卵巢囊肿诊治中国专家共识（2022年版）

卵巢囊肿（ovarian cyst）是妇科常见疾病，可发生于任何年龄段，以育龄期最为多见。卵巢囊肿多为良性，除个别因扭转、破裂等表现为急腹症外，一般无特异性症状。部分功能性卵巢囊肿可伴有月经紊乱、腹部不适等症状，多数随着囊肿的消退而逐渐消失。     

主动脉夹层术后患者心理状况及躯体症状对生活质量的影响

目的 探讨主动脉夹层术后患者心理状况、躯体症状对其生活质量的影响及作用机制，为制订干预计划提供参考。方法 采用广泛性焦虑障碍量表、患者健康问卷抑郁量表、躯体症状量表、12项简明健康状况调查表对327例主动脉夹层术后患者进行调查，根据相关性分析结果提出假设，应用AMOS软件进行结构方程模型分析。结果 主动脉夹层术后患者生活质量得分（81.56±7.36）分，焦虑得分2.00(0, 3.00)分，抑郁得分2.00(0, 3.00)分，躯体症状得分5.00(2.00, 8.00)分；焦虑、抑郁、躯体症状对生活质量有直接影响，焦虑、抑郁通过躯体症状对生活质量有间接影响（均P<0.05）。结论 主动脉夹层术后患者生活质量处于中等偏上水平，应早期对主动脉夹层术后患者的心理状况与躯体症状进行动态评估与监测，及时进行心理干预和症状管理，以改善其生活质量。     

MR-safety in clinical practice at 7T: Evaluation of a multistep screening process in 1819 subjects

IntroductionMR facilities must implement and maintain adequate screening and safety procedures to ensure safety during MR examinations. The aim of this study was to evaluate a multi-step MR safety screening process used at a 7T facility regarding incidence of different types of safety risks detected during the safety procedure.MethodsSubjects scheduled for an MR examination and having entered the 7T facility during 2016–2019 underwent a pre-defined multi-step MR safety screening process. Screening documentation of 1819 included subjects was reviewed, and risks identified during the different screening steps were compiled. These data were also related to documented decisions made by a 7T MR safety committee and reported MR safety incidents.ResultsPassive or active implants (n = 315) were identified in a screening form and/or an additional documented interview in 305 subjects. Additional information not previously self-reported by the subject, regarding implants necessitating safety decisions performed by the staff was revealed in the documented interview in 102 subjects (106 items). In total, the 7T MR safety committee documented a decision in 36 (2%) of the included subjects. All of these subjects were finally cleared for scanning.ConclusionA multi-step screening process allows a thorough MR screening of subjects, avoiding safety incidents. Different steps in the process allow awareness to rise and items to be detected that were missed in earlier steps.Implications for practiceSafety questions posed at a single timepoint during an MR screening process might not reveal all safety risks. Repetition and rephrasing of screening questions leads to increased detection of safety risks. This could be effectively mitigated by a multi-step screening process. A multi-disciplinary safety committee is efficient at short notice responding to unexpected safety issues.     

1401例超长住院日患者分布与影响因素分析

目的分析超长住院患者分布及影响因素,探讨减少超长住院日的措施。方法从江苏省某三甲医院病案管理系统中调取2020年1月1日-2020年12月31日134016例出院患者的住院病案首页资料,对住院时间≥30天的1401例超长住院患者的分布特征进行统计描述,采用Logistic回归模型分析超长住院日的影响因素。结果2020年全院平均住院日为7.13天,其中超长住院患者平均住院日为41.85天。超长住院患者以60岁以上年龄组最多(39.61%);出院科室主要分布在血液科(42.18%)、普通外科(11.85%)、骨科(7.49%)等;疾病类别主要为肿瘤(47.32%)、影响健康状态和与保健机构接触的因素(10.56%)、循环系统疾病(7.07%)等;多因素Logistic回归结果显示,男性(OR=1.188)、离院方式为非医嘱离院或其他(OR=2.046)和死亡病例(OR=3.362)是超长住院的危险因素。结论控制超长住院日对平均住院日影响显著,医院应加强重点人群、重点科室和重点病种管理提高诊疗管理水平,缩短平均住院日。     

Post-cardiac arrest intensive care in Sweden: A survey of current clinical practice

Background

European guidelines recommend targeted temperature management (TTM) in post-cardiac arrest care. A large multicentre clinical trial, however, showed no difference in mortality and neurological outcome when comparing hypothermia to normothermia with early treatment of fever. The study results were valid given a strict protocol for the assessment of prognosis using defined neurological examinations. With the current range of recommended TTM temperatures, and applicable neurological examinations, procedures may differ between hospitals and the variation of clinical practice in Sweden is not known.

Aim

The aim of this study was to investigate current practice in post-resuscitation care after cardiac arrest as to temperature targets and assessment of neurological prognosis in Swedish intensive care units (ICUs).

Methods

A structured survey was conducted by telephone or e-mail in all Levels 2 and 3 (= 53) Swedish ICUs during the spring of 2022 with a secondary survey in April 2023.

Results

Five units were not providing post-cardiac arrest care and were excluded. The response rate was 43/48 (90%) of the eligible units. Among the responding ICUs, normothermia (36–37.7°C) was applied in all centres (2023). There was a detailed routine for the assessment of neurological prognosis in 38/43 (88%) ICUs. Neurological assessment was applied 72–96 h after return of spontaneous circulation in 32/38 (84%) units. Electroencephalogram and computed tomography and/or magnetic resonance imaging were the most common technical methods available.

Conclusion

Swedish ICUs use normothermia including early treatment of fever in post-resuscitation care after cardiac arrest and almost all apply a detailed routine for the assessment of neurological prognosis. However, available methods for prognostic evaluation varies between hospitals.