Measuring clinical outcome

At the present time, there are many fundamental issues coming from the Department of Health or from other national organizations, which will have an effect on the future development of the dietetic profession. The British Diatetic Association (BDA) Professional Development Committee will consider these issues, as and when appropriate, and will publish the information in the form of Briefing Papers.
The first Briefing Paper on 'Quality Assurance' was published by the BDA in November 1989. The second on 'Measuring clinical outcome' is published below. In each case the opinion of BDA members and specialist groups has been sought and the Professional Development Committee wishes to thank individuals and the specialist groups for their comments.
The Briefing Papers are intended to provide information and promote discussion among the membership. I would welcome further comments from readers, which may be directed to the British Dietetic Association Office.     

Evaluating clinical educators: an employer's perspective

An Australian school of nursing's attempt to introduce an evaluation process required by management for clinical educators involved in undergraduate preregistration education is discussed Reliance on student feedback and clinical agencies' perceptions of the quality of teaching were seen as inadequate mechanisms for evaluation The evaluation process adopted incorporated observation of the educators together with self-reflection on their performance We conclude that post-briefings were poorly used and generally not reflective Educators relied heavily on their clinical skills and used a limited range of teaching strategies Whilst evaluation of clinical educators was time consuming and therefore costly, it is argued that it is essential to the integrity of the course The evaluation process has provided direction for support and development of clinical educators within the context of the curriculum     

重组人酸性成纤维细胞生长因子促进创伤愈合的研究

目的：研究重组人酸性成纤维细胞生长因子（rh-aFGF)对兔创伤的促愈合作用。方法：采用兔背部刀割伤模型，将rh-aFGF溶液隔日一次滴注于创面，用创面照像、透明膜描记称量法记录伤后第4、8、12、16天创面面积，用注水法测量伤腔容积，伤后第8、16天取创面组织，观察创面的病理学变化，包括肉芽组织生长与再上皮化情况。结果：rh-aFGF可明显加速兔皮肤创伤的愈合，使创面面积明显缩小（P＜0．05），使伤腔容积明显减少（P＜0．05）。组织学检查：rh-aFGF组创面伤后8天成纤维细胞生长活跃、数量多，其毛细血管胚芽与成纤维细胞数量显著多于对照组；伤后16天，创面收缩与再上皮化明显，新生上皮向创面中心爬行较快。结论：rh-aFGF对兔背部刀伤创面有明显的促修复作用。     

Recombinant follicle stimulating hormone: development of the first biotechnology product for the treatment of infertility. Recombinant Human FSH Product Development Group

Genes encoding the common gonadotrophin subunit and folliclestimulating hormone (FSH)-specific ß subunit wereisolated from a DNA library derived from human fetal liver cells,and inserted into separate expression vectors containing a selectable/amplifiablegene. These vectors were inserted into the genome of the Chinesehamster ovary cell line, resulting in expression of large amountsof biologically active human (h)FSH. This cell line was culturedon microcarrier beads in a large-scale bioreactor. hFSH in thecell culture supernatant was purified to homogeneity by a multistepprocess. The mature ß subunit had seven fewer aminoacid residues than reported in the literature and three otherdifferences were found in the sequence. Similar oligosaccharidestructures were present on recombinant (r)-hFSH and a purifiedurinary (u)-hFSH preparation. In-vitro and in-vivo, the biologicalactivities of u- and r-hFSH were indistinguishable, r-hFSH wasformulated in ampoules containing 75 IU FSH activity ( 7.5 µgFSH), which accounts for >99% of the protein content of thepreparation. Studies in non-human primates and human volunteersshowed the pharmacokinetics of u- and r-hFSH to be similar.In healthy volunteers, r-hFSH stimulated follicular developmentand induced significant increases in serum oestradiol and inhibin.Clinical experience with r-hFSH has shown it is more effectiveat stimulating ovarian follicle growth than urinary gonadotrophins.It is also effective at initiating spermatogenesis when giventogether with human chorionic gonadotrophin.     

