600名中小学生生长发育的评价与分析

本文使用测量营养状况简捷量图法及离差法进行对锦州市8岁、12岁和18岁三个年龄组的600名中小学生的生长发育状况进行了分析与评价。结果发现在生长发育异常中以肥胖较多,尤其是18岁女生多见。两种方法得出的结果相似。测量营养状况简捷量图使用时简易、快速,有推广应用的价值。     

Effectiveness of complete diagnostic examination in clinical practice settings

BACKGROUND: Thorough follow-up of a positive fecal occult blood test (FOBT) result, or a complete diagnostic evaluation (CDE), is recommended as routine care on the basis of findings from colorectal cancer (CRC) screening trials. CDE involves either colonoscopy or the combination of flexible sigmoidoscopy and double contrast barium enema X-ray. However, little evidence outside clinical screening trial settings has been reported in the literature to support CDE performance. The focus of this study was to determine the impact of CDE in primary care practice settings. METHODS: We determined diagnostic outcomes for 461 adult patients with a positive FOBT result in 318 primary care practices in southeastern Pennsylvania and southern New Jersey. Sociodemographic data were collected and CDE status was ascertained for these patients. Polytomous logistic models were used to identify whether having CDE was associated with subsequently being diagnosed with lower gastrointestinal "neoplastic disease" or "other gastrointestinal disease" as compared to "normal findings. RESULTS: Patients who underwent CDE were significantly more likely to have a reported diagnosis of colorectal neoplasia than normal findings (adjusted odds ratio = 3.65, 95% confidence interval = 1.58-8.39, p = 0.02). CDE performance did not result in the differential diagnosis of other gastrointestinal disease. CONCLUSIONS: Patients with a positive screening FOBT who underwent CDE were more likely to be diagnosed with colorectal neoplasia than with less serious conditions or have normal findings. Results support the use of CDE in CRC screening.     

Development of a data dictionary for the Strategies for Post Arrest Resuscitation Care (SPARC) network for post cardiac arrest research

Background

The widely accepted Utstein style has standardized data collection and analysis in resuscitation and post resuscitation research. However, collection of many of these variables poses significant practical challenges. In addition, several important variables in post resuscitation research are missing.

Objective

Our aim was to develop a comprehensive data dictionary and web-based data collection tool as part of the Strategies for Post Arrest Resuscitation Care (SPARC) Network project, which implemented a knowledge translation program for post cardiac arrest therapeutic hypothermia in 37 Ontario hospitals.

Methods

A list of data variables was generated based on the current Utstein style, previous studies and expert opinion within our group of investigators. We developed a data dictionary by creating clear definitions and establishing abstraction instructions for each variable. The data dictionary was integrated into a web-based collection form allowing for interactive data entry. Two blinded investigators piloted the data collection tool, by performing a retrospective chart review.

Results

A total of 454 variables were included of which 400 were Utstein, 2 were adapted from existing studies and 52 were added to address missing elements. Kappa statistics for two outcome variables, survival to discharge and induction of therapeutic hypothermia were 0.86 and 0.64, respectively.

Conclusion

This is the first attempt in the literature to develop a data dictionary as part of a standardized, pragmatic data collection tool for post cardiac arrest research patients. In addition, our dataset defined important variables that were previously missing. This data collection tool can serve as a reference for future trials in post cardiac arrest care.     

不同类型高血压对农村社区居民生命质量的影响

目的了解不同类型高血压对于农村社区居民生命质量的影响。方法以整群抽样方法采用 COOP/WONCA生命质量量表对三峡坝区农村 35岁以上居民进行横断面调查。结果三型高血压人群的体能、日常活动维度得分均较血压正常组差。而各血压类型人群情感维度、社会活动维度得分无明显差异。运用多元 L ogistic回归分析在调整了人口学、行为学影响因素后各型高血压对社区人群生命质量各维度得分的影响并不同。但单纯收缩期高血压和混合型高血压对整体健康的影响更为明显。结论不同类型高血压对于农村社区人群生命质量有着不同的影响 ,在社区高血压干预中应当注重对单纯收缩期高血压和混合型高血压的干预     

Psychiatrists and psychotherapy: Guidelines for future development

Since1986 basic training in psychotherapy is obligatory for physicians specializing in psychiatry. Whereas the vast majority of Swedish psychiatrists recognize psychotherapy as important and the course has been well received, there are still problems that demand attention. The following policy document by the Swedish Psychiatric Association (SPF) aims to influence the authorities involved in implementing necessary reforms: Psychotherapy is psychologic treatment with a health objective and as such should be covered by the same requirements with regard to safe care as other forms of medicine. All public psychotherapy should be supervised by a senior consultant. Although the official policy of the authorities is that psychiatrists should acquire psychotherapy skills, the practical measures taken have been counterproductive. The SPF suggests that medical posts be created for specialists in psychologic psychiatry; the possibility of combining practice in the private and public sectors be reopened; psychiatrists in the public sector be given the possibility of practising psychotherapy; and psychiatrists be given the right to train as psychotherapists. The present obligatory course needs to be modernized. The SPF suggests that the course be lengthened; a requirement of approved supervision be introduced; control of the clinics involved in training be introduced; steps be taken to ensure that the obligatory course gives due attention to the dynamics of the patient-physician relationship. A recent investigation showed that less than one-fourth of patients in need of psychotherapy were receiving treatment. The training volume of psychotherapists needs to be expanded. The SPF urges the national authorities to open a fourth training centre complementing the existing three psychodynamically based programmes with one in cognitive therapy.     

Laparoscopic Surgery for Coeliac Artery Compression Syndrome: Current Management and Technical Aspects

Objectives

The study aims to assess the feasibility and midterm outcome of trans-peritoneal laparoscopy for coeliac artery compression syndrome (CACS).

Design

Retrospective chart review involving four European vascular surgery departments and two surgical teams.

Materials and methods

charts for patients who underwent laparoscopy for symptomatic CACS between December 2003 and November 2009 were reviewed. Preoperative computed tomography (CT) angiography and postoperative duplex scan and/or CT angiography were performed.

Results

Eleven consecutive patients (nine women) with a median age of 52 years (interquartile range: 42.5-59 years) underwent trans-peritoneal laparoscopy for CACS. All patients had a history of postprandial abdominal pain; weight loss exceeded 10% of the body mass in eight cases. Preoperative CT angiography revealed coeliac trunk stenosis >70% in all cases. One patient had additional aortitis and inferior mesenteric artery occlusion, while another patient presented with an occluded superior mesenteric artery. Two conversions occurred (one difficult dissection and one aorto-hepatic bypass needed for incomplete release of CACS). The median blood loss was 195 ml (range: 50-900 ml) and median operative time was 80 min (interquartile range: 65-162.5 years). Symptoms improved immediately in 10/11 patients (no residual stenosis) while one remained unchanged despite a residual stenosis treated by a percutaneous angioplasty. Symptoms reappeared in one patient due to coeliac axis occlusion. The mean follow-up period was 35 ± 23 months (range: 12-78 months).

Conclusion

Our study demonstrates that trans-peritoneal laparoscopy for treating median arcuate ligament syndrome is safe and feasible. Additional patients and a longer follow-up are needed for long-term assessment of this laparoscopic technique.