对6种中华系列临床医学杂志3年中部分病因学研究论文的方法学评价

目的 :对部分国家级核心临床医学期刊近年来发表的病因学研究论文的方法学进行评价。方法 :华西医科大学地区临床流行病学资源与培训中心组织临床流行病学教师对上述 6种中华系列临床医学杂志在过去三年中 ( 1994 7～ 1997 6 )发表的部分病因学研究论文用统一的指标进行评价。结果 :共收集论文 6 1篇 ,其中队列研究 14篇 ,病例对照研究 15篇 ,断面研究 3 2篇。队列研究 14篇中仅有 5篇考虑了混杂因素 ,仅有 6篇应用了OR或RR等测量因果联系强度的指标。病例对照研究 15篇中 14篇用比值比OR表示因果联系的强度 ,10篇采用了统计学方法处理混杂因素。断面研究 3 2篇中用RR或OR表示因果关系者 8个 ,余均采用率的比较、t检验及相关关系等表示变量之间的关系 ,有 14个研究样本偏小。结论 :约半数病因学研究论文存在较严重的方法学缺陷 ,影响研究结果的真实性。为了提高病因学研究质量 ,应当将临床流行病学作为临床医生继续教育的重要内容     

Imaging in population science: cardiovascular magnetic resonance in 100,000 participants of UK Biobank - rationale,challenges and approaches

UK Biobank is a prospective cohort study with 500,000 participants aged 40 to 69. Recently an enhanced imaging study received funding. Cardiovascular magnetic resonance (CMR) will be part of a multi-organ, multi-modality imaging visit in 3–4 dedicated UK Biobank imaging centres that will acquire and store imaging data from 100,000 participants (subject to successful piloting). In each of UK Biobank’s dedicated bespoke imaging centres, it is proposed that 15–20 participants will undergo a 2 to 3 hour visit per day, seven days a week over a period of 5–6 years. The imaging modalities will include brain MRI at 3 Tesla, CMR and abdominal MRI at 1.5 Tesla, carotid ultrasound and DEXA scans using carefully selected protocols. We reviewed the rationale, challenges and proposed approaches for concise phenotyping using CMR on such a large scale. Here, we discuss the benefits of this imaging study and review existing and planned population based cardiovascular imaging in prospective cohort studies. We will evaluate the CMR protocol, feasibility, process optimisation and costs. Procedures for incidental findings, quality control and data processing and analysis are also presented. As is the case for all other data in the UK Biobank resource, this database of images and related information will be made available through UK Biobank’s Access Procedures to researchers (irrespective of their country of origin and whether they are academic or commercial) for health-related research that is in the public interest.     

Migraine in childhood and its prognosis

In 1955 a population study in Uppsala comprising about 9,000 school children showed that migraine increased from 1.4% at the age of seven to 5.3% at fifteen. With increasing age there was an increasing predominance of girls. A matched comparison between 73 children with more pronounced migraine and 73 control children showed a greater tendency in the migraine group to abdominal pain, motion sickness, sleep disturbance and orthostatic symptoms. In a longitudinal study lasting 23 years the 73 migraine children were followed-up until all were over 30 years of age. During puberty and as young adults 62% were free from migraine for at least two years. Of these, 22% again suffered migraine regularly. Thus, 60% had migraine attacks at 30. Girls seem to have a greater relapse rate than boys. Most of the girls with classical migraine were headache free during pregnancy. Every third family with one parent belonging to the migraine group and with children over four years of age had one child with migraine symptoms. Migraine seems to be more frequently inherited via the mother, and to girls.     

Statistical Evaluation of the Use of Concurrent Controls in Treatment Screening Studies

A well‐designed pilot study can advance science by providing essential preliminary data to support or motivate further research, refine study logistics, and demonstrate proof of concept. Often, the outcomes of such studies can be quantified by a success/failure dichotomy. For example, a novel compound may show activation of a neural pathway, or it may not. When an intervention''s efficacy is quantified using a dichotomous outcome, probability mass functions can be enumerated to determine the probability that the observed result from a pilot study supports further evaluation of the intervention since there is only a finite, and often small, number of sample configurations possible. The purpose of this research was to determine the probability of an “efficacy signal” for pilot studies using one‐ and two‐sample pilot study designs. Efficacy signal was defined as the probability of observing a more favorable response proportion relative to a historical control (one‐sample setting) or to a concurrent control (two‐sample setting). An enumeration study (exact simulation) was conducted to calculate the efficacy signal probability. One‐sample study designs yielded higher probability of determining an efficacy signal than the two‐sample setting; however, sampling variation must be accounted for. A 68% score confidence interval is recommended for this purpose.     

