Quantitative evaluation of regular morning meetings aimed at improving work practices associated with effective interdisciplinary communication

In 2000, an interdisciplinary surgical morning meeting (SMM) was introduced into the infants' and toddlers' ward of a major paediatric hospital to help overcome a number of communication and work process problems among the health professionals providing care to children/families. The objective of this study was to evaluate the impact of the SMM on a range of work practices. Comparative design including pre- and postintervention data collection was used. Data were collected on 100 patient records. Twenty children, from each of the five diagnostic-related groups most commonly admitted to the ward, were included. Demographic, medical review, documentation, critical incidents and complaint variables were obtained from three sources: the hospital clinical information system, the children's medical records and the hospital reporting systems for complaints and critical incidents. Children in the postintervention group were significantly more likely to be reviewed regularly by medical staff, to be reviewed in the morning, to have plans for discharge documented regularly throughout their admission and to have admission summary sheets completed at the time of discharge. The findings of the quantitative evaluation add some weight to the arguments for the purposely structured introduction of interdisciplinary teams into acute-care environments.     

超声诊断指标量化评估甲状腺结节

目的 探讨超声鉴别诊断甲状腺结节良、恶性的价值,尝试建立量化分级系统.方法 对1206例患者1329个甲状腺结节的14项超声特征进行评估,计算每项指标的OR值及其赋值,对每个结节进行综合评分,建立量化分级系统.结果 超声诊断指标评分≤3分、4～5分、6～7分、8～9分、10～11分、12～13分、14～15分、16～17分、18～19分、20～21分、22～23分、24～25分、≥26分的各组中,恶性病灶构成比分别为0(0/309)、1.98％ (4/202)、4.40％ (7/159)、14.29％(11/77) 、21.84％(19/87)、59.52％ (25/42)、63.27％(31/49)、81.13％ (43/53)、83.93％ (47/56)、88.33％(53/60)、90.57％ (48/53) 、94.44％(51/54) 、98.44％(126/128).通过ROC曲线得出12分为区分良、恶性结节的最佳界点.根据以上两项结果,初步建立一个分级系统,共分为5级:1级:≤3分(恶性率0),2级:4～7分(恶性率1％～5％),3级:8～11分(恶性率6％～25％),4级:12～21分(恶性率26％～90％),5级:≥22分(恶性率≥90％).结论 量化分级系统使超声报告更加客观化、规范化和标准化,可用于临床评估甲状腺结节恶性风险度.     

Ethical dilemmas associated with small samples

This paper describes the ethical dilemmas which the authors encountered when conducting qualitative research with samples consisting of a small number of participants. Ethical conflicts are explored in terms of the principles of autonomy, non-maleficience, and beneficience with examples from the authors' research experiences. Although there are no definitive resolutions to these conflicts, the paper may increase awareness of the special concerns which require further study and debate.     

超声造影定量评价糖尿病肾病肾功能损害的价值

探讨超声造影定量分析技术观察糖尿病肾病(Diabetic nephropathy,DN)的肾功能损害的临床价值。方法:选取临床已确诊的Mogensen分期为Ⅲ期、Ⅳ期的DN患者16例,其中Ⅲ期为早期DN组,Ⅳ期为临床期DN组,各8例,另选年龄、身高、体质量相匹配的健康志愿者8例为对照组。利用QLAB定量分析软件的时间-强度曲线(Time-intensity curve,TIC)观察感兴趣区(Region of interest,ROI)超声造影定量灌注参数,并统计3组间的差异。结果:早期DN组与对照组比较,肾皮质灌注曲线下面积(Area under curve,AUC)增加、峰值强度(Derived peak intensity,DPI)降低的差异有统计学意义(P<0.05)。临床期DN组与对照组比较,肾血流灌注的达峰时间(Time to peak,TTP)延长、DPI降低、AUC减少、曲线上升支斜率增加(Slope rate of ascending curve,A)的差异有统计学意义(P<0.05)。在早期DN组与对照组、临床期DN组与对照组间的曲线下降支斜率(Slope rate of descending curve,a)的差异均无统计学意义(P>0.05)。结论:超声造影定量分析技术可早期、敏感、方便的评价DN的早期肾功能损害。     

重心平衡测定仪检测人体平衡功能

采用重心平衡测定仪测试人体的姿势图及有关参数。正常人重心摆动轨迹分为中心型、前后型、左右型、多中心型、弥散型5种类型 ,以中心型为主。正常人不同年龄组各参数比较 ,20～30岁组平衡功能最佳 ,重心摆动面积小、轨迹短、速度慢 ,随着年龄增加平衡功能逐渐减退 ,50岁以后明显减退。重心平衡测定仪可做为眩晕、前庭病变、脑部病变辅助诊断和康复功能评测定量指标 ,能客观、定量评价人体静立平衡功能 ,对疾病诊断及鉴别诊断也有帮助     

