点穴推拿治疗颈源性失眠临床研究

目的:观察点穴推拿治疗颈源性失眠的临床疗效。方法:将100例颈源性失眠患者按随机数字表法分为对照组和观察组,每组50例。对照组给予艾司唑仑片治疗,观察组给予点穴推拿治疗,2组均连续治疗10 d。对比2组临床疗效和匹兹堡睡眠质量指数(PSQI)。结果:观察组总有效率94.00%,高于对照组的72.00%,差异有统计学意义(P<0.05)。治疗后,2组PSQI各项细则评分及总分均较治疗前降低,观察组PSQI各项细则评分及总分均低于对照组,差异均有统计学意义(P<0.05)。结论:点穴推拿治疗颈源性失眠疗效优于艾司唑仑片。     

Atención prehospitalaria urgente de los pacientes pediátricos expuestos a tóxicos: características epidemiológico-clínicas y evaluación de la calidad asistencial

ObjectiveTo describe the characteristics of paediatric patients with suspected poisoning treated by advanced life support (ALS) units, and to evaluate quality indicators (QI) for the prehospital emergency care of these patients.MethodA one-year observational study of patients under 18 years of age exposed to poisoning and treated by an ALS unit of the Medical Emergency System in Catalonia. Severe clinical criteria were defined, with 8 QI being evaluated for prehospital emergency care of poisoned paediatric patients.ResultsThe study included a total of 254 patients, with a median age of 14 years-old (p25-75 = 7-16), with intentional poisoning in 50.8% of cases. The most frequently involved toxic agent was carbon monoxide (CO) (33.8%). Poisoning was found in 48.8% of those patients, being serious in 16.5%. Intentionally (OR 5.1; 95% CI: 1.9-13.8) and knowledge of the time of exposure (OD 3.1; 95% CI: 1.3-7.3) were independent risk factors associated with the appearance of severe clinical symptoms. Five QI did not reach the quality standard and included, availability of specific clinical guidelines, activated charcoal administration in selected patients, oxygen therapy administration at maximum possible concentration in carbon monoxide poisoning, electrocardiographic assessment in patients exposed to cardiotoxic substances, and recording of the minimum data set.ConclusionsPaediatric patients attended by ALS units showed specific characteristics, highlighting the involvement of CO and adolescents with voluntary poisoning. The QI assessment was useful to detect weak points in the quality of care of these patients and to develop strategies for improvement.     

Trends in revisional bariatric surgery using the MBSAQIP database 2015-2017

BackgroundThe third most common bariatric surgery is revisional bariatric surgery. The American College of Surgeons tracks outcomes using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program database. We used this database to examine trends in revisional bariatric surgery.ObjectiveTo evaluate how trends in bariatric revisional surgery have changed in recent years.SettingUniversity Hospital, United States.MethodsThe Metabolic and Bariatric Surgery Accreditation Quality Initiative Program database for 2015 to 2017 was examined for revisions of bariatric surgery. Patients who underwent revisional bariatric surgery were identified by the primary Current Procedural Terminology code, the REVCONV and PREVIOUS_SURGERY field as well as secondary Current Procedural Terminology codes. There is no exact code for sleeve gastrectomy (SG) to laparoscopic Roux-en-Y gastric bypass (LRYGB), so we used 43644 (GB)+REVCONV+PREVIOUS_SURGERY for this.ResultsFor the years 2015 to 2017 there were 57,683 revisions/conversions of 528,081 patients. The number of revisions increased over the study period by 5213 cases. The most common revision was laparoscopic adjustable gastric band (LAGB) to SG with 15,433 cases and the second was LAGB to LRYGB with 10,485 cases. There were 14,715 LAGB removals. It is more difficult to track SG to LRYGB but there were 8491 unlisted cases, which may have been sleeve to bypass.ConclusionLAGBs are being taken out or converted, and this group makes up the largest portion of revisions and conversions. It is difficult to track SG to LRYGB, but the number of unlisted cases continues to climb. This will likely surpass LAGB conversions with time. The Metabolic and Bariatric Surgery Accreditation Quality Initiative Program should be modified to capture revisions/conversions of SG.     

