两种方法清洗消毒医用便器的效果监测与分析

目的 比较两种方法清洗消毒医用便器的效果.方法 选取呼吸科重症监护病房医用便器,随机分别使用便器清洗消毒机清洗及传统有效氯消毒液清洗,同时进行微生物学检测.结果 使用SAN24W便器清洗消毒机进行便器消毒,从消毒前的平均菌含量(1.86×105)±(6.42×104)CFU/cm2减少至消毒后的(52.67±36.50)CFU/cm2,与经普通清洗浸泡消毒的便器平均菌含量(8.27×102)±67.68 CFU/cm2相比明显减少,差异有统计学意义(P＜0.01),便器细菌的消亡率达99.97％,细菌减少的对数值均≥5,且未检测出致病菌.结论 便器消毒机清洗简便有效,能够明显降低便器含菌量,提高细菌消亡率.     

MALDI-TOF MS对临床常见真菌鉴定准确性的Meta分析

目的评价基质辅助激光解析电离飞行时间质谱(MALDI-TOF MS)鉴定临床常见真菌的准确性,为临床真菌感染的诊断及治疗提供依据。方法计算机检索各据库,查找MALDI-TOF MS检测真菌准确性的文献,对纳入的文献进行质量评价和数据提取,采用QUADAS-2工具对纳入文献的偏倚风险进行评价,运用Meta-Disc1.4软件进行Meta分析,比较不同菌株来源、菌种、参考方法、使用仪器各亚组的诊断效能。结果共纳入文献26篇,9 708株真菌,基本涵盖了临床常见酵母菌属及丝状真菌属。Meta分析结果显示,MALDI-TOF MS鉴定真菌合并灵敏度[95%置信区间(95%CI)]为0.97(0.97～0.97),合并特异度(95%CI)为0.85(0.81～0.88),合并阳性似然比(95%CI)为5.60(4.55～6.90),合并阴性似然比(95%CI)为0.02(0.01～0.04),诊断比值比(95%CI)为282.40(149.50～533.46),汇总受试者工作特征曲线下面积为0.9078。亚组分析结果显示,MALDI-TOF MS技术对临床酵母菌属及丝状真菌属的鉴定,不受菌株来源、仪器品牌等因素影响,均具有很好的鉴定效果。结论MALDI-TOF MS对临床常见真菌鉴定的准确性高,适合在临床广泛推广应用。     

Yeast Beta-Glucans Ingestion Does Not Influence Body Weight: A Systematic Review and Meta-Analysis of Pre-Clinical Studies

Dietary fiber supplementation has been studied as a promising strategy in the treatment of obesity and its comorbidities. A systematic review and meta-analysis were performed to verify whether the consumption of yeast beta-glucan (BG) favors weight loss in obese and non-obese rodents. The PICO strategy was employed, investigating rodents (Population), subjected to the oral administration of yeast BG (Intervention) compared to animals receiving placebo (Comparison), evaluating body weight changes (Outcome), and based on preclinical studies (Study design). Two reviewers searched six databases and the grey literature. We followed the PRISMA 2020 guidelines, and the protocol was registered on PROSPERO (CRD42021267788). The search returned 2467 articles. Thirty articles were selected for full-text evaluation, and seven studies remained based on the eligibility criteria. The effects of BG intake on body weight were analyzed based on obese (n = 4 studies) and non-obese animals (n = 4 studies). Even though most studies on obese rodents (75%) indicated a reduction in body weight (qualitative analysis), the meta-analysis showed this was not significant (mean difference −1.35 g—95% CI −5.14:2.45). No effects were also observed for non-obese animals. We concluded that the ingestion of yeast BG barely affects the body weight of obese and non-obese animals.     

人尿中羟基多环芳烃分析方法的研究进展

多环芳烃(PAHs)是一类广泛存在于环境中的持久性有机化学污染物。研究表明,PAHs不仅能引起消化道和呼吸道刺激效应,长期暴露还会对哺乳动物产生致畸、致癌和致突变危害。PAHs在人体内主要以葡萄糖苷酸结合的形式存在,酶解后尿中羟基PAHs(OH-PAHs)作为主要的生物标志物可以综合评价人体多途径接触PAHs的内暴露水平。该文对近年来尿中OH-PAHs的不同前处理技术(水解、萃取净化)和检测方法(液相色谱-荧光检测法、气相色谱-质谱法、液相色谱-质谱联用法)进行综述,并对未来发展趋势进行展望。     

