结节性硬化症90例临床诊断及治疗效果探析

目的：提高患者们结节性硬化症的早期诊断率，尽最大可能的避免漏诊和误诊。方法：回顾性分析过去确诊的90例结节性硬化症患者的临床表现及治疗效果。结果：该病以皮肤改变、癫痫、智能低下为特征。结论：注重患者们的皮肤特征性改变尽可能早的检查作出早期的诊断。     

麻醉后呼吸道感染的临床分析

目的 观察麻醉后呼吸道感染患者的临床特征,为临床预防治疗提供依据.方法 回顾性分析医院2009年3月—2010年9月手术麻醉后呼吸道感染患者的病例资料.结果 根据麻醉方式的不同分为全身麻醉、局部浸润麻醉、神经阻滞椎管麻醉,其中全身麻醉术后呼吸道感染占58.1％,局部浸润麻醉呼吸道感染占14.0％,神经阻滞椎管麻醉呼吸道感染占27.9％；呼吸道感染发生率由高至低依次为神经外科、心外科、骨科、肝胆外科、消化外科,分别占47.7％、22.1％、19.8％、5.8％、4.6％；以＞60岁老年人呼吸道感染发生率较高,占41.8％,其次为50～59岁老年人,占19.8％.结论 高龄、全身麻醉患者术后易引发呼吸道感染,针对其发生因素进行防治对降低麻醉后引发呼吸道感染具有重要作用.     

用于老年基础医学研究与临床辅助诊断的神经肽Y及其受体Y1-6检测方法的初步设想

神经肽Y（NPY）作为机体内一种主要的神经递质和能量调控因子，广泛参与机体各种生理功能的调节，是维持机体内环境稳态的重要物质之一。随着对其研究的不断深入，人们发现它可通过与特定靶细胞膜上不同NPY受体Y1-6的特异性结合而启动并激活相应细胞信号传导通路，从而参与对机体生理功能和靶细胞增殖分化的调控，且NPY及其受体在体内的表达水平又可影响机体的正常生理功能、细胞代谢活动、以及这种改变所诱导或促进或参与的某些老年性疾病的发生、发展及转归，并对相关药物的防治带来明显影响。因此，对NPY及其受体含量的检测项目已成为相关老年性疾病与合并症的发病机制分析、疾病进程观察、治疗效果评价、疾病痊愈判断及预后跟踪随访的重要辅助诊断指标之一。为此，本文通过对可用于老年基础医学研究与临床辅助诊断的NPY及其受体检测的酶联免疫吸附法、放射免疫测定法、荧光免疫检测法、化学发光免疫分析法、免疫组织化学法、压电石英晶片免疫传感器法、免疫印迹法、斑点免疫层析及胶体金法、受体放射配基结合分析法、放射自显影法、液体芯片技术、微粒子酶免分析法等进行NPY及其受体检测方法的综述，并提出前瞻性设想和设计，希望这些用于检测NPY及其受体指标的方法能为未来老年医学的研究和临床应用奠定基础。     

Detecting clinically related content in online patient posts

Patients with chronic health conditions use online health communities to seek support and information to help manage their condition. For clinically related topics, patients can benefit from getting opinions from clinical experts, and many are concerned about misinformation and biased information being spread online. However, a large volume of community posts makes it challenging for moderators and clinical experts, if there are any, to provide necessary information. Automatically identifying forum posts that need validated clinical resources can help online health communities efficiently manage content exchange. This automation can also assist patients in need of clinical expertise by getting proper help. We present our results on testing text classification models that efficiently and accurately identify community posts containing clinical topics. We annotated 1817 posts comprised of 4966 sentences of an existing online diabetes community. We found that our classifier performed the best (F-measure: 0.83, Precision: 0.79, Recall:0.86) when using Naïve Bayes algorithm, unigrams, bigrams, trigrams, and MetaMap Symantic Types. Training took 5 s. The classification process took a fraction of 1 s. We applied our classifier to another online diabetes community, and the results were: F-measure: 0.63, Precision: 0.57, Recall: 0.71. Our results show our model is feasible to scale to other forums on identifying posts containing clinical topic with common errors properly addressed.     

Beyond discrimination: A comparison of calibration methods and clinical usefulness of predictive models of readmission risk

BackgroundPrior to implementing predictive models in novel settings, analyses of calibration and clinical usefulness remain as important as discrimination, but they are not frequently discussed. Calibration is a model’s reflection of actual outcome prevalence in its predictions. Clinical usefulness refers to the utilities, costs, and harms of using a predictive model in practice. A decision analytic approach to calibrating and selecting an optimal intervention threshold may help maximize the impact of readmission risk and other preventive interventions.ObjectivesTo select a pragmatic means of calibrating predictive models that requires a minimum amount of validation data and that performs well in practice. To evaluate the impact of miscalibration on utility and cost via clinical usefulness analyses.Materials and methodsObservational, retrospective cohort study with electronic health record data from 120,000 inpatient admissions at an urban, academic center in Manhattan. The primary outcome was thirty-day readmission for three causes: all-cause, congestive heart failure, and chronic coronary atherosclerotic disease. Predictive modeling was performed via L1-regularized logistic regression. Calibration methods were compared including Platt Scaling, Logistic Calibration, and Prevalence Adjustment. Performance of predictive modeling and calibration was assessed via discrimination (c-statistic), calibration (Spiegelhalter Z-statistic, Root Mean Square Error [RMSE] of binned predictions, Sanders and Murphy Resolutions of the Brier Score, Calibration Slope and Intercept), and clinical usefulness (utility terms represented as costs). The amount of validation data necessary to apply each calibration algorithm was also assessed.ResultsC-statistics by diagnosis ranged from 0.7 for all-cause readmission to 0.86 (0.78–0.93) for congestive heart failure. Logistic Calibration and Platt Scaling performed best and this difference required analyzing multiple metrics of calibration simultaneously, in particular Calibration Slopes and Intercepts. Clinical usefulness analyses provided optimal risk thresholds, which varied by reason for readmission, outcome prevalence, and calibration algorithm. Utility analyses also suggested maximum tolerable intervention costs, e.g., $1720 for all-cause readmissions based on a published cost of readmission of $11,862.ConclusionsChoice of calibration method depends on availability of validation data and on performance. Improperly calibrated models may contribute to higher costs of intervention as measured via clinical usefulness. Decision-makers must understand underlying utilities or costs inherent in the use-case at hand to assess usefulness and will obtain the optimal risk threshold to trigger intervention with intervention cost limits as a result.     

