主动固定螺旋电极在右室流出道间隔部起搏中的应用体会

目的探索采用主动固定螺旋电极行右室间隔部起搏的临床可行性。方法随机选择54例需要安装双腔起搏器的患者行右室流出道间隔部起搏,将心室起搏螺旋电极先后定位于右室心尖部及右室流出道间隔部并测试起搏参数。结果右室流出道间隔部电极定位成功率为98.15%,该部位起搏参数满足起搏要求,同时起搏的QRS波时限较心尖部变窄(130.45±18.24msvs153.11±20.10ms,P<0.001)。结论采用主动固定螺旋电极行右室流出道间隔部起搏安全性高、可行性好。     

英夫利西单抗联合甲氨蝶呤治疗活动性类风湿关节炎疗效分析

目的：研究分析英夫利西单抗联合甲氨蝶呤治疗活动性类风湿关节炎的临床效果。方法选取2011年12月—2013年12月在该院收治的130例活动性类风湿关节炎患者作为研究对象,将所有患者随机分为对照组和观察组各65例,对照组患者给予甲氨蝶呤治疗,观察组患者在对照组基础上联合英夫利昔单抗治疗,观察两组患者的临床治疗效果及各项临床指标情况,并作对比分析。结果观察组的晨僵时间、疼痛消失时间、肿胀缓解时间明显少于对照组,两组对比差异有统计学意义（P＜0.05）;观察组治疗后的类风湿因子（RF）、血沉（ESR）、C-反应蛋白（CRP）等指标下降程度明显低于对照组,两组对比差异有统计学意义（P＜0.05）。结论采用英夫利西单抗联合甲氨蝶呤治疗活动性类风湿关节炎具有较高的临床应用价值,能够有效缩短患者的晨僵时间、疼痛消失时间、肿胀缓解时间,改善患者的各项临床指标,值得临床大力推广。     

活动性矫治器早期治疗牙齿反的临床研究

目的：探讨活动性矫治器治疗早期牙齿反的临床疗效,为矫治前牙反提供有效办法。方法对60例牙齿反患儿采用佩戴活动性矫治器的方法进行早期治疗,分别比较这60例患儿治疗前后X线投影测量结果,判断治疗效果。结果60例牙齿反患儿中,矫治时间为2-9个月,其中10例矫治时间2-3个月,37例矫治时间3-7个月,13例矫治时间7-9个月,平均矫治时间（5.8±2.7）个月,所有研究患儿均按照医师要求完成治疗周期;对60例患儿的SNA角、颌凸角、SNB角、ANB角、U1-SN、SN-UIN、CV值治疗前后X线测量显示治疗后较治疗前均显著改善且差异均具有显著的统计学意义（P<0.05）;60例患儿在治疗后结束后1年进行复查,发现有4例儿童复发,均与年龄偏大、存在前牙反的家族史或不良的口腔习惯未破除等原因有密切关系,复发率为6.67%。结论活动性矫治器治疗早期牙齿反具有明显的正畸效果,但同时应该注意对儿童不良习惯的纠正以保持治疗效果。     

金玄痔科熏洗散有效部位制剂的GC-MS指纹图谱研究

目的:对金玄痔科熏洗散及有效部位新制剂进行GC-MS分析,建立了有效部位新制剂的GC-MS指纹图谱。方法:采用GC-MS方法对金玄痔科熏洗散及有效部位新制剂中的主要组分进行分析,并确定指纹图谱中的特征指纹信息。结果:对10个批次的有效部位新制剂进行了测定,并得到了较为理想的包含特征信息的有效部位新制剂的GC-MS指纹图谱。结论:方法重复性好,所建立的指纹图谱为金玄痔科熏洗散有效部位新制剂的质量控制提供了有效手段。     

Participant report of therapist-delivered active ingredients in a telephone-delivered brief motivational intervention predicts taking steps towards change

Objective: Given the widespread potential for disseminating Motivational Interviewing (MI) through technology, the question of whether MI active ingredients are present when not delivered in person is critical to assure high treatment quality. The Participant Rating Form (PRF) was developed and used to evaluate therapist-delivered active ingredients in phone-delivered MI with hazardous drinking Emergency Department patients. Method: A factor analysis of all PRFs completed after receiving one call (n?=?256) was conducted. Multiple regression analysis was used to examine whether PRF factors predicted a measure of motivation to change – taking steps – at the second call (n?=?214). Results: The majority of participants were male (65%), with a mean age of 32 years and with an average alcohol ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) score of 20.5 (SD?=?7.1). Results of the factor analysis for the PRF revealed Relational (working collaboration) and Technical (MI behaviours) factors. After controlling for demographics, alcohol severity and baseline readiness, the technical factor predicted self-report of increased taking steps towards change while the relational factor did not explain any additional variance. Conclusions: Our study adds to the growing literature investigating patient perspectives of therapist skill as a source of information to better understand MI active ingredients. The PRF is a feasible instrument for measuring the patient’s experience of phone-based MI. Results indicate that MI active ingredients of change (relational and technical components) were present in the telephone intervention as hypothesized. Clinical Trial Registration # 01326169.     

