Investigating how electroencephalogram measures associate with delirium: A systematic review

Delirium is a common neurocognitive disorder in hospital settings, characterised by fluctuating impairments in attention and arousal following an acute precipitant. Electroencephalography (EEG) is a useful method to understand delirium pathophysiology. We performed a systematic review to investigate associations between delirium and EEG measures recorded prior, during, and after delirium. A total of 1,655 articles were identified using PsycINFO, Embase and MEDLINE, 31 of which satisfied inclusion criteria. Methodological quality assessment was undertaken, resulting in a mean quality score of 4 out of a maximum of 5. Qualitative synthesis revealed EEG slowing and reduced functional connectivity discriminated between those with and without delirium (i.e. EEG during delirium); the opposite pattern was apparent in children, with cortical hyperexcitability. EEG appears to have utility in differentiating those with and without delirium, but delirium vulnerability and the long-term effects on brain function require further investigation. Findings provide empirical support for the theory that delirium is a disorder of reduced functional brain integration.     

某院药物相关问题分类系统的建立及初步验证

目的对现有药物相关问题分类系统进行改进,在此基础上建立某院药物相关问题分类系统,为更好地监控药物相关问题,促进患者用药安全及节省医疗费用提供帮助。方法在对公开发表的DRPs分类系统进行分析汇总的基础上,选择一相对较完善的系统,结合某院的实际情况,建立适合某院的药物相关问题分类系统,并进行初步验证。结果建立的新系统包含5个部分,75个子类别。结论新的分类系统尽管还有许多需要优化的地方,但参与评估的药师都给予该系统较高的评价,认为新的分类系统更切合某院的实际情况。有利于发挥药师在患者治疗中的作用,为患者提供更优良的药学服务。     

Comorbid depression in surgical cancer patients associated with non-routine discharge and readmission

ObjectiveTo characterize the rates of depression across primary cancer sites, and determine the effects of comorbid depression among surgical cancer patients on established quality of care indicators, non-routine discharge and readmission.MethodsPatients undergoing surgical resection for cancer were selected from the Nationwide Readmissions Database (2010–2014). Multivariable analysis adjusted for patient and hospital level characteristics to ascertain the effect of depression on post-operative outcomes and 30-day readmission rates. Non-routine discharge encompasses discharge to skilled nursing, inpatient rehabilitation, and intermediate care facilities, as well as discharge home with home health services.ResultsAmong 851,606 surgically treated cancer patients, 8.1% had a comorbid diagnosis of depression at index admission (n = 69,174). Prevalence of depression was highest among patients with cancer of the brain (10.9%), female genital organs (10.9%), and lung (10.5%), and lowest among those with prostate cancer (4.9%). Depression prevalence among women (10.9%) was almost twice that of men (5.7%). Depression was associated with non-routine discharge after surgery (OR 1.20, CI:1.18–1.23, p < 0.0001*) and hospital readmission within 30 days (OR 1.12, CI:1.09–1.15, p < 0.001*).ConclusionRates of depression vary amongst surgically treated cancer patients by primary tumor site. Comorbid depression in these patients is associated with increased likelihood of non-routine discharge and readmission.     

Thalamic deep brain stimulation for Tourette Syndrome: A naturalistic trial with brief randomized,double-blinded sham-controlled periods

BackgroundThere is still a lack of controlled studies to prove efficacy of thalamic deep brain stimulation for Tourette's Syndrome.ObjectivesIn this controlled trial, we investigated the course of tic severity, comorbidities and quality of life during thalamic stimulation and whether changes in tic severity can be assigned to ongoing compared to sham stimulation.MethodsWe included eight adult patients with medically refractory Tourette's syndrome. Bilateral electrodes were implanted in the centromedian-parafascicular-complex and the nucleus ventro-oralis internus. Tic severity, quality of life and comorbidities were assessed before surgery as well as six and twelve months after. Short randomized, double-blinded sham-controlled crossover sequences with either active or sham stimulation were implemented at both six- and twelve-months’ assessments. The primary outcome measurement was the difference in the Yale Global Tic Severity Scale tic score between active and sham stimulation. Adverse events were systematically surveyed for all patients to evaluate safety.ResultsActive stimulation resulted in significantly higher tic reductions than sham stimulation (F = 79.5; p = 0.001). Overall quality of life and comorbidities improved significantly in the open-label-phase. Over the course of the trial two severe adverse events occurred that were resolved without sequelae.ConclusionOur results provide evidence that thalamic stimulation is effective in improving tic severity and overall quality of life. Crucially, the reduction of tic severity was primarily driven by active stimulation. Further research may focus on improving stimulation protocols and refining patient selection to improve efficacy and safety of deep brain stimulation for Tourette's Syndrome.     

Computer assisted detection of abnormal airway variation in CT scans related to paediatric tuberculosis

Airway deformation and stenosis can be key signs of pathology such as lymphadenopathy. This study presents a local airway point distribution model (LA-PDM) to automatically analyse regions of the airway tree in CT scans and identify abnormal airway deformation. In our method, the airway tree is segmented and the centreline identified from each chest CT scan. Thin-plate splines, along with a local mesh alignment method for tubular meshes, are used to register the airways and develop point distribution models (PDM). Each PDM is then used to analyse and classify local regions of the airway. This LA-PDM method was developed using 89 training cases and evaluated on a 90 CT test set, where each set includes paediatric tuberculosis (TB) cases (with airway involvement) and non-TB cases (without airway involvement). The LA-PDM was able to accurately distinguish cases with airway involvement with an AUC of the ROC classification (and 95% confidence interval) of 0.87 (0.77–0.94) for the Trachea–LMB–RMB region and 0.81 (0.68–0.90) for the RMB–RUL–BI region – outperforming a comparison method based on airway cross-sectional features. This has the potential to assist and improve airway analysis from CT scans by detecting involved airways and visualising affected airway regions.     

分级预防对慢性苯中毒患者医院感染控制的效果

目的 探讨分级预防在慢性苯中毒患者医院感染控制中的效果。 方法 对2014年7月-2016年6月住院的慢性苯中毒患者进行风险评估,随机选取实验组和对照组各36例,实验组采取分级预防措施进行医院感染控制;对照组使用职业病常规护理措施,比较2组医院感染率。结果 实验组医院感染率为11.11%,对照组感染率为30.56%,实验组医院感染率低于对照组(χ²=4.126,P=0.042)。 结论 分级预防针对性强,可降低慢性苯中毒患者的医院感染率,为科学管理和控制医院感染提供依据。