Domestic violence screening: when will we get it right?

ROUSH K. (2011) Domestic violence screening: when will we get it right? International Nursing Review 59 , 115–116 Domestic violence (DV) is a major health and human rights problem across the globe that causes serious mental and physical health consequences. Regulatory agencies and accrediting organizations include universal screening among required standards for hospitals and ambulatory clinics. Yet we are still failing to identify women suffering from DV and provide them with the resources and care they need. This commentary looks at a study of universal screening in a hospital in Israel and calls for a shift in focus from the question of whether we are screening and why to how we are educating healthcare providers about DV and interventional research for women experiencing DV.     

Cause-specific stillbirth and neonatal death in Sweden: a catchment area-based analysis

A register-based study of the impact of obstetric and neonatal care on stillbirth and neonatal death rate was performed on all births in Sweden in 1983-1995. Each birth was assigned to a primary delivery hospital where the mother with a term singleton pregnancy was most likely to have been delivered (not possible for 25% of the deliveries), and the catchment areas of each hospital were classified according to the level of care of that hospital. Only small differences in total mortality existed between the different levels of care of the primary hospital: areas served by primary hospitals with obstetric service and resources for neonatal intensive care including continuous positive airway pressure but without facilities for ventilator treatment for prolonged periods showed a 7% excess risk of stillbirth or neonatal death.     

循证医学与高血压

循证医学是临床流行病学与临床医学结合的产物，它强调在个人临床经验的基础上，任何医疗决策的确定都应以客观的科学研究为依据。循证医学在高血压定义的确立、目标血压的制定和治疗药物选择中具有重要的指导意义，但在具体应用时须进行辨证分析。     

Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions

BackgroundAlthough emerging data evidences that EUS-guided needle-based confocal laser endomicroscopy (nCLE) accurately diagnoses pancreatic cystic lesions (PCLs), there are a lack of interobserver agreement (IOA) studies utilizing reference histopathological diagnosis and for specific PCL subtypes. Hence, we sought to assess the IOA, intra-observer reliability (IOR), and diagnostic performance of EUS-nCLE using a large cohort of patients with histopathological diagnosis amongst a broad panel of international observers.MethodsEUS-nCLE videos (n = 76) of subjects with PCLs [intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystadenoma (SCA), pseudocyst, and cystic-neuroendocrine tumors/solid pseudopapillary neoplasm (cystic-NET/SPN)], simulating clinical prevalence rates were obtained from 3 prospective studies. An international panel of 13 endosonographers with nCLE experience, blinded to all PCL data, evaluated the video library twice with a two-week washout for PCL differentiation (mucinous vs. non-mucinous) and subtype diagnosis.ResultsThe IOA (κ = 0.82, 95% CI 0.77–0.87) and IOR (κ = 0.82, 95% CI 0.78–0.85) were “almost perfect” to differentiate mucinous vs. non-mucinous PCLs. For PCL subtype, IOA was highest for SCA (almost perfect; κ = 0.85), followed by IPMN (substantial, κ = 0.72), and cystic-NET/SPN (substantial, κ = 0.73). The IOA was moderate for MCN (κ = 0.47), and pseudocyst (κ = 0.57). Compared to histopathology, observers differentiated mucinous vs. non-mucinous PCLs with high accuracy (94.8%, 95% CI 93.3–96.1). For detecting specific PCLs subtypes, EUS-nCLE was highly accurate in diagnosing non-mucinous cysts (SCA: 98%; cystic-NET/SPN: 96%; pseudocyst: 96%) and slightly less accurate for mucinous lesions (IPMN: 86%; MCN: 84%).ConclusionDiagnosis of PCLs by EUS-nCLE guided virtual biopsy is very accurate and reliable for the most prevalent pancreatic cysts in clinical practice.     

