胃粘膜内pH值测定在危重病人中的预警价值

目的 :观察在危重病患者中反映组织水平氧代谢的胃粘膜内 p Hi,与反映全身氧代谢的指标间的关系以及胃粘膜内p Hi的预警价值。方法 :用胃张力计测定危重病患者入科即刻及治疗 2 4h后胃粘膜内 p Hi,并测定 p Ha ,Pa O2 / Fi O2 ,行 APACHE 评分。结果 :死亡组入科即刻 p Hi( 7.13 3± 0 .3 74)较存活组 ( 7.3 89± 0 .0 62 )显著降低 ( P<0 .0 1) ,治疗 2 4小时后胃粘膜内 p Hi死亡组( 6.911± 0 .496)较存活组 ( 7.43 4± 0 .0 5 1)降低更显著 ( P<0 .0 0 1) ;入科即刻 p Hi≤ 7.3 2的患者病死率为 75 .0 %,治疗 2 4h后胃粘膜内 p Hi≤ 7.3 2的患者病死率为 88.9%。结论 :作为局部组织氧合指标的 p Hi在常规的全身氧代谢指标未改变之前就发生了明显的变化 ;p Hi的降低与病死率有明显的相关性。     

对我国卫生资源配置和使用几个深层次问题的思索

我国卫生资源既贫稼又浪费已成为内人士的共识,但又是一个我国卫生事业发展的实际而又紧迫的问题,这个问题不好,就会人为地降低我国卫生事业的公益性和福利性的“含金量”。作者认为,要使我国有限的卫生资源能充分而合理地使用好,就要立足于我国的基本国情,在确保市场的微观调节的前提下,必须运用政府的宏观调控行为和政策指导手段,尽可能为管理体制的改革扫除障碍和给予法制上的保障。     

北海市医疗卫生机构消毒质量动态分析

本文对广西北海市医疗卫生机构1995～1999年消毒监测资料进行了系统的统计分析。结果表明:①5年间北海市医疗卫生机构的消毒总合格率为81.05％;②市直医疗卫生机构的消毒合格率明显高于个体诊所等其它类别医疗机构的。本文还就如何加强对医疗卫生机构的消毒监测管理工作提出了合理性的建议。     

医学模式的转变促进健康观念的更新

健康是人类追求的永恒目标。随着社会的发展,生物医学模式向生物心理社会医学模式转变,“没有疾病就是健康”的观念已过于陈腐,人们对健康的理解已从“没有疾病”发展到包括生理、心理、社会的完满状态,健康的涵义更为深化,健康观念得到更新。     

银川市育智学校47例弱智儿童病因调查及智能测试结果分析

目的 对４７例弱智儿童病因调查及智能测试。方法 采用韦氏智力测验、绘人试验及婴儿一初中生社会生活能力量表三项测试。并对家长进行病史询问。结果 围产期保健工作质量不高是造成儿童智残的重要因素,韦氏智测与绘人试验结果一致;调查儿童中有７８．７％社会适应能力低下。结论 加强围产期保健工作对提高人口质量至关重要;特殊教育是精神发育迟滞儿童最重要的治疗措施。     

COVID-19 in people with neurofibromatosis 1, neurofibromatosis 2, or schwannomatosis

PurposePeople with pre-existing conditions may be more susceptible to severe COVID-19 when infected by SARS-CoV-2. The relative risk and severity of SARS-CoV-2 infection in people with rare diseases such as neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), or schwannomatosis (SWN) is unknown.MethodsWe investigated the proportions of people with NF1, NF2, or SWN in the National COVID Cohort Collaborative (N3C) electronic health record data set who had a positive test result for SARS-CoV-2 or COVID-19.ResultsThe cohort sizes in N3C were 2501 (NF1), 665 (NF2), and 762 (SWN). We compared these with N3C cohorts of patients with other rare diseases (98-9844 individuals) and the general non-NF population of 5.6 million. The site- and age-adjusted proportion of people with NF1, NF2, or SWN who had a positive test result for SARS-CoV-2 or COVID-19 (collectively termed positive cases) was not significantly higher than in individuals without NF or other selected rare diseases. There were no severe outcomes reported in the NF2 or SWN cohorts. The proportion of patients experiencing severe outcomes was no greater for people with NF1 than in cohorts with other rare diseases or the general population.ConclusionHaving NF1, NF2, or SWN does not appear to increase the risk of being SARS-CoV-2 positive or of being a patient with COVID-19 or of developing severe complications from SARS-CoV-2.     

