Transcatheter Mitral Valve Replacement With the Transseptal EVOQUE System

ObjectivesThe aim of this study was to examine the initial experience with a novel transseptal transcatheter mitral valve replacement (TMVR) system.BackgroundTransseptal TMVR may offer a less invasive option than surgery for mitral regurgitation (MR) with greater efficacy and fewer anatomic limitations than transcatheter repair.MethodsPatients were treated with the EVOQUE TMVR system from September 2018 to October 2019. Key inclusion criteria were moderate or greater MR, New York Heart Association functional class ≥II, and high or prohibitive surgical risk. The primary outcome was technical success, defined by Mitral Valve Academic Research Consortium criteria.ResultsFourteen patients were treated, all with at least moderate to severe MR. The median age was 84 years, and the median Society of Thoracic Surgeons score was 4.6%. MR was degenerative in 4 (28.6%), functional in 3 (21.4%), and mixed in 7 (50%). Technical success was achieved in 13 patients (92.9%), and 1 patient was converted to surgery. At 30 days there was 1 noncardiovascular mortality (7.1%), 2 strokes (14.3%), no myocardial infarctions, and no rehospitalizations. Two patients (14.3%) underwent paravalvular leak closure. One patient (7.1%) underwent alcohol septal ablation for left ventricular outflow tract obstruction. Including the 2 patients with paravalvular leak closure, MR was mild or less in all implanted patients at 30 days, with no MR in 10 (83.3%). Mean mitral gradient was 5.8 mm Hg (median). New York Heart Association functional class improved to ≤II in 9 patients (81.8%).ConclusionsThis first-in-human experience has demonstrated the feasibility of the transseptal EVOQUE TMVR system. Further clinical studies are required to establish safety and clinical outcomes.     

脑卒中患者生活质量量表的制订及其评价

目的　制订适合中国人群脑卒中患者的生活质量量表。方法　借鉴国外量表制订的标准程序 ,结合国内的实际情况进行。结果　量表包括生理功能、心理功能、社会生活、症状和总体健康感受 5个领域共 2 2个条目。量表完成时间为 (12 .2 6± 3.31)min ,量表的接受率和完成率分别为 10 0 %和 97.6 %;量表各个领域得分及总分复测信度系数均大于 0 .7,量表生理、心理、社会生活、症状 4个领域的Chronbach’α系数均大于 0 .6 0 ,量表具有可靠结构效度 ,标准关联效度不理想。结论　该量表可以作为意识清楚、病情稳定的脑卒中患者生活质量的测量工具。     

Implementing a Knowledge Translation Intervention in Long-Term Care: Feasibility Results From the Vitamin D and Osteoporosis Study (ViDOS)

ObjectivesTo evaluate the feasibility of implementing an interdisciplinary, multifaceted knowledge translation intervention within long-term care (LTC) and to identify any challenges that should be considered in designing future studies.DesignCluster randomized controlled trial.SettingForty LTC homes across the province of Ontario, Canada.ParticipantsLTC teams composed of physicians, nurses, pharmacists, and other staff.MeasurementsCluster-level feasibility measures, including recruitment, retention, data completion, and participation in the intervention. A process evaluation was completed by directors of care indicating which process/policy changes had been implemented.ResultsRecruitment and retention rates were 22% and 63%, respectively. Good fidelity with the intervention was achieved, including attendance at educational meetings. After ViDOS, 7 process indicators were being newly implemented by more than 50% of active intervention homes.ConclusionDespite recruitment and retention challenges, the multifaceted intervention produced a number of policy/process changes and had good intervention fidelity. This study is registered at ClinicalTrials.gov NCT01398527.     

Feasibility and acceptability of intensive,real-time biobehavioral data collection using ecological momentary assessment,salivary biomarkers,and accelerometers among middle-aged African Americans

Perceived racial discrimination is linked to unhealthy behaviors and stress-related morbidities. A compelling body of research indicates that perceived racial discrimination may contribute to health disparities among African Americans (AAs). The purposes of this study were to describe the study protocol including data collection procedures and study measures and to evaluate the feasibility and acceptability of intensive biobehavioral data collection using ecological momentary assessment (EMA), salivary biomarkers, and accelerometers over 7 days among middle-aged AAs with a goal of understanding the relationships between perceived racial discrimination and biobehavioral responses to stress. Twelve AA men and women participated in the feasibility/acceptability study. They completed surveys, anthropometrics, and received in-person training in EMA and saliva sample collection at baseline. Participants were asked to respond to the random prompt text message-based EMA five times a day, wear an accelerometer daily for 7 days, and to self-collect saliva samples four times a day for 4 consecutive days. The EMA surveys included perceived racial discrimination, affective states, lifestyle behaviors, and social and physical contexts. The mean EMA response rate was 82.8%. All participants collected saliva samples four times a day for 4 consecutive days. About 83% of participants wore the accelerometer on the hip 6 out of 7 days. Despite the perception that the intensive nature of assessments would result in high participant burden, the acceptability of the study procedures was uniformly favorable.     