Effects of mindfulness-based interventions on anthropometric outcomes: A systematic review and meta-analysis

Background and objectivesThe effects of mindfulness-based interventions (MBIs) on anthropometrics remain obscure. This review quantitatively synthesizes the effects of MBIs on decreasing body mass index (BMI), waist circumference (WC), weight, and percent body fat (%BF).MethodsSeven databases, including CINAHL Plus with Full Text, PubMed, PsycINFO, Cochrane, Web of Science Core Collection, Embase, and Sociological Abstracts were searched; studies with a comparison group were selected. Random-effects models were then applied to estimate the pooled effects (Hedge’s g), while exploratory moderation analyses with mixed-effects models were performed to explore potential moderators of MBIs on anthropometrics.ResultsThe pooled effect size was −0.36 (p < .001) on BMI, −0.52 (p < .001) on WC, −1.20 (p < .004) on weight loss, and −0.43 (p = .389) on %BF. The long-term effects from baseline to follow-up and from post-intervention to follow-up were sustained on BMI (−0.37, p = .027; −.24, p = .065) and weight loss (−1.91, p = .027; −0.74, p = .011) respectively. For weight loss, adding mindful movement had greater effects than those without (−2.65 vs −0.39, p < .001).ConclusionOur findings support the short-term MBI effects on BMI reduction, WC, weight, and %BF, and long-term effects on reducing BMI and weight. Future efforts should focus on sustaining effects on reducing WC and %BF.     

前列腺指检按摩方法述评

慢性前列腺炎是男科常见病,临床表现以骨盆区域疼痛和排尿异常两大类症状为主,可伴有焦虑、抑郁等精神障碍类症状,病情复杂,缠绵难愈.其诊疗方法多种多样,但通过直肠指检按摩取液是检查和治疗前列腺炎的基本方法,现多采用弯腰趴伏位检查法,以增加取液成功率和患者依从性.笔者结合多年来使用过的几种指检按摩方法体会,对操作各个环节的要点和注意事项作简要述评.     

Contraception values and preferences: protocol and methods for a global systematic review

ObjectiveValues and preferences of end users are critical considerations for any health guidelines. We sought to examine the literature about values and preferences for contraceptive methods to inform the World Health Organization (WHO) Medical eligibility criteria (MEC) and Selected practice recommendations (SPR) for contraception use. In this article, we present a detailed protocol and methods for this systematic review.Study designWe searched 10 electronic databases for articles published in a peer-reviewed journal from January 1, 2005 through December 31, 2017. Articles had to present qualitative or quantitative information about patients' and providers' values and preferences for contraceptive methods covered under the MEC and SPR guidelines. There were no language or study location restrictions. Citations were screened in duplicate and included articles underwent data abstraction using standardized forms. Study rigor was assessed using an 8-item measure developed by the Evidence Project for quantitative studies and an adapted CASP checklist for qualitative studies.DiscussionWe defined “values and preferences” broadly and designed our search and data extraction strategies accordingly. While this approach has strengths and limitations, we believe it captures the wide range of values and preferences of contraceptive end users and family planning providers that should be considered by WHO in guideline development. We anticipate findings will be useful to inform future research, programmatic, and policy decisions.     

A review of methods for futility stopping based on conditional power

Conditional power (CP) is the probability that the final study result will be statistically significant, given the data observed thus far and a specific assumption about the pattern of the data to be observed in the remainder of the study, such as assuming the original design effect, or the effect estimated from the current data, or under the null hypothesis. In many clinical trials, a CP computation at a pre-specified point in the study, such as mid-way, is used as the basis for early termination for futility when there is little evidence of a beneficial effect. Brownian motion can be used to describe the distribution of the interim Z-test value, the corresponding B-value, and the CP values under a specific assumption about the future data. A stopping boundary on the CP value specifies an equivalent boundary on the B-value from which the probability of stopping for futility can then be computed based on the planned study design (sample size and duration) and the assumed true effect size. This yields expressions for the total type I and II error probabilities. As the probability of stopping increases, the probability of a type I error alpha decreases from the nominal desired level (e.g. 0.05) while the probability of a type II error beta increases from the level specified in the study design. Thus a stopping boundary on the B-value can be determined such that the inflation in type II error probability is controlled at a desired level. An iterative procedure is also described that determines a stopping boundary on the B-value and a final test critical Z-value with specified type I and II error probabilities. The implementation in conjunction with a group sequential analysis for effectiveness is also described.     

