基于入院计划单填写完整率的病案质量持续改进

目的：探讨基于入院计划单填写完整率的病案质量管理持续改进方案。方法：应用PDCA质量改进方法对病案书写质量进行持续改进,将病历书写质量中需要实现的目标、内容分解为计划阶段、执行阶段、检查阶段和总结处理阶段。通过发现问题,制定目标,培训人员,加强检查力度和质量反馈,在每个循环末总结成绩,发现问题,提出整改措施,并将解决发现的问题作为下一循环工作的目标。结果：PDCA质量改进方法可以明显提高病历书写质量,入院计划单填写完整率显著提高。结论： PDCA的质量改进模式是一个行之有效的管理方法,使医院病案书写质量沿着一条规范化、螺旋式的上升轨道运行发展。     

铝佐剂和免疫程序对Sabin IPV免疫原性影响的研究

目的 研究铝佐剂和免疫程序对不同配比的Sabin IPV免疫原性的影响.方法 用Ⅰ、Ⅱ、Ⅲ型脊髓灰质炎病毒原液制备四批Sabin IPV,分别为中剂量无佐剂组、中剂量铝佐剂组、低剂量无佐剂组、低剂量铝佐剂组,采用0、1、2月和0、2、4月两种免疫程序对大鼠进行3针基础免疫,每针基础免疫一个月后采血,并检测免疫后血清中3个型别的中和抗体水平.结果 经过3针基础免疫后,各组Ⅰ、Ⅱ、Ⅲ中和抗体几何平均滴度均显著提高,阳转率均达到100％.对不同组别间两种免疫程序比较无显著差异,但相同条件下,0、2、4月免疫程序可诱导产生更高的抗体水平.对相同免疫程序下不同组别进行比对,添加铝佐剂组与无佐剂组相比可以诱导更高的抗体水平.结论 铝佐剂和免疫程序可提高Sabin IPV免疫原性.     

Specificity of tuberculin skin test improved by BCG immunization schedule change in Japan

IntroductionTuberculin skin test (TST) has been used to diagnose tuberculosis (TB) and latent tuberculosis infection (LTBI). However, in Bacillus Calmette-Guérin (BCG) vaccinated patients, TST tends to produce false-positive results. According to the previous vaccination schedule, Japanese people were mandated to receive up to three doses of BCG-vaccine. The vaccination schedule was changed in 2003 and as per the new schedule, only infants are administered a dose of BCG vaccine. Our hypothesis is that this change can lead to a reduction in the cross-reaction to TST.MethodsWe evaluated the TST results obtained from 1097 recruits from six defense camps and 667 recruits from an air base. These TST data were divided into two groups according to the date of birth: a new group and an old group according to the BCG immunization schedule. We then analyzed positive and negative reaction of TST and erythema sizes.ResultsWe confirmed that the change in BCG-vaccination schedule significantly decreased TST false-positive reaction (P_meta = 1.4 × 10⁻¹⁸; risk ratio = 0.83; 95% confidence interval: 0.80–0.87) and erythema size (P_meta = 1.1 × 10⁻⁴; mean difference = 6.6 mm; 95% confidence interval: 3.2 mm–9.9 mm).ConclusionsWe showed the reduction in BCG cross-reaction to TST, in the new BCG vaccination schedule group, compared to the old group, we also have extracted information on the improvement in the specificity of TST for LTBI and TB diagnosis, which resulted from BCG schedule change.     

Risk for emerging bipolar disorder,variants, and symptoms in children with attention deficit hyperactivity disorder,now grown up

AIM: To determine the prevalence of bipolar disorder (BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder (ADHD) through 14 years’ follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type I and II diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD (MTA). We used the diagnostic interview schedule for children (DISC), administered to both parents (DISC-P) and youth (DISCY). We compared the MTA study subjects with ADHD (n = 579) to a local normative comparison group (LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts (TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic (PM) and non-specific manic (NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD (1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time (df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability (BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG (χ² = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM (df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2 (A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.     

