Dexmedetomidine versus propofol for prolonged sedation in critically ill trauma and surgical patients

Backgroundand Purpose: Currently, dexmedetomidine versus propofol has primarily been studied in medical and cardiac surgery patients with outcomes indicating safe and effective sedation. The purpose of this study was to assess the efficacy of dexmedetomidine versus propofol for prolonged sedation in trauma and surgical patients.MethodsThis was a single-center prospective study conducted in the Trauma/Surgical Intensive Care Unit (ICU) at a Level I academic trauma center. It included patients 18 years of age or older requiring mechanical ventilation who were randomly assigned based on unit bed location to receive either dexmedetomidine or propofol. The primary outcome was duration of mechanical ventilation. Secondary outcomes included mortality; proportion of time in target sedation; incidence of delirium, hypotension, and bradycardia; and ICU and hospital length of stay (LOS).ResultsA total of 57 patients were included. Baseline characteristics were similar between groups. There was no significant difference in duration of mechanical ventilation (median [IQR]) between the dexmedetomidine (78.5[125] hours) and propofol (105[130] hours; p = 0.15) groups. There was no difference between groups in ICU mortality, ICU and hospital LOS, or incidence of delirium. Safety outcomes were also similar. Patients in the dexmedetomidine group spent a significantly greater percentage of time in target sedation (98[8] %) compared to propofol group (92[10] %; p = 0.02).ConclusionsOur results suggest that, similar to medical and cardiac surgery patients, dexmedetomidine and propofol are safe and effective sedation agents in critically ill trauma and surgical patients; however, dexmedetomidine achieves target sedation better than propofol for this specific population.     

基于预防接种异常反应补偿的山东省卡介苗淋巴结炎经济负担测算

目的了解山东省卡介苗(BCG)淋巴结炎经济负担情况。方法以2011年5月至2019年12月山东省304例申请省级补偿的BCG淋巴结炎病例为对象,收集患者基本情况、预防接种相关情况、门诊(住院)病历和收费票据等相关资料,对其直接经济负担(包括直接医疗费用和直接非医疗费用)、间接经济负担和总经济负担进行测算,比较不同特征病例经济负担的差异。结果304例BCG淋巴结炎患者月龄的M(Q1,Q3)为3(2,4)月,其中男性239例(78.6%),淋巴结破溃71例(23.4%),手术227例(74.7%)。单纯门诊、单纯住院和门诊后住院病例分别占25.7%(78例)、7.2%(22例)和67.1%(204例)。贴现后单例直接、间接和总经济负担的M(Q1,Q3)分别为9910(5713,16074)、2081(1547,3122)和12262(7694,18571)元。直接医疗费用占直接经济负担的89.4%,直接经济负担占总经济负担的84.9%,80.0%病例的总经济负担仅占其补偿金额的20.0%左右,只有2.3%的病例总经济负担占补偿金额的60.0%以上。单纯住院和门诊后住院病例的直接、间接和总经济负担高于单纯门诊病例,手术病例的直接、间接和总经济负担高于非手术病例,淋巴结未破溃病例的直接和总经济负担高于破溃病例(均P<0.05)。结论山东省BCG淋巴结炎病例经济负担受诊疗方式的影响,且以直接医疗费用为主。     

唐山市大气PM2.5引起居民健康危害的经济学评价

目的 了解唐山市PM2.5污染对唐山市市区人口造成的健康危害,估算由于PM2.5造成的健康经济损失。方法 收集唐山市2013—2017年基本社会人口资料与大气PM2.5浓度。选择循环系统疾病住院等为健康效应终点,选用适当的暴露-反应关系,采取疾病成本法与支付意愿法相结合的方法评估PM2.5造成的健康效应的经济损失。结果 2013—2017年PM2.5污染造成的经济损失呈现逐年下降的趋势,其中2013年最高,为6.57亿元,占当年GDP的0.27%,2017年最低,为2.97亿元,占当年GDP的0.13%。结论 唐山PM2.5污染造成的健康损失呈现逐年下降的趋势,但数字仍然非常可观,需要进一步加强对PM2.5污染的监控与治理。     

2009—2019 年重庆市涪陵区15 岁以下人群流感病原学监测结果分析

目的 了解重庆市涪陵区2009—2019年15岁以下人群流感病原学的流行趋势及特征,为今后的流感防控工作提供科学依据。方法 分析2009—2019年涪陵区流感网络监测实验室获得的15 岁以下人群流感样病例（Influenza-like illness,ILI）监测结果。结果 女性ILI病毒分离阳性率（14.53%）和男性阳性率（13.74%）无统计学意义（〖XC小五号.EPSP〗=0.98,P＞0.05）;初中生阳性率最高（23.94%）,其次是小学生（19.69%）、幼儿园儿童（17.10%）,散居儿童最低（7.64%）,差异有统计学意义（〖XC小五号.EPSP〗=238.82,P＜0.05）;各学龄段儿童之间流感病毒类型构成差异有统计学意义（〖XC小五号.EPSP〗=40.71,P＜0.05）;ILI病毒检测阳性率的季节规律呈单、双峰交替出现,2010 年、2014 年、2015 年流行高峰出现在夏季,其余年份流行高峰均在冬春季;主要病原学类型为季H3（36.63%）、B型Victoria系（28.60%）、新甲H1（27.98%）、B型Yamagata系（6.44%）,流感病毒阳性率与ILI病例数变化趋势相关（rs=0.312,P＜0.05）; ILI发病后采样时间、采样后送检时间对标本阳性率有显著影响。结论 涪陵区15岁以下人群流感流行处于上升趋势,流行高峰时间处于动态变化,近年来主要在冬春季;初中生和小学生ILI病毒检测阳性率高于学龄前儿童,提示冬春季要加强中小学校学生流感防控工作。     

