上海市浦东新区全科医生甲状腺结节及分化型甲状腺癌相关知识了解情况调查

背景　目前我国甲状腺结节的患病率为20%~76%,已成为内分泌系统的第二大疾病。早发现、早诊断、早治疗是防治甲状腺肿瘤的有效措施,全科医生在其中发挥着重大作用。但是,社区卫生服务中心对甲状腺疾病的管理还存在许多不足之处。目的　了解上海市浦东新区全科医生对甲状腺结节及分化型甲状腺癌（DTC）相关知识的了解情况,发现不足之处并提出改进方法,以期推进甲状腺疾病分级诊疗。方法　于2017-12-20至2018-01-10,依据上海市浦东新区的城乡划分,即城镇地区、城郊结合地区、郊区,使用计算机在各区随机整群抽取3家社区卫生服务中心的全部全科医生为调查对象,采用问卷星形式进行调查,调查内容包括一般资料、甲状腺结节的良恶性评估、甲状腺结节术前及术后管理、DTC术后促甲状腺激素（TSH）抑制治疗和管理及全科医生甲状腺疾病管理能力自我评估。结果　本研究共发放问卷309份,回收307份,有效回收率为99.4%。在全科医生对甲状腺结节良恶性的评估方法的了解情况评估中,对电子计算机断层扫描、磁共振成像及2-氟-2-脱氧D-葡萄糖正电子发射断层显像术,TSH,甲状腺球蛋白的了解程度,不同职称和学历全科医生之间比较,差异均有统计学意义（P<0.05）;不同职称全科医生对血清降钙素的了解程度比较,差异有统计学意义（P<0.05）。在全科医生对甲状腺结节术前及术后管理的了解情况评估中,不同职称全科医生对甲状腺结节术前随访时间、细针穿刺抽吸活检适应证和术后TSH抑制治疗、左甲状腺素替代治疗的了解程度比较,差异均有统计学意义（P<0.05）;不同学历全科医生对甲状腺结节术前随访时间、131I治疗的适应证和禁忌证的了解程度比较,差异均有统计学意义（P<0.05）。在全科医生对DTC术后TSH抑制治疗和管理的了解情况评估中,不同职称全科医生对术后首选L-T4口服制剂、L-T4服用方法、L-T4剂量调整、TSH水平监测的了解程度比较,差异均有统计学意义（P<0.05）;不同学历全科医生对L-T4剂量调整、心脏监测的了解程度比较,差异均有统计学意义（P<0.05）。全科医生对甲状腺结节良恶性评估方法的了解情况得分为（19.1±6.9）分、对甲状腺结节术前与术后管理的了解情况得分为（14.0±7.2）分和对DTC术后TSH抑制治疗和管理的了解情况得分为（13.7±8.4）分,不同学历、职称全科医生对这3部分相关知识的了解情况得分以及总分比较,差异均有统计学意义（P<0.05）;且不同职称、学历全科医生对甲状腺疾病管理能力自我评估比较,差异均有统计学意义（P<0.05）。结论　上海市浦东新区全科医生对甲状腺结节及DTC相关知识的了解较为欠缺,尤其是对甲状腺结节患者的术前转诊随访及术后治疗管理、DTC患者术后TSH抑制治疗和管理的了解,且自我评估对甲状腺疾病的管理能力缺乏信心,需要加强学习和临床培训。     

北京市东城区医务人员传染病报告知识知晓情况调查

目的 了解医疗机构医务人员接受传染病疫情报告方法培训情况和相关知识知晓率,并分析其影响因素.方法 对负责疫情直报的医疗机构医务人员开展面对面问卷调查,采用Epi-data3.0建立数据库,使用SPSS12.0对数据进行统计分析,确定传染病报告知识知晓情况的主要影响因素.结果 本研究的1403份有效问卷中,知晓率合格的问卷比例为61.80％(867/1403).影响被调查对象知晓率的因素为医疗机构级别、工作人员专业、文化程度和参加培训次数等.被调查对象中,三级医疗机构医务人员传染病报告知识知晓合格率好于二级,二级医疗机构好于一级(OR=1.940,95％ CI:1.539 ～2.445,P＜0.05);公共卫生专业的医务人员知晓合格率高于临床、护理及其它专业人员(OR=3.293,95％ CI:1.708 ～6.347,P＜0.05);文化程度为大专及以上的医务人员知晓率高于高中及中专、初中文化程度的医务人员(OR=1.691,95％CI:1.112～2.572,P＜0.05);本年度参加传染病报告知识培训次数＞2次的医务人员知晓率高于参加2次培训的医务人员,参加2次培训的医务人员高于仅参加1次培训的医务人员(OR=2.067,95％CI:1.776 ～2.045,P＜0.05).结论 需要加强对医务人员传染病报告知识的培训,同时改进报卡方式,提高效率,并加强对传染病报告知识培训的督导检查.     

