Clinical diagnosis of acute bacterial rhinosinusitis, typical of experts

Background  Clinical diagnosis of acute bacterial sinusitis (ABS) is a concern when a patient presents with nasal discharge of recent onset together with facial pain or pressure. Given this presentation, the doctor would benefit from having access to software that specifies, first, what diagnostic indicators experts typically use in that diagnosis and then, upon entry of those facts, what experts' typical probability of ABS is in such a case.
Methods  We specified a set of 23 hypothetical presentations of this type by patients 20–75 years of age, involving a comprehensive set of clinical-diagnostic indicators. Members of an international expert panel independently set the probability of ABS in each of these cases. A logistic function of the diagnostic indicators was fitted to the medians of the probabilities.
Results  The fitting led to an expression of the experts' median probability of ABS as a joint function of the duration of the patient's facial pain/pressure, and indicators of the location(s) of this; indicators of exacerbation of the pain/pressure on bending forward, nasal obstruction, maxillary and/or frontal tenderness, pus from middle meatus, purulent postnasal drip, and fever; and indicators of recent upper respiratory tract infection, nasal polyposis and status post sinus surgery. This probability function is accessible at http://www.evimed.ch/ABS .
Interpretation  That probability function, made readily accessible, provides for expertly probability setting in clinical diagnosis of ABS, relevant for decisions about further diagnostics or treatment without further tests.     

云南省1975-2005年5岁以下儿童死亡率变化趋势及质量评价

目的描述云南省1975-2005年5岁以下儿童死亡变化趋势、死亡构成、死因顺位的演变过程,确定目前云南省5岁以下儿童死亡水平,为评估《中国儿童发展纲要》实施情况提供参考数据和制定对策提供依据。方法利用死亡率差别指数了解“人口因素”等对死亡率变化的影响。结果1990-2000年间5岁以下儿童死亡率由127.9‰下降为74.9‰,10年内下降率为41.4%;婴儿死亡率由96.4‰下降为62.4‰,10年内下降了35.3%;死因顺位:新生儿前5位死因为宫内窒息、破伤风、早产(低出生体重)、意外窒息。随年代变化其顺序稍有变动。破伤风死亡全省已下降到17例;死亡构成:NMR/IMR在60%以上,IMR/U5MR在80%以上;U5MR下降52%为“非人口因素”引起。质量检验结果以昆明市和玉溪市U5MR可信度高,相关系数为0.864和0.951。结论1975-2000年云南省5岁以下儿童死亡,一直呈下降趋势,“非人口因素”包括妇幼卫生事业的发展和社会科技进步使U5MR下降为52%。婴儿死亡所占比例越来越高,建议干预措施重点放在新生儿复苏及非正常死亡。     

医疗器械邀请招标的组织

简要介绍医疗器械邀请招标的组织程序,评标原则、方法、内容、标准、要求和注意事项,具有较强的操作性。     

医院管理状况评价方法研究

目的 探讨医院管理绩效状况系统评价的新方法。方法 把医院管理分为目的、组织管理、人和院风四大要素领域，针对管理结构的完善程度，从着眼，诊断分析早存在的问题。结果 应用“健康度”得到应改进的重点。结论 本评价方法具有设计的逻辑性、灵活性、系统性和简洁性等特点。     

高效皮肤清洗剂SGS—1的研制及其安全性评价

本文报道了用于清洗环氧树脂等化学物质的皮肤清洗剂SGS_(-1)的研制。SGS_(-1)的急性毒性、经皮染毒亚急性毒性、致敏性、致畸性、诱变性实验,以及使用SGS_(-1)一年的355人的调查和医学监护体检结果。调查研究结果表明,SGS_(-1)为无毒、无致敏、无诱变、无致畸作用的皮肤清洗防护用品,清洗效果高达99.1～99.6%,对人体健康无影响,且具有预防职业性皮肤病的效果。     

A model for learning to segment temporal sequences, utilizing a mixture of RNN experts together with adaptive variance

This paper proposes a novel learning method for a mixture of recurrent neural network (RNN) experts model, which can acquire the ability to generate desired sequences by dynamically switching between experts. Our method is based on maximum likelihood estimation, using a gradient descent algorithm. This approach is similar to that used in conventional methods; however, we modify the likelihood function by adding a mechanism to alter the variance for each expert. The proposed method is demonstrated to successfully learn Markov chain switching among a set of 9 Lissajous curves, for which the conventional method fails. The learning performance, analyzed in terms of the generalization capability, of the proposed method is also shown to be superior to that of the conventional method. With the addition of a gating network, the proposed method is successfully applied to the learning of sensory–motor flows for a small humanoid robot as a realistic problem of time series prediction and generation.     

