光激化学发光技术定量检测血清PRL方法的建立及评价

摘要：目的 基于光激化学发光技术平台初步建立血清催乳素（PRL）的分析方法,并评估其性能指标。方法 将发光纳米微球和生物素分别标记于一对人PRL单抗,两者与血清中待检泌乳素、链霉亲和素标记的感光微球（通用感光溶液）在均相条件下形成双抗体夹心的检测体系,并对该检测体系的性能指标和相关性进行评价。结果 本方法的批内及批间精密度（变异系数）分别为4.60%和5.25%;检测范围为2.48~ 4240 μIU/ml;加标回收试验的回收率在96.25%-97.16%;胆红素<20 mg/dL、血红蛋白<200 mg/dL、甘油三酯<3000 mg/dL时,均无干扰现象发生;且该方法与贝克曼Unicel Dxi 800 Access 2酶促化学发光免疫系统分析法具有良好的相关性。 结论 光激化学发光法检测血清PRL的方法具有良好的分析性能,可满足临床诊断需求。     

穴位按摩联合中药熏蒸改善中风患者手运动功能障碍的效果观察

【】目的：探讨运用穴位按摩联合中药熏蒸的护理方法对中风后手运动功能障碍的临床疗效。方法：将90例中风后手痉挛状态改良Ashworth分级评价≥Ⅰ级且≤Ⅲ级的患者随机分为A、B、C三组,每组30例。A组选用穴位按摩十宣穴联合中药熏蒸治疗,B组予穴位按摩十宣穴治疗,C组予中药熏蒸治疗。分别于治疗前、治疗1个月后采用改良Ashworth量表(Modified Ashworth Scale,MAS)、手运动功能评定(Fugl-Maeyer Assessment,FMA中的手、腕功能的评分)、日常生活活动能力（Barthel指数）进行康复评定。结果：治疗后三组患者的MAS评定结果、手运动功能积分、日常生活自理能力均较治疗前明显改善(均P＜0.05),其中A组疗效更优于B、C组(均P＜0.05)。结论：穴位按摩十宣穴联合中药熏蒸在改善中风后手功能障碍方面具有积极的作用,能增强患手运动功能。     

Connecting patients,practitioners, and regulators in supporting positive experiences and processes of shared decision making: A progress report

This paper describes a novel approach to explore how regulators, working with patients and practitioners, may contribute to supporting person‐centred care and processes of shared decision making in implementing professional standards and reducing harms. Osteopathic patients report high levels of patient care. However, areas of consultations less likely to be rated as high included “fully understanding your concerns,” “helping you to take control,” and “making a plan of action with you,” suggestive of a paternalistic approach to care and a barrier to the effective implementation of standards. This programme explored how to support patients and practitioners to make more explicit what is important to support consultations with better communication in accordance with standards. A series of workshops took place involving approximately 80 participants, which explored and identified practitioner and patient values; these were themed to develop a common framework and tested using case studies. Aspects of what enables or presents a barrier to a positive consultation were further explored with real patient narratives, and a range of resources were subsequently developed, which may support patients and practitioners to make explicit what is important to them in a consultation. A series of approaches and tools were then developed for piloting including patient curriculum vitae; patient goal planner; patient animation to support preparation for an appointment; infographic: a patient poster or leaflet; practitioner reflective tool; and an audio recording to increase awareness and understanding of values‐based practice. In conclusion, a range of approaches may help to support patients and practitioners to make explicit what is important to them in a consultation. The next phase of our programme will use a range of methods including cluster sampling, pre‐testing and post‐testing with the Consultation and Relational Empathy (CARE) measure tool, and interviews and focus groups with users and practitioners to demonstrate impact.     

Analysis of medical malpractice claims to improve quality of care: Cautionary remarks

Medical malpractice claims can be analysed to gain insights aimed at improving quality of care. However, using medical malpractice claims in medical research raises epistemological and methodological concerns related to certain features of the litigation process. Medical research should therefore approach medical malpractice claims with caution. Taking one recent study as a an example, this article insists on three areas of concern: (a) the quantity of legal materials available for analysis; (b) the content of the legal materials available for analysis; and (c) the ways in which the content of the legal materials should be analysed and the types of inferences that it can support. The article concludes with general recommendations for future medical research that would incorporate medical malpractice claims. These recommendations centre around recognizing the qualitative dimension of legal reasoning.     

Evidential Proximity,Independence, and the evaluation of carcinogenicity

This paper analyses the methods of the International Agency for Research on Cancer (IARC) for evaluating the carcinogenicity of various agents. I identify two fundamental evidential principles that underpin these methods, which I call Evidential Proximity and Independence. I then show, by considering the 2018 evaluation of the carcinogenicity of styrene and styrene‐7,8‐oxide, that these principles have been implemented in a way that can lead to inconsistency. I suggest a way to resolve this problem: admit a general exception to Independence and treat the implementation of Evidential Proximity more flexibly where this exception applies. I show that this suggestion is compatible with the general principles laid down in the 2019 version of IARC's methods guide, its Preamble to the Monographs.     

Psychometric evaluation of the Nurse Competence Scale: A cross‐sectional study

Measuring nurses' competence for practice is critical for quality and safety improvement in nursing care and patient outcomes . While the Nurse Competence Scale is a widely used international measure of the generic nursing competence of nurses in various career stages, it has not been used in Thailand. This study involved the forward–backward translation of the scale into Thai and evaluation of its psychometric properties with 571 nurses at one public and one private hospital in Chiang Mai, Thailand. Participants also completed a demographic form. The content validity analysis revealed that the item‐level content validity index (I‐CVI) was .90, and the scale‐level content validity index (S‐CVI/Average) was .91. The principal component analysis with varimax rotation demonstrated that the six factor structure accounted for 58.45% of the total variance. The Mann–Whitney U‐test showed a significant difference between low and high work experience groups for all six factors, providing further support for the scale's construct validity. The reliability analysis showed an acceptable level of Cronbach's alphas in six factors ranging from .82 to .88. In conclusion, the Thai version demonstrated promising psychometric properties, but requires further testing with nurses in different settings before use in practice.     

Impact of HIV Counseling and Testing on HIV-Infected Men Who Have Sex with Men: The South Beach Health Survey

The impact of HIV counseling and testing on sexual risk-taking and related behaviors reported by HIV-infected men who have sex with men (MSM) was examined in a cross-sectional study conducted among a representative sample of residents living in a resort area. Participants provided specimens of oral mucosal transudate for HIV-antibody testing, were interviewed in their homes, and completed a self-administered questionnaire. Specimens were tested by modified ELISA and, if repeatedly positive, confirmed by Western blot. Of 205 men enrolled, 51 (24.9%) tested positive for antibody to HIV. All 51 had been counseled and tested for antibody to HIV-1 (median = 4 tests); 37 (74%) of 50 reported that their most recent test was positive. Twenty (39.2%) said they had engaged in unprotected insertive anal intercourse in the past year; 15 (29.4%) engaged in unprotected insertive anal intercourse with partners who may have been susceptible to HIV infection. Men who reported that their last HIV-antibody test was positive were three times more likely to have engaged in unprotected insertive anal intercourse in the past year (45.9%) as those who did not know they were infected with HIV (15.4%). Counseling and testing is ineffective as a measure for promoting behavior change among HIV-positive MSM in South Beach. More effective social and behavioral interventions must be developed, implemented, and evaluated.