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Objective:To establish a predictive model and investigate its value in evaluating short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF).Methods:Patients with HBV-ACLF admitted to Tianjin Second People's Hospital and Beijing Youan Hospital, Capital Medical University from May 2015 to October 2018 were enrolled. The data of gender, age, laboratory markers at admission, model for end-stage liver disease (MELD) score and clinical complications were collected for analysis. According to the prognosis on 12-week, patients were divided into survival group and death group. Univariate analysis and binary Logistic regression analysis were used to test the risk factors for short-term prognosis of the patients with HBV-ACLF, and a prediction model was established. The accuracy of each index and the established model were verified by the receiver operating characteristic (ROC) curve.Results:A total of 148 patients with HBV-ACLF were enrolled in the study, 91 cases survived while 57 cases died during the 12-week period. The age, total bilirubin (TBIL), neutrophil percentage (NEUT%), hepatitis B surface antigen (HBsAg), MELD score of death group were higher than those of survival group [age (years old): 50.00 (44.50, 55.00) vs. 43.00 (34.00, 53.00), TBIL (μmol/L): 310.30 (240.70, 405.70) vs. 266.40 (184.20, 360.20), NEUT%: (74.52±13.05)% vs. (66.64±12.35)%, lg HBsAg (kU/L): 3.72 (3.29, 3.92) vs. 2.97 (2.49, 3.78), MELD score: 24.27 (19.71, 27.40) vs. 21.88 (18.83, 24.38), all P < 0.05], while albumin (ALB), total cholesterol (CHO), prothrombin activity (PTA) and alpha-fetoprotein (AFP) were lower than those of survival group [ALB (g/L): 29.80 (27.05, 31.05) vs. 30.80 (28.00, 33.90), CHO (mmol/L): 1.98 (1.50, 2.38) vs. 2.49 (2.05, 3.01), PTA: (30.37±7.09)% vs. (32.94±6.03)%, AFP (μg/L): 21.54 (9.28, 51.54) vs. 66.16 (24.50, 152.80), all P < 0.05]. Logistic regression analysis showed that NEUT%, HBsAg and AFP were independent risk factors for short-term prognosis of patients with HBV-ACLF [odds ratio ( OR) was 77.843, 1.439, 0.995, respectively, all P < 0.05]. According to the results of regression analysis, the NHA-ACLF model (NEUT%+HBsAg+AFP) was established. The formula was logit (NHA-ACLF) = -5.441+5.688×NEUT%+0.430×lg HBsAg-0.005×AFP. The area under the ROC curve (AUC) of the NHA-ACLF model for pred HBV-ACLF patients was 0.790, which was better than NEUT% (AUC = 0.696), lg HBsAg (AUC = 0.670), AFP (AUC = 0.703) and MELD score (AUC = 0.640). When the cut-off value of NHA-ACLF model score was 0.459, the sensitivity was 73.7%, and the specificity was 79.1%. Conclusions:NEUT%, HBsAg and AFP are independent predictive indicator for short-term prognosis in patients with HBV-ACLF. Compared with MELD score, the risk assessment model NHA-ACLF has a greater value in predicting the short-term prognosis of patients with HBV-ACLF.
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Objective Toexploretheimagingcharacteristicsofileocecaltuberculosisbycontrast-enhancedCT.Methods TheCT findingsof16ileocecaltuberculosispatientswereretrospectivelyanalyzed.AllcasesunderwentplainandenhancedCTscan.Results 14casesshowedinhomogeneousthickeningoftheintestinalwallandnarrowingofthelumen,and2casesshowedextensiveanduniform thickeningoftheintestinalwallwithnoobviousnarrowingofthelumen.Theenhancedimagesshowedthat13caseswereobviously heterogeneousenhancement,2caseswerering-likeenhancement,and1casewashomogeneousenhancement.Blurredserosasurface wasseeninallpatients,withsurroundingexudationin14casesandperitoneuminvolvementin12cases.Inallcases,enlargedlymph nodeswerefoundneartheabdominalaortaandonmesentery,withhomogeneousenhancementin10cases,annularenhancementin5casesand calcificationin1case.Conclusion Ileocecaltuberculosisismainlycharacterizedbyinhomogeneousthickeningandheterogeneousenhancementofthe intestinalwall,aswellasnarrowingofthelumen.Thereisoftenobviousexudationaroundtheintestines.Ileocecaltuberculosisoften combineswithenlargedlymphnodesandintrapulmonarytuberculosis.TheenhancedCTscanisofgreatvaluefortheevaluationofileocecal tuberculosis.
