick leave that results from it. Subjects: Sixty‐two individuals on long‐term sick leave due to stress‐related poor health and burnout, and 83 working individuals were screened for the presence of traumatic life events, PTSD and ADHD. Potential background factors involved in burnout were analysed using a multiple logistic regression. Results: Fifty‐two per cent of those on long‐term sick leave were judged to have PTSD and 24 per cent to have ADHD. The number of suspected/possible cases was even higher—71 per cent and 56 per cent, respectively. Nineteen per cent were judged to have both PTSD and ADHD; 56 per cent were judged to have PTSD and/or ADHD. PTSD, ADHD and traumatic life events in the form of sexual assault and severe human suffering were all strongly associated with both burnout and long‐term sick leave. Conclusions: Since ADHD is almost never discussed and PTSD rarely so in the occupational rehabilitation of individuals with burnout, these results should act as a warning signal. Further studies are needed, however, including clinical examinations in order to establish with certainty if PTSD and ADHD can predict burnout followed by long‐term sick leave. Copyright © 2006 John Wiley & Sons, Ltd.     

脊柱原发肿瘤切除术后复发原因的探讨

目的探讨脊柱原发肿瘤复发在手术技术方面的原因。方法对1989至2002年间以广泛性肿瘤切除手术方法治疗的38例脊柱骨巨细胞瘤、骨母细胞瘤、软骨肉瘤和脊索瘤术前、术后X线平片、CT和MRI、手术记录以及随访资料进行回顾性分析。结果32例患者得到随访,平均随访5．1年,17例复发,复发率为53％。肿瘤生长的部位特殊(颈椎和颈胸段)和侵袭广泛程度是导致肿瘤切除不彻底乃至复发的原因;对于暴露简单、病变局限的肿瘤,或者通过增加辅助切口的方法,术后复发率低。结论对于部位特殊、范围广泛、暴露困难的肿瘤,切除前没能将肿瘤游离,广泛切除,是造成肿瘤复发的原因;肿瘤复发可能与分块切除无关;术前精确的手术设计,术中充分的显露是达到广泛切除范围的保证,其中入路的选择至关重要。     

锦州市社区老年人骨质疏松认知状况及影响因素的调查

目的 调查锦州市社区老年人骨质疏松相关知识的认知状况及影响因素,为老年人预防骨质疏松提供依据。 方法 以锦州市60周岁及以上的社区老年人为研究对象,采用自行设计问卷对锦州市225名老年人进行调查。 结果 老年人对骨质疏松知识认知情况尚可,其中对于诊断骨质疏松的常见方法（16%）和女性绝经后激素替代治疗可预防骨质疏松（14.2%）的认知较差。获取骨质疏松知识的最常见途径为电视收音机等媒体117人（52%）;所在社区从未有过骨质疏松知识宣传为196人（87.1%）;身边有从事医疗的家人朋友的老年人为76人（33.8%）;愿意采取预防骨质疏松措施为182人（80.9%）;老年人希望了解骨质疏松知识的途径有专业人士讲授、报刊杂志、电视广播、亲朋好友讲述,分别占25.8%、8.9%、32%、3.1%。不同年龄总人群和女性的骨质疏松认知情况随着年龄的增加呈下降趋势;60~年龄组女性对骨质疏松认知情况优于男性。影响老年人骨质疏松认知情况的因素为愿意采取预防措施、社区宣传、有从事医疗的家人朋友、晒太阳、年龄。 结论 加强骨质疏松的专业健康教育,积极在社区或是电视广播等媒体上开展有针对性、简单易懂的骨质疏松健康教育活动,使老年人知晓骨质疏松的危害和正确的预防方式,能够以正确的方法和积极的心态预防和面对骨质疏松。     

Causative anti-diabetic drugs and the underlying clinical factors for hypoglycemia in patients with diabetes

