Lumbar Puncture Ordering and Results in the Pediatric Population: A Promising Data Source for Surveillance Systems

Background: The Centers for Disease Control and Prevention is incorporating laboratory data into real-time surveillance systems. When normal patterns of laboratory test orders and results are modeled, aberrations can be detected. Because many test orders are available electronically well before results, atypical patterns of test ordering may signal outbreaks.
Objectives: The authors sought to characterize baseline patterns in the ordering and early results of lumbar punctures, motivated by the possibility of using these data for real-time surveillance for early detection of meningitis or encephalitis outbreaks.
Methods: Retrospective cohorts of pediatric emergency department patients at a single hospital (1993–2003) and from the National Hospital and Ambulatory Medical Care Survey (1992–2000) were used for analysis.
Results: Test ordering exhibits seasonal patterns, with monthly peaks in January and August (p < 0.0001). For the hospital cohort, the rate of cerebrospinal fluid pleocytosis exhibits seasonal patterns (p < 0.0001), with a peak from August to October. This is strongly associated with the rate and pattern of clinical neurologic disease (p < 0.0001). A long-term secular decline in daily test ordering is evident, dropping from 5.3 to 2.9 in the hospital sample, and from 371.8 to 185.3 in the national sample (p < 0.001). The long-term rate of pleocytosis has declined (p < 0.0001), though the yield of testing for pleocytosis has improved (p = 0.0104).
Conclusions: Laboratory test patterns correspond with those of clinical disease and are a promising source of surveillance data. Using such data for real-time monitoring requires specific adjustments for patient age, periodicities, and secular trends.     

The Use of Performance Improvement Methods to Enhance Emergency Department Patient Satisfaction in the United States: A Critical Review of the Literature and Suggestions for Future Research

Objectives: The authors reviewed the evidence on performance improvement methods for increasing emergency department (ED) patient satisfaction to provide evidence-based suggestions for clinical practice.
Methods: Data sources consisted of searches through MEDLINE, CINAHL, PSYCHINFO, Cochrane Library, and Emergency Medicine Abstracts and a manual search of references. Articles were included if they reported a performance improvement intervention targeting patient satisfaction in the ED setting. Articles on studies not conducted in the United States or that failed to provide enough details to allow critical evaluation of the study were excluded. Two authors used structured evaluation criteria to independently review each retained study.
Results: Nineteen articles met all selection criteria. Three studies found varying levels of support for multicomponent interventions, predominantly focused on implementation of clinical practice guidelines for specific presenting complaints and process redesign. Sixteen studies evaluated single-component interventions, with the following having at least one supportive study: using alternating patient assignment to provider teams rather than "zone"-based assignment, enhancing provider communication and customer service skills, incorporating information delivery interventions (e.g., pamphlets, video) that target patient expectations, using preformatted charts, and establishing ED-based observation units for specific conditions such as asthma and chest pain.
Conclusions: There is modest evidence supporting a range of performance improvement interventions for improving ED patient satisfaction. Further work is needed before specific, evidence-based recommendations can be made regarding which process changes are most effective. Recommendations are made for improving the quality of performance improvement efforts in the ED setting.     

Influence of Electromagnetic Fields on Function of Automated External Defibrillators

Objectives: In this study, the authors tested whether electromagnetic interference (EMI) is able to impair correct electrocardiogram analysis and produce false‐positive shock advice from automated external defibrillators (AEDs) when the true rhythm is sinus. Methods: Nineteen healthy subjects were used to test five AEDs available on the Austrian market in a prospective, open, and sequence‐randomized study. The primary outcome variable was the absolute number of shocks advised in the presence of EMI. The secondary outcome was the number of impaired analyses caused by incorrectly detected patient movements or electrode failure. Results: Of 760 tests run, 18 (2.37%) cases of false‐positive results occurred, and two of five AEDs recommended shocks in the presence of sinus rhythm. Of 760 tests run, no electrode failures occurred. There were 27 occurrences (3.55%) of motion detected by an AED in the presence of strong electromagnetic fields. Conclusions: AED models differ in their response to EMI; it may be useful to consider specific safety requirements for areas with such fields present. Working personnel and emergency medical services staff should be informed about potential risks and the possible need for patient evacuation before AEDs are attached and shock recommendations are followed.     

MHC—I类抗原加工途径异常与肿瘤关系的研究进展

随着免疫学研究的不断深入，MHC－I类抗原呈递细节已逐渐明晰，全面认识肿瘤细胞MHC－I类相关抗原加工途径缺陷或改变与肿瘤生物学及肿瘤临床的关系，将有助于肿瘤的诊治和预防。     

重组O-GLcNAc糖基转移酶在昆虫细胞中的表达和纯化

蛋白质的 O- Glc NAc糖基化修饰是一种细胞核蛋白与细胞浆蛋白的蛋白质翻译后修饰。不同于膜蛋白和分泌蛋白的糖基化修饰 ,与蛋白质磷酸化修饰相似。催化蛋白质 O- Glc NAc糖基转移酶 ( OGT)已被克隆。用Hi5昆虫细胞系统表达并纯化了具有活性的重组 OGT。在 Hi5昆虫细胞中表达的鼠肝 OGT带有一 His 6标记片段。经镍离子螯合柱纯化后 ,其比活性达到 0 .88nmol· min- 1·m g- 1 OGT。因此本研究为进一步研究蛋白 O- Glc NAc糖基化修饰提供重要资源     

抑郁障碍患者人格特征与发病关系的研究

目的探讨抑郁障碍患者的人格特征与其疾病发病间的关系。方法采用自评抑郁量表(SDS)、艾森克人格问卷 (EPQ)、应对方式评定量表 (WCRS)和归因方式问卷 (ASQ)对 76名抑郁障碍患者进行测试 ,同时选取 84名健康被试进行对照研究。结果①抑郁组患者在EPQ中神经质 (N)与精神质 (P)的得分显著高于健康组。②WCRS的结果显示在“宣泄接纳”、“退避调节”两个因子上 ,抑郁组的平均得分低于健康组。③在ASQ的得分中 ,抑郁组在负性事件归因的自身性、持久性和整体性均显著高于健康组。④抑郁障碍患者的“神经质”人格特质与应对方式的“宣泄接纳”和“退避调节”因子呈负相关 (r = 0 .474)。结论抑郁障碍患者的人格特征可表现为较强的神经质及孤僻、交往障碍 ,他们这种人格特征及应对和归因方式在其发病过程中起着重要作用。