Influence of recent immobilization and recent surgery on mortality in patients with pulmonary embolism

Summary. Background: The influence of recent immobilization or surgery on mortality in patients with pulmonary embolism (PE) is not well known. Methods: We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) data to compare the 3‐month mortality rate in patients with PE, with patients categorized according to the presence of recent immobilization, recent surgery, or neither. Results: Of 18 028 patients with PE, 4169 (23%) had recent immobilization, 2212 (12%) had recent surgery, and 11 647 (65%) had neither. The all‐cause mortality was 10.0% (95% confidence interval [CI] 9.5–10.4), and the PE‐related mortality was 2.6% (95% CI 2.4–2.9). One in every two patients who died from PE had recent immobilization (43%) or recent surgery (6.7%). Only 25% of patients with immobilization had received prophylaxis, as compared with 65% of the surgical patients. Fatal PE was more common in patients with recent immobilization (4.9%; 95% CI 4.3–5.6) than in those with surgery (1.4%; 95% CI 1.0–2.0) or those with neither (2.1%; 95% CI 1.8–2.3). On multivariate analysis, patients with immobilization were at increased risk for fatal PE (odds ratio 2.2; 95% CI 1.8–2.7), with no differences being seen between patients immobilized in hospital or in the community. Conclusions: Forty‐three per cent of patients dying from PE had recent immobilization for ≥ 4 days. Many of these deaths could have been prevented.     

国内20年肺泡蛋白沉积症误诊原因汇总分析

目的 汇总分析20年来国内报道的肺泡蛋白沉积症(PAP)的临床特点、影像学特点、确诊方法、误诊情况、治疗及预后,为临床医师快速准确地诊断本病提供重要线索.方法 回顾性分析1988～2008年国内有关肺泡蛋白沉积症的文献资料,总结126例肺泡蛋白沉积症误诊患者的临床资料.结果 126患者误诊为肺炎19例,肺癌24例,支气管肺炎18例,特发性肺间质纤维化(IPF)19例,肺结核15例,嗜酸性肺炎10例,结节病9例,真菌肺炎7例,上呼吸道感染5例.肺泡蛋白沉积症患者的临床表现缺乏特异性,而影像学表现又呈多样性,临床易误诊,确诊有赖于肺泡灌洗液、肺活检以及病理学检查.结论 肺泡蛋白沉积症临床表现缺乏特异性,极易导致误诊;全肺灌洗是肺泡蛋白沉积症最安全和有效的治疗方法.     

中国血管腔内外科技术发展历程20年介入物理疗法的激光技术、血管腔内支架发展技术、支架材料学改性技术、提高术后患者的生活质量

The endovascular surgery in China has been developing from none to a few, from a few to many, from primary to refinement,from blind to directional, and it is expecting to grow even rapidly as "spring bamboo after a timely rain" in which "science is the first motive force" and a consistent diligence and endeavor putting into it from vascular scientists and practitioners has been playing a distinctively important role. It has experienced a hard initiation and developing process. Describing here is mainly the development of endolumianl vascular surgery for major vein and artery, i.e., the vena cava and the aorta, however it was still from research and practice of the medium-sized vessels. Until now, we have treated more than 137 cases. The total number of patients with aortic dissection treated by endografting should be more than 1 000. The endoluminal treatment, including the hybrid or semi-interventional method for treating aortic dissection is very likely to have a particularly better future in comparison to the treatment for those with the infra-renal abdominal aortic aneurysm in which requires, unlikely the surgery for handling aortic dissections with long segmental involvement of the aorta,less surgical demanding. It is predicted that the distinctively difference we have had now between China and the Western World in term of the incidence of abdominal aortic aneurysm and aortic dissections and their related treatment would be gradually disappeared in the future. The endoluminal treatment for treating greater vessel disorders has less mortality and postoperative complications, such as hyperplagia, stoke or cerebral deficits, paralysis,etc., less rehabilitation is required and thus has a fruitful future.     

