Teaching Culturally Appropriate Care: A Review of Educational Models and Methods

The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient.     

脊髓纵裂分型治疗的疗效分析

目的探讨脊髓纵裂分型治疗的疗效。方法对1978年5月至2006年11月收洽的有完整资料的121例单管型及双管型脊髓纵裂患者的病历资料进行回顾性分析，并通过临床神经功能评分及胫后神经皮层体感诱发电位（FTNCSEP）P40波峰监测，评价其手术及非手术治疗的疗效。结果所有患者均得到随访，随访时间6个月～15年，平均2年6个月。96例双管型患者中手术治疗86例，术后观察和随访发现24例痊愈、22例有明显改善、28例有一定改善、12例无明确效果，临床神经功能评分及PTNCSEP术后有明显改变，尤其是以疼痛为主诉的患者恢复最为明显，手术总有效率为86％；10例双管型患者未行手术治疗，随访发现临床症状无明显改善且有加重趋势。单管型患者25例，手术治疗16例，术前、术后临床神经功能评分及胛NCSEP无明显变化；未手术治疗的9例，随访时上述指标亦无明显变化。结论双管型脊髓纵裂患者脊髓损害重且呈进行性加重，精细的手术治疗可以使大多数患者症状得到缓解，终止神经进行性损伤，确诊后应尽早手术。单管型脊髓纵裂患者脊髓损害轻，无须手术探查。     

Advancing Nursing Practice with a Unit-based Clinical Expert

Objective: To explore patterns in the practice of nursing and patient outcomes.
Design: Qualitative field research.
Population, Sample, Setting: Populations were critical care nurses and critically ill adult patients in the 10-bed medical critical care unit of a 900-bed teaching hospital. A convenience-purposive sample of 27 nurses and 31 patients was studied in 1985.
Methods: Six months of participant observation, unstructured interviews, and the constant comparison method of grounded theory.
Findings: Markedly different patterns were found in expert and nonexpert practice. The substantive theory of conversion helped explain how the majority of nonexpert nurses advanced their practice. The metaphor of catalyzed conversion captures how a unit-based expert nurse serves as a catalyst to advance the practice of nonexperts. Presence, defined as the way of being within a given clinical context, differentiated nurses.
Conclusions: (a) Expert and nonexpert practices are substantively different, (b) Expert and nonexpert practice results in different patient outcomes, (c) Conversion helps explain changes in nonexpert practice.
Clinical Implications: A unit-based expert nurse can increase patient-focused care.     

血清IGFBP-3、PDGF及bFGF联合检测对多囊卵巢综合征患者妊娠结局的预测价值

目的 探究血清胰岛素样生长因子结合蛋白-3(IGFBP-3)、血小板来源生长因子（PDGF）及碱性成纤维细胞生长因子（bFGF）联合检测对多囊卵巢综合征（PCOS）患者妊娠结局的预测价值。方法 选取2021年5月—2022年12月在沧州市中心医院接受治疗的150例PCOS孕妇作为PCOS组,另选取同期在该院产检健康的90例孕妇作为对照组。比较两组血清IGFBP-3、PDGF及bFGF水平;根据PCOS组孕妇的妊娠情况分为妊娠结局良好组119例和妊娠结局不良组31例,统计PCOS患者妊娠结局情况并比较血清IGFBP-3、PDGF、bFGF水平;绘制受试者工作特征（ROC）曲线分析血清IGFBP-3、PDGF和bFGF对PCOS的预测价值。结果 PCOS组血清IGFBP-3水平低于对照组（P <0.05）,PDGF、bFGF水平均高于对照组（P <0.05）。妊娠结局不良组血清IGFBP-3水平低于妊娠结局良好组（P <0.05）,PDGF、bFGF水平均高于妊娠结局良好组（P <0.05）。ROC曲线分析结果显示,血清IGFBP-3、PDGF、bFGF水平预测PC...     

Psychosocial factors and self-help in ankylosing spondylitis patients

Summary The purpose of this research was to investigate psychological factors associated with ankylosing spondylitis (AS), focusing on possible differences between members and nonmembers of self-help groups for people with this form of chronic disease. Analysis of health locus of control beliefs along 3 dimensions: internality powerful others and chance, showed that members of National Ankylosing Spondylitis Society (NASS) self-help groups placed significantly less reliance on powerful others for control of health than did nonmembers. This pattern of beliefs may be related to the nature of AS, which is incurable, progressive, unpredictable and difficult to diagnose. It may therefore appear to the patient that health care professionals have little to offer them. People who join a self-help group may also feel less reliant on medical personnel to control their health. Group members also differed from nonmembers in terms of belief in the value of exercise for AS, frequency of exercise, tendency to seek information about the disorder and perceived social support. A combination of psychosocial and medical variables discriminated between members and nonmembers at a rate of 71.9% accuracy. Results indicate that NASS self-help group members appear to comply more with exercise treatment and also receive a valuable source of social support from fellow members. This investigation demonstrates the utility of including psychosocial variables in the study of chronic disease.     