Quantitative alterations of steroid urinary profiles associated with diabetes mellitus

Capillary gas chromatography was used for the acquisition of quantitative metabolic profiles of urinary steroids from normal subjects and diabetic patients. Structures of 70 steroid metabolites have been assigned tentatively through mass spectrometry. Quantitative differences between the groups of normal and pathological samples (both males and females) are seen primarily for androsterone, etiocholanolone, dehydroepiandrosterone, 11-oxygenated 17-ketosteroids, corticosteroid metabolites, and a newly discovered metabolite, recently identified as a C26 pentol. The only significant difference between two different age groups of normal males was shown by androsterone.     

超声造影定量评价糖尿病肾病早期肾功能损害的价值

目的 观察CEUS定量分析技术诊断早期糖尿病肾病肾功能改变的临床应用价值。方法 收集16例临床确诊早期糖尿病肾病患者为病变组。对照组为45名健康志愿者。对所有受检者双肾皮质进行实时灰阶CEUS灌注成像,以QLab图像分析软件计算ROI内造影剂回声信号的强度,生成时间-密度曲线(TIC),得到CEUS灌注参数。结果 与对照组比较,病变组肾CEUS TIC在视觉上差异不显著,但定量灌注参数中,病变组肾皮质灌注曲线下面积(AUC)增大、达峰绝对值(DPI)减低,差异有统计学意义(P均<0.05)。结论 CEUS定量分析技术能准确、安全、简便、敏感地评估早期糖尿病肾病患者肾功能损害。     

容量负荷对尿毒症患者左心室心肌力学的影响

目的应用二维斑点追踪技术（2D-STI）定量评价尿毒症患者动静脉内瘘（AVF）术后的心肌应变,观察容量负荷改变后,左心室心肌收缩力的变化情况。 方法选取2012年7月至2015年2月山西大医院肾内科收治的尿毒症患者66例,作为AVF组;选取年龄与性别相匹配的健康志愿者30位作为健康对照组。应用2D-STI获取2组研究对象左心室收缩期各节段及整体纵向应变（LS）、环向应变（CS）、径向应变（RS）。根据健康对照组左心室舒张末期容积指数（LVEDVI）确定其正常值参考范围为53~70 ml/m²,将AVF组分为容量正常组（LVEDVI≤70 ml/m²）与容量增大组（LVEDVI>70 ml/m²）。术前AVF组与健康对照组心肌应变比较采用单因素方差分析,两两比较采用LSD-t检验;AVF组术前、术后的比较采用配对t检验;心肌应变与容量负荷参数相关性分析采用拟合曲线;重复性的研究采用Bland-Altman分析法及线性相关,用相关系数（r）与差值表示。 结果（1）健康对照组左心室LS、CS从基底段至心尖段逐渐升高（F=14.19、13.60,P均<0.05）,左心室RS中间段最大,心尖段最小（F=13.14,P<0.05）,AVF组左心室LS、CS、RS各节段变化趋势消失,差异无统计学意义（容量正常组：F=0.02、0.50、0.07,容量增大组：F=0.37、0.12、0.63,P均>0.05）;（2）与健康对照组比较,术前AVF容量正常组与容量增大组左心室各节段及整体LS、CS、RS均减低,术前AVF容量增大组左心室各节段及整体LS、CS、RS高于AVF容量正常组（心尖-中间-基底-整体：LS：F=117.49、61.66、24.91、80.70,CS：F=74.88、43.91、28.14、57.08,RS：F=33.65、96.09、89.86、85.85,P均<0.05）;（3）与术前比较,AVF术后左心室各节段及整体LS减低（t=24.05、23.54、16.64、21.34,P<0.05）;（4）左心室整体纵向应变（GLS）与LVEDVI的相关性：Y=-0.006X²+0.956X-25.719（Y：GLS,X：LVEDVI,R²=0.703）,X=80时,Y值最大。 结论（1）容量负荷对尿毒症患者左心室心肌收缩力有规律性影响,LVEDVI<80 ml/m²时心肌收缩力逐渐增大,LVEDVI>80 ml/m²时逐渐减小。（2）左心室LS参数对容量负荷的变化较敏感,可以评价容量负荷对尿毒症患者心肌力学的影响。     

