糖尿病患者出院准备度与出院指导质量现状 及相关性分析

目的探讨糖尿病患者出院准备度与出院指导质量现状,并进行相关性分析。方法采用便利抽样法,选取2015年5—12月收治于四川大学华西医院的糖尿病患者200例,应用患者一般资料调查表、出院准备度量表和出院指导质量量表进行调查。结果糖尿病患者出院准备度的条目平均分为(8.13±1.37)分,出院指导质量条目平均分为(8.60±1.32)分。糖尿病患者出院准备度各维度得分从高到低依次为可获得的社会支持、疾病知识、出院后应对能力、自身状况;糖尿病患者出院准备度和出院指导质量呈正相关(r=0.544,P0.01)。结论糖尿病患者出院准备度现状处于中高水平,其出院准备度和出院指导质量呈正相关,医务人员应加强出院指导,提高糖尿病患者的出院准备度现状,从而降低患者的再入院率。     

Effects of the Ten Percent Cap in Medicare Home Health Care on Treatment Intensity and Patient Discharge Status

Objective

To estimate the effect of the 10 percent cap introduced to Medicare home health care on treatment intensity and patient discharge status.

Data Sources

Medicare Denominator, Medicare Home Health Claims, and Medicare Provider of Services Files from 2008 through 2010.

Study Design

We used agency-level variation in the proportion of outlier payments prior to the implementation of the 10 percent cap to identify how home health agencies adjusted the number of home health visits and patient discharge status under the new law.

Principal Findings

Under the 10 percent cap, agencies dramatically decreased the number of service visits. Agencies also dropped relatively healthy patients and sent sicker patients to nursing homes.

Conclusions

The drastic reduction in the number of service visits and discontinuation of relatively healthy patients from home health care suggest that the 10 percent cap improved the efficiency of home health services as intended. However, the 10 percent cap increased other types of health care expenditures by pushing sicker patients to use more expensive health services.     

Cluster Analysis of Vulnerable Groups in Acute Traumatic Brain Injury Rehabilitation

Objective

To analyze the complex relation between various social indicators that contribute to socioeconomic status and health care barriers.

Maximizing gait and balance: behaviors and decision-making processes of persons with multiple sclerosis and physical therapists

Purpose: To describe the behavioral decisions used by persons with multiple sclerosis (MS) and physical therapists to maximize gait and balance following outpatient physical therapy.

Methods: A multi-method case series with seven matched pairs (persons with MS–physical therapists). Quota sampling maximized variability among persons with MS (disease steps score range 3–6). Three of the four physical therapists were MS or neurology certified. Persons with MS completed a phone survey, follow-up interview, and standardized questionnaires. Physical therapists completed an interview. Data were collected 2–8 weeks following discharge. Content and constant comparison analyses were used for thematic development and triangulation.

Results: Core themes arose exemplifying the decision-making processes and actions of persons with MS (challenging self by pushing but respecting limits) and physical therapists (finding the right fit). One overarching theme, keeping their lived world large, or participation in valued life roles, emerged integrating both perspectives driving decision-making.

Conclusions: Participants have a shared goal of maximizing gait and balance so persons with MS can participate in valued life roles. Understanding the differences in the behavioral decisions and optimizing skill sets in shared decision-making and self-management may enhance the therapeutic partnership and engagement in gait- and balance-enhancing behaviors.

• Implications for Rehabilitation

• Persons with MS and physical therapists have a shared goal of maximizing gait and balance so persons with MS can participate in valued activities and life roles, or more poetically, keep their lived world large.

• Knowledge that persons with MS aim to challenge themselves by pushing but respecting limits can provide physical therapists with greater insight in helping persons with MS resolve uncertainty, set meaningful goals, and build the routines and resilience needed for engagement in gait- and balance-enhancing behaviors.

• Enriching skill sets in shared decision-making, behavior change and self-management may optimize the physical therapist toolbox.

     

阴道炎五联检验对阴道炎病原体诊断与白带清洁度检测的应用效果分析

目的观察和分析阴道炎五联检验对阴道炎病原体诊断与白带清洁度检测的应用效果。方法选择门诊接受阴道分泌物检查的患者260例作为研究对象,提取患者阴道分泌物标本分别进行阴道炎五联检测和常规镜检,对两种方法检测真菌性阴道炎、滴虫性阴道炎、细菌性阴道炎和白带清洁度的结果进行比较和分析。结果常规镜检法和阴道五联检法检测真菌性阴道炎、滴虫性阴道炎、白带清洁度结果的总符合率分别为95.8%、97.7%和83.8%,两种方法的检出率差异无统计学意义,而两种方法检测细菌性阴道炎结果的总符合率为85.0%,阴道五联检法检出率显著高于常规镜检法(χ2=16.058,P<0.05)。结论阴道炎五联检测法可提高细菌性阴道炎的检出率,具有较高的灵敏度和特异度,可为临床医师制定合理的治疗方案提供有价值的依据。     

