狼疮性肾炎患者预后影响因素分析

目的探讨狼疮性肾炎(lupus nephritis,LN)患者肾损害程度及预后影响因素。方法 303例LN患者根据肾小球有效滤过率(estimated glomerular filtration rate,eGFR)水平分为3组,85例eGFR≤60mL/(min·1.73m2)患者为预后不良组,72例eGFR>60~<90mL/(min·1.73m2)患者为预后中等组,146例eGFR≥90mL/(min·1.73m2)患者为预后良好组;记录各组性别、年龄、24h尿蛋白定量、血红蛋白、血小板计数、抗核抗体ANA、抗ds-DNA抗体、补体C3、补体C4水平、平均动脉压、血钙、血磷、尿酸、SLEDAI评分等指标,采用单因素相关分析和多因素回归分析评估影响肾损害的危险因素。结果 3组年龄、平均动脉压、24h尿蛋白定量、血小板计数、血红蛋白、补体C3、血尿酸水平比较差异有统计学意义(P<0.05),单因素logistic回归分析结果显示年龄(OR=1.31,95%CI:0.010~0.043,P=0.002)、高血压病史(OR=3.31,95%CI:0.711~1.685,P=0.000)、血红蛋白降低(OR=0.98,95%CI:-0.032^-0.013,P=0.000)、低补体血症(OR=0.34,95%CI:-1.800^-0.338,P=0.004)、24h尿蛋白定量增加(OR=1.08,95%CI:0.140~1.720,P=0.012)、尿酸增高(OR=1.00,95%CI:0.004~0.008,P=0.000)、血小板降低(OR=0.97,95%CI:-0.050^-0.000,P=0.370)是肾损害的影响因素;logistic多因素回归分析显示,年龄大(OR=1.67,95%CI:0.024~0.078,P=0.000)、贫血(OR=0.85,95%CI:-0.029^-0.002,P=0.028)、24h尿蛋白定量增加(OR=4.60,95%CI:1.001~2.102,P=0.032)、尿酸水平增高(OR=1.00,95%CI:0.005~0.010,P=0.000)是预后不良的独立危险因素。结论年龄大、贫血、24h尿蛋白定量增高及血尿酸水平增高与LN患者肾功能进一步恶化有关,对预后判断有意义。     

Stanford A型主动脉夹层术后早期发生急性肾损伤的影响因素

目的探讨急性Stanford A型主动脉夹层(acute Stanford type A aortic dissection,AAAD)患者术后早期发生急性肾损伤(acute kidney injury,AKI)的影响因素,为减少AAAD患者术后早期发生AKI提供参考。方法行手术治疗的AAAD患者175例,术后48 h发生AKI者96例为AKI组,未发生AKI者79例为非AKI组。比较2组身高,脉压,手术时间≥8 h、高血压及脏器灌注不良发生率等临床资料;比较2组左室射血分数及血清肌酐、尿酸、谷草转氨酶水平等;多因素logistic回归分析AAAD患者术后早期发生AKI的影响因素。结果AKI组身高[(170.3±7.6)cm]低于非AKI组[(173.1±7.7)cm](P<0.05),脉压[(62.7±17.5)mm Hg]、血清谷草转氨酶水平[24.0(17.0,38.8)u/L]及高血压、手术时间≥8 h、脏器灌注不良比率(86.5%、8.3%、36.5%)高于非AKI组[(54.4±17.9)mm Hg、20.0(15.0,28.0)u/L、70.9%、1.3%、13.9%](P<0.05);2组年龄、性别比例、体质量等一般资料,左室射血分数及血清肌酐、尿酸水平比较差异均无统计学意义(P>0.05)。多因素logistic回归分析结果显示,身高(OR=0.955,95%CI:0.914~0.999,P=0.045),脏器灌注不良(OR=0.245,95%CI:0.109~0.555,P=0.001)、脉压(OR=1.027,95%CI:1.008~1.047,P=0.006)、手术时间(OR=8.787,95%CI:1.028~75.093,P=0.047)是AAAD患者术后早期发生AKI的影响因素。结论身高、脏器灌注不良、脉压、手术时间与AAAD患者术后早期发生AKI有关。     