武汉市公立医院产权制度改革的可行性研究

公立医院产权制度改革是我国当前医疗体制改革的一项重要任务，作为一项全新的系统工程，再加上公立医院本身的特殊性，使公立医院产权制度改革具有复杂性和不可参照性。从目前公立医院产权制度改革的实践，以及武汉市公立医院生存和发展的现状来看，推进公立医院产权制度改革势在必行。通过对武汉市公立医院产权制度改革可行性的研究，为建立新型医疗服务体系提供重要的政策参考依据，使之形成与社会主义市场经济体制相适应，不断满足人民群众多层次、多样化的卫生服务需求的新型公立医院管理运行机制。武汉市对公立医院产权制度改革是符合时代要求的，通过总结改革经验，结合武汉市的实际情况，制定相应的政策，采取合理的措施，是完全可行的。公立医院实行产权制度改革后，可以优化武汉市资源配置，发挥整体效能，增强城市综合医疗服务能力，但即使医院成功实施了改制转制，我们还应当不断进行机制创新、不断更新观念，把改制与内部的经营管理、制度建设结合进行，不断提升医院的核心竞争力，更好地为人民健康服务。     

非开胸的食管剥脱术的探讨(报告13例手术经验)

目的　介绍非开胸食管剥脱术的方法 ,并对此法的应用进行探讨。方法　总结我院以往 12年来用本方法治疗的 13例食管癌病人的经验。复习文献探讨本手术方法的应用。结果　术中失血 5 0～ 15 0ml,无严重出血现象。 1例在分离外侵的上段食管癌时撕破气管膜部 ,行开胸修复。所有病人术后恢复良好 ,无手术死亡 ,其中 4例生存逾 5年。结论　应用本手术方法治疗食管癌是一种可行的手段 ,具有简便、安全的特点。虽然在学术上对本方法有争议之处 ,但随着科技的进步 ,本法将不断完善。需要指出用本手术方法时 ,选择合适的病人非常重要。     

Implementing breast cancer decision aids in community sites: barriers and resources

Objective To assess the feasibility of implementing four patient decision aids (PtDAs) for early stage breast cancer treatment decisions into routine clinical care in community settings. Background There is very limited information available about implementing decision aids into routine clinical practice and most of this information is based on academic centres; more information is needed about implementing them into routine clinical practice in community settings. Design Structured individual interviews. Setting and participants Providers from 12 sites, including nine community hospitals, a community oncology centre and two academic centres. Main outcome measures Usage data, barriers to and resources for implementing the PtDAs. Results Nine of the 12 sites were using the PtDAs with patients. All of the sites were lending the PtDAs to patients, usually without a formal sign‐out system. The keys to successful implementation included nurses’ and social workers’ interest in distributing the PtDAs and the success of the lending model. Barriers that limited or prevented sites from using the PtDA included a lack of physician support, a lack of an organized system for distributing the PtDAs and nurses’ perceptions about patients’ attitude towards participation in decision making. Conclusions It is feasible to implement PtDAs for early stage breast cancer into routine clinical care in community settings, even with few resources available.     

Feasibility analysis of a personalized training plan for learning research methodology

OBJECTIVES: To determine the performance in learning clinical research methodology (CRM) by means of the Keller Plan (KP), to assess its impact on attitudes towards research (AR) and to estimate its acceptability. DESIGN: An educational intervention trial was employed with control group (CG) and random assignment. SETTING: The Family and Community Medicine Teaching Unit in Valencia, Spain, 1997. SUBJECTS: Third-year family residents. RESULTS: In the KP both specific written self-teaching material and interactive computer programme were used, focusing on the tutored resident, with compulsory assessments to continue. In the CG a conventional course was followed. Knowledge of CRM and the AR test (previously validated in another study) were measured at the start. Four tests of successive knowledge, time spent studying, tutorials, final AR test and acceptability were conducted. Non-parametric tests were used. Forty (89%) residents participated, 22 were assigned to KP and 18 to CG. Similar basic characteristics, with exception of AR test (medians 55 Keller, 58 control). KP knowledge tests significantly higher (P = < 0.05) than the CG (medians 101, 88) along with time spent studying (medians 53, 23.4 h). There were no significant differences in AR test, although there was an improvement in both groups, significant in KP but not in CG (median increase of 4.5 and 2). Nine residents used and positively assessed the computer programme. Better acceptability was obtained by the KP in overall evaluation, recommendation of the method and learning dynamic. CONCLUSIONS: The KP obtained better knowledge, motivated studying and was positively accepted.