Moving Knowledge to Action: Aware,Adopt, Adapt (A3)

This article begins with an overview of the knowledge translation (KT) process, introduces commonly used KT terms and the Aware-Adopt-Adapt (A³) KT map. The A³ was created by a nurse practitioner (NP) for practitioners and NP students to provide a map for those who wish to move existing knowledge to practice, yet do not know where to start or do not have the time to take a deeper dive into specific KT theories.     

Implementation of Recommendations for Long-Acting Contraception Among Women Aged 13 to 18 Years in Primary Care

ObjectiveClinical specialty societies recommend long-acting reversible contraceptives (LARCs) as first-line contraception for adolescent women. We evaluated whether a combined educational and process improvement intervention enhanced LARC placement in primary care within an integrated health care system.MethodsThe intervention included journal clubs, live continuing education, point-of-care guidelines, and new patient materials. We conducted a retrospective cohort study across 3 time periods: baseline (January 2013?September 2015), early implementation (October 2015–March 2016), and full implementation (April 2016–June 2017). The primary outcome was the proportion of LARCs placed by primary care clinicians among women aged 13 to 18 years compared with gynecology clinicians.ResultsKaiser Foundation Health Plan of Colorado cared for approximately 20,000 women aged 13 to 18 years in each calendar quarter between 2013 and 2017. Overall, LARC placement increased from 7.0 per 1000 members per quarter at baseline to 13.0 per 1000 during the full intervention. Primary care clinicians placed 6.2% of all LARCs in 2013, increasing to 32.1% by 2017 (P < .001), including 45.5% of contraceptive implants. Clinicians who attended educational sessions were more likely to adopt LARCs than those who did not (17.9% vs 6.4% respectively, P = .009). Neither overall LARC placement rates (relative risk, 1.9; 95% confidence interval, 0.7?5.6) nor contraceptive implant rates (relative risk, 3.0; 95% confidence interval, 0.9?9.8) increased significantly in clinicians who attended educational activities.ConclusionsThis multimodal intervention was associated with increased LARC placement for adolescent women in primary care. The combination of education and process improvement is a promising strategy to promote clinician behavior change.     

L’expert judiciaire et l’irresponsabilité pénale. Débats et controverses au cours du temps et questions contemporaines

IntroductionSince the creation of the Société Médico-Psychologique, an accumulation of discussions at the national level has resulted in legislative changes, which concern people with mental disorders. Public opinion has now become a stakeholder, prompting us, as judicial experts, to address criminal irresponsibility. The authors wish to give an account of the evolution of the ideas and professional practices in alienism and forensic psychiatry regarding criminal liability, irresponsibility, and the evolution of legislative measures in this realm.MethodsTo do so, they rely on the use of their forensic psychiatric and medico-psychological expertise, which has been effective for many years and remains relevant today, as well as on their clinical and theoretical research activities. The methodology is based on the analysis of language and the critical approach of historical and clinical epistemology.Forensic IssuesThey are examined taking into account the cultural and scientific context from the middle of the 19th century to the beginning of the 21st century. Criminal responsibility and irresponsibility are ancient principles codified in Roman law by Marcus Aurelius and which evolved with the political, social and religious conjunctions of each epoch. Whether the reason given for the recognition of criminal irresponsibility is referred to as madness, degeneration, insanity, dementia, psychic abnormality or discernment, it has always been the subject of research by physicians, alienists, and then psychiatrists. The authors analyze the role of the dissemination of the debates from the creation of the Annales Médico-Psychologiques (in 1843) and of the Société Médico-Psychologique (in 1852), illustrating them with some famous cases in specialized literature. The importance of forensic discussions at the Société Médico-Psychologique animated the end of the nineteenth century and the first part of the twentieth century, contributing to the enrichment of psychiatric semiology and to the opening up of new research, notably methodological. This will lead to an evolution of the conceptions relative to what induces the criminal act and will no longer limit irresponsibility to a diagnosis of insanity or dementia ; the study of psychic functioning will be put forward with the notion of discernment and those of self-control of one's actions. If numerous theoretical debates within the profession have fueled “expert disputes” sometimes disqualifying the role of experts, they remained, however, in the medical and judicial field. Over the past decade, these issues have been broadened to include societal debates around issues related to dangerousness and recidivism. This has become a dominant theme in scientific gatherings, before the eruption into the criminal field, of the increasing role played by victims and victims’ associations. Law No. 92-683 of 22 July 1992 introduced into the Penal Code Article 122-1 (1994 Penal Code) replacing Article 64, by inserting the notions of alteration or abolition of discernment. This distinction has given rise to new difficulties and tensions in expert practice ; the law came into force in 1994. During the 2000s, a series of high-profile homicides involving people with serious mental disorders, sometimes carried out in a recidivist situation, hit the headlines in France. This resulted in a shift in public opinion that led to the law of 25 February 2008 on criminal irresponsibility. The law put an end to the judicial dismissal of cases on the grounds of criminal irresponsibility, by introducing other provisions in the form of security measures (judicial supervision and detention of security). This law creates new interferences between legal procedural issues and psychiatric practice ; it also emphasized the importance of the role of experts by creating new missions, including the expertise of dangerousness. The movement linked to the consideration of the place of victims has been accentuated, both by the objective of obtaining a judgment for the perpetrator of the acts, and by the solicitation of their participation in the successive phases of the procedure. We have recently moved on to questions and controversies about the lack of accountability leading to the law of 24 January 2022. The current article 122 did not specify the origin of the psychic disorder causing the abrogation of discernment, which was interpreted by the Minister of Justice as “a legal void”, which must be “filled with urgency”. Title I states: “Provisions limiting criminal irresponsibility in cases of mental disorder resulting from self-induced psychoactive substances”. All these new provisions, as well as the creation of new incriminations and qualifications, certainly engender debates between magistrates and experts, but they are above all part of a concern of the public authorities about the necessity of setting up “provisions limiting criminal liability in the case of mental disorder”. The interpretation of the contribution of the law to a criminal act remains complex, according to the authors, in terms of psychopathological and etiopathogenic research. Within the context of expert practice, this new law will make it necessary to add new questions for the current missions, and it can only result in an increase in the complexity of these missions and in a risk of confusion in the answers.ConclusionThe authors show that the question of criminal liability does not solicit the same questions and problems in the judicial field (the point of view of the forensic psychiatrist, during the expert examination) or in the societal field with the confrontation with all the representations that are attached both to madness and to the passage to the criminal act, which since the beginning of the twentieth century involves other emerging disciplines. From their point of view, the assertion that a psychic disorder can be of such severity so as to affect the free will and discernment of the perpetrator of a criminal act at the time of the offence, must remain within the domain of psychiatry, even if the new law of 24 January 2022, through several of its provisions, would attempt to eliminate this necessity.     