Differential physiological and behavioral cues observed in individuals smoking botanical marijuana versus synthetic cannabinoid drugs

Context: Synthetic cannabinoid use has increased in many states, and medicinal and/or recreational marijuana use has been legalized in some states. These changes present challenges to law enforcement drug recognition experts (DREs) who determine whether drivers are impaired by synthetic cannabinoids or marijuana, as well as to clinical toxicologists who care for patients with complications from synthetic cannabinoids and marijuana. Our goal was to compare what effects synthetic cannabinoids and marijuana had on performance and behavior, including driving impairment, by reviewing records generated by law enforcement DREs who evaluated motorists arrested for impaired driving. Methods: Data were from a retrospective, convenience sample of de-identified arrest reports from impaired drivers suspected of using synthetic cannabinoids (n?=?100) or marijuana (n?=?33). Inclusion criteria were arrested drivers who admitted to using either synthetic cannabinoids or marijuana, or who possessed either synthetic cannabinoids or marijuana; who also had a DRE evaluation at the scene; and whose blood screens were negative for alcohol and other drugs. Exclusion criteria were impaired drivers arrested with other intoxicants found in their drug or alcohol blood screens. Blood samples were analyzed for 20 popular synthetic cannabinoids by using liquid chromatography-tandem mass spectrometry. Delta-9-tetrahydrocannabinol (THC) and THC-COOH were quantified by gas chromatography-mass spectrometry. Statistical significance was determined by using Fisher’s exact test or Student’s t-test, where appropriate, to compare the frequency of characteristics of those in the synthetic cannabinoid group versus those in the marijuana group. Results: 16 synthetic cannabinoid and 25 marijuana records met selection criteria; the drivers of these records were arrested for moving violations. Median age for the synthetic cannabinoid group (n?=?16, 15 males) was 20 years (IQR 19–23 years). Median age for the marijuana group (n?=?25, 21 males) was 20 years (IQR 19–24 years) (p?=?0.46). In the synthetic cannabinoid group, 94% (15/16) admitted to using synthetic cannabinoids. In the marijuana group, 96% (24/25) admitted to using marijuana. Blood was available for testing in 96% (24/25) of the marijuana group; 21 of these 24 had quantitative levels of THC (mean?+?SD?=?10.7?+?5 ng/mL) and THC-COOH (mean?+?SD?=?57.8?+?3 ng/mL). Blood was available for testing in 63% (10/16) of the synthetic cannabinoid group, with 80% (8/10) of these positive for synthetic cannabinoids. Those in the synthetic cannabinoid group were more frequently confused (7/16 [44%] vs. 0/25 [0%], p?≤?0.003) and disoriented (5/16 [31%] vs. 0/25 [0%], p?≤?0.003), and more frequently had incoherent, slurred speech (10/16 [63%] vs. 3/25 [12%], p?=?0.0014) and horizontal gaze nystagmus (8/16 [50%] vs. 3/25 [12%], p?=?0.01) than those in the marijuana group. Conclusion: Drivers under the influence of synthetic cannabinoids were more frequently impaired with confusion, disorientation, and incoherent, slurred speech than drivers under the influence of marijuana in this population evaluated by DREs.     

循证护理临床应用现状浅析

目的分析近年来循证护理在临床应用情况。方法通过检索中国期刊全文数据库,对2002-2006年国内各期刊发表的与循证护理临床应用有关的204篇文章进行了统计和评价。结果循证护理在我国迅速发展,但循证质量有待于进一步提高。结论目前循证护理已广泛应用于临床,但存在证据质量不高,缺乏对证据的评价及误解循证的目的等方面的问题,需要广大护理人员进一步学习和改进。     

提高聘用护士民兵素质的效果评价

为了使聘用护士女子民兵尽快缩短与军人护士的差距，充分发挥军队护理队伍战斗堡垒作用，通过革命传统教育，组织学习军人基本知识，队列训练，加强常规护理技能培训及常用野战急救护理技术培训，建立健全管理制度，增强聘用护士民兵的责任感，提高稳定性和其军事素质；实现规范化管理，增强队伍战斗力。认为提高聘用护士民兵素质是加强国防建设力量的重要措施，是提高部队战斗力的重要保证，是现代化医学科学发展的需要。     

循证护理临床应用现状浅析

目的 分析近年来循证护理在临床应用情况。方法 通过检索中国期刊全文数据库，对2002—2006年国内各期刊发表的与循证护理临床应用有关的204篇文章进行了统计和评价。结果 循证护理在我国迅速发展，但循证质量有待于进一步提高。结论 目前循证护理已广泛应用于临床，但存在证据质量不高，缺乏对证据的评价及误解循证的目的等方面的问题，需要广大护理人员进一步学习和改进。