24‐Hour Rehabilitation Nursing: The Proof Is in the Documentation

For a facility to be classified as an inpatient rehabilitation facility (IRF), Medicare requires that the facility provide 24‐hour rehabilitation nursing. Documentation is important because it helps determine the most appropriate site for the provision of care. Functional assessments are ongoing and should provide information about patients and which interventions are most appropriate; this allows for successful achievement of rehabilitation goals. Nurses must define the elements of a quality assessment based on the individual patient and then monitor findings and respond appropriately. Reimbursement is supported by measuring functional outcomes based on the initial assessment of patients. The final reimbursement, based on possible denial of a claim, is supported by documentation of the functional outcome in the medical record. Medicare contractors cannot observe the everyday interventions nurses use with patients, so they require documentation as proof. This article features examples of documentation that nurses can use to help meet the expectation of 24‐hour nursing. Following through with these suggestions will not only help provide proof of 24‐hour nursing, more accurate reimbursement, and the security of a full reimbursement, but ultimately will ensure quality rehabilitation services and care for patients.     

Repeated provocation tests in asthmatic children for testing tachyphylaxis to histamine

Tachyphylaxis to histamine was investigated in 16 children, aged 7-15 years, with mild asthma. Three consecutive histamine challenges were performed at intervals of 24 hours and 1 hour, respectively. No significant differences in IVC, FEV1, and PC20-histamine values between the three measurements were observed. After a 24 hour interval there was no difference in percentage fall of FEV1, but there was a slight (not significant) decrease in fall of FEV1 after a 1 hour interval. The PC20-histamine values showed good reproducibility with a 24 hour as well as with a 1-hour period between the tests (geometric mean PC20, 2.04 mg/mL +/- 3.50 %SD, 1.96 mg/mL +/- 4.37 %SD, 2.17 mg/mL +/- 4.12 %SD; correlation coefficients for a 24 hour interval, r = 0.87 and for a one-hour interval, r = 0.94 (P less than 0.01]. We conclude that in children there is no strong evidence for tachyphylaxis to histamine. Our results differ from studies on tachyphylaxis in adult asthmatics. Possibly different mechanisms exist in children and in adults.     

Assessing the 16 hour intern shift limit: Results of a multi-center,mixed-methods study of residents and faculty in general surgery

Background

The study explores how residents and faculty assess the ACGME's 16-h limit on intern shifts.

教学环节的科学调整：节约学时提升效率

在教学课时数有限的情况下如何有效地提高教学效果,是当前医学课程教学改革的难点。通过验光学课程教学过程的实践和探索,发现将医学课程的理论、实践、实习三大教学环节进行有机交叉和科学融合,能够节约学时并有效地提高教学效率,同时增强了学生的自主学习、创新意识和实践能力,最终完成高素质人才培养的目标。     

Investigation of the function of the putative self-association site of Epstein-Barr virus (EBV) glycoprotein 42 (gp42)

The Epstein-Barr virus (EBV) glycoprotein 42 (gp42) is a type II membrane protein essential for entry into B cells but inhibits entry into epithelial cells. X-ray crystallography suggests that gp42 may form dimers when bound to human leukocyte antigen (HLA) class II receptor (Mullen et al., 2002) or multimerize when not bound to HLA class II (Kirschner et al., 2009). We investigated this self-association of gp42 using several different approaches. We generated soluble mutants of gp42 containing mutations within the self-association site and found that these mutants have a defect in fusion. The gp42 mutants bound to gH/gL and HLA class II, but were unable to bind wild-type gp42 or a cleavage mutant of gp42. Using purified gp42, gH/gL, and HLA, we found these proteins associate 1:1:1 by gel filtration suggesting that gp42 dimerization or multimerization does not occur or is a transient event undetectable by our methods.     

Ataxin-2 associates with rough endoplasmic reticulum

Ataxin-2 is a novel protein, normally with a domain of 22 consecutive glutamine (Q) residues, which may expand beyond a threshold of (Q)₃₂, causing a neurodegenerative disease named Spinocerebellar ataxia type 2 (SCA2). To obtain clues about the functions of ataxin-2, we used fluorescence microscopy and centrifugation fractionation analyses. Immunocytochemical detection in non-neuronal and neuronal cells showed endogenous and transfected ataxin-2 distributed throughout the cytoplasm, with perinuclear preference and a granular appearance. Triple-labelling and confocal microscopy demonstrated co-localisation with the endoplasmic reticulum (ER) markers calreticulin, calnexin and CFP-ER. The pathogenic form of ataxin-2 with an expanded polyQ domain showed the same distribution pattern. Subcellular fractionation of mouse brain homogenates showed endogenous ataxin-2 associated with rough ER (rER) membranes, in a manner dependent on RNA, salt and phosphorylation. Our data are in agreement with recent findings that ataxin-2 directly interacts with poly(A)-binding protein (PABP), thus associating with polyribosomes under normal conditions and being recruited to stress granules under environmental stress. These data, in conjunction with the presence of Lsm domains within ataxin-2, suggest that ataxin-2 is involved in the processing of mRNA and/or the regulation of translation.     

