互动式健康教育模式对慢性阻塞性肺疾病患者作用的研究

目的 探讨互动式健康教育模式对稳定期慢性阻塞性肺疾病(COPD)患者治疗依从性、门诊随访次数、肺功能以及生活质量影响.方法 选择成都市第二人民医院门诊和住院的稳定期COPD患者77例,根据患者自愿参加健康教育分为健康教育组38例和非健康教育组39例.随访6个月后,比较两组患者的治疗依从性、门诊随访率、肺功能及生活质量.结果 77例完成半年随访,健康教育组的治疗依从性、门诊随访次数和生活质量评分指标较非健康教育组明显改善(P＜0.05);健康教育组与非健康教育组的肺功能指标(FEV1％预计值和FEV1/FVC)差异无统计学意义(P＞0.05).结论 互动式健康教育模式对提高患者的治疗依从性,增加门诊随访次数以及改善生活质量有重要意义.     

Diagnostic performance of free-breathing coronary computed tomography angiography without heart rate control using 16-cm z-coverage CT with motion-correction algorithm

ObjectivesTo evaluate the feasibility of coronary computed tomography angiography (CCTA) in patients with free-breathing using 16-cm z-coverage CT with motion correction algorithm.Methods616 patients underwent CCTA without heart rate control. 325 examinations were performed during breath-holding (group A), and the remaining 291 were performed during free-breathing (group B). The image quality scores were defined as 1 (excellent), 2 (good), 3 (adequate), and 4 (poor). 22 patients in group A and 24 in group B underwent invasive coronary angiography (ICA) after CCTA within two weeks. The image quality score, diagnostic accuracy using ICA as reference, signal-to-noise ratio (SNR), and effective dose (ED) were compared between the two groups.ResultsMean heart rate during scanning was 70.8 ± 13.8 bpm in group A and 70.7 ± 13.2 bpm in group B (P = .950). No significant differences were observed in SNR and image quality score (1.49 ± 0.62 vs. 1.53 ± 0.67; P = .647) between the breath-holding and free-breathing groups. ED (1.99 ± 0.83 mSv vs. 2.01 ± 0.88 mSv) was not significantly different between the two groups (P = .975). In a segment-based analysis, the sensitivity, specificity and diagnostic accuracy in the detection of coronary stenosis of more than 50% were 82.1%, 96.8% and 92.2%, respectively in the breath-holding group and 82.2%, 96.6% and 92.2%, respectively in the free-breathing group with no significant differences for these parameters between the two groups.ConclusionsCCTA for patients without heart rate control and during free-breathing using 16-cm z-coverage CT with motion correction algorithm showed no significant difference in image quality and diagnostic performance compared with CCTA during breath-holding.     

Pharmacotherapy Approaches in Nontuberculous Mycobacteria Infections

Nontuberculous mycobacteria (NTM) comprise a heterogeneous group of organisms, with only a small subset known to cause disease in humans. Although NTM infection is not a reportable disease, both the increasing clinical recognition and recent advancements in laboratory diagnostic capabilities of NTM infections in immunocompromised and immunocompetent patients are rapidly evolving. We reviewed antimicrobial agents used to treat the most frequently encountered NTM infections and examined optimized drug dosing strategies, toxicity profiles, drug-drug interactions, and the role of therapeutic drug monitoring. Antimicrobial susceptibility testing and patient monitoring on therapy were also examined. We used PubMed to review the published literature on the management of select NTM pathogens, the common syndromes encountered since 2000, and select pharmacokinetic principles of select antimicrobial agents used since 1990. We included select clinical trials, systematic reviews, published guidelines, and observational studies when applicable. The prolonged duration and the necessity for combination therapy for most forms of NTM disease can be problematic for many patients. A multidisciplinary care team that includes pharmacy engagement may help increase rates of optimal patient tolerability and successful treatment completion.     

Health Care Provider in Triage to Improve Outcomes

ProblemEmergency departments throughout the nation are experiencing crowding related to increased patient volumes and decreased hospital inpatient bed capacity. As a result of lengthy wait times, patients are leaving without having medical treatment, and satisfaction is poor. The purpose of this quality improvement initiative was placing a provider in triage to complement the existing split-flow process aimed to decrease wait times to see a provider, length of stay (LOS), left without being seen (LWBS) rates, and improve patient satisfaction.MethodsA multiprofessional team was established. Nurses, advanced practice providers, and physicians collaborated on a project to place a provider in triage to assist in seeing patients as soon as possible and begin care or treatment.ResultsThe outcomes of the initiative were positive for ED LOS metrics and patient satisfaction. Door-to-provider time decreased from a high of 56 minutes to a low of 13 minutes. The percentage of patients LWBS decreased from a high of 12% to a low of 1.62%.DiscussionThe project showed that the evidence-based practice of a combined split-flow and provider-in-triage model resulted in improvements in throughput for patients who were treated and released from the emergency department.     

