Involving users in the design of a randomised controlled trial of an intervention to promote early presentation in breast cancer: qualitative study

Background  

The purpose of this study was to explore women's views of the design of a large pragmatic cost-effectiveness randomised controlled trial of the policy of offering a health professional-delivered intervention to promote early presentation with breast symptoms in older women and thereby improve survival, with a view to informing protocol development. The trial will recruit over 100,000 healthy women aged 67+, and outcome data will be collected on those who develop breast cancer. The scale of the trial and the need for long-term follow-up presented a number of design challenges in relation to obtaining consent, ascertaining and contacting participants who developed breast cancer, and collecting outcome data.     

Glucose absorption and gastric emptying in critical illness

Introduction

Gallstones are the most common cause of acute pancreatitis worldwide. Patients with severe acute biliary pancreatitis (SABP) constitute a subgroup of severe acute pancreatitis (SAP) patients in whom systemic inflammation may be triggered and perpetuated by different mechanisms. The aim of this prospective investigation was to examine the adrenal response to corticotropin and the relationship between adrenal function and outcome in patients with SABP.

Methods

Thirty-two patients with SABP were enrolled in this study. A short corticotropin (250 μg) stimulation test (SST) was performed within the first 24 hours of admission to the ICU. Critical illness related corticosteroid insufficiency (CIRCI) was defined as follows: baseline value less than 10 μg/dL, or cortisol response less than 9 μg/dL.

Results

CIRCI occurred in 34.4% of patients. The patients with CIRCI were more severely ill as evidenced by higher APACHE II and SOFA scores and numbers of organ system dysfunction on the day of SST. The in-hospital mortality for the entire group was 21.9%. The CIRCI group had a higher hospital mortality rate compared to those with normal adrenal function (45.5% vs. 9.5%, P = 0.032). The hospital survivors had a higher cortisol response to corticotropin (17.4 (8.3–27.1) vs. 7.2 (1.7–12) μg/dL, P = 0.019). The cortisol response to corticotropin inversely correlated with SOFA score and the number of organ dysfunction on the day of SST. The rates of pancreatic necrosis and bacteremia were significantly higher in the CIRCI group (100% vs 42.9%, P = 0.002; 81.8% vs 23.8%, P = 0.003, respectively).

Conclusions

CIRCI is common in patients with SABP. It is associated with bacteremia, multiple organ dysfunction and increased mortality.     

教师职业倦怠的影响因素调查

目的:探讨不同班级水平、城镇与农村、社会支持与否对教师职业倦怠的影响,探讨大中小学教师职业倦怠与心理健康的关系。方法:①于2003-01/2004-12从新疆维吾尔自治区大、中小学6所汉语学校进行在岗教师的整群抽样,抽取669名汉族教师作为被试进行问卷调查。②采用Maslach教师职业倦怠问卷评估倦怠情况,共有3个维度22道题目构成,采用4点评分法,从"从未如此"到"经常如此"分别记1￣4分。各维度得分为本维度所有项目的平均分,得分越高,倦怠程度越重。采用症状自评量表评估心理状况,该量表共有90个问题,包括10个症状因子,采用5级评分,得分越高,心理问题越严重。③计量资料差异比较采用方差分析,并进行直线相关分析。结果:纳入669名汉族教师,发放问卷669份,回收填写完整、准确的问卷657份(98.2%),城镇437人,农村220人;大学教师181人,中学教师239人,小学教师237人;年龄22￣55岁,平均(38±10)岁。①教师职业倦怠状况:教师在情感衰竭、去个性化和成就感3个维度上的平均数和标准差分别是2.69±0.62,1.79±0.48,3.47±0.44。因采用4级评分,中数为2.5,所以结果显示教师的低成就感较高,情感衰竭程度亦偏高,而去个性化程度并不明显。②大、中,小学教师职业倦怠状况:大学、中学和小学教师三者间进行方差分析比较在职业倦怠的3个维度上比较,差异明显(F=16.25￣27.38,P<0.01),且三者间的两两比较也均有显著性差异(q=3.00￣9.97,P<0.05￣0.01)。小学教师的情感衰竭程度、去个性化与低成就感均最高,大学教师最低。③城镇与农村教师职业倦怠状况比较:城镇与农村教师两者比较,在低成就感和情感衰竭方面差异明显(F=1.5298,1.2656,P<0.01,0.05);在去个性化方面无差异。城镇教师的情感衰竭程度与去个性化得分均是最高,农村教师最低;而低成就感农村教师最高,城镇教师最低。④社会支持对教师职业倦怠的影响:对职业倦怠的3个维度在是否喜欢教师这一职业方面比较,差异不明显(P>0.05)。对职业倦怠的3个维度在领导是否认可和家人是否理解与支持方面比较,差异明显(F=1.3247,1.3141,P<0.05)。⑤教师职业倦怠与心理健康之间的相关性:职业倦怠3个维度与心理健康9个因子呈明显正相关(r=0.219￣0.413,P<0.01)。结论:①大、中、小学教师间职业倦怠差异明显,小学教师职业倦怠最为突出。②农村与城镇教师相比,城镇教师职业倦怠较为严重。③社会支持与否对教师职业倦怠构成一定的影响。④大、中、小学教师的职业倦怠与心理健康有关。     

