Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions?

Background  Mental health interventions should demonstrate an effect on patients’ functioning as well as his/her needs, in particular on unmet needs whose assessment depends on the perspective of either the patient or the clinician. However, individual met and unmet needs appear to change over time, qualitatively and quantitatively, raising questions about their sensitivity to change and about the association between level of needs and treatment. Methods  Data on baseline and follow-up need assessment in community mental health services in four European countries in the context of a cluster randomised trial on a novel mental health service intervention were used, which involved 102 clinicians with key worker roles and 320 patients with schizophrenia or related psychotic disorders. Need assessment was performed with the Camberwell assessment of needs short appraisal schedule (CANSAS) among patients as well as clinicians. Focus is the sensitivity to change in unmet needs over time as well as the concordance between patient and clinician ratings and their relationship with treatment condition. Results  At follow-up 294 patients (92%) had a full need assessment, while clinician rated needs were available for 302 patients (94%). Generally, the total number of met needs remained quite stable, but unmet needs decreased significantly over time, according to patients as well as to clinicians. Sensitivity to change of unmet needs is quite high: about two third of all unmet needs made a transition to no or met need, and more than half of all unmet needs at follow-up were new. Agreement between patient and clinician on unmet needs at baseline as well as follow-up was rather low, without any indication of a specific treatment effect. Conclusions  Individual unmet needs appear to be quite sensitive to change over time but as yet less suitable as outcome criterion of treatment or specific interventions.     

生化指标在早期肾损伤诊断中的应用

目的探讨尿微量白蛋白、尿酶、胱抑素C联合检测在早期肾损伤诊断中的应用。方法采用免疫比浊法检测尿微量白蛋白、胱抑素C含量,速率法测尿酶。结果病例组3项指标均高于健康对照组,且3项指标联合检测阳性率高于单项。结论微量白蛋白、N-乙酰-β-D-氨基葡萄糖苷酶、胱抑素C的3项指标均是早期肾损伤的敏感指标,联合检测对患者肾损伤的早期诊断有应用价值。     

内关穴皮部浅刺和常规针刺脑功能磁共振成像比较

目的:运用功能性磁共振脑功能成像技术,研究内关穴皮部浅刺和常规针刺对不同脑功能区激活的异同。方法:7例青年志愿者分别接受内关穴皮部浅刺和常规针刺,并进行功能性磁共振脑部扫描。统计皮部浅刺和常规针刺状态下脑部各感兴趣区的激活概率、激活点数、激活强度,并进行比较。结果:内关穴皮部浅刺和常规针刺,对左右不同脑区的激活概率、激活点数和激活强度均无显著性差异,但有趋势表明,常规针刺对双侧颞叶和左侧枕叶、右侧小脑有相对集中的激活,皮部浅刺对右侧枕叶、左侧小脑有相对集中的激活。结论:内关穴皮部浅刺和常规针刺对不同脑部功能区激活无显著性差异,但表现有常规针刺更能激活双侧颞叶的趋势。     

献血者血常规指标及生理状况对机采血小板质量的影响

目的观察机采血小板的收集与献血者采前外周血血常规的几项指标和自身生理状况的相关性。方法对采血前、后血小板（PLT）计数等进行分组分析。结果血小板机采量与采前PLT计数呈正相关系（r=0.488）,并与献血者的年龄和体重有关（r值分别为0.206和0.273）。结论采血前外周血血常规的指标和自身生理状况均对机采血小板的收集量有一定的影响。为了进一步提高机采血小板的收集量,保证血小板的质量,机采前必须严格筛查献血者。     

综合指数与粗糙集联用法在评价人群血常规指标健康风险水平的应用

目的应用综合指数与粗糙集理论联用法评价人群血常规指标,为评价相关指标健康风险状况提供参考依据。方法回顾性分析2016-2020年广东地区送往广州达安临床检验中心的20023份血常规标本检验数据,建立指数分析(综合指数)与风险分析(粗糙集理论)联用法评价人群血常规8项指标健康水平,即红细胞计数(RBC)、平均红细胞容积(MCV)、血红蛋白(Hb)、平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)、血细胞比容(HCT)、白细胞计数(WBC)和血小板计数(PLT)。结果广东整体人群血液健康指数(BHI)均值为0.774,其中老年人群为0.742、男性人群为0.758、非老年人群为0.794、女性人群为0.790。2016-2019年各类人群BHI值均表现为逐渐降低,2020年略有上升。在单项指标中,MCHC的健康指数(1.280~1.398)和MCV的健康指数(0.834~1.010)均明显高于其他指标。风险分析提示MCHC在各类人群中均存在较高风险,风险覆盖度分别为整体人群9.362‰、男性人群13.242‰、女性人群20.831‰、老年人群5.579‰和非老年人群7.547‰。结论综合指数与粗糙集理论联用法可以评价人群血常规指标健康风险状况,2016-2020年广东地区人群血常规健康程度为合格水平且表现为总体上升,MCHC和MCV指标对广东地区人血常规健康影响较大,同时在各类人群中MCHC指标均提示不同概率的风险,应加强监测。     