强迫症患者认知功能与病期的关系

目的：探讨强迫症的认知功能障碍与病期的关系。方法：分别用韦氏记忆测验，数字划销测验和威斯康星卡片分类测验评估25例急性强迫症和36例慢性强迫症患者的记忆、注意和执行功能。结果：急性强迫症患者的记忆测验中记图和数字划销测验中第二阶段失误率显著性较慢性强迫症差，其余两组间记忆测验、划销测验和威斯康星卡片分类测验各量表分无显著性差异。结论：强迫症的认知功能与病期无明显相关。     

Diarrhoea during enteral feeding in the critically ill: A comparison of feeds with and without fibre

This randomised double-blind study examined the frequency of diarrhoea in intensive care unit patients given a fibre-containing feed, Enrich, and a fibre-free feed, Ensure. A daily diarrhoea score was calculated from the frequency, volume and consistency of the stools. A score greater than 12 indicated diarrhoea, and greater than 50 severe diarrhoea. Ninety one patients met the criteria for participation: Enrich 45, Ensure 46. The groups were similar in age, sex ratio, feed volume, antibiotic usage, upper gastro-intestinal bleeding prophylaxis and plasma albumin concentrations. Diarrhoea occurred in 16 patients given Enrich and 13 given Ensure, severe diarrhoea affecting 5 and 9 respectively (NS). Forty seven of 343 (14%) Enrich feeding days and 51 of 342 (15%) Ensure feeding days were complicated by diarrhoea — severe diarrhoea: 8 and 12 feeding days (NS). We conclude soy polysaccharide (21 g/L) did not reduce diarrhoea in intensive care unit patients given enteral feeds.     

Sexual dysfunction in male and female patients with epilepsy: A study of 86 outpatients

Sexual dysfunction is a well-known complication of chronic somatic illness. Eighty-six consecutive epileptic outpatients, 38 men and 48 women, without accompanying disorders, were studied. The frequency and symptoms of sexual dysfunction were compared with results from previous studies using identical sexological methodology. The previous studies were of diabetic patients and healthy controls. Eight percent of the epileptic men reported a sexual dysfunction compared to 44% of the diabetics and 13% of the controls. Epileptic women, diabetic women, and controls showed no significant differences in sexual dysfunction (29%, 28%, and 25%, respectively). In both sexes, the sexual function measured by frequencies of coitus and masturbation was normal. Most patients had good control of epileptic attacks on a treatment of monotherapy. Hormonal status was generally within normal limits in both men and women; only a few minor differences were found and they showed no correlation with sexual dysfunction. Psychologically and socially the patients did not differ appreciably from normals, and they exhibited a high degree of disease acceptance. This study, using a biopsychosocial approach in understanding sexual dysfunctions, is in contrast with previous, mainly uncontrolled, studies of epileptic patients that reported high frequencies of hyposexuality in males. We conclude that epilepsy does not necessarily increase the risk of sexual dysfunction in male or female.     

Social HMOs and Other Capitated Arrangements for Children with Special Health Care Needs

Objective: Children with special health care needs are increasingly enrolling in managed care arrangements. However, existing managed care organizations, including traditional HMOs, are often poorly suited for caring for this population. In the adult health care area, new managed care entities, called Social HMOs (S/HMO) and Programs for the All-inclusive Care for the Elderly (PACE), have been created to integrate health and health-related services for chronically ill and disabled adults. We describe these models and assess their potential for serving children with special health care needs. Method: We reviewed the literature on managed care for children with special health care needs and evaluation findings from the S/HMO and PACE models for the elderly. Results: Evaluations of the S/HMO and PACE models have yielded mixed findings. Some of the more positive accomplishments include lower use and expenditures for long-term care services compared to other demonstration projects, greater integration of primary care physicians in decision making concerning long-term care, and improved management of transitions between care levels. On the negative side, start-up has been slow, prospective members have been hesitant to enroll, intermittent and sometimes frequent operating deficits have emerged, no discernible positive effects on health or social outcomes are apparent, and no significant overall savings have emerged. Conclusions: With mixed results so far, caution is required in applying these or similar models for vulnerable child populations. However, given the inadequacies of traditional managed care for this population, we believe experimentation with new models of care that integrate health and health-related services is important. Such experimentation should be fostered only to the extent that the models are carefully designed and then implemented in a manner that protects the interests of children with special health care needs.