Learning patient-specific predictive models from clinical data

We introduce an algorithm for learning patient-specific models from clinical data to predict outcomes. Patient-specific models are influenced by the particular history, symptoms, laboratory results, and other features of the patient case at hand, in contrast to the commonly used population-wide models that are constructed to perform well on average on all future cases. The patient-specific algorithm uses Markov blanket (MB) models, carries out Bayesian model averaging over a set of models to predict the outcome for the patient case at hand, and employs a patient-specific heuristic to locate a set of suitable models to average over. We evaluate the utility of using a local structure representation for the conditional probability distributions in the MB models that captures additional independence relations among the variables compared to the typically used representation that captures only the global structure among the variables. In addition, we compare the performance of Bayesian model averaging to that of model selection. The patient-specific algorithm and its variants were evaluated on two clinical datasets for two outcomes. Our results provide support that the performance of an algorithm for learning patient-specific models can be improved by using a local structure representation for MB models and by performing Bayesian model averaging.     

结缔组织病相关性横纹肌溶解所致急性肾功能衰竭

横纹肌溶解(rhabdomyolysis,RM)是指各种原因引起的横纹肌细胞受损后,肌红蛋白等细胞内容物释放入血液所引起的综合征,并可导致急性肾功能衰竭(acute renal failure,ARF)等一系列并发症,尤其是合并结缔组织病时,更容易出现ARF,临床上应予以重视。笔者就结缔组织病相关性横纹肌溶解所致急性肾功能衰竭作一综述。     

Management of pain associated with debridement of leg ulcers: a randomized,multicentre, pilot study comparing nitrous oxide–oxygen mixture inhalation and lidocaïne–prilocaïne cream

Background Mechanical debridement of fibrin and/or necrosis promotes healing of arterial and venous leg ulcers but is limited by pain associated with the procedure. Objective The main objective of this study was to compare the respective analgesic effect of nitrous oxide oxygen mixture (NOOM) inhalation and lidocaïne–prilocaïne cream (LPC) application during the mechanical repeated debridement of chronic arterial and venous leg ulcers. Methods In this randomized, multicentre, open‐label study, pain was evaluated before and after each care and debridement session using a Visual Analog Scale (VAS) and a Verbal Rating Scale (VRS), in the context of usual debridement and wound care process. The Quality of debridement and tolerability of the treatments were also assessed. Results Forty‐one patients were randomized: 20 received NOOM and 21 LPC. Pain assessed by VAS and VRS was more intense in the NOOM group than in the LPC group (5.29 vs. 3.68 and 2.87 vs. 1.71, P < 0.001, for the two scales respectively). No differences were found concerning quality of debridement, safety or tolerability between the two groups. Conclusion This pilot study demonstrates the superiority of the LPC over NOOM for pain control during the mechanical debridement of chronic leg ulcers.     

Plasma applications in medicine with a special focus on dermatology

The recent tremendous progress in understanding physical plasma phenomenon, together with the development of new plasma sources has put growing focus on the application of plasmas in health care. Active plasma components, such as molecules, atoms, ions, electrons and photons, reactive species, ultraviolet radiation, optical and infrared emission and heat have the ability of activating, controlling and catalysing reactions and complex biochemical procedures. Thermal and non‐thermal (i.e. cold) plasmas – both already widely established in medicine – are used for various therapeutic applications. Particularly in dermatology, plasma applications hold big potential, for example, in wound healing, such as efficient disinfection or sterilization, therapy of various skin infections or tissue regeneration. This review gives an overview on potential plasma applications in medicine – including the recent research on skin diseases – and summarizes possible interactions between plasmas and living tissue.     

Microsatellite markers developed through pyrosequencing allow clonal discrimination in the invasive alga Caulerpa taxifolia

Polymorphic microsatellites were developed for the invasive green algae Caulerpa taxifolia using next generation DNA sequencing. Results showed a limited rate of microsatellites for the amount of sequences, possibly explaining failure of previous attempts for microsatellite development through classical methods. Eight polymorphic loci were selected that exhibited polymorphism and a null or negligible rate of amplification failure. The number of alleles per locus ranged from two to seven. The reconstruction of Multi Locus Genotypes and the heterozygosity and departure from Hardy–Weinberg equilibrium confirmed the influence of clonal reproduction and showed the usefulness of this set of markers to successfully discriminate clonal lineages and analyze the clonal and genetic composition of algal beds. These markers will be used to further investigate the clonal composition and genetic structure in populations of C. taxifolia and to attempt retracing the origin of and pathways followed by invasive clonal lineages.