Recent clinical trials indicated that the intensive glycemic control do not reduce cardiovascular disease mortality among diabetic patients, challenging a significance of the strict glycemic control in diabetes management. Furthermore, retrospective analysis of the Action to Control Cardiovascular Risk in Diabetes study demonstrated a significant association between hypoglycemia and mortality. Here, we systematically reviewed the drug-induced hypoglycemia, and also the underlying clinical factors for hypoglycemia in patients with diabetes. The sulfonylurea use is significantly associated with severe hypoglycemia in patients with type 2 diabetes. The use of biguanide (approximately 45%-76%) and thiazolidinediones (approximately 15%-34%) are also highly associated with the development of severe hypoglycemia. In patients treated with insulin, the intensified insulin therapy is more frequently associated with severe hypoglycemia than the conventional insulin therapy and continuous subcutaneous insulin infusion. Among the underlying clinical factors for development of severe hypoglycemia, low socioeconomic status, aging, longer duration of diabetes, high HbA1c and low body mass index, comorbidities are precipitating factors for severe hypoglycemia. Poor cognitive and mental functions are also associated with severe hypoglycemia.     

Management of impaired self-awareness in persons with traumatic brain injury

Aim: To develop and evaluate a systematic intervention programme for the management of impaired self-awareness (ISD) in people with traumatic brain injury.

Methods: This study adopted a pre-test-post-test control group design. Twenty-one patients with traumatic brain injury were randomly assigned to an experimental group and a control group according to their admission sequence. The groups joined a newly developed Awareness Intervention Programme (AIP) and a conventional rehabilitation programme respectively for 4 weeks. Pre- and post-intervention outcome measures taken from the two groups were compared. Wilcoxon Signed-Ranks Tests were conducted to compare the within-group changes of the outcome measures of the Self-Awareness of Deficits Interview (SADI), the Functional Independence Measure (FIM) and the Lawton Instrumental Activities of Daily Living Score (Lawton IADL) in the control and experimental groups. Mann Whitney U-tests were conducted to compare the across-group differences of improvements of outcome measures between the participants in the two groups.

Results: After AIP training, the participants in the experimental group demonstrated significant improvement in their level of awareness as compared to the control group. However, the functional outcomes of the participants in experimental group did not show significant differences.

Conclusion: The AIP can promote improvement in the level of self-awareness of people with traumatic brain injury. This new programme can be further developed to extend a better carryover treatment effect to functional improvement in daily activities.     

2型糖尿病患者骨密度的调查及相关危险因素分析

目的 探讨南京市T2DM患者骨密度的变化,进行相关危险因素调查.方法 采用美国ALARA,INC公司数字化X线骨密度仪,对2009年1月1日至2010年07月31日在我院内分泌科住院治疗的150例中老年T2DM患者的非惯用手食指、中指、无名指第二指骨BMD进行检测,同时进行相关并发症的筛查,探讨BMD与年龄、性别、...     

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

Purpose

To determine the risk factors of neurologic deficits during PVCR correction, so as to help improve safety during and after surgery.

Methods

A consecutive series of 76 patients with severe and rigid spinal deformities who were treated with PVCR at a single institution between October 2004 and July 2011 were included in our study. Of the 76 patients, 37 were male and 39 female, with an average age of 17.5 years (range 10–48 years). There were 52 adolescent patients (with an age <18 years) and 24 adult patients (with an age ≥18 years). Preoperatively, postoperatively and 6 months after surgery, we performed systemically neurologic function evaluations of each patients through meticulous physical examination. Any new abnormality or deterioration in evaluation of neurologic function than preoperative is reckoned postoperative neurologic deficits. Ten variables that might affect the safety of neurologic deficits during PVCR procedures, including imaging factors, clinical factors and operational factors, were analyzed using univariate analysis. Then the variables with statistical difference were analyzed by using multi-factor unconditional logistic regression analysis.

