产OXA-23型碳青霉烯水解酶鲍曼不动杆菌基因研究

目的了解临床分离12株耐碳青霉烯鲍曼不动杆菌的耐药情况、耐药株来源以及产碳青霉烯酶的类型。方法收集本院对碳青霉烯类药中介或耐药的鲍曼不动杆菌12株，用琼脂稀释法测定最低抑菌浓度(MIC)，脉冲场凝胶电泳(PFGE)分析其同源性，并用聚合酶链反应(PCR)检测分析其耐药基因。结果12株细菌均为多重耐药株，有9株对亚胺培南耐药，6株对美罗培南耐药。对青霉素类、头孢菌素类、复方磺胺甲噁唑均耐药，对氟喹诺酮类和酶抑制剂复合物耐药率最低。12株PFGE图谱分为A、B(B1、B2)2型，以A型为主要流行株(9株)，主要集中在重症监护病房(ICU)。PCR检出12株菌株均携带OXA-23基因，未能检出OXA-24基因。结论本院碳青霉烯类耐药鲍曼不动杆菌流行主要为医院感染所致，该流行株呈多重耐药，12株菌株均产OXA-23型碳青霉烯酶。     

革兰阴性杆菌碳青霉烯酶产生与细菌耐药性关系的研究

目的 研究耐亚胺培南革兰阴性杆菌碳青霉烯酶产生及流行情况.方法 采用琼脂稀释法测定亚胺培南和美罗培南对199株革兰阴性杆菌的MIC,采用乙二胺四乙酸(EDTA)协同实验筛选金属β内酰胺酶表型.PCR扩增耐药菌株碳青霉烯酶基因,并测序分析.脉冲场凝胶电泳(PFGE)分析产酶菌株同源性.结果 141株耐碳青霉烯类铜绿假单胞菌对亚胺培南和美罗培南药敏试验结果显示具有3种模式,以亚胺培南和美罗培南同时耐药为主94株(66.7%)、亚胺培南耐药和美罗培南敏感46株(32.6%)、亚胺培南敏感和美罗培南耐药仅1株(0.7%).但其他耐碳青霉烯类的鲍曼小动杆菌、洛菲不动杆菌、弗劳地柠檬酸杆菌、肺炎克雷伯菌和黏质沙雷菌均对亚胺培南和美罗培南同时耐药.EDTA协同试验结果显示,仅4株耐亚胺培南铜绿假单胞菌为EDTA协同试验阳性(2.8%),其余菌株均为EDTA协同试验阴性.PCR扩增碳青霉烯酶基因结果显示,4株EDTA协同试验阳性的铜绿假单胞菌产VIM-2型金属酶;34株鲍曼不动杆菌菌株中30株(88.2%)产OXA型碳青霉烯酶,其中OXA23型27株(79.4%),OXA24型13株(38.2%),OXA66型23株(67.6%).并且22株(64.7%)细菌同时产生一种以上的OXA型碳青霉烯酶.7株洛菲不动杆菌全部产OXA-23型碳青霉烯酶;11株弗劳地柠檬酸杆菌、5株肺炎克雷伯菌和1株黏质沙雷菌均产KPC-2型碳青霉烯酶,其中6株弗劳地柠檬酸杆菌同时具有IMP-8新亚型金属酶.PFGE结果显示,34株鲍曼不动杆菌中PFGE谱型共有15种,其中有14株属于A型,7株属于B型;7株洛菲不动杆菌不属于同一克隆;4株产VIM-2型金属酶铜绿假单胞菌不属于同一PFGE谱型;11株柠檬酸杆菌属于同一PFGE谱型;5株肺炎克雷伯菌属于同一PFGE谱型.结论 耐碳青霉烯类革兰阴性杆菌对12种抗生素的耐药率均高于碳青霉烯类敏感革兰阴性杆菌的耐药率,而且产生多种碳青霉烯酶,并在弗劳地柠檬酸杆菌、鲍曼不动杆菌和肺炎克雷伯菌中有产酶克隆株的流行.     

鲍曼不动杆菌耐药表型及碳青霉烯酶OXA基因分析

目的 检测鲍曼不动杆菌耐药表型及碳青霉烯酶OXA基因型.方法 用VITEK32鉴定出174株不动杆菌,用K-B纸片检测抗生素的耐药性,用琼脂稀释法测定抗生素的最小抑菌浓度(MIC),用多重PCR方法测定碳青霉烯酶OXA23类,OXA24类,OXA51类和OXA58类基因.结果 检出鲍曼不动杆菌146株(83.91%),耐亚胺培南的鲍曼不动杆菌46株(31.50%).鲍曼不动杆菌呈现出多重耐药性,亚胺培南、奈替米星、左氧氟沙星、头孢吡肟和哌拉西林/他唑巴坦的敏感率分别为70.69%,48.85%,44.83%,43.68%,44.83%.亚胺培南的MIC值为16～64μg/ml;耐亚胺培南鲍曼不动杆菌OXA基因主要为OXA23类,检出率为82.61%,且以OXA23/OXA51类基因为主(60.87%),检出OXA23/OXA58类1株,未测得OXA24类.结论 鲍曼不动杆菌呈现出多重耐药性,以OXA23/OXA51型碳青霉烯酶为主.     

