军队医院机动卫勤分队训练探讨

本文着眼提高军队医院机动卫勤分队训练质量和水平,从四个方面进行了实践：加强管理,提高训练指导水平;注重创新发展,增强训练质量效益;全力保障,改善训练支撑条件;规范考评,检验训练质量效果;严格奖惩,激发训练内在动力。     

Can a Patient use an App at Home to Measure Knee Range of Motion? Utilizing a Mobile App,Curovate, to Improve Access and Adherence to Knee Range of Motion Measurements

IntroductionKnee range of motion is a critical measure of progress after knee injury and knee surgery. However, many patients do not understand the importance of knee range of motion and most do not have a way to self-monitor their knee range of motion at home. The patient being able to measure their own range of motion can provide improved access to this critical health metric, and could improve adherence with their daily knee range of motion exercises. The purpose of this technical report is to determine if a mobile app, Curovate, can provide reliable measures of knee range of motion compared to standard goniometric measurements.ProceduresThere were four positions of knee flexion and four positions of knee extension each measured twice with a standard goniometer and four different mobile devices with the app Curovate. The reliability and validity of the Curovate app was tested across mobile devices and operating systems and compare to goniometric knee range of motion measurements. A total of 80 measurements were taken. All testing was completed on a healthy 23-year-old male with no knee pathology.ResultsA strong positive correlation, Pearson’s r > = 0.9985, for all positions of knee flexion and extension across all four mobile devices as well as each mobile device compared to standard goniometric measurements.ConclusionsThis article presents a unique method for patients to measure their knee range of motion using the mobile app Curovate. Overall, the mobile app, Curovate, was found to have a strong positive correlation across four mobile devices with varying operating systems and compared to goniometric measurements.Level of evidence4     

Estimating the effect of mobility on SARS-CoV-2 transmission during the first and second wave of the COVID-19 epidemic,Switzerland, March to December 2020

IntroductionHuman mobility was considerably reduced during the COVID-19 pandemic. To support disease surveillance, it is important to understand the effect of mobility on transmission.AimWe compared the role of mobility during the first and second COVID-19 wave in Switzerland by studying the link between daily travel distances and the effective reproduction number (R_t ) of SARS-CoV-2.MethodsWe used aggregated mobile phone data from a representative panel survey of the Swiss population to measure human mobility. We estimated the effects of reductions in daily travel distance on R_t via a regression model. We compared mobility effects between the first (2 March–7 April 2020) and second wave (1 October–10 December 2020).ResultsDaily travel distances decreased by 73% in the first and by 44% in the second wave (relative to February 2020). For a 1% reduction in average daily travel distance, R_t was estimated to decline by 0.73% (95% credible interval (CrI): 0.34–1.03) in the first wave and by 1.04% (95% CrI: 0.66–1.42) in the second wave. The estimated mobility effects were similar in both waves for all modes of transport, travel purposes and sociodemographic subgroups but differed for movement radius.ConclusionMobility was associated with SARS-CoV-2 R_t during the first two epidemic waves in Switzerland. The relative effect of mobility was similar in both waves, but smaller mobility reductions in the second wave corresponded to smaller overall reductions in R_t . Mobility data from mobile phones have a continued potential to support real-time surveillance of COVID-19.     

Formative Research for an Innovative Smartphone Application to Improve Distribution of Healthy Foods to Corner Stores in Baltimore City

We sought to collect information about the operations of wholesalers and store owner perceptions of smartphones to plan for and create a smartphone application that will facilitate the distribution of healthy foods to corner stores. In-depth interviews were conducted with wholesalers, corner store owners, distributors, and food environment experts in Baltimore City, Maryland, which included providing feedback for a mockup of the app. Store owners that were comfortable with smartphones liked the idea of the app because it was economically practical, culturally suitable, simple and easy to use, and provided a large variety of items at a fair or low price. We found that barriers to uptake among corner store owners would be high delivery costs, no foreign language capability, and a complicated user interface. This work will inform future projects that will utilize mHealth technology to improve distribution of healthier foods in food deserts.     

