Reducing unwarranted antibiotic use for pediatric acute otitis media: the influence of physicians' explanation and instruction on parent compliance with ‘watchful waiting’

‘Watchful waiting’ (WW) involves prescribing antibiotics but advising against use unless the illness fails to improve in a set time. For childhood ear infections, WW can reduce unnecessary antibiotic use, but parents do not necessarily comply with WW advice. This study examines how physician explanation and instruction is related to parental compliance. A national sample of parents (N?=?134) who received WW advice reported what they remembered physicians saying. These responses were coded for explanatory and instructional elements indicated by relevant clinical guidelines. Parents also reported whether they complied with the WW advice or administered the antibiotic immediately. Parental compliance was predicted by explanation of the nature of ear infections, instruction on monitoring, and instruction on managing pain. Few parents reported any explanation about antibiotics’ adverse effects. Findings suggest physicians can improve parent compliance with WW by improving the quality of the explanation and instruction they provide.     

Exercise promotes IL-6 release from legs in older men with minor response to unilateral immobilization

Physical inactivity is a major contributor to low-grade systemic inflammation. Most of the studies characterizing interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) release from exercising legs have been done in young, healthy men, but studies on inactivity in older people are lacking. The impact of 14 days of one-leg immobilization (IM) on IL-6 and TNF-α release during exercise in comparison to the contralateral control (CON) leg was investigated. Fifteen healthy men (age 68.1?±?1.1?year (mean?±?SEM); BMI 27.0?±?0.4 kg·m²; VO₂max 33.3?±?1.6 ml·kg^?1·min^?1) performed 45?min of two-leg dynamic knee extensor exercise at 19.5?±?0.9 W. Arterial and femoral venous blood samples from the CON and the IM legs were collected every 15?min during exercise, and thigh blood flow was measured with ultrasound Doppler. Arterial plasma IL-6 concentration increased with exercise (rest vs. 45?min, main effect p?p?p?=?.085, effect size 0.28) higher in the IM leg compared to the CON leg (288 (95% CI: 213–373) vs. 220 (95% CI: 152–299) pg·min^?1, respectively). There was no release of TNF-α in either leg and arterial concentrations remained unchanged during exercise (p?>?.05). In conclusion, exercise induces more pronounced IL-6 secretion in healthy older men. Two weeks of unilateral immobilization on the other hand had only a minor influence on IL-6 release. Neither immobilization nor exercise had an effect on TNF-α release across the working legs in older men.     

乌索酸对D-氨基半乳糖致小鼠急性肝损伤的影响

目的：研究乌索酸抗急性肝损伤的作用．方法：利用D-氨基半乳糖（D-GalN）建立小鼠急性肝损伤病理模型，分别以乌索酸按15、30、60mg／kg小鼠口服给药，观察其对急性肝损伤小鼠血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、肝组织丙二醛（MDA）含量及肝脏形态学的影响．结果：急性肝损伤模型组与正常对照组比较，各项指标差异均有显著性（P〈0．01）；乌索酸组与模型组比较，血清ALT、AST、MDA明显降低（P〈0．05），光镜下肝细胞脂肪变性、水样变性明显减轻；结论：乌索酸对D—GalN所致的急性肝损伤小鼠具有保护作用．     

急性脑出血的低场MRI及CT影像特征

目的:探讨急性脑出血的CT与低场MRI影像特征,并分析二者的优缺点,以便更合理的应用.方法:本文收集了近两年经临床确诊的典型的急性脑出血病例48例,其中行CT检查30例,行MRI检查18例,分析两组检查的影象特征,并进行比较.结果:急性脑出血在低场MRI主要表现为T1等或稍高信号,T2均表现为高信号,病灶周围可伴环行水肿;CT主要表现为脑内边界清楚,密度均匀的高密度灶,部分病例表现为高等混杂密度灶,周围伴不规则低密度环形水肿带,给诊断带来困难.结论:CT,MRI诊断急性脑出血各有优缺点,CT快捷,方便,基本满足诊断需要;MRI定位定性准确,二者结合起来,可提高诊断的正确率,更好的为患者服务.     

