后腹腔镜下肾部分切除术对局限性肾癌的疗效分析

目的探讨后腹腔镜下肾部分切除术(RLPN)对局限性肾癌(LRCC)的疗效及安全性。方法对肿瘤直径>4 cm且≤7 cm的LRCC患者68例,均行肾部分切除术(PN),其中RLPN组34例,开放的肾部分切除术(OPN)组34例,对比分析两组的疗效。结果 68例LRCC患者PN术均顺利完成。RLPN组与OPN组LRCC患者性别、年龄、瘤体直径、病程、术前术后肌酐与GFR、引流量等比较,差异均无统计学意义(P均>0.05)。RLPN组手术耗时、血管阻断时间长于OPN组,差异具有统计学意义(P均<0.05);RLPN组输血病例少于OPN组(P均<0.05);RLPN组拔管时间、肠道恢复时间、术后住院时间均明显短于OPN组(P均<0.05)。RLPN组患者围术期无中转开放、输血病例,术后出现1例尿瘘;OPN组围术期有5例输血病例。结论 RLPN能达到与OPN治疗相近的治疗结果,即可保留肾单位又具有微创效果,改善患者预后,是治疗瘤体直径>4 cm且≤7 cm LRCC较为安全可靠的手术方式。     

掌上电脑在护理移动查房中的应用及效果评价

目的了解掌上电脑（PDA）移动护理查房对护理质量的影响。方法对掌上电脑移动查房系统使用前后基础护理、特一级护理、护理文书质量、护理不良事件发生情况、病人及医生对护理工作的满意度等进行调查比较。结果 PDA使用后基础护理、特一级护理、护理文书书写考核合格率得分较PDA使用前明显增高,差异有统计学意义（P〈0.01）,护理不良事件发生率明显降低,病人及医生对护理人员的工作满意度明显增加,差异有统计学意义（P〈0.01）。结论 PDA的使用对优化护理工作流程、改善护患关系、促进护患和谐、提高护理质量有明显的促进作用。     

Dose or content? Effectiveness of pain rehabilitation programs for patients with chronic low back pain: A systematic review

We sought to systematically analyze the influence of dose of pain rehabilitation programs (PRPs) for patients with chronic low back pain (CLBP) on disability, work participation, and quality of life (QoL). Literature searches were performed in PubMed, Cochrane Library, Cinahl, and Embase up to October 2012, using MeSH terms, other relevant terms and free-text words. Randomized controlled trials in English, Dutch, and German, analyzing the effect of PRPs, were included. One of the analyzed interventions had to be a PRP. Outcomes should be reported regarding disability, work participation, or QoL. To analyze dose, the number of contact hours should be reported. Two reviewers independently selected titles, abstracts, and full-text articles on the basis of inclusion and exclusion criteria. Data were extracted and risk of bias was assessed. Effect sizes (ES) were calculated for each intervention, and influence of dose variables was analyzed by a mixed model analysis. Eighteen studies were identified, reporting a wide variety of dose variables and contents of PRPs. Analyses showed that evaluation moment, number of disciplines, type of intervention, duration of intervention in weeks, percentage of women, and age influenced the outcomes of PRPs. The independent effect of dose variables could not be distinguished from content because these variables were strongly associated. Because dose variables were never studied separately or reported independently, we were not able to disentangle the relationship between dose, content, and effects of PRPs on disability, work participation, and QoL.     

Heroin seizures and heroin use in Scotland

The seizure of illicit drugs is a key component of the U.K. drug strategy. Whilst information on the quantity of drugs seized and their weight is routinely collected by enforcement agencies, and released to the media, interpreting the meaning of changes in the amounts recorded is fraught with difficulty as a result of not having access to accurate information on the total amount of illegal drugs available within the UK. This article seeks to compare the quantities of heroin seized by police in Scotland with estimates of the amount of heroin consumed over a 12‐month period. The research shows that over the period 2000–2006 heroin seizures within Scotland typically amounted to around 1% of the total amount of heroin consumed. The paper discusses the possible reasons why heroin seizures may represent such a low percentage of heroin consumed and considers the implications of this work with regard to drug enforcement activities.     