特发性性早熟女童乳腺高频超声显像特征分析

目的:分析研究乳腺高频超声在特发性性早熟女童诊断中应用的价值,为特发性性早熟女童的临床诊断提供新的思路及理论支持。方法:抽取2014年1月至2015年12月我院接收的51例特发性性早熟女童作为研究组,另选取51例同期体检健康者作为对照组。选用Aloka SSD-3500超声显像仪对两组研究对象进行检查,并对盆腔实施常规超声检测,对比观察两组研究对象乳腺大小及组成、超声参数Logistic回归分析结果和血清雌二醇、促卵泡生长激素和黄体生成素水平。结果:采用独立样本t检验可知,研究组周围腺体回声和乳腺中央低回声区长径与厚度相比差异均有统计学意义(P0.05);两组卵泡直径、卵巢容积、卵巢前后径、卵巢横径、卵巢长径相比差异有统计学意义(P0.05),而宫颈长径、子宫容积、子宫体前后径、子宫体横径、子宫体长径相比差异无统计学意义(P0.05);研究组血清雌二醇、促卵泡生长激素和黄体生成素水平均显著高于对照组,差异均有统计学意义(P0.05)。结论:乳腺高频超声在特发性性早熟女童的临床诊断与鉴别中可发挥重大价值,其中卵泡和卵巢形态学参数诊断具有较大价值,且该检查方式具有无创性,操作简单,安全性较高。     

Best practice in clinical facilitation of undergraduate nursing students

Clinical facilitation is critical to successful student clinical experience. The research reported in this paper used an interpretive case study to explore perspectives of clinical facilitators on what constitutes best practice in clinical facilitation of undergraduate nursing students.Eleven clinical facilitators from South East Queensland, Australia, participated in focus groups, interviews and a concept mapping exercise to gather their perspectives on best practice. The data gathered information regarding their prior and current experiences as registered nurses and facilitators, considering reasons they became clinical facilitators, their educational background and self-perceived adequacy of their knowledge for clinical facilitation. Analysis was through constant comparison.Findings of the study provided in-depth insight into the role of clinical facilitators, with best practice conceptualised via three main themes; ‘assessing’, ‘learning to facilitate’ and ‘facilitating effectively’. While they felt there was some autonomy in the role, the clinical facilitators sought a closer liaison with academic staff and feedback about their performance, in particular their assessment of the students. Key strategies identified for improving best practice included educational support for the clinical facilitators, networking, and mentoring from more experienced clinical facilitators. When implemented, these strategies will help develop the clinical facilitators' skills and ensure quality clinical experiences for undergraduate nursing students.     

宣肺豁痰法治疗哮喘（冷哮证）的临床研究

目的：探讨宣肺豁痰法治疗冷哮证的临床效果及其改善肺功能的机制。方法：将125例冷哮证患者随机分为实验组和对照组，实验组（宣肺豁痰法，74例）采用三拗汤和华盖散加减治疗，对照组（51例）采用小青龙汤治疗。用药治疗7天后停药，比较两组拜药后的症状、体征、改善时间及疗效。结果：实验组在哮喘主要症状和体征（除咳嗽外）的控制率明显优于对照组，且这种差异在磋疗的早期即已体现并持续至治疗结束；实验组的起效日寸间明显短于对照组；治疗后随着两组患者临床症状的改善，气道高反应的状态多数得以纠正，治疗后丽组PEF均有显著增加，差异有显著性（P〈0．05），与对照组相比较，实验组在缓解气道痉挛、改善大气道∥能方面有明显优势。治疗后EOS绝对计数及百分比明显下降，实验组下降更显著（P〈0．05）。结论：宣肺豁痰法治疗冷哮证在扩张小气道、缓解其痉挛、消除痰栓、减轻其陶塞等方面较对照组有明显优势。     

子痫前期并可逆性后部白质脑病综合征分析

目的:探讨子痫前期并可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)的临床表现、影像学特点,以便早诊断、早治疗,获得良好的预后。方法:回顾性分析57例病例报道及同仁医院发生的1例子痫前期并可逆性后部白质脑病综合征。结果:产前46例,产后9例,3例发生时间不详。58例均有高血压、蛋白尿伴头痛、视物不清、进而皮质盲。58例中30人行头颅CT检查,2l例未发现异常,7例表现为局灶性低密度改变,以双侧枕部多见,2例表现为病灶广泛、弥漫性水肿。19例行头颅MRI,5例未发现异常,12例提示后部脑白质血管源性水肿。积极治疗、及时终止妊娠视力完全恢复47例,2例视力未恢复,8例未报结局,1例入院后未及时终止妊娠19 h死于脑出血。结论:高血压、蛋白尿伴头痛、皮质盲是子痫前期伴RPLS常见的临床表现,其特点是可逆性大脑皮质性视觉障碍,MRI是诊断的首选方法;早期诊断,及时终止妊娠,合理治疗,预后良好。