急性阑尾炎漏诊,误诊,误治4例分析

急性阑尾炎是常见的急腹症之一，但往往因症状不典型，或患自认为是一般性胃肠炎或是医师不慎而被漏诊，误诊，误治。现介绍4病例以引起同行注意。     

不同强度急性力竭运动恢复24 h大鼠白细胞计数的变化

目的:探讨不同强度急性力竭运动对大鼠血液白细胞数量影响的差别。方法:24只健康雄性SD大鼠随机分为安静对照组、低强度力竭组、高强度力竭组,一次性跑台力竭运动后24 h采血,应用symexF-820半自动血液分析仪检测白细胞数。结果:急性力竭运动组的白细胞数(WBC)、淋巴细胞数(Lymph)、中性粒细胞数(Gran)和中间细胞数(Mid)显著低于安静对照组(P<0.05);高强度急性力竭运动组又比低强度急性力竭运动组明显降低(P<0.05)。结论:1)急性力竭运动导致白细胞数、淋巴细胞数、中性粒细胞数、中间细胞数减少,影响机体免疫功能,力竭运动后24 h机体免疫功能不能恢复到安静水平。2)力竭运动强度对机体的白细胞数影响有差异,强度越高影响越大。     

高水平公路自行车运动员急性低氧运动时肌氧饱和度变化特征研究

目的:研究高水平公路自行车运动员急性低氧运动时肌氧饱和度特征。方法:采用交叉设计,通过无损近红外光谱学技术(NIRS)连续监测17名优秀公路自行车运动员常氧和低氧(模拟3 200 m,FIO2～14.0%)急性递增负荷运动时肌氧饱和度、心肺功能及通气指标的变化。结果:1)在4个不同功率等级低氧Δ[O2Hb]均显著高于常氧对应值,Δ[HHb]在50%、75%和100%最大功率时均显著低于常氧对应值,而Δ[THb]在各相对功率等级时无显著性差异。2)低氧时通气无氧阈(VT)和最大摄氧量(.VO2max)对应的HR、SpO2和Power皆显著低于常氧对应值。低氧时VT和.VO2max对应的低氧通气指标(V.E/V.O2、.VE/V.CO2)皆显著高于常氧对照值。结论:反映心血管系统与肌肉代谢耦联的低氧通气反应(HVR)是肌氧饱和度变化的基础,是肌氧饱和度反映肌肉代谢疲劳的重要生理机制。而提高运动员高原低氧时的HVR是提高其耐缺氧能力的基础,是进而提高有氧能力和运动成绩的关键。     

超声在妇科急腹症中的应用

目的分析各类妇科急腹症超声声像图特点,探讨超声在妇科急腹症中的诊断价值,以提高其诊断正确率,为患者及时正确诊治提供依据。方法选择2009年8月至2011年8月于我所妇科急腹症手术患者60例,所有患者术前均行经腹部超声或经阴道超声检查,术后均行病理学检查。结果：其中异位妊娠29例、不全流产18例、黄体囊肿破裂7例、卵巢囊肿蒂扭转3例、子宫内膜异位症3例。妇科急腹症超声诊断正确57例,诊断符合率达95％。结论超声检查妇科急腹症的准确率较高,对妇科急腹症的有关病因诊断有重要作用,是妇科急腹症首选的检查方法。     

急性乳房炎的早期干预及护理

目的探讨急性乳房炎的早期干预及护理要点。方法随机选择在我院建卡分娩的产妇80例,对其进行早期干预和护理。结果75例产妇未发生乳房炎,1周后出院;5例急性乳房炎早期患者经过精心护理恢复健康,未发现并发症和后遗症。结论通过急性乳房炎的早期干预及护理,可有效阻止乳腺炎的发生和进一步发展,提高护理质量。     

重组人脑利钠肽治疗急性心力衰竭的疗效观察

目的：探讨在监测血清脑钠肽水平下,短期使用注射用重组人脑利钠肽治疗急性心力衰竭或慢性心力衰竭急性发作的临床效果。方法：48例急性心力衰竭患者根据是否使用注射用重组人脑利钠肽分为常规组和注射用重组人脑利钠肽组,对比两组治疗的临床效果和超声心动图情况,并监测BNP水平。结果：治疗7d后,注射用重组人脑利钠肽组临床有效率明显好于常规组（81．7％vs61．6％,P〈0．05）,左室射血分数明显高于常规组（51±6）％vs（46±5）％,（P〈0．01）,且血清脑钠肽水平明显降低（498±209）pg／mL vs（642±318）pg／mL,（P〈0．01）,血清脑钠肽下降水平和左室射血分数提高水平差异有统计学意义（P〈0．05）,有效者治疗后左室射血分数提高及血清脑钠肽下降均强于无效者（P〈0．01）。结论：在血清脑钠肽指导下短期应用注射用重组人脑利钠肽有助于改善急性心力衰竭患者的临床症状和心功能。