中国血管腔内外科技术发展历程20年：介入物理疗法的激光技术、血管腔内支架发展技术、支架材料学改性技术、提高术后患者的生活质量

本文导读：1984年在北京安贞医院，笔者与激光科李峻亨教授应用激光技术，在动物实验的基础上，应用于临床，经皿管腔内导入激光纤维治疗动脉阻塞性疾病及膜型布-加综合征。     

近年喉结核的临床病理特征

目的探讨近年喉结核的临床病理特征。方法回顾性分析48例喉结核患者的临床病理资料。结果患者以男性多见,男女之比为2.2∶1,中位年龄46.5岁。患者均因喉部症状就诊,声嘶为最常见症状,肺部症状及全身症状少。发病部位以声带最常见(64.6%),其次是会厌(31.3%)和室带(25.0%)。肉眼病变以肥厚性或外生性为主,溃疡性病变多发生在会厌和杓区。组织学病变以增生为主型多见(87.5%),坏死为主型及混合型少见。多数标本含菌量较少,菌体多分布于肉芽肿的类上皮细胞及多核巨细胞的胞质内。结论近年喉结核临床表现多不典型,其感染途径可能已发生改变。临床医师对非特异性喉部病变进行诊断时应考虑到喉结核的可能性,显微镜下应注意该病与喉部其他肉芽肿性疾病的鉴别。     

我院两年的用药统计分析

为了解我院临床用药情况,掌握临床用药规律,满足临床治疗用药,同时为指导临床合理用药提供有力的依据,对2004年、2005年医院用药进行了统计分析。本文就有关情况介绍如下。1一般情况统计统计显示:我院所用药物达1100余种,总用药金额4000余万元。使用频率最高的是抗菌药物占35.7     

近年来妇科疾病变化趋势分析

目的了解妇科疾病的变化趋势,把握当前妇女病防治工作的重点,制定有效干预措施,提高妇女健康水平。方法2003年至2008年连续6年妇科疾病进行统计分析,并分别进行总结对比。结果连续6年妇科疾病统计分析可以看出,阴道炎在逐年下降,其他妇科疾病均有上升趋势,特别是最近两年肿瘤的发病较前明显增加。结论加强妇女保健知识的宣传教育和妇女病普查工作,降低妇科疾病患病率,早期发现、早期治疗各类妇科疾病,提高我市女性的健康水平。     

Continued survival gains in recent years among critically ill myeloma patients

Objective  Therapeutic advances have improved survival in patients with myeloma (MM) over the past decade. We investigated whether survival has also improved in critically ill myeloma patients. Design  Retrospective study. Setting  Intensive care unit. Patient  Consecutive myeloma patients admitted to a teaching hospital ICU between 1990 and 2006. We compared three year-of-admission groups (1990–1995, 1996–2001, and 2002–2006) that matched changes in myeloma treatment (chemotherapy only, stem cell transplantation, and new molecules, respectively). Intervention  None. Measurements and main results  We included 196 patients. Reasons for ICU admission and patient characteristics were similar across groups; however, less use of conventional chemotherapy and radiotherapy and greater use of steroids were noted in the more recent periods. Over time, vasopressors and invasive mechanical ventilation were used decreasingly, and noninvasive ventilation increasingly, to treat acute respiratory failure. Hospital mortality decreased from 75% in 1990–1995 to 49% in 1996–2001 and 40% in 2002–2006 (P = 0.0007). Mortality was associated with poor performance status [OR 2.27, 95% CI (1.04–4.99)], need for mechanical ventilation [OR 4.33, 95% CI (1.86–10.10)], need for vasopressors [OR 2.57, 95% CI (1.12–5.86)], and admission for an event related to myeloma progression [OR 2.77, 95% CI (1.13–6.79)]. ICU admission within 48 h after hospital admission was associated with lower mortality [OR 0.28, 95% CI (0.19–0.89)]. Conclusion  Hospital mortality decreased significantly over the last 15 years in myeloma patients admitted to the ICU. Risk factors for death were organ failure and poor chronic health status. Early ICU admission was associated with lower mortality, suggesting opportunities for further improving survival.     

