Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort

Abstract   We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing vs. insulin-providing treatments for diabetes. A total of 2,368 patients with type 2 diabetes and CAD was evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression adjusted for multiple covariates including age, sex, hemoglobin A1c (HbA1c), and diabetes duration. Fifty-one percent of BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR = 1.57, 95% CI: 1.15–2.13). Patients on sulfonylurea (SU) or combination of SU/metformin (Met)/thiazolidinediones (TZD) had marginally higher rates of DPN than the Met/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control, and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN.     

新型脊柱固定器械的研制与临床应用

自１９８９年以来，临床应用一种新型脊柱固定器械，共６８例，其中５２例为胸腰椎骨折，１６例为椎体滑脱。经临床观察和随访，治疗效果满意。这种新型固定器械，既可行胸腰椎骨折的固定，也可行椎体滑脱的复位。根据临床需要，该器械可行压缩、撑开、成角和中立位固定。作者强调，脊柱损伤只要有手术指征，手术时机甚为重要，应早期或立即手术，有利于脊柱骨折和椎管前方骨块的复位，早期也有利于神经功能的恢复。     

跷式骨科牵引架的研制和应用

目的 研制一种一架通用的骨科牵引架。方法 在我们发明的跷式下肢骨折牵引架的基础上，结合人体各部位牵引治疗的不同需要，对各构件进行多用途改造设计并新增构件，使其在需要时能重新组成各种类型的牵引架，材料选用金属。结果 经6次样机实验与修改，研制出可应用于全身各部位牵引的跷式骨科牵引架，结构包括可拆卸和重组的主件(主架，副架，基架)和辅件(L形架、功能扩张板、稳定杆)以及各种连接件等。经102例的住院、门诊和家庭患者的应用，重组功能和疗效均达到了要求，效果满意。结论 一台(架)具备全部骨科牵引架功能的装置(跷式骨科牵引架)的设计和制造是能实现的，并能获得良好的应用效果。     

Measurement of functional ability and health status in the arthritic patient

Chronic arthritis may have great impact on the patient but also on his or her family, relatives and friends. The assessment of the consequences of chronic arthritis and the effect of therapy not only in terms of physical, but also psychological and social dimensions deserves more attention. Functional ability and health status can be measured using a questionnaire or ‘instrument’, high-lighting important aspects not quantified with more traditional measurements. In this paper, arguments to apply such instruments more frequently are given. Health status instruments can be used not only to assess beneficial but also deleterious (side-)effects of therapeutic interventions. The properties are summarized of the most frequently used instruments assessing functional ability and health status. Many of these instruments have been evaluated sufficiently for validity and reliability; their sensitivity to detect change seems to be satisfactory. Therefore it is advisable to choose an internationally accepted, frequently used instrument, reflecting the area of interest.     

A Cross-Sectional,Correlational Study Comparing Individual Characteristics of Younger and Older Nursing Home Residents using Western Canadian Resident Assessment Instrument–Minimum Data Set (RAI-MDS) 2.0

ObjectiveTo compare characteristics of nursing home (NH) residents by age categories in Western Canada.DesignA cross-sectional, correlational analysis of secondary data.Setting and Participants89,231 residents living in Western Canada NHs in the provinces of Alberta, Manitoba, and British Columbia in 2016 and 2017.MethodsResident characteristics (age, sex, marital status, body mass index, medical diagnoses, cognitive function, physical function, depressive symptoms) came from the Resident Assessment Instrument–Minimum Data Set 2.0 and were analyzed using chi-square, analysis of variance, and post hoc pairwise tests. Human developmental stage age categories were used to create 5 age groups: 18-34, 35-50, 51-64, 65-80, and 81 years and older.ResultsThe demographics, medical diagnoses, cognitive function, and physical function characteristics of NH residents among 5 age groups differed considerably (all P < .001). Residents aged 18-34 years were predominately male, never married, with a higher incidence of paralysis and traumatic brain injury. Residents aged 35-50 years had a higher incidence of stroke and multiple sclerosis, and residents aged 51-64 years mainly were morbidly obese and more prone to depression. Residents aged 65-80 years were predominately married and more prone to diabetes, and residents aged 81 years and older were predominately widowed, with a higher incidence of dementia compared with others.Conclusions and ImplicationsFindings describe the uniqueness of younger NH age groups and indicate that the youngest NH residents often have the severe disability and a modest support system (as defined by partnered status) compared to older residents in NHs. Future studies must analyze longitudinal data that track the growth of, and changes in, residents’ health and functional status.     

