Based on the guidelines of the diagnostic test systematic review, this study elaborated the statistical processing of the pooling of data detailed in the systematic review of diagnostic test, discussed the methods for identification and handling of the heterogeneity, evaluated the advantages and disadvantages of the index of the accuracy in diagnostic tests, and proposed the identification method of the publication bias. It also took the data from the published article entitled “Diagnostic Value of ProGRP and NSE for Small Cell Lung Cancer: A Meta-Analysis” as an example for analysis and illustration, which presented clearly the data processing and interpretation of the systematic review of diagnostic test, in order to provide references for clinical researchers to study and conduct the systematic review of diagnostic test.
Objective To analyze different characteristics of extra-vascular lung water ( EVLW) in the patients with acute respiratory distress syndrome( ARDS) , and examine its prognostic value. Methods 23 patients with ARDS admitted between November 2010 and December 2011 were divided into a survival group( n=13) and a dead group( n =10) according to the outcome. The hemodynamic status including extravascular lung water index( EVLWI) was measured in 3 consecutive days, and the relationship between EVLWI and the prognosis of patients was analyzed. Results On the first day of diagnosis, the EVLWI was higher in both groups in comparison with normal value. It was ( 13. 9 ±3. 45) mL/kg in the survival group and ( 14. 87 ±5. 75) mL/kg in the dead group( P gt;0. 05) . However, on the second day, the EVLWI in the survival group dropped significantly after intensive intervention, but the patients in the dead group did not respond well to the treatment and the EVLWI declined slightly. The EVLWI of both groups began to diverge significantly fromeach other, showing average value of ( 11. 07 ±2. 51) mL/kg and ( 15.63 ±5. 05) mL/kg, respectively( P lt; 0. 05) . On the third day, this difference between two groups was still more remarkable, resulting in ( 10.32 ±1.57) mL/kg vs. ( 16. 6 ±4. 33) mL/kg( P lt; 0. 01) . Conclusions The changes of EVLWI can be used to evaluate the effectiveness of treatment and predict the prognosis of patients with ARDS. EVLWI would likely be an indicator to evaluate the pulmonary capillary leakage.
ObjectiveTo explore the effect of continuous health data collection system on residents' heath management. MethodsFrom October 2012 to October 2013, 128 employees aged from 35 to 45 from a bank who volunteered to accept the health management were selected. They were to randomly divided into observation group and control group; the control group received routine outpatient management, while the health management group were observed with continuous data collection system (Zhengguangxing E Health System). We evaluate the changes in physiological indices of a healthy lifestyle one year later. ResultsOne year after administration, the poor lifestyle decreased in observation group obviously (smoking, drinking, poor diet and not take any exercise) compared with that in the control group (P<0.05). The relative health indicators including overweight, abnormal blood pressure, dyslipidemia, abnormal fasting blood-glucose, meliorated much more in observation group than that in the control group (P<0.05). ConclusionContinuous health data collection system for population health management is effective on health management.
ObjectiveTo set up the evaluation form for classroom teaching quality in nursing humanities concern education, in order to conduct the evaluation on nursing teachers in their teaching of humanistic concern in their nursing class teaching. MethodsWe applied the Delphi approach to consult 16 nursing experts to screen the evaluation indicators combining with the method of dispersion degree. Analytic hierarchy process was carried out to determine the indicator weight to establish the evaluation form. Then we used the form to investigate a small sample of 37 nursing teachers. According to the test results, we checked the reliability and validity of the evaluation form. ResultsThe evaluation form was finally determined. It consisted of five level-1 indicators as well as 23 level-2 indicators. The results of Cranach's α showed that the internal consistency reliability and sensitivity of the evaluation form were very high. The results of Spearman correlation analysis showed that the construction of the evaluation form was quite reasonable. The results of factor analysis showed that the discriminant validity of the evaluation form was quite good. ConclusionThe evaluation form is true, credible and reasonably built. It may be used for self-assessment by the teachers, mutual evaluation as well as evaluation of teachers by leaders or experts for the assessment of humanistic teaching in nursing classes.
To realize the accurate positioning and quantitative volume measurement of tumor in head and neck tumor CT images, we proposed a level set method based on augmented gradient. With the introduction of gradient information in the edge indicator function, our proposed level set model is adaptive to different intensity variation, and achieves accurate tumor segmentation. The segmentation result has been used to calculate tumor volume. In large volume tumor segmentation, the proposed level set method can reduce manual intervention and enhance the segmentation accuracy. Tumor volume calculation results are close to the gold standard. From the experiment results, the augmented gradient based level set method has achieved accurate head and neck tumor segmentation. It can provide useful information to computer aided diagnosis.