中医护理本科毕业生就业现状调查与分析

目的:了解中医护理本科毕业生的就业现状及其影响因素,为学生就业指导提供依据。方法:采用自制问卷对黑龙江省1999～2004级中医护理本科毕业生就业现状进行调查。结果:六届毕业生初次就业率大于94.0%;96.6%留在城市工作,其中50.5%的毕业生就业于经济发达的东部城市;73.1%就业于医疗单位,其中82.5%选择三级医院;70.0%的毕业生对目前工作满意;影响就业的前三位因素为实践动手能力、沟通能力和掌握专业知识程度。结论:中医护理本科毕业生就业前景广阔,工作满意度高;护生选择就业单位时会优先考虑薪酬与福利;护生愿意接受学校的就业指导及帮助;学校的首要任务是加强护生实践动手能力的培养。     

临床分离革兰阴性杆菌对头孢吡肟耐药分析

目的：调查我院1999--2003年间临床分离革兰阴性杆菌对头孢吡肟和4种β内酰胺类抗生素的耐药状况，为临床合理用药提供依据。方法：用MicroScan WalkAway-40全自动微生物鉴定和药敏系统对我院临床标本中分离的13721株革兰阴性杆菌进行鉴定和药敏试验。结果：肠杆菌科细菌和非发酵菌等主要临床分离革兰阴性杆菌对头孢吡肟总耐药率为32．4％，对头孢他啶、头孢噻肟、头孢曲松和氨曲南的耐药率分别为31．9％、47．9％、48．5％和38，4％，对头孢吡肟的耐药率略高于头孢他啶，优于其余3种头孢菌素。结论：5年来我院临床分离革兰阴性杆菌除铜绿假单胞菌对头孢吡肟等耐药率无明显变化。头孢吡肟对临床分离的大部分革兰阴性杆菌具有良好的体外抗菌活性，尤其是对易产Bush—Ⅰ型头孢菌素酶的肠杆菌属菌株及柠檬酸杆菌属的抗菌活性远优于其他4种头孢菌素。     

四年来胆道感染的细菌学变化分析

目的研究4年来我院月日道感染的细菌分布、变迁及其中大肠埃希菌ESBLs（超广谱β-内酰胺酶）阳性率的情况。方法取2001年1月～2004年12月在我院确诊为胆道感染行内镜鼻胆管引流或外科手术采集的胆汁标本进行培养、菌种鉴定及药敏分析。结果2001～2004年大肠埃希菌在胆道感染的细菌中所占比率分别为9．3％、19．8％、25．0％、32．3％;其中ESBLS（超广谱β-内酰胺酶）阳性大肠埃希菌的比率分别为44．4％、52．2％、73．1％、85．2％。结论胆道感染的细菌中主要以阴沟肠杆菌、大肠埃希菌、肺炎克雷伯菌、粪肠球菌、铜绿假单胞菌等为主,其中阴沟肠杆菌、肺炎克雷伯菌近年来有所减少,大肠埃希菌近年来明显增多,且大肠埃希菌中ESBLs阳性率逐年上升。     

我国近10年护理研究信息计量分析

随着医院医疗体制改革的不断深入,病人期望获得优质医疗护理服务的呼声越来越高。医院管理、临床教学、护理研究必须跟上这一形式,以适应医疗事业发展和病人的需要。而为了让病人得到高质量、高水平、低价位的护理服务,护理人员必须     

Moderate renal insufficiency at 70 years predicts mortality

BACKGROUND: Glomerular filtration rate (GFR) diminishes with age. Kidney function in the elderly is often assessed by serum creatinine alone, although it is insensitive in this age group. Formulae for predicting GFR are not widely used. AIM: To study the effect of low predicted GFR on mortality. DESIGN: Longitudinal cohort study. Setting: The community-based Jerusalem Seventy Year Olds Longitudinal Study. METHODS: We studied 445 subjects, all aged 70 years, using questionnaires, a medical examination with history-taking, and standard laboratory tests. Moderate renal insufficiency was defined as a predicted GFR of <60 ml/min, based on the Cockcroft-Gault (CG) and the Modification of Diet in Renal Disease (MDRD) equations. RESULTS: Predicted GFR was normally distributed, with a mean +/- SD of 62.4 +/- 15.27 ml/min. Predicted GFR was <60 ml/min in 221 (46%), most of whom had normal serum creatinine. Twelve-year mortality was 38.7% in these 221 vs. 27% in the other 204. The survival advantage was already evident after 3 years. Under Cox proportional hazard analysis using numerous common risk factors as independent variables, lower predicted GFR had a significant mortality risk (hazard ratio 2.108, 95%CI 1.43-3.12, p = 0.0002). DISCUSSION: In community-dwelling elderly people, moderate renal insufficiency as assessed using the CG equation is a strong and independent predictor of mortality. Most of these at-risk patients have 'normal' serum creatinine.     