Adverse effects of early dexamethasone in extremely-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network

BACKGROUND: Early administration of high doses of dexamethasone may reduce the risk of chronic lung disease in premature infants but can cause complications. Whether moderate doses would be as effective but safer is not known. METHODS: We randomly assigned 220 infants with a birth weight of 501 to 1000 g who were treated with mechanical ventilation within 12 hours after birth to receive dexamethasone or placebo with either routine ventilatory support or permissive hypercapnia. The dexamethasone was administered within 24 hours after birth at a dose of 0.15 mg per kilogram of body weight per day for three days, followed by a tapering of the dose over a period of seven days. The primary outcome was death or chronic lung disease at 36 weeks' postmenstrual age. RESULTS: The relative risk of death or chronic lung disease in the dexamethasone-treated infants, as compared with those who received placebo, was 0.9 (95 percent confidence interval, 0.8 to 1.1). Since the effect of dexamethasone treatment did not vary according to the ventilatory approach, the two dexamethasone groups and the two placebo groups were combined. The infants in the dexamethasone group were less likely than those in the placebo group to be receiving oxygen supplementation 28 days after birth (P=0.004) or open-label dexamethasone (P=0.01), were more likely to have hypertension (P<0.001), and were more likely to be receiving insulin treatment for hyperglycemia (P=0.02). During the first 14 days, spontaneous gastrointestinal perforation occurred in a larger proportion of infants in the dexamethasone group (13 percent, vs. 4 percent in the placebo group; P=0.02). The dexamethasone-treated infants had a lower weight (P=0.02) and a smaller head circumference (P=0.04) at 36 weeks' postmenstrual age. CONCLUSIONS: In preterm infants, early administration of dexamethasone at a moderate dose has no effect on death or chronic lung disease and is associated with gastrointestinal perforation and decreased growth.     

中国幼儿睡眠状况评估量表的编制与评价研究

目的 编制适用于我国12～35月龄幼儿的睡眠状况评估量表,评价其信度、效度和可行性,为评估中国幼儿睡眠情况提供适宜的评估工具。 方法 建立条目池,通过头脑风暴法、德尔菲法和预调查对条目进行初筛和修改。采用抽样调查方法,2019年7-11月从全国6个社区、6个乡镇和两家睡眠门诊选择12～35月龄幼儿看护人进行现场调查,共收回有效问卷551份。采用项目分析、效度分析、信度分析、可行性和验证性因子分析对量表进行评价。 结果 幼儿睡眠状况评估量表(12～35个月)包含睡眠节律、夜醒情况、入睡行为、日间嗜睡,睡眠呼吸和异态睡眠6个因子20个条目,累积解释变异量为55.55%。所有条目的内容效度指数介于0.83～1.00。量表入睡潜伏期、夜醒次数、睡眠时间3个条目与简明婴儿睡眠问卷呈正相关(r=0.41、0.69、0.42,P＜0.001)。除日间嗜睡外,社区幼儿量表总分以及其他5个因子得分均低于门诊幼儿(P＜0.05)。量表总Cronbach's α系数为0.72,两周重测信度为0.84,完成率为92.6%。验证性因子分析结果显示,量表的因子结构模型较为合理、稳定。 结论 量表具有较好的信度效度,可以区分不同幼儿的睡眠状况,有助于及早发现幼儿的睡眠问题。     

c-cbl对于K_(562)细胞增殖作用的研究

目的 :研究 p1 2 0参与的信号转导途径与 CML细胞增殖的关系。方法 :利用反转录聚合酶链反应 ( RT-PCR)的方法 ,从人慢性粒细胞白血病 ( CML )细胞系 K5 6 2 细胞中扩增包括 c-cbl基因上游调控区及 5′翻译起始区的一段共 52 3bp c DNA序列 ,反向插入真核表达载体 pc DNA3 .1 ( ) ,转染 K5 6 2细胞系。通过 MTT及集落形成实验检测转基因 K5 6 2 细胞增殖能力的变化 ,研究 c-cbl反义 RNA封闭c-cbl转录产物对于 K5 6 2 细胞增殖的影响。结果 :该种反义封闭作用使 K5 6 2 细胞增殖及集落形成速度明显减慢。结论 :p1 2 0 CBL与 CML细胞的增殖有关。     

我国五城市已婚育龄妇女节育状况调查

目的了解目前我国城市已婚育龄妇女节育状况及其影响因素。方法根据2002年7月所作的五城市已婚夫妇计划生育问卷调查资料，进行流行病学调查分析。结果五城市已婚育龄妇女综合节育率为95．81％。机关妇女低于企业妇女．且不同地区间存在差异。各种避孕方法中，以宫内节育器(IUD)使用率最高，达41．17％。地区、年龄、怀孕次数、夫妇职业、丈夫学历、丈夫原生活地均影响城市已婚育龄妇女节育率，不同职业已婚妇女节育率的影响因素有所不同。结论我国城市已婚育龄妇女的避孕节育在质和量上都达到了较高水平，但不同地区、不同特征的育龄妇女间存在差异。