BEHAVIORAL EXCESSES IN DEPRESSION: A LEARNING THEORY HYPOTHESIS

This paper reviews two learning theory‐based models of experiential contributions to depression: response contingent positive reinforcement and learned helplessness. The authors argue that these models connect to a phenomenon that may explain why symptoms of behavioral excess (e.g. rumination) often occur in depression that is otherwise marked by symptoms of behavioral deficit (e.g. anhedonia). Specifically, the authors illustrate that that concept of schedule strain (or low rates of response contingent reinforcement giving rise to low frequencies of behavior) unites these models. Depression is more likely, or more severe, when schedule strain conditions occur in situations containing reinforcers important to the individual and/or when they simultaneously occur in a number of situations. Conditions of schedule strain are known to give rise to adjunctive behaviors: apparently irrelevant, easy behaviors that deliver immediate reinforcement. This paper suggests that, for some depressed individuals, behavioral excess symptoms like rumination and overeating might serve adjunctive functions. Implications of this hypothesis are discussed.     

Sleep architecture and NREM alterations in children and adolescents with Asperger syndrome

STUDY OBJECTIVES: To analyze sleep in children with Asperger syndrome (AS) by means of standard sleep questionnaires, to evaluate sleep architecture and NREM sleep alterations by means of cyclic alternating pattern (CAP) and to correlate objective sleep parameters with cognitive behavioral measures. DESIGN: Cross-sectional study involving validated sleep questionnaires, neuropsychological scales, and PSG recording. SETTING: Sleep medicine center. PARTICIPANTS: Eight children with AS, 10 children with autism, and 12 healthy control children. INTERVENTIONS: N/A MEASUREMENTS AND RESULTS: Children with AS had a higher prevalence of problems of initiating sleep and daytime sleepiness. Sleep architecture parameters showed minor differences between the 3 groups. CAP parameters showed an increased percentage of A1 and a decreased percentage of A2 subtypes in subjects with AS vs. controls. All A subtype indexes (number per hour of NREM sleep) were decreased, mostly in sleep stage 2 but not in SWS. With respect to children with autism, subjects with AS showed increased CAP rate in SWS and A1 percentage. In subjects with AS, verbal IQ had a significant positive correlation with total CAP rate and CAP rate in SWS and with global and SWS A1 index. The percentage of A2 negatively correlated with full scale IQ, verbal and performance IQ. CBCL total score correlated positively with CAP rate and A1 index while externalizing score correlated negatively with A3%. CONCLUSIONS: This study shows peculiar CAP modifications in children with AS and represents an attempt to correlate the quantification of sleep EEG oscillations with the degree of mental ability/disability.     

Persistence of immune response following bivalent HPV vaccination: A follow-up study among girls routinely vaccinated with a two-dose schedule

BackgroundIn this cohort study, we examined antibody levels and avidity after a two-dose schedule (0, 6 months) of the bivalent HPV-vaccine in girls routinely vaccinated in the Dutch HPV-vaccination program, up to 2 years following vaccination.MethodsA blood sample at 7, 12 and 24 months after the first dose and questionnaire data were collected (n = 56). HPV type-specific antibody concentrations (lU/ml) against seven types (HPV16/18/31/33/45/52/58) were assessed using a validated virus-like particles (VLP) multiplex immunoassay. Avidity was tested using a modification of this assay.ResultsSeropositivity for vaccine types HPV 16 and 18 was 100% up to month 24, but declined for HPV-types 31/33/45/52/58, although not statistically significant for HPV45. All Geometric Mean Concentrations (GMCs) declined by months 12 and 24, but remained high for HPV16/18. Between month 7 and 12, GMCs declined more for other types. High avidity antibodies were induced up to 24 months for vaccine types (75%, 76–78% and 81–82% at months 7, 12 and 24, respectively), but for other types antibody avidity was 16–29% at month 7, 20–32% at month 12 and 19–32% at month 24.ConclusionsGMCs declined over time for HPV-types 16/18/31/33/45/52/58, but remained high for vaccine-types HPV16/18 up to 24 months of follow-up. Antibody avidity was >75% for vaccine types but <35% for other HPV-types. Further follow-up of this cohort will provide insight into antibody and avidity kinetics over time.