Quantity and Quality Relationships in Cardiovascular Medicine

Hospital volume and often also operator volume have documented impacts on the quality of care for aortic and aortocoronary bypass surgery, for percutaneous angioplasty and for radiofrequency ablation for arrhythmias, whereas data are less consistent for treatment of acute myocardial infarction. A review of this research is given. In the Nordic countries hospitals are small, and often the plateau of the learning curve cannot be reached. To discourage low-volume centers from embarking upon too complicated interventional or surgical procedures, the author suggests that a minimal number should be set for certain major procedures, both for hospitals and for physicians.     

Development of an auditory test battery for young children: a pilot study

This article describes the development and results of a pilot study with a recently developed auditory test battery for 4-6-year-old Dutch children. The test battery consisted of a sustained auditory attention (SAA) test, a dichotic words (DW) test, a binaural masking-level difference (BMLD) test, an auditory word discrimination (AWD) test, a gap detection (GD) test and a test of phonemic awareness, the Lindamood Auditory Conceptualization (LAC) test. Our results show that this test battery can be administered successfully to children aged 4 years and older. Most tests showed a clear effect of chronological age; the strongest age effects were found for the DW test and the LAC test. The BMLD test was the only test for which no significant age effect was found in this group of children. A small, but significant right-ear advantage was found on the DW test, for the 4- and the 6-year-olds. Correlations between subtests were in general rather high, suggesting that several tests in this test battery may be tapping into similar auditory abilities.     

不同剂量等比重布比卡因腰麻用于剖宫产手术的临床观察

目的观察不同剂量等比重布比卡因腰麻用于剖宫产手术的麻醉效果、并发症，并探讨其安全性。方法剖宫产手术患者200例，ASAI～II级，随机分为两组，蛛网膜下腔注入0．75％布比卡因2．0ml（A组）和注入0．75％布比卡因1．6ml（B组）。监测并记录两组产妇麻醉前（T1），注药后5rain（T2），取出胎儿后（T3），缝合腹膜时（T4）的平均动脉压（MAP）、心率（HR）和血氧饱和度（SPO2），记录两组产妇感觉阻滞起效时间、感觉阻滞最高平面、运动阻滞起效时间、运动阻滞和感觉阻滞恢复时间。记录两组产妇阻滞后低血压、心动过缓发生率和术中牵拉反应。结果两组产妇年龄、体重、身高和孕龄等一般情况差异均无统计学意义。T2时A组MAP明显低于T1时和B组，HR明显快于T1时和B组（P〈0．05）。两组SPO：组间组内差异无统计学意义。B组感觉阻滞起效时间和运动阻滞起效时间明显长于A组（P〈0．05）。A组感觉阻滞平面明显高于B组（P〈0．05）。B组低血压、心动过缓、恶心呕吐、呼吸困难、牵拉反应和心动过缓等不良反应发生率明显低于A组（P〈0．05）。结论0．75％布比卡因1．6ml腰麻用于剖宫产手术不仅能满足手术需求，与0．75％布比卡因2．0ml用于脊麻相比，安全性更高。     

髓内钉和钢板治疗肱骨近端骨折的Meta分析

目的比较髓内钉和钢板两种内固定治疗肱骨近端骨折的安全性、有效性及差异性。方法计算机检索Pub Med、CENTRAL、EMbase、the ISI Web of Knowledge Databases、VIP、CNKI、CBM和万方数据库,查找所有比较髓内钉和钢板钢板治疗肱骨近端骨折的随机对照试验(RCT)及临床对照试验(CCT),检索时限均为建库至2015年12月31日。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行筛选、资料提取和质量评价后,采用Rev Man5.3软件进行Meta分析。结果共纳入14个研究,1010例患者。Meta分析结果显示:与钢板相比,髓内钉治疗手术时间更短[MD=-23.04,95%CI(-28.47,-17.60),P0.1]、术中出血量较少[SMD=-3.14,95%CI(-4.21,-2.08),P0.1]、骨折愈合时间更短[SMD=-3.03,95%CI(-3.77,-2.28),P0.1],总的并发症无统计学意义[RR=0.38,95%CI(0.25,0.57),P=0.24];然而,ASES评分显示钢板组优于髓内钉组[SMD=-0.63,95%CI(-0.98,-0.28),P0.1],Costant-Murley评分差异无统计学意义[SMD=-0.05,95%CI(-0.21,0.11),P0.1],末次随访时颈干角差异无统计学意义[MD=0.09,95%CI(-0.22,0.40),P0.1],末次随访时Neer征差异无统计学意义[RR=0.51,95%CI(0.25,1.03),P0.1]。结论本系统研究发现,总体而言,治疗肱骨近端骨折时,髓内钉优于钢板。但这一结论仍然需要大样本、高质量的研究及采用关键性指标,进行进一步的论证。     

Drug Burden Index associated with function in community-dwelling older people in Finland: A cross-sectional study

Abstract

Background. This cross-sectional study aimed to investigate the relationship between exposure to anticholinergic and sedative medications, measured with the Drug Burden Index (DBI), and functional outcomes in community-dwelling older people living in Finland.