Increase in chloride from baseline is independently associated with mortality in critically ill children

Purpose

To determine if there is an association between mortality and admission chloride levels and/or increases in the chloride level in critically ill children.

Methods

We performed a retrospective cohort study of all patients admitted to the paediatric intensive care unit (PICU) from January 2014 to December 2015. Patients were excluded for the following reasons: (1) age <?90 days or >?18 years, (2) admission to the cardiac intensive care unit, (3) no laboratory values upon admission to the PICU, (4) history of end-stage renal disease, (5) a disorder of chloride transport, and (6) admission for diabetic ketoacidosis. The patients were stratified on the basis of admission chloride levels (hypochloraemia, <?96 mEq/L; normochloraemia, 96–109 mEq/L; and hyperchloraemia,?≥?110 mEq/L) and dichotomised on the basis of an increase in chloride in the first day (<?5 mEq/L, ≥?5 mEq/L). Our primary outcome was in-hospital mortality.

Results

A total of 1935 patients [55% female, median age 6.3 years IQR (1.9–13.4)] were included. The overall mortality was 4% (n?=?71) and day 2 AKI occurred in 17% (n?=?333. Hypochloraemia, hyperchloraemia, and an increase in serum chloride?≥?5 mEq/L occurred in 2%, 21%, and 12%, respectively. After adjusting for confounders, increase in chloride?≥?5 mEq/L was associated with a 2.3 (95% CI 1.03–5.21) greater odds of mortality.

Conclusions

An increase in serum chloride level in the first day of admission is common and an independent risk factor for mortality in critically ill children. Further studies are warranted to identify how chloride disturbances contribute to mortality risk in critically ill children.

     

我国近10年脑卒中恢复期护理研究的文献计量分析

目的 分析我国近10年脑卒中恢复期护理的研究现状,为进一步开展脑卒中恢复期护理干预提供参考依据。 方法 应用文献计量学法回顾2008—2018年发表在我国12种护理科技期刊上关于脑卒中恢复期护理研究的文献。 结果 共检出文献40篇,其中基金资助论文高达70%;总被引频次为400次;发文量最多的地区是上海市,共11篇;57.50%的文献设计类型为实验性研究;研究热点以中医护理为主(25.64%);另外53.85%的文献涉及生活能力或质量、自我管理等的改善。 结论 近年我国脑卒中恢复期护理研究的论文均具有一定质量,但是需要加强地区间的合作,以更好更快促进该领域的发展。以随机对照试验为设计类型的中医护理将会成为研究热点和研究趋势。     

近10年康复辅助器具相关研究的可视化分析

目的 分析近10年康复辅助器具领域国内外研究现状、研究热点和趋势。方法 检索2012至2021年中国知网和Web of Science (WoS)数据库核心合集相关文献。应用CiteSpace及VOSviewer可视化分析作者、国家/地区、机构、研究热点及趋势。结果与结论 国内外年发文量均呈逐年上升趋势。国内发文最多的团队为喻洪流团队,发文最多的机构为中国残疾人辅助器具中心。国外发文最多的团队为Maysam G团队,发文最多的机构为匹兹堡大学。国家发文量最多及中介中心性最高的是美国。国内外康复辅助器具相关研究热点主要集中于康复辅助器具产品的设计与研发、康复辅助器具在特殊/脆弱人群中的应用、康复辅助器具及其相关专业服务的应用效果研究;预测基于智能感知、类脑计算、深度学习及虚拟/增强现实的智能辅助器具产品设计研发及应用研究是本领域的发展趋势。