地方医学院校实验教学学分制改革的探索与实践

实验教学学分制作为学分制学籍管理的重要组成部分,是改变我国地方医学教育长期以来重理论轻实践的教育倾向,推动实验室改革的重大举措。泸州医学院从2008年起开展了实验教学学分制试点工作,本文希望能在完善管理制度、改善实验室条件、改革实验内容、建立实验教学新体系、健全实验教学质量保障体系等方面作了一些尝试和努力,希望能给其他地方医学院校提供有益的借鉴和参考。     

Screening of a polar extract of Paeonia rockii: composition and antioxidant and antifungal activities

Ethnopharmacological relevance

The genus Paeonia (Paeoniaceae), is one of the most important source of crude drugs in traditional Chinese medicine and investigation on many species is large. Up to now studies on Paeonia rockii, one of the eight species recognized in the section Moutan, are very limited.

Aim of the study

This research aimed to investigate the composition of Paeonia rockii roots and to evaluate the in vitro free-radical scavenging and antifungal activities of a polar extract (PPR) and its major constituents.

Materials and methods

PPR was obtained from defatted dried roots of Paeonia rockii using MeOH as extraction solvent. Its n-BuOH soluble portion (PPR-B) was purified by Sephadex LH-20 followed by RP-HPLC to give nineteen compounds belonging to the classes polyphenols, monoterpenes and triterpenes. Their structure were spectrally characterized (UV, 1D and 2D NMR, MS). The polyphenols content of PPR and PPR-B was examined by the Folin-Ciocalteau colorimetric assay and HPLC method. Both extracts (PPR and PPR-B) and their major constituents were tested for the free-radical scavenging activity by DPPH-test, and for the antifungal activity by three methods (micro-broth dilution method, XTT assay and Candida albicans morphological analysis).

Results

5-Butylhydroxy-γ-lactone (1), and ethyl-arabinopyranoside (2) have been isolated for the first time as naturally occurring compounds and taxifolin (3) was reported for the first time in Paeonia spp. Nine polyphenols, four monoterpenes and three triterpenes were also identified. Both the extracts PPR and PPR-B had high polyphenol content, and high concentration of gallic acid derivatives and paeoniflorin, chemotaxonomic characteristic markers of the genus. PPR, gallic acid and methyl-gallate displayed high potency in scavenging free-radicals (DPPH test, EC₅₀ 13.3, 1.2, 1.9 μg/ml, respectively). Both the extracts and gallic acid individually showed an interesting antifungal property (MIC₅₀ at 24 h 25, 0.9 and 30 μg/ml, respectively) and notably, a combination of paeoniflorin/gallic acid (MIC₅₀ = 0.5 + 20 μg/ml, respectively) was more active than the single compound in inhibiting Candida growth.

Conclusion

The polar methanolic extract (PPR), its n-BuOH soluble fraction and constituents of Paeonia rockii were extensively investigated. Both extracts and some of their compounds have the ability to scavenge free-radicals and to inhibit Candida albicans growth.     

用科学发展理念构建药品监管体系的几点思考

目的对构建科学合理的药品监管体系提出几点思考。方法分析了药品生产经营企业通过GMP、GSP认证后存在的主要问题。结果与结论通过建立许可、认证与信用管理相结合的模式以及行政管理与行业协会管理相结合的模式,可有效解决上述问题。     

2型糖尿病患者糖化血红蛋白及餐后血糖与尿清蛋白排泄率的关系

目的探讨2型糖尿病(T2DM)病人糖化血红蛋白(HBA1c)、餐后2 h血糖(2hPBG)与12 h尿清蛋白排泄率(UAE)的关系。方法选择113例空腹血糖(FBG)控制达标的T2DM患者及54例体检正常人群。HbA1c检测用高效液相色谱法,2 hPBG检测用葡萄糖氧化酶法,尿清蛋白检测用放射免疫法,记录12 h尿量,计算出UAE。按照HbA1c及2 h PBG水平将113例患者分为A组(HbA1c<7%且PBG<10 mmol/L),B组(HbA1c<7%且PBG≥10 mmol/L),C组(HbA1c>7%且PBG<10mmol/L)和D组(HbA1c≥7%且PBG≥10 mmol/L)。结果113例T2DM患者UAE均高于正常对照组(P<0.01)。D组UAE水平明高于A,B,C组(P<0.01,P<0.05,P<0.01);A组UAE水平明显低于C组(P<0.05)。B组与A,C组UAE无差异(P>0.05)。结论T2DM病人FBG控制达标后,餐后血糖及HbA1c控制不良仍会加重尿清蛋白排泄。因此强化血糖控制要重视HbA1c和餐后血糖的监测及达标。