Structural Basis for Complementary and Alternative Medicine: Phytochemical Interaction with Non-Structural Protein 2 Protease—A Reverse Engineering Strategy

Objective: To understand the druggability of the bioactive compounds from traditional herbal formulations "Nilavembu Kudineer" and "Swasthya Raksha Amruta Peya" to heal chikungunya virus (CHIKV) infection. Methods: The efficiency of twenty novel chemical entities from "Nilavembu Kudineer" and "Swasthya Raksha Amruta Peya" to inhibit CHIKV infection in silico were evaluated. Ligands were prepared using Ligprep module of Schr?dinger. Active site was identified using SiteMap program. Grid box was generated using receptor grid generation wizard. Molecular docking was carried out using Grid Based Ligand Docking with Energetics (GLIDE) program. Results: Molecular docking studies showed that among twenty compounds, andrographoside, deoxyandrographoside, neoandrographolide, 14-deoxy-11-oxoandrographolide, butoxone and oleanolic acid showed GLIDE extra precision (XP) score of –9.10, –8.72, –8.25, –7.38, –7.28 and –7.01, respectively which were greater than or comparable with chloroquine (reference compound) XP score (–7.08) and were found to interact with the key residues GLU 1043, LYS 1045, GLY 1176, LEU 1203, HIS 1222 and LYS 1239 which were characteristic functional unit crucial for replication of CHIKV. Conclusion: The binding affinity and the binding mode of chemical entities taken from herbal formulations with non-structural protein 2 protease were understood and our study provided a novel strategy in the development and design of drugs for CHIKV infection.     

“SS-TD-IRO-PBL”教学模式在药剂学实验教学中的构建与实施

目的:探讨"SS-TD-IRO-PBL"模式在药剂学实验教学中的构建及其实践。方法:针对药剂学实验教学中存在的问题及国内外现有的单一教学方法的不足,从情境的模拟、思维的逆向、任务的驱动、问题的预置四个角度构建药剂学"SS-TD-IRO-PBL"综合实验教学模式,并调查了开展该模式进行教学的效果。结果与结论:成功构建"SS-TD-IRO-PBL"综合实验教学模式,通过任务驱动、自学、展示、引导、逆向思考、自我表达等多种方式,教会学生如何学习,适合于药剂学实验教学;学生调查问卷显示,该模式在提高学生学习积极性、帮助学生掌握药剂学实验技能、将理论知识与实际应用结合、提升综合能力等方面有较好的效果。     

Effect of Mindfulness‐Based stress reduction in rheumatoid arthritis patients

Objective

To assess the effect of a meditation training program, Mindfulness‐Based Stress Reduction (MBSR), on depressive symptoms, psychological status, and disease activity in patients with rheumatoid arthritis (RA) through a randomized, waitlist‐controlled pilot study.

Methods

Participants were randomized to either an MBSR group, where they attended an 8‐week course and 4‐month maintenance program, or to a waitlist control group, where they attended all assessment visits and received MBSR free of charge after study end. Participants received usual care from their rheumatologists throughout the trial. Self‐report questionnaires were used to evaluate depressive symptoms, psychological distress, well‐being, and mindfulness. Evaluation of RA disease activity (by Disease Activity Score in 28 joints) included examination by a physician masked to treatment status. Adjusted means and mean changes in outcomes were estimated in mixed model repeated measures analyses.

Results

Sixty‐three participants were randomized: 31 to MBSR and 32 to control. At 2 months, there were no statistically significant differences between groups in any outcomes. At 6 months, there was significant improvement in psychological distress and well‐being (P = 0.04 and P = 0.03, respectively), and marginally significant improvement in depressive symptoms and mindfulness (P = 0.08 and P = 0.09, respectively). There was a 35% reduction in psychological distress among those treated. The intervention had no impact on RA disease activity.

Conclusion

An 8‐week MBSR class was not associated with change in depressive symptoms or other outcomes at 2‐month followup. Significant improvements in psychological distress and well‐being were observed following MBSR plus a 4‐month program of continued reinforcement. Mindfulness meditation may complement medical disease management by improving psychological distress and strengthening well‐being in patients with RA.