Influenza M2 virus-like particles confer a broader range of cross protection to the strain-specific pre-existing immunity

Immunity in humans with annual vaccination does not provide effective protection against antigenically distinct strains. As an approach to improve cross-protection in the presence of pre-existing strain-specific immunity, we investigated the efficacy of heterologous and heterosubtypic protection in previously vaccinated mice at earlier times after subsequent immunization with conserved-antigenic target influenza M2 ectodomain (M2e) virus-like particle vaccine (M2e5× VLP). Immunization of mice with H1N1 split vaccine induced virus specific antibodies to homologous influenza virus but did not provide heterosubtypic hemagglutination inhibiting antibody responses and cross-protection. However, subsequent M2e5× VLP immunization induced an M2e specific antibody response as well as interferon-γ (IFN-γ) producing cells in systemic and mucosal sites. Upon lethal challenge with H3N2 or H5N1 subtype influenza viruses, subsequently immunized mice with M2e5× VLP were well protected against heterosubtypic influenza viruses. These results provide evidence that non-seasonal immunization with M2e5× VLP, an experimental candidate for universal vaccine, is a promising approach for broadening the cross-protection even in the presence of strain-specific immunity.     

Attention bias in earthquake-exposed survivors: An event-related potential study

The Chinese Wenchuan earthquake, which happened on the 28th of May in 2008, may leave deep invisible scars in individuals. China has a large number of children and adolescents, who tend to be most vulnerable because they are in an early stage of human development and possible post-traumatic psychological distress may have a life-long consequence. Trauma survivors without post-traumatic stress disorder (PTSD) have received little attention in previous studies, especially in event-related potential (ERP) studies. We compared the attention bias to threat stimuli between the earthquake-exposed group and the control group in a masked version of the dot probe task. The target probe presented at the same space location consistent with earthquake-related words was the congruent trial, while in the space location of neutral words was the incongruent trial. Thirteen earthquake-exposed middle school students without PTSD and 13 matched controls were included in this investigation. The earthquake-exposed group showed significantly faster RTs to congruent trials than to incongruent trials. The earthquake-exposed group produced significantly shorter C1 and P1 latencies and larger C1, P1 and P2 amplitudes than the control group. In particular, enhanced P1 amplitude to threat stimuli was observed in the earthquake-exposed group. These findings are in agreement with the prediction that earthquake-exposed survivors have an attention bias to threat stimuli. The traumatic event had a much greater effect on earthquake-exposed survivors even if they showed no PTSD symptoms than individuals in the controls. These results will provide neurobiological evidences for effective intervention and prevention to post-traumatic mental problems.     

The maternal experience of kangaroo holding

OBJECTIVE: To describe the maternal experience of kangaroo holding premature infants in the neonatal intensive care unit. Design: Qualitative, naturalistic inquiry design using open-ended, transcribed audiotaped face-to-face interviews. SETTING: Level III 70-bed tertiary care neonatal intensive care unit in Delaware. PARTICIPANTS: Eighteen mothers who kangaroo held their premature infants were interviewed over a 5-month period of time. INTERVENTION: Mothers were interviewed following a 60-minute kangaroo holding session in the neonatal intensive care unit. Additionally, unobtrusive detailed observation of each mother's kangaroo holding experience was recorded and analyzed. MAIN OUTCOME MEASURE: Maternal behaviors and interactions and related nursing and environmental interactions. RESULTS: Triangulation of demographic data, observation data, and themes of the interviews supports the use of kangaroo holding as a method to improve maternal confidence in caring for premature infants. Mothers reported feelings of "being needed" and "feeling comfortable" with the holding experience regardless of the infant's physical health status. CONCLUSIONS: Results identify maternal experiences of and responses to kangaroo holding in the intensive care environment, leading to the increased understanding of the multifaceted advantages of kangaroo holding on maternal attachment behaviors.     

握物受扰平衡恢复时上肢运动控制机理的实验研究

目的研究人手在握物受扰后的恢复过程以及整个过程中视觉对于神经肌肉控制系统的影响。方法在人手握物状态下,对所握物体施加干扰,记录上臂在恢复过程中的运动信号和肌电信号,对相关的运动和肌电信号参数进行分析,分别在有无视觉的两种情况下进行实验,对比实验结果。结果恢复平衡主要通过肢体的移动和肌肉的收缩完成。在无视觉的情况下恢复平衡反应时间有延迟,运动幅度加大。结论握物受扰后主要依靠上肢腕和肘关节运动和前臂的腕屈肌活动恢复平衡和抓紧状态。自身的感觉反馈是控制的主要信息源,视觉对于人体上肢恢复平衡有加快响应和减小运动幅度的作用。     

邓小平理论的时代观纵横谈

邓小平理论的时代观,始于战争和平观念的转变,成于时代基本特征的高度概括,终于和平与发展两大问题总体对策——建设中国特色社会主义的确立。因此,邓小平理论的时代观是马列主义时代观的新阶段,与时俱进是邓小平理论时代观发展的历史必然性。