Detecting acute confusion in older adults: Comparing clinical reasoning of nurses working in acute,long-term,and community health care environments

In an article on a previous study involving hospitalized older adults (McCarthy, 2003), it was argued that the theory of situated clinical reasoning explains why nurses often fail to recognize acute confusion. Further, the theory illuminates how nurses' perspectives toward health in aging affect the ways they regard and ultimately deal with older people in this particular clinical situation. The purpose of the current study was to challenge and refine the theory by exploring the influence of different care environments on clinical reasoning related to acute confusion. Following a period of participant observation, a purposive sample of 30 nurses, 10 each from a teaching hospital, a long-term facility, and a home care agency, participated in semistructured interviews. Dimensional analysis provided the methodological framework for data collection and interpretation. The results reinforce prior findings that the ability of nurses to recognize acute confusion and to distinguish it from dementia can be attributed to their personal philosophies about aging. Care environment was identified as a factor that influenced clinical reasoning in limited ways under certain conditions and within certain contexts.     

A three-dimensional evaluation of the upper airway in adolescents

The link between the facial growth and airway function has been a subject of controversy in orthodontics for many years. This study investigates how well lateral cephalometric headfilms depict three-dimensional upper airway structures. Subjects are 11 normal adolescent children, ages 7-16 years old. Airway information over the same anatomic area in the nasopharynx is compared between lateral cephalometric headfilms and three-dimensional cone beam computed tomography (CT) scans. Intra-subject proportion of airway volume to area shows moderate variability. CT airway volume shows more variability than corresponding headfilm airway area.     

DADS诱导人白血病细胞分化中的代谢变化

目的 研究二烯丙基二硫诱导人髓性白血病HL-60细胞分化过程中蛋白质组的差异表达.方法 运用蛋白质组学方法(双向凝胶电泳、质谱分析、生物信息学方法)分析鉴定DADS诱导HL-60细胞分化的差异表达蛋白质.结果 初步鉴定的差异表达蛋白质点中二型碳酸酐酶、磷酸丙糖异构酶、醛缩酶A在处理组中均表达下调,其功能与细胞代谢调节有关.结论 DADS可通过抑制二型碳酸酐酶表达和抑制糖酵解途径,抑制HL-60细胞增殖,诱导其分化.     

Does gestational sac volume predict the outcome of missed miscarriage managed expectantly?

PURPOSE: The aim of this study was to investigate whether gestational sac volume (GSV) can predict the outcome of missed miscarriages that are managed expectantly. METHODS: This was a prospective observational study. Between February 1, 2000, and January 31, 2001, all patients with a confirmed first-trimester missed miscarriage who chose to undergo expectant management were recruited to participate. A single investigator performed all sonographic examinations and measurements. The main outcome measure was a complete spontaneous abortion within 4 weeks of the initial diagnosis. A complete miscarriage was defined as a maximum anteroposterior diameter of the endometrium of less than 15 mm on transvaginal sonography and no persistent heavy vaginal bleeding. The patients could opt to undergo surgery at any time, but those who had not expelled the products of conception within 4 weeks of the diagnosis were advised to have surgical uterine evacuation. RESULTS: In total, 90 patients were enrolled, and 86 patients completed the study. The mean GSV, as measured by 3-dimensional sonography, was 9.7 +/- 8.9 ml, and the mean sac diameter was 24.5 +/- 8.0 mm. A significant exponential correlation was found between the mean sac diameter and the GSV (r = 0.86; p < 0.0001). Forty-six (53.5%) of the 86 patients experienced a complete miscarriage within 4 weeks of the diagnosis (ie, expectant management was successful), but expectant management was unsuccessful in the remaining 40 (46.5%) patients (5 had an incomplete miscarriage, and 35 did not expel the products of conception). The GSV did not differ significantly between the "successful" and "unsuccessful" groups (p = 0.82). A logistic regression analysis showed no significant correlation between GSV and the outcome of missed miscarriages managed expectantly (p = 0.59). CONCLUSIONS: The GSV does not predict the outcome of expectant management of missed miscarriage within 4 weeks of the diagnosis.     

Dimensional measures of psychopathology. The probability of being classified with a psychiatric disorder using empirically derived symptom scales

Objectives: We sought to develop a ranking scheme that assigns a probability of having one of four psychiatric disorders to children based on their scores on a symptom scale. We then estimated the impact of each scale symptom on the prevalence of the disorder in the population. Method: Logistic regressions were specified for ADHD, ODD, depressive, and conduct disorders using all the individual symptoms in the pertinent scale as predictors. Individual fitted values from the regression function then served as a probability scale measure. We combined the prevalence and influence of each scale symptom to calculate its overall impact on the prevalence of the disorder. Results: Probability distributions had a wide range of values and discriminated between cases and non-cases. Those having a disorder were consistently associated with higher probabilities in the scale. The estimated probability corresponds to the empiric prevalence of the diagnosis in a group of persons sharing the same estimated probabilities. Symptoms varied on their impact on the prevalence of the disorder. Conclusions: We recommend the estimated probability of the disorder based on the empirically defined scales as dimensional measures that complement prevalence of the disorder. Different symptoms are identified as targets for screening when selection is based on their impact on the prevalence of the disorder than when selection is based on the strength of the association with the disorder. We recommend using a common nosology with different classification schemes; the categorical definition of the disorder, the probability of having the disorder, and the impact of each symptom in the prevalence. Different measures serve different purposes. Accepted: 5 April 2002 Correspondence to Maritza Rubio-Stipec     

Proteomic alterations of the variants of human aldehyde dehydrogenase isozymes correlate with hepatocellular carcinoma.

