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21.
Yasuaki?SaijoEmail authorView authors OrcID profile Eiji?Yoshioka Yoshihiko?Nakagi Yasuyuki?Kawanishi Sharon?J.?B.?Hanley Takahiko?Yoshida 《International archives of occupational and environmental health》2017,90(6):539-553
Objectives
To elucidate the impact of social support and its interrelations with other demand–control–support (DCS) model factors on presenteeism and absenteeism, and to determine which DCS factors were most influential.Methods
Questionnaires from 2535 local government employees were analyzed. The Brief Job Stress Questionnaire (BJSQ) was used to assess DCS factors including job demand, job control, and social support from supervisors and coworkers. The Stanford Presenteeism Scale 13-item version (SPS-13) was used to evaluate both absenteeism (absent days) and presenteeism. For the latter, the Work Impairment Score (WIS) and the Work Output Score (WOS) were also used. Possible confounder-adjusted logistic and negative binomial regression analyses were performed to obtain odds ratios (ORs) for WIS and WOS and relative risks (RRs) for absenteeism according to DCS factors.Results
Higher job control had a significantly protective effect on higher WIS in both males and females and a lower WOS in males. Based on a point estimate of an OR per 1 standard deviation change of each DCS factor, job control had the strongest effect on higher WIS in both males and females and a lower WOS in males. Higher job demand resulted in significantly higher ORs for both male and female WIS, and a lower WOS in females. Support from supervisors had a significantly protective effect on higher WIS in females and a lower WOS in males. Support from coworkers had a significantly protective effect on higher WIS in males. Higher support from coworkers had a significantly protective effect on absenteeism among both males and females, and higher job control had a significantly protective effect in females. The combination of high job strain and low support from supervisors had a significantly worsening effect, except for absenteeism in females. High job strain and low support from coworkers had a significantly worsening effect except for WOS in males.Conclusions
The results suggest job control was the DCS factor most related to presenteeism. Higher support from supervisors and coworkers had a protective effect on presenteeism, and higher job demand had a worsening effect. Higher support from coworkers had a protective effect on absenteeism among both males and females. Interventions should focus on improving job control as a possible countermeasure to presenteeism, and encouraging support from coworkers as a possible countermeasure to absenteeism.22.
Early Administration of Adjuvant β‐Lactam Therapy in Combination with Vancomycin among Patients with Methicillin‐Resistant Staphylococcus aureus Bloodstream Infection: A Retrospective,Multicenter Analysis
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23.
Erica?BorgstromEmail authorView authors OrcID profile Rachel?Morris Diana?Wood Simon?Cohn Stephen?Barclay 《BMC medical education》2016,16(1):306
Background
Over recent years there has been an increase in teaching of both palliative care and reflective practice in UK medical schools. The palliative care teaching at the University of Cambridge School of Clinical Medicine is multi-faceted and involves students writing reflective essays after individually meeting patients approaching the end of life during their final year general practice and hospital medicine placements. This paper draws on two studies examining this teaching element to analyse what the students found valuable about it and to comment on the practice of meeting patients and subsequent reflective writing.Methods
Two studies have explored students’ perceptions of these course components. The first was a thematic analysis of 234 reflective essays from 123 students written in 2007-2008, including examining what students wrote about the exercise itself. The second project involved a semi-structured questionnaire that students completed anonymously; this paper reports on the free text elements of that study [sample size =107]. Since similar themes were found in both studies, the coding structures from each project were compared and combined, enabling triangulation of the findings around what the students found valuable from the palliative care teaching involving meeting patients and reflective writing.Results
Overall, students reported that these components of the palliative care teaching are valuable. Four main themes were identified as aspects that students valued: (1) dedicated time with patients, (2) learning about wider elements of treatment and holistic care, (3) practicing communication skills, and (4) learning about themselves through reflective writing. Some students expressed a dislike for having to formally write a reflective essay.Conclusion
It is possible to arrange for all of the medical students to individually meet at least two patients receiving palliative or end of life care. Students found these encounters valuable and many wrote about the benefit of formally writing about these experiences. Students reported finding this model useful in widening their skill-set and understanding of palliative care.24.