肺结节患者术后延迟出院的危险因素分析

目的 探讨肺结节手术患者术后延迟出院的影响因素。方法 回顾性分析2021年6月至8月东部战区总医院因肺结节全麻下行胸腔镜/达芬奇机器人手术患者223例的电子病历资料,其中男91例,女132例。采用单因素分析和二元logistic回归分析筛选肺结节患者术后延迟出院的危险因素。结果 以术后住院时间≥3 d的159例(71.3%)患者为延迟出院组,<3 d的64例(28.7%)为正常出院组。延迟组患者的年龄、男性比例、吸烟史比例、胸腔镜手术占比、手术时长、术中补液量、术中失液量、丙泊酚使用量、术后并发症发生率、胸腔引流管留置时间及引流量明显高于正常出院组(P<0.05)。二元logistic回归分析显示,年龄大[OR=1.063,95%CI(1.016～1.111),P=0.008]、引流管留置时间长[OR=8.743,95%CI(4.144～18.445),P<0.01]以及使用常规静脉镇痛泵[OR=3.759,95%CI(1.232～11.468),P=0.020]是术后住院时长≥3 d的独立危险因素。结论 年龄大、引流管留置时间长以及使用常规静脉镇痛泵可影响肺结节手术...     

AECOPD患者再入院的危险因素分析

目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者再入院的影响因素。方法 回顾性分析283例AECOPD患者临床资料,根据患者出院后90 d内是否非计划再入院分为再入院组75例和非再入院组208例,通过单因素及多因素logistic回归分析AECOPD患者再入院的影响因素。结果 283例AECOPD患者出院90d内非计划性再入院率为26.50%。logistic回归分析:年龄高(OR=1.893,95%CI:1.121～2.757)、营养不良(OR=2.604,95%CI:1.245～4.019)、FEF75预计值升高(OR=1.365,95%CI:1.057～2.562)、过去1年急性加重次数≥2次(OR=2.071,95%CI:1.319～3.280)为AECOPD患者非计划性再入院的独立影响因素。文化程度高(OR=0.722,95%CI:0.501～0.943)、FEV₁实际值升高(OR=0.513,95%CI:0.361～0.733)、坚持运动锻炼(OR=0.410,95%CI:0.282～0.741)为AECOPD患者再入院风险的保护因素。结论 年...     

血清S100A4水平与急性心肌梗死患者预后相关性分析

目的探讨血清钙卫蛋白A4(S100A4)水平对急性心肌梗死(AMI)患者预后的预测价值。方法选取中铁二局集团中心医院2015年6月至2018年6月诊治的128例AMI患者作为研究组,根据患者住院期间和出院后30d主要心血管不良事件(MACE)发生情况分为非MACE组(37例)和MACE组(91例);同时选取64例体检健康人群作为对照组。检测研究对象血清S100A4、B型脑钠肽(BNP)和心肌肌钙蛋白T(cTnT)水平。采用多因素Logistic回归分析MACE发生的危险因素,同时采用受试者工作特征曲线(ROC曲线)分析血清S100A4、BNP和cTnT对AMI患者发生MACE的预测价值。结果非MACE组血清S100A4、BNP和cTnT水平显著性低于MACE组(P<0.05)。受试者工作特征曲线分析显示:S100A4对AMI患者预后的预测价值优于BNP和cTnT。多因素Logistic回归分析显示:年龄(OR=2.90,95%CI 1.24~6.74)、Killip分级(OR=5.02,95%CI 2.53~9.94)、吸烟史(OR=1.67,95%CI 1.07~2.61)、BNP>389.17pg/mL(OR=1.76,95%CI 1.19~2.61)、cTnT>0.93ng/mL(OR=1.61,95%CI 1.05~2.49)、S100A4>120.56pg/mL(OR=1.88,95%CI 1.16~3.02)是AMI患者发生MACE的危险因素。结论 AMI患者血清S100A4水平显著上升,可作为预测AMI患者MACE发生的标志物。     