Acupuncture in patients with headache

We aimed to investigate the effectiveness of acupuncture in addition to routine care in patients with primary headache (> 12 months, two or more headaches/month) compared with treatment with routine care alone and whether the effects of acupuncture differ in randomized and non-randomized patients. In a randomized controlled trial plus non-randomized cohort, patients with headache were allocated to receive up to 15 acupuncture sessions over 3 months or to a control group receiving no acupuncture during the first 3 months. Patients who did not consent to randomization received acupuncture treatment immediately. All subjects were allowed usual medical care in addition to study treatment. Number of days with headache, intensity of pain and health-related quality of life (SF-36) were assessed at baseline, and after 3 and 6 months using standardized questionnaires. Of 15 056 headache patients (mean age 44.1 ± 12.8 years, 77% female), 1613 were randomized to acupuncture and 1569 to control, and 11 874 included in the non-randomized acupuncture group. At 3 months, the number of days with headache decreased from 8.4 ± 7.2 (estimated mean ± s.e. ) to 4.7 ± 5.6 in the acupuncture group and from 8.1 ± 6.8 to 7.5 ± 6.3 in the control group ( P  < 0.001). Similarly, intensity of pain and quality of life improvements were more pronounced in the acupuncture vs. control group ( P  < 0.001). Treatment success was maintained through 6 months. The outcome changes in non-randomized patients were similar to those in randomized patients. Acupuncture plus routine care in patients with headache was associated with marked clinical improvements compared with routine care alone.     

How do Dutch general practitioners diagnose children's urinary tract infections?

Objective  To study which tests general practitioners used to diagnose a urinary tract infection (UTI) in children and which patient characteristics were associated with test choice.
Design  Retrospective chart review on the diagnosis of UTIs in children in Dutch general practices who were diagnosed as having a UTI. A total of 49 general practices participated in the study, and provided information on 148 children aged 0–12 years old.
Results  The nitrite test, which is recommended as first step, was performed in 87% of the children during the first contact. Less than 30% of the children had a dipslide and 37% a cultured urine. About half of all children with a UTI diagnosis had a follow-up contact in general practice, and an average of 83% of these children had their urine tested. The recommended test, a dipslide, was performed in 26% of the children with a follow-up contact. Patient age and UTI history were associated with choice of test.
Conclusions  The diagnostic procedures for UTIs in children in general practices could be improved, with focus on the importance of an accurate UTI diagnosis in all children, and explaining which tests should be performed and what the test results mean.     

大剂量甲基强的松龙冲击疗法治疗系统性红斑狼疮48例临床分析

目的观察大剂量甲基强的松龙冲击疗法的临床疗效及与常规激素疗法进行比较.方法对我院1993年～2000年资料较完整的48例系统性红斑狼疮重点在治疗效果上进行分析.结果经采用大剂量甲基强的松龙冲击疗法治疗的36例中,好转31例(86.1%),无效4例(11.1%),死亡1例(2.8%);经常规激素治疗的12例中,好转7例(58.3%),无效2例(16.7%),死亡3例(25%).结论大剂量甲基强的松龙冲击疗法在疗效等方面优于常规激素疗法.     

康复新液联合生长抑素治疗急性十二指肠溃疡出血的临床研究

目的 探析康复新液联合注射用生长抑素治疗急性十二指肠溃疡出血的临床效果。方法 选取2020年1月—2022年1月中国人民解放军南部战区总医院诊治的106例急性十二指肠溃疡出血患者，以随机数字表法将所有患者分为对照组和治疗组，各53例。对照组首先缓慢静脉注射0.25 mg注射用生长抑素作为负荷剂量，而后立即静脉点滴0.25 mg/h。如果两次输液给药间隔大于3～5 min，采取重新静脉注射0.25 mg注射用生长抑素以确保给药的连续性。治疗组在对照组治疗的基础上口服康复新液，10 mL/次，3次/d。两组连续治疗7 d。比较两组的临床疗效、临床指标、血清炎性因子水平。结果 治疗后，治疗组总有效率为98.11%，显著高于对照组的总有效率83.02%（P＜0.05）。治疗后，治疗组大便隐血转阴时间、禁食时间均短于对照组（P＜0.05）。治疗后，两组血清白细胞介素-6（IL-6）水平均较治疗前下降（P＜0.05）；且治疗组的血清IL-6水平均低于对照组（P＜0.05）。结论 康复新液联合注射用生长抑素治疗急性十二指肠溃疡出血的效果更显著，可有效改善临床症状、降低血清IL-6水平。