江苏省镇江市肺结核患者电子药盒管理模式评估

目的分析电子药盒在镇江市肺结核患者管理的应用情况,为全市推广使用提供借鉴。方法以2017年10月1日—12月30日确诊并符合条件患者为研究对象,分析不同特征患者强化期末和疗程结束时服药依从性变化、停止使用电子药盒原因;对医务人员使用电子药盒的满意度和接受度进行问卷调查。结果使用电子药盒管理的患者中,初治患者2月末及疗程结束时规则服药率均显著高于复治患者(P<0.05);每日服药时间相同或接近患者治疗2月末规则服药率显著高于每日服药时间不同患者(P<0.05);强化期规则服药的患者全疗程规则服药率显著高于强化期规则服药较差患者(P<0.05);≥60岁患者全疗程停止使用电子药盒比例显著高于其他年龄段(P=0.04);93.8%的医务人员认为电子药盒对提醒患者服药/复诊有帮助。结论电子药盒具有一定推广价值,但在使用中需关注患者每日服药时间及强化期规则服药情况,同时加强对复治患者及低年龄组随访管理。     

Comparison of ambulatory and polysomnographic recording of jaw muscle activity during sleep in normal subjects

Clinicians and investigators need a simple and reliable recording device to diagnose or monitor sleep bruxism (SB). The aim of this study was to compare recordings made with an ambulatory electromyographic telemetry recorder (TEL-EMG) with those made with standard sleep laboratory polysomnography with synchronised audio-visual recording (PSG-AV). Eight volunteer subjects without current history of tooth grinding spent one night in a sleep laboratory. Simultaneous bilateral masseter EMG recordings were made with a TEL-EMG and standard PSG. All types of oromotor activity and rhythmic masseter muscle activity (RMMA), typical of SB, were independently scored by two individuals. Correlation and intra-class coefficient (ICC) were estimated for scores on each system. The TEL-EMG was highly sensitive to detect RMMA (0·988), but with low positive predictive value (0·231) because of a high rate of oromotor activity detection (e.g. swallowing and scratching). Almost 72% of false-positive oromotor activity scored with the TEL-EMG occurred during the transient wake period of sleep. A non-significant correlation between recording systems was found (r = 0·49). Because of the high frequency of wake periods during sleep, ICC was low (0·47), and the removal of the influence of wake periods improved the detection reliability of the TEL-EMG (ICC = 0·88). The TEL-EMG is sensitive to detect RMMA in normal subjects. However, it obtained a high rate of false-positive detections because of the presence of frequent oromotor activities and transient wake periods of sleep. New algorithms are needed to improve the validity of TEL-EMG recordings.     

某综合医院多重耐药菌感染目标性监测与综合干预研究

目的了解某综合医院住院患者多重耐药菌(MDRO)感染情况,采取有效的综合干预措施,以期降低医院MDRO感染。方法对2012年10月—2013年12月住院患者开展MDRO目标性监测,采取综合干预措施,比较干预前后MDRO医院感染发生情况。结果共调查住院患者62 384例,病原学送检率为17.91%(11 176例),606例次患者检出MDRO,其中MDRO医院感染292例次(0.47%),社区感染/定植314例次。MDRO医院感染例次率由干预前的0.65%(75/11 603),降至干预后的0.26%(36/13 875),差异具有统计学意义(χ2=21.08,P0.05)。结论采取综合干预措施可有效控制MDRO医院感染。     

影响多导睡眠监测结果的原因分析

目的：探讨睡眠监测失败和误差的原因。方法：分析31例多导睡眠监测失败个案的各种主观性因素及客观性因素,并对患者接受检查的依从性进行各个单因素相关回归分析及其各自的偏相关分析。结果：睡眠监测失败原因为颈带过紧、电极导电不良或脱落、胸带或腹带过松、指间血氧饱和度连接脱落或歪斜、导联过多影响入睡、患者有强烈手术意愿、一过性高血压、小儿安静期与活动期鉴别不清、不明原因SaO2过低9种。患者个人月收入、职务(职称)、文化程度、SaO2≤85％的时间占睡眠总时间的百分比、性别这5个因素对患者受全夜间监测的依从性有影响。结论：为保证多导睡眠监测一次成功,应牢记常见失败原因,分清重点导联与非重点导联,对耐受力较强的患者可完整连接所有导联,对耐受力较差者应适当减少导联数。导联数最少可减少至5个。     

The impact of intracranial pressure monitoring on mortality after severe traumatic brain injury

Background

The effect of intracranial pressure (ICP) monitoring on mortality after severe traumatic brain injury (sTBI) remains unclear. We hypothesized that ICP monitoring would not be associated with improved survival in patients with sTBI.

Methods

A retrospective analysis was performed on sTBI patients, defined as admission Glasgow Coma Scale score of 8 or less with intracranial hemorrhage. Patients who underwent ICP monitoring were compared with patients who did not. The primary outcome measure was inhospital mortality.

Results

Of 123 sTBI patients meeting inclusion criteria, 40 (32.5%) underwent ICP monitoring. On bivariate and multivariate regression analyses, ICP monitoring was associated with decreased mortality (odds ratio = .32, 95% confidence interval = .10 to .99, P = .049). This finding persisted on propensity-adjusted analysis.

Conclusions

ICP monitoring is associated with improved survival in adult patients with sTBI. In addition, significant variability exists in the use of ICP monitoring among patients with sTBI.     