带状疱疹疼痛患者远期疼痛危险因素分析

目的 探讨带状疱疹(HZ)急性期疼痛患者发生远期(>6个月)疼痛的危险因素。方法 采用1:1配对的病例对照研究方法,纳入6个月后VAS评分≥3分的带状疱疹神经痛患者102例为病例组,与其年龄、性别、受累神经节段相匹配且未发生远期疼痛的患者102例为对照组,对影响因素行单因素和多因素条件Logistic回归分析。结果 前驱痛(OR=4.26,95%CI:2.09～8.69)、糖尿病(OR=4.06,95%CI:1.62～10.07)、72 h内使用抗病毒药物(OR=0.26,95%CI:0.12～0.55)、使用钙通道调节剂(OR=0.35,95%CI:0.17～0.75)、阿片类药物使用<4周(OR=0.29,95%CI:0.11～0.74)、阿片类药物使用≥4周(OR=1.87,95%CI:0.79～4.45)、72 h内就医(OR=0.61,95%CI:0.28～1.33)与带状疱疹急性期疼痛患者发生远期疼痛存在相关性。结论 前驱痛、糖尿病是HZ急性期疼痛患者发生远期疼痛的危险因素;72 h内使用抗病毒药物、使用钙通道调节剂、阿片类药物使用<4周是HZ急性期疼痛患...     

老年患者无痛内镜下逆行性胰胆管造影术不良反应及其危险因素分析

目的探讨老年患者无痛内镜下逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)的主要不良反应及其发生的危险因素。方法静脉麻醉辅助下行ERCP诊治的老年患者126例,观察ERCP围术期血压、心率、呼吸频率、血氧饱和度(blood oxygen saturation,SpO2)等变化以及不良反应发生情况;采用多因素logistic回归分析主要不良反应发生的危险因素。结果126例患者ERCP术中收缩压[(107.2±10.6)mm Hg]、SpO2[(89.70±0.38)%]均较术前[(120.8±12.5)mm Hg、(98.80±0.56)%]明显降低(P0.05),术前、术中及术后舒张压、心率、呼吸频率比较差异均无统计学意义(P0.05);术中并发低氧血症(SpO290%)47例(37.3%),血压下降22例,心动过缓3例,恶心呕吐及呛咳各1例;多因素logistic回归分析结果显示,年龄≥80岁(OR=5.309,95%CI:1.987~14.186,P=0.000)、吸烟≥10支/d且30a以上(OR=5.447,95%CI:2.075~14.300,P=0.000)、饮酒≥40g/d且20a以上(OR=3.563,95%CI:1.183~10.731,P=0.000)、体质量指数≥30kg/m2(OR=23.833,95%CI:2.296~191.702,P=0.000)、合并慢性阻塞性肺疾病(OR=8.308,95%CI:3.162~21.824,P=0.000)、丙泊酚用量≥280mg(OR=3.773,95%CI:1.708~8.336,P=0.000)、操作时间≥2h(OR=4.993,95%CI:2.117~11.777,P=0.000)是老年患者无痛ERCP发生低氧血症的危险因素。结论低氧血症是老年患者无痛ERCP术中的主要不良反应,高龄(≥80岁)、长期大量吸烟(≥10支/d且在30a以上)、长期大量饮酒(≥40g/d且在20a以上)、高体质量指数(≥30kg/m2)、合并慢性阻塞性肺疾病、丙泊酚用量大(≥280mg)、操作时间长(≥2h)是其发生的危险因素。     