一种能精确检测人间期细胞核中21号染色体拷贝数的DNA探针 总被引:4,自引:0,他引:4
目的制备能精确检测人类间期细胞核中21号染色体拷贝数的FISH探针。方法利用万能引物PCR法,从定位于人21q11的YAC克隆881D2分离制备DNA探针,并用于与8例正常人和5例21三体患者的外周血淋巴细胞中期相和间期核,及经细胞松弛素B(cytochalasinB)诱导的双核细胞进行FISH分析。结果该探针具有以下特点:(1)长度集中于350~750bp;(2)其靶序列位于21号染色体长臂上且紧靠着丝粒;(3)特异性强;(4)杂交信号明亮,容易辨认;(5)对中期相及间期细胞核中21号染色体的检出率分别高达99.60%和98.40%。结论制备的DNA探针能精确检测人类间期细胞核中21号染色体的拷贝数,且适用于细胞分裂时21号染色体分离情况的研究 相似文献
25.
J.?J.?VehreschildEmail authorView authors OrcID profile C.?P.?Heussel A.?H.?Groll M.?J.?G.?T.?Vehreschild G.?Silling G.?Würthwein M.?Brecht O.?A.?Cornely 《European radiology》2017,27(8):3275-3282
Background
Serial chest CT is the standard of care to establish treatment success in invasive pulmonary aspergillosis (IPA). Data are lacking how response should be defined.Methods
Digital CT images from a clinical trial on treatment of IPA were re-evaluated and compared with available biomarkers. Total volume of pneumonia was added up after manual measurement of each lesion, followed by statistical analysis.Results
One-hundred and ninety CT scans and 309 follow-up datasets from 40 patients were available for analysis. Thirty-one were neutropenic. Baseline galactomannan (OR 4.06, 95%CI: 1.08–15.31) and lesion volume (OR 3.14, 95%CI: 0.73–13.52) were predictive of death. Lesion volume at d7 and trend between d7 and d14 were strong predictors of death (OR 20.01, 95%CI: 1.42–282.00 and OR 15.97, 95%CI: 1.62–157.32) and treatment being rated as unsuccessful (OR 4.75, 95%CI: 0.94–24.05 and OR 40.69, 95%CI: 2.55–649.03), which was confirmed by a Cox proportional hazards model using time-dependent covariates.Conclusion
Any increase in CT lesion volume between day 7 and day 14 was a sensitive marker of a lethal outcome (>50%), supporting a CT rescan each one and 2 weeks after initial detection of IPA. The predictive value exceeded all other biomarkers. Further CT follow-up after response at day 14 was of low additional value.Key Points
? CT evaluation offers good prediction of outcome for invasive pulmonary aspergillosis.? Predictive capability exceeds galactomannan, blood counts, and lesion count.? Any progression between day 7 and day 14 constitutes a high-risk scenario.26.
Thomas?Vogel Rebekka?Maria?Wrobel Oliver?Graupner Silvia?Lobmaier Hubertus?Feussner Bettina?KuschelEmail authorView authors OrcID profile 《Archives of gynecology and obstetrics》2018,298(3):511-519
Introduction
Little is known concerning the interaction of achalasia and pregnancy and about an optimal time and type for treatment. Achalatic women of our collective of patients with at least one pregnancy in their history resulting in confinement or miscarriage were invited for a structured interview.Materials and methods
43 of 109 female patients were included. Questionnaire contained questions on symptoms, type of symptoms, whether patients could link a specific event with outbreak of disease. Date of primary diagnosis and individual therapies were double checked against our documentation as well as duration of complaints and kind of therapy. Patients were asked about their obstetric history, whether and how symptoms had changed, and during which pregnancy week symptoms have occurred. Temporal correlation of the diagnosis of achalasia and pregnancy was investigated.Results
There was no relationship between pregnancy and onset of achalasia. Risk of subfertility, undernourishment, premature birth, or miscarriage does not seem to be increased in achalasia. Health condition often worsened significantly during pregnancy, mainly in the first trimester and particularly in the untreated patients.Conclusions
It is advisable to clarify the diagnosis if symptoms suspicious of an achalasia are present before a planned pregnancy. In case of manifest achalasia, surgical treatment should be performed before pregnancy and the improvement in the state of health should be anticipated, as, otherwise, a considerable deterioration of the symptoms during pregnancy may occur. Scientific impact of our observations is very limited and prospective clinical trials are required.27.