The quest for accuracy of blood pressure measuring devices

The accuracy of blood pressure (BP) measuring devices is fundamental to good practice and scientific research. International guidelines on BP measurement are provided for clinicians who diagnose and treat patients with hypertension, clinical researchers who conduct trials on the efficacy of BP lowering drugs and interventional strategies, epidemiologists who conduct population surveys to determine the demographic consequences of hypertension on society, and researchers who perform meta‐analyses on published research to further influence the practice of medicine and the provision of resources. Although the outcomes of the endeavors of all these groups are dependent on the accuracy of BP measurements, the equipment is often of doubtful accuracy and the methodology of measurement is often poorly described and frequently not standardized. Thus, the fundamental element of hypertension evaluation has been largely ignored by both clinical practitioners and scientific researchers. Here, the authors briefly review the development of efforts to improve and validate the accuracy of BP measuring devices and highlight the deficiencies that persist. We conclude that, to protect the public from the serious consequences of inaccurate BP measurements, the following steps are required: (1) regulatory requirement for mandatory independent validation of all BP measuring devices using a universal protocol; (2) accreditation of laboratories for the performance of BP device validations; (3) online evaluation of validation studies with detection of protocol violations prior to publication of results; and (4) establishment of an independent scientific forum for the listing of accurate BP measuring devices.     

Thieving rodents as substitute dispersers of megafaunal seeds

The Neotropics have many plant species that seem to be adapted for seed dispersal by megafauna that went extinct in the late Pleistocene. Given the crucial importance of seed dispersal for plant persistence, it remains a mystery how these plants have survived more than 10,000 y without their mutualist dispersers. Here we present support for the hypothesis that secondary seed dispersal by scatter-hoarding rodents has facilitated the persistence of these large-seeded species. We used miniature radio transmitters to track the dispersal of reputedly megafaunal seeds by Central American agoutis, which scatter-hoard seeds in shallow caches in the soil throughout the forest. We found that seeds were initially cached at mostly short distances and then quickly dug up again. However, rather than eating the recovered seeds, agoutis continued to move and recache the seeds, up to 36 times. Agoutis dispersed an estimated 35% of seeds for >100 m. An estimated 14% of the cached seeds survived to the next year, when a new fruit crop became available to the rodents. Serial video-monitoring of cached seeds revealed that the stepwise dispersal was caused by agoutis repeatedly stealing and recaching each other's buried seeds. Although previous studies suggest that rodents are poor dispersers, we demonstrate that communities of rodents can in fact provide highly effective long-distance seed dispersal. Our findings suggest that thieving scatter-hoarding rodents could substitute for extinct megafaunal seed dispersers of tropical large-seeded trees.     

Implanted Microsensor Continuous IOP Telemetry Suggests Gaze and Eyelid Closure Effects on IOP—A Preliminary Study

PurposeTo explore the effect of gaze direction and eyelid closure on intraocular pressure (IOP).MethodsEleven patients with primary open-angle glaucoma previously implanted with a telemetric IOP sensor were instructed to view eight equally-spaced fixation targets each at three eccentricities (10°, 20°, and 25°). Nine patients also performed eyelid closure. IOP was recorded via an external antenna placed around the study eye. Differences of mean IOP between consecutive gaze positions were calculated. Furthermore, the effect of eyelid closure on gaze-dependent IOP was assessed.ResultsThe maximum IOP increase was observed at 25° superior gaze (mean ± SD: 4.4 ± 4.9 mm Hg) and maximum decrease at 25° inferonasal gaze (−1.6 ± 0.8 mm Hg). There was a significant interaction between gaze direction and eccentricity (P = 0.003). Post-hoc tests confirmed significant decreases inferonasally for all eccentricities (mean ± SEM: 10°: −0.7 ± 0.2, P = 0.007; 20°: −1.1 ± 0.2, P = 0.006; and 25°: −1.6 ± 0.2, P = 0.006). Eight of 11 eyes showed significant IOP differences between superior and inferonasal gaze at 25°. IOP decreased during eyelid closure, which was significantly lower than downgaze at 25° (mean ± SEM: −2.1 ± 0.3 mm Hg vs. −0.7 ± 0.2 mm Hg, P = 0.014).ConclusionsOur data suggest that IOP varies reproducibly with gaze direction, albeit with patient variability. IOP generally increased in upgaze but decreased in inferonasal gaze and on eyelid closure. Future studies should investigate the patient variability and IOP dynamics.     

Total Hip Arthroplasty in Patients 50 Years or Less : Do We Improve Activity Profiles?

The primary objective of this study was to use step activity monitoring to quantify activity changes after total hip arthroplasty in patients 50 years or less. Secondly, we investigated whether step activity measurements correlated with the Harris hip and UCLA scores. We prospectively analyzed 37 patients (age ≤ 50) treated with primary THA. Patient activity was recorded with a step activity monitor. Harris hip and UCLA scores were analyzed. Total daily stride counts increased by an average of 30.0%. Increases were noted in the percent of daily time spent at high, moderate and low activity. Increases in daily time spent at high activity moderately correlated with the UCLA activity score but did not correlate with the HHS. Both the UCLA score and the HHS did not correlate with mean daily strides. Following THA, patients ≤ 50 years of age increase their activity by taking more daily strides and improve their activity profile by spending more time at higher activity. Improvements in step activity moderately correlate with improvements in UCLA scores.