Leukocyte Esterase Versus ICM 2018 Criteria in the Diagnosis of Periprosthetic Joint Infection

BackgroundA leukocyte esterase (LE) test is inexpensive and provides real-time information about patients suspected of periprosthetic joint infections (PJIs). The 2018 International Consensus Meeting (ICM) recommends it as a diagnostic tool with a 2+ cutoff. There is still a lack of data revealing LE utility versus the ICM 2018 criteria for PJI.MethodsThis is a retrospective study of patients who underwent revision total hip and total knee arthroplasty at a single institution between March 2009 and December 2019. All patients underwent joint aspiration before the arthrotomy, and the LE strip test was performed on aspirated joint fluid. PJI was defined using the 2018 ICM criteria.ResultsAs per the 2018 ICM criteria, 78 patients were diagnosed with chronic PJI and 181 were not infected. An LE test with a cutoff of $\ge$1+ had a sensitivity of 0.744, a specificity of 0.906, a positive predictive value of 0.773, an accuracy of 0.825 (95% confidence interval 0.772-0.878), and a negative predictive value of 0.891. The positive likelihood ratio (LR+) was 7.917. Using an LE cutoff of 2 + had a sensitivity of 0.513, a specificity of 1.000, and an accuracy of 0.756 (95% confidence interval—0.812).ConclusionLE is a rapid and inexpensive test which can be performed at the bedside. Its performance is valuable as per ICM criteria. Based on the findings of this study and the given cohort, we suggest using the cutoff of LE1+ (result = negative or trace) as a point of care test to exclude infection, whereas LE at 2 + threshold has near absolute specificity for the diagnosis.     

Medical decision making for older patients during multidisciplinary oncology team meetings

Objectives

Multidisciplinary team meetings aim to facilitate efficient and accurate communication surrounding the complex process of treatment decision making for older patients with cancer. This process is even more complicated for older (≥70?years) patients as the lack of empirical evidence on treatment regimens in patients with age-related problems such as comorbidity and polypharmacy, necessitates a patient-centred approach.This study investigates the decision making process for older patients with cancer during multidisciplinary team meetings and the extent to which geriatric evaluation and geriatric expertise contribute to this process.

Publisher's announcement

On the national level in Ecuador in 1982 roughly 61 percent of elderly people 60 years and over lived in complex family households, but this was 70 percent in the Coastal region (Costa) compared with only 54 percent in the Mountain region (Sierra), these two regions comprising over 95 percent of Ecuador's 1982 population. The regional difference could not be explained by standard demographic or socioeconomic characteristics available in the 1982 Census, either among all elderly people or unmarried women elderly. Rather, the regional difference may reflect underlying value and attitude differences not measured in the Census. As the marital structure of the adult population in the two areas has been quite different, consensual union being much more common in the Costa than the Sierra, we are left to wonder if there might be two different family systems at play. Such speculation will need to be addressed by future research.     

Comparison of Direct Interview and Family History Diagnoses of Alcohol Dependence

Using data from The Collaborative Study on the Genetics of Alcoholism, we compare direct interview diagnoses of alcohol dependence to those obtained by history from family members. Using a requirement of three or more positive implications by history, the specificity, sensitivity, and positive predictive values are 98%, 39%, and 45%, respectively.
A logistic analysis found the gender of the relative and alcoholism in the informant to be significant, but not the gender of the informant. The partial odds ratio of a diagnosis at interview associated with a positive family history diagnosis was 13.6. The relationship between the informant and relative was significant, with negative reports from an offspring or mate more influential than a negative report from a parent or second-degree relative.
We derived a recursive equation to combine a variable number of family history reports, wherein the probabilities associated with a single report are computed from the logistic analysis. This permits the use of family history information both as a proxy for an uninterviewed relative, as well as a second source of information to be used in the analysis of genetic family data.     

家庭式护理干预对初产妇的影响

目的：探讨家庭式护理干预对初产妇的影响。方法选取入该院待产的259例初产孕妇为研究对象,根据其入院顺序分成家庭式护理组(A组,n=144)和对照组(B组,n=115)两组。比对两组孕妇干预前后不良情绪变化情况,记录其母婴结局及母乳喂养情况。结果①干预后,两组产妇不良情绪及睡眠质量均较干预前明显改善,其中A组改善效果优于B组(P<0.05);②两组产妇在分娩方式对比上差异无统计学意义(P>0.05),但A组总产程、失血量明显低于B组,且新生儿阿氏评分及母乳喂养成功率均高于B组(P<0.05)。结论对初产妇予以分娩全程家庭式护理干预措施,能有效节省分娩时间、减少出血量,提高母婴预后质量,值得临床推广。     

社区老年脑卒中患者家庭跟进式护理的效果观察

目的 观察社区老年脑卒中患者家庭跟进式护理的效果。 方法 选取2015年1~12月出院的老年脑卒中患者97例,采用隐匿随机数字表法将其分为2组。对照组48例仅进行随访和评估,观察组49例给予社区家庭跟进式护理。比较2组患者出院时、居家6个月后的血压、血糖、血脂、并发症发生率、再次卒中发生率和戒烟、戒酒、锻炼情况及生活能力、运动功能。 结果 居家6个月后观察组血压、血糖、血脂、戒烟、戒酒、锻炼达标率分别为73.47%、97.96%、61.22%、71.43%,明显高于对照组的54.17%、79.17%、37.50%、29.17%,Barthel指数、简式Fugl-Meyer运动功能评分均高于对照组(t=5.119,P=0.035; t=5.873,P=0.031),并发症发生率低于对照组(χ²=5.538,P=0.019)。2组患者再次卒中发生率比较,差异无统计学意义(P=0.242)。 结论 社区家庭跟进式护理可有效控制脑卒中患者发病的危险因素,降低并发症发生率,而且可根据患者恢复情况给予科学的指导和督促,对恢复患者生活能力和运动功能有显著的作用。     

Discapacidad intelectual en niños y adolescentes: influencia en la familia y la salud familiar. Revisión sistemática

Objective

To examine the influence of a child or adolescent with intellectual disabilities on the family unit.