Outcomes of clients in need of intensive team care in Flexible Assertive Community Treatment in Sweden

Background: Flexible Assertive Community Treatment (Flexible ACT) has been implemented in Sweden during recent years due to increasing interest in integrated services for people with severe mental illness. To date, few studies have been done on Flexible ACT effectiveness.

Aims: The overall aim of this study was to explore the extent to which clients assigned to the Flexible ACT board for ACT intensive care were stabilized with improved everyday functioning, social outcomes, and changes in healthcare use.

Methods: Ninety-three participants with psychosis, in need of ACT from six newly started Flexible ACT teams, were included. Data were collected using the Social Outcome Index scale (SIX), Practical and Social Functioning Scale, and a healthcare usage questionnaire.

Results: There was a significant positive change in everyday functioning and in the SIX-item ‘friendship’ at 18-months follow-up. A positive correlation was also found between everyday functioning and the SIX-item ‘friendship’ and a negative correlation between duration of ACT and everyday functioning. A significant increase in number of inpatient hospital days and psychiatric outpatient visits also occurred.

Conclusion: Clients with psychosis who need ACT may benefit from Flexible ACT through improved social functioning. Being involved in meaningful activities and supported by others are key aspects of recovering from mental illness and are enhanced by Flexible ACT.     

变革型领导、心理授权对社区全科医生组织创新气氛的影响研究

目的　探讨社区卫生服务中心全科医生组织创新气氛状况,分析变革型领导、心理授权对全科医生组织创新气氛的影响。方法　于2016年9—10月,采用多阶段抽样方法,首先根据城区、郊区、城乡结合区域分层,按照约1∶1∶1的比例,从上海市浦东新区45所社区卫生服务中心中随机抽取10所;然后整群纳入各社区卫生服务中心中全部在岗注册的全科医生,共计380例为调查对象。采用自行设计的全科医生基本情况调查表、组织创新气氛量表、变革型领导量表、心理授权量表调查社区卫生服务中心全科医生的基本情况、组织创新气氛、变革型领导、心理授权水平。共发放问卷380份,回收有效问卷355份,问卷的有效回收率为93.4%。结果　355例全科医生组织创新气氛量表得分为（3.82±0.57）分,其中团队协力、上级支持维度得分较高,分别为（4.13±0.66）、（4.00±0.74）分,资源保障、激励机制的维度得分较低,分别为（3.14±0.88）、（2.89±0.60）分。变革型领导量表得分为（5.61±0.89）分;心理授权量表得分为（3.92±0.69）分。变革型领导量表得分、心理授权量表得分与组织创新气氛量表得分呈线性正相关（P<0.01）;除资源保障维度得分外,变革型领导量表得分、心理授权量表得分与组织创新气氛量表各维度（团队协力、上级支持、领导躬行、组织促进、自主工作、激励机制）得分呈线性正相关（P<0.01）。多元逐步回归分析结果显示,变革型领导、心理授权量表得分是组织创新气氛量表得分的影响因素（P<0.01）。结论　社区卫生服务中心全科医生组织创新气氛处于中等水平,变革型领导、心理授权与组织创新气氛呈线性正相关。管理者应以加强变革型领导和心理授权为切入点,充分发挥变革型领导行为作用,提升全科医生心理授权水平,营造组织创新气氛,从而高效高质地推进社区卫生工作。     

Instability of brain connectivity during nonrapid eye movement sleep reflects altered properties of information integration