On the atrial response to focal discharges in man

INTRODUCTION: Triggers and vulnerability are key factors for the occurrence of atrial fibrillation (AF). The aim of this study was to assess spatial dispersion of atrial refractoriness and vulnerability in response to both focal discharges as well as programmed electrical stimulation in patients undergoing ablation of atrial arrhythmogenic foci. METHODS AND RESULTS: Twenty-nine patients were studied, and 12 right atrial unipolar electrograms were recorded. Inducibility of AF was assessed by a pacing protocol that started with one extrastimulus, followed by more aggressive pacing until AF was obtained. Mean fibrillatory intervals were used to assess the local refractoriness of each recording site. Spatial dispersion of refractoriness was calculated as the coefficient of dispersion (CD value: standard deviation of the mean of all local mean fibrillatory intervals as a percentage of the overall mean fibrillatory interval). Based on our previous study, a CD value 3.0 was considered enhanced spatial dispersion of refractoriness. Fifteen of 29 patients had normal dispersion of refractoriness (mean CD value 1.65 +/- 0.43), and AF was inducible with burst pacing only. These patients had focal discharges causing rapid atrial tachycardia with a focal activation pattern. Activation mapping of focal activity was possible in 14 of 15 patients. Focal triggering of AF occurred in only 1 of 15 patients. Fourteen of 29 patients had enhanced dispersion (mean CD value 4.2 +/- 0.72). AF was inducible with a single extrastimulus in 11 of 14 patients (P < 0.001). Focal triggering of AF occurred in all 14 patients. CONCLUSION: Spatial dispersion of atrial refractoriness determines whether focal atrial discharges trigger AF with disorganized activity or, alternatively, only rapid atrial tachycardia.     

Radio-frequency plasma treatment improves the growth and attachment of endothelial cells on poly(methyl methacrylate) substrates: implications in tissue engineering

The aim of this study was to improve the biocompatibility of poly(methyl methacrylate) (PMMA) substrates for possible applications in corneal prostheses or in micro-carrier cell culture systems. PMMA substrates were exposed to radio-frequency (RF) argon and nitrogen plasmas for 5 and 10 min each. The PMMA films were examined by Fourier transform infrared (FT-IR) spectroscopy, to characterize the surface changes after plasma exposure. Plasma treatment in general was found to decrease the water contact angle of PMMA, thus increasing its hydrophilicity. There was also an associated increase in the work of adhesion of plasma-treated PMMA substrates. PMMA substrates exhibited differential properties towards endothelial cell (CPA-47) growth. The untreated PMMA surface did not support endothelial growth, compared with both polystyrene (TCPS) and plasma-treated PMMA, while plasma (PL):PMMA exhibited growth rates slightly lower than the TCPS control, as assessed by [³H]thymidine incorporation profiles. The compatibility and growth supportive properties of PL: PMMA were further confirmed by an MTT assay, which showed preserved cellular viability and mitochondrial activity of the cells. Confocal microscopic visualization of cells with fluorescence-labeled vimentin showed normal organization of the cytoskeletal fibers, indicating appropriate attachment to the substrate. Cells growing on PL:PMMA maintained their functionality, as seen from Factor VIII expression. Taken collectively, the findings of this study point out the suitability of RF plasma treatment in inducing desirable changes in PMMA substrates, so as to improve their ability to support the growth and attachment of endothelial cells.     

Plasma gas discharge deposited fluorocarbon polymers exhibit reduced elutability of adsorbed albumin and fibrinogen

The adsorption and subsequent detergent elutability of fibrinogen and albumin were measured on various treated and untreated polymer films in order to determine whether the relative adsorption of these proteins was responsible for the enhanced thromboresistance of Dacron vascular grafts treated with tetrafluoroethylene in a radio frequency glow discharge (RFGD) apparatus. Fluorocarbon-coated surfaces varying in the relative proportions of CF, CF₂' and CF groups and in the ratio of fluorine to carbon were prepared by RFGD treatment of poly(ethylene terephthalate) (PET) films with tetrafluoroethylene or perfluoropropane. The adsorption of fibrinogen and albumin to these fluorocarbon-coated surfaces was comparable to the adsorption of the proteins to polytetrafluoroethylene (PTFE) and PET. However, the elutability of fibrinogen and albumin from the RFGD fluorocarbon surfaces with sodium dodecyl sulfate was much lower than that from PTFE or PET. Other RFGD treatments of PET, such as ethylene deposition or argon etching, did not reduce the extent of albumin elutability as dramatically as did the RFGD fluorocarbon treatments. The strong albumin binding to RFGD fluorocarbon surfaces may be exploited clinically to enhance the retention of albumin preadsorbed to blood-contacting surfaces fo render them thromboresistant.     

甲钴胺对大鼠受损背根节A-类神经元自发放电的抑制作用

目的:研究甲钴胺(methylcobalamin,Methyl B12)对损伤背根节(dorsal root ganglion,DRG)A-类神经元的不同模式自发放电的作用。方法:在大鼠L5椎间孔植入不锈钢柱制备大鼠DRG慢性压迫模型(chronic com-pression of DRG,CCD)上,利用在体单纤维细胞外记录方法研究Methyl B12对受损DRG神经元自发放电的影响。结果:(1)CCD模型大鼠出现明显的双侧机械刺激引起缩足反应阈值降低(P<0.001);(2)Methyl B12(300μmol/L)对受损A-类DRG神经元自发放电具有显著的抑制作用(n=13,P<0.05);(3)Methyl B12(300μmol/L)对受损A-类DRG神经元非周期和周期放电模式自发放电均有抑制作用,且两者之间没有明显差异。结论:Methyl B12(300μmol/L)对受损DRG A-类神经元产生的异位自发放电具有抑制作用,且对于非周期和周期放电模式的抑制作用没有差异。