传统床边考转向与OSCE相结合的临床考核新模式探究

通过分设问诊、体格检查、中医病案书写、疾病诊断、方剂、经典共6站考核,评估实习医师的中医临床技能,探索本科生实习期间,中医内科出科考实施OSCE与传统床边考相结合的考核模式,同时对参加考试的学生进行问卷调查,了解其对改革考试模式的态度和想法.拟以该考核模式与客观结构化考试相接轨,以替代传统的病人床边考.     

Adductor Canal Blocks Reduce Inpatient Opioid Consumption While Maintaining Noninferior Pain Control and Functional Outcomes After Total Knee Arthroplasty

BackgroundThe use of perioperative adductor canal blocks (PABs) continues to be a highly debated topic for total knee arthroplasty (TKA). Here, we evaluate the effect of PABs on immediate postoperative subjective pain scores, opioid consumption, and objective functional outcomes.MethodsOn December 1, 2019, an institution-wide policy change was begun to use PABs in primary elective TKAs. Patient demographics, immediate postoperative nursing documented pain scores, opioid administration events, and validated physical therapy functional scores were prospectively collected as part of the standard of care and retrospectively queried through our electronic data warehouse. A historical comparison cohort was derived from consecutive patients undergoing TKA between July 1, 2019 and November 30, 2019.Results405 primary TKAs received PABs, while 789 patients were in the control cohort. Compared with controls, average verbal rating scale pain scores were lower among PAB recipients from 0-12 hours (2.42 ± 1.60 vs 2.05 ± 1.60; <.001) and 24-36 hours (4.92 ± 2.00 vs 4.47 ± 2.27; <.01). PAB recipients demonstrated significantly lower opioid consumption within the first 24 hours (44.34 ± 40.98 vs 36.83 ± 48.13; P < .01) and during their total inpatient stay (92.27 ± 109.81 vs 77.52 ± 123.11; <.05). AM-PAC scores within the first 24 hours were also higher for PABs (total scores: 20.28 ± 3.06 vs 20.71 ± 3.12; <.05).ConclusionWhile the minimal clinically important differences in pain scores and functional status were comparable between both cohorts, patients demonstrated a significant reduction in overall inpatient opiate consumption after the introduction of PABs. Surgeons should consider these findings when evaluating for perioperative pain management, opioid-sparing, and rapid discharge protocols.     

胃脘痛证型与甲皱微循环关系的探讨

本文对胃脘痛组66例和健康对照组44例进行了甲皱微循环检查。并按田牛氏加权积分法进行综合分析。检测结果表明胃脘痛组(包括虚、实证)的甲皱微循环加权积分值明显高于对照组(P<0.01和0.001),其中胃脘痛实证组的加权积分值又明显高于虚证组(P<0.001)。据此认为胃脘痛患者“血淤”之病理机制是较普遍存在的,甲皱微循环加权积分值可作为临床区分胃脘痛虚、实证的客观指标之一。     

Validation of the objective assessment of facial movement with a new software-based system

Background: Most used subjective Unilateral Peripheral Facial Palsy (UPFP) grading systems are characterized by high variability and low reproducibility and doesn’t allow a separate evaluation of single facial regions.

Objective: To assess the reliability of a new objective method for classification of UPFP, comparing it with House-Brackmann (HB) and Sunnybrook facial grading (SFGS) systems.

Method: Forty-seven patients affected by UPFP of different HB grade were included. Each patient underwent a blinded examination by three different operators, via the two subjective methods (HBGS and SFGS) and a newly proposed objective one, that was obtained from a digital video-analysis, named SMART FACIAL system. Results were converted by validated conversion scales into HBGS grades and statistically compared.

Results: In 87,23% (n° 41 pts) consistency was found between the grades obtained with all the three evaluation methods; in 10,41% (n°5 pts), between HBGS and SFGS grade and in 2,08% (n°1?pt) between HBGS grades and SMART-FACIAL system. Statistical analysis showed significant correlation among the three systems (p?<?.000).

Conclusions: The SMART FACIAL system presents high reliability also in comparison with the most frequently used subjective methods.

Significance: This method represents a fast, simple and thorough way to analyze UPFP, especially during physical rehabilitation.     

Envelope frequency following responses are stronger for high-pass than low-pass filtered vowels

Background: To assess hearing in response to speech, the envelope frequency following response (FFR) can be observed at the fundamental frequency of a vowel stimulus and its harmonics. FFRs are complex non-linear phenomena, which require better understanding for allowing robust inferences on the assessment of hearing and hearing aid fitting.

Objectives: To evaluate the effect of stimulus bandwidth on FFR detection rates using filtered vowel stimuli with equal sound levels.

Design: FFRs were collected whilst presenting repeated vowels (in consonant-vowel-consonant format) filtered into different bandwidths. Eighty stimuli per word were presented at 70?dB SPL LAeq through insert earphones with an inter-stimulus interval of 1?s. Responses were detected using frequency-domain Hotelling's T2 (HT2) tests for individual multiples of the fundamental frequency (F0) and for combinations of F0 multiples.

Study sample: A total of 11 native English-speaking subjects with normal hearing thresholds.

Results: Average detection rates are highest (69%) with stimuli high-pass filtered >1000?Hz, and significantly lower for low-pass filtered stimuli (40%).

Conclusions: High-pass filtered vowels therefore appear to elicit stronger FFRs than low-pass filtered vowels at the same dB SPL LAeq. For testing hearing using band-limited speech, filtering effects (due to hearing loss, hearing aid setting or stimulus choice) on responses must be considered.     