肺癌胸膜早期种植转移:螺旋CT与手术病理对照研究

目的:评价CT诊断肺癌胸膜早期种植转移的价值,并分析漏诊原因。方法:回顾性分析43例经手术病理确诊肺癌胸膜种植转移的CT、手术病理资料,作对照研究。结果:43例中,术前CT仅诊断8例,其中Ⅲ级5例,Ⅱ级3例,诊断符合率19%(8/43),CT实际显示胸膜转移结节28例,其中Ⅰ级10例、Ⅱ级13例,Ⅲ级5例,未显示Ⅰ级15例,CT检出率为65%(28/43)。28例中,术前CT漏诊Ⅰ级和Ⅱ级各10例,漏诊率71%(20/28)。20例中,CT漏诊叶间胸膜、肺表面脏层胸膜、纵隔胸膜、肋胸膜、膈胸膜转移,漏诊率分别为0%、33%、36%、43%、80%。结论:CT能准确检出、诊断肺癌中晚期胸膜转移,但检出胸膜早期微小病灶有明显局限性,在CT诊断中,忽视对膈胸膜、肋胸膜、肺表面脏胸膜上Ⅰ、Ⅱ级较早转移灶的观察,是导致漏诊的原因之一。     

X射线照射量(治疗水平)标准装置的研究和建立

Ｘ射线照射量（治疗水平）标准装置是由标准剂量仪，Ｘ射线照射源，测量车、定位系统及其辅助设备组成，本文作者主要介绍标准装置各个部分的构成及技术参数，该标准装置于１９９１年通过国家技术监督局认证，尔后，正式开展放射仪表的检定和校准工作。     

网状减张小切口缝合法提高大鼠背部张力皮瓣存活机制

Foropenseverewoundandthewoundafterdebridement,mostscholarsthinkthewoundshouldbeclosedindelayedfirst-phase.Meshrelaxingshortincision(MRSI)methodcanclosemoreskindeficiencyandhightensionopenwound,andavoidsubcutaneoushematomaandskinflapdrift.Intheexperiment,theexperimentalmodelonrattensionskinflaphasbeeninvolved,andthecontentofendothelin(ET)inratskinflaptissuehasbeenmeasuredinvariousperiodofwoundhealingaftermeshedrelaxingshortincisionsuturewithimmunohistochemistry,inordertodiscussprobablemechani…     

Getting to Dissemination

The combination of a stage model of psychotherapy and treatment manualization has been a major step forward in treatment development and efficacy testing, but not in dissemination. I argue that the technological model of treatment development makes research on the practical application of these technologies difficult. If we continue on our present course, research on dissemination will be uncommon, expensive, and largely irrelevant to the practical issues that need to be faced. It makes more sense to proceed directly to dissemination research. Alternative methods, including manipulated training designs, will permit this, but these fundamentally challenge the implicit assumptions of the stage model.     

胸椎错位并心律异常13例临床报告

目的 探讨脊柱源性心律紊乱的主要发病部位。方法 对13例脊柱病变引发的心律紊乱，主要以纠正上胸段错位为主，采用理筋、整脊和功能锻炼治疗。结果 经治疗均临床治愈，随访半年以上无复发。结论 脊源性心律紊乱主要部位在胸椎。     

148例新生儿眼结膜炎与产妇阴道病原感染相关性的分析

目的了解自然分娩产妇产道细菌性感染（不包括衣原体）对于新生儿眼结膜炎的发病影响，加强围产期保健，防止婴幼儿视力损害。方法对148例新生儿眼结膜炎患者作结膜囊渗出物细菌培养和药敏试验，根据培养结果将患儿分为A组：培养阴性（无菌生长）组，B组：培养阳性组（有菌生长），同时相应将A组、B组患儿母亲分为产妇A组和产妇B组，作阴道分泌物涂片革兰染色检查相对照。结果产妇A组检出病原菌者5例（17．2％），清洁度正常，未检出病原菌及滴虫者24例（82．8％）。患儿B组检出淋病奈瑟氏菌13株（10．9％），其它各属菌株106株（89．1％）。产妇B组涂片见有白细胞内外革兰阴性双球菌者11例（9．2％）；其它病原菌及念珠菌、滴虫感染者76例（63．9％），清洁度正常，未检出病原菌及滴虫者32例（26．9％）。产妇A组产道感染阳性率17．2％，B组阳性率73．1％，两者比较差异有极显著性（P〈0.001）。结论新生儿眼结膜炎与产妇产道感染有密切相关性，应加强对妊娠中晚期孕妇的生殖道感染防治，减少新生儿经产道感染的几率。