Quantitative evaluation of urinalysis test strips

BACKGROUND: Urine test strip results are generally reported in categories (i.e., ordinal scaled), but automated strip readers are now available that can report quantitative data. We investigated the possible use of these meters to complement flow cytometry of urine and compared reflectance readings with quantitative determinations of urinary glucose and microalbumin. METHODS: We compared URISYS 2400 (Roche) quantitative reflectance data with data from the UF-100 (Sysmex) and biochemical data for 436 nonpathologic and pathologic urine samples. RESULTS: Reproducibility of the reflectance signal was good for high- and low-concentration urine pools for protein (0.8% and 0.9% and 1.5% and 2.2% within and between runs, respectively), leukocyte esterase (1.1% and 1.0%; 5.1% and 1.2%), hemoglobin (1.7% and 1.1%; 8.9% and 1.1%) and glucose (2.1% and 0.5%; 6.5% and 2.3%). Fair agreement was obtained between UF-100 and test strip reflectance data for erythrocytes and hemoglobin (r = -0.680) and leukocytes and leukocyte esterase (r = -0.688). Higher correlations were observed for biochemical and test strip data comparing protein and albumin (r = -0.825) and glucose data (r = -0.851). The lower limits of detection for erythrocytes and leukocytes were 8 x 10(6)/L and 19 x 10(6)/L, respectively. The protein test (n = 220) detected 86% (95% confidence interval, 78-92%) of samples with <30 mg/L albumin with a specificity of 84% (95% confidence interval, 76-91%). CONCLUSIONS: In urine test strip analysis, quantitative hemoglobin and leukocyte esterase reflectance data are complementary with flow cytometric results and glucose and albumin results.     

客观评价小潮气量通气

机械通气(MV)可改善气体交换,但也可导致机械通气相关性肺损伤(简称气压伤)和循环功能抑制,因此,近年来强调小潮气量(VT)通气,这在特定患者发挥了积极作用,但也出现了滥用趋势.VT是否合适主要依据患者的呼吸生理学特点,其核心是胸肺组织的压力-容积(P-V)曲线.     

Quantitative haemodynamic evaluation of aortic cannulas

We have designed a new type of aortic cannula for extracorporeal circulation which we hypothesize has superior haemodynamic characteristics compared with existing types. The aim of the study was to perform a quantitative evaluation of the haemodynamic performance of commercially available aortic cannulas against our new design. Six existing cannulas and two self-designed, modified DLP cannulas were investigated. Pressure drop, peak velocity and wall thickness were obtained from in vitro experiments. Pressure drop and turbulent stresses were obtained by in vivo experiments. At 5 L/min the pressure drops of the new design were 18-25 mmHg in vitro and 20 mmHg in vivo compared with 25-92 mmHg in vitro and 28-90 mmHg in vivo for the six commercially available cannulas. Turbulent stresses of the new design varied between 25 and 50 N/m2 in vivo compared with 125-500 N/m2. Both in vivo and in vitro results showed a clear haemodynamic superiority of the new cannula-tip design compared with all existing types.     

Extrahepatic cholangiocarcinoma associated with clonorchiasis: CT evaluation

BACKGROUND: I evaluated the computed tomographic (CT) features of nine pathologically proven cases of cholangiocarcinoma in the extrahepatic bile duct associated with clonorchiasis. METHODS: CT scans of nine pathologically proven cholangiocarcinoma associated with clonorchiasis were reviewed retrospectively. CT scans were analyzed for the following parameters: tumor (detection, location, gross morphologic type, contrast enhancement), intrahepatic bile duct (dilatation, pattern of dilatation), common bile duct (dilatation, Clonorchis sinensis worms), gallbladder (inflammation, C. sinensis worms), invasion of the contiguous viscera (pancreas, duodenum, liver), lobar atrophy, and lymphadenopathy and metastasis. RESULTS: CT depicted the level and cause of obstruction in all nine patients (100%). Contrast enhancement of the tumors relative to the liver parenchyma showed isoattenuation in five tumors (55%) and hyperattenuation in four tumors (44%). Severe, uniform dilatation of the intrahepatic bile duct was identified in six patients (67%) and central dilatation was seen in two patients (22%). No evidence of dilatation of the intrahepatic bile duct was seen in one patent (11%). Most tumors were located in the proximal third of the extrahepatic bile duct ( n = 7, 78%). Male preponderance was found ( n = 8, 89%). CONCLUSION: Cholangiocarcinoma associated with clonorchiasis was located predominantly in the proximal third of the extrahepatic bile duct and detected more readily than nonclonorchiasis-associated cholangiocarcinoma.