Inferior Vena Cava Filters: Aligning Practice With Evidence to Improve Patient Outcomes

BackgroundDespite indications for the removal of temporary inferior vena cava (IVC) filters, many filters are unintentionally left in place, predisposing patients to adverse outcomes.ObjectiveThis quality improvement study set out to determine the impact of an IVC filter retrieval protocol on filter retrieval rates and patients lost to follow-up for patients who had undergone placement of a temporary IVC filter.MethodsFollowing a quasi-experimental design, data of all consecutive patients who underwent insertion of a temporary IVC filter for a period of 24-month preprotocol and 12-month postprotocol were compared.ResultsFilter retrieval rates of eligible filters increased from 64.2% to 100%; patients lost to follow-up decreased from 35.9% to 0% (p < .01, both outcomes).ConclusionAdoption of a comprehensive IVC filter protocol by the service that implants these devices can improve filter retrieval rates and decrease patients being lost to follow-up.     

精索静脉曲张手术后患者的管理策略

手术治疗精索静脉曲张在改善精液质量、提高配偶自然怀孕率和缓解局部疼痛症状中的作用已为多数医生所认同。随着手术方式的改进,越来越多的精索静脉曲张患者接受手术治疗,然而,临床对手术后患者的管理还重视不够。本文系统介绍了对精索静脉曲张手术后患者的疗效判断和后续治疗选择,包括观察随诊、非手术治疗方法和再手术。     

Pharmacy patron perspectives of community pharmacist administered influenza vaccinations

Background

One approach to boost influenza vaccination coverage has been to expand immunization authority. In 2012, the province of Ontario gave community pharmacists the authority to administer the influenza vaccine.

黄芪桂枝汤对于风湿痹证患者的改善作用研究

目的:分析和研究黄芪桂枝汤对于风湿痹证患者的改善作用。方法:选择了56例患者进行研究主要对象,将所有参与研究的56例患者分成了对照组(28例)和观察组(28例),使用的分组方式为随机数字表法。对照组使用的治疗方式为西药,观察组则在西药治疗的基础之上增加了黄芪桂枝汤进行联合治疗。之后对比两个组别患者的治疗疗效以及疼痛积分值。结果:对照组之中有11例患者为治愈,11例患者为好转,剩余6例患者为未愈;观察组之中有15例患者为治愈,12例患者为好转,剩余1例患者为未愈,对照组之中患者的治疗疗效明显低于观察组之中的患者。在进行治疗之前,对照组与观察组患者之间的对比不具有统计学意义,对照组当中患者的疼痛积分值明显低于观察组患者,P <0.05说明数据的差异存在统计学意义。结论:在对风湿痹证患者进行治疗时,加用黄芪桂枝汤能够起到标本兼治以及扶正祛邪的作用,值得推广。     

Sensory evoked potentials in patients with Rett syndrome through the lens of animal studies: Systematic review

ObjectiveSystematically review the abnormalities in event related potential (ERP) recorded in Rett Syndrome (RTT) patients and animals in search of translational biomarkers of deficits related to the particular neurophysiological processes of known genetic origin (MECP2 mutations).MethodsPubmed, ISI Web of Knowledge and BIORXIV were searched for the relevant articles according to PRISMA standards.ResultsERP components are generally delayed across all sensory modalities both in RTT patients and its animal model, while findings on ERPs amplitude strongly depend on stimulus properties and presentation rate. Studies on RTT animal models uncovered the abnormalities in the excitatory and inhibitory transmission as critical mechanisms underlying the ERPs changes, but showed that even similar ERP alterations in auditory and visual domains have a diverse neural basis. A range of novel approaches has been developed in animal studies bringing along the meaningful neurophysiological interpretation of ERP measures in RTT patients.ConclusionsWhile there is a clear evidence for sensory ERPs abnormalities in RTT, to further advance the field there is a need in a large-scale ERP studies with the functionally-relevant experimental paradigms.SignificanceThe review provides insights into domain-specific neural basis of the ERP abnormalities and promotes clinical application of the ERP measures as the non-invasive functional biomarkers of RTT pathophysiology.     

癌症患者心理韧性质性研究的系统评价

目的 系统评价有关癌症患者心理韧性发展的真实体验,为更好地制定心理韧性干预方案提供理论依据。方法 计算机检索Cochrane Library、Medline、CINAHL、Embase、PubMed、Web of Science、Psyc INFO以及中国生物医学文献数据库、中国知网、维普、万方数据库从建库至2019年6月相关的质性研究。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准（2016）对文献进行评价,采用汇集性整合方法进行结果整合。结果 共纳入10篇文献,提炼42个明确的结果,形成8个类别,汇总成3个整合结果。①心理韧性发展是动态循环的过程：危机负性期,调节成长期,积极转化期,循环强化期;②心理韧性的阻碍因素：个体（消极应对,错误认知,症状和体象困扰）,环境（传统社会文化,医疗环境,家庭负担）;③心理韧性的保护因素：个体（积极心理与应对方式,复原经历,宗教信仰,自我表露,利他主义与行为）,环境（家庭因素,医疗照护,人际支持）。结论 心理韧性的发展是动态循环过程,受个体和环境因素影响,医护人员应根据不同阶段的影响因素给予针对性护理措施,促进患者心理韧性的形成和发展,提高患者的生活质量。     

密盖息治疗49例恶性骨转移瘤疗效观察

目的:观察密盖息(鲑鱼降钙素)的治疗骨转移瘤疼痛和血清钙的临床疗效。方法:单用组用密盖息100IU,肌肉注射,每日2次,共7d。联合化疗组化疗后加密盖息100IU肌肉注射,每日2次,每次7d。治疗结束进行疗效评价。结果:单用组骨痛完全缓解66.7%(12/18)。联合化疗组骨痛完全缓解率87.1%(27/31)。单用组血钙降至正常,占77.8%(14/18),联合化疗组血钙完全降至正常占100%(31/31)。副作用是暂时性的心动过速、皮肤潮红、头晕、恶心呕吐,无需特殊处理,自行缓解。结论:密盖息治疗骨转移瘤有止痛、降低血钙作用良好,副作用小,可以在临床上安全使用。     

128例老年胃癌患者围手术期临床特点分析及护理对策

目的：提高对老年胃癌患者围术期护理的认识。方法：对128例≥65岁胃癌患者与同期〈65岁212例胃癌患者围术期各方面资料进行对比分析。结果：≥65岁组术前合并症多，全胃及联合脏器切除比例高、创伤大，术后非手术相关并发症多，患者文化水平较低，社会支持水平低。结论：对老年胃癌患者应重视术前的全面评估和充分准备，争取和利用患者的社会支持系统，采取灵活多样的形式进行健康教育，术后重视呼吸系统、心血管系统并发症及手术相关并发症（吻合口瘙、胃排空障碍、胰腺炎、胸腔积液或腹腔积液等）的预防和护理。