To develop novel markers for hepatocellular carcinomas (HCC), 10 cases were analyzed by 2-dimensional electrophoresis (2DE) and matrix-assisted laser desorption ionization mass spectrometry. Results were compared to those of paired adjacent nontumorous liver tissues. Comparative analysis of the respective spot patterns in 2DE revealed that 3 variants of class 3 aldehyde dehydrogenase (ALDH-3) newly appeared while 2 variants of ALDH-2 diminished to undetectable levels in HCC. However, 4 ALDH-1 variants with different pIs remained unaffected. This pattern of concomitant appearance and disappearance of ALDH-3 and ALDH-2 variants was consistently observed in all HCC tissues. Our results suggest that alterations of ALDH isozyme variants may be closely correlated to HCC and that proteomic analysis of these proteins might be a novel approach to identify the molecular events in detail during hepatocarcinogenesis.     

A comparative study of physicochemical properties of AH Plus and Epiphany root canal sealants

AIM: To evaluate setting time, solubility and disintegration, flow, film thickness, and dimensional change following setting in a dual-cured resin root canal sealer Epiphany compared with an epoxy-resin-based sealer AH Plus. METHODOLOGY: The experiments were performed according to ANSI/ADA Specification 57 which tests the physicochemical properties of endodontic sealing materials. Five samples of each material were tested for each of the properties. In addition, deionized distilled water from the solubility test of Epiphany was submitted for analysis of the cations Fe, Ni, Ca, Mg, Zn, Na, and K in an atomic absorption spectrometer. Three samples were analysed. RESULTS: There were no statistical differences (P>0.05) in flow (AH Plus: 38.57 mm; Epiphany: 35.74 mm) and film thickness (AH Plus: 10.6 microm; Epiphany: 20.1 microm). The solubility (AH Plus: 0.21%; Epiphany: 3.41%) and dimensional alterations following setting (AH Plus: expansion of 1.3%; Epiphany: expansion of 8.1%) were statistically different (P<0.05). The setting times of both sealants were in accordance with ANSI/ADA requirements. CONCLUSIONS: Setting time, flow, and film thickness tests for both cements conformed to ANSI/ADA standards. Dimensional alteration test for both cements were greater than values considered acceptable by ANSI/ADA. Epiphany values regarding solubility were also greater than values considered acceptable by ANSI/ADA.     

Accuracy of cartilage and subchondral bone spatial thickness distribution from MRI

PURPOSE: To assess three-dimensional measurement accuracy of articular cartilage (AC) and subchondral bone (SB) thickness from MRI. MATERIALS AND METHODS: A computer program was used to calculate AC and SB thickness from MRI (three-dimensional spoiled gradient echo (SPGR),.31-mm resolution, 1-mm slice thickness) of six adult femoral heads. Specimens were imaged in five anatomical planes ranging between +30 degrees to -30 degrees from neutral and cut into 2-mm thick sections along the five anatomical planes. Faxitron x-ray was used to produce microradiographic (.05-mm resolution) images of the sections. RESULTS: In-plane measurement accuracy was.165 +/-.108 mm for AC thickness and.387 +/-.174 mm for SB thickness. Taking into account chemical-shift misregistration in SB thickness, accuracy of measurements improved to.213 +/- 128 mm. Out-of-plane (three-dimensional) thickness accuracy of the model, assessed by numerical simulation, was.015 mm. However, three-dimensional thickness errors in specimens were.319 +/-.256 mm for AC and.253 +/-.183 mm for SB thickness. CONCLUSION: Errors in three-dimensional AC thickness were attributed to volume-averaging effects caused by oblique intersection of the image plane with the joint surface. Errors in three-dimensional SB thickness were attributed to chemical-shift artifact. We conclude that accuracy of AC thickness is within clinically acceptable standards but that more sophisticated pulse sequences are needed to improve the measurement of SB thickness.     

食管癌三维适形放射治疗

三维适形放射治疗是目前我国临床运用广泛的精确放射治疗方式之一，尤其近10年来，三维适形放射治疗在提高局控率和生存率方面取得了长足进步。本文对近5年来国内多家医院食管癌三维适形放射治疗方法进行综述，介绍目前食管癌三维适形放射治疗在剂量以及分割方式、适应症选择以及并发症控制、单一的三维适形放射治疗以及多种治疗手段的综合运用上存在不同的见解。