Nonrapid eye movement (NREM) sleep is associated with fading consciousness in humans. Recent neuroimaging studies have demonstrated the spatiotemporal alterations of the brain functional connectivity (FC) in NREM sleep, suggesting the changes of information integration in the sleeping brain. However, the common stationarity assumption in FC does not satisfactorily explain the dynamic process of information integration during sleep. The dynamic FC (dFC) across brain networks is speculated to better reflect the time‐varying information propagation during sleep. Accordingly, we conducted simultaneous EEG‐fMRI recordings involving 12 healthy men during sleep and observed dFC across sleep stages using the sliding‐window approach. We divided dFC into two aspects: mean dFC (dFC_mean) and variance dFC (dFC_var). A high dFC_mean indicates stable brain network integrity, whereas a high dFC_var indicates instability of information transfer within and between functional networks. For the network‐based dFC, the dFC_var were negatively correlated with the dFC_mean across the waking and three NREM sleep stages. As sleep deepened, the dFC_mean decreased (N0~N1 > N2 > N3), whereas the dFC_var peaked during the N2 stage (N0~N1 < N3 < N2). The highest dFC_var during the N2 stage indicated the unstable synchronizations across the entire brain. In the N3 stage, the overall disrupted network integration was observed through the lowest dFC_mean and elevated dFC_var, compared with N0 and N1. Conclusively, when the network specificity (dFC_mean) breaks down, the consciousness dissipates with increasing variability of information exchange (dFC_var).     

Addressing the ethical grey zone in surgery: a framework for identification and safe introduction of novel surgical techniques and procedures

While the introduction of new surgical techniques can radically improve patient care, they may equally expose patients to unforeseen harms associated with untested procedures. The enthusiastic uptake of laparoscopic cholecystectomy in the early 1990s saw a dramatic increase in the rate of common bile duct injuries, and was described by Alfred Cuschieri as ‘the biggest unaudited free‐for‐all in the history of surgery’ due to ‘a lack of effective centralised control’. Whether a new surgical intervention is considered an acceptable ‘minor’ variation of an established procedure, or is sufficiently ‘novel’ to constitute experimentation on human subjects is often unclear. Furthermore, once a new technique is identified as experimental, there is no agreed protocol for safety evaluation in a first‐in‐human setting. In phase I (first‐in‐human) pharmacological trials only small, single arm cohorts of highly selected patients are enrolled in order to establish the safety profile of a new drug. This exposes only a small number of patients to the unknown or unforeseen risks that may be associated with a new agent, in a highly regulated and scientifically rigorous manner. There is no equivalent study design for the introduction of new and experimental surgical procedures. This article proposes a practical stepwise approach to the safe introduction of new surgical procedures that surgeons and surgical departments can adopt. It includes criteria for new surgical techniques which require formal prospective ethical evaluation, and a novel study design for conducting a safety evaluation at the ‘first in human’ stage.     

多元整合型督查模式在临床护理质量管理的应用

目的构建一套有效的护理质量督查模式,提升护理质量管理水平,促进质量持续改进。方法对临床护理质量督查标准、督查专家、督查对象、督查方法、督查结果、督查改进等进行多元整合,在全院106个护理病区实施,比较实施多元整合型督查模式前后全院护理质量敏感指标落实率及护理不良事件发生率。结果实施后,护理质量指标落实率显著高于实施前,护理不良事件发生率显著低于实施前(P0.05,P0.01)。结论应用多元整合型督查模式,从过程和结果全面监控护理质量,有利于提升护理管理者能力,鼓励护士参与护理质量管理,提高护理质量。     

Applicability of NeuroTrend as a bedside monitor in the neuro ICU

Objective

To assess whether ICU caregivers can correctly read and interpret continuous EEG (cEEG) data displayed with the computer algorithm NeuroTrend (NT) with the main attention on seizure detection and determination of sedation depth.

基于灰度积分投影与模糊C均值聚类的肺实质分割

提出一种基于灰度积分投影与模糊C均值聚类的肺实质分割算法,用于CT图像的快速自动分割。首先,对原始肺部CT图像分别在水平和垂直方向上进行灰度积分投影;然后,选用平滑样条曲线拟合平滑原始图像的积分投影曲线,并提取拟合平滑前后曲线的极大值点,确定肺实质初始边界;最后,利用模糊C均值聚类算法对边界内区域进行分割,结合滚动小球法修复边界区域,获得肺实质区域。选取LIDC (肺部图像数据库联盟)数据库中20组图像（平均每组图像包含120幅CT图像）进行实验,平均分割精度为95.66%,平均每幅图像花费时间为0.77 s。实验结果表明,该方法可以用于CT图像肺实质分割,具有全自动、高精度、鲁棒性等特点。