养阴益气活血汤对慢性心力衰竭患者心功能及生活质量的影响

目的:研究养阴益气活血汤对慢性心力衰竭患者心功能和生活质量的影响。方法:将慢性心力衰竭患者86例随机分为2组。对照组采用常规西药治疗,观察组联合养阴益气活血汤治疗。观察比较2组左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、生活质量评分、中医证候积分、疗效和不良反应。结果:治疗后,2组LVEF升高,LVEDD、LVESD降低,且观察组LVEF高于对照组,LVEDD、LVESD低于对照组,差异有统计学意义(P<0.05)。治疗后,2组中医证候积分、生活质量评分均降低,且观察组中医证候积分、生活质量评分低于对照组,差异有统计学意义(P<0.05)。观察组总有效率为93.02%,对照组总有效率为76.74%,观察组总有效率高于对照组(P<0.05)。结论:养阴益气活血汤治疗慢性心力衰竭,能显著改善患者心功能,提高生活质量,安全可靠。     

ArcCHECK系统在食管癌螺旋断层放疗计划验证中的应用

目的 探讨ArcCHECK系统在食管癌断层治疗旋转照射和固定野照射计划验证中的应用,总结相关经验。方法 对32例不同部位食管癌分别制作Helical旋转照射和Direct固定野照射验证计划,并通过ArcCHECK测量、分析,对比验证结果通过率。分析靶体积与计划验证通过率的相关性。将靶体积较小的治疗验证计划分别放在ArcCHECK模体中心和外周探测点处,分析验证通过率差异。结果 Helical计划验证通过率高于Direct计划(P<0.01),其靶体积与验证通过率的相关系数分别为-0.364和-0.042,P值分别为0.041和0.819。Helical计划采用3%/2mm标准时,高剂量区放在模体中心和外周探测点处测得的通过率不同(P=0.005),后者通过率更高;采用3%/3mm标准时与Direct计划的3%/3m、3%/2mm标准的相近(P均>0.05)。结论 Helical计划验证通过率普遍高于Direct计划,原因可能与ArcCHECK探测器的角度响应以及因更多参考点受到低剂量辐射而未参与计算有关,另外还可能跟Direct计划对断层治疗剂量控制系统要求更高有关。在Helical验证计划中,当采用3%/3mm标准时,靶体积越大,验证时出现较低通过率的可能性增加,但相关系数较低。验证计划的高剂量区位于模体中心或者探测点处都可以实现计划验证,综合考量建议放在模体等中心处。     

基于生物活性与效应基准的中药质量 评价技术发展现状与展望

中药质量的评控问题是制约中药现代化发展的瓶颈,因此有必要在现有检测方法的基础上结合生物评价,继而更为全面地保证中药质量。生物评价是完善中药质量标准、保证临床功效和安全性评价的重要方法,已成为中药质量标准化发展趋势之一。在此处主要论述了近年来基于生物活性与效应基准的中药质量评价技术和已取得的部分研究进展,同时对目前中药质量生物评价研究与应用中存在的主要问题进行探讨,进一步对其未来应用做出展望,从而更好的对中药质量进行控制。     

认知行为干预在冠心病患者护理中的应用效果

目的观察认知行为干预在冠心病患者护理中的应用效果。方法选取本院2016年12月～2018年2月期间收治的53例冠心病患者,根据住院号奇偶性情况将其随机分为观察组(n=27)和对照组(n=26),对照组予以常规护理,观察组予以认知行为干预。比较两组患者控制态度评分、心理状况评分、生活质量改善情况及依从性。结果观察组控制态度评分、心理状况评分、生活质量改善情况及依从性与对照组比较,差异有统计学意义(P0.05)。结论在冠心病患者护理中给予认知行为干预应用效果极佳,可作为临床干预首选措施。     

Changes in the SF-12 among Depressed Elders Six Months after Discharge from an Inpatient Geropsychiatric Unit

Using the SF-12 to measure physical and mental functioning, the authors examine the intra-individual changes in health-related quality of life (HRQOL) 6 months post-discharge for depressed older adults. In addition, they examine three sets of predictors that might influence these changes. The sample of depressed older adults was recruited from an inpatient geropsychiatry unit. Although their physical and mental health scores on the SF-12 were lower than comparable norms, the sample showed an average increase in their mental functioning but a decrease in the physical functioning over the 6 months. Negative life-events were significant predictors of people who reported no change in their mental health functioning and decreases in their physical health functioning. Interestingly, those who experienced positive life events were more likely to report declines and younger participants were more likely to report no change in their physical functioning. The findings indicate that the effects of depression on HRQOL can have enduring effects on a sample of previously hospitalized older adults. The significance of life event changes might signify the importance of taking into account non-traditional areas of medical interventions. Further, the findings indicate the usefulness of the SF-12 quantifying HRQOL outcomes.