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Mobile learning behaviors are the greatly concerned hotspot in educational field.However, the specific mobile learning behaviors of university undergraduates are not subdivided in the current researches.The mobile learning behavior data of university undergraduates in different learning circumstances were recorded by literature survey, interview and questionnaire investigation, the characteristics of mobile learning behaviors were subdivided and analyzed in order to help them work out their strategy for mobile learning in different learning circumstances, which showed that the frequency of intelligent mobile learning was higher than that of traditional mobile learning in specific academic activities (academic exchange, self learning, academic sharing, transmission and search), and that the new generation of digital young people showed their preference to mobile learning due to its advantage of convenience while the disadvantage of its function and operation limited its persistent use.It is thus the hope of university undergraduates, especially medical undergraduates, to develop more devices and tools that are convenient for their mobile learning by making use of the advantages of intelligent mobile terminal and traditional terminals.
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Objective To explore and assess the reasonable application of integrated collaborative service mode in obstetrics and gynecology clinical service.Methods 152 pregnant women admitted in obstetric outpatient from March 2016 to May 2016 were randomly assigned into observation group and control group,76 cases in each group.The control group received obstetric traditional outpatient treatment and hospitalization mode,while the observation group implemented the integrated collaborative service mode.It was a integrated mode based on the traditional mode and multidisciplinary professionals integrated into groups for synergistic services,from the beginning of pregnancy to discharge.Results The number of cases who were knowledged maternal diseases,intraoperative coordination,reasonable diet and breastfeeding of the observation group (69,70,69,66) were superior to those of the control group (51,40,54,50) (x2=17.56,52.58,12.44,11.11,all P<0.001).The incidence rate of maternal and neonatal complications of the observation group were significantly lower than those of the control group(t=12.04,6.49,2.87,9.26,-7.14,all P<0.005).And patients satisfaction survey was improved,the number of satisfaction and complaint in the observation group was 70 persons,1 person,which of the control group was 70 persons,6 persons (x2=7.65,P<0.01).Conclusion Integrated collaborative service mode can improve the quality of medical service and patients' satisfaction,while reduce cesarean section rate,postpartum hemorrhage and maternal complications.Integrated collaborative service mode is an effective method to promote the development of perinatal medicine.
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The change of library space is driven by various factors, such as technology innovation, users demand and the changing competitive environments. The evolution processes of library space were thus clarified by retrie-ving CNKI, namely from computer and IT to Internet and wide application of information and communication tech-nology, from physical space to virtual space, from space function to information commons, learning, pioneering work and social intercourse, which can eventually lead to the intelligent, individual and ubiquitous library space.
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OBJECTIVE:To compare clinical efficacy and safety of budesonide and beclometasone assisting with terbutaline by atomization inhalation in the treatment of acute pediatric asthma attack. METHODS:150 pediatric patients with acute asthma attack were randomly divided into group A and group B,with 75 cases in each group. Both group received symptomatic support treatment as low-flow oxygen inhalation,eliminating phlegm,relieving a cough,dilating bronchus and anti-infection,and atomization inhala-tion of budesonide,1 ml each time,bid. Based on this,group A was given atomization inhalation of budesonide,2 ml each time, bid;group B was given atomization inhalation of beclometasone,2 ml,bid. Treatment course of 2 groups lasted for 7 d. Clini-cal efficacy,asthma control,PEF% and the occurrence of ADR were observed in 2 groups;the time of symptoms and signs dis-appearance and hospitalization time were recorded,and symptoms and signs of children were scored 1 day before treatment and 7 days after treatment. RESULTS:During treatment,2 cases and 3 cases were withdraw from the test in group A and group B, respectively. The total effective rates of group A and B were 91.78% and 94.44%,and the rate of asthma control 95.89% and 94.44%,without statistical significance(P>0.05). The time of breathing difficulties disappearance,cough disappearance time, wheezing disappearance time and hospitalization time of group A were separately (2.11 ± 0.54),(3.28 ± 0.93),(4.38 ± 1.05), (5.83±1.29)d;those of B group were separately(2.07±0.52),(3.30±0.96),(4.45±1.08),(5.90±1.33)d,there was no sig-nificant difference between 2 groups(P>0.05). The clinical symptoms and signs score of group A before and after treatment were separately (4.28 ± 0.94) and (0.15 ± 0.04);those of before and after treatment of group B were separately (4.23 ± 0.91) and(0.11±0.03). There was significant difference before and after treatment(P0.05). The PEF% of group A before and after treatment were separately (51.4 ± 9.8)% and (67.2 ± 11.2)%;those of before and after treatment of group B were separately(52.0±7.1)%and(68.3±8.7)%. There was significant difference before and after treatment (P0.05). No obvi-ous ADR was found in 2 groups. CONCLUSIONS:Budesonide and beclometasone assisting with terbutaline by atomization inha-lation in the treatment for acute pediatric asthma attack possess the same effects and can efficiently relieve symptoms and signs, increase the rate of asthma control and shorten the rehabilita-tion course with good safety.