Validation of the cancer needs questionnaire (CNQ) short-form version in an ambulatory cancer setting

The short-form Cancer Needs Questionnaire (CNQ) is a self-administered cancer-specific questionnaire designed to assess patients' needs across several domains. The purpose of this study is to further evaluate its internal consistency and construct validity, in a group of ambulatory patients with cancer. Four hundred and fifty patients with a variety of cancer types participated. Factor analysis reproduced five domains: psychological; health information; physical and daily living; patient care and support; and interpersonal communication needs. Cronbach's alpha coefficients ranged from 0.94 to 0.77, indicating substantial consistency across items grouped in the five domains. A priori predictions regarding convergent and contrasting groups construct validity were explored using bivariate relationships between domains of the short-form CNQ, the EORTC QLQC-30 and Beck Depression Inventory (short-form), with support provided for most of the predictions. The current study provides supportive evidence that the short-form CNQ is a reliable and valid instrument for assessing the needs of patients with cancer in an ambulatory care setting.     

STAGO COMPACT CT全自动血凝仪的系统维护

目的：探索全自动血凝仪的系统维护方法，保证血凝结果的质量，提高仪器的使用寿命。方法：对血凝仪4年使用中的经验和教训的总结，将仪器本身中的维护功能常规化操作，制定出操作的先后顺序，并加入自创的一些方法，制定出SIAGOGO COMPACT CT全自动血凝仪的系统维护对策。结果：使用1年来证明减少了仪器小故障的常发。结论：经过使用此系统维护，作者认为此方法对此类仪器进行系统维护是行之有效的，应该对此系列仪器也是—个好的维护对策。可进行推广。     

两种尿沉渣分析仪在临床上的应用评价

目的对Diasys R／S2003和普利生尿沉渣分析系统进行性能及临床应用的评估。方法分别对两台尿沉渣仪与牛鲍氏计数板法进行可比性试验，并对两仪器作准确性、重复性、线性检测；对Diasys进行携带污染率检查。结果Diasys R／S2003和普利生均与牛鲍氏计数板法显示相关（r〉r0．01）且有非常显著性意义（P〈0．01）；准确率分别为124．2％和95．8％；重复性低值CV％分别为6．5％和3．6％，高值CV％分别为6．2％和3．7％；且均显示良好线性；而Diasys的携带污染率为0．14％。结论两台仪器均符合NCCLS尿沉渣定量分析标准，检测结果与临床相符，具有准确性好、精密度高、操作简便、污染少、成本低等优点，因此两者都是目前比较理想的尿沉渣分析仪。     

Development and validation of a psychometric scale for assessing healthcare professionals' knowledge in radiation protection

Introduction

Healthcare professionals must sufficiently understand ionising radiation and the associated protection measures to avoid unnecessarily exposing patients and staff to ionising radiation. Hence, a proper safety culture is important to lowering health risks. The development and establishment of an instrument that can indicate healthcare professionals' understanding/knowledge of radiation protection concepts can greatly contribute to a good safety culture.The purpose of the present study was to develop and psychometrically test the Healthcare Professional Knowledge of Radiation Protection (HPKRP) self-evaluation scale, which was designed to measure the knowledge level of radiation protection by healthcare professionals working with ionising radiation in a clinical environment.