盐酸芦氟沙星片治疗各种感染的临床研究

本研究采用武汉滨湖制药厂研制的盐酸芦氟沙星片治疗细菌性感染５０例,其中呼吸道感染１７例,泌系统感染１５例,其他感染１８例。临床痊愈率和有效率为６４．００％和９０．００％。共分离出病原菌４４株,以病原菌进行疗效统计,痊愈率和有效率为５９．１％和８８．６％,病原菌清除率为８８．６４％。     

三氧化二砷应用于淋巴瘤的基础及临床研究进展

三氧化二砷治疗急性早幼粒细胞白血病取得成功后又被实验性用于淋巴瘤的治疗，近年来国内外学者在此方面做了大量研究工作，发现三氧化二砷通过多种途径发挥抗淋巴瘤效应，且很多物质能够增强或减弱这种效应，三氧化二砷治疗对其他化疗药物不敏感的复发及难治性淋巴瘤仍有一定效果且毒副作用小，提示三氧化二砷是一种极具潜力的治疗淋巴瘤的新型药物，现就相关基础及临床研究成果进行综述，     

Predictors of attrition in a cohort study of HIV infection and methamphetamine dependence

Abstract

Longitudinal cohort studies of HIV and substance use disorders play an important role in understanding these conditions, but high rates of attrition can threaten their integrity and generalizability. This study aimed to identify factors associated with attrition in a 5-year observational cohort study of 469 individuals with and without HIV infection and methamphetamine (MA) dependence. Rates of attrition in our four study groups were approximately 24% in HIV?MA?, 15% in HIV+MA?, 56% in HIV?MA+, and 47% in HIV+MA+ individuals. Predictors of attrition in the overall cohort included history of MA, alcohol, and other substance dependence, learning impairment, reduced cognitive reserve, and independence in activities of daily living (all ps?<?0.05), but varied somewhat by clinical group. Of particular note, enrollment in a neuroimaging sub-study was associated with significantly boosted rates of retention in the MA groups. Results from this investigation highlight the complexity of the clinical factors that influence retention in cohort studies of HIV-infected MA users and might guide the development and implementation of targeted retention efforts.     

临床床旁案例学习模式在康复教学中的应用研究

目的:探究临床床旁案例学习模式在康复教学中的应用效果。方法:将选修《神经系统疾病物理治疗》的70例学生按照既往成绩绩点排序,进行配对设计,分为临床床旁案例学习组和课堂案例学习组各35例,比较分析2组学生案例操作成绩和小组案例汇报表现评分。采用《案例学习调查问卷》调研学生对临床床旁案例学习和课堂案例学习的反馈。结果:临床床旁案例学习组案例操作得分显著高于课堂案例学习组(P<0.05);汇报内容,临床床旁案例学习组显著高于课堂案例组(P<0.05)。临床案例学习组问卷总分显著高于课堂案例学习组(P<0.01);学生认为临床场旁案例学习模式对于增强专业知识的综合运用、批判性思维、自主学习、临床案例处理、医患沟通、团队合作等能力方面,显著高于课堂案例组(P<0.05)。问卷的一般频数统计结果提示超过90%的学生认为临床床旁案例教学有助于提高课程学习效果、自主学习能力、学生的人文关怀意识、临床思维能力、加强团队合作能力。结论:和课堂案例学习比较,临床床旁案例学习模式更有利于培养学生的专业知识的综合运用能力、临床思维能力、自主学习能力、团队合作能力。     