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The design principles of healthcare wearable devices: ambient intelligence, service continuity, and micro-context provide more choice and solutions for the healthcare and social needs, and have the potential to be an integral part of the modern health care system. The use of wearable devices will contribute to the innovation of healthcare data acquisition and healthcare behaviors, the promotion of health consciousness and literacy, it also benefits the patient education, clinical pathway, medical model and health management performance.
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BACKGROUND: The mental health of primary school teachers who have been working in remote mountain areas for a long time can be affected by the environment and conditions there.OBJECTIVE: To analyze the present mental health of mountain-area teachers to seek countermeasures of raising their mental health level.DESIGN: An investigation of random sampling questionnaires was carried out with the primary school teachers in remote mountain areas as observational subjects.SETTING: Department of Education, Xinzhou Teachers' Training Institute.PARTICIPANTS: From December 2003 to February 2004, 182 teachers who were randomly sampled from the 28 most remote mountain schools selected from seven counties and cities such as Wutai, Shenchi and Hequ in Shanxi Province, were selected as investigation subjects.METHODS: The self-assessed/measured symptom scale was used to assess the mental health of mountain area teachers. The scale was made up of 90 items, including 9 factors such as somatic disorder, obsessive disorder, interpersonal sensitivity, anxiety, depression, hostility, horror, paranoia,and psychoticism. There were 5 scaling levels: 1 shows 'never', 2 shows'mild', 3 shows 'moderate', 4 shows 'rather serious' and 5 shows 'severe'. Evaluation standard: If the factor score ≥ 2, they had mild symptoms; if any factor score ≥ 3, they were regarded as probably having mental problems above moderate degree. The major statistical indexes were the 9 factor scores, detection rate of moderate pain (factor score ≥ 3) and positive item number (factor score ≥ 2), all of which were compared with the national normal norm.MAIN OUTCOME MEASURES: The mental health of male/female teachers and teachers of different ages in mountain areas.RESULTS: Totally 182 copies of questionnaire were distributed, and 146of them were collected, with an effective rate of 80.2%. ① The total detection rate of psychological problems was 51.7%, in which male teachers made up 48.8% while female teachers 53.3%. Those with psychological problems above moderate level constituted 6.1%, of which male teachers held 1.4% and female teachers held 4.8%. The detection rate of each psychological problem among teachers of mountain areas ranged from2.1% to 12.3%. The symptoms ranked in detection rate from high to low were obsessive disorder, anxiety, interpersonal sensitivity, depression, somatic symptom, psychoticism, paranoia, horror and hostility. ② The total score and total average score of self-assessed/measured symptom inventory of mountain area teachers were obviously higher than those of the normal norm. The number of positive items was smaller than that of the normal norm, but the average score of positive items was obviously higher than that of the normal norm. It showed that the level of mental health of mountain area teachers was generally lower than that of normal population in the nation. ③ All the factor scores on the self-assessed/measured symptom inventory of mountain area teachers were obviously higher than the level of national normal population (P ≤ 0.01). ④The number and average score of positive items of mountain area female teachers were higher than those of the male teachers. The factor scores on interpersonal sensitivity, depression and anxiety of the female teachers were higher than those of the male teachers with significant difference (P ≤ 0.05). ⑤The average score of positive items and the score of the factors such as somatic symptom and horror of the teachers aged ≥ 30 years old were significantly higher than those of the teachers aged under 30 years old (P≤ 0.01).CONCLUSION: The detection rate of psychological problems of mountain area teachers was relatively higher, which were mainly presented as obsessive disorder, interpersonal sensitivity, anxiety, depression, and somatic symptom. On the self-assessed/measured symptom inventory of the mountain area teachers, the total score, the total average score, the average score of positive items and the score of each factor were obviously higher than those of the national normal population. The incidence rate of psychological problems of the female teachers was higherthan that of the male teachers. The mental health leve1 of teachers aged 30 years old or above was relatively lower.
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OBJECTIVE: To provide reference for the improvement of management quality of high-alert medications in ward area. METHODS: Risk management was used to estimate risk factor of commonly used high-alert medications in ward area. Then the homologous management measures were formulated based on potential risk. RESULTS: With enforcement of risk management, risk awareness of relevant responsible person was strengthened. They knew more knowledge about high-alert medications and its rate increased from 60% to 96%. The phenomena such as nonstandard storage and placement of drugs, unclear identification had never happened again. CONCLUSION: The application of risk management in high-alert medications contributes to improve anti-distress awareness of relevant responsible person, guarantee safety of drug use and enhance the quality of care.