Oxytocin discontinuation after the active phase of labor is established

Despite the widespread usage of oxytocin, there is still no consensus on its mode of administration. The scope of the present meta-analysis was to assess the effect of oxytocin discontinuation after the active phase of labor is established on maternal fetal and neonatal outcomes. We searched Medline, Scopus, Popline, ClinicalTrials.gov and Google Scholar databases. Eight studies were finally retrieved, which involved 1232 parturient. We observed significantly decreased rates of cesarean sections among parturient that discontinued oxytocin (OR 0.51, 95% CI 0.35, 0.74) as well as decreased rates of uterine hyperstimulation (OR 0.33, 95% CI 0.19, 0.58). Similarly, cases of non-reassuring fetal heart rates were fewer among women that did not receive oxytocin after the establishment of the active phase of labor (OR 0.63, 95% CI 0.41, 0.97). Keeping in mind the aforementioned maternal and neonatal adverse effects that seem to result from infusion of oxytocin until delivery, future practice should aim towards its discontinuation after the establishment of the active phase of labor, as it does not seem to influence the total duration of labor. Future studies should aim towards specific populations of parturient in order to clarify whether different approaches are needed.     

豚鼠主动全身过敏试验两种阳性物质选择的探讨

目的 比较两种阳性物质人血白蛋白、卵白蛋白对豚鼠主动全身过敏作用,为过敏性试验提供较好的阳性对照。方法 将豚鼠随机分为14组,以人血白蛋白、卵白蛋白(2、10、100 mg/只)、0.9%氯化钠注射液等受试物为对照,研究不同致敏剂量、激发剂量、激发时间等条件下,豚鼠全身主动过敏的反应情况。结果 在2~100 mg/只剂量范围内,人血白蛋白、卵白蛋白豚鼠主动全身过敏反应的发生率为100%。在2~10 mg/只剂量范围内,过敏症状发生程度随致敏剂量、激发剂量的增加而增加,相同剂量的卵白蛋白较人血白蛋白反应程度更强。结论 豚鼠主动全身过敏试验,阳性对照推荐使用卵白蛋白,剂量为2 mg/只。     

Active Shooter Training in the Emergency Department: A Safety Initiative

Problem

Active shooter incidents are becoming more common, and although they are still rare compared with other shooting sites, incidents have increased in health care facilities. Agencies such as the Federal Bureau of Investigation, The Joint Commission, and the Emergency Nurses Association have emphasized that an action plan and training are essential for hospital preparedness.

Do medicine residents triage patients with gastrointestinal bleeding appropriately?

Background: Gastrointestinal specialists depend on internal medicine (IM) teams to accurately identify acute gastrointestinal bleeding (GIB). We evaluated whether IM residents’ assessment of GIB correlated with the impressions of GI specialists during consultations at an inner-city university teaching hospital. Methods: A questionnaire was distributed to house staff requesting GIB consultations and to the GI fellows performing the consults between August 2011 and April 2012. Residents and fellows were asked to assess GIB, specifically melena, using a stool color card and digital rectal examination (DRE) findings. Fellow DRE findings served as controls for stool color identification. Results: Eighty-seven GI consults were eligible for the study. Residents and fellows completed 81 and 86 questionnaires, respectively. A total of 76 questionnaires were included for analysis. A DRE was performed by medical staff before calling a consult in 65% of cases compared with fellows (97% of cases, P = 0.0001). Residents more frequently labeled stool as melena (42%) in patients as compared with fellows (12%, P = 0.0001). Residents inaccurately identified melenic stools in 22 patients (11 based on stool color and 11 based on DRE findings). Residents were more likely to label a consult as emergent than fellows (13.5% vs 4%, P < 0.05). Conclusion: Residents are less likely to perform DRE during an evaluation for GIB and to accurately identify melena based on stool color or DRE findings. There appears to be a need to educate residents on the appropriate terminology for stool color and the importance of DRE to accurately triage patients with acute GIBs.