Development of a parent-proxy quality-of-life chronic cough-specific questionnaire: clinical impact vs psychometric evaluations

BACKGROUND: Chronic cough affects at least 7% of children, and the impact of this on families is significant. Although adult cough-specific quality-of-life (QOL) instruments have been shown to be a useful cough outcome measure, no suitable cough-specific QOL for parents of children with chronic cough exists. This article compares two methods of item reduction (clinical impact and psychometric) and reports on the statistical properties of both QOL instruments. METHOD: One hundred seventy children (97 boys and 73 girls; median age, 4 years; interquartile range, 3 to 7.25 years) and one of their parents participated. A preliminary 50-item parent cough-specific QOL (PC-QOL) questionnaire was developed from conversations with parents of children with chronic cough (ie, cough for > 3 weeks). Parents also completed generic QOL questionnaires (eg, Pediatric Quality of Life Inventory, version 4.0 [PedsQL4.0] and the 12-item Short Form Health Survey, version 2 [SF-12v2]). RESULTS: The clinical impact and psychometric method of item reduction resulted in 27-item and 26-item PC-QOL questionnaires, respectively, with approximately 50% of items overlapping. Internal consistency among the final items from both methods was excellent. Some evidence for concurrent and criterion validity of both methods was established as significant correlations were found between subscales of the PC-QOL questionnaire and the scales of the SF-12v2 and PedsQL4.0 scores. The PC-QOL questionnaire derived from both methods was sensitive to change following an intervention. CONCLUSION: Chronic cough significantly impacts on the QOL of both parents and children. Although the PC-QOL questionnaires derived from a clinical impact method and from a psychometric method contained different items, both versions were shown to be internally consistent and valid. Further testing is required to compare both final versions to objective and subjective cough measures.     

Scirrhous carcinoma of the stomach: A clinical and pathological study of 106 surgical cases

Clinical and pathological characteristics of scirrhous carcinoma of the stomach were studied in 106 cases treated by gastrectomy between 1973 and 1983. The male to female ratio was 0.58. The percentage of scirrhous carcinomas to all gastric carcinomas resected in the same period was three times higher in females than males. The age distribution of the patients suggested that there were two peaks in the forties and sixties in the male, and in the thirties and fifties in the female. The incidence of scirrhous carcinoma in all types of gastric carcinoma was significantly higher in the twenties, thirties and forties compared to the lowest incidence in the seventies. In the female group the primary lesion had a tendency to be adjacent to the fundic gland area and to avoid intestinal metaplasia. In the male the opposite was recognized. Cancer nests with single cells or only several cells were common in this type of carcinoma. These findings suggest that there might be two biologically different scirrhous carcinomas both in the male and the female, the appearance of single carcinoma cells might be favored by female sex hormones and young ages, and not only the original gastric mucosa but also mucosa with intestinal metaplasia could be precursors of single carcinoma cells.     

The effects of perinatal hypoxia on the behavioral,neurochemical, and neurohistological toxicity of the metabolic inhibitor 3-nitropropionic acid

3-nitropropionic acid (3-NPA) neurotoxicity and long-term effects of perinatal hypoxia were evaluated in 18 adult rats. Hypoxia-insulted (I) and noninsulted (NI) rats were delivered by cesarean section. Hypoxic insult was effected by submerging dissected uterine horns in warmed saline for 15 min. NI rats were delivered from the adjacent nonsubmerged horns. At postnatal day 90, I and NI rats were trained to perform tasks thought to measure behaviors dependent upon aspects of time estimation (TE), motivation, and learning. At 12 months of age, rats were injected i.p. with escalating doses of 3-NPA (5 mg/kg/day to a maximum of 30 mg/kg/day) immediately after each test session and sacrificed at the end of treatment. Additional male rats were used as untreated controls. Although 3-NPA produced a dose-dependent impairment of performance in each task, the effects were qualitatively similar for each group. A significant difference between I and NI rats was, however, observed in the TE task where NI rats completed less of the task at high doses of 3-NPA compared to I rats. Compared to untreated controls, dopamine concentrations were decreased in caudate nucleus of both I and NI rats after 3-NPA. Specific areas most frequently damaged included cerebral cortex, hippocampal subfield CA1, thalamus, caudate nucleus, and the cerebellum. Lesions usually were less extensive in the I rather than NI members of a littermate pair, suggesting a possible protective effect of perinatal hypoxia against subsequent 3-NPA neurotoxicity.     

危害行为风险评估和护理干预在流浪精神障碍患者中的应用

目的 探讨危害行为风险评估和护理干预对流浪精神障碍患者的应用效果。 方法将115例流浪精神障碍患者按住院号的单双数分为研究组和对照组,研究组58例实施危害行为风险评估和基于危害行为风险评估的护理干预,对照组57例实施常规护理干预。分别于干预前和干预3个月后比较2组WHO残疾评定量表Ⅱ(WHO-DAS Ⅱ)评分和观察危害行为发生情况。 结果 干预前,2组WHO-DASⅡ总分、各领域因子得分及危害行为发生率比较,差异无统计学意义;干预后,研究组的WHO-DASⅡ总分及理解与交流、自我照料、生活活动、社会参与的因子得分均低于对照组;研究组的吵架斗殴、吐痰、毁物、色情行为的发生率低于对照组。 结论 基于危害行为的风险评估和护理干预对流浪精神障碍患者的理解与交流、自我照料、生活活动、社会参与等领域的功能有改善作用,有利于防止患者发生危害行为。     

Don't just do something,stand there! The value and art of deliberate clinical inertia

It can be difficult to avoid unnecessary investigations and treatments, which are a form of low‐value care. Yet every intervention in medicine has potential harms, which may outweigh the potential benefits. Deliberate clinical inertia is the art of doing nothing as a positive response. This paper provides suggestions on how to incorporate deliberate clinical inertia into our daily clinical practice, and gives an overview of current initiatives such as ‘Choosing Wisely’ and the ‘Right Care Alliance’. The decision to ‘do nothing’ can be complex due to competing factors, and barriers to implementation are highlighted. Several strategies to promote deliberate clinical inertia are outlined, with an emphasis on shared decision‐making. Preventing medical harm must become one of the pillars of modern health care and the art of not intervening, that is, deliberate clinical inertia, can be a novel patient‐centred quality indicator to promote harm reduction.     

生活行为综合干预妊娠期糖尿病的效果评价

目的：探讨生活行为综合干预对妊娠糖尿病（GDM）患者临床预后的影响,为完善干预策略提供理论依据。方法：238例GDM患者随机分为对照组和干预组。对照组给予常规健康教育,实验组实施基于健康教育、膳食干预、运动干预、心理干预等生活行为综合干预。SPSS统计学软件分析评价两种干预方法的干预效果。结果：干预前,实验组与对照组基线资料中年龄、怀孕前体重、怀孕前BMI、文化程度、家族史、家庭年收入等均无差异（P>0.05）。干预后,实验组患者BMI、餐后血糖、甘油三酯、总胆固醇较干预前的降低量大于对照组,且均有统计学差异（P<0.05）,但两组患者高密度脂蛋白及低密度脂蛋白的变化无统计学差异（P>0.05）;干预后,对照组出现早产（29.0%）、巨大儿（20.2%）的概率高于实验组（χ2=5.11, P=0.024; χ2=4.20, P=0.040）,对照组患者并发妊娠高血压（6.5%）的概率高于实验组（3.5%）（P<0.05）。结论：综合干预在患者一般临床结局及改善妊娠相关并发症结局方面均优于对照组,值得进一步在大人群中推广应用。