Committing to genomic answers for all kids: Evaluating inequity in genomic research enrollment

PurposePersistent inequities in genomic medicine and research contribute to health disparities. This analysis uses a context-specific and equity-focused strategy to evaluate enrollment patterns for Genomic Answers for Kids (GA4K), a large, metropolitan-wide genomic study on children.MethodsElectronic health records for 2247 GA4K study participants were used to evaluate the distribution of individuals by demographics (race, ethnicity, and payor type) and location (residential address). Addresses were geocoded to produce point density and 3-digit zip code maps showing local and regional enrollment patterns. Health system reports and census data were used to compare participant characteristics with reference populations at different spatial scales.ResultsRacial and ethnic minoritized and populations with low-income were underrepresented in the GA4K study cohort. Geographic variation demonstrates inequity in enrollment and participation among children from historically segregated and socially disadvantaged communities.ConclusionOur findings illustrate inequity in enrollment related to both GA4K study design and structural inequalities, which we suspect may exist for similar US-based studies. Our methods provide a scalable framework for continually evaluating and improving study design to ensure equitable participation in and benefits from genomic research and medicine. The use of high-resolution, place-based data represents a novel and practical means of identifying and characterizing inequities and targeting community engagement.     

The diagnostic accuracy of rapid diagnostic tests for Ebola virus disease: a systematic review

BackgroundEbola virus disease (EVD) is a dangerous condition that can cause an epidemic. Several rapid diagnostic tests (RDTs) have been developed to diagnose EVD. These RDTs promise to be quicker and easier to use than the current reference standard diagnostic test, PCR.ObjectivesTo assess the diagnostic accuracy of RDTs for EVD.MethodsA systematic review of diagnostic accuracy studies.Data sourcesThe following bibliographic databases were searched from inception to present: MEDLINE (Ovid), Embase, Global Health, Cochrane Central Register of Controlled Trials, WHO Global Index Medicus database, Web of Science, PROSPERO register of Systematic Reviews, and Clinical Trials.Gov.Study eligibility criteriaDiagnostic accuracy studies.ParticipantsPatients presenting to the Ebola treatment units with symptoms of EVD.InterventionsRDTs; reference standard, RT-PCR.Assessment of risk of biasQuality Assessment of Diagnostic Accuracy Studies-2 tool.Methods of data synthesisSummary estimates of diagnostic accuracy study were produced for each device type. Subgroup analyses were performed for RDT type and specimen material. A sensitivity analysis was performed to assess the effect of trial design and bias.ResultsWe included 15 diagnostic accuracy studies. The summary estimate of sensitivity for lateral flow assays was 86.1% (95% CI, 86–86.2%), with specificity of 97% (95% CI, 96.1–97.9%). The summary estimate for rapid PCR devices was sensitivity of 96.2% (95% CI, 95.3–97.9%), with a specificity of 96.8% (95% CI, 95.3–97.9%). Pre-specified subgroup analyses demonstrated that RDTs were effective on a range of specimen material. Overall, the risk of bias throughout the included studies was low, but it was high in patient selection and uncertain in the flow and timing domains.ConclusionsRDTs possess both high sensitivity and specificity compared with RT-PCR among symptomatic patients presenting to the Ebola treatment units. Our findings support the use of RDTs as a ‘rule in’ test to expedite treatment and vaccination.     

Mother and clinician experiences of a trial of a video feedback parent–infant intervention for mothers experiencing difficulties consistent with ‘personality disorder’: A qualitative interview study

Objectives

We explored mothers' and clinicians' experiences of a video feedback intervention adapted for perinatal ‘personality disorder’ (VIPP-PMH) and the acceptability of a randomised controlled trial (RCT) examining its effectiveness.

Design

In-depth qualitative interviews with participants from a two-phase feasibility study of the VIPP-PMH intervention. Participants were mothers experiencing enduring difficulties in managing emotions and relationships, consistent with a ‘personality disorder’, and their 6- to 36-month-old children.

Methods

Forty-four qualitative interviews were conducted, including all nine mothers receiving VIPP-PMH during the pilot phase, 25 of the 34 mothers participating in the RCT (14 allocated to the VIPP-PMH arm and 9 from the control arm), 11 of the 12 clinicians delivering VIPP-PMH and one researcher. Interview data were thematically analysed.

Results

Mothers described feeling motivated to take part in the research and understood the need for randomisation. Research visits were largely experienced positively, with some suggestions for improvement in questionnaire timing and accessibility. Almost all mothers initially felt anxious about being filmed, but reported positive experiences of the intervention, particularly valuing its non-judgemental, positive and child-focussed nature, their supportive relationship with the therapist and the insights they gained on their child.

Conclusions

The findings indicate the likely feasibility and acceptability of undertaking a future definitive RCT of the VIPP-PMH intervention in this population. In designing a future trial, a positive and non-judgemental therapeutic relationship will be important to allay mothers' anxieties about being filmed, and careful consideration should be given to the timing and accessibility of questionnaires used.