儿科临床分离多重耐药鲍曼不动杆菌耐药性和产OXA酶的研究

目的研究儿科临床分离多重耐药鲍曼不动杆菌耐药性和OXA酶基因存在情况。方法收集2010年1—12月北京儿童医院住院患儿中分离多重耐药鲍曼不动杆菌42株。用美国BD公司Phoenix100微生物分析仪,进行菌株鉴定和13种抗菌药物的药敏试验,按照CLSI 2010年推荐标准判断结果。用多重PCR方法检测OXA酶OXA-23、OXA-24、OXA-51和OXA-58 4组基因。PCR产物测序结果通过GenBank进行比对分析,确定其基因型别。结果多重耐药鲍曼不动杆菌42株对亚胺培南和美罗培南耐药率分别为76.2%和78.6%。未发现对多黏菌素耐药的菌株。42株菌中41株(97.6%)扩增出特异性条带,为OXA基因阳性。其中,OXA-51组基因阳性38株(90.4%);OXA-23组基因阳性28株(66.7%);OXA-58组基因阳性2株(4.8%)。未扩增出OXA-24组基因。有27株(64.2%)OXA-51和OXA-23组基因同时阳性。携带OXA-23基因鲍曼不动杆菌均为对碳青霉烯类抗生素耐药的菌株。结论儿科临床分离多重耐药鲍曼不动杆菌的耐药情况严重。以同时产OXA-51和OXA-23型OXA酶为主。OXA-23基因是导致鲍曼不动杆菌对碳青霉烯类抗生素耐药的主要原因。     

碳青霉烯类耐药鲍曼不动杆菌流行病学及碳青霉烯酶类型的研究

目的 了解碳青霉烯类耐药鲍曼不动杆菌的耐药性、同源性及碳青霉烯酶类型。方法 收集本院碳青霉烯类耐药鲍曼不动杆菌45株，浓度梯度法(Etest)测定最低抑菌浓度(MIC)；采用脉冲场凝胶电泳(PFGE)分析同源性；通过等电点聚焦电泳(IEF)、三维试验、2-巯基丙酸抑制试验、聚合酶链反应(PCR)、克隆测序等方法分析碳青霉烯酶类型。结果 45株细菌均为多重耐药株，仅对头孢哌酮/舒巴坦、氨苄西林/舒巴坦耐药率较低分别为2．2％和6．5％，敏感率分别为63．0％和43．5％。45株菌株PFGE图谱分为A、B两型，A型是主要流行株(44株)，主要集中在重症监护病房(ICU)。B型1株来自血液科病房。45株菌中有43株产碳青霉烯酶，其中16号株(PFGE为B型)等电点有6．6、7．2两个条带，pI6．6为OXA-23，其余42株(A1～A4亚型)pIs均有6．4、7．0两个条带，均不被克拉维酸、氯唑西林及2-巯基丙酸抑制，PCR方法也未能检出OXA-23、OXA-24系列的基因。结论 本院碳青霉烯类耐药鲍曼不动杆菌流行主要为医院感染所致，该流行株呈多重耐药，未发现金属酶，仅1株产OXA型碳青霉烯酶，为OXA-23。     

重症监护病房碳青霉烯类抗生素耐药鲍曼不动杆菌耐药机制及同源性分析

目的分析耐碳青霉烯类抗生素鲍曼不动杆菌基因型,进行同源性分析,探讨碳青霉烯类抗生素耐药率升高的原因。方法应用WHONET5.0分析广州医学院第一附属医院重症监护病房(ICU)分离的鲍曼不动杆菌耐药率变化。收集2008年1月至2009年12月ICU碳青霉烯类抗生素耐药鲍曼不动杆菌35株,应用VITEK-2全自动细菌鉴定仪进行菌株鉴定,采用K-B纸片扩散法测定15种抗菌药物的敏感性,PCR检测金属β内酰胺酶及碳青霉烯酶OXA基因,脉冲场凝胶电泳(PFGE)分析同源性。结果该院分离的鲍曼不动杆菌对碳青霉烯类抗生素的耐药率显著增加,对美罗培南的耐药率从10.8%升高到62.3%,对亚胺培南的耐药率从13.5%升高到58.8%。PFGE分析存在8个克隆;blaOXA-51、blaOXA-23、blaOXA-58阳性的分别为33株(94.3%)、20株(57.1%)和6株(17.1%)。ISAba1相关blaOXA-23是碳青霉烯酶主要的存在形式。未检测到金属β内酰胺酶。结论该院ICU分离的鲍曼不动杆菌OXA-23型碳青霉烯酶基因检出率最高,并存在交叉感染的情况,应引起临床重视。     

