Contributions to the Study of Immediate and Early X-ray Reactions with Regard to Chemoprotection

Summary

Isolated suspended uterine horns of the rat show a leakage of histamine into their bathing fluid. The leakage is increased by 50 kv x-irradiation in doses of 1000 r. Such increase is suggested to be due to liberation of the bio-amine from its storage sites. The phenomenon is comparable to that found for serotonin and catecholamines.     

Supervision: Critical Reflection for Transformational Learning,Part 1

Rooted in medicine and psychology, genetic counseling is a unique practice with a defined set of skills. Training is guided by practice-based competencies that define the requisite skills of an entry-level practitioner. Practicing genetic counselors with expertise in a variety of medical settings provide direct supervision that guides student development. In this article, we provide background on the history of genetic counseling, the model of practice, accreditation and certification standards, and an overview of clinical supervision as well as a review of supervision literature specific to the field.     

Effect of change in coding rules on recording diabetes in hospital administrative datasets

AimDuring 2008–2011 Australian Coding Standards mandated a causal relationship between diabetes and inpatient care as a criterion for recording diabetes as a comorbidity in hospital administrative datasets. We aim to measure the effect of the causality mandate on recorded diabetes and associated inter-hospital variations.MethodFor patients with diabetes, all admissions between 2004 and 2013 to all New South Wales acute public hospitals were investigated. Poisson mixed models were employed to derive adjusted rates and variations.ResultsThe non-recorded diabetes incidence rate was 20.7%. The causality mandate increased the incidence rate four fold during the change period, 2008–2011, compared to the pre- or post-change periods (32.5% vs 8.4% and 6.9%). The inter-hospital variation was also higher, with twice the difference in the non-recorded rate between hospitals with the highest and lowest rates (50% vs 24% and 27% risk gap). The variation decreased during the change period (29%), while the rate continued to rise (53%). Admission characteristics accounted for over 44% of the variation compared with at most two per cent attributable to patient or hospital characteristics. Contributing characteristics explained less of the variation within the change period compared to pre- or post-change (46% vs 58% and 53%). Hospital relative performance was not constant over time.ConclusionThe causality mandate substantially increased the non-recorded diabetes rate and associated inter-hospital variation. Longitudinal accumulation of clinical information at the patient level, and the development of appropriate adoption protocols to achieve comprehensive and timely implementation of coding changes are essential to supporting the integrity of hospital administrative datasets.     

Effects of a nurse-led transitional care program on clinical outcomes,health-related knowledge,physical and mental health status among Chinese patients with coronary artery disease: A randomized controlled trial

BackgroundCoronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China.ObjectivesTo examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease.DesignRandomized controlled trial.MethodsThe Omaha system and Pender’s health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n = 100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n = 99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014.ResultsCompared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t = 5.762, P = 0.000; diastolic blood pressure, t = 4.250, P = 0.000; fasting blood glucose, t = 2.249, P = 0.027; total cholesterol, t = 4.362, P = 0.000; triglyceride, t = 3.147, P = 0.002; low density lipoprotein cholesterol, t = 2.399, P = 0.018; and body mass index, t = 3.166, P = 0.002), higher knowledge scores for coronary artery disease (total knowledge score, t = −7.099, P = 0.000), better physical health status (t = −2.503, P = 0.014) and mental health status (t = −2.950, P = 0.004).ConclusionsThis study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender’s health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.     

妊娠合并卵巢肿瘤蒂扭转40例临床分析

目的分析本院40例妊娠合并卵巢肿瘤蒂扭转患者的临床情况。方法选取1999年1月～2013年6月于本院进行诊治的40例妊娠合并卵巢肿瘤蒂扭转患者为研究对象，将其病理结果、扭转时间、妊娠结局及治疗方式进行统计与比较。结果40例患者中主要以成熟性囊性畸胎瘤为主，其发生率明显高于其他种类；扭转时间中以13～28周者所占比例最高，明显高于其他时间者，且足月产率高于早产率及流产率，采用附件切除手术者比例明显高于其他治疗方式，差异均有统计学意义（P〈0．05）。结论妊娠合并卵巢肿瘤蒂扭转患者中主要以成熟性囊性畸胎瘤为主，且妊娠中期发生率相对较高，但经积极治疗可有效改善预后。     

Osteopathic treatment in patients with primary dysmenorrhoea: A randomised controlled trial