ObjectiveTo observe the level of extravascular lung water index (ELWI) in serious septic patients with ARDS,and the effects of ulinastatin (UTI) on ELWI. MethodsA perspective control study was performed on 48 severe septic patients with ARDS from the emergency department and ICU in Shanghai Changzhen Hospital from January 2010 to December 2012. Pulse indicator continuous cardiac output (PICCO) technique was utilized for measuring ELWI. Meanwhile the oxygenation index (PaO2/FiO2) was detected. The patients were randomized as an UTI group (n=30) and a control group (n=18). Both groups received routine comprehensive treatments,and the UTI group additionally received 30 000 units/kg UTI intravenous drip 4 times a day for continuous 3 days. The PaO2/FiO2,ELWI,Murray lung injury score,APACHEⅡ score,SOFA score and 28-day mortality were determined. ResultsThe APACHE Ⅱ score,Murray and SOFA score had no statistical difference between the UTI group and the control group before treatment (P>0.05),and decreased significantly after 4 and 7 days of treatment in both groups compared with those before treatment (P<0.05). There were varying degrees of PaO2/FiO2 decrease and ELWI increase before treatment in both groups with no significant difference between two groups (P>0.05). After treatment,the PaO2/FiO2 increased and ELWI decreased in both groups,and the UTI group had better PaO2/FiO2 and ELWI than the control group (P<0.05). The difference in 28-day mortality between the UTI group and the control group was statistically significant (10.0% vs. 33.3%,P<0.05). ConclusionsSevere septic patients with ARDS are all complicated with ELWI increase. Routine therapy combined with UTI can decrease ELWI,improve clinical symptoms,and decrease 28-day mortality.
ObjectiveNew Rural Cooperative Medical Systems (NCMS) has been constructed as a financial protection for rural population commencing 2003. With the development of NCMS, there were quite a few management models existing across the nation. In order to assess the management alternatives, we try to explore how to set up a set of indicators to analysis management effect of different management models. MethodsBy literature review, we sorted all qualitative indicators into 8 types. Delphi and Multi-Attribute utility theories were applied to construct the appraisal indicators, including shaping first and second level indicators and assigning the weights for each type of indicators. ResultsWe managed to identify the indicator system which was comprised of 4 types of first level indicators, aiming at claim, manament process, transparency and supervision on accredited hospitals. Besides, there were 9 sub-indicators. ConclusionThe evaluation indicators are constructed for future assessment on management effect of rural health insurance.
ObjectiveTo evaluate the application value and significance of pulse indicator continuous cardiac output (PiCCO) in perioperative treatment of adult congenital heart disease (ACHD). MethodsBetween June 2014 and June 2015, 100 adult patients (44 females and 56 males) underwent congenital heart disease operation. Patients were randomly divided into a PiCCO group and an experience treatment (control) group. According to the data of PiCCO detection, the PiCCO group was treated with vasoactive drugs and liquid balance management, the control group was treated by routine monitoring data. The clinical effectiveness of the two groups was compared. ResultsThe ventilator time, ICU time and length of stay in the PiCCO group were significantly shorter than those in the control group with statistical differences (P=0.02, 0.03, 0.04). The drug dosage (dopamine, milrinone) during ICU were higher in the PiCCO group than those in the control group (P<0.01, P=0.04). There was no mortality in both groups. No significant difference was found in the incidence of postoperative complications between the two groups (P>0.05). ConclusionThe application of PiCCO in the perioperative treatment of adult congenital heart disease can promote the early recovery of ACHD patients, and has a certain safety and effectiveness. Actively vasoactive drugs application to maintain circulation early in ICU has positive effect on the patient's recovery.
Objective To observe effects of enhanced recovery after surgery (ERAS) technique on stress indicators in patients undergoing laparoscopic rectal cancer surgery. Methods One hundred and twenty patients underwent laparoscopic rectal cancer surgery (Dixon) in the Xinqiao Hospital of the Third Military Medical University were included in this study and then were randomly divided into an ERAS group (n=60) and a conventional treatment group (n=60). The patients in the ERAS group were treated with an ERAS concept during the perioperative period. The patients in the conventional treatment group were treated with a traditional treatment concept during the perioperative period. The stress indicators including white blood cell count (WBC) and C-reactive protein (CRP) and interleukin (IL)-6 levels were compared in the two groups at admission, 1 h before operation, and 24 h, 48 h, and 72 h after operation. The first postoperative anal exhaust time, the first postoperative defecation time, the total hospitalization time, and readmission rate were also recorded after operation. Results ① The age, gender, tumor diameter, and TNM stage had no significant differences in these two groups (P>0.05). ② There were no significant differences in the WBC, CRP and IL-6 levels at admission and 1 h before operation between the two groups (P>0.05). The levels of CRP, IL-6, and WBC in the ERAS group were significantly lower than those in the conventional treatment group at 24 h, 48 h and 72 h after operation (P<0.05). ③ The first postoperative anal exhaust time, the first postoperative defecation time, and the total hospitalization time in the ERAS group were significantly shorter than those in the conventional treatment group (P<0.05). There was no significant difference in readmission rate between the two groups (P<0.05). Conclusion ERAS concept is helpful in reducing stress response and could promote earlier recovery of patients with rectal cancer.
Glomerular filtration rate (GFR), which can be estimated by Gates method with dynamic kidney single photon emission computed tomography (SPECT) imaging, is a key indicator of renal function. In this paper, an automatic computer tomography (CT)-assisted detection method of kidney region of interest (ROI) is proposed to achieve the objective and accurate GFR calculation. In this method, the CT coronal projection image and the enhanced SPECT synthetic image are firstly generated and registered together. Then, the kidney ROIs are delineated using a modified level set algorithm. Meanwhile, the background ROIs are also obtained based on the kidney ROIs. Finally, the value of GFR is calculated via Gates method. Comparing with the clinical data, the GFR values estimated by the proposed method were consistent with the clinical reports. This automatic method can improve the accuracy and stability of kidney ROI detection for GFR calculation, especially when the kidney function has been severely damaged.