Sampling methods for the study of pneumococcal carriage: A systematic review

Streptococcus pneumoniae is an important pathogen worldwide. Accurate sampling of S. pneumoniae carriage is central to surveillance studies before and following conjugate vaccination programmes to combat pneumococcal disease. Any bias introduced during sampling will affect downstream recovery and typing. Many variables exist for the method of collection and initial processing, which can make inter-laboratory or international comparisons of data complex. In February 2003, a World Health Organisation working group published a standard method for the detection of pneumococcal carriage for vaccine trials to reduce or eliminate variability. We sought to describe the variables associated with the sampling of S. pneumoniae from collection to storage in the context of the methods recommended by the WHO and those used in pneumococcal carriage studies since its publication. A search of published literature in the online PubMed database was performed on the 1st June 2012, to identify published studies that collected pneumococcal carriage isolates, conducted after the publication of the WHO standard method. After undertaking a systematic analysis of the literature, we show that a number of differences in pneumococcal sampling protocol continue to exist between studies since the WHO publication. The majority of studies sample from the nasopharynx, but the choice of swab and swab transport media is more variable between studies. At present there is insufficient experimental data that supports the optimal sensitivity of any standard method. This may have contributed to incomplete adoption of the primary stages of the WHO detection protocol, alongside pragmatic or logistical issues associated with study design. Consequently studies may not provide a true estimate of pneumococcal carriage. Optimal sampling of carriage could lead to improvements in downstream analysis and the evaluation of pneumococcal vaccine impact and extrapolation to pneumococcal disease control therefore further in depth comparisons would be of value.     

Criteria and methods used for the assessment of fitness for work: a systematic review

The main findings from reports published in scientific journals on the criteria and methods used to assess fitness for work were reviewed. Systematic searches were made using internet engine searches (1966-2005) with related keywords. 39 reports were identified, mostly from the US and western Europe. Assessment of fitness for work is defined by most as the evaluation of a worker's capacity to work without risk to their own or others' health and safety. It is mainly assessed at recruitment (pre-offer or post-offer), and when changes of work or health conditions occur. Five main criteria used by occupational doctors to evaluate fitness for work were identified: the determination of worker's capacity and worker's risk in relation to his or her workplace, as well as ethical, economic and legal criteria. Most authors agreed that assessment tools used need to be specific and cost-effective, and probably none gives unequivocal answers. Outcomes from fitness for work assessments range from "fit" to "unfit", with other possible intermediate categories such as "fit subject to work modifications", "fit with restrictions" or "conditionally fit (temporarily, permanently)". Workplace modifications to improve or adjust working conditions must always be considered. There is confusion about the decision-making process to be used to judge about fitness for work. There is very scarce scientific evidence based on empirical data, probably because there are no standard or valid methodologies for all professions and circumstances.     

Investigating community-based health and health promotion for homeless people: a mixed methods review

Homeless people are susceptible to a range of health problems, yet in terms of health promotion, tend to be a hard-to-reach, marginalized group. Robust evidence regarding the ability to engage with this population via effective health promotion programmes is essential if policy and practice are to be informed to improve the health of homeless people. A structured review was conducted with the aim of examining what is known about community-based health promotion for homeless people. Six databases were searched and 8435 records screened. Thirteen studies met the inclusion criteria. A mixed-methods 'combined separate synthesis' approach was used to accommodate both quantitative and qualitative evidence within one review. Three themes emerged: (i) incorporating homelessness, (ii) health improving and (iii) health engaging. The review has implications for health promotion design, with evidence suggesting that as part of a tailored approach, homeless people must be actively involved in intervention development, ensuring that appropriate, acceptable and potentially effective individual elements are incorporated into community-based interventions.     

Nutrition,supplementation and weight reduction in combat sports: a review

Nutrition is the aspect closely connected to physical activity and may affect body composition, sports performance and post-workout regeneration. Using an appropriate diet plan is a proven method to optimize performance improvements in combat sports. In the majority of combat sports athletes are classified according to their body mass in order to minimize differences between competitors. Many athletes induce weight loss in order to gain an advantage over their opponents. The review was undertaken to provide safe, evidence-based protocols helping athletes in weight reduction without negative effects on sports performance. The nutritional requirements for combat sports athletes, sports supplements, gradual and rapid weight reduction strategies are discussed in this review.     