Methods. The study population consisted of community-dwelling older people (n = 700) enrolled in the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. Outcomes included walking speed, chair stands test, grip strength, timed up and go (TUG) test, instrumental activities of daily living (IADL), and Barthel Index.

Results. Exposure to DBI drugs was identified in 37% of participants: 24% had a DBI range between >0 <1, and 13% DBI ≥1. After adjusting for confounders, exposure to DBI drugs was associated with slower walking speed (P < 0.0001), poorer performance on chair stands (P = 0.0001) and TUG (P < 0.0001), difficulties in IADL (P < 0.0001), and Barthel Index (P < 0.0001). The mean adjusted walking speed, time to complete chair stands and TUG, IADL, and Barthel scores were significantly poorer among participants with higher DBI ranges.

Conclusion. In older adults living in Finland, DBI was associated with impaired function on previously tested and new outcomes. This finding supports the use of the DBI as tool, in combination with other assessments, to identify older people at risk of functional impairment. The findings highlight the need for revision of current guidelines to improve the quality of drug use in older people.     

GIP and Insulin Responses to a Test Meal in Healthy and Obese Subjects

Twenty-three obese and 17 control subjects were studied after ingestion of a heavy breakfast. Blood samples were drawn before and at 30, 60, 90, 120, 150, and 180 min after the start of the meal. The mean serum insulin level was significantly (p < 0.02) higher in the obese than in the control group throughout the study, whereas the mean blood glucose concentration was significantly (p < 0.02) higher in the obese group at 30, 60, and 90 min only. No significant differences between the two groups were noted in fasting or in postprandial plasma GIP, and it appears that hypersecretion of GIP is not responsible for the hyperinsulinemia seen in obesity.     

American Public Health Association Meeting

Unit managers do need formal supervisory training. Training should focus on their approach to the decision making process as wel as their performance within it. Quality circle training was deemed most appropriate, because it focuses on team management and the development of skills needed to handle interactions in team settings.     

合理情绪疗法对广泛性焦虑障碍药物治疗效果的影响

目的:探讨并研究合理情绪疗法对广泛性焦虑障碍药物治疗效果影响。方法:选取我院自2013年6月-2014年4月我院心理咨询门诊的广泛性焦虑障碍患者120例,随机分为两组,每组60例,治疗期8周。对照组采用药物进行治疗,试验组在对照组的基础上同时进行合理情绪疗法治疗。结果:试验组采用药物治疗联合合理情绪疗法明显优于对照组,在对于患者治疗前后的SAS、HAMA评分中进行比较,发现试验组治疗后较治疗前SAS、HAMA分明显降低(t=6.6496,8.9374;P0.05),具有统计学意义。结论:合理情绪疗法在对广泛性焦虑障碍患者的治疗中,能够有效提高患者的生活质量,减少患者的不良情绪。     

Myocardial bridging increases the risk of coronary spasm

BACKGROUND: Myocardial bridging (MB) has been associated with cardiac events. Whether coronary spasm is one factor contributing to those events is unknown. HYPOTHESIS: This study investigated whether the likelihood of coronary spasm is increased in patients with MB. METHODS: A spasm-provocation test was performed by infusing acetylcholine into the left coronary artery in 114 Japanese patients with chest pain. The test result was defined as positive when the diameter of the coronary artery was reduced by > or = 50% and ST-segment changes were documented. Myocardial bridging was defined as a > 15% reduction in coronary arterial diameter during systole after intracoronary injection of nitroglycerin. RESULTS: Myocardial bridging was identified in 41 patients (36%) and was located in the mid-segment of the left anterior descending coronary artery (LAD) in all patients. Patients with MB experienced coronary spasm more frequently than patients without MB (MB+: 73%; MB-: 40%, p = 0.0006). Furthermore, among patients with a positive spasm-provocation test, coronary spasm occurred more frequently in the mid-segment of the LAD in patients with MB than in those without MB (MB+: 73%; MB-: 45%, p = 0.0259). Multivariate regression analysis demonstrated that MB was a predictor of coronary spasm (odds ratio: 3.478, p = 0.0088). CONCLUSIONS: These results suggest that MB increases the risk of coronary spasm and that coronary spasm may be the proximate etiology of cardiac events associated with MB.