脑卒中患者发生急性期疲劳危险因素的Meta分析

目的系统评价脑卒中患者发生急性期疲劳的危险因素。方法计算机检索PubMed、Web of Science、EMbase、The Cochrane Library、CNKI、VIP和WanFang Data数据库,搜集脑卒中患者发生急性期疲劳危险因素的病例-对照研究、队列研究和横断面研究,检索时限均从建库至2019年4月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入14个研究,包括2 658例研究对象,涉及危险因素13个。Meta分析结果显示:女性[OR=1.54,95%CI(1.23,1.94),P=0.000 2]、农村居住地[OR=1.46,95%CI(1.11,1.91),P=0.007]、糖尿病[OR=1.54,95%CI(1.24,1.92),P<0.000 1]、高脂血症[OR=1.41,95%CI(1.10,1.80),P=0.007]、冠心病[OR=1.94,95%CI(1.30,2.89),P=0.001]、既往卒中史[OR=1.54,95%CI(1.07,2.23),P<0.000 01]、卒中前疲劳[OR=4.51,95%CI(3.33,6.09),P<0.000 01]、基底节区卒中[OR=2.76,95%CI(1.21,6.29),P<0.000 01]、NIHSS>3分[OR=2.11,95%CI(1.59,2.79),P<0.000 01]、入院血糖水平[OR=1.08,95%CI(0.38,1.78),P=0.003]、卒中后睡眠障碍[OR=2.40,95%CI(1.87,3.07),P<0.000 01]、卒中后疼痛[OR=2.32,95%CI(1.56,3.45),P<0.000 1]和卒中后抑郁[OR=3.31,95%CI(1.94,5.66),P<0.000 1]均是脑卒中患者发生急性期疲劳的危险因素。结论当前证据显示,女性、农村居住地、糖尿病、高脂血症、冠心病、既往卒中史、卒中前疲劳、基底节区卒中、NIHSS评分>3分、入院血糖水平、卒中后睡眠障碍、卒中后疼痛和卒中后抑郁是脑卒中患者发生急性期疲劳的危险因素。医务人员应对具有以上危险因素的高危患者加强防护,以降低卒中后疲劳发生率,改善患者临床预后结局。     

弹力罩在门诊患儿头皮静脉输液辅助固定中的应用

Objective In order to evaluate the clinic effects of elastic covering for fixed scalp intravenous transfusion in children. Methods Four hundred and eight children were divided into control group (201 cases) and observation group (208 cases) randomly, the observation group was given the elastic covering to assist fixation, and the control group was given the traditional long medical adhesive plaster to go around the head to assist fixation. To compare whether the needles emerged from blood vessel, the liquid was leak out and finished transfusion successfully or not during the transfusion as well as the children~ compliance when pulled out the needles and their parents' satisfaction and so on. Results There were significant difference between the two groups in the indexes which had been compared (P＜0.01) . Conclusions The elastic cover is more advantageous in fixing needle than traditional method and it also bring good benefit for society and economy and can be used widely in clinic practice.     

弹力罩在门诊患儿头皮静脉输液辅助固定中的应用

Objective In order to evaluate the clinic effects of elastic covering for fixed scalp intravenous transfusion in children. Methods Four hundred and eight children were divided into control group (201 cases) and observation group (208 cases) randomly, the observation group was given the elastic covering to assist fixation, and the control group was given the traditional long medical adhesive plaster to go around the head to assist fixation. To compare whether the needles emerged from blood vessel, the liquid was leak out and finished transfusion successfully or not during the transfusion as well as the children~ compliance when pulled out the needles and their parents' satisfaction and so on. Results There were significant difference between the two groups in the indexes which had been compared (P＜0.01) . Conclusions The elastic cover is more advantageous in fixing needle than traditional method and it also bring good benefit for society and economy and can be used widely in clinic practice.     

循证医学在疾病防治中的应用

随着科学技术的飞速发展,在疾病的防治中,新药和新的防治措施层出不穷,如何在这浩如烟海的世界中,迅速寻找到最新最佳的治疗证据,如何在疾病的防治中实践循证医学,是我们临床医生面临的新问题.本文结合具体实例就在疾病的防治中如何实践循证医学作一简单介绍.     

Academic reawakening: Situated experiences of undertaking a post graduate masters course in dementia

Master's level education can play important function in developing the knowledge and skills for nurses and allied professionals working in advanced roles in dementia care. However, little is known about the challenges experienced by professionals when making the transition to post-graduate study. This was a qualitative study comprising individual interviews with 15 graduates, nine of whom were nurses, who had experience of attending a part-time Master's in Dementia Care in the Northwest of England. Four sequential themes emerged from the data: ‘Deciding what to do’, ‘Taking it on’, ‘Keeping going’ and ‘Endings and New beginnings’. Findings confirmed that Master's education for nurses and other professionals is significant in developing knowledge and instilling confidence in changing practice. Nevertheless, professionals experienced challenges in juggling the competing demands of education, family and work and were seen to navigate and negotiate their student journey by drawing on internal resources and external supports. The study adds to evidence that Master's level study is likely to benefit practice in dementia care; however, employers and Higher Education Institutions need to develop effective and flexible supports to enable nurses and allied professionals to engage effectively in part-time taught post graduate education.     