Correlation between the occurrence of 1H-MRS lipid signal, necrosis and lipid droplets during C6 rat glioma development

The aim of this study was to investigate the possible correlation between the 1H MRS mobile lipid signal, necrosis and lipid droplets in C6 rat glioma. First, the occurrence of necrosis and lipid droplets was determined during tumor development, by a histological analysis performed on 34 rats. Neither necrosis nor lipid droplets were observed before 18 days post-implantation. At later stages of development, both necrosis and lipid droplets were apparent, the lipid droplets being mainly located within the necrotic areas. Using a second group of eight rats, a temporal correlation was evidenced between mobile lipid signal detected by in vivo single-voxel one- (136 ms echo time) and two-dimensional J-resolved 1H MR spectroscopy, and the presence of necrosis and lipid droplets on the histological sections obtained from the brains of the same rats. Finally, spatial distribution of the mobile lipid signal was analyzed by chemical-shift imaging performed on a third group of eight animals, at the end of the tumor growth. The spectroscopic image corresponding to the resonance of mobile lipids had its maximum intensity in the center of the tumor where necrotic regions were observed on the histological sections. These necrotic areas contained large amounts of lipid droplets. All these results suggest that mobile lipids detected in vivo by 1H MRS (136 ms echo time) in C6 rat brain glioma arise mainly from lipid droplets located in necrosis.     

Mobile Phone Text Messaging Intervention for Cervical Cancer Screening: Changes in Knowledge and Behavior Pre-Post Intervention

Background

Cervical cancer poses a significant threat to Korean American women, who are reported to have one of the highest cervical cancer mortality rates in the United States. Studies consistently report that Korean American women have the lowest Pap test screening rates across US ethnic groups.

Objective

In response to the need to enhance cervical cancer screening in this vulnerable population, we developed and tested a 7-day mobile phone text message-based cervical cancer Screening (mScreening) intervention designed to promote the receipt of Pap tests by young Korean American women.

Methods

We developed and assessed the acceptability and feasibility of a 1-week mScreening intervention to increase knowledge of cervical cancer screening, intent to receive screening, and the receipt of a Pap test. Fogg’s Behavior Model was the conceptual framework that guided the development of the mScreening intervention. A series of focus groups were conducted to inform the development of the intervention. The messages were individually tailored for each participant and delivered to them for a 7-day period at each participant’s preferred time. A quasi-experimental research design of 30 Korean American women aged 21 to 29 years was utilized with baseline, post (1 week after the completion of mScreening), and follow-up (3 months after the completion of mScreening) testing.

Results

Findings revealed a significant increase in participants’ knowledge of cervical cancer (P<.001) and guidelines for cervical cancer screening (P=.006). A total of 23% (7/30) (95% CI 9.9-42.3) of the mScreening participants received a Pap test; 83% (25/30) of the participants expressed satisfaction with the intervention and 97% (29/30) reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention.

Conclusions

This study provides evidence of the effectiveness and feasibility of the mScreening intervention. Mobile technology is a promising tool to increase both knowledge and receipt of cervical cancer screening. Given the widespread usage of mobile phones among young adults, a mobile phone-based health intervention could be a low-cost and effective method of reaching populations with low cervical cancer screening rates, using individually tailored messages that cover broad content areas and overcome restrictions to place and time of delivery.     

Initial Outcomes From a 4-Week Follow-Up Study of the Text4baby Program in the Military Women’s Population: Randomized Controlled Trial

Background

The use of mobile phone technologies for health promotion and disease prevention has advanced rapidly in recent years. Text4baby is a theory-based mobile health (mHealth) program in which text messages are delivered to pregnant women and new mothers to improve their health care beliefs and behaviors and improve health status and clinical outcomes. Recent evaluations of Text4baby have found that it improves targeted health attitudes and beliefs, but effects on behavior have not yet been determined.

Objective

In this study, investigators aimed to evaluate Text4baby in the military women’s population.