Field evaluation of typhoid conjugate vaccine in a catch-up campaign among children aged 9 months to 15 years in Sindh,Pakistan

BackgroundTyphoid conjugate vaccine (TCV) has recently been introduced in the expanded program for immunization (EPI) in Pakistan. Before its introduction in routine immunization, a onetime catchup campaign among children 9 months to 15 years old was conducted in November 2019. We performed field evaluation of TCV against culture confirmed Salmonella Typhi (S. Typhi) among 9 months to 15 years old children during the catch up campaign in Karachi and Hyderabad.MethodsA rapid assessment of blood culture confirmed S. Typhi was performed. Age eligible cases of culture confirmed S. Typhi were identified from the laboratory networks of Aga Khan University Hospital Karachi and Hyderabad, Kharadar General Hospital Karachi, and Liaqat University of Medical & Health Sciences (LUMHS) Hyderabad. Information on sociodemographic, typhoid vaccination history and antimicrobial resistance was collected using a structured questionnaire.Patient medical records and lab reports were also reviewed to collect information on diagnosis and antimicrobial susceptibility information. Information about the population vaccination coverage during catch-up campaign was obtained from the provincial EPI office. Field performance of TCV in catchup campaign was measured by calculating the effectiveness using rapid screening method which is less resource-intensive technique of calculating vaccine effectiveness (VE).ResultsOverall, 968 culture confirmed typhoid cases were enrolled. Among them, 82% (793/968) were from Karachi and 18% (175/968) from Hyderabad. The average age of the participants was 5.68 years, and 54% (523/968) were male. 6% (62/968) of the culture confirmed S. Typhi cases were multidrug resistant (MDR), and 61% (586/968) were extensively drug resistant (XDR). The VE using the TCV coverage data provided by EPI was 98%.ConclusionTCV is effective against culture confirmed S. Typhi among children aged 9 months to 15 years in the catch-up campaign setting. While typhoid vaccination can significantly decrease the burden of typhoid disease, improvements in sanitation and hygiene are necessary for the prevention of spread of enteric fever. Longer term follow up will be needed to assess the duration of protection and requirement for booster doses of TCV.     

Validation of parental reports of rotavirus vaccination of their children compared to the national immunization registry

BackgroundThe introduction of rotavirus vaccines into national immunization programs necessitates vaccine effectiveness evaluations. Parental report of vaccination status is a simple and accessible source of information; however, its validity is unclear.AimsTo validate parental reports of rotavirus immunization compared to documentation of vaccination in national immunization registry, and to assess vaccine effectiveness by each method.MethodsParents of 1272 children aged 2–59 months from northern Israel hospitalized for gastroenteritis in 2011–2015 were interviewed on the sociodemographics and rotavirus vaccination status of their child. Rotavirus immunization status based on parental report was compared to that documented in the national immunization registry, which was considered the gold standard. Stool samples collected from patients were tested for rotavirus antigen by immunochromotgraphy. In a rotavirus test-negative case-control study, vaccination history was compared between children found positive for rotavirus and those who tested negative. Vaccine effectiveness for ≥ 1 dose vs. zero doses was calculated as: (1-adjusted odds ratio) * 100.ResultsThe sensitivity and specificity of parental report of their child's immunization with a rotavirus vaccine were 97% (95% CI 96–98), and 75% (95% CI 65–82), respectively. Kappa coefficient was 0.69 (p < 0.001) for the agreement between the two methods. Rotavirus vaccine effectiveness was 72% (95% CI 54–84) when using parental report of rotavirus immunization and 79% (95% CI 62–88) when using the registry.ConclusionParental report of their child's immunization with a rotavirus vaccine demonstrated high sensitivity, although the specificity was relatively low. Vaccine effectiveness was similar regardless of method used to determine rotavirus immunization status. Parental report of vaccination status can be useful in vaccine effectiveness assessment.