三阴性乳腺癌危险因素及临床特征分析

目的探讨三阴性乳腺癌(triple negative breast cancer,TNBC)的相关危险因素及临床病理学特征。方法 210例乳腺癌患者,70例TNBC患者为观察组,140例非TNBC患者为对照组,比较2组一般资料,分析TNBC的危险因素以及临床病理学特征。结果 2组年龄、体质量指数、泌乳情况、使用避孕药以及产次比较差异均有统计学意义(P0.05);多因素logistic回归分析显示,体质量指数25kg/m~2(OR=9.604,95%CI:3.670~89.237,P=0.002)、抑制泌乳(OR=9.00,95%CI:1.070~75.668,P=0.043)、使用避孕药(OR=13.280,95%CI:3.322~113.423,P=0.006)是TNBC发生的危险因素;TNBC主要表现为进展期浸润性导管癌,且具有更高的T、M分期。结论肥胖、抑制泌乳以及口服避孕药是女性TNBC发生的危险因素,TNBC恶性程度高于非TNBC。     

口腔颌面部恶性肿瘤术后手术部位感染因素分析

目的分析口腔颌面部恶性肿瘤患者术后手术部位感染的相关因素。方法采用回顾性研究方法,将240例口腔颌面部恶性肿瘤手术治疗患者纳入研究,统计术后手术部位感染发生率、肿瘤分布部位,根据是否发生感染分为感染组和非感染组;将术前血清白蛋白水平、术前牙结石情况、手术方式、术中是否使用抗生素、术中出血量、手术时长、置管时长、住院时长、术后放置引流管情况及转入重症加强护理病房(ICU)时长考虑为可能影响术后术区感染的因素,对比感染组与非感染组患者上述指标,进行单因素分析。将单因素分析发现可能相关的因素(P0.05)纳入logistic回归分析,找出独立危险因素。结果舌癌患者术后手术部位感染率最高,其次为颊癌、唇癌、牙龈癌,而腭癌无感染发生,P 0.05。通过对比非感染组和感染组单因素分析发现感染组患者术前血清白蛋白≤35g/L、术前牙周结石Ⅲ度、术式Ⅲ(扩大切除+颈淋巴结清扫+皮瓣修复术)、术中使用抗生素、置管时间≤24h、住院时间18d、术后放置引流管的百分率均较非感染组高,差异均有统计学意义(P0.05)。两组在术中出血量、手术时长、转入ICU时长比较差异均无统计学意义(P0.05)。多因素logistic回归分析发现导致患者术后手术部位感染的独立危险因素包括:术前牙周结石Ⅲ度(OR=7.149,P=0.014)、术前血清白蛋白≤35g/L(OR=0.059,P=0.034)、术式Ⅲ(OR=4.135,P=0.024)、住院时间18d(OR=24.845,P=0.009)。结论研究发现术前牙周结石Ⅲ度、术前血清白蛋白值≤35g/L、术式Ⅲ、住院时间18d是口腔颌面部恶性肿瘤患者术后手术部位感染的独立危险因素,且感染多发生在舌癌患者中,应针对具备上述特征的患者重点预防术后术区感染。     

中老年臂踝脉搏波传导速度与动脉硬化危险因素的关系

目的探讨中老年患者臂踝脉搏波传导速度(baPWV)与动脉硬化危险因素的关系。方法通过对2012-2016年沈阳市第十人民医院心内科住院治疗行baPWV测定的360例患者数据进行统计,其中符合入选标准、资料完整的186例纳入统计分析。按照baPWV测定结果分为两组:非动脉硬化组(baPWV1 400cm/s)61例和动脉硬化组(baPWV≥1 400cm/s)125例。通过多因素logistic回归分析发现对baPWV有意义的危险因素。结果与非动脉硬化组比较,动脉硬化组的年龄、静息心率、高血压严重程度、baPWV明显高于非动脉硬化组(P0.05)。baPWV的多因素logistic回归分析:除年龄、吸烟史外,高血压分级、静息心率是baPWV的独立危险因素(OR=3.220,95%CI=1.912~5.422,P=0.000;OR=2.226,95%CI=0.897~5.524,P=0.085;OR=2.175,95%CI=1.583~2.990,P=0.000;OR=3.523,95%CI=1.654~7.506,P=0.001);血清总胆红素是保护因素(OR=0.378,95%CI=0.152~0.937,P=0.036)。结论增龄、吸烟、高血压水平、静息心率是动脉僵硬度增加的独立危险因素,而总胆红素是保护因素。     

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.