Normal reference intervals of prognostic nutritional index in healthy adults: A large multi‐center observational study from Western China

BackgroundIt has been widely reported that the prognostic nutritional index (PNI) played a pivotal role in nutritional assessment of surgical patients and tumor prognosis. In order to improve the accuracy of evaluation in Western China, we established reference intervals (RIs) of PNI in healthy controls.MethodsA retrospective cohort study on healthy ethnic Han adults (18–79 years) was conducted to explore the influences of age, gender, study centers, and instruments on PNI and to establish RIs. The data came from a healthy routine examination center database and laboratory information system (LIS) of four centers in Western China, and there were 200 persons selected randomly for verification of RIs.ResultsFive thousand eight hundred and thirty‐nine healthy candidates were enrolled. PNI showed a marked gender dependence, and males had significantly higher PNI than females across all ages (p < 0.01). We found that PNI is significantly different between age groups (p < 0.01), the value of PNI tended to decrease with age increasing. There is also an obvious influence of centers and instruments on PNI (p < 0.01).ConclusionsWe established reference intervals of PNI in healthy Han Chinese population in Western China and validated successfully. Further established RIs will lead to better standardizations of PNI for clinical applications.     

罕见事件Meta分析中大型研究与小型研究之间的差异

目的以实证研究的方式探讨罕见事件Meta分析中大型研究与小型研究之间的差异。方法通过2003年1月至2018年5月The Cochrane数据库收集的系统评价数据,筛选出具有罕见事件、至少纳入5个研究和至少纳入1个大型研究的二分类结局变量的Meta分析。采用Peto和经典OR值作为效应量,比较包含大型研究与排除大型研究(仅小型研究)Meta分析OR值的大小、方向和P值。结果共纳入214个Meta分析。在214对OR值中,基于Peto OR值,有66对(30.84%)OR值的方向不一致(Kappa=0.33);基于经典OR值,有69对(32.24%)OR值的方向不一致。多数(83.18%)小型研究的Meta分析中,采用Peto方法与经典方法相比,得出的P值更小。结论对有罕见事件二分类变量结局指标的Meta分析,采用不同的效应量和统计方法,包含大型研究的结果和小型研究的结果之间存在较大差异。     

延安市甲状腺疾病的流行病学调查

目的：了解延安市甲状腺疾病流行病学特点。方法：采用整群随机抽样的方法随机抽取2012年3月—2012年9月延安市社区和乡镇6层样本,调查对象为18岁以上常住（≥5年）人口2970人,采用高频超声进行甲状腺检查,对总人群、性别、年龄等数据进行统计学分析。结果：高频超声检出甲状腺异常的总阳性率31.58%（男性28.24%,女性33.70%）;甲状腺局灶性结节粗患病率27.68%（男性25.37%,女性29.14%）,标化患病率26.89%（男性23.71%,女性29.32%）,男女患病率差异有统计学意义（P〈0.05）;甲状腺结节患病率随年龄增长有增加趋势（P〈0.05）。甲状腺弥漫性病变粗患病率3.91%（男性2.87%,女性4.56%）,标化患病率为3.67%（男性2.71%,女性3.91%）,男女患病率差异有统计学意义（P〈0.05）,甲状腺弥漫性病变患病率随年龄增长无增加趋势（P〉0.05）,其患病率主要集中在30~50岁,且女性发病率明显高于男性（P〈0.05）。结论：延安市甲状腺疾病的患病率较高,采用高频超声进行甲状腺疾病的筛查有重要意义。     

Study abroad as a process of learning intercultural competence in nursing

The aim of this research was to describe an international student exchange programme as a context of learning intercultural competence in nursing. Twelve Finnish nursing students who had participated in an exchange programme in the United Kingdom participated. The data consisted of group interviews, learning documents, background questionnaires and research diary notes, and the method of inductive content analysis was used. Study abroad as a process of learning intercultural competence consisted of three ethno-categories: transition from one culture to another, adjustment to the difference and gaining intercultural sensitivity. The exchange programme as a context of learning intercultural competence was characterized by a problematic orientation phase, a study abroad phase that involved stressful but rewarding adjustment to the intercultural differences and an inadequate re-entry debriefing phase. In order for the international experience of nursing students to have an impact on their understanding of diversity, they need assistance in each phase of the programme. Particularly, the students need intercultural tutoring and mentoring to venture into encounters with local people, including direct client contacts, during their study abroad.