ObjectivesTo investigate the effectiveness of a series of osteopathic treatments in patients with pain due to primary dysmenorrhoea.Design and settingsMulti-centered randomised controlled trial with an osteopathic intervention group and an untreated (“waiting list”) control group.SubjectsWomen aged 14 years and older with a regular menstrual cycle, diagnosed with primary dysmenorrhoea.InterventionSix osteopathic treatments over a period of three menstrual cycles or no osteopathic treatment. At each treatment session, dysfunctional structures were tested and treated based on osteopathic principles. In both groups, pain medication on demand was allowed, but was documented.Outcome measuresPrimary outcome measures were average pain intensity (API) during menstruation, assessed by the Numeric Rating Scale (NRS), and days of dysmenorrhoeal pain exceeding 50% of NRS maximum (DDP). Main secondary outcome measure was health-related quality of life.ResultsA total of 60 individuals (average age 33 years) were randomised, seven patients dropped out. API decreased in the intervention group from 4.6 to 1.9 (95%CI = −1.9 to −3.5), and from 4.3 to 4.2 in controls (95%CI = −0.7 to 0.5); between group difference of means (BGDoM): 2.6, 95%CI = 1.7 to 3.6; p < 0.005. DDP decreased from 2.2 to 0.2 days in the intervention group (95%CI = −2.5 to −1.3), and from 2.3 to 1.9 in controls (95%CI = −1.0 to 0.2); BGDoM 1.5; 95%CI = 0.6 to 2.3; p = 0.002. A positive impact on quality of life (physical component score) could be observed in the osteopathic treatment group only.ConclusionsA series of osteopathic treatments might be beneficial for women suffering from primary dysmenorrhoea.     

Placental pathology and clinical trials: Histopathology data from prior and study pregnancies may improve analysis

Placental pathology may explain adverse outcomes and reveal likely recurrent lesions. Stratifying women into intervention arms of a perinatal trial on the basis of the placental histopathological findings of the index pregnancy and evaluating the effect of the interventions against the placental findings at conclusion of a trial may enhance the trial.The Cochrane Central Register of Controlled Trials with “obstetrics” or “perinatal” in the Title, Abstract, or Keywords published in 2015 were classified as to whether placental pathological findings from a previous pregnancy could have been used to stratify the women into the trial and placental pathology (findings) at the end of the study trial could have explained differences in the trial results, and whether these were performed.Two hundred and twenty three of the 275 studies were not relevant. Placental pathology was an outcome measure in 2 of the remaining 52 studies. Seven trials could have benefitted by stratifying women based on previous placental pathology findings, and placental pathology findings at the end of the trial could have explained the trial results but in none of them were these performed. There were 30 trials where placental pathology could have provided an explanation for the result but review of the pathology was not undertaken in any. In the remaining 13 trials, placental pathology was unlikely to be an influence before or after the trial; however, placental pathology would have been of interest or be indicated in most of them.Placental pathology appears to be omitted from perinatal clinical trials. Seventy-four percent (37 of 50) could have benefitted by using placental pathology results of a prior pregnancy to stratify women into intervention arms or incorporating placental pathology results in the evaluation of the interventions.     

The efficacy of supplementation with the novel medical food,Souvenaid, in patients with Alzheimer's disease: A systematic review and meta-analysis of randomized clinical trials

Background and rationale: Certain nutritional supplements are being marketed for the management of Alzheimer's disease (AD), but the evidence for their effectiveness is not established. The objective of this review was to evaluate the evidence from randomized clinical trial (RCTs) examining the effect of Souvenaid in patients with AD.

Methods: We conducted electronic searches in Medline, Embase, PsychINFO, CINAHL, and The Cochrane Library. The reporting quality of the included studies was determined using the Cochrane collaboration tool for assessing the risk of bias. Two reviewers independently determined eligibility, assessed the reporting quality of included studies and extracted data.

Results: Three studies with a total of 1011 participants were included. All were of good reporting quality. Meta-analyses revealed non-significant differences in cognition (ADAS-cog scores MD: 0.08, 95% CI: ?0.71 to 0.88) and function (ADCS-ADL scores MD: 0.36, 95% CI: ?0.54 to 1.25) between Souvenaid and placebo. One study showed significant increase in neuropsychological test battery composite z-score with Souvenaid compared with placebo, and another reported significant improvement in delayed verbal recall for a subgroup of patients with very mild AD. There was no significant effect on global clinical function. No serious adverse events were observed.

Conclusions: The evidence from published clinical trials does not show that supplementation with Souvenaid has beneficial effects on functional ability, behaviour, or global clinical change. Souvenaid may cause improvements in verbal recall in patients at early stages of AD. Few RCTs examining the effect of Souvenaid have been conducted, and they are all funded by same manufacturer. Future research should include using unified tools to measure cognition, function, and behaviour in AD.     

卵巢囊肿蒂扭转应用彩色多普勒超声诊断的临床诊断价值探析

目的：探讨卵巢囊肿蒂扭转应用彩色多普勒超声诊断的临床价值。方法选择我院收治的彩色多普勒超声检查证实为卵巢囊肿蒂扭转的34例患者为研究对象，所有患者均接受彩色多普勒超声检查，回顾分析患者的彩色多普勒超声检查方法，患者超声声像图表现以及与术后病理检查结果的对比。结果所有34例观察对象中，28例患者术后病理检查证实为卵巢囊肿蒂扭转，超声检查准确率为82.35%。卵巢囊肿蒂扭转的彩色多普勒超声检查主要表现为盆腔或腹腔积液，囊壁增厚，混合型团块等等。结论由本次医学研究结果可知，彩色多普勒超声是一种较为有效的卵巢囊肿蒂扭转临床检查和诊断方法，能够准确判断患者的疾病类型和病情，且操作方法较为简单方便，因而具有较高的临床推广和应用价值。