失血性休克紧急手术模拟演练在新入职护士培训中的应用效果分析

目的:探讨失血性休克紧急手术模拟演练在新入职护士培训中的应用效果。方法:选取2019年医院外科手术室新入职护士31人为对照组,另选2020年医院新入职护士31人为观察组,对照组实施常规培训方法,观察组在对照组基础上实施失血性休克紧急手术模拟演练,比较两组应用效果。结果:干预后观察组护士急救相关核心制度、急救抢救药物知识、抢救流程、紧急手术各类应急预案评分均高于对照组(P<0.05);干预后观察组护士除颤仪、呼吸机、心肺复苏仪、徒手心肺复苏操作技能评分均高于对照组(P<0.05);干预后观察组护士抢救配合能力、案例分析能力、应急处理能力、学习兴趣、沟通能力评分均高于对照组(P<0.05);观察组护士工作能力优良率为96.77%,高于对照组的70.97%(P<0.05)。结论:失血性休克紧急手术模拟演练应用于新入职护士培训中,不仅可有效提高其理论知识水平、操作技能及综合能力,还能提高其工作能力优良率。     

Prospective Benefit-Risk Monitoring of New Drugs for Rapid Assessment of Net Favorability in Electronic Health Care Data

BackgroundBenefit-risk assessment (BRA) methods can combine measures of benefits and risks into a single value.ObjectivesTo examine BRA metrics for prospective monitoring of new drugs in electronic health care data.MethodsUsing two electronic health care databases, we emulated prospective monitoring of three drugs (rofecoxib vs. nonselective nonsteroidal anti-inflammatory drugs, prasugrel vs. clopidogrel, and denosumab vs. bisphosphonates) using a sequential propensity score–matched cohort design. We applied four BRA metrics: number needed to treat and number needed to harm; incremental net benefit (INB) with maximum acceptable risk; INB with relative-value–adjusted life-years; and INB with quality-adjusted life-years (QALYs). We determined whether and when the bootstrapped 99% confidence interval (CI) for each metric excluded zero, indicating net favorability of one drug over the other.ResultsFor rofecoxib, all four metrics yielded a negative value, suggesting net favorability of nonselective nonsteroidal anti-inflammatory drugs over rofecoxib, and the 99% CI for all but the number needed to treat and number needed to harm excluded the null during follow-up. For prasugrel, only the 99% CI for INB-QALY excluded the null, but trends in values over time were similar across the four metrics, suggesting overall net favorability of prasugrel versus clopidogrel. The 99% CI for INB-relative-value–adjusted life-years and INB-QALY excluded the null in the denosumab example, suggesting net favorability of denosumab over bisphosphonates.ConclusionsProspective benefit-risk monitoring can be used to determine net favorability of a new drug in electronic health care data. In three examples, existing BRA metrics produced qualitatively similar results but differed with respect to alert generation.     

More than a decade after live donor nephrectomy: a prospective cohort study

Previously reported short‐term results after live kidney donation show no negative consequences for the donor. The incidence of new‐onset morbidity takes years to emerge, making it highly likely that this will be missed during short‐term follow‐up. Therefore, evidence on long‐term outcome is essential. A 10‐year follow‐up on renal function, hypertension, quality of life (QOL), fatigue, and survival was performed of a prospective cohort of 100 donors. After a median follow‐up time of 10 years, clinical data were available for 97 donors and QOL data for 74 donors. Nine donors died during follow‐up of unrelated causes to donation, and one donor was lost to follow‐up. There was a significant decrease in kidney function of 12.9 ml/min (P < 0.001) at follow‐up. QOL showed significant clinically relevant decreases of 10‐year follow‐up scores in SF‐36 dimensions of physical function (P < 0.001), bodily pain (P = 0.001), and general health (P < 0.001). MFI‐20 scores were significantly higher for general fatigue (P < 0.001), physical fatigue (P < 0.001), reduced activity (P = 0.019), and reduced motivation (P = 0.030). New‐onset hypertension was present in 25.6% of the donors. Donor outcomes are excellent 10 years post‐donation. Kidney function appears stable, and hypertension does not seem to occur more frequently compared to the general population.     

Implementing newer agents for the management of castrate‐resistant prostate cancer: what is known and what is needed?