Improved Electrically Evoked Auditory Steady-State Response Thresholds in Humans

Electrically evoked auditory steady-state responses (EASSRs) are EEG potentials in response to periodic electrical stimuli presented through a cochlear implant. For low-rate pulse trains in the 40-Hz range, electrophysiological thresholds derived from response amplitude growth functions correlate well with behavioral T levels at these rates. The aims of this study were: (1) to improve the correlation between electrophysiological thresholds and behavioral T levels at 900 pps by using amplitude-modulated (AM) and pulse-width-modulated (PWM) high-rate pulse trains, (2) to develop and evaluate the performance of a new statistical method for response detection which is robust in the presence of stimulus artifacts, and (3) to assess the ability of this statistical method to determine reliable electrophysiological thresholds without any stimulus artifact removal. For six users of a Nucleus cochlear implant and a total of 12 stimulation electrode pairs, EASSRs to symmetric biphasic bipolar pulse trains were recorded with seven scalp electrodes. Responses to six different stimuli were analyzed: two low-rate pulse trains with pulse rates in the 40-Hz range as well as two AM and two PWM high-rate pulse trains with a carrier rate of 900 pps and modulation frequencies in the 40-Hz range. Responses were measured at eight different stimulus intensities for each stimulus and stimulation electrode pair. Artifacts due to the electrical stimulation were removed from the recordings. To determine the presence of a neural response, a new statistical method based on a two-sample Hotelling T (2) test was used. Measurements from different recording electrodes and adjacent stimulus intensities were combined to increase statistical power. The results show that EASSRs to modulated high-rate pulse trains account for some of the temporal effects at 900 pps and result in improved electrophysiological thresholds that correlate very well with behavioral T levels at 900 pps. The proposed statistical method for response detection based on a two-sample Hotelling T (2) test has comparable performance to previously used one-sample tests and does not require stimulus artifacts to be removed from the EEG signal for the determination of reliable electrophysiological thresholds.     

Videostrobokymographic Analysis of Benign Vocal Fold Lesions

Objectives—Videostrobokymography (VSK) has recently been introduced. The aim of this study was to analyze vibratory patterns and objective parameters in various benign vocal fold lesions using VSK and to examine the efficacy of VSK in clinical applications.

Material and Methods—Using VSK, we analyzed the vibration patterns of normal vocal folds, various benign lesions such as nodules, polyps, cysts and Reinke's edema and cases of unilateral vocal fold paralysis. We also calculated the objective parameters open quotient and asymmetric index and compared them with their mean values in normal controls.

Results—In nodules, polyps and cysts, the open quotient at the site of the lesion was similar to the mean value in the normal controls; however, on the other parts of the vocal folds, it was much larger than the normal mean value. In Reinke's edema, irregular and asymmetric vibrations were observed. The posterior area of the vocal folds showed larger open quotients than the anterior area. In unilateral vocal fold paralysis, irregular vocal fold vibration and incomplete closure of the vocal folds were documented. Much larger asymmetric indices were calculated for unilateral vocal fold paralysis than in normal controls or for other lesions. The asymmetric index may be a good quantitative parameter of vibration in patients with vocal fold paralysis.

Conclusion—This study demonstrated that VSK could generate clear quantitative documentation of fine vibrations of vocal folds in many different types of benign lesion. VSK has the potential to be an effective tool for the quantitative analysis of vibratory patterns of vocal folds in clinical settings.     

TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) US clinical trial: Performance of a rapid deployment aortic valve

Background

The TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) trial (NCT01700439) evaluated the performance of the INTUITY rapid deployment aortic valve replacement (RDAVR) system in patients with severe aortic stenosis.

郑州市实现消除碘缺乏病阶段目标研究

〔目的〕为了 2 0 0 0年郑州市完成消除碘缺乏病阶段目标。〔方法〕采用《实现消除碘缺乏病阶段目标评估方案》规定的方法进行。〔结果〕碘盐生产 (批发 )单位、销售点、居民户三级碘盐合格率分别为 99.0 %、99.0 %、96 .71% ;尿 8- 10岁儿童甲状腺肿大率 ,触诊为 3.4 8%、B超法为 4 .15 % ;8- 10岁儿童尿碘中位数 2 82 .1μg/L ;健康教育测试 ,五年级学生及家庭主妇知识及格率为 99.33%、98.0 7% ,行为正确率为 84 .6 7%、10 0 %。〔结论〕郑州市 2 0 0 0年达到消除碘缺乏病阶段目标。     

Importance of size in defining binge eating episodes in bulimia nervosa

OBJECTIVE: This study sought to determine if amount of food consumed is important in defining binge eating episodes in individuals with bulimia nervosa (BN). METHOD: Women (N = 30) with DSM-IV BN (OBN) and women (N = 25) who would have met DSM-IV criteria for BN except that their binge episodes were not objectively large (SBN) were recruited from the community. Subjects completed telephone interviews and questionnaires. RESULTS: Results demonstrated no significant differences between women with OBN and SBN in levels of dietary restraint, disinhibition, or hunger; no significant differences in general psychopathology; and significant differences in frequency of binge/purge episodes and impulsiveness. Differences in impulsiveness remained after controlling for frequency of binge/purge episodes. DISCUSSION: These results partially validate current diagnostic criteria for bulimia nervosa and elucidate one factor, impulsiveness, that may be important in understanding objective binge episodes in bulimia nervosa.