Sacral neuromodulation for faecal incontinence – 10 years' experience at a Scottish tertiary centre

Introduction

Sacral nerve stimulation (SNS) is increasingly popular in the management of faecal incontinence. This paper reports the first 10-year experience of SNS in the management of faecal incontinence at a tertiary referral centre. Data was collected in a prospectively maintained database.

Toxic interactions among Pb, Zn, and Cd with varying levels of dietary Ca and vitamin D: Hematological system

Rats were fed lead (0.5%), zinc (0.63%), cadmium (90 ppm), and control diets individually and in combinations with each other. These diets were fed for 42 days with two levels of calcium (0.1 and 0.9%) and three levels of vitamin D (0, 2000, and 50,000 IU/kg of feed). The most significant findings were: a more severe anemia when zinc and cadmium were fed together than when fed individually; a marked reduction of a lead-induced reticulocytosis when toxic zinc or cadmium diets were fed; a reduction of urine δ-aminolevulinic acid levels by the administration of excess zinc to lead-fed rats, or when excess cadmium was fed in low vitamin D diets; and the low serum iron levels of zinc toxicity were further reduced by low calcium or high vitamin D diets.     

Optimal two‐stage reliability studies

The intraclass correlation is often used to assess the reliability of a measurement system. There is a considerable literature devoted to optimizing the standard assessment plan in which a number of subjects are measured repeatedly. We propose a two‐stage investigation, here called a leveraged plan (LP), where in Stage I, we measure a number of subjects once. Then in Stage II, we select a subset of subjects with extreme initial measurements for repeated measurement. For a fixed total number of measurements, we show that the optimal LP provides a more precise estimate of the intraclass correlation coefficient than does the optimal standard plan (SP). We provide a table for finding the optimal LP given the true intraclass correlation and a specified precision for the estimate. For a fixed total number of measurements N, a nearly optimal LP makes roughly N/2 measurements in Stage I and then selects roughly N/6 extreme subjects to re‐measure thrice each in Stage II. We also compare optimal leveraged with optimal SPs when there is a limit on the number of times each subject can be re‐measured. Copyright © 2009 John Wiley & Sons, Ltd.     

Family‐centred outcome measurement following paediatric stroke

Background/aim: Therapy programmes aim to provide services that are family‐centred and address the specific needs of children. The Canadian Occupational Performance Measure (COPM) and the Perceived Efficacy and Goal Setting system (PEGS) are two measures that are available to assist in determining therapy priorities for children and their parents; however, the use of these measures has not been documented for children who have sustained a stroke. This project aimed to describe the functional concerns identified by children and their parents following paediatric stroke. Methodology: A cross‐sectional design was used. A total of 26 children were recruited from a paediatric stroke outpatient clinic, and functional concerns were identified using either the COPM or the PEGS. Results: Children and their parents identified similar issues. Of the 26 participants, 23 (88.5%) reported ongoing functional concerns at three months or more following stroke, whereas three participants did not identify any ongoing functional concerns. Functional concerns were grouped into categories of self‐care, productivity and leisure as outlined in the Canadian Model of Occupational Performance. Concerns were identified across all functional domains by both children and their parents. Conclusions: The COPM and PEGS provided useful information about functional issues that are important to children and their parents following paediatric stroke. Use of these client‐centred measures provides an opportunity to better understand the impact of paediatric stroke on children’s functional abilities, and allows greater scope for service provision and planning for this group of children.     

Physical Compatibility of Sodium Glycerophosphate and Calcium Gluconate in Pediatric Parenteral Nutrition Solutions

Background: The solubility of inorganic calcium and phosphate in parenteral solutions can be complicated in pediatrics due to the dosing of calcium and phosphorus at the saturation point. The purpose of this study was to test the solubility of sodium glycerophosphate (NaGP) with calcium gluconate in pediatric parenteral nutrition (PN) solutions. Methods: Five PN solutions were compounded by adding calcium gluconate at 10, 20, 30, 40, and 50 mEq/L and corresponding concentrations of NaGP at 10, 20, 30, 40, and 50 mmol/L. Each of the 5 solutions was compounded using 1.5% and 4% amino acids, cysteines, and lipids. Compatibility was evaluated by visual inspection (precipitation, haze, and color change). Solutions were evaluated microscopically for any microcrystals and measured by a turbidimeter for changes in turbidity. Solutions were further analyzed using United States Pharmacopeia 788 standards. Six hundred seventy‐one PN solutions were compounded at various concentrations and evaluated for visual stability. Results: Compatibility testing showed no changes in the PN solution in any of the concentrations tested. Microscopically, no microcrystals were detected. The turbidimeter measurements had changes of ≤0.14 nephelometric turbidity units for all test solutions. There were no visual changes in any of the 671 PN solutions. Conclusion: It is recommended that NaGP replace sodium phosphate in PN solutions. This would eliminate the concern of calcium and phosphorus precipitation and the need of any saturation curves.     

藏族初中生心理健康状况与应对方式的关系研究

目的 了解应对方式对藏族初中生心理健康状况的影响。方法 采用自编的一般资料,中学生心理健康评定量表、简易应对方式问卷对786名藏族初中生进行问卷调查。结果 分层回归分析显示,第一层人口变量中上学方式、年级、家庭人均月收入、是否留守、学习成绩进入藏族初中生心理健康状况的回归方程(F=8.526,P=0.000),控制人口变量后,应对方式能独立解释心理健康状况21.70%的方差变异。结论 住校、初一、留守、学习成绩差、家庭收入低的藏族初中生心理健康状况差;管理者加强应对技巧的培训,能改善藏族初中生的心理健康状况。     

2018年西藏地区居民住院服务利用情况分析

目的 分析2018年西藏地区居民住院服务利用的情况,了解现状并为相关部门合理配置资源提供依据。方法 用多阶段分层整群随机抽样的方法,对15岁及以上西藏居民的住院情况进行统计分析,共10 501份问卷,采用描述性分析、χ2检验及logistic回归分析。结果 2018年西藏地区15岁及以上居民住院率为8.2%,住院原因中消化系统疾病占比（22.0%）最高;需住未住率为1.4%,未住原因中其他原因占比（38.4%）最高,其次为经济困难（29.1%）。多因素分析中男性（OR:1.788,95%CI:1.535～2.083）、45~54岁（OR:3.319,95%CI:2.457～4.483）、未在婚（OR:1.704,95%CI:1.408～2.062）、自评健康分值良好（OR:2.423,95%CI:1.842～3.189）、不患慢性病（OR:2.208,95%CI:1.871～2.605）是住院的保护因素。结论 2018年西藏地区住院率及住院服务利用低,多种因素影响居民住院情况,应根据实际需求实施有针对性的措施。     

甲型H1N1流感流行期间发热门诊的医院感染控制措施

目的总结甲型H1N1流感流行期间发热门诊的医院感染措施经验。方法调配人力资源,强化培训,使消毒隔离和个人防护措施落实到位。结果预检筛查发热患者2453例,确诊的甲型H1N1流感患者140例,占5.7%;与患者密切接触者和医务人员未发生感染,及时有效地阻止了疫情的扩散和蔓延。结论发热门诊的布局、管理体系和完善的工作流程,在应对突发公共卫生事件的救治中有重要意义。