攀枝花地区耐碳青霉烯类鲍曼不动杆菌OXA基因型及分子流行病学分析

目的通过研究攀枝花地区临床分离的耐碳青霉烯类鲍曼不动杆菌的耐药性及碳青霉烯酶OXA类型,了解该地区耐碳青霉烯类鲍曼不动杆菌的耐药机制及分子流行病学特征。方法收集2014年1月至2015年5月攀枝花地区两所三甲医院临床分离的127株鲍曼不动杆菌;采用KB法检测21种抗菌药物敏感性,比较碳青霉烯类鲍曼不动杆菌耐药组和敏感组的耐药率;采用聚合酶链反应(PCR)检测OXA基因;最后采用肠杆菌基因间一致重复序列聚合酶链反应(ERIC-PCR)进行分子分型及同源性分析。结果 66株耐碳青霉烯类鲍曼不动杆菌对多黏菌素B、米诺环素、头孢哌酮/舒巴坦的耐药率最低,分别为15.2%、22.7%、24.2%,对其余18种抗菌药物耐药率均高于80.0%,耐药率明显高于敏感组菌株;OXA-23和OXA-51基因的检出率分别为92.4%、98.5%,OXA-24和OXA-58基因未检出;ERIC-PCR分子分型主要可分为A、B、C、D 4个型,以B型为主。结论攀枝花地区耐碳青霉烯类鲍曼不动杆菌耐药非常严重,OXA-23、OXA-51基因为该地区耐碳青霉烯类鲍曼不动杆菌重要基因型,B型为主要流行株。     

耐碳青霉烯类鲍曼不动杆菌耐药机制研究

目的了解碳青霉烯类耐药鲍曼不动杆菌的耐药性、同源性及其耐药机制。方法收集碳青霉烯类耐药鲍曼不动杆菌20株,用E试验行药敏测定;脉冲场凝胶电泳(PFGE)行同源性分析;通过等电点聚热电泳(IEF)、三维试验及抑制试验、PCR、克隆测序、十二烷基硫酸钠-聚丙酰胺凝胶电泳(SDS-PAGE)等方法分析碳青霉烯酶型及外膜蛋白(OMP)。结果20株碳青霉烯类耐药鲍曼不动杆菌对多黏菌素B仍保持良好的敏感性(90%),莫西沙星对约40%菌株的MIC在0.125mg/L以下;根据PFGE图谱将其分为5型,A1型是主要流行株(9株),主要集中在我校附属二院ICU和附属一院呼吸科;所有菌株均产等电点6.7的碳青霉烯酶,PCR方法及测序证实为OXA-23型碳青霉烯酶,未发现金属酶,且都含有Ⅰ类整合子,但未发现质粒;OMP分析发现部分克隆有31ku的条带丢失。结论亚胺培南耐药不动杆菌存在医院间克隆传播,值得关注;我校鲍曼不动杆菌主要产生OXA-23型碳青霉烯酶;OMP31ku的条带丢失是耐药机制之一;我校耐碳青霉烯类鲍曼不动杆菌耐药机制可能是产酶和OMP丢失共同作用。     

耐碳青霉烯类抗生素不动杆菌的β内酰胺酶研究

目的了解不动杆菌属细菌对碳青霉烯类药物的耐药机制,耐药菌株的基因同源性和传播机制。方法采用改良Hodge试验和乙二胺四乙酸(EDTA)协同试验筛选耐亚胺培南不动杆菌碳青霉烯酶,等电聚焦电泳(IEF)测定产β内酰胺酶等电点,blaTEM,blaSHV,blaCTX-M-Ga-Gc,blaPER-1,blaOXA-23,blaMBL等,引物的PCR进行β内酰胺酶的基因分型,并对PCR产物进行测序;Southern印迹进行苯唑西林酶OXA-23的基因定位脉冲场电泳(PFGE)研究耐亚胺培南不动杆菌同源性。结果6株耐碳青霉烯类不动杆菌均产OXA-23型酶,其中5株同时产PER-1型ESBLs。6株菌blaOXA-23均定位于染色体。3株琼氏不动杆菌属于同一PFGE分型,3株鲍曼不动杆菌分别属于2种PFGE分型。结论产OXA-23型碳青霉烯酶是导致不动杆菌对碳青霉烯类药物耐药的重要原因,同时存在blaOXA-23的克隆传播。     

多重耐药鲍曼不动杆菌中OXA碳青霉烯酶基因的研究

目的 调查我院院内分离的多重耐药鲍曼不动杆菌中OXA碳青霉烯酶基因的存在情况,为临床合理使用抗菌药物和控制院内感染的发生提供科学依据.方法 用WalkAway 96 PLUS NC31复合板鉴定菌种,用微量稀释法和K-B纸片扩散法测定菌株的药敏情况,PCR法检测OXA23、OXA24、OXA48、OXA55、OXA58、OXA60、OXA64、OXA66基因在46株院内分离的多重耐药鲍曼不动杆菌中的存在情况,对部分阳性基因进行测序.结果 46株多重耐药鲍曼不动杆菌中,41株(89.1%)OXA23组基因阳性,其余基因检测均阴性.结论 我院院内分离的多重耐药鲍曼不动杆菌对碳青霉烯类抗菌药物耐药的主要原因之一是产OXA23组碳青霉烯酶.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.