Methods

Investigators conducted a randomized controlled trial at Madigan Army Medical Center in Tacoma, Washington, from December 2011 through September 2013. All participants were pregnant women first presenting for care at Madigan. Investigators conducted a baseline assessment using a 24-item, self-administered online survey of attitudes and behaviors related to Text4baby message content. Participants were randomized to Text4baby plus usual care (intervention) or usual care alone (control). Investigators analyzed treatment effects of Text4baby on short-term targeted outcomes 4 weeks post enrollment.

Results

For this study, 943 patients were randomized and completed a baseline assessment. The average patient age was 28 years and nearly 70% self-identified as Caucasian. 48.7% of enrollees (459/943) completed the first follow-up assessment. Higher rates of single and working/in-school patients dropped out of the intervention arm of the study, and we adjusted for this finding in subsequent models. However, while investigators were unable to re-survey these participants, only 1.9% of Text4baby enrollees (18/943) dropped the service during the study period. Adjusted and unadjusted logistic generalized estimating equation models were developed to assess intervention effects on measured outcomes. In the model adjusting for age, marital status, having had a previous baby, and race/ethnicity, there was a significant effect of Text4baby intervention exposure on increased agreement with belief in the importance of taking prenatal vitamins (OR 1.91, 95% CI 1.08-3.34, P=.024). All of these attitudes had been targeted by at least one text message during the 4-week evaluation period examined in this study. In unadjusted models, there was a significant effect of intervention exposure on belief in the importance of visiting a health care provider to be a healthy new mother (OR 1.52, 95% CI 1.01-2.31, P=.046) and in the health risks of alcohol during pregnancy (OR 2.06, 95% CI 1.00-4.31, P=.05). No behavioral effects of the intervention were observed in this analysis.

Conclusions

Text4baby is a promising program that offers lessons for future mHealth activities. This large-scale study demonstrated initial effects of the program on attitudes and beliefs targeted by the messages received by women during the study period. Results confirm previous findings from Text4baby studies and other mHealth research. Future analyses will examine dosage effects of the intervention on behaviors and clinical outcomes.     

体外反搏患者移动随访平台的研究

目的：建立一个服务于体外反搏（ECP）患者的移动随访平台。便于医生在反搏治疗过程中及结束后随时随地获取患者反馈的信息。并提供正确的康复指导．预防严重并发症的发生。方法：平台采用浏览器／月艮务器（B／S）与客户端／服务器（C／S）两种工作模式,Web服务器安装与配置互联网信息服务（IIS）与邮件传输协议（SMTP）服务,其应用程序利用Vs开发环境,采用C＋＋语言,基于ASP．NET编写。患者随访资料使用SQLServer设计的数据库存储与管理,心电数据及其测量参数按照医学数字成像和通信（DICOM）标准文件格式进行封装与存储。通过调用DICOM读接口和绘图函数显示于移动终端浏览器上。结果：建立了一个由移动终端、心电工作站与web服务器组成的移动随访平台,通过智能手机等设备,患者可输人随访资料与上传自测心电数据．医生可查阅并使用平台提供的电子邮件发送功能给予患者康复指导。结论：随着移动技术的发展,移动医疗将逐步被医疗界所重视,通过移动设备实现对患者的随访可极大地提高随访效率,是值得探讨的一种新的随访方式。     

活动承重和固定承重假体膝关节单髁置换疗效的系统评价

[目的]比较活动和同定承重假体在膝关节单髁置换疗效,评价两种不同似体的差异.[方法]检索Med-line、Embase、Cochrane library、CBM,收集活动和固定承重假体膝关节甲髁置换的临床对照试验,提取数据并采用RevMan 5.0.18进行Meta分析.[结果]纳入5个对照试验,共331例于术,其中活动承重假体组158例,固定承重假体组173例.两组术后两年的临床泮分、功能评分、疼痛评分、关节活动度、假休的磨损率、脱位率和翻修牢比较无明显的统计学差异.[结论]目前证据未能表明活动承重假体或固定承重假体较另一假休更具优势,但考虑纳入研究的总体样木艟小,建议开展更多大样本的对照试验以增加证据的强度.