28.
A prospective study of multiple needle biopsies versus a single open biopsy for testicular sperm extraction in men with non-obstructive azoospermia 总被引:13,自引:9,他引:4
Little is known about the efficacy and the factors affecting the outcome of
fine needle aspiration biopsy of the testis for sperm retrieval in
azoospermic men with defective spermatogenesis. A prospective study was
designed to compare the efficacy of needle and open (window) testicular
biopsies for testicular epididymal sperm extraction (TESE) in 35
consecutive men with azoospermia due to defective spermatogenesis
undergoing testicular biopsy for intracytoplasmic injection of oocytes.
Each of the consecutive 35 patients underwent TESE using a 19 gauge
butterfly needle followed by a window (1-1.5 cm-sized incision) testicular
biopsy in the same procedure. The extraction of spermatozoa into culture
medium was compared with the assessment of testicular biopsies by
histology, the mode of biopsy (needle or open biopsy) and the amount of
tissue retrieved by either method. Testicular spermatozoa were retrieved in
22 (63%) who had an open testicular biopsy compared with five (14%)
patients who had multiple needle biopsies, respectively; the difference was
statistically significant. Open testicular biopsy retrieves more testicular
tissue than needle biopsy. Needle testicular biopsy retrieved testicular
spermatozoa in 50% of those with hypospermatogenesis, 10% with focal
spermatogenesis and in no patients with maturation arrest or Sertoli
cell-only pattern. In contrast, sperm retrieval was successful in 100%, 90%
and 66% of those with respective histologies using open testicular biopsy.
Other than bruising, for which they required no analgesia, none of the
patients suffered any obvious complications associated with traditional
testicular biopsy. We conclude that open testicular biopsy is more
effective than needle biopsy for the retrieval of testicular spermatozoa in
azoospermic men with defective spermatogenesis. The difference observed may
be related to the amount of testicular tissue retrieved and to the
influence of testicular histology.
相似文献
29.
A prospective trial was undertaken to evaluate the efficacy of stimulated
in-vitro fertilization (SIVF) and stimulated intrauterine insemination
(SIUI) in couples with unexplained and mild male factor infertility. In
all, 80 couples were allocated to treatment with SIVF or SIUI, both
treatments following the same protocol [clomiphene citrate and follicle
stimulating hormone (FSH) injection], except that higher doses of FSH were
used in the SIVF treatment cycles. Initially, 41 couples were allocated to
and started treatment with SIVF but eight cases were eventually converted
to SIUI because of under-response. Similarly, although 39 couples were
initially allocated to SIUI treatment, five of these converted to SIVF
because of over-response. The treatment cycles that were converted either
to SIUI or to SIVF were not considered as treatment failures but as
treatment changes and so were included in the analyses. Of the final 38
SIVF cycles, four were cancelled (dysfunctional response), failed
fertilization occurred in five cycles and 29 subjects reached embryo
transfer. There were two biochemical pregnancies [positive human chorionic
gonadotrophin (HCG) only], two clinical abortions and seven live births. Of
the final 42 SIUI cycles, only two were cancelled, insemination being
performed in the remaining 40 cases. The result was one clinical abortion,
three ectopics and eight live births. The proportion of cycles with
positive HCG was identical (28.9% per cycle treated for SIVF and 28.6% for
SIUI) and the livebirth rates were also not different (18.4% per cycle
treated for SIVF and 19.0% for SIUI). The cost per maternity of SIUI was
approximately half that of SIVF (Pounds Sterling 1923 versus Pounds
Sterling 4611) and so we conclude that, as SIUI had an efficacy that was
not significantly different from SIVF (using similar protocols) but was
more cost-effective, it must be considered the more appropriate form of
management for the treatment of unexplained and mild male factor
infertility. Indeed, it is hard to justify the routine use of IVF, as a
first approach, in unexplained infertility.
相似文献
30.
M.?L.?SundeEmail authorView authors OrcID profile A.?Neg?rd T.??resland N.?Bakka J.?T.?Geitung A.?E.?F?rden 《International journal of colorectal disease》2018,33(5):609-617