A systematic review of methods of uncertainty analysis and their applications in the assessment of chemical exposures,effects, and risks

Methods of uncertainty analysis are being included increasingly in regulatory chemical risk assessment. Although best practices have been established by several safety agencies in Europe and the United States, they exist only in the grey literature – there has been no comprehensive analysis of the scientific, peer-reviewed literature on these methods. We therefore conducted a systematic review of the recent peer-reviewed literature (2007–2013) on uncertainty analysis relevant to chemical risks. The main objective was to determine whether current methods are robust enough for regulatory use, because the methods used to protect public health must meet the most stringent scientific standards. Based on 297 papers, we concluded that the peer-reviewed literature is much more critical about the disadvantages of those methods, compared to the grey literature. Furthermore, uncertainty analyses can be influenced significantly by subjective expert judgment. As a suggested improvement, we developed guidelines for transparent reporting of uncertainty assessment results.     

A comparative study on different methods for the determination of energy expenditure

Summary In order to determine energy expenditure, the Douglas Bag technique (DB) and Kofranyi-Michaelis respirometers (KM) have been widely used under field conditions for several decades. Some years ago the Oxylog (OX) method was developed, measuring simultaneously the difference of partial oxygen pressure in inspired and expired air (PO₂ diff.) by two polarographic oxygen sensors. In order to compare these three methods laboratory experiments (3 test subjects, 5 different bicycle ergometer work loads, 180 measurements per apparatus) were performed. Oxygen uptake (VO₂) varied between about 0.9 to 3.01/min. The VO₂data obtained by the DB method, which were used as a reference, and those obtained by the KM method agreed fairly well. The recorded data of OX underestimated VO₂up to 21%, with the deviation increasing with work intensity. A sufficient accuracy of recorded VO₂ was observed only up to moderate work intensity. OX data calculated from ventilation volume of inspired air per minute (V₁) and PO₂ diff., measured by OX, were always about 19% higher than those recorded by OX. This means that the calculated VO₂ values of the OX corresponded fairly well with DB values at heavy work loads. The reason for the differences between recorded and calculated OX data is still unknown. Further research is urgently needed. Deceased     

不同方法保湿清洗医疗器械效果的对比分析

目的 检测分析3种不同保湿方法清洗医疗器械的效果.方法 选择＜7d全院临床科室使用后的医疗器械,采用3种不同的保湿和清洗方法处理;A组:0.5％含氯消毒剂保湿+手工清洗,B组:酶清洗剂保湿+机洗,C组:碱性清洗液+酶清洗剂保湿+超声+升级后的清洗机清洗;清洗后的器械用目测方法:裸视和带光源5倍放大镜下观察及隐血试验法检测其清洗效果.结果 3种方法处理器械裸视目测合格率A组:为92.01％,B组:为96.07％,C组:为99.14％,C组明显高于A组,差异有统计学意义(P＜0.01).结论 医院应根据新标准的要求,选择合适的保湿清洗器械方法,建立正确的清洗流程.     

Safety of contraceptive methods for women with rheumatoid arthritis: a systematic review

Background

Women with rheumatoid arthritis (RA) and their clinicians may have unique concerns about certain methods of contraception.

Study Design

We conducted a systematic review of the literature in the MEDLINE database through February 2009 for peer-reviewed journal articles on use of any method of contraception, or progestins or estrogens, and progression of RA.

Results

We identified eight articles that met the inclusion criteria: six examined oral contraceptives (OCs), one progesterone, and one estrogen. We found no studies on other methods of contraception. For OCs, no consistent pattern of improvement or worsening of disease emerged and most patients showed little change in RA symptoms. We saw little improvement in the studies examining progesterone and estrogen.

Conclusion

Although sparse and based primarily on older studies of poor quality, this information suggests that OC use is unlikely to affect RA disease progression. Research is needed on other forms of contraception, such as DMPA and IUD.     

Khat use and mental illness: a critical review

Khat has been used as a stimulant plant in many parts of Africa and the Arabian Peninsula for centuries. Its current use among particular migrant communities in Europe and elsewhere has caused alarm among policy makers and health care professionals. In the United Kingdom, the debate over the psychiatric and social implications of khat use has led to a demand for stricter legal control of this stimulant plant. This paper (a) provides a historical overview of khat use, and (b) reviews the evidence for the existence of a causal link between khat use and mental illness. To do so, we undertook a detailed search of social and medical science databases for case reports, qualitative and quantitative articles on khat use and mental illness from 1945 to 2006. The validity and reliability of the studies that met our inclusion criteria were examined. Lastly, although highlighting health concerns about khat use we suggest that the debate about this popular drug in migrant populations carries elements of a 'moral panic'. There is a need for improved research on khat use and its possible association with psychiatric disorders.