Men receiving androgen‐deprivation therapy will in time develop metastatic castrate‐resistant prostate cancer (mCRPC). Whilst effective treatment options for mCRPC have traditionally been limited, new agents are becoming available. Since 2010, the number and class of agents available to treat mCRPC has increased dramatically. As such, there is a need for clear guidance on the optimum treatment and sequence of treatments for mCRPC before and after chemotherapy. This evidence‐based statement, reflecting the views of the authors, provides suggestions on the continued relevance of conventional approaches to first‐ and second‐line treatment in mCRPC, the potential role of novel treatments, and factors that may influence the choice of hormonal agents and/or chemotherapy.     

PKP与“五点式”支撑复位综合疗法治疗新鲜骨质疏松性胸腰椎压缩骨折疗效比较

目的:观察经皮椎体后凸成形术(PKP)与"五点式"支撑复位综合疗法治疗新鲜骨质疏松性胸腰椎压缩骨折(OVCFs)在缓解疼痛、矫正脊柱后凸畸形、改善患者生活质量及邻近再骨折发生率、骨密度改善等方面的效果。方法:回顾性分析OVCFs患者74例,其中37例行PKP手术治疗(A组),37例行"五点式"支撑复位综合疗法治疗(B组),术后常规拍摄伤椎及其邻近阶段X线片,行骨密度检查,2组治疗后6、12、24个月进行随访,记录患者疼痛视觉模拟评分(VAS)、伤椎前缘高度、后凸Cobb角、Oswesty功能障碍指数(ODI)、邻近再骨折发生率、骨密度改善情况。结果:A组伤椎前缘高度恢复、后凸畸形矫正、疼痛缓解及功能活动、骨密度改善等方面均优于B组,差异有统计学意义(P0.05)。A组与B组邻近节段发生骨折率分别为8.1%和18.9%,差异有统计学意义(P0.05)。结论:PKP能使OVCFs患者的腰背疼痛得到有效缓解,能矫正后凸畸形,改善患者生活质量,降低邻近阶段骨折的再发生。     

Amhezole,A Novel Fungal Secondary Metabolite from Aspergillus terreus for Treatment of Microbial Mouth Infection

Bio‐guided fractionation of Aspergillus terreus extract leads to isolation of a novel terpenoidal secondary metabolite. The isolated compound and the total alcoholic extract of Aspergillus terreus showed a remarkable activity against microbial mouth infections; namely, Candida albicans, Lactobacillus acidophilus, Streptococcus gordonii, and S. mutan. Moreover, the Minimum Inhibitory Concentration of the isolated compound was determined and showed low values. The combination of each of the alcoholic extract of A. terreus and the isolated compound Coe‐Comfort tissue conditioner inhibited the growth of Candida albicans at concentrations of 500 and 7.81 µg/mL, respectively, Lactobacillus acidophilus at concentrations of 250 and 7.81 µg/mL, respectively, Streptococcus gordonii at concentrations of 1000 and 62.50 µg/mL, respectively, and S. mutans at concentrations of 1000 and 125 µg/mL, respectively. The oral dosing of the extract and the isolated compound did not show any significant effect on the activity of alanine aminotransferase, aspirate aminotransferase, and the levels of blood urea and serum creatinine. Copyright © 2017 John Wiley & Sons, Ltd.     

Repair of periodontal tissues In vivo and in vitro

Repair of experimental cavities in dental roots and of periodontal wounds was studied in vivo and in vitro. Incisors from monkeys were extracted and experimental cavities were made in the roots. The teeth were either replanted immediately or cultured for 1-12 weeks in tissue culture medium. After 8 weeks the tissue reaction around the replanted teeth was evaluated on demineralized histological sections and undecalcified freeze-sections incubated for histochemical demonstration of certain enzymes. The cultured teeth were evaluated on decalcified histological sections. In the experimental cavities of the replanted teeth reparative cementum was found. It was frequently separated from the denuded dentin while a firm attachment was always established to the intermediate cementum and dental cementum at the periphery of the cavities. The reparative cementum was also firmly attached to some small areas on the exposed dentin surface where resorption had taken place. The activity of alkaline and acid phosphatase was lower in the connective tissue in the experimental cavities than in the surrounding PDM, suggesting an incomplete regeneration of the periodontal membrane in these areas. A loose connective tissue devoid of demonstrable collagen fibers was found in the cavities in vitro. The reparative cementum did not fill the experimental cavities in the replanted teeth. The alveolar bone extended into the experimental cavities and made the width of the PDM normal also in the experimental cavities. Epithelial and endothelial cells were numerous in the connective tissue separating the reparative cementum from the alveolar bone in the experimental cavities. It is possible that they contribute to the integrity of the PDM and prevent resorption of the dental root.