Adjustment in Childhood Brain Tumor Survival: Child, Mother, and Teacher Report

Examined the adjustment of 6- to 18-year-old children and adolescents(n = 38) 2 to 5 years postdiagnosis of brain tumor with respectto standardized measures of anxiety and depression; self-perceptions;and adaptive living skills. Child, mother, and teacher reportdata were used. Maternal adjustment (anxiety and depression,parenting stress) was also assessed. Children and adolescentssurviving brain tumors reported themselves to be generally withinthe normal range. However, maternal ratings of social problemswere higher than normative scores and significantly lower thannorms on social problems, scholastic competence, and communicationskills. Teacher ratings on the Teacher Rating Form were allwithin normal limits. Maternal adjustment measures were withinthe normal range, although the Parent-Child Dysfunctional Interactionsubscale of the Parenting Stress Index was elevated. No differencesin scores were found between children in regular and specialeducation, or between children who had received radiation andthose who did not. This sample of survivors of pediatric braintumors and their mothers had relatively mild problems in adjustment,supporting a competency-based view of the adaptation of pediatricpatients and their families.     

妊娠前不同体重指数与围产结局的关系研究

目的研究妊娠前不同体重指数对围产结局的影响。方法回顾性分析2005~2007年在我院分娩的单胎妇女238例,按妊娠前体重指数(BMI)分为BMI在19.8~23.9的正常BMI组、BMI 24~27的高BMI组和BMI≥27的肥胖组。新生儿体重≥4000g为巨大儿。比较正常BMI组、高BMI组和肥胖组的围产结局。结果全部资料共有238例,其中正常BMI组182例,高BMI组117例,肥胖组56例,巨大儿的发生率分别为10.4%、19.6%、28.6%,妊娠期高血压病、妊娠期糖尿病、羊水过多的风险随妊娠前BMI增加而上升,早产、剖宫产、新生儿病率的发生率亦随妊娠前BMI增加而升高,差异有显著性。结论妊娠前异常的母亲体重指数高度影响巨大儿的发生率;随妊娠前BMI增加不良围产结局的风险增加。     

Comparison of the PROMIS Preference Score (PROPr) and EQ-5D-5L Index Value in General Population Samples in the United Kingdom,France, and Germany

ObjectivesThe Patient-Reported Outcome Measurement Information System (PROMIS) Preference score (PROPr) can be used to assess health state utility (HSU) and estimate quality-adjusted life-years in cost-effectiveness analyses. It is based on item response theory and promises to overcome limitations of existing HSU scores such as ceiling effects. The PROPr contains 7 PROMIS domains: cognitive abilities, depression, fatigue, pain, physical function, sleep disturbance, and ability to participate in social roles and activities. We aimed to compare the PROPr with the 5-level EQ-5D (EQ-5D-5L) in terms of psychometric properties using data from 3 countries.MethodsWe collected PROMIS-29 profile and EQ-5D-5L data from 3 general population samples (United Kingdom = 1509, France = 1501, Germany = 1502). Given that cognition is not assessed by the PROMIS-29, it was predicted by the recommended linear regression model. We compared the convergent validity, known-groups construct validity, and ceiling and floor effects of the PROPr and EQ-5D-5L.ResultsThe mean PROPr (0.48, 0.53, 0.48; P<.01) and EQ-5D-5L scores (0.82, 0.85, 0.83; P<.01) showed significant differences of similar magnitudes (d = 0.34; d = 0.32; d = 0.35; P<.01) across all samples. The differences were invariant to sex, income, occupation, education, and most conditions but not for age. The Pearson correlation coefficients between both scores were r = 0.74, r = 0.69, and r = 0.72. PROPr’s ceiling and floor effects both were minor to moderate. The EQ-5D-5L’s ceiling (floor) effects were major (negligible).ConclusionsBoth the EQ-5D-5L and the PROPr assessed by the PROMIS-29 show high validity. The PROPr yields considerably lower HSU values than the EQ-5D-5L. Consequences for quality-adjusted life-year measurements should be investigated in future research.