新疆艾滋病高发区维汉民族干部教师和医生婚姻及性态度性行为和艾滋病知识的调查分析

目的了解新疆艾滋病高发区维吾尔族和汉族的干部、教师和医生,对婚姻及性的态度、性行为和艾滋病知识知晓率的情况及差异,为该地区的艾滋病预防和干预策略的制定提供参考依据。方法选择新疆伊犁州和乌鲁木齐市艾滋病高流行区街道/社区机关、中小学和医院中,18～60岁已婚的维吾尔族和汉族的干部、教师、医生进行抽样问卷调查。结果共调查769人(维吾尔族491人、汉族278人),平均年龄为36.98岁。对待婚姻的态度,64.9%的调查对象认为婚姻是神圣的;91.7%不同意或很不同意女性为了生活而卖淫的说法;80%认为女性保持贞操很重要或重要;60.6%认为多次结婚、多次离婚是件丢人的事情;对婚前性行为,58.2%持抵制态度;对"一夜情",72.5%持抵制态度;对同性恋,88.3%持抵制态度;对以上7个问题维汉族态度差异有统计学意义(P<0.01)。93.5%的调查对象结过一次婚;对待男人找暗娼行为,80.6%认为是不光彩的行为;对待与多人有性关系,82.5%认为是一件见不得人的事情;以上3个问题维汉族态度差异无统计学意义(P>0.05)。婚前性行为(32.6%)、婚外性行为(11.6%)、每周性行为次数(34.2%的1次、31.5%的2次)和有婚外性行为时使用安全套的原因(防病占53.4%),以上4个问题维汉族差异有统计学意义(P<0.05)。初次性行为的年龄(平均为25.22岁)、发生婚外性行为的场所主要是宾馆(占63.4%)、发生婚外性行为时安全套使用情况(每次都用占55.7%)和不使用安全套原因(主要是没有快感占41.8%),此4个问题维汉族差异无统计学意义(P>0.05)。维吾尔族艾滋病知识知晓率为92.4%,汉族为93.6%,维汉族差异没有统计学意义(P>0.05);发生婚外性行为每次都用安全套者的艾滋病知识知晓率为91.83%,有时用的知晓率为91.84%,从不使用的知晓率为92.08%,三者间差异无统计学意义(P>0.05)。结论新疆艾滋病高发区维汉民族干部、教师和医生对待婚姻及性的态度和性行为存在一定的开放程度,但是维吾尔族相对于汉族较保守,此类人群的艾滋病知识知晓率较高,应根据此类人群和不同民族的特征,有的放矢地开展艾滋病的健康教育和行为干预。     

Neural processing stages during object-substitution masking and their relationship to perceptual awareness

The extent of visual perceptual processing that occurs in the absence of awareness is as yet unclear. Here we examined event-related-potential (ERP) indices of visual and cognitive processes as awareness was manipulated through object-substitution masking (OSM), an awareness-disrupting effect that has been hypothesized to result from the disruption of reentrant signaling to low-level visual cortical areas. In OSM, a visual stimulus array is briefly presented that includes a parafoveal visual target denoted by a cue, typically consisting of several surrounding dots. When the offset of the target-surrounding cue dots is delayed relative to the rest of the array, a striking reduction in the perception of the target image surrounded by the dots is observed. Using faces and houses as the target stimuli, we found that successful OSM reduced or eliminated all the measured electrophysiological indices of visual processing stages after 130 ms post-stimulus. More specifically, when targets were missed within the masked condition (i.e., on trials with effective OSM that disrupted awareness), we observed fully intact early feed-forward processing up through the visual extrastriate P1 ERP component peaking at 100 ms, followed by reduced low-level activity over the occipital pole 130–170 ms post-stimulus, reduced ERP indices of lateralized shifts of attention toward the parafoveal target, reduced object-generic visual processing, abolished object-category-specific (face-specific) processing, and reduced late visual short-term-memory processing activity. The results provide a comprehensive electrophysiological account of the neurocognitive underpinnings of effective OSM of visual-object images, including evidence for central roles of early reentrant signal disruption and insufficient visual attentional deployment.     

Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC): Standardisation of the principal subscale to assess awareness in patients with disorders of consciousness

Establishing valid and reliable measures for use with patients with disorders of consciousness (DOC) following profound brain injury is challenging due to a number of factors including the complex presentation of such patients and assessor variability. The auditory modality has been demonstrated to have greater sensitivity for detecting awareness in DOC patients. However, there are no measures developed to assess auditory responsiveness specifically. The objective of this study was to examine the psychometric properties of the principal subscale of a music therapy assessment tool (MATADOC) developed for use with adult DOC patients. The subscale assesses behavioural domains essential for diagnosis of awareness. Twenty-one adult patients were recruited from a specialist rehabilitation unit. In a prospective study with repeated measures, internal consistency, inter-rater and test–retest reliability and dimensionality were examined. The five-item scale showed satisfactory internal reliability (α = .76) and a strong first principal component. Corrected item-total correlations were all > .45. Inter-rater intra-class correlations (ICCs) ranged from 0.65–1.00 and intra-rater ICCs from 0.77–0.90. Rasch analysis confirmed these impressions of a reliable, unidimensional and homogenous scale. Diagnostic outcomes had 100% agreement with a validated external reference standard. The results indicate that the MATADOC principal subscale provides a new behavioural measure that can contribute to interdisciplinary assessment of awareness with DOC patients.     

Sensitivity to masked conditioned stimuli predicts conditioned response magnitude under masked conditions

Expression of conditioned fear has been reported to be independent of perceptual awareness of conditioned stimuli (CSs). Previous studies have been criticized, however, for not adequately assessing perceptual awareness. We fear-conditioned participants to one of two symbols and measured skin conductance responses to dichoptically masked and unmasked CSs. Participants also performed a target detection task and sensitivity (d') to the masked conditioned stimuli (CS+, CS-) was measured. Results showed that sensitivity under masking conditions was related to conditioned responses to masked CSs but not unmasked CSs. Thus, a strong relationship between expression of conditioned fear and awareness of the CS+ emerges when the latter is assessed by signal detection methods. Without consensus on how awareness should be defined, these findings bring balance to previous studies that have typically used less sensitive assessments of awareness.     

Awareness and attitude of general population regarding allograft skin donation in Riyadh,Saudi Arabia: Cross-sectional study

IntroductionBurns are one of the major health issues that considerably affect variable groups of the population, varying in age and severity. Despite advances in burn surgical and non-surgical treatments, patient's appearance still represents public health issue. In regards to surgical treatment of burns, skin grafting is still considered the gold standard. One of the major burdens in the burn surgical treatments is the availability of the skin for grafting. As for the non-surgical treatment different modalities of skin dressings or substitutes are still available as an option.MethodsA validated questionnaire based study was utilized to acquire assessment of the overall general population knowledge, awareness and attitude toward skin donation. In addition, it surveyed community personal willingness to donate their skin to a skin bank after being deceased, to help solve skin shortages due to the lack of skin banks in Saudi Arabia.ResultsA total of 698 individuals completed the questionnaire over the period of 5 months, from February 2018 till June 2018. Married, postgraduate females, with a history of burn in close family members or similar individuals showed a positive attitude toward skin donation. However, 22% of the participants did not agree to donate their skin due to religious reasons.ConclusionThe study concluded that the majority of participants were willing to donate their skin, and they were aware of the concept of skin donation and its crucial importance in surgical burn management. The current study showed the majority of participants were aware of skin donation and skin use for burn treatment, in addition to having positive attitude toward skin donation. Men were more aware than the women of skin donation. Religious concern was a major reason for participants’ skin donation refusal, an issue that can be addressed by contacting Islamic scholars to issue a Fatwa approving the cause.     

Monitoring techniques; neuromuscular blockade and depth of anaesthesia

This article outlines the physical principles underlying peripheral nerve stimulation and depth of anaesthesia monitoring in relation to anaesthesia. The patterns of nerve stimulation most commonly used in clinical practice are described including train-of-four, double burst stimulation and tetanic stimulation, as well as methods used to measure motor response. The key technologies currently used to monitor level of consciousness during anaesthesia are also described, namely methods based on electroencephalography and stimulus evoked potentials, including limitations of their use. Published clinical guidelines on the use of both nerve stimulators and level of consciousness monitors are also discussed.