Results

No patient in this series had permanent paraplegia and nerve root injury due to operation. Change of neurologic status was found in six patients after surgery. Results of single-factor comparison demonstrated that the following seven variables were statistically different (P < 0.05): location of apex at main curve (X ₃), Cobb angle at the main curve at the coronal plane (X ₄), scoliosis associated with thoracic hyperkyphosis (X ₅), level of vertebral column resected (X ₆), number of segmental vessels ligated (X ₇), preexisting neurologic dysfunction (X ₈), and associated with intraspinal and brain stem anomalies (X ₉). The multi-factor unconditional logistic regression analysis revealed that X ₈ (OR = 49.322), X ₉ (OR = 18.423), X ₅ (OR = 11.883), and X ₆ (OR = 8.769) were independent and positively correlated with the neurologic deficit.

Conclusions

Preexisting neurologic dysfunction, associated with intraspinal and brain stem anomalies, scoliosis associated with thoracic hyperkyphosis and level of vertebral column resected are independent risk factors for neurologic deficits during PVCR procedure.     

探讨骨质疏松性骨折的相关影响因素及预防

目的对98例骨质疏松性骨折患者进行相关危险因素分析,旨在早期采取恰当的预防措施防止骨折并发症的发生,进而提高生活质量。方法对我院收治的98例50~89岁老年骨质疏松性骨折患者根据年龄、骨折发生时的状态及相关危险因素进行总结分析。结果股骨颈、椎体、桡骨远端较其他部位容易发生骨质疏松性骨折。女性骨折占63.27%,男性占36.73%,意外跌倒是造成老年人骨质疏松性骨折的主要危险因素。结论骨质疏松患者由于骨骼脆性增加,当受到轻微的外力撞击或震动时,即可发生骨折。因此,针对老年骨质疏松性骨折的危险因素,采取有效的预防措施,以降低骨质疏松性骨折的发生率。     

肝内胆管结石合并胆管癌相关因素探讨

目的 探讨肝内胆管结石合并胆管癌相关临床因素及其演变过程.方法 对420例肝内胆管结石接受手术的患者进行调查,内容包括年龄、合并肝病、胆道感染病程等.对80 例疑有胆管癌者,术中于胆镜下钳取结石部位胆管炎症粘膜组织或切除肝脏标本,进行DNA 含量及Agnor 颗粒计数分析.结果 年龄&gt;50 岁,合并丙肝或乙肝、肝硬化、胆道感染史&gt;10 年的47 例患者发现胆管癌7 例(14.8%).DNA 含量及Agnor 颗粒计数:单纯增生与轻、中、重度非典型增生及高、中、低分化胆管癌均数逐渐升高.单纯增生组与轻度非典型增生组差异无显著性(P&gt;0.05).其余各两组差异均有统计学意义(P&lt;0.05).结论 胆管结石合并胆管癌发生的可能机制是反复炎症刺激原胆管上皮增生、化生原癌形成的演变过程.     

综合ICU腹泻现状调查及危险因素分析

目的：：探讨 ICU患者入院2周内腹泻的流行病学特点并分析其危险因素。方法：283例我院综合ICU 2013年10月-2014年8月收住的患者纳入研究。记录患者一般资料及肠内营养情况、药物使用情况,应用多元及多层统计学方法分析腹泻危险因素。结果：共283例患者、1603个 ICU住院日纳入研究。42例(15%)患者出现腹泻,共计88个ICU住院日,发生率为5.5次/百ICU住院日。腹泻平均发生在入住ICU后第6天,89%的患者(252例)腹泻天数小于4 d。腹泻的危险因素包括：超过60%目标营养量的肠内营养、使用抗生素和使用抗真菌药物[相对风险分别为1.75、3.64和2.79]。超过60%目标营养量的肠内营养合并应用抗生素或抗真菌药物[相对风险分别为4.7和11.2]腹泻风险较单因素大幅增加。结论：在综合 ICU入住后前2周内腹泻发生率为15%,导致腹泻发生的危险因素为超量(>60%目标营养量)使用肠内营养、使用抗生素和/或使用抗真菌药物。